18722 Federal Register / Vol. 74, No. 78 / Friday, April 24, 2009 / Notices 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS—Continued 

Activity name Number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Key Informant Interviews with EHC Program Users and Stakeholders to Develop Cases ............................................................ 25 1 1 25 

Appreciative Inquiry Workshop ........................................................ 20 1 6 120 

Total .......................................................................................... 344 (1) (1) 246 

1 Not applicable. 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Activity name Number of 

respondents 

Total burden 

hours 

Average hourly 

wage rate * Total cost burden 

Key Informant Interviews with EHC Research Centers Staff .......... 13 13 $54.27 $706 

Online Survey with EHC Research Centers Staff ........................... 95 24 54.27 1,302 

Key Informant Interviews with EHC Stakeholder Group Members 2 2 43.52 87 

Key Informant Interviews with EHC Program Users and Stakeholders .......................................................................................... 19 19 46.73 888 

Online Survey with EHC Program Users and Stakeholders ........... 170 43 46.73 2009 

Key Informant Interviews with EHC Program Users and Stakeholders to Develop Cases ............................................................ 25 25 46.73 1,168 

Appreciative Inquiry Workshop ........................................................ 20 120 51.14 6,137 

Total .......................................................................................... 344 246 (1) 12,297 

* Wage rates were calculated using the following data: (1) For the Governance Interviews and the Online Survey with EHC Research Centers 

Staff the hourly rate is a weighted average for physicians ($58.76 per hour) and medical and health services managers ($37.82); (2) for the Governance Interviews with EHC Stakeholder Group Members the hourly rate is the rate for average for medical and health services managers 

($37.82); (3) for the Governance Interviews and the Online Survey with EHC Program Users and Stakeholders the hourly rate is a weighted average for physicians ($58.76 per hour), general and operations managers ($43.52 per hour), medical and health services managers ($37.82 per 

hour), and social and community service managers ($24.73 per hour); (4) for the Workshop the hourly rate is a weighted average for physicians 

($58.76 per hour) and general and operations managers ($43.52 per hour) from the mean of the average wages, National Compensation Survey: 

Occupational Wages in the United States 2006, U.S. Department of Labor, Bureau of Labor Statistics. 1 Not applicable. 

Estimated Annual Costs to the Federal 

Government 

Exhibit 3 shows the estimated cost of 

this one year data collection for the 

evaluation of the EHC program, 

including the cost of developing the 

methodology and data collection 

instruments, collecting and analyzing 

the data, publishing the results, etc. The 

work will be carried out by IMPAQ 

International and Abt Associates under 

contract to the Agency for Healthcare 

Research and Quality. 

EXHIBIT 3—ESTIMATED ANNUAL

COST * TO THE FEDERAL GOVERNMENT

Cost component Total cost 

Project Development .................... $137,901 

Data Collection Activities .............. 179,172 

Data Processing and Analysis ..... 170,577 

Publication of Results ................... 63,686 

Project Management .................... 97,236 

Total ....................................... 648,572 

* Please note the costs include fully loaded 

costs (overhead, G&A). 

Request for Comments 

In accordance with the above-cited 

Paperwork Reduction Act legislation, 

comments on AHRQ’s information 

collection are requested with regard to 

any of the following: (a) Whether the 

proposed collection of information is 

necessary for the proper performance of 

AHRQ health care research 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: April 15, 2009. 

Carolyn M. Clancy, 

Director. 

[FR Doc. E9–9245 Filed 4–23–09; 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: 

‘‘Building an Implementation Toolset 

for E-Prescribing.’’ In accordance with 

the Paperwork Reduction Act of 1995, 

Public Law 104–13 (44 U.S.C. 

3506(c)(2)(A)), AHRQ invites the public 

mstockstill on PROD1PC66 with NOTICES

Federal Register / Vol. 74, No. 78 / Friday, April 24, 2009 / Notices 18723 

to comment on this proposed 

information collection. 

DATES: Comments on this notice must be 

received by June 23, 2009. 

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 

e-mail at doris.lefkowitz@ahrg.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

‘‘Building an Implementation Toolset 

for E-Prescribing’’ 

AHRQ proposes to develop and test 

an electronic prescribing (e-prescribing) 

toolset to provide information and tools 

of sufficient detail to act as a ‘‘how-to 

guide’’ for implementing e-prescribing 

across various organizational settings. 

The current system of prescribing and 

dispensing medications in the United 

States poses widespread safety and 

efficiency problems. E-prescribing 

systems have the potential to avert some 

of the more than 2 million adverse drug 

events (ADEs) annually, of which 

130,000 are life threatening. Eprescribing also has enormous potential 

to create savings in health care costs, 

both through reducing ADEs and 

through more efficient work processes 

of prescribers and pharmacists. One 

recent study estimated the potential 

savings at $27 billion per year in the 

United States. [Johnston D, Pan E, 

Middleton B, Walker J, Bates DW. The 

value of computerized provider order 

entry in ambulatory settings. 2003 [cited 

2003/12/10]. Available from: http:// 

www.citl.org/research/ 

ACPOE_Executive_Preview.pdf.] 

The Medicare Prescription Drug 

Improvement and Modernization Act 

(MMA) of 2003, Public Law 108–173, 

provided that Medicare Part D sponsors 

are required to establish electronic 

prescription drug programs to provide 

for electronic transmittal of certain 

information to the prescribing provider 

and dispensing pharmacy and the 

dispenser. There is no requirement that 

prescribers or dispensers implement eprescribing, but those who do 

electronically transmit prescription and 

certain other prescription-related 

information for Medicare Part D covered 

drugs prescribed for Medicare Part D 

eligible individuals, either directly or 

through an intermediary, are required to 

comply with any applicable final 

standards that are in effect. 

However, adoption of e-prescribing 

technology remains limited. On the 

surface, e-prescribing involves getting a 

prescription from point A to point B. In 

reality, the complexity of e-prescribing 

reflects all aspects of the process from 

appropriate prescribing, through 

dispensing, to correct patient use. 

Much current work has been on the 

adoption of technical standards that 

establish a common language, contain 

technical specifications, and provide 

other specific criteria designed to be 

used consistently as rules or definitions. 

While standards are a necessary 

foundation for e-prescribing systems, 

they are insufficient in themselves to 

insure a successful implementation. Of 

equal importance to successful eprescribing implementations are 

appropriate workflows and sustainable 

commitment from the various 

organizations that must participate in 

such a system. 

This Accelerating Change and 

Transformation in Organizations and 

Networks (ACTION) project will 

produce a toolset to help a diverse range 

of provider organizations, from small 

independent offices to large medical 

groups to ‘‘safety net’’ clinics, to adopt 

e-prescribing systems and use them 

effectively in ways that advance the 

organization’s goals. By enabling the 

greater adoption of e-prescribing 

systems that are effective in improving 

safety, quality and reducing prescription 

drug costs, the project will advance each 

of the priorities embodied in AHRQ’s 

mission, which is to improve the 

quality, safety, efficiency, and 

effectiveness of health care for all 

Americans. 

This work is being conducted by the 

RAND Corporation under AHRQ 

ACTION contract HHSA290200600017, 

Task Order #4, period of performance— 

8/1/08–1/31/10. It is being conducted 

pursuant to AHRQ’s statutory authority 

to conduct research and evaluations (1) 

on health care and systems for the 

delivery of such care, including 

activities with respect to health care 

technologies, facilities and equipment, 

42 U.S.C. 299a(a)(5), and (2) to advance 

training for health care practitioners and 

researchers in the use of information 

systems. 42 U.S.C. 299b–3(a)(2). 

Method of Collection 

In order to evaluate the draft toolset’s 

usability and usefulness, we will pilot 

test the toolset by studying its effects 

among 6 practices that are attempting to 

implement e-prescribing for the first 

time. Field researchers will visit each 

practice before and after the eprescribing implementation effort to 

conduct semi-structured interviews and 

observations of work processes. Finally, 

selected members of the practices will 

be surveyed via a web-based instrument 

regarding the effort’s success and the 

degree to which elements of the toolset 

were helpful. 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated 

annualized burden hours for the 

respondents’ time to participate in this 

project. Pre-test and post-test interviews 

will be conducted with 3 physicians, 3 

nurses or clinical support staff and 3 

other staff from each of the 6 test sites. 

Eight physicians from each of the 6 test 

sites will complete the physician survey 

and 12 other staff from each site will 

complete the other staff survey. The 

total burden hours are estimated to be 

168 hours. 

Exhibit 2 shows the estimated 

annualized cost burden associated with 

the respondent’s time to participate in 

this project. The total cost burden is 

estimated to be $7,423. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Form name Number of 

sites 

Number of 

responses per 

site 

Hours per 

response 

Total burden 

hours 

Pre-test Interviews: 

Physician interviews ................................................................................. 6 3 1 18 

Nurse or clinical support interviews .......................................................... 6 3 1 18 

Other staff interviews ................................................................................ 6 3 1 18 

Post-test interviews: 

Physician interviews ................................................................................. 6 3 1 18 

Nurse or clinical support interviews .......................................................... 6 3 1 18 

mstockstill on PROD1PC66 with NOTICES

18724 Federal Register / Vol. 74, No. 78 / Friday, April 24, 2009 / Notices 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS—Continued 

Form name Number of 

sites 

Number of 

responses per 

site 

Hours per 

response 

Total burden 

hours 

Other staff interviews ................................................................................ 6 3 1 18 

Web-based survey: 

Physician survey ....................................................................................... 6 8 30/60 24 

Other staff survey ..................................................................................... 6 12 30/60 36 

Total ................................................................................................... 48 (1) (1) 168 

1 Not applicable. 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Form name Number of 

sites 

Total burden 

hours 

Average 

hourly wage 

rate * 

Total cost 

burden 

Pre-test Interviews: 

Physician interviews ................................................................................. 6 18 $78.24 $1,408 

Nurse or clinical support interviews .......................................................... 6 18 30.42 548 

Other staff interviews ................................................................................ 6 18 14.97 269 

Post-test interviews: 

Physician interviews ................................................................................. 6 18 78.24 1,408 

Nurse or clinical support interviews .......................................................... 6 18 30.42 548 

Other staff interviews ................................................................................ 6 18 14.97 269 

Web-based survey: 

Physician survey ....................................................................................... 6 24 78.24 1,878 

Other staff survey ..................................................................................... 6 36 30.42 1,095 

Total ................................................................................................... 48 168 (1) 7,423 

* Based upon the mean of the national average hourly wages for physicians and surgeons, registered nurses, and medical secretaries, National Compensation Survey: Occupational wages in the United States July 2007, U.S. Department of Labor, Bureau of Labor Statistics. 1 Not applicable. 

Estimated Annual Costs to the Federal 

Government 

Exhibit 3 shows the estimated total 

and annual costs of this project. Since 

data collection will not exceed one year, 

the total and annual costs are the same. 

The total cost is estimated to be 

$119,976. 

EXHIBIT 3—ESTIMATED TOTAL AND ANNUAL COST

Cost component Total cost Annualized 

cost 

Instrument Development .................................................................................................................................................. $12,533 $12,533 

Data Collection Activities ................................................................................................................................................. 33,422 33,422 

Data Processing and Analysis ......................................................................................................................................... 16,711 16,711 

Report Preparation/Publication ........................................................................................................................................ 16,711 16,711 

Project Management ........................................................................................................................................................ 4,178 4,178 

Overhead ......................................................................................................................................................................... 36,421 36,421 

Total .......................................................................................................................................................................... 119,976 119,976 

Request for Comments 

In accordance with the above-cited 

Paperwork Reduction Act legislation, 

comments on AHRQs 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: April 15, 2009. 

Carolyn M. Clancy, 

Director. 

[FR Doc. E9–9247 Filed 4–23–09; 8:45 am] 

BILLING CODE 4160–90–M 

mstockstill on PROD1PC66 with NOTICES