14370 Federal Register / Vol. 77, No. 47 / Friday, March 9, 2012 / Notices 

EARLY TERMINATIONS GRANTED FEBRUARY 1, 2012 THRU FEBRUARY 29, 2012—Continued 

20120505 ......................................................... G Alfred E. Mann MannKind Corporation; Alfred E. Mann. 

02/14/2012 

20120477 ......................................................... G GTCR Fund IX/A, L.P.; Universal American Corp.; GTCR Fund IX/A, L.P. 

20120496 ......................................................... G Amgen Inc.; Micromet, Inc.; Amgen Inc. 

20120498 ......................................................... G The Weir Group PLC; Starr L. Pitzer and Christine H. Pitzer; The Weir Group PLC. 

02/15/2012 

20120501 ......................................................... G KEMET Corporation; Denham Commodity Partners IV LP; KEMET Corporation. 

20120506 ......................................................... G Redtop Holdings Limited; Intermediate Capital Group plc; Redtop Holdings Limited. 

02/16/2012 

20111164 ......................................................... G Apple Inc.; Rockstar Bidco, L.P.; Apple Inc. 

20111389 ......................................................... G Microsoft Corporation; Rockstar Bidco, LP; Microsoft Corporation. 

20111423 ......................................................... G Research In Motion Limited; Rockstar Bidco, LP; Research In Motion Limited. 

02/17/2012 

20111146 ......................................................... G Apple Inc.; CPTN Holdings LLC; Apple Inc. 

20120508 ......................................................... G Medical Properties Trust, Inc.; FFC Partners II, L.P.; Medical Properties Trust, Inc. 

20120510 ......................................................... G GS Engineering & Construction Corporation; Inmobiliaria Espacio, S.A.; GS Engineering & 

Construction Corporation. 

20120513 ......................................................... G Archipelago Holdings; CDC Corporation; Archipelago Holdings.

20120516 ......................................................... G Gores Capital Partners HI, L.P.; The Pep Boys-Manny, Moe & Jack; Gores Capital Partners III, L.P. 

02/23/2012 

20120338 ......................................................... G TE Connectivity Ltd.; Wendel SA; TE Connectivity Ltd. 

20120469 ......................................................... G Raymond James Financial, Inc.; Regions Financial Corp.; Raymond James Financial, Inc. 

20120519 ......................................................... G Molibdenos y Metales S.A.; Molycorp, Inc.; Molibdenos y Metales S.A. 

02/24/2012 

20120502 ......................................................... G CVS Caremark Corporation; Health Net, Inc.; CVS Caremark Corporation. 

20120522 ......................................................... G Innovative Interfaces Holdings Ltd.; Gerald M. Kline; Innovative Interfaces Holdings Ltd. 

20120523 ......................................................... G KRG Capital Fund IV. L.P.; Frontenac VIII Limited Partnership; KRG Capital Fund IV. L.P. 

20120524 ......................................................... G Roger S. Penske; Roger S. Penske; Roger S. Penske. 

20120529 ......................................................... G Fidelity National Financial. Inc.; O’Charley’s Inc.; Fidelity National Financial, Inc. 

02/27/2012 

20120536 ......................................................... G Oracle Corporation; Taleo Corporation; Oracle Corporation. 

FOR FURTHER INFORMATION CONTACT: 

Renee Chapman, Contact 

Representative, or Theresa Kingsberry, 

Legal Assistant, Federal Trade 

Commission, Premerger Notification 

Office, Bureau of Competition, Room H– 

303, Washington, DC 20580, (202) 326– 

3100. 

By Direction of the Commission. 

Donald S. Clark, 

Secretary. 

[FR Doc. 2012–5606 Filed 3–8–12; 8:45 a.m.] 

BILLING CODE 6750–01–M 

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. 

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: 

‘‘Workflow Assessment for Health IT 

Toolkit Evaluation.’’ 

In accordance with the Paperwork 

Reduction Act, 44 U.S.C. 3501–3521, 

AHRQ invites the public to comment on 

this proposed information collection. 

DATES: Comments on this notice must be 

received by May 8, 2012. 

ADDRESSES: Written comments should 

be submitted to: Doris Lefkowitz, 

Reports Clearance Officer, AHRQ, by 

email 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 

email at doris.lefkowitz@AHRQ.hhs.gov. 

SUPPLEMENTARY INFORMATION: 


srobinson on DSK4SPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 47 / Friday, March 9, 2012 / Notices 14371 

Proposed Project 

Workflow Assessment for Health IT 

Toolkit Evaluation 

AHRQ is a lead Federal agency in 

developing and disseminating evidence 

and evidence-based tools on how health 

IT can improve health care quality, 

safety, efficiency, and effectiveness. 

Understanding clinical work practices 

and how they will be affected by 

practice innovations such as 

implementing health IT has become a 

central focus of health IT research. 

While much of the attention of health IT 

research and development had been 

directed at the technical issues of 

building and deploying health IT 

systems, there is growing consensus that 

deployment of health IT has often had 

disappointing results, and while 

technical challenges remain, there is a 

need for greater attention to 

sociotechnical issues and the problems 

of modeling workflow. 

The implementation of health IT in 

practice is costly in time and effort and 

less is known about these issues in 

small- and medium-sized practices 

where the impact of improved or 

disrupted workflows may have 

especially significant consequences 

because of limited resources. Practices 

would derive great benefit from effective 

tools for assessing workflow during 

many types of health IT 

implementation, such as creating 

disease registries, collecting quality 

measures, using patient portals, or 

implementing a new electronic health 

record system. To that end, in 2008, 

AHRQ funded the development of the 

Workflow Assessment for Health IT 

toolkit (Workflow toolkit). Through this 

toolkit, end users should obtain a better 

understanding of the impact of health IT 

on workflow in ambulatory care for each 

of the following stages of health IT 

implementation: (1) Determining system 

requirements, (2) selecting a vendor, (3) 

preparing for implementation, or (4) 

using the system post implementation. 

They should also be able to effectively 

utilize the publicly available workflow 

tools and methods before, during, and 

after health IT implementation while 

recognizing commonly encountered 

issues in health IT implementation. In 

the current project AFIRQ is conducting 

an evaluation to ensure that the newly 

developed Workflow toolkit is useful to 

small- and medium-sized ambulatory 

care clinic managers, clinicians, and 

staff. 

The evaluation will consist of field 

assessments of use of the Workflow 

toolkit in 18 small- and medium-sized 

practices and gathering feedback from 

two Health IT Regional Extension 

Centers (RECs) who are providing 

support to some of these practices. The 

evaluation will address the issues of 

system validation as classically defined 

in software engineering: determining 

whether the software or system actually 

meets the requirements of the user to 

perform the relevant tasks. The 

evaluation will answer the following 

questions: 

• Are results correct? Are individual 

tools included in the Workflow toolkit 

accurate? Does workflow assessment 

with the Workflow toolkit provide 

accurate information the practice can 

act upon? 

• Does knowledge change? Does user 

knowledge and capacity change? Does 

user knowledge of workflow in their 

own practice change? 

• Do decisions change? Do user 

decisions about workflow assessment 

change? Do user decisions about health 

information technology (health IT) 

implementation change? 

• Do outcomes change? Are changes 

in workflow favorable? Are changes in 

clinical practices favorable? Are changes 

to the practice favorable? Are changes 

for patients favorable? 

To answer these questions the 

proposed evaluation will be conducted 

to examine usefulness of the Workflow 

toolkit in small- and medium-sized 

practices. The evaluation will be 

conducted with 18 practices affiliated 

with one of two Practice-based Research 

Networks (PBRNs) in Oregon and 

Wisconsin, and with the Health IT 

Regional Extension Centers (RECs) in 

those States. Participants will be 

recruited who agree to use the Workflow 

toolkit in their specific health IT project 

for a minimum of 10 weeks. This will 

provide an opportunity to observe use of 

the Workflow toolkit amongst its 

intended end users, who are best 

positioned to provide critical feedback 

to improve the functionality of the 

Workflow toolkit. 

This study is being conducted by 

AHRQ through its contractors, the 

Oregon Rural Practice-based Research 

Network (ORPRN) and the Wisconsin 

Research & Education Network (WREN), 

pursuant to AHRQ’s statutory authority 

to conduct and support research on 

health care and on systems for the 

delivery of such care, including 

activities with respect to the quality, 

effectiveness, efficiency, 

appropriateness, and value of health 

care services and with respect to health 

care technologies, facilities, and 

equipment. 42 U.S.C. 299a(a)(1) and (5). 

Method of Collection 

To achieve the goals of this project the 

following data collections will be 

implemented: 

(1) Pre-Workflow Toolkit Interview: 

these will consist of semi-structured 

interviews with practice staff and with 

three specialists from each Health IT 

Regional Extension Center. These 

interviews are designed to examine the 

knowledge, attitudes, and barriers to 

and facilitators of workflow assessment 

for implementation of health IT. 

Respondents will be asked to define 

workflow, to rate its importance to the 

practice or REC and to health IT 

implementation, to describe factors 

motivating use of the Workflow toolkit, 

to describe previous experience with 

assessing or redesigning workflow, and 

to describe previous experience with 

health IT implementation and the effect 

of this implementation on work 

processes in their practice (practices) or 

for their clients (RECs). 

(2) Observations: Participating 

practices will form small teams (Clinic 

Study Teams) who will use the 

Workflow toolkit. A member of the 

project staff will join each Clinic Study 

Team or the three specialists at each of 

the two RECs, as participant-observer 

and will meet with the team at times to 

be determined by the teams, but at least 

every two weeks after the Pre-Workflow 

Toolkit Interview for at least four visits. 

During these visits project staff will 

participate in and keep field notes 

regarding the practice’s or REC’s 

workflow assessment activities. 

(3) Usage Logs: As part of their 

workflow assessment process, Clinic 

Study Teams, and REC staff, will be 

asked to meet weekly. For weekly 

meetings at which a project staff 

member is not present, Clinic Study 

Teams and REC staff will keep a record 

of workflow assessment activities 

including use of the workflow 

assessment toolkit, recording in a freeform journal the purpose and results of 

the activity as well as issues that arose 

in the process. 

(4) Post-Workflow Toolkit Interview: 

This final interview will consist of 

individual semi-structured interviews of 

practice staff and three specialists from 

each Health IT Regional Extension 

Center. These interviews will (a) reexamine their knowledge and attitudes 

about workflow assessment; (b) revisit 

the barriers to and facilitators of 

workflow assessment; (c) discuss 

changes that have taken place as a result 

of the process; (d) explore outcomes in 

terms of: (d.1) for practices, the 

perceived impacts on clinicians, the 

practice staff, the practice, and the 


srobinson on DSK4SPTVN1PROD with NOTICES
14372 Federal Register / Vol. 77, No. 47 / Friday, March 9, 2012 / Notices 

patients; and (d.2) for RECs, technician 

confidence in guiding affiliated clinics 

in understanding workflow; and finally 

(e) assess the overall impressions about 

the usefulness of the Workflow toolkit 

as well as any suggested changes. 

The outcome of the evaluation will be 

a report including recommendations for 

enhancing and improving the Workflow 

toolkit. The report will provide results 

about the perceived usefulness of the 

Workflow toolkit. Results will be 

produced separately for practices and 

RECs as well as for both user groups as 

a whole. The report will also include 

specific suggestions on how to revise 

Workflow toolkit to make it more useful 

to its intended audiences. 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated annual 

burden hours for each respondent’s time 

to participate in this evaluation. The 

Pre-Workflow interview will be 

completed by a total of up to 248 

persons (about 12 per practice) and 

requires one hour. Up to four 

observations will be conducted for up to 

248 persons and they are each estimated 

to take two hours. Ten usage logs will 

be completed by a total of up to 248 

persons (one per week of study activity) 

and completion of a single usage log 

should take no longer than 15 minutes. 

The Post-Workflow interview will be 

completed by a total of up to 248 

persons and requires one hour. 

The total annual burden is estimated 

to be 3,100 hours or 155 hours per 

practice or Regional Extension Center. 

Exhibit 2 shows the estimated annual 

cost burden associated with the 

organizations’ time to participate in this 

research. The total annual burden is 

estimated to be $96,100. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Data collection Number of 

respondents 

Number of 

respoonses 

per 

respondent 

Hours per 

response 

Total burden 

hours 

Pre-Workflow Toolkit Interview ........................................................................ 248 1 1 248 

Observations .................................................................................................... 248 4 2 1,984 

Usage Logs ...................................................................................................... 248 10 15/60 620 

Post-Workflow Toolkit Interview ....................................................................... 248 1 1 248 

Total .......................................................................................................... 992 NA NA 3,100 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Data collection Number of 

respondents 

Total burden 

hours 

Average 

hourly wage 

rate* 

Total cost 

burden 

Pre-Workflow Toolkit Interview ........................................................................ 248 248 $31.00 $7,688 

Observations .................................................................................................... 248 1,984 31.00 61,504 

Usage Logs ...................................................................................................... 248 620 31.00 19,220 

Post-Workflow Toolkit Interview ....................................................................... 248 248 31.00 7,688 

Total .......................................................................................................... 992 147 NA 96,100 

* The hourly wage for the participants across the four data collections (pre-workflow toolkit interviews, observations, usage logs, and postworkflow toolkit interview) is based upon a weighted mean of the average hourly wages for Family and General Practitioners (1.5; $87.84 per 

hour); office managers (1.0; $35.18 per hour); front office staff (1.0; $15.15 per hour); medical assistants or nurses (2.5; $24.36 per hour); nurse 

care managers (0.5; $33.57); social workers (0.1; $24.44 per hour); health educators (0.1; $25.12 per hour); information technology specialists 

(0.25; $23.43 per hour); quality improvement directors (0.25; 25.12 per hour); and technical staff (1.0; $33.14 per hour) for Oregon and Wisconsin from the U.S. Department of Labor, Bureau of Labor Statistics, May 2010 National Occupational Employment and Wage Estimates for the 

United States, Occupational Employment Statistics (OES), Washington, DC (Feb. 2009), http://bls.GOV/oes/2010/may/www.bls.GOVOessrcst.htm 

(accessed November, 2011). 

Estimated Annual Costs to the Federal 

Government 

The estimated total cost to the Federal 

Government for this project is $793,456 

over a 27-month period from September 

23, 2011 to December 22, 2013. The 

estimated average annual cost is 

$352,646. Exhibit 3 provides a 

breakdown of the estimated total and 

average annual costs by category. 

EXHIBIT 3—ESTIMATED TOTAL AND ANNUAL COST* TO THE FEDERAL GOVERNMENT

Cost component Total cost Annualized cost 

Project Management and Coordination Activities ................................................................................... $96,449 $42,866 

Develop Research and Recruitment Plans ............................................................................................. 78,383 34,837 

Compliance with PRA .............................................................................................................................. 12,267 5,452 

Obtaining IRB approval ........................................................................................................................... 10,254 4,557 

Develop Data Analysis Plan .................................................................................................................... 18,246 8,109 

Conduct Evaluation .................................................................................................................................. 534,401 237,512 

Data analysis and Final Report ............................................................................................................... 23,554 10,468 

Ensure 508-compliant deliverables ......................................................................................................... 19,902 8,845 

Total .................................................................................................................................................. 793,456 352,646 

* Costs are fully loaded including overhead and G&A. 


srobinson on DSK4SPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 47 / Friday, March 9, 2012 / Notices 14373 

Request for Comments 

In accordance with the Paperwork 

Reduction Act, 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 healthcare 

research and healthcare 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: February 29, 2012. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2012–5574 Filed 3–8–12; 8:45 am] 

BILLING CODE 4160–90–M 

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. 

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: 

‘‘Demonstration of a Health Literacy 

Universal Precautions Toolkit.’’ In 

accordance with the Paperwork 

Reduction Act, 44 U.S.C. 3501–3521, 

AHRQ invites the public to comment on 

this proposed information collection. 

DATES: Comments on this notice must be 

received by May 8, 2012. 

ADDRESSES: Written comments should 

be submitted to: Doris Lefkowitz, 

Reports Clearance Officer, AHRQ, by 

email 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 

email at doris.lefkowitz@AHRQ.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

Demonstration of Health Literacy 

Universal Precautions Toolkit 

A goal of Healthy People 2020 is to 

increase Americans’ health literacy, 

defined as, ‘‘the degree to which 

individuals have the capacity to obtain, 

process, and understand basic health 

information and services needed to 

make appropriate health decisions.’’ 

The effects of limited literacy are 

numerous and serious, including 

medication errors resulting from 

patients’ inability to read labels; 

underuse of preventive measures such 

as Pap smears and vaccines; poor selfmanagement of conditions such as 

asthma and diabetes; and higher rates of 

hospitalization and longer hospital 

stays. 

According to the 2003 National 

Assessment of Adult Literacy (NAAL), 

more than one-third of Americans—77 

million people—have limited health 

literacy. Although some adults are more 

likely than others to have difficulty 

understanding and acting upon health 

information (e.g., minority Americans, 

elderly), providers cannot tell by 

looking which patients have limited 

health literacy. Experts recommend that 

providers assume all patients may have 

difficulty understanding health-related 

information. Known as adopting ‘‘health 

literacy universal precautions,’’ 

providers create an environment in 

which all patients benefit from clear 

communication. 

AHRQ contracted with the University 

of North Carolina at Chapel Hill to 

develop the Health Literacy Universal 

Precautions Toolkit to help primary care 

practices ensure that systems are in 

place to promote better understanding 

of health-related information by all 

patients. As part of Toolkit 

development, testing of a ‘‘prototype 

Toolkit’’ was conducted in eight 

primary care practices over an eightweek period. Testing provided 

important information about 

implementation and resulted in 

refinement of the Toolkit, which AHRQ 

made publically available in Spring 

2010. At this time, the Toolkit includes 

20 tools to prepare practices for health 

literacy-related quality improvement 

activities and to guide them in 

improving their performance related to 

four domains: (1) Improving spoken 

communication with patients, (2) 

improving written communication with 

patients, (3) enhancing patient selfmanagement and empowerment, and (4) 

linking patients to supportive systems 

in the community. 

The tools included in the Health 

Literacy Universal Precautions Toolkit 

are listed below: 

Tools To Start on the Path to 

Improvement 

Tool 1: Form a Team 

Tool 2: Assess Your Practice 

Tool 3: Raise Awareness 

Tools To Improve Spoken 

Communication 

Tool 4: Tips for Communicating Clearly 

Tool 5: The Teach-Back Method 

Tool 6: Follow up with Patients 

Tool 7: Telephone Considerations 

Tool 8: Brown Bag Medication Review 

Tool 9: How to Address Language 

Differences 

Tool 10: Culture and Other 

Considerations 

Tools To Improve Written 

Communication 

Tool 11: Design Easy-to-Read Material 

Tool 12: Use Health Education Material 

Effectively 

Tool 13: Welcome Patients: Helpful 

Attitude, Signs, and More 

Tools To Improve Self-Management and 

Empowerment 

Tool 14: Encourage Questions 

Tool 15: Make Action Plans 

Tool 16: Improve Medication Adherence 

and Accuracy 

Tool 17: Get Patient Feedback 

Tools to Improve Supportive Systems 

Tool 18: Link Patients to Non-Medical 

Support 

Tool 19: Medication Resources 

Tool 20: Use Health and Literacy 

Resources in the Community 

AHRQ will now conduct a 

demonstration of the Health Literacy 

Universal Precautions Toolkit. The 

purpose of this demonstration project is 

to explore whether the Toolkit helps 

motivated practices to make changes 

intended to improve communication 

with and support for patients of all 

literacy levels. Twelve primary care 

practices will be recruited to implement 

at least four tools from the Health 

Literacy Universal Precautions Toolkit. 

The project team will provide 

participating practices with limited 

technical assistance throughout the 

implementation period. Data regarding 

the assistance provided will contribute 


srobinson on DSK4SPTVN1PROD with NOTICES