Patient Perpective of Delivery of Health Care Through the use of an Electronic Health Record Survey

Forms and Documents

Document Name	Status
App F4 Patient Survey Fact Sheet Spanish REV 8.30.10.docx Supplementary Document	2010-09-21
App F3 Patient Letter Spanish REV 8.30.10.docx Supplementary Document	2010-09-21
App K_Focus Group Moderator's Guide REV 8.30.10.docx Supplementary Document	2010-09-21
App J2 Focus Group Postcard.docx Supplementary Document	2010-09-21
App J1 Patient Focus Group Fact Sheet REV 8.30.10.docx Supplementary Document	2010-09-21
App I Patient recruitment log.docx Supplementary Document	2010-09-21
App H2 Patient Recruitment Script Spanish.docx Supplementary Document	2010-09-21
App H1 Patient Recruitment Script.docx Supplementary Document	2010-09-21
App G PracticeThank You letter REV 9.17.10.docx Supplementary Document	2010-09-21
App F2 Patient Survey Fact Sheet English REV 8.30.10.docx Supplementary Document	2010-09-21
App F1 Patient Letter English REV 8.30.10.docx Supplementary Document	2010-09-21
App E2 Patient Survey Spanish REV 8.30.10.docx Supplementary Document	2010-09-21
App E1 Patient Survey English REV 8.30.10.docx Supplementary Document	2010-09-21
App D3 Medical practice Followup Letter REV 9.17.10.docx Supplementary Document	2010-09-21
App D2 Physician Practice Fact Sheet REV 9.17.10.docx Supplementary Document	2010-09-21
App D1 Physician Practice Advance Letter REV 9.17.10.docx Supplementary Document	2010-09-21
App C Physician Practice Screener REV 9.17.10.docx Supplementary Document	2010-09-21
App B 60 day FR Notice.doc Supplementary Document	2010-09-21
App A ARRA.pdf Supplementary Document	2010-09-21
PPHC OMB Part B revised as of 09 17 2010.docx Supporting Statement B	2010-09-21
0990-PatientPerspectiveApp A ARRA.pdf Supplementary Document	2010-05-04
0990-PatientPerspective_App J1 Patient Focus Group Fact Sheet.doc Supplementary Document	2010-05-04
0990-PatientPerspective_App J2 Focus Group Postcard.doc Supplementary Document	2010-05-04
0990-PatientPerspective_App F1 Patient Letter English.doc Supplementary Document	2010-05-04
0990-PatientPerspective_App G PracticeThank You letter.doc Supplementary Document	2010-05-04
0990-PatientPerspective_App D1 Physician Practice Advance Letter.doc Supplementary Document	2010-05-04
0990-PatientPerspecive_App D2 Physician Practice Fact Sheet.doc Supplementary Document	2010-05-04
0990-PatientPerspective_App D3 Medical practice Followup Letter.doc Supplementary Document	2010-05-04
0990-PatientPerspective_App I Patient recruitment log.doc Supplementary Document	2010-05-04
PPHC OMB Part A revised as of 09 17 2010.docx Supporting Statement A	2010-09-21

IC Document Collections

IC ID	Document Title	Status
193000	Patients at Primary Care Pactices (Patient Focus Groups) Other-recruitment	New
192999	Patients at Primary Care Practices Other-Script	New
192998	Staff at Primary Care Practices Other-Script	New

ICR Details

OMB Control No: 0990-0361	ICR Reference No: 201005-0990-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Patient Perpective of Delivery of Health Care Through the use of an Electronic Health Record Survey
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: 09/29/2010
	Date Received in OIRA: 05/24/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2013	36 Months From Approved
Responses	902	0	0
Time Burden (Hours)	251	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The HITECH Act builds on existing federal efforts to encourage health IT adoption and use, and contains provisions that are expected to promote the widespread adoption of health IT among health care providers. Health IT experts agree that HITECH stimulus funds are likely to improve how physicians practice medicine for Medicare and Medicaid beneficiaries and, ultimately, for advancing patient-centered medical care for all Americans. However, there is an evidence gap about patients' preferences and perceptions of delivery of health care services by providers who have adopted EHR systems in their practices.

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Authorizing Statute(s): US Code: 30 USC 13001 Name of Law: Health Information Technology for Economic and Clinical Health Act
   PL: Pub.L. 111 - 5 3001 Name of Law: Office of the National Coordinator for Health Information Technology
  

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:
	75 FR 5329	02/02/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 27344	05/14/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Staff at Primary Care Practices
Patients at Primary Care Practices
Patients at Primary Care Pactices (Patient Focus Groups)

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ICR Summary 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	902	0	0	902	0	0
Annual Time Burden (Hours)	251	0	0	251	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 a new data collection.

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Annual Cost to Federal Government: $299,830

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]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Yes

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: 05/24/2010

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