50692 Federal Register / Vol. 77, No. 163 / Wednesday, August 22, 2012 / Notices 

reporting obligations. Please rank these 

requirements in two ways: First, please 

indicate those that constitute the 

greatest burden and opportunity cost in 

terms of limiting the provision of highquality HIV services. Second, please 

identify those that provide or have the 

potential to provide the most benefit for 

program planning, monitoring, 

evaluation, or deficiency remediation. 

3. Please describe specific 

recommendations for simplifying grants 

administration that could address the 

greatest sources of grantee burden and 

reduce any associated adverse effects on 

staff and service provision. What 

specific changes in federal, state, local, 

or tribal policies, improvements in 

public health infrastructure, or other 

modifications are needed to achieve an 

optimized balance between data 

streamlining, reporting burden and 

outcome monitoring? What specific 

policies and infrastructure are needed to 

standardize data requirements at the 

national, state, and local levels across 

federal programs supporting HIV/AIDS 

services? 

4. What specific solutions have 

grantees, sub-grantees, or contractors 

implemented to manage the 

administration requirements for data 

collection, monitoring, and reporting? 

For example, what tools and strategies 

have been developed to integrate federal 

data and reporting requirements, 

generate reports, monitor local 

programs, and identify the need for 

corrective action? What lessons do these 

hold for how HHS might streamline data 

collection and lessen administrative 

burdens for its HIV grantees? And how 

might the federal government improve 

the utility of program monitoring data to 

enhance the efficiency and effectiveness 

of program services implemented for 

state, local, and tribal governments? 

5. As part of its effort, HHS seeks to 

reduce by at least 20–25 percent data 

elements collected for monitoring HIV 

services. What specific 

recommendations can you offer for 

eliminating indicators or data elements 

without affecting adversely HHS’s 

capacity to monitor outcomes of its HIV 

grants programs? Please estimate the 

potential improvements these 

recommendations would yield in terms 

of personnel time, costs, or other 

resources saved. 

6. What extant HIV data reporting 

systems or approaches to data reporting 

are the most effective, efficient, and 

acceptable for grantees? What 

recommendations would you offer for 

facilitating both data reporting and data 

sharing between funders and grantees? 

What data from funders are the highest 

priorities for grantees to monitor 

performance, identify services gaps, or 

otherwise inform resource allocation 

and program implementation decisions? 

7. What approach is recommended for 

mapping and measuring achievement of 

reduced HIV reporting burden? Please 

recommend any relevant publications or 

reports that may prove illustrative. 

Dated: August 8, 2012. 

Ronald O. Valdiserri, 

Deputy Assistant Secretary for Health, 

Infectious Diseases. 

[FR Doc. 2012–20578 Filed 8–21–12; 8:45 am] 

BILLING CODE 4150–28–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Request for Information on Quality 

Measurement Enabled by Health IT— 

Extension Date for Responses 

AGENCY: Agency for Healthcare Research 

and Quality (AHRQ), Health and Human 

Services (HHS). 

ACTION: Notice of extension in comment 

period. 

SUMMARY: The Agency for Healthcare 

Research and Quality (AHRQ) requests 

information from the Public, including 

diversified stakeholders (health 

information technology (IT) system 

developers, including vendors; payers, 

quality measure developers, end-users, 

clinicians, health care consumers) 

regarding current successful strategies 

and challenges regarding quality 

measurement enabled by health IT. 

Quality measurement—the assessment 

of the timeliness, completeness and 

appropriateness of preventive services, 

diagnostic services, and treatment 

provided in health care—has been most 

generally conducted via paper chart 

information capture, manual chart 

abstraction, and the analysis of 

administrative claims data. Through this 

notice, the comment period has been 

extended. The subject matter content 

remains unchanged from the original 

notice which was previously published 

on July 20, 2012 (www.GPO.gov/fdsys/ 

PKG/FR-2012-07-20/html/2012- 

17530.htm) 

DATES: Submit comments on or before 

September 21, 2012. 

ADDRESSES: Electronic responses are 

preferred and should be addressed to 

HIT–PTQ@AHRQ.hhs.gov. Nonelectronic responses will also be 

accepted. Please send by mail to: 

Rebecca Roper, Agency for Healthcare 

Research and Quality, Attention: HITEnabled QM RFI Responses, 540 Gaither 

Road, Room 6000, Rockville, MD 20850, 

Phone: 301–427–1535. 

FOR FURTHER INFORMATION CONTACT: 

Please identify in the subject line of 

emails that you are inquiring about the 

‘‘Question about HIT-enabled QM RFI’’. 

Contact Angela Nunley, email: 

Angela.Nunley@AHRQ.hhs.gov, Phone: 

301–427- 1505, or, Rebecca Roper, 

email: Rebecca.Roper@.AHRQ.hhs.gov, 

Phone: 301–427–1535. 

SUPPLEMENTARY INFORMATION: 

Background 

Health information technology (IT), 

such as, electronic health records (EHR) 

which may include clinical decision 

support and health information 

exchange, has seen a tremendous 

increase in adoption in recent years. 

Some institutions have successfully 

used health IT to generate health ITenabled quality measures which may be 

retooled versions of established paperbased or administrative data-driven 

quality measures or (preferably) they are 

‘‘de novo’’ quality measures that were 

developed with the capabilities of 

health IT in mind. These new health ITenabled quality measures seek to 

leverage the use of electronic clinical 

data capture, analysis and reporting to 

measure and report electronically 

enabled quality measures in order to 

facilitate improvements in the quality of 

care provided. AHRQ supports research 

to improve health care quality through 

enhancements in the safety, efficiency, 

and effectiveness of health care 

available to all Americans. Through this 

RFI, AHRQ is seeking information 

related to successful strategies and/or 

remaining challenges encountered 

regarding the development of health ITenabled quality measure development 

and reporting. 

Health IT has the potential to advance 

quality measurement and reporting 

through the use of efficient automated 

data collection, analysis, processing, 

and its ability to facilitate information 

exchange among and across care 

settings, providers, and patients. Quality 

measurement enabled by health IT, 

referred to as health IT-enabled quality 

measurement, is an emerging field. 

There are numerous perspectives on 

how to achieve the future state of 

quality measurement. These varied 

perspectives sometimes include 

competing choices and challenges: (1) 

Underdeveloped or unavailable 

infrastructure (e.g., whether the measure 

set should be extensive or 

parsimonious); (2) incompleteness of 

the measure set (e.g., developing 

measures that matter to consumers, how 

to measure value); and (3) technology 

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Federal Register / Vol. 77, No. 163 / Wednesday, August 22, 2012 / Notices 50693 

challenges (e.g., how might 

unstructured data be captured in the 

EHR to be used for measurement, if and 

how to integrate patient-generated and 

clinician-generated data). 

In preparation for the development of 

this RFI, AHRQ generated a high-level 

overview of the current state of quality 

measurement through health IT, 

challenges facing the advancement of 

quality measurement enabled by health 

IT, a partial catalog of current efforts 

seeking to address those challenges, 

and, possibilities for the next generation 

of health IT-enabled quality 

measurement. This report, ‘‘An 

environmental snapshot — Quality 

Measurement Enabled by Health IT: 

Overview, Possibilities, and Challenges’’ 

can be found at http:// 

healthit.AHRQ.gov/ 

HealthITEnabledQualityMeasurement/ 

Snapshot.pdf. 

AHRQ is committed to garnering 

further insight in order to facilitate 

meaningful advancements in the next 

generation of quality measurement. 

Through this Request for Information 

AHRQ is seeking information on the 

building blocks of health IT-enabled 

quality measurement in terms of 

perspectives, practicalities, and 

priorities. Responses will be used in 

conjunction with deliberative activities 

to inform the development of a 

summary report to be released to the 

public approximately in summer 2013. 

Respondents should note that this 

Request for Information is completely 

voluntary; respondents are welcome to 

address as many of the questions posed 

as they wish. 

AHRQ would appreciate if you clearly 

indicate the number of the question area 

to which you are providing a response. 

This RFI is for planning purposes only. 

Responses to this are not offers, cannot 

be accepted by the Government to form 

a binding contract, and are not intended 

to influence regulation. 

Questions Regarding Quality 

Measurement Enabled by Health IT 

1. Briefly describe what motivates 

your interest in clinically-informed 

quality measures through health 

information technology. To what extent 

is your interest informed by a particular 

role (e.g., provider, payer, government, 

vendor, quality measure developer, 

quality improvement organization, 

standards organization, consumer 

advocate) in this area? 

2. Whose voices are not being heard 

or effectively engaged at the crucial 

intersection of health IT and quality 

measurement? What non-regulatory 

approaches could facilitate enhanced 

engagement of these parties? 

3. Some quality measures of interest 

have been more difficult to generate, 

such as measures of greater interest to 

consumers, measures to assess value, 

specialty-specific measures, measures 

across care settings (i.e., measures 

enabled by health information 

exchange), and measures that take into 

account variations in risk. Describe the 

infrastructure that would be needed to 

ensure development of such measures. 

4. What health IT-enabled quality 

measures, communication channels, 

and/or technologies are needed to better 

engage consumers either as contributors 

of quality information or as users of 

quality information? 

5. How do we motivate measure 

developers to create new health ITenabled quality measures (which are 

distinct from existing measures which 

were retooled into electronicallyproduced quality measures) that 

leverage the unique data available 

through health IT? Please provide 

examples of where this has been 

successfully. What new measures are in 

the pipeline to leverage data available 

through health IT? 

6. Describe how quality measurement 

and ‘‘real-time’’ reporting could inform 

clinical activity, and the extent to which 

it could be considered synonymous 

with clinical decision support. 

7. Among health IT-enabled quality 

measures you are seeking to generate in 

a reliable fashion, including the 

currently proposed Meaningful Use 

Stage 2 measure set, what types of 

advances and/or strategies for e-measure 

generation if pursued, would support 

more efficient generation of quality 

measures? 

8. Many EHR, HIE, and other health 

IT vendors are developing software code 

to support measures. Tools such as the 

Measure Authoring Tool (MAT) were 

created to improve efficiencies in the 

process of creating and implementing 

eMeasures. What additional approaches 

might be used to enable consistent, 

accurate, and efficient quality 

measurement when using health IT? 

9. How do you see the establishment 

and adoption of data standards 

impacting the future of health ITenabled quality measurement? For what 

types of quality measures should a 

combination of natural language 

processing and structured data be 

considered? 

10. Much support has been voiced for 

the need of longitudinal data in quality 

measurement. What are the strengths 

and weaknesses of different information 

architectures and technologies to 

support health IT-enabled quality 

measurement across time and care 

settings? How can data reuse (capture 

once, use many times) be supported in 

different models? What examples might 

you provide of successful longitudinal 

health IT-enabled quality measurement 

(across time and/or across multiples 

care settings)? 

11. What are the most effective means 

by which to educate providers on the 

importance of health IT-enabled quality 

measurement and how clinical 

information is used to support health 

IT-enabled quality measurement and 

reporting? How can providers be better 

engaged in the health IT-enabled quality 

measurement process? 

12. What is the best way to facilitate 

bi-directional communication between 

vendors and measure developers to 

facilitate collaboration in health ITenabled measure development? 

13. To what extent do you anticipate 

adopting payment models that use 

quality measurement informed by 

electronic clinical records (as opposed 

to exclusively using claims data)? What 

strategies are you pursuing to gain 

access to clinical data and test the 

reliability of health IT-enabled clinical 

outcome measures? How do you 

anticipate sharing quality measure 

results with consumers and other 

stakeholders? 

14. What tools, systems, and/or 

strategies has your organization been 

using to aggregate information from 

various EHRs and other health IT for use 

in quality measurement? What strategies 

is your organization pursuing to move 

toward greater automation in quality 

measurement? 

15. Please describe scalable programs, 

demonstrations, or solutions (domestic 

or internationally) that show material 

progress toward quality measurement 

enabled by health IT. 

Reference Material 

Anderson KM, Marsh CA, lsenstein H, 

Flemming AC, Reynolds J. An 

Environmental Snapshot: Health ITenabled Quality Measurement: Efforts, 

Challenges, and Possibilities (Prepared by 

Booz Allen Hamilton, under Contract No. 

HHSA290200900024I.) AHRQ Publication 

No. 12–0061–EF. Rockville, MD: Agency 

for Healthcare Research and Quality. July 

2012. See: http://healthit.AHRQ.gov/ 

HealthITEnabledQualityMeasurement/ 

Snapshot.pdf 

Dated: August 15, 2012. 

Carolyn M. Clancy, 

AHRQ Director. 

[FR Doc. 2012–20550 Filed 8–21–12; 8:45 am] 

BILLING CODE 4160–90–M 

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