FINAL_AHA_FOA_060517.pdf

U.S. Department of Health and Human Services

Office of the National Coordinator for Health Information Technology

Funding Opportunity Announcement

Tracking Electronic Health Record Adoption, Use, and Related Insights in U.S. Hospitals

Application Due Date: July 5, 2017

Anticipated Award Date: September 13, 2017

Table of Contents

Executive Summary

A. Program Description/Purpose Structure and Approach Performance Goals/Program Milestones

B. Funding Opportunity Award Information Key Award Parameters Key Dates Roles and Responsibilities Under a Cooperative Agreement

C. Eligibility Information

D. Application and Submission Information Application Package Application Submission Instructions Restrictions on Oral Conversations

E. Application Review Information Screening Review Merit Review Pre-Award Risk Assessment

F. Federal Award Administration Information Award Decisions Notice of Grant Award Terms and Conditions

G. Points of Contact

Appendix A – Tips for Writing a Strong Application Appendix B – Instructions – SF-424 Application for Federal Assistance Appendix C - Instructions – SF-424A, Budget Information for Non-Construction Programs Appendix D – Budget Narrative/Justification Template Appendix E – Letter of Commitment Template

Executive Summary

This funding opportunity announcement (FOA) will provide funds in the form of a sole source, single award, through a cooperative agreement between the Office of the National Coordinator for Health Information Technology (ONC) and American Hospital Association (AHA). The AHA has a series of survey tools that provide a comprehensive resource for analysis and comparison of health care industry trends in U.S. hospitals; including adoption and use of health information technology (health IT). The AHA has an ongoing data collection effort designed to capture information on the adoption and use of electronic health records, as well as users’ attitudes towards electronic health records (EHR) in U.S.

hospitals. Currently, the AHA is the only data source available that captures nationally representative data on the rate of interoperability among U.S. hospitals.

Interoperability is defined as the ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user.

Tracking the adoption and use of health IT, particularly interoperability, is critical to assessing the nation’s progress towards achieving widespread interoperability, evaluating the effects of ONC programs, and measuring the impact of interoperability on improving the quality and cost of health care.

Since 2008, the AHA and ONC have worked collaboratively to collect data for these purposes through an annual AHA Information Technology Survey (IT Supplement), a supplementary data collection that is separate from the AHA’s annual general census of hospitals. The survey has enabled ONC to track health IT adoption and use, evaluate its programs, and inform policy. This survey has been used by collaborative partners and independent researchers to further the body of knowledge in health IT research.

A. Program Description/Purpose

I. Background The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) declared it a national objective to achieve widespread exchange of health information through interoperable certified electronic health records (EHRs) technology nationwide by December 31, 2018. The 21st Century Cures Act, enacted in 2016, further defined interoperability establishing it as a national priority. These laws build upon the plan set forth in the Health Information Technology for Economic and Clinical Health (HITECH) Act to advance a nationwide health IT infrastructure to facilitate the electronic use and exchange of information and to improve the quality and efficiency of health care, among other objectives. Since 2008, ONC has partnered with the AHA to conduct a survey regarding the adoption and use of health IT in U.S.

hospitals. ONC’s input on the survey instrument allows the agency to track key performance measures regarding the interoperable exchange of health information by hospitals, which has direct implications on the success of federal initiatives outlined in MACRA. Continuing to track the adoption and use of EHRs and related attitudes and insights in U.S. hospitals is critical to the responsibilities of ONC. This survey will assist ONC in measuring the nation’s progress in achieving widespread interoperability.

II. Purpose Significant federal investments to accelerate the adoption of EHRs and exchange of clinical data are now in place. It is critical to continue to track the adoption and use of EHRs and related insights to: (1) ascertain the status of adoption and evaluate existing and proposed policy decisions; (2) evaluate the impact of ONC programs and related incentives for meaningful use; and (3) make resources available to ONC and external researchers to assess the effects of health IT adoption and exchange on key aspects of care, such as quality and efficiency. The data generated under this funding opportunity will enable ONC and other researchers to carry out these important activities for inpatient settings.

III. Scope of Services This potential cooperative agreement involves data collection designed to capture information on the adoption and use of electronic health records, as well as users’ attitudes towards them in U.S. hospitals.

The AHA is uniquely positioned, with the necessary survey experience and membership of nearly 5,000 hospitals, to develop the survey instrument necessary to track the progress of health IT adoption and use among U.S. hospitals that ONC monitors. This survey will be developed and fielded annually for the duration of the contract. ONC will use the results of this data collection effort for public dissemination of health IT progress.

Structure and Approach

I. Cooperative Agreement Management & Work Plan Subgoal 1.1: Initial Meeting - The recipient shall meet with ONC staff within seven (7) working days of the award of the cooperative agreement to discuss the work plan, which will include work schedule, the data collection plan, and general insights on the direction of the survey.

Subgoal 1.2: Work Plan – The recipient shall produce a draft work plan within seven (7) working days of the initial meeting that reflects the discussions from the initial meeting. ONC staff will provide comments/ of the plan within five (5) working days.

Subgoal 1.3: Final Work Plan – The recipient shall produce a final work plan within (7) working days of receipt of ONC feedback that reflects the feedback received.

II. Survey Instrument Development The recipient shall gain insight from the Project Officer and, other applicable representatives from ONC, to help determine relevant subject matter for the given survey year. The recipient will consider this insight in the context of competing goals to both capture most relevant data and maintain data continuity across years. The recipient will update both the mailed survey instrument and a web-based version based on the insight gained from ONC representatives.

III. Survey Instrument Production and Data Collection The recipient must:

Subgoal 3.1. Update the paper survey instrument and web-based survey Subgoal 3.2. Mail the initial request and ask that responses be completed online or by regular mail Subgoal 3.3. Contact non-respondents by email and telephone to encourage participation;

contacted respondents are identified in the data Subgoal 3.4. Complete and finalize data collection

IV. Data Delivery The recipient must provide ONC with a preliminary data file and a final data file that meet data quality standards established by ONC.

Subgoal 4.1. Preliminary Data File. The recipient must provide ONC a preliminary data file when responses total roughly half the expected number of respondents.

Subgoal 4.2. Final Data File. The recipient must deliver the finalized data file in an approved format finalized in the government-approved work plan (e.g. .txt, .csv, .sas7bdat (SAS)). Accompanying the delivery must be the most relevant year of AHA general hospital census data, for the purposes of added characteristics for responding hospitals, in addition to a comprehensive data dictionary for both the general survey and the IT supplement.

Subgoal 4.3. Data Quality. The recipient must ensure all data have been properly coded and cleaned prior to delivery to ONC. For example, the data shall not contain: (1) multiple responses/codes referring to the same intended response; and/or (2) inconsistent responses across questions that do not follow the proper skip pattern (e.g. a mail-respondent reports the hospital does not have access to an exchange arrangement, but the same respondent reports, via an on-line submission that they are participating in an exchange and activity exchange data.)

V. Public Availability The recipient must make available to the public the micro-level data at a fee schedule designed to recoup remaining costs of conducting the survey. The schedule for public availability is governed by this document’s terms and conditions. The purpose of public availability is to allow independent researchers to examine health IT adoption and use, as well as its relationship in improving the quality and cost of health care.

VI. Goal Description, Standards, Schedule & Deliverable Table

The table below identifies specific milestones to support the execution of the cooperative agreement and the due date by which the milestones will be met.

Task Deliverable Due Date Goal 1 Cooperative Agreement & Work Plan

Overall cooperative agreement management ensures successful and timely performance by providing the technical and functional activities required by the cooperative agreement

Continuous

Subgoal1.1: Initial Meeting Meeting minutes/summary inclusive of Work Plan discussions during initial meeting

Within seven (7) working days of the initial meeting

Subgoal 1.2: Work Plan

Draft Work Plan is appropriate for accomplishing the goals and includes the schedule, the data collection plan, and general insights on the direction of this year’s survey.

Within seven (7) working days of the initial meeting; Draft work plan reflects the discussion from the initial meeting. ONC staff will provide comments/approval of the plan within five (5) working days.

Subgoal 1.3: Final Work Plan The recipient shall produce a final work plan reflecting feedback received from ONC on the Draft Work Plan

Within (7) working days of receipt of ONC feedback, the recipient must provide a Final Work Plan that reflects the feedback received.

Goal 2: Update Survey Instrument

The recipient shall gain insight from the Project Officer and other applicable representatives from ONC to help determine relevant subject matter for the given survey year. The recipient will consider this insight to capture the most relevant data and maintain data continuity across years.

October 2017

Goal 3: Survey Instrument Production and Data Collection

Subgoal 3.1. Update the web-based survey instrument based on product of Goal 2.

Web-based instrument enables sound data collection

October 2017

Task Deliverable Due Date

Subgoal 3.2. Mail the initial request to complete the survey online or by returning the completed instrument

Mail-based instrument enables sound data collection

October 2017

Subgoal 3.3. Contact non-respondents by email and telephone to encourage participation.

ONC is provided examples of AHA email follow-up to non-respondents; respondents gained through AHA follow-up are identified in the data

October 2017 – February 2018

Subgoal 3.4. Complete and finalize data collection

Final response rate exceeds 50 percent of all non-federal acute care hospitals

February 2017

Goal 4: Data Delivery

Subgoal 4.1. Preliminary Data File

ONC receives a preliminary data file when responses total roughly half the expected number of respondents.

January 2018

Subgoal 4.2. Final Data File

Data file is delivered in an approved format and on time.

Accompanying the delivery shall be the most relevant year of AHA general hospital census data, for the purposes of added characteristics for responding hospitals.

March 2018

Subgoal 4.3. Data Quality

The recipient shall ensure all data have been properly coded and cleaned prior to delivery to ONC.

The data shall not contain multiple versions of “like” responses and/or obvious inconsistencies

March 2018

Goal 5: Public Availability Data file is made available to the public at a fee schedule designed to recoup remaining costs of data collection effort

See Terms and Conditions

Note: The recipient will be expected to meet the goals and due dates listed in this table annually throughout the duration of contract.

Performance Goals/Program Milestones A performance goal/program milestone is a target level of performance expressed as a tangible, measurable objective, against which actual achievement can be compared. The performance goals/program milestones associated with this FOA, and ensuing award, are as follows:

Project Goals

1. Successfully capture a statistically representative sample of the U.S. hospital population.

To be consistent with past implementations, the survey instrument should have a response rate of no less than 60%. Individual questions in the survey should have a response rate of no less than 85%.

2. The survey should continue to capture trend data on key health IT measures.

Key health IT measures include the adoption of Basic electronic health records; the adoption of functionalities that meet the criteria of the first two stages of the CMS EHR Incentive Programs; exchange of health information (i.e. laboratory results, radiology reports, medication histories, and summary of care records); the capability to find, send, receive, and use health information from sources outside the hospital, and the adoption of functionalities for patient engagement.

3. The timely release of the data.

In order to best compare the progress of health IT adoption and use, the survey should be conducted over a similar time period each year. ONC expects the results of the data collection no later than March of the fiscal year in which the survey was administered.

B. Funding Opportunity Award Information

Key Award Parameters

Title: Tracking Electronic Health Record Adoption, Use, and Related Insights in

U.S. Hospitals

Federal Funding Agency: Department of Health and Human Services

Office of the National Coordinator for Health Information Technology

Announcement Type: Cooperative Agreement

Application Type: Non-Competing Continuation Funding Opportunity Announcement Number: NAP-AX-17-001

Catalog of Federal Domestic Assistance (CFDA) Number: 93.851

Eligible Applicants: The American Hospital Association (AHA)

Legislative Authority: Consolidated Appropriations Act, 2017, Pub. L. No. 115-31, Division H, Title II and Title XXX, §§ 3001 (c)(2) and 3011 of the Public Health Service Act

Approximate Amount of Available Funding (inclusive of direct and indirect costs) : $105,000

Anticipated Number of Awards: 1

Approximately Amount of Each Award: $105,000

Project Period: September 13, 2017 to September 12, 2021

Budget Period(s): September 13, 2017 to September 12, 2018

Funding of future non-competing continuation awards is conditioned on the availability of funds, satisfactory progress by the recipient, and an awarding office determination that continued funding of the award is in the best interests of the Government.

Cost-Sharing Requirements: There is no cost sharing or match requirement for this award.

Program Income: In the event program income is generated, there are four potential ways in which ONC may require that a recipient apply program income as specified in the Notice of Grant Award (NGA): 1) deduct it from total allowable project/program costs to determine the net allowable costs on which the Federal share of costs is based; 2) add it to funds otherwise available for the project, generally resulting in an increase to the total approved budget; 3) use it to meet a matching or cost sharing requirement; or 4) a combination of these alternatives.

Costs paid by program income generally are subject to the applicable cost principles and other Federal requirements and must be disbursed for project purposes before requesting additional payments of Federal funds. In the event program income remains at the end of the award, the additional income is considered part of the award funding and must be returned to ONC.

Intergovernmental Review This program is excluded from Executive Order 12372.

I. Sole Source Justification

The AHA has an ongoing data collection effort in place designed to capture information on the adoption and use of electronic health records, as well as users’ attitudes towards them in U.S. hospitals. Since 2008, ONC has supported the data collection and acquired the resulting data through a single-source cooperative agreement.

The AHA Annual Survey of Hospitals collects data from more than 6,300 hospitals through the U.S.

This data is a primary resource for government agencies and has been used by the Centers for Disease Control and Prevention, the U.S. Census Bureau, and CMS. The IT Supplement currently reaches more than 3,500 hospitals in the U.S. The IT Supplement is a separate collection effort from the AHA’s general census tracking survey project that has been conducted continuously since 1946.1 Over this time span, the general census tracking survey has enjoyed an average response rate in excess of 75 percent.

Such a high level of response is exceptional for a voluntary survey that includes both member and non-member hospitals. Building on the success of the general survey, the response rates for the IT Supplement have exceeded 60 percent each year since its inception, an exemplary response rate for a comparatively newer data collection effort.

As the leading acute care hospital membership organization (approximately 80 percent of non-federal acute care hospitals are members), the AHA is uniquely suited to build on the response rate successes of prior years. Its credibility and reputation as a hospital advocacy and research center are unmatched by any other organization. In addition, the AHA has more than 60 years of experience in survey development and design and effective data collection through mail-based, and now Internet-based, efforts.

In an effort to measure key components of interoperability, ONC has made it a priority to measure health care providers’ ability to electronically send, receive, find, and integrate information received from outside sources. Without funding to supplement the cost of data collection, the AHA would not conduct an IT survey of this scope. ONC’s input on the survey instrument also allows the agency to

1 American Hospital Association.http://www.ahadataviewer.com/ http://www.ahadataviewer.com/ track key performance measures regarding the interoperable exchange of health information by hospitals. The AHA’s IT Supplement is the only known source that tracks key performance measures regarding the interoperable exchange of health information by hospitals. Our national progress on interoperability also has direct implications on the success of federal initiatives such as delivery system reform and achieving “widespread interoperability” as outlined in MACRA.

Tracking and reporting on progress allows us to know where we are collectively starting from, how much progress we have made over time, and whether we have met important milestones. In addition, the AHA’s IT Supplement has the capability to track specific functionalities included or under consideration for future inclusion in federal programs (such as meaningful use). ONC’s ability to provide input on the content of the IT Supplement to measure interoperability and EHR functionalities is critical to informing and evaluating federal health IT policies and programs.

This survey has served the public good in that it has been the foundation of important public research on EHR adoption, as well as examining the impact EHR use has on the quality and efficiency of care in inpatient settings. Examples of such studies include Holmgren et al. 2016, Lammers et al. 2016, Walker et al. 2016, and McLaughlin et al. 2015,.i,ii,iii,iv

II. Proposal Criteria

Applicant must address the following in their proposal:

How the recipient will update the survey and the web-based survey tool to collect health IT information among U.S. hospitals;

How will the survey instrument be administered;

How the recipient plans to achieve a statistically representative response rate;

How the data collected will be reviewed and cleaned for quality; and How the data will be delivered to ONC.

III. General Funding Requirements

The application must address the following requirements:

Adoption of electronic health records;

Find, send, receive, and use of electronic exchange of health information;

Adoption and use of electronic health record functionalities that correspond with the criteria for the Centers of Medicare & Medicaid (CMS) Electronic Health Record Incentive Program; and Delivery of data within a timely manner.

Key Dates Milestone Date

FOA Released

June 6, 2017

Applications Due

July 5, 2017

Anticipated Award Date

September 13, 2017

Anticipated Project Start Date

September 13, 2017

Roles and Responsibilities Under a Cooperative Agreement The funding instrument used for this program will be the cooperative agreement, an assistance mechanism, in which substantial ONC programmatic involvement is anticipated during the project period. Under the cooperative agreement, the ONC purpose is to support and stimulate the recipients’ activities by involvement in, and otherwise working jointly with, the recipient in a partnership role; it is not to assume direction, prime responsibility, or a dominant role in the activities. Consistent with this premise, the dominant role and prime responsibility resides with the recipient for the project as a whole.

To facilitate appropriate involvement, during the period of this cooperative agreement, ONC and the recipient will be in contact monthly and more frequently when appropriate.

Specific tasks and activities may be shared between the recipient and ONC include, but not limited to:

Review and approval of the work plan and all other deliverables submitted to meet the goals of the project (identified in the Deliverable Table)

Providing tactical guidance and feedback during project execution

Engaging with leadership of the organization, as necessary, to ensure successful execution of the cooperative agreement.

C. Eligibility Information

See Section B, Funding Opportunity Award Information, for eligibility, cost-sharing, and other key award information.

D. Application and Submission Information

Application Package The following documents comprise, as applicable, the application package. Additional information regarding each of these documents is further provided.

Project Abstract Project Narrative Form SF-424, Application for Federal Assistance Form SF-424A, Budget Information for Non-Construction Programs Form SF-424B, Assurances for Non-Construction Programs Form SF-LLL, Disclosure of Lobbying Activities Budget Narrative Letters of Commitment Proof of Non-Profit Status (if, applicable) Indirect Cost Agreement(s) – including recipient, sub-recipient, and contractors agreements (if applicable)

Appendix A, Tips for Writing a Strong Application, can be used as a resource.

The Project Narrative and Budget Narrative sections of the application must be double-spaced, on 8-1/2” X 11” plain white paper with 1” margins on all sides, and use either Cambria or Times New Roman font size of not less than 11 point. Smaller font sizes may be used to fill in the Standard Forms, exhibits, and figures, though all text in forms, exhibits, and figures must not be smaller than 8 point font.

Project Abstract Applicants shall include a one-page abstract that is no more than 500 words. This abstract is often distributed to the public and Congress and represents a high-level summary of the project. As a result, applicant should prepare a clear, accurate, concise abstract that can be understood without reference to other parts of the application and that provides a description of the proposed project, including: the project’s goal(s), objectives, overall approach, anticipated outcomes, products, and duration.

The applicant shall place the following information at the top of the Project Abstract (this information is not included in the 500 word maximum):

• Project Title

• Applicant Name

• Physical Address

• Contact Name

• Contact Phone Numbers (Voice, Fax)

• E-Mail Address

• Web Site Address, if applicable

Project Narrative The project narrative provides is the most substantive information regarding the proposed project in a clear and concise manner. To that end, the project narrative should address the elements articulated in the Program Description/Purpose and Structure and Approach sections of this FOA. The project narrative should also align with the Performance Goals/Program Milestones and Merit Review Evaluation criteria presented in this FOA (e.g. organizational experience, past performance etc.).

The Project Narrative must be double-spaced, formatted to 8 ½” x 11” (letter-size) pages, 1” or larger margins on all sides, and a font size of not less than 11 point. The maximum length allowed for the Project Narrative is 10 pages. A Project Narrative that exceeds the 10 page limit will not be accepted.

Resumes of Key Personnel, if requested, are not counted as part of the Project Narrative and are not included in the 10 page limit.

Form SF-424, Application for Federal Assistance Appendix B provides line-by-line instructions to complete the form. Please note that the SF-424 is used for a wide variety of Federal grant programs, and Federal agencies have the discretion to require some or all of the information on these forms. Accordingly, when completing the form, please use the instructions in Appendix B in lieu of the standard instructions attached to SF-424.

Form SF-424A, Budget Information for Non-Construction Programs Appendix C provides line-by-line instructions to complete the form. Please note that the SF-424A is used for a wide variety of Federal grant programs, and Federal agencies have the discretion to require some or all of the information on these forms. Accordingly, when completing the form, please use the instructions in Appendix C in lieu of the standard instructions attached to SF-424A. All direct and indirect costs must be allowable, allocable, reasonable and necessary.

Form SF-424B, Assurances for Non-Construction Programs This form contains laws and other assurances applicants must comply with under the discretionary funds programs administered by the Office of the National Coordinator for Health Information Technology.

Please note that a duly authorized representative of the applicant organization must certify that the organization is in compliance with these assurances.

Form SF-LLL, Disclosure of Lobbying Activities This form contains the name and address of lobbying registrants. Please note that a duly authorized representative of the applicant organization must sign the disclosure form. Failure to complete and sign the form may result in civil penalties ranging from $10,000 to $100,000.

Budget Narrative The budget narrative describes how the proposed budget, as articulated in the SF-424A, aligns with the applicant’s project narrative. That is to ensure that costs are realistic (not artificially too low) and reasonable (not inflated) in view of programmatic requirements. Appendix D provides a template to complete the budget narrative populated with sample information.

When more than 33% of a project’s total budget falls under a contractual expense, a detailed budget narrative/justification must be provided for each sub-contractor or sub-grantee. Applicants requesting funding for multi-year grant programs are required to provide a combined multi-year budget narrative/justification, as well as a detailed budget narrative/justification for each year of potential grant funding. A separate budget narrative/justification is also required for each potential year of grant funding requested.

The full Budget Narrative/Justification should be included in the application immediately following the SF 424 forms. The Budget Narrative must be double-spaced, formatted to 8 ½” x 11” (letter-size) pages, 1” or larger margins on all sides, and a font size of not less than 11 point.

Letters of Commitment (If Applicable) Include letters of commitment confirming the support to the project (should it be funded) made by key collaborating organizations and agencies. Any organization that is specifically named to have a significant coordination role in carrying out the project should be considered an essential collaborator such as interstate, intrastate, and regional partners. At a minimum, the letter must explain the demonstrated commitment to the project and how they will advance coordination and collaboration among critical stakeholders. See Appendix E for an example letter of commitment.

Applicants will also provide a letter of commitment from entities that will be responsible for generating reports based on transactional data (e.g. health information service providers, technology vendors, or others). These entities should have the capacity and resources to produce required reports on adoption and use in a timely manner. See Appendix E for an example letter of commitment.

These letters should not be considered as part of the page limit. Signed letters of commitment should be scanned and included as attachments.

Proof of Non-Profit Status Non-profit applicants must submit proof of non-profit status. Any of the following constitutes acceptable proof of such status:

A copy of a currently valid IRS tax exemption certificate.

A statement from a state taxing body, state attorney general, or other appropriate state official certifying that the applicant organization has a non-profit status and that none of the net earnings accrue to any private shareholders or individuals.

A certified copy of the organization’s certificate of incorporation or similar document that clearly establishes non-profit status.

Indirect Cost Agreement(s) Applicants that have included indirect costs in their budgets must include a copy of the current indirect cost rate agreement approved by the Department of Health and Human Services or another federal agency. This is optional for applicants that have not included indirect costs in their budgets. Further, if any sub-contractors or sub-grantees are requesting indirect costs, copies of their indirect cost agreements must also be included with the application.

Application Submission Instructions

1) You must access the electronic application for this program via www.grants.gov. You can search the downloadable application page by the Funding Opportunity Announcement Number NAP- AX-17-001 or CFDA number 93.851.

2) The applicant will be able to download a copy of the application packet and complete it off-line.

In order to complete the application, an organization must have a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number. A DUNS number can be obtained via http://fedgov.dnb.com/webform and typically takes 1 to 2 business days. Please plan accordingly.

3) Completed applications are uploaded into Grants.gov. APPLICATIONS WILL NOT BE

ACCEPTED THROUGH ANY OTHER WEBSITE, AND WILL NOT BE ACCEPTED THROUGH

PAPER MAIL, COURIER, OR DELIVERY SERVICE.

In order to upload applications into Grants.gov:

a) An applicant must be registered in the System for Award Management (SAM), at sam.gov, which requires having a DUNS number. The SAM registration process takes 7 to 10 business days so please plan accordingly. If you have already registered with SAM, but have not renewed your registration in the last 12 months, you will need to renew your registration.

The following website depicts the SAM registration process:

http://www.grants.gov/web/grants/applicants/organization-registration.html

b) An applicant must be registered in Grants.gov which can take several days. To that end, applicants are strongly encouraged to register and test Grants.gov logins and passwords well in advance of the application deadline date. For assistance with www.grants.gov, please contact them at support@Grants.gov or 1-800-518-4726. Resources are available 24 hours a day/7 days a week.

A depiction of the Grants.gov application process can be found at http://www.grants.gov/web/grants/applicants/apply-for-grants.html

4) After electronically submitting your application, Grants.gov will generate an email a tracking number and date of receipt verification confirming that the application was received, the date and time the application was received, and a tracking number. This notification does not ensure that your application could be opened and read -- only that the application was received.

The deadline for the submission of applications under this Funding Opportunity Announcement is 11:59 Eastern Standard Time on July 5, 2017. Applications that fail to meet the application deadline will not be reviewed and will receive no further consideration.

http://www.grants.gov/ http://fedgov.dnb.com/webform http://www.grants.gov/ http://grants.gov/ http://www.grants.gov/web/grants/applicants/organization-registration.html http://www.grants.gov/web/grants/applicants/apply-for-grants.html

Restrictions on Oral Conversations This funding announcement is subject to restrictions on oral conversations during the period of time commencing with the submission of a formal application by an individual or entity and ending with the award of the competitive funds. Federal officials may not participate in oral communications initiated by any person or entity concerning a pending application for a competitive grant or other competitive form of federal financial assistance, whether or not the initiating party is a federally registered lobbyist.

This restriction applies unless:

The communication is purely logistical The communication is made at a widely attended gathering The communication is to or from a federal agency official and another federal Government employee The communication is to or from a federal agency official and an elected chief executive of a state, local, or tribal government, or to or from a federal agency official and the Presiding Officer or Majority Leader in each chamber of a state legislature

The communication is initiated by the federal agency official

E. Application Review Information

Screening Review

Applicants that do not meet the following screening criteria will be eliminated and will not be sent forward for merit review:

The applicant meets the eligibility criteria The application is received by the required deadline through http://www.grants.gov The application contains all required components (e.g. Project Abstract, Project Narrative, SF-424 etc.)

The application meets the formatting and length requirements. The Project Narrative must not exceed 10 pages. The Project Abstract and resumes do not count as part of the Project Narrative length limitation.

Appendices and attachments are not used as a mechanism to exceed page limits of the Project Narrative

Merit Review An independent review panel, of at least three individuals, will evaluate applications that meet the screening criteria identified above. These reviewers will be experts in their field from academic institutions, non-profit organizations, and local and Federal government agencies. Reviewers will review, evaluate, and score applications, in accordance with the criteria identified below:

Criteria:

1. Discussion and Understanding of the Project – 10 points maximum

The applicant demonstrates knowledge and understanding of the adoption of EHRs and survey methodology.

2. Technical Approach – 25 points maximum

The applicant’s approach is succinct and logical in format and demonstrates methods consistent with the tasks to be accomplished. The applicant proposes a clear and detailed approach for collecting and analyzing the survey data. The applicant must clearly identify an approach for verifying the accuracy of the data through audit or other approved means.

3. Personnel Qualification and Past Performance – 50 points maximum

The applicant must demonstrate and provide evidence of experience for the following. All evidence must be provided in the specific format outlined below and be submitted as an appendix to the applicant’s proposal.

3.1: An existing data collection effort on EHR adoption with accompanying survey instrument(s) that have the capacity to track both a “basic” and “comprehensive” electronic health record as defined by Jha et al. 2009.v

3.2: The applicant must also provide evidence of their past work producing this type of reports for other clients and a list of client names and contract information.

4. Management Plan – 15 points maximum

The applicant must provide the names of staff that will be overseeing the analysis of the data and preparation of the ongoing reports.

MAXIMUM TECHNICAL SCORE = 100 POINTS

The application will be reviewed for completeness by the Office of Procurement and Grants, and for responsiveness by ONC. An incomplete application and application that is non-responsive to the eligibility criteria will not advance through the review process. The applicant will be notified that their application did not meet submission requirements.

An objective review panel will evaluate your application according to the criteria listed in the Criteria section above.

Pre-Award Risk Assessment ONC is required to conduct a risk assessment to assess the risk posed by a potential recipient, prior to issuing an award. In doing so, ONC will take into account the applicant’s financial stability, quality of management systems, history of performance, reports and findings from audits, and the applicant’s ability to effectively implement statutory, regulatory, or other requirements imposed on non-Federal entities. To facilitate this assessment, ONC may review information available in systems, such as the Excluded Parties List System, review documentation, such as previous audits, and/or desk reviews or site visits conducted from previous awards. ONC may elect not to fund applicants with management or financial instability that directly relates to the organization’s ability to implement statutory, regulatory or other requirement s (45 CFR Part 75.205.)

F. Federal Award Administration Information

Award Decisions The final award decision will be made by the National Coordinator for Health Information Technology taking into consideration several factors such as the results of the merit review process, results of the pre-award risk assessment, compliance with programmatic and grants management requirements; the reasonableness of the estimated costs, available funding, geographical dispersion, program priorities;

and the likelihood that the proposed project will result in the benefits expected. All applicants will receive a summary of the objective review panel’s assessment of the application’s strengths, weaknesses, and score.

Notice of Grant Award Successful applicants will receive a letter of notification acknowledging that an award was funded, but does not provide authorization for the applicant to begin performance and expend funds associated with the award.

Following this notice, successful applicants will receive a Notice of Grant Award (NGA). The NGA will include, at a minimum, the following:

Legal name and address of the organization or institutions to whom ONC has issued an award Award number assigned by ONC Project period, specifying the amount of time ONC intends to support the project without requiring re-competition for funds Total amount of financial assistance approved by ONC during the project period Budget period, specifying the increments in which the project will be funded, subject to the availability of funds Applicable award terms and conditions Performance goals, indicators, milestones, or expected outcomes (such as outputs, or services performed or public impacts of any of these) with an expected timeline for accomplishment

The successful applicant’s Authorized Representatives will receive the NGA electronically from ONC.

The recipient accepts the award by drawing down funds. By accepting an ONC award, the recipient assumes legal, financial, administrative, and programmatic responsibility for administering the award in accordance with the terms and conditions of the award, as well as applicable laws, rules, regulations, and Executive Orders governing HHS assistance awards, all of which are to be incorporated into the award by reference. Failure to comply with these requirements may result in suspension or termination of the awards and/or ONC’s recovery of award funds.

Terms and Conditions

Incorporated by Reference The NGA is subject to, by reference, the terms and conditions incorporated in the following documents:

45 CFR, Part 75—Uniform Administrative Requirements, Cost Principles, and Audit Requirements

For HHS Awards http://www.ecfr.gov/cgi-bin/text-idx?SID=06a0b0411d1520fae5e2799030e64ebf&node=pt45.1.75&rgn=div5

HHS Grants Policy Statement https://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf

Specific terms and conditions, incorporated by reference above, are further delineated below due to their importance in terms of integrity, achieving programmatic objectives, and/or sound financial stewardship of federal funds.

Performance Reporting ONC Program Progress Reports (PPR) are due semi-annually. The PPR will address, to the extent applicable:

degree to which performance goals were attained (actual performance versus targeted performance) data source and validation method for performance measures opportunities to address performance deficiencies accomplishments next steps challenges barriers recommendations to address challenges and barriers

ONC will provide specific guidance regarding the content and format of the PPR before the reports are due.

Financial Reporting Expenditures must be reported, on a semi-annual basis, using the SF-425, Federal Financial Report (FFR). Reports are due to HHS no later than April 30 of each year the award is active for funds expended between October and March, and no later than October 31 for funds expended between April and September. The semi-annual FFR will be submitted using the Online Data Collection (OLDC) system. ONC will not accept reports sent directly to the ONC Grants mailbox.

The FFR Cash Transaction Report, a subset of the SF-425, Federal Financial Report, is submitted via the Payment Management System (PMS) every calendar quarter for the life of the award. The report must be submitted within 30 days after the end of the quarter (January 31, April 30, July 31, and October 31).

http://www.ecfr.gov/cgi-bin/text-idx?SID=06a0b0411d1520fae5e2799030e64ebf&node=pt45.1.75&rgn=div5 http://www.ecfr.gov/cgi-bin/text-idx?SID=06a0b0411d1520fae5e2799030e64ebf&node=pt45.1.75&rgn=div5 https://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf

Federal Funding and Accountability and Transparency Act of 2006 The Federal Funding Accountability and Transparency Act of 2006 (Transparency Act), includes a requirement for recipients of Federal grants to report information about first-tier sub-awards and executive compensation under Federal assistance awards issued in FY2011 or later. All recipients of ONC grants and cooperative agreements are required to report to the Federal Subaward Reporting System (FSRS) available at www.fsrs.gov on all sub-awards over $25,000.

Federal Awardee Performance and Integrity Information System (FAPIIS) As of January 1, 2016, recipients of Federal grants and cooperative agreements are subject to new mandatory disclosure requirements. Recipients that have Federal contracts, grants, and cooperative agreement awards with a cumulative total value greater than $10,000,000 must disclose in FAPIIS, semiannually, any information about criminal, civil, and administrative proceedings for the most recent five-year period in connection with the award or performance of a grant, cooperative, agreement, or procurement contract from the Federal Government. All information posted in FAPIIS on or after April 15, 2011, except past performance reviews required for Federal procurement contracts, will be publicly available.

Funding Restrictions Funds cannot be used for the following purposes:

To supplant or replace current public or private funding To supplant ongoing or usual activities of any organization involved in the project To purchase or improve land, or to purchase, construct, or make permanent improvements to any building To reimburse pre-award costs

Conflict of Interest The term “organizational conflict of interest” means that the applicant, including its chief executives, directors, consultants, sub recipients, or any other personnel that are substantially involved in the performance of this assistance agreement, has interests which:

May diminish its capacity to give impartial, technically sound, objective assistance and advise in performing this tasks;

May otherwise result in a biased work product under this assistance agreement; or, May result in an unfair competitive advantage to itself or others.

In accordance with Section 75.112 of Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, all applicants and non-federal entities must disclose, in writing, any potential conflict of interest (COI) that they have with the awarding agency and/or any other pass-through entities. The applicant shall notify the ONC grants management officer (GMO) when they believe an actual or potential COI may exist.

If, after award, a recipient discovers a COI, with respect to the assistance agreement, it shall make an immediate and full disclosure in writing to the ONC GMO. The disclosure shall include identification of the actual or potential conflict, the manner in which it arose, and a description of the action the awardee has taken, or proposed to take, to avoid, eliminate, or neutralize the conflict.

In the event the recipient was aware of an organizational COI, prior to award of the assistance agreement, and did not disclose the conflict to the GMO, or becomes aware of an organizational COI http://grants.nih.gov/grants/guide/url_redirect.htm?id=11170 after award of this assistance agreement and does not disclose the COI within ten (10) days of becoming aware of such conflict, the Government may terminate the assistance agreement and the recipient shall not be entitled to reimbursement of any costs incurred in performing the assistance agreement.

The rights and remedies of the Government, under this term and condition, shall not be exclusive and are in addition to any other rights and remedies provided to the Government under law, regulation, or any other available enforcement mechanism.

Non-Disclosure Requirements The federal award may require the recipient to have access to information relating to any and all aspects of grants management operations that may be of a technical, legal, sensitive and/or confidential nature and which may be the sole property of the U.S. Government. To mitigate risks associated with such access, the recipient shall ensure that all its personnel, including chief executives, directors, consultants, sub recipients, or any other personnel substantially involved in the performance of this award sign a non-disclosure agreement prior to the commencement of any work on the award.

In addition, recipient shall put in place appropriate procedures for the protection of such information and shall be liable to the Government for any misuse or unauthorized disclosure of such information by its personnel.

The rights and remedies of the Government, under this term and condition, shall not be exclusive and are in addition to any other rights and remedies provided to the Government under law, regulation, or any other available enforcement mechanism.

Mandatory Disclosures In accordance with Section 75.113, Mandatory Disclosures, of the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards. The non-Federal entity or applicant for a Federal award must disclose, in a timely manner, in writing to the Federal awarding agency or pass-through entity all violations of Federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award. Failure to make required disclosures can result in any of the remedies described in Section 75.371 of the Uniform Requirements including suspension or debarment.

Records Retention Grantees generally must retain financial and programmatic records, supporting documents, statistical records, and all other records that are required by the terms of a grant, or may reasonably be considered pertinent to a grant, for a period of three years from the date the final FFR is submitted. For awards where the FFR is submitted at the end of the competitive segment, the three-year retention period will be calculated from the date the final FFR, for the entire competitive segment, is submitted.

45 CFR Part 75.361 provides exceptions and qualifications to the three-year retention requirement. For example, if any litigation, claim, financial management review, or audit is started before the expiration of the three-year period, the records must be retained until all litigation, claims, or audit findings involving the records have been resolved and final action taken. This section also specifies the retention period for other types of grant-related records, including indirect cost proposals and property records.

See 45 CFR 75.335for record retention and access requirements for contracts under grants.

Modifications Modifications and/or amendments to the cooperative agreement must be effective upon the mutual agreement of both parties, except where ONC is authorized under the Terms and Conditions of award, 45 CFR Part 75, or…