[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.
____________________