[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.

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