Workflow Assessment for Health IT Toolkit Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #6 Attachment F - Post Workflow Toolkit Interview Guide REC	Form and Instruction	New	Available
Form Form #5 Attachment E - Post Workflow toolkit Interview Guide Practice	Form and Instruction	New	Available
Form Form #4 Workflow Assessment Usage Log	Form and Instruction	New	Available
Form Form #3 Workflow Toolkit Activities and Perspectives Observation Log	Form and Instruction	New	Available
Form Form #2 Attachment B - Pre-Workflow Toolkit Interview Guide REC	Form and Instruction	New	Available
Form Form #1 Attachment A - Pre-Workflow Toolkit Interview Guide Practice	Form and Instruction	New	Available
AHRQ Workflow Assessment for Health IT Toolkit Eval 2012_SummaryPartARevisions.docx	Supplementary Document	Uploaded 2012-10-04	Available
Supporting Statement B - Workflow Assessment for Health IT Toolkit Evaluation 3-16-2012.doc	Supporting Statement B	Uploaded 2012-05-23	Available
Attachment I - Response to Public Comments 041712.docx	Supplementary Document	Uploaded 2012-05-23	Available
Attachment H -- List of Subcontractor Practices.docx	Supplementary Document	Uploaded 2012-05-23	Available
Attachment G -- Federal Register Notice.pdf	Supplementary Document	Uploaded 2012-05-23	Available
Supporting Statement A - Workflow Assessment for Health IT Toolkit Evaluation 9-14-2012.doc	Supporting Statement A	Uploaded 2012-10-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202468	Post-Workflow Toolkit Interview	Form and Instruction	New	Attachment F - Post Workflow Toolkit Interview Guide REC
202468	Post-Workflow Toolkit Interview	Form and Instruction	New	Attachment E - Post Workflow toolkit Interview Guide Practice
202467	Usage Logs	Form and Instruction	New	Workflow Assessment Usage Log
202466	Observations	Form and Instruction	New	Workflow Toolkit Activities and Perspectives Observation Log
202465	Pre-Workflow Toolkit Interview	Form and Instruction	New	Attachment B - Pre-Workflow Toolkit Interview Guide REC
202465	Pre-Workflow Toolkit Interview	Form and Instruction	New	Attachment A - Pre-Workflow Toolkit Interview Guide Practice
202464	Creation of Clinic Study Team	Instruction	New

ICR Details

OMB Control No: 0935-0201	ICR Reference No: 201205-0935-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Workflow Assessment for Health IT Toolkit Evaluation
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: 10/12/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/24/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2015	36 Months From Approved
Responses	4,380	0	0
Time Burden (Hours)	3,114	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The evaluation will consist of field assessments of use of the Workflow toolkit in 18 small- and medium-sized practices and gathering feedback from two Health IT Regional Extension Centers (RECs) who are providing support to some of these practices. The evaluation will address the issues of system validation as classically defined in software engineering: determining whether the software or system actually meets the requirements of the user to perform the relevant tasks. The evaluation will answer the following questions: oAre results correct? Are individual tools included in the Workflow toolkit accurate? Does workflow assessment with the Workflow toolkit provide accurate information the practice can act upon? oDoes knowledge change? Does user knowledge and capacity change? Does user knowledge of workflow in their own practice change? oDo decisions change? Do user decisions about workflow assessment change? Do user decisions about health information technology (health IT) implementation change? oDo outcomes change? Are changes in workflow favorable? Are changes in clinical practices favorable? Are changes to the practice favorable? Are changes for patients favorable?

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

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 14370	03/09/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 30011	05/21/2012
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Creation of Clinic Study Team
Observations	Form #3	Workflow Toolkit Activities and Perspectives Observation Log
Post-Workflow Toolkit Interview	Form #6, Form #5	Attachment E - Post Workflow toolkit Interview Guide Practice ,   Attachment F - Post Workflow Toolkit Interview Guide REC
Pre-Workflow Toolkit Interview	Form #1, Form #2	Attachment A - Pre-Workflow Toolkit Interview Guide Practice ,   Attachment B - Pre-Workflow Toolkit Interview Guide REC
Usage Logs	Form #4	Workflow Assessment Usage Log

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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	4,380	0	0	4,380	0	0
Annual Time Burden (Hours)	3,114	0	0	3,114	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 request.

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Annual Cost to Federal Government: $352,646

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 05/24/2012

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