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Section III: Steps Taken to Increase Proactive Disclosures

Both the President and Attorney General focused on the need for agencies to work proactively to post information online without waiting for individual requests to be received. 

Describe here the steps your agency has taken both to increase the amount of material that is available on your agency website, and the usability of such information, including providing examples of proactive disclosures that have been made during this past reporting period (i.e., from March 2012 to March 2013).  In doing so, answer the questions listed below and describe any additional steps taken by your agency to make and improve proactive disclosures of information. 

  1. Provide examples of material that your agency has posted this past year.
    More than 40 new documents were posted by ASPE, consisting of reports to Congress, statistical reports, issue papers and feasibility studies on a range of topics (for example, coordinating publicly assisted housing with physical and mental health services, designing research to evaluate the Long-Term Care Registered Apprenticeship Programs administered by the U.S. Department of Labor, supporting adoption of health IT, estimating federal child care assistance eligibility and receipt, and creating a national child abuse registry); data summaries (for example, a summary of Census income and poverty data, and a compilation of economic literature on cost containment and health care innovation); research and issue briefs analyzing the impact of the Affordable Care Act on particular segments of the population (for example, women, immigrant families, homeless families, young adults, and children); and guides (for example, describing HHS-sponsored data collection systems and surveys, describing HHS policies and principles regarding scientific integrity, and explaining how to maximize the utility of evaluation findings).  

    The OCR, within OS, added these and other materials to its Health Information Privacy home page: State Attorneys General (SAG) training videos, slides, and computer-based modules on the Health Insurance Portability and Accountability Enforcement Act (HIPAA), which will help State Attorneys General implement their enforcement authority under the Health Information Technology for Economic and Clinical Health (HITECH) Act; an audit protocol used in a pilot program in which 115 HIPAA covered entities were audited to assess their privacy and security compliance, which has been referenced by covered entities and business associates as a best practice/standard of what to expect if their organization were to be audited by OCR; updates to a list of breaches of unsecured protected health information affecting five-hundred or more individuals; selected major civil rights compliance agreements; and major corrective action closure letters.  The OCR also published a Federal Health Care Conscience Protection Fact Sheet; Federal Health Care Conscience Protection PowerPoint; links to 2010 ADA Standards for Accessible Design; links to the U.S. Department of Justice Title II Technical Assistance Manual and Best Practices Tool Kit for State and Local Government; National HIV/AIDS Strategy Blog Posts Badge; HIV/AIDS Federal News Badge; Testing Makes Us Stronger Badge; Environmental Justice webpage; Section 1557 LGBT Questions and Answers; and OCR Training of HRSA and its Grantees.

    Other Staff Divisions within the OS also posted new material this reporting period.  For example, ASFR posted information on the HHS budget, financial reports, and grant information, including the HHS Operating Plans (current and archived), HHS Budget and Performance, and the Agency Financial Report.  The ASFR posted brief reports on overseas trips by staff and the Secretary, reports about their participation in international conferences, and the minutes and agendas of international flu vaccine workshops.  New information was added to the OGC web site about the OGC mission, organization, key personnel, and careers.  The OMHA posted an ongoing list of appeals and claim receipts.  The entire OIG website was revamped and now includes all speeches and Hill testimony, new training audio and video podcasts, and the OIG Deadbeat Parents’ listing.

    The CDC FOIA office posted monthly statistics, policies, and purchase card holder listings. 

    Components of CMS posted numerous new materials about their programs for this period.  For example, the Medicare Shared Savings program posted the listing of approved Accountable Care Organizations at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/News.html; the Hospital Value Based Purchasing – Medicare Spending per Beneficiary program made data describing the average spending levels during hospitals’ Medicare Spending per Beneficiary episodes accessible and downloadable from the Hospital Compare website at www.hospitalcompare.hhs.gov/Data/spending-per-hospital-patient.aspx; the End Stage Renal Disease Prospective Payment System website posted key trends from the first year of monitoring, and pre-and post-implementation outcome information, regarding morbidity and mortality, anemia management, bone and mineral metabolism, access infection, and fluid management, at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/Spotlight.html; the Five Star Quality Rating System (CCSQ/SCG) was created to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which the public may want to ask questions, and was posted at http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS.html; CMS Fast Facts, a quick reference statistical summary of annual CMS program and financial data, was posted at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Fast-Facts/index.html; and Medicare Advantage, Part D, and Retiree Drug Subsidy payment data for 2006-2010 was posted at http://www.cms.gov/Medicare/Medicare-Advantage/Plan-Payment/Plan-Payment-Data.html.  The Center for Medicare & Medicaid Innovation, which fosters healthcare transformation by finding new ways to pay for and deliver care that can lower costs and improve care, posted information about Health Care Innovation Awards at http://innovations.cms.gov/initiatives/Innovation-Awards/index.html, information about Pioneer Accountable Care Organizations at http://innovations.cms.gov/initiatives/ACO/Pioneer/index.html, and information about the Federal Coordinated Health Care Office Memorandum of Understanding between CMS and the Commonwealth of Massachusetts for Federal State Partnership to Test a Capitated Financial Alignment Model for Medicare-Medicaid Enrollees – Demonstration to Integrate Care for Dual Eligible Beneficiaries at https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MassMOU.pdf.  The Center for Clinical Standards and Quality established a website that provides high level results of the surveys conducted by State Agencies captured by the ASPEN System; it provides deficiency information for Nursing Homes at http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationEnforcement/2567report.html.

    Components of the FDA continued to create web pages for specific issues of heightened consumer or media interest to better inform the public without requiring the submission of a FOIA request.  For example, FDA posted extensive information about the multistate fungal meningitis outbreak, the Nut Butter recall, the food thickener recall, pet jerky, egg farm inspections, a new inspections database, and energy drinks.  The FDA also continued to post weekly enforcement reports; recall information; budget records; import refusals; international agreements; product approvals; press releases; tobacco retailer letters; clinical investigator correspondence; warning letters and responses; orders of retention, recall, destruction and cessation of manufacturing of HCT/Ps; agendas, rosters, background packages, and minutes of advisory committee meetings; inspection records and firm responses; field work plans; sample results; FDA monthly performance data (which includes tracking of FOIA metrics); new regulations and guidance for the Center for Tobacco Products; post-approval studies; and FDA Safety Communications for blood and blood products,  tissues and cellular products, and vaccines.  The Center for Tobacco Products, FDA’s newest product center, began posting orders for substantial equivalence and at least 200 grandfather determination letters at the end of the reporting period.

    Using data that health centers are required to report each year, HRSA posted 11 patient profile and quality-of-care tables for each of the 1,100 HRSA-funded community health centers.  Previously, the data was available only through a FOIA request and was provided in the form of a spreadsheet.  Now it is presented online in a user-friendly format that includes percentages. 

    One of the lists most frequently requested from IHS, information about Open Dumps on Tribal Lands, was posted to the IHS Office of Environmental Health and Engineering website, where it is now easily found by the public.  The IHS FOIA office staff members worked with the Office of Information Technology to update the list quarterly and to ensure the documents are easily accessible and downloadable.  The IHS has received positive feedback on the fact that the information is available directly from the internet without the need for a FOIA request. 

    Examples of new data posted by NIH include: exposure data and documentation underlying the exposure assessment used in the epidemiologic risk analyses in the Diesel Exhaust in Miners Study, which are described in five published exposure assessment papers that appeared in the Annals of Occupational Hygiene; two data sets from genome-wide association studies: one study sequenced affected members of melanoma families and identified a novel melanoma predisposition gene, and the other study provides data from a study to discover genome variations among people who are highly resistant to HIV infection; five Pathology Working Group Reports; an illustrative mapping database system designed to facilitate communication and coordination of biomedical research by major government agencies and philanthropic organizations around the world; datasets used in the Deputy Director for Extramural Research’s blog posts; compilations of data, reports, and analyses on NIH extramural programs archived from a variety of NIH sources; and other information provided in communications with the public using social media, such as Twitter, blogs, Facebook and YouTube.

    The most frequently requested records from SAMHSA are contracts and grant applications.  The SAMHSA posted a contract and grant application from the 2012 fiscal year that it anticipated would be of interest to the public.   
  1. Beyond posting new material, is your agency taking steps to make the posted information more useful to the public, especially to the community of individuals who regularly access your agency’s website, such as soliciting feedback on the content and presentation of the posted material, improving search capabilities on the site, creating mobile applications, providing explanatory material, etc.?
    Yes.
  1. If so, provide examples of such improvements.
    The ASPE is revamping the public facing internet page http://aspe.hhs.gov to make it more user-friendly and efficient.  The “searching for reports” feature on the far left tab is now much more prominent, and the search feature is more direct and less confusing.  The ASPE has eliminated some of the extraneous search options to make a cleaner interface. 

    The IOS has been working to improve the current quality of information that is being placed on the web to ensure that the information is written in plain language.  The IOS has updated all of its sites utilizing plain language standards.

    The OGA improved the search capability on www.globalhealth.gov and currently is in the process of adding a new “Voice of the Customer” tool that will give site users the ability to provide immediate feedback on the functionality of the site and the usefulness o the topics presented there.

    The OCR is undergoing a redesign of its website to make posted information more accessible to our website visitors.  The redesign will solicit and incorporate public feedback to improve communication, search function capabilities, and content dissemination for the website’s audience.  The redesign is expected to be completed during FY 2013/2014.  The OCR published new guidance on the HIPAA Privacy Rule’s de-identification standard, and is encouraging feedback and suggestions on methods OCR can use to improve upon that guidance.

    The OGC’s website allows interested members of the public to subscribe to e-mail alerts to learn of new career openings at OGC.  It provides the following:  “Sign Up!  Want to know when a new career opening is available in the HHS Office of the General Counsel?  Subscribe to our Career Openings email alerts!”

    The OIG routinely solicits input from users and internal employees by way of an electronic OIG “Suggestion” box, in addition to using Twitter, YouTube and Podcasts.

    The ACF’s Children’s Bureau is exploring use of a “customer satisfaction” survey for users to evaluate the usefulness of its Child Welfare Information Gateway website.

    The CDC’s FOIA website contains plainly written explanations of FOIA and FOIA exemptions, and offers requesters an online status checker.  The CDC also posts backlog counts on the website each month, providing a running history.  The CDC program staff proactively post information to their websites, thus eliminating the need for duplicative postings on the FOIA website.

    The CMS invites members of the public to submit questions and feedback to CMS at the following URL: https://questions.cms.gov/newrequest.php.  The CMS Data Navigator (http://dnav.cms.gov/) is an easy-to-use, menu-driven search tool that makes the data and information resources of the CMS more easily available.  It can be used to find data and information products for specific CMS programs, such as Medicare and Medicaid, or on specific health care topics or settings-of-care.  Navigator displays search results by data type, making it easier to locate specific types of information (e.g., data files, publications, statistical reports, etc.).  Members of the public can submit email inquiries to the CMS Data Navigator mailbox at: DataNavigator@cms.hhs.gov.

    The FDA enhanced its Warning Letter webpage in response to feedback from the public.  For instance, FDA streamlined the subject matter index so that letters are now easier to find through a subject matter search.  The FDA’s Transparency Taskforce continues to interface with the public regarding access to FDA records; the FDA’s website has a “contact us” button, which invites the public to submit comments and questions via email, mail, or telephone.  The FDA uses “ForeSee” to survey stakeholders and solicit feedback about its website.

    The HRSA conducted limited surveys to determine how to make posted information more useful to the public.  The IHS tested links, performed other checks, and responded quickly to feedback from users, to ensure that the FOIA web site and documents remain easy to read, complete, in accessible formats, and compliant with Section 508 of the Americans with Disabilities Act.

    The NIH is using several tools to improve the usefulness of its posted information: 1) PubReader, which makes the reading experience of scientific journal articles much more user friendly, especially with mobile devices (it fits a journal article to any screen, laptop or tablet and includes thumbnails of all the tables and figures in the paper); 2) the “52 Weeks for Women’s Health” mobile application; 3) a new search capability for the NIH website that includes features such as “Type Ahead Search,” which will recommend the most popular search terms relative to the first few characters typed, as well as “Best Bets” and recommended pages; and, 4) the NIH Director’s Blog, which allows for user feedback and comments in the individual posts.
  1. Describe any other steps taken to increase proactive disclosures at your agency.
    The Representatives of the OS and CMS attended a Smart Disclosure Summit and shared information they learned within the agency.  The summit was valuable in informing agency efforts to design proactive disclosures aimed at helping consumers make well-informed health-related choices and decisions. 

    The OCR coordinated with the Department to issue press releases on major civil rights and HIPAA findings and settlement agreements from completed investigations.  In addition, the OCR used a listserv to notify civil rights subscribers about completed complaint investigations posted to the website.  The OCR also established a listserv to inform the public about Health Information Privacy and Security, FAQs (frequently asked questions), guidance and technical materials.  The listserv included more than 18.000 subscribers.

    The OIG proactively posted any documents it believed would generate public interest.  When OIG noticed a pattern of requests for a certain set of records, it proactively posted the records.

    The FDA posted a list of FOIA contacts in each component on its intranet FOIA webpage, to help ensure that they are included in Open Government discussions.  The FDA discussed proactive disclosure at FOIA training sessions and FOIA Council[1] meetings, and coordinated planned postings between Centers and the Office of Public Affairs.  FDA used social media, such as Facebook and Flickr, to disseminate information to the public (see https://www.facebook.com/FDA and http://www.flickr.com/photos/fdaphotos/ ).  The FDA hosted webinars for the public via its website.  Recent topics included tissue safety and hearing aids (see http://www.fda.gov/AboutFDA/Transparency/Basics/ucm197102.htm).  FDA provided the public with the ability to subscribe to RSS feed notices or sign up to receive automated emails for updates to over 100 different web pages/databases (seehttp://www.fda.gov/AboutFDA/ContactFDA/StayInformed/GetEmailUpdates/default.htm).  For example, more than 67,000 users subscribed to FDA’s Warning Letter webpage; each time the Warning Letter page was updated (at least weekly), those subscribers received an automated email notifying them that the web pages were updated, with a link to the page.

    The IHS FOIA staff updated its FOIA Coordinator listing regularly and in a timely manner when staffing changes occurred, to facilitate Open Government contacts and discussions.  They researched records frequently requested under FOIA and regularly consulted program and Area staff to identify records appropriate for pro-active release, and then assisted program offices in posting records.  For example, they advised several program offices at the Headquarters level regarding information they could contribute to the Frequently Requested Records portion of the FOIA web site or could link to from the FOIA web site; they posted PowerPoint presentations on FOIA and the Privacy Act to explain the differences in their access provisions to the public and for Area FOIA Coordinators to use to train staff in their Areas (the information enabled requesters to be more specific in making their requests and reduced the number of Privacy Act requests made to the FOIA Office); and they worked closely with program offices at the Headquarters and Area levels to educate FOIA staff about  the programs’ records and which information is considered exempt, to ensure that nonexempt information is released to the fullest extent possible.

    Measures described in other parts of this report demonstrate efforts made by NIH to increase proactive disclosures.  The entire NIH community, not just its FOIA community, was dedicated to communicating with the public and to continually improving on the ways in which it communicates with the public.

[1] The FOIA Council is a group of FOIA professionals at FDA that meet approximately once per month to discuss agency-wide FOIA issues and other disclosure-related issues.  Each FDA component has at least one representative on the Council.