Federal Register / Vol. 77, No. 98 / Monday, May 21, 2012 / Notices 30011 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN—Continued 

Form name Number of 

respondents 

Total burden 

hours 

Average 

hourly wage 

rate a

Total cost 

burden 

Total ................................................................................................... 3,788 1,446 na $34,329 

a Mean hourly and wage costs for Colorado were derived from the Bureau of Labor and Statistics National Compensation Survey for May 2010 

(http://www.bls.gov/oes/current/oes_co.htm). b Hourly rate for all workers (occupation code 00–0000) estimates the cost of time for patients. 

c Hourly rate for medical records and health information technician (29–2071). 

d Hourly rate for Healthcare Practitioners and Technical Workers, All Other (29–9799). 

Estimated Annual Costs to the Federal 

Government 

Exhibit 3 shows the estimated total 

and annualized cost to the Federal 

Government for conducting this 

research. These estimates include the 

costs associated with the project such as 

the preparation of survey administration 

procedures, labor costs, administrative 

expenses, costs associated with copying, 

postage, and telephone expenses, data 

management and analysis, preparation 

of final reports, and dissemination of 

findings/results/products. The 

annualized and total costs are identical 

since the data collection period will last 

for one year. The total cost is estimated 

to be $784,910. 

EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST

Cost component Total Annualized 

cost 

Administration .......................................................................................................................................................... $81,654 $81,654 

Research Activities .................................................................................................................................................. 446,201 446,201 

Dissemination Activities ........................................................................................................................................... 57,222 57,222 

Final Report ............................................................................................................................................................. 57,864 57,864 

Overhead ................................................................................................................................................................. 141,969 141,969 

Total .................................................................................................................................................................. 784,910 784,910 

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 health care 

research and health care 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: May 3, 2012. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2012–12171 Filed 5–18–12; 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: 

‘‘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. 

This proposed information collection 

was previously published in the Federal 

Register on March 9th, 2012 and 

allowed 60 days for public comment. 

One comment was received. The 

purpose of this notice is to allow an 

additional 30 days for public comment. 

DATES: Comments on this notice must be 

received by June 20, 2012. 

ADDRESSES: Written comments should 

be submitted to: AHRQ’s OMB Desk 

Officer by fax at (202) 395–6974 

(attention: AHRQ’s desk officer) or by 

email at 

OIRA_submission@omb.eop.gov 

(attention: AHRQ’s desk officer). 

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 

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 


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30012 Federal Register / Vol. 77, No. 98 / Monday, May 21, 2012 / Notices 

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 AHRQ 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 activities and data collections 

will be implemented: 

(1) Creation of Clinic Study Team: 

Each participating practice will form 

small teams, referred to as Clinic Study 

Teams, who will participate in the PreWorkflow Toolkit Interview, use the 

Workflow toolkit and participate in 

Observations, and participate in the 

Post-Workflow Toolkit Interview. Each 

team will include a maximum of 14 

individuals and may represent the 

following types of respondents: 

clinicians, office managers, front office 

staff, medical assistant or nurse, nurse 

care manager, social worker, health 

educator, information technology 

specialist, and/or quality improvement 

director. 

(2) 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). 

(3) 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. 

(4) 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. 

(5) 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 

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

confidence in guiding affiliated clinics 

in understanding workflow; and finally 

(e) assess the overall impressions about 


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Federal Register / Vol. 77, No. 98 / Monday, May 21, 2012 / Notices 30013 

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. Each 

practice will convene a ‘‘Clinic Study 

Team’’ consisting of no more than 14 

individuals; this process will take 

approximately 8 hours per practice, or 

about 35 minutes per person. The PreWorkflow interview will be completed 

by a total of up to 258 persons (about 

14 per practice and 3 per REC) and 

requires one hour. Up to four 

observations will be conducted for up to 

258 persons and they are each estimated 

to take two hours. Ten usage logs will 

be completed by a total of up to 258 

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 258 

persons and requires one hour. 

The total annual burden is estimated 

to be 3,372. 

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 $104,813. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Data collection 

Maximum 

number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Creation of Clinic Study Team ......................................................................... 252 1 35/60 147 

Pre-Workflow Toolkit Interview ........................................................................ 258 1 1 258 

Observations .................................................................................................... 258 4 2 2,064 

Usage Logs ...................................................................................................... 258 10 15/60 645 

Post-Workflow Toolkit Interview ....................................................................... 258 1 1 258 

Total .......................................................................................................... 1,284 NA NA 3,372 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Data collection 

Maximum 

number of 

respondents 

Total burden 

hours 

Average 

hourly rate * 

Total cost 

burden 

Creation of Clinic Study Team ......................................................................... 252 147 32.28 4,745 

Pre-Workflow Toolkit Interview ........................................................................ 258 258 32.28 8,005 

Observations .................................................................................................... 258 2,064 32.28 64,044 

Usage Logs ...................................................................................................... 258 645 32.28 20,014 

Post-Workflow Toolkit Interview ....................................................................... 258 258 32.28 8,005 

Total .......................................................................................................... 1,284 3,372 NA 104,813 

* 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. 


ebenthall on DSK5SPTVN1PROD with NOTICES
30014 Federal Register / Vol. 77, No. 98 / Monday, May 21, 2012 / Notices 

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: May 3, 2012. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2012–12168 Filed 5–18–12; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

[60–Day–12–0834] 

Proposed Data Collections Submitted 

for Public Comment and 

Recommendations 

In compliance with the requirement 

of Section 3506(c)(2)(A) of the 

Paperwork Reduction Act of 1995 for 

opportunity for public comment on 

proposed data collection projects, the 

Centers for Disease Control and 

Prevention (CDC) will publish periodic 

summaries of proposed projects. To 

request more information on the 

proposed projects or to obtain a copy of 

the data collection plans and 

instruments, call 404–639–7570 or send 

comments to Kimberly S. Lane, at 1600 

Clifton Road, MS D74, Atlanta, GA 

30333 or send an email to omb@cdc.gov. 

Comments are invited on: (a) Whether 

the proposed collection of information 

is necessary for the proper performance 

of the functions of the agency, including 

whether the information shall have 

practical utility; (b) the accuracy of the 

agency’s estimate of the burden of the 

proposed collection 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 

on respondents, including through the 

use of automated collection techniques 

or other forms of information 

technology. Written comments should 

be received within 60 days of this 

notice. 

Proposed Project 

Occupational Injuries and Illnesses 

among Emergency Medical Services 

(EMS) Workers: A NEISS–Work 

Telephone Interview Survey— 

Revision—National Institute for 

Occupational Safety and Health 

(NIOSH), Centers for Disease Control 

and Prevention (CDC). 

Background and Brief Description 

Studies have reported that EMS 

workers have higher rates of non-fatal 

injuries and illnesses as compared to the 

general worker population. As EMS 

professionals are tasked with protecting 

the health of the public and treating 

urgent medical needs, it follows that 

understanding and preventing injuries 

and illnesses among EMS workers will 

have a benefit reaching beyond the 

workers to the general public. 

As mandated in the Occupational 

Safety and Health Act of 1970 (Pub. L. 

91–596), the mission of NIOSH is to 

conduct research and investigations on 

occupational safety and health. Related 

to this mission, the purpose of this 

project is to conduct research that will 

provide a detailed description of nonfatal occupational injuries and illnesses 

incurred by EMS workers. This project 

bridges a gap of limited existing EMS 

worker injury and illness surveillance 

identified in a 2007 National Highway 

Traffic Safety Administration (NHTSA) 

report. The project uses two related data 

sources. The first source is data 

abstracted from medical records of EMS 

workers treated in a nationally stratified 

sample of emergency departments. 

These data are routinely collected by the 

occupational supplement to the 

National Electronic Injury Surveillance 

System (NEISS–Work). The second data 

source, for which NIOSH is seeking 

OMB approval for a two year extension, 

is responses to telephone interview 

surveys of the injured and ill EMS 

workers identified within NEISS–Work. 

Collection of telephone interview data 

began in July 2010. 

Data collected under the original 

OMB approval for this project indicate 

that EMS workers are willing to respond 

to detailed questions about their 

occupational injury and related 

circumstances. However, in order to 

obtain enough data to produce stable, 

detailed national estimates, data 

collection should continue until July 1, 

2014. This will provide a total of four 

years of data for analysis. 

The ongoing telephone interview 

surveys will supplement NEISS–Work 

data with an extensive description of 

EMS worker injuries and illnesses, 

including worker characteristics, injury 

types, injury circumstances, injury 

outcomes, and use of personal 

protective equipment. Previous reports 

describing occupational injuries and 

illnesses to EMS workers provide 

limited details on specific regions or 

sub-segments of the population and 

many are outdated. As compared to 

these earlier studies, the scope of the 

telephone interview data is broader as it 

includes sampled cases nationwide and 

has no limitations in regards to type of 

employment (i.e., volunteer versus 

career). Results from the telephone 

interviews will be weighted and 

reported as estimates of EMS workers 

treated for occupational injuries and 

illnesses in emergency departments. 

The sample size for the telephone 

interview survey is estimated to be 

approximately 150 EMS workers 

annually for the proposed four year 

duration of the study. This estimate is 

based on preliminary analysis of the 

data collected to-date. The estimate has 

been reduced from the original sample 

projection of 175 EMS workers. 

Consequently, the burden has been 

reduced as well. Each telephone 

interview takes approximately 20 

minutes to complete, resulting in an 

annualized burden estimate of 50 hours. 

Using the routine NEISS–Work data, an 

analysis of all identified EMS workers 

will be performed to determine if there 

are any differences between the 

telephone interview responder and nonresponder groups. 

This project is a collaborative effort 

between the Division of Safety Research 

in the NIOSH and the Office of 

Emergency Medical Services in NHTSA. 

Both agencies have a strong interest in 

improving surveillance of EMS worker 

injuries and illnesses to provide the 

information necessary for effectively 

targeting and implementing prevention 

efforts and, consequently, reducing 

occupational injuries and illnesses 

among EMS workers. The Consumer 

Product Safety Commission (CPSC) will 

also contribute to this project as they are 

responsible for coordinating the 

collection of all NEISS–Work data and 

for overseeing the collection of all 

telephone interview data. 


ebenthall on DSK5SPTVN1PROD with NOTICES