Supporting Statement A_NLM Generic ICR_06-01-2009

Supporting Statement A for

Request for Generic Clearance to Conduct Voluntary Customer/Partner Surveys (NLM)

June 1, 2009

Name: David Sharlip

Address: National Library of Medicine

8600 Rockville Pike

Bldg. 38A, Rm. B2N12

Bethesda, MD 20894-3844

Telephone: 301-402-9680

Fax: 301-402-0871

Email: [email protected]

Generic Clearance to Conduct Voluntary Customer/Partner Surveys (NLM)

Table of contents

A. JUSTIFICATION 3

A.1 Circumstances Making the Collection of Information Necessary 3

A.2. Purpose and Use of the Information collection 4

A.3 Use of Information Technology and Burden Reduction 6

A.4 Efforts to Identify Duplication and Use of Similar Information 7

A.5 Impact on Small Businesses or Other Small Entities 7

A.6 Consequences of Collecting the Information Less Frequently 7

A.7 Special Circumstances Relating to the Guidelines of 5 CFR 1320.5 7

A.8 Comments in Response to the Federal Register Notice and Efforts to Consult Outside Agency 7

A.9 Explanation of Any Payment of Gift to Respondents 8

A.10 Assurance of Confidentiality Provided to Respondents 8

A.11 Justification for Sensitive Questions 8

A.12 Estimates of Hour Burden Including Annualized Hourly Costs 8

A.13 Estimate of Other Total Annual Cost Burden to Respondents or Record

keepers 9

A.14 Annualized Cost to the Federal Government 9

A.15 Explanation for Program Changes or Adjustments 9

A.16 Plans for Tabulation and Publication and Project Time Schedule 10

A.17 Reason(s) Display of OMB Expiration Date is Inappropriate 10

A.18 Exceptions to Certification for Paperwork Reduction Act Submissions 10

List of Attachments:

Attachment 1 - Example of previously approved NLM Customer/Partner Surveys Request

Attachment 2 - Example of previously approved NLM Survey Instrument

Attachment 3 - Proposed NLM Customer/Partner Surveys

Generic Clearance to Conduct Voluntary Customer/Partner Surveys (NLM)

A. JUSTIFICATION

A.1 Circumstances Making the Collection of Information Necessary

This is a request that the Office of Management and Budget (OMB) approve, under the Paperwork Reduction Act, an extension of generic clearance OMB 0925-0476 for the National Library of Medicine (NLM) to conduct a number of customer satisfaction surveys to implement Executive Order 12862.  This order directs federal agencies that provide significant services directly to the public to survey customers to determine the kind and quality of services they want and their level of satisfaction with existing services.  The order also requires future surveys to continually assess the level of customer satisfaction.  The current OMB authorization to conduct surveys approved under this generic clearance will expire on July 31, 2009.   

In addition to the Executive Order, the NLM is legislatively mandated by 42 USC 286 to assist the advancement of medical and related sciences and to aid the dissemination and exchange of scientific and other information important to the progress of medicine and to the public health. This mandate specifically directs the NLM to promote the use of computers and telecommunications by health professionals (including health professionals in rural areas) for the purpose of improving access to biomedical information for health care delivery and medical research.

In 1994, the NLM was designated a "Federal Reinvention Laboratory" with a major objective of improving its methods of delivering information to the public.  At a minimum, necessary elements in improving the delivery of information include; (1) development of easy-to-use access and delivery mechanisms that promote the public's understanding of health information, drawing on research in lay terminology, graphical and multimedia presentations;   (2) assisting those providing health information to the public to make effective use of electronic services through Internet connections, training, and other means, with an emphasis on those serving minority groups, low income populations, and seniors;  (3) promoting integrations of NLM services with other electronic services covering regional, state, or local health information; and  (4) conducting and supporting research, development, and evaluation of the public's health information needs, information seeking behavior and learning styles, information systems that meet the public's needs, and the impact of access to information.

NLM has become an international leader in health informatics research and development, especially in consumer health informatics. As a result, NLM needs to remain contemporary in consumer health informatics research by utilizing research methods that yield a better understanding of the predictors of consumer satisfaction. Without ongoing insights into the predictors of consumer satisfaction, NLM will lack the research findings to make evidence-based changes in the content, design and editorial management of its consumer Web sites and will not optimally serve the public.

One of the most effective means of determining if NLM is providing satisfactory services to its customers or partners is through periodic voluntary satisfaction surveys that can be activated quickly.  Getting customer/partner input has and will continue to facilitate resource allocation.  

The requested extension of this information collection was published in the Federal Register on March 30, 2009 (Vol. 74, No. 59, p. 14137) and allowed 60 days for public comment. One public comment was received which was non-substantive.

A.2 Purpose and Use of the Information Collection

NLM will collect and use information gathered through these surveys to identify strengths and weaknesses in current service provisions and to make improvements that are practical and feasible.  Information from the customer and/or partner surveys will be used to plan and direct resources and efforts to improve or maintain NLM's high quality of service to affected public.  To assess the needs of rurally situated health care providers, NLM needs to conduct periodic surveys to ensure that these providers have the ability to access the wealth of information in the Library's many databases and programs.  If this information is not collected, vital feedback, regarding customer and/or partner satisfaction with various aspects of NLM's services will be unavailable.

Without ongoing insights into the predictors of consumer satisfaction, NLM will lack the research findings to make evidence-based changes in the content, design and editorial management of its consumer Web sites and cannot optimally serve the public. Some of the predictors of consumer satisfaction identified within the current literature include content quality, usability and design; consumer health information seeking habits on the Internet; prior online experience and health knowledge; as well as demographic information. In recent years, the literature has emphasized that assessments of broad consumer attitudes about health, wellness and motivational inclinations are as important to predict consumer satisfaction of consumer informatics websites as more traditional demographic variables such as gender, education level, age and geographic location.

To explore consumer attitudes as predictors of consumer satisfaction, NLM may employ some social science methods that are widely advocated within the health communication, mass communication and consumer health informatics research literature. These methods may include occasionally asking respondents to sort through opinion statements with which they agree or disagree and then, specify what opinion statements they agree or disagree with the most. NLM will use a second level discrimination in surveys where the selected sample is derived from experienced computer users.  The discrimination approach to measure attitudes is most simplified by web-based software, therefore NLM will use this approach for online or computer work station-based consumer satisfaction surveys. The use of this approach provides better insights into the attitudes that predict consumer satisfaction of health information Web sites, which keeps NLM at the forefront of consumer health informatics research and development.

One example of how NLM staff used feedback from customers and partners to improve online services involved an online survey of ClinicalTrials.gov users conducted between October 20 and November 13, 2006. A link to the survey was posted on the homepage and other key locations so that visitors could click on it if they wanted to participate. Analysis of 1,234 completed surveys provided a preliminary view of key stakeholders and their needs.

Overall, the survey provided a useful snapshot on who was using ClinicalTrials.gov, how often, why, and for what reason. As a result, the ClinicalTrials.gov user interface was updated in 2007, based in part on these findings, to address user needs more effectively. Further, these survey results were used to plan a usability and accessibility study of ClinicalTrials.gov, which was funded through an NIH Evaluation Express Award and completed in early 2008.

An example of an approved generic survey conducted under the current clearance is provided (see Attachment 1) as well as a sample survey instrument (see Attachment 2). 

NLM has identified the potential customer and partner satisfaction surveys (see Attachment 3) for which it is requesting OMB approval to conduct under the extension of this generic clearance. According to OMB guidelines for generic clearances for voluntary customer/partner satisfaction surveys, the NLM will establish an independent review process to assure the development and implementation of high quality customer/partner surveys within the NLM.  It is understood that if OMB approves this request for extension of generic clearance, individual survey instruments must be submitted to OMB prior to actual use.

Following is a synopsis of some of the current and proposed information collections NLM will conduct once OMB approval is granted authorizing the next 3-year clearance extension.

Public Health Record (PHR) Survey

NLM will deploy to production a Personal Health Record (PHR) application in spring 2009. The NLM PHR is intended for users of varying ages and education levels who need a way to keep important information about their health records or those of their loved ones in one place readily accessible to them. This will include information such as medical history, allergies, vaccinations, major surgeries, current medications, and health care appointments. One of our most effective means of determining whether we are providing satisfactory services to our users is the ability to survey them to determine demographics, satisfaction levels, feedback on problem areas, and suggestions for improvements. Users will be asked at random to respond to a brief set of questions. Each survey will be designed so the individual responses will take no more than 5-6 minutes.

NLM Gateway Survey

The NLM Gateway is used by scores of thousands of people doing more than 150,000 searches each month. We have had excellent results from recent surveys that helped guide a user-focused redesign of important areas of the system. We now propose further voluntary user surveys at about the rate of one per year, to help us understand any shifts in demographics or changes in user needs and wishes. Each survey would ask 250 users a small number of questions, with a response burden of 5-6 minutes per user who agreed to respond to the survey.

RxTerms Survey

RxTerms is a new drug interface terminology that has been made available for public download and testing. Its purpose is to provide a free and efficient terminology for the input of medication information. Users who want to download RxTerms are requested to provide a contact email address. The registered users will be contacted by email to take part in a survey to see how they are using RxTerms, to gather comments on its usability and other suggestions for improvement. The survey is voluntary and does not affect their right to use RxTerms. The survey will not take more than 12 minutes to complete. The results will help us improve RxTerms.

SureScripts-RxHub Survey

NLM is funded by the Bethesda Hospitals Emergency Preparedness Partnership (BHEPP) to perform a study on the usefulness of an on-line prescription history retrieval service provided by SureScripts-RxHub in the care of patients, particularly in the situation of a disaster or emergency. NLM will assist Suburban Hospital (one of the BHEPP Hospitals) to establish connection with SureScripts-RxHub. The data from SureScripts-RxHub will be compared to the manually obtained home medication list for every patient attending the Emergency Department to see if they are complete and accurate. Another component of the study is the usability of the SureScripts-RxHub data service. We will carry out interviews with ED nurses at Suburban Hospital to see if they find the SureScripts-RxHub information helpful and timesaving in their process of medication history taking. This interview is voluntary. The response burden will not be over 30 minutes.

A.3 Use of Improved Information Technology and Burden Reduction

As appropriate, automated information technology will be used to collect and process information for these surveys to reduce the burden on the public.  For example, the use of secondary discrimination techniques to better assess consumer attitudes is dependent on the use of information technology to reduce the burden on the respondent and as aforementioned, often shortens the length of survey instruments.

The majority of the surveys will be conducted over the Internet or by electronic mail.  A few will more appropriately, involve written or oral responses to brief questionnaires.

A.4 Efforts to Identify Duplication and Use of Similar Information

NLM information collection surveys conducted after the approval of previous generic clearance under OMB 0925-0476 were designed to address specific programs and databases and to obtain feedback for desired improvements to present systems and programs.  There is a need for continual input from customers and partners and as NLM has incorporated suggestions from earlier surveys into procedures, it is necessary to ask if the improvements are efficacious.  The extension of this generic clearance will enable NLM to determine if there have been improvements in service that resulted from the previous feedback customers provided.

A.5 Impact on Small Businesses or Other Small Entities

Small businesses or other small entities may be involved in these efforts, but NLM will keep the burden on them to a minimum with short, user-friendly surveys that will be strictly voluntary.  Therefore, there will not be a significant impact on small businesses.

A.6 Consequences of Collecting the Information Less Frequently

NLM will conduct surveys only at intervals considered appropriate to measure the impact of changes because of initial satisfaction surveys and to monitor the level of performance. In most cases, the NLM likely will conduct satisfaction surveys annually or biennially after the establishment of a baseline. Collection on a less frequent basis than annually or biennially might reduce the practical utility of the information and inhibit the NLM's ability to monitor changes.

 
A.7 Special Circumstances Relating to the Guidelines of 5 CFR 1320.5

These surveys will be implemented in a manner that fully complies with 5 CFR 1320.5.

 
A.8 Comments in Response to the Federal Register Notice and Efforts to Consult Outside the Agency

NLM programs will use routine contacts with customers and partners and other qualitative information collection activities to identify areas of interest and concern to customers.  NLM will utilize in-house staff with expertise in statistics and the staff of contractors in developing survey plans.  As needed, NLM may also utilize the statistical resources of the National Center for Health Statistics, which has a questionnaire design laboratory.  Additional support may be sought from outside experts to help in design and implementation of the surveys.

The requested extension of this information collection was published in the Federal Register on March 30, 2009 (Vol. 74, No. 59, p. 14137) and allowed 60 days for public comment. One public comment was received which was non-substantive.

A.9 Explanation of Any Payment or Gift to Respondents

No payment or gift will be provided to survey respondents.

A.10 Assurance of Confidentiality Provided to Respondents

Individual respondents will not be identified and participation will be strictly voluntary. Respondents will be assured that neither their participation/non-participation nor any responses to items will have any effect on their eligibility for or receipt of services.

A.11 Justification for Sensitive Questions

No questions will be asked of a personal or sensitive nature.

 
A.12 Estimates of Hour Burden Including Annualized Hourly Costs

The total estimated burden hours imposed by the proposed collections is provided in Table A. 12-1 below. NLM projects up to 30 customer surveys will be conducted over the duration of the 3-year clearance period with a sample size ranging between 10 and 2,800 customers and a total of 27,910 respondents.   

A.12-1 Estimates of Hour Burden
Types of Respondents	Number  of Respondents	Frequency of  Response	Average time per response	Annual Hour Burden
Researchers, Physicians, Other Health Care Providers, Librarians, Students, General Public	27,910	1	.129	3,600

The chart provided in Attachment 3 lists the proposed individual surveys and estimated burden hours for the duration of the requested 3-year clearance extension.

The proposed surveys will be completed by a range of members of the public, including researchers, physicians, librarians, other health care providers, students, and the general public.

Cost has been estimated using the U.S. Department of Labor (DOL) Bureau of Labor Statistics occupational employment statistics http://www.bls.gov/oes/data.htm

The total estimated cost to respondents is $69,399 over a 3-year period. Table A.12-2 below provides the estimated annualized cost to respondents.

A-12-2 Annualized Cost to Respondents
Type of Respondents	Number of Respondents	Frequency  of Response	Hourly Wage Rate	Respondent Cost
Researchers, Physicians, Other Health Care Providers, Librarians, Students, General Public *	9,303	1	$19.24	$23,133

* Not all respondents have an associated cost

A.13 Estimates of Other Total Annual Cost Burden to Respondents and Record Keepers

There is no other annual cost burden to report for respondents or record keepers for this collection.

There are no capital and startup costs/operation and maintenance costs associated with these surveys.

 

A.14 Annualized Cost to the Federal Government

The approximate annualized cost to the government for this data collection effort is $36,000.   An average of six (6) surveys are projected to be conducted per year with the total costs estimated to be $6,000 for administrative and technical support in processing individual survey instruments through clearance. 

 
A.15 Explanation for Program Changes or Adjustments

This is a request for an extension of NLM’s current generic clearance authorization.

An additional 920 burden hours are being requested to accommodate the proposed surveys to be conducted during the next 3-year period.

 
A.16 Plans for Tabulation and Publication and Project Time Schedule

NLM tabulates results immediately after completion of future surveys and strives to publish selected findings in pertinent refereed journals and other edited publications within a timely fashion in order to contribute to the literature in consumer health informatics.

 
A.17 Reason(s) Display of OMB Expiration Date is Inappropriate

We are not requesting an exemption to the display of the OMB Expiration date.

 
A.18 Exceptions to Certification for Paperwork Reduction Act Submissions

This collection of information involves no exceptions to the Certification for Paperwork Reduction Act Submissions

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