Patient-Reported Health Information Technology and Workflow

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #8 Interview Guide for Follow-Up	Form and Instruction	New	Available
Form Form #7 Patient Interview Guide	Form and Instruction	New	Available
Form Form #6 Clinician and Office Staff Survey	Form and Instruction	New	Available
Form Form #5 Interview Guide for Clinicians and Office Staff	Form and Instruction	New	Available
Form Form #4B Guide for Interview with Physician Leader	Form and Instruction	New	Available
Form Form #4 Guide for Interview with Practice Manager	Form and Instruction	New	Available
Form Form #3 Practice Tour Guide	Form and Instruction	New	Available
Form Form #2 Pre-Visit Questionnaire	Form and Instruction	New	Available
Form Form #1 Preliminary Conference Call Discussion Guide	Form and Instruction	New	Available
SS Part B -- Patient-Reported Health IT and Workflow.docx	Supporting Statement B	Uploaded 2013-05-07	Available
Attachment S -- Information Sheet for Patient Observations.docx	Supplementary Document	Uploaded 2013-05-07	Available
Attachment N -- List of Subcontractor Practices.docx	Supplementary Document	Uploaded 2013-05-07	Available
Attachment M -- Federal Register Notice.pdf	Supplementary Document	Uploaded 2013-05-07	Available
Attachment F -- Observation Form.docx	Supplementary Document	Uploaded 2013-05-07	Available
Attachment K -- Email for Follow-Up.docx	Supplementary Document	Uploaded 2013-05-07	Available
Attachment R -- Information Sheet for Patient Interviews and Observations.docx	Supplementary Document	Uploaded 2013-05-07	Available
Attachment H -- Clinician and Office Staff Survey Invitation.docx	Supplementary Document	Uploaded 2013-05-07	Available
Attachment H -- Clinician and Office Staff Survey Invitation.docx	Supplementary Document	Uploaded 2013-05-07	Available
Attachment Q -- Information Sheet for Office Staff.docx	Supplementary Document	Uploaded 2013-05-07	Available
Attachment P -- Information Sheet for Clinicians.docx	Supplementary Document	Uploaded 2013-05-07	Available
Attachment P -- Information Sheet for Clinicians.docx	Supplementary Document	Uploaded 2013-05-07	Available
Attachment O -- Information Sheet for Practice Managers.docx	Supplementary Document	Uploaded 2013-05-07	Available
SS Part A -- Patient-Reported Health IT and Workflow.doc	Supporting Statement A	Uploaded 2013-05-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206891	Post Visit Follow-up to Review the Workflow Process Map(s)	Form and Instruction	New	Interview Guide for Follow-Up
206890	Patient Interviews	Form and Instruction	New	Patient Interview Guide
206889	Survey of Clinicians and Office Staff	Form and Instruction	New	Clinician and Office Staff Survey
206888	Interviews with Clinicians and Office Staff	Form and Instruction	New	Interview Guide for Clinicians and Office Staff
206887	Interviews with Practice Manager and Physician Leader	Form and Instruction	New	Guide for Interview with Physician Leader
206887	Interviews with Practice Manager and Physician Leader	Form and Instruction	New	Guide for Interview with Practice Manager
206886	Practice Tour	Form and Instruction	New	Practice Tour Guide
206885	Pre-Visit Questionnaire	Form and Instruction	New	Pre-Visit Questionnaire
206884	Preliminary Conference Call	Form and Instruction	New	Preliminary Conference Call Discussion Guide

ICR Details

OMB Control No: 0935-0212	ICR Reference No: 201305-0935-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No: 19458
Title: Patient-Reported Health Information Technology and 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: 07/24/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/13/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2016	36 Months From Approved
Responses	336	0	0
Time Burden (Hours)	215	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The use of patient-reported information is not yet widely integrated into health IT. This project will fill the gaps in the current literature by exploring the influence of sociotechnical factors--for clinicians and their office staff, and for patients--in capturing and using patient-reported information in ambulatory health IT systems and associated workflows. The goal of the project is to answer the following research questions: o How does the use of health IT to capture and use patient-reported information support or hinder the workflow from the viewpoints of clinicians, office staff, and patients? o How does the sociotechnical context influence workflow related to the capture and use of patient-reported information? o How do practices redesign their workflow to incorporate the capture and use of patient-reported information?

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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:
	78 FR 10175	02/13/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 25450	05/01/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Interviews with Clinicians and Office Staff	Form #5	Interview Guide for Clinicians and Office Staff
Interviews with Practice Manager and Physician Leader	Form #4, Form #4B	Guide for Interview with Practice Manager ,   Guide for Interview with Physician Leader
Patient Interviews	Form #7	Patient Interview Guide
Post Visit Follow-up to Review the Workflow Process Map(s)	Form #8	Interview Guide for Follow-Up
Practice Tour	Form #3	Practice Tour Guide
Pre-Visit Questionnaire	Form #2	Pre-Visit Questionnaire
Preliminary Conference Call	Form #1	Preliminary Conference Call Discussion Guide
Survey of Clinicians and Office Staff	Form #6	Clinician and Office Staff 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	336	0	0	336	0	0
Annual Time Burden (Hours)	215	0	0	215	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: $258,053

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: 05/13/2013

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