69–006 

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 


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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. 


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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 DiVerDate Aug 31 2005 06:49 Nov 18, 2007 Jkt 069006 PO 00000 Frm 00003 Fmt 6659 Sfmt 6621 E:\HR\OC\HR451.XXX HR451

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rector 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 


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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 


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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; 


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(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. 


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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. 


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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 FounVerDate Aug 31 2005 06:49 Nov 18, 2007 Jkt 069006 PO 00000 Frm 00009 Fmt 6659 Sfmt 6602 E:\HR\OC\HR451.XXX HR451

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dation. 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. 


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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 conformancetesting 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 inVerDate Aug 31 2005 06:49 Nov 18, 2007 Jkt 069006 PO 00000 Frm 00011 Fmt 6659 Sfmt 6602 E:\HR\OC\HR451.XXX HR451

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dustry 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 


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13 

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. 


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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. 


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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. 


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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. 


ccoleman on PRODPC75 with REPORTS
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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. 


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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. 


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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. 


ccoleman on PRODPC75 with REPORTS
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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 interoperability standards. 


ccoleman on PRODPC75 with REPORTS
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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 interoperable 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. 


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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. 


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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 RepubVerDate Aug 31 2005 06:49 Nov 18, 2007 Jkt 069006 PO 00000 Frm 00023 Fmt 6604 Sfmt 6601 E:\HR\OC\HR451.XXX HR451

ccoleman on PRODPC75 with REPORTS
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lican, 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 InstiVerDate Aug 31 2005 06:49 Nov 18, 2007 Jkt 069006 PO 00000 Frm 00024 Fmt 6604 Sfmt 6601 E:\HR\OC\HR451.XXX HR451

ccoleman on PRODPC75 with REPORTS
25 

tute 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. 


ccoleman on PRODPC75 with REPORTS
26 

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; 


ccoleman on PRODPC75 with REPORTS
27 

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:] 


ccoleman on PRODPC75 with REPORTS
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ccoleman on PRODPC75 with REPORTSh2406t.eps
29 

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 


ccoleman on PRODPC75 with REPORTSh2406u.eps
30 

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 


ccoleman on PRODPC75 with REPORTS
31 

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 


ccoleman on PRODPC75 with REPORTS
32 

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 


ccoleman on PRODPC75 with REPORTS
33 

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. 


ccoleman on PRODPC75 with REPORTS
34 

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 


ccoleman on PRODPC75 with REPORTS
35 

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.] 


ccoleman on PRODPC75 with REPORTS
36 

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. 


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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. 


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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. 


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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. 


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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 inVerDate Aug 31 2005 06:49 Nov 18, 2007 Jkt 069006 PO 00000 Frm 00042 Fmt 6604 Sfmt 6601 E:\HR\OC\HR451.XXX HR451

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tegration 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.] 


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Appendix: 

H.R. 2406, SECTION-BY-SECTION ANALYSIS, AMENDMENT ROSTER


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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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