[Congressional Record Volume 152, Number 101 (Thursday, July 27, 2006)]
[House]
[Pages H5978-H6004]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          HEALTH INFORMATION TECHNOLOGY PROMOTION ACT OF 2006

  The SPEAKER pro tempore. Pursuant to House Resolution 952 and rule 
XVIII, the Chair declares the House in the Committee of the Whole House 
on the State of the Union for the consideration of the bill, H.R. 4157.

                              {time}  1311


                     In the Committee of the Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the State of the Union for the consideration of the bill 
(H.R. 4157) to amend the Social Security Act to encourage the 
dissemination, security, confidentiality, and usefulness of health 
information technology, with Mr. Simpson in the chair.
  The Clerk read the title of the bill.
  The CHAIRMAN. Pursuant to the rule, the bill is considered read the 
first time.
  General debate shall not exceed 1 hour, with 35 minutes equally 
divided and controlled by the chairman and ranking minority member of 
the Committee on Energy and Commerce, and 25 minutes equally divided 
and controlled by the chairman and ranking minority member of the 
Committee on Ways and Means.
  The gentleman from Texas (Mr. Barton) and the gentleman from New 
Jersey (Mr. Pallone) each will control 17\1/2\ minutes, and the 
gentlewoman from Connecticut (Mrs. Johnson) and the gentleman from 
California (Mr. Stark) each will control 12\1/2\ minutes.
  The Chair recognizes the gentleman from Texas.
  Mr. BARTON of Texas. Mr. Chairman, I yield myself such time as I may 
consume.
  Mr. Chairman, I am pleased that the House today is going to consider 
H.R. 4157, the Health Information Technology Promotion Act of 2006. 
This legislation should help move our health care system into the 
modern era and the modern information age.
  We all remember a time when e-mail was a dream and getting the 
legislative text from the House of Representatives Web site was 
impossible because it simply did not exist. As information systems have 
moved into the digital age, Congress and most of the private sector 
have embraced it. We have found that we could get information much more 
efficiently and quickly at much less cost.
  The health care system, for whatever reason, has not done that. For 
all of its medical genius and astonishing technology in terms of 
surgery and orthopedics and diagnosis, American health care is still 
stuck back in the 19th century, with a paper record system that is 
inefficient, wasteful, error-prone and occasionally dangerous. The 
legislation before us today should change that.
  With H.R. 4157, records that have been stuffed in a file cabinet and 
illegible prescriptions that nobody can read scrawled on pieces of 
paper will finally give way to digital medical records, electronic 
prescribing, and efficient coordination of care. Sick patients will get 
better and everybody should save money.
  The bill before us sets out a framework for endorsing core 
interoperability guidelines and mandates compliance for a Federal 
information system within 3 years of endorsement of such guidelines. Of 
vital importance are provisions contained in the legislation that 
create safe harbors to the Stark and Anti-kickback laws for the 
provision of health information technology and services to better 
coordinate care between hospitals and providers. These changes are long 
overdue.
  Hospitals and other health care entities that have invested in 
systems that are tested and work well should be able to share their 
experience and purchasing power with physicians. Current laws have 
prevented these reasonable steps to better coordinate patient care by 
not allowing the sharing of health information technology systems.
  Also, I would like to express support for the Secretary of Health and 
Human Services to look at the list of entities that we make eligible 
for this safe harbor and to expand upon it, specifically, to include 
independent clinical laboratories which carry a great deal of health 
data that should be shared electronically.

                              {time}  1315

  These safe harbors will allow for economical sharing of health 
information technology to better coordinate care, reduce medical error, 
and improve patient outcomes.
  Medical science in recent years has produced tremendous discoveries 
that have revolutionized how we treat disease and care for patients. 
Unfortunately, the medical record information technologies needed to 
take advantage of these discoveries remain locked in an era of paper 
and filing cabinets. We can do better, and the legislation before us 
today will do better.
  Mr. Chairman, I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield myself 3 minutes.
  Our Nation's health care system is arguably the most inefficient and 
costly system in the industrialized world. We spend approximately $1.7 
billion annually on health care, and yet many of our citizens are in 
poorer health than the citizens of countries that spend far less. That 
is because our Nation's health care system is wrought with

[[Page H5979]]

problems, including skyrocketing costs that make it difficult for 
Americans to afford the care that they need, inconsistent quality, and 
huge disparities in care and access. Clearly, the status quo is not 
working and something has to be done to fix these problems. Health care 
experts around the country agree that health information technology, or 
HIT, could provide a partial solution to our problems.
  Now, while estimates vary, the potential savings from HIT could reach 
between $81 billion and $170 billion annually by improving coordination 
of care, patient safety, disease management, and prevention efforts. 
Under the Republican bill we are debating today, however, none of these 
savings will be realized. That is because the bill will do nothing to 
move our Nation forward on health information technology.
  The CBO agrees with the Democrats, and I quote, ``CBO estimates that 
enacting H.R. 4157 would not significantly affect either the rate at 
which the use of health technology will grow or how well that 
technology will be designed and implemented.'' So I don't want anybody 
to be fooled here today. Don't let the Republicans sell you this lemon.
  My friends on the other side of the aisle would have us believe that 
this bill is going to transform our health care system into a model of 
efficiency, and it is all a bunch of hype. Let me mention a few ways in 
which this bill is flawed.
  First of all, there is virtually no funding, and I stress that, 
virtually no funding to help providers, such as physicians or 
hospitals, to purchase this technology. The meager amount of funding 
authorized in this bill will barely make a dent in advancing the use of 
HIT. Instead of making grants or loans available to doctors to help 
them purchase equipment or train employees, Republicans have decided to 
roll back anti-kickback and self-referral protections so that doctors 
will have to rely on other types of providers for this technology. Make 
no mistake about it, this is going to open the door for fraud and abuse 
to run rampant and will eventually add to our health care costs.
  Secondly, this bill does nothing to improve protections for medical 
privacy. Electronic health information systems that make it easier to 
exchange medical information require new privacy protections to be 
implemented and strongly enforced. In spite of the privacy breaches we 
saw this year at the Veterans Administration, and also at CMS, 
Republicans don't seem to think there is a need to strengthen our 
Nation's privacy laws. But I have to tell you, Americans are not going 
to stand for this. They are not going to want their most personal 
information floating around cyberspace without any reasonable 
safeguards.
  There are a number of other problems with this bill, Mr. Chairman, 
but let me finally talk about the process in which this bill was 
developed. House Republicans have taken an opportunity for all of us to 
work together on an important issue and they have squandered it. The 
Senate was able to pass a bipartisan bill that would accomplish a lot 
more than the bill we are debating today. They authorize grants and 
loans, they don't roll back fraud and abuse protections, and they 
ensure interoperability. But they did this all on a bipartisan basis in 
the Senate.
  Democrats in the House tried to offer that bill as a substitute in 
the Rules Committee yesterday, but we were denied the substitute. And 
it is a shame that House Republicans couldn't follow the Senate's lead 
and work with Democrats to move our Nation forward on HIT and improve 
the health of all Americans.
  I urge my colleagues to vote ``no'' on this bill, because although we 
think that health information technology is very important, this bill 
will not accomplish the goal.
  Mr. Chairman, I reserve the balance of my time.


                         Parliamentary Inquiry

  Mr. BARTON of Texas. Parliamentary inquiry, Mr. Chairman.
  The CHAIRMAN. The gentleman will state his inquiry.
  Mr. BARTON of Texas. Mr. Chairman, how is time going to be rotated? 
Do we do all the Energy and Commerce time and then the Ways and Means 
time; or do we rotate in sequence?
  The CHAIRMAN. The Chair would accommodate the wishes of the managers.
  Mr. BARTON of Texas. Okay. Congresswoman Johnson says the Energy and 
Commerce Committee goes first.
  Mr. PALLONE. I think, Mr. Chairman, we were told in advance that we 
would do Energy and Commerce first, so that is the way we would prefer 
to proceed.
  Mr. BARTON of Texas. Okay. That is what Congresswoman Johnson also 
says. I was not informed of that.
  Mr. Chairman, I yield 3 minutes to a distinguished physician member 
of the Committee on Energy and Commerce, Dr. Murphy of Pennsylvania.
  Mr. MURPHY. I thank the chairman and the Members for an opportunity 
to talk about this vitally important bill.
  Years ago, when I was working at Children's Hospital in Pittsburgh, I 
happened to be walking by the emergency room when a resident called me 
urgently in on a case that was there. It was a child who was having 
out-of-control behavior, rapid heart rate, rapid breathing, and she 
merely commented that this child's behavior was out of control. That 
could have been a symptom of anything. Was the child having a seizure? 
Was the child poisoned? Was the child having a drug problem, a 
neurological crisis, a heart problem, or a whole host of issues?
  As it was, I happened to recognize the child as a patient of mine and 
we quickly came to the conclusion that one of the aspects may be a 
medication overdose, or a bad medication reaction. The parents had not 
yet arrived and we had not yet accessed his medical records. Why? 
Because the medical records were in a file somewhere back in my office 
in another section of the hospital and were ones that the emergency 
room staff could not acquire.
  Think of this, too. If one of us, any of us, any American is 
traveling in a town somewhere in America and a medical crisis hits 
them, for someone who is diabetic or perhaps has heart disease or some 
other problems, where do we get the records to determine what to do? It 
is for this reason that we recognize about $162 billion a year is lost 
in health care, according to the RAND Corporation, and you include all 
the other paperwork and problems that come with hospital care, perhaps 
$290 plus billion is spent on that. Why? Because of medical records.
  The current medical records system is this: Room after room after 
room in a hospital filled with paper files. What happens if we move to 
electronic medical records where it is, instead of here, it is in a 
computer? This is what that room looks like. It is now in a computer, 
accessible to physicians in a hospital, with pass codes and access 
codes that keep it secure, because HIPAA laws say it must be secure; 
that people can't have that, and then it becomes records that look more 
like this.
  Again, a doctor with clear authorization ahead of time could find a 
patient's name, see their status, see what is going on, and move 
towards that and pull these records out. Otherwise, you end up in a 
situation of medical crisis. Patients can carry this information in a 
credit card or on a zip drive they can carry on their key chain. All 
this is critically important because it saves lives and saves money.
  The best doctors and the best hospitals in America, if they cannot 
get the patient information they need when they need it, it can lead to 
morbid consequences: Higher mortality. And that is what ultimately this 
bill is about. This is a huge step forward because we have to have 
standards and other things moving forward. Hospitals all across America 
are moving towards some level of electronic medical records. But if we 
don't find ways of making them able to talk to each other, with uniform 
standards, interoperability, et cetera, we are essentially creating a 
medical Tower of Babel. We have more information, but they can't talk 
to each other.
  At that moment of crisis in a health care center, whatever that is, 
whether you are at home or far away, no matter how good your doctor and 
hospital is, you want them to have that information. Patients can 
preauthorize that information. They can carry that with them. But this 
is the new technology, and if we don't do this, we will see many lives 
lost, and that is something we cannot afford to do. That is why I urge 
the passage of this bill.

[[Page H5980]]

  Mr. PALLONE. Mr. Chairman, I yield 3 minutes to the gentleman from 
California (Mr. Waxman).
  Mr. WAXMAN. Mr. Chairman, we should not pass H.R. 4157 without 
including essential privacy protections for the health information of 
American consumers. Privacy protection should go hand-in-hand with 
efforts to promote health information technology, yet the Republican 
leadership refused to include appropriate privacy protections or allow 
consideration of privacy amendments.
  Our health care system will not be effective if privacy fears deter 
Americans from seeking appropriate treatment. Unfortunately, survey 
after survey demonstrates that American consumers lack confidence that 
the privacy of their personal health information will be protected.
  Just last year, the California Health Care Foundation found that 
nearly two-thirds of Americans polled were concerned about the privacy 
of their health information, and one out of eight had taken steps that 
could have put their health at risk simply because of privacy concerns. 
Moving health records into electronic form is only likely to increase 
their fears unless we act to ensure appropriate privacy protections are 
in place.
  Recent incidents involving security threats to medical information 
have underscored the vulnerability of electronically maintained data. 
In June, we learned that Medicare data on 17,000 beneficiaries enrolled 
in a Medicare prescription drug plan had been put at risk due to 
inappropriate security protections on a computer file. And then the 
Department of Veterans Affairs' computer that was stolen several months 
ago contained sensitive information that included disability ratings 
for some veterans and notes about some veterans' health conditions.
  In fact, according to the Privacy Rights Clearinghouse, nearly 90 
million electronic data records of U.S. residents have been compromised 
because of security breaches in just the past year and a half.
  This administration's lax approach to enforcing existing medical 
privacy requirements has raised additional concerns. A recent 
Washington Post article reported that the administration has not 
imposed a single civil fine under the Federal medical privacy rule 
despite nearly 20,000 complaints of violations over the 3 years the 
rule has been in effect.
  It is irresponsible for Congress to promote the development and use 
of health information technology without ensuring that necessary 
privacy and security for health information are in place.
  I thank the gentleman from New Jersey for yielding to me so I could 
point out these specific concerns that I have with this legislation, 
and I wish we could address them.
  Mr. BARTON of Texas. Mr. Chairman, I yield myself 30 seconds before I 
yield to Mr. Castle.
  Under the current law, called HIPAA, we have very strict privacy 
protection guidelines. Those guidelines are currently under review. 
There have been over 50,000 comments filed with HHS for some proposed 
changes in those. Nothing in the Senate bill, that is a companion bill 
to this bill, deals with privacy.
  Privacy is an important issue, but more important is that we get a 
health information system technology in place, and that is what this 
bill does.
  Mr. Chairman, I yield 2 minutes to the former Governor of the First 
State, the great State of Delaware (Mr. Castle).
  Mr. CASTLE. Mr. Chairman, I would like to thank Chairman Barton for 
yielding, but I also want to thank him for his great work on this 
important legislation, H.R. 4157, which I support; and also the 
gentlewoman from Connecticut (Mrs. Johnson) has worked on this for some 
time, and will be speaking shortly.
  With recent reports estimating that medical errors may be responsible 
for up to 98,000 deaths and 1.5 million medication errors each year, 
there is no doubt in my mind that the time has come to move towards an 
electronic health records system.
  I am pleased this legislation officially establishes the Office of 
the National Coordinator for Health Information Technology, because it 
is absolutely vital that the Federal Government take the leading role 
in establishing such a system. Without a strategic Federal plan, I 
worry that each State will be left to their own devices and we will end 
up with a patchwork system. I am hopeful that the standards which are 
set will be easily adaptable for the States and regions that are 
already working on such connectivity.
  In my State of Delaware, we have established the Delaware Health 
Information Network. It has secured a $4 million contract with the 
Agency for Health Care Research and Quality to establish an e-health 
system in our hospitals, physicians' offices, and laboratories. 
Eventually, we hope this will be extended to our nursing homes and 
community health centers as well.
  Because Delaware is such a small State, it is quite possible that our 
network can spread across the Mid-Atlantic region to include New 
Jersey, Pennsylvania, and Maryland, and that is why we have been 
working so hard to get it right and to make sure interoperability truly 
exists.
  A national health electronic infrastructure could truly be lifesaving 
for the millions of patients who access our health care system every 
day, as we have seen in our VA hospitals. There is real opportunity 
here to have electronic patient records, with appropriate private 
protections, electronic prescribing, real-time understanding of 
prescription interactions, and improved outcomes.
  I am hopeful this bill will be swiftly conferenced with the Senate 
version so every State may get involved. Real achievement only comes 
when we improve health care, reduce costs, and start saving lives.
  Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentleman from 
Texas (Mr. Green).
  (Mr. GENE GREEN of Texas asked and was given permission to revise and 
extend his remarks.)
  Mr. GENE GREEN of Texas. Mr. Chairman, I rise in opposition to the 
Health Information Technology Promotion Act. Health IT, as we call it, 
has the potential to revolutionize our health care system by improving 
health outcomes through increased efficiency and accuracy. Despite the 
bill's title, however, this legislation would do little to actually 
promote the adoption of health IT among the providers who would most 
benefit from it.
  Most importantly, the bill fails to include adequate funding to help 
providers invest in this promising technology. The $30 million in grant 
funding is only a drop in the bucket, so to speak, and will be 
stretched thin among the many providers who need financial assistance 
with health IT adoption.

                              {time}  1330

  Unfortunately, the Rules Committee failed to make in order either the 
Dingell/Rangel substitute or my amendment, which would have gone a long 
way to facilitating widespread health IT adoption. Specific to my 
amendment, which I submitted with my colleagues on our committee, Mr. 
Gonzalez and Mr. Rush, would authorize a Medicare add-on payment, a 
competitive grant and a State loan program to help providers invest in 
this technology.
  If health IT is a priority of the Federal Government, then we need to 
put our money where our mouth is.
  The bill is also sorely lacking in privacy protections. If patients 
are going to buy in to the benefits of health IT, we must ensure that 
personal health information is as secure as possible.
  We already know from nationwide surveys that two-thirds of Americans 
are concerned about security of their personal health information.
  The very nature of health IT is at risk of privacy breach; therefore, 
the proliferation of health IT must be accompanied by increased privacy 
protections.
  Unfortunately the Rules Committee failed to allow the Markey/Capps 
amendment to be considered. That important amendment would have 
required patient consent before their health records were shared, as 
well as patient notification in the event of a privacy breach. This 
commonsense amendment would have closed a glaring loophole that we 
currently have in HIPAA.
  In doing so, it would have given patients the privacy assurance they 
need to share important health information and to maximize the benefits 
of health IT to their personal health.

[[Page H5981]]

  It is not often I advocate that the House should follow the Senate's 
lead, however, we should have better served our constituents if we take 
up the Senate bill.
  Passed unanimously by the Senate, that bipartisan health IT bill will 
provide the necessary resources and pave the way for Americans to 
benefit from the promised health IT.
  I encourage my colleagues to vote against this bill.
  Mr. BARTON of Texas. Mr. Chairman, I yield 2 minutes to another 
distinguished member of the Energy and Commerce Committee, who is also 
a medical physician, Dr. Burgess of Texas.
  Mr. BURGESS. Mr. Chairman, thank you for bringing this important bill 
to the floor.
  The bill, 4157, will codify and expand the authorities and duties of 
the office of the National Coordinator for Health Information 
Technology, Department of Health and Human Services. This includes a 
number of responsibilities, such as endorsing the interoperability 
guidelines under a schedule, conducting a national survey on the 
information exchange capabilities of certain entities, and reviewing 
Federal information systems and security practices.
  The bill requires that certain Federal health information collection 
systems be capable of receiving information in a form consistent with 
any guidelines endorsed by the National Coordinator, within 3 years of 
endorsement.
  We have heard some discussion about the issues of grants. Currently 
there are grants through both CMS and my own Texas medical foundation 
back in Texas. But indeed, this bill authorizes targeted grants to help 
integrated health systems relay information and better coordinate the 
delivery of care for uninsured, under insured and medically underserved 
populations.
  The bill also contains a demonstration program to promote the 
adoption of health IT in the small physician setting, absolutely 
critical in many of our rural markets.
  My colleague, Dr. Murphy, was up here a moment ago and showed a 
picture of a medical record, an old paper medical records system in a 
hospital. I actually want to tell you that that is pretty far from the 
truth. Normally you go in medical records department, it is nowhere 
near that clean. There are records stacked on the floor. They are 
stacked by dictation machines. Oftentimes a critical record is hard to 
find.
  But contrast that with what I saw in New Orleans, Louisiana when we 
had a hearing down there earlier this year. The records room of Charity 
Hospital is absolute chaos. There is still water on the floor. There 
are records all over that room. There is black mold growing up the 
sides of the records. Clearly, those records are unusable in any form 
or any hope to be usable in the future. That is why this legislation is 
so critical. Lives, as well as money and time can be saved if we make 
these important steps towards enacting this legislation.
  Mr. PALLONE. Mr. Chairman, I yield 4 minutes to our ranking member of 
the full committee, the gentleman from Michigan (Mr. Dingell).
  (Mr. DINGELL asked and was given permission to revise and extend his 
remarks.)
  Mr. DINGELL. Well, Mr. Chairman, here we are again. Bad legislation, 
bad procedure, unfair behavior by the majority, and the inability to 
have a proper discussion of the matter before us or to have an honest 
chance to amend a bad bill.
  My Republican colleagues are wasting a fine opportunity to make real 
progress in an area in which most Members of Congress are highly 
supportive, health information technology. We have a chance not only to 
save money and time, but we also have a chance to save lives. But we 
won't even allow a proper discussion or fair and decent amendments.
  We have a chance to help providers to transform their practices so 
that they could better serve the needs of their patients and so that 
there could be electronic communications with providers, health plans 
and with the government.
  The Democrats sought a substitute to the committee bill under the 
rules. The Rules Committee, as usual, rejected it. So we are 
functioning under a gag rule. This alternative was identical to the 
bill the Senate passed unanimously last November with strong privacy 
protections, and with bipartisan sponsorship and support. The Senate 
bill, S. 1418, was jointly introduced after being negotiated between 
Senators Frist, Clinton, Enzi and Kennedy. But we won't be permitted to 
vote on it today. We must hear from our Republicans as to why it is 
they are afraid to allow proper debate, or why it is that they won't 
allow a proper vote on matters which could strongly, broadly and 
importantly affect their constituents and mine.
  The bill before us falls short. First, it makes no progress towards 
protecting the privacy and security of health information. Expanded use 
of electronic health care systems clearly has a great potential 
benefit, but it also poses serious threats to patients' privacy by 
creating greater amounts of personal information susceptible to 
thieves, rascals, rogues and unauthorized users.
  President Bush said something to my Republican colleagues, and I hope 
every once in a while they listen to their leader. He said this: ``I 
presume I am like most Americans. I think my medical records should be 
private. I don't want people prying into them. I don't want people 
looking at them. I don't want people opening them up unless I say it's 
fine for you to do so.''
  Well, why is it that you won't protect, then, the records of people 
and share the concerns of the President?
  Second, H.R. 4157 fails to include sufficient Federal funding to 
foster the adoption and implementation of health information technology 
such as electronic medical records. Start-up costs are a very 
significant failure and a barrier that physicians face.
  Third, H.R. 4157 goes too far in undermining fraud and abuse laws as 
its response to needed investment. The exceptions provided in this bill 
to the Stark self-referral and anti-kickback statutes potentially 
encourage biased decision making about a patient's treatment, and it 
sets up a situation where a doctor may be compelled to be confined in a 
system run by a particular hospital or health care provider.
  Fourth, the bill falls short in establishing comprehensive standards. 
It does little or nothing to promote the adoption of standards by 
providers. The fastest way to accomplish this would be to have the 
Federal Government to abide by the standards that it adopts for 
electronic communications so that others in the private sector will 
follow. H.R. 4157 does none of this.
  The bill fails seriously on issues of patient privacy, funding for 
health information technology, providing and promoting electronic 
communications between providers, and protecting against fraud. This is 
a bad bill. A chance to write good law has been rejected. The bill 
should be rejected, and I urge my colleagues to vote ``no.''
  Mr. BARTON of Texas. Mr. Chairman, I yield 2 minutes to the Vice 
Chairman of the Energy and Commerce Committee, the brightest bloom to 
come out of Laurel, Mississippi, Chip Pickering.
  Mr. PICKERING. Mr. Chairman, I rise today in support of very 
significant legislation. Too often in this place we are faced with 
dilemmas and difficult choices of trying to find savings that could 
diminish care, the quality of care, the availability, the accessibility 
of care. But this is actually an opportunity for us, in this Chamber, 
and as we go through the legislative process in the House and the 
Senate, to have significant savings to allow a stronger, more 
sustainable Medicare Medicaid health care system, that instead of 
reducing the quality of care, improves the quality of care, reduces 
errors and improves the efficiency of how health care is delivered. 
This is a great opportunity and it should be an opportunity of 
bipartisan support. I do believe that when we get to the final product, 
that when we finish the House and the Senate conference, that this is 
something where we can have broad consensus. We do not necessarily need 
partisan division on something that has such great promise and 
potential to save money, the resources that we so desperately need in 
our health care system, but, more importantly, to protect and promote 
and to heal the individuals and the lives across the country.
  Just coming out of Katrina, we have seen in hospitals and health 
clinics and community health centers across Mississippi, the loss of 
medical records. If

[[Page H5982]]

we have electronic records in place, that will not happen in future 
storms. This is a critical protection to the records which are vital to 
the health care of our citizens. Those that are poor and low income, 
electronic records in community health centers and in Medicaid systems 
and in VA systems have seen and will see tremendous benefits. This is 
an area in health care policy where we should not be divided, where we 
should find agreement, and we should accomplish good things together.
  Mr. Chairman, I support this legislation, and thank you for your 
leadership on this issue.
  Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentleman from 
Illinois (Mr. Rush).
  Mr. RUSH. Mr. Chairman, I was disappointed with this bill during the 
mark-up in the Energy and Commerce Committee, and I remain disappointed 
with the final version on the floor today. With information technology, 
this Congress has an opportunity to revolutionize the way health care 
is delivered in this country, but this bill is weak and it merely props 
up the status quo. And, Mr. Chairman, this bill could actually make 
things worse.
  My main concern is that underserved communities would not be a part 
of the health care information technology revolution. Too often 
communities such as those I represent where a disproportionate number 
are minority Americans and are the last to garner the benefits of new 
technological developments. As such, it is vital that any serious HIT 
bill have a funding component that aids low income providers. 
Unfortunately, this bill does virtually nothing to address this very 
serious problem.
  Nor does this bill have adequate requirements for interoperability 
which is, of course, a very huge flaw. Many low-income residents in 
densely populated urban environments do not have a primary care doctor 
that serves as a consistent medical provider. Instead, these citizens 
often go from provider to provider, from clinic to clinic, and receive 
their health care only sporadically. As such, it is vital that all of 
these providers are connected to interoperable information systems, 
such that they are all able to communicate with each other and share 
necessary medical information. Without interoperability requirements, 
we are left with the possibility of a network of fragmented health care 
delivery systems that are not able to talk to each other and coordinate 
care.
  Mr. Chairman, I must oppose this bill, and I urge my colleagues to 
oppose it also.
  Mr. BARTON of Texas. Mr. Chairman, I yield 2 minutes to a 
distinguished congressman from the Pelican State of Louisiana, who is a 
cardiovascular surgeon, Dr. Boustany.
  Mr. BOUSTANY. Mr. Chairman, during my career as a cardiovascular 
surgeon, I saw far too many nurses, physicians and patients waste 
valuable time on paperwork. And I saw situations where available 
critical information was not available during a crisis.
  Immediately following Hurricane Katrina and Rita, the need for 
portable electronic medical records became undeniable when thousands of 
patients' records were destroyed or inaccessible. But we did see some 
hope in that the New Orleans VA Hospital, despite being flooded, had 
records for 50,000 patients that survived because of the electronic 
nature of the records and the backup system that was available.
  We also saw a secure Web site, Katrinahealth.org, established through 
a private/public partnership that was another promising example.

                              {time}  1345

  When it comes to the use of information technology, America's health 
care sector has lagged far behind other economic sectors for decades. 
Our inefficiencies also squander billions of health care dollars that 
could otherwise go to helping patients.
  This legislation pending before the House today is critical. It will 
help overcome one of the most significant barriers to the adoption of 
health IT. Small physician practices find it financially difficult to 
invest in health IT equipment. The investment can run as high as 
$120,000 per physician. Federal statutes currently make it illegal for 
these providers to accept this equipment from a hospital or an 
insurance partner. To address this problem, this bill would provide the 
adequate safe harbor so that organizations could donate equipment to 
physicians without violating law.
  H.R. 4157 will help empower patients. It does preserve State privacy 
laws. It limits skyrocketing costs. And it will improve quality. 
Failure to modernize our health system is simply unacceptable, 
particularly given the aging population, the rising health care costs, 
and the prospects of future natural disasters.
  So I urge passage of this very important legislation.
  Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentlewoman from 
California (Mrs. Capps).
  Mrs. CAPPS. Mr. Chairman, I thank my colleague for yielding.
  I rise in strong opposition to H.R. 4157. Rather than move our health 
care system into the 21st century, this bill does little other than 
bestow gifts upon the insurance companies and big businesses. HIT does 
have great promise, great opportunity. And as a nurse, I know very well 
the importance, for example, of electronic medical records. But if the 
leadership was really serious about facilitating wider-spread adoption 
of HIT that is able to deliver better quality health care for patients, 
this bill would have contained the following:
  A timeline for achieving interoperability; funding so that hospitals 
and physicians could afford to purchase the technology; and, as I 
mentioned when I spoke against the rule, privacy protections. What good 
is health information technology if providers cannot communicate with 
each? What good is the existence of health IT if nobody can afford to 
use it? And what good is making our personal, private, sensitive 
information vulnerable to improper access and disclosure?
  Unfortunately, we are still in an age where individuals may be 
discriminated against because of health conditions. Here is our chance 
in a bill to protect personal information from being used to 
discriminate against people. And my colleagues on the other side of the 
aisle have indicated they do not care about patients' rights to 
privacy. If you look carefully at the organizations supporting privacy 
protections, you will notice they are patient advocates, consumer 
groups, health professionals.
  Those opposing it? The industry.
  Whom are we passing this bill for today? I thought it was supposed to 
be for patients so that they could receive better care and for the 
health professionals so they could provide better care. But it is clear 
to me that this bill before us disregards patients' needs.
  We need to start over and do a better job. HIT is that important. But 
not this bill. I, therefore, oppose H.R. 4157 and urge my colleagues to 
vote ``no.''
  Mr. BARTON of Texas. Mr. Chairman, I yield 2 minutes to a member of 
the committee, the distinguished majority whip from the Show-Me State 
of Missouri, the Honorable Mr. Blunt.
  Mr. BLUNT. Mr. Chairman, I thank Chairman Barton for yielding and for 
bringing this bill to the floor.
  The chairman and members of our committee, particularly Mrs. Johnson 
from Connecticut on the Ways and Means Committee, have been so 
instrumental in getting this bill to the floor today. This is a 
critically important start.
  As I sat here and listened to the debate, it is clearly like we are 
debating two different bills: one that wants to change the entire world 
in one bill and one that wants to step forward.
  On the privacy issue, this does not do anything to change current 
privacy standards, but what it does is allow the information that 
people have about their health to be shared in a way that helps them. 
And in terms of the cost, taxpayers pay an awful lot of the health care 
cost in the country today. And as my good friend Mr. Pickering pointed 
out, this is a way to minimize cost and maximize benefits to patients 
at the same time. That does not happen very often.
  Mr. Chairman, we have a little town in my district, Branson, 
Missouri, and it has lots of tourists. Seven or eight million people 
come there ever year. Last year, last August, I was sitting at lunch 
beside the hospital administrator, and he shared with me that 
particularly in about the fall, most of the tourists that come are 
retired. Many of

[[Page H5983]]

them come as part of a package travel situation. And he said, If you 
are retired and you paid for a package travel, if you feel like getting 
on the bus, getting on the airplane, you more often than not make an 
effort to make that trip, and more times than you would expect, the 
first stop on that trip is the hospital. For somebody who is on that 
motor coach who should not have probably gotten on but they get to 
Branson, Missouri, not feeling all that well, with the right kind of 
ability to get their health information shared, a 3-day visit to the 
hospital could be a 3-hour visit to the hospital.
  We need to start this process. Chairman Barton understands that. Mrs. 
Johnson understands that. Our committee understands that. This is the 
way to do it today. I am pleased to see this bill on the floor. It is 
an important first step. You can never get there if you do not take the 
first step. This is a great first step.
  And, Chairman Barton, I applaud your efforts to get this bill on the 
floor.
  Mr. PALLONE. Mr. Chairman, I yield myself the balance of my time.
  Mr. Chairman, I just wanted to say, from personal experience in my 
home State of New Jersey over the last few months, I have visited a 
number of hospitals throughout the State and looked at their health IT, 
and I have also talked to a number of physicians. The reason that this 
legislation is not going to accomplish the goal of really expanding 
health IT, and I can tell just from my experiences with these 
hospitals, first of all, most of the doctors say that even for a small 
group practice, they probably have to invest about $50,000 or more into 
health IT. And given the reimbursement rates and what is happening 
right now, most physicians, particularly small group physicians in 
rural areas and in urban areas, are not able to make that kind of 
investment. So that is why we need a funding source.
  This bill has very little funding, minimal. And the substitute, which 
is based on the Senate bill, on a bipartisan basis, would provide the 
funding to make a meaningful difference so that we would have an 
increase in health IT. That is what this is all about. That is why we 
should reject this bill and adopt something like the Senate bill.
  In addition, with regard to the privacy provisions, when I visited 
the hospitals in New Jersey, it was very clear to me that when you 
start to move with a lot of these electronic and high-tech systems, 
there is going to be a real problem with privacy that may not exist now 
with traditional systems. Moving to an electronic system, you have to 
have additional privacy guarantees. And we feel, again, the Democratic 
substitute that was rejected by the Rules Committee had those privacy 
guarantees. I think they are going to be part of our motion to 
recommit.
  This is the time to address the privacy issue in the context of this 
bill, and I would ask that we reject the legislation.
  Mr. BARTON of Texas. Mr. Chairman, before I yield to Congressman Clay 
of Missouri, let me compliment Subcommittee Chairman Deal for his 
efforts on this bill. He cannot be here today because his mother is 
ill, but he worked very hard.
  Mr. Chairman, I yield 1 minute to the distinguished congressman from 
Missouri (Mr. Clay).
  Mr. CLAY. Mr. Chairman, I thank the gentleman for yielding.
  Mr. Chairman, I rise today in support of H.R. 4157, the Health 
Information Technology Promotion Act of 2006. I believe the bill before 
us is a thoughtful and measured approach for establishing the Federal 
Government's role in promoting the adoption of a national health 
information network.
  The bill before us takes the logical step of codifying the Office of 
the National Coordinator for Health IT at HHS. This will ensure long-
term stability and continuity in the establishment of policies and 
programs relating to network interoperability, product certification, 
and adoption throughout the health care stakeholder community. It will 
also prove beneficial to both providers and public health agencies 
nationwide as vital clinical, prescribing, and laboratory information 
will be accessible through one integrated network.
  I want to thank Congresswoman Johnson and Congressman Deal for their 
good work.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield myself 5 minutes.
  I rise in strong support of the legislation and would submit my 
opening statement for the Record.
  I would like to comment on some of the comments of my colleagues made 
earlier. Before I do that, let me just take a moment to thank Chairman 
Barton and Representative Nathan Deal and my own chairman, Chairman 
Bill Thomas, for their support and effort in the development of this 
bill. But instead of doing my opening statement, let me comment on some 
of the things that have been said to this point.
  First of all, on the issue of privacy, this bill sets the groundwork 
to improve privacy by putting in place a study of State privacy laws 
and Federal privacy laws so we can see what is working, what is not 
working, how similar are the State laws, where might their differences 
inhibit the security of a nationwide system. In other words, it gives 
us the knowledge we need to upgrade our HIPAA system if, indeed, that 
is necessary. It may tell us that is not necessary. But it would be 
absolutely irresponsible to move ahead without the information that 
will be developed as a result of this legislation. HIPAA already 
provides absolute protection of our health information.
  What we want to know is when you do what this bill envisions, that 
is, you create a nationwide interoperable health information system to 
put that in place and secure personal health data, are there changes 
you need to make in Federal law? Are there commonalities in State laws 
that need to be brought closer? Are there any changes, indeed, that 
need to be made to absolutely secure individual personal health data as 
we move to this system? That is the issue on privacy.
  Secondly, this bill adopts a whole new coding system, the ICD-10 
system. Under today's system, you cannot tell whether a hospital has 
made a great leap forward in quality because they are doing a better 
job or simply because they have changed an operative technique from an 
invasive operation to a noninvasive approach to that surgical 
procedure. So we have to know more about what we are doing so we can 
talk honestly to ourselves about quality, so we can upgrade quality, 
and so we can pay accurately. This bill does that.
  This bill sets up an Office of Technology, and we need that office to 
assure that the public and private sectors work together to create an 
environment in which great companies in America compete to provide the 
best possible technology, all of which becomes interoperable.
  So without a Federal office involved, without standards being set, we 
will not have that interoperable system that we know is going to be so 
important to improve the quality of our health care system.
  Not only do we need to have standards; we need to accelerate 
dissemination because the power of health information technology is not 
in a single provider. It is in the system-wide impact of it. So this 
bill helps disseminate that technology in part through its grant 
provision. But, realistically, the government is not going to pay for 
this. The system is going to do it because it creates such system 
efficiencies that it pays the system back. However, in addition to 
grants we encourage the system to be able to dissiminate technology by 
allowing consortium to develop, by allowing a hospital in a small town 
to work with the big employers in that town, the big insurers in that 
town, to get together to get a good deal on technology or on several 
technologies so that technologies are appropriate to the providers but 
are interoperable.
  So this not only deals with the development of standards, with the 
dissemination of technology, with building the knowledge base we need 
to ensure the privacy of personal health information. It moves to a 
more modern coding system, and it will deliver to us a dramatic 
revolutionary increase in the quality of health care available in 
America. It will not only reduce medical errors and eliminate adverse 
drug interactions, saving millions of dollars, reduce administrative 
costs by billions, but also allow us to do chronic disease management 
for our seniors, care management for the severely ill, and upgrade the 
quality of diagnosis and

[[Page H5984]]

treatment and return ourselves to a patient-centered affordable health 
care system.
  So this is an important bill that sets the foundation for the future. 
And I am astounded at my colleagues on the other side of the aisle 
opposing it because it does not do things we are not yet prepared to 
do.
  Today the House of Representatives has the opportunity to pass 
legislation that will lay the foundation for a new era in health care. 
Systemwide adoption of health information technology will dramatically 
improve the quality of care. It will reduce medical errors, reduce 
duplication and unnecessary care, and bring cutting edge information to 
the service of doctors as they diagnose and treat their patients. It 
will also eliminate many of the administrative inefficiencies that 
characterize the American health system and strengthen and protect the 
security and confidentiality of health information systems. In short it 
will fundamentally advance the practice of medicine and improve the 
quality of care all Americans will have access to.
  Unfortunately, the adoption of health information technology has been 
frustratingly slow. Since the full potential of this technology can 
only be harnessed if it is widely disseminated amongst all types and 
sizes of providers, it is imperative to pass H.R. 4157 to speed the 
adoption and diffusion of health information technology.
  This legislation is modest in scope. It lays the groundwork for 
fundamental change by removing the barriers to private sector adoption. 
It provides for a national framework for the development and widespread 
dissemination of interoperable health information technology by 
creating an office to coordinate the development of a national health 
information system. It promotes common-sense cooperation between 
doctors and hospitals and other providers by allowing entities to 
provide physicians and others with hardware, software, training or IT 
support services. It updates diagnosis coding systems for the digital 
age and provides an expedited process for ongoing updating of 
technology standards. It begins a process for creating greater 
commonality amongst state and federal security and confidentiality laws 
and regulations in order to better protect and strengthen the exchange 
and health information. Additionally, it provides grants for the 
adoption of health information technology to coordinate care among the 
uninsured and to implement technology in small physician practices. 
Finally, it includes studies and reports on the expansion of telehealth 
services in Medicare.
  Health information technology touches every aspect of the health care 
system. It will enable us to provide disease management for all those 
with chronic illnesses, care management for those with severe, complex 
illnesses, and provide access to preventive and appropriate care for 
the uninsured. It will reduce medical errors, adverse drug 
interactions, and decisive support to improve the quality of diagnosing 
and treating patients.
  The role technology can play in the systems of health care will be as 
revolutionary as the role technology has played in health care research 
and treatments. H.R. 4157 removes barriers to greater adoption of 
information technology in the health system so the long overdue 
potential of technology can be realized in health care.
  Mr. Chairman, I reserve the balance of my time.

                              {time}  1400

  Mr. STARK. Mr. Chairman, I yield myself such time as I may consume.
  (Mr. STARK asked and was given permission to revise and extend his 
remarks.)
  Mr. STARK. Mr. Chairman, I am going to start with three fairy tales, 
I had four, but my staff made me cut one out, fairy tales your mother 
would tell you.
  One, if you didn't clean your ears, potatoes would grow in your ears. 
The second fairy tale my mother told me was if you ate too many 
watermelon seeds, a watermelon vine would grow out of your belly 
button. The third fairy tale is that this bill will do one blessed 
thing to help information technology.
  I am not surprised that my colleagues on the other side of the aisle 
spin every issue in a partisan way, but it is a shame that you are now 
using health information technology as a pawn to advance your bankrupt 
ideology. The promise that information technology holds to save lives 
and money is vast, but H.R. 4157 forestalls that promise.
  It is a lousy bill. It does nothing. H.R. 4157 doesn't provide for 
the development of or the adoption of interoperability standards; it 
does not provide funding to help providers transition to an electronic 
medical records system; and it does not strengthen privacy protections.
  It does do one thing: It weakens Medicare's fraud and abuse laws. My 
colleague from Louisiana on the Ways and Means Committee acknowledged 
in our full committee markup that if the fraud and abuse provisions 
were removed from this bill, it would accomplish nothing. Zip. That is 
a Republican who said that.
  CBO says, ``CBO estimates that enacting H.R. 4157 would not 
significantly affect either the rate at which the use of health 
technology will grow or how well that technology will be designed and 
implemented.''
  The reason that it has no cost is it doesn't do a bloody thing.
  People who I often disagree with, America's Health Insurance Plans, 
representing the for-profit hospitals and plans, wrote to us and said, 
``The pending legislation falls short of its stated goals and will lead 
to serious unintended consequences for consumers. We have consistently 
shared these concerns, and cannot support the legislation with the 
following provisions as currently drafted.''
  I don't know what my colleagues across the aisle think they are 
doing. We offered some amendments to address the serious failings of 
this bill and we were opposed on party line votes. Mrs. Johnson, Mr. 
Shaw and Mr. Hayworth voted against adding funding so that doctors 
could afford to transition. These same people, Mrs. Johnson, Mr. Shaw 
and Mr. Hayworth voted against adding provisions that contain waste, 
fraud and abuse. They opposed setting a date certain for the 
implementation of interoperability and standards. And they opposed, Mr. 
Shaw, Mr. Hayworth and Mrs. Johnson, an amendment to make sure that 
people's private medical records were protected. Unfortunately, these 
amendments, all rejected on party line votes, would have improved the 
bill somewhat.
  This does not have to be a partisan issue. The Senate was able to 
pass unanimously a bill that is greatly better than this bad bill.
  I have spent countless hours reading and discussing this issue with 
physicians and other experts. I spent a day at the VA to learn about 
their system. On numerous occasions, I have reached across the aisle in 
an attempt to come up with some vision about how we might move forward.
  Sadly, this is just a fig leaf, a political statement for campaigns 
that does absolutely nothing to improve the future of information 
technology, which is sadly needed by our medal providers. Indeed, it 
does harm to that. I hope we can reject this bill, come back after the 
elections when there is a better climate for bipartisan work and report 
a bill out that will do some good.
  I urge my colleagues to oppose 4157.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield 2 minutes to the 
gentleman from Pennsylvania (Mr. English).
  Mr. ENGLISH of Pennsylvania. Mr. Chairman, I want to thank the 
gentlelady for yielding.
  I rise today in support of H.R. 4157, which is not a panacea, but is 
an important starting point on this very important topic.
  This legislation would work to ensure interoperability standards for 
health IT are adopted, stimulating investment in electronic health 
records, electronic prescribing and other forms of IT that have been 
demonstrated to make health care safer and more efficient.
  Only through a truly interoperable, nationwide system will the 
benefits of health information technology be fully realized. The 
widespread adoption of health IT holds great promise to reduce medical 
errors and administrative costs, which can lead it to a dramatic 
improvement in the quality, the delivery and the cost of health care.
  A couple of years ago in my district, I established a Health Care 
Cost Containment Task Force which identified preventable mistakes and 
physician errors as a significant source of health care costs in the 
system. One of my task force's recommendations was to help curb the 
rise of preventable medical errors through the implementation of health 
information technology.
  I am very pleased with the work that our subcommittee and its 
chairman have done in this area. This is a very important initiative 
because, compared

[[Page H5985]]

to other industries, health care has a neolithic perspective when it 
comes to information technology.
  The core idea, Mr. Chairman, behind an electronic health care system, 
is that doctors in one State treating an emergency room patient 
visiting from another State should be able to access that patient's 
records on a nationwide health care technology system. In this way, the 
patient will be better protected, the doctors will be able to treat the 
patient more quickly and more effectively, which would cut down on 
errors, and the Nation will save on health care spending.
  By supporting this legislation, we make a significant move forward in 
bringing health care information technology fully into the 21st century 
and, in the process, saving lives and resources as well.
  Mr. STARK. Mr. Chairman, I am pleased to yield 2 minutes to my 
colleague from the Virgin Islands, Dr. Christensen, who knows firsthand 
how important the issue is before us today.
  Mrs. CHRISTENSEN. Mr. Chairman, I thank Mr. Stark for yielding.
  Mr. Chairman, there is no doubt that health information technology, 
or HIT, holds great promise in helping us solve some of our most 
pressing health care issues, such as reducing escalating health care 
costs and medical errors.
  Yesterday I appeared before the Rules Committee to request that an 
amendment to H.R. 4157 be made in order which would ensure that HIT 
monitor and measure the racial, ethnic and geographic health 
disparities. The amendment, like others, was not accepted, and the 
committee lost an opportunity to make this bill better, to improve the 
health of millions of hard-working Americans who it is proven are 
discriminated against in health care and further reduce the health care 
costs caused by disparities.
  Disparities that cause, for example, the maternal mortality rate for 
African American women to be almost five times higher than that for 
their white counterparts; or the infant mortality rate in African 
Americans and American Indian/Alaska Natives to be more than two times 
higher; or although they account for just one-quarter of the total U.S. 
population, for Latino and African Americans to account for more than 
two-thirds of newly reported AIDS patients.
  A recent IOM report noted that anywhere from 44,000 to 98,000 deaths 
were caused each year by medical errors, but another report by former 
Surgeon General Dr. David Satcher found that health disparities caused 
more than 85,000 preventable deaths in African Americans every year.
  The amendment I sponsored would have played a key role in helping 
providers, executives and administrators in the health care system 
better ensure an equity in the delivery of health care that does not 
now exist, while at the same time, further reducing unnecessary health 
care costs.
  So today before us is a bill that doesn't have the needed privacy 
protections; it is underfunded, which ensures inequity will exist 
across the country; and does nothing to correct the greatest injustice 
of our time, the health care disparities that cause premature and 
preventable deaths and disability every day in this country that has 
the wherewithal to do better.
  I encourage my colleagues to oppose H.R. 4157.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield myself 40 seconds.
  Mr. Chairman, my colleagues on the other side of the aisle are acting 
as if we had technology that, if we only had the money, we could 
implement. That just isn't so. Secretary Levitt and Dr. Brailer have 
led a phenomenal aggressive, strong effort and through their effort, 
working with the public and private sector, they have established 
standards for electronic health records and for E-prescribing.
  But there are a lot more standards to be set. And in this bill, we do 
have a date certain, but it is way off in 2009. I think we will get 
there before then. But, as important, we put in this bill a very 
progressive, accelerated way of updating those standards, because this 
is going to be about continuous improvement.
  My colleagues on the other side of the aisle that talk about minority 
health are absolutely right. Unless we get health information 
technology implanted and we move to chronic disease management and 
health care management, we cannot meet the needs of care our minority 
population need. That is why this bill is so important.
  Mr. STARK. Mr. Chairman I am pleased at this time to yield 2 minutes 
to the gentleman from Rhode Island (Mr. Kennedy), who has been a 
champion on the issue of information technology.
  Mr. KENNEDY of Rhode Island. Mr. Chairman, I thank Mr. Stark for his 
leadership on this issue.
  Mr. Chairman, we are talking today about the potential to 
revolutionize our health care system by means of technology that we are 
using in almost every other industry currently in our society except 
the industry that probably could benefit the most from it, and that is 
our health care system.
  We are after this for many different reasons, but one of the reasons 
I am after it for is because I want to reduce the cost of health care 
for my constituents. My constituents, whether they be businesses that 
are paying exorbitant premiums for their workers, or the workers who 
are paying high premiums themselves, or whether it is not only the 
consumer, but it is even the providers that are getting shortchanged on 
their reimbursement, no one is happy with the current health care 
system.
  So, Mr. Chairman, what we could do today is do what has been already 
outlined by the Rand report, which says we could save $162 billion in 
direct costs because we would now not have to duplicate care if we have 
care now that is tracked, so we don't have to go to four different 
doctors and not have each doctor repeat the same test.
  We can now make sure that the best in care gets to everybody, because 
now the evidence base will be available to all doctors, no matter where 
they live in this country, so people will get the same and the best of 
care.
  But, frankly, Mr. Chairman, this bill doesn't do it. This bill 
doesn't do it. Why? Because it doesn't implement the quality standards 
to ensure that people get that good care. It doesn't ensure that we 
move quickly to the adoption, because, one, it sets up the adoption 
date too far in the future. Why are we waiting? If we are acknowledging 
this is important, why are we putting this off?
  Next, when it comes to making sure that there is privacy, I don't 
frankly understand how we can go into an electronic age in medical 
records and not ensure that people's personal medical privacy is 
protected.
  For those reasons, I will be voting against this legislation.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, yield 2 minutes to the 
gentleman from Missouri (Mr. Hulshof).
  (Mr. HULSHOF asked and was given permission to revise and extend his 
remarks.)
  Mr. HULSHOF. Mr. Chairman, I would like to thank the Chair of the 
Health Subcommittee, especially for her bold initiative and leadership 
on this bill, for really trying to wrestle with a very important issue 
and looking ahead and being a visionary as far as employing technology 
and how we can improve health care in this country. It is a good bill. 
I am proud to be an original cosponsor.
  I would especially like to touch some the telemedicine, telehealth, 
provisions. I appreciate very much that Mr. Thompson of California and 
I have put together a bill where the bottom line, Mr. Chairman, is that 
with advancements in telecommunications, health care providers in small 
communities can now access resources that are available in the finest 
hospitals and academic institutions in the country.
  The quality of one's health care should not be dictated by one's ZIP 
Code. So I am very excited about the fact that technologies like 
interactive video conferencing, the Internet, satellite, are already 
systematically changing the face of our Nation's health care.
  This legislation directs the Secretary to work with the telehealth 
community, especially as far as services across State lines. We know 
that that is an issue. We want to expand the origination and consulting 
sites so that more of our underserved communities will have access to 
the best health care that the community has to offer.

                              {time}  1415

  I would like to brag a little bit, Mr. Chairman, because telehealth 
patients

[[Page H5986]]

from small towns throughout my district in Missouri have been receiving 
specialist care or services from a variety of specialists, including 
mental health providers. I know that is certainly a hot-button issue 
for many here, without having to take available time, maybe, away for 
caring for a loved one or from work or for school or for other parental 
duties.
  Right now there are 2,000 patients in Missouri that are cared for 
using Missouri's telehealth network. It is estimated over 40,000 
radiological examinations have been performed. In fact, one example: a 
critical-access hospital in the small town of Macon, Missouri, 
unexpectedly lost the only radiologist in the area. There was not 
another specialist within that underserved area.
  Fortunately, the University of Missouri stepped in to provide 
coverage during this 4-month period of time so this small community 
could have access to a qualified radiologist. Again, there are lots of 
good things in this bill. But telemedicine is one piece of it. I 
commend the chairwoman and I urge everyone to support it.
  I thank the chair of the Health Subcommittee, on which I serve, for 
her bold leadership on this bill and improving health information 
technology in this country.
  H.R. 4157 will launch the American healthcare system into full 
capacity to take advantage of the best technology. This will give all 
Americans better health care, more accessible medical records, and 
better quality of care.
  It is a good bill of which I am proud to be an original cosponsor.
  I would like to touch on the telemedicine provisions of the bill.
  The Health Information Technology Promotion Act includes important 
provisions for the advancement of telehealth services--Requires the 
Secretary of HHS to take steps that expedite the provision of 
telehealth services across State lines by taking a closer look at State 
licensure issues; requires the Secretary to conduct two studies: (1) a 
study on the use of store and forward technology in the provision of 
telehealth services; and (2) a study on the coverage of telehealth 
services provided in home health agencies, county mental health clinics 
and other publicly funded mental health facilities.
  Advancement in telecommunications now allows health care providers in 
small communities to access the resources available in the finest 
hospitals and academic institutions. Individuals in this country should 
receive the health care they need regardless of where they live. A 
person's address should not dictate the state of their health. 
Technologies such as interactive videoconferencing, the Internet and 
satellite are already systematically changing the face of our Nation's 
health care.
  In 2000, the Congressional Budget Office estimated that the 
telehealth provisions of the Medicare, Medicaid, and SCHIP Benefits 
Improvement and Protection Act of 2000, BIPA, would cost $150 million 
over 5 years. In June I asked CMS to provide me with information on how 
much the Federal Government has spent to date to get an idea of how 
close we are to CBO projections. I was astonished to find that since 
October 1, 2001 Medicare has only reimbursed for approximately $1.2 
million total for telehealth services and originating site facility 
fees. This illustrates that the Federal Government has made a minor 
contribution compared to what we were expected to spend. And more needs 
to be done.
  This legislation highlights the capabilities of telemedicine by 
directing the Secretary to work with the telehealth community to find 
solutions to the services across State lines issue, and expanding 
origination and consulting sites so more of our underserved communities 
will have access to the best health care this country has to offer.
  I would also like to brag on how, because of telehealth, patients 
from small towns throughout my district are able to receive services 
from a variety of specialists, including mental health providers, 
without having to take valuable time away from work, school or parental 
duties.
  Currently in Missouri, over 2,000 patients per year are cared for 
using the Missouri Telehealth Network and it is estimated that over 
40,000 radiology exams have been performed. In fact, in my district, a 
Critical Access Hospital in the town of Macon unexpectedly lost its 
only radiologist, leaving the area without a specialist in this area. 
Fortunately, the University of Missouri stepped in to provide coverage 
through the telehealth network for a 4-month period until a new 
radiologist was hired. Without this option, Macon residents would have 
been forced to either commute or simply go without radiological care.
  It is my hope that via this legislation, rural and underserved areas 
in my district and across the country will be able to find the same 
successes experienced with the Missouri Telehealth Network.
  Mr. STARK. Mr. Chairman, I yield 2\1/2\ minutes to the gentleman from 
Texas (Mr. Doggett).
  Mr. DOGGETT. Mr. Chairman, during the 12 years that Republicans have 
controlled this House, they have done very little to address the real 
concerns of families confronted with a health care crisis. This 
afternoon during rush hour, some family, in fact probably many 
families, will suffer a severe auto accident on the way home.
  Perhaps a mom will be found to have breast cancer, or a child a 
serious childhood disease. And as these health care challenges emerge, 
tens of thousands of families across America will end up not only 
driven into despair but into bankruptcy.
  And yet Republicans have not offered real solutions to address those 
kinds of problems. Recognizing their failures earlier this year, both 
Senate and House Republican leaders declared there would be a ``health 
care week.'' Well, the Senate took up their ``health care week,'' and 
every old, retread Republican proposal that they had was rejected.
  So I guess too embarrassed to have ``health care week'' here in the 
House, even though they declared it, the Republicans canceled ``health 
care week,'' just like they have canceled so many of the commitments 
that they made back in 1994 to the American people.
  And what they have left as their one new idea for the crisis that 
American families face in health care is this pitiful proposal. They 
have discovered that the answer to the problems American families face 
with health care is not what the American families thought was their 
problem about getting access to affordable, quality health care. No, it 
is bad handwriting. Yes. We all know the legendary bad handwriting of 
physicians that is the subject of cartoons and stories.
  But by golly, they are solving that. All of these physicians, and the 
hospitals and the clinics, will be using electronic records and solve 
that penmanship problem. Well, that is not a bad idea. It is just that 
they do not put their money where their mouth is.
  They tell the physicians and the clinics, you figure out how to pay 
for this technology. And in the process of this transformation, once 
again, as they have done with our library records and our phone records 
and our veterans records, they couldn't really care less about privacy.
  Think about whether you want your psychiatric records, your 
prescription records on the Internet for other people to see. Because 
this legislation does not provide the guarantee of privacy. And so 
fearful are they of a true debate about protecting the privacy rights 
of Americans to their medical records, to their health care records, 
that may affect their future employment, that may affect their future 
family relations, that may affect their ability to get insurance.
  So fearful are they of a debate about that, they refuse to let us 
offer even one amendment to address patient privacy.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I ask how much time is 
remaining.
  The CHAIRMAN. The gentlewoman has 2\1/2\ minutes remaining.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield 1 minute to the 
gentleman from New Jersey (Mr. Ferguson).
  Mr. FERGUSON. Mr. Chairman, I thank the gentlewoman for yielding me 
time.
  Mr. Chairman, I rise today in favor of a bill that would help us 
usher in 21st-century medicine into the doctors' offices of our 
country. By encouraging the dissemination of health information 
technology, we move full speed ahead toward establishing an 
infrastructure necessary to create an environment where errors are 
reduced and care is improved.
  This bill promotes cooperation between doctors and hospitals and 
provides physicians with the IT support services they need to establish 
this infrastructure. In particular, I am pleased this bill includes an 
amendment that I sponsored in the Energy and Commerce Committee with 
Congressman Towns that would provide grants for the use of health 
information technology to coordinate care for the uninsured.

[[Page H5987]]

  These grants are targeted to integrated health systems that have 
demonstrated success in the past for treating the uninsured and 
underinsured populations in underserved communities. This is just one 
example of how this bill helps to provide the necessary framework for 
health IT for all Americans.
  Mr. Chairman, I invite all of our colleagues to support this 
commonsense legislation. It will help establish a framework of care for 
all Americans as we head into the 21st century.
  Mr. STARK. Mr. Chairman, to close debate for our side, I yield 1 
minute to the gentleman from Maryland (Mr. Hoyer), the distinguished 
minority whip, who supports information technology, but realizes this 
bill does nothing to help it.
  Mr. HOYER. Mr. Chairman, Democrats worked with the health care and 
technology industries to write a bill that would lead to the widespread 
use of information technology in medicine, a necessity. The effective 
use of it can reduce medical errors, health care costs, and save lives.
  Mr. Chairman, we should be taking up the Dingell-Rangel bill today, a 
bill that was virtually identical to the bill that passed unanimously 
in the United States Senate. Instead, we are voting on a Republican 
bill that fails to provide for the development or adoption of 
interoperability standards, that fails to provide funding to help 
providers transition to an electronic medical records system, and that 
fails to strengthen privacy protections.
  What a shame. What a missed opportunity. We should oppose this bill, 
and we should bring the Rangel bill to the floor.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield 30 seconds to the 
gentleman from Pennsylvania (Mr. Murphy).
  Mr. MURPHY. Mr. Chairman, for the record I would like to note that 
the HIPAA laws do apply to this with regard to privacy, whereby there 
would be fines up to $250,000 and up to 10 years in prison for 
disclosure or obtaining health information in many of these areas. So 
it does apply.
  The second is the CBO report which is being taken out of context. It 
mentioned that there can be savings for Medicare in this. And as 
hospitals learn to adapt to health information technology, if they do 
not adapt right, that may be more costly; but overall there are many 
savings in this.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield the balance of our 
time to the gentleman from Illinois (Mr. Kirk).
  Mr. KIRK. Mr. Chairman, I rise in support of this legislation because 
it will dramatically improve civilian health care, the way this 
technology has already done for veterans across America. When Katrina 
hit New Orleans, many civilian hospital record rooms were wiped out, 
including the medical history of thousands.
  Meanwhile, American veterans already had fully electronic medical 
records, and their medical histories were seamlessly transmitted to 
other VA hospitals in Baton Rouge or Houston for complete care.
  There is a reason why Senator Clinton and Speaker Gingrich both so 
strongly support a full deployment of electronic medical records. They 
reduce medical errors and improve care as they already have 
demonstrated to do so heavily in the VA.
  Our Federal law already sanctions any violation of medical privacy 
with up to 10 years in jail and $250,000 fines.
  This legislation is the third part of our suburban agenda, 
commonsense reforms to improve the health care for all American 
patients.
  Mr. CLAY. Mr. Chairman, I rise today in support of H.R. 4157, the 
Health Information Technology Promotion Act of 2006. I believe the bill 
before us is a thoughtful and measured approach for establishing the 
Federal government's role in promoting the adoption of a national 
health information network.
  The bill before us takes the logical step of codifying the Office of 
the National Coordinator for Health IT at HHS. This will ensure long-
term stability and continuity in the establishment of policies and 
programs relating to network interoperability, product certification, 
and adoption throughout the health care stakeholder community. It will 
also prove beneficial to both providers and public health agencies 
nationwide, as vital clinical, prescribing, and laboratory information 
will be accessible through one integrated network.
  Just last week, the Institute of Medicine released its report on the 
number error rates involved with prescribing patient medications, and 
how the use of e-prescribing would contribute to reducing the number of 
annual errors in hospitals by 400,000 and save an estimated $3.5 
billion this year alone. Utilizing health IT is not only economically 
beneficial, but will also prevent many costly and unnecessary patient 
injuries relating to drug interactions.
  I realize the bill before us is not a perfect one, and I agree with 
my friends who have stated that stronger protections for the security 
and privacy of personal health information are desperately needed. Let 
me be clear that I'm very disappointed that some thoughtful amendments 
offered by my Democratic colleagues on security and privacy will not be 
considered today. I do not believe, however, that health IT platforms 
used for the preservation or transmission of identifiable patient 
information are any more vulnerable to security breaches than modern 
paper-based record systems.
  In fact, many providers, insurers, and hospitals have already 
transitioned from paper based records to electronic health record 
systems, while taking internal steps to ensure that appropriate 
security and access controls are built into their IT systems and are 
compliant with current law. All we are doing today is taking the next 
step to ensure that all who choose to utilize health IT have a 
blueprint for system standards to ensure optimal functionality for all 
participants.
  I thank Congresswoman Johnson and Congressman Deal for their good 
work.
  Mr. CARDIN. Mr. Chairman, I rise in opposition to this bill. I am 
disappointed that the House has missed an opportunity to promote in a 
meaningful way our health care system's transition from a paper-based 
medical records system to an electronic one. Congress is in nearly 
unanimous agreement that this move is necessary, and that it is in the 
best interest of patients, providers, and health care quality over all.
  But it appears that we have before us legislation that will do little 
to move the Nation toward that goal, and that in some respects, may be 
harmful. As a member of the Ways and Means Committee, which considered 
this bill earlier this year, I had the opportunity to vote on several 
amendments that would have strengthened this bill, that would have 
enabled our Committee to bring this bill to the floor with bipartisan 
support. Those amendments would have added funding so that doctors 
could afford to transition to electronic medical records; removed 
provisions that expand fraud and abuse, set a date certain for the 
implementation of interoperability standards, and guaranteed the 
confidentiality of personal health information. Unfortunately, each was 
defeated on a party-line vote.
  So the bill before us today still contains several fundamental 
problems. The first is the lack of strong privacy protections. Mr. 
Chairman, I wonder how many breaches of supposedly secure electronic 
medical records must occur before we get serious about enacting strong 
privacy protections into law. In two weeks, we will mark the 10th 
anniversary of the Health Insurance Portability and Accountability Act. 
Privacy regulations stemming from that law were finally issued in 2001. 
Ten years ago, Americans' familiarity with electronic communication and 
electronic transfer of information was quite limited. HIPAA does not 
protect individuals.
  The second is a lack of funding. My colleagues, Mr. Wynn, Mr. Engel, 
and Ms. Schakowsky and I offered an amendment that would have provided 
grants for community health centers and hospitals with high numbers of 
low-income patients. These are the facilities that already face severe 
financial strains. They include many community health centers in 
Baltimore and larger facilities such as Prince George's Hospital Center 
in my home state of Maryland. They do not have extra money to implement 
expensive health information technology systems. Our amendment would 
have given them needed help to take advantage of health information 
technology for their patients, many of whom face significant health 
challenges due to chronic illnesses. If adopted, our amendment would 
have helped these facilities leap the financial hurdles that will 
otherwise prevent the spread of health information technology. 
Unfortunately, the Rules Committee refused to allow our amendment to be 
made in order.
   Mr. Chairman, many of my colleagues have made this point, but it 
bears repeating: The nonpartisan Congressional Budget Office estimates 
that enacting this bill in its present form ``would not significantly 
affect either the rate at which the use of health technology will grow 
or how well that technology will be designed and implemented.'' The 
lack of funding is one of the primary reasons why.
  I am also very concerned about the exceptions to the Stark anti-self-
referral and anti-kickback laws contained in the underlying bill. These 
provisions would serve to seriously weaken these important consumer 
protection

[[Page H5988]]

laws. In H.R. 4157 as it is being considered today, physicians could be 
offered free or discounted technology in exchange for referring their 
patients to a facility or for a particular service. According to the 
Congressional Budget Office, these exceptions would raise health care 
costs.
   Mr. Chairman, I will vote for the motion to recommit, which will 
protect medical privacy. It will ensure that patients can keep their 
medical records out of electronic databases unless they first give 
their permission. It will require patient notification if their health 
information is misused, lost, or stolen. It requires the use of 
encryption and other safeguards against theft. Importantly, it would 
permit patients to limit access to particularly sensitive information, 
such as mental health data. Finally it would protect state privacy laws 
that may be more protective of patient confidentiality.
  I support the provisions of the bipartisan bill passed by the Senate, 
and I would hope that, for the sake of improved patient care, for 
better access to health information technology, for better privacy 
standards, that is the bill that emerges from conference. I urge my 
colleagues to join me in opposition to H.R. 4157.
  Mr. VAN HOLLEN. Mr. Chairman, I rise today in reluctant opposition to 
H.R. 4157, the Information Technology Promotion Act of 2005. It is 
unfortunate that the House Republican leadership refused to allow this 
Congress the opportunity to strengthen this bill and protect the 
privacy of patients.
  Like many of my colleagues, I support moving our health care system 
into the ``information age''--it holds the promise of saving lives, 
saving money, and saving time. However, I am concerned that H.R. 4157 
does not adequately protect the privacy of patients. In light of 
millions of electronic data records being exposed due to recent high-
profile security breaches, it is troubling that this legislation does 
not adequately address this critical issue.
  Unfortunately, the House Republican leadership would not allow us the 
opportunity to vote on an alternative bill that was based on the 
bipartisan Senate health information technology legislation (S. 1418)--
which unanimously passed that chamber. This alternative proposal 
included safeguards for Americans to protect their personal medical 
records from identity thieves.
   Mr. Chairman, health information technology should not be a partisan 
issue. Congress should not miss the opportunity to transition our 
health care into the 21st century, but it must be done in a manner that 
will protect the sensitive health information of millions of Americans. 
I am hopeful that the final version of the legislation will be 
fashioned in a bipartisan, bicameral fashion by the House-Senate 
Conference.
  Mr. KIND. Mr. Chairman, I rise in appreciation that House Leadership 
has at last brought a health information technology bill to the Floor. 
As a cochair of the New Democrat Coalition, I have been a long-time 
supporter of health IT. I believe health IT, if done correctly, will 
highlight the need for personal accountability in health care, advance 
technological innovation, promote fiscal responsibility and, most 
importantly, improve health and save lives. Additionally, great strides 
can be made in homeland security as well as tracking disease and 
infection.
  I am pleased that H.R. 4157 will codify in law the Office of the 
National Coordinator for Health Information Technology and that the 
coordinator will be tasked with devising a national strategic plan for 
implementing health IT. Additionally, the grant money authorized by the 
bill is a worthwhile, if small, step in the right direction. 
Representing western Wisconsin, I know too well how difficult it is for 
small medical practices to afford the purchase and upkeep of software 
and hardware needed for electronic medical records. The $5 million in 
grants to rural or underserved urban areas is the first of many such 
grants Congress must facilitate.
  While I am pleased the bill is moving forward, I am disappointed that 
negotiations were not done in a more bipartisan manner. It is good to 
see that harmful and invasive policies on privacy issues were removed 
from the bill, and I am hopeful that when the House and Senate meet in 
conference, members will take a hard look at strengthening further the 
bill's privacy provisions.
   Mr. Chairman, I plan on voting for this health IT bill and look 
forward to working with the Senate on improving it. America's doctors, 
nurses, and patients deserve 21st century technology in the health care 
system, and it is past time for Congress to be acting on this issue.
  The CHAIRMAN. All time for general debate has expired.
  In lieu of the amendments recommended by the Committees on Energy and 
Commerce and Ways and Means printed in the bill, the amendment in the 
nature of a substitute printed in part A of House Report 109-603, 
modified by the amendment printed in part B of the report, is adopted. 
The bill, as amended, shall be considered as the original bill for 
purpose of further amendment under the 5-minute rule and shall be 
considered as read.
  The text of the bill, as amended, is as follows:

     SECTION 1. SHORT TITLE AND TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Health 
     Information Technology Promotion Act of 2006''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title and table of contents.
Sec. 2. Preserving privacy and security laws.

TITLE I--COORDINATION FOR, PLANNING FOR, AND INTEROPERABILITY OF HEALTH 
                         INFORMATION TECHNOLOGY

Sec. 101. Office of the National Coordinator for Health Information 
              Technology.
Sec. 102. Report on the American Health Information Community.
Sec. 103. Interoperability planning process; Federal information 
              collection activities.
Sec. 104. Grants to integrated health systems to promote health 
              information technologies to improve coordination of care 
              for the uninsured, underinsured, and medically 
              underserved.
Sec. 105. Small physician practice demonstration grants.

        TITLE II--TRANSACTION STANDARDS, CODES, AND INFORMATION

Sec. 201. Procedures to ensure timely updating of standards that enable 
              electronic exchanges.
Sec. 202. Upgrading ASC X12 and NCPDP standards.
Sec. 203. Upgrading ICD codes; coding and documentation of non-medical 
              information.
Sec. 204. Strategic plan for coordinating implementation of transaction 
              standards and ICD codes.
Sec. 205. Study and report to determine impact of variation and 
              commonality in State health information laws and 
              regulations.

TITLE III--PROMOTING THE USE OF HEALTH INFORMATION TECHNOLOGY TO BETTER 
                         COORDINATE HEALTH CARE

Sec. 301. Safe harbors to antikickback civil penalties and criminal 
              penalties for provision of health information technology 
              and training services.
Sec. 302. Exception to limitation on certain physician referrals (under 
              Stark) for provision of health information technology and 
              training services to health care professionals.
Sec. 303. Rules of construction regarding use of consortia.

                    TITLE IV--ADDITIONAL PROVISIONS

Sec. 401. Promotion of telehealth services.
Sec. 402. Study and report on expansion of home health-related 
              telehealth services.
Sec. 403. Study and report on store and forward technology for 
              telehealth.
Sec. 404. Methodology for reporting uniform price data for inpatient 
              and outpatient hospital services.
Sec. 405. Inclusion of uniform price data.
Sec. 406. Ensuring health care providers participating in PHSA 
              programs, Medicaid, SCHIP, or the MCH program may 
              maintain health information in electronic form.
Sec. 407. Ensuring health care providers participating in the Medicare 
              program may maintain health information in electronic 
              form.
Sec. 408. Study and report on State, regional, and community health 
              information exchanges.

     SEC. 2. PRESERVING PRIVACY AND SECURITY LAWS.

       Nothing in this Act (or the amendments made by this Act) 
     shall be construed to affect the scope, substance, or 
     applicability of section 264(c) of the Health Insurance 
     Portability and Accountability Act of 1996 and any regulation 
     issued pursuant to such section.

TITLE I--COORDINATION FOR, PLANNING FOR, AND INTEROPERABILITY OF HEALTH 
                         INFORMATION TECHNOLOGY

     SEC. 101. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH 
                   INFORMATION TECHNOLOGY.

       (a) In General.--Title II of the Public Health Service Act 
     is amended by adding at the end the following new part:

                ``PART D--HEALTH INFORMATION TECHNOLOGY

     ``SEC. 271. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH 
                   INFORMATION TECHNOLOGY.

       ``(a) Establishment.--There is established within the 
     Department of Health and Human Services an Office of the 
     National Coordinator for Health Information Technology that 
     shall be headed by the National Coordinator for Health 
     Information Technology (referred to in this part as the 
     `National Coordinator'). The National Coordinator shall be 
     appointed by and report directly to the Secretary. The 
     National Coordinator shall be paid at a rate equal to the 
     rate of basic pay for level IV of the Executive Schedule.
       ``(b) Goals of Nationwide Interoperable Health Information 
     Technology Infrastructure.--The National Coordinator shall

[[Page H5989]]

     perform the duties under subsection (c) in a manner 
     consistent with the development of a nationwide interoperable 
     health information technology infrastructure that--
       ``(1) improves health care quality, promotes data accuracy, 
     reduces medical errors, increases the efficiency of care, and 
     advances the delivery of appropriate, evidence-based health 
     care services;
       ``(2) promotes wellness, disease prevention, and management 
     of chronic illnesses by increasing the availability and 
     transparency of information related to the health care needs 
     of an individual for such individual;
       ``(3) promotes the availability of appropriate and accurate 
     information necessary to make medical decisions in a usable 
     form at the time and in the location that the medical service 
     involved is provided;
       ``(4) produces greater value for health care expenditures 
     by reducing health care costs that result from inefficiency, 
     medical errors, inappropriate care, and incomplete or 
     inaccurate information;
       ``(5) promotes a more effective marketplace, greater 
     competition, greater systems analysis, increased consumer 
     choice, enhanced quality, and improved outcomes in health 
     care services;
       ``(6) with respect to health information of consumers, 
     advances the portability of such information and the ability 
     of such consumers to share and use such information to assist 
     in the management of their health care;
       ``(7) improves the coordination of information and the 
     provision of such services through an effective 
     infrastructure for the secure and authorized exchange and use 
     of health care information;
       ``(8) is consistent with legally applicable requirements 
     with respect to securing and protecting the confidentiality 
     of individually identifiable health information of a patient;
       ``(9) promotes the creation and maintenance of 
     transportable, secure, Internet-based personal health 
     records, including promoting the efforts of health care 
     payers and health plan administrators for a health plan, such 
     as Federal agencies, private health plans, and third party 
     administrators, to provide for such records on behalf of 
     members of such a plan;
       ``(10) promotes access to and review of the electronic 
     health record of a patient by such patient;
       ``(11) promotes health research and health care quality 
     research and assessment; and
       ``(12) promotes the efficient and streamlined development, 
     submission, and maintenance of electronic health care 
     clinical trial data.
       ``(c) Duties of the National Coordinator.--
       ``(1) Strategic planner for interoperable health 
     information technology.--The National Coordinator shall 
     provide for a strategic plan for the nationwide 
     implementation of interoperable health information technology 
     in both the public and private health care sectors consistent 
     with subsection (b).
       ``(2) Principal advisor to the secretary.--The National 
     Coordinator shall serve as the principal advisor to the 
     Secretary on the development, application, and use of health 
     information technology, and shall coordinate the policies and 
     programs of the Department of Health and Human Services for 
     promoting the use of health information technology.
       ``(3) Intragovernmental coordinator.--The National 
     Coordinator shall ensure that health information technology 
     policies and programs of the Department of Health and Human 
     Services are coordinated with those of relevant executive 
     branch agencies and departments with a goal to avoid 
     duplication of effort, to align the health information 
     architecture of each agency or department toward a common 
     approach, to ensure that each agency or department conducts 
     programs within the areas of its greatest expertise and its 
     mission in order to create a national interoperable health 
     information system capable of meeting national public health 
     needs effectively and efficiently, and to assist Federal 
     agencies and departments in security programs, policies, and 
     protections to prevent unauthorized access to individually 
     identifiable health information created, maintained, or in 
     the temporary possession of that agency or department. The 
     coordination authority provided to the National Coordinator 
     under the previous sentence shall supercede any such 
     authority otherwise provided to any other official of the 
     Department of Health and Human Services. For the purposes of 
     this paragraph, the term `unauthorized access' means access 
     that is not authorized by that agency or department including 
     unauthorized employee access.
       ``(4) Advisor to omb.--The National Coordinator shall 
     provide to the Director of the Office of Management and 
     Budget comments and advice with respect to specific Federal 
     health information technology programs.
       ``(5) Promoter of health information technology in 
     medically underserved communities.--The National Coordinator 
     shall--
       ``(A) identify sources of funds that will be made available 
     to promote and support the planning and adoption of health 
     information technology in medically underserved communities, 
     including in urban and rural areas, either through grants or 
     technical assistance;
       ``(B) coordinate with the funding sources to help such 
     communities connect to identified funding; and
       ``(C) collaborate with the Agency for Healthcare Research 
     and Quality and the Health Services Resources Administration 
     and other Federal agencies to support technical assistance, 
     knowledge dissemination, and resource development, to 
     medically underserved communities seeking to plan for and 
     adopt technology and establish electronic health information 
     networks across providers.''.
       (b) Treatment of Executive Order 13335.--Executive Order 
     13335 shall not have any force or effect after the date of 
     the enactment of this Act.
       (c) Transition From ONCHIT Under Executive Order.--
       (1) In general.--All functions, personnel, assets, 
     liabilities, administrative actions, and statutory reporting 
     requirements applicable to the old National Coordinator or 
     the Office of the old National Coordinator on the date before 
     the date of the enactment of this Act shall be transferred, 
     and applied in the same manner and under the same terms and 
     conditions, to the new National Coordinator and the Office of 
     the new National Coordinator as of the date of the enactment 
     of this Act.
       (2) Rule of construction.-- Nothing in this section or the 
     amendment made by this section shall be construed as 
     requiring the duplication of Federal efforts with respect to 
     the establishment of the Office of the National Coordinator 
     for Health Information Technology, regardless of whether such 
     efforts are carried out before or after the date of the 
     enactment of this Act.
       (3) Acting national coordinator.--Before the appointment of 
     the new National Coordinator, the old National Coordinator 
     shall act as the National Coordinator for Health Information 
     Technology until the office is filled as provided in section 
     271(a) of the Public Health Service Act, as added by 
     subsection (a). The Secretary of Health and Human Services 
     may appoint the old National Coordinator as the new National 
     Coordinator.
       (4) Definitions.--For purposes of this subsection:
       (A) New national coordinator.--The term ``new National 
     Coordinator'' means the National Coordinator for Health 
     Information Technology appointed under section 271(a) of the 
     Public Health Service Act, as added by subsection (a).
       (B) Old national coordinator.--The term ``old National 
     Coordinator'' means the National Coordinator for Health 
     Information Technology appointed under Executive Order 13335.

     SEC. 102. REPORT ON THE AMERICAN HEALTH INFORMATION 
                   COMMUNITY.

       Not later than one year after the date of the enactment of 
     this Act, the Secretary of Health and Human Services shall 
     submit to Congress a report on the work conducted by the 
     American Health Information Community (in this section 
     referred to as ``AHIC''), as established by the Secretary. 
     Such report shall include the following:
       (1) A description of the accomplishments of AHIC, with 
     respect to the promotion of the development of national 
     guidelines, the development of a nationwide health 
     information network, and the increased adoption of health 
     information technology.
       (2) Information on how model privacy and security policies 
     may be used to protect confidentiality of health information, 
     and an assessment of how existing policies compare to such 
     model policies.
       (3) Information on the progress in--
       (A) establishing uniform industry-wide health information 
     technology standards;
       (B) achieving an internet-based nationwide health 
     information network;
       (C) achieving interoperable electronic health record 
     adoption across health care providers; and
       (D) creating technological innovations to promote security 
     and confidentiality of individually identifiable health 
     information.
       (4) Recommendations for the transition of AHIC to a longer-
     term or permanent advisory and facilitation entity, 
     including--
       (A) a schedule for such transition;
       (B) options for structuring the entity as either a public-
     private or private sector entity;
       (C) the collaberative role of the Federal Government in the 
     entity;
       (D) steps for--
       (i) continued leadership in the facilitation of guidelines 
     or standards;
       (ii) the alignment of financial incentives; and
       (iii) the long-term plan for health care transformation 
     through information technology; and
       (E) the elimination or revision of the functions of AHIC 
     during the development of the nationwide health information 
     network.

     SEC. 103. INTEROPERABILITY PLANNING PROCESS; FEDERAL 
                   INFORMATION COLLECTION ACTIVITIES.

       Part D of title II of the Public Health Service Act, as 
     added by section 101(a), is amended by adding at the end the 
     following new section:

     ``SEC. 272. INTEROPERABILITY PLANNING PROCESS; FEDERAL 
                   INFORMATION COLLECTION ACTIVITIES.

       ``(a) Strategic Interoperability Planning Process.--
       ``(1) Assessment and endorsement of core strategic 
     guidelines.--
       ``(A) In general.--Not later than December 31, 2006, the 
     National Coordinator shall publish a strategic plan, 
     including a schedule, for the assessment and the endorsement

[[Page H5990]]

     of core interoperability guidelines for significant use cases 
     consistent with this subsection. The National Coordinator may 
     update such plan from time to time.
       ``(B) Endorsement.--
       ``(i) In general.--Consistent with the schedule under this 
     paragraph and not later than one year after the publication 
     of such schedule, the National Coordinator shall endorse a 
     subset of core interoperability guidelines for significant 
     use cases. The National Coordinator shall continue to endorse 
     subsets of core interoperability guidelines for significant 
     use cases annually consistent with the schedule published 
     pursuant to this paragraph, with endorsement of all such 
     guidelines completed not later than August 31, 2009.
       ``(ii) Consultation.--All such endorsements shall be in 
     consultation with the American Health Information Community 
     and other appropriate entities.
       ``(iii) Voluntary compliance.--Compliance with such 
     guidelines shall be voluntary, subject to subsection (b)(1).
       ``(C) Consultation with other parties.--The National 
     Coordinator shall develop and implement such strategic plan 
     in consultation with the American Health Information 
     Community and other appropriate entities.
       ``(D) Definitions.--For purposes of this section:
       ``(i) Interoperability guideline.--The term 
     `interoperability guideline' means a guideline to improve and 
     promote the interoperability of health information technology 
     for purposes of electronically accessing and exchanging 
     health information. Such term includes named standards, 
     architectures, software schemes for identification, 
     authentication, and security, and other information needed to 
     ensure the reproducible development of common solutions 
     across disparate entities.
       ``(ii) Core interoperability guideline.--The term `core 
     interoperability guideline' means an interoperability 
     guideline that the National Coordinator determines is 
     essential and necessary for purposes described in clause (i).
       ``(iii) Significant use case.--The term `significant use 
     case' means a category (as specified by the National 
     Coordinator) that identifies a significant use or purpose for 
     the interoperability of health information technology, such 
     as for the exchange of laboratory information, drug 
     prescribing, clinical research, and electronic health 
     records.
       ``(2) National survey.--
       ``(A) In general.--Not later than August 31, 2008, the 
     National Coordinator shall conduct one or more surveys 
     designed to measure the capability of entities (including 
     Federal agencies, State and local government agencies, and 
     private sector entities) to exchange electronic health 
     information by appropriate significant use case. Such surveys 
     shall identify the extent to which the type of health 
     information, the use for such information, or any other 
     appropriate characterization of such information may relate 
     to the capability of such entities to exchange health 
     information in a manner that is consistent with methods to 
     improve the interoperability of health information and with 
     core interoperability guidelines.
       ``(B) Dissemination of survey results.--The National 
     Coordinator shall disseminate the results of such surveys in 
     a manner so as to--
       ``(i) inform the public on the capabilities of entities to 
     exchange electronic health information;
       ``(ii) assist in establishing a more interoperable 
     information architecture; and
       ``(iii) identify the status of health information systems 
     used in Federal agencies and the status of such systems with 
     respect to interoperability guidelines.
       ``(b) Federal Health Information Collection Activities.--
       ``(1) Requirements.--With respect to a core 
     interoperability guideline endorsed under subsection 
     (a)(1)(B) for a significant use case, the President shall 
     take measures to ensure that Federal activities involving the 
     broad collection and submission of health information are 
     consistent with such guideline within three years after the 
     date of such endorsement.
       ``(2) Promoting use of non-identifiable health information 
     to improve health research and health care quality.--
       ``(A) In general.--Where feasible, and consistent with 
     applicable privacy or security or other laws, the President, 
     in consultation with the Secretary, shall take measures to 
     allow timely access to useful categories of non-identifiable 
     health information in records maintained by the Federal 
     government, or maintained by entities under contract with the 
     Federal government, to advance health care quality and health 
     research where such information is in a form that can be used 
     in such research. The President shall consult with 
     appropriate Federal agencies, and solicit public comment, on 
     useful categories of information, and appropriate measures to 
     take. The President may consider the administrative burden 
     and the potential for improvements in health care quality in 
     determining such appropriate measures. In addition, the 
     President, in consultation with the Secretary, shall 
     encourage voluntary private and public sector efforts to 
     allow access to such useful categories of non-identifiable 
     health information to advance health care quality and health 
     research.
       ``(B) Non-identifiable health information defined.--For 
     purposes of this paragraph, the term `non-identifiable health 
     information' means information that is not individually 
     identifiable health information as defined in rules 
     promulgated pursuant to section 264(c) of the Health 
     Insurance Portability and Accountability Act of 1996 (42 
     U.S.C. 1320d-2 note), and includes information that has been 
     de-identified so that it is no longer individually 
     identifiable health information, as defined in such rules.
       ``(3) Annual review and report.--For each year during the 
     five-year period following the date of the enactment of this 
     section, the National Coordinator shall review the operation 
     of health information collection by and submission to the 
     Federal government and the purchases (and planned purchases) 
     of health information technology by the Federal government. 
     For each such year and based on the review for such year, the 
     National Coordinator shall submit to the President and 
     Congress recommendations on methods to--
       ``(A) streamline (and eliminate redundancy in) Federal 
     systems used for the collection and submission of health 
     information;
       ``(B) improve efficiency in such collection and submission;
       ``(C) increase the ability to assess health care quality; 
     and
       ``(D) reduce health care costs.''.

     SEC. 104. GRANTS TO INTEGRATED HEALTH SYSTEMS TO PROMOTE 
                   HEALTH INFORMATION TECHNOLOGIES TO IMPROVE 
                   COORDINATION OF CARE FOR THE UNINSURED, 
                   UNDERINSURED, AND MEDICALLY UNDERSERVED.

       Subpart I of part D of title III of the Public Health 
     Service Act (42 U.S.C. 254b et seq.) is amended by adding at 
     the end the following:

     ``SEC. 330M. GRANTS FOR IMPROVEMENT OF THE COORDINATION OF 
                   CARE FOR THE UNINSURED, UNDERINSURED, AND 
                   MEDICALLY UNDERSERVED.

       ``(a) In General.--The Secretary may make grants to 
     integrated health care systems, in accordance with this 
     section, for projects to better coordinate the provision of 
     health care through the adoption of new health information 
     technology, or the significant improvement of existing health 
     information technology, to improve the provision of health 
     care to uninsured, underinsured, and medically underserved 
     individuals (including in urban and rural areas) through 
     health-related information about such individuals, throughout 
     such a system and at the point of service.
       ``(b) Eligibility.--
       ``(1) Application.--To be eligible to receive a grant under 
     this section, an integrated health care system shall prepare 
     and submit to the Secretary an application, at such time, in 
     such manner, and containing such information as the Secretary 
     may require, including--
       ``(A) a description of the project that the system will 
     carry out using the funds provided under the grant;
       ``(B) a description of the manner in which the project 
     funded under the grant will advance the goal specified in 
     subsection (a); and
       ``(C) a description of the populations to be served by the 
     adoption or improvement of health information technology.
       ``(2) Optional reporting condition.--The Secretary may also 
     condition the provision of a grant to an integrated health 
     care system under this section for a project on the 
     submission by such system to the Secretary of a report on the 
     impact of the health information technology adopted (or 
     improved) under such project on the delivery of health care 
     and the quality of care (in accordance with applicable 
     measures of such quality). Such report shall be at such time 
     and in such form and manner as specified by the Secretary.
       ``(c) Integrated Health Care System Defined.--For purposes 
     of this section, the term `integrated health care system' 
     means a system of health care providers that is organized to 
     provide care in a coordinated fashion and has a demonstrated 
     commitment to provide uninsured, underinsured, and medically 
     underserved individuals with access to such care.
       ``(d) Priorities.--In making grants under this section, the 
     Secretary shall give priority to an integrated health care 
     system--
       ``(1) that can demonstrate past successful community-wide 
     efforts to improve the quality of care provided and the 
     coordination of care for the uninsured, underinsured, and 
     medically underserved; or
       ``(2) if the project to be funded through such a grant--
       ``(A) will improve the delivery of health care and the 
     quality of care provided; and
       ``(B) will demonstrate savings for State or Federal health 
     care benefits programs or entities legally obligated under 
     Federal law to provide health care from the reduction of 
     duplicative health care services, administrative costs, and 
     medical errors.
       ``(e) Limitation, Matching Requirement, and Conditions.--
       ``(1) Limitation on use of funds.--None of the funds 
     provided under a grant made under this section may be used 
     for a project providing for the adoption or improvement of 
     health information technology that is used exclusively for 
     financial record keeping, billing, or other non-clinical 
     applications.
       ``(2) Matching requirement.--To be eligible for a grant 
     under this section an integrated health care system shall 
     contribute

[[Page H5991]]

     non-Federal contributions to the costs of carrying out the 
     project for which the grant is awarded in an amount equal to 
     $1 for each $5 of Federal funds provided under the grant.
       ``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $15,000,000 for each of fiscal years 2007 and 2008.''.

     SEC. 105. SMALL PHYSICIAN PRACTICE DEMONSTRATION GRANTS.

       Part D of title II of the Public Health Service Act, as 
     added by section 101(a) and amended by section 103, is 
     amended by adding at the end the following new section:

     ``SEC. 273. SMALL PHYSICIAN PRACTICE DEMONSTRATION GRANTS.

       ``(a) In General.--The Secretary shall establish a 
     demonstration program under which the Secretary makes grants 
     to small physician practices (including such practices that 
     furnish services to individuals with chronic illnesses) that 
     are located in rural areas or medically underserved urban 
     areas for the purchase and support of health information 
     technology.
       ``(b) Eligibility.--To be eligible to receive a grant under 
     this section, an applicant shall prepare and submit to the 
     Secretary an application, at such time, in such manner, and 
     containing such information, as the Secretary may require.
       ``(c) Reporting.--
       ``(1) Required reports by small physician practices.--A 
     small physician practice receiving a grant under subsection 
     (a) shall submit to the Secretary an evaluation on the health 
     information technology funded by such grant. Such evaluation 
     shall include information on--
       ``(A) barriers to the adoption of health information 
     technology by the small physician practice;
       ``(B) issues for such practice in the use of health 
     information technology;
       ``(C) the effect health information technology will have on 
     the quality of health care furnished by such practice; and
       ``(D) the effect of any medical liability rules on such 
     practice.
       ``(2) Report to congress.--Not later than January 1, 2009, 
     the Secretary shall submit to Congress a report on the 
     results of the demonstration program under this section.
       ``(d) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $5,000,000 for each of fiscal years 2007 and 2008.''.

        TITLE II--TRANSACTION STANDARDS, CODES, AND INFORMATION

     SEC. 201. PROCEDURES TO ENSURE TIMELY UPDATING OF STANDARDS 
                   THAT ENABLE ELECTRONIC EXCHANGES.

       Section 1174(b) of the Social Security Act (42 U.S.C. 
     1320d-3(b)) is amended--
       (1) in paragraph (1)--
       (A) in the first sentence, by inserting ``and in accordance 
     with paragraph (3)'' before the period; and
       (B) by adding at the end the following new sentence: ``For 
     purposes of this subsection and section 1173(c)(2), the term 
     `modification' includes a new version or a version 
     upgrade.''; and
       (2) by adding at the end the following new paragraph:
       ``(3) Expedited procedures for adoption of additions and 
     modifications to standards.--
       ``(A) In general.--For purposes of paragraph (1), the 
     Secretary shall provide for an expedited upgrade program (in 
     this paragraph referred to as the `upgrade program'), in 
     accordance with this paragraph, to develop and approve 
     additions and modifications to the standards adopted under 
     section 1173(a) to improve the quality of such standards or 
     to extend the functionality of such standards to meet 
     evolving requirements in health care.
       ``(B) Publication of notices.--Under the upgrade program:
       ``(i) Voluntary notice of initiation of process.--Not later 
     than 30 days after the date the Secretary receives a notice 
     from a standard setting organization that the organization is 
     initiating a process to develop an addition or modification 
     to a standard adopted under section 1173(a), the Secretary 
     shall publish a notice in the Federal Register that--

       ``(I) identifies the subject matter of the addition or 
     modification;
       ``(II) provides a description of how persons may 
     participate in the development process; and
       ``(III) invites public participation in such process.

       ``(ii) Voluntary notice of preliminary draft of additions 
     or modifications to standards.--Not later than 30 days after 
     the date of the date the Secretary receives a notice from a 
     standard setting organization that the organization has 
     prepared a preliminary draft of an addition or modification 
     to a standard adopted by section 1173(a), the Secretary shall 
     publish a notice in the Federal Register that--

       ``(I) identifies the subject matter of (and summarizes) the 
     addition or modification;
       ``(II) specifies the procedure for obtaining the draft;
       ``(III) provides a description of how persons may submit 
     comments in writing and at any public hearing or meeting held 
     by the organization on the addition or modification; and
       ``(IV) invites submission of such comments and 
     participation in such hearing or meeting without requiring 
     the public to pay a fee to participate.

       ``(iii) Notice of proposed addition or modification to 
     standards.--Not later than 30 days after the date of the date 
     the Secretary receives a notice from a standard setting 
     organization that the organization has a proposed addition or 
     modification to a standard adopted under section 1173(a) that 
     the organization intends to submit under subparagraph 
     (D)(iii), the Secretary shall publish a notice in the Federal 
     Register that contains, with respect to the proposed addition 
     or modification, the information required in the notice under 
     clause (ii) with respect to the addition or modification.
       ``(iv) Construction.--Nothing in this paragraph shall be 
     construed as requiring a standard setting organization to 
     request the notices described in clauses (i) and (ii) with 
     respect to an addition or modification to a standard in order 
     to qualify for an expedited determination under subparagraph 
     (C) with respect to a proposal submitted to the Secretary for 
     adoption of such addition or modification.
       ``(C) Provision of expedited determination.--Under the 
     upgrade program and with respect to a proposal by a standard 
     setting organization for an addition or modification to a 
     standard adopted under section 1173(a), if the Secretary 
     determines that the standard setting organization developed 
     such addition or modification in accordance with the 
     requirements of subparagraph (D) and the National Committee 
     on Vital and Health Statistics recommends approval of such 
     addition or modification under subparagraph (E), the 
     Secretary shall provide for expedited treatment of such 
     proposal in accordance with subparagraph (F).
       ``(D) Requirements.--The requirements under this 
     subparagraph with respect to a proposed addition or 
     modification to a standard by a standard setting organization 
     are the following:
       ``(i) Request for publication of notice.--The standard 
     setting organization submits to the Secretary a request for 
     publication in the Federal Register of a notice described in 
     subparagraph (B)(iii) for the proposed addition or 
     modification.
       ``(ii) Process for receipt and consideration of public 
     comment.--The standard setting organization provides for a 
     process through which, after the publication of the notice 
     referred to under clause (i), the organization--

       ``(I) receives and responds to public comments submitted on 
     a timely basis on the proposed addition or modification 
     before submitting such proposed addition or modification to 
     the National Committee on Vital and Health Statistics under 
     clause (iii);
       ``(II) makes publicly available a written explanation for 
     its response in the proposed addition or modification to 
     comments submitted on a timely basis; and
       ``(III) makes public comments received under clause (I) 
     available, or provides access to such comments, to the 
     Secretary.

       ``(iii) Submittal of final proposed addition or 
     modification to ncvhs.--After completion of the process under 
     clause (ii), the standard setting organization submits the 
     proposed addition or modification to the National Committee 
     on Vital and Health Statistics for review and consideration 
     under subparagraph (E). Such submission shall include 
     information on the organization's compliance with the notice 
     and comment requirements (and responses to those comments) 
     under clause (ii).
       ``(E) Hearing and recommendations by national committee on 
     vital and health statistics.--Under the upgrade program, upon 
     receipt of a proposal submitted by a standard setting 
     organization under subparagraph (D)(iii) for the adoption of 
     an addition or modification to a standard, the National 
     Committee on Vital and Health Statistics shall provide notice 
     to the public and a reasonable opportunity for public 
     testimony at a hearing on such addition or modification. The 
     Secretary may participate in such hearing in such capacity 
     (including presiding ex officio) as the Secretary shall 
     determine appropriate. Not later than 120 days after the date 
     of receipt of the proposal, the Committee shall submit to the 
     Secretary its recommendation to adopt (or not adopt) the 
     proposed addition or modification.
       ``(F) Determination by secretary to accept or reject 
     national committee on vital and health statistics 
     recommendation.--
       ``(i) Timely determination.--Under the upgrade program, if 
     the National Committee on Vital and Health Statistics submits 
     to the Secretary a recommendation under subparagraph (E) to 
     adopt a proposed addition or modification, not later than 90 
     days after the date of receipt of such recommendation the 
     Secretary shall make a determination to accept or reject the 
     recommendation and shall publish notice of such determination 
     in the Federal Register not later than 30 days after the date 
     of the determination.
       ``(ii) Contents of notice.--If the determination is to 
     reject the recommendation, such notice shall include the 
     reasons for the rejection. If the determination is to accept 
     the recommendation, as part of such notice the Secretary 
     shall promulgate the modified standard (including the 
     accepted proposed addition or modification accepted) as a 
     final rule under this subsection without any further notice 
     or public comment period.
       ``(iii) Limitation on consideration.--The Secretary shall 
     not consider a proposal under this subparagraph unless the 
     Secretary determines that the requirements of subparagraph 
     (D) (including publication of notice and opportunity for 
     public comment) have been met with respect to the proposal.

[[Page H5992]]

       ``(G) Exemption from paperwork reduction act.--Chapter 35 
     of title 44, United States Code, shall not apply to a final 
     rule promulgated under subparagraph (F).
       ``(H) Treatment as satisfying requirements for notice-and-
     comment.--Any requirements under section 553 of title 5, 
     United States Code, relating to notice and an opportunity for 
     public comment with respect to a final rule promulgated under 
     subparagraph (F) shall be treated as having been met by 
     meeting the requirements of the notice and opportunity for 
     public comment provided under provisions of subparagraphs 
     (B)(iii), (D), and (E).
       ``(I) No judicial review.--A final rule promulgated under 
     subparagraph (F) shall not be subject to judicial review.''.

     SEC. 202. UPGRADING ASC X12 AND NCPDP STANDARDS.

       (a) In General.--The Secretary of Health and Human Services 
     shall provide by notice published in the Federal Register for 
     the following replacements of standards to apply to 
     transactions occurring on or after April 1, 2009:
       (1) Accredited standards committee x12 (asc x12) 
     standard.--The replacement of the Accredited Standards 
     Committee X12 (ASC X12) version 4010 adopted under section 
     1173(a) of such Act (42 U.S.C. 1320d-2(a)) with the ASC X12 
     version 5010, as reviewed by the National Committee on Vital 
     Health Statistics.
       (2) National council for prescription drug programs (ncpdp) 
     telecommunications standards.--The replacement of the 
     National Council for Prescription Drug Programs (NCPDP) 
     Telecommunications Standards version 5.1 adopted under 
     section 1173(a) of such Act (42 U.S.C. 1320d-2(a)) with 
     whichever is the latest version of the NCPDP 
     Telecommunications Standards that has been approved by such 
     Council and reviewed by the National Committee on Vital 
     Health Statistics as of April 1, 2007.
       (b) No Judicial Review.--The implementation of subsection 
     (a), including the determination of the latest version under 
     subsection (a)(2), shall not be subject to judicial review.

     SEC. 203. UPGRADING ICD CODES; CODING AND DOCUMENTATION OF 
                   NON-MEDICAL INFORMATION.

       (a) Upgrading ICD Codes.--
       (1) In general.--The Secretary of Health and Human Services 
     shall provide by notice published in the Federal Register for 
     the replacement of the International Classification of 
     Diseases, 9th revision, Clinical Modification (ICD-9-CM) 
     under the regulation promulgated under section 1173(c) of the 
     Social Security Act (42 U.S.C. 1320d-2(c)), including for 
     purposes of part A of title XVIII of such Act, with both of 
     the following:
       (A) The International Classification of Diseases, 10th 
     revision, Clinical Modification (ICD-10-CM).
       (B) The International Classification of Diseases, 10th 
     revision, Procedure Coding System (ICD-10-PCS).
       (2) Application.--The replacement made by paragraph (1) 
     shall apply, for purposes of section 1175(b)(2) of the Social 
     Security Act (42 U.S.C. 1320d-4(b)(2)), to services furnished 
     on or after October 1, 2010.
       (3) Rules of construction.--Nothing in paragraph (1) shall 
     be construed--
       (A) as affecting the application of classification 
     methodologies or codes, such as CPT or HCPCS codes, other 
     than under the International Classification of Diseases 
     (ICD); or
       (B) as superseding the authority of the Secretary of Health 
     and Human Services to maintain and modify the coding set for 
     ICD-10-CM and ICD-10-PCS, including under the amendments made 
     by section 201.
       (b) Coding and Documentation of Non-Medical Information.--
     In any regulation or other action implementing the 
     International Classification of Diseases, 10th revision, 
     Clinical Modification (ICD-10-CM), the International 
     Classification of Diseases, 10th revision, Procedure Coding 
     System (ICD-10-PCS), or other version of the International 
     Classification of Diseases, 10th revision, the Secretary of 
     Health and Human Services shall ensure that no health care 
     provider is required to code to a level of specificity that 
     would require documentation of non-medical information on the 
     external cause of any given type of injury.

     SEC. 204. STRATEGIC PLAN FOR COORDINATING IMPLEMENTATION OF 
                   TRANSACTION STANDARDS AND ICD CODES.

       Not later than the date that is 180 days after the date of 
     the enactment of this Act, the Secretary of Health and Human 
     Services, in consultation with relevant public and private 
     entities, shall develop a strategic plan with respect to the 
     need for coordination in the implementation of--
       (1) transaction standards under section 1173(a) of the 
     Social Security Act, including modifications to such 
     standards under section 1174(b)(3) of such Act, as added by 
     section 201; and
       (2) any updated versions of the International 
     Classification of Diseases (ICD), including the replacement 
     of ICD-9 provided for under section 203(a).

     SEC. 205. STUDY AND REPORT TO DETERMINE IMPACT OF VARIATION 
                   AND COMMONALITY IN STATE HEALTH INFORMATION 
                   LAWS AND REGULATIONS.

       Part C of title XI of the Social Security Act is amended by 
     adding at the end the following new section:


``STUDY AND REPORT TO DETERMINE IMPACT OF VARIATION AND COMMONALITY IN 
             STATE HEALTH INFORMATION LAWS AND REGULATIONS

       ``Sec. 1180.  (a) Study.--For purposes of promoting the 
     development of a nationwide interoperable health information 
     technology infrastructure consistent with section 271(b) of 
     the Public Health Service Act, the Secretary shall conduct a 
     study of the impact of variation in State security and 
     confidentiality laws and current Federal security and 
     confidentiality standards on the timely exchanges of health 
     information in order to ensure the availability of health 
     information necessary to make medical decisions at the 
     location in which the medical care involved is provided. Such 
     study shall examine--
       ``(1)(A) the degree of variation and commonality among the 
     requirements of such laws for States; and
       ``(B) the degree of variation and commonality between the 
     requirements of such laws and the current Federal standards;
       ``(2) insofar as there is variation among and between such 
     requirements, the strengths and weaknesses of such 
     requirements; and
       ``(3) the extent to which such variation may adversely 
     impact the secure, confidential, and timely exchange of 
     health information among States, the Federal government, and 
     public and private entities, or may otherwise impact the 
     reliability of such information.
       ``(b) Report.--Not later than 18 months after the date of 
     the enactment of this section, the Secretary shall submit to 
     Congress a report on the study under subsection (a) and shall 
     include in such report the following:
       ``(1) Analysis of need for greater commonality.--A 
     determination by the Secretary on the extent to which there 
     is a need for greater commonality of the requirements of 
     State security and confidentiality laws and current Federal 
     security and confidentiality standards to better protect, 
     strengthen, or otherwise improve the secure, confidential, 
     and timely exchange of health information among States, the 
     Federal government, and public and private entities.
       ``(2) Recommendations for greater commonality.--Insofar as 
     the Secretary determines under paragraph (1) that there is a 
     need for greater commonality of such requirements, 
     recommendations on the extent to which (and how) the current 
     Federal security and confidentiality standards should be 
     changed in order to provide the commonality needed to better 
     protect, strengthen, or otherwise improve the secure, 
     confidential, and timely exchange of health information.
       ``(3) Specific recommendation on legislative changes for 
     greater commonality.--A specific recommendation on the extent 
     to which and how such standards should supersede State laws, 
     in order to provide the commonality needed to better protect 
     or strengthen the security and confidentiality of health 
     information in the timely exchange of such information and 
     legislative language in the form of a bill to effectuate such 
     specific recommendation.
       ``(c) Congressional Consideration of Legislation Providing 
     for Greater Commonality.--
       ``(1) Rules of house of representatives and senate.--This 
     subsection is enacted by the Congress--
       ``(A) as an exercise of the rulemaking power of the House 
     of Representatives and the Senate, respectively, and as such 
     they are deemed a part of the rules of each House, 
     respectively, but applicable only with respect to the 
     procedure to be followed in that House in the case of a 
     greater commonality bill defined in paragraph (4), and they 
     supersede other rules only to the extent that they are 
     inconsistent therewith; and
       ``(B) with full recognition of the constitutional right of 
     either House to change the rules (so far as relating to the 
     procedure of that House) at any time, in the same manner and 
     to the same extent as in the case of any other rule of that 
     House.
       ``(2) Introduction.--On the date on which the final report 
     is submitted under subsection (b)(3)--
       ``(A) a greater commonality bill shall be introduced (by 
     request) in the House by the majority leader of the House, 
     for himself and the minority leader of the House, or by 
     Members of the House designated by the majority leader and 
     minority leader of the House; and
       ``(B) a greater commonality bill shall be introduced (by 
     request) in the Senate by the majority leader of the Senate, 
     for himself and the minority leader of the Senate, or by 
     Members of the Senate designated by the majority leader and 
     minority leader of the Senate.

     If either House is not in session on the day on which such a 
     report is submitted, the greater commonality bill shall be 
     introduced in that House, as provided in the preceding 
     sentence, on the first day thereafter on which the House is 
     in session.
       ``(3) Referral.--A greater commonality bill shall be 
     referred by the Presiding Officers of the respective House to 
     the appropriate committee (or committees) of such House, in 
     accordance with the rules of that House.
       ``(4) Greater commonality bill defined.--For purposes of 
     this section, the term `greater commonality bill' means a 
     bill--
       ``(A) the title of which is the following: `A Bill to 
     provide the commonality needed to better protect, strengthen, 
     or otherwise improve the secure, confidential, and timely 
     exchange of health information'; and

[[Page H5993]]

       ``(B) the text of which, as introduced, consists of the 
     text of the bill included in the report submitted under 
     subsection (b)(3).
       ``(d) Definitions.--For purposes of this section:
       ``(1) Current federal security and confidentiality 
     standards.--The term `current Federal security and 
     confidentiality standards' means the Federal privacy 
     standards established pursuant to section 264(c) of the 
     Health Insurance Portability and Accountability Act of 1996 
     (42 U.S.C. 1320d-2 note) and security standards established 
     under section 1173(d) of the Social Security Act.
       ``(2) State.--The term `State' has the meaning given such 
     term when used in title XI of the Social Security Act, as 
     provided under section 1101(a) of such Act (42 U.S.C. 
     1301(a)).
       ``(3) State security and confidentiality laws.--The term 
     `State security and confidentiality laws' means State laws 
     and regulations relating to the privacy and confidentiality 
     of health information or to the security of such 
     information.''.

TITLE III--PROMOTING THE USE OF HEALTH INFORMATION TECHNOLOGY TO BETTER 
                         COORDINATE HEALTH CARE

     SEC. 301. SAFE HARBORS TO ANTIKICKBACK CIVIL PENALTIES AND 
                   CRIMINAL PENALTIES FOR PROVISION OF HEALTH 
                   INFORMATION TECHNOLOGY AND TRAINING SERVICES.

       (a) For Civil Penalties.--Section 1128A of the Social 
     Security Act (42 U.S.C. 1320a-7a) is amended--
       (1) in subsection (b), by adding at the end the following 
     new paragraph:
       ``(4) For purposes of this subsection, inducements to 
     reduce or limit services described in paragraph (1) shall not 
     include the practical or other advantages resulting from 
     health information technology or related installation, 
     maintenance, support, or training services.''; and
       (2) in subsection (i), by adding at the end the following 
     new paragraph:
       ``(8) The term `health information technology' means 
     hardware, software, license, right, intellectual property, 
     equipment, or other information technology (including new 
     versions, upgrades, and connectivity) designed or provided 
     primarily for the electronic creation, maintenance, or 
     exchange of health information to better coordinate care or 
     improve health care quality, efficiency, or research.''.
       (b) For Criminal Penalties.--Section 1128B of such Act (42 
     U.S.C. 1320a-7b) is amended--
       (1) in subsection (b)(3)--
       (A) in subparagraph (G), by striking ``and'' at the end;
       (B) in the subparagraph (H) added by section 237(d) of the 
     Medicare Prescription Drug, Improvement, and Modernization 
     Act of 2003 (Public Law 108-173; 117 Stat. 2213)--
       (i) by moving such subparagraph 2 ems to the left; and
       (ii) by striking the period at the end and inserting a 
     semicolon;
       (C) in the subparagraph (H) added by section 431(a) of such 
     Act (117 Stat. 2287)--
       (i) by redesignating such subparagraph as subparagraph (I);
       (ii) by moving such subparagraph 2 ems to the left; and
       (iii) by striking the period at the end and inserting ``; 
     and''; and
       (D) by adding at the end the following new subparagraph:
       ``(J) any nonmonetary remuneration (in the form of health 
     information technology, as defined in section 1128A(i)(8), or 
     related installation, maintenance, support or training 
     services) made to a person by a specified entity (as defined 
     in subsection (g)) if--
       ``(i) the provision of such remuneration is without an 
     agreement between the parties or legal condition that--
       ``(I) limits or restricts the use of the health information 
     technology to services provided by the physician to 
     individuals receiving services at the specified entity;
       ``(II) limits or restricts the use of the health 
     information technology in conjunction with other health 
     information technology; or
       ``(III) conditions the provision of such remuneration on 
     the referral of patients or business to the specified entity;
       ``(ii) such remuneration is arranged for in a written 
     agreement that is signed by the parties involved (or their 
     representatives) and that specifies the remuneration 
     solicited or received (or offered or paid) and states that 
     the provision of such remuneration is made for the primary 
     purpose of better coordination of care or improvement of 
     health quality, efficiency, or research; and
       ``(iii) the specified entity providing the remuneration (or 
     a representative of such entity) has not taken any action to 
     disable any basic feature of any hardware or software 
     component of such remuneration that would permit 
     interoperability.''; and
       (2) by adding at the end the following new subsection:
       ``(g) Specified Entity Defined.--For purposes of subsection 
     (b)(3)(J), the term `specified entity' means an entity that 
     is a hospital, group practice, prescription drug plan 
     sponsor, a Medicare Advantage organization, or any other such 
     entity specified by the Secretary, considering the goals and 
     objectives of this section, as well as the goals to better 
     coordinate the delivery of health care and to promote the 
     adoption and use of health information technology.''.
       (c) Effective Date and Effect on State Laws.--
       (1) Effective date.--The amendments made by subsections (a) 
     and (b) shall take effect on the date that is 120 days after 
     the date of the enactment of this Act.
       (2) Preemption of state laws.--No State (as defined in 
     section 1101(a) of the Social Security Act (42 U.S.C. 
     1301(a)) for purposes of title XI of such Act) shall have in 
     effect a State law that imposes a criminal or civil penalty 
     for a transaction described in section 1128A(b)(4) or section 
     1128B(b)(3)(J) of such Act, as added by subsections (a)(1) 
     and (b), respectively, if the conditions described in the 
     respective provision, with respect to such transaction, are 
     met.
       (d) Study and Report to Assess Effect of Safe Harbors on 
     Health System.--
       (1) In general.--The Secretary of Health and Human Services 
     shall conduct a study to determine the impact of each of the 
     safe harbors described in paragraph (3). In particular, the 
     study shall examine the following:
       (A) The effectiveness of each safe harbor in increasing the 
     adoption of health information technology.
       (B) The types of health information technology provided 
     under each safe harbor.
       (C) The extent to which the financial or other business 
     relationships between providers under each safe harbor have 
     changed as a result of the safe harbor in a way that 
     adversely affects or benefits the health care system or 
     choices available to consumers.
       (D) The impact of the adoption of health information 
     technology on health care quality, cost, and access under 
     each safe harbor.
       (2) Report.--Not later than three years after the effective 
     date described in subsection (c)(1), the Secretary of Health 
     and Human Services shall submit to Congress a report on the 
     study under paragraph (1).
       (3) Safe harbors described.--For purposes of paragraphs (1) 
     and (2), the safe harbors described in this paragraph are--
       (A) the safe harbor under section 1128A(b)(4) of such Act 
     (42 U.S.C. 1320a-7a(b)(4)), as added by subsection (a)(1); 
     and
       (B) the safe harbor under section 1128B(b)(3)(J) of such 
     Act (42 U.S.C. 1320a-7b(b)(3)(J)), as added by subsection 
     (b).

     SEC. 302. EXCEPTION TO LIMITATION ON CERTAIN PHYSICIAN 
                   REFERRALS (UNDER STARK) FOR PROVISION OF HEALTH 
                   INFORMATION TECHNOLOGY AND TRAINING SERVICES TO 
                   HEALTH CARE PROFESSIONALS.

       (a) In General.--Section 1877(b) of the Social Security Act 
     (42 U.S.C. 1395nn(b)) is amended by adding at the end the 
     following new paragraph:
       ``(6) Information technology and training services.--
       ``(A) In general.--Any nonmonetary remuneration (in the 
     form of health information technology or related 
     installation, maintenance, support or training services) made 
     by a specified entity to a physician if--
       ``(i) the provision of such remuneration is without an 
     agreement between the parties or legal condition that--

       ``(I) limits or restricts the use of the health information 
     technology to services provided by the physician to 
     individuals receiving services at the specified entity;
       ``(II) limits or restricts the use of the health 
     information technology in conjunction with other health 
     information technology; or
       ``(III) conditions the provision of such remuneration on 
     the referral of patients or business to the specified entity;

       ``(ii) such remuneration is arranged for in a written 
     agreement that is signed by the parties involved (or their 
     representatives) and that specifies the remuneration made and 
     states that the provision of such remuneration is made for 
     the primary purpose of better coordination of care or 
     improvement of health quality, efficiency, or research; and
       ``(iii) the specified entity (or a representative of such 
     entity) has not taken any action to disable any basic feature 
     of any hardware or software component of such remuneration 
     that would permit interoperability.
       ``(B) Health information technology defined.--For purposes 
     of this paragraph, the term `health information technology' 
     means hardware, software, license, right, intellectual 
     property, equipment, or other information technology 
     (including new versions, upgrades, and connectivity) designed 
     or provided primarily for the electronic creation, 
     maintenance, or exchange of health information to better 
     coordinate care or improve health care quality, efficiency, 
     or research.
       ``(C) Specified entity defined.--For purposes of this 
     paragraph, the term `specified entity' means an entity that 
     is a hospital, group practice, prescription drug plan 
     sponsor, a Medicare Advantage organization, or any other such 
     entity specified by the Secretary, considering the goals and 
     objectives of this section, as well as the goals to better 
     coordinate the delivery of health care and to promote the 
     adoption and use of health information technology.''.
       (b) Effective Date; Effect on State Laws.--
       (1) Effective date.--The amendment made by subsection (a) 
     shall take effect on the date that is 120 days after the date 
     of the enactment of this Act.
       (2) Preemption of state laws.--No State (as defined in 
     section 1101(a) of the Social Security Act (42 U.S.C. 
     1301(a)) for purposes of title XI of such Act) shall have in 
     effect a State law that imposes a criminal or civil penalty 
     for a transaction described in section 1877(b)(6) of such 
     Act, as added by subsection (a), if the conditions described 
     in such section, with respect to such transaction, are met.

[[Page H5994]]

       (c) Study and Report to Assess Effect of Exception on 
     Health System.--
       (1) In general.--The Secretary of Health and Human Services 
     shall conduct a study to determine the impact of the 
     exception under section 1877(b)(6) of such Act (42 U.S.C. 
     1395nn(b)(6)), as added by subsection (a). In particular, the 
     study shall examine the following:
       (A) The effectiveness of the exception in increasing the 
     adoption of health information technology.
       (B) The types of health information technology provided 
     under the exception.
       (C) The extent to which the financial or other business 
     relationships between providers under the exception have 
     changed as a result of the exception in a way that adversely 
     affects or benefits the health care system or choices 
     available to consumers.
       (D) The impact of the adoption of health information 
     technology on health care quality, cost, and access under the 
     exception.
       (2) Report.--Not later than three years after the effective 
     date described in subsection (b)(1), the Secretary of Health 
     and Human Services shall submit to Congress a report on the 
     study under paragraph (1).

     SEC. 303. RULES OF CONSTRUCTION REGARDING USE OF CONSORTIA.

       (a) Application to Safe Harbor From Criminal Penalties.--
     Section 1128B(b)(3) of the Social Security Act (42 U.S.C. 
     1320a-7b(b)(3)) is amended by adding after and below 
     subparagraph (J), as added by section 301(b)(1), the 
     following: ``For purposes of subparagraph (J), nothing in 
     such subparagraph shall be construed as preventing a 
     specified entity, consistent with the specific requirements 
     of such subparagraph, from forming a consortium composed of 
     health care providers, payers, employers, and other 
     interested entities to collectively purchase and donate 
     health information technology, or from offering health care 
     providers a choice of health information technology products 
     in order to take into account the varying needs of such 
     providers receiving such products.''.
       (b) Application to Stark Exception.--Paragraph (6) of 
     section 1877(b) of the Social Security Act (42 U.S.C. 
     1395nn(b)), as added by section 302(a), is amended by adding 
     at the end the following new subparagraph:
       ``(D) Rule of construction.--For purposes of subparagraph 
     (A), nothing in such subparagraph shall be construed as 
     preventing a specified entity, consistent with the specific 
     requirements of such subparagraph, from--
       ``(i) forming a consortium composed of health care 
     providers, payers, employers, and other interested entities 
     to collectively purchase and donate health information 
     technology; or
       ``(ii) offering health care providers a choice of health 
     information technology products in order to take into account 
     the varying needs of such providers receiving such 
     products.''.

                    TITLE IV--ADDITIONAL PROVISIONS

     SEC. 401. PROMOTION OF TELEHEALTH SERVICES.

       (a) Facilitating the Provision of Telehealth Services 
     Across State Lines.--The Secretary of Health and Human 
     Services shall, in coordination with physicians, health care 
     practitioners, patient advocates, and representatives of 
     States, encourage and facilitate the adoption of State 
     reciprocity agreements for practitioner licensure in order to 
     expedite the provision across State lines of telehealth 
     services.
       (b) Report.--Not later than 18 months after the date of the 
     enactment of this Act, the Secretary of Health and Human 
     Services shall submit to Congress a report on the actions 
     taken to carry out subsection (a).
       (c) State Defined.--For purposes of this subsection, the 
     term ``State'' has the meaning given that term for purposes 
     of title XVIII of the Social Security Act.

     SEC. 402. STUDY AND REPORT ON EXPANSION OF HOME HEALTH-
                   RELATED TELEHEALTH SERVICES.

       (a) Study.--The Secretary of Health and Human Services 
     shall conduct a study to determine the feasibility, 
     advisability, and the costs of--
       (1) including coverage and payment for home health-related 
     telehealth services as part of home health services under 
     title XVIII of the Social Security Act; and
       (2) expanding the list of sites described in paragraph 
     (4)(C)(ii) of section 1834(m) of the Social Security Act (42 
     U.S.C. 1395m(m)) to include county mental health clinics or 
     other publicly funded mental health facilities for the 
     purpose of payment under such section for the provision of 
     telehealth services at such clinics or facilities.
       (b) Specifics of Study.--Such study shall demonstrate 
     whether the changes described in paragraphs (1) and (2) of 
     subsection (a) will result in the following:
       (1) Enhanced health outcomes for individuals with one or 
     more chronic conditions.
       (2) Health outcomes for individuals furnished telehealth 
     services or home health-related telehealth services that are 
     at least comparable to the health outcomes for individuals 
     furnished similar items and services by a health care 
     provider at the same location of the individual or at the 
     home of the individual, respectively.
       (3) Facilitation of communication of more accurate clinical 
     information between health care providers.
       (4) Closer monitoring of individuals by health care 
     providers.
       (5) Overall reduction in expenditures for health care items 
     and services.
       (6) Improved access to health care.
       (c) Home Health-Related Telehealth Services Defined.--For 
     purposes of this section, the term ``home health-related 
     telehealth services'' means technology-based professional 
     consultations, patient monitoring, patient training services, 
     clinical observation, patient assessment, and any other 
     health services that utilize telecommunications technologies. 
     Such term does not include a telecommunication that consists 
     solely of a telephone audio conversation, facsimile, 
     electronic text mail, or consultation between two health care 
     providers.
       (d) Report.--Not later than 18 months after the date of the 
     enactment of this Act, the Secretary of Health and Human 
     Services shall submit to Congress a report on the study 
     conducted under subsection (a) and shall include in such 
     report such recommendations for legislation or administration 
     action as the Secretary determines appropriate.

     SEC. 403. STUDY AND REPORT ON STORE AND FORWARD TECHNOLOGY 
                   FOR TELEHEALTH.

       (a) Study.--The Secretary of Health and Human Services, 
     acting through the Director of the Office for the Advancement 
     of Telehealth, shall conduct a study on the use of store and 
     forward technologies (that provide for the asynchronous 
     transmission of health care information in single or 
     multimedia formats) in the provision of telehealth services. 
     Such study shall include an assessment of the feasibility, 
     advisability, and the costs of expanding the use of such 
     technologies for use in the diagnosis and treatment of 
     certain conditions.
       (b) Report.--Not later than 18 months after the date of the 
     enactment of this Act, the Secretary of Health and Human 
     Services shall submit to Congress a report on the study 
     conducted under subsection (a) and shall include in such 
     report such recommendations for legislation or administration 
     action as the Secretary determines appropriate.

     SEC. 404. ENSURING HEALTH CARE PROVIDERS PARTICIPATING IN 
                   PHSA PROGRAMS, MEDICAID, SCHIP, OR THE MCH 
                   PROGRAM MAY MAINTAIN HEALTH INFORMATION IN 
                   ELECTRONIC FORM.

       Part D of title II of the Public Health Service Act, as 
     added by section 101(a) and amended by sections 103 and 105, 
     is further amended by adding at the end the following new 
     section:

     ``SEC. 274. ENSURING HEALTH CARE PROVIDERS MAY MAINTAIN 
                   HEALTH INFORMATION IN ELECTRONIC FORM.

       ``(a) In General.--Any health care provider that 
     participates in a health care program that receives Federal 
     funds under this Act, or under title V, XIX, or XXI of the 
     Social Security Act, shall be deemed as meeting any 
     requirement for the maintenance of data in paper form under 
     such program (whether or not for purposes of management, 
     billing, reporting, reimbursement, or otherwise) if the 
     required data is maintained in an electronic form.
       ``(b) Relation to State Laws.--Beginning on the date that 
     is one year after the date of the enactment of this section, 
     subsection (a) shall supersede any contrary provision of 
     State law.
       ``(c) Construction.--Nothing in this section shall be 
     construed as--
       ``(1) requiring health care providers to maintain or submit 
     data in electronic form;
       ``(2) preventing a State from permitting health care 
     providers to maintain or submit data in paper form; or
       ``(3) preventing a State from requiring health care 
     providers to maintain or submit data in electronic form.''.

     SEC. 405. ENSURING HEALTH CARE PROVIDERS PARTICIPATING IN THE 
                   MEDICARE PROGRAM MAY MAINTAIN HEALTH 
                   INFORMATION IN ELECTRONIC FORM.

       Section 1871 of the Social Security Act (42 U.S.C. 1395hh) 
     is amended by adding at the end the following new subsection:
       ``(g)(1) Any provider of services or supplier shall be 
     deemed as meeting any requirement for the maintenance of data 
     in paper form under this title (whether or not for purposes 
     of management, billing, reporting, reimbursement, or 
     otherwise) if the required data is maintained in an 
     electronic form.
       ``(2) Nothing in this subsection shall be construed as 
     requiring health care providers to maintain or submit data in 
     electronic form.''.

     SEC. 406. STUDY AND REPORT ON STATE, REGIONAL, AND COMMUNITY 
                   HEALTH INFORMATION EXCHANGES.

       (a) Study.--The Secretary of Health and Human Services 
     shall conduct a study on issues related to the development, 
     operation, and implementation of State, regional, and 
     community health information exchanges. Such study shall 
     include the following, with respect to such health 
     information exchanges:
       (1) Profiles detailing the current stages of such health 
     information exchanges with respect to the progression of the 
     development, operation, implementation, organization, and 
     governance of such exchanges.
       (2) The impact of such exchanges on healthcare quality, 
     safety, and efficiency, including--
       (A) any impact on the coordination of health information 
     and services across healthcare providers and other 
     organizations relevant to health care;
       (B) any impact on the availability of health information at 
     the point-of-care to make timely medical decisions;
       (C) any benefits with respect to the promotion of wellness, 
     disease prevention, and chronic disease management;

[[Page H5995]]

       (D) any improvement with respect to public health 
     preparedness and response;
       (E) any impact on the widespread adoption of interoperable 
     health information technology, including electronic health 
     records;
       (F) any contributions to achieving an Internet-based 
     national health information network;
       (G) any contribution of health information exchanges to 
     consumer access and to consumers' use of their health 
     information; and
       (H) any impact on the operation of--
       (i) the Medicaid and Medicare programs;
       (ii) the State Children's Health Insurance Program (SCHIP);
       (iii) disproportionate share hospitals described in section 
     1923 of the Social Security Act;
       (iv) Federally-qualified health centers; or
       (v) managed care plans, if a significant number of the 
     plan's enrollees are beneficiaries in the Medicaid program or 
     SCHIP.
       (3) Best practice models for financing, incentivizing, and 
     sustaining such health information exchanges.
       (4) Information identifying the common principles, 
     policies, tools, and standards used (or proposed) in the 
     public and private sectors to support the development, 
     operation, and implementation of such health information 
     exchanges.
       (5) A description of any areas in which Federal government 
     leadership is needed to support growth and sustainability of 
     such health information exchanges.
       (b) Report.--Not later than one year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall submit to Congress a report on the study 
     described in subsection (a), including such recommendations 
     as the Secretary determines appropriate to facilitate the 
     development, operation, and implementation of health 
     information exchanges.

  The CHAIRMAN. No further amendment to the bill, as amended, is in 
order except those printed in part C of the report. Each amendment may 
be offered only in the order printed in the report, by a member 
designated in the report, shall be considered read, shall be debatable 
for the time specified in the report, equally divided and controlled by 
the proponent and an opponent, shall not be subject to amendment, and 
shall not be subject to a demand for division of the question.


                Amendment No. 1 Offered by Mr. Hinojosa

  The CHAIRMAN. It is now in order to consider amendment No. 1 printed 
in part C of House Report 109-603.
  Mr. HINOJOSA. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 1 offered by Mr. Hinojosa:
       In section 271(b)(8) of the Public Health Service Act, as 
     added by section 101(a) of the Bill, strike ``is consistent'' 
     and insert ``provides for the confidentiality and security of 
     individually identifiable health information, consistent''.
       In section 271(b) of the Public Health Service Act, as 
     added by section 101(a) of the Bill, strike ``and'' at the 
     end of paragraph (11), strike the period at the end of 
     paragraph (12) and insert ``; and'', and add at the end the 
     following new paragraph:
       ``(13) improves the availability of information and 
     resources for individuals with low or limited literacy or 
     language skills.''.

  The CHAIRMAN. Pursuant to House Resolution 952, the gentleman from 
Texas (Mr. Hinojosa) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Texas.
  Mr. HINOJOSA. Mr. Chairman, I yield myself such time as I may 
consume.
  Mr. Chairman, I rise today to offer an amendment to help ensure equal 
access to our health care system. All too often a lack of education can 
limit the quality of life of an individual. This is especially true 
when considering issues that govern one's health and well being.
  To change this fact, I am offering an amendment that would help 
ensure that all citizens would benefit from advances in our medical 
technology and new information. My amendment directs the national 
coordinator for the health information technology to increase 
information and medical resources for individuals with low literacy.
  Passage of this amendment would create a new national priority for 
bridging the literacy gap in health care resources and assign 
responsibility of that goal to the new national coordinator.
  The new priority is especially important in the race to cure 
diabetes. In my congressional district, over 100,000 individuals suffer 
from this disease. And while our Nation is constantly working to find 
new ways of combating diabetes, most of those inventions rely heavily 
on medical technology that requires its users to have a certain level 
of mathematical skills, access to the Internet, and in some cases, at a 
minimum, a high school level of literacy.
  While at first these requirements may seem ordinary and readily 
available, in districts such as mine, this is all but impossible. It is 
impossible because a large number of citizens who suffer from diabetes 
are undereducated, or they are elderly and lack computer skills. In 
some cases they live in poverty.
  Simply put, the most effective treatments for individuals with 
diabetes and other illnesses remain out of the reach of citizens who 
need it most. Due to the lack of focus and the creation of our 
technology, millions die each year.
  Additionally, according to a study sponsored by the American Diabetes 
Association, an organization that has endorsed this amendment, our 
Nation pays over $100 billion a year in lost wages, lost productivity, 
emergency room visits and care.
  A clear example of what is at risk if we fail to launch an aggressive 
effort geared at removing literacy barriers to health care information 
and technology can be witnessed in my own district's 41 percent 
diabetes mortality rate.
  That means that due to health care literacy barriers, one in two 
citizens diagnosed with diabetes in my district will die from diabetes 
complications.
  To help change this fact, I urge my colleagues to support this 
amendment.
  Mr. Chairman, may I inquire how much time I have remaining.
  The CHAIRMAN. The gentleman has 2 minutes remaining.
  Does any Member claim time in opposition to the amendment?
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I claim time in opposition 
to the amendment. I don't intend to oppose the amendment. I am just 
claiming the time.
  The CHAIRMAN. Without objection, the gentlewoman from Connecticut 
will control 5 minutes.
  There was no objection.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I think the gentleman's 
amendment points out why health information technology is so terribly 
important to making the next leap forward in quality that medical 
science has made available to us.
  It will take a lot more teaching of patients. It will take a much 
different relationship between nurses and medical personnel and 
patients to make sure that they have the guidance and support they need 
to prevent their disease from getting worse or to follow a regimen that 
will prevent their chronic illness from compromising their lives.

                              {time}  1430

  So this issue of communication is going to be a bigger issue in the 
next round of the American health care system even than it is today.
  But I would like to yield to the gentleman from Pennsylvania for some 
questions.
  Mr. MURPHY. I thank the gentlewoman, and I have a question for the 
distinguished gentleman from Texas just to help clarify this, because 
my assumption is the amendment would be one that would help those who 
have problems with illiteracy or language skills, perhaps English 
language is not of good grasp to them and they may be in a hospital 
where the staff may not be aware of that, and one of the importance of 
an electronic medical record is the files would be there on record. So 
even if the person had limited abilities, the doctor would have access. 
But I want to just ask a clarifying question to make sure this is what 
you meant by this amendment.
  By this, I am assuming it is not a matter that would impede in any 
way the doctor's ability to have information on record, that would have 
swift and high standards of medical care there, in no way would this 
impede; such as the records would have to be written in multiple 
languages for doctors who wouldn't necessarily understand that. I am 
assuming that is the case in this, that you are saying that the best 
interest of the patient is what you have in mind here so that the 
records are always available, that the doctor could understand them 
clearly even if the patient has difficulty communicating. Am I correct 
in that, sir?
  Mr. HINOJOSA. In my opinion, if the patient gives permission that 
that information be released, I have no problem with that.

[[Page H5996]]

  Mr. MURPHY. I am assuming that is what you meant. It is important 
that hospitals not see this as something that they, for example, have 
to constantly rewrite records in ways that would impair understanding 
between physicians as well. And along those lines, I think it is an 
excellent idea to provide it, because it does provide access of 
information for the doctors.
  Mr. HINOJOSA. If the gentleman will allow me to explain. I think that 
the intent of my amendment is to be able to acknowledge that there are 
people out there who can not get one of these new machines that we use 
now to measure the glucose, if I am a diabetic, and be able to take it 
and follow the instructions if they are limited English proficient, for 
example. In many cases, the lower the level of education attainment, 
the more difficult it is to use some of this modern equipment that is 
available in technology. And so the intent of Congress would be to 
address that group, regardless of the size, the percentage of people 
who need that extra assistance with the training necessary to use the 
modern equipment.
  Mr. MURPHY. Reclaiming my time, that makes sense, because I work with 
many patients who are disabled, who have literacy problems, and it is 
important that the medical community works to help those patients. I 
just want to make sure also the electronic medical records then serve 
both purposes, to help those patients, but certainly to make sure the 
primary aspects of having the medical records there electronically is 
to help doctors communicate quickly and swiftly with accurate data. 
Along those lines, I think it is an excellent idea.
  Mr. HINOJOSA. Mr. Chairman, I would like to hear Congresswoman Nancy 
Johnson's thoughts on being able to work with us on this amendment, 
because it is very important not only in South Texas, but throughout 
the country.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, we certainly are willing 
to accept the gentleman's amendment. It is a very thoughtful and 
important one.
  Mr. HINOJOSA. I thank the gentlewoman for accepting this amendment 
and working with me to eliminate the literacy barriers from our health 
care system.
  Mr. Chairman, I yield back the balance of my time.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield back the balance 
of my time.
  The CHAIRMAN. The question is on the amendment offered by the 
gentleman from Texas (Mr. Hinojosa).
  The amendment was agreed to.


                  Amendment No. 2 Offered by Mr. Towns

  The CHAIRMAN. It is now in order to consider amendment No. 2 printed 
in part C of House Report 109-603.
  Mr. TOWNS. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 2 offered by Mr. Towns:
       Add at the end of section 101 the following:
       (d) Study of Health Information Technology in Medically 
     Underserved Communities.--
       (1) Study.--The National Coordinator for Health Information 
     Technology shall conduct a study on the development and 
     implementation of health information technology in medically 
     underserved communities. The study shall--
       (A) identify barriers to successful implementation of 
     health information technology in these communities;
       (B) examine the impact of health information technology on 
     providing quality care and reducing the cost of care to these 
     communities;
       (C) examine urban and rural community health systems and 
     determine the impact that health information technology may 
     have on the capacity of primary health providers; and
       (D) assess the feasibility and the costs associated with 
     the use of health information technology in these 
     communities.
       (2) Report.--Not later than 18 months after the date of the 
     enactment of this Act, the National Coordinator shall submit 
     to Congress a report on the study conducted under paragraph 
     (1) and shall include in such report such recommendations for 
     legislation or administrative action as the Coordinator 
     determines appropriate.

  The CHAIRMAN. Pursuant to House Resolution 952, the gentleman from 
New York (Mr. Towns) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from New York.
  Mr. TOWNS. Mr. Chairman, I am really concerned that, in implementing 
any health information technology initiative, that we will not have the 
best information to address the needs of medically underserved areas. 
My amendment to H.R. 4157 creates a critically important study that 
would give us the benchmarks to use in implementing this technology in 
these communities, both urban and rural.
  First, the proposed study will examine and determine the impact of 
health information technology on improving the capacity of primary care 
providers in medically underserved communities.
  Second, the study would identify the barriers to the implementation 
of health information technology in these communities.
  Third, the study will assess the feasibility and costs associated 
with implementing health information technology in these communities.
  Some of the Nation's finest foundations have done tremendous work in 
how health information technology can be used in hard-to-reach and 
difficult areas to serve in our Nation. They include the Markle 
Foundation, the Robert Wood Johnson Foundation, and the Henry J. Kaiser 
Family Foundation. We want to incorporate this work and other's work 
done by the Agency For Health Care Research and Quality, and make sure 
it is applied to the development and implementation of health 
information technology and medically underserved areas.
  For these reasons, Mr. Speaker, I believe that this study is vital to 
the assessment, examination, and implementation of health information, 
technology in medically underserved areas in this Nation. And I do 
believe that my amendment adds considerable value to the health 
information technology bill. I have worked in a bipartisan fashion on 
this bill with Representative Ferguson of New Jersey to present the 
portion of the bill related to grants in medically underserved areas.
  Mr. Chairman, I do feel that this amendment strengthens this bill and 
is something that we really need to do if we want to reach the hard-to-
reach areas and to be able to have the kind of data and have the kind 
of information to give them quality health care.
  On that note, Mr. Chairman, I reserve the balance of my time.
  The CHAIRMAN. Who claims time in opposition?
  Mrs. JOHNSON of Connecticut. I rise to support this amendment.
  The CHAIRMAN. Does the gentlewoman claim time in opposition?
  Mrs. JOHNSON of Connecticut. I claim time in opposition.
  The CHAIRMAN. Without objection, the gentlewoman will control 5 
minutes.
  There was no objection.
  Mrs. JOHNSON of Connecticut. I claim time to say we accept the 
amendment. It is a very thoughtful amendment and an important one, and 
we thank the gentleman from New York (Mr. Towns).
  Mr. TOWNS. I want to thank the gentlewoman from Connecticut for 
supporting the amendment.
  Mr. Chairman, I yield back the balance of my time,
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield back the balance 
of my time.
  The CHAIRMAN. The question is on the amendment offered by the 
gentleman from New York (Mr. Towns).
  The question was taken; and the Chairman announced that the ayes 
appeared to have it.
  Mr. PALLONE. Mr. Chairman, I demand a recorded vote.
  The CHAIRMAN. Pursuant to clause 6 of rule XVIII, further proceedings 
on the amendment offered by the gentleman from New York will be 
postponed.


           Amendment No. 3 Offered by Mr. Jackson of Illinois

  The CHAIRMAN. It is now in order to consider amendment No. 3 printed 
in part C of House Report 109-603.
  Mr. JACKSON of Illinois. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 3 offered by Mr. Jackson of Illinois:
       In section 102, add at the end the following new paragraph:
       (5) Recommendations on the inclusion of emergency contact 
     or next-of-kin information (including name and phone number) 
     in interoperable electronic health records.


[[Page H5997]]


  The CHAIRMAN. Pursuant to House Resolution 952, the gentleman from 
Illinois (Mr. Jackson) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Illinois.
  Mr. JACKSON of Illinois. Mr. Chairman, my amendment simply states 
that emergency contact or next-of-kin information should be included in 
the interoperable electronic health records.
  Mr. Chairman, in an instant, a wrong turn, a sudden fall, a missed 
step, someone, indeed anyone, can find themselves in a crisis and in 
need of emergency medical care. Nationwide, nearly 1 million people 
arrive in emergency rooms each year unconscious or physically unable to 
give informed consent for their care.
  Consider the story of Elaine Sullivan. A very active 71-year-old 
woman, Elaine fell at home while trying to get into her bathtub. When 
paramedics arrived, she realized that injuries to her mouth and head 
made her unable to communicate and give informed consent for her own 
care. Although stable for the first few days, she began to slip into 
critical condition. The hospital failed to notify her family for 6 
days, and tragically Elaine Sullivan died alone in the hospital.
  In the aftermath of this tragedy, Elaine Sullivan's daughter, Jan, 
and granddaughter, Laura, turned their personal pain to public action. 
Jan and Laura Greenwald went to work to make sure that that never 
happened to their loved ones or anyone else's loved one again.
  In Elaine Sullivan's memory and honor, I introduced H.R. 2560 so that 
in the future phone calls to loved ones will always be made. This 
amendment, Mr. Chairman, which includes a provision of H.R. 2560, is a 
modest step to ensure that this situation doesn't happen again.
  Let me be clear. Most hospitals notify the next of kin of unconscious 
emergency room arrivals relatively quickly. However, emergency rooms 
are extremely high pressure and sometimes chaotic environments. In the 
hustle and bustle of the ER, despite the professionalism and the 
dedication of staff, there are real risks that a simple phone call may 
or may not be able to be made in a timely fashion.
  Consider for a moment just one distressing but relevant scenario. 
Your loved one is out of town on a business trip. On the way they are 
involved in a serious head-on collision, unconscious and unable to 
communicate. They are rushed to the nearest hospital, and unbeknownst 
to you they lie comatose fighting for their life miles from home. 
Doctors and nurses work feverishly to provide emergency medical care to 
a patient who is only the name on a license, but to you they are the 
love of your life.
  If your electronic health records contained emergency contact or 
next-of-kin information, this could help hospital staff quickly notify 
you about your loved one's condition. You could rush to be by their 
side and possibly share critical medical history and information. 
Emergency contact and next-of-kin information should be included in 
electronic medical records to ensure that family members are notified 
and informed decisions are made during a medical emergency.
  Mr. Chairman, I ask for an ``aye'' vote on the Jackson amendment.
  Mr. Chairman, I reserve the balance of my time.
  The CHAIRMAN. Does the gentlewoman from Connecticut claim the time in 
opposition?
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I rise in opposition.
  The CHAIRMAN. Without objection, the gentlewoman from Connecticut 
will control 5 minutes.
  There was no objection.
  Mrs. JOHNSON of Connecticut. First of all, the gentleman from 
Illinois has brought a very thoughtful amendment to this bill. The 
information that he wants included in electronic health record is 
extremely important information, and I support your amendment.
  Mr. JACKSON of Illinois. I thank the gentlewoman for supporting our 
amendment, Mr. Chairman.
  I yield back the balance of my time.
  The CHAIRMAN. The question is on the amendment offered by the 
gentleman from Illinois (Mr. Jackson).
  The amendment was agreed to.


                 Amendment No. 4 Offered by Mr. Cuellar

  The CHAIRMAN. It is now in order to consider amendment No. 4 printed 
in part C of House Report 109-603.
  Mr. CUELLAR. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 4 printed in House Report 109-603 offered by 
     Mr. Cuellar:
       In section 330M(d) of the Public Health Service Act, as 
     added by section 104 of the Bill, strike ``or'' at the end of 
     paragraph (1), strike the period at the end of paragraph (2) 
     and insert ``; or'', and add at the end the following new 
     paragraph:
       ``(3) if the project to be funded through such a grant will 
     emphasize the improvement of access to medical care and 
     medical care for medically underserved populations which are 
     geographically isolated or located in underserved urban 
     areas.''.

  The CHAIRMAN. Pursuant to House Resolution 952, the gentleman from 
Texas (Mr. Cuellar) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Texas.
  Mr. CUELLAR. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, my amendment to H.R. 4157 emphasizes the priority of 
funding grants which would improve access, coordination, and the 
provision of health care to the uninsured, underinsured, and medically 
underserved areas in both rural and urban areas in the State and in the 
country.
  This amendment will add priority antiquated health system grant 
proposals which improve medical care access and health care by way of 
health information technology to patients in underserved rural and 
urban areas. In my district, which encompasses both rural and urban 
areas, I have seen the need for health IT to promote better health care 
and accessibility.
  In some of my rural counties, citizens are faced with few health care 
options and in many cases, are forced to travel great distances to see 
doctors, specialists, and go to a hospital or care facility which can 
address their individual health needs. In my hometown of Laredo, Texas, 
a major South Texas urban area, there is a great need for health IT to 
better coordinate and provide the care to the uninsured and 
underinsured, and of course, the underserved patients.
  Citizens in America's remote and rural isolated areas and urban 
areas, which often lack sufficient medical services, face very 
difficult challenges to access quality health care and treatment. New 
health information technology, including the health IT to be funded by 
grants to be integrated with the health care systems, and this 
particular bill, a bill that I support, lays the essential groundwork 
for a new era of sensibility and quality health care that all Americans 
deserve regardless of where they call home.
  Mr. Chairman, I ask for favorable consideration of my amendment, and 
I believe this amendment is acceptable to Mrs. Johnson.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I rise in support of the 
amendment. I understand there are some technical adjustments that your 
staff and our staff talked about that we will work on.
  Mr. CUELLAR. And I will work with your staff in conference committee 
to address those technical points. I am in agreement with that. I 
believe my staff has been working with your staff.
  Mrs. JOHNSON of Connecticut. With that understanding, I am pleased to 
support the gentleman's amendment.
  Mr. CUELLAR. I thank the gentlewoman.
  Mr. Chairman, I yield back the balance of my time.
  The CHAIRMAN. Does any Member claim time in opposition to the 
amendment?
  The question is on the amendment offered by the gentleman from Texas 
(Mr. Cuellar).
  The amendment was agreed to.

                              {time}  1445


            Amendment No. 5 Offered by Mr. Price of Georgia

  The CHAIRMAN. It is now in order to consider amendment No. 5 printed 
in part C of House Report 109-603.
  Mr. PRICE of Georgia. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 5 offered by Mr. Price of Georgia:

[[Page H5998]]

       Add at the end of title II the following new section:

     SEC. 206. REPORT ON APPROPRIATENESS OF CLASSIFICATION 
                   METHODOLOGIES AND CODES FOR ADDITIONAL 
                   PURPOSES.

       Not later than the date that is 180 days after the date of 
     the enactment of this Act, the Secretary of Health and Human 
     Services shall submit to Congress a report that evaluates--
       (1) the applicability of health care classification 
     methodologies and codes for purposes beyond the coding of 
     services for diagnostic documentation or billing purposes;
       (2) the usefulness, accuracy, and completeness of such 
     methodologies and codes for such purposes; and
       (3) the capacity of such methodologies and codes to produce 
     erroneous or misleading information, with respect to such 
     purposes.

  The CHAIRMAN. Pursuant to House Resolution 952, the gentleman from 
Georgia (Mr. Price) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Georgia.
  Mr. PRICE of Georgia. Mr. Chairman, I yield myself such time as I may 
consume.
  (Mr. PRICE of Georgia asked and was given permission to revise and 
extend his remarks.)
  Mr. PRICE of Georgia. Mr. Chairman, I rise to thank both the chairman 
of the committee and Chairman Dreier and the Rules Committee members.
  As a physician, I know the importance of having appropriate 
information available in order to make quality health care decisions, 
and I am cautiously optimistic about the prospects in that portion of 
the bill.
  My amendment addresses section 203, the area of the bill that seeks 
to upgrade the ICD codes.
  ICD, or international classification of diseases, codes are 
diagnostic codes, series of letters and numbers that identify with some 
specificity the various diseases or conditions for which a patient is 
being treated.
  ICD codes can be very useful in tracking various patients with 
similar conditions. They may be helpful in research that may aid in the 
future treatment of patients with the same disease.
  ICD codes are diagnostic codes. They were intended to be used to 
identify as accurately as possible the diagnosis that a particular 
patient has.
  ICD codes were not designed to be used for anything beyond 
documentation of a diagnosis.
  However, they are being used, in combination with other codes, 
particularly CPT or billing codes, to evaluate various kinds of 
treatment and whether that treatment is appropriate or efficient or of 
quality.
  There are many people who are providing health care for our citizens, 
who are taking care of our families, who have significant reservations 
regarding the use of those codes for purposes for which they were never 
designed.
  It is possible that the use of these codes for other needs may, in 
fact, result in conclusions that are at best misleading, and worse, 
incorrect, thereby having the possible outcome of harming the treatment 
of future patients.
  Consequently, my amendment calls for a report from the Secretary of 
Health and Human Services to Congress that would determine the 
applicability, usefulness, accuracy and completeness of the use of 
these codes.
  It also asks for information on the capacity of the use of these 
codes to produce erroneous or misleading information.
  Science relies on the accuracy of information in order to make 
correct judgments, determinations and decisions on how one should 
proceed. We here in Congress should do no less.
  The consequences of our decisions can be significant, and it is 
imperative that we have accurate data upon which to make those 
decisions. The information that will result from this amendment will 
allow us to make those decisions with greater confidence in their 
benefit to our constituents.
  I ask my colleagues for their support in assisting us in gaining 
greater insight into this important matter. I ask for their support on 
this amendment.
  Mr. Chairman, I reserve the balance of my time.
  The CHAIRMAN. Does any Member claim the time in opposition to the 
amendment?
  Mrs. JOHNSON of Connecticut. Yes, I claim time in opposition to the 
amendment. Although I do not oppose the amendment, I would like to 
comment.
  The CHAIRMAN. Without objection, the gentlewoman from Connecticut 
will control the time.
  There was no objection.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield myself such time 
as I may consume.
  I would like to comment on the amendment. Mr. Price has been a very 
active and fine mind as we developed this bill, and I welcome his 
amendment.
  I do think we need to evaluate new methodologies and procedures very 
carefully; and as a physician, he brings to this issue a lot of 
information and a lot of concern about both advances and also problems 
that could develop.
  I will say one of the strengths of the bill that has not been talked 
about on the floor here today is that it does move us to the ICD 10 
system from the ICD 9 system, and that will give us a great deal more 
ability to look at quality, to judge quality, to pay for quality, to 
analyze actually what series of symptoms responded best to precisely 
what treatment approach.
  But there are also shoals in every water, and I think your study is 
very appropriate. The ICD 10 system is now not only more glandular, but 
we also think it will help us to reduce fraud and abuse. But no matter 
how many positive things we think it will contribute, it is also wise 
to know and watch for and evaluate whether or not it is creating 
problems that we did not anticipate.
  So I welcome this study, and I thank Mr. Price for his contribution.
  Mr. Chairman, I yield back the balance of my time.
  Mr. PRICE of Georgia. Mr. Chairman, I yield myself such time as I may 
consume.
  I appreciate those comments, and I would agree, I think it is 
important that we move forward with a more specific ICD coding system. 
ICD 10 will do that, and hopefully it will be adopted in a timely 
fashion.
  This report will be back prior to the installation of those new 
codes, and so I look forward to seeing the results of this report and 
hopefully making some recommendation at that time, and urge my 
colleagues to support this amendment.
  Mr. Chairman, I yield back the balance of my time.
  The CHAIRMAN. The question is on the amendment offered by the 
gentleman from Georgia (Mr. Price).
  The amendment was agreed to.


                Amendment No. 6 Offered by Miss McMorris

  The CHAIRMAN. It is now in order to consider amendment No. 6 printed 
in part C of House Report 109-603.
  Miss McMORRIS. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 6 offered by Miss McMorris:
       At the end of title IV, insert the following new section:

     SEC. 409. PROMOTING HEALTH INFORMATION TECHNOLOGY AS A TOOL 
                   FOR CHRONIC DISEASE MANAGEMENT.

       (a) In General.--The Secretary of Health and Human Services 
     shall establish a two-year project to demonstrate the impact 
     of health information technology on disease management for 
     individuals entitled to medical assistance under a State plan 
     under title XIX of the Social Security Act.
       (b) Structure of Project.--The project under subsection (a) 
     shall--
       (1) create a web-based virtual case management tool that 
     provides access to best practices for managing chronic 
     disease; and
       (2) provide chronic disease patients and caregivers access 
     to their own medical records and to a single source of 
     information on chronic disease.
       (c) Competition.--Not later than the date that is 90 days 
     after the date of the enactment of this Act, the Secretary of 
     Health and Human Services shall seek proposals from States to 
     carry out the project under subsection (a). The Secretary 
     shall select not less than four of such proposals submitted, 
     and at least one proposal selected shall include a regional 
     approach that features access to an integrated hospital 
     information system in at least two adjoining States and that 
     permits the measurement of health outcomes.
       (d) Report.--Not later than the date that is 90 days after 
     the last day of the project under subsection (a), the 
     Secretary of Health and Human Services shall submit to 
     Congress a report on such project and shall include in such 
     report the amount of any cost-savings resulting from the 
     project and such recommendations for legislation or 
     administrative action as the Secretary determines 
     appropriate.

  The CHAIRMAN. Pursuant to House Resolution 952, the gentlewoman from

[[Page H5999]]

Washington (Miss McMorris) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Washington.
  Miss McMORRIS. Mr. Chairman, I yield myself as much time as I may 
consume.
  I rise to offer the McMorris-Smith MAP IT amendment, the Medicaid 
Access Project through Information Technology proposal. This amendment 
is supported by the Healthcare Information and Management Systems, the 
Society Information Technology Industry Council, the American Health 
Information Management Association, the American Hospital Association, 
the Federation of American Hospitals, the American Medical Association, 
and the U.S. Chamber of Commerce.
  The McMorris-Smith amendment and the underlying bill will help 
fulfill President Bush's goal of most Americans having an electronic 
health record by the year 2014.
  I am pleased to offer this bipartisan amendment which strengthens the 
Health Information Technology Promotion Act and its goal of encouraging 
the adoption of health information technology into our health care 
system. As I have traveled throughout eastern Washington, I have seen 
the need for health information technology and the potential that it 
has not just to improve health care delivery but also save costs.
  Information technology has the power to revolutionize the delivery of 
health care. This bill is a first step toward encouraging the 
utilization of health IT on a national level, and I applaud the efforts 
of Chairman Deal and Chairman Johnson for leading this effort.
  This bill represents collaboration between health care providers, 
payers, patient advocates and the IT community and will pave the way 
for better access to quality health care for Americans.
  As we move forward to set these new standards in place, it is crucial 
that we take steps to include health information technology in 
government-funded health programs like Medicare and Medicaid. Health 
information technology will increase effectiveness, efficiency, overall 
quality, and promote cost savings in the long run.
  This amendment strengthens the underlying bill by incorporating a 
Web-based tool to manage chronic disease populations within Medicaid. 
This provision will allow for the creation of a virtual case management 
program that provides patients and providers access to a real-time 
electronic medical record. We need to seriously study the effects of 
using health IT to better serve patients and taxpayers.
  Modest estimates show that medical errors cause around 400,000 
avoidable injuries and fatalities annually and more than 800,000 in 
elderly care centers and over a half a million befall Medicare patients 
in outpatient care. The cost incurred from correcting and treating 
medication-related errors occurring in hospitals, not counting doctors' 
offices and other facilities, was projected to be at least $3.5 billion 
annually. These staggering numbers can and should change.
  The United States spends more than 2\1/2\ times any other country on 
health care. We need to ensure that we are maximizing our resources and 
getting a high return on our investment. A study published in August of 
2005 by the Institute for Public Policy and Economic Analysis at 
Eastern Washington University found that for every dollar spent on a 
technology-enabled disease management program, it provided up to $10 in 
medical savings and even more in terms of nonmedical cost savings. At a 
time when most States are facing increased taxes or cutting Medicaid 
benefits, increasing outcomes and cutting costs is a win-win situation.
  The McMorris-Smith amendment would allow us to more fully study the 
cost savings and patient benefits of utilizing health information 
technology within one of Medicaid's most costly populations, chronic 
disease sufferers. Any piece of comprehensive health information 
technology legislation must help address the cost and care of this 
population that consumes 80 percent of the Medicaid resources, yet that 
is just 20 percent of the Medicaid population.
  We can address this issue. This amendment takes savings and quality 
theories and provides a vehicle for practical application now.
  Thank you for your consideration. I urge Members to adopt the 
McMorris-Smith amendment and support the underlying bill.
  Mr. Chairman, I reserve the balance of my time.
  The CHAIRMAN. Who claims time in opposition to the amendment?
  Mr. SMITH of Washington. Mr. Chairman, I am not in opposition to the 
amendment, but I would claim the time unless somebody is.
  The CHAIRMAN. Without objection, the gentleman from Washington will 
control the time in opposition.
  There was no objection.
  Mr. SMITH of Washington. Mr. Chairman, I yield to myself as much time 
as I may consume.
  I want to thank Representative McMorris for her leadership on this 
bipartisan issue.
  This amendment really gets at the heart of why health care 
information technology is important in the first place, and there are 
really two big reasons. Number one, it can significantly improve the 
quality of care for patients; and, number two, it can significantly 
reduce health care inflation. Right now, if you want to do anything to 
improve the quality of health care in this country getting inflation 
under control is job one so that people can access that.
  That is what health care information technology has the promise to 
do; and this amendment, in particular, focuses on one aspect of it 
where it could really reduce the costs and improve the quality of care, 
helping a specific class of patients get the best information possible 
for the best disease management possible.
  All across the world, information is being developed even as we sit 
here on how to better deal with all kinds of different diseases. But 
how do we make sure that both patients and providers have real-time 
access to that best information and employ it? That is what this 
amendment aims to do. For diabetes patients with Medicaid, it can give 
us a real case example of how we can save money and improve the quality 
of care for these patients.
  I think there is unbelievable potential if we have the best 
information possible. Too often now patients do not know what the best 
care is. Too often providers do not even know at the moment what the 
best care is; and as a consequence, they do not get it and the patients 
do not receive it. Health care quality goes down and costs go up, as 
procedures are either repeated or the wrong procedures are done.
  This amendment gives us a great opportunity to do an isolated case 
study on how to make this work in disease management to improve the 
quality of care and get costs under control.
  Mr. Chairman, I reserve the balance of my time.
  Miss McMORRIS. Mr. Chairman, I yield 30 seconds to the gentleman from 
Pennsylvania (Mr. Murphy), my friend.
  Mr. MURPHY. Mr. Chairman, I thank the gentlewoman for putting this 
important amendment in.
  Previously, it has been cited that the CBO report did not show a 
savings. Let me mention three things that chronic care management does. 
300,000 asthmatic children were studied with chronic care and found 
that lowered rehospitalization by 34 percent. University of Pittsburgh 
Medical Center reduced rehospitalization of diabetics by 75 percent. 
Washington Hospital, Washington, PA, reduced rehospitalization of 
chronic heart disease by 50 percent.
  I suggest the CBO look at how electronic medical records can save 
money in this.
  I have listed a lot of these things in a report entitled, ``Critical 
Condition, the State of the Union's Health Care,'' which I have 
available at my Web site; and I urge my colleagues to look at that, and 
I urge the CBO to read it as well. They might learn something.
  Mr. SMITH of Washington. Mr. Chairman, I yield 1 minute to the 
gentlewoman from Illinois (Ms. Bean).
  Ms. BEAN. Mr. Chairman, I rise in strong support of this Smith-
McMorris amendment to establish a 2-year health IT demonstration 
project for Medicaid patients with chronic diseases.
  This bill is a step in the right direction, but the Smith-McMorris 
amendment would actually speed the implementation of health IT in a 
crucial and tangible way. It will not only improve efficiency and 
quality, but will also

[[Page H6000]]

help control the growing costs for Medicaid patients with chronic 
health conditions.
  Mr. Chairman, these patients often have complex medical conditions, 
relying on multiple doctors and numerous medications.
  This amendment would put patients in better control of their medical 
information, provide improved access and more information for 
caregivers, and create a Web-based resource to promote best practices 
for chronic care management.
  Mr. Chairman, the need for health IT is well established and will 
both save lives and billions of dollars. This body talks often about 
the need to improve quality of care and reduce inefficient spending 
under Medicaid. The Smith-McMorris amendment promises us an opportunity 
to move beyond rhetoric and actually better care and more responsible 
return on our tax dollars.

                              {time}  1500

  Mr. SMITH of Washington. Mr. Chairman, may I inquire how much time I 
have left.
  The CHAIRMAN. The gentleman has 2\1/2\ minutes remaining.
  Mr. SMITH of Washington. Mr. Chairman, I yield myself 15 seconds to 
close and to once again thank Representative McMorris and to point out 
how important chronic disease management is in saving money. This is an 
outstanding opportunity for us to use technology to do that, and I urge 
adoption of the amendment.
  Mr. Chairman, I yield the balance of my time to Representative 
McMorris.
  Miss McMORRIS. Mr. Chairman, I yield my good friend from South 
Carolina (Mr. Wilson) 1 minute.
  Mr. WILSON of South Carolina. I want to congratulate Congresswoman 
McMorris on her leadership with Congressman Smith on this issue.
  As a person who has a son who is a doctor in California, I am very 
grateful to be here and support the amendment, which will create a Web-
based virtual case management tool that provides access to the best 
practices for managing chronic disease.
  Additionally, this amendment would provide for chronic disease 
patients and caregivers to have access to their own medical records and 
to a single source of information on chronic disease.
  Further, it directs the Secretary to select at least four proposals 
from those submitted by States and at least one proposal selected to 
include a regional approach featuring access to an integrated hospital 
information system in at least two adjoining States that permits the 
measurement of outcomes.
  I know personally that our family has benefited from the best of 
health care. One of our sons has been a cancer survivor. And I just 
want to congratulate, again, Congresswoman McMorris on her leadership; 
and I urge adoption of the amendment.
  Miss McMORRIS. Mr. Chairman, may I inquire as to how much time 
remains.
  The CHAIRMAN. The gentlewoman has 1\3/4\ minutes remaining.
  Miss McMORRIS. Mr. Chairman, I yield 1 minute to my good friend from 
Georgia (Mr. Gingrey).
  Mr. GINGREY. Mr. Chairman, I am very happy to rise in support of the 
amendment of the gentlewoman from Washington. A little disappointed my 
own great amendments were not made in order but very happy to support 
hers.
  As a physician, having practiced 30 years of clinical medicine, there 
is no question that the cost of chronic disease management is the most 
costly, and particularly under Medicaid. I think the gentlewoman has 
the exact right idea, to be able to monitor this information on a real-
time basis so that physicians know exactly what they are spending and 
what is cost effective.
  I was very happy as a member of the Rules Committee to recommend her 
amendment be made in order. Thank goodness it was, and I proudly stand 
here today to recommend this amendment to all of my colleagues on both 
sides of the aisle. I commend her for the good job she has done.
  Miss McMORRIS. Mr. Chairman, I yield to the great chairman of the 
subcommittee who, without her support, we would not be having this 
amendment before us today.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, I rise in strong support 
of this amendment. First of all, of all the systems in America that 
really need this kind of attention, it is our Medicaid system because 
they deal mostly with elderly and poor whose health has long been 
neglected.
  So I know this is going to give us a lot of very good insight and 
information into how we can both improve the quality and reduce the 
cost of care in our Medicaid system, and I congratulate the gentlewoman 
and her cosponsors for bringing this before us today.
  Miss McMORRIS. Mr. Chairman. I yield back the balance of my time.
  The CHAIRMAN. The question is on the amendment offered by the 
gentlewoman from Washington (Miss McMorris).
  The amendment was agreed to.


                  Amendment No. 2 Offered by Mr. Towns

  The CHAIRMAN. Pursuant to clause 6 of rule XVIII, the pending 
business is the demand for a recorded vote on the amendment offered by 
the gentleman from New York (Mr. Towns) on which further proceedings 
were postponed and on which the ayes prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The CHAIRMAN. A recorded vote has been demanded.
  A recorded vote was ordered.
  The vote was taken by electronic device, and there were--ayes 417, 
noes 1, not voting 14, as follows:

                             [Roll No. 414]

                               AYES--417

     Abercrombie
     Ackerman
     Aderholt
     Akin
     Alexander
     Allen
     Andrews
     Baca
     Bachus
     Baird
     Baker
     Baldwin
     Barrett (SC)
     Barrow
     Bartlett (MD)
     Barton (TX)
     Bass
     Bean
     Beauprez
     Becerra
     Berkley
     Berman
     Berry
     Biggert
     Bilbray
     Bilirakis
     Bishop (GA)
     Bishop (NY)
     Bishop (UT)
     Blackburn
     Blumenauer
     Blunt
     Boehlert
     Boehner
     Bonilla
     Bonner
     Bono
     Boozman
     Boren
     Boswell
     Boucher
     Boustany
     Boyd
     Bradley (NH)
     Brady (PA)
     Brady (TX)
     Brown (OH)
     Brown (SC)
     Brown, Corrine
     Brown-Waite, Ginny
     Burgess
     Burton (IN)
     Butterfield
     Buyer
     Calvert
     Camp (MI)
     Campbell (CA)
     Cannon
     Cantor
     Capito
     Capps
     Capuano
     Cardin
     Cardoza
     Carnahan
     Carson
     Carter
     Case
     Castle
     Chabot
     Chandler
     Chocola
     Clay
     Cleaver
     Coble
     Cole (OK)
     Conaway
     Conyers
     Cooper
     Costa
     Costello
     Cramer
     Crenshaw
     Cuellar
     Culberson
     Cummings
     Davis (AL)
     Davis (CA)
     Davis (FL)
     Davis (IL)
     Davis (KY)
     Davis (TN)
     Davis, Tom
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Dent
     Diaz-Balart, L.
     Diaz-Balart, M.
     Dicks
     Dingell
     Doggett
     Doolittle
     Doyle
     Drake
     Dreier
     Duncan
     Edwards
     Ehlers
     Emanuel
     Emerson
     Engel
     English (PA)
     Eshoo
     Etheridge
     Farr
     Fattah
     Feeney
     Ferguson
     Filner
     Fitzpatrick (PA)
     Flake
     Foley
     Forbes
     Ford
     Fortenberry
     Foxx
     Frank (MA)
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Garrett (NJ)
     Gerlach
     Gibbons
     Gilchrest
     Gillmor
     Gingrey
     Gohmert
     Gonzalez
     Goode
     Goodlatte
     Gordon
     Granger
     Graves
     Green (WI)
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Gutknecht
     Hall
     Harman
     Harris
     Hart
     Hastings (FL)
     Hastings (WA)
     Hayes
     Hayworth
     Hefley
     Hensarling
     Herger
     Herseth
     Higgins
     Hinchey
     Hinojosa
     Hobson
     Hoekstra
     Holden
     Honda
     Hooley
     Hostettler
     Hoyer
     Hulshof
     Hunter
     Hyde
     Inglis (SC)
     Inslee
     Israel
     Issa
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Jenkins
     Jindal
     Johnson (CT)
     Johnson (IL)
     Johnson, E. B.
     Johnson, Sam
     Jones (NC)
     Jones (OH)
     Kanjorski
     Kaptur
     Keller
     Kelly
     Kennedy (MN)
     Kennedy (RI)
     Kildee
     Kilpatrick (MI)
     Kind
     King (IA)
     King (NY)
     Kingston
     Kirk
     Kline
     Knollenberg
     Kolbe
     Kucinich
     Kuhl (NY)
     LaHood
     Langevin
     Lantos
     Larsen (WA)
     Larson (CT)
     Latham
     LaTourette
     Leach
     Lee
     Levin
     Lewis (CA)
     Lewis (KY)
     Linder
     Lipinski
     LoBiondo
     Lofgren, Zoe
     Lowey
     Lucas
     Lungren, Daniel E.
     Lynch
     Mack
     Maloney
     Manzullo
     Marchant
     Markey
     Marshall
     Matheson
     Matsui
     McCarthy
     McCaul (TX)
     McCollum (MN)
     McCotter
     McCrery
     McDermott
     McGovern
     McHenry
     McHugh
     McIntyre
     McKeon
     McMorris
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Melancon
     Mica
     Michaud
     Miller (FL)
     Miller (MI)
     Miller (NC)
     Miller, Gary
     Miller, George
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (KS)
     Moran (VA)
     Murphy
     Murtha
     Musgrave
     Myrick
     Nadler
     Napolitano
     Neal (MA)
     Neugebauer
     Ney
     Northup
     Norwood
     Nunes
     Nussle
     Oberstar
     Obey
     Olver
     Ortiz
     Osborne
     Otter

[[Page H6001]]


     Owens
     Oxley
     Pallone
     Pascrell
     Pastor
     Payne
     Pearce
     Pelosi
     Pence
     Peterson (MN)
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Platts
     Poe
     Pombo
     Pomeroy
     Porter
     Price (GA)
     Price (NC)
     Pryce (OH)
     Putnam
     Radanovich
     Rahall
     Ramstad
     Rangel
     Regula
     Rehberg
     Reichert
     Renzi
     Reyes
     Reynolds
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Ros-Lehtinen
     Ross
     Rothman
     Roybal-Allard
     Royce
     Ruppersberger
     Rush
     Ryan (OH)
     Ryan (WI)
     Ryun (KS)
     Sabo
     Salazar
     Sanchez, Linda T.
     Sanchez, Loretta
     Sanders
     Saxton
     Schakowsky
     Schiff
     Schmidt
     Schwartz (PA)
     Schwarz (MI)
     Scott (GA)
     Scott (VA)
     Sensenbrenner
     Serrano
     Sessions
     Shadegg
     Shaw
     Shays
     Sherman
     Sherwood
     Shimkus
     Shuster
     Simmons
     Simpson
     Skelton
     Slaughter
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Snyder
     Sodrel
     Solis
     Souder
     Spratt
     Stark
     Stearns
     Strickland
     Stupak
     Sullivan
     Sweeney
     Tancredo
     Tanner
     Tauscher
     Taylor (MS)
     Taylor (NC)
     Terry
     Thomas
     Thompson (CA)
     Thompson (MS)
     Thornberry
     Tiahrt
     Tiberi
     Tierney
     Towns
     Turner
     Udall (CO)
     Udall (NM)
     Upton
     Van Hollen
     Velazquez
     Visclosky
     Walden (OR)
     Walsh
     Wamp
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Weldon (FL)
     Weldon (PA)
     Weller
     Westmoreland
     Whitfield
     Wicker
     Wilson (NM)
     Wilson (SC)
     Wolf
     Woolsey
     Wu
     Wynn
     Young (AK)
     Young (FL)

                                NOES--1

       
     Paul
       

                             NOT VOTING--14

     Clyburn
     Crowley
     Cubin
     Davis, Jo Ann
     Deal (GA)
     Evans
     Everett
     Fossella
     Holt
     Istook
     Lewis (GA)
     McKinney
     Millender-McDonald
     Wexler

                              {time}  1529

  Messrs. WELDON of Florida, CUMMINGS, and INSLEE changed their vote 
from ``no'' to ``aye.''
  So the amendment was agreed to.
  The result of the vote was announced as above recorded.
  The CHAIRMAN. Under the rule, the Committee rises.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Feeney) having assumed the chair, Mr. Simpson, Chairman of the 
Committee of the Whole House on the State of the Union, reported that 
that Committee, having had under consideration the bill (H.R. 4157) to 
amend the Social Security Act to encourage the dissemination, security, 
confidentiality, and usefulness of health information technology, 
pursuant to House Resolution 952, he reported the bill, as amended 
pursuant to that rule, back to the House with further sundry amendments 
adopted by the Committee of the Whole.
  The SPEAKER pro tempore. Under the rule, the previous question is 
ordered.
  Is a separate vote demanded on any amendment? If not, the Chair will 
put them en gros.
  The amendments were agreed to.
  The SPEAKER pro tempore. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.


               Motion to Recommit Offered by Mr. Doggett

  Mr. DOGGETT. Mr. Speaker, I have a motion to recommit at the desk.
  The SPEAKER pro tempore. Is the gentlemen opposed to the bill?
  Mr. DOGGETT. I certainly am, Mr. Speaker.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:

       Mr. Doggett moves to recommit the bill H.R. 4157 to the 
     Committees on Energy and Commerce and Ways and Means with 
     instructions to report the same back to the House forthwith 
     with the following amendment:
       Amend section 205 to read as follows:

     SEC. 205. PRIVACY AND SECURITY PROTECTIONS.

       (a) In General.--The Secretary of Health and Human Services 
     shall provide for standards for health information technology 
     (as such term is used in this Act) that include the following 
     privacy and security protections:
       (1) Except as provided in succeeding paragraphs, each 
     entity must--
       (A) expressly recognize the individual's right to privacy 
     and security with respect to the electronic disclosure of 
     such information;
       (B) permit individuals to exercise their right to privacy 
     and security in the electronic disclosure of such information 
     to another entity by obtaining the individual's written or 
     electronic informed consent, which consent may authorize 
     multiple disclosures; and
       (C) permit an individual to prohibit access to certain 
     categories of individuals (as defined by the Secretary) of 
     particularly sensitive information, including data relating 
     to infection with the human immunodeficiency virus (HIV), to 
     mental health, to sexually transmitted diseases, to 
     reproductive health, to domestic violence, to substance abuse 
     treatment, to genetic testing or information, to diabetes, 
     and other information as defined by the Secretary after 
     consent has been provided under subparagraph (B).
       (2) Informed consent may be inferred, in the absence of a 
     contrary indication by the individual--
       (A) to the extent necessary to provide treatment and obtain 
     payment for health care in emergency situations;
       (B) to the extent necessary to provide treatment and 
     payment where the health care provider is required by law to 
     treat the individual;
       (C) if the health care provider is unable to obtain consent 
     due to substantial barriers to communicating with the 
     individual and the provider reasonably infers from the 
     circumstances, based upon the exercise of professional 
     judgment, that the individual does not object to the 
     disclosure or that the disclosure is in the best interest of 
     the individual; and
       (D) to the extent that the information is necessary to 
     carry out or otherwise implement a medical practitioner's 
     order or prescription for health services, medical devices or 
     supplies, or pharmaceuticals.
       (3) The protections must prohibit the improper use and 
     disclosure of individually identifiable health information by 
     any entity.
       (4) The protections must provide any individual a right to 
     obtain damages and other relief against any entity for the 
     entity's improper use or disclosure of individually 
     identifiable health information.
       (5) The protections must require the use of reasonable 
     safeguards, including audit capabilities, encryption and 
     other technologies that make data unusable to unauthorized 
     persons, and other measures, against the risk of loss or 
     unauthorized access, destruction, use, modification, or 
     disclosure of individually identifiable health information.
       (6) The protections must provide for notification to any 
     individual whose individually identifiable health information 
     has been lost, stolen, or used for an unauthorized purpose by 
     the entity responsible for the information and notification 
     by the entity to the Secretary.
       (b) List of Entities.--The Secretary shall maintain a 
     public list identifying entities whose health information has 
     been lost, stolen, or used in an unauthorized purpose as 
     described in subsection (a)(6) and how many patients were 
     affected by such action.
       (c) Construction.--Nothing in this section shall be 
     construed as superseding, altering, or affecting (in whole or 
     in part) any statute, regulation, order, or interpretation in 
     effect in any State that affords any person privacy and 
     security protections greater than that the privacy and 
     security protections described in subsection (a), as 
     determined by the Secretary.

  Mr. DOGGETT (during the reading). Mr. Speaker, I ask unanimous 
consent that the motion to recommit be considered as read and printed 
in the Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  The SPEAKER pro tempore. The gentleman is recognized for 5 minutes.
  Mr. DOGGETT. Mr. Speaker, this is an important motion for a modest 
bill. It leaves this bill with an opportunity to move forward today 
with just one important change, and that is the addition of vital 
personal privacy protection of what should be genuinely personal 
medical records.
  In my youth, there was a popular song called ``I Heard it Through the 
Grapevine.'' These days, it's ``I saw it on the Internet.'' In this 
busy world of busy bodies and identity theft and commercial snooping, I 
believe what a patient confides to a physician about an ailment, what a 
young couple tells a psychologist about their marriage, what 
prescription a pharmacist provides, that highly personal information 
should not be spread and read on the Internet.
  The consequences of unwanted disclosure of personal health 
information is more than embarrassment or humiliation. It may mean the 
loss of a job or a promotion. It may mean that an individual refuses to 
confide necessary information to their doctor or avoids health care and 
critical medical tests because of fear that the information will be 
disclosed without her consent.
  This Administration has shown little interest in personal privacy, 
whether it was the privacy of library records or phone conversations or 
veterans' records.

[[Page H6002]]

  The Federal Government scored a D-plus on the 2005 Computer Security 
Report Card, with the Departments of Health and Human Services, 
Veterans Affairs, and Homeland Security scoring an F. And the 
Administration's record on health care privacy is even worse. As the 
Post disclosed last month, there have been 19,420 complaints during the 
Bush Administration about privacy violations. There have, during this 
Administration, been almost 20,000 complaints about invasions of 
privacy with medical records, and all of that has not resulted in a 
single civil fine anywhere in this country under the protections that 
are available there, and only two criminal cases out of that 20,000.
  This is not an adequate performance, and that is why Dr. Deborah 
Peel, one of my Texas neighbors, and a host of professional and public 
health organizations have urged us to adopt meaningful privacy 
protections in this bill.
  Mr. Speaker, I yield 1 minute to the gentleman from Rhode Island (Mr. 
Kennedy), who has been such an advocate on this.
  Mr. KENNEDY of Rhode Island. Mr. Speaker, I want to ask a few 
questions to my colleagues about this privacy law.
  Do you think it should be a violation of Federal health privacy law 
to be able to hack into an electronic database for health information? 
I think it should be against the law. But it is not against the law.
  If a hospital employee accesses your health record, for example, for 
a famous movie star and sells it to a tabloid, do you think that is 
wrong? Well, that is not against the law now. If you can allow a 
hospital information to be accessible through an information network, 
this is now permissible.
  All of these things are permissible under the HIPAA law. And if you 
do not like that, you are going to hate what this bill does to HIPAA, 
which is going to magnify it 100 times. There is going to be no 
protection for privacy whatsoever.
  And that is why I ask all of you to join us in the motion to 
recommit. Your constituents will thank you for it if you vote for the 
motion to recommit.
  Mr. DOGGETT. Mr. Speaker, I thank the gentleman, and I yield the 
balance of my time to the gentleman from Massachusetts (Mr. Markey), 
who has led the way on privacy issues across this country.
  Mr. MARKEY. Mr. Speaker, I thank the gentleman from Texas for his 
leadership on this issue.
  There is no privacy protection in this bill. We are about to move to 
an era where all of your drug records, all of your psychiatric records, 
all of your children's medical records are going online. William Butler 
Yeats, the great Irish poet, said that in dreams begin responsibility. 
We have a responsibility to have privacy protections built into this 
bill.
  What do the Republicans say? They say trust the Department of Health 
and Human Services. This year Tom Davis, the Government Reform 
Committee, gave a grade to all agencies in the protection of privacy. 
Do you know what grade Tom Davis and your Government Reform Committee 
gave to the Department of Health and Human Services? An F. Now, that is 
Medicare and Medicaid. That is one quarter of all Americans. Now we are 
taking all private citizens as well and the Republicans are saying 
``trust the Department of Health and Human Services.''
  What our motion to recommit says is that every American has the right 
to say that their children's medical records do not have to be put 
online; that everyone does not have to know about it; that they have a 
right to say no, they don't want those records online; that each family 
can make that decision for themselves.
  Vote ``aye'' on the Doggett motion to recommit.
  Mr. BARTON of Texas. Mr. Speaker, I rise in opposition to the motion 
to recommit.
  The SPEAKER pro tempore. The gentleman from Texas is recognized for 5 
minutes.
  Mr. BARTON of Texas. Mr. Speaker, I want to compliment my good 
friends who have spoken on this motion to recommit. I know all three of 
the gentlemen, and they are fine fellows and fine public servants and 
believe passionately in what they speak of. If I were a doctor on this 
debate, I believe I would have to recommend they take a Valium and just 
calm down. We do not get this fixed if there is a problem.
  Whatever the law is today on medical record privacy, the law is going 
to be tomorrow on medical record privacy. Nothing in this bill changes 
that. This is a health information technology bill. We are actually 
trying to get medical records in our country, the greatest Nation the 
world has ever known, to use technology that many other industries and 
many other groups have already incorporated into their daily business 
routine.
  Now, there is an ongoing study at HHS on privacy. They have received 
over 50,000 public comments so far. This bill before us, if it becomes 
law, has an implementation period. There is going to be adequate time 
to come back, if we need to, with a specific medical technology privacy 
bill.
  In past Congresses, Mr. Markey and I have been co-chairmen of the 
Privacy Caucus in the House, along with Senator Shelby and Senator Dodd 
in the Senate. I am as strong an advocate of protecting personal 
privacy as anybody in this body. I would say Mr. Markey and others 
share the passion just as strongly as I do.
  The bill before us today is not a privacy bill. This motion to 
recommit is a privacy amendment. We should reject it and then move the 
underlying bill. And if and when we need to address medical privacy as 
a stand-alone issue, there will be adequate time and adequate resources 
devoted to that.
  Mr. KENNEDY of Rhode Island. Mr. Speaker, will the gentleman yield?
  Mr. BARTON of Texas. I yield to the gentleman from Rhode Island.
  Mr. KENNEDY of Rhode Island. Companies that are in the business of 
storing patient health information online are not covered under HIPAA. 
Are not covered under HIPAA.
  Mr. BARTON of Texas. Mr. Speaker, reclaiming my time, they are 
covered under adequate laws, and HIPAA is the medical privacy law.
  Please vote against the motion to recommit.
  Mr. Speaker, I yield the balance of my time to the subcommittee 
chairman from the Ways and Means Committee, who has worked so 
tirelessly on this bill, Mrs. Johnson of Connecticut.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, remember, adoption of HIPAA 
was a multi-year process, very controversial, very difficult, 50,000 
comments just on the regulations.
  The SPEAKER pro tempore. The gentlewoman will suspend.
  In debate on a motion to recommit, time is not controlled. Therefore, 
although the gentleman may yield as he pleases, he must remain on his 
feet.
  Mr. BARTON of Texas. I know the rules. I'm supposed to be standing 
up. I apologize.
  Mrs. JOHNSON of Connecticut. My legislation explicitly does not 
change HIPAA.
  The behavior described of hacking in and revealing what would be 
under HIPAA is a fine of $250,000 and 10 years in jail. So HIPAA is 
there. It protects our privacy.
  What this bill does is to put in place a study to look at what has 
happened in the States, what has happened between State law and Federal 
law, to look and see if there are things that need to be done to create 
greater commonality amongst all these laws so that the nationwide 
interoperable health information system will protect health information 
to the current or a higher standard. So in the bill it has to be to a 
higher standard. But we maintain current law. There is absolute 
protection.
  And, remember, this specific approach was rejected by Donna Shalala 
and President Clinton; so do not take this vote lightly, folks. What 
you are voting for is a radical change in a law that is terribly 
important to all of us and we maintain in this bill.
  Mr. BARTON of Texas. Mr. Speaker, I yield back the balance of my 
time.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the motion to recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.


                             Recorded Vote

  Mr. DOGGETT. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.

[[Page H6003]]

  The SPEAKER pro tempore. Pursuant to clause 8 and clause 9 of rule 
XX, this 15-minute vote on the motion to recommit will be followed by 
5-minute votes on passage of H.R. 4157, if ordered, and the motion to 
instruct on H.R. 2830.
  The vote was taken by electronic device, and there were--ayes 198, 
noes 222, not voting 12, as follows:

                             [Roll No. 415]

                               AYES--198

     Abercrombie
     Ackerman
     Allen
     Andrews
     Baca
     Baird
     Baldwin
     Barrow
     Bean
     Becerra
     Berkley
     Berman
     Berry
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boren
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brown (OH)
     Brown, Corrine
     Butterfield
     Capps
     Capuano
     Cardin
     Cardoza
     Carnahan
     Carson
     Case
     Chandler
     Clay
     Cleaver
     Conyers
     Costa
     Costello
     Cramer
     Cuellar
     Cummings
     Davis (AL)
     Davis (CA)
     Davis (FL)
     Davis (IL)
     Davis (TN)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Dicks
     Dingell
     Doggett
     Doyle
     Edwards
     Emanuel
     Engel
     Eshoo
     Etheridge
     Farr
     Fattah
     Filner
     Ford
     Frank (MA)
     Gonzalez
     Gordon
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Harman
     Hastings (FL)
     Herseth
     Higgins
     Hinchey
     Hinojosa
     Holden
     Holt
     Honda
     Hooley
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson, E. B.
     Jones (NC)
     Jones (OH)
     Kanjorski
     Kaptur
     Kennedy (RI)
     Kildee
     Kilpatrick (MI)
     Kind
     Kucinich
     Langevin
     Lantos
     Larsen (WA)
     Larson (CT)
     Lee
     Levin
     Lipinski
     Lofgren, Zoe
     Lowey
     Lynch
     Maloney
     Markey
     Marshall
     Matheson
     Matsui
     McCarthy
     McCollum (MN)
     McDermott
     McGovern
     McIntyre
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Melancon
     Michaud
     Millender-McDonald
     Miller (NC)
     Miller, George
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (VA)
     Murtha
     Nadler
     Napolitano
     Neal (MA)
     Oberstar
     Obey
     Olver
     Ortiz
     Otter
     Owens
     Pallone
     Pascrell
     Pastor
     Paul
     Payne
     Pelosi
     Peterson (MN)
     Pomeroy
     Price (NC)
     Rahall
     Rangel
     Reyes
     Ross
     Rothman
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Sabo
     Salazar
     Sanchez, Linda T.
     Sanchez, Loretta
     Sanders
     Schakowsky
     Schiff
     Schwartz (PA)
     Scott (GA)
     Scott (VA)
     Serrano
     Sherman
     Skelton
     Slaughter
     Smith (WA)
     Snyder
     Solis
     Spratt
     Stark
     Strickland
     Stupak
     Tanner
     Tauscher
     Taylor (MS)
     Thompson (CA)
     Thompson (MS)
     Tierney
     Towns
     Udall (CO)
     Udall (NM)
     Van Hollen
     Velazquez
     Visclosky
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Woolsey
     Wu
     Wynn

                               NOES--222

     Aderholt
     Akin
     Alexander
     Bachus
     Baker
     Barrett (SC)
     Bartlett (MD)
     Barton (TX)
     Bass
     Beauprez
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Blackburn
     Blunt
     Boehlert
     Boehner
     Bonilla
     Bonner
     Bono
     Boozman
     Boustany
     Bradley (NH)
     Brady (TX)
     Brown (SC)
     Brown-Waite, Ginny
     Burgess
     Burton (IN)
     Buyer
     Calvert
     Camp (MI)
     Campbell (CA)
     Cannon
     Cantor
     Capito
     Carter
     Castle
     Chabot
     Chocola
     Coble
     Cole (OK)
     Conaway
     Cooper
     Crenshaw
     Culberson
     Davis (KY)
     Davis, Tom
     Dent
     Diaz-Balart, L.
     Diaz-Balart, M.
     Doolittle
     Drake
     Dreier
     Duncan
     Ehlers
     Emerson
     English (PA)
     Everett
     Feeney
     Ferguson
     Fitzpatrick (PA)
     Flake
     Foley
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Garrett (NJ)
     Gerlach
     Gibbons
     Gilchrest
     Gillmor
     Gingrey
     Gohmert
     Goode
     Goodlatte
     Granger
     Graves
     Green (WI)
     Gutknecht
     Hall
     Harris
     Hart
     Hastings (WA)
     Hayes
     Hayworth
     Hefley
     Hensarling
     Herger
     Hobson
     Hoekstra
     Hostettler
     Hulshof
     Hunter
     Hyde
     Inglis (SC)
     Issa
     Jenkins
     Jindal
     Johnson (CT)
     Johnson (IL)
     Johnson, Sam
     Keller
     Kelly
     Kennedy (MN)
     King (IA)
     King (NY)
     Kingston
     Kirk
     Kline
     Knollenberg
     Kolbe
     Kuhl (NY)
     LaHood
     Latham
     LaTourette
     Leach
     Lewis (CA)
     Lewis (KY)
     Linder
     LoBiondo
     Lucas
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     McCaul (TX)
     McCotter
     McCrery
     McHenry
     McHugh
     McKeon
     McMorris
     Mica
     Miller (FL)
     Miller (MI)
     Miller, Gary
     Moran (KS)
     Murphy
     Musgrave
     Myrick
     Neugebauer
     Ney
     Northup
     Norwood
     Nunes
     Nussle
     Osborne
     Oxley
     Pearce
     Pence
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Platts
     Poe
     Pombo
     Porter
     Price (GA)
     Pryce (OH)
     Putnam
     Radanovich
     Ramstad
     Regula
     Rehberg
     Reichert
     Renzi
     Reynolds
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Ros-Lehtinen
     Royce
     Ryan (WI)
     Ryun (KS)
     Saxton
     Schmidt
     Schwarz (MI)
     Sensenbrenner
     Sessions
     Shadegg
     Shaw
     Shays
     Sherwood
     Shimkus
     Shuster
     Simmons
     Simpson
     Smith (NJ)
     Smith (TX)
     Sodrel
     Souder
     Stearns
     Sullivan
     Sweeney
     Tancredo
     Taylor (NC)
     Terry
     Thornberry
     Tiahrt
     Tiberi
     Turner
     Upton
     Walden (OR)
     Walsh
     Wamp
     Weldon (FL)
     Weldon (PA)
     Weller
     Westmoreland
     Whitfield
     Wicker
     Wilson (NM)
     Wilson (SC)
     Wolf
     Young (AK)
     Young (FL)

                             NOT VOTING--12

     Clyburn
     Crowley
     Cubin
     Davis, Jo Ann
     Deal (GA)
     Evans
     Fossella
     Istook
     Lewis (GA)
     McKinney
     Thomas
     Wexler

                              {time}  1603

  Mr. BOOZMAN changed his vote from ``aye'' to ``no.''
  Mr. BLUMENAUER changed his vote from ``no'' to ``aye.''
  So the motion to recommit was rejected.
  The result of the vote was announced as above recorded.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.


                             Recorded Vote

  Mrs. JOHNSON of Connecticut. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. This will be a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 270, 
noes 148, not voting 14, as follows:

                             [Roll No. 416]

                               AYES--270

     Aderholt
     Akin
     Alexander
     Allen
     Bachus
     Baird
     Baker
     Barrett (SC)
     Barrow
     Bartlett (MD)
     Barton (TX)
     Bass
     Bean
     Beauprez
     Berkley
     Biggert
     Bilbray
     Bilirakis
     Bishop (GA)
     Bishop (UT)
     Blackburn
     Blunt
     Boehlert
     Boehner
     Bonilla
     Bonner
     Bono
     Boozman
     Boren
     Boucher
     Boustany
     Boyd
     Bradley (NH)
     Brady (TX)
     Brown (SC)
     Brown-Waite, Ginny
     Burgess
     Burton (IN)
     Buyer
     Calvert
     Camp (MI)
     Campbell (CA)
     Cannon
     Cantor
     Capito
     Carnahan
     Carson
     Carter
     Castle
     Chabot
     Chocola
     Clay
     Cleaver
     Coble
     Cole (OK)
     Conaway
     Cooper
     Costa
     Cramer
     Crenshaw
     Cuellar
     Culberson
     Davis (FL)
     Davis (KY)
     Davis (TN)
     Davis, Tom
     DeFazio
     Dent
     Diaz-Balart, L.
     Diaz-Balart, M.
     Dicks
     Doolittle
     Drake
     Dreier
     Edwards
     Ehlers
     Emerson
     English (PA)
     Everett
     Feeney
     Ferguson
     Fitzpatrick (PA)
     Foley
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Gerlach
     Gibbons
     Gilchrest
     Gillmor
     Gohmert
     Gonzalez
     Goode
     Goodlatte
     Gordon
     Granger
     Graves
     Green (WI)
     Gutknecht
     Hall
     Harman
     Harris
     Hart
     Hastings (WA)
     Hayes
     Hayworth
     Hefley
     Hensarling
     Herger
     Herseth
     Hinojosa
     Hobson
     Hoekstra
     Hooley
     Hulshof
     Hunter
     Hyde
     Inglis (SC)
     Inslee
     Israel
     Issa
     Jenkins
     Jindal
     Johnson (CT)
     Johnson (IL)
     Johnson, Sam
     Keller
     Kelly
     Kennedy (MN)
     Kind
     King (IA)
     King (NY)
     Kingston
     Kirk
     Kline
     Knollenberg
     Kolbe
     Kuhl (NY)
     LaHood
     Larsen (WA)
     Latham
     LaTourette
     Leach
     Lewis (CA)
     Lewis (KY)
     Linder
     Lipinski
     LoBiondo
     Lofgren, Zoe
     Lucas
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Marshall
     Matheson
     McCarthy
     McCaul (TX)
     McCotter
     McCrery
     McHenry
     McHugh
     McKeon
     McMorris
     Meeks (NY)
     Melancon
     Mica
     Miller (FL)
     Miller (MI)
     Miller, Gary
     Moore (KS)
     Moran (KS)
     Moran (VA)
     Murphy
     Musgrave
     Myrick
     Neugebauer
     Ney
     Northup
     Norwood
     Nunes
     Nussle
     Oberstar
     Ortiz
     Osborne
     Oxley
     Pearce
     Peterson (MN)
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Platts
     Poe
     Pombo
     Porter
     Price (GA)
     Pryce (OH)
     Putnam
     Radanovich
     Ramstad
     Regula
     Rehberg
     Reichert
     Renzi
     Reynolds
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Ros-Lehtinen
     Royce
     Ruppersberger
     Ryan (WI)
     Ryun (KS)
     Sabo
     Salazar
     Sanchez, Loretta
     Saxton
     Schmidt
     Schwartz (PA)
     Schwarz (MI)
     Sensenbrenner
     Sessions
     Shadegg
     Shaw
     Shays
     Sherwood
     Shimkus
     Shuster
     Simmons
     Simpson
     Skelton
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Sodrel
     Souder
     Stearns
     Sullivan
     Sweeney
     Tancredo
     Tauscher
     Taylor (NC)
     Terry
     Thompson (CA)
     Thornberry
     Tiahrt
     Tiberi
     Towns
     Turner
     Udall (CO)
     Upton
     Walden (OR)
     Walsh
     Weldon (FL)
     Weldon (PA)
     Weller
     Westmoreland
     Whitfield
     Wicker
     Wilson (NM)
     Wilson (SC)
     Wolf
     Wu
     Young (AK)
     Young (FL)

                               NOES--148

     Abercrombie
     Ackerman
     Andrews
     Baca
     Baldwin
     Becerra
     Berman
     Berry
     Bishop (NY)

[[Page H6004]]


     Blumenauer
     Boswell
     Brady (PA)
     Brown (OH)
     Brown, Corrine
     Butterfield
     Capps
     Capuano
     Cardin
     Cardoza
     Case
     Chandler
     Conyers
     Costello
     Cummings
     Davis (AL)
     Davis (CA)
     Davis (IL)
     DeGette
     Delahunt
     DeLauro
     Dingell
     Doggett
     Doyle
     Duncan
     Emanuel
     Engel
     Eshoo
     Etheridge
     Farr
     Fattah
     Filner
     Flake
     Ford
     Frank (MA)
     Garrett (NJ)
     Gingrey
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hastings (FL)
     Higgins
     Hinchey
     Holden
     Holt
     Honda
     Hostettler
     Hoyer
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson, E. B.
     Jones (NC)
     Jones (OH)
     Kanjorski
     Kaptur
     Kennedy (RI)
     Kildee
     Kilpatrick (MI)
     Kucinich
     Langevin
     Lantos
     Larson (CT)
     Lee
     Levin
     Lowey
     Lynch
     Maloney
     Markey
     Matsui
     McCollum (MN)
     McDermott
     McGovern
     McIntyre
     McNulty
     Meehan
     Meek (FL)
     Michaud
     Millender-McDonald
     Miller (NC)
     Miller, George
     Mollohan
     Moore (WI)
     Murtha
     Nadler
     Napolitano
     Neal (MA)
     Obey
     Olver
     Otter
     Owens
     Pallone
     Pascrell
     Pastor
     Paul
     Pelosi
     Pomeroy
     Price (NC)
     Rahall
     Rangel
     Reyes
     Ross
     Rothman
     Roybal-Allard
     Rush
     Ryan (OH)
     Sanchez, Linda T.
     Sanders
     Schakowsky
     Schiff
     Scott (GA)
     Scott (VA)
     Serrano
     Sherman
     Slaughter
     Snyder
     Solis
     Spratt
     Stark
     Strickland
     Stupak
     Tanner
     Taylor (MS)
     Thompson (MS)
     Tierney
     Udall (NM)
     Van Hollen
     Velazquez
     Visclosky
     Wamp
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Woolsey
     Wynn

                             NOT VOTING--14

     Clyburn
     Crowley
     Cubin
     Davis, Jo Ann
     Deal (GA)
     Evans
     Fossella
     Istook
     Lewis (GA)
     McKinney
     Payne
     Pence
     Thomas
     Wexler

                              {time}  1611

  So the bill was passed.
  The result of the vote was announced as above recorded.
  The title of the bill was amended so as to read: ``A Bill to promote 
a better health information system.''.
  A motion to reconsider was laid on the table.

                          ____________________