[House Report 110-451]
[From the U.S. Government Publishing Office]





110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    110-451

======================================================================



 
      HEALTHCARE INFORMATION TECHNOLOGY ENTERPRISE INTEGRATION ACT

                                _______
                                

 November 15, 2007.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

Mr. Gordon of Tennessee, from the Committee on Science and Technology, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 2406]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Science and Technology, to whom was 
referred the bill (H.R. 2406) to authorize the National 
Institute of Standards and Technology to increase its efforts 
in support of the integration of the healthcare information 
enterprise in the United States, having considered the same, 
report favorably thereon with an amendment and recommend that 
the bill as amended do pass.

                                CONTENTS

                                                                   Page
   I. Amendment.......................................................2
  II. Purpose of the Bill.............................................4
 III. Background and Need for the Legislation.........................5
  IV. Hearing Summary.................................................6
   V. Committee Actions...............................................9
  VI. Summary of Major Provisions of the Bill........................10
 VII. Section-by-Section Analysis....................................10
VIII. Committee Views................................................11
  IX. Cost Estimate..................................................13
   X. Congressional Budget Office Cost Estimate......................13
  XI. Compliance with Public Law 104-4 (Unfunded Mandates)...........14
 XII. Committee Oversight Findings and Recommendations...............14
XIII. Statement on General Performance Goals and Objectives..........14
 XIV. Constitutional Authority Statement.............................14
  XV. Federal Advisory Committee Statement...........................14
 XVI. Congressional Accountability Act...............................15
XVII. Earmark Identification.........................................15
XVIII.Statement on Preemption of State, Local, or Tribal Law.........15

 XIX. Changes in Existing Laws Made by the Bill, As Reported.........15
  XX. Committee Recommendations......................................15
 XXI. Additional Views...............................................16
XXII. Proceedings of Full Committee Markup...........................18

                              I. AMENDMENT

  The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Healthcare Information Technology 
Enterprise Integration Act''.

SEC. 2. FINDINGS.

  Congress finds the following:
          (1) The National Institute of Standards and Technology, 
        because of the electronic commerce, information technology and 
        security expertise in its laboratories and the healthcare 
        component of the Malcolm Baldrige National Quality Award, and 
        its long history of working with the information technology and 
        healthcare industries, is well equipped to complement the 
        healthcare information technology implementation efforts as 
        established by Executive Order 13335 of April 27, 2004, by 
        addressing the technical challenges posed by healthcare 
        information enterprise integration.
          (2) Therefore, it is in the national interest for the 
        National Institute of Standards and Technology to accelerate 
        its efforts--
                  (A) to participate in the development of technical 
                standards, standards conformance tests, and enterprise 
                integration processes that are necessary to increase 
                efficiency and quality of care, and lower costs in the 
                healthcare industry; and
                  (B) ensuring that all components of the United States 
                healthcare infrastructure can be a part of an 
                electronic information network that is reliable, 
                interoperable, and secure.

SEC. 3. HEALTHCARE INFORMATION ENTERPRISE INTEGRATION INITIATIVE.

  (a) Establishment.--The Director of the National Institute of 
Standards and Technology shall establish an initiative for advancing 
healthcare information enterprise integration within the United States. 
In carrying out this section, the Director shall involve various units 
of the National Institute of Standards and Technology, including its 
laboratories and the Malcolm Baldrige National Quality Program. This 
initiative shall build upon ongoing efforts of the National Institute 
of Standards and Technology, the private sector, and other Federal 
agencies, shall involve consortia that include government and industry, 
and shall be designed to permit healthcare information enterprise 
integration. These efforts shall complement ongoing activities 
occurring under Executive Order 13335 of April 27, 2004.
  (b) Technical Activities.--In order to carry out this section, the 
Director may focus on--
          (1) information technology standards and interoperability 
        analysis, which may include the development of technical 
        testbeds;
          (2) supporting the establishment of conformance testing 
        infrastructure, including software conformance and 
        certification;
          (3) security;
          (4) medical device communication;
          (5) supporting the provisioning of technical architecture 
        products for management and retrieval; and
          (6) information management including electronic health 
        records management, health information usability, and access 
        and decision support.
  (c) Other Activities.--The Director may assist healthcare 
representatives and organizations and Federal agencies in the 
development of technical roadmaps that identify the remaining steps 
needed to ensure that technical standards for application protocols, 
interoperability, data integrity, and security, as well as the 
corollary conformance test protocols, will be in place. These roadmaps 
shall rely upon voluntary consensus standards where possible consistent 
with Federal technology transfer laws.
  (d) Plans and Reports.--Not later than 90 days after the date of 
enactment of this Act, and annually thereafter, the Director shall 
transmit a report to the Committee on Science and Technology of the 
House of Representatives and the Committee on Commerce, Science, and 
Transportation of the Senate on the activities of the National 
Institute of Standards and Technology under this section.

SEC. 4. FEDERAL HEALTHCARE INFORMATION TECHNOLOGY SYSTEMS AND 
                    INFRASTRUCTURE.

  (a) Guidelines and Standards.--Not later than 12 months after the 
date of enactment of this Act, the Director of the National Institute 
of Standards and Technology, in consultation with industry and 
appropriate Federal agencies, shall report on development of 
technology-neutral information technology infrastructure guidelines and 
standards, or the adoption of existing technology-neutral industry 
guidelines and private sector standards, for use by Federal agencies to 
enable those agencies to effectively select and utilize healthcare 
information technologies in a manner that is--
          (1) sufficiently secure to meet the needs of those agencies 
        (as is consistent with the Computer Security Act of 1987, as 
        amended, section 225 of the Homeland Security Act of 2002, and 
        title III of the E-Government Act of 2002), their transaction 
        partners, and the general public;
          (2) interoperable, to the maximum extent possible; and
          (3) inclusive of ongoing Federal efforts that provide 
        technical expertise to harmonize existing standards and assist 
        in the development of interoperability specifications.
  (b) Elements.--The guidelines and standards developed under 
subsection (a) shall--
          (1) promote the use by Federal agencies of commercially 
        available products that incorporate the guidelines and 
        standards developed under subsection (a);
          (2) develop uniform testing procedures suitable for 
        determining the conformance of commercially available and 
        Federal healthcare information technology products with the 
        guidelines and standards;
          (3) support and promote the testing of electronic healthcare 
        information technologies utilized by Federal agencies;
          (4) provide protection and security profiles;
          (5) establish a core set of interoperability specifications 
        in transactions between Federal agencies and their transaction 
        partners; and
          (6) include validation criteria to enable Federal agencies to 
        select healthcare information technologies appropriate to their 
        needs.
  (c) Reports.--Not later than 18 months after the date of enactment of 
this Act, and annually thereafter, the Director shall transmit to the 
Congress a report that includes a description and analysis of--
          (1) the level of interoperability and security of 
        technologies for sharing healthcare information among Federal 
        agencies; and
          (2) the problems Federal agencies are having with, and the 
        progress such agencies are making toward, ensuring 
        interoperable and secure healthcare information systems and 
        electronic healthcare records.

SEC. 5. RESEARCH AND DEVELOPMENT PROGRAMS.

  (a) Healthcare Information Enterprise Integration Research Centers.--
          (1) In general.--The Director of the National Institute of 
        Standards and Technology, in consultation the Director of the 
        National Science Foundation and other appropriate Federal 
        agencies, shall establish a program of assistance to 
        institutions of higher education (or consortia thereof which 
        may include nonprofit entities and Federal Government 
        laboratories) to establish multidisciplinary Centers for 
        Healthcare Information Enterprise Integration.
          (2) Review; competition.--Grants shall be awarded under this 
        subsection on a merit-reviewed, competitive basis.
          (3) Purpose.--The purposes of the Centers shall be--
                  (A) to generate innovative approaches to healthcare 
                information enterprise integration by conducting 
                cutting-edge, multidisciplinary research on the systems 
                challenges to healthcare delivery; and
                  (B) the development and use of information 
                technologies and other complementary fields.
          (4) Research areas.--Research areas may include--
                  (A) the interfaces between human information and 
                communications technology systems;
                  (B) voice-recognition systems;
                  (C) software that improves interoperability and 
                connectivity among systems;
                  (D) software dependability in systems critical to 
                healthcare delivery;
                  (E) measurement of the impact of information 
                technologies on the quality and productivity of 
                healthcare;
                  (F) healthcare information enterprise management; and
                  (G) information technology security and integrity.
          (5) Applications.--An institution of higher education (or a 
        consortium thereof) seeking funding under this subsection shall 
        submit an application to the Director at such time, in such 
        manner, and containing such information as the Director may 
        require. The application shall include, at a minimum, a 
        description of--
                  (A) the research projects that will be undertaken by 
                the Center and the respective contributions of the 
                participating entities;
                  (B) how the Center will promote active collaboration 
                among scientists and engineers from different 
                disciplines, such as information technology, biologic 
                sciences, management, social sciences, and other 
                appropriate disciplines;
                  (C) technology transfer activities to demonstrate and 
                diffuse the research results, technologies, and 
                knowledge; and
                  (D) how the Center will contribute to the education 
                and training of researchers and other professionals in 
                fields relevant to healthcare information enterprise 
                integration.
  (b) National Information Technology Research and Development 
Program.--The National High-Performance Computing Program established 
by section 101 of the High-Performance Computing Act of 1991 (15 U.S.C. 
5511) shall coordinate Federal research and development programs 
related to the development and deployment of health information 
technology, including activities related to--
          (1) computer infrastructure;
          (2) data security;
          (3) development of large-scale, distributed, reliable 
        computing systems;
          (4) wired, wireless, and hybrid high-speed networking;
          (5) development of software and software-intensive systems;
          (6) human-computer interaction and information management 
        technologies; and
          (7) the social and economic implications of information 
        technology.
  (c) Strategic Plan for Healthcare Technologies and Classification.--
          (1) In general.--The Director of the National Institute of 
        Standards and Technology, in consultation with the Director of 
        the National Science Foundation, not later than 90 days after 
        the date of enactment of this Act, shall establish a task force 
        whose membership includes representatives of other Federal 
        agencies and industry groups (such as the American Health 
        Information Management Association and the American Medical 
        Informatics Association) to develop a strategic plan including 
        recommendations for--
                  (A) the development, adoption, and maintenance of 
                terminologies and classifications;
                  (B) gaining commitment of terminology and 
                classification stakeholders (such as developers, end 
                users, and other service and technology suppliers) to 
                principles and guidelines for open and transparent 
                processes to enable cost-effective interoperability and 
                complete and accurate information;
                  (C) the design of a centralized authority or 
                governance model, including principles for its 
                operation and funding scenarios;
                  (D) United States participation in the International 
                Health Terminology Standards Development Organization; 
                and
                  (E) any other issues identified by the task force.
          (2) Task force report.--The task force shall report its 
        findings and recommendations to the Committee on Science and 
        Technology of the House of Representatives not later than 18 
        months after the date of enactment of this Act. The task force 
        shall terminate after transmitting such report.
          (3) Federal advisory committee act.--The task force 
        established under this subsection shall not be subject to the 
        Federal Advisory Committee Act (5 U.S.C. App.).

SEC. 6. AUTHORIZATION OF APPROPRIATIONS.

  There are authorized to be appropriated to the Director of the 
National Institute of Standards and Technology for carrying out this 
Act $8,000,000 for each of the fiscal years 2009 and 2010, to be 
derived from amounts authorized under section 3001 of Public Law 110-
69.

                        II. PURPOSE OF THE BILL

    The purpose of this bill is to direct the National 
Institute of Standards and Technology (NIST) to establish an 
initiative to advance healthcare information enterprise 
integration; to direct NIST to work with industry toward the 
development of or the adoption of technology-neutral technical 
guidelines and standards for healthcare information technology 
(HIT) systems used by Federal agencies; to create a program of 
grants to universities and consortia for multidisciplinary HIT 
research centers; to direct the National High-Performance 
Computing Program to coordinate Federal research and 
development programs related to HIT; to direct NIST to 
establish a task force to develop recommendations on standards 
harmonization; and to authorize appropriations for fiscal years 
2009 and 2010 to conduct these activities.

                III. BACKGROUND AND NEED FOR LEGISLATION

    While many sectors of the U.S. economy have fully 
integrated information technology into their operations, the 
U.S. healthcare system continues to rely on pen and paper for 
the bulk of its information needs. From patient medical 
histories, to prescriptions, to hospital charts, handwritten 
notations are the basis for patient care information. This 
system is costly, antiquated, and prone to dangerous or life-
threatening medical errors. More than 98,000 Americans die and 
more than one million patients suffer injuries each year as a 
result of broken healthcare practices and system failures. 
According to the National Academies, between 30 and 40 percent 
of healthcare costs--more than half a trillion dollars per 
year--is spent on ``overuse, underuse, misuse, duplication, 
system failures, and unnecessary repetition, poor 
communication, and inefficiency''. In addition, the lack of 
integrated, interoperable electronic healthcare records (EHRs) 
means that, in our health care system, patients themselves must 
act as their own comprehensive healthcare record which often 
adds additional error in treatment.
    Information technology (IT) offers enormous potential 
benefits to improve the functioning and efficiency of U.S. 
healthcare. A fully realized interoperable healthcare IT system 
could reduce errors, improve communication, help eliminate 
redundancy, and provide numerous other benefits that would 
protect patients and save up to tens of billions of dollars per 
year. The central challenge to achieving such a system is 
interoperability--the ability of data systems, medical devices 
and software from different vendors based on a diverse array of 
platforms to share patient EHRs, electronic physician orders 
for lab tests and drug prescriptions, electronic referrals to 
specialists, electronic access to information about current 
recommended treatments and research findings, and other 
information. Data security and privacy requirements present 
additional challenges, as electronic systems must comply with 
Federal and state laws mandating patient privacy.
    Interoperability and data security in IT systems is 
accomplished by establishing technical standards for data 
formats, data exchange protocols, and other system 
communication needs. These standards enable different 
manufacturers and vendors to build and sell medical software 
and hardware devices that are based on the same underlying 
communication techniques. Without these standards, and the 
interoperable systems they enable, it is wasteful to spend 
money on healthcare IT systems, and healthcare providers are 
therefore reluctant to do so.
    The Federal government's lead agency for supporting the 
development of technical standards is NIST, which has a long 
history of working with the private sector, Federal agencies 
and other stakeholders to develop consensus-based standards in 
such fields as electronic commerce, manufacturing, and 
information security. NIST's organic legislation gives the 
agency authority to work in any field in which there is 
deficiency in technical standards. NIST has already conducted 
important work on technical standards to advance the adoption 
of secure, interoperable healthcare IT systems nationwide, 
working cooperatively with HHS. NIST also has expertise in 
developing conformance testing protocols to ensure that 
software products meet technical standards. Because of NIST's 
unique expertise in the technical standards-development process 
and its long history of involvement with guiding the 
development and adoption of consensus-based standards, it is 
important that NIST's role in healthcare IT be codified in 
statute.
    The provisions of H.R. 2406 are based on recommendations in 
a 2004 report from the President's Information Technology 
Advisory Committee (PITAC) entitled Revolutionizing Health Care 
Through Information Technology, and a 2005 report from the 
National Academies entitled Building a Better Delivery System. 
These reports included specific recommendations for the 
development of a single set of standards for the 
interoperability of clinical information, the acceleration by 
the Federal government of the development of standards for the 
security of healthcare IT systems, and the establishment of 
multidisciplinary research programs in key areas of healthcare 
IT.

                          IV. HEARING SUMMARY

    On February 23, 2006, the Subcommittee on Environment, 
Technology and Standards of the House Committee on Science held 
a hearing titled Health Care Information Technology: What are 
the Opportunities for and Barriers to Inter-operable Health 
Information Technology Systems? The Committee held the hearing 
to learn about the potential benefits of IT to healthcare 
providers and consumers, the impact of IT on healthcare costs 
and quality, and the major challenges to implementing a 
national healthcare information technology system.
    Interoperability allows different information technology 
systems and software applications to communicate, exchange 
data, and use that information. Interoperable health IT systems 
can involve electronic healthcare records (EHRs); electronic 
physician orders for drug prescriptions and lab tests; 
electronic referrals to specialists and other health care 
providers; and electronic access to current treatments and 
research findings. For these systems to share information, 
especially if they are from different manufacturers and/or 
vendors, they must use common standards for data transmission, 
medical terminology, security, and other features.
    The hearing reviewed Federal, state and private-sector 
efforts to promote connectivity, which enables healthcare 
providers to access patient data from any location. The hearing 
also examined efforts to develop standards for security, 
confidentiality and interoperability, which are crucial to the 
adoption of effective healthcare IT systems.
    The Subcommittee heard testimony from: (1) Dr. William 
Jeffrey, Director of the National Institute of Standards and 
Technology (NIST); (2) Dr. Jody Pettit, Project Chair at the 
Oregon Health Care Quality Corporation; (3) Ms. Diane 
Cecchettini, RN, President and CEO of MultiCare Health System; 
(4) Mr. John Jay Kenagy, Chief Information Officer at Oregon 
Health and Science University; (5) Dr. Homer Chin, Medical 
Director for Clinical Information Systems at Kaiser Permanente 
Northwest; (6) Mr. Luis Machuca, President and CEO of Kryptiq 
Corportation; and (7) Mr. Prem Urali, President and CEO of 
HealthUnity Corporation.

Summary of hearing

    Dr. Jeffrey testified that NIST has been working with the 
Office of the National Coordinator for Health Information 
Technology (ONC) on standards harmonization, conformity 
assessment, developing the architectural management system for 
the health information network, and confidentiality and 
security. He said that because there are so many healthare IT 
standards in existence and under development, NIST is working 
with the healthcare community ``to develop and demonstrate a 
prototype healthcare standards landscape.''
    Dr. Pettit testified that the goal of the Oregon Health 
Information Infrastructure (OHII) is to ``catalyze the 
formation of a regional health information organization.'' She 
emphasized that the patient must be at the center of the 
healthcare IT system development process, and that the free 
flow of information is key. Finally, she argued that while 
Federal initiatives are moving forward, state initiatives are 
not being given enough support. She called on the Federal 
government to provide assistance or start-up capital.
    Ms. Cecchettini testified that implementing EHRs has helped 
MultiCare Health System to reduce errors and redundant costs, 
to contact patients for drug recalls, and to improve childhood 
immunization and mammogram compliance figures. Ms. Cecchettini 
called for the Federal and state governments to adopt common 
standards to support interoperability, to provide payment 
incentives for adopters of information technology, to ensure 
protection of consumer privacy by enforcing security measures, 
and to support common vocabulary for medical technology.
    Mr. Kenagy testified that the large number of choices 
rather than lack of choices available for healthcare IT 
adoption is a problem. In addition, he stated that learning and 
implementing a new healthcare IT system takes significant time 
for clinicians and other healthcare professionals. He called on 
the Federal government to expand research in healthcare IT, to 
support training programs for clinicians and IT professionals, 
and to address the economic disincentives to invest in 
healthcare IT.
    Dr. Chin testified that Kaiser Permanente Northwest (KPNW) 
has been successful at utilizing healthcare IT because KPNW 
offers an integrated comprehensive healthcare system and 
because it provides prepaid insurance to its members, providing 
an incentive to keep members healthy. He identified a lack of 
incentives to be efficient and effective at delivering 
healthcare, and the subjective and changing nature of 
healthcare as the two primary problems facing effective 
healthcare. Dr. Chin stated that the Federal and state 
governments should provide incentives for healthcare 
organizations to implement IT, and more stringent standards.
    Mr. Machuca testified that healthcare IT adoption 
strategies should focus on collaboration and communication in 
addition to EHRs. He called on the government to fund the 
implementation of electronic collaboration in public health 
settings and to mediate a standard for patient medical records.
    Mr. Urali testified that efforts to promote healthcare IT 
adoption must start with clinicians. He encouraged the 
government to fund education and training to promote best 
practices, and to focus on creating the right policy and 
incentives environment, and that the private sector should 
innovate. Finally, he stated that there should be a greater 
focus on the regional level for adoption, rather than the 
national level.
    On September 26, 2007 the Committee on Science and 
Technology held a hearing entitled Meeting the Need for 
Interoperability and Information Security Healthcare IT. This 
hearing provided an opportunity for private-sector stakeholders 
to discuss the current state of healthcare information 
technology and to provide their comments and views on H.R. 
2406, a bill to support the development of technical standards 
for healthcare information technology systems by the National 
Institute of Standards and Technology (NIST).
    The rising cost of healthcare, as well as the need to 
improve patient care, has prompted both the private and public 
sectors to look for new ways to economically provide high-
quality medical care. Many industries have experienced 
significant increases in efficiency brought on by the 
introduction of information technology (IT) over the past two 
decades. However, as an industry reliant upon information, the 
healthcare industry lags behind other sectors in implementing 
IT systems. Needs for interoperability, reliability, and 
confidentiality have created a cautious attitude within the 
healthcare industry towards the adoption of IT.
    The purpose of the hearing was to examine progress toward 
the broad use of information technology in healthcare and the 
investments in technical standards development that are needed 
to facilitate the adoption of secure, interoperable healthcare 
IT systems. Hearing participants discussed the potential 
benefits of IT to US healthcare, and the role of NIST in the 
development of healthcare IT technical standards.
    The Subcommittee heard testimony from: (1) Ms. Linda L. 
Kloss, Chief Executive Officer of the American Health 
Information Management Association (AHIMA); (2) Dr. David E. 
Silverstone, Clinical Professor at Yale School of Medicine and 
Assistant Chief of Ophthalmology at Yale New Haven Hospital and 
chairman of the Health Information Technology Committee of the 
American Society of Cataract and Refractive Surgery; (3) Mr. 
Michael Raymer, Vice President and General Manager for Product 
Strategy and New Business Initiatives at GE Healthcare 
Integrated IT Solutions; (4) Ms. Noel Williams, President of 
the Hospital Corporation of American (HCA) Information 
Technology & Services, Inc.; and (5) Mr. Justin T. Barnes, Vice 
President of Marketing and Government Affairs for Greenway 
Medical Technologies, Inc.

Summary of hearing

    Ms. Kloss testified that data content standards, especially 
a standardized method of medical terminology, is a significant 
issue that the Federal government should help guide the 
development of through NIST. She also stated that despite many 
beneficial voluntary private-sector efforts to develop 
standards, a long-term collaborative program for IT standards 
would be very helpful.
    Dr. Silverstone testified that healthcare IT is needed to 
increase quality of care through better dissemination of 
medical information while decreasing the cost of care. He 
reported that adoption of IT systems has been slow by 
healthcare professionals, emphasizing that for many 
practitioners it is prohibitively expensive. Creating an 
effective and interoperable system is necessary for adoption by 
the small practices that dominate the American healthcare 
industry. Mr. Raymer testified that current healthcare IT 
standards efforts by existing public/private collaborations 
such as the Health Information Technology Standards Panel 
(HITSP) are effective in establishing standards. However, 
NIST's involvement could be beneficial in bridging the gaps in 
current efforts and providing expertise where existing projects 
fall short. Such expertise includes testing, security 
standards, and facilitation of interoperability between Federal 
agencies.
    Ms. Williams testified that the presence of IT in 
healthcare would be beneficial and that it is under-implemented 
in the industry today. She testified that interoperability is a 
major issue when hospitals consider implementing an HIT system 
and that HIT efforts need national leadership to effectively 
coordinate the many organizations developing and promoting HIT 
standards. NIST has a role to play in standards development for 
HIT.
    Mr. Barnes testified that the government could provide more 
incentives for adoption of HIT. The development of standards is 
already underway by public/private collaborations, and thus the 
real benefit of increased NIST participation would be to 
provide assistance to this process while recognizing the 
leadership role of the Healthcare Information Technology 
Standards Panel.

                          V. COMMITTEE ACTIONS

    As summarized in Section IV, the Subcommittee on 
Environment, Technology and Standards of the Committee on 
Science heard testimony in the 109th Congress relevant to the 
provisions of H.R. 2406 on February 23, 2006, and the Committee 
on Science and Technology heard testimony in the 110th Congress 
relevant to the provisions of H.R. 2406 on September 26, 2007.
    On October 24, 2007, the full Committee on Science and 
Technology met to consider H.R. 2406 as introduced. The 
Committee considered three amendments to the bill:
    1. Mr. Gordon offered an amendment to clarify that the NIST 
work in healthcare IT authorized by the bill is to complement 
existing Federal efforts in healthcare IT, to strike the 
creation of a senior interagency council, to authorize $8 
million for NIST in FY 2009 and FY 2010 to carry out the 
programs in the bill, and to make other minor changes. The 
amendment was agreed to by voice vote.
    2. Mr. Hill offered an amendment directing NIST, in 
consultation with the National Science Foundation, to establish 
a task force including other Federal agencies and industry 
groups that will develop recommendations for the development of 
medical terminologies and classification, U.S. participation in 
the International Health Terminology Standards Development 
Organization, and related issues.
    3. Mr. Gingrey offered a second degree amendment to Mr. 
Hill's amendment, to strike consultation with the National 
Science Foundation. The amendment failed by a vote of 13-20. 
The Committee then voted on Mr. Hill's amendment, which passed 
by a vote of 21-13.
    The bill as amended was then adopted by voice vote. Mr. 
Lampson moved that the Committee favorably report H.R. 2406 as 
amended to the House, and the motion was agreed to by voice 
vote.

        VI. SUMMARY OF MAJOR PROVISIONS OF THE BILL AS REPORTED

    The bill establishes an initiative for healthcare 
information enterprise integration at NIST. It directs NIST, 
working with the private sector, to establish technical 
standards for healthcare IT for Federal agencies that will 
promote the interoperability of Federal healthcare information 
systems. It creates a program of grants to universities and 
consortia to conduct multidisciplinary research in healthcare 
IT areas, directs the National High-Performance Computing 
Program to coordinate Federal R&D on healthcare IT, and further 
directs NIST to establish a task force to develop 
recommendations on standards harmonization. Finally, it 
authorizes $8 million for NIST in FY 2009 and FY 2010.

        VII. SECTION-BY-SECTION ANALYSIS OF THE BILL AS REPORTED

Section 1. Short title

    The Healthcare Information Technology Enterprise 
Integration Act.

Section 2. Findings

    Establishes Congressional findings that the National 
Institute of Standards and Technology (NIST) is well equipped 
to complement existing Federal healthcare information 
technology (HIT) implementation efforts because of its 
experience with electronic commerce, information technology and 
security, as well as healthcare business through the Malcolm 
Baldrige National Quality Program. Further finds that it is in 
the national interest for NIST to accelerate its efforts in 
technical areas related to HIT.

Section 3. Healthcare information enterprise integration initiative

    Directs NIST to establish an initiative to advance HIT 
enterprise integration in the U.S., building on existing 
efforts at NIST and involving government and industry 
consortia. The initiative will complement other Federal HIT 
work under Executive Order 13335. Technical activities of this 
initiative may include standards and interoperability analysis 
and the development of technical testbeds, supporting the 
establishment of conformance testing infrastructure, 
information security and confidentiality, medical device 
communication, data management and retrieval architecture, and 
information management for electronic healthcare records, 
health information usability, and physician decision support. 
The initiative may also include assistance to outside 
organizations and Federal agencies in developing technical 
roadmaps for HIT enterprise integration, relying on voluntary 
consensus standards where possible. NIST shall report to 
Congress annually on these activities.

Section 4. Federal healthcare information technology systems and 
        infrastructure

    Directs NIST to report on the development of or adoption of 
new or existing private-sector, technology-neutral HIT 
guidelines and standards for use by Federal agencies within 12 
months of enactment. The guidelines and standards shall enable 
agencies to select and utilize HIT systems that provide 
security and confidentiality and are interoperable, in a manner 
that is inclusive of existing Federal efforts related to HIT. 
They shall promote the use of commercial HIT systems by Federal 
agencies, include conformance-testing procedures, provide 
confidentiality profiles, establish interoperability 
specifications, and include validation criteria. NIST will 
report annually on the progress toward and barriers to adoption 
of interoperable, secure and confidential HIT systems by 
Federal agencies.

Section 5. Research and development programs

    Directs NIST, in consultation with the National Science 
Foundation (NSF), to establish a competitive grant program for 
universities or consortia (which may include nonprofits and 
Federal laboratories) to establish Centers for Healthcare 
Information Enterprise Integration. The Centers will generate 
innovative approaches to HIT enterprise integration by 
conducting research on the interfaces between human information 
and communications technology systems, voice-recognition 
systems, interoperability software, software dependability, 
metrics of the impact of information technology on healthcare, 
healthcare information enterprise management, and information 
technology security and integrity. Grant applications shall 
include descriptions of proposed projects, efforts to foster 
multidisciplinary collaboration, and technology transfer and 
education activities. The National High-Performance Computing 
Program established by the High-Performance Computing Act of 
1991 shall coordinate federal R&D programs related to HIT. 
NIST, in consultation with NSF, shall establish a task force 
that includes other Federal agencies and industry groups to 
make recommendations to Congress on development of medical 
terminologies and related issues, within 18 months.

Section 6. Authorization of Appropriations

    Authorizes $8 million for NIST in each of FY 2009 and FY 
2010 to carry out this Act. The funds are to be derived from 
amounts authorized under Section 3001 of P.L. 110-69 (the 
America COMPETES Act).

                         VIII. COMMITTEE VIEWS

    The Committee believes that a wider adoption of information 
technology by the healthcare industry would bring important 
benefits to the industry, to patients, and to the nation as a 
whole. A fully realized system of healthcare IT (HIT) in the 
U.S. could save tens of billions of dollars per year, improve 
the quality of patient care, and help prevent life-threatening 
medical errors. While information technology has been embraced 
by many sectors of the economy, resulting in major increases in 
efficiency, the healthcare industry has been slow to invest in 
IT systems. The Committee would like to see this adoption 
accelerated.
    In order to allow the healthcare industry to make greater 
investments in information technology, it is critical that HIT 
systems be interoperable. Interoperability of systems allows 
them to communicate and exchange data, even if they are built 
and sold by different, competing manufacturers. The absence of 
interoperability prevents the realization of many of the 
advantages of information technology, such as the fast and 
inexpensive exchange of information. A lack of interoperability 
makes healthcare providers reluctant to invest in IT systems, 
because there is not a reasonable guarantee that they will be 
able to communicate and exchange data with other systems that 
are currently in use, or with systems that may be installed in 
the future.
    It is also vital that HIT systems ensure the secure 
protection of patient information. Security is the protection 
of information from disclosure to people who are not authorized 
to have it. Protecting patients' records depends on keeping 
patient medical information, such as medical histories and 
current medications, confidential. Without a reasonable 
guarantee that information stored on a healthcare IT system 
will be kept securely, patients and the general public may 
resist interacting with these systems.
    Both interoperability and security of HIT systems depend on 
technical standards, which enable manufacturers to build 
systems that are based on the same underlying communication 
techniques. These techniques allow diverse systems to exchange 
information, and also enable information about access to 
patient records, patient consent and notification, and other 
aspects of security to be accurately transmitted through the 
system.
    The Committee recognizes that Federal healthcare IT efforts 
have been coordinated to date by the Department of Health and 
Human Services (HHS), under an executive order from 2004. NIST 
has performed technical HIT work for HHS under a MOU, including 
research on conformance requirements for electronic healthcare 
records systems, standards-based technology for sharing 
clinical documents, and tests and tools for improving 
interoperability of healthcare IT systems. In addition, NIST 
cryptographic standards are being used by private-sector 
healthcare standards development organizations.
    The Committee believes that NIST should play a greater role 
in the field of healthcare IT. NIST's work should complement 
and support the efforts currently ongoing at the Department of 
Health and Human Services. The Committee further believes that 
an expanded effort by NIST to work with the private sector in 
guiding the development and harmonization of technical 
standards in HIT will accelerate the arrival of secure, 
interoperable healthcare IT systems. NIST's long track record 
of successful collaboration with industry and Federal agencies 
in developing technical standards in fields ranging from 
electronic commerce to industrial control to information 
security provides the Committee with confidence that a codified 
NIST role will be beneficial to this effort.
    The bill also directs NIST, working with the private 
sector, to develop or adopt existing private-sector technical 
standards for healthcare IT systems that are to be used by 
Federal agencies. Currently, Federal healthcare records systems 
at the Departments of Defense and Veterans Affairs and in other 
agencies are not interoperable, because they are not based on 
the same technical standards nor do they incorporate sufficient 
security protocols. The Committee believes that NIST is well 
positioned to improve the interoperability of these systems 
through the adoption of government-wide technical healthcare IT 
standards. This is a role analogous to NIST's work under the 
Federal Information Security Management Act (FISMA) to develop 
standards for the security of unclassified Federal computer 
systems. This provision is designed to permit NIST maximum 
flexibility in deciding between the adoption of existing 
private-sector HIT standards and the development of new ones 
when necessary, as is consistent with existing federal 
technology transfer laws, including the National Technology 
Transfer and Advancement Act of 1995 (Section 12 of PL 104-
113).
    The bill also includes the creation of a grant program at 
NIST for universities or consortia to conduct multidisciplinary 
research in areas relevant to healthcare IT, such as human-
system interfaces, voice-recognition technology, and healthcare 
information enterprise management. The Committee believes that 
there are significant gaps in current understanding of many of 
these areas of technology, and a multidisciplinary approach to 
addressing them is likely to improve the efficiency and utility 
of healthcare IT systems.

                           IX. COST ESTIMATE

    A cost estimate and comparison prepared by the Director of 
the Congressional Budget Office under section 402 of the 
Congressional Budget Act of 1974 has been timely submitted to 
the Committee on Science and Technology prior to the filing of 
this report and is included in Section X of this report 
pursuant to House Rule XIII, clause 3(c)(3).
    H.R. 2406 does not contain new budget authority, credit 
authority, or changes in revenues or tax expenditures. Assuming 
that the sums authorized under the bill are appropriated, H.R. 
2406 does authorize additional discretionary spending, as 
described in the Congressional Budget Office report on the 
bill, which is contained in Section X of this report.

              X. CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

                                                  October 26, 2007.
Hon. Bart Gordon,
Chairman, Committee on Science and Technology,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 2406, the 
Healthcare Information Technology Enterprise Integration Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Susan Willie.
            Sincerely,
                                                   Peter R. Orszag.
    Enclosure.

H.R. 2406--Healthcare Information Technology Enterprise Integration Act

    H.R. 2406 would direct the National Institute of Standards 
and Technology (NIST) to develop a plan to coordinate efforts 
by the health care industry and federal agencies to integrate 
the information systems that support health care services. The 
bill also would require NIST to report to the Congress on the 
status of efforts to develop guidelines and standards to ensure 
that such information technology (IT) systems are interoperable 
and secure. H.R. 2406 also would authorize NIST to establish a 
grant program to encourage the development of IT systems that 
would meet established standards. Finally, the bill would 
require the Director of NIST to establish a task force to 
develop a strategic plan to standardize the terms and 
classifications used in developing integrated IT systems.
    The bill would authorize the appropriation of $8 million in 
each of fiscal years 2009 and 2010. Based on information from 
NIST, CBO estimates that implementing the provisions of H.R. 
2406 would cost $16 million over the 2008-2012 period, subject 
to appropriation of the amounts authorized to be appropriated 
to NIST in the America COMPETES Act. Enacting H.R. 2406 would 
not affect direct spending or revenues.
    H.R. 2406 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act. The 
bill would authorize a grant program that could benefit public 
institutions of higher education. Any costs they might incur 
would result from complying with conditions of federal 
assistance.
    The CBO staff contact for this estimate is Susan Willie. 
This estimate was approved by Theresa Gullo, Deputy Assistant 
Director for Budget Analysis.

                  XI. COMPLIANCE WITH PUBLIC LAW 104-4

    H.R. 2406 contains no unfunded mandates.

         XII. COMMITTEE OVERSIGHT FINDINGS AND RECOMMENDATIONS

    The oversight findings and recommendations of the Committee 
on Science and Technology are reflected in the body of this 
report.

      XIII. STATEMENT ON GENERAL PERFORMANCE GOALS AND OBJECTIVES

    Pursuant to clause 3(c) of House rule XIII, the goals of 
H.R. 2406 are to advance the adoption of healthcare information 
technology systems in the private sector and the Federal 
government, by accelerating the development of technical 
standards that will enable these systems to be interoperable 
while protecting the security of patients' health information.

                XIV. CONSTITUTIONAL AUTHORITY STATEMENT

    Article I, section 8 of the Constitution of the United 
States grants Congress the authority to enact H.R. 2406.

                XV. FEDERAL ADVISORY COMMITTEE STATEMENT

    No Federal Advisory Committees are created by H.R. 2406.

                 XVI. CONGRESSIONAL ACCOUNTABILITY ACT

    The Committee finds that H.R. 2406 does not relate to the 
terms and conditions of employment or access to public services 
or accommodations within the meaning of section 102(b)(3) of 
the Congressional Accountability Act (Public Law 104-1).

                      XVII. EARMARK IDENTIFICATION

    H.R. 2406 does not contain any congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9(d), 9(e), or 9(f) of rule XXI.

     XVIII. STATEMENT ON PREEMPTION OF STATE, LOCAL, OR TRIBAL LAW

    This bill is not intended to preempt any state, local, or 
tribal law.

       XIX. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    This bill makes no changes in existing law.

                     XX. COMMITTEE RECOMMENDATIONS

    On October 24, 2007, the Committee on Science and 
Technology favorably reported the Healthcare Information 
Technology Enterprise Integration Act by a voice vote, and 
recommended its enactment.

XXI. ADDITIONAL VIEWS ON H.R. 2406, THE ``HEALTH INFORMATION TECHNOLOGY 
   ENTERPRISE INTEGRATION ACT'' OF REPRESENTATIVES RALPH HALL, PHIL 
  GINGREY, VERNON EHLERS, MICHAEL MCCAUL, TOM FEENEY AND ADRIAN SMITH

    The American Health Information Community (AHIC) is a 
federal advisory body, chartered in 2005 to make 
recommendations to the Secretary of the U.S. Department of 
Health and Human Services on how best to accelerate the 
development and adoption of health information technology, 
including terminologies and classifications. Since 2005, the 
Federal Government has spent $122 million for activities 
related to coordinating health information technology, and the 
President has budgeted $118 million for FY 2008. In addition, 
AHIC and the National Library of Medicine are already working 
on medical terminologies and definitions. Additionally, the 
Office of the National Coordinator at the Department of Health 
and Human Services also established the Health Information 
Technology Standards Panel (HITSP)--public/private partnership 
with broad participation across more than 300 health related 
organizations--to identify and harmonize data and technical 
standards for healthcare.
    At the Committee markup of H.R. 2406, an amendment was 
offered by Mr. Hill to create a new ``task force'' that is run 
through the National Institute of Standards and Technology 
(NIST) in consultation with the National Science Foundation 
(NSF). The minority feels that such a charter is not only 
redundant, but may slow the forward progress that is already 
being made by AHIC and HITSP. Indeed, AHIC has already 
recommended adoption of some standards, and several have 
already been rolled out.
    Even more problematic to the minority is that the Hill 
amendment would go against NIST's core competencies and instead 
saddle NIST with responsibilities far outside of its expertise. 
NIST has never been a body that set standards. It takes an 
agreed-upon policy and develops the technical standards around 
that policy. However, as head of this new task force, NIST 
would be also charged with creating recommendations for the 
design of a centralized authority that develops, encourages 
adoption of, and maintains health information technology 
terminologies and classifications. These roles are beyond the 
scope of NIST. Further complicating this process, the amendment 
by Representative Hill also adds another agency into the 
picture--one that also lacks the expertise or experience in 
setting policies for health information technology. It is 
inadvisable for NIST to consult specifically with the NSF. 
While the NSF does have an important role to play with 
information technologies basic research, some of which may have 
the potential to be used by the health industry, determining 
standards and health terminology is not within their expertise.
    Representative Gingrey (GA) offered a perfecting amendment 
to the amendment offered by Representative Hill (IN). The 
purpose of this perfecting amendment was to remove the National 
Science Foundation (NSF) from the task force to evaluate 
creation of national policies on health information technology 
standards. This amendment was supported by the minority, but 
was voted down by the majority. The Hill amendment to the bill 
was accepted in its original format after a vote in Committtee 
and will be included in the bill that is reported to the House.
    In addition to concerns about the Hill amendment, the 
minority is also concerned with the language directing funding 
for this bill come from funds authorized for the COMPETES Act 
of 2007 (PL 110-69). Retroactively authorizing programs through 
previously authorized legislation sets a questionable precedent 
for future programs to be authorized in a similar manner. This 
practice would hamper the agencies enumerated in COMPETES which 
have long suffered declining or stagnant budgets. The purpose 
of the COMPETES Act was to increase America's competitiveness 
and innovation capacity. It is not clear that this bill 
directly achieves that purpose.
    We urge our colleagues to consider the vital importance of 
properly and effectively creating national policies on health 
information technology standards in a focused manner so that 
these policies are universally and quickly adoptable.

                                   Ralph M. Hall.
                                   Vernon J. Ehlers.
                                   Phil Gingrey.
                                   Michael T. McCaul.
                                   Tom Feeney.
                                   Adrian Smith.

    XXII. PROCEEDINGS OF THE FULL COMMITTEE MARKUP ON H.R. 2406, TO 
    AUTHORIZE THE NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY TO 
 INCREASE ITS EFFORTS IN SUPPORT OF THE INTEGRATION OF THE HEALTH CARE 
              INFORMATION ENTERPRISE IN THE UNITED STATES

                              ----------                              


                      WEDNESDAY, OCTOBER 24, 2007

                          House of Representatives,
                       Committee on Science and Technology,
                                                    Washington, DC.

    The Committee met, pursuant to call, at 10:10 a.m., in Room 
2318 of the Rayburn House Office Building, Hon. Bart Gordon 
[Chairman of the Committee] presiding.
    Chairman Gordon. Good morning. The Committee will come to 
order, pursuant to notice. The Committee of Science and 
Technology meets to consider the following measures: H.R. 2406, 
To authorize the National Institute of Standards and Technology 
to Increase its efforts in support of the integration of health 
care information enterprises in the United States; H.R. 3877, 
the Mine Communications Technology Innovation Act; and H.R. 
1834, the National Ocean Exploration Program Act.
    As we start, let me welcome back Mike Quear. Mike is the 
brains and the inspiration for, particularly the health care 
bit of this. As we pointed out the other day, Mr. Hall was very 
complimentary; Mike had a stroke recently, complicated by some 
other matters. He is back, and we are glad you are here, Mike. 
You are very important to the entire Committee.
    We now proceed with the markup, and I will begin with a 
brief statement. Today the Committee meets to markup three 
bills dealing with a wide range of issues.
    The first bill we will markup, H.R. 2406, deals with the 
issue of health care information technology. The broad use of 
IT in the health care sector could have far reaching benefits, 
including saving tens of billions of dollars per year--and that 
is tens of billions of dollars for both the taxpayers as well 
as for patients--improving the quality of medical care, and 
reducing dangerous medical errors.
    But meeting the challenge of developing and maintaining 
such a system is not simple. In order to achieve broad 
implementation, we need widely accepted technical standards 
that will let health care IT systems inter-operate while 
protecting patient privacy.
    H.R. 2406 authorizes the National Institute of Standards 
and Technology to increase its efforts to support the 
integration of health care IT in the United States, to develop 
or adapt or adopt existing technical health care IT standards 
for federal agencies, and to create a university grant program 
for multi-disciplinary research in health care IT--and I thank 
Mr. Wu for that addition. The bill is based on the 
recommendations of a report by the President's Information 
Technology Advisory Committee in 2004 and a study by the 
National Academies in 2005.
    The next bill we will markup is H.R. 3877, which addresses 
the issue of underground mine communication technology.
    Tragedies in West Virginia and Utah over the last few years 
have given us a painful illustration for the need for robust 
emergency communications in mines.
    H.R. 3877 authorizes research and standards development 
programs to address the important challenge of communication 
technology for underground mines. The bill authorizes an R&D 
and standards development program at the National Institute of 
Standards and Technology at NIST to promote development of 
innovative communications and tracking technologies of 
underground mines.
    To be clear, this bill has not, in any way, diminished the 
role of the National Institute for Occupational Safety and 
Health. NIST's efforts to promote improved communications 
technology through R&D and technical standards only support 
NIOSH's important work. And I want to thank Mr. Matheson for 
bringing this very important and timely issue to us.
    The National Ocean Exploration and National Undersea 
Research Program Act formally authorizes two programs at NOAA 
that have made important contributions to our knowledge of the 
oceans and developed technologies that enable us to explore 
these vast areas of our planet.
    Once again the Committee has three good bills in front of 
it, which do address three different, but critical issues.
    And once again, we are marking up both Republican and 
Democratic bills, because as I have said before, good ideas are 
good ideas, regardless of where they might originate. And I 
urge my colleagues to support each of these good bills.
    I now recognize Mr. Hall to present his opening remarks.
    [The prepared statement of Chairman Gordon follows:]
               Prepared Statement of Chairman Bart Gordon
    Today the Committee meets to markup three bills dealing with a wide 
range of issues.
    The first bill we will markup, H.R. 2406, deals with the issue of 
health care information technology. The broad use of IT in the health 
care sector could have far reaching benefits, including saving tens of 
billions of dollars per year, improving the quality of medical care, 
and reducing dangerous medical errors.
    But meeting the challenge of developing and maintaining such a 
system is not simple. In order to achieve broad implementation, we need 
widely accepted technical standards that will let health care IT 
systems inter-operate while protecting patient privacy.
    H.R. 2406 authorizes the National Institute of Standards and 
Technology (NIST) to increase its efforts to support the integration of 
health care IT in the United States, to develop or adopt existing 
technical health care IT standards for federal agencies, and to create 
a university grant program for multi-disciplinary research in health 
care IT.
    The bill is based on the recommendations of a report by the 
President's Information Technology Advisory Committee (PITAC) in 2004 
and a study by the National Academies in 2005.
    The next bill we will markup is H.R. 3877, which addresses the 
issue of underground mine communication technology.
    Tragedies in West Virginia and Utah over the last few years have 
given us a painful illustration of the need for robust emergency 
communications in mines.
    H.R. 3877 authorizes research and standards development programs to 
address the important challenge of communications technology for 
underground mines. The bill authorizes an R&D and standards development 
program at the National Institute of Standards and Technology (NIST) to 
promote development of innovative communications and tracking 
technologies for underground mines.
    To be clear, this bill does not in any way diminish the role of the 
National Institute for Occupational Safety and Health (NIOSH). NIST's 
efforts to promote improved communications technology through R&D and 
technical standards support NIOSH's important work.
    Historically, NIST has worked with industry and federal agencies on 
long- term R&D projects and development of technical standards, 
including first responder radio communications, and is the best agency 
to bridge the research and technology gap in the field of mine 
communications.
    Finally, we will also consider H.R. 1834, introduced by our 
colleague on the Natural Resources Committee, Rep. Saxton. The National 
Ocean Exploration and National Undersea Research Program Act formally 
authorizes two programs at NOAA that have made important contributions 
to our knowledge of the oceans and developed technologies that enable 
us to explore these vast areas of our planet.
    Once again the Committee has three good bills in front of it which 
address three different, but critical issues.
    And once again, we are marking up both Republican and Democratic 
bills, because as I have said before, good ideas are good ideas 
regardless of where they come from. I urge my colleagues to support 
each of these good bills.

    Mr. Hall. Thank you, Mr. Chairman. As you very ably pointed 
out, I am pleased, and our side of the docket is pleased that 
this committee is marking up three good bills today.
    H.R. 2406 will certainly help clarify and codify NIST's 
role in the integration of health information technology. NIST 
has played a very important role in health information 
technology through their work with the Department of Health and 
Human Services, and this legislation helps them to continue 
that vital role as we develop inter-operability standards.
    H.R. 3877 offers another opportunity to clarify NIST's role 
in the important area of mine communication technology. AS the 
tragedy in Utah unfortunately illustrated, we have a lot of 
work to do to improve communications between surface personnel 
and underground miners so as to advance miner health and 
safety.
    And finally, H.R. 1834 authorizes two programs that are 
already in existence at NOAA, the Ocean Exploration Program and 
the National Undersea Research Program. These are two excellent 
initiatives, and it is time that we codify their goals and 
objections into law.
    I would like to thank you and your staff for working with 
us to improve these bills and craft good policy.
    I yield back the balance of my time.
    [The prepared statement of Mr. Hall follows:]
           Prepared Statement of Representative Ralph M. Hall
    Thank you, Mr. Chairman. I am pleased that this committee is 
marking up three good bills today. H.R. 2406 will help clarify and 
codify NIST's role in the integration of health information technology. 
NIST has played an important role in health information technology 
through their work with the department of health and human services, 
and this legislation helps them continue that vital role as we develop 
inter-operability standards.
    H.R. 3877 offers another opportunity to clarify NIST's role in the 
important area of mine communications technology. As the tragedy in 
Utah unfortunately illustrated, we have a lot of work to do to improve 
communications between surface personnel and underground miners so as 
to advance miner health and safety.
    Finally, H.R. 1834 authorizes two programs that are already in 
existence at NOAA, the Ocean Exploration Program and the National 
Undersea Research Program. These are two excellent initiatives, and it 
is time that we codify their goals and objectives into law.
    I would like to thank you and your staff for working with us to 
improve these bills and craft good policy.
    I yield back the balance of my time.

    Chairman Gordon. Thank you, Mr. Hall.
    Without objection, Members may place statements in the 
records at any point.
    [The prepared statement of Mr. Mitchell follows:]
         Prepared Statement of Representative Harry E. Mitchell
    Thank you, Mr. Chairman.
    As you know, our nation is facing a health care crisis. And I'm not 
even talking about the rising cost. We have an information crisis. 
Different information is stored in different systems, and too often we 
have to jump through hoops do share it. We have yet to get vital health 
information stored in one uniform system.
    The inability to share health information puts patient care at 
risk. According to the Institute of Medicine, as many as 98,000 people 
die in hospitals yearly from medical errors such as improper 
medications and incorrect diagnoses, and as much as 49 percent of 
diagnostic testing is replicated because previous tests results are not 
readily accessible.
    In addition to the honor of serving on this committee, I have the 
honor of serve as Chairman of the Veterans' Affairs Committee's 
Subcommittee on Oversight and Investigations. In the course of our work 
there, we have seen serious problems with medical information sharing 
between the Department of Defense and the Veterans Administration. 
Veterans are finding technological and bureaucratic hurdles when they 
try to access their own medical histories. This puts their medical care 
at risk, and I think our nation's heroes deserve better.
    I am pleased with the work that the Science and Technology 
Committee has dome to help create a solution to this long vexing 
problem. I am a proud co-sponsor of H.R. 2406, and I am confident that 
this legislation will establish the technical standards necessary to 
ensure secure and accurate health care information sharing between 
federal agencies like the DOD and the VA.
    I yield back.

    [The prepared statement of Mr. Gingrey follows:]
           Prepared Statement of Representative Phil Gingrey
    Mr. Chairman, I thank you for this opportunity to work with you on 
this important bill in a truly bipartisan fashion. I want to openly 
express my support for H.R. 2406.
    Together, over the past few weeks since our last hearing you and I 
have worked closely together to make some very crucial changes to this 
bill so that this bill will best capture the role of NIST and the use 
of their technical expertise in assisting with the future of standards 
development in health information technology.
    As you know, health information technology is a topic of great 
importance to me as a physician Member of this body--so I appreciate 
you putting forth this important legislation and I am excited to see 
the immense amount of positive impact your bill will have on properly 
developing inter-operability standards for Health Information 
Technology.
    As I have stated many times before, Health Information Technology 
is one of the most promising ways to tackle today's problem of 
skyrocketing health care costs. According to a recent Rand study A 
correctly implemented and widely adopted inter-operable HIT system 
would save the American health care system more than $160 billion 
annually.
    In addition to this immense cost savings, there is the possibility 
that according to a recent IOM study a properly implemented HIT would 
eliminate medical errors that lead to almost 100,000 deaths every year.
    Health information technology is and should continue to be a 
priority in Washington. Reaching our full potential for HIT in the most 
efficient and effective way is essential to providing the best future 
health care and taxpayer return to our American people and I believe 
that NIST is a vital player in this arena.
    In the words of NIST themselves, NIST has a strong history in 
serving as a neutral third party in addressing sensitive measurement 
issues and have had a reputation of success because they have been 
committed to their scope of assisting in and working closely with the 
development of ``best practices'' of standards using these high level 
of technical expertise. This is NOT to be confused with developing the 
best practices guidelines themselves.
    Therefore I am so glad that Chairman Gordon put forth this 
legislation that focuses of the technical expertise that the National 
Institute of Standards and Technology will official bring to the table 
in assisting ongoing efforts to the creation and implementation of HIT 
inter-operability standards not only quickly, but properly.
    This bill has three specific and well targeted goals. (1)The first 
is to codifies into statute the role of NIST in the development of 
Health Information Technology Standards. (2) Second, is to clearly 
indicate that NIST's role will be to give technical assistance for the 
development and adoption of these of standards. (3) Third, is to allow 
NIST the authority to grant funds to institutes of higher education to 
research technical components of HIT.
    I want to commend the Chairman for taking into account the repeated 
recommendations of the witnesses at our hearing a few weeks ago and 
working in a bipartisan fashion with the Minority to create legislation 
that will NOT allow the duplication of efforts already underway at HHS 
for national HIT standards and at the NIH's National Library of 
Medicine for international HIT standards.
    Every one of the witnesses repeatedly mentioned the crucial 
importance of NOT duplicating and not undermining the efforts already 
underway by our own government organizations. Duplication of such 
efforts would be a waste of tax-payer dollars and would undermine the 
goals of bringing HIT effectively to the tax-paying American people. 
Therefore, I again commend the special efforts Chairman Gordon has 
taken in his bill to specifically indicate that NIST's efforts should 
only build upon and not undermine efforts already taking place.
    I thank you again Mr. Chairman and I look forward to a successful 
markup of this bill that will continue to capture the strengths of H.R. 
2406.

    Chairman Gordon. We will now consider H.R. 2406, To 
authorize the National Institute of Standards and Technology to 
increase its efforts in support of the integration of health 
care information enterprise in the United States, and I yield 
myself five minutes to describe the bill.
    The goal of H.R. 2406 is to promote the adoption and 
utilization of information technology in the health care 
community and creation of an inter-operable and secure network 
of electric health care records. There is a general consensus 
that the result of fully utilized information technology would 
be to lower costs--and when I mean lower costs, I mean billions 
of dollars in lower costs--for both the Federal Government as 
well as for patients, and to improve patient care.
    Regardless of its acknowledged benefits, the use of IT by 
the health care community remains low and lags far behind other 
segments of our economy, such as financial services, banking 
manufacturing, and e-business. In January, I started holding a 
series of roundtables with the health care community to 
identify the barriers to their use of IT. What I discovered was 
concern about the lack of inter-operability between the 
different health care IT systems as well as serious 
reservations about the security, confidentiality, and privacy 
of patient data in electronic format were major issues of the 
health care community.
    In a world of electronic information, these issues can only 
be resolved through the development of technical standards, and 
these standards currently do not exist in any comprehensive 
form.
    NIST already has a proven track record in this type of 
work. One reason IT has been so heavily utilized in the 
banking, financial services, and e-business, telecommunications 
and manufacturing has been NIST's support for the development 
of inter-operability and security standards in those sectors. 
H.R. 2406 builds upon NIST's proven track record.
    In addition, H.R. 2406 implements the recommendations of 
the President's Information Technology Advisory Committee 
report revolutionizing health care through information 
technology and the National Academies of Engineering and the 
Institute of Medicine's Report, Building a Better Delivery 
System in Engineering Healthcare Partnership. H.R. 2406 also 
incorporates the recommendations and views that the T&I 
Subcommittee received at its hearing. In addition, H.R. 2406 
authorizes activities which NIST identifies as areas where they 
could do more work and make significant contributions to the 
health care field.
    Later, I will also be offering a manager's amendment to 
H.R. 2406. This amendment reflects the comments the Committee 
received during our September hearing on the bill, and in 
consolation with NIST. And I want to thank Dr. Gingrey and his 
staff for their input in making this amendment even a better 
amendment. I would encourage the adoption of this amendment, 
and I urge my colleagues to support the bill.
    I now recognize Mr. Hall to present any remarks on the 
bill.
    Mr. Hall. Chairman, I thank you, and I, too, would like to 
express my support for H.R. 2406, a bill to authorize NIST's 
efforts to assist in the development of health information 
technology standards.
    America has the most advance health care system in the 
world, and our doctors and scientists have extended and 
improved the lives of people worldwide. Our nation offers 
cutting-edge research and technologies to offer hope to 
millions of people; however, despite these amazing advancement, 
our health care system is hampered by outdated recordkeeping.
    Far too many patients suffer from paper-record errors and 
mistakes rising from the inability to get timely information to 
health care providers. Indeed, several studies indicate that 
our country could save tens of billions of dollars annually by 
moving to electronic health care records. But in order for that 
to happen, we need to have clear inter-operability standards 
for industries to follow so that we can safely and securely 
share electronic data between computer networks.
    This legislation will codify the role that NIST plays in 
advancing health information technology standards.
    I would like to thank Dr. Gingrey, also, as you have, Mr. 
Chairman, for working so closely with our staff and yours in 
this legislation, and I want to yield the balance of my time to 
him to speak on the bill.
    But before I close, I want to acknowledge Mr. Quear's 
excellent work on this legislation. He has worked long and hard 
on the topic over the last few months and years, and his 
efforts have continued even while he was recuperating from his 
illness. I have worked with him as a Democrat, and I have 
worked with him as a Republican, and you can't hook him up 
wrong. We are awfully glad to have him back.
    [The prepared statement of Mr. Hall follows:]
           Prepared Statement of Representative Ralph M. Hall
    Thank you, Mr. Chairman. I, too, would like to express my support 
for H.R. 2406, a bill to authorize NIST's efforts to assist in the 
development of health information technology standards.
    America has the most advanced health care system in the world. Our 
doctors and scientists have extended and improved the lives of people 
worldwide. Our nation offers cutting-edge research and technologies to 
offer hope to millions.
    However, despite these amazing advancements, our health care system 
is hampered by outdated record keeping. Far too many patients suffer 
from paper-record errors and mistakes arising from the inability to get 
timely information to health care providers. Indeed, several studies 
indicate that our country could save tens of billions of dollars 
annually by moving to electronic health care records. But, in order for 
that to happen, we need to have clear inter-operability standards for 
industries to follow so that we can safely and securely share 
electronic data between computer networks.
    This legislation will codify the role that NIST plays in advancing 
health information technology standards. I would like to thank Dr. 
Gingrey for working so closely with our staff and yours on this 
legislation, and I want to yield the balance of my time to him to speak 
on the bill.
    But before I close, I want to acknowledge Mike Quear's excellent 
work on this legislation. He has worked long and hard on this topic 
over the last few months and years, and his efforts have continued even 
while he was recuperating from his illness. I know that we all wish him 
a speedy recovery and return to Washington.
    With that, I yield the balance of my time to the distinguished 
Member from Georgia, Dr. Gingrey.

    Chairman Gordon. With that, I yield the balance of my time 
to the distinguished Member from Georgia, Dr. Gingrey.
    Mr. Gingrey. Mr. Chairman, I thank you and the Ranking 
Member for yielding time to me to make an opening statement as 
well, and it has been great to work with you on truly an 
important bill in a bipartisan fashion. I want to openly 
express my support, indeed, for H.R. 2406.
    Together over the past few weeks since our last hearing, 
you and I have worked closely to make some very crucial changes 
to this bill so that it will best capture the role of NIST and 
the use of their technical expertise in assisting with the 
future of standards development in health information 
technology. As you know and have already stated, health 
information technology is a topic of great importance to me as 
a physician member of this body, and so, indeed, I appreciate 
you putting forth this important legislation, and I am excited 
to see the immense amount of positive impact your bill will 
have on properly developing inter-operability standards for 
HIT.
    As I have stated many times before, health information 
technology is indeed one of the most promising ways to tackle 
today's problems of skyrocketing health care costs. According 
to a recently Rand study, a correctly implemented and widely 
adopted inter-operable HIT system would save the American 
health care system more than--and it has already been said--
billions of dollars. But the ran study actually said more than 
$160 billion annually, so we are talking about a huge amount of 
savings.
    In addition to this immense cost savings, there is a 
possibility that, according to a recent Institute of Medicine 
study, a properly implemented HIT would eliminate medical 
errors that lead to almost 100,000 deaths every year. Now, this 
was a report by Institute of Medicine a number of years ago, 
and I think they are probably pretty accurate.
    Health information technology is and should continue to be 
a priority in Washington. Reaching our full potential in the 
most efficient and effective way is essential to providing the 
best future health care and taxpayer return to our American 
people, and I believe that NIST is a vital player in this 
arena.
    In the words of NIST themselves, NIST has a strong history 
in serving as a neutral third party in addressing sensitive 
measurement issues, and have had a reputation of success 
because they have been committed to their scope and assisting 
in and working closely with the development of best practices 
of standards used in these high levels of technical expertise. 
This is not to be confused with developing the best practices 
guidelines, themselves.
    Therefore, I am so glad that Chairman Gordon put forth this 
legislation that focuses on the technical expertise that NIST 
will officially bring to the table in assisting ongoing efforts 
to the creation and implementation of HIT inter-operability. So 
I want to commend the Chairman. I think that this is a good 
bill. I have got a second-degree amendment that I will offer at 
a later time, but I thank the Chairman, and I look forward to a 
successful markup of this bill, and that will continue to 
capture the strength of H.R. 2406.
    Chairman Gordon. Thank you, Dr. Gingrey, for your really 
helpful firsthand information on this issue. Does anyone else 
wish to be recognized?
    Mr. Bartlett. Mr. Chairman?
    Chairman Gordon. Mr. Bartlett is recognized.
    Mr. Bartlett. I would just like to note that our country 
really doesn't have much of a health care system. We have a 
really good sick-care system, the best in the world. And I 
would hope that we can move towards more of a health care 
system so that we will have less and less need for our really 
good sick-care system. Thank you very much.
    Chairman Gordon. Thank you, Mr. Bartlett. You always add to 
our body of information.
    Does anyone else wish to be recognized?
    I ask unanimous consent that the bill is considered as read 
and open to amendment at any point and that the Members proceed 
with the amendments in the order of the roster. Without 
objection, so ordered.
    The first amendment on the roster is the manager's 
amendment, offered by the Chair.
    The Clerk will report the amendment.
    The Clerk. Amendment to H.R. 2406, offered by Mr. Gordon of 
Tennessee.
    Chairman Gordon. I ask unanimous consent to dispense with 
the reading. Without objection, so ordered.
    I recognize myself for five minutes to explain the 
amendment. This amendment makes some important improvements to 
H.R. 2406. It reflects the helpful comments the Committee 
received from witnesses and stakeholders during our September 
hearing on the bill, and in consultation with NIST, and with 
Ranking Member Hall, and with Mr. Gingrey.
    Specifically, the amendment makes clear that NIST's 
activities will complement, not compete, against the work of 
the National Coordinator of the Department of Health and Human 
Services by conducting work on technical standards for HIT. IT 
also ensures that NIST will fully participate in the 
development of technical standards and guidelines in 
cooperation and collaboration with the private sector.
    The amendment emphasizes that NIST will focus on technical-
security issues. It is not the intent of the Committee that 
NIST should become engaged in privacy policy issues.
    Finally, the amendment strikes the language creating a 
senior interagency council for all federal health care 
information technology infrastructures to avoid redundancy and 
makes additional minor corrections.
    I would strongly urge adoption of the amendment, and I 
would like to ask Counsel if--Mike is here--if the--Mr. Gingrey 
had a good suggestion that the 12-month study be increased to 
18 months. Was that included in this amendment? Do you know? 
Was that included? Okay, excuse me. I think that speaks for 
itself, then.
    Is there further discussion on the amendment? If not, the 
occurs upon the amendment. All in favor, say aye; opposed, no. 
The ayes have it. The amendment is agreed to.
    The second amendment on the roster is offered by Mr. Hill. 
The gentleman from Indiana, are you ready to proceed with you 
amendment?
    Mr. Hill. I am, Mr. Chairman.
    Chairman Gordon. The Clerk will report the amendment.
    The Clerk. Amendment to H.R. 2406, offered by Mr. Hill of 
Indiana.
    Chairman Gordon. I ask unanimous consent to dispense with 
the reading. Without objection, so ordered.
    The gentleman is recognized for five minutes to explain his 
amendment.
    Mr. Hill. Thank you, Mr. Chairman, for introducing this 
important piece of legislation. Moving our health information 
technology into the 21st century can both save money and 
improve the quality of care for patients.
    By increasing health IT capabilities, medical professionals 
will better be able to access critical health information of 
patients. And by streamlining health information retrieval, we 
can better ensure higher quality of care for patients. We 
currently have the technology to make this possible. The 
Chairman's bill is terrific start, and my amendment would 
improve the facilitation of this transition.
    My amendment would direct the National Institute of 
Standards and Technology, NIST, and the National Science 
Foundation, NSF, to create a task force, comprised of other 
federal agencies and private industry groups to develop a 
strategic plan for implementation of health care technologies 
and classifications. This roadmap would provide several 
important recommendations, including the following: a plan for 
the development, adoption, and maintenance of terminologies and 
classifications; a plan for gaining the commitment of 
stakeholders to principles and guidelines for this process; and 
a plan to design a centralized authority or governance model to 
maintain the program.
    Eighteen months after this legislation is enacted, the task 
force would report its findings back to the Science Committee, 
where we can then debate and enact further legislation if we 
deem it necessary.
    Mr. Chairman, my amendment would begin the process of 
brining stakeholders together and develop strategies that would 
move us forward. My amendment is endorsed by the American 
Health Information Management Association and the American 
Medical Informatics Association.
    Mr. Chairman, this basically does one thing: according to 
the old Bible scriptures, there is the Tower of Babel, where we 
had many different languages. This amendment tears down the 
Tower of Babel and creates a common language that is so 
important to deliver health technology.
    So I ask unanimous consent to insert the support letter of 
the American Health Information Management Association and the 
American Medical Informatics Association into the record, and 
Mr. Chairman, I thank you for bringing a well drafted bill that 
addresses a critical area of need for our country, and I urge 
the adoption of my amendment.
    [The information follows:]
    
    

    Chairman Gordon. Is there further discussion on the 
amendment?
    Dr. Gingrey is recognized.
    Mr. Gingrey. Mr. Chairman, I do rise in opposition to this 
amendment, really, because I think we end up getting too much 
babbling, as Mr. Hill mentioned.
    There is already a task force underway, designed to achieve 
the ends of the Hill amendment. The American Health Information 
Community, AHIC, is a federal advisory body, chartered in 2005, 
to make recommendations to the Secretary of the U.S. Department 
of Health and Human Services on how to accelerate the 
development and adoption of HIT, including terminologies and 
classifications. Since 2005, the Federal Government has already 
spent $122 million for activities related to coordinating 
health information technology, and the President has budgeted 
$118 million for FY 2008.
    In addition, AHIC and the National Library of Medicine are 
already working on medical terminologies and definition. The 
Office of the National Coordinator at the Department of Health 
and Human Services also established the Health Information 
Technologies Standards Panel, HITSP, and this is a public-
private partnership, with broad participation across more than 
300 health-related organizations for the purposes of 
identifying and harmonizing data and technical standards for 
health care. So I say establishing a new task force that is run 
through NIST and NSF is not only redundant, but it also may 
slow the forward progress that is already being made by AHIC 
and HITSP.
    Indeed, AHIC has already recommended adoption of some 
standards, and several have already been ruled out, so this 
amendment would go against NIST's core competency and instead 
saddle NIST with, I think, responsibilities that are outside of 
their expertise. NIST has never been a body that sets 
standards. They take an agreed-upon policy and then develop the 
technical standards around that policy. While this amendment 
does not task them with setting standards, it does put them in 
charge of a task force that creates recommendations for the 
development and adoption of terminologies and classifications.
    Moreover, as head of this task force, NIST is also charge 
with creating recommendations for the design of a centralized 
authority on this topic. Both of these roles, I think, are 
beyond the scope of NIST, so I think that this amendment unduly 
complicates an otherwise good, bipartisan bill.
    And again, I think, you know, you got too much babbling, 
quite honestly. It brings in another agency that was not part 
of the mix before. It is not clear why NIST would consult 
specifically with the National Science Foundation. In addition, 
this amendment does not clarify what NSF will do, exactly, so 
you know, for these reasons, Mr. Chairman, I respectfully 
oppose the Hill amendment, and I yield back.
    Chairman Gordon. Thank you, Mr. Gingrey. Let me say again, 
I think those were very thoughtful comments.
    Let me give you some background on the origin of this 
amendment. These were stakeholders that came to the Committee 
with these recommendations, and I guess this somewhat 
simplifies it, but I think the way to look at this is that our 
original bill looks at inter-operability on a national basis. 
What this does is add another level to it, and that is it helps 
to look at it on a more international basis. The reason that is 
important, as you know, now, oftentimes, x-rays that are taken 
during the day might be read and developed in India or 
Australia during our night/their day, sent back to us. I think 
this can add to additional savings. I think this can add, 
hopefully, to exports as our stakeholders told us.
    The reason that the National Science Foundation has a very 
small role here, consultative role, is that they deal with the 
international business community. They are best able to help us 
with that international piece of it. We, as always, will 
continue to work with you as we go through this process, as we 
go to the Senate and beyond. We continue to want to make a good 
bill better, but from all that I have seen and heard, I think 
Mr. Hill's amendment does improve an already good bill.
    And I would also--and I was reminded that this is just a 
report, also, an advisory report.
    Mr. Hill is recognized.
    Mr. Hill. Mr. Chairman, in my opening remarks, I asked for 
unanimous consent to insert a letter of endorsement from the 
American Health Information Management Association and the 
Medical Informatics Association, so I would repeat that 
request.
    Chairman Gordon. And may I ask, did you amend your 
amendment, as requested, Mr. Gingrey, to change the report--the 
time from 12 months to 18 months?
    Mr. Gingrey. I did. We changed it from 12 months to 18 
months, and that amendment was requested by the gentleman from 
Georgia, and we have conceded to that request.
    Mr. Hall. Mr. Chairman?
    Chairman Gordon. Mr. Hall is recognized.
    Mr. Hall. I would just say a word or so in opposition to 
the amendment. And when he goes biblical on me, it reminds me 
of Billy Graham saying he loved the sinner but he hated the 
sin.
    I am crazy about the author of this bill here, and I admire 
him very much, and I have worked with him long ago, and he is a 
good man, and all of you folks that you have mentioned look 
forward to this because they are part of the task force. I 
don't blame them for supporting this amendment.
    It is not the worst amendment in the world, but why not use 
HHS, since they are developing this already, and this is 
already a task force here, and it seems like it is a little 
redundant. It is not a killer of the bill, but I had hoped that 
these two men, so thoughtful both of them, and so knowledgeable 
could get together and work out something that we could agree 
on.
    I yield back my time, and I realize I haven't hardly said 
anything.
    Chairman Gordon. But you do it well, and thank you, Mr. 
Hall. Dr. Ehlers is recognized.
    Mr. Ehlers. Thank you, Mr. Chairman, and I am afraid I will 
probably say more than the previous speaker, but it will mean 
less. People from Texas have a way of saying a lot in very few 
words.
    I just have to express some concerns about this, the 
amendment, and the inclusion NSF. NSF has a lot on its plate. I 
don't think it has any particular expertise in this area that 
we want to draw on because they do not--NSF excels not so much 
by having a lot of expertise in house, but by giving grants to 
people who do have a lot of expertise and do a lot of research 
and perform extremely well for our nation, and that has been 
NSF's role, and I am not sure why we want to include NSF.
    Let me also express concern about an even bigger issue. I 
noticed that the funding for this bill is going to come out of 
the America Competes funding. The funding for Matheson's bill 
which is coming up is coming out of the funding for the America 
Competes Act. I never, on any stretch of the imagination, 
thought that money was going to go to ongoing projects like 
this. The whole idea is to improve our education, our programs 
in math and science, to improve our manufacturing capabilities, 
improve our ability to compete with other countries, and we are 
not really competing that much with health care, except for the 
people who fly to Thailand to get surgery at 10 percent of the 
cost.
    But I hope this is not a trend that every bill that comes 
along that needs money, we are going to say, well, we will take 
it out of the America Competes Act. On the surface--and I don't 
like to accuse anyone of subterfuge--but it seems the way to 
get around the pay requirements that the current Congress has.
    I really have to register extreme reservations about 
starting to use the America Competes Act to fund all of the 
bills that we come up with here, and pretty soon, we will 
defeat the overall goal.
    And I know, Mr. Chairman, you have worked very, very hard 
on the America Competes Act, and I totally agree with you and 
supported you at every turn of the road on that, but I just 
want to throw a precaution flag here and say, hey, wait a 
minute. That is not what I thought we were going to use that 
money for.
    With that, I will yield back.
    Chairman Gordon. Thank you, Mr. Ehlers.
    Let me, again, thank you for always having a very 
thoughtful approach to this. I will make a couple of 
suggestions. First of all, as you know, the--for NIST in the 
America Competes Act was doubled. You say that we are not 
competing with other countries in terms of health care, i.e. 
Thailand or whatever might be the case. The fact of the matter 
is I would say that we are in dramatic competition, because our 
health care costs is the most rapid growing part of any 
business's bills. You know, if you look at automobiles right 
now, we talked about automobiles not being competitive. To a 
great extent, the reason is the health care costs, so clearly, 
by getting our health care costs down, I think it does make us 
more competitive.
    I agree with you that his should not be a kitty that we go 
to for every pet cause. I very sincerely think that reducing 
our health care costs makes us more competitive on an 
international basis, and I certainly yield to Dr. Ehlers for 
any other comments.
    Mr. Ehlers. Well, obviously, I am well aware of the 
automobile situation, being from Michigan. The problem is not 
just health care costs, but the fact that the auto companies 
gave lifetime health benefits to retirees who are retiring at 
age 55 and weren't expected to live that long. So they dug 
themselves, both the unions and the companies, dug themselves 
into a huge hole.
    I recognize the competitive aspects of health care, but 
that is not really what the America Competes Act was getting 
at. I am struck by the comment that Mr. Bartlett made before he 
left, and what he says is very true. I was struck some years 
ago, when I spent a year in Germany, and at that time, we 
referred to our health care as hospitalization insurance. Over 
there, it was called health care. Well, we have changed, but we 
haven't changed the motif of health care in this country. The 
reason the Europeans call that is because it is largely 
preventive, to reduce costs through prevention, which we have 
no real--we handle it through public health agencies here and 
never give them enough money.
    I am not trying to get into major argument here, but I just 
want to comment that there are a lot of factors in health care 
costs other than IT, and I am not sure that really affects the 
competitiveness as much as we would like. But I won't make a 
big issue of it now. I am just serving notice that I have got 
some pirates waiting to board the ship if this happens again 
and again. Thank you.
    Chairman Gordon. I think you are a good conscience on that 
issue, and you should be. I would say, as was said, a billion 
here, a billion there starts to add up. As Dr. Gingrey pointed 
out, this is hundreds of billions of dollars, and it can make a 
big difference.
    Okay, is there further discussion on the amendment?
    Dr. Baird.
    Mr. Baird. Mr. Chairman, I appreciate very much my Ranking 
Member and friend Dr. Ehlers's comments about NSF and just 
wonder if the author of the bill or if someone might enlighten 
us about the rationale for including NSF, and if they have had 
a chance to discuss this NSF to see what they would add or 
whether that would detract from their mission.
    Chairman Gordon. If the gentleman would yield to me?
    Mr. Baird. I would be happy.
    Chairman Gordon. Again, it is my--this amendment was 
developed in response from the stakeholders in trying to take 
this from more of a national inter-operability to the potential 
to have international inter-operability. The national--NSF is a 
point of contact for much of our international scientific work, 
and it really is not a matter--I mean it is a--I wouldn't say 
they are a major component of this, but it is an effort to 
better the best we all can in incremental parts. And that was 
the reason. This will continue to be fleshed out as the 
Chairman of the Committee that oversees NSF--we want to 
continue to get your input on this as we go through the process 
through the Senate and through conference, and we want to get 
the best bill possible. The bill that was introduced wasn't the 
best bill possible. The bill we have today, you know, wasn't 
the best bill; we have amended it. And I think we can probably 
continue to do so.
    Mr. Baird. I appreciate that, and I think NSF does have a 
strong international component, and that is certainly a worthy 
aspect of this amendment, and I intend to support the 
amendment, but I would like to, down the road, you know, before 
final passage, at least have some discussions with NSF and see 
what specifically they feel they can add to this debate and 
make sure that it is not drawing resources, unnecessarily, from 
an already fairly stretched entity.
    Chairman Gordon. If the gentleman would yield? I think that 
is well said. If you will look at the wording, it says in 
consultation with the Director of the National Science 
Foundation. So it is, in essence, to ask them if they have 
value added. If they say they don't have value added, then we 
move on.
    Mr. Baird. I appreciate very much the explanation. Thank 
you.
    Chairman Gordon. Does anyone wish to speak?
    Mr. Gingrey. Mr. Chairman?
    Chairman Gordon. Dr. Gingrey.
    Mr. Gingrey. I have a second-degree amendment to the Hill 
Amendment.
    Chairman Gordon. The Clerk will report the bill.
    The Clerk. Amendment to H.R. 2406, offered by Mr. Gingrey 
of Georgia, to the amendment offered by Mr. Hill of Indiana.
    Chairman Gordon. I ask unanimous consent to dispense with 
the reading. Without objection, so ordered.
    The gentleman is recognized for five minutes to explain his 
amendment.
    Mr. Gingrey. Mr. Chairman, thank you, and first of all, let 
me--I do want to thank Representative Hill.
    As he knows, I had two second-degree amendments to offer. 
One, of course, was to extend the time period for NIST to 
report back to the Committee. I think the amendment, the 
original Hill amendment, was nine months, and well, actually, a 
total of 12 months, three months to form the committee, and 
nine months to report back. That amendment, or that second-
degree amendment would just simply say--and this was at NIST's 
request--that is not enough time, to give them, instead of 12 
months, actually, 18 months, a year and a half. I want to thank 
Mr. Hill for accepting that amendment and making that a part 
of, an amendment to, his amendment, so I don't have to offer 
that second-degree amendment.
    The other one, though, that I am offering now, is just 
simply to strike language that says in consultation with the 
Director of the National Science Foundation. And as I had 
mentioned in my remarks in opposition to the Hill Amendment, I 
felt that, indeed, it brings in yet another agency that was not 
part of the mix before, and as has been stated, I think, more 
eloquently than I by Dr. Ehlers, it is really not clear why 
NIST would consult specifically with the NSF, and I think, 
actually, Dr. Baird just expressed some concerns, too. What 
exactly do they bring to the table? I am not clear, and so I 
think that this amendment would just simply get them out of the 
mix. As Mr. Hill said in describing his amendment, you know, in 
making a reference and analogy to the Tower of Babel, sometimes 
you can put too many cooks and spoil the broth, and I don't 
really think we need NSF in here, so that is the amendment, and 
it just simply strikes that language.
    And I yield back, Mr. Chairman.
    Chairman Gordon. Is there further discussion on the 
amendment?
    Mr. Baird. Mr. Chairman?
    Chairman Gordon. Dr. Baird is recognized.
    Mr. Baird. Yes, I appreciate Mr. Gingrey's comments, the 
gentleman from Georgia, but I think with the chair having 
pointed out that the language with NSF, basically involving the 
consultation, given that NSF already has groups working on 
this, given their international reach, at that level--if we 
were mandating a whole new operation for NSF, I would, perhaps, 
be supportive of Mr. Gingrey's amendment, but the notion that 
we are just consulting with NSF, I think it is a sound 
judgment, and therefore, I would encourage Mr. Gingrey to 
perhaps consider withdrawing the portion of his amendment that 
specifically rules out NSF.
    If we are asking on our top science agencies in this 
country to give us consultation on a matter of this importance, 
I think that makes sense, and I would support the original 
language, and urge defeat of this particular amendment.
    Chairman Gordon. Thank you, Dr. Baird. Is there further 
discussion on the amendment? If there is no other discussion, 
the vote occurs on Dr. Gingrey's amendment to the amendment. 
All in favor, say aye; opposed no. In the judgment of the 
Chair, the nos have it.
    Mr. Gingrey. Mr. Chairman, could I have a recorded vote, 
please?
    Chairman Gordon. Certainly. The roll will be called.
    The Clerk. Chairman Gordon.
    Chairman Gordon. No.
    The Clerk. Chairman Gordon votes no. Mr. Costello.
    Mr. Costello. No.
    The Clerk. Mr. Costello votes no. Ms. Johnson.
    [No response.]
    The Clerk. Ms. Woolsey.
    [No response.]
    The Clerk. Mr. Udall.
    Mr. Udall. No.
    The Clerk. Mr. Udall votes no. Mr. Wu.
    [No response.]
    The Clerk. Mr. Baird.
    Mr. Baird. No.
    The Clerk. Mr. Baird votes no. Mr. Miller.
    [No response.]
    The Clerk. Mr. Lipinski.
    Mr. Lipinski. No.
    The Clerk. Mr. Lipinski votes no. Mr. Lampson.
    Mr. Lampson. No.
    The Clerk. Mr. Lampson votes no. Ms. Giffords.
    Ms. Giffords. No.
    The Clerk. Ms. Giffords votes no. Mr. McNerney.
    Mr. McNerney. No.
    The Clerk. Mr. McNerney votes no. Ms. Richardson.
    Ms. Richardson. No.
    The Clerk. Ms. Richardson votes no. Mr. Kanjorski.
    [No response.]
    The Clerk. Ms. Hooley.
    Ms. Hooley. No.
    The Clerk. Ms. Hooley votes no. Mr. Rothman.
    Mr. Rothman. No.
    The Clerk. Mr. Rothman votes no. Mr. Matheson.
    Mr. Matheson. No.
    The Clerk. Mr. Matheson votes no. Mr. Ross.
    Mr. Ross. No.
    The Clerk. Mr. Ross votes no. Mr. Chandler.
    Mr. Chandler. No.
    The Clerk. Mr. Chandler votes no. Mr. Carnahan.
    Mr. Carnahan. No.
    The Clerk. Mr. Carnahan votes no. Mr. Melancon.
    Mr. Melancon. No.
    The Clerk. Mr. Melancon votes no. Mr. Hill.
    Mr. Hill. No.
    The Clerk. Mr. Hill votes no. Mr. Mitchell.
    Mr. Mitchell. No.
    The Clerk. Mr. Mitchell votes no. Mr. Wilson.
    [No response.]
    The Clerk. Mr. Hall.
    Mr. Hall. Aye.
    The Clerk. Mr. Hall votes aye. Mr. Sensenbrenner.
    [No response.]
    The Clerk. Mr. Lamar Smith.
    [No response.]
    The Clerk. Mr. Rohrabacher.
    [No response.]
    The Clerk. Mr. Bartlett.
    [No response.]
    The Clerk. Mr. Ehlers.
    Mr. Ehlers. Aye.
    The Clerk. Mr. Ehlers votes aye. Mr. Lucas.
    Mr. Lucas. Aye.
    The Clerk. Mr. Lucas votes aye. Mrs. Biggert.
    Ms. Biggert. Aye.
    The Clerk. Mrs. Biggert votes aye. Mr. Akin.
    Mr. Akin. Aye.
    The Clerk. Mr. Akin votes aye. Mr. Bonner.
    [No response.]
    The Clerk. Mr. Feeney.
    Mr. Feeney. Aye.
    The Clerk. Mr. Feeney votes aye. Mr. Neugebauer.
    Mr. Neugebauer. Aye.
    The Clerk. Mr. Neugebauer votes aye. Mr. Inglis.
    Mr. Inglis. Aye.
    The Clerk. Mr. Inglis vote aye. Mr. Reichert.
    [No response.]
    The Clerk. Mr. McCaul.
    Mr. Mr. McCaul. Aye.
    The Clerk. Mr. McCaul votes aye. Mr. Diaz-Balart.
    Mr. Diaz-Balart. Aye.
    The Clerk. Mr. Diaz-Balart votes aye. Mr. Gingrey.
    Mr. Gingrey. Aye.
    The Clerk. Mr. Gingrey votes aye. Mr. Bilbray.
    [No response.]
    The Clerk. Mr. Adrian Smith.
    Mr. Adrian Smith. Aye.
    The Clerk. Mr. Adrian Smith votes aye. Mr. Broun.
    [No response.]
    Chairman Gordon. The gentleman from California?
    The Clerk. Mr. Rohrabacher.
    Mr. Rohrabacher. Aye.
    The Clerk. Okay, Mr. Rohrabacher votes aye.
    Chairman Gordon. Mr. Wu.
    The Clerk. Mr. Wu is not recorded. Mr. Wu votes no.
    Chairman Gordon. How is Ms. Woolsey recorded?
    The Clerk. Ms. Woolsey is not recorded. Ms. Woolsey votes 
no.
    Chairman Gordon. Happy birthday, Ms. Woolsey.
    Ms. Woolsey. Thank you very much.
    Chairman Gordon. Is there anyone who has not had their vote 
recorded? If not, the Clerk will report.
    The Clerk. Mr. Chairman, 13 Members vote aye, and 20 
Members vote no.



    Chairman Gordon. Thank you. The amendment fails--amendment 
to the amendment fails. And let me just quickly say we spent a 
lot of time on a very small but important part of this bill, 
because we have spent months on the rest of the bill, and have 
worked it out to get a very, very good bill, and I thank 
everyone for this constructive last effort, and it will 
continue as we go on to Senate and to conference.
    The vote now occurs on Mr. Hill's amendment. All in favor, 
say aye; opposed, nay. It appears the ayes have it. The ayes 
have it. Is there----
    Mr. Gingrey. Mr. Chairman.
    Chairman Gordon. Yes?
    Mr. Gingrey. I would like a recorded vote on that, please.
    Chairman Gordon. The Clerk will call the roll.
    The Clerk. Chairman Gordon.
    Chairman Gordon. Aye.
    The Clerk. Chairman Gordon votes aye. Mr. Costello.
    Mr. Costello. Aye.
    The Clerk. Mr. Costello votes aye. Ms. Johnson.
    [No response.]
    The Clerk. Ms. Woolsey.
    Ms. Woolsey. Aye.
    The Clerk. Ms. Woolsey votes aye. Mr. Udall.
    Mr. Udall. Aye.
    The Clerk. Mr. Udall votes aye. Mr. Wu.
    Mr. Wu. Aye.
    The Clerk. Mr. Wu votes aye. Mr. Baird.
    Mr. Baird. Aye.
    The Clerk. Mr. Baird votes aye. Mr. Miller.
    [No response.]
    The Clerk. Mr. Lipinski.
    Mr. Lipinski. Aye.
    The Clerk. Mr. Lipinski votes aye. Mr. Lampson.
    Mr. Lampson. Aye.
    The Clerk. Mr. Lampson votes aye. Ms. Giffords.
    Ms. Giffords. Aye.
    The Clerk. Ms. Giffords votes aye. Mr. McNerney.
    Mr. McNerney. Aye.
    The Clerk. Mr. McNerney votes aye. Ms. Richardson.
    Ms. Richardson. Aye.
    The Clerk. Ms. Richardson votes aye. Mr. Kanjorski.
    Mr. Kanjorski. Aye.
    The Clerk. Mr. Kanjorski votes aye. Ms. Hooley.
    Ms. Hooley. Aye.
    The Clerk. Ms. Hooley votes aye. Mr. Rothman.
    Mr. Rothman. Aye.
    The Clerk. Mr. Rothman votes aye. Mr. Matheson.
    Mr. Matheson. Aye.
    The Clerk. Mr. Matheson votes aye. Mr. Ross.
    Mr. Ross. Aye.
    The Clerk. Mr. Ross votes aye. Mr. Chandler.
    Mr. Chandler. Aye.
    The Clerk. Mr. Chandler votes aye. Mr. Carnahan.
    Mr. Carnahan. Aye.
    The Clerk. Mr. Carnahan votes aye. Mr. Melancon.
    Mr. Melancon. Aye.
    The Clerk. Mr. Melancon votes aye. Mr. Hill.
    Mr. Hill. Aye.
    The Clerk. Mr. Hill votes aye. Mr. Mitchell.
    Mr. Mitchell. Aye.
    The Clerk. Mr. Mitchell votes aye. Mr. Wilson.
    [No response.]
    The Clerk. Mr. Hall.
    Mr. Hall. No.
    The Clerk. Mr. Hall votes no. Mr. Sensenbrenner.
    [No response.]
    The Clerk. Mr. Lamar Smith.
    [No response.]
    The Clerk. Mr. Rohrabacher.
    Mr. Rohrabacher. No.
    The Clerk. Mr. Rohrabacher votes no. Mr. Bartlett.
    [No response.]
    The Clerk. Mr. Ehlers.
    Mr. Ehlers. No.
    The Clerk. Mr. Ehlers votes no. Mr. Lucas.
    Mr. Lucas. No.
    The Clerk. Mr. Lucas votes no. Mrs. Biggert.
    Ms. Biggert. No.
    The Clerk. Mrs. Biggert votes no. Mr. Akin.
    Mr. Akin. No.
    The Clerk. Mr. Akin votes no. Mr. Bonner.
    [No response.]
    The Clerk. Mr. Feeney.
    Mr. Feeney. No.
    The Clerk. Mr. Feeney votes no. Mr. Neugebauer.
    Mr. Neugebauer. No.
    The Clerk. Mr. Neugebauer votes no. Mr. Inglis.
    Mr. Inglis. No.
    The Clerk. Mr. Inglis vote no. Mr. Reichert.
    [No response.]
    The Clerk. Mr. McCaul.
    Mr. McCaul. No.
    The Clerk. Mr. McCaul votes no. Mr. Diaz-Balart.
    Mr. Diaz-Balart. No.
    The Clerk. Mr. Diaz-Balart votes no. Mr. Gingrey.
    Mr. Gingrey. No.
    The Clerk. Mr. Gingrey votes no. Mr. Bilbray.
    [No response.]
    The Clerk. Mr. Adrian Smith.
    Mr. Adrian Smith. No.
    The Clerk. Mr. Adrian Smith votes no. Mr. Broun.
    [No response.]
    Chairman Gordon. How was Senator Udall reported?
    The Clerk. Mr. Udall is not recorded.
    Mr. Udall. Aye.
    The Clerk. Mr. Udall votes aye.
    Chairman Gordon. Is there anyone else that has not been 
recorded? The Clerk will report.
    The Clerk. Mr. Chairman, 21 Members vote aye, and 13 
Members vote no.



    Chairman Gordon. The amendment passes. Are there other 
amendments? If no, then the vote is on the bill H.R. 2406, as 
amended. All of those in favor, say aye; all opposed, say no. 
In the opinion of the Chair, the ayes have it.
    I recognize Mr. Lampson to offer a motion.
    Mr. Lampson. Mr. Chairman, I move that the Committee 
favorably report H.R. 2406, as amended, to the House with the 
recommendation that the bill do pass. Furthermore, I move that 
the staff be instructed to prepare the legislative report and 
make necessary technical and conforming changes and that the 
Chairman take all necessary steps to bring the bill before the 
House for consideration.
    Chairman Gordon. The question is on the motion to report 
the bill favorably. Those in favor of the motion will signify 
by saying aye; opposed, no. The ayes have it, and the bill is 
favorably reported.
    Without objection, the motion to reconsider is laid upon 
the desk. Members will have two subsequent calendar days in 
which to submit supplement Minority or additional views on the 
measure, ending Monday, October the 29th at 9:00 a.m.
    I move, pursuant to Clause 1 of Rule 22 of the Rules of the 
House of Representatives that the Committee authorize the 
Chairman to offer such motions as may be necessary in the House 
to adopt and pass H.R. 2406, To authorize the National 
Institute of Standards and Technology to increase its effort in 
support of the integration of health care information 
enterprise in the United States, as amended. Without objection, 
so ordered.
    Chairman Gordon. Let me say to the Members, this appears to 
be our last markup of this year. I thank you for your 
attendance. I think this is probably a record year, and we want 
to do more than just have numbers. We want to have good 
content, too, and this is 30-something bills, all of which have 
been bipartisan. All but one had been unanimous. I thank you 
for your cooperation, and let us continue next year in the same 
way.
    This concludes this markup----
    Mr. Lampson. Mr. Chairman, just may I before you end, just 
commend you for the leadership that you have provided to this 
committee. It has been excellent. It is great to work with you, 
and I think this is a wonderful committee to be a part of. 
Thank you so much.
    Chairman Gordon. Thank you.
    Mr. Lampson. And the staff.
    Chairman Gordon. I was going to say, it helps to have 
excellent staff. And we do. Thank you very much.
    [Whereupon, at 11:18 a.m., the Committee was adjourned.]

                               Appendix:

                              ----------                              


        H.R. 2406, Section-by-Section Analysis, Amendment Roster






                     Section-by-Section Analysis of
    H.R. 2406, To authorize the National Institute of Standards and 
Technology to increase its efforts in support of the integration of the 
        health care information enterprise in the United States

Section 1. Findings

Section 2. Health Care Information Enterprise Integration Initiative

    Directs NIST to establish an initiative to advance HIT enterprise 
integration nationally, building on existing efforts at NIST and other 
federal agencies, and involving government and industry consortia. 
Technical activities of this program will focus on technical standards 
and inter-operability analysis and the development of technical 
testbeds, software conformance and certification, security and privacy, 
medical device communication, data management and retrieval 
architecture, conformance testing infrastructure, and health care 
information usability and decision support. The initiative may also 
include assistance to outside organizations and federal agencies in 
developing technical roadmaps for HIT enterprise integration, relying 
on voluntary consensus standards where possible. The Director shall 
report to Congress annually on these activities.

Section 3. Federal Healthcare Information Technology Systems and 
                    Infrastructure

    Directs NIST to develop new or adopt existing technology-neutral 
HIT guidelines and standards for use by federal agencies within six 
months of enactment. The guidelines and standards shall enable agencies 
to select HIT systems that provide security and privacy and are inter-
operable. They shall promote the use of commercial HIT systems by 
federal agencies, include conformance-testing procedures, provide 
privacy profiles, establish inter-operability specifications, and 
include validation criteria to enable agencies to select appropriate 
HIT systems. NIST will report annually on the progress toward and 
barriers to adoption of inter-operable, secure and private HIT systems 
by federal agencies. Directs the Department of Commerce to establish a 
Senior Interagency Council on Federal Healthcare Information Technology 
Infrastructure, with responsibilities to coordinate development and 
deployment of HIT systems across the Federal Government, associated 
technology transfer, and federal funding for and participation in 
private standards-development organizations as related to HIT.

Section 4. Research and Development Programs

    Directs NIST, in consultation with NSF, to establish a grant 
program for institutions of higher education partnering with 
businesses, non-profits and government laboratories to establish 
Centers for Healthcare Information Enterprise Integration. Grants shall 
be awarded on a competitive, merit-reviewed basis. The Centers will 
generate innovative approaches to HIT enterprise integration by 
conducting research on the interfaces between human information and 
communications technology systems, voice-recognition systems, inter-
operability software, software dependability, metrics of the impact of 
information technology on health care, health care information 
enterprise management, and information technology security and 
integrity. Grant applications shall include descriptions of proposed 
projects, efforts to foster multi-disciplinary collaboration, and 
technology transfer and education activities. The National High-
Performance Computing Program established by the High-Performance 
Computing Act of 1991 shall coordinate federal R&D programs related to 
HIT.



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