Federal Register: April 24, 2009 (Volume 74, Number 78)
DOCID: fr24ap09-65 FR Doc E9-9247
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
NOTICE: NOTICES
DOCID: fr24ap09-65
DOCUMENT ACTION: Notice.
SUBJECT CATEGORY:
Agency Information Collection Activities: Proposed Collection; Comment Request
DATES: Comments on this notice must be received by June 23, 2009.
DOCUMENT 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 EPrescribing.'' In
accordance with the Paperwork Reduction Act of 1995, Public Law 10413 (44 U.S.C. 3506(c)(2)(A)), AHRQ invites the public
[[Page 18723]]
to comment on this proposed information collection.
SUMMARY:
Agency Information Collection Activities; Proposals, Submissions, and Approvals
SUPPLEMENTAL INFORMATION
Proposed Project
``Building an Implementation Toolset for EPrescribing''
AHRQ proposes to develop and test an electronic prescribing (e prescribing) toolset to provide information and tools of sufficient detail to act as a ``howto guide'' for implementing eprescribing 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 108173, 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 e prescribing, but those who do electronically transmit prescription and certain other prescriptionrelated 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 eprescribing technology remains limited. On the surface, eprescribing involves getting a prescription from point A to point B. In reality, the complexity of eprescribing 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 e prescribing 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 eprescribing systems and use them effectively in ways that advance the
organization's goals. By enabling the greater adoption of eprescribing
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
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 eprescribing for the first time. Field researchers will visit each practice before and after the eprescribing implementation effort to conduct semistructured interviews and observations of work processes. Finally, selected members of the practices will be surveyed via a webbased 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. Pretest 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 1Estimated Annualized Burden Hours
Number of
Form name Number of responses per Hours per Total burden
sites site response hours Pretest Interviews:
Physician interviews........................ 6 3 1 18
Nurse or clinical support interviews........ 6 3 1 18
Other staff interviews...................... 6 3 1 18 Posttest interviews:
Physician interviews........................ 6 3 1 18
Nurse or clinical support interviews........ 6 3 1 18 [[Page 18724]]
Other staff interviews...................... 6 3 1 18 Webbased 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 2Estimated Annualized Cost Burden
Number of Total burden Average hourly Total cost
Form name sites hours wage rate * burden Pretest 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 Posttest 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 Webbased 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 3Estimated Total and Annual Cost
Annualized
Cost component Total cost 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 abovecited 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. E99247 Filed 42309; 8:45 am]
BILLING CODE 416090M
FOR FURTHER INFORMATION CONTACT
Doris Lefkowitz, AHRQ Reports Clearance Officer, (301) 4271477, or by email at
doris.lefkowitz@ahrg.hhs.gov.