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
31284 Federal Register / Vol. 74, No. 124 / Tuesday, June 30, 2009 / Notices 

• How are physicians using thirdparty information in making prescribing 

decisions, including patient medication 

history, generic drug information, and 

patient-specific formulary data? 

• How are physician practices and 

retail and mail-order pharmacies using 

e-prescribing systems to communicate 

electronically with each other? 

• What are the most common reasons 

that physician practices and pharmacies 

communicate about prescriptions 

generated by physician e-prescribing 

systems (regardless of how they were 

sent)? 

• What are the facilitators of and 

challenges to implementing eprescribing features that support 

physician access to third-party 

information in making prescribing 

decisions and features that support 

electronic communication between 

physician practices and pharmacies? 

• What are the perceived effects of 

having access to e-prescribing features 

that support physician access to thirdparty information in making prescribing 

decisions and features that support 

electronic communication between 

physician practices and pharmacies on 

physician practice and pharmacy 

operations, physician prescribing 

behavior and patient outcomes? 

• What are the implications for policy 

efforts to promote e-prescribing? 

Estimated Annual Respondent Burden 

Interviews will be conducted at a total 

of 110 organizations over the two years 

of this project. Within each of the 24 

participating physician practices (12 

annually), two interviews will be 

conducted: one with the medical 

director or physician-user best able to 

describe practice processes for eprescribing, who will provide a clinical 

perspective (Interview Protocol 2), and 

a second with an IT administrator or 

office manager, who can provide a 

technical and operational perspective 

(Interview Protocol 1). The other 86 

organizations will each have only one 

interview, for a total of 43 additional 

interviews annually. Eight different 

organization-specific interview 

protocols have been developed, with 

response times ranging from 30 minutes 

to 1 hour. 

Exhibit 1 shows the estimated annual 

burden hours for each organization’s 

time to participate in this research. The 

total annual burden is estimated to be 

57 hours. 

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 $3,004. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Form name Number of 

organizations* 

Number of 

responses per 

organization 

Hours per 

response 

Total burden 

hours 

Interview Protocol 1—Physician Practice IT Administrator or Office Manager ................................................................................ 12 1 30/60 6 

Interview Protocol 2—Physician Practice Medical Director or Physician User ................................................................................... 12 1 45/60 9 

Interview Protocol 3—Pharmacy Pharmacist-In-Charge ................. 28 1 1 28 

Interview Protocol 4—State Pharmacy Association Representative 6 1 1 6 

Interview Protocol 5—Pharmacy IT Vendor Representative ........... 1 1 1 1 

Interview Protocol 6—E-prescribing System Vendor Representative ................................................................................................ 3 1 1 3 

Interview Protocol 7—E-prescribing Connectivity and Content 

Vendor Representatives ............................................................... 3 1 1 3 

Interview Protocol 8—Other E-prescribing Experts ......................... 2 1 30/60 1 

Total .......................................................................................... 67 NA NA 57 

The estimated total number of unique organizations participating in each year of the study is 55 since Interview Protocols 1 and 2 will both be 

administered to respondents in physician practices. 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Form name Number of 

organizations* 

Total burden 

hours 

Average hourly 

wage rate** Total cost burden 

Interview Protocol 1—Physician Practice IT Administrator or Office Manager .............................................................................. 12 6 32 .62 $196 

Interview Protocol 2—Physician Practice Medical Director or 

Physician User ........................................................................... 12 9 80 .42 724 

Interview Protocol 3—Pharmacy Pharmacist-In-Charge ............... 28 28 48 .09 1,347 

Interview Protocol 4—State Pharmacy Association Representative .............................................................................................. 6 6 49 .89 299 

Interview Protocol 5—Pharmacy IT Vendor Representative ......... 1 1 54 .75 55 

Interview Protocol 6—E-prescribing System Vendor Representative .............................................................................................. 3 3 54 .75 164 

Interview Protocol 7—E-prescribing Connectivity and Content 

Vendor Representatives ............................................................. 3 3 54 .75 164 

Interview Protocol 8—Other E-prescribing Experts ....................... 2 1 54 .75 55 

Total ........................................................................................ 67 57 NA 3,004 

* The estimated total number of unique organizations participating in each year of the study is 55 since Interview Protocols 1 and 2 will both be 

administered to respondents in physician practices. 

** Wage rates were calculated using the mean hourly wage from the U.S. Department of Labor, Bureau of Labor Statistics, May 2007 National 

Occupational Employment and Wage Estimates for the United States, Occupational Employment Statistics (OES), Washington, DC (Feb. 2009), 

http://www.bls.gov/oes/2007/may/oes_nat.htm (accessed April 2009). Wage rate for Interview Protocol 3—Pharmacy Pharmacist-In-Charge reflects the weighted average for retail and mail order pharmacists ($47.58 per hour) and pharmacy chain representatives ($54.75 per hour). 


sroberts on PROD1PC70 with NOTICES6
Federal Register / Vol. 74, No. 124 / Tuesday, June 30, 2009 / Notices 31285 

Estimated Annual Costs to the Federal 

Government 

The estimated total cost to the Federal 

Government for this project is $374,635 

over a two-year period from February 2, 

2009 to February 1, 2010. The estimated 

average annual cost is $187,318. Exhibit 

3 provides a breakdown of the estimated 

total and average annual costs by 

category. 

EXHIBIT 3—ESTIMATED TOTAL AND ANNUAL COST* TO THE FEDERAL GOVERNMENT

Cost component Total cost Annualized cost 

Project Development and Project Management .............................................................................................. $87,783 $43,892 

Data Collection Activities ................................................................................................................................. 141,048 70,524 

Data Analysis ................................................................................................................................................... 55,884 27,942 

Publication and Dissemination of Results ....................................................................................................... 89,920 44,960 

Total .......................................................................................................................................................... 374,635 187,318 

* Costs are fully loaded including overhead and 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, quality 

improvement and 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: June 22, 2009. 

Carolyn M. Clancy, 

Director. 

[FR Doc. E9–15089 Filed 6–29–09; 8:45 am] 

BILLING CODE 4160–90–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

National Institutes of Health 

Breast Cancer and Environmental 

Research Act of 2008; Delegation of 

Authority 

Notice is hereby given that I have 

delegated to the Director, National 

Institutes of Health (NIH), the 

authorities under Section 2 of the Breast 

Cancer and Environmental Research Act 

of 2008, Public Law 110–354, as 

amended, which amends Subpart 1 of 

Part C of Title IV of the Public Health 

Service Act by adding Section 417F, 

authorizing the establishment of the 

Interagency Breast Cancer and 

Environmental Research Coordinating 

Committee. I am also delegating the 

authority under Section 417F of the 

Public Health Service Act, as amended, 

to select both voting and nonvoting 

members of the Committee and to 

review the necessity of the Committee 

in the year 2011 and, thereafter, at least 

once every two years. 

This delegation shall be exercised in 

accordance with the Department’s 

applicable policies, procedures, 

guidelines, and regulations. 

In addition, I ratified and affirmed 

any actions taken by the NIH Director or 

his subordinates which involved the 

exercise of the authorities delegated 

herein prior to the effective date of this 

delegation. 

This delegation is effective upon date 

of signature. 

Dated: June 23, 2009. 

Kathleen Sebelius, 

Secretary. 

[FR Doc. E9–15439 Filed 6–29–09; 8:45 am] 

BILLING CODE 4140–01–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Meeting of the National Advisory 

Council for Healthcare Research and 

Quality Subcommittee on Quality 

Measures for Children’s Healthcare in 

Medicaid and Children’s Health 

Insurance Programs (CHIP) 

AGENCY: Agency for Healthcare Research 

and Quality (AHRQ), Department of 

Health and Human Services. 

ACTION: Notice of public meeting. 

SUMMARY: In accordance with section 

10(a) of the Federal Advisory Committee 

Act, 5 U.S.C. App. 2, this notice 

announces a meeting of the National 

Advisory Council for Healthcare 

Research and Quality Subcommittee on 

Quality Measures for Children’s 

Healthcare in Medicaid and Children’s 

Health Insurance Programs (CHIP). 

DATES: The meeting will be held on 

Wednesday, July 22, 2009, from 10 a.m. 

to 5 p.m. and Thursday, July 23, 2009 

from 9 a.m. to 5 p.m. 

ADDRESSES: Holiday Inn Capitol, 550 C 

Street, SW., Washington, DC 20024. 

FOR FURTHER INFORMATION CONTACT: 

Padmini Jagadish, Public Health Analyst 

at the Agency for Healthcare Research 

and Quality, 540 Gaither Road, 

Rockville, Maryland 20850, (301) 427– 

1927. For press-related information, 

please contact Karen Migdail at (301) 

427–1855. 

If sign language interpretation or other 

reasonable accommodation for a 

disability is needed, please contact Mr. 

Michael Chew, Director, Office of Equal 

Employment Opportunity Program, 

Program Support Center, on (301) 443– 

1144, no later than July 3, 2009. 

SUPPLEMENTARY INFORMATION: 

I. Purpose 

The National Advisory Council for 

Healthcare Research and Quality was 

established in accordance with section 

921 (now section 931) of the Public 

Health Service Act, 42 U.S.C. 299c. In 

accordance with its statutory mandate, 

the Council is to advise the Secretary of 

the Department of Health and Human 

Services and the Director, Agency for 

Healthcare Research and Quality 

(AHRQ), on matters related to actions of 

AHRQ to enhance the quality, and 

improve the outcomes of health care 

services; improve access to such 

services through scientific research; and 

promote improvements in clinical 

practice and in the organization, 


sroberts on PROD1PC70 with NOTICES6