[Federal Register: December 1, 2008 (Volume 73, Number 231)]
[Notices]               
[Page 72805-72806]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr01de08-73]                         

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality

 
Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.

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SUMMARY: This notice announces the intention of the Agency for 
Healthcare Research and Quality (AHRQ) to request that the Office of 
Management and Budget (OMB) approve the proposed information collection 
project: ``Colorado Regional Health Information Exchange (CORHIO)--
Point of Care Exchange System Evaluation: Point of Care Questionnaires 
and Focus Groups.'' In accordance with the Paperwork Reduction Act of 
1995, 44 U.S.C. 3506(c)(2)(A), AHRQ invites the public to comment on 
this proposed information collection.

DATES: Comments on this notice must be received by January 30, 2009.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by e-mail at 
doris.lefkowitz@ahrq.hhs.gov.
    Copies of the proposed collection plans, data collection 
instruments, and specific details on the estimated burden can be 
obtained from the AHRQ Reports Clearance Officer.

FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports 
Clearance Officer, (301) 427-1477, or by e-mail at 
doris.lefkowitz@ahrq.hhs.gov.

SUPPLEMENTARY INFORMATION: 

Proposed Project

    Colorado Regional Health Information Exchange (CORHIO)--Point of 
Care Exchange System Evaluation: Point of Care Questionnaires and Focus 
Groups
    AHRQ proposes a case study of the point-of-care (POC) clinical 
exchange system at the Colorado Regional Health Information Exchange 
(CORHIO). The CORHIO is an AHRQ State and Regional Demonstration 
Project contract which supports the administrative and technical 
implementation of an information technology service to provide secure 
electronic transmission of clinical information between partner health 
care entities to improve the efficiency, quality, and safety of patient 
care.
    The key element of CORHIO is the POC clinical exchange system, 
which doctors can use to access information about individual patients 
as they care for them. The POC clinical exchange system is an Internet-
based portal which allows authorized users to log in and request 
clinical information for a specific patient. The POC clinical exchange 
system is composed of two functions: The patient search function and 
the data exchange function. The patient search function is supported by 
the CORHIO master patient index, which is an index of all the patients 
that have been seen within a given time period at CORHIO's partner 
health care organizations (HCOs). The patient search function allows 
users to enter identifying information for a patient, such as name, 
date of birth, or medical record number, and searches to determine if 
the patient has received medical care at one of the partner HCOs. The 
POC clinical exchange system will then display all potential matching 
identities available at the CORHIO partner HCOs. Users select the 
appropriate match, if it exists, and request available data for the 
selected patient. The data exchange function aggregates and displays 
the available data from multiple partner HCOs for the selected patient.
    This proposed information collection will provide input from 
clinicians at four participating HCOs regarding the usability of the 
system and the value of the exchanged Clinical information to inform 
decision-making, patient disposition and potentially redundant test 
ordering. Additionally, this case study will provide important 
information to inform future design and phase implementation of the 
CORHIO system.
    This case study is being conducted pursuant to AHRQ's statutory 
mandate to conduct and support research, evaluations and initiatives to 
advance the creation of effective linkages between various sources of 
health information, including the development of information networks 
(42 U.S.C. 299b-3(a)(3)).

Method of Collection

    This case study includes 2 distinct data collections regarding the 
POC clinical exchange system:
    1. POC Questionnaire--a survey of end-users at three emergency 
departments (ED) regarding their experiences with the POC clinical 
exchange system and its effect on patient care. This questionnaire will 
be used to collect data from the EDs for one week quarterly in 2009 and 
for the first quarter of 2010.
    2. Focus Groups--focus groups with select high- and low-use users 
of the POC clinical exchange system from each of the three EDs and one 
Call Center. Focus groups will be conducted at 4 and 8 months after 
users begin using the POC system.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated burden hours for the respondents' 
time to participate in this project. The POC questionnaire will be 
administered to the three participating EDs only, while the focus 
groups will be held at both the EDs and the one participating call 
center. The POC questionnaire will be administered quarterly for an 
entire week at each ED. There are typically two doctors per shift, 21 
shifts per week and an average of 25 patients seen by each doctor per 
shift. One attending physician per shift will respond, resulting in 
about 525 patient encounters per each ED over a one week period. Since 
the POC questionnaire will be completed for each patient seen, 525 
questionnaires will be completed each quarter, resulting in about 2,100 
completed questionnaires per year (4 quarters x 525 per quarter) per 
ED. The POC questionnaire is estimated to require about two minutes to 
complete.
    However, the POC clinical exchange system will be used for only 
about 10 percent of the visits. This means that for 90 percent of the 
visits providers will check off ``Did not use'' and select a reason why 
they did not use the system, which will take 5 to 10 seconds. The 
maximum time of two minutes was used for all responses to calculate a 
conservative estimate of the burden.
    The focus groups will be conducted twice a year at each of the four 
participating facilities and are expected to take one hour or less to 
complete. The maximum expected time of one hour was used to calculate a 
conservative estimate of the burden. The total burden hours for all 
data collections is estimated to be 242 hours.

[[Page 72806]]



                                  Exhibit 1--Estimated Annualized Burden Hours
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                                                                     Number of
                    Form name                        Number of     responses per     Hours per     Total burden
                                                    respondents     respondent       response          hours
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POC Questionnaire...............................               3           2,100            2/60             210
Focus Groups....................................               4               8               1              32
                                                 ---------------------------------------------------------------
    Total.......................................               7              na              na             242
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    Exhibit 2 shows the annualized cost burden for the respondent's 
time to participate in this project. The total cost burden is estimated 
to be $21,775.

                                   Exhibit 2--Estimated Annualized Cost Burden
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                                                     Number of     Total burden   Average hourly    Total cost
                    Form name                       respondents        hours      wage rate* ($)    burden ($)
----------------------------------------------------------------------------------------------------------------
POC Questionnaire...............................               3             210           92.03          19,326
Focus Groups....................................               4              32           76.53           2,449
                                                 ---------------------------------------------------------------
    Total.......................................               7             242              na          21,775
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* Based upon the weighted average of the ``registered nurse'' mean and the ``surgeon'' mean of the average
  wages, May 2007 National Occupational Employment and Wage Estimates, United States, U.S. Department of Labor,
  Bureau of Labor Statistics. http://www.bls.gov/oes/current/oes_nat.htm#b29-0000 (accessed Nov. 1, 2008). The
  ``surgeon'' mean salary was used for the 3 ED respondents and the ``registered nurse'' mean salary was used
  for the 1 Call Center.

Estimated Annual Costs to the Federal Government

    Exhibit 3 shows the total and annualized cost of this two-year 
project to the federal government. The total cost is $34,730 and 
includes $7,500 for project development, $8,400 for data collection 
activities, $6,580 for data processing and analysis, $1,000 for the 
publication of results and $11,250 for project management.

                        Exhibit 3--Estimated Cost
------------------------------------------------------------------------
                                                            Annualized
             Cost component               Total cost ($)     cost ($)
------------------------------------------------------------------------
Project Development.....................           7,500           3,750
Data Collection Activities..............           8,400           4,200
Data Processing and Analysis............           6,580           3,290
Publication of Results..................           1,000             500
Project Management......................          11,250           5,625
Overhead................................               0               0
                                         -------------------------------
    Total...............................          34,730          17,365
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Request for Comments

    In accordance with the above-cited Paperwork Reduction Act 
legislation, comments on AHRQ's information collection are requested 
with regard to any of the following: (a) Whether the proposed 
collection of information is necessary for the proper performance of 
AHRQ health care research, quality improvement and information 
dissemination functions, including whether the information will have 
practical utility; (b) the accuracy of AHRQ's estimate of burden 
(including hours and costs) of the proposed collection(s) of 
information; (c) ways to enhance the quality, utility, and clarity of 
the information to be collected; and (d) ways to minimize the burden of 
the collection of information upon the respondents, including the use 
of automated collection techniques or other forms of information 
technology.
    Comments submitted in response to this notice will be summarized 
and included in the Agency's subsequent request for OMB approval of the 
proposed information collection. All comments will become a matter of 
public record.

    Dated: November 14, 2008.
Carolyn M. Clancy,
Director.
[FR Doc. E8-28033 Filed 11-28-08; 8:45 am]

BILLING CODE 4160-90-M