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

E XHIBIT 

### 2—E STIMATED 

### A NNUALIZED 

### C OST 

### B URDEN

### —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.



### E XHIBIT 

### 3—E STIMATED 

### TOTAL AND 

### A NNUALIZED 

### C OST

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


### 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 StudyTeams, 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 workflowassessment 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 ExtensionCenter. 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


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

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, orabout 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.



### E XHIBIT 

### 1—E STIMATED 

### A NNUALIZED 

### B URDEN 

### H OURS

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 64 5 Post-Workflow Toolkit Interview ....................................................................... 258 1 1 258

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



### E XHIBIT 

### 2—E STIMATED 

### A NNUALIZED 

### C OST 

### B URDEN

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 32.2864,044 Usage Logs ...................................................................................................... 258 645 32.28 2 0,014 Post-Workflow Toolkit Interview ....................................................................... 258 258 32.28 8,005

Total .......................................................................................................... 1,284 3,372 NA 1 04,813
* 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.



### E XHIBIT 

### 3—E STIMATED 

### TOTAL AND 

### A NNUAL 

### C OST 

### * TO THE 

### F EDERAL 

### G OVERNMENT

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.


### 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 willprovide 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 thetelephone 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.