[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3607 Introduced in House (IH)]







109th CONGRESS
  1st Session
                                H. R. 3607

  To improve the quality of health care through the implementation of 
  computerized provider order entry systems in hospitals and skilled 
   nursing facilities that will result in a reduction in the rate of 
 medication errors and in redundancies and will create more efficiency.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 28, 2005

 Mr. Sweeney introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
  To improve the quality of health care through the implementation of 
  computerized provider order entry systems in hospitals and skilled 
   nursing facilities that will result in a reduction in the rate of 
 medication errors and in redundancies and will create more efficiency.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``The Future of Healthcare--Granting 
Access to Innovation in America Act (GAIA Act)''.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Medical errors, such as the miscalculation of 
        prescribed dosage amounts and the illegible handwriting of 
        physicians, cause many unnecessary deaths in the United States 
        each year.
            (2) There are 98,000 preventable deaths that occur each 
        year from medication errors in the United States.
            (3) According to a 2004 Health Grades report on patient 
        safety in American hospitals, medication errors are the 6th 
        leading cause of death among patients in hospitals in the 
        United States.

SEC. 3. IMPLEMENTATION OF COMPUTERIZED PROVIDER ORDER ENTRY TECHNOLOGY.

    (a) In General.--The Secretary of Health and Human Services, in 
consultation with the Administrator of the Centers for Medicare & 
Medicaid Services and with the National Health Information Technology 
Coordinator, may make grants to hospitals and skilled nursing 
facilities to carry out demonstration projects for the purpose of 
reducing the rate of medication errors and improving the quality of 
care in the hospitals and skilled nursing facilities by installing or 
upgrading computerized technology that assists in preventing such 
errors and that increases the quality of care through capabilities such 
as the following:
            (1) Providing information on drug-allergy contraindications 
        and interactions between drugs.
            (2) Ensuring that all drug orders are legible.
            (3) Providing physicians and other clinicians with a menu 
        of medications, complete with default doses and a range of 
        potential doses for each medication.
    (b) Requirements Regarding Decision-Support Software.--
            (1) In general.--With respect to the computer technology 
        described in subsection (a) (referred to in this section as 
        ``CPOE technology''), a grant may be made under such subsection 
        only if the applicant involved agrees--
                    (A) for grants made pursuant to subsection 
                (l)(2)(A) to ensure that when the CPOE technology 
                involved becomes operational, the software described in 
                paragraph (2) has been installed for use with the CPOE 
                technology; or
                    (B) for a grant made pursuant to subsection 
                (l)(2)(B) that is an initial grant referred to in such 
                subsection, to ensure that such software is installed 
                for use with the CPOE technology not later than one 
                year after the receipt of the initial grant under 
                subsection (a).
            (2) Description of software.--For purposes of paragraph 
        (1), the software described in this paragraph is computer 
        software that assists physicians and clinicians who order 
        prescription drugs and tests in making medication-related 
        decisions through functions such as the following:
                    (A) Providing computerized advice regarding drug 
                doses, selection, duration, and frequencies.
                    (B) Performing drug-allergy checks, drug-
                laboratory-value checks, and checks on interactions 
                between drugs.
                    (C) Providing reminders with respect to corollary 
                orders or drug guidelines.
                    (D) Incorporating patient-specific or pathogen-
                specific information.
    (c) Requirements Regarding Electronic Medication Administration 
Record.--
            (1) In general.--A grant may be made under subsection (a) 
        only if the applicant involved agrees--
                    (A) for grants made pursuant to subsection 
                (l)(2)(A) to ensure that when the CPOE technology 
                involved becomes operational, the software described in 
                paragraph (2) has been installed for use with the CPOE 
                technology; or
                    (B) for a grant made pursuant to subsection 
                (l)(2)(B) that is an initial grant referred to in such 
                subsection, to ensure that such software is installed 
                for use with the CPOE technology not later than one 
                year after the receipt of the initial grant under 
                subsection (a).
            (2) Description of software.--For purposes of paragraph 
        (1), the software described in this paragraph is software 
        providing for an electronic record known as an electronic 
        medication administration record (also known as EMAR) and is a 
        fully closed-loop medication process that, for the patient 
        involved, electronically documents the specific drug, dosages, 
        routes and times for the administration of medication, and acts 
        as a scheduler by linking to a pharmacy information system 
        through a bar-code point-of-care system.
    (d) Certain Uses of Grant.--The purposes for which a grant under 
subsection (a) may be expended include the following:
            (1) Purchasing and installing CPOE technology.
            (2) Purchasing and installing decision-support software and 
        EMAR for purposes of subsections (b) and (c).
            (3) Updating CPOE technology, decision-support software, 
        and EMAR.
            (4) Training and updating the usage associated with CPOE 
        technology, decision support software, and EMAR with the goal 
        of attaining a 100 percent rate of compliance among physicians 
        and other clinicians who order prescription drugs and tests.
    (e) Facilities With Previously Installed CPOE Technology.--A grant 
under subsection (a) may be made to a hospital or a skilled nursing 
facility that installed CPOE technology prior to receiving an initial 
grant under such subsection. Such a hospital or facility may expend the 
grant for the purposes described in paragraphs (2) through (4) of 
subsection (d).
    (f) Matching Requirement.--
            (1) In general.--A grant may be made under subsection (a) 
        only if the applicant involved agrees that, with respect to the 
        costs to be incurred by the applicant in carrying out the 
        purpose described in such subsection, the applicant will make 
        available non-Federal contributions (in cash or in kind) toward 
        such costs in an amount determined by the Secretary. Such 
        contributions may be made directly or through donations from 
        public or private entities.
            (2) Determination of amount of non-federal contribution.--
        Non-Federal contributions required in subsection (a) may be in 
        cash or in kind, fairly evaluated, including equipment or 
        services (and excluding indirect or overhead costs). Amounts 
        provided by the Federal Government, or services assisted or 
        subsidized to any significant extent by the Federal Government, 
        may not be included in determining the amount of such non-
        Federal contributions.
    (g) Reports by Hospitals and Skilled Nursing Facilities.--A grant 
may be made under subsection (a) only if the applicant involved agrees 
that, for each fiscal year for which the grant is made, the applicant 
will submit to the Secretary, acting through the National Health 
Information Technology Coordinator, a report that provides details on 
the following:
            (1) Quantitative reductions in medication errors.
            (2) The level of compliance by physicians, clinicians, and 
        other staff with respect to the usage of CPOE technology.
            (3) The difference between administrative and clinical 
        workflows before the implementation of CPOE technology and 
        after the usage of such technology.
            (4) Alterations and improvements with respect to workflow 
        in the case of facilities that have CPOE technology.
            (5) An analysis on the improvement of the quality of care 
        and patient satisfaction within the hospital or skilled nursing 
        facility involved.
            (6) The overall economic savings associated with the usage 
        of CPOE technology.
    (h) Application.--A grant may be made under subsection (a) only if 
an application for the grant is submitted to the Secretary and the 
application is in such form, is made in such manner, and contains such 
agreements, assurances, and information as the Secretary determines to 
be necessary to carry out this section. The Secretary shall provide 
technical assistance to hospitals and skilled nursing facilities in the 
application process.
    (i) Limitation of Grant.--A grant under subsection (a) may not be 
made in an amount exceeding $500,000.
    (j) Report to Congress.--Not later than five years after the 
initial distribution of grants under subsection (a), the Secretary 
shall submit to the Congress a report on the progress of the program 
under such subsection.
    (k) Definitions.--For purposes of this Act:
            (1) The term ``barcode point-of-care'' means a system that 
        uses bar codes in association with a computer server that 
        interfaces with the admission, discharge, transfer, and 
        pharmacy systems, and with EMAR software, in order to ensure 
        that a patient receives the medications intended for the 
        patient, including the intended dosages.
            (2) The term ``CPOE technology'' has the meaning indicated 
        for such term in subsection (b)(1).
            (3) The term ``decision-support software'' means the 
        computer software described in subsection (b)(2).
            (4) The terms ``electronic medication administration 
        record'' and ``EMAR'' have the meaning indicated for such terms 
        in subsection (c)(2).
            (5) The term ``rural hospital'' means a hospital located in 
        a rural area, as defined in section 1886(d)(2)(D) of the Social 
        Security Act.
            (6) The term ``rural skilled nursing facility'' means a 
        skilled nursing facility located in a rural area, as defined in 
        section 413.333 of title 42, Code of Federal Regulations.
            (7) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (8) The term ``skilled nursing facility'' has the meaning 
        indicated for such term in section 1819(a) of the Social 
        Security Act.
    (l) Funding.--
            (1) Authorization of appropriation.--For the purpose of 
        carrying out this section, there is authorized to be 
        appropriated $25,000,000 for each of the fiscal years 2006 
        through 2010.
            (2) Reservation of amounts.--Of the amounts appropriated 
        under paragraph (1), the Secretary shall reserve amounts in 
        accordance with the following:
                    (A) Fifty percent for grants under section (a) for 
                the initial purchase and installation of CPOE 
                technology and decision-support software. Amounts 
                reserved under this subparagraph are not available for 
                hospitals and skilled nursing facilities referred to in 
                subsection (e) and are not available for the purposes 
                described in paragraphs (3) and (4) of subsection (d).
                    (B) Fifty percent for grants under such subsection 
                for upgrading such technology and software and for 
                other purposes authorized in paragraphs (2) through (4) 
                of subsection (d), including initial and subsequent 
                grants under subsection (a) to hospitals and skilled 
                nursing facilities referred to in subsection (e).
                    (C) Twenty percent for grants under such subsection 
                to rural hospitals and rural skilled nursing facilities 
                in the aggregate, which percentage includes amounts 
                reserved under subparagraphs (A) and (B) that are used 
                for grants under subsection (a) to rural hospitals and 
                rural skilled nursing facilities.
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