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EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN—Continued
Number of
respondents

Form name
Total ...................................................................................................

Total burden
hours

3,788

Average
hourly wage
rate a

1,446

na

Total cost
burden
$34,329

a Mean

hourly and wage costs for Colorado were derived from the Bureau of Labor and Statistics National Compensation Survey for May 2010
(http://www.bls.gov/oes/current/oes_co.htm).
b Hourly rate for all workers (occupation code 00–0000) estimates the cost of time for patients.
c Hourly rate for medical records and health information technician (29–2071).
d Hourly rate for Healthcare Practitioners and Technical Workers, All Other (29–9799).

Estimated Annual Costs to the Federal
Government
Exhibit 3 shows the estimated total
and annualized cost to the Federal
Government for conducting this
research. These estimates include the

costs associated with the project such as
the preparation of survey administration
procedures, labor costs, administrative
expenses, costs associated with copying,
postage, and telephone expenses, data
management and analysis, preparation

of final reports, and dissemination of
findings/results/products. The
annualized and total costs are identical
since the data collection period will last
for one year. The total cost is estimated
to be $784,910.

EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST
Cost component

Annualized
cost

Administration ..........................................................................................................................................................
Research Activities ..................................................................................................................................................
Dissemination Activities ...........................................................................................................................................
Final Report .............................................................................................................................................................
Overhead .................................................................................................................................................................

$81,654
446,201
57,222
57,864
141,969

$81,654
446,201
57,222
57,864
141,969

Total ..................................................................................................................................................................

784,910

784,910

Request for Comments

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Total

In accordance with the Paperwork
Reduction Act, 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 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.

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Agency for Healthcare Research and
Quality
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Agency for Healthcare Research
and Quality, HHS.

AGENCY:
ACTION:

Notice.

Dated: May 3, 2012.
Carolyn M. Clancy,
Director.

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:
‘‘Workflow Assessment for Health IT
Toolkit Evaluation.’’ In accordance with
the Paperwork Reduction Act, 44 U.S.C.
3501–3521, AHRQ invites the public to
comment on this proposed information
collection.
This proposed information collection
was previously published in the Federal
Register on March 9th, 2012 and
allowed 60 days for public comment.
One comment was received. The
purpose of this notice is to allow an
additional 30 days for public comment.

[FR Doc. 2012–12171 Filed 5–18–12; 8:45 am]

DATES:

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SUMMARY:

Comments on this notice must be
received by June 20, 2012.

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Written comments should
be submitted to: AHRQ’s OMB Desk
Officer by fax at (202) 395–6974
(attention: AHRQ’s desk officer) or by
email at
[email protected]
(attention: AHRQ’s desk officer).
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
email at [email protected].
SUPPLEMENTARY INFORMATION:
ADDRESSES:

Proposed Project
Workflow Assessment for Health IT
Toolkit Evaluation
AHRQ is a lead Federal agency in
developing and disseminating evidence
and evidence-based tools on how health
IT can improve health care quality,
safety, efficiency, and effectiveness.
Understanding clinical work practices
and how they will be affected by
practice innovations such as
implementing health IT has become a
central focus of health IT research.
While much of the attention of health IT
research and development had been
directed at the technical issues of
building and deploying health IT

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systems, there is growing consensus that
deployment of health IT has often had
disappointing results, and while
technical challenges remain, there is a
need for greater attention to
sociotechnical issues and the problems
of modeling workflow.
The implementation of health IT in
practice is costly in time and effort and
less is known about these issues in
small- and medium-sized practices
where the impact, of improved or
disrupted workflows may have
especially significant consequences
because of limited resources. Practices
would derive great benefit from effective
tools for assessing workflow during
many types of health IT
implementation, such as creating
disease registries, collecting quality
measures, using patient portals, or
implementing a new electronic health
record system. To that end, in 2008,
AHRQ funded the development of the
Workflow Assessment for Health IT
toolkit (Workflow toolkit). Through this
toolkit, end users should obtain a better
understanding of the impact of health IT
on workflow in ambulatory care for each
of the following stages of health IT
implementation: (1) Determining system
requirements, (2) selecting a vendor, (3)
preparing for implementation, or (4)
using the system post implementation.
They should also be able to effectively
utilize the publicly available workflow
tools and methods before, during, and
after health IT implementation while
recognizing commonly encountered
issues in health IT implementation. In
the current project AHRQ is conducting
an evaluation to ensure that the newly
developed Workflow toolkit is useful to
small- and medium-sized ambulatory
care clinic managers, clinicians, and
staff.
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:
• Are 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?
• Does knowledge change? Does user
knowledge and capacity change? Does

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user knowledge of workflow in their
own practice change?
• Do decisions change? Do user
decisions about workflow assessment
change? Do user decisions about health
information technology (health IT)
implementation change?
• Do outcomes change? Are changes
in workflow favorable? Are changes in
clinical practices favorable? Are changes
to the practice favorable? Are changes
for patients favorable?
To answer these questions the
proposed evaluation will be conducted
to examine usefulness of the Workflow
toolkit in small- and medium-sized
practices. The evaluation will be
conducted with 18 practices affiliated
with one of two Practice-based Research
Networks (PBRNs) in Oregon and
Wisconsin, and with the Health IT
Regional Extension Centers (RECs) in
those States. Participants will be
recruited who agree to use the Workflow
toolkit in their specific health IT project
for a minimum of 10 weeks. This will
provide an opportunity to observe use of
the Workflow toolkit amongst its
intended end users, who are best
positioned to provide critical feedback
to improve the functionality of the
Workflow toolkit.
This study is being conducted by
AHRQ through its contractors, the
Oregon Rural Practice-based Research
Network (ORPRN) and the Wisconsin
Research & Education Network (WREN),
pursuant to AHRQ’s statutory authority
to conduct and support research on
health care and on systems for the
delivery of such care, including
activities with respect to the quality,
effectiveness, efficiency,
appropriateness and value of health care
services and with respect to health care
technologies, facilities, and equipment.
42 U.S.C. 299a(a)(1) and (5).
Method of Collection
To achieve the goals of this project the
following activities and data collections
will be implemented:
(1) Creation of Clinic Study Team:
Each participating practice will form
small teams, referred to as Clinic Study
Teams, who will participate in the PreWorkflow Toolkit Interview, use the
Workflow toolkit and participate in
Observations, and participate in the
Post-Workflow Toolkit Interview. Each
team will include a maximum of 14
individuals and may represent the
following types of respondents:
clinicians, office managers, front office
staff, medical assistant or nurse, nurse
care manager, social worker, health
educator, information technology
specialist, and/or quality improvement
director.

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(2) Pre-Workflow Toolkit Interview:
these will consist of semi-structured
interviews with practice staff and with
three specialists from each Health IT
Regional Extension Center. These
interviews are designed to examine the
knowledge, attitudes, and barriers to
and facilitators of workflow assessment
for implementation of health IT.
Respondents will be asked to define
workflow, to rate its importance to the
practice or REC and to health IT
implementation, to describe factors
motivating use of the Workflow toolkit,
to describe previous experience with
assessing or redesigning workflow, and
to describe previous experience with
health IT implementation and the effect
of this implementation on work
processes in their practice (practices) or
for their clients (RECs).
(3) Observations: Participating
practices will form small teams (Clinic
Study Teams) who will use the
Workflow toolkit. A member of the
project staff will join each Clinic Study
Team or the three specialists at each of
the two RECs, as participant-observer
and will meet with the team at times to
be determined by the teams, but at least
every two weeks after the Pre-Workflow
Toolkit Interview for at least four visits.
During these visits project staff will
participate in and keep field notes
regarding the practice’s or REC’s
workflow assessment activities.
(4) Usage Logs: As part of their
workflow assessment process, Clinic
Study Teams, and REC staff, will be
asked to meet weekly. For weekly
meetings at which a project staff
member is not present, Clinic Study
Teams and REC staff will keep a record
of workflow assessment activities
including use of the workflow
assessment toolkit, recording in a freeform journal the purpose and results of
the activity as well as issues that arose
in the process.
(5) Post-Workflow Toolkit Interview:
This final interview will consist of
individual semi-structured interviews of
practice staff and three specialists from
each Health IT Regional Extension
Center. These interviews will (a) Reexamine their knowledge and attitudes
about workflow assessment; (b) revisit
the barriers to and facilitators of
workflow assessment; (c) discuss
changes that have taken place as a result
of the process; (d) explore outcomes in
terms of: (d.1) for practices, the
perceived impacts on clinicians, the
practice staff, the practice, and the
patients; and (d.2) for RECs, technician
confidence in guiding affiliated clinics
in understanding workflow; and finally
(e) assess the overall impressions about

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Federal Register / Vol. 77, No. 98 / Monday, May 21, 2012 / Notices
the usefulness of the Workflow toolkit
as well as any suggested changes.
The outcome of the evaluation will be
a report including recommendations for
enhancing and improving the Workflow
toolkit. The report will provide results
about the perceived usefulness of the
Workflow toolkit. Results will be
produced separately for practices and
RECs as well as for both user groups as
a whole. The report will also include
specific suggestions on how to revise
Workflow toolkit to make it more useful
to its intended audiences.

Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annual
burden hours for each respondent’s time
to participate in this evaluation. Each
practice will convene a ‘‘Clinic Study
Team’’ consisting of no more than 14
individuals; this process will take
approximately 8 hours per practice, or
about 35 minutes per person. The PreWorkflow interview will be completed
by a total of up to 258 persons (about
14 per practice and 3 per REC) and
requires one hour. Up to four
observations will be conducted for up to
258 persons and they are each estimated

to take two hours. Ten usage logs will
be completed by a total of up to 258
persons (one per week of study activity)
and completion of a single usage log
should take no longer than 15 minutes.
The Post-Workflow interview will be
completed by a total of up to 258
persons and requires one hour.
The total annual burden is estimated
to be 3,372.
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 $104,813.

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS
Maximum
number of
respondents

Data collection

Number of
responses per
respondent

Hours per
response

Total burden
hours

Creation of Clinic Study Team .........................................................................
Pre-Workflow Toolkit Interview ........................................................................
Observations ....................................................................................................
Usage Logs ......................................................................................................
Post-Workflow Toolkit Interview .......................................................................

252
258
258
258
258

1
1
4
10
1

35/60
1
2
15/60
1

147
258
2,064
645
258

Total ..........................................................................................................

1,284

NA

NA

3,372

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN
Maximum
number of
respondents

Data collection

Total burden
hours

Average
hourly rate *

Total cost
burden

Creation of Clinic Study Team .........................................................................
Pre-Workflow Toolkit Interview ........................................................................
Observations ....................................................................................................
Usage Logs ......................................................................................................
Post-Workflow Toolkit Interview .......................................................................

252
258
258
258
258

147
258
2,064
645
258

32.28
32.28
32.28
32.28
32.28

4,745
8,005
64,044
20,014
8,005

Total ..........................................................................................................

1,284

3,372

NA

104,813

* The hourly wage for the participants across the four data collections (pre-workflow toolkit interviews, observations, usage logs, and postworkflow toolkit interview) is based upon a weighted mean of the average hourly wages for Family and General Practitioners (1.5; $87.84 per
hour); office managers (1.0; $35.18 per hour); front office staff (1.0; $15.15 per hour); medical assistants or nurses (2.5; $24.36 per hour); nurse
care managers (0.5; $33.57); social workers (0.1; $24.44 per hour); health educators (0.1; $25.12 per hour); information technology specialists
(0.25; $23.43 per hour); quality improvement directors (0.25; 25.12 per hour); and technical staff (1.0; $33.14 per hour) for Oregon and Wisconsin from the U.S. Department of Labor, Bureau of Labor Statistics, May 2010 National Occupational Employment and Wage Estimates for the
United States, Occupational Employment Statistics (OES), Washington, DC (Feb. 2009), http://bls.gov/oes/2010/may/www.bls.govoessrcst.htm
(accessed November, 2011).

Estimated Annual Costs to the Federal
Government
The estimated total cost to the Federal
Government for this project is $793,456

over a 27-month period from September
23, 2011 to December 22, 2013. The
estimated average annual cost is
$352,646. 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

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Cost component

Total cost

Annualized cost

Project Management and Coordination Activities .......................................................................................
Develop Research and Recruitment Plans .................................................................................................
Compliance with PRA ..................................................................................................................................
Obtaining IRB approval ...............................................................................................................................
Develop Data Analysis Plan ........................................................................................................................
Conduct Evaluation ......................................................................................................................................
Data analysis and Final Report ...................................................................................................................
Ensure 508-compliant deliverables .............................................................................................................

$96,449
78,383
12,267
10,254
18,246
534,401
23,554
19,902

$42,866
34,837
5,452
4,557
8,109
237,512
10,468
8,845

Total ......................................................................................................................................................

793,456

352,646

* Costs are fully loaded including overhead and G&A.

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Federal Register / Vol. 77, No. 98 / Monday, May 21, 2012 / Notices

Request for Comments
In accordance with the Paperwork
Reduction Act, 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 healthcare
research and healthcare 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: May 3, 2012.
Carolyn M. Clancy,
Director.
[FR Doc. 2012–12168 Filed 5–18–12; 8:45 am]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
[60–Day–12–0834]

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Proposed Data Collections Submitted
for Public Comment and
Recommendations
In compliance with the requirement
of Section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995 for
opportunity for public comment on
proposed data collection projects, the
Centers for Disease Control and
Prevention (CDC) will publish periodic
summaries of proposed projects. To
request more information on the
proposed projects or to obtain a copy of
the data collection plans and
instruments, call 404–639–7570 or send
comments to Kimberly S. Lane, at 1600
Clifton Road, MS D74, Atlanta, GA
30333 or send an email to [email protected].
Comments are invited on: (a) Whether
the proposed collection of information
is necessary for the proper performance
of the functions of the agency, including
whether the information shall have
practical utility; (b) the accuracy of the

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agency’s estimate of the burden of the
proposed collection 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
on respondents, including through the
use of automated collection techniques
or other forms of information
technology. Written comments should
be received within 60 days of this
notice.
Proposed Project
Occupational Injuries and Illnesses
among Emergency Medical Services
(EMS) Workers: A NEISS–Work
Telephone Interview Survey—
Revision—National Institute for
Occupational Safety and Health
(NIOSH), Centers for Disease Control
and Prevention (CDC).
Background and Brief Description
Studies have reported that EMS
workers have higher rates of non-fatal
injuries and illnesses as compared to the
general worker population. As EMS
professionals are tasked with protecting
the health of the public and treating
urgent medical needs, it follows that
understanding and preventing injuries
and illnesses among EMS workers will
have a benefit reaching beyond the
workers to the general public.
As mandated in the Occupational
Safety and Health Act of 1970 (Pub. L.
91–596), the mission of NIOSH is to
conduct research and investigations on
occupational safety and health. Related
to this mission, the purpose of this
project is to conduct research that will
provide a detailed description of nonfatal occupational injuries and illnesses
incurred by EMS workers. This project
bridges a gap of limited existing EMS
worker injury and illness surveillance
identified in a 2007 National Highway
Traffic Safety Administration (NHTSA)
report. The project uses two related data
sources. The first source is data
abstracted from medical records of EMS
workers treated in a nationally stratified
sample of emergency departments.
These data are routinely collected by the
occupational supplement to the
National Electronic Injury Surveillance
System (NEISS–Work). The second data
source, for which NIOSH is seeking
OMB approval for a two year extension,
is responses to telephone interview
surveys of the injured and ill EMS
workers identified within NEISS–Work.
Collection of telephone interview data
began in July 2010.
Data collected under the original
OMB approval for this project indicate
that EMS workers are willing to respond
to detailed questions about their

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occupational injury and related
circumstances. However, in order to
obtain enough data to produce stable,
detailed national estimates, data
collection should continue until July 1,
2014. This will provide a total of four
years of data for analysis.
The ongoing telephone interview
surveys will supplement NEISS–Work
data with an extensive description of
EMS worker injuries and illnesses,
including worker characteristics, injury
types, injury circumstances, injury
outcomes, and use of personal
protective equipment. Previous reports
describing occupational injuries and
illnesses to EMS workers provide
limited details on specific regions or
sub-segments of the population and
many are outdated. As compared to
these earlier studies, the scope of the
telephone interview data is broader as it
includes sampled cases nationwide and
has no limitations in regards to type of
employment (i.e., volunteer versus
career). Results from the telephone
interviews will be weighted and
reported as estimates of EMS workers
treated for occupational injuries and
illnesses in emergency departments.
The sample size for the telephone
interview survey is estimated to be
approximately 150 EMS workers
annually for the proposed four year
duration of the study. This estimate is
based on preliminary analysis of the
data collected to-date. The estimate has
been reduced from the original sample
projection of 175 EMS workers.
Consequently, the burden has been
reduced as well. Each telephone
interview takes approximately 20
minutes to complete, resulting in an
annualized burden estimate of 50 hours.
Using the routine NEISS–Work data, an
analysis of all identified EMS workers
will be performed to determine if there
are any differences between the
telephone interview responder and nonresponder groups.
This project is a collaborative effort
between the Division of Safety Research
in the NIOSH and the Office of
Emergency Medical Services in NHTSA.
Both agencies have a strong interest in
improving surveillance of EMS worker
injuries and illnesses to provide the
information necessary for effectively
targeting and implementing prevention
efforts and, consequently, reducing
occupational injuries and illnesses
among EMS workers. The Consumer
Product Safety Commission (CPSC) will
also contribute to this project as they are
responsible for coordinating the
collection of all NEISS–Work data and
for overseeing the collection of all
telephone interview data.

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