22880 Federal Register / Vol. 78, No. 74 / Wednesday, April 17, 2013 / Notices 

1Copies of the Minutes of the Federal Open 

Market Committee at its meeting held on March 19– 

20, 2013, which includes the domestic policy 

directive issued at the meeting, are available upon 

request to the Board of Governors of the Federal 

Reserve System, Washington, DC 20551. The 

minutes are published in the Federal Reserve 

Bulletin and in the Board’s Annual Report. 

First National Bank of Menahga & 

Sebeka, Menahga, Minnesota. 

Board of Governors of the Federal Reserve 

System, April 12, 2013. 

Margaret McCloskey Shanks, 

Deputy Secretary of the Board. 

[FR Doc. 2013–09031 Filed 4–16–13; 8:45 am] 

BILLING CODE 6210–01–P 

FEDERAL RESERVE SYSTEM 

Federal Open Market Committee; 

Domestic Policy Directive of March 19– 

20, 2013 

In accordance with Section 271.25 of 

its rules regarding availability of 

information (12 CFR part 271), there is 

set forth below the domestic policy 

directive issued by the Federal Open 

Market Committee at its meeting held 

on March 19–20, 2013.1

Consistent with its statutory mandate, 

the Federal Open Market Committee 

seeks monetary and financial conditions 

that will foster maximum employment 

and price stability. In particular, the 

Committee seeks conditions in reserve 

markets consistent with federal funds 

trading in a range from 0 to 1⁄4 percent. 

The Committee directs the Desk to 

undertake open market operations as 

necessary to maintain such conditions. 

The Desk is directed to continue 

purchasing longer-term Treasury 

securities at a pace of about $45 billion 

per month and to continue purchasing 

agency mortgage-backed securities at a 

pace of about $40 billion per month. 

The Committee also directs the Desk to 

engage in dollar roll and coupon swap 

transactions as necessary to facilitate 

settlement of the Federal Reserve’s 

agency mortgage-backed securities 

transactions. The Committee directs the 

Desk to maintain its policy of rolling 

over maturing Treasury securities into 

new issues and its policy of reinvesting 

principal payments on all agency debt 

and agency mortgage-backed securities 

in agency mortgage-backed securities. 

The System Open Market Account 

Manager and the Secretary will keep the 

Committee informed of ongoing 

developments regarding the System’s 

balance sheet that could affect the 

attainment over time of the Committee’s 

objectives of maximum employment 

and price stability. 

By order of the Federal Open Market 

Committee, April 10, 2013. 

William B. English, 

Secretary, Federal Open Market Committee. 

[FR Doc. 2013–08952 Filed 4–16–13; 8:45 am] 

BILLING CODE 6210–01–P 

FEDERAL RETIREMENT THRIFT 

INVESTMENT BOARD 

Sunshine Act; Notice of Meeting 

TIME AND DATE: 9:00 a.m. (Eastern Time) 

April 22, 2013. 

PLACE: 10th Floor Training Room, 77 K 

Street NE., Washington, DC 20002. 

STATUS: Parts will be open to the public 

and parts closed to the public. 

MATTERS TO BE CONSIDERED: 

Parts Open to the Public 

1. Approval of the Minutes of the March 

25, 2013 Board Member Meeting 

2. Approval of the Minutes of the 

October 9, 2012 ETAC Meeting 

3. Thrift Savings Plan Activity Reports 

by the Executive Director 

a. Monthly Participant Activity Report 

b. Quarterly Investment Policy Report 

c. Legislative Report 

4. Quarterly Vendor Financials 

5. Annual Financial Audit—Clifton 

Larson Allen (CLA) 

6. Office of Enterprise Planning Report 

7. Default Investment Fund Option 

8. Communications Update 

9. Sequestration and the TSP 

Parts Closed to the Public 

1. Procurement 

CONTACT PERSON FOR MORE INFORMATION: 

Kimberly Weaver, Director, Office of 

External Affairs, (202) 942–1640. 

Dated: April 15, 2013. 

James B. Petrick, 

Secretary, Federal Retirement Thrift 

Investment Board. 

[FR Doc. 2013–09117 Filed 4–15–13; 11:15 am] 

BILLING CODE 6760–01–P 

GENERAL SERVICES 

ADMINISTRATION 

[Notice–CIB–2013–03; Docket No. 2013– 

0002; Sequence 11] 

Privacy Act of 1974; Notice of 

cancellation of System of Record 

Notice (SORN) 

AGENCY: General Services 

Administration (GSA). 

ACTION: Withdrawal of GSA/GOV–8 

Excluded Parties List System (EPLS) 

System of Record Notice (SORN). 

SUMMARY: Pursuant to the Privacy Act of 

1974 (5 U.S.C. 552a), notice is given that 

the General Services Administration 

(GSA), is canceling the following system 

of record notice: GSA/GOV–8 Excluded 

Parties List System (EPLS). 

DATES: Effective Date: April 17, 2013. 

FOR FURTHER INFORMATION CONTACT: Call 

or email the GSA Privacy Act Officer: 

telephone 202–208–1317; email 

gsa.privaccyact@gsa.gov. 

ADDRESSES: GSA Privacy Act Officer 

(CIB), General Services Administration, 

1800 F Street NW., Washington, DC 

20405. 

SUPPLEMENTARY INFORMATION: 

The GSA/GOV–8 Excluded Parties 

List System (EPLS) is being cancelled 

because the information in the system is 

now part of the (GSA/GOVT–9) System 

of Award Management (SAM). The 

(SORN) was published in the Federal 

Register at 73 FR 22374 on Friday, April 

25, 2008. 

Dated: April 11, 2013. 

James Atwater, 

Acting Director, Office of Information 

Management. 

[FR Doc. 2013–09004 Filed 4–16–13; 8:45 am] 

BILLING CODE 6820–34–P 

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: 

‘‘Applying Novel Methods to Better 

Understand the Relationship between 

Health IT and Ambulatory Care 

Workflow Redesign.’’ 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 January 28th, 2013 and 

allowed 60 days for public comment. No 

comments were 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 May 17, 2013. 


sroberts on DSK5SPTVN1PROD with NOTICES
Federal Register / Vol. 78, No. 74 / Wednesday, April 17, 2013 / Notices 22881 

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 

Applying Novel Methods to Better 

Understand the Relationship between 

Health IT and Ambulatory Care 

Workflow Redesign. 

The Agency for Healthcare Research 

and Quality (AHRQ) requests that the 

Office of Management and Budget 

(OMB) approve, under the Paperwork 

Reduction Act of 1995, AHRQ’s 

collection of information for the project 

‘‘Applying Novel Methods to Better 

Understand the Relationship between 

Health IT and Ambulatory Care 

Workflow Redesign.’’ The data to be 

collected consists of interviews and 

focus groups with clinical, non-clinical, 

and management staff about their 

experiences with new health 

information technology (IT) in an 

ambulatory care facility. The overall 

goal of this study is to characterize the 

relationship between health IT 

implementation and health care 

workflow in six (6) small and mediumsized ambulatory care practices 

implementing patient-centered medical 

homes (PCMH), with a focus on the 

influence of behavioral and 

organizational factors and the effects of 

disruptive events. 

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. 

Health IT has been widely viewed as 

holding great promise to improve the 

quality of health care in the U.S. Health 

IT can improve access to information for 

both patients and providers, 

empowering patients to become 

involved in their own self-care. 

Increased patient safety can result from 

health IT when records are shared, 

medications are reconciled, and adverse 

event alerts are in place. When health IT 

improves efficiency, providers can 

spend more time directly caring for 

patients, ultimately improving the 

quality of care patients receive. 

In redesigning an ambulatory office 

practice as a patient-centered medical 

home (PCMH), health IT is intended to 

allow for a seamless and organized flow 

of information among providers. The 

health IT system is critical, because 

under the PCMH model, a team of 

clinicians aims to provide continuous 

and coordinated care throughout a 

patient’s lifetime. 

Unfortunately, health IT systems can 

fail to generate anticipated results and 

even carry unintended consequences 

which undermine usability and 

usefulness. Directly or indirectly, health 

IT may create more work, new work, 

excessive system demands, or 

inefficient workflow (the sequence of 

clinical tasks). Electronic reminders and 

alerts may be timed poorly. Software 

may require excessive switching 

between screens, leading to cognitive 

distractions for end users. Providers 

may spend more time on health IT 

system-related tasks than on direct 

patient care. 

The literature also suggests that the 

ambulatory health care environment is 

full of unpredictable yet frequently 

occurring events requiring actions that 

deviate from normal practice. 

Unpredictable events such as 

interruptions requiring a provider’s 

immediate attention, or disruptions in 

the normal functioning of the health IT 

system (exceptions) divert health care 

workers from the usual course of 

workflow. The inability of health IT to 

properly accommodate these events 

could cause compromises to clinical 

work. 

Because of adverse, unintended and 

disruptive consequences, developing an 

understanding of how health IT 

implementation alters clinical work 

processes and workflow is crucial. 

Unfortunately, research is scarce, and 

methods of investigation vary widely. 

Empirical evidence of health IT’s impact 

on clinical workflow has been 

‘‘anecdotal, insufficiently supported, or 

otherwise deficient in terms of scientific 

rigor’’ (Carayon and Karsh, 2010). 

This study aims to examine more 

systematically the impact of health IT 

on workflow in six (6) small and 

medium-sized ambulatory care practices 

varying in their characteristics but all 

implementing PCMH. All of the 

practices will be in the process of 

implementing a new health IT system 

during the course of the study, but some 

may have an existing, baseline system 

such as an electronic health record 

system. The focus of the study will be 

on the new systems being implemented. 

It will employ the complementary 

quantitative and qualitative methods of 

previous research. The combination of 

methods produces quantitative results 

and allows validation through 

observation and solicitation of 

qualitative participant opinions. 

The specific goals of this study are to 

identify 1) the relationship between 

health IT implementation and 

ambulatory care workflow; 2) the 

behavioral and organizational factors 

and the role they play in mitigating or 

augmenting the impact of health IT on 

workflow; and 3) how the impacts of 

health IT are magnified through 

disruptive events such as interruptions 

and exceptions. 

This study is being conducted by 

AHRQ through its contractor, Billings 

Clinic, pursuant to AHRQ’s statutory 

authority to conduct and support 

research on healthcare and on systems 

for the delivery of such care, including 

activities with respect to the quality, 

effectiveness, efficiency, 

appropriateness and value of healthcare 

services and with respect to clinical 

practice, including primary care and 

practice-oriented research. 42 U.S.C. 

299a(a)(1) and (4). 

Method of Collection 

To achieve the goals of this project the 

following data collection will be 

implemented: 

(1) Mapping of Study Practices. This 

activity will detect any changes made to 

the physical layout as a result of 

implementing PCMH and health IT. 

Practices will be mapped at the 

beginning of the study and maps will be 

updated as needed. Recording this 

information will not burden the clinic 

staff and is not included in the burden 

estimates. 

(2) Staff Observation. Clinicians 

(physicians, nurse practitioners, 

physician assistants, nurses, medical 

assistants, pharmacists, and case 

managers) and non-clinical office 

personnel will be observed to delineate 

the overall characteristics of clinical 

workflow before, during, and after 

health IT implementation. Particular 

attention will be paid to interruptions 

and exceptions. If necessary and if the 

situation allows, observers will as 

unobtrusively as possible ask clinic staff 

to clarify certain observed actions. 

Recording this information will not 

burden the clinic staff and is not 

included in the burden estimates. 

(3) Before—After Time and Motion 

Study. This activity quantifies staffs 

time expenditures on different clinical 

activities and delineates the sequence of 

task execution. It will be conducted 

before and after health IT 

implementation. This data will be 

collected by observation only. 

Recording this information will not 


sroberts on DSK5SPTVN1PROD with NOTICES
22882 Federal Register / Vol. 78, No. 74 / Wednesday, April 17, 2013 / Notices 

burden the clinic staff and is not 

included in the burden estimates. 

(4) Extraction of Clinical Data. Logs, 

audits trails, and time-stamped clinical 

data will be extracted from the health IT 

system to reconstruct clinical workflow 

related to the health IT system. This 

information validates and supplements 

the data recorded by human observers. 

Extracting this data will not burden the 

clinic staff and is not included in the 

burden estimates. 

(5) Semi-Structured Interviews. This 

data collection will be conducted posthealth IT implementation to solicit 

attitudes and perceptions by health IT 

end users including clinical staff, nonclinical personnel, and management 

regarding how health IT has changed 

their workflow. Particular attention will 

be paid to behavioral and organizational 

factors. 

(6) Focus Group. A focus group will 

be conducted post-health IT 

implementation with the clinical staff, 

non-clinical personnel, and 

management team to ensure the research 

findings, as well as the interpretation of 

the findings, accurately reflect their 

experiences using health IT. 

On-site data collection will be 

conducted over a 5-day period during 

each of three phases. Preimplementation data collection 

activities will be conducted prior to user 

training. During-implementation data 

collection will begin when staff are 

instructed to start using the health IT 

system. Post-implementation data 

collection will be conducted 

approximately 3 months after 

implementation at each study practice. 

The qualitative study components of 

this project, namely staff observations, 

semi-structured interviews, and focus 

groups, will generate qualitative data in 

the form of observation notes and 

interview transcripts. The time-andmotion study and the electronic clinical 

data will produce quantitative 

information in the form of sequences of 

clinical activities and information about 

the duration, location, and performer of 

each action. Mapping will create 

annotated floor plans delineating the 

physical layout of each study clinic, 

which will be incorporated in the 

collection and analysis of the data of the 

other study components. 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated annual 

burden hours for participation in this 

study. The semi-structured interview 

will be completed by 60 respondents 

across the 6 clinics (10 per practice) and 

requires one hour. Sixty (60) clinic staff 

members will be asked to participate in 

the focus group across all 6 clinics (10 

per practice). The focus group requires 

no more than 45 minutes. The total 

annual burden is estimated to be 105 

hours. 

Exhibit 2 shows the estimated annual 

cost burden associated with the 

respondents’ time to participate in this 

research. The total annual burden is 

estimated to be $5,505. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Form name Number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Semi-Structured Interview ............................................................................... 60 1 1 60 

Focus Group .................................................................................................... 60 1 45/60 45 

Total .......................................................................................................... 120 na na 105 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Form name Number of 

respondents 

Total burden 

hours 

Average 

hourly wage 

rate* 

Total cost 

burden 

Semi-Structured Interview ............................................................................... 60 60 $55 $3,300 

Focus Group .................................................................................................... 60 45 49 2,205 

Total .......................................................................................................... 120 105 na 5,505

*Based upon the mean of the average wages, National Compensation Survey: wages in the United States July 2010, U.S. Department of 

Labor, Bureau of Labor Statistics, http://www.bls.gov/ncs/ocs/sp/nctb1477.pdf. For the semi-structured interviews, hourly wage is an average including 2 physicians or surgeons ($85.67), 1 registered nurse ($32.42), 2 non-physician providers (measured here as physician assistants, 

$43.44), and 1 senior administrator (measured here as ‘‘Medical and health services managers,’’ $42.28). For focus groups, 3.34 physicians or 

surgeons ($85.67), 1.66 non-physician providers (measured here as physician assistants, $43.44), 3.34 registered nurses ($32.42), and 1.66 

medical assistants ($14.46). 

Estimated Annual Costs to the Federal 

Government 

The total cost of this study is 

$799,014 over a 36-month time period 

from June 1, 2012 through May 31, 2015 

for an annualized cost of $266,338. 

(Because the project entails gathering 

data before, during, and after health IT 

implementation, a period of 21 months 

is planned for data collection.) Exhibit 

3 provides a breakdown of the estimated 

total and average annual costs by 

category. 

EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST

Cost component Total cost Annualized cost 

Project Development ............................................................................................................................... $135,759 $45,253 

Data Collection Activities ......................................................................................................................... 177,460 59,153 

Data Processing and Analysis ................................................................................................................. 239,426 79,809 

Publication of Results .............................................................................................................................. 51,779 17,260 

Project Management ................................................................................................................................ 67,729 22,576 

Overhead ................................................................................................................................................. 126,861 42,287 


sroberts on DSK5SPTVN1PROD with NOTICES
Federal Register / Vol. 78, No. 74 / Wednesday, April 17, 2013 / Notices 22883 

EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST—Continued 

Cost component Total cost Annualized cost 

Total .................................................................................................................................................. 799,014 266,338 

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: April 4, 2013. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2013–08833 Filed 4–16–13; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

AHRQ Standing Workgroup for Quality 

Indicator Measure Specification 

AGENCY: Agency for Healthcare Research 

and Quality (AHRQ), HHS. 

ACTION: Notice of request for 

nominations. 

SUMMARY: The Agency for Healthcare 

Research and Quality (AHRQ) is seeking 

nominations for both a time-limited 

workgroup and a standing workgroup to 

be convened by an AHRQ contractor. 

The workgroups shall be comprised of 

individuals with knowledge of the 

AHRQ Quality Indicators (QIs), their 

technical specifications, and associated 

methodological issues. The overarching 

goals of each group are to provide 

feedback to AHRQ regarding 

refinements to the QIs. The time-limited 

workgroup is more restricted to specific 

clinical or methodological issues, while 

the standing workgroup addresses 

broader issues related to the 

measurement cycle. 

Because AHRQ did not get a set of 

candidates with anticipated breadth of 

diversity of experience as required in 

response to our notice (https:// 

www.federalregister.gov/articles/2013/ 

01/28/2013-01348/ahrq-standingworkgroup-for-quality-indicatormeasure-specification) published on 

January 28, 2013, Volume 78, No. 18, 

page numbers: 5810 & 5811, AHRQ 

resubmits the same notice to give 

opportunity to those interested in this 

objective. 

DATES: Please submit nominations on or 

before May 3, 2013. Self-nominations 

are welcome. Third-party nominations 

must indicate that the individual has 

been contacted and is willing to serve 

on the workgroup. Selected candidates 

will be contacted by AHRQ no later than 

May 17, 2013. Please include the 

workgroup of interest. Candidates may 

apply for both workgroups. 

ADDRESSES: Nominations can be sent in 

the form of a letter or email, preferably 

as an electronic file with an email 

attachment, and should specifically 

address the submission criteria as noted 

below. Electronic submissions are 

strongly encouraged. Responses should 

be submitted to: Pamela Owens, Ph.D., 

Senior Research Scientist, Agency for 

Healthcare Research and Quality, Center 

for Delivery, Organization and Markets, 

540 Gaither Road, Rockville, MD 20850, 

Email: PAM.OWENS@AHRQ.hhs.gov, 

Phone: (301) 427–1412, Fax: (301) 427– 

1430. 

FOR FURTHER INFORMATION CONTACT: 

Please contact Pamela Owens, see her 

information above. 

Background 

The AHRQ Quality Indicators (AHRQ 

QIs) are a unique set of measures of 

health care quality that make use of 

readily available hospital inpatient 

administrative data. The QIs have been 

used for various purposes. Some of 

these include tracking, hospital selfassessment, reporting of hospitalspecific quality or pay for performance. 

The AHRQ QIs are provider- and arealevel quality indicators and currently 

consist of four modules: the Prevention 

Quality Indicators (PQIs), the Inpatient 

Quality Indicators (IQIs), the Patient 

Safety Indicators (PSIs), and the 

Pediatric Quality Indicators (PQIs). In 

response to feedback from the AHRQ QI 

user community and guidance from 

NQF, AHRQ is committed to the 

ongoing improvement and refinement of 

the QIs in an accurate and transparent 

manner. For additional information 

about the AHRQ QIs, please visit the 

AHRQ Web site at http:// 

www.qualityindicators.AHRQ.gov. 

SUPPLEMENTARY INFORMATION: These 

workgroups are being administered by 

AHRQ’s contractor as part of a 

structured approach to formally and 

broadly engage stakeholders, and to 

enhance and expand transparency about 

the scientific development of the AHRQ 

QIs. 

Time-Limited Workgroup 

Time-limited workgroups are 

formative in nature, providing feedback 

on significant measure improvement 

issues and representing a broad range of 

stakeholders. The focus for this 

upcoming year will be the Prevention 

Quality Indicators (PQI). The role of 

time-limited group members is to: (1) 

Provide technical guidance on the PQI 

specifications and rationales, risk 

adjustment strategies, and other quality 

measurement issues; (2) provide input 

on critical information gaps, as well as 

research methods to address them; (3) 

provide guidance on draft 

recommendations for the PQI measure 

refinements; (4) offer scientifically 

rigorous recommendations for the 

evaluation and validation efforts 

required to ensure the accuracy of the 

PQIs; and, (5) provide input on and 

review of the contractor’s technical 

report resulting from the workgroup’s 

discussions. 

The time-limited workgroup will 

consist of 8–12 members consisting of: 

• One or more statisticians 

specialized in the relevant statistical 

methods and applications 

• One or more individuals with 

expertise in population health, 

community health care and prevention, 

and access to and quality of care 

• One or more individuals with 

experience using AHRQ PQI measures 

for assessing health system performance 

and public reporting 


sroberts on DSK5SPTVN1PROD with NOTICES