Feasibility of secure messaging for pediatric patients with chronic disease: Pilot implementation in pediatric respiratory medicine

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #7 Post-intervention Provider Log	Form and Instruction	New	Available
Form Form #6 Pre-intervention Provider Log	Form and Instruction	New	Available
Form Form #4 Qualitative Interview	Form and Instruction	New	Available
Form Form #3 Qualitative Interview	Form and Instruction	New	Available
Form Form #1 Patient Demographic Survey	Form and Instruction	New	Available
ATTACHMENT C -- rev.Forms.doc	Supplementary Document	Uploaded 2008-07-23	Available
Supporting Statement Part B 2-26-2008.doc	Supporting Statement B	Uploaded 2008-07-23	Available
ATTACHMENT C -- Forms.doc	Supplementary Document	Uploaded 2008-04-23	Available
Attachment B -- 30 Day FR Notice.pdf	Supplementary Document	Uploaded 2008-04-23	Available
Attachment A -- Healthcare Research and Quality Act of 1999.pdf	Supplementary Document	Uploaded 2008-04-23	Available
Supporting Statement Part A 7-22-2008.doc	Supporting Statement A	Uploaded 2008-07-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
184808	Post-intervention Provider Log	Form and Instruction	New	Post-intervention Provider Log
184807	Pre-intervention Provider Log	Form and Instruction	New	Pre-intervention Provider Log
184806	Provider Qualitative Interviews	Form and Instruction	New	Qualitative Interview
184805	Provider E-messaging	Other-Description	New
184804	Patient Qualitative Interview	Form and Instruction	New	Qualitative Interview
184803	Patient E-messaging	Other-Description	New
184802	Patient Demographic Survey	Form and Instruction	New	Patient Demographic Survey

ICR Details

OMB Control No: 0935-0141	ICR Reference No: 200805-0935-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Feasibility of secure messaging for pediatric patients with chronic disease: Pilot implementation in pediatric respiratory medicine
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/23/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/06/2008
Terms of Clearance: OMB approves this package with the agency’s concurrence that this work is a developmental and hypothesis generating study rather than one designed to test hypothesis about the value of such a program. The study design will not allow for drawing conclusions about population subgroups (e.g., those defined by age, gender, disease, and socioeconomic status).

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2010	24 Months From Approved
Responses	7,804	0	0
Time Burden (Hours)	1,895	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: AHRQ proposes to evaluate how the implementation of a secure email messaging (e-messaging) system between clinicians and adolescent patients affects: (1) time spent by providers communicating with patients, (2) Emergency Department utilization for medication refills, and (3) qualitative satisfaction with care of the patients. The study will be conducted in the Yale University School of Medicine Pediatric Respiratory Medicine Clinic.

---

Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 8872	02/15/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 21954	04/23/2008
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
Patient Demographic Survey	Form #1	Patient Demographic Survey
Patient E-messaging
Patient Qualitative Interview	Form #3	Qualitative Interview
Post-intervention Provider Log	Form #7	Post-intervention Provider Log
Pre-intervention Provider Log	Form #6	Pre-intervention Provider Log
Provider E-messaging
Provider Qualitative Interviews	Form #4	Qualitative Interview

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	7,804	0	0	7,804	0	0
Annual Time Burden (Hours)	1,895	0	0	1,895	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection.

---

Annual Cost to Federal Government: $199,985

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/06/2008

---