Using Health Information Technology in Practice Redesign: Impact of Health Information Technology on Workflow

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #6 Summary of Diabetes Self-Care Activities Survey	Form and Instruction	New	Available
Form Form #5 Patient Activation Measures Survey	Form and Instruction	New	Available
Form Form #4 Patient Interview Guide	Form and Instruction	New	Available
Form Form #3 Technology Acceptance Model Survey	Form and Instruction	New	Available
Form Form #2 Staff Interview Guide	Form and Instruction	New	Available
Form Form #1 Introduction for Orientation Meeting	Form and Instruction	New	Available
SS Part B -- Using HIT in Practice Redesign - Impact of HIT on Workflow 11-13-2012.docx	Supporting Statement B	Uploaded 2013-01-11	Available
Attachment K -- AHRQs response to Public Comments.docx	Supplementary Document	Uploaded 2013-01-11	Available
Attachment J -- Public Comment from TMA.pdf	Supplementary Document	Uploaded 2013-01-11	Available
Attachment I -- Federal Register Notice.pdf	Supplementary Document	Uploaded 2013-01-11	Available
Attachment B -- Direct Observations Field Notes Form.doc	Supplementary Document	Uploaded 2013-01-11	Available
Attachment C -- Directions for Artifact and Spatial Data Collection.docx	Supplementary Document	Uploaded 2013-01-11	Available
Attachment M -- Consent Form to Participate in Patient Interview.docx	Supplementary Document	Uploaded 2013-01-11	Available
Attachment L -- Consent Form to Participate in Clinic Staff Interview.docx	Supplementary Document	Uploaded 2013-01-11	Available
SS Part A -- Using HIT in Practice Redesign - Impact of HIT on Workflow 11-6-2012.docx	Supporting Statement A	Uploaded 2013-01-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
205429	Summary of Diabetes Self Care Activities Survey	Form and Instruction	New	Summary of Diabetes Self-Care Activities Survey
205428	Patient Activation Measures Survey	Form and Instruction	New	Patient Activation Measures Survey
205427	Patient Semi-Structured Interviews	Form and Instruction	New	Patient Interview Guide
205426	Technology Acceptance Model Survey	Form and Instruction	New	Technology Acceptance Model Survey
205425	Staff Semi-Structured Interviews	Form and Instruction	New	Staff Interview Guide
205424	Project orientation meeting	Form and Instruction	New	Introduction for Orientation Meeting

ICR Details

OMB Control No: 0935-0208	ICR Reference No: 201301-0935-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Using Health Information Technology in Practice Redesign: Impact of Health Information Technology on Workflow
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 without change	Conclusion Date: 03/19/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/15/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	36 Months From Approved
Responses	420	0	0
Time Burden (Hours)	252	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The goal of the project is to understand the impact of implementing health IT-enabled care coordination on workflow within small community-based primary care clinics in various stages of practice redesign. The focus of this study is the interaction of health IT and care coordination workflow in the context of practice redesign. This study will focus on clinic staff caring for patients with diabetes within small primary care clinics to understand enablers and barriers to care coordination workflow through the use of health IT.

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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 65888	10/31/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 942	01/07/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Patient Activation Measures Survey	Form #5	Patient Activation Measures Survey
Patient Semi-Structured Interviews	Form #4	Patient Interview Guide
Project orientation meeting	Form #1	Introduction for Orientation Meeting
Staff Semi-Structured Interviews	Form #2	Staff Interview Guide
Summary of Diabetes Self Care Activities Survey	Form #6	Summary of Diabetes Self-Care Activities Survey
Technology Acceptance Model Survey	Form #3	Technology Acceptance Model Survey

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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	420	0	0	420	0	0
Annual Time Burden (Hours)	252	0	0	252	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: $266,643

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: 01/15/2013

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