Federal Register / Vol. 74, No. 124 / Tuesday, June 30, 2009 / Notices 31281 

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 

to comment on this proposed 

information collection. 

This proposed information collection 

was previously published in the Federal 

Register on April 24th, 2009 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 July 30, 2009. 

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 

e-mail at doris.lefkowitz@ahrq.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 

respondent’s 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. 

The pre-test and post-test observations 

will involve no more than 1 physician, 

1 nurse or clinical support staff and 2 

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 annual burden is estimated to be 

186 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 $8,297. 


sroberts on PROD1PC70 with NOTICES6
31282 Federal Register / Vol. 74, No. 124 / Tuesday, June 30, 2009 / Notices 

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 and On-Site Observations 

Pre-test interview guide ................................................................................... 6 9 1 54 

Pre-test on-site observation guide ................................................................... 6 4 15/60 6 

Post-Test Interviews and On-Site Observations 

Post-test interview guide ................................................................................. 6 9 1 54 

Post-test on-site observation guide ................................................................. 6 4 30/60 12 

Web-Based Survey 

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

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

Total .......................................................................................................... 36 na na 186 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Form name Number of 

sites 

Total burden 

hours 

Average hourly wage rate*

Total cost 

burden 

Pre-Test Interviews and On-Site Observations 

Pre-test interview guide ................................................................................... 6 54 $41.79 $2,257 

Pre-test on-site observation guide ................................................................... 6 6 41.79 251 

Post-Test Interviews 

Post-test interview guide ................................................................................. 6 54 41.79 2,257 

Post-test on-site observation guide ................................................................. 6 12 41.79 501 

Web-Based Survey 

Physician questionnaire ................................................................................... 6 24 79.33 1,904 

Other staff questionnaire ................................................................................. 6 36 31.31 1,127 

Total .......................................................................................................... 36 186 na 8,297 

*Based upon the national average hourly wages for physicians and surgeons, all others (29–1069; $79.33), registered nurses (29–1111; 

$31.31), and health care support workers, all others (31–9099; $14.74), National Compensation Survey: Occupational wages in the United States 

May 2008, U.S. Department of Labor, Bureau of Labor Statistics. 

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 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 


sroberts on PROD1PC70 with NOTICES6
Federal Register / Vol. 74, No. 124 / Tuesday, June 30, 2009 / Notices 31283 

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: June 22, 2009. 

Carolyn M. Clancy, 

Director. 

[FR Doc. E9–15086 Filed 6–29–09; 8:45 am] 

BILLING CODE 4160–90–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: ‘‘Health 

IT Community Tracking Study 2009.’’ In 

accordance with the Paperwork 

Reduction Act of 1995, 44 U.S.C. 

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

to comment on this proposed 

information collection. 

DATES: Comments on this notice must be 

received by August 31, 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@ahrq.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

Health IT Community Tracking Study 

2009 

Electronic prescribing (e-prescribing) 

is a central focus of efforts to promote 

health information technology (IT) and 

is of particular interest to AHRQ 

because of its potential to improve 

patient safety by reducing medication 

errors. Despite many public- and 

private-sector initiatives to support eprescribing, to date, physician adoption 

and use has been limited (Friedman, 

Schueth and Bell 2009). Recently, 

section 132 of the Medicare 

Improvements for Patients and 

Providers Act of 2008 (MIPPA), Public 

Law 110–275, authorized a new 

incentive program for eligible 

individual providers who are successful 

e-prescribers. In addition, section 4101 

of the American Recovery and 

Reinvestment Act of 2009 (ARRA), 

Public Law 111–5, provides incentives 

for meaningful use of electronic health 

record technology, which includes the 

use of e-prescribing. 

The potential gains from e-prescribing 

assume that prescribers and pharmacists 

have access to the required features and 

use them. Limited research on the topic 

suggests, however, that not all eprescribing systems currently have the 

full range of e-prescribing features 

required under MIPPA; that even when 

the features are available, physician 

practices face barriers to implementing 

them effectively; and even when they 

are implemented at the practice level, 

physicians may not use them. For 

example, in a small, exploratory 

qualitative study by Grossman, et al. 

(2005), physicians did not routinely 

have access to patient medication 

histories or formulary data for a 

significant portion of their patients and 

when they did, physicians often did not 

use the information, instead continuing 

to rely on patients for medication 

history and pharmacists to identify 

formulary issues. Several studies have 

identified that IT system limitations, 

workflow and training issues, and real 

or perceived regulatory barriers present 

obstacles in both the physician and 

pharmacy settings to electronic 

transmission of prescriptions (Grossman 

et al. 2007; NORC 2007; Rupp and 

Warholak 2008; Warholak and Rupp 

2009). 

AHRQ proposes to conduct a 

qualitative research study designed to 

help build knowledge on how the eprescribing features required under 

MIPPA are actually being implemented 

and used by physicians and pharmacies 

in 12 nationally representative 

communities. These communities have 

been studied longitudinally since the 

mid-1990s as part of the Center for 

Studying Health System Change (HSC) 

Community Tracking Study (CTS) 

(Center for Studying Health System 

Change 2007). This qualitative study 

will collect data from physician 

practices and pharmacies that are using 

electronic transmission of prescriptions 

to allow a focus on both the facilitators 

of and barriers to this critical aspect of 

e-prescribing. The study will be the first 

to ask questions of physician practices 

and pharmacies in the same 

communities on the same topics, 

providing a much more complete 

picture of e-prescribing implementation. 

For example, in addition to gaining 

physician and pharmacy perspectives 

on electronic transmission, the study 

will explore how physician practices 

use patient formulary data and how 

pharmacies perceive changes in the 

communication with physician 

practices around formulary issues with 

e-prescribing. 

Information collected by this study 

will inform strategies to promote the 

adoption and effective use of eprescribing being developed by AHRQ 

and other Department of Health and 

Human Services agencies, including the 

Centers for Medicare & Medicaid 

Services (CMS) and the Office of the 

National Coordinator for Health IT, as 

well as State and local governments and 

private health care organizations. In 

particular, while physician adoption has 

been the focus of most policy efforts, 

findings from the study can help 

identify and shape strategies to promote 

more effective implementation of eprescribing in retail and mail-order 

pharmacies. This work will be 

conducted by AHRQ’s contractor, the 

Center for Studying Health System 

Change (HSC), under contract number 

290–05–0007–03. This study is being 

conducted pursuant to AHRQ’s 

statutory authority to conduct and 

support research 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). 

Method of Collection 

The study will use qualitative 

methods, including telephone 

interviews with physician practices and 

pharmacies, as well as State pharmacy 

associations, IT vendors and other eprescribing experts. Using semistructured interview protocols, the 

following specific research questions 

will be addressed to provide an in-depth 

look at unexplored barriers to effective 

e-prescribing use in physician practices 

and pharmacies, including: 


sroberts on PROD1PC70 with NOTICES6