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National Electronic Health Records Survey (NEHRS)

OMB: 0920-1015

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Supporting Statement B for Request for Clearance:

NATIONAL ELECTRONIC HEALTH RECORDS SURVEY


OMB No. 0920-1015

Expires 07/31/2020


Contact Information:


Brian W. Ward, Ph.D.

Team Lead, Ambulatory Care Team

Ambulatory and Hospital Care Statistics Branch

Division of Health Care Statistics

National Center for Health Statistics

Centers for Disease Control and Prevention

301-458-4568

301-458-4032 (fax)

[email protected]


October 28, 2019

































List of Attachments

Att A – Applicable Laws and Regulations

Att B1 – 60-day FRN

Att B2 – Public Comments and Response

Att C1 – 2019 Instrument

Att C2 – 2019 Web Instrument Screenshots

Att C3 – Proposed 2020 Instrument

Att D – Changes to the Instrument

Att E – List of Consultants

Att F – ERB Approval Letter

Att G– Letters

Att H – Flyer

Att I – CATI script

  1. Respondent Universe and Sampling Methods



The National Electronic Health Records Survey (NEHRS) target universe is non-federally employed physicians (excluding those in the specialties of anesthesiology, radiology and pathology) practicing in the United States and classified as “office-based patient care.” The sampling frame used for the survey consists of universe physicians listed in the American Medical Association (AMA) and the American Osteopathic Association (AOA) Masterfiles. To enable state-based estimates from this survey, a sample of 202 physicians is selected from each U.S. state and the District of Columbia (DC) (a national total of 10,302) annually for NEHRS. Within each state, the physicians are selected using systematic random sampling from a list in which physicians are arrayed by specialty groups and metropolitan statistical area (MSA) status.



Table 1. Table of NEHRS physician universe and physician sample size by state, 2019 Universe

Geography

Universe

Sample




United States

517,122

10,302

Alabama

6,658

202

Alaska

883

202

Arizona

10,301

202

Arkansas

3,709

202

California

66,705

202

Colorado

9,528

202

Connecticut

7,133

202

Delaware

1,315

202

District of Columbia

1,878

202

Florida

35,440

202

Georgia

14,677

202

Hawaii

2,252

202

Idaho

1,794

202

Illinois

20,768

202

Indiana

8,821

202

Iowa

3,428

202

Kansas

3,949

202

Kentucky

6,305

202

Louisiana

7,490

202

Maine

2,298

202

Maryland

12,278

202

Massachusetts

14,663

202

Michigan

16,380

202

Minnesota

9,313

202

Mississippi

3,231

202

Missouri

8,761

202

Montana

1,305

202

Nebraska

2,522

202

Nevada

3,535

202

New Hampshire

2,021

202

New Jersey

17,380

202

New Mexico

2,739

202

New York

38,066

202

North Carolina

15,324

202

North Dakota

843

202

Ohio

18,381

202

Oklahoma

4,697

202

Oregon

7,225

202

Pennsylvania

22,440

202

Rhode Island

2,166

202

South Carolina

6,685

202

South Dakota

1,054

202

Tennessee

10,549

202

Texas

39,165

202

Utah

3,844

202

Vermont

962

202

Virginia

13,329

202

Washington

11,582

202

West Virginia

2,504

202

Wisconsin

8,332

202

Wyoming

514

202



The expected response rates for the 2020-2022 NEHRS data collections are 45%. These estimated response rates are based on the average of the 2015 and 2017 OMB-defined response rates. The 2015 and 2017 NEHRS used the same sequential, mixed-mode administration as the 2020-2022 data collections will use. The 2018 NEHRS response rates were not included because the data and response rates are not finalized; the 2019 NEHRS response rates were not included as these data are in the process of being collected at the initial writing of this package.



The response rates from the past three completed survey data collections are shown in Table 2. Note that there was no data collection in 2016, and that 2015 NEHRS was the first year of the web questionnaire. NEHRS defined completes as respondents who completed the eligibility questions and provided non-blank responses for all of the key questions that supported the main survey objectives. Partial respondents were defined as respondents who answered the eligibility questions but did not provide non-blank responses for all the key questions. The response rates presented in the 2nd column of Table 2 incorporate complete and partials as the respondent as specified in the OMB’s Standards and Guidelines for Statistical Surveys. The response rate calculation used for NEHRS publications only includes completes as respondents. Partials are included with eligible refusals because they did not contribute to the key questions. The response rates used for NEHRS publications are presented in the 3rd column of Table 2.







Table 2. Response rates from collection period 2014—2017 NEHRS


OMB Standards & Guidelines Weighted Response Rate

NEHRS publications Weighted Response Rate

2014 NEHRS

71%

63%

2015 NEHRS

52%

49%

2017 NEHRS

37%

34%



  1. Procedures for the Collection of Information



The sampling frame will be constructed from the AMA and the AOA Masterfiles. To enable state-based estimates from this survey, a sample of 202 physicians is selected from each U.S. state and DC (a national total of 10,302) annually for NEHRS. Within each state, the physicians are selected using systematic random sampling from a list in which physicians are arrayed by specialty groups and MSA status.



The 2020, 2021 and 2022 NEHRS data collections are expected to use the same sequential, mixed-mode administration using web, mail, and computer-assisted telephone interview (CATI) modes, in that order, as done in the 2017, 2018 and 2019 NEHRS. A contractor will conduct the data collection; however, the contractor for the 2020, 2021 and 2022 surveys has not yet been selected. The data collection will continue to use the Tailored Design Method, also known as Dillman’s survey method,1 with some modifications. Recruitment begins with mail and email invitations to a self-administered web-based survey, and for non-responders, recruitment includes up to three survey mailings with a paper self-administered questionnaire. For non-responders to both the self-administered web-based survey and the paper self-administered questionnaire, a computer-assisted telephone interview (CATI) follow-up will be administered. The email and mail letters can be found in Attachment G. The flyer showing the use of NEHRS data is in Attachment H. The CATI script can be found in Attachment I.



The data are weighted to produce state and national estimates using the inverses of selection probabilities, with nonresponse adjustments within state and specialty group. The data source will undergo calibration adjustment factors to adjust estimated total physicians to known totals within specialty strata. Sampling errors are computed using the linearized Taylor series method of approximation, as applied in the SUDAAN software package.



  1. Methods to Maximize Response Rates and Deal with No Response



NEHRS uses multiple methods for maximizing physician response. The survey questionnaire is designed to minimize the amount of time for physicians to participate. Along with the 1st mailing of the paper questionnaire, we provide a NCHS flyer or report that uses NEHRS data to show the importance of the survey (Attachment H). Since the web instrument was first implemented in 2015, there has been an increasing number of physicians who have responded through the self-administered web instrument. This shows the preference for receiving email invitations, and responding to the survey through the web instrument. As such, beginning with the 2019 NEHRS there has been additional emphasis on locating physician email addresses. As an optional task that was funded in 2019 NEHRS, tracing of email addresses is projected to increase the number of physician respondents who are administered the survey through the web, and reduce the number of needed follow-up contacts among these physicians. If this proves to be true in 2019, and funding allows, we will continue this in subsequent data collections. Additionally, extensive web searches and follow-up phone calls will be performed to locate the status of non-responding physicians. Effective techniques for converting refusals have been developed, each flexible and responsive to individual concerns. Conversion is successful by emphasizing the following ideas: professional responsibility to enhance knowledge of the adoption and use of EHRs in the United States, and that data are only reported as descriptive statistics. Optimization of the use of resources as recommended by expert methodologists was another optional task added in 2019 that was meant to address non response.

The 2015 NEHRS had a weighted response rate of 52%; 2017 NEHRS had a weighted response rate of 37%. We expect the 2020-2022 NEHRS response rates to be between the 2015 and 2017 rates, because the procedures and materials are similar to those used in 2015 and 2017. Methods to raise the response rate of future surveys are currently being considered and include two that are being implemented in the 2019 NEHRS: email tracing to increase email addresses for the web questionnaire as described above and optimizing non-response follow-up. Optimizing non-response follow-up includes, but is not limited to, reallocating resources to improve response in the CATI mode (e.g., aligning interviewer schedules with the most effective times for successful call completion based upon experience from previous data collection efforts).

NCHS will investigate the specific causes of nonresponse in order to devise additional corrective measures, as funds permit. This may include further understanding about survey methods in order to inform the reason for non-response (e.g., burden, brand, time, content).

  1. Tests and Procedures or Methods to be Undertaken

No tests of procedures are anticipated. The survey questions and procedures have been used in prior surveys. The questionnaire has the same questions as the 2018 and 2019 NEHRS, OMB No. 0920-1015.

  1. Individuals Consulted on Statistical Aspects and Individuals Collecting and/or Analyzing Data



The individual responsible for the data collection design is:



Iris Shimizu, Ph.D.

Mathematical Statistician

Statistical Research and Survey Design Staff

Division of Research and Methodology

National Center for Health Statistics/CDC

(301) 458-4497

[email protected]



The individuals responsible for collecting the data:



A contractor will be responsible for data collection. However, the contractor for 2020, 2021 and 2022 NEHRS have not yet been selected.



The individuals responsible for analysis of the data are:



Brian W. Ward, Ph.D.

Team Lead, Ambulatory Care Team

Ambulatory and Hospital Care Statistics Branch

Division of Health Care Statistics

National Center for Health Statistics/CDC

301-458-4568

[email protected]

1 The Tailored Design Method (TDM), also known as the Dillman survey method, is regarded as the standard for mail surveys. TDM includes steps such as sending a personalized letter, the questionnaire with return postage, a follow-up postcard, and multiple packets to non-respondents.

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AuthorMyrick, Kelly L. (CDC/DDPHSS/NCHS/DHCS)
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