[Congressional Record Volume 151, Number 153 (Thursday, November 17, 2005)]
[Senate]
[Pages S13260-S13277]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
WIRED FOR HEALTH CARE QUALITY ACT
Mr. FRIST. Mr. President, I ask unanimous consent that the Senate
proceed to the immediate consideration of Calendar No. 178, S. 1418.
The PRESIDING OFFICER. The clerk will report the bill by title.
The legislative clerk read as follows:
A bill (S. 1418) to enhance the adoption of a nationwide
interoperable health information technology system and to
improve the quality and reduce the costs of health care in
the United States.
There being no objection, the Senate proceeded to consider the bill,
which had been reported from the Committee on Health, Education, Labor,
and Pensions, with an amendment.
(Strike the part shown in black brackets and insert the part shown in
italic.)
[[Page S13261]]
S. 1418
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 ``Wired for Health Care
Quality Act''.
[SEC. 2. IMPROVING HEALTH CARE, QUALITY, SAFETY, AND
EFFICIENCY.
[The Public Health Service Act (42 U.S.C. 201 et seq.) is
amended by adding at the end the following:
``TITLE XXIX--HEALTH INFORMATION TECHNOLOGY
[``SEC. 2901. DEFINITIONS.
[``In this title:
[``(1) Health care provider.--The term `health care
provider' means a hospital, skilled nursing facility, home
health entity, health care clinic, federally qualified health
center, group practice (as defined in section 1877(h)(4) of
the Social Security Act), a pharmacist, a pharmacy, a
laboratory, a physician (as defined in section 1861(r) of the
Social Security Act), a health facility operated by or
pursuant to a contract with the Indian Health Service, a
rural health clinic, and any other category of facility or
clinician determined appropriate by the Secretary.
[``(2) Health information.--The term `health information'
has the meaning given such term in section 1171(4) of the
Social Security Act.
[``(3) Health insurance plan.--The term `health insurance
plan' means--
[``(A) a health insurance issuer (as defined in section
2791(b)(2));
[``(B) a group health plan (as defined in section
2791(a)(1)); and
[``(C) a health maintenance organization (as defined in
section 2791(b)(3)).
[``(4) Laboratory.--The term `laboratory' has the meaning
given that term in section 353.
[``(5) Pharmacist.--The term `pharmacist' has the meaning
given that term in section 804 of the Federal Food, Drug, and
Cosmetic Act.
[``(6) Qualified health information technology.--The term
`qualified health information technology' means a
computerized system (including hardware, software, and
training) that--
[``(A) protects the privacy and security of health
information;
[``(B) maintains and provides permitted access to health
information in an electronic format;
[``(C) incorporates decision support to reduce medical
errors and enhance health care quality;
[``(D) complies with the standards adopted by the Federal
Government under section 2903; and
[``(E) allows for the reporting of quality measures under
section 2908.
[``(7) State.--The term `State' means each of the several
States, the District of Columbia, Puerto Rico, the Virgin
Islands, Guam, American Samoa, and the Northern Mariana
Islands.
[``SEC. 2902. OFFICE OF THE NATIONAL COORDINATOR OF HEALTH
INFORMATION TECHNOLOGY.
[``(a) Office of National Health Information Technology.--
There is established within the Office of the Secretary an
Office of the National Coordinator of Health Information
Technology (referred to in this section as the `Office'). The
Office shall be headed by a National Coordinator who shall be
appointed by the President, in consultation with the
Secretary, and shall report directly to the Secretary.
[``(b) Purpose.--It shall be the purpose of the Office to
carry out programs and activities to develop a nationwide
interoperable health information technology infrastructure
that--
[``(1) ensures that patients' health information is secure
and protected;
[``(2) improves health care quality, reduces medical
errors, and advances the delivery of patient-centered medical
care;
[``(3) reduces health care costs resulting from
inefficiency, medical errors, inappropriate care, and
incomplete information;
[``(4) ensures that appropriate information to help guide
medical decisions is available at the time and place of care;
[``(5) promotes a more effective marketplace, greater
competition, and increased choice through the wider
availability of accurate information on health care costs,
quality, and outcomes;
[``(6) improves the coordination of care and information
among hospitals, laboratories, physician offices, and other
entities through an effective infrastructure for the secure
and authorized exchange of health care information;
[``(7) improves public health reporting and facilitates the
early identification and rapid response to public health
threats and emergencies, including bioterror events and
infectious disease outbreaks;
[``(8) facilitates health research; and
[``(9) promotes prevention of chronic diseases.
[``(c) Duties of the National Coordinator.--The National
Coordinator shall--
[``(1) serve as a member of the public-private American
Health Information Collaborative established under section
2903;
[``(2) serve as the principal advisor to the Secretary
concerning the development, application, and use of health
information technology, and coordinate and oversee the health
information technology programs of the Department;
[``(3) facilitate the adoption of a nationwide,
interoperable system for the electronic exchange of health
information;
[``(4) ensure the adoption and implementation of standards
for the electronic exchange of health information to reduce
cost and improve health care quality;
[``(5) ensure that health information technology policy and
programs of the Department are coordinated with those of
relevant executive branch agencies (including Federal
commissions) with a goal of avoiding duplication of efforts
and of helping to ensure that each agency undertakes health
information technology activities primarily within the areas
of its greatest expertise and technical capability;
[``(6) to the extent permitted by law, coordinate outreach
and consultation by the relevant executive branch agencies
(including Federal commissions) with public and private
parties of interest, including consumers, payers, employers,
hospitals and other health care providers, physicians,
community health centers, laboratories, vendors and other
stakeholders;
[``(7) advise the President regarding specific Federal
health information technology programs; and
[``(8) submit the reports described under section 2903(i)
(excluding paragraph (4) of such section).
[``(d) Detail of Federal Employees.--
[``(1) In general.--Upon the request of the National
Coordinator, the head of any Federal agency is authorized to
detail, with or 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.
[``(2) Effect of detail.--Any detail of personnel under
paragraph (1) shall--
[``(A) not interrupt or otherwise affect the civil service
status or privileges of the Federal employee; and
[``(B) be in addition to any other staff of the Department
employed by the National Coordinator.
[``(3) Acceptance of detailees.--Notwithstanding any other
provision of law, the Office may accept detailed personnel
from other Federal agencies without regard to whether the
agency described under paragraph (1) is reimbursed.
[``(e) Rule of Construction.--Nothing in this section shall
be construed to require the duplication of Federal efforts
with respect to the establishment of the Office, regardless
of whether such efforts were carried out prior to or after
the enactment of this title.
[``(f) Authorization of Appropriations.--There are
authorized to be appropriated such sums as may be necessary
to carry out the activities of the Office under this section
for each of fiscal years 2006 through 2010.
[``SEC. 2903. AMERICAN HEALTH INFORMATION COLLABORATIVE.
[``(a) Purpose.--The Secretary shall establish the public-
private American Health Information Collaborative (referred
to in this section as the `Collaborative') to--
[``(1) advise the Secretary and recommend specific actions
to achieve a nationwide interoperable health information
technology infrastructure;
[``(2) serve as a forum for the participation of a broad
range of stakeholders to provide input on achieving the
interoperability of health information technology; and
[``(3) recommend standards (including content,
communication, and security standards) for the electronic
exchange of health information for adoption by the Federal
Government and voluntary adoption by private entities.
[``(b) Composition.--
[``(1) In general.--The Collaborative shall be composed
of--
[``(A) the Secretary, who shall serve as the chairperson of
the Collaborative;
[``(B) the Secretary of Defense, or his or her designee;
[``(C) the Secretary of Veterans Affairs, or his or her
designee;
[``(D) the Secretary of Commerce, or his or her designee;
[``(E) the National Coordinator for Health Information
Technology;
[``(F) representatives of other relevant Federal agencies,
as determined appropriate by the Secretary; and
[``(G) representatives from each of the following
categories to be appointed by the Secretary from nominations
submitted by the public--
[``(i) consumer and patient organizations;
[``(ii) experts in health information privacy and security;
[``(iii) health care providers;
[``(iv) health insurance plans or other third party payors;
[``(v) standards development organizations;
[``(vi) information technology vendors;
[``(vii) purchasers or employers; and
[``(viii) State or local government agencies or Indian
tribe or tribal organizations.
[``(2) Considerations.--In appointing members under
paragraph (1)(G), the Secretary shall select individuals with
expertise in--
[``(A) health information privacy;
[``(B) health information security;
[``(C) health care quality and patient safety, including
those individuals with experience in utilizing health
information technology to improve health care quality and
patient safety;
[``(D) data exchange; and
[[Page S13262]]
[``(E) developing health information technology standards
and new health information technology.
[``(3) Terms.--Members appointed under paragraph (1)(G)
shall serve for 2 year terms, except that any member
appointed to fill a vacancy for an unexpired term shall be
appointed for the remainder of such term. A member may serve
for not to exceed 180 days after the expiration of such
member's term or until a successor has been appointed.
[``(c) Recommendations and Policies.--The Collaborative
shall make recommendations to identify uniform national
policies for adoption by the Federal Government and voluntary
adoption by private entities to support the widespread
adoption of health information technology, including--
[``(1) protection of health information through privacy and
security practices;
[``(2) measures to prevent unauthorized access to health
information;
[``(3) methods to facilitate secure patient access to
health information;
[``(4) the ongoing harmonization of industry-wide health
information technology standards;
[``(5) recommendations for a nationwide interoperable
health information technology infrastructure;
[``(6) the identification and prioritization of specific
use cases for which heath information technology is valuable,
beneficial, and feasible;
[``(7) recommendations for the establishment of an entity
to ensure the continuation of the functions of the
Collaborative; and
[``(8) other policies determined to be necessary by the
Collaborative.
[``(d) Standards.--
[``(1) Existing standards.--The standards adopted by the
Consolidated Health Informatics Initiative shall be deemed to
have been recommended by the Collaborative under this
section.
[``(2) First year review.--Not later than 1 year after the
date of enactment of this title, the Collaborative shall--
[``(A) review existing standards (including content,
communication, and security standards) for the electronic
exchange of health information, including such standards
adopted by the Secretary under paragraph (2)(A);
[``(B) identify deficiencies and omissions in such existing
standards; and
[``(C) identify duplication and overlap in such existing
standards;
and recommend modifications to such standards as necessary.
[``(3) Ongoing review.--Beginning 1 year after the date of
enactment of this title, and annually thereafter, the
Collaborative shall--
[``(A) review existing standards (including content,
communication, and security standards) for the electronic
exchange of health information, including such standards
adopted by the Secretary under paragraph (2)(A);
[``(B) identify deficiencies and omissions in such existing
standards; and
[``(C) identify duplication and overlap in such existing
standards;
and recommend modifications to such standards as necessary.
[``(4) Limitation.--The standards described in this section
shall be consistent with any standards developed pursuant to
the Health Insurance Portability and Accountability Act of
1996.
[``(e) Federal Action.--Not later than 60 days after the
issuance of a recommendation from the Collaborative under
subsection (d)(2), the Secretary of Health and Human
Services, the Secretary of Veterans Affairs, and the
Secretary of Defense, in collaboration with representatives
of other relevant Federal agencies, as determined appropriate
by the Secretary, shall jointly review such recommendations.
The Secretary shall provide for the adoption by the Federal
Government of any standard or standards contained in such
recommendation.
[``(f) Coordination of Federal Spending.--Not later than 1
year after the adoption by the Federal Government of a
recommendation as provided for in subsection (e), and in
compliance with chapter 113 of title 40, United States Code,
no Federal agency shall expend Federal funds for the purchase
of any form of health information technology or health
information technology system for clinical care or for the
electronic retrieval, storage, or exchange of health
information that is not consistent with applicable standards
adopted by the Federal Government under subsection (e).
[``(g) Coordination of Federal Data Collection.--Not later
than 3 years after the adoption by the Federal Government of
a recommendation as provided for in subsection (e), all
Federal agencies collecting health data for the purposes of
surveillance, epidemiology, adverse event reporting,
research, or for other purposes determined appropriate by the
Secretary shall comply with standards adopted under
subsection (e).
[``(h) Voluntary Adoption.--Any standards adopted by the
Federal Government under subsection (e) shall be voluntary
with respect to private entities.
[``(i) Reports.--The Secretary shall submit to the
Committee on Health, Education, Labor, and Pensions and the
Committee on Finance of the Senate and the Committee on
Energy and Commerce and the Committee on Ways and Means of
the House of Representatives, on an annual basis, a report
that--
[``(1) describes the specific actions that have been taken
by the Federal Government and private entities to facilitate
the adoption of an interoperable nationwide system for the
electronic exchange of health information;
[``(2) describes barriers to the adoption of such a
nationwide system;
[``(3) contains recommendations to achieve full
implementation of such a nationwide system; and
[``(4) contains a plan and progress toward the
establishment of an entity to ensure the continuation of the
functions of the Collaborative.
[``(j) Application of FACA.--The Federal Advisory Committee
Act (5 U.S.C. App.) shall apply to the Collaborative, except
that the term provided for under section 14(a)(2) shall be 5
years.
[``(k) Rule of Construction.--Nothing in this section shall
be construed to require the duplication of Federal efforts
with respect to the establishment of the Collaborative,
regardless of whether such efforts were carried out prior to
or after the enactment of this title.
[``(l) Authorization of Appropriations.--There are
authorized to be appropriated such sums as may be necessary
to carry out this section for each of fiscal years 2006
through 2010.
[``SEC. 2904. IMPLEMENTATION AND CERTIFICATION OF HEALTH
INFORMATION STANDARDS.
[``(a) Implementation.--
[``(1) In general.--The Secretary, based upon the
recommendations of the Collaborative, shall develop criteria
to ensure uniform and consistent implementation of any
standards for the electronic exchange of health information
voluntarily adopted by private entities in technical
conformance with such standards adopted under this title.
[``(2) Implementation assistance.--The Secretary may
recognize a private entity or entities to assist private
entities in the implementation of the standards adopted under
this title using the criteria developed by the Secretary
under this section.
[``(b) Certification.--
[``(1) In general.--The Secretary, based upon the
recommendations of the Collaborative, shall develop criteria
to ensure and certify that hardware, software, and support
services that claim to be in compliance with any standard for
the electronic exchange of health information adopted under
this title have established and maintained such compliance in
technical conformance with such standards.
[``(2) Certification assistance.--The Secretary may
recognize a private entity or entities to assist in the
certification described under paragraph (1) using the
criteria developed by the Secretary under this section.
[``(c) Delegation Authority.--The Secretary, through
consultation with the Collaborative, may delegate the
development of the criteria under subsections (a) and (b) to
a private entity.
[``SEC. 2905. GRANTS TO FACILITATE THE WIDESPREAD ADOPTION OF
INTEROPERABLE HEALTH INFORMATION TECHNOLOGY.
[``(a) Competitive Grants to Facilitate the Widespread
Adoption of Health Information Technology.--
[``(1) In general.--The Secretary may award competitive
grants to eligible entities to facilitate the purchase and
enhance the utilization of qualified health information
technology systems to improve the quality and efficiency of
health care.
[``(2) Eligibility.--To be eligible to receive a grant
under paragraph (1) an entity shall--
[``(A) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require;
[``(B) submit to the Secretary a strategic plan for the
implementation of data sharing and interoperability measures;
[``(C) be a--
[``(i) not for profit hospital;
[``(ii) group practice (including a single physician); or
[``(iii) another health care provider not described in
clause (i) or (ii);
[``(D) adopt the standards adopted by the Federal
Government under section 2903;
[``(E) require that health care providers receiving such
grants implement the measurement system adopted under section
2908 and report to the Secretary on such measures;
[``(F) demonstrate significant financial need; and
[``(G) provide matching funds in accordance with paragraph
(4).
[``(3) Use of funds.--Amounts received under a grant under
this subsection shall be used to facilitate the purchase and
enhance the utilization of qualified health information
technology systems.
[``(4) Matching requirement.--To be eligible for a grant
under this subsection an entity shall contribute non-Federal
contributions to the costs of carrying out the activities for
which the grant is awarded in an amount equal to $1 for each
$3 of Federal funds provided under the grant.
[``(5) Preference in awarding grants.--In awarding grants
under this subsection the Secretary shall give preference
to--
[``(A) eligible entities that are located in rural,
frontier, and other underserved areas as determined by the
Secretary; and
[``(B) eligible entities that will link, to the extent
practicable, the qualified health information system to local
or regional health information networks.
[``(b) Competitive Grants to States for the Development of
State Loan Programs to Facilitate the Widespread Adoption of
Health Information Technology.--
[``(1) In general.--The Secretary may award competitive
grants to States for the establishment of State programs for
loans to
[[Page S13263]]
health care providers to facilitate the purchase and enhance
the utilization of qualified health information technology.
[``(2) Establishment of fund.--To be eligible to receive a
competitive grant under this subsection, a State shall
establish a qualified health information technology loan fund
(referred to in this subsection as a `State loan fund') and
comply with the other requirements contained in this section.
A grant to a State under this subsection shall be deposited
in the State loan fund established by the State. No funds
authorized by other provisions of this title to be used for
other purposes specified in this title shall be deposited in
any State loan fund.
[``(3) Eligibility.--To be eligible to receive a grant
under paragraph (1) a State shall--
[``(A) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require;
[``(B) submit to the Secretary a strategic plan in
accordance with paragraph (4);
[``(C) establish a qualified health information technology
loan fund in accordance with paragraph (2);
[``(D) require that health care providers receiving such
loans--
[``(i) link, to the extent practicable, the qualified
health information system to a local or regional health
information network; and
[``(ii) consult with the Center for Best Practices
established in section 914(d) to access the knowledge and
experience of existing initiatives regarding the successful
implementation and effective use of health information
technology;
[``(E) require that health care providers receiving such
loans adopt the standards adopted by the Federal Government
under section 2903(d);
[``(F) require that health care providers receiving such
loans implement the measurement system adopted under section
2908 and report to the Secretary on such measures; and
[``(G) provide matching funds in accordance with paragraph
(8).
[``(4) Strategic plan.--
[``(A) In general.--A State that receives a grant under
this subsection shall annually prepare a strategic plan that
identifies the intended uses of amounts available to the
State loan fund of the State.
[``(B) Contents.--A strategic plan under subparagraph (A)
shall include--
[``(i) a list of the projects to be assisted through the
State loan fund in the first fiscal year that begins after
the date on which the plan is submitted;
[``(ii) a description of the criteria and methods
established for the distribution of funds from the State loan
fund; and
[``(iii) a description of the financial status of the State
loan fund and the short-term and long-term goals of the State
loan fund.
[``(5) Use of funds.--
[``(A) In general.--Amounts deposited in a State loan fund,
including loan repayments and interest earned on such
amounts, shall be used only for awarding loans or loan
guarantees, or as a source of reserve and security for
leveraged loans, the proceeds of which are deposited in the
State loan fund established under paragraph (1). Loans under
this section may be used by a health care provider to
facilitate the purchase and enhance the utilization of
qualified health information technology.
[``(B) Limitation.--Amounts received by a State under this
subsection may not be used--
[``(i) for the purchase or other acquisition of any health
information technology system that is not a qualified health
information technology system;
[``(ii) to conduct activities for which Federal funds are
expended under this title, or the amendments made by the
Wired for Health Care Quality Act; or
[``(iii) for any purpose other than making loans to
eligible entities under this section.
[``(6) Types of assistance.--Except as otherwise limited by
applicable State law, amounts deposited into a State loan
fund under this subsection may only be used for the
following:
[``(A) To award loans that comply with the following:
[``(i) The interest rate for each loan shall be less than
or equal to the market interest rate.
[``(ii) The principal and interest payments on each loan
shall commence not later than 1 year after the loan was
awarded, and each loan shall be fully amortized not later
than 10 years after the date of the loan.
[``(iii) The State loan fund shall be credited with all
payments of principal and interest on each loan awarded from
the fund.
[``(B) To guarantee, or purchase insurance for, a local
obligation (all of the proceeds of which finance a project
eligible for assistance under this subsection) if the
guarantee or purchase would improve credit market access or
reduce the interest rate applicable to the obligation
involved.
[``(C) As a source of revenue or security for the payment
of principal and interest on revenue or general obligation
bonds issued by the State if the proceeds of the sale of the
bonds will be deposited into the State loan fund.
[``(D) To earn interest on the amounts deposited into the
State loan fund.
[``(7) Administration of state loan funds.--
[``(A) Combined financial administration.--A State may (as
a convenience and to avoid unnecessary administrative costs)
combine, in accordance with State law, the financial
administration of a State loan fund established under this
subsection with the financial administration of any other
revolving fund established by the State if otherwise not
prohibited by the law under which the State loan fund was
established.
[``(B) Cost of administering fund.--Each State may annually
use not to exceed 4 percent of the funds provided to the
State under a grant under this subsection to pay the
reasonable costs of the administration of the programs under
this section, including the recovery of reasonable costs
expended to establish a State loan fund which are incurred
after the date of enactment of this title.
[``(C) Guidance and regulations.--The Secretary shall
publish guidance and promulgate regulations as may be
necessary to carry out the provisions of this subsection,
including--
[``(i) provisions to ensure that each State commits and
expends funds allotted to the State under this subsection as
efficiently as possible in accordance with this title and
applicable State laws; and
[``(ii) guidance to prevent waste, fraud, and abuse.
[``(D) Private sector contributions.--
[``(i) In general.--A State loan fund established under
this subsection may accept contributions from private sector
entities, except that such entities may not specify the
recipient or recipients of any loan issued under this
subsection.
[``(ii) Availability of information.--A State shall make
publically available the identity of, and amount contributed
by, any private sector entity under clause (i) and may issue
letters of commendation or make other awards (that have no
financial value) to any such entity.
[``(8) Matching requirements.--
[``(A) In general.--The Secretary may not make a grant
under paragraph (1) to a State unless the State agrees to
make available (directly or through donations from public or
private entities) non-Federal contributions in cash toward
the costs of the State program to be implemented under the
grant in an amount equal to not less than $1 for each $1 of
Federal funds provided under the grant.
[``(B) Determination of amount of non-federal
contribution.--In determining the amount of non-Federal
contributions that a State has provided pursuant to
subparagraph (A), the Secretary may not include any amounts
provided to the State by the Federal Government.
[``(9) Preference in awarding grants.--The Secretary may
give a preference in awarding grants under this subsection to
States that adopt value-based purchasing programs to improve
health care quality.
[``(10) Reports.--The Secretary shall annually submit to
the Committee on Health, Education, Labor, and Pensions and
the Committee on Finance of the Senate, and the Committee on
Energy and Commerce and the Committee on Ways and Means of
the House of Representatives, a report summarizing the
reports received by the Secretary from each State that
receives a grant under this subsection.
[``(c) Grants for the Implementation of Regional or Local
Health Information Technology Plans.--
[``(1) In general.--The Secretary may award competitive
grants to eligible entities to implement regional or local
health information plans to improve health care quality and
efficiency through the electronic exchange of health
information pursuant to the standards, protocols, and other
requirements adopted by the Secretary under sections 2903 and
2908.
[``(2) Eligibility.--To be eligible to receive a grant
under paragraph (1) an entity shall--
[``(A) demonstrate financial need to the Secretary;
[``(B) demonstrate that one of its principal missions or
purposes is to use information technology to improve health
care quality and efficiency;
[``(C) adopt bylaws, memoranda of understanding, or other
charter documents that demonstrate that the governance
structure and decisionmaking processes of such entity allow
for participation on an ongoing basis by multiple
stakeholders within a community, including--
[``(i) physicians (as defined in section 1861(r) of the
Social Security Act), including physicians that provide
services to low income and underserved populations;
[``(ii) hospitals (including hospitals that provide
services to low income and underserved populations);
[``(iii) pharmacists or pharmacies;
[``(iv) health insurance plans;
[``(v) health centers (as defined in section 330(b)) and
Federally qualified health centers (as defined in section
1861(aa)(4) of the Social Security Act);
[``(vi) rural health clinics (as defined in section
1861(aa) of the Social Security Act);
[``(vii) patient or consumer organizations;
[``(viii) employers; and
[``(ix) any other health care providers or other entities,
as determined appropriate by the Secretary;
[``(D) adopt nondiscrimination and conflict of interest
policies that demonstrate a commitment to open, fair, and
nondiscriminatory participation in the health information
plan by all stakeholders;
[``(E) adopt the standards adopted by the Secretary under
section 2903;
[[Page S13264]]
[``(F) require that health care providers receiving such
loans implement the measurement system adopted under section
2908 and report to the Secretary on such measures;
[``(G) facilitate the electronic exchange of health
information within the local or regional area and among local
and regional areas;
[``(H) prepare and submit to the Secretary an application
in accordance with paragraph (3); and
[``(I) agree to provide matching funds in accordance with
paragraph (5).
[``(3) Application.--
[``(A) In general.--To be eligible to receive a grant under
paragraph (1), an entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require.
[``(B) Required information.--At a minimum, an application
submitted under this paragraph shall include--
[``(i) clearly identified short-term and long-term
objectives of the regional or local health information plan;
[``(ii) a technology plan that complies with the standards
adopted under section 2903 and that includes a descriptive
and reasoned estimate of costs of the hardware, software,
training, and consulting services necessary to implement the
regional or local health information plan;
[``(iii) a strategy that includes initiatives to improve
health care quality and efficiency, including the use and
reporting of health care quality measures adopted under
section 2908;
[``(iv) a plan that describes provisions to encourage the
implementation of the electronic exchange of health
information by all physicians, including single physician
practices and small physician groups participating in the
health information plan;
[``(v) a plan to ensure the privacy and security of
personal health information that is consistent with Federal
and State law;
[``(vi) a governance plan that defines the manner in which
the stakeholders shall jointly make policy and operational
decisions on an ongoing basis; and
[``(vii) a financial or business plan that describes--
[```(I) the sustainability of the plan;
[```(II) the financial costs and benefits of the plan; and
[```(III) the entities to which such costs and benefits
will accrue.
[``(4) Use of funds.--Amounts received under a grant under
paragraph (1) shall be used to establish and implement a
regional or local health information plan in accordance with
this subsection.
[``(5) Matching requirement.--
[``(A) In general.--The Secretary may not make a grant
under this subsection 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 50 percent of such costs ($1 for each $2 of
Federal funds provided under the grant).
[``(B) Determination of amount contributed.--Non-Federal
contributions required under subparagraph (A) 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 by the Federal Government, may not be
included in determining the amount of such non-Federal
contributions.
[``(d) Reports.--Not later than 1 year after the date on
which the first grant is awarded under this section, and
annually thereafter during the grant period, an entity that
receives a grant under this section shall submit to the
Secretary a report on the activities carried out under the
grant involved. Each such report shall include--
[``(1) a description of the financial costs and benefits of
the project involved and of the entities to which such costs
and benefits accrue;
[``(2) an analysis of the impact of the project on health
care quality and safety;
[``(3) a description of any reduction in duplicative or
unnecessary care as a result of the project involved;
[``(4) a description of the efforts of recipients under
this section to facilitate secure patient access to health
information; and
[``(5) other information as required by the Secretary.
[``(e) Authorization of Appropriations.--
[``(1) In general.--For the purpose of carrying out this
section, there is authorized to be appropriated $125,000,000
for fiscal year 2006, $150,000,000 for fiscal year 2007, and
such sums as may be necessary for each of fiscal years 2008
through 2010.
[``(2) Availability.--Amounts appropriated under paragraph
(1) shall remain available through fiscal year 2010.
[``SEC. 2906. DEMONSTRATION PROGRAM TO INTEGRATE INFORMATION
TECHNOLOGY INTO CLINICAL EDUCATION.
[``(a) In General.--The Secretary may award grants under
this section to carry out demonstration projects to develop
academic curricula integrating qualified health information
technology systems in the clinical education of health
professionals. Such awards shall be made on a competitive
basis and pursuant to peer review.
[``(b) Eligibility.--To be eligible to receive a grant
under subsection (a), an entity shall--
[``(1) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require;
[``(2) submit to the Secretary a strategic plan for
integrating qualified health information technology in the
clinical education of health professionals and for ensuring
the consistent utilization of decision support software to
reduce medical errors and enhance health care quality;
[``(3) be--
[``(A) a health professions school;
[``(B) a school of nursing; or
[``(C) a graduate medical education program;
[``(4) provide for the collection of data regarding the
effectiveness of the demonstration project to be funded under
the grant in improving the safety of patients, the efficiency
of health care delivery, and in increasing the likelihood
that graduates of the grantee will adopt and incorporate
health information technology in the delivery of health care
services; and
[``(5) provide matching funds in accordance with subsection
(c).
[``(c) Use of Funds.--
[``(1) In general.--With respect to a grant under
subsection (a), an eligible entity shall--
[``(A) use grant funds in collaboration with 2 or more
disciplines; and
[``(B) use grant funds to integrate qualified health
information technology into community-based clinical
education.
[``(2) Limitation.--An eligible entity shall not use
amounts received under a grant under subsection (a) to
purchase hardware, software, or services.
[``(d) Matching Funds.--
[``(1) In general.--The Secretary may award a grant to an
entity under this section only if the entity agrees to make
available non-Federal contributions toward the costs of the
program to be funded under the grant in an amount that is not
less than $1 for each $2 of Federal funds provided under the
grant.
[``(2) Determination of amount contributed.--Non-Federal
contributions under paragraph (1) may be in cash or in kind,
fairly evaluated, including equipment or services. 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 contributions.
[``(e) Evaluation.--The Secretary shall take such action as
may be necessary to evaluate the projects funded under this
section and publish, make available, and disseminate the
results of such evaluations on as wide a basis as is
practicable.
[``(f) Reports.--Not later than 1 year after the date of
enactment of this title, and annually thereafter, the
Secretary shall submit to the Committee on Health, Education,
Labor, and Pensions and the Committee on Finance of the
Senate, and the Committee on Energy and Commerce and the
Committee on Ways and Means of the House of Representatives a
report that--
[``(1) describes the specific projects established under
this section; and
[``(2) contains recommendations for Congress based on the
evaluation conducted under subsection (e).
[``(g) Authorization of Appropriations.--There is
authorized to be appropriated to carry out this section,
$5,000,000 for fiscal year 2007, and such sums as may be
necessary for each of fiscal years 2008 through 2010.
[``(h) Sunset.--This section shall not apply after
September 30, 2010.
[``SEC. 2907. LICENSURE AND THE ELECTRONIC EXCHANGE OF HEALTH
INFORMATION.
[``(a) In General.--The Secretary shall carry out, or
contract with a private entity to carry out, a study that
examines--
[``(1) the variation among State laws that relate to the
licensure, registration, and certification of medical
professionals; and
[``(2) how such variation among State laws impacts the
secure electronic exchange of health information--
[``(A) among the States; and
[``(B) between the States and the Federal Government.
[``(b) Report and Recommendations.--Not later than 1 year
after the date of enactment of this title, the Secretary
shall publish a report that--
[``(1) describes the results of the study carried out under
subsection (a); and
[``(2) makes recommendations to States regarding the
harmonization of State laws based on the results of such
study.
[``SEC. 2908. QUALITY MEASUREMENT SYSTEMS.
[``(a) In General.--The Secretary of Health and Human
Services, the Secretary of Veterans Affairs, the Secretary of
Defense, and representatives of other relevant Federal
agencies, as determined appropriate by the Secretary,
(referred to in the section as the `Secretaries') shall
jointly develop a quality measurement system for the purpose
of measuring the quality of care patients receive.
[``(b) Requirements.--The Secretaries shall ensure that the
quality measurement system developed under subsection (a)
comply with the following:
[``(1) Measures.--
[``(A) In general.--Subject to subparagraph (B), the
Secretaries shall select measures of quality to be used by
the Secretaries under the systems.
[``(B) Requirements.--In selecting the measures to be used
under each system pursuant to subparagraph (A), the
Secretaries shall, to the extent feasible, ensure that--
[[Page S13265]]
[``(i) such measures are evidence based, reliable and
valid;
[``(ii) such measures include measures of process,
structure, patient experience, efficiency, and equity; and
[``(iii) such measures include measures of overuse,
underuse, and misuse of health care items and services.
[``(2) Priorities.--In developing the system under
subsection (a), the Secretaries shall ensure that priority is
given to--
[``(A) measures with the greatest potential impact for
improving the quality and efficiency of care provided under
Federal programs;
[``(B) measures that may be rapidly implemented by group
health plans, health insurance issuers, physicians,
hospitals, nursing homes, long-term care providers, and other
providers; and
[``(C) measures which may inform health care decisions made
by consumers and patients.
[``(3) Weights of measures.--The Secretaries shall assign
weights to the measures used by the Secretaries under each
system established under subsection (a).
[``(4) Risk adjustment.--The Secretaries shall establish
procedures to account for differences in patient health
status, patient characteristics, and geographic location. To
the extent practicable, such procedures shall recognize
existing procedures.
[``(5) Maintenance.--The Secretaries shall, as determined
appropriate, but in no case more often than once during each
12-month period, update the quality measurement systems
developed under subsection (a), including through--
[``(A) the addition of more accurate and precise measures
under the systems and the retirement of existing outdated
measures under the systems; and
[``(B) the refinement of the weights assigned to measures
under the systems.
[``(c) Required Considerations in Developing and Updating
the Systems.--In developing and updating the quality
measurement systems under this section, the Secretaries
shall--
[``(1) consult with, and take into account the
recommendations of, the entity that the Secretaries has an
arrangement with under subsection (e);
[``(2) consult with representatives of health care
providers, consumers, employers, and other individuals and
groups that are interested in the quality of health care; and
[``(3) take into account--
[``(A) any demonstration or pilot program conducted by the
Secretaries relating to measuring and rewarding quality and
efficiency of care;
[``(B) any existing activities conducted by the Secretaries
relating to measuring and rewarding quality and efficiency;
[``(C) any existing activities conducted by private
entities including health insurance plans and payors; and
[``(D) the report by the Institute of Medicine of the
National Academy of Sciences under section 238(b) of the
Medicare Prescription Drug, Improvement, and Modernization
Act of 2003.
[``(d) Required Considerations in Implementing the
Systems.--In implementing the quality measurement systems
under this section, the Secretaries shall take into account
the recommendations of public-private entities--
[``(1) that are established to examine issues of data
collection and reporting, including the feasibility of
collecting and reporting data on measures; and
[``(2) that involve representatives of health care
providers, consumers, employers, and other individuals and
groups that are interested in quality of care.
[``(e) Arrangement With an Entity to Provide Advice and
Recommendations.--
[``(1) Arrangement.--On and after July 1, 2006, the
Secretaries shall have in place an arrangement with an entity
that meets the requirements described in paragraph (2) under
which such entity provides the Secretaries with advice on,
and recommendations with respect to, the development and
updating of the quality measurement systems under this
section, including the assigning of weights to the measures
under subsection (b)(2).
[``(2) Requirements described.--The requirements described
in this paragraph are the following:
[``(A) The entity is a private nonprofit entity governed by
an executive director and a board.
[``(B) The members of the entity include representatives
of--
[``(i) health insurance plans and providers with experience
in the care of individuals with multiple complex chronic
conditions or groups representing such health insurance plans
and providers;
[``(ii) groups representing patients and consumers;
[``(iii) purchasers and employers or groups representing
purchasers or employers;
[``(iv) organizations that focus on quality improvement as
well as the measurement and reporting of quality measures;
[``(v) State government health programs;
[``(vi) individuals or entities skilled in the conduct and
interpretation of biomedical, health services, and health
economics research and with expertise in outcomes and
effectiveness research and technology assessment; and
[``(vii) individuals or entities involved in the
development and establishment of standards and certification
for health information technology systems and clinical data.
[``(C) The membership of the entity is representative of
individuals with experience with urban health care issues and
individuals with experience with rural and frontier health
care issues.
[``(D) If the entity requires a fee for membership, the
entity shall provide assurances to the Secretaries that such
fees are not a substantial barrier to participation in the
entity's activities related to the arrangement with the
Secretaries.
[``(E) The entity--
[``(i) permits any member described in subparagraph (B) to
vote on matters of the entity related to the arrangement with
the Secretary under paragraph (1); and
[``(ii) ensures that member voting provides a balance among
disparate stakeholders, so that no member organization
described in subparagraph (B) unduly influences the outcome.
[``(F) With respect to matters related to the arrangement
with the Secretary under paragraph (1), the entity conducts
its business in an open and transparent manner and provides
the opportunity for public comment.
[``(G) The entity operates as a voluntary consensus
standards setting organization as defined for purposes of
section 12(d) of the National Technology Transfer and
Advancement Act of 1995 (Public Law 104-113) and Office of
Management and Budget Revised Circular A-119 (published in
the Federal Register on February 10, 1998).
[``(f) Use of Quality Measurement System.--
[``(1) In general.--For purposes of activities conducted or
supported by the Secretary under this Act, the Secretary
shall, to the extent practicable, adopt and utilize the
measurement system developed under this section.
[``(2) Collaborative agreements.--With respect to
activities conducted or supported by the Secretary under this
Act, the Secretary may establish collaborative agreements
with private entities, including group health plans and
health insurance issuers, providers, purchasers, consumer
organizations, and entities receiving a grant under section
2908, to--
[``(A) encourage the use of the health care quality
measures adopted by the Secretary under this section; and
[``(B) foster uniformity between the health care quality
measures utilized by private entities.
[``(g) Dissemination of Information.--Beginning on January
1, 2008, in order to make comparative quality information
available to health care consumers, health professionals,
public health officials, researchers, and other appropriate
individuals and entities, the Secretary shall provide for the
aggregation and analysis of quality measures collected under
section 2905 and the dissemination of recommendations and
best practices derived in part from such analysis.
[``(h) Technical Assistance.--The Secretary shall provide
technical assistance to public and private entities to enable
such entities to--
[``(1) implement and use evidence-based guidelines with the
greatest potential to improve health care quality,
efficiency, and patient safety; and
[``(2) establish mechanisms for the rapid dissemination of
information regarding evidence-based guidelines with the
greatest potential to improve health care quality,
efficiency, and patient safety.
[``SEC. 2909. APPLICABILITY OF PRIVACY AND SECURITY
REGULATIONS.
[``The regulations promulgated by the Secretary under part
C of title XI of the Social Security Act and sections 261,
262, 263, and 264 of the Health Insurance Portability and
Accountability Act of 1996 with respect to the privacy,
confidentiality, and security of health information shall--
[``(1) apply to any health information stored or
transmitted in an electronic format on or after the date of
enactment of this title; and
[``(2) apply to the implementation of standards, programs,
and activities under this title.
[``SEC. 2910. STUDY OF REIMBURSEMENT INCENTIVES.
[``The Secretary shall carry out, or contract with a
private entity to carry out, a study that examines methods to
create efficient reimbursement incentives for improving
health care quality in Federally qualified health centers,
rural health clinics, and free clinics.''.
[SEC. 3. HEALTH INFORMATION TECHNOLOGY RESOURCE CENTER.
[Section 914 of the Public Health Service Act (42 U.S.C.
299b-3) is amended by adding at the end the following:
[``(d) Center for Best Practices.--
[``(1) In general.--The Secretary, acting through the
Director, shall develop a Center for Best Practices to
provide technical assistance and develop best practices to
support and accelerate efforts to adopt, implement, and
effectively use interoperable health information technology
in compliance with section 2903 and 2908.
[``(2) Center for best practices.--
[``(A) In general.--The Center shall support activities to
meet goals, including--
[``(i) providing for the widespread adoption of
interoperable health information technology;
[``(ii) providing for the establishment of regional and
local health information networks to facilitate the
development of interoperability across health care settings
and improve the quality of health care;
[[Page S13266]]
[``(iii) the development of solutions to barriers to the
exchange of electronic health information; or
[``(iv) other activities identified by the States, local or
regional health information networks, or health care
stakeholders as a focus for developing and sharing best
practices.
[``(B) Purposes.--The purpose of the Center is to--
[``(i) provide a forum for the exchange of knowledge and
experience;
[``(ii) accelerate the transfer of lessons learned from
existing public and private sector initiatives, including
those currently receiving Federal financial support;
[``(iii) assemble, analyze, and widely disseminate evidence
and experience related to the adoption, implementation, and
effective use of interoperable health information technology;
and
[``(iv) assure the timely provision of technical and expert
assistance from the Agency and its contractors.
[``(C) Support for activities.--To provide support for the
activities of the Center, the Director shall modify the
requirements, if necessary, that apply to the National
Resource Center for Health Information Technology to provide
the necessary infrastructure to support the duties and
activities of the Center and facilitate information exchange
across the public and private sectors.
[``(3) Technical assistance telephone number or website.--
The Secretary shall establish a toll-free telephone number or
Internet website to provide health care providers and
patients with a single point of contact to--
[``(A) learn about Federal grants and technical assistance
services related to interoperable health information
technology;
[``(B) learn about qualified health information technology
and the quality measurement system adopted by the Federal
Government under sections 2903 and 2908;
[``(C) learn about regional and local health information
networks for assistance with health information technology;
and
[``(D) disseminate additional information determined by the
Secretary.
[``(4) Authorization of appropriations.--There are
authorized to be appropriated to carry out this subsection,
such sums as may be necessary for each of fiscal years 2006
through 2010.''.
[SEC. 4. REAUTHORIZATION OF INCENTIVE GRANTS REGARDING
TELEMEDICINE.
[Section 330L(b) of the Public Health Service Act (42
U.S.C. 254c-18(b)) is amended by striking ``2002 through
2006'' and inserting ``2006 through 2010''.]
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Wired for Health Care
Quality Act''.
SEC. 2. IMPROVING HEALTH CARE QUALITY, SAFETY, AND
EFFICIENCY.
The Public Health Service Act (42 U.S.C. 201 et seq.) is
amended by adding at the end the following:
``TITLE XXIX--HEALTH INFORMATION TECHNOLOGY AND QUALITY
``SEC. 2901. DEFINITIONS.
``In this title:
``(1) Health care provider.--The term `health care
provider' means a hospital, skilled nursing facility, home
health entity, health care clinic, federally qualified health
center, group practice (as defined in section 1877(h)(4) of
the Social Security Act), a pharmacist, a pharmacy, a
laboratory, a physician (as defined in section 1861(r) of the
Social Security Act), a health facility operated by or
pursuant to a contract with the Indian Health Service, a
rural health clinic, and any other category of facility or
clinician determined appropriate by the Secretary.
``(2) Health information.--The term `health information'
has the meaning given such term in section 1171(4) of the
Social Security Act.
``(3) Health insurance plan.--The term `health insurance
plan' means--
``(A) a health insurance issuer (as defined in section
2791(b)(2));
``(B) a group health plan (as defined in section
2791(a)(1)); and
``(C) a health maintenance organization (as defined in
section 2791(b)(3)).
``(4) Laboratory.--The term `laboratory' has the meaning
given that term in section 353.
``(5) Pharmacist.--The term `pharmacist' has the meaning
given that term in section 804 of the Federal Food, Drug, and
Cosmetic Act.
``(6) Qualified health information technology.--The term
`qualified health information technology' means a
computerized system (including hardware and software) that--
``(A) protects the privacy and security of health
information;
``(B) maintains and provides permitted access to health
information in an electronic format;
``(C) incorporates decision support to reduce medical
errors and enhance health care quality;
``(D) complies with the standards adopted by the Federal
Government under section 2903; and
``(E) allows for the reporting of quality measures under
section 2908.
``(7) State.--The term `State' means each of the several
States, the District of Columbia, Puerto Rico, the Virgin
Islands, Guam, American Samoa, and the Northern Mariana
Islands.
``SEC. 2902. OFFICE OF THE NATIONAL COORDINATOR OF HEALTH
INFORMATION TECHNOLOGY.
``(a) Office of National Health Information Technology.--
There is established within the Office of the Secretary an
Office of the National Coordinator of Health Information
Technology (referred to in this section as the `Office'). The
Office shall be headed by a National Coordinator who shall be
appointed by the President, in consultation with the
Secretary, and shall report directly to the Secretary.
``(b) Purpose.--It shall be the purpose of the Office to
coordinate and oversee programs and activities to develop a
nationwide interoperable health information technology
infrastructure that--
``(1) ensures that patients' health information is secure
and protected;
``(2) improves health care quality, reduces medical errors,
and advances the delivery of patient-centered medical care;
``(3) reduces health care costs resulting from
inefficiency, medical errors, inappropriate care, and
incomplete information;
``(4) ensures that appropriate information to help guide
medical decisions is available at the time and place of care;
``(5) promotes a more effective marketplace, greater
competition, and increased choice through the wider
availability of accurate information on health care costs,
quality, and outcomes;
``(6) improves the coordination of care and information
among hospitals, laboratories, physician offices, and other
entities through an effective infrastructure for the secure
and authorized exchange of health care information;
``(7) improves public health reporting and facilitates the
early identification and rapid response to public health
threats and emergencies, including bioterror events and
infectious disease outbreaks;
``(8) facilitates health research; and
``(9) promotes prevention of chronic diseases.
``(c) Duties of the National Coordinator.--The National
Coordinator shall--
``(1) serve as a member of the public-private American
Health Information Collaborative established under section
2903;
``(2) serve as the principal advisor to the Secretary
concerning the development, application, and use of health
information technology, and coordinate and oversee the health
information technology programs of the Department;
``(3) facilitate the adoption of a nationwide,
interoperable system for the electronic exchange of health
information;
``(4) ensure the adoption and implementation of standards
for the electronic exchange of health information to reduce
cost and improve health care quality;
``(5) ensure that health information technology policy and
programs of the Department are coordinated with those of
relevant executive branch agencies (including Federal
commissions) with a goal of avoiding duplication of efforts
and of helping to ensure that each agency undertakes health
information technology activities primarily within the areas
of its greatest expertise and technical capability;
``(6) to the extent permitted by law, coordinate outreach
and consultation by the relevant executive branch agencies
(including Federal commissions) with public and private
parties of interest, including consumers, payers, employers,
hospitals and other health care providers, physicians,
community health centers, laboratories, vendors and other
stakeholders;
``(7) advise the President regarding specific Federal
health information technology programs; and
``(8) submit the reports described under section 2903(i)
(excluding paragraph (4) of such section).
``(d) Detail of Federal Employees.--
``(1) In general.--Upon the request of the National
Coordinator, the head of any Federal agency is authorized to
detail, with or 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.
``(2) Effect of detail.--Any detail of personnel under
paragraph (1) shall--
``(A) not interrupt or otherwise affect the civil service
status or privileges of the Federal employee; and
``(B) be in addition to any other staff of the Department
employed by the National Coordinator.
``(3) Acceptance of detailees.--Notwithstanding any other
provision of law, the Office may accept detailed personnel
from other Federal agencies without regard to whether the
agency described under paragraph (1) is reimbursed.
``(e) Rule of Construction.--Nothing in this section shall
be construed to require the duplication of Federal efforts
with respect to the establishment of the Office, regardless
of whether such efforts were carried out prior to or after
the enactment of this title.
``(f) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section,
$5,000,000 for fiscal year 2006, $5,000,000 for fiscal year
2007, and such sums as may be necessary for each of fiscal
years 2008 through 2010.
``SEC. 2903. AMERICAN HEALTH INFORMATION COLLABORATIVE.
``(a) Purpose.--The Secretary shall establish the public-
private American Health Information Collaborative (referred
to in this section as the `Collaborative') to--
``(1) advise the Secretary and recommend specific actions
to achieve a nationwide interoperable health information
technology infrastructure;
``(2) serve as a forum for the participation of a broad
range of stakeholders to provide input on achieving the
interoperability of health information technology; and
``(3) recommend standards (including content,
communication, and security standards) for the electronic
exchange of health information (including for the reporting
of quality data under section 2908) for adoption by the
Federal Government and voluntary adoption by private
entities.
``(b) Composition.--
``(1) In general.--The Collaborative shall be composed of--
``(A) the Secretary, who shall serve as the chairperson of
the Collaborative;
[[Page S13267]]
``(B) the Secretary of Defense, or his or her designee;
``(C) the Secretary of Veterans Affairs, or his or her
designee;
``(D) the Secretary of Commerce, or his or her designee;
``(E) the National Coordinator for Health Information
Technology;
``(F) representatives of other relevant Federal agencies,
as determined appropriate by the Secretary; and
``(G) representatives from each of the following categories
to be appointed by the Secretary from nominations submitted
by the public--
``(i) consumer and patient organizations;
``(ii) experts in health information privacy and security;
``(iii) health care providers;
``(iv) health insurance plans or other third party payors;
``(v) standards development organizations;
``(vi) information technology vendors;
``(vii) purchasers or employers; and
``(viii) State or local government agencies or Indian tribe
or tribal organizations.
``(2) Considerations.--In appointing members under
paragraph (1)(G), the Secretary shall select individuals with
expertise in--
``(A) health information privacy;
``(B) health information security;
``(C) health care quality and patient safety, including
those individuals with expertise in utilizing health
information technology to improve health care quality and
patient safety;
``(D) data exchange; and
``(E) developing health information technology standards
and new health information technology.
``(3) Participation.--Membership and procedures of the
Collaborative shall ensure a balance among various sectors of
the healthcare system so that no single sector unduly
influences the recommendations of the Collaborative.
``(4) Terms.--Members appointed under paragraph (1)(G)
shall serve for 2 year terms, except that any member
appointed to fill a vacancy for an unexpired term shall be
appointed for the remainder of such term. A member may serve
for not to exceed 180 days after the expiration of such
member's term or until a successor has been appointed.
``(c) Recommendations and Policies.--Not later than 1 year
after the date of enactment of this title, and annually
thereafter, the Collaborative shall recommend to the
Secretary uniform national policies for adoption by the
Federal Government and voluntary adoption by private entities
to support the widespread adoption of health information
technology, including--
``(1) protection of health information through privacy and
security practices;
``(2) measures to prevent unauthorized access to health
information;
``(3) methods to facilitate secure patient access to health
information;
``(4) fostering the public understanding of health
information technology;
``(5) the ongoing harmonization of industry-wide health
information technology standards;
``(6) recommendations for a nationwide interoperable health
information technology infrastructure;
``(7) the identification and prioritization of specific use
cases for which health information technology is valuable,
beneficial, and feasible;
``(8) recommendations for the establishment of an entity to
ensure the continuation of the functions of the
Collaborative; and
``(9) other policies (including recommendations for
incorporating health information technology into the
provision of care and the organization of the health care
workplace) determined to be necessary by the Collaborative.
``(d) Standards.--
``(1) Existing standards.--The standards adopted by the
Consolidated Health Informatics Initiative shall be deemed to
have been recommended by the Collaborative under this
section.
``(2) First year review.--Not later than 1 year after the
date of enactment of this title, the Collaborative shall--
``(A) review existing standards (including content,
communication, and security standards) for the electronic
exchange of health information, including such standards
adopted by the Secretary under paragraph (2)(A);
``(B) identify deficiencies and omissions in such existing
standards; and
``(C) identify duplication and overlap in such existing
standards;
and recommend new standards and modifications to such
existing standards as necessary.
``(3) Ongoing review.--Beginning 1 year after the date of
enactment of this title, and annually thereafter, the
Collaborative shall--
``(A) review existing standards (including content,
communication, and security standards) for the electronic
exchange of health information, including such standards
adopted by the Secretary under paragraph (2)(A);
``(B) identify deficiencies and omissions in such existing
standards; and
``(C) identify duplication and overlap in such existing
standards;
and recommend new standards and modifications to such
existing standards as necessary.
``(4) Limitation.--The standards and timeframe for adoption
described in this section shall be consistent with any
standards developed pursuant to the Health Insurance
Portability and Accountability Act of 1996.
``(e) Federal Action.--Not later than 60 days after the
issuance of a recommendation from the Collaborative under
subsection (d)(2), the Secretary of Health and Human
Services, the Secretary of Veterans Affairs, and the
Secretary of Defense, in collaboration with representatives
of other relevant Federal agencies, as determined appropriate
by the Secretary, shall jointly review such recommendations.
The Secretary shall provide for the adoption by the Federal
Government of any standard or standards contained in such
recommendation.
``(f) Coordination of Federal Spending.--Not later than 1
year after the adoption by the Federal Government of a
recommendation as provided for in subsection (e), and in
compliance with chapter 113 of title 40, United States Code,
no Federal agency shall expend Federal funds for the purchase
of any form of health information technology or health
information technology system for clinical care or for the
electronic retrieval, storage, or exchange of health
information that is not consistent with applicable standards
adopted by the Federal Government under subsection (e).
``(g) Coordination of Federal Data Collection.--Not later
than 3 years after the adoption by the Federal Government of
a recommendation as provided for in subsection (e), all
Federal agencies collecting health data for the purposes of
quality reporting, surveillance, epidemiology, adverse event
reporting, research, or for other purposes determined
appropriate by the Secretary, shall comply with standards
adopted under subsection (e).
``(h) Voluntary Adoption.--
``(1) In general.--Any standards adopted by the Federal
Government under subsection (e) shall be voluntary with
respect to private entities.
``(2) Rule of construction.--Nothing in this section shall
be construed to require that a private entity that enters
into a contract with the Federal Government adopt the
standards adopted by the Federal Government under section
2903 with respect to activities not related to the contract.
``(3) Limitation.--Private entities that enter into a
contract with the Federal Government shall adopt the
standards adopted by the Federal Government under section
2903 for the purpose of activities under such Federal
contract.
``(i) Reports.--The Secretary shall submit to the Committee
on Health, Education, Labor, and Pensions and the Committee
on Finance of the Senate and the Committee on Energy and
Commerce and the Committee on Ways and Means of the House of
Representatives, on an annual basis, a report that--
``(1) describes the specific actions that have been taken
by the Federal Government and private entities to facilitate
the adoption of an interoperable nationwide system for the
electronic exchange of health information;
``(2) describes barriers to the adoption of such a
nationwide system;
``(3) contains recommendations to achieve full
implementation of such a nationwide system; and
``(4) contains a plan and progress toward the establishment
of an entity to ensure the continuation of the functions of
the Collaborative.
``(j) Application of FACA.--The Federal Advisory Committee
Act (5 U.S.C. App.) shall apply to the Collaborative, except
that the term provided for under section 14(a)(2) shall be 5
years.
``(k) Rule of Construction.--Nothing in this section shall
be construed to require the duplication of Federal efforts
with respect to the establishment of the Collaborative,
regardless of whether such efforts were carried out prior to
or after the enactment of this title.
``(l) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section,
$4,000,000 for fiscal year 2006, $4,000,000 for fiscal year
2007, and such sums as may be necessary for each of fiscal
years 2008 through 2010.
``SEC. 2904. IMPLEMENTATION AND CERTIFICATION OF HEALTH
INFORMATION STANDARDS.
``(a) Implementation.--
``(1) In general.--The Secretary, based upon the
recommendations of the Collaborative, shall develop criteria
to ensure uniform and consistent implementation of any
standards for the electronic exchange of health information
voluntarily adopted by private entities in technical
conformance with such standards adopted under this title.
``(2) Implementation assistance.--The Secretary may
recognize a private entity or entities to assist private
entities in the implementation of the standards adopted under
this title using the criteria developed by the Secretary
under this section.
``(b) Certification.--
``(1) In general.--The Secretary, based upon the
recommendations of the Collaborative, shall develop criteria
to ensure and certify that hardware and software that claim
to be in compliance with any standard for the electronic
exchange of health information adopted under this title have
established and maintained such compliance in technical
conformance with such standards.
``(2) Certification assistance.--The Secretary may
recognize a private entity or entities to assist in the
certification described under paragraph (1) using the
criteria developed by the Secretary under this section.
``(c) Delegation Authority.--The Secretary, through
consultation with the Collaborative, may accept
recommendations on the development of the criteria under
subsections (a) and (b) from a Federal agency or private
entity.
[[Page S13268]]
``SEC. 2905. GRANTS TO FACILITATE THE WIDESPREAD ADOPTION OF
INTEROPERABLE HEALTH INFORMATION TECHNOLOGY.
``(a) Competitive Grants to Facilitate the Widespread
Adoption of Health Information Technology.--
``(1) In general.--The Secretary may award competitive
grants to eligible entities to facilitate the purchase and
enhance the utilization of qualified health information
technology systems to improve the quality and efficiency of
health care.
``(2) Eligibility.--To be eligible to receive a grant under
paragraph (1) an entity shall--
``(A) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require;
``(B) submit to the Secretary a strategic plan for the
implementation of data sharing and interoperability measures;
``(C) be a--
``(i) not for profit hospital;
``(ii) individual or group practice; or
``(iii) another health care provider not described in
clause (i) or (ii);
``(D) adopt the standards adopted by the Federal Government
under section 2903;
``(E) implement the measurement system adopted under
section 2908 and report to the Secretary on such measures;
``(F) demonstrate significant financial need; and
``(G) provide matching funds in accordance with paragraph
(4).
``(3) Use of funds.--Amounts received under a grant under
this subsection shall be used to facilitate the purchase and
enhance the utilization of qualified health information
technology systems and training personnel in the use of such
technology.
``(4) Matching requirement.--To be eligible for a grant
under this subsection an entity shall contribute non-Federal
contributions to the costs of carrying out the activities for
which the grant is awarded in an amount equal to $1 for each
$3 of Federal funds provided under the grant.
``(5) Preference in awarding grants.--In awarding grants
under this subsection the Secretary shall give preference
to--
``(A) eligible entities that are located in rural,
frontier, and other underserved areas as determined by the
Secretary;
``(B) eligible entities that will link, to the extent
practicable, the qualified health information system to local
or regional health information plan or plans; and
``(C) with respect to an entity described in subsection
(a)(2)(C)(iii), a nonprofit health care provider.
``(b) Competitive Grants to States for the Development of
State Loan Programs to Facilitate the Widespread Adoption of
Health Information Technology.--
``(1) In general.--The Secretary may award competitive
grants to States for the establishment of State programs for
loans to health care providers to facilitate the purchase and
enhance the utilization of qualified health information
technology.
``(2) Establishment of fund.--To be eligible to receive a
competitive grant under this subsection, a State shall
establish a qualified health information technology loan fund
(referred to in this subsection as a `State loan fund') and
comply with the other requirements contained in this section.
A grant to a State under this subsection shall be deposited
in the State loan fund established by the State. No funds
authorized by other provisions of this title to be used for
other purposes specified in this title shall be deposited in
any State loan fund.
``(3) Eligibility.--To be eligible to receive a grant under
paragraph (1) a State shall--
``(A) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require;
``(B) submit to the Secretary a strategic plan in
accordance with paragraph (4);
``(C) establish a qualified health information technology
loan fund in accordance with paragraph (2);
``(D) require that health care providers receiving such
loans--
``(i) link, to the extent practicable, the qualified health
information system to a local or regional health information
network; and
``(ii) consult with the Health Information Technology
Resource Center established in section 914(d) to access the
knowledge and experience of existing initiatives regarding
the successful implementation and effective use of health
information technology;
``(E) require that health care providers receiving such
loans adopt the standards adopted by the Federal Government
under section 2903;
``(F) require that health care providers receiving such
loans implement the measurement system adopted under section
2908 and report to the Secretary on such measures; and
``(G) provide matching funds in accordance with paragraph
(8).
``(4) Strategic plan.--
``(A) In general.--A State that receives a grant under this
subsection shall annually prepare a strategic plan that
identifies the intended uses of amounts available to the
State loan fund of the State.
``(B) Contents.--A strategic plan under subparagraph (A)
shall include--
``(i) a list of the projects to be assisted through the
State loan fund in the first fiscal year that begins after
the date on which the plan is submitted;
``(ii) a description of the criteria and methods
established for the distribution of funds from the State loan
fund; and
``(iii) a description of the financial status of the State
loan fund and the short-term and long-term goals of the State
loan fund.
``(5) Use of funds.--
``(A) In general.--Amounts deposited in a State loan fund,
including loan repayments and interest earned on such
amounts, shall be used only for awarding loans or loan
guarantees, or as a source of reserve and security for
leveraged loans, the proceeds of which are deposited in the
State loan fund established under paragraph (1). Loans under
this section may be used by a health care provider to
facilitate the purchase and enhance the utilization of
qualified health information technology and training of
personnel in the use of such technology.
``(B) Limitation.--Amounts received by a State under this
subsection may not be used--
``(i) for the purchase or other acquisition of any health
information technology system that is not a qualified health
information technology system;
``(ii) to conduct activities for which Federal funds are
expended under this title, or the amendments made by the
Wired for Health Care Quality Act; or
``(iii) for any purpose other than making loans to eligible
entities under this section.
``(6) Types of assistance.--Except as otherwise limited by
applicable State law, amounts deposited into a State loan
fund under this subsection may only be used for the
following:
``(A) To award loans that comply with the following:
``(i) The interest rate for each loan shall be less than or
equal to the market interest rate.
``(ii) The principal and interest payments on each loan
shall commence not later than 1 year after the loan was
awarded, and each loan shall be fully amortized not later
than 10 years after the date of the loan.
``(iii) The State loan fund shall be credited with all
payments of principal and interest on each loan awarded from
the fund.
``(B) To guarantee, or purchase insurance for, a local
obligation (all of the proceeds of which finance a project
eligible for assistance under this subsection) if the
guarantee or purchase would improve credit market access or
reduce the interest rate applicable to the obligation
involved.
``(C) As a source of revenue or security for the payment of
principal and interest on revenue or general obligation bonds
issued by the State if the proceeds of the sale of the bonds
will be deposited into the State loan fund.
``(D) To earn interest on the amounts deposited into the
State loan fund.
``(7) Administration of state loan funds.--
``(A) Combined financial administration.--A State may (as a
convenience and to avoid unnecessary administrative costs)
combine, in accordance with State law, the financial
administration of a State loan fund established under this
subsection with the financial administration of any other
revolving fund established by the State if otherwise not
prohibited by the law under which the State loan fund was
established.
``(B) Cost of administering fund.--Each State may annually
use not to exceed 4 percent of the funds provided to the
State under a grant under this subsection to pay the
reasonable costs of the administration of the programs under
this section, including the recovery of reasonable costs
expended to establish a State loan fund which are incurred
after the date of enactment of this title.
``(C) Guidance and regulations.--The Secretary shall
publish guidance and promulgate regulations as may be
necessary to carry out the provisions of this subsection,
including--
``(i) provisions to ensure that each State commits and
expends funds allotted to the State under this subsection as
efficiently as possible in accordance with this title and
applicable State laws; and
``(ii) guidance to prevent waste, fraud, and abuse.
``(D) Private sector contributions.--
``(i) In general.--A State loan fund established under this
subsection may accept contributions from private sector
entities, except that such entities may not specify the
recipient or recipients of any loan issued under this
subsection.
``(ii) Availability of information.--A State shall make
publicly available the identity of, and amount contributed
by, any private sector entity under clause (i) and may issue
letters of commendation or make other awards (that have no
financial value) to any such entity.
``(8) Matching requirements.--
``(A) In general.--The Secretary may not make a grant under
paragraph (1) to a State unless the State agrees to make
available (directly or through donations from public or
private entities) non-Federal contributions in cash toward
the costs of the State program to be implemented under the
grant in an amount equal to not less than $1 for each $1 of
Federal funds provided under the grant.
``(B) Determination of amount of non-federal
contribution.--In determining the amount of non-Federal
contributions that a State has provided pursuant to
subparagraph (A), the Secretary may not include any amounts
provided to the State by the Federal Government.
[[Page S13269]]
``(9) Preference in awarding grants.--The Secretary may
give a preference in awarding grants under this subsection to
States that adopt value-based purchasing programs to improve
health care quality.
``(10) Reports.--The Secretary shall annually submit to the
Committee on Health, Education, Labor, and Pensions and the
Committee on Finance of the Senate, and the Committee on
Energy and Commerce and the Committee on Ways and Means of
the House of Representatives, a report summarizing the
reports received by the Secretary from each State that
receives a grant under this subsection.
``(c) Competitive Grants for the Implementation of Regional
or Local Health Information Technology Plans.--
``(1) In general.--The Secretary may award competitive
grants to eligible entities to implement regional or local
health information plans to improve health care quality and
efficiency through the electronic exchange of health
information pursuant to the standards, protocols, and other
requirements adopted by the Secretary under sections 2903 and
2908.
``(2) Eligibility.--To be eligible to receive a grant under
paragraph (1) an entity shall--
``(A) demonstrate financial need to the Secretary;
``(B) demonstrate that one of its principal missions or
purposes is to use information technology to improve health
care quality and efficiency;
``(C) adopt bylaws, memoranda of understanding, or other
charter documents that demonstrate that the governance
structure and decisionmaking processes of such entity allow
for participation on an ongoing basis by multiple
stakeholders within a community, including--
``(i) physicians (as defined in section 1861(r) of the
Social Security Act), including physicians that provide
services to low income and underserved populations;
``(ii) hospitals (including hospitals that provide services
to low income and underserved populations);
``(iii) pharmacists or pharmacies;
``(iv) health insurance plans;
``(v) health centers (as defined in section 330(b)) and
Federally qualified health centers (as defined in section
1861(aa)(4) of the Social Security Act);
``(vi) rural health clinics (as defined in section 1861(aa)
of the Social Security Act);
``(vii) patient or consumer organizations;
``(viii) employers; and
``(ix) any other health care providers or other entities,
as determined appropriate by the Secretary;
``(D) demonstrate the participation, to the extent
practicable, of stakeholders in the electronic exchange of
health information within the local or regional plan pursuant
to paragraph (2)(C);
``(E) adopt nondiscrimination and conflict of interest
policies that demonstrate a commitment to open, fair, and
nondiscriminatory participation in the health information
plan by all stakeholders;
``(F) adopt the standards adopted by the Secretary under
section 2903;
``(G) require that health care providers receiving such
grants implement the measurement system adopted under section
2908 and report to the Secretary on such measures;
``(H) facilitate the electronic exchange of health
information within the local or regional area and among local
and regional areas;
``(I) prepare and submit to the Secretary an application in
accordance with paragraph (3); and
``(J) agree to provide matching funds in accordance with
paragraph (5).
``(3) Application.--
``(A) In general.--To be eligible to receive a grant under
paragraph (1), an entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require.
``(B) Required information.--At a minimum, an application
submitted under this paragraph shall include--
``(i) clearly identified short-term and long-term
objectives of the regional or local health information plan;
``(ii) a technology plan that complies with the standards
adopted under section 2903 and that includes a descriptive
and reasoned estimate of costs of the hardware, software,
training, and consulting services necessary to implement the
regional or local health information plan;
``(iii) a strategy that includes initiatives to improve
health care quality and efficiency, including the use and
reporting of health care quality measures adopted under
section 2908;
``(iv) a plan that describes provisions to encourage the
implementation of the electronic exchange of health
information by all physicians, including single physician
practices and small physician groups participating in the
health information plan;
``(v) a plan to ensure the privacy and security of personal
health information that is consistent with Federal and State
law;
``(vi) a governance plan that defines the manner in which
the stakeholders shall jointly make policy and operational
decisions on an ongoing basis;
``(vii) a financial or business plan that describes--
``(I) the sustainability of the plan;
``(II) the financial costs and benefits of the plan; and
``(III) the entities to which such costs and benefits will
accrue; and
``(viii) if the case of an applicant entity that is unable
to demonstrate the participation of all stakeholders pursuant
to paragraph (2)(C), the justification from the entity for
any such nonparticipation.
``(4) Use of funds.--Amounts received under a grant under
paragraph (1) shall be used to establish and implement a
regional or local health information plan in accordance with
this subsection.
``(5) Matching requirement.--
``(A) In general.--The Secretary may not make a grant under
this subsection 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 50 percent of such costs ($1 for each $2 of
Federal funds provided under the grant).
``(B) Determination of amount contributed.--Non-Federal
contributions required under subparagraph (A) 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 by the Federal Government, may not be
included in determining the amount of such non-Federal
contributions.
``(d) Reports.--Not later than 1 year after the date on
which the first grant is awarded under this section, and
annually thereafter during the grant period, an entity that
receives a grant under this section shall submit to the
Secretary a report on the activities carried out under the
grant involved. Each such report shall include--
``(1) a description of the financial costs and benefits of
the project involved and of the entities to which such costs
and benefits accrue;
``(2) an analysis of the impact of the project on health
care quality and safety;
``(3) a description of any reduction in duplicative or
unnecessary care as a result of the project involved;
``(4) a description of the efforts of recipients under this
section to facilitate secure patient access to health
information; and
``(5) other information as required by the Secretary.
``(e) Requirement to Achieve Quality Improvement.--The
Secretary shall annually evaluate the activities conducted
under this section and shall, in awarding grants, implement
the lessons learned from such evaluation in a manner so that
awards made subsequent to each such evaluation are made in a
manner that, in the determination of the Secretary, will
result in the greatest improvement in quality measurement
systems under section 2908.
``(f) Limitation.--An eligible entity may only receive one
non-renewable grant under subsection (a), one non-renewable
grant under subsection (b), and one non-renewable grant under
subsection (c).
``(g) Authorization of Appropriations.--
``(1) In general.--For the purpose of carrying out this
section, there is authorized to be appropriated $116,000,000
for fiscal year 2006, $141,000,000 for fiscal year 2007, and
such sums as may be necessary for each of fiscal years 2008
through 2010.
``(2) Availability.--Amounts appropriated under paragraph
(1) shall remain available through fiscal year 2010.
``SEC. 2906. DEMONSTRATION PROGRAM TO INTEGRATE INFORMATION
TECHNOLOGY INTO CLINICAL EDUCATION.
``(a) In General.--The Secretary may award grants under
this section to carry out demonstration projects to develop
academic curricula integrating qualified health information
technology systems in the clinical education of health
professionals. Such awards shall be made on a competitive
basis and pursuant to peer review.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall--
``(1) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require;
``(2) submit to the Secretary a strategic plan for
integrating qualified health information technology in the
clinical education of health professionals and for ensuring
the consistent utilization of decision support software to
reduce medical errors and enhance health care quality;
``(3) be--
``(A) a health professions school;
``(B) a school of nursing; or
``(C) an institution with a graduate medical education
program;
``(4) provide for the collection of data regarding the
effectiveness of the demonstration project to be funded under
the grant in improving the safety of patients, the efficiency
of health care delivery, and in increasing the likelihood
that graduates of the grantee will adopt and incorporate
health information technology, and implement the quality
measurement system adopted under section 2908, in the
delivery of health care services; and
``(5) provide matching funds in accordance with subsection
(c).
``(c) Use of Funds.--
``(1) In general.--With respect to a grant under subsection
(a), an eligible entity shall--
``(A) use grant funds in collaboration with 2 or more
disciplines; and
[[Page S13270]]
``(B) use grant funds to integrate qualified health
information technology into community-based clinical
education.
``(2) Limitation.--An eligible entity shall not use amounts
received under a grant under subsection (a) to purchase
hardware, software, or services.
``(d) Matching Funds.--
``(1) In general.--The Secretary may award a grant to an
entity under this section only if the entity agrees to make
available non-Federal contributions toward the costs of the
program to be funded under the grant in an amount that is not
less than $1 for each $2 of Federal funds provided under the
grant.
``(2) Determination of amount contributed.--Non-Federal
contributions under paragraph (1) may be in cash or in kind,
fairly evaluated, including equipment or services. 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 contributions.
``(e) Evaluation.--The Secretary shall take such action as
may be necessary to evaluate the projects funded under this
section and publish, make available, and disseminate the
results of such evaluations on as wide a basis as is
practicable.
``(f) Reports.--Not later than 1 year after the date of
enactment of this title, and annually thereafter, the
Secretary shall submit to the Committee on Health, Education,
Labor, and Pensions and the Committee on Finance of the
Senate, and the Committee on Energy and Commerce and the
Committee on Ways and Means of the House of Representatives a
report that--
``(1) describes the specific projects established under
this section; and
``(2) contains recommendations for Congress based on the
evaluation conducted under subsection (e).
``(g) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section, $5,000,000 for
fiscal year 2007, and such sums as may be necessary for each
of fiscal years 2008 through 2010.
``(h) Sunset.--This section shall not apply after September
30, 2010.
``SEC. 2907. LICENSURE AND THE ELECTRONIC EXCHANGE OF HEALTH
INFORMATION.
``(a) In General.--The Secretary shall carry out, or
contract with a private entity to carry out, a study that
examines--
``(1) the variation among State laws that relate to the
licensure, registration, and certification of medical
professionals; and
``(2) how such variation among State laws impacts the
secure electronic exchange of health information--
``(A) among the States; and
``(B) between the States and the Federal Government.
``(b) Report and Recommendations.--Not later than 1 year
after the date of enactment of this title, the Secretary
shall publish a report that--
``(1) describes the results of the study carried out under
subsection (a); and
``(2) makes recommendations to States regarding the
harmonization of State laws based on the results of such
study.
``SEC. 2908. QUALITY MEASUREMENT SYSTEM.
``(a) In General.--The Secretary, in consultation with the
Secretary of Veterans Affairs, the Secretary of Defense, and
representatives of other relevant Federal agencies, as
determined appropriate by the Secretary, shall develop or
adopt a quality measurement system, including measures to
assess that effectiveness, timeliness, patient self-
management, patient centeredness, efficiency, and safety, for
the purpose of measuring the quality of care patients
receive.
``(b) Requirements.--The Secretary shall ensure that the
quality measurement system developed under subsection (a)
comply with the following:
``(1) Measures.--
``(A) In general.--Subject to subparagraph (B), the
Secretary shall select measures of quality to be used by the
Secretary under the systems.
``(B) Requirements.--In selecting the measures to be used
under each system pursuant to subparagraph (A), the Secretary
shall, to the extent feasible, ensure that--
``(i) such measures are evidence based, reliable and valid;
``(ii) such measures include measures of clinical processes
and outcomes, patient experience, efficiency, and equity; and
``(iii) such measures include measures of overuse and
underuse of health care items and services.
``(2) Priorities.--In developing the system under
subsection (a), the Secretary shall ensure that priority is
given to--
``(A) measures with the greatest potential impact for
improving the quality and efficiency of care provided under
Federal programs;
``(B) measures that may be rapidly implemented by group
health plans, health insurance issuers, physicians,
hospitals, nursing homes, long-term care providers, and other
providers; and
``(C) measures which may inform health care decisions made
by consumers and patients.
``(3) Weights of measures.--The Secretary shall assign
weights to the measures used by the Secretary under each
system established under subsection (a).
``(4) Risk adjustment.--The Secretary shall establish
procedures to account for differences in patient health
status, patient characteristics, and geographic location. To
the extent practicable, such procedures shall recognize
existing procedures.
``(5) Maintenance.--The Secretary shall, as determined
appropriate, but in no case more often than once during each
12-month period, update the quality measurement systems
developed under subsection (a), including through--
``(A) the addition of more accurate and precise measures
under the systems and the retirement of existing outdated
measures under the systems; and
``(B) the refinement of the weights assigned to measures
under the systems.
``(c) Required Considerations in Developing and Updating
the Systems.--In developing and updating the quality
measurement systems under this section, the Secretary shall--
``(1) consult with, and take into account the
recommendations of, the entity that the Secretary has an
arrangement with under subsection (e);
``(2) consult with representatives of health care providers
(including physicians, pharmacists, nurses, and other health
care professionals), consumers, employers, and other
individuals and groups that are interested in the quality of
health care; and
``(3) take into account--
``(A) any demonstration or pilot program conducted by the
Secretary relating to measuring and rewarding quality and
efficiency of care;
``(B) any existing activities conducted by the Secretary
relating to measuring and rewarding quality and efficiency;
``(C) any existing activities conducted by private entities
including health insurance plans and payors; and
``(D) the report by the Institute of Medicine of the
National Academy of Sciences under section 238(b) of the
Medicare Prescription Drug, Improvement, and Modernization
Act of 2003.
``(d) Required Considerations in Implementing the
Systems.--In implementing the quality measurement systems
under this section, the Secretary shall take into account the
recommendations of public-private entities--
``(1) that are established to examine issues of data
collection and reporting, including the feasibility of
collecting and reporting data on measures; and
``(2) that involve representatives of health care providers
(including physicians, pharmacists, nurses, and other health
care professionals), consumers, employers, and other
individuals and groups that are interested in quality of
care.
``(e) Arrangement With an Entity to Provide Advice and
Recommendations.--
``(1) Arrangement.--On and after July 1, 2006, the
Secretary shall have in place an arrangement with an entity
that meets the requirements described in paragraph (2) under
which such entity provides the Secretary with advice on, and
recommendations with respect to, the development and updating
of the quality measurement systems under this section,
including the assigning of weights to the measures under
subsection (b)(2).
``(2) Requirements described.--The requirements described
in this paragraph are the following:
``(A) The entity is a private nonprofit entity governed by
an executive director and a board.
``(B) The members of the entity include representatives
of--
``(i) health insurance plans and health care providers with
experience in the care of individuals with multiple complex
chronic conditions or groups representing such health
insurance plans and providers;
``(ii) groups representing patients and consumers;
``(iii) purchasers and employers or groups representing
purchasers or employers;
``(iv) organizations that focus on quality improvement as
well as the measurement and reporting of quality measures;
``(v) State government health programs;
``(vi) individuals or entities skilled in the conduct and
interpretation of biomedical, health services, and health
economics research and with expertise in outcomes and
effectiveness research and technology assessment; and
``(vii) individuals or entities involved in the development
and establishment of standards and certification for health
information technology systems and clinical data.
``(C) The membership of the entity is representative of
individuals with experience with urban health care issues and
individuals with experience with rural and frontier health
care issues.
``(D) If the entity requires a fee for membership, the
entity shall provide assurances to the Secretary that such
fees are not a substantial barrier to participation in the
entity's activities related to the arrangement with the
Secretary.
``(E) The entity--
``(i) permits any member described in subparagraph (B) to
vote on matters of the entity related to the arrangement with
the Secretary under paragraph (1); and
``(ii) ensures that member voting provides a balance among
disparate stakeholders, so that no member organization
described in subparagraph (B) unduly influences the outcome.
``(F) With respect to matters related to the arrangement
with the Secretary under paragraph (1), the entity conducts
its business in an open and transparent manner and provides
the opportunity for public comment.
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``(G) The entity operates as a voluntary consensus
standards setting organization as defined for purposes of
section 12(d) of the National Technology Transfer and
Advancement Act of 1995 (Public Law 104-113) and Office of
Management and Budget Revised Circular A-119 (published in
the Federal Register on February 10, 1998).
``(f) Use of Quality Measurement System.--
``(1) In general.--For purposes of activities conducted or
supported by the Secretary under this Act, the Secretary
shall, to the extent practicable, adopt and utilize the
measurement system developed under this section.
``(2) Collaborative agreements.--With respect to activities
conducted or supported by the Secretary under this Act, the
Secretary may establish collaborative agreements with private
entities, including group health plans and health insurance
issuers, providers, purchasers, consumer organizations, and
entities receiving a grant under section 2905, to--
``(A) encourage the use of the health care quality measures
adopted by the Secretary under this section; and
``(B) foster uniformity between the health care quality
measures utilized by private entities.
``(3) Reporting.--The Secretary shall implement procedures
to enable the Department of Health and Human Services to
accept the electronic submission of data for purposes of
quality measurement using the quality measurement system
adopted under this section and using the standards adopted by
the Federal Government under section 2903.
``(g) Dissemination of Information.--Beginning on January
1, 2008, in order to make comparative quality information
available to health care consumers, health professionals,
public health officials, researchers, and other appropriate
individuals and entities, the Secretary shall provide for the
dissemination, aggregation, and analysis of quality measures
collected under section 2905 and the dissemination of
recommendations and best practices derived in part from such
analysis.
``(h) Technical Assistance.--The Secretary shall provide
technical assistance to public and private entities to enable
such entities to--
``(1) implement and use evidence-based guidelines with the
greatest potential to improve health care quality,
efficiency, and patient safety; and
``(2) establish mechanisms for the rapid dissemination of
information regarding evidence-based guidelines with the
greatest potential to improve health care quality,
efficiency, and patient safety.
``SEC. 2909. ENSURING PRIVACY AND SECURITY.
``Nothing in this title shall be construed to affect the
scope or substance of--
``(1) section 264 of the Health Insurance Portability and
Accountability Act of 1996;
``(2) sections 1171 through 1179 of the Social Security
Act; and
``(3) any regulation issued pursuant to any such section;
and such sections shall remain in effect.
``SEC. 2910. STUDY OF REIMBURSEMENT INCENTIVES.
``The Secretary shall carry out, or contract with a private
entity to carry out, a study that examines methods to create
efficient reimbursement incentives for improving health care
quality in Federally qualified health centers, rural health
clinics, and free clinics.''.
SEC. 3. HEALTH INFORMATION TECHNOLOGY RESOURCE CENTER.
Section 914 of the Public Health Service Act (42 U.S.C.
299b-3) is amended by adding at the end the following:
``(d) Health information technology resource center.--
``(1) In general.--The Secretary, acting through the
Director, shall develop a Health Information Technology
Resource Center to provide technical assistance and develop
best practices to support and accelerate efforts to adopt,
implement, and effectively use interoperable health
information technology in compliance with section 2903 and
2908.
``(2) Health information technology resource center.--
``(A) In general.--The Center shall support activities to
meet goals, including--
``(i) providing for the widespread adoption of
interoperable health information technology;
``(ii) providing for the establishment of regional and
local health information networks to facilitate the
development of interoperability across health care settings
and improve the quality of health care;
``(iii) the development of solutions to barriers to the
exchange of electronic health information; or
``(iv) other activities identified by the States, local or
regional health information networks, or health care
stakeholders as a focus for developing and sharing best
practices.
``(B) Purposes.--The purpose of the Center is to--
``(i) provide a forum for the exchange of knowledge and
experience;
``(ii) accelerate the transfer of lessons learned from
existing public and private sector initiatives, including
those currently receiving Federal financial support; and
``(iii) assemble, analyze, and widely disseminate evidence
and experience related to the adoption, implementation, and
effective use of interoperable health information technology.
``(C) Support for activities.--To provide support for the
activities of the Center, the Director shall modify the
requirements, if necessary, that apply to the National
Resource Center for Health Information Technology to provide
the necessary infrastructure to support the duties and
activities of the Center and facilitate information exchange
across the public and private sectors.
``(3) Technical assistance telephone number or website.--
The Secretary shall establish a toll-free telephone number or
Internet website to provide health care providers and
patients with a single point of contact to--
``(A) learn about Federal grants and technical assistance
services related to interoperable health information
technology;
``(B) learn about qualified health information technology
and the quality measurement system adopted by the Federal
Government under sections 2903 and 2908;
``(C) learn about regional and local health information
networks for assistance with health information technology;
and
``(D) disseminate additional information determined by the
Secretary.
``(4) Rule of construction.--Nothing in this subsection
shall be construed to require the duplication of Federal
efforts with respect to the establishment of the Center,
regardless of whether such efforts were carried out prior to
or after the enactment of this subsection.''.
SEC. 4. REAUTHORIZATION OF INCENTIVE GRANTS REGARDING
TELEMEDICINE.
Section 330L(b) of the Public Health Service Act (42 U.S.C.
254c-18(b)) is amended by striking ``2002 through 2006'' and
inserting ``2006 through 2010''.
Mr. FRIST. Mr. President, I ask unanimous consent that the Enzi
substitute at the desk be agreed to, the committee-reported amendment,
as amended, be agreed to, the bill, as amended, be read a third time
and passed, the motion to reconsider be laid upon the table, and that
any statements relating to the bill be printed in the Record.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment (No. 2671) was agreed to.
(The amendment is printed in today's Record under ``Text of
Amendments.'')
The committee amendment in the nature of a substitute, as amended,
was agreed to.
The bill (S. 1418), as amended, was read the third time and passed.
Mr. FRIST. Mr. President, the Senate just passed a bill that takes a
major step--major step--to bringing health care into the information
age, finally. This bill, the Wired for Health Care Quality Act,
reflects the hard work by Senator Enzi, to whom I will turn the floor
over shortly, myself, Senator Kennedy, Senator Clinton, and many
others.
This bill will do as much as anything we have done in this Congress
and the last Congress and the Congress before that to cut waste and
inefficiency out of our health care system. What the bill does is
encourage the use of secure and interoperable health care records,
electronic records, electronic medical records.
This has a huge benefit for every American. It reduces waste and
inefficiency. It reduces medical errors. It improves the quality of
health care. It reduces health care costs throughout the system,
raising quality. When you lower costs and you raise quality, by
definition, you improve access as well.
This bill will help empower patients to become full partners in what
we all have as a vision; and that is, a patient-centered, provider-
friendly, consumer-driven system that will be driven by information,
and be driven by choice, and be driven by control.
Patient privacy is protected. This secure exchange of lifesaving
information improves efficiency throughout the system. It will allow,
for the first time, because there are interoperable standards that are
set, the exchange of information, which will seamlessly help integrate
health care delivery from the time a patient first presents to see a
physician or a nurse to ultimate discharge and treatment.
So this really is a pivotal moment. I encourage the House to act
quickly on the legislation.
Again, I thank Senator Enzi for his leadership. Without it, this
moment simply would not be possible. I thank Senator Clinton who has
stressed, from day one, the importance of having quality injected into
this bill, and Senator Kennedy. I thank them all for their commitment
to this effort.
I thank the staff who have worked many hours: Andrea Palm, Katy Barr,
Steve Northrup, and David Bowen, and many others.
Mr. President, I do want to at least turn to my colleague to thank
him and
[[Page S13272]]
so he can make a few comments because this is truly historic
legislation. And although it is mighty early in the morning now--late
at night or early in the morning--this really is a historic time for
health care and health care delivery.
The PRESIDING OFFICER. The Senator from Wyoming.
Mr. ENZI. Mr. President, I thank the leader for his kind comments but
much more so for his diligent work and leadership on this issue. As the
heart doctor of the Senate, and the doctor with a lot of heart, he
understands the need for health information technology and worked in a
very bipartisan way with Senator Clinton to come up with some of the
precepts we have in this bill. Senator Kennedy and I were working on
some other aspects of it. And we merged those two to come up with a
much more comprehensive health IT bill.
This will make a huge difference in the country. A RAND study that
was recently released said this will save about $162 billion a year in
medical costs. In my opinion, that is not even going to be the biggest
benefit. The biggest benefit is that it is going to allow medical data
to move with the people as they move.
When they go to the doctor's office, they will not have to take that
little clipboard and fill out whatever it is they can remember about
their health. And it will not matter because a lot more information
will be available to the doctor so he can make the right kinds of
decisions and choices.
It will also benefit travelers. If a tourist is out on the road and
has a wreck and has to see a doctor, they will have their information
with them. They will have access to it so the doctor will know what
medications they are on, even if they are in a coma, and can make sure
they are taken care of properly. And yes, it will reduce medical errors
and eliminate some adverse reactions from medications or even missed
medications.
So this will make a huge difference to the people of this country.
The difficulty with doing something by unanimous consent is that a lot
of times people think there is not much to it, or if there wasn't much
controversy, that nothing really happened. But there has been
controversy that has been taken care of behind the scenes, where people
got together and actually realized how important this was. So they
worked together to come up with solutions, and came up with a truly
bipartisan solution in this instance.
So it is almost too bad that it has to go through unanimous consent,
that we cannot have some very heated debates on the floor so people
will realize the intensity and the interest in the bill.
But there is not anything bad about the bill. This was a teamwork
effort from both sides of the aisle. I appreciate the leader mentioning
a number of the people who were involved in this bill. This is a truly
monumental piece of legislation we just passed, and I add the
encouragement to have the House act on it quickly.
Mr. President, I rise today to applaud the Senate passage of S. 1418,
the Wired for Health Care Quality Act. As chairman of the Committee on
Health, Education, Labor, and Pensions, I have been working to improve
the quality and reduce the cost of health care in this Nation.
Some of the most serious challenges facing health care today--medical
errors, inconsistent quality, and rising costs--can be addressed
through the effective application of available health information
technology linking all elements of the health care system. Information-
sharing networks have the potential to enable decision support anywhere
at any time, thus improving the quality of health care and reducing
costs.
Health IT allows medical data to move with people as they move. When
they go to the doctor's office they won't have to take the clipboard
and write down everything they can remember about themselves. This
system also benefits travelers. If a tourist were to get in a car wreck
or hurt in some other way, the doctor would be able to find out
everything he or she needs to know. If in a coma this technology could
save a person's life and if they happen to be on medications, it could
prevent adverse drug reactions. This system could also cut down on
medical errors with prescriptions--instead of deciphering the doctor's
handwriting, the information could be given to the pharmacist
electronically.
A RAND study recently released suggested that health IT has the
potential to save $162 billion a year. In order for these savings to be
realized, we must create an infrastructure for interoperability. S.
1418 is the first step in building that infrastructure.
Most folks agree that there are significant barriers to widespread
adoption of interoperable health information technology. One of the
primary barriers is the current lack of agreed-upon standards and
common implementation guides and a certification process. This bill
addresses those factors in a way that appropriately incorporates
involvement of both the public and private sectors.
This legislation brings the government and the private sector
together to make health care better, safer and more efficient by
accelerating the widespread adoption of interoperable health
information technology and quality measurement across our health care
system. The legislation formalizes involvement of private entities in
the standards and policy-setting process by directing the Secretary to
establish and chair the public-private American Health Information
Collaborative, which shall be composed of representatives of the public
and private sectors. S. 1418 also codifies the Office of the National
Coordinator for Health Information Technology. President Bush,
Secretary Leavitt, and Dr. Brailer have done a lot to advance the
health IT infrastructure, and I am glad that Congress is finally
stepping up to the plate.
In order to address the health information technology ``adoption
gap'' in the United States, S. 1418 authorizes three grant programs
that will carefully target financial support to health care providers
and consortia for the purpose of facilitating the adoption of
interoperable health information technology. To maximize the Secretary
of Health and Human Service's flexibility, the bill leaves to the
discretion of the Secretary the allocation of the authorization among
the three programs.
In addition, the greatest improvements in quality of health care and
cost savings will be realized when all elements of the health care
system are electronically connected and speak a common technical
language--that is they are interoperable. For this reason, each grant
program requires that each grant recipient acquire only qualified
health information technology systems that are capable of supporting
common technical standards adopted by the Federal Government.
Another barrier to widespread adoption of interoperable health
information is cultural. I recognize that many physicians and hospitals
are hesitant to move from paper-based systems to electronic systems.
Some physicians have been writing prescriptions by hand for many years
and may resist changing to electronic prescribing. One way to address
this cultural barrier to the widespread adoption of health information
technology is to support teaching hospitals and continuing education
programs that integrate health information technology in the clinical
education of health care professionals. Exposing students and residents
to effective everyday uses of health IT will lead to a greater adoption
by these students and residents when they graduate and begin practicing
on their own. The bill authorizes the Secretary to award demonstration
grants to health professions centers and academic health centers to
integrate health IT into clinical education in community settings.
The issue of health IT is also critical for effective response in
public health emergencies. Interoperable health IT systems will help to
track infectious disease outbreaks and increase the Federal
Government's rapid response in emergency situations.
I thank all of my Senate colleagues for their support of this very
important legislation, which will help facilitate the widespread
adoption of electronic health records to ultimately result in fewer
mistakes, lower costs, better care, and greater patient participation
in their health and well-being. This is a great stride forward in the
journey to improve our Nation's health care system. I look forward to
seeing meaningful health information technology legislation signed into
law this Congress.
[[Page S13273]]
I would like to commend various staff for the hard work they did in
bringing this bill to fruition. First, I want to recognize my fine
staff from the Senate HELP Committee, who have doggedly worked with
many interested parties over many months--Stephen Northrup and Katy
Barr. I would also like to recognize David Bowen from Senator Kennedy's
office for his dedication to this legislation. Elizabeth Hall of
Senator Frist's office did a good job providing leadership support
throughout the process. I should also mention Andrea Palm from Senator
Clinton's office and Michelle Spence with Senator Ensign's office for
ensuring that the health care quality provisions stayed strong.
Secondly, I want to recognize the work of the Senate Finance Committee
and the complementary bill supporting improvements in health care
quality in the Medicaid and Medicare programs that has contributed to
our success today. Mark Hayes and Ted Totman from the Senate Finance
Committee were very dedicated to seeing this bill pass. And finally,
without the dedication and patience of Bill Baird of Senate Legislative
Counsel, we would not have the bill that will pass here today.
Mr. KENNEDY. Mr. President, today the Senate has passed legislation
that can help transform our health care system and save lives. The
Wired for Health Care Quality Act will improve the use of lifesaving
health information technology in hospitals and doctors' offices across
the country. In so doing, we will improve the quality of care, lower
administrative costs, and reduce medical errors.
This legislation is being considered by the Senate because of the
leadership and commitment of the chairman of our Health Committee,
Senator Enzi. He made health information technology a priority for our
committee, and he has guided this legislation to the Senate floor.
Successful legislation takes creative thinking and hard work--and
Senator Enzi has supplied an abundance of both to this measure.
I also thank our partners in this legislation, Senator Frist and
Senator Clinton. As a surgeon, Senator Frist knows firsthand the
importance of making sure that doctors have the information they need
to provide the best possible care for patients--and that they get that
information in time for it to be of value. It is inconceivable that in
the 21st century, doctors are asked to treat patients in life or death
situations without knowing their medical histories or even the
medications they are taking--but that happens every hour of every day
in hospitals and emergency rooms around the country. Senator Frist has
been tireless in his commitment to correcting this unacceptable
situation.
Senator Clinton has done an excellent job as well. She has championed
better studies of the comparative effectiveness of medications, she is
dedicated to improving the quality of care for every patient, and this
legislation owes much to her ability and commitment.
This legislation is urgently needed, because we live in a new era of
medical miracles and rapid changes in medicine.
Modern electronics have given doctors implantable pacemakers to save
patients from sudden cardiac failure.
The sequencing of the human genome offers extraordinary opportunities
for new cures and better treatments.
But there is another medical miracle to add to the list.
Modern information technology can transform health care as profoundly
as any of these discoveries.
We have a moral responsibility to make the miracles of modern
medicine available to every American--but we have failed to meet that
responsibility. Costs are crushing our health care system. Premiums are
going through the roof. The ranks of the uninsured grow every day.
Families are forced to choose between paying the cost of health care or
paying for food, rent, and college tuition. That is not the American
dream.
Information technology alone can't solve these problems, but it can
help substantially. Electronic medical records. Software to warn if a
treatment could harm a patient. Computer prescribing. These and many
other applications of information technology can save lives and
dramatically reduce costs.
Despite the wonders of modern medicine, too many patients today are
harmed by preventable mishaps. They waste hours and face new risk when
tests must be duplicated, because a crucial record is locked in another
archive. Too many doctors only guess at the right course of treatment,
because they don't know a patient's medical history. Millions of
patients are needlessly put at risk, and billions of dollars are
wasted.
When so many Americans are already struggling to afford health care
for their families, it is profoundly wrong to squander more than half a
trillion dollars each year on administrative expenses.
The Department of Health and Human Services estimates that better use
of information technology will save $140 billion every year. Such
savings would produce a technology dividend worth over $700 on the cost
of an average family's insurance policy. That is like getting 1 month
free every year.
Other nations are already using this extraordinary technology to cut
costs and save lives--but America lags behind. We can't continue to
allow the high cost of health care to price American goods and services
out of the global marketplace.
The need to invest in this technology is urgent. In the words of
Secretary Leavitt, ``Every day that we delay, lives are lost.'' The
time to act is now. The bill before us will improve care, save lives
and make health care more affordable for every American.
The need to reduce medical errors is especially urgent. It is already
6 years since the Institute of Medicine reported that medical errors
cause 98,000 deaths every year. According to the National Patient
Safety Foundation, 42 percent of Americans have been affected by a
medical error, either personally or through a friend or relative. One
out of every three of those affected said that the error had a
permanent negative effect on the patient's health. The exact figures
may be the subject of debate, but it is undeniable that preventable
deaths occur in our health care system all too often. For even one
patient to die needlessly in our health care system ought to be
unacceptable.
Our response should be broad based. New technology, new ideas, aud
new ways of practicing medicine all have a role in improving the
quality of care and saving lives. We no longer expect airline pilots to
navigate by looking at the stars or local landmarks. Engineers no
longer rely on slide rules to design strong buildings. In virtually
every field except medicine, professionals use computers to expand
their skills. Yet in medicine, we expect doctors to keep in their heads
the possible interactions of the dozens of medications that a patient
may be receiving. Under these circumstances, the wonder is not that
errors occur, but that they don't occur even more frequently.
The evidence that information technology can save lives is
undeniable. In terms of drug safety alone, a recent analysis by the
RAND Corporation estimates that by using computerized data, the nation
could prevent 2.2 million adverse drug events, and 1 million additional
days in the hospital.
What we have today, in the words of the Institute of Medicine, is a
``quality chasm.'' Doctors repeat tests that have already been
performed. Residents take medical histories that have already been
taken. Patients show up for doctor's appointments that are essentially
a waste of time because the tests have been performed but the results
have not yet been delivered.
Information technology can help close this gap by improving the
coordination of care, providing guidance on the best methods of care
and reminding busy physicians when it's time to schedule preventive
screenings. The Veterans Administration is a national leader in using
IT to improve quality, and patients get better preventive services
there than almost any other patient group in America gets, especially
in areas such as proper cholesterol screening, eye exams for diabetic
patients, and proper immunization against pneumonia.
Electronic medical records improve the quality of care, and can also
improve our ability to monitor drug safety, detect outbreaks of disease
before they become epidemics and decide which treatments are most
effective for patients.
Electronic medical records can be critical in a natural disaster. The
devastation of Hurricane Katrina was
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compounded because most hospitals kept their records on paper. As a
result, medical histories of tens of thousands of hurricane survivors
were irretrievably lost. It would be inexcusable if we didn't make the
investments needed for the nation to benefit from these innovations.
Information technology doesn't simply improve the quality of care--it
reduces costs as well. According to the Institute of Medicine, each
prescription error that is prevented saves $4,000 in additional care.
This isn't just a theory. Since 1996, when the Veterans Administration
began investing significantly in information technology, its costs per
patient have actually decreased by 7 percent while private sector costs
per patient have increased by 62 percent.
Excessive administrative costs are weighing down our health care
system. We are spending over $500 billion a year on such costs--nearly
33 cents out of every health care dollar. These already high costs are
also growing 50 percent faster than other health costs. It can cost as
much as $20 to process a single insurance claim using antiquated paper
records--and nearly half the 18 billion insurance claims in America are
still settled in this old-fashioned way every year. We know that paper-
based records are prone to error. About one in four health insurance
claims is initially rejected because of errors. By contrast, in the
financial industry, only 1 in 10,000 ATM transactions has an error.
Despite clear evidence that health IT saves lives and cuts costs, its
use is still scandalously low. Our health care system should be the
envy of the world, but nations from Australia to Scandinavia are
outpacing us in this technology. In Sweden and Holland, nine out of ten
primary care physicians use electronic medical records. In Britain,
Austria, Finland and many other nations, it is over half. But in the
United States, less than a quarter of all doctors use electronic
medical records.
Obviously, there are significant barriers to the adoption of health
information technology that Congress should also address. Many
providers don't have the financial ability to absorb the costs of
buying the equipment, making the transition to computer systems, and
training staff. It costs a physician's office $30,000 and significant
aggravation to install the system. The savings from its use tend to
come over the longer term, while the costs are immediate, which is a
major financial barrier to hospitals, physicians, and nursing homes
already drowning in red ink. Providers get savings over the long run,
but the largest share of the savings goes to payers, not providers. If
a diabetic is kept out of the hospital by better management of his
condition as the result of information technology, that's a loss of
revenue to the hospital.
This bipartisan legislation will help overcome these barriers. It
requires the development of standards on interoperability and other
technical measures for health information technology, and it
establishes a public-private consultation to develop those standards.
But standards without Federal resources are not enough to achieve the
goal of a modern health care system that we all share. That is why the
legislation includes financial assistance to hard pressed providers to
meet the technical standards. It provides this assistance in three ways
in recognizing the fact that different health care providers and
different communities will have different needs. It authorizes direct
grants to needy providers. It authorizes financial assistance to
establish regional networks. And it creates an innovative Federal-
State, public-private partnership to modernize health care by enabling
states to fund low interest loans to help health professionals in
financial need to acquire the technology to improve the quality and
efficiency of health care.
Getting the right hardware and software into the hands of doctors is
only half the battle. It is also essential to see that doctors have
access to the knowledge necessary to make the technology a success. The
legislation establishes a Best Practices Center where technology users
can learn from the experience of others who have established such
networks. It sets up a Help line at the Department of Health and Human
Services to answer technical questions and help meet technical
requirements. To assist doctors in sorting through the confusing array
of options for this technology, the legislation establishes a
certification program, so that providers can quickly determine whether
particular systems meet the applicable technical standards.
There are many Senate colleagues who deserve great credit for their
thoughtful contributions to this legislation and for their leadership
in getting to this moment.
Again, I commend the chairman of our Health Committee, Senator Enzi,
for his impressive leadership on this issue. It has been a privilege to
work closely with him and his staff since the beginning of this year
and to deal with this priority.
The pending legislation combines the bill that Chairman Enzi and I
introduced and the bill that Senator Frist and Senator Clinton
introduced. We have also had broad input from many other committee
members, and we have produced a better bill because of it.
Senator Dodd was a leader on the issue in the last Congress as well,
and our bill includes many of his ideas, especially on making sure that
standards are widely available.
Senator Ensign made sure that best practices are front and center in
implementing this technology.
Our subcommittee chairman, Senator Burr, has a strong interest in
using information technology to improve our ability to respond to
bioterrorist attacks or other disease emergencies, when lost hours can
mean countless lost lives.
Senator Reed of Rhode Island had the innovative idea of including a
1-800 number to help providers on technical questions. Senator Harkin
contributed important proposals to use the technology to improve the
treatment of chronic diseases.
Senator Reid of Nevada has shown impressive leadership in making sure
technology improves the lives of American families, and I thank him for
his strong support.
Senator Snowe and Senator Stabenow have a major commitment to
effective funding for this technology, and I look forward to working
with them on this issue in the days to come. I also commend Senator
Snowe for her strong commitment to protecting the privacy of electronic
medical data.
I also commend Steve Northrup and Katy Barr of Senator Enzi's staff,
Andrea Palm of Senator Clinton's staff, Liz Hall of Senator Frist's
staff, and my own health staff, for their effective work on this issue
for so many months.
I thank these and all our Senate colleagues who contributed to the
legislation we consider today. I look forward to working with all of
you and with our colleagues in the House to see this needed measure
signed into law as soon as possible.
Mr. ENZI. Mr. President, I rise today to speak about the passage of
1418, the Wired for Health Care Quality Act. As chairman of the
Committee on Health, Education, Labor, and Pensions, I have been
working to improve the quality and reduce the cost of health care in
this Nation. I commend the ranking member of my committee for his
dedication to this great cause.
I want to commend my colleague from Maine, Senator Snowe, and my
colleague from Michigan, Senator Stabenow, for their leadership on the
issue of health information technology. They have made a major
contribution to the debate, and I look forward to working with them as
we continue to consider this important issue.
I see the legislation we consider today as the first step toward more
effective use of information technology in health care. This proposal
will provide the framework to improve the use of health IT. Senator
Snowe and Senator Stabenow have several thoughtful proposals on
providing additional financial incentives through Medicare for the use
of health information technology.
Providing adequate funding for health IT is a critically important
issue, and I believe that it should be carefully considered in our
committee and by the Senate. I look forward to working with my
colleagues on the committee and with Senator Snowe and Senator Stabenow
to see that health IT receives an appropriate level of funding.
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I also believe it is important to examine carefully the privacy
protections that apply to individually identifiable health information
maintained in electronic databases. The manager's amendment to S. 1418
contains several important provisions relating to privacy, including a
GAO investigation on methods to enhance privacy protections for
electronically stored and transmitted health information.
I believe it is important to examine the issues surrounding
implementation and adoption of health IT systems carefully. To that
end, I intend to hold a hearing by the Memorial Day recess next year on
the essential issue of funding to promote wide adoption of health
information technology. We will also examine the report of the GAO to
address the critical issue of protections for the privacy of health
information that must be part of health IT systems and practices. I
will work closely with my colleagues, Senator Snowe and Senator
Stabenow, as well as with the ranking member on this hearing.
I will also work with the Finance Committee, the committee with
jurisdiction over Medicare, and with Senators Stabenow and Snowe on
legislation to spur the widespread adoption of interoperable health
information technology through such innovative financing mechanisms,
and we will work to achieve passage of that legislation before the end
of this Congress.
I happen to be an original sponsor of legislation in the Finance
Committee to reward high-quality health care through value based
purchasing under Medicare. By rewarding doctors and hospitals for the
quality of care they provide, not just the quantity of care, we can
improve health care quality in a fiscally responsible way.
I look forward to working with Senators Kennedy, Grassley, Baucus,
Snowe, Stabenow, Frist, and Clinton on these important proposals, and I
commend them for their leadership on this important field of health IT.
Mr. KENNEDY. I thank the distinguished chairman of our Health
Committee for his impressive leadership on the issue of health
information technology. Health information technology can revolutionize
health care, with lasting benefits in areas from improving quality to
better detection of bioterrorist attacks and epidemics.
I also commend my colleagues, Senator Stabenow and Senator Snowe, for
their commitment to seeing that we provide adequate financial support
for doctors and hospitals to use health information technology systems.
I will work closely with them, and with our chairman and our colleagues
on the health committee, to see that we build on the legislation under
consideration today in order to assist health care providers to meet
the cost of acquiring health IT.
Senator Snowe and Senator Stabenow have made a major contribution to
our debate, and I look forward to working with them on additional
proposals on this important issue in the very near future.
Ms. SNOWE. Mr. President, I want to commend Senators Enzi, Kennedy,
Frist, and Clinton for their work in addressing the inadequate state of
our individual health records today. The Wired for Health Care Quality
Act will accelerate the development of essential standards to protect
investment in health information technology. Very soon the Federal
Government will require compliance with these standards for its
purchases--a long overdue step in modernizing health care information
management.
I began work with on this issue in the last Congress when we learned
from the Institute of Medicine that an estimated 98,000 Americans die
each year as a result of medical errors. Technology can help us prevent
these deaths and injuries from medical mistakes. That is one reason I
joined with Senator Stabenow to assure that we implement live saving
technology.
A second reason for our work is that information technology, IT, will
help us reduce the cost of health care. As health care costs increase
far more rapidly than inflation, care becomes less affordable and the
ranks of the uninsured grow. Each of us appreciates that technology
will help us reduce that unsustainable trend. Recent reports
demonstrate that the cost of implementing health IT is exceeded by a
single year of savings. That is a remarkable return on investment, but
since an estimated 89 percent of savings accrues to payers, not
providers, standards alone will not spur adoption.
Since the rewards for adoption primarily accrue to payers and
patients, it is wholly appropriate that payers--including the Federal
Government--act in their best interest to reduce costs. That means we
must ensure adoption not just by those providers for whom investment is
relatively easy, but by those with lesser resources, such as the many
who provide care for our Medicare, Medicaid, and SCHIP beneficiaries. I
look forward to working with my colleagues to see that we implement
financing--including grants and tax incentives--to allow all providers
to adopt this promising technology. Otherwise we will see a two-tiered
system develop.
If some patients do not receive the benefits of the electronic health
record the President has set as a goal, their care will suffer. In
fact, if their providers cannot adopt technology, their clinical data
may not be not properly integrated in pay-for-performance
methodologies. If the resulting criteria don't account for such
patients, they then pose the risk of inadequate compensation to
providers, and many may decline to serve them. So it is critical that
we assure all providers can adopt health IT.
I thank Chairman Enzi and the Senator Kennedy for their commitment to
a hearing next spring on the adoption and financing issue. I also thank
the majority leader for his assistance. The issue of adoption certainly
multiple committees, and we appreciate his efforts in helping the full
Senate to consider promising financing proposals to assure broad
adoption.
As we move forward together, we should also remember to follow the
physician's adage--certainly one the leader knows so well--to ``first
do no harm''. We are all agreed that genetic information, which may
indicate probability of disease, must be protected. One's medical
record includes even more than probability--it is indisputable evidence
of the presence of disease, the drugs one uses, your full physical and
mental health history. Consequently, Americans are worried about their
health records. A recent survey demonstrates that two-thirds of all
consumers have substantial concerns about the privacy of their medical
records. The same proportion say that recent reports of privacy
breaches have actually increased these concerns. So it comes as no
surprise that consumers engage in behaviors to avoid such data from
even being created--such as paying out-of-pocket for medical expenses,
using a different physician on occasion, or simply asking that vital
information not be included in their chart. Patients even forgo
treatment altogether in fear of disclosure. This compromises health, so
we simply must provide Americans with confidence in the security of
their health record.
We simply must have the highest levels of data security. So first we
must see procedures established to assure that inappropriate disclosure
does not occur. Next, if a data breach does occur, the patient must be
informed. To do otherwise is unconscionable.
I am pleased to see that the managers amendment requires such
notification for those handling data under the programs established by
this legislation, and the bill also establishes a process to address
concerns on medical data privacy by directing a GAO study to guide us
in providing the assurance all Americans must have that their medical
data is protected. I thank my colleagues for including these essential
provisions.
Today marks the beginning of a process to offer all Americans a
safer, more affordable system of health care. I look forward with
Senator Stabenow to working with the majority leader and Senators Enzi,
Kennedy, and Clinton, as well as Senators Grassley and Baucus, as we
move forward to realizing the full potential of health IT become
reality for our constituents. The rewards in lives and dollars saved
compels us to act promptly.
Ms. STABENOW. Mr. President, I want to commend the leadership of
Senators Enzi, Kennedy, Frist, and Clinton in this critically important
arena. Their diligent work in introducing and passing S. 1418
establishes the groundwork necessary to begin to realize the promises
of health information technology, IT.
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The evidence showing the ability of health IT to reduce costs and
improve quality of care is simply overwhelming. Dr. David Brailer's
office attributes savings from widespread adoption of electronic health
records in the range of 7.5 percent to 30 percent of annual health care
spending that is between $135 and $540 billion annually.
Manufacturers in Michigan and across the country are struggling to
remain competitive in a global market with skyrocketing health care
costs. Health IT can, and should, play a key role in managing these
costs.
Equally compelling is the promise health IT holds for improving the
quality of our health care system by ensuring that patients get the
care they need, at the right time, and in the best setting.
To realize these promises, however, Congress must enact legislation
providing meaningful resources through Federal financial incentives,
both mandatory grants and tax incentives, to physicians, hospitals,
skilled nursing facilities, and community health and mental health
centers for health information technology.
Health care providers are struggling to keep up with their daily
needs at the same time they are anticipating cuts in their rates. A
major barrier to widespread use of IT is the initial investment cost:
the costs of procuring and implementing health IT can be staggering.
Every day we delay providing Federal seed money through a grant
program and accelerated depreciation of health information technology
expenses, we delay getting health information technology systems in
place, and businesses, taxpayers and patients pay in both dollars and
lives.
I appreciate the majority leader's commitment to encourage the
chairman and ranking member of the Finance Committee and the chairman
and ranking member of the HELP Committee to schedule, at the earliest
opportunity, consideration of legislative proposals to ensure federal
funding to accelerate adoption of health IT.
A meaning Federal investment must be robust, funded with mandatory,
rather than discretionary, dollars, and available to individual
providers and health care systems.
This is not the place to skimp on dollars; we know every dollar we
spend will come back to us many times over. Federal investments,
through grants and tax incentives, in health information technology
will result in lower Medicare, Medicaid and SCHIP spending, reduced
medical errors, and greater quality and efficiency in our health care
system. We must provide a level of funding that will allow a
significant percentage of our health care providers to adopt and use
health IT systems. Additionally, funding must not be limited to
authorizations of appropriations. We must actually provide the dollars
needed to begin realizing the benefits of health IT.
Nor should we limit funds to providers in networks. We should work
towards a system where all health care providers are linked, but we do
not need to wait for those networks to be formed to see the benefits of
health IT. Standalone e-prescribing systems could reduce medication
errors by 50 percent; there is no reason to delay the quality, safety,
and financial savings possible through immediate health IT adoption by
individual providers.
In addition to funding, we must pay careful attention to privacy and
confidentiality rights and concerns. A patient's right to health
information privacy is paramount, and an essential component of the
health care provider-patient relationship. According to a survey
recently released by the California HealthCare Foundation, CHCF, 67
percent of Americans remain concerned about the privacy of their
personal health information. The survey also reports that many
consumers may be putting their health at risk by avoiding their regular
doctor or forgoing needed tests over privacy concerns. Apprehension
over privacy and confidentiality, if not addressed thoughtfully, could
pose enormous barriers to the savings and health care improvements
possible through adoption of health information technologies. Strong,
enforceable privacy safeguards based on a patient's right to health
information privacy are absolutely critical as we move towards a
nationwide, interoperable electronic health care system.
I appreciate provisions included in the managers' amendment
addressing the need for patients to be notified if their individually
identifiable health information is wrongfully disclosed and a study by
the General Accounting Office examining the issue as it relates to all
Americans.
I look forward to working with the majority leader, and Senators
Snowe, Enzi, Kennedy, and Clinton, as well as Senator Grassley and
Baucus to ensure passage of legislation this Congress providing
meaningful, substantial Federal financial incentives to accelerate
adoption of life and dollar saving health information technologies.
Mr. FRIST. Mr. President, I am pleased to speak in support of S.
1418. I share an important goal with Senators Enzi, Kennedy, Snowe,
Stabenow, and Clinton--to improve health care quality and reduce costs
through the use of health information technology tools.
I spent 20 years as a physician and heart surgeon before coming to
the Senate. Like most physicians, I wanted the latest and best medical
technology, anything that could make my patients healthier or more
comfortable, while reducing health care costs and increasing
efficiency.
But amidst the artificial heart assist devices, lasers, CT Scan
machines, endoscopic devices, digital X-Rays, and digital thermometers,
doctors today keep patient records the same way I did and the way my
father did 50 years ago: on paper, in manila folders in file cabinets,
in the basements of clinics and hospitals. Yet computers, and computer
technology, is everywhere, both inside and outside the hospitals and
clinics. From bedside monitors to massive MRI machines, computers power
almost all of the diagnostic devices we rely on.
S. 1418 represents an important and crucial first step towards
recognizing the importance of computers and the electronic medical
record in contemporary health care. Establishing interoperability of
the electronic medical record, an essential hurdle towards effective
use of health information technology, is a priority. Proposals for
providing Federal financial incentives for physicians, community health
centers, community mental health centers, hospitals and skilled nursing
facilities like that introduced by Senator Snowe and Senator Stabenow
need to be considered.
Assuring proper funding of health IT is an issue of major importance
for the Senate to consider in the coming congressional session. I will
work with the chairman and ranking member of the Finance Committee and
the chairman and ranking member of the HELP committee as well as
Senators Snowe and Stabenow to encourage these committees to schedule,
at the earliest opportunity, consideration of legislative proposals to
ensure creative and reasonable Federal funding for such an important
and relevant mission. I will also work with relevant committees to
encourage consideration of legislation that would enable providers to
connect to a secure, interoperable network for the electronic exchange
of health information.
Mrs. CLINTON. I would like to commend Chairman Enzi and Senator
Kennedy for all of their work on this legislation. I would also like to
recognize the commitment and leadership of the majority leader, who I
have been working closely with on this issue. Today's passage of S.
1418, the Wired for Health Care Quality Act, is a fundamental first
step in establishing a nationwide, interoperable health IT
infrastructure.
Our legislation provides the framework and authorizes several grant
programs to begin the process of funding health IT projects that are
compliant with the framework established in the bill. The legislation
introduced by Senators Snowe and Stabenow and their work more broadly
on this issue will be critical as we work on additional financing
mechanisms. I am anxious to begin that work and am committed to working
closely with them, and my colleagues on the HELP and Finance committees
to ensure that physicians and hospitals are able to afford to
participate in a 21st century health care system.
Mr. ENZI. I see this bill as the first step of many in improving the
health care in the United States. I look forward to working with my
friends on the Finance Committee as well as
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working with Senators Snowe and Stabenow to look at creative financing
mechanisms to help doctors and hospitals go on line.
Mr. FRIST. Mr. President, in closing our comments on this bill, I
also thank my staff who have been shepherding this for me for the last
3 years, Liz Hall, Jennifer Romans, and many others. The real
significance is that patient care will be improved. It will get the
waste and abuse out of the system. It makes the health care system more
efficient. I am excited about it. Having interoperable standards that
people begin to agree with means you will have an influx of private
capital which will help with the spreading of this information
technology infrastructure over time.
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