[Congressional Record Volume 163, Number 124 (Monday, July 24, 2017)]
[House]
[Pages H6173-H6174]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
VETERANS AFFAIRS MEDICAL SCRIBE PILOT ACT OF 2017
Mr. ROE of Tennessee. Mr. Speaker, I move to suspend the rules and
pass the bill (H.R. 1848) to direct the Secretary of Veterans Affairs
to carry out a pilot program on the use of medical scribes in
Department of Veterans Affairs medical centers, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 1848
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 ``Veterans Affairs Medical
Scribe Pilot Act of 2017''.
SEC. 2. DEPARTMENT OF VETERANS AFFAIRS MEDICAL SCRIBE PILOT
PROGRAM.
(a) In General.--The Secretary of Veterans Affairs shall
carry out a two-year pilot program under which the Secretary
shall increase the use of medical scribes at Department of
Veterans Affairs medical centers.
(b) Locations.--The Secretary shall carry out the pilot
program at the 10 medical centers of the Department as
follows:
(1) At least four such medical centers located in rural
areas.
(2) At least four such medical centers located in urban
areas.
(3) Two such medical centers located in areas with need for
increased access or increased efficiency, as determine by the
Secretary.
(c) Medical Scribes.--
(1) Hiring.--Under the pilot program the Secretary shall--
(A) hire 20 new Department of Veterans Affairs term
employees as medical scribes; and
(B) seek to enter into contracts with appropriate entities
for the employment of 20 additional medical scribes.
(2) Distribution.--The Secretary shall assign four medical
scribes to each of the 10 medical centers of the Department
where the Secretary carries out the pilot program as follows:
(A) Two scribes shall be assigned to each of two
physicians.
(B) Thirty percent of the scribes shall be employed in the
provision of emergency care.
(C) Seventy percent of the scribes shall be employed in the
provision of speciality care in specialties with the longest
patient wait times or lowest efficiency ratings, as
determined by the Secretary.
(d) Reports.--
(1) Reports to congress.--Not later than 180 days after the
commencement of the pilot program required under this
section, and every 180 days thereafter for the duration of
the pilot program, the Secretary of Veterans Affairs shall
submit to Congress a report on the pilot program. Each such
report shall include each of the following:
(A) A separate analysis of each the following with respect
to medical scribes employed by the Department of Veterans
Affairs and medical scribes performing Department of Veterans
Affairs functions under a contract:
(i) Provider efficiency.
(ii) Patient satisfaction.
(iii) Average wait time.
(iv) The number of patients seen per day by each physician
or practitioner.
(v) The amount of time required to hire and train an
employee to perform medical scribe functions under the pilot
program.
(B) Metrics and data for analyzing the effects of the pilot
program, including an evaluation of the each of the elements
under clauses (i) through (iv) of subparagraph (A) at medical
centers who employed scribes under the pilot program for an
appropriate period preceding the hiring of such scribes.
(2) Comptroller general report.--Not later than 90 days
after the termination of the pilot program under this
section, the Comptroller General of the United States shall
submit to Congress a report on the pilot program. Such report
shall include a comparison of the pilot program with similar
programs carried out in the private sector.
(e) Definitions.--In this section:
(1) The term ``medical scribe'' means an unlicensed
individual hired to enter information into the electronic
health record or chart at the direction of a physician or
licensed independent practitioner whose responsibilities
include the following:
(A) Assisting the physician or practitioner in navigating
the electronic health record.
(B) Responding to various messages as directed by the
physician or practitioner.
(C) Entering information into the electronic health record,
as directed by the physician or practitioner.
(2) The terms ``urban'' and ``rural'' have the meanings
given such terms under the rural-urban commuting codes
developed by the Secretary of Agriculture and the Secretary
of Health and Human Services.
(f) Funding.--The pilot program under this section shall be
carried out using amounts otherwise authorized to be
appropriated for the Department of Veterans Affairs. No
additional amounts are authorized to be appropriated to carry
out such program.
SEC. 3. PROHIBITION ON SMOKING IN FACILITIES OF THE VETERANS
HEALTH ADMINISTRATION.
(a) Prohibition.--Section 1715 of title 38, United States
Code, is amended to read as follows:
``Sec. 1715. Prohibition on smoking in facilities of the
Veterans Health Administration
``(a) Prohibition.--(1)(A) Except as provided in
subparagraph (B), no person may smoke indoors in any facility
of the Veterans Health Administration.
``(B) In the case of a facility of the Veterans Health
Administration that is a community living center, no person
may smoke indoors in such facility on or after December 31,
2018.
``(2) No person may smoke outdoors in any facility of the
Veterans Health Administration on or after October 1, 2021.
``(b) Definitions.--In this section:
``(1) The term `smoke' includes the smoking of cigarettes
(including e-cigarettes or electronic cigarettes), cigars,
pipes, and any other combustion of tobacco.
[[Page H6174]]
``(2) The term `facility of the Veterans Health
Administration' means any land or building (including any
medical center, nursing home, domiciliary facility,
outpatient clinic, or center that provides readjustment
counseling) that is--
``(A) under the jurisdiction of the Department of Veterans
Affairs;
``(B) under the control of the Veterans Health
Administration; and
``(C) not under the control of the General Services
Administration.
``(3) The term `community living center' means a facility
of the Department that provides nursing home care.''.
(b) Conforming Amendments.--
(1) The table of sections at the beginning of chapter 17 of
such title is amended by striking the item relating to
section 1715 and inserting the following:
``1715. Prohibition on smoking in facilities of the Veterans Health
Administration.''.
(2) Section 526 of the Veterans Health Care Act of 1992
(Public Law 102-585) is repealed.
(c) Effective Date.--This section shall take effect 90 days
after the date of the enactment of this Act.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Tennessee (Mr. Roe) and the gentleman from Minnesota (Mr. Walz) each
will control 20 minutes.
The Chair recognizes the gentleman from Tennessee.
General Leave
Mr. ROE of Tennessee. Mr. Speaker, I ask unanimous consent that all
Members have 5 legislative days in which to revise and extend their
remarks and to include extraneous remarks.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Tennessee?
There was no objection.
Mr. ROE of Tennessee. Mr. Speaker, I rise today in support of H.R.
1848, as amended, the Veterans Affairs Medical Scribe Pilot Act of
2017, which I am proud to sponsor.
One of my priorities as chairman of the House Committee on Veterans'
Affairs is to increase access to care for veteran patients. One way to
do that is help hardworking Department of Veterans Affairs clinicians
to be more efficient in the practice of high-quality care.
The Veterans Affairs Medical Scribe Pilot Act of 2017 would do just
that by creating a 2-year pilot program to test the use of scribes in
VA medical centers.
{time} 1545
Scribes are increasingly used in the private sector to help doctors
navigate and document a patient's electronic health record. That allows
doctors to place their focus not on a computer screen, but squarely on
the patient.
I jokingly say, Mr. Speaker, that it was electronic health records
that made me a Congressman. Basically, it ran me out of the medical
office. That is a slight exaggeration, but it is not too far off.
Like many doctors I hear from today, I found the increasing amount of
time that I was spending attending to electronic health record
requirements, necessary as they may be, detracted from the quality of
my patients' interactions and significantly slowed down how smoothly my
clinic day would operate. I believe the same is true at VA. Many
doctors now, Mr. Speaker, are spending over half their time entering
information, just basically being data entry people.
Onsite visits to VA medical facilities across the country, my staff
and I always ask VA employees how we can help them provide safer,
better care and see more patients. By far, one of the most common
responses that we hear is a plea to ``give us scribes; give us some
help.''
That is exactly what passage of H.R. 1848, as amended, will do.
This bill also includes provisions of H.R. 1662, a bill sponsored by
Dr. Brad Wenstrup, the chairman of the Subcommittee on Health, which
would bring VA medical centers in line with every other major
healthcare system by prohibiting smoking on VA medical facility
properties.
I thank Dr. Wenstrup for his leadership on this issue, and I am
grateful to be working with him to make VA medical facilities healthy,
smoke-free places for VA employees to serve veterans and for veterans
to seek care.
Mr. Speaker, I urge all my colleagues to support me in supporting
H.R. 1448, as amended, and I reserve the balance of my time.
Mr. WALZ. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I support H.R. 1848, as amended, the Veterans Affairs
Medical Scribe Pilot Act of 2017, offered by Chairman Roe.
No one knows more about this, and I appreciate the chairman's
education that goes into learning about the practice of medicine.
Having a physician as the chairman is invaluable. This issue of scribes
and how it interfaces with the doctor providing the care and the
electronic medical record has been invaluable for me to understand.
I know that the chairman and many physicians have said they feel they
are spending too much time entering the data and not enough time on
patients. Chairman Roe's legislation would allow for the use of scribes
within the VA during a 2-year pilot program. It has been proven to
assist physicians and alleviate administrative burdens.
This is smart stuff, again. I appreciate the insight brought to us
and making more efficiencies in the system.
Mr. Speaker, I urge support of the bill, and I yield back the balance
of my time.
Mr. ROE of Tennessee. Mr. Speaker, once again, I encourage all
Members to support this legislation, and I yield back the balance of my
time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Tennessee (Mr. Roe) that the House suspend the rules and
pass the bill, H.R. 1848, as amended.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds
being in the affirmative, the ayes have it.
Mr. WALZ. Mr. Speaker, I object to the vote on the ground that a
quorum is not present and make the point of order that a quorum is not
present.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this question will be postponed.
The point of no quorum is considered withdrawn.
____________________