[Congressional Record Volume 144, Number 141 (Friday, October 9, 1998)]
[Senate]
[Pages S12174-S12177]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BENNETT (for himself and Mr. Mack):
   S. 2609. A bill to ensure confidentiality with respect to medical 
records and health care-related information, and for other purposes to 
the Committee on Labor and Human Resources.


             The Medical Information Protection Act of 1998

  Mr. BENNETT. Mr. President, today I introduce the Medical Information 
Protection Act of 1998. I know it is late in the 105th Congress and 
that there will not be time to give this legislation full 
consideration. However, I feel strongly about this issue and did not 
want this session to end without the introduction of this legislation. 
I feel that great progress has been made and that the legislation that 
I am introducing addresses many of the concerns that have been 
expressed. I will include letters and statements of support for the 
Record from the following groups: American Medical Informatics 
Association; Joint Healthcare Information Technology Alliance; 
Intermountain Health Care; Premier Institute; Association of American 
Medical Colleges; American Health Information Management Association; 
Healthcare Leadership Council; Federation of American Health Systems; 
American Hospital Association and Pharmaceutical Research and 
Manufacturers of America. It is my intention to reintroduce this 
legislation early in the 106th Congress and seek for its passage.
  Most individuals wrongly assume that their personal health 
information is protected under federal law. It is not. Federal law 
protects the confidentiality of our video rental records, and federal 
law ensures us access to information about us such as our credit 
history. However, there is no current federal law which will protect 
the confidentiality of our medical information and ensure us access to 
our own medical information. This is a circumstance that must change. 
This is a circumstance that the Medical Information Protection Act will 
correct.
  At this time, the only protection of an individual's personal medical 
information is under state law. These state laws, where they exist, are 
incomplete, inconsistent and inadequate. At last check, there were over 
34 states with each state having its own unique set of laws to protect 
medical records. In many states there is no penalty for releasing and 
disseminating the most private information about our health and the 
health care that we have received. Many of our local health care 
systems continue to expand across state lines and are forced to deal 
with multiple and conflicting state laws. In addition, advances in 
technology allow information to be moved instantaneously across the 
country or around the world. The majority of providers, insurers, 
health care professionals, researchers and patients agree that there is 
an increasingly urgent need for uniformity in our laws that govern 
access to and disclosure of personal health information.
  Mr. President, I remind my colleagues that if we do not act by August 
of 1999, the Health Insurance Portability and Accountability Act of 
1996 (HIPAA) requires the Secretary of Health and Human Services (HHS) 
to put into place regulations governing health information in an 
electronic format. Thus, we could have a circumstance where paper based 
records and electronic based records are treated differently. I urge my 
colleagues to work with me to pass legislation that would give HHS 
clear direction and provide each American with greater protection of 
their health information.
  Mr. President, I ask unanimous consent that the letters of support be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                       Pharmaceutical Research and


                                     Manufacturers of America,

                                  Washington, DC, October 7, 1998.
     Hon. Robert F. Bennett,
     U.S. Senate,
     Washington, DC.
       Dear Senator Bennett: The Pharmaceutical Research and 
     Manufacturers of America (PhRMA) applauds your introduction 
     of the Medical Information Protection Act of 1998 and your 
     leadership on this issue. This legislation would help 
     patients in important ways. First, it would protect the 
     confidentiality of their medical information. Second, it 
     would help patients with unmet medical needs and their 
     families by facilitating valuable biomedical research leading 
     to the discovery and development of innovative medicines. 
     Third, it would protect and promote health care quality by 
     encouraging the appropriate use of medical information for 
     epidemiological research, pharmaco-economics and outcomes 
     analysis.
       Your bill provides a sound regulatory framework to help 
     foster biomedical research and the delivery of high-quality 
     care in an increasingly integrated health care system, while 
     at the same time preserving the confidentiality of sensitive 
     medical information identifying patients.
       PhRMA welcomes the Medical Information Protection Act of 
     1998 as a good prescription to help patients, commends you 
     leadership on this issue, and looks forward to working 
     together.
           Sincerely,
                                                   Alan F. Holmer,
     President.
                                  ____



                                American Hospital Association,

                                  Washington, DC, October 2, 1998.

  AHA Applauds Introduction of Bill That Protects Privacy of Patient 
                          Medical Information

       The American Hospital Association (AHA) applauds the 
     introduction of a new bill which for the first time would 
     establish a federal confidentiality law that protects 
     patients' private health care information.
       As guardians of patient medical information, hospitals and 
     health systems have long sought strong federal legislation 
     that would establish a uniform national standard to protect 
     patient privacy. The bill, the Medical Information Protection 
     Act of 1998, appropriately balances the need to protect the 
     privacy of confidential patient information with the need for 
     that information to flow freely among health care providers.
       ``Comprehensive confidentiality legislation is critical to 
     thousands of patients who come through the doors of our 
     nation's hospitals each day,'' said AHA President Dick 
     Davidson. ``It puts in place the safeguards needed to protect 
     the most sensitive and personal information. We commend 
     Senator Bennett for introducing the bill and for his 
     leadership and guidance on an issue that is relevant to 
     everyone.''
       The Medical Information Protection Act bill:
       Allows patients in all states access to their records, a 
     right not currently given in some areas.
       Establishes full federal preemption of all state 
     confidentiality laws--with the exception of some key public 
     health laws--and sets a uniform standard over weaker or 
     stronger state laws so that patient information is equally 
     protected even as providers are linked across delivery sites 
     and state boundaries.
       Recognizes the need for confidential medical information to 
     move appropriately and timely within groups and systems of 
     providers without impeding the quality of care.
       Broadly applies not only to providers, payers, and 
     employers, but also to law enforcement agencies. The Bennett 
     bill moves in the right direction on this issue by setting a 
     national standard for how law enforcers can gain access to 
     confidential patient records.
       Contains language that, for the first time, would put in 
     place federal sanctions against those who inappropriately 
     disclose medical information.
       ``This is an issue that affects each of us personally,'' 
     Davidson said. ``America's hospitals and health systems look 
     forward to working with Senator Bennett and Congress to help 
     enact legislation to protect the privacy of each and every 
     individual they serve.''
       The AHA is a not-for-profit organization of health care 
     provider organizations that are committed to the health 
     improvement of their communities. The AHA is the national 
     advocate for its members, which includes 5,000 hospitals, 
     health care systems, networks and other providers of care. 
     Founded in 1898, AHA provides education for health care 
     leaders and is a source of information on health care issues 
     and trends. For more information, visit the AHA Web site at 
     www.aha.org.

[[Page S12175]]

     
                                  ____
                                                  American Medical


                                      Informatics Association,

                                    Bethesda, MD, October 5, 1998.
     Hon. Robert F. Bennett,
     U.S. Senate,
     Washington, DC.
       Dear Senator Bennett: The American Medical Informatics 
     Association (AMIA) is a national organization dedicated to 
     the development and application of medical informatics in 
     support of patient care, teaching, research, and health care 
     administration. On behalf of AMIA's more than 3,800 
     physicians, researchers, librarians, information systems 
     managers, and other professionals with expertise in 
     information technologies, I write to commend you on the 
     introduction of the ``Medical Information Protection Act of 
     1998.''
       AMIA recognizes that the enormous potential of computer and 
     communications technology to improve health care delivery, 
     quality and access cannot be realized unless individuals, and 
     the society-at-large, are reasonably certain that safeguards 
     are in place to protect the confidentiality of personal 
     health information in medical records. Simply, every person 
     must feel that his or her health data is protected against 
     unnecessary disclosure. At the same time, there can be no 
     doubt that the delivery of highest quality health care and 
     advances in medical research cannot proceed without the 
     timely and efficient transfer of health data across the 
     health information infrastructure. Thus, in developing 
     national standards for health information, Congress--as 
     charged by the Health Insurance Portability and 
     Accountability Act of 1996--must thoughtfully and carefully 
     balance the rights of individuals, the capacity of the health 
     care system to provide needed health care, and the interests 
     of our nation as a whole. We believe that the ``Medical 
     Information Protection Act'' does an admirable job of 
     accomplishing those complex goals.
       Our association is especially concerned that health 
     information standards allow appropriate access to health data 
     for research, while adequately protecting patient 
     confidentiality. Dr. Don Detmer, Co-Chair of AMIA's Public 
     Policy Committee, was pleased to consult with your staff on a 
     number of occasions to address that issue, and to devise 
     enforcement mechanisms to effectively sanction the misuse of 
     protected health information.
       The American Medical Informatics Association thanks you for 
     introducing the ``Medical Information Protection Act of 
     1998.'' We look forward to passage of the bill, an essential 
     first step in the development of a national health 
     information strategy to advance the health of our nation.
           Sincerely,
     Paul D. Clayton, Ph.D.,
       President.
                                  ____

                                      Joint Healthcare Information


                                          Technology Alliance,

                                                  October 5, 1998.
     Hon. Robert F. Bennett,
     U.S. Senate,
     Washington, DC.
       Dear Senator Bennett: Representing a broad array of 
     medical, information, and technology professionals involved 
     in the development, use, management, and security of 
     healthcare information systems, the organizations of the 
     Joint Healthcare Information Technology Alliance (JHITA) 
     strongly support enactment of federal legislation to protect 
     the confidentiality of medical records. We write today to 
     commend you on the introduction of the ``Medical Information 
     Protection Act of 1998.''
       The more than 50,000 members of our constituent 
     organizatons--physicians, researchers and other health 
     professionals, medical records professionals and information 
     systems managers and executives, healthcare information 
     technology developers and vendors--believe that computer and 
     communications technologies hold enormous potential to 
     improve healthcare delivery, quality and access, while also 
     reducing costs. Yet, these benefits cannot be realized unless 
     individuals, and society, are confident that safeguards are 
     in place to protect the confidentiality of personal health 
     information. Simply, every person must feel that his or her 
     health data is protected against unnecessary disclosure. At 
     the same time, there can be no doubt of the need for timely 
     and efficient transfer of health data across the health 
     information infrastructure. Thus, national standard for the 
     collection, use and dissemination of healthcare information 
     must thoughtfully and carefully balance the rights of 
     individuals, the capacity of the healthcare system to provide 
     needed services and the interests of our nation as a whole. 
     The JHITA believes that the ``Medical Information Protection 
     Act'' does an admirable job of accomplishing those complex 
     goals.
       In order for national fair information standards to offer 
     consistent and genuine guidance and protection to healthcare 
     professionals and consumers, and effect significant Federal 
     penalties and sanctions for the misuse of health data, the 
     JHITA believes that federal law must preempt the current 
     patchwork of federal, state and local laws and regulations 
     governing health information. We applaud your commitment in 
     the ``Medical Information Protection Act'' to a uniform and 
     high level of confidentiality for all health information, 
     regardless of the individual's diagnosis or state of 
     residence.''
       The Joint Healthcare Information Technology Alliance thanks 
     you for introducing the ``Medical Information Protection Act. 
     We look forward to working with you to win passage of the 
     bill, an essential first step in the development of a 
     national health information strategy that will advance the 
     health of our nation and protect the rights of all.
           Sincerely,
     Linda Kloss,
       Executive Vice President & CEO, AHIMA.
     Carla Smith,
       Executive Director, CHIM.
     John Page,
       Executive Director, HIMSS.
     Dennis Reynolds,
       Executive Director, AMIA.
     Richard Correll,
       President, CHIME.
                                  ____

                                       american Health Information


                                       Management Association,

                                  Washington, DC, October 6, 1998.
     Senator Robert F. Bennett,
     Dirksen Building,
     Washington, DC.
       Dear Senator Bennett: On behalf of the more than 37,000 
     members of the American Health Information Management 
     Association (AHIMA), thank you for once again being in the 
     forefront of the effort to pass legislation to protect the 
     confidentiality of individually identifiable health 
     information. AHIMA is pleased to offer its strong support for 
     the Medical Information Protection Act of 1998.
       During the past several years, we have worked with you and 
     your Legislative Director Paul A. ``Chip'' Yost and developed 
     several legislative proposals that have resulted in the 
     current bill. The hard work put into the drafting of this 
     landmark legislation has paid-off. The bill strikes a hard-
     to-achieve balance between protecting the confidentiality of 
     a patient's health information while not impeding the 
     provision of patient care or the operations of the nation's 
     health care delivery system. One of the most important facets 
     of the Medical Information Protection Act is that it contains 
     strong criminal and civil sanctions to provide remedies 
     against wrongful disclosure of health information. In 
     addition, the legislation will eliminate the current 
     patchwork-quilt of various state statutes and regulations, 
     thus providing all Americans the confidentiality protections 
     that they truly deserve.
       Senator, AHIMA is pleased to continue working with you and 
     your office on this important issue. Your dedication has kept 
     us encouraged that Congress will pass legislation to 
     establish a uniform national policy for the use and 
     disclosure of individually identifiable health information. 
     As you know from our past association, AHIMA has been a 
     leader in the effort to pass comprehensive confidentiality 
     legislation. Throughout the legislative process, we have 
     achieved a reputation for working on a bipartisan basis with 
     various elected officials and health policy makers. In this 
     context, we continue to support your efforts and offer our 
     assistance and expertise to help move this important issue 
     forward.
       Again, thank you for your dedication to this important 
     issue. If AHIMA can provide any assistance, please do not 
     hesitate to contact me in the AHIMA Washington, DC Office at 
     (202) 218-3535.
           Sincerely,

                                      Kathleen A. Frawley, JD,

                                       Vice President, Legislative
     and Public Policy Services.
                                  ____



                                Healthcare Leadership Council,

                                  Washington, DC, October 7, 1998.

  Healthcare Leadership Council Commends Senator Bennett for Medical 
                        Information Act of 1998

       WASHINGTON, DC.--The Healthcare Leadership Council (HLC) 
     today commended Sen. Robert Bennett (R-UT) for introducing 
     the ``Medical Information Protection Act of 1998.''
       ``This bill protects the confidentiality of patient health 
     information and establishes new federal penalties for its 
     misuse,'' said HLC President Pamela G. Bailey. ``At the same 
     time, the Bennett bill allows for the appropriate use of 
     patient health information to promote a better health care 
     delivery system and protect vital health care research.''
       Information is the cornerstone of a high quality, 
     innovative health care system,'' Bailey said. ``In fact, it 
     can be an issue of life or death. Without access to patient 
     information, physicians, health plans, hospitals and 
     researchers would be unable to provide the high standard of 
     care that Americans deserve.''
       As the leading innovators in the health care industry, HLC 
     members support federal rules to ensure patient 
     confidentiality rather than the increasingly confusing 
     patchwork of state laws. ``The Bennett bill would replace 
     this patchwork of state laws with a strong federal law that 
     protects patients and provides a workable, uniform framework 
     that facilitates the delivery of the highest quality health 
     care.''
       ``In the debate over patient confidentiality, we sometimes 
     lose sight of what most patients want most--to get healthy. 
     Fundamental to the fantastic advances made in treatment of so 
     many diseases is our ability to use patient information 
     throughout our increasingly complex health care system,'' 
     said Bailey.
       The HLC is committed to working toward final enactment of 
     comprehensive, uniform

[[Page S12176]]

     confidentiality legislation by the August 1999 deadline 
     imposed under the Health Insurance Portability and 
     Accountability Act.
       The HLC is a coalition of the chief executive of America's 
     leading health care institutions.
                                  ____

                                                     Federation of


                                      American Health Systems,

                                  Washington, DC, October 7, 1998.

    FAHS Praises Introduction of Medical Information Protection Act


    applauds utah gop senator bennett for his leadership and health 
                       community outreach efforts

       The Federation today praised Sen. Robert Bennett (R-UT) for 
     introducing the Medical Information Protection Act of 1998 
     and applauded his leadership in drawing upon the input of a 
     broad range of health care organizations in crafting the 
     legislation.
       ``Although it's a bit like walking a tight-rope, Sen. 
     Bennett's commitment to working with varying interests on 
     this important issue should be commended,'' said Laura 
     Thevenot, Federation Executive Vice President and COO. ``He 
     has approached the task before Congress of passing 
     legislation relating to medical records confidentiality by 
     August of 1999 with openness and a real determination to 
     reach a consensus that protects patients and still allows 
     hospitals and health systems to do their jobs. This 
     legislation establishes a good framework for an issue that 
     will be debated at length when the 106th Congress convenes 
     next January.''
       Thevenot highlighted a couple of key provisions in the 
     legislation: uniform national confidentiality standards, 
     which would avoid a cumbersome patchwork of state law and 
     regulation, and enhanced security safeguards to ensure 
     appropriate access to patient data.
       ``As the debate moves forward, one of the Federation's 
     primary concerns is that Congress not tie the hands of 
     hospitals and health systems by putting obstacles in the way 
     of their commitment to provide the necessary treatment and 
     care patients need,'' Thevenot added. ``Our commitment has 
     always been and will remain to serve the patient. Proper uses 
     of information for treatment, payment, quality improvement, 
     and where appropriate, research, are a critical component of 
     that commitment.''
                                  ____



                                    Intermountain Health Care,

                              Salt Lake City, UT, October 2, 1998.
     Hon. Robert F. Bennett,
     Dirksen Senate Office Building,
     Washington, DC.
       Dear Senator Bennett: Intermountain Health Care (``IHC'') 
     applauds the introduction of the ``Medical Information 
     Protection Act of 1998.'' IHC is deeply appreciative of your 
     leadership in developing legislation to establish uniform 
     federal confidentiality standards. IHC also wishes to express 
     its deep appreciation of the hard work and dedication of Chip 
     Yost and Mike Nielsen of your staff.
       The bill you have crafted reflects a keen understanding of 
     the need to strike an appropriate balance between 
     safeguarding patient identifiable health information and 
     facilitating the coordination and delivery of high quality, 
     network-based health care, such as that provided at IHC. 
     Indeed, striking the right balance is critical to the 
     delivery of the best possible patient care.
       As you well know, IHC has developed state-of-the-art 
     electronic medical records and common databases which we used 
     extensively not just for treatment and payment but for such 
     fundamental quality enhancing activities as outcomes review, 
     disease management, health promotion and quality assurance. 
     You bill rightly recognizes that all of these efforts are 
     essential to optimizing patient health.
       In addition, we are particularly pleased that you have 
     called for federal preemption of state law. Health systems 
     like IHC, which operate across state lines, would have 
     enormous difficulty complying with different federal and 
     state standards.
       As you know, IHC is a large integrated health care delivery 
     system based in Salt Lake City and operating in the states of 
     Utah, Idaho, and Wyoming. The IHC system includes 23 
     hospitals, 33 clinics, 16 home health agencies, and 400 
     employed physicians. Additionally, our system operates a 
     large Health Plans Division with enrollment of 350,000 
     directly insured plus 430,000 who use our networks through 
     other insurers. IHC's 20,000 employees are keenly aware of 
     their responsibility to safeguard personal health information 
     and IHC has invested considerable resources in order to 
     develop effective protections and procedures.
       IHC pledges to work with you toward enactment of this 
     important legislation well in advance of the August 1999 
     deadline established by the Health Insurance Portability and 
     Accountability Act of 1996. Please do not hesitate to contact 
     me or IHC's Washington Counsel Michael A. Romansky (202/756-
     8069) and Karen S. Sealander (202/756-8024) of McDermott, 
     Will & Emery with questions or for further information.
           Sincerely,

                                        John T. Nielsen, Esq.,

                                                Senior Counsel and
     Director of Government Relations.
                                  ____



                                            Premier Institute,

                                  Washington, DC, October 5, 1998.

The Premier Institute Applauds Introduction of the Medical Information 
                         Protection Act of 1998

       Washington, DC.--Jim Scott, president of the Premier 
     Institute, commended Senator Robert F. Bennett (R-UT) for his 
     leadership in introducing the ``Medical Information 
     Protection Act of 1998.'' ``This legislation protects 
     patients from being subjected to unauthorized or 
     inappropriate use of their medical records and, at the same 
     time, ensures that hospitals and health plans have access to 
     information necessary to do their jobs in serving patients,'' 
     said Scott. ``Senator Bennett creates workable standards that 
     protect patient's confidentiality and assures that medical 
     information is available for the treatment, quality 
     assurance, and research needs that are so important to our 
     health care system and the patients it serves.''
       The Bennett bill recognizes the many legitimate uses for 
     medical information and provides the right regulatory 
     framework for safeguarding the use and disclosure of 
     protected health information by the health care industry. The 
     bill permits its use for patient treatment, quality enhancing 
     activities, payment for health care activities, and research 
     for the development of life saving pharmaceuticals and new 
     medical procedures. By providing for a singular authorization 
     process when a patient accesses the health care system, the 
     bill avoids costly administrative burdens for health care 
     providers and barriers to the efficient use of information 
     within integrated care networks, hospital systems, physician-
     hospital organizations, or managed care organizations.
       The bill also adopts uniform national confidentiality 
     standards. Given the increasingly complex and interstate 
     nature of the way health information flows in today's 
     delivery system, strong preemption of state confidentiality 
     laws protects consumers and minimizes the costs associated 
     with the increasing patchwork of conflicting state laws.
       Finally, the bill clearly recognizes the value of medical 
     research and does not establish unnecessary barriers to 
     research. It allows for the use of protected health 
     information in research activities while holding medical 
     researchers to confidentiality requirements that protect the 
     identity of the individuals in a medical study. Under this 
     bill, researchers will continue to have access to databases 
     of patient information that are crucial in discovering trends 
     and anomalies that lead to cures for diseases over time.
       ``Today marks the introduction of an important piece of 
     legislation for the future of our health care system,'' said 
     Scott. ``We look forward to working with Senator Bennett to 
     enact the right patient confidentiality standards into law.''
       Premier is a strategic alliance of leading hospitals and 
     healthcare systems across the country, representing nearly 
     215 owners and the 800 hospitals and healthcare facilities 
     they operate, and approximately 900 other affiliated 
     hospitals. Premier provides hospitals and healthcare systems 
     across the nation with products and services designed to help 
     them reduce costs, develop integrated delivery systems, 
     manage technology, and share knowledge. The organization 
     maintains offices in Charlotte, NC; San Diego, CA; Chicago, 
     IL; and Washington, DC.
                                  ____

                                           Association of American


                                             Medical Colleges,

                                  Washington, DC, October 2, 1998.
     Hon. Robert Bennett,
     U.S. Senate, Dirksen Senate Offices Building, Washington, DC.
       Dear Senator Bennett: I write to convey the Association of 
     American Medical Colleges' (AAMC) support for your bill 
     entitled the ``Medical Information Protection Act.'' The AAMC 
     represents the nation's 125 accredited medical schools, 
     approximately 400 major teaching hospitals, and 86 academic 
     and professional societies representing over 90,000 faculty 
     members.
       We believe the Medical Information Protection Act is a 
     thoughtful effort to address the very important and complex 
     issues surrounding the protection of patient health 
     information. This legislation is a significant step in the 
     right direction as Congress attempts to achieve the delicate 
     balance between the competing goods of individual privacy and 
     the considerable public benefit that results from controlled 
     access to health information that is crucial to our country's 
     continuing ability to deliver high-quality health care and 
     cutting-edge research.
       Over the past year, the AAMC has advocated for medical 
     information privacy legislation that employees appropriate 
     confidentiality safeguards while ensuring access to patient 
     records and other archival materials required to pursue 
     biomedical, behavioral, and health services research. The 
     AAMC is pleased that the Medical Information Protection Act 
     incorporates many of the major principles articulated by the 
     Association.
       In particular, the AAMC supports the legislation's clear 
     and workable definitions for ``protected health information'' 
     and ``nonidentifiable health information,'' the creation of 
     appropriate safeguards and stiff penalties to protect patient 
     confidentiality, and the proposed preemption of state privacy 
     laws. While recognizing that preemption is a politically 
     highly-charged issue, the Association believes that, in an 
     era of rapidly emerging information technology and major 
     consolidation of the health care industry, protecting the 
     ability of medical information to flow unimpeded across state 
     lines is essential to the functioning of a high-quality, 
     medically-effective and efficient care delivery system.

[[Page S12177]]

       In addition, the AAMC applauds the bill's affirmation of 
     support for the role of institutional review boards in the 
     disclosure of protected health information for research 
     purposes. We believe that the security of medical information 
     created, maintained and used in the course of medical 
     research would be significantly strengthened by the 
     provisions of this bill.
       We thank you for your leadership on this issue and look 
     forward to continuing to work with you as this bill is 
     considered by the Senate.
           Sincerely,
                                             Jordan J. Cohen, M.D.
                                                        President.
                                 ______