Notice: Request for Tools and Methods Used by Small- and Medium-Sized 
Practices for Analyzing and Redesigning Workflows Either Before or 
After Health Information Technology Implementation

Federal Register: June 25, 2009 (Volume 74, Number 121)      
                  Page 30299-30301

AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS.

ACTION: Notice of request for information.

SUMMARY: This notice announces the intention of the Agency for 
Healthcare Research and Quality (AHRQ) to request information from (1) 
small- and medium-sized practices about how they study or redesign 
their workflow, including information on the use of tools and methods 
for studying workflow, and (2) others (e.g., experts, vendors, 
professional associations) that have developed, implemented and used 
tools and methods for studying workflow in the context of health IT 
implementation and use. Workflow is defined as the way work is 
performed and patient-related information is communicated within small- 
and medium-sized practices and between those practices and external 
organizations such as community pharmacies and local hospitals. It is 
our understanding that there is currently no standard description of 
workflows for care processes that can be used to guide decisions of 
where and how to incorporate health information technology. This 
Request for Information is part of a three-pronged effort to scan the 
environment, the literature and knowledgeable and interested parties to 
produce a useful list of resources that may assist small- and medium-
sized medical practices and clinics to consider the utility and 
potential effectiveness of incorporating health IT into the way they 
practice and communicate patient information. The responses to this 
request for information will be considered for reference and possible 
incorporation into an electronic toolkit to be made available on the 
Internet to assist small- and medium-sized practices in analyzing or

[[Page 30300]]

redesigning workflow either before or after implementation of one or 
more health IT applications. All responses to this request for 
information are voluntary.

DATES: Submit comments on or before August 24, 2009.

ADDRESSES: Electronic responses are preferred and should be addressed 
to: WorkflowRFI@ahrq.hhs.gov. Non-electronic responses will also be 
accepted. Please send to: Teresa Zayas-Cab[aacute]n, Senior Manager, 
Health IT, Agency for Healthcare Research and Quality, Attention: 
Workflow RFI Responses, 540 Gaither Road, Room 6115, Rockville, MD 
20850, Phone: 301-427-1586.

FOR FURTHER INFORMATION CONTACT: Teresa Zayas-Cab[aacute]n, e-mail: 
Teresa.ZayasCaban@AHRQ.hhs.gov, Web site of the project on 
``Incorporating Health Information Technology Into Workflow Redesign'': 
http://cqpi.engr.wisc.edu/withit_home.

SUPPLEMENTARY INFORMATION: 

Submission Criteria

    To assist small- and medium-sized medical practices or clinics 
considering implementation of any health IT, AHRQ is requesting 
information about tools, methods, technologies, and data reporting 
procedures that may be used to analyze and possibly improve the 
delivery of health care in such settings. From our perspective, these 
settings would include practices for which investment in health IT is 
financially burdensome and therefore regarded as high risk. While AHRQ 
welcomes all comments on the above described subject, the agency is 
particularly interested in obtaining information and opinions from 
small- and medium-sized healthcare practices that have implemented or 
are considering implementing health information technology as well as 
information and opinions from workflow or health IT experts, vendors, 
professional associations, and others that have developed and/or used 
workflow analysis or redesign tools. In descriptions of workflow 
analytic tools or approaches and health IT that have been deployed 
successfully or unsuccessfully, it would be helpful to receive basic 
information about the characteristics of the practice(s) or clinic(s) 
where particular tools, approaches, or health IT have been used 
including:
     The number of physicians and providers (physician 
assistants or nurse practitioners) in the practice or clinic.
     The total number of staff (e.g., nurses, medical 
assistants, receptionists, educators) in the practice or clinic.
     The number of patient visits the practice or clinic had in 
2008.
     The medical or surgical specialties within the practice or 
clinic. Specialties can include: family medicine, internal medicine, 
pediatrics, geriatrics, hematolology, oncology, cardiology, 
pulmonology, endocrinology, gastroenterology, rheumatology, 
ophthalmology, obstetrics and gynecology, nephrology, infectious 
diseases, physical medicine and rehabilitation, dermatology, 
neurosurgery, general surgery, pediatric surgery, cardiovascular 
surgery, thoracic surgery, vascular surgery, transplant surgery, 
urology, plastic surgery, orthopedic surgery, otolaryngology, and 
anesthesiology.
     Any ancillary services located on-site at the practice or 
clinic. Examples include: laboratory, radiology, physical therapy, 
occupational therapy, speech therapy, pharmacy.

With regard to health IT, please indicate what specific health IT 
applications and software have been used in particular settings; e.g.: 
electronic medical records (EMRs) (i.e., electronic records of health-
related information on individual patients that may be created, 
gathered, managed, and consulted by authorized clinicians and staff 
within a single health care organization), electronic health records 
(EHRs) (i.e., electronic records of health-related information on 
individual patients that conform to nationally recognized 
interoperability standards and that may be created, managed, and 
consulted by authorized clinicians and staff across more than one 
health care organization), computerized provider order entry (or CPOE), 
e-prescribing, digital imaging, telemedicine, and others. Please 
include information regarding:
     Functionality of each health IT application (i.e., what 
you use them for).
     How long each health IT application has been in use.

With regard to workflow analysis and redesign tools, please tell us 
about any tools, methods, technologies, or data reports to analyze or 
redesign the way work is done and information flows in your practice or 
clinic before or after health IT implementation. Examples of tools 
include process analysis, flowcharting, task analysis and lean 
management. Other examples include using data reports from a health IT 
application to analyze or understand processes and workflow.
    For each tool, method, technology or data report we would 
appreciate the following information:
     Name and acronym of the tool, method, technology, or data 
report.
     Authors, sources and/or references.
     Background about the tool, method, technology, or data 
report; i.e., how did you learn about it.
     Intended purpose; i.e., what it was used for and at what 
point it was used during the redesign and/or implementation process.
     How the tool, method, technology, or data report was used. 
Please describe the procedure or steps for using it as well as who 
participated in its use.
     Resources needed to use the tool, method, technology, or 
data report (e.g., expertise, time, software).
     Information about reliability and validity of the tool, 
method, technology, or data report, if applicable.
     Advantages and disadvantages of the tool, method, 
technology, or data report.
     How useful, overall, the tool, method, technology, or data 
report is.
     How easy or difficult is it to use the tool, method, 
technology, or data report.

Additionally, please provide information that you think will assist our 
target audience to avoid pitfalls of complicated or inappropriate tools 
and software. If you are willing and authorized to share any referenced 
tools, please submit them with your response along with instructional 
documents related to the tool and its use, including any restrictions 
or prerequisite permissions necessary for use by others.
    In describing the impact of health IT on organization of work and 
workflow, a discussion of the following topics would provide valuable 
information for small- and medium-sized practices or clinics:
     Support that was available during the health IT 
implementation (e.g., additional staff, overtime, additional time to 
complete tasks, technical support, internal versus external support).
     Training provided to the users including the duration of 
the training (e.g., number of days of training per end user), and the 
methods used to train users (e.g., `train-the-trainer,' super users, 
lecture, hands-on training).
     Discussion of successful or unsuccessful interfacing of 
the health IT application(s) is/are interfaced with each other and/or 
other IT, such as IT applications of ancillary services (e.g., lab 
system).
     Discussion of any formal evaluation of the health IT 
implementation was conducted and any measures used for the evaluation 
(e.g., impact on job satisfaction, efficiency, workload, decisionmaking 
accuracy, quality of care, cost).


[[Page 30301]]


In assessing the implementation of health IT, comments about the impact 
of particular health IT applications on different domains of a practice 
or clinic are requested. Thus, we would appreciate comments on how 
health IT has impacted or supports:
     Communication among practice or clinic staff (e.g., 
physician, nurse, medical assistant, physician assistant, receptionist, 
technician).
     Coordination of care among practice or clinic staff (e.g., 
physician, nurse, medical assistant, physician assistant, receptionist, 
technician).
     Information flow between the practice or clinic and 
external healthcare organizations (e.g., community pharmacies, imaging 
centers, local hospitals).
     Clinicians' work during patient visit.
     Clinicians' thought processes as they care for patients.
     Access to patient-related information.

Additional Submission Instructions

    Responders should identify any information that they believe is 
confidential commercial information. Information reasonably so labeled 
will be protected in accordance with the FOIA, 5 U.S.C. 552(b)(4), and 
will not be released by the agency in response to any FOI requests. It 
will not be incorporated directly into any requirements or standards 
that the agency may develop as a result of this inquiry regarding 
useful tools or information for small- and medium-sized medical 
practices regarding implementation of health information technology in 
such practices.

    Dated: June 17, 2009.
Carolyn M. Clancy,
AHRQ, Director.
[FR Doc. E9-14947 Filed 6-24-09; 8:45 am]

BILLING CODE 4160-90-P