Notice of Funding Opportunity Assessing Use of Health IT by U.S. Physicians Providing Outpatient Care.pdf

U.S. Department of Health and Human Services

Office of the National Coordinator for Health Information Technology

Notice of Funding Opportunity Assessing Use of Health IT by U.S. Physicians Providing

Outpatient Care

Assistance Listings (CFDA) Number 93.851

Application Due Date: 07/22/2024

Anticipated Award Date: 08/30/2024

Program Contact Jordan Everson Office of the National Coordinator for Health Information Technology 330 C Street SW Washington, D.C., 20201 Jordan.everson@hhs.gov

Grants Contact Carmel Halloun Office of the National Coordinator for Health Information Technology 330 C Street SW Washington, D.C., 20201 ONCGrants@hhs.gov

Table of Contents

Executive Summary

Background

A. Program Description Approach Performance Goals

B. Funding Opportunity Award Information Key Award Parameters Key Dates Substantial Involvement of ONC Informational Session

C. Eligibility Information

D. Application and Submission Information Address to request application package

Content and Form of Application Submission Unique Entity Identifier and System for Award Management (SAM) Funding Restrictions

E. Application Review Information Merit Review Criteria Review and Selection Process Pre-Award Risk Assessment

F. Federal Award Administration Information Award Decisions Federal Award Notices Terms and Conditions Non-Discrimination Legal Requirements for Recipients of Federal Financial Assistance

Performance Reporting Financial Reporting Funding Restrictions Conflict of Interest Non-disclosure Requirements Mandatory Disclosures Health IT Coordination Requirements Intangible Property and Copyrights Records Retention Modifications

Audit Requirements Enforcement Actions/Termination Stevens Amendment 508 Compliance

G. HHS Awarding Agency Contact(s)

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

Through this notice of funding opportunity (NOFO), the Office of the National Coordinator for Health Information Technology (ONC) is accepting applications for a cooperative agreement to measure the use of health information technology (IT) among office-based physicians. The purpose of this cooperative agreement is to measure U.S. office-based physicians' use of interoperable health IT, their experience using health IT, and the impact of health IT on the care they deliver. The cooperative agreement is intended to produce detailed data on interoperability and use of health IT by office-based physicians. These data will result in insights on the implementation and effects of federal health IT policies, allow for identification of disparities in the physicians adopting and using interoperable health IT in terms of the populations they serve or unintended consequences such as increased burden on clinicians resulting from the implementation of health IT, and will inform ONC's ongoing efforts to achieve better health enabled by data through coordination and regulation. The cooperative agreement recipient is encouraged to make the key findings of the cooperative agreement publicly available via their website; peer-reviewed publications in biomedical journals; presentations at conferences; webinars, or blog posts. This cooperative agreement includes an initial performance period of one year and funding for that year of up to $425,000. The cooperative agreement includes 4 additional optional performance years.

Background

According to section 4003 of the 21st Century Cures Act (Cures Act) enacted in 2016, the term 'interoperability,' with respect to health information technology, means such health information technology that— "(A) enables the secure exchange of electronic health information with, and use of electronic health information from, other health information technology without special effort on the part of the user;” "(B) allows for complete access, exchange, and use of all electronically accessible health information for authorized use under applicable State or Federal law;” and "(C) does not constitute information blocking as defined in section 3022(a).”[1]

A number of federal health IT policies have sought to advance the use of interoperable health IT among health care providers over the last decade. In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act incentivized the adoption and use of certified health IT and electronic exchange of health information.[2] The 21st Century Cures Act expanded interoperability by supporting patients’ access and use of their electronic health information through standards-based application programming interfaces (APIs); authorizing creation of an approach to enable nationwide exchange of patient health information; and addressing barriers to interoperability including information blocking. Several implementing regulations were finalized between 2020 and 2024 including ONC’s Cures Act Final Rule,[3] ONC’s Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) Final Rule,[4] the Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access Final Rule,[5] and CMS’s Interoperability and Prior Authorization Final Rule.[6]

These policies are needed to promote interoperability, particularly among physicians providing care to outpatients. In a survey of primary care physicians in 2018, the most commonly cited improvement to health IT that primary care physicians desired was improvements to interoperability.[7] In a 2022 survey of family physicians by the American Board of Family Medicine (ABFM), physicians reported low satisfaction with their electronic health records (EHRs) and substantial variation across EHR developers.[8] EHRs generally are often cited as contributing to physician burnout, and analysis of data from the ABFM indicate that fewer than 20% of family medicine physicians rate the usability of their EHRs as excellent.

Policies to improve interoperability specifically have been recently cited as a means to reduce provider burden associated with EHR use and could impact usability.[9] Yet, the current state of interoperability as experienced by physicians suggests uneven progress towards wide use of technology that makes it easy to provide patient care that is fully informed by information from diverse outside sources, and that continued progress warrants continued monitoring. ABFM data from 2022 indicated that most family physicians were only somewhat satisfied with their ability to access information from other organizations as enabled by interoperable health IT and less than one quarter of physicians indicated it was very easy to use information from outside organizations to treat their patients (forthcoming).

Prominent barriers to the use of that information included missing necessary information and conversely that physicians received too much low value information.

[1] https://www.govinfo.gov/content/pkg/PLAW-114publ255/pdf/PLAW-114publ255.pdf [2] https://www.govinfo.gov/content/pkg/PLAW-111publ5/pdf/PLAW-111publ5.pdf [3] 85 FR 25642 https://www.federalregister.gov/d/2020-07419 [4] 89 FR 1192 https://www.federalregister.gov/d/2023-28857 [5] 85 FR 25510 https://www.federalregister.gov/d/2020-05050 [6] https://www.federalregister.gov/d/2024-00895 [7] Stanford Medicine and the Harris Poll. How Doctors Feel About Electronic Health Records May 31, 2018.

https://med.stanford.edu/content/dam/sm/ehr/documents/EHR-Poll-Presentation.pdf [8] Hendrix, Nathaniel, et al. "Variation in Family Physicians’ Experiences Across Different Electronic Health Record Platforms: a Descriptive Study." Journal of General Internal Medicine (2023): 1-8.

[9] American Medical Informatics Association. 25x5 Policy Reforms to Reduce Documentation Burden.

https://brand.amia.org/m/3383c51896daa888/original/2023-25x5-Policy-Reforms.pdf October 20, 2023.

A. Program Description

The purpose of this cooperative agreement is to support conducting national surveys to assess the extent to which physicians use interoperable health IT and their experience using that technology to support the effective care of their patients. This information will provide important insight into whether Federal policy is having the intended effect of leading to better health enabled by data and to highlight remaining challenges, inadequacies, and pain points to using interoperable health IT to easily use information from diverse sources to provide effective patient care. This information is intended to inform ongoing policy and coordination work by ONC to address remaining barriers to the widespread use of interoperable health IT.

This award will also support the identification of strategies to further measure the use of health IT to expand ONC's approach to evaluating the impact of policy.

Approach

Applicants are required to submit a Project Narrative, as discussed in section D. The Project Narrative should outline the technical approach, which may include, but is not limited to, the following components:

• Sampling strategy

• Data collection strategy, including approach to outreach and response accrual

• Developing content for measurement drawing from prior surveys supported by ONC:

• Approach to ensuring data quality

• Data analysis, interpretation and publication including an approach to coordinating with ONC on production of data products and publications and an approach to presenting findings to ONC staff, leadership and Federal partners.

• Timeline, including data availability, frequency of fielding and planned data delivery schedule

• Approach to making research data available to other entities for research purposes.

• Create a strategy for future measurement of the use of health IT, potentially including the use of data derived from electronic health records or strategies to survey additional groups.

Under this cooperative agreement, the recipient will have primary responsibility for determining a sampling approach, response accrual, and ensuring data quality. ONC and the recipient will collaborate in development of survey content, data analysis, interpretation and publication.

Performance Goals

A performance goal is a target level of performance expressed as a tangible, measurable objective or milestone, against which actual achievement can be compared. The performance goals associated with this notice of funding opportunity (NOFO), and ensuing award, are as follows:

1. Develop survey questions that align with physicians’ understanding and use of health IT to support key measures on interoperability and health IT use by U.S. physicians providing outpatient care.

2. Ensure that survey questions are developed so that they will result in high quality and valid data that reflects physicians' perspectives.

3. Collect survey responses from U.S. physicians providing outpatient care to produce national level estimates on key health IT measures with a response rate over 50%.

4. Collaborate and coordinate with ONC on the analysis and interpretation of results, and publication of written products that assess physicians’ use of interoperable health IT and their experience using that technology to support the effective care of their patients (e.g., assess interoperability and health IT use by U.S. providing outpatient care).

5. Develop a strategy for continued valid and representative measurement of the use of health IT.

B. Funding Opportunity Award Information

Key Award Parameters

Funding Opportunity Title: Assessing Use of Health IT by U.S. Physicians Providing Outpatient Care

Federal Funding Agency: Department of Health and Human Services

Office of the National Coordinator for Health Information Technology

Award Type: Cooperative Agreement

Application Type: New

Funding Opportunity Number: NAP-AX-24-001

Catalog of Federal Domestic Assistance (CFDA) Number: 93.851

Legislative Authority: H.R. 2882 Further Consolidated Appropriations Act, 2024Public Law

118-47

Approximate Amount of Available Funding (inclusive of direct and indirect costs) :

Anticipated Number of Awards: 1

Approximate Amount of Each Award: $425,000

Project Period: 08/30/2024 through 08/29/2029

Budget Period(s): 08/30/2024 through 08/29/2025

Elligible Applicants: Eligible applicants include domestic public or private, non-profit or for-profit entities.

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.

Key Dates

Milestone Date NOFO Released

06/14/2024

Informational Session

06/20/2024

Letter of Intent to Apply Due

06/28/2024

Applications Due

07/22/2024

Anticipated Award Date

08/30/2024

Anticipated Project Start Date

08/30/2024

Substantial Involvement of ONC

The funding instrument used for this program will be a cooperative agreement, an assistance mechanism in which substantial ONC programmatic involvement is anticipated during the project period. Under a cooperative agreement, ONC’s purpose is to support and stimulate the recipient’s activities by involvement with the recipient; 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, when appropriate, more frequently.

ONC involvement will include:

• Guidance on sampling approach and data collection strategy

• Collaboration to develop content for measurement

• Guidance on timeline, and data quality assurance approach

• Collaboration on data analysis, interpretation and publication

• Participation in the selection of key personnel, such as consultants

• Review and approval of substantive provisions of proposed sub awards or contracts

• Review and approval of deliverables

• Guidance and feedback during project execution

• Collaboration in developing an ongoing measurement strategy

Informational Session ONC will conduct an informational session, via a webinar, to:

• Discuss the background, purpose, scope, terms and conditions and other provisions in the NOFO

• Explain the eligibility and application requirements

• Describe the application review process

• Provide an opportunity for interested parties to ask questions

Further details about the informational session – including the date, time, and instructions for joining – are available at https://us06web.zoom.us/meeting/register/tZ0ocuGvrjsjGdAfnNIZvAKg7G_vK3YTcLO8.

To ensure that ONC addresses all comments and questions regarding this announcement during the information session, please submit any comments and questions, via email, to PhysicianHITSurvey@hhs.gov.

Letter of Intent

Although not required, applicants are strongly encouraged to submit a non-binding e-mail letter of intent to apply for this funding opportunity. This letter of intent will assist ONC in planning for the application review process.

The Letter of Intent is requested by 11:59 P.M. Eastern Standard Time on June 28, 2024 and should be sent to PhysicianHITSurvey@hhs.gov. The notice should identify the name of the applicant organization, the city and state in which the applicant organization is located, and the Notice of Funding Opportunity title and number.

C. Eligibility Information

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

D. Application and Submission Information

Address to Request Application Package

You may obtain an application package electronically by accessing Grants.gov at http://www.grants.gov/. You can find it by searching on the CFDA number shown on the cover page of this funding opportunity. If you have problems accessing the application or difficulty downloading, contact:

Procurement and Grants Division Email: oncgrants@hhs.gov

Content and Form of Application Submission

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

• 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 must 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. Personal identifying information should be excluded from the abstract.

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 the most substantive information regarding the proposed project in a clear and concise manner. The project narrative should also align with the Performance Goals (see section A.) and merit review evaluation criteria (see section E.) presented in this NOFO.

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 20 pages. A Project Narrative that exceeds the 20 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 20 page limit.

Your project narrative should include the following components. These components will be counted as part of the page limit. The suggested lengths of the sections, given below, are guidelines to help applicants create a balanced document, and not mandatory restrictions:

Discussion and Understanding of the Project (1-2 pages) This section should describe the applicant’s understanding of the project and the broader context related to the goals of the cooperative agreement. This would include a brief discussion about the current state of health IT including describing the current health IT policy and regulatory landscape related to the goals of the cooperative agreement.

Personnel Qualification and Past Performance (2-5 pages) This section should describe the applicant’s personnel qualification and past performance demonstrating experience consistent with successfully meeting the goals of the cooperative agreement.

Management Plan and Budget (1-2 pages) This section should discuss the overall project management approach and the types and level of staffing, resources and infrastructure in place to support measurement. This should include an approach to maintaining a project plan and ensuring program goals and milestones are met. This should include identifying the roles of key staff, identifying the role of subcontractors and/or any other external consultants or subject matter experts, and the approach to collaboration and communication strategy with ONC, including provision of progress reports. The applicant must provide the names of staff that will be overseeing the analysis of the data and preparation of the ongoing reports. This section should also include the proposed budget.

Technical approach (5-10 pages) This section should describe the applicant’s methodological approach to meet the goals of the cooperative agreement. The following aspects should be addressed in this section:

Sampling Strategy This section should describe the applicant’s approach to obtain data on a national sample of U.S.

physicians (i.e., not centered on specific states or regions) that provide outpatient care. This section should include discussion on how the applicant will collect data that represent diverse range of practice settings (e.g. rural vs. urban, specialty type, practice group size, etc). This section should describe how the applicant will target physicians providing direct patient care as opposed to those in specialties that do not provide such care and physicians solely engaged in other work (e.g., management or research).

Data Collection Strategy This section should describe your organization’s approach for data collection. This discussion should include a description of the method (qualitative, quantitative survey) and modality (e.g. telephone, mail, or online) and its strengths and limitations. The discussion should also include the applicant’s approach for identifying and targeting physicians, as opposed to front desk or office staff. This discussion should include any anticipated challenges in reaching the target population, and strategies that may be used to address these challenges. A description of your organization’s outreach efforts should be included.

Achieving a high response rate is a widely acknowledged best practice that can reduce risks of non-response bias, and on average surveys of health professionals have accrued a response rate of 50%.[10- 11] This section should describe your organization’s strategy for achieving a high response rate equivalent to or greater than that average such as your approach for following-up with non-respondents to the data collection approach.

Developing Content for Measurement This section should describe how your organization plans to develop and finalize measures to be included in the data collection to meet the goals of the cooperative agreement. The applicant should list the prioritized set of topics and measures. Examples of topics for consideration include:

• Use of certified health IT;

• Health information exchange activity and interoperability of health IT systems (e.g., ability to in query (or find), send, receive, incorporate and use electronic health information from sources outside their healthcare organization as described in ONC publications);

• Experience with, satisfaction with, benefits from, and barriers to interoperability

• Health IT usability and provider burden associated with health IT;

• Responsible use of Artificial Intelligence in health IT;

• Use of health IT functionalities for patient engagement;

• Telehealth; and

• Use of health IT to support public health activities

Data Quality and Delivery The applicant should describe how they plan to ensure the selected measures will be well understood and result in valid responses, such as through the use of recognized best practices in survey research1..

This section should include a description of the processes for properly coding and cleaning the final dataset and processes in place to assure the quality and completeness of the data, including the types of quality checks performed. This section should describe how the applicant will provide the final data set and related documentation, including formats and level of information.

1 https://aapor.org/standards-and-ethics/best-practices/#1668112232393-81909bee-60db

Data Analysis, Interpretation and Publication The applicant should describe their approach to analyzing and interpreting the data and disseminating the results. This section should describe the use of any subject matter experts, consultants or expert panels in informing interpretation of results. This section should also include a description of the data analysis plan and strategy for disseminating data findings. This section should describe an approach to coordinate and collaborate with ONC on data analysis, production of data products, and publications to highlight the recipient’s key findings. Collaboration and, at minimum, coordination are encouraged to avoid duplicative efforts by the recipient and ONC. This section should also describe an approach to interpreting and presenting findings to ONC staff, leadership and Federal partners, which may include the use of an expert panel to interpret the data.

[10] Meyer, Vincent Maurice, et al. "Global overview of response rates in patient and health care professional surveys in surgery: a systematic review." Annals of surgery 275.1 (2022): e75-e81.

[11] Cho, Young Ik, Timothy P. Johnson, and Jonathan B. VanGeest. "Enhancing surveys of health care professionals: a meta-analysis of techniques to improve response." Evaluation & the health professions 36.3 (2013): 382-407.

Timeline The applicant should describe a cadence or timeline for the key project milestones, including survey content development, data collection, data quality assurance, data delivery, and analysis. The timeline should reflect the first year of the project period and should be able to be projected over the full project period.

Approach to making data available to others The applicant should describe how they plan to make a de-identified or limited data set available for use by the public, including any governance and review processes to provide access to that data as the applicant believes appropriate.

Strategy to address gaps in measurement The applicant should develop a plan to identify and describe gaps in the survey based on the sampling strategy, data collection strategy or analysis of the first year of data collection. For example, the applicant should propose a strategy to assess if a sampling strategy focuses on specific specialties, or if data collection over (or under) represents physicians from some practice settings. The application should describe strategies to address these gaps such as the use of alternative data sources, partnerships with other organizations or alternative outreach approaches. This plan may also include the use of other data sources, such as metadata derived from health IT, to assess physicians’ use of health IT.

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.

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-recipient. Applicants requesting funding for multi-year award 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 federal award funding. A separate budget narrative/justification is also required for each potential year of federal 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.

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. If your organization does not engage in lobbying, please insert “non-applicable” on the document and include the authorized representative name, contact information, and signature.

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 are not considered as part of the total 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-recipients are requesting indirect costs, copies of their indirect cost agreements must also be included with the application. Cost allocation plans are not accepted.

Application Submission Instructions

1) You must access the electronic application for this program via http://www.grants.gov. You can search the downloadable application page by the Notice of Funding Opportunity Number NAP- AX-24-001 or CFDA number 93.851.

2) Applicants will be able to download a copy of the application packet and complete it off-line. In order to complete the application, In order to complete the application, an organization shall have a Unique Entity Identifier (UEI). A UEI can be obtained via registering at http://SAM.gov and typically takes 7 to 10 business days. Please plan accordingly.

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

ACCEPTED THROUGH ANY OTHER WEBSITE, AND WILL NOT BE ACCEPTED

THROUGH PAPER MAIL, E-MAIL, COURIER, OR DELIVERY SERVICE.

In order to upload applications into Grants.gov:

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

b) Please note that entities registering in SAM shall submit a notarized letter appointing their authorized Entity Administrator. This will not impact the registration approval process, but is required as part of your registration. For additional information, read SAM’s updated FAQs to learn more about changes to the notarized letter review process and other system improvements. The following website depicts the SAM registration process:

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

c) An applicant shall 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 is 12:00PM Eastern Standard Time on July 22, 2024. Applications that fail to meet the application deadline will not be reviewed and will receive no further consideration.

ONC determines whether an application has met the deadline based on the time of submission indicated in grants.gov.

Unique Entity Identifier and System for Award Management (SAM)

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.

b) Please note that entities registering in SAM must submit a notarized letter appointing their authorized Entity Administrator. This will not impact the registration approval process, but is required as part of your registration. For additional information, read SAM’s updated FAQs to learn more about changes to the notarized letter review process and other system improvements.

c) An applicant must provide a unique valid entity identifier on the application. ONC may not make a federal award to an applicant until the applicant has complied with all applicable unique entity identifier and SAM requirements and, if an applicant has not fully complied with the requirements by the time ONC is ready to make an award, ONC may determine that the applicant is not qualified to receive a federal award and make an award to another complying applicant.

The following website depicts the SAM registration process:

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

Funding Restrictions

Program Income

There are four potential ways in which ONC may require that a recipient apply program income as specified in the NGA: 1) deduct it from total allowable 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 program, 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 program 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. If program income is generated, the recipient must use the additive method.

Intergovernmental Review

Applications for this funding opportunity are not subject to review by states under Executive Order 12372, “Intergovernmental Review of Federal Programs” (45 CFR 100). Please check box “C” on item 19 of the SF 424 (Application for Federal Assistance) as Review by State Executive Order 12372, does not apply to this funding opportunity.

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

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.

Criteria

Reviewers will review, evaluate, and score applications, in accordance with the criteria identified below:

1.Discussion and Understanding of the Project – 10 points maximum The applicant demonstrates knowledge and understanding of key issues related to adoption and use of interoperable health IT by physicians and survey methodology to address those issues. The application addresses the purpose and objectives of this NOFO.

2.Personnel Qualification and Past Performance – 40 points maximum The applicant must describe and provide evidence of its experience for the items listed below. All evidence must be submitted as an appendix to the applicant’s proposal.

2.1: Prior data collection efforts on physician experience using health IT at the national level among U.S. physicians, and the quality of that data collection effort, including whether it generated a high response rate.

2.2: Evidence of past work producing reports and publications on health IT from these past data collection efforts.

2.3 Data collection and survey development infrastructure and resources to conduct a national level survey of U.S. physicians providing outpatient care.

2.4 Relationships with physicians or physician organizations to facilitate survey develop and recruitment of respondents.

2.5 Applicant has physicians on staff with subject matter expertise in health IT and interoperability that can support measurement development needed for this cooperative agreement.

3.Management Plan – 10 points maximum The applicant describes a clear and workable plan to meet program goals and ensure program milestones are met. The applicant provides the names of staff that will be involved in the management and technical approach of this project, including the sampling approach, developing the content of the survey, overseeing the analysis of the data and preparation of the ongoing reports. The applicant describes a workable plan and timeline for managing and evaluating development of survey content. The applicant describes an effective plan for managing survey data collection and delivery of data to ONC. The applicant provides a proposed timeline for fielding the survey. The applicant describes their approach to collaborate with ONC on development of written products, including proposed roles and responsibilities of personnel.

4.Budget—15 points maximum The applicant budget is sufficiently detailed to explain how they will use the award funds to conduct the survey. The applicant’s proposed allocation of the budget is in line with the goals of the cooperative agreement.

5.Technical Approach – 25 points maximum The applicant’s approach is succinct and logical in format and demonstrates methods consistent with the goals to be accomplished. The applicant proposes a clear and detailed approach for developing and finalizing survey content so that the survey will result in high quality and valid data that reflects physicians' perspectives. The applicant proposes a detailed and robust approach to collecting information care to produce national level estimates on key health IT measures with a response rate over 50%. The applicant describes an analysis and dissemination plan likely to result in wide use of the results by policymakers and researchers. The applicant clearly identifies an approach for verifying the validity and accuracy of the data through cognitive interview, audit or other means. The applicant describe an approach to developing a strategy for valid and representative measurement of the use of health IT that describes how such an approach would complement the survey that the applicant plans.

MAXIMUM TECHNICAL SCORE = 100 POINTS

Review and Selection Process Applicants must meet the following screening criteria. Any applications that do not meet these 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 20 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

• It is the Grants Management Officer’s (GMO) discretion to continue the review process for an ineligible application if it is in the best interests of the government to meet the objectives of the program.

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 requirements as outlined in 45 CFR 75.205.

For any Federal award under a notice of funding opportunity, if the HHS awarding agency anticipates that the total Federal share will be greater than the simplified acquisition threshold on any Federal award under a notice of funding opportunity may include, over the period of performance (see §75.2 Simplified

Acquisition Threshold), this section must also inform applicants: i. That the HHS awarding agency, prior to making a Federal award with a total amount of Federal share greater than the simplified acquisition threshold, is required to review and consider any information about the applicant that is in the designated integrity and performance system accessible through SAM (currently FAPIIS) (see 41 U.S.C. 2313); ii. That an applicant, at its option, may review information in the designated integrity and performance systems accessible through SAM and comment on any information about itself that the HHS awarding agency previously entered and is currently in the designated integrity and performance system accessible through SAM; iii. That the HHS awarding agency will consider any comments by the applicant, in addition to the other information in the designated integrity and performance system, in making a judgment about the applicant’s integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in §75.205.

F. Federal Award Administration Information

Award Decisions

The final award decision will be made by the National Coordinator for Health Information Technology, or an authorized designee, 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, any mandatory statutes or regulations associated to this program; and the likelihood that the proposed project will result in the benefits expected. All applicants will receive a summary of the independent review panel’s assessment of the application’s strengths, weaknesses, and score.

Federal Award Notices

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 Award (NOA). The NOA 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, objectives, or expected outcomes (such as outputs, or services performed or public impacts of any of these) with an expected timeline for accomplishment

The successful applicants’ Authorized Representatives will receive the NOA 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

Administrative and National Policy Requirements Awards issued under this announcement are subject to 45 CFR Part 75 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards currently in effect or implemented during the period of award, other Department regulations and policies in effect at the time of award, and applicable statutory provisions. The Code of Federal Regulations (CFR) is available at www.ecfr.gov.

An application funded with the release of federal funds through a grant award does not constitute, or imply compliance with federal regulations. Funded organizations are responsible for ensuring that their activities comply with all applicable federal regulations.

Non-Discrimination Legal Requirements for Recipients of Federal Financial Assistance

Per Executive Order (E.O.) 13985 entitled Advancing Racial Equity and Support for Underserved Communities Through the Federal Government (Jan. 20, 2021), should you successfully compete for an award, recipients of federal financial assistance (FFA) from HHS shall administer their programs in compliance with federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age and, in some circumstances,…