[Congressional Record (Bound Edition), Volume 151 (2005), Part 20]
[Senate]
[Pages 27178-27195]
[From the U.S. Government Publishing Office, www.gpo.gov]




                   WIRED FOR HEALTH CARE QUALITY ACT

  Mr. FRIST. Mr. President, I ask unanimous consent that the Senate 
proceed to the immediate consideration of Calendar No. 178, S. 1418.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The legislative clerk read as follows:

       A bill (S. 1418) to enhance the adoption of a nationwide 
     interoperable health information technology system and to 
     improve the quality and reduce the costs of health care in 
     the United States.

  There being no objection, the Senate proceeded to consider the bill, 
which had been reported from the Committee on Health, Education, Labor, 
and Pensions, with an amendment.
  (Strike the part shown in black brackets and insert the part shown in 
italic.)

                                S. 1418

       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 ``Wired for Health Care 
     Quality Act''.

     [SEC. 2. IMPROVING HEALTH CARE, QUALITY, SAFETY, AND 
                   EFFICIENCY.

       [The Public Health Service Act (42 U.S.C. 201 et seq.) is 
     amended by adding at the end the following:

              ``TITLE XXIX--HEALTH INFORMATION TECHNOLOGY

     [``SEC. 2901. DEFINITIONS.

       [``In this title:
       [``(1) Health care provider.--The term `health care 
     provider' means a hospital,

[[Page 27179]]

     skilled nursing facility, home health entity, health care 
     clinic, federally qualified health center, group practice (as 
     defined in section 1877(h)(4) of the Social Security Act), a 
     pharmacist, a pharmacy, a laboratory, a physician (as defined 
     in section 1861(r) of the Social Security Act), a health 
     facility operated by or pursuant to a contract with the 
     Indian Health Service, a rural health clinic, and any other 
     category of facility or clinician determined appropriate by 
     the Secretary.
       [``(2) Health information.--The term `health information' 
     has the meaning given such term in section 1171(4) of the 
     Social Security Act.
       [``(3) Health insurance plan.--The term `health insurance 
     plan' means--
       [``(A) a health insurance issuer (as defined in section 
     2791(b)(2));
       [``(B) a group health plan (as defined in section 
     2791(a)(1)); and
       [``(C) a health maintenance organization (as defined in 
     section 2791(b)(3)).
       [``(4) Laboratory.--The term `laboratory' has the meaning 
     given that term in section 353.
       [``(5) Pharmacist.--The term `pharmacist' has the meaning 
     given that term in section 804 of the Federal Food, Drug, and 
     Cosmetic Act.
       [``(6) Qualified health information technology.--The term 
     `qualified health information technology' means a 
     computerized system (including hardware, software, and 
     training) that--
       [``(A) protects the privacy and security of health 
     information;
       [``(B) maintains and provides permitted access to health 
     information in an electronic format;
       [``(C) incorporates decision support to reduce medical 
     errors and enhance health care quality;
       [``(D) complies with the standards adopted by the Federal 
     Government under section 2903; and
       [``(E) allows for the reporting of quality measures under 
     section 2908.
       [``(7) State.--The term `State' means each of the several 
     States, the District of Columbia, Puerto Rico, the Virgin 
     Islands, Guam, American Samoa, and the Northern Mariana 
     Islands.

     [``SEC. 2902. OFFICE OF THE NATIONAL COORDINATOR OF HEALTH 
                   INFORMATION TECHNOLOGY.

       [``(a) Office of National Health Information Technology.--
     There is established within the Office of the Secretary an 
     Office of the National Coordinator of Health Information 
     Technology (referred to in this section as the `Office'). The 
     Office shall be headed by a National Coordinator who shall be 
     appointed by the President, in consultation with the 
     Secretary, and shall report directly to the Secretary.
       [``(b) Purpose.--It shall be the purpose of the Office to 
     carry out programs and activities to develop a nationwide 
     interoperable health information technology infrastructure 
     that--
       [``(1) ensures that patients' health information is secure 
     and protected;
       [``(2) improves health care quality, reduces medical 
     errors, and advances the delivery of patient-centered medical 
     care;
       [``(3) reduces health care costs resulting from 
     inefficiency, medical errors, inappropriate care, and 
     incomplete information;
       [``(4) ensures that appropriate information to help guide 
     medical decisions is available at the time and place of care;
       [``(5) promotes a more effective marketplace, greater 
     competition, and increased choice through the wider 
     availability of accurate information on health care costs, 
     quality, and outcomes;
       [``(6) improves the coordination of care and information 
     among hospitals, laboratories, physician offices, and other 
     entities through an effective infrastructure for the secure 
     and authorized exchange of health care information;
       [``(7) improves public health reporting and facilitates the 
     early identification and rapid response to public health 
     threats and emergencies, including bioterror events and 
     infectious disease outbreaks;
       [``(8) facilitates health research; and
       [``(9) promotes prevention of chronic diseases.
       [``(c) Duties of the National Coordinator.--The National 
     Coordinator shall--
       [``(1) serve as a member of the public-private American 
     Health Information Collaborative established under section 
     2903;
       [``(2) serve as the principal advisor to the Secretary 
     concerning the development, application, and use of health 
     information technology, and coordinate and oversee the health 
     information technology programs of the Department;
       [``(3) facilitate the adoption of a nationwide, 
     interoperable system for the electronic exchange of health 
     information;
       [``(4) ensure the adoption and implementation of standards 
     for the electronic exchange of health information to reduce 
     cost and improve health care quality;
       [``(5) ensure that health information technology policy and 
     programs of the Department are coordinated with those of 
     relevant executive branch agencies (including Federal 
     commissions) with a goal of avoiding duplication of efforts 
     and of helping to ensure that each agency undertakes health 
     information technology activities primarily within the areas 
     of its greatest expertise and technical capability;
       [``(6) to the extent permitted by law, coordinate outreach 
     and consultation by the relevant executive branch agencies 
     (including Federal commissions) with public and private 
     parties of interest, including consumers, payers, employers, 
     hospitals and other health care providers, physicians, 
     community health centers, laboratories, vendors and other 
     stakeholders;
       [``(7) advise the President regarding specific Federal 
     health information technology programs; and
       [``(8) submit the reports described under section 2903(i) 
     (excluding paragraph (4) of such section).
       [``(d) Detail of Federal Employees.--
       [``(1) In general.--Upon the request of the National 
     Coordinator, the head of any Federal agency is authorized to 
     detail, with or without reimbursement from the Office, any of 
     the personnel of such agency to the Office to assist it in 
     carrying out its duties under this section.
       [``(2) Effect of detail.--Any detail of personnel under 
     paragraph (1) shall--
       [``(A) not interrupt or otherwise affect the civil service 
     status or privileges of the Federal employee; and
       [``(B) be in addition to any other staff of the Department 
     employed by the National Coordinator.
       [``(3) Acceptance of detailees.--Notwithstanding any other 
     provision of law, the Office may accept detailed personnel 
     from other Federal agencies without regard to whether the 
     agency described under paragraph (1) is reimbursed.
       [``(e) Rule of Construction.--Nothing in this section shall 
     be construed to require the duplication of Federal efforts 
     with respect to the establishment of the Office, regardless 
     of whether such efforts were carried out prior to or after 
     the enactment of this title.
       [``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as may be necessary 
     to carry out the activities of the Office under this section 
     for each of fiscal years 2006 through 2010.

     [``SEC. 2903. AMERICAN HEALTH INFORMATION COLLABORATIVE.

       [``(a) Purpose.--The Secretary shall establish the public-
     private American Health Information Collaborative (referred 
     to in this section as the `Collaborative') to--
       [``(1) advise the Secretary and recommend specific actions 
     to achieve a nationwide interoperable health information 
     technology infrastructure;
       [``(2) serve as a forum for the participation of a broad 
     range of stakeholders to provide input on achieving the 
     interoperability of health information technology; and
       [``(3) recommend standards (including content, 
     communication, and security standards) for the electronic 
     exchange of health information for adoption by the Federal 
     Government and voluntary adoption by private entities.
       [``(b) Composition.--
       [``(1) In general.--The Collaborative shall be composed 
     of--
       [``(A) the Secretary, who shall serve as the chairperson of 
     the Collaborative;
       [``(B) the Secretary of Defense, or his or her designee;
       [``(C) the Secretary of Veterans Affairs, or his or her 
     designee;
       [``(D) the Secretary of Commerce, or his or her designee;
       [``(E) the National Coordinator for Health Information 
     Technology;
       [``(F) representatives of other relevant Federal agencies, 
     as determined appropriate by the Secretary; and
       [``(G) representatives from each of the following 
     categories to be appointed by the Secretary from nominations 
     submitted by the public--
       [``(i) consumer and patient organizations;
       [``(ii) experts in health information privacy and security;
       [``(iii) health care providers;
       [``(iv) health insurance plans or other third party payors;
       [``(v) standards development organizations;
       [``(vi) information technology vendors;
       [``(vii) purchasers or employers; and
       [``(viii) State or local government agencies or Indian 
     tribe or tribal organizations.
       [``(2) Considerations.--In appointing members under 
     paragraph (1)(G), the Secretary shall select individuals with 
     expertise in--
       [``(A) health information privacy;
       [``(B) health information security;
       [``(C) health care quality and patient safety, including 
     those individuals with experience in utilizing health 
     information technology to improve health care quality and 
     patient safety;
       [``(D) data exchange; and
       [``(E) developing health information technology standards 
     and new health information technology.
       [``(3) Terms.--Members appointed under paragraph (1)(G) 
     shall serve for 2 year terms, except that any member 
     appointed to fill a vacancy for an unexpired term shall be 
     appointed for the remainder of such term. A member may serve 
     for not to exceed 180 days after the expiration of such 
     member's term or until a successor has been appointed.

[[Page 27180]]

       [``(c) Recommendations and Policies.--The Collaborative 
     shall make recommendations to identify uniform national 
     policies for adoption by the Federal Government and voluntary 
     adoption by private entities to support the widespread 
     adoption of health information technology, including--
       [``(1) protection of health information through privacy and 
     security practices;
       [``(2) measures to prevent unauthorized access to health 
     information;
       [``(3) methods to facilitate secure patient access to 
     health information;
       [``(4) the ongoing harmonization of industry-wide health 
     information technology standards;
       [``(5) recommendations for a nationwide interoperable 
     health information technology infrastructure;
       [``(6) the identification and prioritization of specific 
     use cases for which heath information technology is valuable, 
     beneficial, and feasible;
       [``(7) recommendations for the establishment of an entity 
     to ensure the continuation of the functions of the 
     Collaborative; and
       [``(8) other policies determined to be necessary by the 
     Collaborative.
       [``(d) Standards.--
       [``(1) Existing standards.--The standards adopted by the 
     Consolidated Health Informatics Initiative shall be deemed to 
     have been recommended by the Collaborative under this 
     section.
       [``(2) First year review.--Not later than 1 year after the 
     date of enactment of this title, the Collaborative shall--
       [``(A) review existing standards (including content, 
     communication, and security standards) for the electronic 
     exchange of health information, including such standards 
     adopted by the Secretary under paragraph (2)(A);
       [``(B) identify deficiencies and omissions in such existing 
     standards; and
       [``(C) identify duplication and overlap in such existing 
     standards;
     and recommend modifications to such standards as necessary.
       [``(3) Ongoing review.--Beginning 1 year after the date of 
     enactment of this title, and annually thereafter, the 
     Collaborative shall--
       [``(A) review existing standards (including content, 
     communication, and security standards) for the electronic 
     exchange of health information, including such standards 
     adopted by the Secretary under paragraph (2)(A);
       [``(B) identify deficiencies and omissions in such existing 
     standards; and
       [``(C) identify duplication and overlap in such existing 
     standards;
     and recommend modifications to such standards as necessary.
       [``(4) Limitation.--The standards described in this section 
     shall be consistent with any standards developed pursuant to 
     the Health Insurance Portability and Accountability Act of 
     1996.
       [``(e) Federal Action.--Not later than 60 days after the 
     issuance of a recommendation from the Collaborative under 
     subsection (d)(2), the Secretary of Health and Human 
     Services, the Secretary of Veterans Affairs, and the 
     Secretary of Defense, in collaboration with representatives 
     of other relevant Federal agencies, as determined appropriate 
     by the Secretary, shall jointly review such recommendations. 
     The Secretary shall provide for the adoption by the Federal 
     Government of any standard or standards contained in such 
     recommendation.
       [``(f) Coordination of Federal Spending.--Not later than 1 
     year after the adoption by the Federal Government of a 
     recommendation as provided for in subsection (e), and in 
     compliance with chapter 113 of title 40, United States Code, 
     no Federal agency shall expend Federal funds for the purchase 
     of any form of health information technology or health 
     information technology system for clinical care or for the 
     electronic retrieval, storage, or exchange of health 
     information that is not consistent with applicable standards 
     adopted by the Federal Government under subsection (e).
       [``(g) Coordination of Federal Data Collection.--Not later 
     than 3 years after the adoption by the Federal Government of 
     a recommendation as provided for in subsection (e), all 
     Federal agencies collecting health data for the purposes of 
     surveillance, epidemiology, adverse event reporting, 
     research, or for other purposes determined appropriate by the 
     Secretary shall comply with standards adopted under 
     subsection (e).
       [``(h) Voluntary Adoption.--Any standards adopted by the 
     Federal Government under subsection (e) shall be voluntary 
     with respect to private entities.
       [``(i) Reports.--The Secretary shall submit to the 
     Committee on Health, Education, Labor, and Pensions and the 
     Committee on Finance of the Senate and the Committee on 
     Energy and Commerce and the Committee on Ways and Means of 
     the House of Representatives, on an annual basis, a report 
     that--
       [``(1) describes the specific actions that have been taken 
     by the Federal Government and private entities to facilitate 
     the adoption of an interoperable nationwide system for the 
     electronic exchange of health information;
       [``(2) describes barriers to the adoption of such a 
     nationwide system;
       [``(3) contains recommendations to achieve full 
     implementation of such a nationwide system; and
       [``(4) contains a plan and progress toward the 
     establishment of an entity to ensure the continuation of the 
     functions of the Collaborative.
       [``(j) Application of FACA.--The Federal Advisory Committee 
     Act (5 U.S.C. App.) shall apply to the Collaborative, except 
     that the term provided for under section 14(a)(2) shall be 5 
     years.
       [``(k) Rule of Construction.--Nothing in this section shall 
     be construed to require the duplication of Federal efforts 
     with respect to the establishment of the Collaborative, 
     regardless of whether such efforts were carried out prior to 
     or after the enactment of this title.
       [``(l) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as may be necessary 
     to carry out this section for each of fiscal years 2006 
     through 2010.

     [``SEC. 2904. IMPLEMENTATION AND CERTIFICATION OF HEALTH 
                   INFORMATION STANDARDS.

       [``(a) Implementation.--
       [``(1) In general.--The Secretary, based upon the 
     recommendations of the Collaborative, shall develop criteria 
     to ensure uniform and consistent implementation of any 
     standards for the electronic exchange of health information 
     voluntarily adopted by private entities in technical 
     conformance with such standards adopted under this title.
       [``(2) Implementation assistance.--The Secretary may 
     recognize a private entity or entities to assist private 
     entities in the implementation of the standards adopted under 
     this title using the criteria developed by the Secretary 
     under this section.
       [``(b) Certification.--
       [``(1) In general.--The Secretary, based upon the 
     recommendations of the Collaborative, shall develop criteria 
     to ensure and certify that hardware, software, and support 
     services that claim to be in compliance with any standard for 
     the electronic exchange of health information adopted under 
     this title have established and maintained such compliance in 
     technical conformance with such standards.
       [``(2) Certification assistance.--The Secretary may 
     recognize a private entity or entities to assist in the 
     certification described under paragraph (1) using the 
     criteria developed by the Secretary under this section.
       [``(c) Delegation Authority.--The Secretary, through 
     consultation with the Collaborative, may delegate the 
     development of the criteria under subsections (a) and (b) to 
     a private entity.

     [``SEC. 2905. GRANTS TO FACILITATE THE WIDESPREAD ADOPTION OF 
                   INTEROPERABLE HEALTH INFORMATION TECHNOLOGY.

       [``(a) Competitive Grants to Facilitate the Widespread 
     Adoption of Health Information Technology.--
       [``(1) In general.--The Secretary may award competitive 
     grants to eligible entities to facilitate the purchase and 
     enhance the utilization of qualified health information 
     technology systems to improve the quality and efficiency of 
     health care.
       [``(2) Eligibility.--To be eligible to receive a grant 
     under paragraph (1) an entity shall--
       [``(A) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require;
       [``(B) submit to the Secretary a strategic plan for the 
     implementation of data sharing and interoperability measures;
       [``(C) be a--
       [``(i) not for profit hospital;
       [``(ii) group practice (including a single physician); or
       [``(iii) another health care provider not described in 
     clause (i) or (ii);
       [``(D) adopt the standards adopted by the Federal 
     Government under section 2903;
       [``(E) require that health care providers receiving such 
     grants implement the measurement system adopted under section 
     2908 and report to the Secretary on such measures;
       [``(F) demonstrate significant financial need; and
       [``(G) provide matching funds in accordance with paragraph 
     (4).
       [``(3) Use of funds.--Amounts received under a grant under 
     this subsection shall be used to facilitate the purchase and 
     enhance the utilization of qualified health information 
     technology systems.
       [``(4) Matching requirement.--To be eligible for a grant 
     under this subsection an entity shall contribute non-Federal 
     contributions to the costs of carrying out the activities for 
     which the grant is awarded in an amount equal to $1 for each 
     $3 of Federal funds provided under the grant.
       [``(5) Preference in awarding grants.--In awarding grants 
     under this subsection the Secretary shall give preference 
     to--
       [``(A) eligible entities that are located in rural, 
     frontier, and other underserved areas as determined by the 
     Secretary; and
       [``(B) eligible entities that will link, to the extent 
     practicable, the qualified health information system to local 
     or regional health information networks.
       [``(b) Competitive Grants to States for the Development of 
     State Loan Programs to Facilitate the Widespread Adoption of 
     Health Information Technology.--
       [``(1) In general.--The Secretary may award competitive 
     grants to States for the establishment of State programs for 
     loans to

[[Page 27181]]

      health care providers to facilitate the purchase and enhance 
     the utilization of qualified health information technology.
       [``(2) Establishment of fund.--To be eligible to receive a 
     competitive grant under this subsection, a State shall 
     establish a qualified health information technology loan fund 
     (referred to in this subsection as a `State loan fund') and 
     comply with the other requirements contained in this section. 
     A grant to a State under this subsection shall be deposited 
     in the State loan fund established by the State. No funds 
     authorized by other provisions of this title to be used for 
     other purposes specified in this title shall be deposited in 
     any State loan fund.
       [``(3) Eligibility.--To be eligible to receive a grant 
     under paragraph (1) a State shall--
       [``(A) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require;
       [``(B) submit to the Secretary a strategic plan in 
     accordance with paragraph (4);
       [``(C) establish a qualified health information technology 
     loan fund in accordance with paragraph (2);
       [``(D) require that health care providers receiving such 
     loans--
       [``(i) link, to the extent practicable, the qualified 
     health information system to a local or regional health 
     information network; and
       [``(ii) consult with the Center for Best Practices 
     established in section 914(d) to access the knowledge and 
     experience of existing initiatives regarding the successful 
     implementation and effective use of health information 
     technology;
       [``(E) require that health care providers receiving such 
     loans adopt the standards adopted by the Federal Government 
     under section 2903(d);
       [``(F) require that health care providers receiving such 
     loans implement the measurement system adopted under section 
     2908 and report to the Secretary on such measures; and
       [``(G) provide matching funds in accordance with paragraph 
     (8).
       [``(4) Strategic plan.--
       [``(A) In general.--A State that receives a grant under 
     this subsection shall annually prepare a strategic plan that 
     identifies the intended uses of amounts available to the 
     State loan fund of the State.
       [``(B) Contents.--A strategic plan under subparagraph (A) 
     shall include--
       [``(i) a list of the projects to be assisted through the 
     State loan fund in the first fiscal year that begins after 
     the date on which the plan is submitted;
       [``(ii) a description of the criteria and methods 
     established for the distribution of funds from the State loan 
     fund; and
       [``(iii) a description of the financial status of the State 
     loan fund and the short-term and long-term goals of the State 
     loan fund.
       [``(5) Use of funds.--
       [``(A) In general.--Amounts deposited in a State loan fund, 
     including loan repayments and interest earned on such 
     amounts, shall be used only for awarding loans or loan 
     guarantees, or as a source of reserve and security for 
     leveraged loans, the proceeds of which are deposited in the 
     State loan fund established under paragraph (1). Loans under 
     this section may be used by a health care provider to 
     facilitate the purchase and enhance the utilization of 
     qualified health information technology.
       [``(B) Limitation.--Amounts received by a State under this 
     subsection may not be used--
       [``(i) for the purchase or other acquisition of any health 
     information technology system that is not a qualified health 
     information technology system;
       [``(ii) to conduct activities for which Federal funds are 
     expended under this title, or the amendments made by the 
     Wired for Health Care Quality Act; or
       [``(iii) for any purpose other than making loans to 
     eligible entities under this section.
       [``(6) Types of assistance.--Except as otherwise limited by 
     applicable State law, amounts deposited into a State loan 
     fund under this subsection may only be used for the 
     following:
       [``(A) To award loans that comply with the following:
       [``(i) The interest rate for each loan shall be less than 
     or equal to the market interest rate.
       [``(ii) The principal and interest payments on each loan 
     shall commence not later than 1 year after the loan was 
     awarded, and each loan shall be fully amortized not later 
     than 10 years after the date of the loan.
       [``(iii) The State loan fund shall be credited with all 
     payments of principal and interest on each loan awarded from 
     the fund.
       [``(B) To guarantee, or purchase insurance for, a local 
     obligation (all of the proceeds of which finance a project 
     eligible for assistance under this subsection) if the 
     guarantee or purchase would improve credit market access or 
     reduce the interest rate applicable to the obligation 
     involved.
       [``(C) As a source of revenue or security for the payment 
     of principal and interest on revenue or general obligation 
     bonds issued by the State if the proceeds of the sale of the 
     bonds will be deposited into the State loan fund.
       [``(D) To earn interest on the amounts deposited into the 
     State loan fund.
       [``(7) Administration of state loan funds.--
       [``(A) Combined financial administration.--A State may (as 
     a convenience and to avoid unnecessary administrative costs) 
     combine, in accordance with State law, the financial 
     administration of a State loan fund established under this 
     subsection with the financial administration of any other 
     revolving fund established by the State if otherwise not 
     prohibited by the law under which the State loan fund was 
     established.
       [``(B) Cost of administering fund.--Each State may annually 
     use not to exceed 4 percent of the funds provided to the 
     State under a grant under this subsection to pay the 
     reasonable costs of the administration of the programs under 
     this section, including the recovery of reasonable costs 
     expended to establish a State loan fund which are incurred 
     after the date of enactment of this title.
       [``(C) Guidance and regulations.--The Secretary shall 
     publish guidance and promulgate regulations as may be 
     necessary to carry out the provisions of this subsection, 
     including--
       [``(i) provisions to ensure that each State commits and 
     expends funds allotted to the State under this subsection as 
     efficiently as possible in accordance with this title and 
     applicable State laws; and
       [``(ii) guidance to prevent waste, fraud, and abuse.
       [``(D) Private sector contributions.--
       [``(i) In general.--A State loan fund established under 
     this subsection may accept contributions from private sector 
     entities, except that such entities may not specify the 
     recipient or recipients of any loan issued under this 
     subsection.
       [``(ii) Availability of information.--A State shall make 
     publically available the identity of, and amount contributed 
     by, any private sector entity under clause (i) and may issue 
     letters of commendation or make other awards (that have no 
     financial value) to any such entity.
       [``(8) Matching requirements.--
       [``(A) In general.--The Secretary may not make a grant 
     under paragraph (1) to a State unless the State agrees to 
     make available (directly or through donations from public or 
     private entities) non-Federal contributions in cash toward 
     the costs of the State program to be implemented under the 
     grant in an amount equal to not less than $1 for each $1 of 
     Federal funds provided under the grant.
       [``(B) Determination of amount of non-federal 
     contribution.--In determining the amount of non-Federal 
     contributions that a State has provided pursuant to 
     subparagraph (A), the Secretary may not include any amounts 
     provided to the State by the Federal Government.
       [``(9) Preference in awarding grants.--The Secretary may 
     give a preference in awarding grants under this subsection to 
     States that adopt value-based purchasing programs to improve 
     health care quality.
       [``(10) Reports.--The Secretary shall annually submit to 
     the Committee on Health, Education, Labor, and Pensions and 
     the Committee on Finance of the Senate, and the Committee on 
     Energy and Commerce and the Committee on Ways and Means of 
     the House of Representatives, a report summarizing the 
     reports received by the Secretary from each State that 
     receives a grant under this subsection.
       [``(c) Grants for the Implementation of Regional or Local 
     Health Information Technology Plans.--
       [``(1) In general.--The Secretary may award competitive 
     grants to eligible entities to implement regional or local 
     health information plans to improve health care quality and 
     efficiency through the electronic exchange of health 
     information pursuant to the standards, protocols, and other 
     requirements adopted by the Secretary under sections 2903 and 
     2908.
       [``(2) Eligibility.--To be eligible to receive a grant 
     under paragraph (1) an entity shall--
       [``(A) demonstrate financial need to the Secretary;
       [``(B) demonstrate that one of its principal missions or 
     purposes is to use information technology to improve health 
     care quality and efficiency;
       [``(C) adopt bylaws, memoranda of understanding, or other 
     charter documents that demonstrate that the governance 
     structure and decisionmaking processes of such entity allow 
     for participation on an ongoing basis by multiple 
     stakeholders within a community, including--
       [``(i) physicians (as defined in section 1861(r) of the 
     Social Security Act), including physicians that provide 
     services to low income and underserved populations;
       [``(ii) hospitals (including hospitals that provide 
     services to low income and underserved populations);
       [``(iii) pharmacists or pharmacies;
       [``(iv) health insurance plans;
       [``(v) health centers (as defined in section 330(b)) and 
     Federally qualified health centers (as defined in section 
     1861(aa)(4) of the Social Security Act);
       [``(vi) rural health clinics (as defined in section 
     1861(aa) of the Social Security Act);
       [``(vii) patient or consumer organizations;
       [``(viii) employers; and
       [``(ix) any other health care providers or other entities, 
     as determined appropriate by the Secretary;

[[Page 27182]]

       [``(D) adopt nondiscrimination and conflict of interest 
     policies that demonstrate a commitment to open, fair, and 
     nondiscriminatory participation in the health information 
     plan by all stakeholders;
       [``(E) adopt the standards adopted by the Secretary under 
     section 2903;
       [``(F) require that health care providers receiving such 
     loans implement the measurement system adopted under section 
     2908 and report to the Secretary on such measures;
       [``(G) facilitate the electronic exchange of health 
     information within the local or regional area and among local 
     and regional areas;
       [``(H) prepare and submit to the Secretary an application 
     in accordance with paragraph (3); and
       [``(I) agree to provide matching funds in accordance with 
     paragraph (5).
       [``(3) Application.--
       [``(A) In general.--To be eligible to receive a grant under 
     paragraph (1), an entity shall submit to the Secretary an 
     application at such time, in such manner, and containing such 
     information as the Secretary may require.
       [``(B) Required information.--At a minimum, an application 
     submitted under this paragraph shall include--
       [``(i) clearly identified short-term and long-term 
     objectives of the regional or local health information plan;
       [``(ii) a technology plan that complies with the standards 
     adopted under section 2903 and that includes a descriptive 
     and reasoned estimate of costs of the hardware, software, 
     training, and consulting services necessary to implement the 
     regional or local health information plan;
       [``(iii) a strategy that includes initiatives to improve 
     health care quality and efficiency, including the use and 
     reporting of health care quality measures adopted under 
     section 2908;
       [``(iv) a plan that describes provisions to encourage the 
     implementation of the electronic exchange of health 
     information by all physicians, including single physician 
     practices and small physician groups participating in the 
     health information plan;
       [``(v) a plan to ensure the privacy and security of 
     personal health information that is consistent with Federal 
     and State law;
       [``(vi) a governance plan that defines the manner in which 
     the stakeholders shall jointly make policy and operational 
     decisions on an ongoing basis; and
       [``(vii) a financial or business plan that describes--

       [```(I) the sustainability of the plan;
       [```(II) the financial costs and benefits of the plan; and
       [```(III) the entities to which such costs and benefits 
     will accrue.

       [``(4) Use of funds.--Amounts received under a grant under 
     paragraph (1) shall be used to establish and implement a 
     regional or local health information plan in accordance with 
     this subsection.
       [``(5) Matching requirement.--
       [``(A) In general.--The Secretary may not make a grant 
     under this subsection to an entity unless the entity agrees 
     that, with respect to the costs to be incurred by the entity 
     in carrying out the infrastructure program for which the 
     grant was awarded, the entity will make available (directly 
     or through donations from public or private entities) non-
     Federal contributions toward such costs in an amount equal to 
     not less than 50 percent of such costs ($1 for each $2 of 
     Federal funds provided under the grant).
       [``(B) Determination of amount contributed.--Non-Federal 
     contributions required under subparagraph (A) may be in cash 
     or in kind, fairly evaluated, including equipment, 
     technology, or services. Amounts provided by the Federal 
     Government, or services assisted or subsidized to any 
     significant extent by the Federal Government, may not be 
     included in determining the amount of such non-Federal 
     contributions.
       [``(d) Reports.--Not later than 1 year after the date on 
     which the first grant is awarded under this section, and 
     annually thereafter during the grant period, an entity that 
     receives a grant under this section shall submit to the 
     Secretary a report on the activities carried out under the 
     grant involved. Each such report shall include--
       [``(1) a description of the financial costs and benefits of 
     the project involved and of the entities to which such costs 
     and benefits accrue;
       [``(2) an analysis of the impact of the project on health 
     care quality and safety;
       [``(3) a description of any reduction in duplicative or 
     unnecessary care as a result of the project involved;
       [``(4) a description of the efforts of recipients under 
     this section to facilitate secure patient access to health 
     information; and
       [``(5) other information as required by the Secretary.
       [``(e) Authorization of Appropriations.--
       [``(1) In general.--For the purpose of carrying out this 
     section, there is authorized to be appropriated $125,000,000 
     for fiscal year 2006, $150,000,000 for fiscal year 2007, and 
     such sums as may be necessary for each of fiscal years 2008 
     through 2010.
       [``(2) Availability.--Amounts appropriated under paragraph 
     (1) shall remain available through fiscal year 2010.

     [``SEC. 2906. DEMONSTRATION PROGRAM TO INTEGRATE INFORMATION 
                   TECHNOLOGY INTO CLINICAL EDUCATION.

       [``(a) In General.--The Secretary may award grants under 
     this section to carry out demonstration projects to develop 
     academic curricula integrating qualified health information 
     technology systems in the clinical education of health 
     professionals. Such awards shall be made on a competitive 
     basis and pursuant to peer review.
       [``(b) Eligibility.--To be eligible to receive a grant 
     under subsection (a), an entity shall--
       [``(1) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require;
       [``(2) submit to the Secretary a strategic plan for 
     integrating qualified health information technology in the 
     clinical education of health professionals and for ensuring 
     the consistent utilization of decision support software to 
     reduce medical errors and enhance health care quality;
       [``(3) be--
       [``(A) a health professions school;
       [``(B) a school of nursing; or
       [``(C) a graduate medical education program;
       [``(4) provide for the collection of data regarding the 
     effectiveness of the demonstration project to be funded under 
     the grant in improving the safety of patients, the efficiency 
     of health care delivery, and in increasing the likelihood 
     that graduates of the grantee will adopt and incorporate 
     health information technology in the delivery of health care 
     services; and
       [``(5) provide matching funds in accordance with subsection 
     (c).
       [``(c) Use of Funds.--
       [``(1) In general.--With respect to a grant under 
     subsection (a), an eligible entity shall--
       [``(A) use grant funds in collaboration with 2 or more 
     disciplines; and
       [``(B) use grant funds to integrate qualified health 
     information technology into community-based clinical 
     education.
       [``(2) Limitation.--An eligible entity shall not use 
     amounts received under a grant under subsection (a) to 
     purchase hardware, software, or services.
       [``(d) Matching Funds.--
       [``(1) In general.--The Secretary may award a grant to an 
     entity under this section only if the entity agrees to make 
     available non-Federal contributions toward the costs of the 
     program to be funded under the grant in an amount that is not 
     less than $1 for each $2 of Federal funds provided under the 
     grant.
       [``(2) Determination of amount contributed.--Non-Federal 
     contributions under paragraph (1) may be in cash or in kind, 
     fairly evaluated, including equipment or services. Amounts 
     provided by the Federal Government, or services assisted or 
     subsidized to any significant extent by the Federal 
     Government, may not be included in determining the amount of 
     such contributions.
       [``(e) Evaluation.--The Secretary shall take such action as 
     may be necessary to evaluate the projects funded under this 
     section and publish, make available, and disseminate the 
     results of such evaluations on as wide a basis as is 
     practicable.
       [``(f) Reports.--Not later than 1 year after the date of 
     enactment of this title, and annually thereafter, the 
     Secretary shall submit to the Committee on Health, Education, 
     Labor, and Pensions and the Committee on Finance of the 
     Senate, and the Committee on Energy and Commerce and the 
     Committee on Ways and Means of the House of Representatives a 
     report that--
       [``(1) describes the specific projects established under 
     this section; and
       [``(2) contains recommendations for Congress based on the 
     evaluation conducted under subsection (e).
       [``(g) Authorization of Appropriations.--There is 
     authorized to be appropriated to carry out this section, 
     $5,000,000 for fiscal year 2007, and such sums as may be 
     necessary for each of fiscal years 2008 through 2010.
       [``(h) Sunset.--This section shall not apply after 
     September 30, 2010.

     [``SEC. 2907. LICENSURE AND THE ELECTRONIC EXCHANGE OF HEALTH 
                   INFORMATION.

       [``(a) In General.--The Secretary shall carry out, or 
     contract with a private entity to carry out, a study that 
     examines--
       [``(1) the variation among State laws that relate to the 
     licensure, registration, and certification of medical 
     professionals; and
       [``(2) how such variation among State laws impacts the 
     secure electronic exchange of health information--
       [``(A) among the States; and
       [``(B) between the States and the Federal Government.
       [``(b) Report and Recommendations.--Not later than 1 year 
     after the date of enactment of this title, the Secretary 
     shall publish a report that--
       [``(1) describes the results of the study carried out under 
     subsection (a); and
       [``(2) makes recommendations to States regarding the 
     harmonization of State laws based on the results of such 
     study.

     [``SEC. 2908. QUALITY MEASUREMENT SYSTEMS.

       [``(a) In General.--The Secretary of Health and Human 
     Services, the Secretary of Veterans Affairs, the Secretary of 
     Defense,

[[Page 27183]]

     and representatives of other relevant Federal agencies, as 
     determined appropriate by the Secretary, (referred to in the 
     section as the `Secretaries') shall jointly develop a quality 
     measurement system for the purpose of measuring the quality 
     of care patients receive.
       [``(b) Requirements.--The Secretaries shall ensure that the 
     quality measurement system developed under subsection (a) 
     comply with the following:
       [``(1) Measures.--
       [``(A) In general.--Subject to subparagraph (B), the 
     Secretaries shall select measures of quality to be used by 
     the Secretaries under the systems.
       [``(B) Requirements.--In selecting the measures to be used 
     under each system pursuant to subparagraph (A), the 
     Secretaries shall, to the extent feasible, ensure that--
       [``(i) such measures are evidence based, reliable and 
     valid;
       [``(ii) such measures include measures of process, 
     structure, patient experience, efficiency, and equity; and
       [``(iii) such measures include measures of overuse, 
     underuse, and misuse of health care items and services.
       [``(2) Priorities.--In developing the system under 
     subsection (a), the Secretaries shall ensure that priority is 
     given to--
       [``(A) measures with the greatest potential impact for 
     improving the quality and efficiency of care provided under 
     Federal programs;
       [``(B) measures that may be rapidly implemented by group 
     health plans, health insurance issuers, physicians, 
     hospitals, nursing homes, long-term care providers, and other 
     providers; and
       [``(C) measures which may inform health care decisions made 
     by consumers and patients.
       [``(3) Weights of measures.--The Secretaries shall assign 
     weights to the measures used by the Secretaries under each 
     system established under subsection (a).
       [``(4) Risk adjustment.--The Secretaries shall establish 
     procedures to account for differences in patient health 
     status, patient characteristics, and geographic location. To 
     the extent practicable, such procedures shall recognize 
     existing procedures.
       [``(5) Maintenance.--The Secretaries shall, as determined 
     appropriate, but in no case more often than once during each 
     12-month period, update the quality measurement systems 
     developed under subsection (a), including through--
       [``(A) the addition of more accurate and precise measures 
     under the systems and the retirement of existing outdated 
     measures under the systems; and
       [``(B) the refinement of the weights assigned to measures 
     under the systems.
       [``(c) Required Considerations in Developing and Updating 
     the Systems.--In developing and updating the quality 
     measurement systems under this section, the Secretaries 
     shall--
       [``(1) consult with, and take into account the 
     recommendations of, the entity that the Secretaries has an 
     arrangement with under subsection (e);
       [``(2) consult with representatives of health care 
     providers, consumers, employers, and other individuals and 
     groups that are interested in the quality of health care; and
       [``(3) take into account--
       [``(A) any demonstration or pilot program conducted by the 
     Secretaries relating to measuring and rewarding quality and 
     efficiency of care;
       [``(B) any existing activities conducted by the Secretaries 
     relating to measuring and rewarding quality and efficiency;
       [``(C) any existing activities conducted by private 
     entities including health insurance plans and payors; and
       [``(D) the report by the Institute of Medicine of the 
     National Academy of Sciences under section 238(b) of the 
     Medicare Prescription Drug, Improvement, and Modernization 
     Act of 2003.
       [``(d) Required Considerations in Implementing the 
     Systems.--In implementing the quality measurement systems 
     under this section, the Secretaries shall take into account 
     the recommendations of public-private entities--
       [``(1) that are established to examine issues of data 
     collection and reporting, including the feasibility of 
     collecting and reporting data on measures; and
       [``(2) that involve representatives of health care 
     providers, consumers, employers, and other individuals and 
     groups that are interested in quality of care.
       [``(e) Arrangement With an Entity to Provide Advice and 
     Recommendations.--
       [``(1) Arrangement.--On and after July 1, 2006, the 
     Secretaries shall have in place an arrangement with an entity 
     that meets the requirements described in paragraph (2) under 
     which such entity provides the Secretaries with advice on, 
     and recommendations with respect to, the development and 
     updating of the quality measurement systems under this 
     section, including the assigning of weights to the measures 
     under subsection (b)(2).
       [``(2) Requirements described.--The requirements described 
     in this paragraph are the following:
       [``(A) The entity is a private nonprofit entity governed by 
     an executive director and a board.
       [``(B) The members of the entity include representatives 
     of--
       [``(i) health insurance plans and providers with experience 
     in the care of individuals with multiple complex chronic 
     conditions or groups representing such health insurance plans 
     and providers;
       [``(ii) groups representing patients and consumers;
       [``(iii) purchasers and employers or groups representing 
     purchasers or employers;
       [``(iv) organizations that focus on quality improvement as 
     well as the measurement and reporting of quality measures;
       [``(v) State government health programs;
       [``(vi) individuals or entities skilled in the conduct and 
     interpretation of biomedical, health services, and health 
     economics research and with expertise in outcomes and 
     effectiveness research and technology assessment; and
       [``(vii) individuals or entities involved in the 
     development and establishment of standards and certification 
     for health information technology systems and clinical data.
       [``(C) The membership of the entity is representative of 
     individuals with experience with urban health care issues and 
     individuals with experience with rural and frontier health 
     care issues.
       [``(D) If the entity requires a fee for membership, the 
     entity shall provide assurances to the Secretaries that such 
     fees are not a substantial barrier to participation in the 
     entity's activities related to the arrangement with the 
     Secretaries.
       [``(E) The entity--
       [``(i) permits any member described in subparagraph (B) to 
     vote on matters of the entity related to the arrangement with 
     the Secretary under paragraph (1); and
       [``(ii) ensures that member voting provides a balance among 
     disparate stakeholders, so that no member organization 
     described in subparagraph (B) unduly influences the outcome.
       [``(F) With respect to matters related to the arrangement 
     with the Secretary under paragraph (1), the entity conducts 
     its business in an open and transparent manner and provides 
     the opportunity for public comment.
       [``(G) The entity operates as a voluntary consensus 
     standards setting organization as defined for purposes of 
     section 12(d) of the National Technology Transfer and 
     Advancement Act of 1995 (Public Law 104-113) and Office of 
     Management and Budget Revised Circular A-119 (published in 
     the Federal Register on February 10, 1998).
       [``(f) Use of Quality Measurement System.--
       [``(1) In general.--For purposes of activities conducted or 
     supported by the Secretary under this Act, the Secretary 
     shall, to the extent practicable, adopt and utilize the 
     measurement system developed under this section.
       [``(2) Collaborative agreements.--With respect to 
     activities conducted or supported by the Secretary under this 
     Act, the Secretary may establish collaborative agreements 
     with private entities, including group health plans and 
     health insurance issuers, providers, purchasers, consumer 
     organizations, and entities receiving a grant under section 
     2908, to--
       [``(A) encourage the use of the health care quality 
     measures adopted by the Secretary under this section; and
       [``(B) foster uniformity between the health care quality 
     measures utilized by private entities.
       [``(g) Dissemination of Information.--Beginning on January 
     1, 2008, in order to make comparative quality information 
     available to health care consumers, health professionals, 
     public health officials, researchers, and other appropriate 
     individuals and entities, the Secretary shall provide for the 
     aggregation and analysis of quality measures collected under 
     section 2905 and the dissemination of recommendations and 
     best practices derived in part from such analysis.
       [``(h) Technical Assistance.--The Secretary shall provide 
     technical assistance to public and private entities to enable 
     such entities to--
       [``(1) implement and use evidence-based guidelines with the 
     greatest potential to improve health care quality, 
     efficiency, and patient safety; and
       [``(2) establish mechanisms for the rapid dissemination of 
     information regarding evidence-based guidelines with the 
     greatest potential to improve health care quality, 
     efficiency, and patient safety.

     [``SEC. 2909. APPLICABILITY OF PRIVACY AND SECURITY 
                   REGULATIONS.

       [``The regulations promulgated by the Secretary under part 
     C of title XI of the Social Security Act and sections 261, 
     262, 263, and 264 of the Health Insurance Portability and 
     Accountability Act of 1996 with respect to the privacy, 
     confidentiality, and security of health information shall--
       [``(1) apply to any health information stored or 
     transmitted in an electronic format on or after the date of 
     enactment of this title; and
       [``(2) apply to the implementation of standards, programs, 
     and activities under this title.

[[Page 27184]]



     [``SEC. 2910. STUDY OF REIMBURSEMENT INCENTIVES.

       [``The Secretary shall carry out, or contract with a 
     private entity to carry out, a study that examines methods to 
     create efficient reimbursement incentives for improving 
     health care quality in Federally qualified health centers, 
     rural health clinics, and free clinics.''.

     [SEC. 3. HEALTH INFORMATION TECHNOLOGY RESOURCE CENTER.

       [Section 914 of the Public Health Service Act (42 U.S.C. 
     299b-3) is amended by adding at the end the following:
       [``(d) Center for Best Practices.--
       [``(1) In general.--The Secretary, acting through the 
     Director, shall develop a Center for Best Practices to 
     provide technical assistance and develop best practices to 
     support and accelerate efforts to adopt, implement, and 
     effectively use interoperable health information technology 
     in compliance with section 2903 and 2908.
       [``(2) Center for best practices.--
       [``(A) In general.--The Center shall support activities to 
     meet goals, including--
       [``(i) providing for the widespread adoption of 
     interoperable health information technology;
       [``(ii) providing for the establishment of regional and 
     local health information networks to facilitate the 
     development of interoperability across health care settings 
     and improve the quality of health care;
       [``(iii) the development of solutions to barriers to the 
     exchange of electronic health information; or
       [``(iv) other activities identified by the States, local or 
     regional health information networks, or health care 
     stakeholders as a focus for developing and sharing best 
     practices.
       [``(B) Purposes.--The purpose of the Center is to--
       [``(i) provide a forum for the exchange of knowledge and 
     experience;
       [``(ii) accelerate the transfer of lessons learned from 
     existing public and private sector initiatives, including 
     those currently receiving Federal financial support;
       [``(iii) assemble, analyze, and widely disseminate evidence 
     and experience related to the adoption, implementation, and 
     effective use of interoperable health information technology; 
     and
       [``(iv) assure the timely provision of technical and expert 
     assistance from the Agency and its contractors.
       [``(C) Support for activities.--To provide support for the 
     activities of the Center, the Director shall modify the 
     requirements, if necessary, that apply to the National 
     Resource Center for Health Information Technology to provide 
     the necessary infrastructure to support the duties and 
     activities of the Center and facilitate information exchange 
     across the public and private sectors.
       [``(3) Technical assistance telephone number or website.--
     The Secretary shall establish a toll-free telephone number or 
     Internet website to provide health care providers and 
     patients with a single point of contact to--
       [``(A) learn about Federal grants and technical assistance 
     services related to interoperable health information 
     technology;
       [``(B) learn about qualified health information technology 
     and the quality measurement system adopted by the Federal 
     Government under sections 2903 and 2908;
       [``(C) learn about regional and local health information 
     networks for assistance with health information technology; 
     and
       [``(D) disseminate additional information determined by the 
     Secretary.
       [``(4) Authorization of appropriations.--There are 
     authorized to be appropriated to carry out this subsection, 
     such sums as may be necessary for each of fiscal years 2006 
     through 2010.''.

     [SEC. 4. REAUTHORIZATION OF INCENTIVE GRANTS REGARDING 
                   TELEMEDICINE.

       [Section 330L(b) of the Public Health Service Act (42 
     U.S.C. 254c-18(b)) is amended by striking ``2002 through 
     2006'' and inserting ``2006 through 2010''.]

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Wired for Health Care 
     Quality Act''.

     SEC. 2. IMPROVING HEALTH CARE QUALITY, SAFETY, AND 
                   EFFICIENCY.

       The Public Health Service Act (42 U.S.C. 201 et seq.) is 
     amended by adding at the end the following:

        ``TITLE XXIX--HEALTH INFORMATION TECHNOLOGY AND QUALITY

     ``SEC. 2901. DEFINITIONS.

       ``In this title:
       ``(1) Health care provider.--The term `health care 
     provider' means a hospital, skilled nursing facility, home 
     health entity, health care clinic, federally qualified health 
     center, group practice (as defined in section 1877(h)(4) of 
     the Social Security Act), a pharmacist, a pharmacy, a 
     laboratory, a physician (as defined in section 1861(r) of the 
     Social Security Act), a health facility operated by or 
     pursuant to a contract with the Indian Health Service, a 
     rural health clinic, and any other category of facility or 
     clinician determined appropriate by the Secretary.
       ``(2) Health information.--The term `health information' 
     has the meaning given such term in section 1171(4) of the 
     Social Security Act.
       ``(3) Health insurance plan.--The term `health insurance 
     plan' means--
       ``(A) a health insurance issuer (as defined in section 
     2791(b)(2));
       ``(B) a group health plan (as defined in section 
     2791(a)(1)); and
       ``(C) a health maintenance organization (as defined in 
     section 2791(b)(3)).
       ``(4) Laboratory.--The term `laboratory' has the meaning 
     given that term in section 353.
       ``(5) Pharmacist.--The term `pharmacist' has the meaning 
     given that term in section 804 of the Federal Food, Drug, and 
     Cosmetic Act.
       ``(6) Qualified health information technology.--The term 
     `qualified health information technology' means a 
     computerized system (including hardware and software) that--
       ``(A) protects the privacy and security of health 
     information;
       ``(B) maintains and provides permitted access to health 
     information in an electronic format;
       ``(C) incorporates decision support to reduce medical 
     errors and enhance health care quality;
       ``(D) complies with the standards adopted by the Federal 
     Government under section 2903; and
       ``(E) allows for the reporting of quality measures under 
     section 2908.
       ``(7) State.--The term `State' means each of the several 
     States, the District of Columbia, Puerto Rico, the Virgin 
     Islands, Guam, American Samoa, and the Northern Mariana 
     Islands.

     ``SEC. 2902. OFFICE OF THE NATIONAL COORDINATOR OF HEALTH 
                   INFORMATION TECHNOLOGY.

       ``(a) Office of National Health Information Technology.--
     There is established within the Office of the Secretary an 
     Office of the National Coordinator of Health Information 
     Technology (referred to in this section as the `Office'). The 
     Office shall be headed by a National Coordinator who shall be 
     appointed by the President, in consultation with the 
     Secretary, and shall report directly to the Secretary.
       ``(b) Purpose.--It shall be the purpose of the Office to 
     coordinate and oversee programs and activities to develop a 
     nationwide interoperable health information technology 
     infrastructure that--
       ``(1) ensures that patients' health information is secure 
     and protected;
       ``(2) improves health care quality, reduces medical errors, 
     and advances the delivery of patient-centered medical care;
       ``(3) reduces health care costs resulting from 
     inefficiency, medical errors, inappropriate care, and 
     incomplete information;
       ``(4) ensures that appropriate information to help guide 
     medical decisions is available at the time and place of care;
       ``(5) promotes a more effective marketplace, greater 
     competition, and increased choice through the wider 
     availability of accurate information on health care costs, 
     quality, and outcomes;
       ``(6) improves the coordination of care and information 
     among hospitals, laboratories, physician offices, and other 
     entities through an effective infrastructure for the secure 
     and authorized exchange of health care information;
       ``(7) improves public health reporting and facilitates the 
     early identification and rapid response to public health 
     threats and emergencies, including bioterror events and 
     infectious disease outbreaks;
       ``(8) facilitates health research; and
       ``(9) promotes prevention of chronic diseases.
       ``(c) Duties of the National Coordinator.--The National 
     Coordinator shall--
       ``(1) serve as a member of the public-private American 
     Health Information Collaborative established under section 
     2903;
       ``(2) serve as the principal advisor to the Secretary 
     concerning the development, application, and use of health 
     information technology, and coordinate and oversee the health 
     information technology programs of the Department;
       ``(3) facilitate the adoption of a nationwide, 
     interoperable system for the electronic exchange of health 
     information;
       ``(4) ensure the adoption and implementation of standards 
     for the electronic exchange of health information to reduce 
     cost and improve health care quality;
       ``(5) ensure that health information technology policy and 
     programs of the Department are coordinated with those of 
     relevant executive branch agencies (including Federal 
     commissions) with a goal of avoiding duplication of efforts 
     and of helping to ensure that each agency undertakes health 
     information technology activities primarily within the areas 
     of its greatest expertise and technical capability;
       ``(6) to the extent permitted by law, coordinate outreach 
     and consultation by the relevant executive branch agencies 
     (including Federal commissions) with public and private 
     parties of interest, including consumers, payers, employers, 
     hospitals and other health care providers, physicians, 
     community health centers, laboratories, vendors and other 
     stakeholders;
       ``(7) advise the President regarding specific Federal 
     health information technology programs; and
       ``(8) submit the reports described under section 2903(i) 
     (excluding paragraph (4) of such section).
       ``(d) Detail of Federal Employees.--
       ``(1) In general.--Upon the request of the National 
     Coordinator, the head of any Federal agency is authorized to 
     detail, with or without reimbursement from the Office, any of 
     the personnel of such agency to the Office to assist it in 
     carrying out its duties under this section.
       ``(2) Effect of detail.--Any detail of personnel under 
     paragraph (1) shall--
       ``(A) not interrupt or otherwise affect the civil service 
     status or privileges of the Federal employee; and
       ``(B) be in addition to any other staff of the Department 
     employed by the National Coordinator.

[[Page 27185]]

       ``(3) Acceptance of detailees.--Notwithstanding any other 
     provision of law, the Office may accept detailed personnel 
     from other Federal agencies without regard to whether the 
     agency described under paragraph (1) is reimbursed.
       ``(e) Rule of Construction.--Nothing in this section shall 
     be construed to require the duplication of Federal efforts 
     with respect to the establishment of the Office, regardless 
     of whether such efforts were carried out prior to or after 
     the enactment of this title.
       ``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $5,000,000 for fiscal year 2006, $5,000,000 for fiscal year 
     2007, and such sums as may be necessary for each of fiscal 
     years 2008 through 2010.

     ``SEC. 2903. AMERICAN HEALTH INFORMATION COLLABORATIVE.

       ``(a) Purpose.--The Secretary shall establish the public-
     private American Health Information Collaborative (referred 
     to in this section as the `Collaborative') to--
       ``(1) advise the Secretary and recommend specific actions 
     to achieve a nationwide interoperable health information 
     technology infrastructure;
       ``(2) serve as a forum for the participation of a broad 
     range of stakeholders to provide input on achieving the 
     interoperability of health information technology; and
       ``(3) recommend standards (including content, 
     communication, and security standards) for the electronic 
     exchange of health information (including for the reporting 
     of quality data under section 2908) for adoption by the 
     Federal Government and voluntary adoption by private 
     entities.
       ``(b) Composition.--
       ``(1) In general.--The Collaborative shall be composed of--
       ``(A) the Secretary, who shall serve as the chairperson of 
     the Collaborative;
       ``(B) the Secretary of Defense, or his or her designee;
       ``(C) the Secretary of Veterans Affairs, or his or her 
     designee;
       ``(D) the Secretary of Commerce, or his or her designee;
       ``(E) the National Coordinator for Health Information 
     Technology;
       ``(F) representatives of other relevant Federal agencies, 
     as determined appropriate by the Secretary; and
       ``(G) representatives from each of the following categories 
     to be appointed by the Secretary from nominations submitted 
     by the public--
       ``(i) consumer and patient organizations;
       ``(ii) experts in health information privacy and security;
       ``(iii) health care providers;
       ``(iv) health insurance plans or other third party payors;
       ``(v) standards development organizations;
       ``(vi) information technology vendors;
       ``(vii) purchasers or employers; and
       ``(viii) State or local government agencies or Indian tribe 
     or tribal organizations.
       ``(2) Considerations.--In appointing members under 
     paragraph (1)(G), the Secretary shall select individuals with 
     expertise in--
       ``(A) health information privacy;
       ``(B) health information security;
       ``(C) health care quality and patient safety, including 
     those individuals with expertise in utilizing health 
     information technology to improve health care quality and 
     patient safety;
       ``(D) data exchange; and
       ``(E) developing health information technology standards 
     and new health information technology.
       ``(3) Participation.--Membership and procedures of the 
     Collaborative shall ensure a balance among various sectors of 
     the healthcare system so that no single sector unduly 
     influences the recommendations of the Collaborative.
       ``(4) Terms.--Members appointed under paragraph (1)(G) 
     shall serve for 2 year terms, except that any member 
     appointed to fill a vacancy for an unexpired term shall be 
     appointed for the remainder of such term. A member may serve 
     for not to exceed 180 days after the expiration of such 
     member's term or until a successor has been appointed.
       ``(c) Recommendations and Policies.--Not later than 1 year 
     after the date of enactment of this title, and annually 
     thereafter, the Collaborative shall recommend to the 
     Secretary uniform national policies for adoption by the 
     Federal Government and voluntary adoption by private entities 
     to support the widespread adoption of health information 
     technology, including--
       ``(1) protection of health information through privacy and 
     security practices;
       ``(2) measures to prevent unauthorized access to health 
     information;
       ``(3) methods to facilitate secure patient access to health 
     information;
       ``(4) fostering the public understanding of health 
     information technology;
       ``(5) the ongoing harmonization of industry-wide health 
     information technology standards;
       ``(6) recommendations for a nationwide interoperable health 
     information technology infrastructure;
       ``(7) the identification and prioritization of specific use 
     cases for which health information technology is valuable, 
     beneficial, and feasible;
       ``(8) recommendations for the establishment of an entity to 
     ensure the continuation of the functions of the 
     Collaborative; and
       ``(9) other policies (including recommendations for 
     incorporating health information technology into the 
     provision of care and the organization of the health care 
     workplace) determined to be necessary by the Collaborative.
       ``(d) Standards.--
       ``(1) Existing standards.--The standards adopted by the 
     Consolidated Health Informatics Initiative shall be deemed to 
     have been recommended by the Collaborative under this 
     section.
       ``(2) First year review.--Not later than 1 year after the 
     date of enactment of this title, the Collaborative shall--
       ``(A) review existing standards (including content, 
     communication, and security standards) for the electronic 
     exchange of health information, including such standards 
     adopted by the Secretary under paragraph (2)(A);
       ``(B) identify deficiencies and omissions in such existing 
     standards; and
       ``(C) identify duplication and overlap in such existing 
     standards;

     and recommend new standards and modifications to such 
     existing standards as necessary.

       ``(3) Ongoing review.--Beginning 1 year after the date of 
     enactment of this title, and annually thereafter, the 
     Collaborative shall--
       ``(A) review existing standards (including content, 
     communication, and security standards) for the electronic 
     exchange of health information, including such standards 
     adopted by the Secretary under paragraph (2)(A);
       ``(B) identify deficiencies and omissions in such existing 
     standards; and
       ``(C) identify duplication and overlap in such existing 
     standards;
     and recommend new standards and modifications to such 
     existing standards as necessary.
       ``(4) Limitation.--The standards and timeframe for adoption 
     described in this section shall be consistent with any 
     standards developed pursuant to the Health Insurance 
     Portability and Accountability Act of 1996.
       ``(e) Federal Action.--Not later than 60 days after the 
     issuance of a recommendation from the Collaborative under 
     subsection (d)(2), the Secretary of Health and Human 
     Services, the Secretary of Veterans Affairs, and the 
     Secretary of Defense, in collaboration with representatives 
     of other relevant Federal agencies, as determined appropriate 
     by the Secretary, shall jointly review such recommendations. 
     The Secretary shall provide for the adoption by the Federal 
     Government of any standard or standards contained in such 
     recommendation.
       ``(f) Coordination of Federal Spending.--Not later than 1 
     year after the adoption by the Federal Government of a 
     recommendation as provided for in subsection (e), and in 
     compliance with chapter 113 of title 40, United States Code, 
     no Federal agency shall expend Federal funds for the purchase 
     of any form of health information technology or health 
     information technology system for clinical care or for the 
     electronic retrieval, storage, or exchange of health 
     information that is not consistent with applicable standards 
     adopted by the Federal Government under subsection (e).
       ``(g) Coordination of Federal Data Collection.--Not later 
     than 3 years after the adoption by the Federal Government of 
     a recommendation as provided for in subsection (e), all 
     Federal agencies collecting health data for the purposes of 
     quality reporting, surveillance, epidemiology, adverse event 
     reporting, research, or for other purposes determined 
     appropriate by the Secretary, shall comply with standards 
     adopted under subsection (e).
       ``(h) Voluntary Adoption.--
       ``(1) In general.--Any standards adopted by the Federal 
     Government under subsection (e) shall be voluntary with 
     respect to private entities.
       ``(2) Rule of construction.--Nothing in this section shall 
     be construed to require that a private entity that enters 
     into a contract with the Federal Government adopt the 
     standards adopted by the Federal Government under section 
     2903 with respect to activities not related to the contract.
       ``(3) Limitation.--Private entities that enter into a 
     contract with the Federal Government shall adopt the 
     standards adopted by the Federal Government under section 
     2903 for the purpose of activities under such Federal 
     contract.
       ``(i) Reports.--The Secretary shall submit to the Committee 
     on Health, Education, Labor, and Pensions and the Committee 
     on Finance of the Senate and the Committee on Energy and 
     Commerce and the Committee on Ways and Means of the House of 
     Representatives, on an annual basis, a report that--
       ``(1) describes the specific actions that have been taken 
     by the Federal Government and private entities to facilitate 
     the adoption of an interoperable nationwide system for the 
     electronic exchange of health information;
       ``(2) describes barriers to the adoption of such a 
     nationwide system;
       ``(3) contains recommendations to achieve full 
     implementation of such a nationwide system; and
       ``(4) contains a plan and progress toward the establishment 
     of an entity to ensure the continuation of the functions of 
     the Collaborative.
       ``(j) Application of FACA.--The Federal Advisory Committee 
     Act (5 U.S.C. App.) shall apply to the Collaborative, except 
     that the term provided for under section 14(a)(2) shall be 5 
     years.
       ``(k) Rule of Construction.--Nothing in this section shall 
     be construed to require the duplication of Federal efforts 
     with respect to the establishment of the Collaborative, 
     regardless of whether such efforts were carried out prior to 
     or after the enactment of this title.
       ``(l) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $4,000,000 for fiscal year 2006,

[[Page 27186]]

     $4,000,000 for fiscal year 2007, and such sums as may be 
     necessary for each of fiscal years 2008 through 2010.

     ``SEC. 2904. IMPLEMENTATION AND CERTIFICATION OF HEALTH 
                   INFORMATION STANDARDS.

       ``(a) Implementation.--
       ``(1) In general.--The Secretary, based upon the 
     recommendations of the Collaborative, shall develop criteria 
     to ensure uniform and consistent implementation of any 
     standards for the electronic exchange of health information 
     voluntarily adopted by private entities in technical 
     conformance with such standards adopted under this title.
       ``(2) Implementation assistance.--The Secretary may 
     recognize a private entity or entities to assist private 
     entities in the implementation of the standards adopted under 
     this title using the criteria developed by the Secretary 
     under this section.
       ``(b) Certification.--
       ``(1) In general.--The Secretary, based upon the 
     recommendations of the Collaborative, shall develop criteria 
     to ensure and certify that hardware and software that claim 
     to be in compliance with any standard for the electronic 
     exchange of health information adopted under this title have 
     established and maintained such compliance in technical 
     conformance with such standards.
       ``(2) Certification assistance.--The Secretary may 
     recognize a private entity or entities to assist in the 
     certification described under paragraph (1) using the 
     criteria developed by the Secretary under this section.
       ``(c) Delegation Authority.--The Secretary, through 
     consultation with the Collaborative, may accept 
     recommendations on the development of the criteria under 
     subsections (a) and (b) from a Federal agency or private 
     entity.

     ``SEC. 2905. GRANTS TO FACILITATE THE WIDESPREAD ADOPTION OF 
                   INTEROPERABLE HEALTH INFORMATION TECHNOLOGY.

       ``(a) Competitive Grants to Facilitate the Widespread 
     Adoption of Health Information Technology.--
       ``(1) In general.--The Secretary may award competitive 
     grants to eligible entities to facilitate the purchase and 
     enhance the utilization of qualified health information 
     technology systems to improve the quality and efficiency of 
     health care.
       ``(2) Eligibility.--To be eligible to receive a grant under 
     paragraph (1) an entity shall--
       ``(A) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require;
       ``(B) submit to the Secretary a strategic plan for the 
     implementation of data sharing and interoperability measures;
       ``(C) be a--
       ``(i) not for profit hospital;
       ``(ii) individual or group practice; or
       ``(iii) another health care provider not described in 
     clause (i) or (ii);
       ``(D) adopt the standards adopted by the Federal Government 
     under section 2903;
       ``(E) implement the measurement system adopted under 
     section 2908 and report to the Secretary on such measures;
       ``(F) demonstrate significant financial need; and
       ``(G) provide matching funds in accordance with paragraph 
     (4).
       ``(3) Use of funds.--Amounts received under a grant under 
     this subsection shall be used to facilitate the purchase and 
     enhance the utilization of qualified health information 
     technology systems and training personnel in the use of such 
     technology.
       ``(4) Matching requirement.--To be eligible for a grant 
     under this subsection an entity shall contribute non-Federal 
     contributions to the costs of carrying out the activities for 
     which the grant is awarded in an amount equal to $1 for each 
     $3 of Federal funds provided under the grant.
       ``(5) Preference in awarding grants.--In awarding grants 
     under this subsection the Secretary shall give preference 
     to--
       ``(A) eligible entities that are located in rural, 
     frontier, and other underserved areas as determined by the 
     Secretary;
       ``(B) eligible entities that will link, to the extent 
     practicable, the qualified health information system to local 
     or regional health information plan or plans; and
       ``(C) with respect to an entity described in subsection 
     (a)(2)(C)(iii), a nonprofit health care provider.
       ``(b) Competitive Grants to States for the Development of 
     State Loan Programs to Facilitate the Widespread Adoption of 
     Health Information Technology.--
       ``(1) In general.--The Secretary may award competitive 
     grants to States for the establishment of State programs for 
     loans to health care providers to facilitate the purchase and 
     enhance the utilization of qualified health information 
     technology.
       ``(2) Establishment of fund.--To be eligible to receive a 
     competitive grant under this subsection, a State shall 
     establish a qualified health information technology loan fund 
     (referred to in this subsection as a `State loan fund') and 
     comply with the other requirements contained in this section. 
     A grant to a State under this subsection shall be deposited 
     in the State loan fund established by the State. No funds 
     authorized by other provisions of this title to be used for 
     other purposes specified in this title shall be deposited in 
     any State loan fund.
       ``(3) Eligibility.--To be eligible to receive a grant under 
     paragraph (1) a State shall--
       ``(A) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require;
       ``(B) submit to the Secretary a strategic plan in 
     accordance with paragraph (4);
       ``(C) establish a qualified health information technology 
     loan fund in accordance with paragraph (2);
       ``(D) require that health care providers receiving such 
     loans--
       ``(i) link, to the extent practicable, the qualified health 
     information system to a local or regional health information 
     network; and
       ``(ii) consult with the Health Information Technology 
     Resource Center established in section 914(d) to access the 
     knowledge and experience of existing initiatives regarding 
     the successful implementation and effective use of health 
     information technology;
       ``(E) require that health care providers receiving such 
     loans adopt the standards adopted by the Federal Government 
     under section 2903;
       ``(F) require that health care providers receiving such 
     loans implement the measurement system adopted under section 
     2908 and report to the Secretary on such measures; and
       ``(G) provide matching funds in accordance with paragraph 
     (8).
       ``(4) Strategic plan.--
       ``(A) In general.--A State that receives a grant under this 
     subsection shall annually prepare a strategic plan that 
     identifies the intended uses of amounts available to the 
     State loan fund of the State.
       ``(B) Contents.--A strategic plan under subparagraph (A) 
     shall include--
       ``(i) a list of the projects to be assisted through the 
     State loan fund in the first fiscal year that begins after 
     the date on which the plan is submitted;
       ``(ii) a description of the criteria and methods 
     established for the distribution of funds from the State loan 
     fund; and
       ``(iii) a description of the financial status of the State 
     loan fund and the short-term and long-term goals of the State 
     loan fund.
       ``(5) Use of funds.--
       ``(A) In general.--Amounts deposited in a State loan fund, 
     including loan repayments and interest earned on such 
     amounts, shall be used only for awarding loans or loan 
     guarantees, or as a source of reserve and security for 
     leveraged loans, the proceeds of which are deposited in the 
     State loan fund established under paragraph (1). Loans under 
     this section may be used by a health care provider to 
     facilitate the purchase and enhance the utilization of 
     qualified health information technology and training of 
     personnel in the use of such technology.
       ``(B) Limitation.--Amounts received by a State under this 
     subsection may not be used--
       ``(i) for the purchase or other acquisition of any health 
     information technology system that is not a qualified health 
     information technology system;
       ``(ii) to conduct activities for which Federal funds are 
     expended under this title, or the amendments made by the 
     Wired for Health Care Quality Act; or
       ``(iii) for any purpose other than making loans to eligible 
     entities under this section.
       ``(6) Types of assistance.--Except as otherwise limited by 
     applicable State law, amounts deposited into a State loan 
     fund under this subsection may only be used for the 
     following:
       ``(A) To award loans that comply with the following:
       ``(i) The interest rate for each loan shall be less than or 
     equal to the market interest rate.
       ``(ii) The principal and interest payments on each loan 
     shall commence not later than 1 year after the loan was 
     awarded, and each loan shall be fully amortized not later 
     than 10 years after the date of the loan.
       ``(iii) The State loan fund shall be credited with all 
     payments of principal and interest on each loan awarded from 
     the fund.
       ``(B) To guarantee, or purchase insurance for, a local 
     obligation (all of the proceeds of which finance a project 
     eligible for assistance under this subsection) if the 
     guarantee or purchase would improve credit market access or 
     reduce the interest rate applicable to the obligation 
     involved.
       ``(C) As a source of revenue or security for the payment of 
     principal and interest on revenue or general obligation bonds 
     issued by the State if the proceeds of the sale of the bonds 
     will be deposited into the State loan fund.
       ``(D) To earn interest on the amounts deposited into the 
     State loan fund.
       ``(7) Administration of state loan funds.--
       ``(A) Combined financial administration.--A State may (as a 
     convenience and to avoid unnecessary administrative costs) 
     combine, in accordance with State law, the financial 
     administration of a State loan fund established under this 
     subsection with the financial administration of any other 
     revolving fund established by the State if otherwise not 
     prohibited by the law under which the State loan fund was 
     established.
       ``(B) Cost of administering fund.--Each State may annually 
     use not to exceed 4 percent of the funds provided to the 
     State under a grant under this subsection to pay the 
     reasonable costs of the administration of the programs under 
     this section, including the recovery of reasonable costs 
     expended to establish a State loan fund which are incurred 
     after the date of enactment of this title.
       ``(C) Guidance and regulations.--The Secretary shall 
     publish guidance and promulgate regulations as may be 
     necessary to carry out the provisions of this subsection, 
     including--
       ``(i) provisions to ensure that each State commits and 
     expends funds allotted to the State

[[Page 27187]]

     under this subsection as efficiently as possible in 
     accordance with this title and applicable State laws; and
       ``(ii) guidance to prevent waste, fraud, and abuse.
       ``(D) Private sector contributions.--
       ``(i) In general.--A State loan fund established under this 
     subsection may accept contributions from private sector 
     entities, except that such entities may not specify the 
     recipient or recipients of any loan issued under this 
     subsection.
       ``(ii) Availability of information.--A State shall make 
     publicly available the identity of, and amount contributed 
     by, any private sector entity under clause (i) and may issue 
     letters of commendation or make other awards (that have no 
     financial value) to any such entity.
       ``(8) Matching requirements.--
       ``(A) In general.--The Secretary may not make a grant under 
     paragraph (1) to a State unless the State agrees to make 
     available (directly or through donations from public or 
     private entities) non-Federal contributions in cash toward 
     the costs of the State program to be implemented under the 
     grant in an amount equal to not less than $1 for each $1 of 
     Federal funds provided under the grant.
       ``(B) Determination of amount of non-federal 
     contribution.--In determining the amount of non-Federal 
     contributions that a State has provided pursuant to 
     subparagraph (A), the Secretary may not include any amounts 
     provided to the State by the Federal Government.
       ``(9) Preference in awarding grants.--The Secretary may 
     give a preference in awarding grants under this subsection to 
     States that adopt value-based purchasing programs to improve 
     health care quality.
       ``(10) Reports.--The Secretary shall annually submit to the 
     Committee on Health, Education, Labor, and Pensions and the 
     Committee on Finance of the Senate, and the Committee on 
     Energy and Commerce and the Committee on Ways and Means of 
     the House of Representatives, a report summarizing the 
     reports received by the Secretary from each State that 
     receives a grant under this subsection.
       ``(c) Competitive Grants for the Implementation of Regional 
     or Local Health Information Technology Plans.--
       ``(1) In general.--The Secretary may award competitive 
     grants to eligible entities to implement regional or local 
     health information plans to improve health care quality and 
     efficiency through the electronic exchange of health 
     information pursuant to the standards, protocols, and other 
     requirements adopted by the Secretary under sections 2903 and 
     2908.
       ``(2) Eligibility.--To be eligible to receive a grant under 
     paragraph (1) an entity shall--
       ``(A) demonstrate financial need to the Secretary;
       ``(B) demonstrate that one of its principal missions or 
     purposes is to use information technology to improve health 
     care quality and efficiency;
       ``(C) adopt bylaws, memoranda of understanding, or other 
     charter documents that demonstrate that the governance 
     structure and decisionmaking processes of such entity allow 
     for participation on an ongoing basis by multiple 
     stakeholders within a community, including--
       ``(i) physicians (as defined in section 1861(r) of the 
     Social Security Act), including physicians that provide 
     services to low income and underserved populations;
       ``(ii) hospitals (including hospitals that provide services 
     to low income and underserved populations);
       ``(iii) pharmacists or pharmacies;
       ``(iv) health insurance plans;
       ``(v) health centers (as defined in section 330(b)) and 
     Federally qualified health centers (as defined in section 
     1861(aa)(4) of the Social Security Act);
       ``(vi) rural health clinics (as defined in section 1861(aa) 
     of the Social Security Act);
       ``(vii) patient or consumer organizations;
       ``(viii) employers; and
       ``(ix) any other health care providers or other entities, 
     as determined appropriate by the Secretary;
       ``(D) demonstrate the participation, to the extent 
     practicable, of stakeholders in the electronic exchange of 
     health information within the local or regional plan pursuant 
     to paragraph (2)(C);
       ``(E) adopt nondiscrimination and conflict of interest 
     policies that demonstrate a commitment to open, fair, and 
     nondiscriminatory participation in the health information 
     plan by all stakeholders;
       ``(F) adopt the standards adopted by the Secretary under 
     section 2903;
       ``(G) require that health care providers receiving such 
     grants implement the measurement system adopted under section 
     2908 and report to the Secretary on such measures;
       ``(H) facilitate the electronic exchange of health 
     information within the local or regional area and among local 
     and regional areas;
       ``(I) prepare and submit to the Secretary an application in 
     accordance with paragraph (3); and
       ``(J) agree to provide matching funds in accordance with 
     paragraph (5).
       ``(3) Application.--
       ``(A) In general.--To be eligible to receive a grant under 
     paragraph (1), an entity shall submit to the Secretary an 
     application at such time, in such manner, and containing such 
     information as the Secretary may require.
       ``(B) Required information.--At a minimum, an application 
     submitted under this paragraph shall include--
       ``(i) clearly identified short-term and long-term 
     objectives of the regional or local health information plan;
       ``(ii) a technology plan that complies with the standards 
     adopted under section 2903 and that includes a descriptive 
     and reasoned estimate of costs of the hardware, software, 
     training, and consulting services necessary to implement the 
     regional or local health information plan;
       ``(iii) a strategy that includes initiatives to improve 
     health care quality and efficiency, including the use and 
     reporting of health care quality measures adopted under 
     section 2908;
       ``(iv) a plan that describes provisions to encourage the 
     implementation of the electronic exchange of health 
     information by all physicians, including single physician 
     practices and small physician groups participating in the 
     health information plan;
       ``(v) a plan to ensure the privacy and security of personal 
     health information that is consistent with Federal and State 
     law;
       ``(vi) a governance plan that defines the manner in which 
     the stakeholders shall jointly make policy and operational 
     decisions on an ongoing basis;
       ``(vii) a financial or business plan that describes--

       ``(I) the sustainability of the plan;
       ``(II) the financial costs and benefits of the plan; and
       ``(III) the entities to which such costs and benefits will 
     accrue; and

       ``(viii) if the case of an applicant entity that is unable 
     to demonstrate the participation of all stakeholders pursuant 
     to paragraph (2)(C), the justification from the entity for 
     any such nonparticipation.
       ``(4) Use of funds.--Amounts received under a grant under 
     paragraph (1) shall be used to establish and implement a 
     regional or local health information plan in accordance with 
     this subsection.
       ``(5) Matching requirement.--
       ``(A) In general.--The Secretary may not make a grant under 
     this subsection to an entity unless the entity agrees that, 
     with respect to the costs to be incurred by the entity in 
     carrying out the infrastructure program for which the grant 
     was awarded, the entity will make available (directly or 
     through donations from public or private entities) non-
     Federal contributions toward such costs in an amount equal to 
     not less than 50 percent of such costs ($1 for each $2 of 
     Federal funds provided under the grant).
       ``(B) Determination of amount contributed.--Non-Federal 
     contributions required under subparagraph (A) may be in cash 
     or in kind, fairly evaluated, including equipment, 
     technology, or services. Amounts provided by the Federal 
     Government, or services assisted or subsidized to any 
     significant extent by the Federal Government, may not be 
     included in determining the amount of such non-Federal 
     contributions.
       ``(d) Reports.--Not later than 1 year after the date on 
     which the first grant is awarded under this section, and 
     annually thereafter during the grant period, an entity that 
     receives a grant under this section shall submit to the 
     Secretary a report on the activities carried out under the 
     grant involved. Each such report shall include--
       ``(1) a description of the financial costs and benefits of 
     the project involved and of the entities to which such costs 
     and benefits accrue;
       ``(2) an analysis of the impact of the project on health 
     care quality and safety;
       ``(3) a description of any reduction in duplicative or 
     unnecessary care as a result of the project involved;
       ``(4) a description of the efforts of recipients under this 
     section to facilitate secure patient access to health 
     information; and
       ``(5) other information as required by the Secretary.
       ``(e) Requirement to Achieve Quality Improvement.--The 
     Secretary shall annually evaluate the activities conducted 
     under this section and shall, in awarding grants, implement 
     the lessons learned from such evaluation in a manner so that 
     awards made subsequent to each such evaluation are made in a 
     manner that, in the determination of the Secretary, will 
     result in the greatest improvement in quality measurement 
     systems under section 2908.
       ``(f) Limitation.--An eligible entity may only receive one 
     non-renewable grant under subsection (a), one non-renewable 
     grant under subsection (b), and one non-renewable grant under 
     subsection (c).
       ``(g) Authorization of Appropriations.--
       ``(1) In general.--For the purpose of carrying out this 
     section, there is authorized to be appropriated $116,000,000 
     for fiscal year 2006, $141,000,000 for fiscal year 2007, and 
     such sums as may be necessary for each of fiscal years 2008 
     through 2010.
       ``(2) Availability.--Amounts appropriated under paragraph 
     (1) shall remain available through fiscal year 2010.

     ``SEC. 2906. DEMONSTRATION PROGRAM TO INTEGRATE INFORMATION 
                   TECHNOLOGY INTO CLINICAL EDUCATION.

       ``(a) In General.--The Secretary may award grants under 
     this section to carry out demonstration projects to develop 
     academic curricula integrating qualified health information 
     technology systems in the clinical education of health 
     professionals. Such awards shall be made on a competitive 
     basis and pursuant to peer review.
       ``(b) Eligibility.--To be eligible to receive a grant under 
     subsection (a), an entity shall--
       ``(1) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require;
       ``(2) submit to the Secretary a strategic plan for 
     integrating qualified health information

[[Page 27188]]

     technology in the clinical education of health professionals 
     and for ensuring the consistent utilization of decision 
     support software to reduce medical errors and enhance health 
     care quality;
       ``(3) be--
       ``(A) a health professions school;
       ``(B) a school of nursing; or
       ``(C) an institution with a graduate medical education 
     program;
       ``(4) provide for the collection of data regarding the 
     effectiveness of the demonstration project to be funded under 
     the grant in improving the safety of patients, the efficiency 
     of health care delivery, and in increasing the likelihood 
     that graduates of the grantee will adopt and incorporate 
     health information technology, and implement the quality 
     measurement system adopted under section 2908, in the 
     delivery of health care services; and
       ``(5) provide matching funds in accordance with subsection 
     (c).
       ``(c) Use of Funds.--
       ``(1) In general.--With respect to a grant under subsection 
     (a), an eligible entity shall--
       ``(A) use grant funds in collaboration with 2 or more 
     disciplines; and
       ``(B) use grant funds to integrate qualified health 
     information technology into community-based clinical 
     education.
       ``(2) Limitation.--An eligible entity shall not use amounts 
     received under a grant under subsection (a) to purchase 
     hardware, software, or services.
       ``(d) Matching Funds.--
       ``(1) In general.--The Secretary may award a grant to an 
     entity under this section only if the entity agrees to make 
     available non-Federal contributions toward the costs of the 
     program to be funded under the grant in an amount that is not 
     less than $1 for each $2 of Federal funds provided under the 
     grant.
       ``(2) Determination of amount contributed.--Non-Federal 
     contributions under paragraph (1) may be in cash or in kind, 
     fairly evaluated, including equipment or services. Amounts 
     provided by the Federal Government, or services assisted or 
     subsidized to any significant extent by the Federal 
     Government, may not be included in determining the amount of 
     such contributions.
       ``(e) Evaluation.--The Secretary shall take such action as 
     may be necessary to evaluate the projects funded under this 
     section and publish, make available, and disseminate the 
     results of such evaluations on as wide a basis as is 
     practicable.
       ``(f) Reports.--Not later than 1 year after the date of 
     enactment of this title, and annually thereafter, the 
     Secretary shall submit to the Committee on Health, Education, 
     Labor, and Pensions and the Committee on Finance of the 
     Senate, and the Committee on Energy and Commerce and the 
     Committee on Ways and Means of the House of Representatives a 
     report that--
       ``(1) describes the specific projects established under 
     this section; and
       ``(2) contains recommendations for Congress based on the 
     evaluation conducted under subsection (e).
       ``(g) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $5,000,000 for 
     fiscal year 2007, and such sums as may be necessary for each 
     of fiscal years 2008 through 2010.
       ``(h) Sunset.--This section shall not apply after September 
     30, 2010.

     ``SEC. 2907. LICENSURE AND THE ELECTRONIC EXCHANGE OF HEALTH 
                   INFORMATION.

       ``(a) In General.--The Secretary shall carry out, or 
     contract with a private entity to carry out, a study that 
     examines--
       ``(1) the variation among State laws that relate to the 
     licensure, registration, and certification of medical 
     professionals; and
       ``(2) how such variation among State laws impacts the 
     secure electronic exchange of health information--
       ``(A) among the States; and
       ``(B) between the States and the Federal Government.
       ``(b) Report and Recommendations.--Not later than 1 year 
     after the date of enactment of this title, the Secretary 
     shall publish a report that--
       ``(1) describes the results of the study carried out under 
     subsection (a); and
       ``(2) makes recommendations to States regarding the 
     harmonization of State laws based on the results of such 
     study.

     ``SEC. 2908. QUALITY MEASUREMENT SYSTEM.

       ``(a) In General.--The Secretary, in consultation with the 
     Secretary of Veterans Affairs, the Secretary of Defense, and 
     representatives of other relevant Federal agencies, as 
     determined appropriate by the Secretary, shall develop or 
     adopt a quality measurement system, including measures to 
     assess that effectiveness, timeliness, patient self-
     management, patient centeredness, efficiency, and safety, for 
     the purpose of measuring the quality of care patients 
     receive.
       ``(b) Requirements.--The Secretary shall ensure that the 
     quality measurement system developed under subsection (a) 
     comply with the following:
       ``(1) Measures.--
       ``(A) In general.--Subject to subparagraph (B), the 
     Secretary shall select measures of quality to be used by the 
     Secretary under the systems.
       ``(B) Requirements.--In selecting the measures to be used 
     under each system pursuant to subparagraph (A), the Secretary 
     shall, to the extent feasible, ensure that--
       ``(i) such measures are evidence based, reliable and valid;
       ``(ii) such measures include measures of clinical processes 
     and outcomes, patient experience, efficiency, and equity; and
       ``(iii) such measures include measures of overuse and 
     underuse of health care items and services.
       ``(2) Priorities.--In developing the system under 
     subsection (a), the Secretary shall ensure that priority is 
     given to--
       ``(A) measures with the greatest potential impact for 
     improving the quality and efficiency of care provided under 
     Federal programs;
       ``(B) measures that may be rapidly implemented by group 
     health plans, health insurance issuers, physicians, 
     hospitals, nursing homes, long-term care providers, and other 
     providers; and
       ``(C) measures which may inform health care decisions made 
     by consumers and patients.
       ``(3) Weights of measures.--The Secretary shall assign 
     weights to the measures used by the Secretary under each 
     system established under subsection (a).
       ``(4) Risk adjustment.--The Secretary shall establish 
     procedures to account for differences in patient health 
     status, patient characteristics, and geographic location. To 
     the extent practicable, such procedures shall recognize 
     existing procedures.
       ``(5) Maintenance.--The Secretary shall, as determined 
     appropriate, but in no case more often than once during each 
     12-month period, update the quality measurement systems 
     developed under subsection (a), including through--
       ``(A) the addition of more accurate and precise measures 
     under the systems and the retirement of existing outdated 
     measures under the systems; and
       ``(B) the refinement of the weights assigned to measures 
     under the systems.
       ``(c) Required Considerations in Developing and Updating 
     the Systems.--In developing and updating the quality 
     measurement systems under this section, the Secretary shall--
       ``(1) consult with, and take into account the 
     recommendations of, the entity that the Secretary has an 
     arrangement with under subsection (e);
       ``(2) consult with representatives of health care providers 
     (including physicians, pharmacists, nurses, and other health 
     care professionals), consumers, employers, and other 
     individuals and groups that are interested in the quality of 
     health care; and
       ``(3) take into account--
       ``(A) any demonstration or pilot program conducted by the 
     Secretary relating to measuring and rewarding quality and 
     efficiency of care;
       ``(B) any existing activities conducted by the Secretary 
     relating to measuring and rewarding quality and efficiency;
       ``(C) any existing activities conducted by private entities 
     including health insurance plans and payors; and
       ``(D) the report by the Institute of Medicine of the 
     National Academy of Sciences under section 238(b) of the 
     Medicare Prescription Drug, Improvement, and Modernization 
     Act of 2003.
       ``(d) Required Considerations in Implementing the 
     Systems.--In implementing the quality measurement systems 
     under this section, the Secretary shall take into account the 
     recommendations of public-private entities--
       ``(1) that are established to examine issues of data 
     collection and reporting, including the feasibility of 
     collecting and reporting data on measures; and
       ``(2) that involve representatives of health care providers 
     (including physicians, pharmacists, nurses, and other health 
     care professionals), consumers, employers, and other 
     individuals and groups that are interested in quality of 
     care.
       ``(e) Arrangement With an Entity to Provide Advice and 
     Recommendations.--
       ``(1) Arrangement.--On and after July 1, 2006, the 
     Secretary shall have in place an arrangement with an entity 
     that meets the requirements described in paragraph (2) under 
     which such entity provides the Secretary with advice on, and 
     recommendations with respect to, the development and updating 
     of the quality measurement systems under this section, 
     including the assigning of weights to the measures under 
     subsection (b)(2).
       ``(2) Requirements described.--The requirements described 
     in this paragraph are the following:
       ``(A) The entity is a private nonprofit entity governed by 
     an executive director and a board.
       ``(B) The members of the entity include representatives 
     of--
       ``(i) health insurance plans and health care providers with 
     experience in the care of individuals with multiple complex 
     chronic conditions or groups representing such health 
     insurance plans and providers;
       ``(ii) groups representing patients and consumers;
       ``(iii) purchasers and employers or groups representing 
     purchasers or employers;
       ``(iv) organizations that focus on quality improvement as 
     well as the measurement and reporting of quality measures;
       ``(v) State government health programs;
       ``(vi) individuals or entities skilled in the conduct and 
     interpretation of biomedical, health services, and health 
     economics research and with expertise in outcomes and 
     effectiveness research and technology assessment; and
       ``(vii) individuals or entities involved in the development 
     and establishment of standards and certification for health 
     information technology systems and clinical data.
       ``(C) The membership of the entity is representative of 
     individuals with experience with urban health care issues and 
     individuals with experience with rural and frontier health 
     care issues.

[[Page 27189]]

       ``(D) If the entity requires a fee for membership, the 
     entity shall provide assurances to the Secretary that such 
     fees are not a substantial barrier to participation in the 
     entity's activities related to the arrangement with the 
     Secretary.
       ``(E) The entity--
       ``(i) permits any member described in subparagraph (B) to 
     vote on matters of the entity related to the arrangement with 
     the Secretary under paragraph (1); and
       ``(ii) ensures that member voting provides a balance among 
     disparate stakeholders, so that no member organization 
     described in subparagraph (B) unduly influences the outcome.
       ``(F) With respect to matters related to the arrangement 
     with the Secretary under paragraph (1), the entity conducts 
     its business in an open and transparent manner and provides 
     the opportunity for public comment.
       ``(G) The entity operates as a voluntary consensus 
     standards setting organization as defined for purposes of 
     section 12(d) of the National Technology Transfer and 
     Advancement Act of 1995 (Public Law 104-113) and Office of 
     Management and Budget Revised Circular A-119 (published in 
     the Federal Register on February 10, 1998).
       ``(f) Use of Quality Measurement System.--
       ``(1) In general.--For purposes of activities conducted or 
     supported by the Secretary under this Act, the Secretary 
     shall, to the extent practicable, adopt and utilize the 
     measurement system developed under this section.
       ``(2) Collaborative agreements.--With respect to activities 
     conducted or supported by the Secretary under this Act, the 
     Secretary may establish collaborative agreements with private 
     entities, including group health plans and health insurance 
     issuers, providers, purchasers, consumer organizations, and 
     entities receiving a grant under section 2905, to--
       ``(A) encourage the use of the health care quality measures 
     adopted by the Secretary under this section; and
       ``(B) foster uniformity between the health care quality 
     measures utilized by private entities.
       ``(3) Reporting.--The Secretary shall implement procedures 
     to enable the Department of Health and Human Services to 
     accept the electronic submission of data for purposes of 
     quality measurement using the quality measurement system 
     adopted under this section and using the standards adopted by 
     the Federal Government under section 2903.
       ``(g) Dissemination of Information.--Beginning on January 
     1, 2008, in order to make comparative quality information 
     available to health care consumers, health professionals, 
     public health officials, researchers, and other appropriate 
     individuals and entities, the Secretary shall provide for the 
     dissemination, aggregation, and analysis of quality measures 
     collected under section 2905 and the dissemination of 
     recommendations and best practices derived in part from such 
     analysis.
       ``(h) Technical Assistance.--The Secretary shall provide 
     technical assistance to public and private entities to enable 
     such entities to--
       ``(1) implement and use evidence-based guidelines with the 
     greatest potential to improve health care quality, 
     efficiency, and patient safety; and
       ``(2) establish mechanisms for the rapid dissemination of 
     information regarding evidence-based guidelines with the 
     greatest potential to improve health care quality, 
     efficiency, and patient safety.

     ``SEC. 2909. ENSURING PRIVACY AND SECURITY.

       ``Nothing in this title shall be construed to affect the 
     scope or substance of--
       ``(1) section 264 of the Health Insurance Portability and 
     Accountability Act of 1996;
       ``(2) sections 1171 through 1179 of the Social Security 
     Act; and
       ``(3) any regulation issued pursuant to any such section;
     and such sections shall remain in effect.

     ``SEC. 2910. STUDY OF REIMBURSEMENT INCENTIVES.

       ``The Secretary shall carry out, or contract with a private 
     entity to carry out, a study that examines methods to create 
     efficient reimbursement incentives for improving health care 
     quality in Federally qualified health centers, rural health 
     clinics, and free clinics.''.

     SEC. 3. HEALTH INFORMATION TECHNOLOGY RESOURCE CENTER.

       Section 914 of the Public Health Service Act (42 U.S.C. 
     299b-3) is amended by adding at the end the following:
       ``(d) Health information technology resource center.--
       ``(1) In general.--The Secretary, acting through the 
     Director, shall develop a Health Information Technology 
     Resource Center to provide technical assistance and develop 
     best practices to support and accelerate efforts to adopt, 
     implement, and effectively use interoperable health 
     information technology in compliance with section 2903 and 
     2908.
       ``(2) Health information technology resource center.--
       ``(A) In general.--The Center shall support activities to 
     meet goals, including--
       ``(i) providing for the widespread adoption of 
     interoperable health information technology;
       ``(ii) providing for the establishment of regional and 
     local health information networks to facilitate the 
     development of interoperability across health care settings 
     and improve the quality of health care;
       ``(iii) the development of solutions to barriers to the 
     exchange of electronic health information; or
       ``(iv) other activities identified by the States, local or 
     regional health information networks, or health care 
     stakeholders as a focus for developing and sharing best 
     practices.
       ``(B) Purposes.--The purpose of the Center is to--
       ``(i) provide a forum for the exchange of knowledge and 
     experience;
       ``(ii) accelerate the transfer of lessons learned from 
     existing public and private sector initiatives, including 
     those currently receiving Federal financial support; and
       ``(iii) assemble, analyze, and widely disseminate evidence 
     and experience related to the adoption, implementation, and 
     effective use of interoperable health information technology.
       ``(C) Support for activities.--To provide support for the 
     activities of the Center, the Director shall modify the 
     requirements, if necessary, that apply to the National 
     Resource Center for Health Information Technology to provide 
     the necessary infrastructure to support the duties and 
     activities of the Center and facilitate information exchange 
     across the public and private sectors.
       ``(3) Technical assistance telephone number or website.--
     The Secretary shall establish a toll-free telephone number or 
     Internet website to provide health care providers and 
     patients with a single point of contact to--
       ``(A) learn about Federal grants and technical assistance 
     services related to interoperable health information 
     technology;
       ``(B) learn about qualified health information technology 
     and the quality measurement system adopted by the Federal 
     Government under sections 2903 and 2908;
       ``(C) learn about regional and local health information 
     networks for assistance with health information technology; 
     and
       ``(D) disseminate additional information determined by the 
     Secretary.
       ``(4) Rule of construction.--Nothing in this subsection 
     shall be construed to require the duplication of Federal 
     efforts with respect to the establishment of the Center, 
     regardless of whether such efforts were carried out prior to 
     or after the enactment of this subsection.''.

     SEC. 4. REAUTHORIZATION OF INCENTIVE GRANTS REGARDING 
                   TELEMEDICINE.

       Section 330L(b) of the Public Health Service Act (42 U.S.C. 
     254c-18(b)) is amended by striking ``2002 through 2006'' and 
     inserting ``2006 through 2010''.
  Mr. FRIST. Mr. President, I ask unanimous consent that the Enzi 
substitute at the desk be agreed to, the committee-reported amendment, 
as amended, be agreed to, the bill, as amended, be read a third time 
and passed, the motion to reconsider be laid upon the table, and that 
any statements relating to the bill be printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 2671) was agreed to.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  The committee amendment in the nature of a substitute, as amended, 
was agreed to.
  The bill (S. 1418), as amended, was read the third time and passed.
  Mr. FRIST. Mr. President, the Senate just passed a bill that takes a 
major step--major step--to bringing health care into the information 
age, finally. This bill, the Wired for Health Care Quality Act, 
reflects the hard work by Senator Enzi, to whom I will turn the floor 
over shortly, myself, Senator Kennedy, Senator Clinton, and many 
others.
  This bill will do as much as anything we have done in this Congress 
and the last Congress and the Congress before that to cut waste and 
inefficiency out of our health care system. What the bill does is 
encourage the use of secure and interoperable health care records, 
electronic records, electronic medical records.
  This has a huge benefit for every American. It reduces waste and 
inefficiency. It reduces medical errors. It improves the quality of 
health care. It reduces health care costs throughout the system, 
raising quality. When you lower costs and you raise quality, by 
definition, you improve access as well.
  This bill will help empower patients to become full partners in what 
we all have as a vision; and that is, a patient-centered, provider-
friendly, consumer-driven system that will be driven by information, 
and be driven by choice, and be driven by control.
  Patient privacy is protected. This secure exchange of lifesaving 
information improves efficiency throughout the system. It will allow, 
for the first time, because there are interoperable standards that are 
set, the exchange of information, which will seamlessly help integrate 
health care delivery from the time a patient first presents to see a 
physician or a nurse to ultimate discharge and treatment.

[[Page 27190]]

  So this really is a pivotal moment. I encourage the House to act 
quickly on the legislation.
  Again, I thank Senator Enzi for his leadership. Without it, this 
moment simply would not be possible. I thank Senator Clinton who has 
stressed, from day one, the importance of having quality injected into 
this bill, and Senator Kennedy. I thank them all for their commitment 
to this effort.
  I thank the staff who have worked many hours: Andrea Palm, Katy Barr, 
Steve Northrup, and David Bowen, and many others.
  Mr. President, I do want to at least turn to my colleague to thank 
him and so he can make a few comments because this is truly historic 
legislation. And although it is mighty early in the morning now--late 
at night or early in the morning--this really is a historic time for 
health care and health care delivery.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. ENZI. Mr. President, I thank the leader for his kind comments but 
much more so for his diligent work and leadership on this issue. As the 
heart doctor of the Senate, and the doctor with a lot of heart, he 
understands the need for health information technology and worked in a 
very bipartisan way with Senator Clinton to come up with some of the 
precepts we have in this bill. Senator Kennedy and I were working on 
some other aspects of it. And we merged those two to come up with a 
much more comprehensive health IT bill.
  This will make a huge difference in the country. A RAND study that 
was recently released said this will save about $162 billion a year in 
medical costs. In my opinion, that is not even going to be the biggest 
benefit. The biggest benefit is that it is going to allow medical data 
to move with the people as they move.
  When they go to the doctor's office, they will not have to take that 
little clipboard and fill out whatever it is they can remember about 
their health. And it will not matter because a lot more information 
will be available to the doctor so he can make the right kinds of 
decisions and choices.
  It will also benefit travelers. If a tourist is out on the road and 
has a wreck and has to see a doctor, they will have their information 
with them. They will have access to it so the doctor will know what 
medications they are on, even if they are in a coma, and can make sure 
they are taken care of properly. And yes, it will reduce medical errors 
and eliminate some adverse reactions from medications or even missed 
medications.
  So this will make a huge difference to the people of this country. 
The difficulty with doing something by unanimous consent is that a lot 
of times people think there is not much to it, or if there wasn't much 
controversy, that nothing really happened. But there has been 
controversy that has been taken care of behind the scenes, where people 
got together and actually realized how important this was. So they 
worked together to come up with solutions, and came up with a truly 
bipartisan solution in this instance.
  So it is almost too bad that it has to go through unanimous consent, 
that we cannot have some very heated debates on the floor so people 
will realize the intensity and the interest in the bill.
  But there is not anything bad about the bill. This was a teamwork 
effort from both sides of the aisle. I appreciate the leader mentioning 
a number of the people who were involved in this bill. This is a truly 
monumental piece of legislation we just passed, and I add the 
encouragement to have the House act on it quickly.
  Mr. President, I rise today to applaud the Senate passage of S. 1418, 
the Wired for Health Care Quality Act. As chairman of the Committee on 
Health, Education, Labor, and Pensions, I have been working to improve 
the quality and reduce the cost of health care in this Nation.
  Some of the most serious challenges facing health care today--medical 
errors, inconsistent quality, and rising costs--can be addressed 
through the effective application of available health information 
technology linking all elements of the health care system. Information-
sharing networks have the potential to enable decision support anywhere 
at any time, thus improving the quality of health care and reducing 
costs.
  Health IT allows medical data to move with people as they move. When 
they go to the doctor's office they won't have to take the clipboard 
and write down everything they can remember about themselves. This 
system also benefits travelers. If a tourist were to get in a car wreck 
or hurt in some other way, the doctor would be able to find out 
everything he or she needs to know. If in a coma this technology could 
save a person's life and if they happen to be on medications, it could 
prevent adverse drug reactions. This system could also cut down on 
medical errors with prescriptions--instead of deciphering the doctor's 
handwriting, the information could be given to the pharmacist 
electronically.
  A RAND study recently released suggested that health IT has the 
potential to save $162 billion a year. In order for these savings to be 
realized, we must create an infrastructure for interoperability. S. 
1418 is the first step in building that infrastructure.
  Most folks agree that there are significant barriers to widespread 
adoption of interoperable health information technology. One of the 
primary barriers is the current lack of agreed-upon standards and 
common implementation guides and a certification process. This bill 
addresses those factors in a way that appropriately incorporates 
involvement of both the public and private sectors.
  This legislation brings the government and the private sector 
together to make health care better, safer and more efficient by 
accelerating the widespread adoption of interoperable health 
information technology and quality measurement across our health care 
system. The legislation formalizes involvement of private entities in 
the standards and policy-setting process by directing the Secretary to 
establish and chair the public-private American Health Information 
Collaborative, which shall be composed of representatives of the public 
and private sectors. S. 1418 also codifies the Office of the National 
Coordinator for Health Information Technology. President Bush, 
Secretary Leavitt, and Dr. Brailer have done a lot to advance the 
health IT infrastructure, and I am glad that Congress is finally 
stepping up to the plate.
  In order to address the health information technology ``adoption 
gap'' in the United States, S. 1418 authorizes three grant programs 
that will carefully target financial support to health care providers 
and consortia for the purpose of facilitating the adoption of 
interoperable health information technology. To maximize the Secretary 
of Health and Human Service's flexibility, the bill leaves to the 
discretion of the Secretary the allocation of the authorization among 
the three programs.
  In addition, the greatest improvements in quality of health care and 
cost savings will be realized when all elements of the health care 
system are electronically connected and speak a common technical 
language--that is they are interoperable. For this reason, each grant 
program requires that each grant recipient acquire only qualified 
health information technology systems that are capable of supporting 
common technical standards adopted by the Federal Government.
  Another barrier to widespread adoption of interoperable health 
information is cultural. I recognize that many physicians and hospitals 
are hesitant to move from paper-based systems to electronic systems. 
Some physicians have been writing prescriptions by hand for many years 
and may resist changing to electronic prescribing. One way to address 
this cultural barrier to the widespread adoption of health information 
technology is to support teaching hospitals and continuing education 
programs that integrate health information technology in the clinical 
education of health care professionals. Exposing students and residents 
to effective everyday uses of health IT will lead to a greater adoption 
by these students and residents when they graduate and begin practicing 
on their own.

[[Page 27191]]

The bill authorizes the Secretary to award demonstration grants to 
health professions centers and academic health centers to integrate 
health IT into clinical education in community settings.
  The issue of health IT is also critical for effective response in 
public health emergencies. Interoperable health IT systems will help to 
track infectious disease outbreaks and increase the Federal 
Government's rapid response in emergency situations.
  I thank all of my Senate colleagues for their support of this very 
important legislation, which will help facilitate the widespread 
adoption of electronic health records to ultimately result in fewer 
mistakes, lower costs, better care, and greater patient participation 
in their health and well-being. This is a great stride forward in the 
journey to improve our Nation's health care system. I look forward to 
seeing meaningful health information technology legislation signed into 
law this Congress.
  I would like to commend various staff for the hard work they did in 
bringing this bill to fruition. First, I want to recognize my fine 
staff from the Senate HELP Committee, who have doggedly worked with 
many interested parties over many months--Stephen Northrup and Katy 
Barr. I would also like to recognize David Bowen from Senator Kennedy's 
office for his dedication to this legislation. Elizabeth Hall of 
Senator Frist's office did a good job providing leadership support 
throughout the process. I should also mention Andrea Palm from Senator 
Clinton's office and Michelle Spence with Senator Ensign's office for 
ensuring that the health care quality provisions stayed strong. 
Secondly, I want to recognize the work of the Senate Finance Committee 
and the complementary bill supporting improvements in health care 
quality in the Medicaid and Medicare programs that has contributed to 
our success today. Mark Hayes and Ted Totman from the Senate Finance 
Committee were very dedicated to seeing this bill pass. And finally, 
without the dedication and patience of Bill Baird of Senate Legislative 
Counsel, we would not have the bill that will pass here today.
  Mr. KENNEDY. Mr. President, today the Senate has passed legislation 
that can help transform our health care system and save lives. The 
Wired for Health Care Quality Act will improve the use of lifesaving 
health information technology in hospitals and doctors' offices across 
the country. In so doing, we will improve the quality of care, lower 
administrative costs, and reduce medical errors.
  This legislation is being considered by the Senate because of the 
leadership and commitment of the chairman of our Health Committee, 
Senator Enzi. He made health information technology a priority for our 
committee, and he has guided this legislation to the Senate floor. 
Successful legislation takes creative thinking and hard work--and 
Senator Enzi has supplied an abundance of both to this measure.
  I also thank our partners in this legislation, Senator Frist and 
Senator Clinton. As a surgeon, Senator Frist knows firsthand the 
importance of making sure that doctors have the information they need 
to provide the best possible care for patients--and that they get that 
information in time for it to be of value. It is inconceivable that in 
the 21st century, doctors are asked to treat patients in life or death 
situations without knowing their medical histories or even the 
medications they are taking--but that happens every hour of every day 
in hospitals and emergency rooms around the country. Senator Frist has 
been tireless in his commitment to correcting this unacceptable 
situation.
  Senator Clinton has done an excellent job as well. She has championed 
better studies of the comparative effectiveness of medications, she is 
dedicated to improving the quality of care for every patient, and this 
legislation owes much to her ability and commitment.
  This legislation is urgently needed, because we live in a new era of 
medical miracles and rapid changes in medicine.
  Modern electronics have given doctors implantable pacemakers to save 
patients from sudden cardiac failure.
  The sequencing of the human genome offers extraordinary opportunities 
for new cures and better treatments.
  But there is another medical miracle to add to the list.
  Modern information technology can transform health care as profoundly 
as any of these discoveries.
  We have a moral responsibility to make the miracles of modern 
medicine available to every American--but we have failed to meet that 
responsibility. Costs are crushing our health care system. Premiums are 
going through the roof. The ranks of the uninsured grow every day. 
Families are forced to choose between paying the cost of health care or 
paying for food, rent, and college tuition. That is not the American 
dream.
  Information technology alone can't solve these problems, but it can 
help substantially. Electronic medical records. Software to warn if a 
treatment could harm a patient. Computer prescribing. These and many 
other applications of information technology can save lives and 
dramatically reduce costs.
  Despite the wonders of modern medicine, too many patients today are 
harmed by preventable mishaps. They waste hours and face new risk when 
tests must be duplicated, because a crucial record is locked in another 
archive. Too many doctors only guess at the right course of treatment, 
because they don't know a patient's medical history. Millions of 
patients are needlessly put at risk, and billions of dollars are 
wasted.
  When so many Americans are already struggling to afford health care 
for their families, it is profoundly wrong to squander more than half a 
trillion dollars each year on administrative expenses.
  The Department of Health and Human Services estimates that better use 
of information technology will save $140 billion every year. Such 
savings would produce a technology dividend worth over $700 on the cost 
of an average family's insurance policy. That is like getting 1 month 
free every year.
  Other nations are already using this extraordinary technology to cut 
costs and save lives--but America lags behind. We can't continue to 
allow the high cost of health care to price American goods and services 
out of the global marketplace.
  The need to invest in this technology is urgent. In the words of 
Secretary Leavitt, ``Every day that we delay, lives are lost.'' The 
time to act is now. The bill before us will improve care, save lives 
and make health care more affordable for every American.
  The need to reduce medical errors is especially urgent. It is already 
6 years since the Institute of Medicine reported that medical errors 
cause 98,000 deaths every year. According to the National Patient 
Safety Foundation, 42 percent of Americans have been affected by a 
medical error, either personally or through a friend or relative. One 
out of every three of those affected said that the error had a 
permanent negative effect on the patient's health. The exact figures 
may be the subject of debate, but it is undeniable that preventable 
deaths occur in our health care system all too often. For even one 
patient to die needlessly in our health care system ought to be 
unacceptable.
  Our response should be broad based. New technology, new ideas, aud 
new ways of practicing medicine all have a role in improving the 
quality of care and saving lives. We no longer expect airline pilots to 
navigate by looking at the stars or local landmarks. Engineers no 
longer rely on slide rules to design strong buildings. In virtually 
every field except medicine, professionals use computers to expand 
their skills. Yet in medicine, we expect doctors to keep in their heads 
the possible interactions of the dozens of medications that a patient 
may be receiving. Under these circumstances, the wonder is not that 
errors occur, but that they don't occur even more frequently.
  The evidence that information technology can save lives is 
undeniable. In terms of drug safety alone, a recent analysis by the 
RAND Corporation estimates that by using computerized

[[Page 27192]]

data, the nation could prevent 2.2 million adverse drug events, and 1 
million additional days in the hospital.
  What we have today, in the words of the Institute of Medicine, is a 
``quality chasm.'' Doctors repeat tests that have already been 
performed. Residents take medical histories that have already been 
taken. Patients show up for doctor's appointments that are essentially 
a waste of time because the tests have been performed but the results 
have not yet been delivered.
  Information technology can help close this gap by improving the 
coordination of care, providing guidance on the best methods of care 
and reminding busy physicians when it's time to schedule preventive 
screenings. The Veterans Administration is a national leader in using 
IT to improve quality, and patients get better preventive services 
there than almost any other patient group in America gets, especially 
in areas such as proper cholesterol screening, eye exams for diabetic 
patients, and proper immunization against pneumonia.
  Electronic medical records improve the quality of care, and can also 
improve our ability to monitor drug safety, detect outbreaks of disease 
before they become epidemics and decide which treatments are most 
effective for patients.
  Electronic medical records can be critical in a natural disaster. The 
devastation of Hurricane Katrina was compounded because most hospitals 
kept their records on paper. As a result, medical histories of tens of 
thousands of hurricane survivors were irretrievably lost. It would be 
inexcusable if we didn't make the investments needed for the nation to 
benefit from these innovations.
  Information technology doesn't simply improve the quality of care--it 
reduces costs as well. According to the Institute of Medicine, each 
prescription error that is prevented saves $4,000 in additional care. 
This isn't just a theory. Since 1996, when the Veterans Administration 
began investing significantly in information technology, its costs per 
patient have actually decreased by 7 percent while private sector costs 
per patient have increased by 62 percent.
  Excessive administrative costs are weighing down our health care 
system. We are spending over $500 billion a year on such costs--nearly 
33 cents out of every health care dollar. These already high costs are 
also growing 50 percent faster than other health costs. It can cost as 
much as $20 to process a single insurance claim using antiquated paper 
records--and nearly half the 18 billion insurance claims in America are 
still settled in this old-fashioned way every year. We know that paper-
based records are prone to error. About one in four health insurance 
claims is initially rejected because of errors. By contrast, in the 
financial industry, only 1 in 10,000 ATM transactions has an error.
  Despite clear evidence that health IT saves lives and cuts costs, its 
use is still scandalously low. Our health care system should be the 
envy of the world, but nations from Australia to Scandinavia are 
outpacing us in this technology. In Sweden and Holland, nine out of ten 
primary care physicians use electronic medical records. In Britain, 
Austria, Finland and many other nations, it is over half. But in the 
United States, less than a quarter of all doctors use electronic 
medical records.
  Obviously, there are significant barriers to the adoption of health 
information technology that Congress should also address. Many 
providers don't have the financial ability to absorb the costs of 
buying the equipment, making the transition to computer systems, and 
training staff. It costs a physician's office $30,000 and significant 
aggravation to install the system. The savings from its use tend to 
come over the longer term, while the costs are immediate, which is a 
major financial barrier to hospitals, physicians, and nursing homes 
already drowning in red ink. Providers get savings over the long run, 
but the largest share of the savings goes to payers, not providers. If 
a diabetic is kept out of the hospital by better management of his 
condition as the result of information technology, that's a loss of 
revenue to the hospital.
  This bipartisan legislation will help overcome these barriers. It 
requires the development of standards on interoperability and other 
technical measures for health information technology, and it 
establishes a public-private consultation to develop those standards.
  But standards without Federal resources are not enough to achieve the 
goal of a modern health care system that we all share. That is why the 
legislation includes financial assistance to hard pressed providers to 
meet the technical standards. It provides this assistance in three ways 
in recognizing the fact that different health care providers and 
different communities will have different needs. It authorizes direct 
grants to needy providers. It authorizes financial assistance to 
establish regional networks. And it creates an innovative Federal-
State, public-private partnership to modernize health care by enabling 
states to fund low interest loans to help health professionals in 
financial need to acquire the technology to improve the quality and 
efficiency of health care.
  Getting the right hardware and software into the hands of doctors is 
only half the battle. It is also essential to see that doctors have 
access to the knowledge necessary to make the technology a success. The 
legislation establishes a Best Practices Center where technology users 
can learn from the experience of others who have established such 
networks. It sets up a Help line at the Department of Health and Human 
Services to answer technical questions and help meet technical 
requirements. To assist doctors in sorting through the confusing array 
of options for this technology, the legislation establishes a 
certification program, so that providers can quickly determine whether 
particular systems meet the applicable technical standards.
  There are many Senate colleagues who deserve great credit for their 
thoughtful contributions to this legislation and for their leadership 
in getting to this moment.
  Again, I commend the chairman of our Health Committee, Senator Enzi, 
for his impressive leadership on this issue. It has been a privilege to 
work closely with him and his staff since the beginning of this year 
and to deal with this priority.
  The pending legislation combines the bill that Chairman Enzi and I 
introduced and the bill that Senator Frist and Senator Clinton 
introduced. We have also had broad input from many other committee 
members, and we have produced a better bill because of it.
  Senator Dodd was a leader on the issue in the last Congress as well, 
and our bill includes many of his ideas, especially on making sure that 
standards are widely available.
  Senator Ensign made sure that best practices are front and center in 
implementing this technology.
  Our subcommittee chairman, Senator Burr, has a strong interest in 
using information technology to improve our ability to respond to 
bioterrorist attacks or other disease emergencies, when lost hours can 
mean countless lost lives.
  Senator Reed of Rhode Island had the innovative idea of including a 
1-800 number to help providers on technical questions. Senator Harkin 
contributed important proposals to use the technology to improve the 
treatment of chronic diseases.
  Senator Reid of Nevada has shown impressive leadership in making sure 
technology improves the lives of American families, and I thank him for 
his strong support.
  Senator Snowe and Senator Stabenow have a major commitment to 
effective funding for this technology, and I look forward to working 
with them on this issue in the days to come. I also commend Senator 
Snowe for her strong commitment to protecting the privacy of electronic 
medical data.
  I also commend Steve Northrup and Katy Barr of Senator Enzi's staff, 
Andrea Palm of Senator Clinton's staff, Liz Hall of Senator Frist's 
staff, and my own health staff, for their effective work on this issue 
for so many months.
  I thank these and all our Senate colleagues who contributed to the 
legislation we consider today. I look forward

[[Page 27193]]

to working with all of you and with our colleagues in the House to see 
this needed measure signed into law as soon as possible.
  Mr. ENZI. Mr. President, I rise today to speak about the passage of 
1418, the Wired for Health Care Quality Act. As chairman of the 
Committee on Health, Education, Labor, and Pensions, I have been 
working to improve the quality and reduce the cost of health care in 
this Nation. I commend the ranking member of my committee for his 
dedication to this great cause.
  I want to commend my colleague from Maine, Senator Snowe, and my 
colleague from Michigan, Senator Stabenow, for their leadership on the 
issue of health information technology. They have made a major 
contribution to the debate, and I look forward to working with them as 
we continue to consider this important issue.
  I see the legislation we consider today as the first step toward more 
effective use of information technology in health care. This proposal 
will provide the framework to improve the use of health IT. Senator 
Snowe and Senator Stabenow have several thoughtful proposals on 
providing additional financial incentives through Medicare for the use 
of health information technology.
  Providing adequate funding for health IT is a critically important 
issue, and I believe that it should be carefully considered in our 
committee and by the Senate. I look forward to working with my 
colleagues on the committee and with Senator Snowe and Senator Stabenow 
to see that health IT receives an appropriate level of funding.
  I also believe it is important to examine carefully the privacy 
protections that apply to individually identifiable health information 
maintained in electronic databases. The manager's amendment to S. 1418 
contains several important provisions relating to privacy, including a 
GAO investigation on methods to enhance privacy protections for 
electronically stored and transmitted health information.
  I believe it is important to examine the issues surrounding 
implementation and adoption of health IT systems carefully. To that 
end, I intend to hold a hearing by the Memorial Day recess next year on 
the essential issue of funding to promote wide adoption of health 
information technology. We will also examine the report of the GAO to 
address the critical issue of protections for the privacy of health 
information that must be part of health IT systems and practices. I 
will work closely with my colleagues, Senator Snowe and Senator 
Stabenow, as well as with the ranking member on this hearing.
  I will also work with the Finance Committee, the committee with 
jurisdiction over Medicare, and with Senators Stabenow and Snowe on 
legislation to spur the widespread adoption of interoperable health 
information technology through such innovative financing mechanisms, 
and we will work to achieve passage of that legislation before the end 
of this Congress.
  I happen to be an original sponsor of legislation in the Finance 
Committee to reward high-quality health care through value based 
purchasing under Medicare. By rewarding doctors and hospitals for the 
quality of care they provide, not just the quantity of care, we can 
improve health care quality in a fiscally responsible way.
  I look forward to working with Senators Kennedy, Grassley, Baucus, 
Snowe, Stabenow, Frist, and Clinton on these important proposals, and I 
commend them for their leadership on this important field of health IT.
  Mr. KENNEDY. I thank the distinguished chairman of our Health 
Committee for his impressive leadership on the issue of health 
information technology. Health information technology can revolutionize 
health care, with lasting benefits in areas from improving quality to 
better detection of bioterrorist attacks and epidemics.
  I also commend my colleagues, Senator Stabenow and Senator Snowe, for 
their commitment to seeing that we provide adequate financial support 
for doctors and hospitals to use health information technology systems. 
I will work closely with them, and with our chairman and our colleagues 
on the health committee, to see that we build on the legislation under 
consideration today in order to assist health care providers to meet 
the cost of acquiring health IT.
  Senator Snowe and Senator Stabenow have made a major contribution to 
our debate, and I look forward to working with them on additional 
proposals on this important issue in the very near future.
  Ms. SNOWE. Mr. President, I want to commend Senators Enzi, Kennedy, 
Frist, and Clinton for their work in addressing the inadequate state of 
our individual health records today. The Wired for Health Care Quality 
Act will accelerate the development of essential standards to protect 
investment in health information technology. Very soon the Federal 
Government will require compliance with these standards for its 
purchases--a long overdue step in modernizing health care information 
management.
  I began work with on this issue in the last Congress when we learned 
from the Institute of Medicine that an estimated 98,000 Americans die 
each year as a result of medical errors. Technology can help us prevent 
these deaths and injuries from medical mistakes. That is one reason I 
joined with Senator Stabenow to assure that we implement live saving 
technology.
  A second reason for our work is that information technology, IT, will 
help us reduce the cost of health care. As health care costs increase 
far more rapidly than inflation, care becomes less affordable and the 
ranks of the uninsured grow. Each of us appreciates that technology 
will help us reduce that unsustainable trend. Recent reports 
demonstrate that the cost of implementing health IT is exceeded by a 
single year of savings. That is a remarkable return on investment, but 
since an estimated 89 percent of savings accrues to payers, not 
providers, standards alone will not spur adoption.
  Since the rewards for adoption primarily accrue to payers and 
patients, it is wholly appropriate that payers--including the Federal 
Government--act in their best interest to reduce costs. That means we 
must ensure adoption not just by those providers for whom investment is 
relatively easy, but by those with lesser resources, such as the many 
who provide care for our Medicare, Medicaid, and SCHIP beneficiaries. I 
look forward to working with my colleagues to see that we implement 
financing--including grants and tax incentives--to allow all providers 
to adopt this promising technology. Otherwise we will see a two-tiered 
system develop.
  If some patients do not receive the benefits of the electronic health 
record the President has set as a goal, their care will suffer. In 
fact, if their providers cannot adopt technology, their clinical data 
may not be not properly integrated in pay-for-performance 
methodologies. If the resulting criteria don't account for such 
patients, they then pose the risk of inadequate compensation to 
providers, and many may decline to serve them. So it is critical that 
we assure all providers can adopt health IT.
  I thank Chairman Enzi and the Senator Kennedy for their commitment to 
a hearing next spring on the adoption and financing issue. I also thank 
the majority leader for his assistance. The issue of adoption certainly 
multiple committees, and we appreciate his efforts in helping the full 
Senate to consider promising financing proposals to assure broad 
adoption.
  As we move forward together, we should also remember to follow the 
physician's adage--certainly one the leader knows so well--to ``first 
do no harm''. We are all agreed that genetic information, which may 
indicate probability of disease, must be protected. One's medical 
record includes even more than probability--it is indisputable evidence 
of the presence of disease, the drugs one uses, your full physical and 
mental health history. Consequently, Americans are worried about their 
health records. A recent survey demonstrates that two-thirds of all 
consumers have substantial concerns about the privacy of their medical 
records. The same proportion say that recent reports of privacy 
breaches

[[Page 27194]]

have actually increased these concerns. So it comes as no surprise that 
consumers engage in behaviors to avoid such data from even being 
created--such as paying out-of-pocket for medical expenses, using a 
different physician on occasion, or simply asking that vital 
information not be included in their chart. Patients even forgo 
treatment altogether in fear of disclosure. This compromises health, so 
we simply must provide Americans with confidence in the security of 
their health record.
  We simply must have the highest levels of data security. So first we 
must see procedures established to assure that inappropriate disclosure 
does not occur. Next, if a data breach does occur, the patient must be 
informed. To do otherwise is unconscionable.
  I am pleased to see that the managers amendment requires such 
notification for those handling data under the programs established by 
this legislation, and the bill also establishes a process to address 
concerns on medical data privacy by directing a GAO study to guide us 
in providing the assurance all Americans must have that their medical 
data is protected. I thank my colleagues for including these essential 
provisions.
  Today marks the beginning of a process to offer all Americans a 
safer, more affordable system of health care. I look forward with 
Senator Stabenow to working with the majority leader and Senators Enzi, 
Kennedy, and Clinton, as well as Senators Grassley and Baucus, as we 
move forward to realizing the full potential of health IT become 
reality for our constituents. The rewards in lives and dollars saved 
compels us to act promptly.
  Ms. STABENOW. Mr. President, I want to commend the leadership of 
Senators Enzi, Kennedy, Frist, and Clinton in this critically important 
arena. Their diligent work in introducing and passing S. 1418 
establishes the groundwork necessary to begin to realize the promises 
of health information technology, IT.
  The evidence showing the ability of health IT to reduce costs and 
improve quality of care is simply overwhelming. Dr. David Brailer's 
office attributes savings from widespread adoption of electronic health 
records in the range of 7.5 percent to 30 percent of annual health care 
spending that is between $135 and $540 billion annually.
  Manufacturers in Michigan and across the country are struggling to 
remain competitive in a global market with skyrocketing health care 
costs. Health IT can, and should, play a key role in managing these 
costs.
  Equally compelling is the promise health IT holds for improving the 
quality of our health care system by ensuring that patients get the 
care they need, at the right time, and in the best setting.
  To realize these promises, however, Congress must enact legislation 
providing meaningful resources through Federal financial incentives, 
both mandatory grants and tax incentives, to physicians, hospitals, 
skilled nursing facilities, and community health and mental health 
centers for health information technology.
  Health care providers are struggling to keep up with their daily 
needs at the same time they are anticipating cuts in their rates. A 
major barrier to widespread use of IT is the initial investment cost: 
the costs of procuring and implementing health IT can be staggering.
  Every day we delay providing Federal seed money through a grant 
program and accelerated depreciation of health information technology 
expenses, we delay getting health information technology systems in 
place, and businesses, taxpayers and patients pay in both dollars and 
lives.
  I appreciate the majority leader's commitment to encourage the 
chairman and ranking member of the Finance Committee and the chairman 
and ranking member of the HELP Committee to schedule, at the earliest 
opportunity, consideration of legislative proposals to ensure federal 
funding to accelerate adoption of health IT.
  A meaning Federal investment must be robust, funded with mandatory, 
rather than discretionary, dollars, and available to individual 
providers and health care systems.
  This is not the place to skimp on dollars; we know every dollar we 
spend will come back to us many times over. Federal investments, 
through grants and tax incentives, in health information technology 
will result in lower Medicare, Medicaid and SCHIP spending, reduced 
medical errors, and greater quality and efficiency in our health care 
system. We must provide a level of funding that will allow a 
significant percentage of our health care providers to adopt and use 
health IT systems. Additionally, funding must not be limited to 
authorizations of appropriations. We must actually provide the dollars 
needed to begin realizing the benefits of health IT.
  Nor should we limit funds to providers in networks. We should work 
towards a system where all health care providers are linked, but we do 
not need to wait for those networks to be formed to see the benefits of 
health IT. Standalone e-prescribing systems could reduce medication 
errors by 50 percent; there is no reason to delay the quality, safety, 
and financial savings possible through immediate health IT adoption by 
individual providers.
  In addition to funding, we must pay careful attention to privacy and 
confidentiality rights and concerns. A patient's right to health 
information privacy is paramount, and an essential component of the 
health care provider-patient relationship. According to a survey 
recently released by the California HealthCare Foundation, CHCF, 67 
percent of Americans remain concerned about the privacy of their 
personal health information. The survey also reports that many 
consumers may be putting their health at risk by avoiding their regular 
doctor or forgoing needed tests over privacy concerns. Apprehension 
over privacy and confidentiality, if not addressed thoughtfully, could 
pose enormous barriers to the savings and health care improvements 
possible through adoption of health information technologies. Strong, 
enforceable privacy safeguards based on a patient's right to health 
information privacy are absolutely critical as we move towards a 
nationwide, interoperable electronic health care system.
  I appreciate provisions included in the managers' amendment 
addressing the need for patients to be notified if their individually 
identifiable health information is wrongfully disclosed and a study by 
the General Accounting Office examining the issue as it relates to all 
Americans.
  I look forward to working with the majority leader, and Senators 
Snowe, Enzi, Kennedy, and Clinton, as well as Senator Grassley and 
Baucus to ensure passage of legislation this Congress providing 
meaningful, substantial Federal financial incentives to accelerate 
adoption of life and dollar saving health information technologies.
  Mr. FRIST. Mr. President, I am pleased to speak in support of S. 
1418. I share an important goal with Senators Enzi, Kennedy, Snowe, 
Stabenow, and Clinton--to improve health care quality and reduce costs 
through the use of health information technology tools.
  I spent 20 years as a physician and heart surgeon before coming to 
the Senate. Like most physicians, I wanted the latest and best medical 
technology, anything that could make my patients healthier or more 
comfortable, while reducing health care costs and increasing 
efficiency.
  But amidst the artificial heart assist devices, lasers, CT Scan 
machines, endoscopic devices, digital X-Rays, and digital thermometers, 
doctors today keep patient records the same way I did and the way my 
father did 50 years ago: on paper, in manila folders in file cabinets, 
in the basements of clinics and hospitals. Yet computers, and computer 
technology, is everywhere, both inside and outside the hospitals and 
clinics. From bedside monitors to massive MRI machines, computers power 
almost all of the diagnostic devices we rely on.
  S. 1418 represents an important and crucial first step towards 
recognizing the importance of computers and the electronic medical 
record in contemporary health care. Establishing interoperability of 
the electronic medical

[[Page 27195]]

record, an essential hurdle towards effective use of health information 
technology, is a priority. Proposals for providing Federal financial 
incentives for physicians, community health centers, community mental 
health centers, hospitals and skilled nursing facilities like that 
introduced by Senator Snowe and Senator Stabenow need to be considered.
  Assuring proper funding of health IT is an issue of major importance 
for the Senate to consider in the coming congressional session. I will 
work with the chairman and ranking member of the Finance Committee and 
the chairman and ranking member of the HELP committee as well as 
Senators Snowe and Stabenow to encourage these committees to schedule, 
at the earliest opportunity, consideration of legislative proposals to 
ensure creative and reasonable Federal funding for such an important 
and relevant mission. I will also work with relevant committees to 
encourage consideration of legislation that would enable providers to 
connect to a secure, interoperable network for the electronic exchange 
of health information.
  Mrs. CLINTON. I would like to commend Chairman Enzi and Senator 
Kennedy for all of their work on this legislation. I would also like to 
recognize the commitment and leadership of the majority leader, who I 
have been working closely with on this issue. Today's passage of S. 
1418, the Wired for Health Care Quality Act, is a fundamental first 
step in establishing a nationwide, interoperable health IT 
infrastructure.
  Our legislation provides the framework and authorizes several grant 
programs to begin the process of funding health IT projects that are 
compliant with the framework established in the bill. The legislation 
introduced by Senators Snowe and Stabenow and their work more broadly 
on this issue will be critical as we work on additional financing 
mechanisms. I am anxious to begin that work and am committed to working 
closely with them, and my colleagues on the HELP and Finance committees 
to ensure that physicians and hospitals are able to afford to 
participate in a 21st century health care system.
  Mr. ENZI. I see this bill as the first step of many in improving the 
health care in the United States. I look forward to working with my 
friends on the Finance Committee as well as working with Senators Snowe 
and Stabenow to look at creative financing mechanisms to help doctors 
and hospitals go on line.
  Mr. FRIST. Mr. President, in closing our comments on this bill, I 
also thank my staff who have been shepherding this for me for the last 
3 years, Liz Hall, Jennifer Romans, and many others. The real 
significance is that patient care will be improved. It will get the 
waste and abuse out of the system. It makes the health care system more 
efficient. I am excited about it. Having interoperable standards that 
people begin to agree with means you will have an influx of private 
capital which will help with the spreading of this information 
technology infrastructure over time.

                          ____________________