[Congressional Record Volume 153, Number 86 (Thursday, May 24, 2007)]
[Senate]
[Pages S6858-S6860]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CARPER (for himself and Mr. Voinovich):
  S. 1490. A bill to provide for the establishment and maintenace of 
electronic personal health records for individuals and family members 
enrolled in Federal employee health benefits plans under chaper 89 of 
title 5, United States Code, and for other purposes; to the Committee 
on Homeland Security and Govermental Affairs.
  Mr. CARPER. Mr. President, I rise today to reintroduce a piece of 
legislation that Senator Voinovich and I have been working on for over 
a year now.
  The Federal Employees Electronic Personal Health Records Act of 2007 
makes available electronic personal health records for every enrollee 
of a Federal health benefits plan who wishes to have one.
  Americans will probably spend more than $2 trillion on health care 
this year alone. Over the next 10 years, health care costs will more 
than double, topping $4 trillion in 2015.
  We spend $6,700 per person on health care, more than twice of what 
other industrialized nations spend; and for the most part, we are not 
receiving the gold standard of treatment in care.
  A 2005 survey found that medical error rates in the United States far 
exceed those of other Western countries.
  And in that survey, one in three Americans reported getting the wrong 
dosage of medication, incorrect test results, mistakes in treatment, or 
late notification of a test result. That is nearly 15 percent higher 
than similar results in Britain and Germany.
  Our excessive reliance on paper record keeping makes our health care 
system less efficient, more costly and more prone to mistakes.
  Doctors diagnose patients without knowing their full medical history, 
what they are allergic to, what kind of surgeries they have had, 
whether they have complained about similar symptoms before.
  Time constraints, or medical necessity, often force doctors to form a 
quick diagnosis. Sometimes that diagnosis is wrong and sometimes it 
proves to be a costly error.
  The widespread use of health information technology, the ability to 
immediately grab someone's full medical history off of a computer, can 
help doctors provide better care more cheaply. It has the potential to 
drastically transform the way we provide health care.
  If we are looking for success stories on how health care 
professionals have integrated the use of electronic health records into 
their daily routines, we don't have to look any further than our own 
Departments of Defense and Veterans Affairs.
  Times have certainly changed since I retired from the Navy some 16 
years ago. I used to keep all my medical records in a brown manila 
folder.
  I carried this manila folder with me from the time I left Ohio State, 
on to Pensacola, Corpus Christi Naval Air Station, out to California, 
across the seas and back again, and finally, getting off of active duty 
and coming to Delaware to enroll in business school, on the GI bill, at 
the University of Delaware.
  Over a decade ago, the DOD and the VA decided there was a better way. 
And the results have been nothing short of phenomenal.
  Today, when a patient enrolls in DOD's Military Health System, they 
get an electronic health record, not a brown manila folder in which to 
carry years of paper medical records. Your electronic record will 
follow you wherever you go, both during your time when you are serving 
in the military and when you leave to join our veterans' community.
  Researchers and doctors now laud the VA for having the foresight to 
use electronic health records to improve patient care and transform 
itself into one of the best health care operations in the country.
  And the cost? About $78 per patient, roughly the cost of not 
repeating one blood test. In other words, money well spent.
  I have witnessed that new-found satisfaction right in my own back 
yard, at our Veterans Medical Center in Elsmere, DE. Veterans from 
neighboring States are now coming to Elsmere to seek care instead of 
going to regular civilian hospitals near them.
  So what is keeping the rest of the Nation's health care system from 
following the lead of the DOD and the VA?
  The answer is the high cost of implementing the latest information 
technologies, as well as the lack of uniformity among various 
technology products.
  A physician can spend up to $40,000 implementing an electronic health 
records system. A hospital can spend up to five times that amount.
  If that weren't enough of a reason to say ``no thanks,'' there is 
another. We don't have a set of national standards in place to make 
sure that once health care providers have made the switch, their new 
systems can communicate with the hospital or doctor on the other side 
of town.
  As a nation, we cannot afford to rely solely on health care providers 
to bring the health care industry into the 21st century.
  While I was Governor, I signed legislation that would call for the 
creation of a statewide information network to bring our health care 
system into the 21st century. Delaware is well underway toward meeting 
our goal of establishing the first statewide health information 
infrastructure.
  We must think outside of the box and build on health information 
technology initiatives that are all already underway in other areas of 
the health care industry.
  The Federal Employees Electronic Personal Health Records Act of 2006 
will require all Insurance Plans that contract with the Federal 
Employees Health Benefits Program, FEHBP, to make available an 
electronic personal health record for enrollees in the program.
  Via the Internet, an enrollee will be able to log-on to his or her 
electronic personal health record to keep track of such things as their 
medications, cholesterol and glucose levels, allergies, and 
immunization records. An enrollee will also be able to view a 
comprehensive, easily understood listing of their health care claims.
  An enrollee can easily share sections of the electronic personal 
health record with their health care provider, ensuring that their 
health care provider has the most up-to-date and accurate health 
information when making clinical decisions.
  Having health information readily available will increase the 
efficiency and safety of health care for an enrollee by eliminating 
unwarranted tests, procedures, and prescriptions.
  Most importantly, the legislation ensures that the electronic 
personal health records provided for through this act are kept private 
and secure.
  The electronic personal health records are required to include a 
number of security features, such as a user authentication and audit 
trails.
  The legislation also requires that insurance plans comply with all 
privacy and security regulations outlined in the Health Insurance 
Portability and Accountability Act.
  This bill is designed to jumpstart this new technology by requiring 
some of the largest health insurance companies to offer electronic 
personal health records, which many are already doing.
  As more insurance companies, health care providers and consumers use 
this new technology, I am convinced that more people will recognize its 
advantages and we can more quickly move America's health care industry 
into the 21st century.
  And as the Nation's largest employer-sponsored health insurance 
program, who better than the Federal Employees Health Benefit Program 
to lead the way in this endeavor.
  I urge my colleagues to support the Federal Employees Electronic 
Personal Health Records Act of 2007.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1490

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Federal Employees Electronic 
     Personal Health Records Act of 2007''.

[[Page S6859]]

     SEC. 2. ELECTRONIC PERSONAL HEALTH RECORDS FOR FEDERAL 
                   EMPLOYEE HEALTH BENEFITS PLANS.

       (a) Contract Requirement.--Section 8902 of title 5, United 
     States Code, is amended by adding at the end the following:
       ``(p) Each contract under this chapter shall require the 
     carrier to provide for the establishment and maintenance of 
     electronic personal health records in accordance with section 
     8915.''.
       (b) Electronic Personal Health Records.--Chapter 89 of 
     title 5, United States Code, is amended by adding after 
     section 8914 the following:

     ``Sec. 8915. Electronic personal health records

       ``(a) In this section, the term--
       ``(1) `claims data' means--
       ``(A) a comprehensive record of health care services 
     provided to an individual, including prescriptions; and
       ``(B) contact information for providers of health care 
     services; and
       ``(2) `standard electronic format' means a format that--
       ``(A) uses open electronic standards;
       ``(B) enables health information technology to be used for 
     the collection of clinically specific data;
       ``(C) promotes the interoperability of health care 
     information across health care settings, including reporting 
     under this section and to other Federal agencies;
       ``(D) facilitates clinical decision support;
       ``(E) is useful for diagnosis and treatment and is 
     understandable for the individual or family member; and
       ``(F) is based on the Federal messaging and health 
     vocabulary standard endorsed by--
       ``(i) the Office of the National Coordinator for Health 
     Information Technology;
       ``(ii) the American Health Information Community; or
       ``(iii) the Secretary of Health and Human Services.
       ``(b)(1) Each carrier entering into a contract for a health 
     benefits plan under section 8915 shall provide for the 
     establishment and maintenance of electronic personal health 
     records for each individual and family member enrolled in 
     that health benefits plan in accordance with this section.
       ``(2) In the administration of this section, the Office of 
     Personnel Management--
       ``(A) shall ensure that each individual and family member 
     is provided--
       ``(i) timely notice of the establishment and maintenance of 
     electronic personal health records; and
       ``(ii) an opportunity to file an election at any time to--
       ``(I) not participate in the establishment or maintenance 
     of an electronic personal health record for that individual 
     or family member; and
       ``(II) in the case of an electronic personal health record 
     that is established under this section, terminate that 
     electronic personal health record;
       ``(B) shall ensure that each electronic personal health 
     record shall--
       ``(i) be based on standard electronic formats;
       ``(ii) be available for electronic access through the 
     Internet for the use of the individual or family member to 
     whom the record applies;
       ``(iii) enable the individual or family member to--
       ``(I) share any contents of the electronic personal health 
     record through transmission in standard electronic format, 
     fax transmission, or other additional means to providers of 
     health care services or other persons;
       ``(II) copy or print any contents of the electronic 
     personal health record; and
       ``(III) add supplementary health information, such as 
     information relating to--

       ``(aa) personal, medical, and emergency contacts;
       ``(bb) laboratory tests;
       ``(cc) social history;
       ``(dd) health conditions;
       ``(ee) allergies;
       ``(ff) dental services;
       ``(gg) immunizations;
       ``(hh) prescriptions;
       ``(ii) family health history;
       ``(jj) alternative treatments;
       ``(kk) appointments; and
       ``(ll) any additional information as needed;

       ``(iv) contain--
       ``(I) to the extent feasible, claims data from--

       ``(aa) providers of health care services that participate 
     in health benefits plans under this chapter;
       ``(bb) other providers of health care services; and
       ``(cc) other health benefits plans in which the individual 
     or family members have participated;

       ``(II) to the extent feasible, clinical care, 
     pharmaceutical, and laboratory records; and
       ``(III) the name of the source for each item of health 
     information;
       ``(v) authenticate the identity of each individual upon 
     accessing the electronic personal health record; and
       ``(vi) contain an audit trail to list the identity of 
     individuals who access the electronic personal health record; 
     and
       ``(C) shall ensure that the individual or family member may 
     designate--
       ``(i) any other individual to access and exercise control 
     over the sharing of the electronic personal health record; 
     and
       ``(ii) any other individual to access the electronic 
     personal health record in an emergency;
       ``(D) shall require each health benefits plan to comply 
     with all privacy and security regulations promulgated under 
     section 246(c) of the Health Insurance Portability and 
     Accountability Act of 1996 (42 U.S.C. 1320d-2) and other 
     relevant laws relating to privacy and security;
       ``(E) shall require each carrier that enters into a 
     contract for a health benefits plan to provide for the 
     electronic transfer of the contents of an electronic personal 
     health record to another electronic personal health record 
     under a different health benefits plan maintained under this 
     section or a similar record not maintained under this section 
     if--
       ``(i) coverage in a health benefits plan under this chapter 
     for an individual or family member terminates; and
       ``(ii) that individual or family member elects such a 
     transfer;
       ``(F) shall require each carrier to provide for education, 
     awareness, and training on electronic personal health records 
     for individuals and family members enrolled in health 
     benefits plans; and
       ``(G) may require each carrier to provide for an electronic 
     personal health record to be made available for electronic 
     access, other than through the Internet, for the use of the 
     individual or family member to whom the record applies, if 
     that individual or family member requests such access.
       ``(3) Nothing in paragraph (2)(C) shall be construed to 
     provide any rights additional to the rights provided under 
     the privacy and security regulations promulgated under 
     section 246(c) of the Health Insurance Portability and 
     Accountability Act of 1996 (42 U.S.C. 1320d-2) and other 
     relevant laws relating to privacy and security.''.
       (c) Technical and Conforming Amendment.--The table of 
     sections for chapter 89 of title 5, United States Code, is 
     amended by adding at the end the following:

``Sec. 8915. Electronic personal health records.''.

     SEC. 3. EFFECTIVE DATES AND APPLICATION.

       (a) In General.--Except as provided under subsection (b), 
     the amendments made by this Act shall take effect 30 days 
     after the date of enactment of this Act.
       (b) Establishment and Maintenance of Electronic Personal 
     Health Records.--The requirement for the establishment and 
     maintenance of electronic personal health records under 
     sections 8902(p) and 8915 of title 5, United States Code (as 
     added by this Act), shall apply with respect to contracts for 
     health benefits plans under chapter 89 of that title which 
     take effect on and after January of the earlier of--
       (1) the first calendar year following 2 years after the 
     date of enactment of this Act; or
       (2) any calendar year determined by the Office of Personnel 
     Management.
  Mr. VOINOVICH. Mr. President, I wish to speak about a bill my 
colleague Senator Carper and I introduced today, the Electronic 
Personal Health Records Act. The purpose of this legislation is to 
provide for the establishment and maintenance of electronic personal 
health records for individuals and family members enrolled in the 
Federal Employee Health Benefits Plan, FEHBP.
  The widespread adoption of health information technology, such as 
electronic health records, EHR, will revolutionize the health care 
profession. In fact, the Institute of Medicine, the National Committee 
on Vital and Health Statistics, and other expert panels have identified 
information technology as one of the most powerful tools in reducing 
medical errors and improving the quality of care. Unfortunately, our 
country's health care industry lags far behind other sectors of the 
economy in its investment in IT.
  The Institute of Medicine estimates that there are nearly 98,000 
deaths each year resulting from medical errors. Many of these deaths 
can be directly attributed to the inherent imperfections of our current 
paper-based health care system. This statistic is startling and one 
that I hope will motivate my colleagues to take a close look at the 
goals of our legislation.
  The voluntary EHRs that would be established through the Electronic 
Personal Health Records Act will provide clinicians with real-time 
access to their patient's health history. Each EHR would contain claims 
data, contact information for providers of health care services, and 
other useful information for diagnosis and treatment. The records will 
be available cost-free to FEHBP participants and will maintain strict 
adherence to the Health Insurance Portability and Accountability Act, 
HIPAA.
  Under the bill, the Office of Personnel Management, OPM, would be 
required to ensure that all carriers who participate in FEHBP educate 
their members about the implementation of the EHR, as well as give 
timely notice of the establishment of the record and an opportunity for 
each individual to elect not to participate in the program.
  OPM, through their carriers, would also have to ensure that all 
records

[[Page S6860]]

would be available for electronic access through Internet, fax, or 
printed method for the use of the individual, and that to the extent 
possible, records could be transferred from one plan to another. The 
bill would require EHRs to be made available 2 years after the passage 
of the legislation or earlier at the discretion of OPM in consultation 
with the Office of the National Coordinator for Health Information 
Technology within HHS.
  Not only can EHRs save lives and improve the quality of health care, 
they also have the potential to reduce the cost of the delivery of 
health care. According to Rand Corporation, the health care delivery 
system in the United States could save approximately $160 billion 
annually with the widespread use of electronic medical records. As a 
result, the private market is already moving toward implementing 
electronic medical records.
  This bill, simply encourages the health care industry to continue in 
that direction and take their use of technology in the delivery of care 
to the next step. I urge my colleagues to consider not only the benefit 
it will provide to the 8 million individuals who receive their health 
care through the FEHBP, but also to our Nation's overall health care 
system.
                                 ______