[Congressional Record Volume 151, Number 76 (Thursday, June 9, 2005)]
[Senate]
[Pages S6333-S6337]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DODD:
  S. 1223. A bill to amend the Public Health Service Act to improve the 
quality and efficiency of health care delivery through improvements in 
health care information technology, and for other purposes; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. DODD. Mr. President, today I am pleased to announce the 
reintroduction of the Information Technology for Health Care Quality 
Act. By encouraging health care providers to invest in information 
technology (IT), this legislation has the potential to bring 
skyrocketing health care costs under control and improve the overall 
quality of care in our nation.
  We are facing a health care crisis in our country. According to the 
Census Bureau, 45 million Americans were without health insurance in 
2003--an increase of 1.4 million over 2002. In many respects, we have 
the greatest health system in the world, but far too many Americans are 
unable to take advantage of this system.
  The number of uninsured continues to rise because the cost of health 
care continues to soar. Year after year, health care costs increase by 
double-digit percentages. The cost of employer-sponsored coverage 
increased by 11 percent last year, after a 14-percent increase in 2003. 
Employers are dropping health care coverage because they can no longer 
afford to foot the bill.
  One of the ways to provide health care coverage to every American is 
to reign in health care costs. And expanding the use of IT in health 
care is the best tool we have to control costs. Studies have shown that 
as much as one-third of health care spending is for redundant or 
inappropriate care. Estimates suggest that up to 14 percent of 
laboratory tests and 11 percent of medication usage are unnecessary. 
Finally, and perhaps most disturbingly, we know that it takes, on 
average, 17 years for evidence to be incorporated into clinical 
practice. Along these same lines, a recent study showed that patients 
receive the best evidence-based treatment only about half the time.
  Significant cost-savings will undoubtedly be realized simply by 
moving away from a paper-based system, where patient charts and test 
results are easily lost or misplaced, to an electronic system where 
data is easily stored, transferred from location to location, and 
retrieved at any time. With health IT, physicians will have their 
patients' medical information, at their fingertips. A physician will no 
longer have to take another set of X-Rays because the first set was 
misplaced, or order a test that the patient had six months ago in 
another hospital because she is unaware that the test ever took place. 
The potential for cost-savings from simply eliminating redundancies and 
unnecessary tests, and reducing administrative and transaction costs, 
is substantial.
  Of course, when we consider the improved quality of care and patient 
safety that will result from wider adoption of health IT, the impact on 
cost is even greater. For example, IT can provide decision support to 
ensure that physicians are aware of the most up-to-date, evidence-based 
best practices regarding a specific disease or condition, which will 
reduce expensive hospitalizations. Given all of these benefits, 
estimates suggest that Electrontc Health Records (EHRs) alone could 
save more than $100 billion each year. The full benefits of IT could be 
multiple hundreds of billions annually. Such a significant reduction in 
health care costs would allow us to provide coverage to millions of 
uninsured Americans.

  The benefits of IT go beyond economics. I am sure that all of my 
colleagues are familiar with the Institute of Medicine (IOM) estimate 
that up to 98,000 Americans die each year as a result of medical 
errors. A RAND Corporation study from last year showed that, on 
average, patients receive the recommended care for certain widespread 
chronic conditions only half of the time. That is an astonishing 
figure. To put it in a slightly different way, for many of the health 
conditions with which physicians should be most familiar, half of all 
patients are essentially being treated incorrectly.
  Most experts in the field of patient safety and health care quality, 
incuding the IOM, agree that improving IT is one of the crucial steps 
towards safer and better health care. By providing physicians with 
access to patients' complete medical history, as well as electronic 
cues to help them make the correct treatment decisions, IT has the 
potential to significantly impact the care that Americans receive. It 
is impossible to put a value on the potential savings in human lives 
that would undoubtedly result from a nationwide investment in health 
care information technology.
  It might seem counterintuitive that we can realize tremendous cost 
savings while, at the same time, improving care for patients. But in 
fact, improving patient care is essential to reducing costs. IT is the 
key to unlocking the door--it has the potential to lead to improvements 
in care and efficiency that will save patients' lives, reduce costs, 
and reduce the number of uninsured.
  Unfortunately, despite the impact that IT can have on cost, 
efficiency, patient safety, and health care quality, most health care 
providers have not yet begun to invest in new technologies. The use of 
IT in most hospitals and doctors' offices lags far behind almost every 
other sphere of society. The vast majority of written work, such as 
patient charts and prescriptions, is still done using pen and paper. 
This leads to mistakes, higher costs, reduced quality of care, and in 
the most tragic cases, death.
  There is no question in my mind that the federal government has a 
significant role to play in expanding investment in health IT. The 
legislation that I am introducing today defines that role. First, this 
bill would establish federal leadership in defining a Nationai Health 
Information Infrastructure (NHII) and adopting health IT standards. 
While I am pleased that the administration has already appointed a 
National Coordinator for Health Information Technology, I believe that 
the authority given to the Coordinator and the resources at his 
disposal are not equal to the enormity of his task. That is why my 
legislation creates an office in the White House, the Office of Health 
Information Technology, to oversee all of the Federal Government's 
activities in the area of health IT, and to create and implement a 
national strategy to expand the adoption of IT in health care.
  This office would also be responsible for leading a collaborative 
effort between the public and private sectors to develop technical 
standards for health IT. These standards will ensure that health care 
information can be shared between providers, so that a family moving 
from Connecticut to California will not have to leave their medical 
history behind. At the same time, this bill would ensure that the 
adopted standards protect the privacy of patient records. While the 
creation of portable electronic health records is an important goal, 
privacy and confidentiality must not be sacrificed.
  This legislation would also provide financial assistance to 
individual health care providers to stimulate investment in IT, and to 
communities to help them set up interoperable IT infrastructures at the 
local level, often referred to as Local Health Information 
Infrastructures--LHIIs. IT requires a huge capital investment. Many 
providers, especially small doctors offices, and safety-net and rural 
hospitals and health centers, simply cannot afford to make the type of 
investment that is needed.
  Finally, this legislation would provide for the development of a 
standard

[[Page S6334]]

set of health care quality measures. The creation of these measures is 
critical to better understanding how our health care system is 
performing, and where we need to focus our efforts to improve the 
quality of care. IT has the potential to drastically improve our 
ability to capture these quality measures. All recipients of Federal 
funding under this bill would be required to regularly report on these 
measures, as well as the impact that IT is having on health care 
quality, efficency, and cost savings.
  The establishment of standard quality measures is also the first step 
in moving our nation towards a system where payment for health care is 
more appropriately aligned--a system in which health care providers are 
paid not simply for the volume of patients that they treat, but for the 
quality of care that they deliver. To this end, my legislation would 
require the Secretary of Health and Human Services to report to 
Congress on possible changes to Federal reimbursement and payment 
structures that would encourage the adoption of IT to improve health 
care quality and patient safety.
  I know that many of my colleagues, including Senator Enzi, Senator 
Kennedy, Senator Clinton, Senator Frist and Senator Gregg, have an 
interest in this issue. I look forward to working with all of them to 
move legislation this year. It is time for our country to make a 
concerted effort to bring the health care sector into the 21st century. 
We must invest in health IT systems, and we must begin to do so 
immediately. The number uninsured, the skyrocketing cost of care, and 
the number of medical errors should all serve as a wake-up call. We 
have a tool at our disposal to address all of these problems, and there 
is no more time to waste. I urge my colleagues to support this 
legislation.
  I ask unanimous consent that the text of this bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1223

       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 ``Information Technology for 
     Health Care Quality Act''.

     SEC. 2. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

       The Public Health Service Act (42 U.S.C. 201 et seq.) is 
     amended by adding at the end thereof the following:

            ``TITLE XXIX--HEALTH CARE INFORMATION TECHNOLOGY

     ``SEC. 2901. DEFINITIONS.

       ``In this title:
       ``(1) Coverage area.--The term `coverage area' means the 
     boundaries of a local health information infrastructure.
       ``(2) Director.--The term `Director' means the Director of 
     the Office of Health Information Technology.
       ``(3) Health care provider.--The term `health care 
     provider' means a hospital, skilled nursing facility, home 
     health entity, health care clinic, community health center, 
     group practice (as defined in section 1877(h)(4) of the 
     Social Security Act, including practices with only 1 
     physician), and any other facility or clinician determined 
     appropriate by the Director.
       ``(4) Health information technology.--The term `health 
     information technology' means a computerized system that--
       ``(A) is consistent with the standards developed pursuant 
     to section 2903;
       ``(B) permits the secure electronic transmission of 
     information to other health care providers and public health 
     entities; and
       ``(C) includes--
       ``(i) an electronic health record (EHR) that provides 
     access in real-time to the patient's complete medical record;
       ``(ii) a personal health record (PHR) through which an 
     individual (and anyone authorized by such individual) can 
     maintain and manage their health information;
       ``(iii) computerized provider order entry (CPOE) technology 
     that permits the electronic ordering of diagnostic and 
     treatment services, including prescription drugs;
       ``(iv) decision support to assist physicians in making 
     clinical decisions by providing electronic alerts and 
     reminders to improve compliance with best practices, promote 
     regular screenings and other preventive practices, and 
     facilitate diagnoses and treatments;
       ``(v) error notification procedures so that a warning is 
     generated if an order is entered that is likely to lead to a 
     significant adverse outcome for the patient; and
       ``(vi) tools to allow for the collection, analysis, and 
     reporting of data on adverse events, near misses, and the 
     quality of care provided to the patient.
       ``(5) Local health information infrastructures.--The term 
     `local health information infrastructure' means an 
     independent organization of health care entities established 
     for the purpose of linking health information systems to 
     electronically share information. A local health information 
     infrastructure may not be a single business entity.
       ``(6) Office.--The term `Office' means the Office of Health 
     Information Technology established under section 2902.

     ``SEC. 2902. OFFICE OF HEALTH INFORMATION TECHNOLOGY.

       ``(a) Establishment.--There is established within the 
     executive office of the President an Office of Health 
     Information Technology. The Office shall be headed by a 
     Director to be appointed by the President. The Director shall 
     report directly to the President.
       ``(b) Purpose.--It shall be the purpose of the Office to--
       ``(1) improve the quality and increase the efficiency of 
     health care delivery through the use of health information 
     technology;
       ``(2) provide national leadership relating to, and 
     encourage the adoption of, health information technology;
       ``(3) direct all health information technology activities 
     within the Federal Government; and
       ``(4) facilitate the interaction between the Federal 
     Government and the private sector relating to health 
     information technology development and use.
       ``(c) Duties and Responsibilities.--The Office shall be 
     responsible for the following:
       ``(1) National strategy.--The Office shall develop a 
     national strategy for improving the quality and enhancing the 
     efficiency of health care through the improved use of health 
     information technology and the creation of a National Health 
     Information Infrastructure.
       ``(2) Federal leadership.--The Office shall--
       ``(A) serve as the principle advisor to the President 
     concerning health information technology;
       ``(B) direct all health information technology activity 
     within the Federal Government, including approving or 
     disapproving agency policies submitted under paragraph (3);
       ``(C) work with public and private health information 
     technology stakeholders to implement the national strategy 
     described in paragraph (1); and
       ``(D) ensure that health information technology is utilized 
     as fully as practicable in carrying out health surveillance 
     efforts.
       ``(3) Agency policies.--
       ``(A) In general.--The Office shall, in accordance with 
     this paragraph, approve or disapprove the policies of Federal 
     departments or agencies with respect to any policy proposed 
     to be implemented by such agency or department that would 
     significantly affect that agency or department's use of 
     health information technology.
       ``(B) Submission of proposal.--The head of any Federal 
     Government agency or department that desires to implement any 
     policy with respect to such agency or department that would 
     significantly affect that agency or department's use of 
     health information technology shall submit an implementation 
     proposal to the Office at least 60 days prior to the proposed 
     date of the implementation of such policy.
       ``(C) Approval or disapproval.--Not later than 60 days 
     after the date on which a proposal is received under 
     subparagraph (B), the Office shall determine whether to 
     approve the implementation of such proposal. In making such 
     determination, the Office shall consider whether the proposal 
     is consistent with the national strategy described in 
     paragraph (1). If the Office fails to make a determination 
     within such 60-day period, such proposal shall be deemed to 
     be approved.
       ``(D) Failure to approve.--Except as otherwise provided for 
     by law, a proposal submitted under subparagraph (B) may not 
     be implemented unless such proposal is approved or deemed to 
     be approved under subparagraph (C).
       ``(4) Coordination.--The Office shall--
       ``(A) encourage the development and adoption of clinical, 
     messaging, and decision support health information data 
     standards, pursuant to the requirements of section 2903;
       ``(B) ensure the maintenance and implementation of the data 
     standards described in subparagraph (A);
       ``(C) oversee and coordinate the health information 
     technology efforts of the Federal Government;
       ``(D) ensure the compliance of the Federal Government with 
     Federally adopted health information technology data 
     standards;
       ``(E) ensure that the Federal Government consults and 
     collaborates on decision making with respect to health 
     information technology with the private sector and other 
     interested parties; and
       ``(F) in consultation with private sector, adopt 
     certification and testing criteria to determine if electronic 
     health information systems interoperate.
       ``(5) Communication.--The Office shall--
       ``(A) act as the point of contact for the private sector 
     with respect to the use of health information technology; and
       ``(B) work with the private sector to collect and 
     disseminate best health information technology practices.
       ``(6) Evaluation and dissemination.--The Office shall 
     coordinate with the Agency for Health Research and Quality 
     and other Federal agencies to--
       ``(A) evaluate and disseminate information relating to 
     evidence of the costs and benefits

[[Page S6335]]

     of health information technology and to whom those costs and 
     benefits accrue;
       ``(B) evaluate and disseminate information on the impact of 
     health information technology on the quality and efficiency 
     of patient care; and
       ``(C) review Federal payment structures and differentials 
     for health care providers that utilize health information 
     technology systems.
       ``(7) Technical assistance.--The Office shall utilize 
     existing private sector quality improvement organizations 
     to--
       ``(A) promote the adoption of health information technology 
     among healthcare providers; and
       ``(B) provide technical assistance concerning the 
     implementation of health information technology to healthcare 
     providers.
       ``(8) Federal reimbursement.--
       ``(A) In general.--Not later than 6 months after the date 
     of enactment of this title, the Office shall make 
     recommendations to the President and the Secretary of Health 
     and Human Service on changes to Federal reimbursement and 
     payment structures that would encourage the adoption of 
     information technology (IT) to improve health care quality 
     and safety.
       ``(B) Plan.--Not later than 90 days after receiving 
     recommendations under subparagraph (A), the Secretary shall 
     provide to the relevant Committees of Congress a report that 
     provides, with respect to each recommendation, a plan for the 
     implementation, or an explanation as to why implementation is 
     inadvisable, of such recommendations. The Office shall 
     continue to monitor federally funded and 
     supported information technology and quality initiatives 
     (including the initiatives authorized in this title), and 
     periodically update recommendations to the President and 
     the Secretary.
       ``(d) Resources.--The President shall make available to the 
     Office, the resources, both financial and otherwise, 
     necessary to enable the Director to carry out the purposes 
     of, and perform the duties and responsibilities of the Office 
     under, this section.
       ``(e) Detail of Federal Employees.--Upon the request of the 
     Director, the head of any Federal agency is authorized to 
     detail, without reimbursement from the Office, any of the 
     personnel of such agency to the Office to assist it in 
     carrying out its duties under this section. Any such detail 
     shall not interrupt or otherwise affect the civil service 
     status or privileges of the Federal employee.

     ``SEC. 2903. PROMOTING THE INTEROPERABILITY OF HEALTH CARE 
                   INFORMATION TECHNOLOGY SYSTEMS.

       ``(a) Development, and Federal Government Adoption, of 
     Standards.--
       ``(1) Adoption.--
       ``(A) In general.--Not later than 2 years after the date of 
     the enactment of this title, the Director, in collaboration 
     with the Consolidated Health Informatics Initiative (or a 
     successor organization to such Initiative), shall provide for 
     the adoption by the Federal Government of national data and 
     communication health information technology standards that 
     promote the efficient exchange of data between varieties of 
     provider health information technology systems. In carrying 
     out the preceding sentence, the Director may adopt existing 
     standards. Except as otherwise provided for in this title, 
     standards adopted under this section shall be voluntary for 
     private sector entities.
       ``(B) Grants or contracts.--The Director may utilize grants 
     or contracts to provide for the private sector development of 
     standards for adoption by the Federal Government under 
     subparagraph (A).
       ``(C) Definition.--In this paragraph, the term `provide 
     for' means that the Director shall promulgate, and each 
     Federal agency or department shall adopt, regulations to 
     ensure that each such agency or department complies with the 
     requirements of subsection (b).
       ``(2) Requirements.--The standards developed and adopted 
     under paragraph (1) shall be designed to--
       ``(A) enable health information technology to be used for 
     the collection and use of clinically specific data;
       ``(B) promote the interoperability of health care 
     information across health care settings;
       ``(C) facilitate clinical decision support through the use 
     of health information technology; and
       ``(D) ensure the privacy and confidentiality of medical 
     records.
       ``(3) Public private partnership.--Consistent with 
     activities being carried out on the date of enactment of this 
     title, including the Consolidated Health Informatics 
     Initiative (or a successor organization to such Initiative), 
     health information technology standards shall be adopted by 
     the Director under paragraph (1) at the conclusion of a 
     collaborative process that includes consultation between the 
     Federal Government and private sector health care and 
     information technology stakeholders.
       ``(4) Privacy and security.--The regulations promulgated by 
     the Secretary under part C of title XI of the Social Security 
     Act (42 U.S.C. 1320d et seq.) and sections 261, 262, 263, and 
     264 of the Health Insurance Portability and Accountability 
     Act of 1996 (42 U.S.C. 1320d-2 note) with respect to the 
     privacy, confidentiality, and security of health information 
     shall apply to the implementation of programs and activities 
     under this title.
       ``(5) Pilot tests.--To the extent practical, the Director 
     shall pilot test the health information technology data 
     standards developed under paragraph (1) prior to their 
     implementation under this section.
       ``(6) Dissemination.--
       ``(A) In general.--The Director shall ensure that the 
     standards adopted under paragraph (1) are widely disseminated 
     to interested stakeholders.
       ``(B) Licensing.--To facilitate the dissemination and 
     implementation of the standards developed and adopted under 
     paragraph (1), the Director may license such standards, or 
     utilize other means, to ensure the widespread use of such 
     standards.
       ``(b) Implementation of Standards.--
       ``(1) Purchase of systems by the secretary.--Effective 
     beginning on the date that is 1 year after the adoption of 
     the technology standards pursuant to subsection (a), the 
     Secretary shall not purchase any health care information 
     technology system unless such system is in compliance with 
     the standards adopted under subsection (a), nor shall the 
     Director approve any proposal pursuant to section 2902(c)(3) 
     unless such proposal utilizes systems that are in compliance 
     with the standards adopted under subsection (a).
       ``(2) Recipients of federal funds.--Effective on the date 
     described in paragraph (1), no appropriated funds may be used 
     to purchase a health care information technology system 
     unless such system is in compliance with applicable standards 
     adopted under subsection (a).
       ``(c) Modification of Standards.--The Director shall 
     provide for ongoing oversight of the health information 
     technology standards developed under subsection (a) to--
       ``(1) identify gaps or other shortcomings in such 
     standards; and
       ``(2) modify such standards when determined appropriate or 
     develop additional standards, in collaboration with standard 
     setting organizations.

     ``SEC. 2904. LOAN GUARANTEES FOR THE ADOPTION OF HEALTH 
                   INFORMATION TECHNOLOGY.

       ``(a) In General.--The Director shall guarantee payment of 
     the principal of and the interest on loans made to eligible 
     entities to enable such entities--
       ``(1) to implement local health information infrastructures 
     to facilitate the development of interoperability across 
     health care settings to improve quality and efficiency; or
       ``(2) to facilitate the purchase and adoption of health 
     information technology to improve quality and efficiency.
       ``(b) Eligibility.--To be eligible to receive a loan 
     guarantee under subsection (a) an entity shall--
       ``(1) with respect to an entity desiring a loan guarantee--
       ``(A) under subsection (a)(1), be a coalition of entities 
     that represent an independent consortium of health care 
     stakeholders within a community that--
       ``(i) includes--

       ``(I) physicians (as defined in section 1881(r)(1) of the 
     Social Security Act);
       ``(II) hospitals; and
       ``(III) group health plans or other health insurance 
     issuers (as such terms are defined in section 2791); and

       ``(ii) may include any other health care providers; or
       ``(B) under subsection (a)(2) be a health care provider;
       ``(2) to the extent practicable, adopt the national health 
     information technology standards adopted under section 2903;
       ``(3) provide assurances that the entity shall submit to 
     the Director regular reports on the activities carried out 
     under the loan guarantee, including--
       ``(A) a description of the financial costs and benefits of 
     the project involved and of the entities to which such costs 
     and benefits accrue;
       ``(B) a description of the impact of the project on health 
     care quality and safety; and
       ``(C) a description of any reduction in duplicative or 
     unnecessary care as a result of the project involved;
       ``(4) provide assurances that not later than 30 days after 
     the development of the standard quality measures pursuant to 
     section 2906, the entity shall submit to the Director regular 
     reports on such measures, including provider level data and 
     analysis of the impact of information technology on such 
     measures;
       ``(5) prepare and submit to the Director an application at 
     such time, in such manner, and containing such information as 
     the Director may require.
       ``(c) Use of Funds.--Amounts received under a loan 
     guarantee under subsection (a) shall be used--
       ``(1) with respect to a loan guarantee described in 
     subsection (a)(1)--
       ``(A) to develop a plan for the implementation of a local 
     health information infrastructure under this section;
       ``(B) to establish systems for the sharing of data in 
     accordance with the national health information technology 
     standards developed under section 2903;
       ``(C) to purchase directly related integrated hardware and 
     software to establish an interoperable health information 
     technology system that is capable of linking to a local 
     health care information infrastructure; and
       ``(D) to train staff, maintain health information 
     technology systems, and maintain adequate security and 
     privacy protocols;
       ``(2) with respect to a loan guarantee described in 
     subsection (a)(2)--
       ``(A) to develop a plan for the purchase and installation 
     of health information technology;

[[Page S6336]]

       ``(B) to purchase directly related integrated hardware and 
     software to establish an interoperable health information 
     technology system that is capable of linking to a national or 
     local health care information infrastructure; and
       ``(C) to train staff, maintain health information 
     technology systems, and maintain adequate security and 
     privacy protocols; and
       ``(3) to carry out any other activities determined 
     appropriate by the Director.
       ``(d) Special Considerations for Certain Entities.--In 
     awarding loan guarantees under this section, the Director 
     shall give special consideration to eligible entities that--
       ``(1) provide service to low-income and underserved 
     populations; and
       ``(2) agree to electronically submit the information 
     described in paragraphs (3) and (4) of subsection (b) on a 
     daily basis.
       ``(e) Special Considerations for Local Health Information 
     Infrastructures.--In awarding loan guarantees under this 
     section to local health information infrastructures, the 
     Director shall give special consideration to eligible 
     entities that--
       ``(1) include at least 50 percent of the patients living in 
     the designated coverage area;
       ``(2) incorporate public health surveillance and reporting 
     into the overall architecture of the proposed infrastructure; 
     and
       ``(3) link local health information infrastructures.
       ``(f) Areas of Specific Interest.--In awarding loan 
     guarantees under this section, the Director shall include--
       ``(1) entities with a coverage area that includes an entire 
     State; and
       ``(2) entities with a multi-state coverage area.
       ``(g) Administrative Provisions.--
       ``(1) Aggregate amount.--
       ``(A) In general.--Except as provided in subparagraph (B), 
     the aggregate amount of principal of loans guaranteed under 
     subsection (a) with respect to an eligible entity may not 
     exceed $5,000,000. In any 12-month period the amount 
     disbursed to an eligible entity under this section (by a 
     lender under a guaranteed loan) may not exceed $5,000,000.
       ``(B) Exception.--The cumulative total of the principal of 
     the loans outstanding at any time to which guarantees have 
     been issued under subsection (a) may not exceed such 
     limitations as may be specified in appropriation Acts.
       ``(2) Protection of federal government.--
       ``(A) In general.--The Director may not approve an 
     application for a loan guarantee under this section unless 
     the Director determines that--
       ``(i) the terms, conditions, security (if any), and 
     schedule and amount of repayments with respect to the loan 
     are sufficient to protect the financial interests of the 
     United States and are otherwise reasonable, including a 
     determination that the rate of interest does not exceed such 
     percent per annum on the principal obligation outstanding as 
     the Director determines to be reasonable, taking into account 
     the range of interest rates prevailing in the private market 
     for loans with similar maturities, terms, conditions, and 
     security and the risks assumed by the United States; and
       ``(ii) the loan would not be available on reasonable terms 
     and conditions without the enactment of this section.
       ``(B) Recovery.--
       ``(i) In general.--The United States shall be entitled to 
     recover from the applicant for a loan guarantee under this 
     section the amount of any payment made pursuant to such loan 
     guarantee, unless the Director for good cause waives such 
     right of recovery, and, upon making any such payment, the 
     United States shall be subrogated to all of the rights of the 
     recipient of the payments with respect to which the loan was 
     made.
       ``(ii) Modification of terms.--Any terms and conditions 
     applicable to a loan guarantee under this section may be 
     modified by the Director to the extent the Director 
     determines it to be consistent with the financial interest of 
     the United States.
       ``(3) Defaults.--The Director may take such action as the 
     Director deems appropriate to protect the interest of the 
     United States in the event of a default on a loan guaranteed 
     under this section, including taking possession of, holding, 
     and using real property pledged as security for such a loan 
     guarantee.
       ``(h) Authorization of Appropriations.--
       ``(1) In general.--There is authorized to be appropriated 
     to carry out this section, $250,000,000 for each of fiscal 
     years 2006 through 2011.
       ``(2) Availability.--Amounts appropriated under 
     subparagraph (A) shall remain available for obligation until 
     expended.

     ``SEC. 2905. GRANTS FOR THE PURCHASE OF HEALTH INFORMATION 
                   TECHNOLOGY.

       ``(a) In General.--The Director may award competitive 
     grants to eligible entities--
       ``(1) to implement local health information infrastructures 
     to facilitate the development of interoperability across 
     health care settings; or
       ``(2) to facilitate the purchase and adoption of health 
     information technology.
       ``(b) Eligibility.--To be eligible to receive a grant under 
     section (a) an entity shall--
       ``(1) demonstrate financial need to the Director;
       ``(2) with respect to an entity desiring a grant--
       ``(A) under subsection (a)(1), represent an independent 
     consortium of health care stakeholders within a community 
     that--
       ``(i) includes--

       ``(I) physicians (as defined in section 1881(r)(1) of the 
     Social Security Act);
       ``(II) hospitals; and
       ``(III) group health plans or other health insurance 
     issuers (as such terms are defined in section 2791); and

       ``(ii) may include any other health care providers; or
       ``(B) under subsection (a)(2) be a health care provider 
     that provides health care services to low-income and 
     underserved populations;
       ``(3) adopt the national health information technology 
     standards developed under section 2903;
       ``(4) provide assurances that the entity shall submit to 
     the Director regular reports on the activities carried out 
     under the loan guarantee, including--
       ``(A) a description of the financial costs and benefits of 
     the project involved and of the entities to which such costs 
     and benefits accrue;
       ``(B) a description of the impact of the project on health 
     care quality and safety; and
       ``(C) a description of any reduction in duplicative or 
     unnecessary care as a result of the project involved;
       ``(5) provide assurances that not later than 30 days after 
     the development of the standard quality measures pursuant to 
     section 2906, the entity shall submit to the Director regular 
     reports on such measures, including provider level data and 
     analysis of the impact of information technology on such 
     measures;
       ``(6) prepare and submit to the Director an application at 
     such time, in such manner, and containing such information as 
     the Director may require; and
       ``(7) agree to provide matching funds in accordance with 
     subsection (g).
       ``(c) Use of Funds.--Amounts received under a grant under 
     subsection (a) shall be used to--
       ``(1) with respect to a grant described in subsection 
     (a)(1)--
       ``(A) to develop a plan for the implementation of a local 
     health information infrastructure under this section;
       ``(B) to establish systems for the sharing of data in 
     accordance with the national health information technology 
     standards developed under section 2903;
       ``(C) to implement, enhance, or upgrade a comprehensive, 
     electronic health information technology system; and
       ``(D) to maintain adequate security and privacy protocols;
       ``(2) with respect to a grant described in subsection 
     (a)(2)--
       ``(A) to develop a plan for the purchase and installation 
     of health information technology;
       ``(B) to purchase directly related integrated hardware and 
     software to establish an interoperable health information 
     technology system that is capable of linking to a national or 
     local health care information infrastructure; and
       ``(C) to train staff, maintain health information 
     technology systems, and maintain adequate security and 
     privacy protocols;
       ``(3) maintain adequate security and privacy protocols; and
       ``(4) to carry out any other activities determined 
     appropriate by the Director.
       ``(d) Special Considerations for Certain Entities.--In 
     awarding grants under this section, the Director shall give 
     special consideration to eligible entities that--
       ``(1) provide service to low-income and underserved 
     populations; and
       ``(2) agree to electronically submit the information 
     described in paragraphs (4) and (5) of subsection (b).
       ``(e) Special Considerations for Local Health Information 
     Infrastructures.--In awarding grants under this section to 
     local health information infrastructures, the Director shall 
     give special consideration to eligible entities that--
       ``(1) include at least 50 percent of the patients living in 
     the designated coverage area;
       ``(2) incorporate public health surveillance and reporting 
     into the overall architecture of the proposed infrastructure; 
     and
       ``(3) link local health information infrastructures;
       ``(f) Areas of Specific Interest.--In awarding grants under 
     this section, the Director shall include--
       ``(1) entities with a coverage area that includes an entire 
     State; and
       ``(2) entities with a multi-state coverage area.
       ``(g) Matching Requirement.--
       ``(1) In general.--The Director may not make a grant under 
     this section to an entity unless the entity agrees that, with 
     respect to the costs to be incurred by the entity in carrying 
     out the infrastructure program for which the grant was 
     awarded, the entity will make available (directly or through 
     donations from public or private entities) non-Federal 
     contributions toward such costs in an amount equal to not 
     less than 20 percent of such costs ($1 for each $5 of Federal 
     funds provided under the grant).
       ``(2) Determination of amount contributed.--Non-Federal 
     contributions required under paragraph (1) may be in cash or 
     in kind, fairly evaluated, including equipment, technology, 
     or services. Amounts provided by the Federal Government, or 
     services assisted or subsidized to any significant extent

[[Page S6337]]

     by the Federal Government, may not be included in determining 
     the amount of such non-Federal contributions.
       ``(h) Authorization of Appropriations.--
       ``(1) In general.--There is authorized to be appropriated 
     to carry out this section, $250,000,000 for each of fiscal 
     years 2006 through 2011.
       ``(2) Availability.--Amounts appropriated under paragraph 
     (1) shall remain available for obligation until expended.''.

     SEC. 3. STANDARDIZED MEASURES OF QUALITY HEALTH CARE AND DATA 
                   COLLECTION.

       Title XXIX of the Public Health Service Act, as added by 
     section 2, is amended by adding at the end the following:

     ``SEC. 2906. STANDARDIZED MEASURES OF QUALITY HEALTH CARE.

       ``(a) In General.--
       ``(1) Collaboration.--The Secretary of Health and Human 
     Services, the Secretary of Defense, and the Secretary of 
     Veterans Affairs (referred to in this section as the 
     `Secretaries'), in consultation with the Quality Interagency 
     Coordination Taskforce (as established by Executive Order on 
     March 13, 1998), the Institute of Medicine, the Joint 
     Commission on Accreditation of Healthcare Organizations, the 
     National Committee for Quality Assurance, the American Health 
     Quality Association, the National Quality Forum, the Medicare 
     Payment Advisory Committee, and other individuals and 
     organizations determined appropriate by the Secretaries, 
     shall establish uniform health care quality measures to 
     assess the effectiveness, timeliness, patient-centeredness, 
     efficiency, equity, and safety of care delivered across all 
     federally supported health delivery programs.
       ``(2) Development of measures.--Not later than 18 months 
     after the date of enactment of this title, the Secretaries 
     shall develop standardized sets of quality measures for each 
     of the 20 priority areas for improvement in health care 
     quality as identified by the Institute of Medicine in their 
     report entitled `Priority Areas for National Action' in 2003, 
     or other such areas as identified by the Secretaries in order 
     to assist beneficiaries in making informed choices about 
     health plans or care delivery systems. The selection of 
     appropriate quality indicators under this subsection shall 
     include the evaluation criteria formulated by clinical 
     professionals, consumers, and data collection experts.
       ``(3) Pilot testing.--Each federally supported health 
     delivery program may conduct a pilot test of the quality 
     measures developed under paragraph (2) that shall include a 
     collection of patient-level data and a public release of 
     comparative performance reports.
       ``(b) Public Reporting Requirements.--The Secretaries, 
     working collaboratively, shall establish public reporting 
     requirements for clinicians, institutional providers, and 
     health plans in each of the federally supported health 
     delivery program described in subsection (a). Such 
     requirements shall provide that the entities described in the 
     preceding sentence shall report to the appropriate Secretary 
     on the measures developed under subsection (a).
       ``(c) Full Implementation.--The Secretaries, working 
     collaboratively, shall implement all sets of quality measures 
     and reporting systems developed under subsections (a) and (b) 
     by not later than the date that is 1 year after the date on 
     which the measures are developed under subsection (a)(2).
       ``(d) Reports.--Not later than 1 year after the date of 
     enactment of this title, and annually thereafter, the 
     Secretary shall--
       ``(1) submit to Congress a report that details the 
     collaborative efforts carried out under subsection (a), the 
     progress made on standardizing quality indicators throughout 
     the Federal Government, and the state of quality measurement 
     for priority areas that links data to the report submitted 
     under paragraph (2) for the year involved; and
       ``(2) submit to Congress a report that details areas of 
     clinical care requiring further research necessary to 
     establish effective clinical treatments that will serve as a 
     basis for additional quality indicators.
       ``(e) Comparative Quality Reports.--Beginning not later 
     than 3 years after the date of enactment of this title, in 
     order to make comparative quality information available to 
     health care consumers, including members of health disparity 
     populations, health professionals, public health officials, 
     researchers, and other appropriate individuals and entities, 
     the Secretaries shall provide for the pooling, analysis, and 
     dissemination of quality measures collected under this 
     section. Nothing in this section shall be construed as 
     modifying the privacy standards under the Health Insurance 
     Portability and Accountability Act of 1996 (Public Law 104-
     191).
       ``(f) Ongoing Evaluation of Use.--The Secretary of Health 
     and Human Services shall ensure the ongoing evaluation of the 
     use of the health care quality measures established under 
     this section.
       ``(g) Evaluation and Regulations.--
       ``(1) Evaluation.--
       ``(A) In general.--The Secretary shall, directly or 
     indirectly through a contract with another entity, conduct an 
     evaluation of the collaborative efforts of the Secretaries to 
     establish uniform health care quality measures and reporting 
     requirements for federally supported health care delivery 
     programs as required under this section.
       ``(B) Report.--Not later than 1 year after the date of 
     enactment of this title, the Secretary of Health and Human 
     Services shall submit a report to the appropriate committees 
     of Congress concerning the results of the evaluation under 
     subparagraph (A).
       ``(2) Regulations.--
       ``(A) Proposed.--Not later than 6 months after the date on 
     which the report is submitted under paragraph (1)(B), the 
     Secretary shall publish proposed regulations regarding the 
     application of the uniform health care quality measures and 
     reporting requirements described in this section to federally 
     supported health delivery programs.
       ``(B) Final regulations.--Not later than 1 year after the 
     date on which the report is submitted under paragraph (1)(B), 
     the Secretary shall publish final regulations regarding the 
     uniform health care quality measures and reporting 
     requirements described in this section.
       ``(h) Definitions.--In this section, the term `federally 
     supported health delivery program' means a program that is 
     funded by the Federal Government under which health care 
     items or services are delivered directly to patients.''.
                                 ______