```

[Senate Report 110-187]
[From the U.S. Government Publishing Office]

                                                       Calendar No. 318
110th Congress                                                   Report
                                 SENATE
 1st Session                                                    110-187

======================================================================
 
                   WIRED FOR HEALTH CARE QUALITY ACT

                                _______
                                

                October 1, 2007.--Ordered to be printed

                                _______
                                

   Mr. Kennedy, from the Committee on Health, Education, Labor, and 
                   Pensions, submitted the following

                              R E P O R T

                         [To accompany S. 1693]

    The Committee on Health, Education, Labor, and Pensions, to 
which was referred the bill (S. 1693) to enhance the adoption 
of a nationwide interoperable health information technology 
system and to improve the quality and reduce the costs of 
health care in the United States, having considered the same, 
reports favorably thereon with an amendment in the nature of a 
substitute and recommends that the bill (as amended) do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and Summary..............................................1
 II. Background and Need for Legislation..............................2
III. Legislative History and Committee Action.........................3
 IV. Explanation of Bill and Committee Views..........................3
  V. Cost Estimate...................................................13
 VI. Application of Law to the Legislative Branch....................17
VII. Regulatory Impact Statement.....................................17
VIII.Section-by-Section Analysis.....................................17

 IX. Changes in Existing Law.........................................23

                         I. Purpose and Summary

    The purpose of S. 1693, the ``Wired for Health Care Quality 
Act'' is to enhance the adoption of a nationwide interoperable 
health information technology system and to improve the quality 
and reduce the cost of health care in the United States.
    The bill amends the Public Health Service Act by adding a 
new title, ``Health Information Technology and Quality''. The 
bill enhances the use of health information technology to 
improve health care quality, while protecting the privacy and 
security of health information. The bill also establishes the 
Office of the National Coordinator for Health Information 
Technology within the Office of the Secretary for Health and 
Human Services (referred to hereafter as ``the Secretary''), 
and formalizes the role of private entities in the standards-
setting process by establishing the public-private Partnership 
for Health Care Improvement. The bill also establishes the 
American Health Information Community to provide advice to the 
Secretary and Federal agencies concerning policy considerations 
related to health information technology. The National 
Coordinator will serve as member of both the Partnership and 
the American Health Information Community, and will serve as a 
liaison between those entities and the Federal government. The 
bill authorizes three grant programs to facilitate the 
widespread adoption of interoperable health information 
technology. The legislation also authorizes competitive grants 
to carry out demonstration projects to develop academic 
curricula integrating qualified health information technology 
systems in the clinical education of health professionals. In 
order to improve health care quality, the bill tasks the 
Secretary with developing and utilizing quality measures and 
facilitates the analysis of large data sets to improve 
measurement of quality and efficiency of health care. Finally, 
the bill establishes a Health Information Technology Resource 
Center within the Agency for Health Care Research and Quality 
to provide technical assistance and develop best practices to 
support and accelerate efforts to adopt, implement, and 
effectively use interoperable health information technology.

                II. Background and Need for Legislation

    Studies by the Institute of Medicine and other expert 
bodies have revealed serious problems with health care quality 
and medical errors. Additionally, a RAND study stated that 
adult Americans receive recommended care only 55 percent of the 
time. Nearly 30 percent of health care spending is for 
treatments that may not improve health status, may be 
redundant, or may be inappropriate for the patient's condition 
according to Dartmouth University researchers.
    Some of the most serious challenges facing health care 
today--medical errors, inconsistent quality, and rising costs--
can be addressed through the effective application of health 
information technology linking all elements of the health care 
system and using the system to improve information available to 
physicians to improve quality, enhance preventive care, and 
reduce errors.
    In April 2004, the President signed an Executive Order 
announcing his commitment to the promotion of health 
information technology to lower costs, reduce medical errors, 
improve quality of care, and provide better information for 
patients and physicians. In particular, the President called 
for widespread adoption of electronic health records and for 
health information to follow patients throughout their care in 
a seamless and secure manner.
    This committee agrees that if we move from a paper-based 
health care system to secure, interoperable electronic health 
records, we will reduce mistakes and save lives, time and 
money. This legislation will bring the government and the 
private sector together to make health care better, safer and 
more efficient by accelerating the widespread adoption of 
interoperable health information technology and quality 
measurement across our health care system.
    Interoperability is a shared goal across the health care 
industry. The national strategy for achieving interoperability 
of digital health information calls for Federal agencies--who 
pay more than one-third of all health care costs--to 
collaborate with private entities in developing and adopting an 
architecture, standards, implementation specifications, a 
certification process, and a method of governance for ongoing 
implementation of health IT. Once the market has structure, 
patients, providers, medical professionals, and vendors will be 
better able to innovate, create efficiencies, and improve care.
    The legislation formalizes involvement of private entities 
in the standards-setting process by establishing the 
Partnership for Health Care Improvement, composed of 
representatives of the public and private sectors. The National 
Coordinator for Health Information Technology will serve as a 
member of the Partnership.
    The committee agrees that an investment in health 
information technology now will decrease health care costs over 
the long-term. This legislation targets Federal funding to 
those who need the most help updating and advancing health 
information technology.

             III. Legislative History and Committee Action

    The HELP Committee has a strong tradition of making 
bipartisan progress on health information technology, 
regardless of whether the chairmanship is held by a Republican 
or a Democrat.
    In the 109th Congress, Senators Enzi, Kennedy, Frist, 
Clinton, Alexander, Dodd, Burr, Harkin, Isakson, Mikulski, 
DeWine, Jeffords, Roberts, Bingaman, Murray, Bond, Hagel, 
Martinez, Talent, Nelson (FL), and Obama introduced S. 1418, 
the ``Wired for Health Care Quality Act.'' On July 20, 2005, 
the committee reported that bill (as amended by a Chairman's 
substitute) by unanimous voice vote. The bill was approved by 
the full Senate by unanimous consent on November 18, 2005. The 
House of Representatives also approved legislation on health 
information technology in the 109th Congress, but the Senate 
and House were unable to resolve the differences between the 
two bills before the 109th Congress adjourned.
    The committee's commitment to health IT continued in the 
110th Congress. On June 26, 2007, Senators Kennedy, Enzi, 
Clinton, Hatch, Obama, Alexander, Gregg, Isakson, Roberts, and 
Burr introduced S. 1693, the ``Wired for Health Care Quality 
Act''. On June 27, 2007, the committee held an executive 
session to consider S. 1693. After accepting a substitute 
amendment offered by Senator Kennedy and amendments offered by 
Senator Reed and Senator Dodd by unanimous voice vote, the 
committee approved S. 1693, as amended, by unanimous voice 
vote.

              IV. Explanation of Bill and Committee Views

  OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY

    In April 2004, by Executive Order, President George W. Bush 
established the Office of the National Coordinator for Health 
Information Technology, operating from the Office of the 
Secretary. The Office is charged with developing a blueprint 
for a nationwide interoperable health information technology 
infrastructure and coordinating health information technology 
policies and programs across the Federal Government.
    The National Coordinator will serve as member of both the 
Partnership and the American Health Information Community, 
serving as the primary advisor to the Secretary, and will serve 
as a liaison between those entities and the Federal Government, 
ensuring the adoption of standards for the electronic exchange 
of health information, and interacting with public and private 
stakeholders. In carrying out the activities of the Office, the 
National Coordinator shall work to ensure the security and 
privacy of patient health information and the electronic 
exchange of health information. Additionally, the Office of the 
National Coordinator shall be responsible for ensuring that 
health information technology initiatives are coordinated 
across programs of the Department of Health and Human Services 
as well as with other Federal agencies. The National 
Coordinator shall also review Federal health information 
technology investments to ensure investments are meeting 
published objectives and at the request of the Office of 
Management and Budget, shall provide advice and comments. The 
committee encourages the Office of the National Coordinator for 
Health Information Technology to work in collaboration with 
programs and departments within the Department of Health and 
Human Services, including the Office of Minority Health, Indian 
Health Service, Office for Civil Rights, Administration on 
Aging, and the Office of Disability, and with other Federal 
agencies including the Department of Justice. The committee 
encourages the National Coordinator to ensure that the 
membership of boards, councils, partnerships, working groups, 
and other entities created by and utilized by the Office are 
representative of the diversity of the Nation's populations and 
regions, and ensure a balance among various sectors of the 
health care system so that no single sector unduly influences 
the recommendations and outcomes. This is necessary to help 
ensure wider adoption and utilization of health information 
technology to improve health care quality and patient safety 
for all population groups, including populations at risk for 
health disparities, medically unserved and underserved 
populations, and rural populations.
    The bill also specifies that an additional responsibility 
of the Office is to enhance the use of health information 
technology to improve the quality of health care in the 
prevention and treatment of chronic disease. The committee 
believes the United States cannot address rising health care 
costs without more focus on preventing chronic disease. 
According to the Centers for Disease Control, the medical care 
costs of people with chronic diseases account for more than 75 
percent of the Nation's medical care costs. In addition, 
chronic disease accounts for 70 percent of all death in the 
United States. The committee believes adoption and promotion of 
health information technology can lead to innovative 
interventions to prevent disease and reduce health care costs. 
The committee encourages reports to assess the impact of health 
information technology in communities with health disparities 
and to identify practices to increase the adoption of such 
technology by health care providers in such communities.
    The Secretary has begun undertaking the activities outlined 
in this section of the legislation. It is the committee's 
intent not to require the duplication of Federal efforts with 
respect to the establishment of the Office.

                QUALIFIED HEALTH INFORMATION TECHNOLOGY

    The committee believes that the inclusion of decision 
support in an interoperable health information technology 
system is critical to reducing medical errors and improving the 
quality of care patients receive. For that reason, the 
committee included the incorporation of decision support in the 
definition of qualified health information technology. The 
definition clearly states that qualified health information 
technology means a computerized system and it is the intent of 
the committee that decision support be included in that system, 
but the committee recognizes that each potential component 
(hardware or software) of a comprehensive interoperable health 
information technology system may not include a decision 
support feature. It is not the intention of the committee to 
restrict these components from participation in an 
interoperable qualified health information technology system, 
but rather to require that decision support be integrated 
within the system and available to any user.
    The committee recognizes that there are a variety of policy 
and technical matters on which the recommendations and judgment 
of non-government experts are especially important. The 
technical challenges of implementing a nationwide health 
information architecture are formidable, and require careful 
consideration by those with special expertise in health care 
and information technology. To provide this important technical 
advice, the legislation establishes a private-sector 
Partnership for Health Care Improvement.
    Equally important are the major social and policy 
considerations raised by broader use of health IT. These 
include questions of privacy and security, inclusion of all 
communities in the progress that health IT brings and the 
bridging of digital divides that might otherwise hinder the 
broader adoption of health IT. To provide advice to the Federal 
Government on these and similar important policy matters, the 
legislation establishes the American Health Information 
Community, the membership of which reflects the broad variety 
of perspectives needed to provide effective recommendations on 
policy challenges associated with health IT.
    The areas of interest served by the Partnership and 
Community, though distinct, are clearly intertwined. For this 
reason, the legislation provides mechanisms to ensure that the 
deliberations of each body are informed by the other, and 
provides that the National Coordinator will liaise between the 
two.

                PARTNERSHIP FOR HEALTH CARE IMPROVEMENT

    The committee believes there are significant barriers to 
widespread adoption of interoperable health information 
technology. One of the primary barriers is the current lack of 
agreed-upon standards and common implementation guidelines and 
a certification process. The committee believes this bill 
addresses those factors in a way that appropriately 
incorporates involvement of both the public and private 
sectors.
    The legislation establishes the Partnership for Health Care 
Improvement to recommend specific technical standards and 
policies to achieve a nationwide interoperable health 
information technology infrastructure, and to serve as a forum 
for the participation of a broad range of stakeholders to 
provide input on achieving the interoperability of health 
information technology. It is the intent of the Committee to 
ensure that the Partnership recommends standards for the 
electronic exchange of health information and ongoing 
modifications to these standards facilitating the widespread 
adoption of interoperable health IT.
    The Partnership shall strive for maximum cost-effectiveness 
by building on existing standards and policy work, establishing 
efficient processes and minimizing the negative economic impact 
of any new requirements it defines. As a general principle, the 
Partnership should seek existing solutions and minimal 
modifications, creating new solutions only when truly needed. 
Even so, some change will be required to ensure 
interoperability. The extent of such change must be determined 
using a defined process. To do so effectively requires close 
and continuous interaction with standards development 
organizations and other potential sources of relevant models 
for its own work.
    The process to identify and specify these standards and 
policies must engage all affected stakeholders, as the 
credibility and compliance with the decisions of the 
Partnership will ultimately depend on whether those who are 
affected by standards and policies were able to participate in 
the decisionmaking process. It is the intent of the committee 
to ensure a balance among all stakeholders, so that no member 
organization unduly influences recommendations from the 
Partnership.

                 AMERICAN HEALTH INFORMATION COMMUNITY

    The American Health Information Community is established by 
the legislation to provide policy advice on issues arising from 
more widespread adoption of health IT. These include protecting 
the privacy and security of information in electronic format, 
fostering public understanding of health IT, and defining 
appropriate uses of health IT, among other policy issues. The 
Community's policy recommendations are essential to the success 
of widespread adoption of interoperable health information 
technology.
    With respect to the American Health Information Community 
policies, the committee encourages the entity to ensure the 
application of appropriate uses of a nationwide health 
information network including improving the quality of care in 
rural and frontier communities, reducing health disparities, 
and fostering the understanding of health information 
technology among U.S. populations and subpopulations. Policies 
must incorporate input from health care consumers.

                    ADOPTION AND EFFECT OF STANDARDS

    The bill directs the Partnership, on an ongoing basis, to 
recommend new standards for the electronic exchange of health 
information and modifications to existing standards, identify 
deficiencies and omissions in existing standards, and identify 
duplication and overlap in existing standards. The bill directs 
the President to provide for the adoption by the Federal 
Government of any standard or implementation specification 
recommended by the Partnership within 90 days after the 
issuance of such recommendation. The bill specifies the 
Secretary, the Secretary of Veterans Affairs, and the Secretary 
of Defense, in collaboration with representatives of other 
relevant Federal agencies, jointly review such recommendations.
    The committee believes that when private entities contract 
with the government to provide health care services, those 
entities should be able to exchange interoperable information 
with the Federal Government. To accomplish this under their 
contracts, private entities must adopt the same standards as 
the Federal Government. However, this requirement only applies 
to the external exchange of information. The committee does not 
intend for private entities to have to adopt the government's 
standards for their internal business processes, even if those 
processes ultimately support the exchange of information under 
the contract.
    Not later than 1 year after the adoption by the Federal 
Government of a recommended standard, no Federal agency shall 
expend Federal funds for the purchase of any form of health 
information technology system for clinical care or for the 
electronic retrieval, storage, or exchange of health 
information that is not consistent with applicable standards 
adopted by the Federal Government. The committee believes it is 
critical that the Federal Government comply with the data 
standards recommended by the Partnership in order to create a 
nationwide interoperable health information technology 
infrastructure. Pilot testing of standards is important to 
ensuring that they are usable and practical. For this reason, 
the committee included a provision to allow, but not require, 
the pilot testing of any standard before its adoption.
    The legislation requires the Secretary of HHS to implement 
procedures to enable the Department to accept the electronic 
submission of data. Participation in the electronic submission 
of reports utilizing standards is voluntary for private 
entities, but the Department shall permit such submission. The 
provision is intended to provide private entities the option of 
submitting data electronically so that reporting becomes simply 
another function of an interoperable health information 
technology system.
    The adoption of standards is an important component of 
establishing consistent and common content and communication 
between health information technology systems and consistent 
and common use of adopted standards is another vital piece of 
establishing a nationwide interoperable health information 
system. This bill directs the Secretary or his designee, based 
upon the recommendation of the Partnership, to establish 
criteria for the implementation and certification of standards 
adopted by the Federal Government. Additionally, the bill 
authorizes the Secretary to recognize a private entity to 
assist with the development of criteria for the implementation 
of the standards and certification of products for compliance 
with the standards.
    It is the committee's intent to work with the 
Administration and ensure that this legislation complements 
steps the Administration has taken towards ensuring 
interoperable health IT by 2014.

                  IMPROVING THE QUALITY OF HEALTH CARE

    The committee believes that the use of health information 
technology will help to improve the quality of health care in 
the prevention and management of chronic disease, improve 
health care quality for all populations including rural and 
frontier communities, medically underserved communities, and 
communities at risk for health disparities. The committee 
strongly believes that fostering the development and use of 
health care quality measures will benefit from collaboration 
with multi-stakeholder groups that reflect the diversity of the 
U.S. population.
    The Federal Government possesses a significant amount of 
publicly financed information that could be used to 
dramatically improve health care quality and making care more 
affordable for all Americans. Several businesses and health 
insurance plans in the private sector already utilize their own 
data to compare and examine the cost and effectiveness of the 
care their workers and beneficiaries are receiving. The 
legislation expands this research effort by allowing qualified 
organizations to access defined Federal health care data to 
determine more effective and affordable health care solutions, 
while placing a premium on the privacy and security of 
patients. The bill authorizes the release of de-identified 
patient data, reimbursement claims data and survey data 
maintained by the programs administered by the Secretary to 
qualified organizations, known as Quality Reporting 
Organizations (QROs). QROs can then use this data to analyze 
and develop reports on the cost and quality of health care 
while including necessary safeguards to protect patient 
privacy. These reports can be requested by private sector 
organizations to measure health care quality and costs in a 
community. Any reports or results derived from this data must 
be released to the public within 1 year, including detailed 
information on the methodology, standards and measures of 
quality used in developing the reports.
    In every instance beneficiary privacy is ensured by 
requiring QROs to comply with the Health Insurance Portability 
and Accountability Act (HIPAA) and the Privacy Act. To further 
ensure beneficiary protection, the bill also requires a privacy 
review by the Secretary of any analytical report prepared by a 
QRO prior to its release.
    In addition, the legislation ensures that the Secretary 
permits researchers to access Federal health care data for 
research provided they comply with appropriate criteria as 
established by the Secretary.
    This legislation directs the Secretary, to develop, adopt 
and utilize quality measures for the purpose of measuring the 
quality and efficiency of health care that patients receive. 
The bill directs the Secretary to designate a single entity to 
promote the development of quality measures and provide the 
Secretary with advice and recommendations on the key elements 
and priorities of a national system for health care performance 
measurement. In carrying out its duties, the designated entity 
shall ensure that such measures are evidence-based, reliable, 
and valid and include measures of clinical process and 
outcomes, patient experience, efficiency, and equity, as well 
as measures to assess the effectiveness, timeliness, patient 
self-management, patient centeredness, and safety of care 
received by patients. Further, the bill directs the designated 
entity to give priority to measures with the greatest impact 
for improving performance and efficiency, measures that may be 
rapidly implemented, measures that help consumers and patients 
make informed decisions about their care, measures that apply 
to multiple services furnished by different providers, measures 
that can be integrated into the technology standards setting 
and certification process.
    The RAND Institute reports that patients receive care that 
is appropriate to their condition only 55 percent of the time 
and best clinical practices take, on average, 17 years to reach 
the bedside. The committee finds that the development and 
adoption of a quality measurement system and its integration 
with the interoperable health information technology system 
under this legislation is a critical step in eradicating these 
deficiencies and improving the quality of health care that all 
Americans receive.
    In developing and updating the quality measures, the 
Secretary shall enter an arrangement with a private entity to 
receive advice and recommendations with regard to the 
development and updating of quality measures. The committee 
intends the development and updating of the quality measures to 
recognize those established measurement sets that have gone 
through a multi-stakeholder, open and accountable process and 
are currently in use by both the Secretary and the private 
sector, including the Health Plan Employer Data and Information 
Set and the Consumer Assessment of Health Plans. It is the 
intention of the committee to avoid the duplication of these 
established measures and expects that the Secretary will adopt 
these measure sets and additions to them. The committee intends 
the widespread adoption and use of measures developed pursuant 
to this legislation adopted through the development and 
updating of the quality measurement system.
    The legislation also requires reporting of quality measures 
by entities receiving grants and loans and allows the Secretary 
to aggregate, analyze and disseminate quality data for the 
purposes of providing information to consumers, professionals, 
officials and researchers.

          LOWERING THE BARRIERS TO IMPLEMENTATION OF HEALTH IT

    The committee recognizes that a major barrier to widespread 
adoption of health information technology in the U.S. health 
care system is the high cost of such technology. The typical 
cost of purchasing a robust health information technology 
system for a solo or group practitioner is estimated to be 
thousands of dollars per provider. In addition to this, there 
are typically ongoing system maintenance and management costs 
that must be borne. In the hospital setting, costs vary widely. 
Nonetheless, purchasing a robust health information technology 
system, conducting training of personnel, integrating a new 
health information technology system into legacy computerized 
systems, and purchasing technical support services can cost 
millions of dollars for a community hospital of average size.
    Most experts estimate that the widespread adoption of 
health information technology will result in a substantial cost 
savings over time in our health care system. While providers 
must bear the full cost of acquiring these systems, a large 
part of these economic savings will accrue to health insurers 
and large integrated health care systems, rather than to 
physicians in office practices or smaller community hospitals.
    Many physicians and community hospitals, community health 
centers and other provider organizations operate with small 
financial margins and have difficulty affording modern health 
information technology systems for use in these clinical 
settings. Because of the current cost and segmented 
reimbursement, rates of adoption of modern health information 
technology in the United States are very low.
    In order to address the health information technology 
``adoption gap'' in the United States, S.1693 authorizes three 
grant programs that will carefully target financial support to 
health care providers and consortia for the purpose of 
facilitating the adoption of interoperable health information 
technology. For the purposes of this act, within the definition 
of health care provider, the term ``laboratory'' is intended to 
include not-for-profit blood centers. The bill leaves to the 
discretion of the Secretary the allocation of the funding among 
the three programs.
    In addition, the greatest improvements in quality of health 
care and cost savings will be realized when all elements of the 
health care system are electronically connected and speak a 
common technical language--that is they are interoperable. For 
this reason, each grant program requires that each grant 
recipient acquire only qualified health information technology 
systems that are capable of supporting common technical 
standards and full interoperability and reporting performance 
on quality measures adopted by the Federal Government under 
this legislation.
    The first grant program will award grants, on a competitive 
basis, to health care providers to facilitate the purchase and 
enhance the utilization of qualified health information 
technology systems to improve the quality and efficiency of 
health care. Awards will be made by the Secretary. Grant 
recipients must provide matching funds equal to $1 for each $3 
of Federal funds provided under the grant.
    Because the committee recognizes the importance of 
targeting scarce Federal resources where they are most needed, 
this grant program will give preference to providers that may 
be least likely to have the capital to acquire health 
information technology in the absence of a grant--those that 
are located in medically underserved areas. The committee also 
recognizes that while there are immediate improvements in 
quality of care and error reduction with the use of health 
information technology such as electronic health records, the 
full benefits of implementing such systems will only be 
realized when individual provider's systems are all 
interconnected and patient information will be available when 
and where it is needed. Thus, this grant program will also give 
preference to providers that will link, to the extent 
practicable, their health information system to local or 
regional health information systems. The bill also gives 
preference to those grantees that enhance the development of a 
``medical home'' for patients. For too many patients, care is 
scattered and uncoordinated. Health IT offers the opportunity 
to bring greater coordination and cohesion to medical 
treatment, thus improving outcomes and reducing disparities.
    In order to maximize the utility of health information 
technology systems acquired under this grant program in 
improving and measuring quality of care, grant recipients will 
be required to report on quality measures adopted by the 
Federal Government under this bill.
    The second program will award grants on a competitive basis 
to States for the establishment of State programs that will 
offer loans to health care providers to facilitate the purchase 
and enhance the utilization of qualified health information 
technology. To be eligible to receive such a grant, States must 
establish a State loan fund and submit an application to the 
Secretary with a strategic plan for awarding loans to eligible 
entities. State loan programs will be required to stipulate 
that preference in awarding loans will be given to providers 
who will link, to the extent practicable, their health 
information system to local or regional health information 
systems. States will be required to match $1 for every $1 of 
Federal funds provided under the grant. The Secretary may give 
preference to States that adopt value-based purchasing programs 
to improve health care quality.
    To maximize the likelihood that scarce Federal resources 
will be spent on projects with the greatest likelihood of 
success, recipients of loans will also be required to consult 
as necessary with the Health Information Technology Resource 
Center--established in this bill--that will provide technical 
assistance and develop best practices to support and accelerate 
efforts to adopt, implement, and use effectively interoperable 
health information technology.
    To maximize the utility of health information technology 
systems acquired under this loan program in improving and 
measuring quality of care, loan recipients will be required to 
report on quality measures adopted by the Federal Government 
under this bill.
    States may use grant funds to make loans directly to 
providers or may use funds to securitize additional loans or 
bonds, thereby augmenting the total amount of capital available 
in the program to lend to providers. In addition, State 
programs may accept voluntary contributions from private 
entities that may have a strong interest in expanding adoption 
of health information technology among health care providers in 
their State or local area. As an incentive for private entities 
to contribute voluntarily to the loan program, programs may 
publicize the names of private entities that make 
contributions. The committee sees a positive marketing value 
associated with this public recognition of responsible 
corporate citizenship.
    The third program allows the Secretary to award competitive 
grants to implement regional or local health information 
technology plans that improve health care quality and 
efficiency through the use of interoperable health information 
technology compliant with technology standards and the quality 
measurement system. To receive a grant, eligible entities must 
be comprised of a consortium of community stakeholders that 
demonstrate financial need, adopt policies that demonstrate a 
commitment to open and fair participation, and demonstrate a 
commitment to improving the quality of health care through the 
use of interoperable health information technology.
    The committee finds that the development and implementation 
of regional or local health information technology plans is a 
critical strategy in the Nation's efforts to build a nationwide 
interoperable health information technology infrastructure. 
Community exchange of health information through regional or 
local health information technology plans compliant with 
standards will maximize the benefits that patients experience 
from system-wide use of health IT and minimize costly 
technology links and retrofitting that would be necessary if 
health care stakeholders adopt health IT independent of an 
interoperable regional or local health information technology 
plan.
    However, the committee recognizes that there may be 
instances in which inclusion of all required stakeholders 
outlined may not be possible and the legislation provides the 
Secretary some flexibility in such cases. However, the 
committee believes that only applications that demonstrate the 
strongest commitment to a community-wide collaboration through 
the most extensive partnering feasible be provided funding.
    The legislation authorizes $139 million in fiscal year 2008 
and 2009, to remain available until expended. The bill leaves 
to the discretion of the Secretary the allocation of funding 
authorized for this section among the three programs.

               ENSURING THE PRIVACY OF HEALTH INFORMATION

    Because the committee believes that protecting the privacy 
and security of health information is an essential aspect of 
creating an interoperable health information infrastructure, 
the bill establishes several important privacy protections. 
First, the bill recognizes that privacy protections under HIPAA 
do not directly apply to one set of new entities that have 
arisen as a result of new health IT. The bill thus applies the 
regulations promulgated under HIPAA to these entities. The bill 
also clarifies that individuals have a right, to the extent 
provided under HIPAA, to inspect and obtain a copy of their 
medical records in electronic format, and to have a covered 
entity amend protected health information in an electronic 
format--a provision that is especially helpful in guarding 
against medical fraud.
    The committee encourages the Office of the National 
Coordinator for Health Information Technology to ensure that 
the development and use of health information technology does 
not adversely affect privacy. The committee encourages the 
Office of the National Coordinator for Health Information 
Technology to work with the Department of Justice and the 
Office of Civil Rights in this effort.

           INTEGRATION OF HEALTH IT INTO HEALTH CARE PRACTICE

    Another barrier to widespread adoption of interoperable 
health information is cultural. The committee recognizes that 
many physicians and hospitals are hesitant to move from paper-
based systems to electronic systems. Some physicians have been 
writing prescriptions by hand for many years and may resist 
changing to electronic records and prescribing systems.
    This committee believes that one way to address this 
cultural barrier to the widespread adoption of health 
information technology is to support teaching hospitals and 
continuing education programs that integrate health information 
technology in the clinical education of health care 
professionals. The committee believes that exposing students 
and residents to effective everyday uses of health IT will lead 
to a greater adoption by these students and residents in their 
future medical practice. The bill authorizes the Secretary to 
award demonstration grants to health professions centers and 
academic health centers to integrate health IT into clinical 
education in community settings. To be eligible, grantees must 
submit a strategic plan and provide matching funds of at least 
$1 for every $2 of Federal funding. The Secretary is required 
to evaluate the program and disseminate the results, and to 
report annually to Congress. The bill also reauthorizes 
Telemedicine Incentive Grants through 2010. These grants were 
established to encourage State licensure bodies to address 
remote treatment issues.
    The bill also amends the Public Health Service Act and 
directs the Secretary, acting through the Director of the 
Agency for Health Care Research and Quality, to develop a 
Health Information Technology Resource Center to provide 
technical assistance and develop best practices to support and 
accelerate the efforts of States and health care providers to 
adopt, implement, and use effectively health information 
technology that complies with the standards and quality 
measurement system adopted by the Federal Government. The 
committee believes it is important to provide a forum for the 
exchange of knowledge and experience, accelerate the transfer 
of lessons learned from existing public and private sector 
initiatives, and assemble, analyze, and widely disseminate 
evidence and experience related to the adoption, 
implementation, and effective use of interoperable health 
information technology. The Secretary has begun undertaking the 
activities outlined in this section of the legislation. It is 
the committee's intent not to require the duplication of 
Federal efforts with respect to the establishment of the 
Center.
    The committee believes this legislation integrates 
technology and quality to create a seamless, efficient health 
care system for the 21st century. This legislation will help 
facilitate the widespread adoption of electronic health records 
to ultimately result in fewer mistakes, lower costs, better 
care, and greater patient participation in their health and 
well being.

                            V. Cost Estimate

    Pursuant to Section 402 of the Congressional Budget Act of 
1974, the committee estimates the cost of the legislation will 
be equal to the amounts discussed in the following estimate 
provided by the Congressional Budget Office.

                                                     July 25, 2007.
Hon. Edward M. Kennedy,
Chairman, Committee on Health, Education, Labor, and Pensions,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 1693, the Wired for 
Health Care Quality Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Tom Bradley.
            Sincerely,
                                                   Peter R. Orszag.
    Enclosure.

S. 1693--Wired for Health Care Quality Act

    Summary: CBO estimates that implementing S. 1693 would cost 
$47 million in 2008 and $317 million over the 2008-12 period, 
assuming appropriation of the necessary amounts. Enacting the 
bill would have no effect on direct spending or revenues.
    On April 27, 2004, the President issued Executive Order 
13335, which established within the Office of the Secretary of 
Health and Human Services (HHS) the position of National Health 
Information Technology Coordinator. The Secretary subsequently 
established the Office of the National Coordinator of Health 
Information Technology (ONCHIT) and the American Health 
Information Community (AHIC) to support the adoption of health 
information technology. S. 1693 would amend the Public Health 
Service Act (PHSA) to codify the establishment and 
responsibilities of those entities. In addition, the bill would 
authorize funding for grants to facilitate the widespread 
adoption of certain health information technology. S. 1693 
would authorize the appropriation of $150 million for 2008 and 
$150 million for 2009 for those activities.
    S. 1693 also would require the Agency for Healthcare 
Research and Quality (AHRQ) to establish a Health Information 
Technology Resource Center to provide technical assistance to 
support the adoption of health information technology, 
authorize AHRQ to award grants to develop and test quality 
measures, and extend through 2009 authorization for a program 
to provide telemedicine grants. CBO estimates that implementing 
those provisions would require the appropriation of $11 million 
for 2008 and $25 million over the 2008-12 period.
    S. 1693 contains an intergovernmental mandate as defined in 
the Unfunded Mandates Reform Act (UMRA) because it would limit 
the application of State and local law. However, CBO estimates 
that the net costs of the mandate would be minimal and far 
below the threshold established in UMRA ($66 million in 2007, 
as adjusted for inflation). In general, the bill would benefit 
State, local, and tribal governments and any costs they incur 
as a result of participating in the grant programs would result 
from complying with conditions of Federal assistance. The bill 
contains no private-sector mandates as defined in UMRA.
    Estimated cost to the Federal Government: The estimated 
cost of S. 1693 is shown in the following table. The costs of 
this legislation fall within budget function 550 (health).

----------------------------------------------------------------------------------------------------------------
                                                               By fiscal year, in millions of dollars--
                                                     -----------------------------------------------------------
                                                        2007      2008      2009      2010      2011      2012
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION

Spending under Current Law:
    Estimated Budget Authority \1\..................        61         0         0         0         0         0
    Estimated Outlays...............................        18        28        12         2         0         0
Proposed Changes:
    Estimated Authorization Level...................         0       161       161         1         1         1
    Estimated Outlays...............................         0        47       119       105        39         7
Spending under S. 1693:
    Estimated Authorization Level \1\...............        61       161       161         1         1         1
    Estimated Outlays...............................        18        75       131       107        39         7
----------------------------------------------------------------------------------------------------------------
\1\ The 2007 level is CBO's estimate of the funding for the activities of the Office of the National Coordinator
  of Health Information Technology and the American Health Information Community, including funds reprogrammed
  by the Secretary of Health and Human Services from other activities.

    Basis of estimate: S. 1693 would amend the Public Health 
Service Act to add title 30--which would deal with health 
information technology and quality--and to create a Health 
Information Technology Resource Center and extend authorization 
for a program to provide telemedicine grants. For this 
estimate, CBO assumes that S. 1693 will be enacted near the end 
of fiscal year 2007, that the necessary amounts will be 
appropriated each year, and that outlays will follow historical 
patterns for similar activities of the Department of Health and 
Human Services. CBO estimates that implementing those 
provisions would cost $47 million in 2008 and $317 million over 
the 2008-12 period.

Health Information Technology and Quality

    The National Coordinator of Health Information Technology 
serves as the senior advisor to the Secretary of HHS and the 
President on all health information technology programs and 
initiatives, and is responsible for:

           Developing and maintaining a strategic plan 
        to guide the nationwide implementation of electronic 
        health records in both the public and private health 
        care sectors;
           Coordinating spending by Federal agencies 
        for health information technology programs and 
        initiatives; and
           Coordinating outreach activities to private 
        industry and serving as the catalyst for change in the 
        health care industry.

    In June 2005, the Secretary announced the creation of the 
American Health Information Community, a public-private 
collaboration to provide a forum for public and private 
interests to recommend specific actions that will accelerate 
the widespread adoption of electronic records and other health 
information technology. Based on information provided by the 
Department of Health and Human Services, CBO estimates that $61 
million is available in 2007 for the activities of ONCHIT and 
AHIC ($42 million from funds appropriated to the Secretary and 
$19 million from funds reprogrammed from other activities).
    S. 1693 would add title 30 to the Public Health Service Act 
to specify the responsibilities of ONCHIT, AHIC, and a new 
organization--the Partnership for Health Care Improvement. The 
current responsibilities of AHIC would be divided between AHIC 
and the Partnership, with AHIC focusing on development of 
policy and the Partnership focusing on the technical aspects of 
developing and promoting the adoption of health information 
technology.
    The bill also would establish several grant programs to 
promote the adoption of health information technology.
    For most of the activities under title 30, S. 1693 would 
specify the amounts authorized to be appropriated for fiscal 
years 2008 and 2009: $5 million in each year for ONCHIT, $2 
million in each year for the Partnership, $2 million in each 
year for AHIC, and $141 million in each year for grant 
programs. Those specified amounts total $150 million in each of 
fiscal years 2008 and 2009. In addition, the bill would 
authorize the Secretary, acting through AHRQ, to make grants to 
support the development and testing of quality measures. CBO 
estimates the necessary funding for those grants would amount 
to $1 million for 2008 and $5 million over the 2008-12 period. 
Thus, CBO estimates that the necessary funding for activities 
under title 30 would total $151 million for fiscal year 2008 
and $305 million over the 2008-12 period.
    Of the $141 million in specified funding for grant programs 
in each of fiscal years 2008 and 2009, $139 million a year 
would be allocated to three grant programs--for health care 
providers, States, and to implement regional or local plans for 
the exchange of health information--to facilitate the adoption 
of health information technology, and $2 million a year would 
be allocated to a fourth grant program to develop academic 
curricula integrating health information technology systems 
into the clinical education of health professionals.
    The bill would limit eligibility for the grants to health 
care providers to providers that demonstrate significant 
financial need. Those providers would be required to provide $1 
of matching funds for every $3 of Federal grant funds, and they 
could use the funds to purchase and enhance the utilization of 
health information technology and for training personnel in the 
use of the technology.
    States would be eligible for grants that would fund the 
establishment of State programs for loans to health care 
providers to facilitate the purchase and use of health 
information technology. States would have to provide $1 of 
matching funds for every $1 of Federal grant funds.
    The grants to implement regional or local plans for the 
exchange of health information would require $1 of matching 
funds for every $2 of Federal grant funds.

Other provisions

    In addition to adding title 30 to the Public Health Service 
Act, S. 1693 would amend that act to establish a Health 
Information Technology Resource Center to provide technical 
assistance to support the adoption of health information 
technology, and it would extend through 2009 authorization for 
a program to provide telemedicine grants. The Center would be 
administered by AHRQ, and the telemedicine grants would be 
administered by the Health Resources and Services 
Administration (HRSA). CBO estimates that implementing those 
provisions would require additional appropriations for 2008 and 
2009 of $5 million a year for the Center and $5 million a year 
for HRSA.
    Intergovernmental and private-sector impact: S. 1693 would 
deem an operator of a health information electronic database a 
covered entity under the Health Insurance Portability and 
Accountability Act (HIPAA). With some exceptions HIPAA preempts 
State laws that impose standards less stringent than the 
Federal standard. Therefore, State standards with respect to an 
operator of a health information database that are less 
stringent than the new Federal standard would be preempted by 
the bill. That preemption would be an intergovernmental mandate 
as defined in UMRA because it would limit the application of 
State and local law. However, CBO estimates that the net costs 
of the mandate would be minimal and far below the threshold 
established in UMRA ($66 million in 2007, as adjusted for 
inflation).
    The bill also would authorize grants to States and public 
health entities to assist them with purchasing information 
technology systems to improve the delivery of health care. 
Public institutions of higher education also would benefit from 
grants authorized in the bill to develop academic curricula or 
analyze data. Any costs those governments or institutions 
incur, including matching funds, would result from complying 
with conditions of Federal assistance.
    The bill contains no private-sector mandates as defined in 
UMRA.
    Estimate prepared by: Federal costs: Tom Bradley; Impact on 
state, local, and tribal governments: Lisa Ramirez-Branum; 
Impact on the private sector: Stuart Hagen.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

            VI. Application of Law to the Legislative Branch

    The Committee finds that the legislation 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.

                    VII. Regulatory Impact Statement

    Pursuant to the requirements of paragraph 11(b) of rule 
XXVI of the Standing Rules of the Senate, the committee has 
determined that the bill will not have a significant regulatory 
impact.

                   VIII. Section-by-Section Analysis

Section 1. Short title

    Wired for Health Care Quality Act.

Section 2. Improving Health Care Quality, Safety, and Efficiency

    Amends the Public Health Service Act by adding at the end: 
``Title XXX--Health Information Technology and Quality''.

Section 3001. Definitions

    ``Community,'' ``Health Care Provider,'' ``Health 
Information,'' ``Health Plan,'' ``Individually Identifiable 
Health Information,'' ``Laboratory,'' ``National Coordinator,'' 
``Partnership,'' ``Qualified Health Information Technology,'' 
and ``State''.

Section 3002. Office of the National Coordinator for Health Information 
        Technology

    Section 3002 establishes within the office of the Secretary 
an Office of the National Coordinator for Health Information 
Technology and defines its responsibilities. The Office will 
ensure coordination of health information technology 
initiatives across programs of the Department of Health and 
Human Services and related government agencies. It will create 
a strategic plan for the implementation of an interoperable 
health information technology infrastructure with the purpose 
of reviewing Federal health information technology investments 
with measurable outcome goals for health information technology 
to assess progress within the Department of HHS and other 
Federal agencies. It will review Federal purchases of health IT 
to ensure compliance with the Partnership's plans for health 
IT, as well as the implementation of health IT systems by other 
organizations in order to draw lessons for other health care 
providers. The Office will also study how to use these systems 
to utilize health IT to improve quality of care and chronic 
disease management. The Office will further work to increase 
the penetration of health IT in communities with health 
disparities. In order to publicize its activities, the Office 
will maintain a Web site which publishes a schedule for the 
assignment of significant use cases, recommendations of the 
Community, quality measures, and identifies potential funding 
sources for health information technology systems. The Office 
will also devise a plan to replace itself after this section's 
provisions sunset on September 30, 2014.

Section 3003. Partnership for Health Care Improvement; Standards and 
        technology

    Section 3003 establishes the public-private Partnership for 
Health Care Improvement comprised of individuals from the 
public and private sectors. This Partnership shall recommend 
standards, implementation specifications, and certification 
criteria for electronic exchange of health information for 
adoption by the Federal Government and voluntary adoption by 
private entities. The Partnership will hold public hearings for 
comment on its recommendations, and ensure that all its 
recommendations are compliant with HIPAA in order to protect 
patient privacy. In addition to issuing recommendations, the 
Partnership will also serve as a forum for technical experts in 
the field of health information technology. The governance 
rules of the Partnership and information about its meetings 
will be publicly available on a Web site maintained by the 
Partnership.
    Members of the Partnership will serve 3-year terms. The 
membership will include representatives of consumer or patient 
organizations, privacy experts, security experts, health care 
providers, health insurance representatives, insurance 
purchasers, and information technology vendors, with the 
National Coordinator serving as the liaison among the parties 
and to the Federal Government. The Majority Leader of the 
Senate, the Minority Leader of the Senate, the Speaker of the 
House, and the Minority Leader of the House will each appoint a 
member of the Partnership. Partnership recommendations shall be 
reviewed by the Secretaries of HHS, Veterans Affairs, Defense, 
and related agencies. If appropriate, the President shall 
provide for the Federal Government's adoption of the 
recommendations.

Section 3004. American Health Information Community--Policies

    Section 3004 creates a committee known as the American 
Health Information Community, which makes recommendations on 
policy issues related to health IT. These recommendations shall 
be designed for adoption by the Federal Government and the 
voluntary adoption by private entities. The recommendations of 
the Community shall address the following issues among others:
          1. Protection of patients' control of the 
        acquisition, use and release of their health 
        information;
          2. Protection of individually identifiable health 
        information by notifying patients of wrongful 
        disclosure and by allowing patients to access their own 
        health information;
          3. Identification of appropriate uses of the national 
        health information network, including collection of 
        quality data and public reporting, biosurveillance, 
        medical research, and drug safety;
          4. Increasing the involvement of health care 
        providers and staff in health IT systems design and 
        implementation;
          5. Fostering the public understanding of health 
        information technology; and
          6. Promulgation of a strategy to use health IT to 
        improve chronic disease management.
    All recommendations of the Community shall be consistent 
with HIPAA to ensure the protection of patient privacy. The 
Community will hold public hearings for comment on its 
recommendations, and publish its findings in the Federal 
Register and the Web site of the National Coordinator.
    The membership of the Community will be chosen by a variety 
of officials to represent a wide range of viewpoints. It will 
be composed of three members appointed by the Secretary, 
including one representative of DHHS. One will be appointed by 
the Secretary of Veterans Affairs and represent DVA. The 
majority and minority leaders of the Senate and the Speaker and 
minority leader of the House of Representatives will each 
appoint one member. Nine members will be appointed by the 
Comptroller General to represent different parts of the health 
care community, including representatives of health care 
providers, consumer groups, insurance companies, technology 
vendors and organized labor. There will also be experts in 
privacy and security, improving health care in disadvantaged 
areas, and health care quality measurement. All members serve 
three year terms.
    The Community will be able to draw both on outside 
expertise and Federal resources. Outside entities shall advise 
the Community on issues of health privacy and security, patient 
safety, ethics, research data exchange, and information 
technology standards. The Federal Government shall provide the 
Community access to resources from the Library of Congress, 
Federal agencies, and elected representatives. The Federal 
Advisory Committee Act shall apply to the Community.
    Two million dollars is authorized to be appropriated to 
support the Community's activities in fiscal year 2008 and 
fiscal year 2009. The provisions applying to the Community will 
sunset on September 20, 2014.

Section 3005. Federal purchasing and data collection

    Section 3005 prohibits the Federal Government from 
purchasing health IT systems that do not comply with the 
adopted recommendations of the Partnership. Within 3 years, the 
Federal Government will also establish a common format for 
reporting health information. However, all Federal standards 
shall be voluntary with respect to private entities. Private 
entities contracting with the Federal Government shall adopt 
the government's standards for their activities under Federal 
contract.

Section 3006. Quality and efficiency reports

    Section 3006 provides that the government contract with 
three Quality Reporting Organizations (QROs) to utilize Federal 
health care data for the purpose of producing reports on health 
care quality. The Secretary will draft regulations for QROs to 
request heath quality reports in exchange for a reasonable fee. 
These three outside organizations must have expertise in the 
analysis of such data and have the technological infrastructure 
appropriate to utilize Federal health IT standards. In order to 
ensure patient privacy, the QROs must ensure patient privacy by 
adhering to HIPAA standards in addition to those of sections 
552 and 552a of U.S.C. Title 5. Moreover, these protections 
continue to apply if the organization's contract with the 
Federal Government is terminated. Researchers will be able to 
access the information provided they comply with guidelines 
established by the Secretary. The QROs are also required to 
protect the security of patient data.

TITLE II--FACILITATING THE WIDESPREAD ADOPTION OF INTEROPERABLE HEALTH 
                         INFORMATION TECHNOLOGY

Section 201. Facilitating the widespread adoption of interoperable 
        health information technology

    Title XXX of the Public Health Service Act as created by 
Section 101 is further amended by adding at the end the 
following provisions:

Section 3008. Facilitating the widespread adoption of interoperable 
        health information technology

    Section 3008 establishes three grant programs at HHS: a 
grant program for health IT adoption in health care facilities, 
a competitive grant program for State loan programs in health 
IT, and a program to supply funds for the implementation of 
regional and local health IT network. To fund these three 
programs, $139 million is authorized to be appropriated. The 
program for health provider IT adoption gives grants directly 
to health care providers for four purposes: the purchase of 
qualified health IT systems, personnel training in these 
systems, increasing utilization of health IT and improving 
chronic disease management. The State program allows States to 
apply for grants to State qualified health IT loan funds to 
match State contributions to these programs. They may not 
directly duplicate other Federal spending in the bill. The 
program for regional and local health IT allows a wide range of 
entities to jointly apply for grants to produce regional and 
local health IT networks. These entities may include health 
care providers, health insurance companies, patient advocacy 
groups, and others. These programs have four common eligibility 
requirements:
          1. Adoption of standards consistent with those 
        approved by the government;
          2. Matching of Federal contributions with other 
        funds: $1 for every $3 of Federal contributions in 
        health IT adoption grants, $1 for every $1 of Federal 
        contributions in the State loan program, and $1 for 
        every $2 of Federal contributions in the local and 
        regional network program;
          3. Notification of individuals if their health 
        information is wrongfully disclosed; and
          4. Medical care delivery staff input in system 
        design.
    Network grants have the following additional requirements:
          1. Integrate stakeholders into local and regional 
        health IT networks when possible;
          2. Practice of non-discrimination for all 
        stakeholders in the network;
          3. Input of medical care delivery staff in systems 
        design;
          4. Features to reduce barriers to provider 
        implementation of health IT; and
          5. Draft plans to protect patient privacy and 
        security, to maintain compliance with Federal 
        standards, and to ensure the financial sustainability 
        of the networks.

Section 3009. Demonstration program to integrate information technology 
        into clinical education

    Section 3009 establishes a demonstration program to give 
grants to institutions of medical education in order to 
integrate health IT into their curricula. These projects must 
involve two or more medical disciplines and match 50 percent of 
the Federal contribution with money from other sources. The 
institutions must report to the Secretary within 1 year on the 
effectiveness of the projects. Two million dollars is 
authorized to be appropriated for this purpose in fiscal year 
2008 and fiscal year 2009. The provisions of this program 
sunset on September 30, 2012.

            TITLE III--IMPROVING THE QUALITY OF HEALTH CARE

Section 301. Consensus process for the adoption of quality measures for 
        use in the Nationwide Interoperable Health Information 
        Technology Infrastructure

    Title XXX of the Public Health Service Act, as amended by 
section 201, is further amended by adding at the end the 
following:

Section 3010. Fostering development and use of health quality measures

    Section 3010 requires the Secretary of HHS to develop and 
use health care quality measures for the purpose of measuring 
the quality and efficiency of health care patients receive. The 
Secretary shall designate an organization to promote the 
development of quality measures and provide the Secretary with 
advice and recommendations on the key elements and priorities 
of a national system for health care performance measurement. 
The organization will endorse national consensus quality 
measures and recommend quality measures to the Secretary of HHS 
for adoption and use. The organization will further coordinate 
setting standards for the development and testing of quality 
measures. The quality measures adopted by the Secretary will be 
integrated into the Partnership's certification process. In 
addition, the organization will also promote the development of 
electronic health records that allow automatic collection, 
aggregation and transmission of quality measurements.
    The designated organization itself must be a private 
nonprofit governed by a president and a board of directors 
which represent health care providers, health plans, patients 
or consumers, health care purchasers or employers, and health 
care practitioners. The board of directors should have 
experience with urban and rural health care issues, State and 
local health programs, safety net and quality issues and be 
experts in health information technology standards and 
technology assessment. The organization will conduct business 
in an open and transparent fashion which allows for public 
comment.
    The quality measures endorsed by the organization must be 
evidence-based, and must include measures of clinical process 
and outcomes, patient experience, efficiency, equity, patient 
centeredness, patient self-management, safety, underuse and 
overuse. Priority is given to quality measures with the 
greatest potential for improving care, that may be implemented 
rapidly, that inform patient choice, that can be integrated 
into the certification process, that facilitate physician 
decision-making using health IT, and that apply to multiple 
health services. The organization shall establish procedures to 
ensure appropriate risk adjustment and for the maintenance or 
quality measures. The Secretary may award grants to 
organizations to support the development and testing of quality 
measures.

Section 3011. Adoption and use of quality measures; Reporting

    In Section 3011, the Secretary is given the responsibility 
of selecting quality measures for use and ensuring that these 
measures are integrated into the bill's overall health IT 
framework. The Secretary will decide which quality measures 
shall be adopted from those recommended to him by multi-
stakeholder groups and endorsed by the designated organization. 
Moreover, the Secretary shall ensure that all adopted measures 
are integrated into the standards adopted pursuant to Section 
3005. In addition, all quality measures are required to 
complement quality measures for programs in Titles XVIII, XIX, 
and XXI of the Social Security Act and not conflict with the 
needs of programs under that title as determined by the 
Administrator of the CMS.
    The Secretary shall also devise regulations to allow the 
distribution, aggregation and analysis of selected quality 
measures.

                     TITLE IV--PRIVACY AND SECURITY

Section 401. Privacy and security

    Title XXX of the Public Health Service Act, as amended by 
section 301, is further amended by adding at the end the 
following:

Section 3013. Ensuring privacy and security

    Section 3013 introduces new privacy protections for health 
IT. The section extends HIPAA privacy protections to cover 
health records stored in certain health information electronic 
databases. It further recognizes the right of individuals to 
look at their health records stored in electronic form to the 
extent provided under HIPAA. Victims of medical fraud are also 
recognized as having the right to view the fraudulently entered 
information and amend their records to the extent provided 
under HIPAA.

                   TITLE V--MISCELLANEOUS PROVISIONS

Section 501. GAO study

    Section 501 stipulates that within a year of an enactment, 
the Comptroller General submit a report to Congress detailing 
circumstances in which it is necessary and workable to require 
health plans, health care clearinghouses, and health care 
providers to notify parents of wrongful disclosure of 
individually identifiable health information.

Section 502. Health Information Technology Resource Center

    Section 502 amends Section 914 of the Public Health Service 
Act to include a requirement that the Secretary develop a 
Health Information Technology Resource Center to serve as a 
forum to explore lessons learned from public or private sector 
initiatives, assemble evidence concerning adoption of health 
information technology, establish local and regional networks, 
and provide for exchange of electronic health data.

Section 503. Facilitating the provision of telehealth services across 
        state lines

    Section 503 reauthorizes section 330L of the Public Health 
Service Act: Telemedicine; Incentive Grants Regarding 
Coordination Among States. Section 330L allows the Secretary of 
HHS to make grants to States that have adopted regional State 
reciprocity agreements. Such sums as may be necessary are 
authorized to be appropriated for fiscal year 2008 and fiscal 
year 2009.

                      IX. Changes in Existing Law

    In compliance with rule XXVI paragraph 12 of the Standing 
Rules of the Senate, the following provides a print of the 
statute or the part or section thereof to be amended or 
replaced (existing law proposed to be omitted is enclosed in 
black brackets, new matter is printed in italic, existing law 
in which no change is proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *

[SEC. 330L. [254C-18] TELEMEDICINE; INCENTIVE GRANTS REGARDING 
                    COORDINATION AMONG STATES.

    [(a) In General.--The Secretary may make grants to State 
professional licensing boards to carry out programs under which 
such licensing boards of various States cooperate to develop 
and implement State policies that will reduce statutory and 
regulatory barriers to telemedicine.
    [(b) Authorization of Appropriations.--For the purpose of 
carrying out subsection (a), there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years 2002 through 2006.]

SEC. 330L. TELEMEDICINE; INCENTIVE GRANTS REGARDING COORDINATION AMONG 
                    STATES.

    (a) Facilitating the Provision of Telehealth Services 
Across State Lines.--The Secretary may make grants to States 
that have adopted regional State reciprocity agreements for 
practitioner licensure, in order to expedite the provision of 
telehealth services across State lines.
    (b) Authorization of Appropriations.--For the purpose of 
carrying out subsection (a), there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years 2008 and 2009.

           *       *       *       *       *       *       *

SEC. 914. [299B-3] INFORMATION SYSTEMS FOR HEALTH CARE IMPROVEMENT.

    (a) In General.--* * *

           *       *       *       *       *       *       *

    (d) Health Information Technology Resource Center.--
          (1) In general.--The Secretary, acting through the 
        Director, shall develop a Health Information Technology 
        Resource Center (referred to in this subsection as the 
        ``Center'' to provide technical assistance and develop 
        best practices to support and accelerate efforts to 
        adopt, implement, and effectively use interoperable 
        health information technology in compliance with 
        sections 3003 and 3010.
          (2) Purposes.--The purposes of the Center are to--
                  (A) provide a forum for the exchange of 
                knowledge and experience;
                  (B) accelerate the transfer of lessons 
                learned from existing public and private sector 
                initiatives, including those currently 
                receiving Federal financial support;
                  (C) assemble, analyze, and widely disseminate 
                evidence and experience related to the 
                adoption, implementation, and effective use of 
                interoperable health information technology;
                  (D) provide for the establishment of regional 
                and local health information networks to 
                facilitate the development of interoperability 
                across health care settings and improve the 
                quality of health care;
                  (E) provide for the development of solutions 
                to barriers to the exchange of electronic 
                health information; and
                  (F) conduct other activities identified by 
                the States, local, or regional health 
                information networks, or health care 
                stakeholders as a focus for developing and 
                sharing best practices.
          (3) Support for activities.--To provide support for 
        the activities of the Center, the Director shall modify 
        the requirements, if necessary, that apply to the 
        National Resource Center for Health Information 
        Technology to provide the necessary infrastructure to 
        support the duties and activities of the Center and 
        facilitate information exchange across the public and 
        private sectors.
          (4) Rule of construction.--Nothing in this subsection 
        shall be construed to require the duplication of 
        Federal efforts with respect to the establishment of 
        the Center, regardless of whether such efforts were 
        carried out prior to or after the enactment of this 
        subsection.
     (e) Authorization of Appropriations.--There is authorized 
to be appropriated, such sums as may be necessary for each of 
fiscal years 2008 and 2009 to carry out this section.

           *       *       *       *       *       *       *

                   TITLE XXIX--LIFESPAN RESPITE CARE

SEC. 2901. [300II] DEFINITIONS.

           *       *       *       *       *       *       *

SEC. 2905. [300II-4] AUTHORIZATION OF APPROPRIATIONS.

           *       *       *       *       *       *       *

          TITLE XXX--HEALTH INFORMATION TECHNOLOGY AND QUALITY

SEC. 3001. DEFINITIONS; REFERENCE.

    (a) In General.--In this title:
          (1) Community.--The term ``Community'' means the 
        American Health Information Community established under 
        section 3004.
          (2) Health care provider.--The term ``health care 
        provider'' means a hospital, skilled nursing facility, 
        home health entity, health care clinic, federally 
        qualified health center, group practice (as defined in 
        section 1877(h)(4) of the Social Security Act), a 
        pharmacist, a pharmacy, a laboratory, a physician (as 
        defined in section 1861(r) of the Social Security Act), 
        a practitioner (as defined in section 1842(b)(18)(CC) 
        of the Social Security Act), a health facility operated 
        by or pursuant to a contract with the Indian Health 
        Service, a rural health clinic, and any other category 
        of facility or clinician determined appropriate by the 
        Secretary.
          (3) Health information.--The term ``health 
        information'' has the meaning given such term in 
        section 1171(4) of the Social Security Act.
          (4) Health insurance plan.--
                  (A) In general.--The term ``health insurance 
                plan'' means--
                          (i) a health insurance issuer (as 
                        defined in section 2791(b)(2));
                          (ii) a group health plan (as defined 
                        in section 2791(a)(1)); and
                          (iii) a health maintenance 
                        organization (as defined in section 
                        2791(b)(3)); or
                          (iv) a safety net health plan.
                  (B) Safety net health plan.--The term 
                ``safety net health plan'' means a managed care 
                organization, as defined in section as 
                1932(a)(1)(B)(i) of the Social Security Act--
                          (i) that is exempt from or not 
                        subject to Federal income tax, or that 
                        is owned by an entity or entities 
                        exempt from or not subject to Federal 
                        income tax; and
                          (ii) for which not less than 75 
                        percent of the enrolled population 
                        receives benefits under a Federal 
                        health care program (as defined in 
                        section 1128B(f)(1) of the Social 
                        Security Act) or a health care plan or 
                        program which is funded, in whole or in 
                        part, by a State (other than a program 
                        for government employees).
                  (C) References.--All references in this title 
                to ``health plan'' shall be deemed to be 
                references to ``health insurance plan.''
          (5) Individually identifiable health information.--
        The term ``individually identifiable health 
        information'' has the meaning given such term in 
        section 1171 of the Social Security Act.
          (6) Laboratory.--The term ``laboratory'' has the 
        meaning given such term in section 353.
          (7) National coordinator.--The term ``National 
        Coordinator'' means the National Coordinator of Health 
        Information Technology appointed pursuant to section 
        3002.
          (8) Partnership.--The term ``Partnership'' means the 
        Partnership for Health Care Improvement established 
        under section 3003.
          (9) Qualified health information technology.--The 
        term ``qualified health information technology'' means 
        a computerized system (including hardware and software) 
        that--
                  (A) protects the privacy and security of 
                health information;
                  (B) maintains and provides permitted access 
                to health information in an electronic format;
                  (C) with respect to individually identifiable 
                health information maintained in a designated 
                record set, preserves an audit trail of each 
                individual that has gained access to such 
                record set;
                  (D) incorporates decision support to reduce 
                medical errors and enhance health care quality;
                  (E) complies with the standards adopted by 
                the Federal Government under section 3003;
                  (F) has the ability to transmit and exchange 
                information to other health information 
                technology systems and, to the extent feasible, 
                public health information technology systems; 
                and
                  (G) allows for the reporting of quality 
                measures adopted under section 3010.
          (10) State.--The term ``State'' means each of the 
        several States, the District of Columbia, Puerto Rico, 
        the Virgin Islands, Guam, American Samoa, and the 
        Northern Mariana Islands.
    (b) References to Social Security Act.--Any reference in 
this section to the Social Security Act shall be deemed to be a 
reference to such Act as in effect on the date of enactment of 
this title.

SEC. 3002. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION 
                    TECHNOLOGY.

    (a) Establishment.--There is established within the office 
of the Secretary, the Office of the National Coordinator of 
Health Information Technology. The National Coordinator shall 
be appointed by the Secretary in consultation with the 
President, and shall report directly to the Secretary.
    (b) Purpose.--The Office of the National Coordinator shall 
be responsible for--
          (1) ensuring that key health information technology 
        initiatives are coordinated across programs of the 
        Department of Health and Human Services;
          (2) ensuring that health information technology 
        policies and programs of the Department of Health and 
        Human Services are coordinated with such policies and 
        programs of other relevant Federal agencies including 
        Federal commissions and advisory committees) with a 
        goal of avoiding duplication of efforts and of helping 
        to ensure that each agency undertakes activities 
        primarily within the areas of its greatest expertise 
        and technical capability;
          (3) reviewing Federal health information technology 
        investments to ensure that Federal health information 
        technology programs are meeting the objectives of the 
        strategic plan published by the Office of the National 
        Coordinator of Health Information Technology to 
        establish a nationwide interoperable health information 
        technology infrastructure;
          (4) providing comments and advice regarding specific 
        Federal health information technology programs, at the 
        request of Office of Management and Budget; and
          (5) enhancing the use of health information 
        technology to improve the quality of health care in the 
        prevention and management of chronic disease and to 
        address population health.
    (c) Role With Community and the Partnership.--The Office of 
the National Coordinator shall--
          (1) serve as an ex officio member of the Community, 
        and act as a liaison between the Federal Government and 
        the Community;
          (2) serve as an ex officio member of the Partnership 
        and act as a liaison between the Federal Government and 
        the Partnership; and
          (3) serve as a liaison between the Partnership and 
        the Community.
    (d) Reports and Website.--The Office of the National 
Coordinator shall--
          (1) develop and publish a strategic plan for 
        implementing a nationwide interoperable health 
        information technology infrastructure;
          (2) maintain and frequently update an Internet 
        website that--
                  (A) publishes the schedule for the assessment 
                of standards for significant use cases;
                  (B) publishes the recommendations of the 
                Community;
                  (C) publishes the recommendations of the 
                Partnership;
                  (D) publishes quality measures;
                  (E) identifies sources of funds that will be 
                made available to facilitate the purchase of, 
                or enhance the utilization of, health 
                information technology systems, either through 
                grants or technical assistance; and
                  (F) publishes a plan for a transition of any 
                functions of the Office of the National 
                Coordinator that should be continued after 
                September 30, 2014;
          (3) prepare a report on the lessons learned from 
        major public and private health care systems that have 
        implemented health information technology systems, 
        including an explanation of whether the systems and 
        practices developed by such systems may be applicable 
        to and usable in whole or in part by other health care 
        providers; and
          (4) assess the impact of health information 
        technology in communities with health disparities and 
        identify practices to increase the adoption of such 
        technology by health care providers in such 
        communities.
    (e) Rule of Construction.--Nothing in this section shall be 
construed as requiring the duplication of Federal efforts with 
respect to the establishment of the Office of the National 
Coordinator for Health Information Technology, regardless of 
whether such efforts are carried out before or after the date 
of the enactment of this title.
    (f) Authorization of Appropriations.--There is authorized 
to be appropriated to carry out this section, $5,000,000 for 
each of fiscal years 2008 and 2009.
    (g) Sunset.--The provisions of this section shall not apply 
after September 30, 2014.

SEC. 3003. PARTNERSHIP FOR HEALTH CARE IMPROVEMENT-STANDARDS AND 
                    TECHNOLOGY.

    (a) Establishment.--
          (1) In general.--There is established a public-
        private Partnership for Health Care Improvement to--
                  (A) provide advice to the Secretary and the 
                Nation and recommend specific actions to 
                achieve a nationwide interoperable health 
                information technology infrastructure;
                  (B) make recommendations concerning 
                standards, implementation specifications, and 
                certification criteria for the electronic 
                exchange of health information (including for 
                the reporting of quality data under section 
                3010) for adoption by the Federal Government 
                and voluntary adoption by private entities;
                  (C) serve as a forum for the participation of 
                a broad range of stakeholders with specific 
                technical expertise in the development of 
                standards, implementation specifications, and 
                certification criteria to provide input on the 
                effective implementation of health information 
                technology
                  (D) develop and maintain an Internet web site 
                that--
                          (i) publishes established governance 
                        rules (including a subsequent 
                        appointment process);
                          (ii) publishes a business plan;
                          (iii) publishes meeting notices at 
                        least 14 days prior to each meeting;
                          (iv) publishes meeting agendas at 
                        least 7 days prior to each meeting; and
                          (v) publishes meeting materials at 
                        least 3 days prior to each meeting.
          (2) Limitation.--The Partnership shall not meet or 
        take any action until an advisory committee charter has 
        been filed with the Secretary and with the appropriate 
        committees of the Senate and House of Representatives 
        for the Community described in section 3004.
    (b) Membership.--
          (1) Appointments.--
                  (A) In general.--The Partnership shall be 
                composed of members to be appointed as follows:
                          (i) 2 members shall be appointed by 
                        the Secretary.
                          (ii) member shall be appointed by the 
                        majority leader of the Senate.
                          (iii) 1 member shall be appointed by 
                        the minority leader of the Senate.
                          (iv) 1 member shall be appointed by 
                        the Speaker of the House of 
                        Representatives.
                          (v) 1 member shall be appointed by 
                        the minority leader of the House of 
                        Representatives.
                          (vi) Seven members shall be appointed 
                        by the Comptroller General of whom--
                                  (I) one member shall be a 
                                representative of consumer or 
                                patient organizations;
                                  (II) one member shall be a 
                                representative of organizations 
                                with expertise in privacy;
                                  (III) one member shall be a 
                                representative of organizations 
                                with expertise in security;
                                  (IV) one member shall be a 
                                representative of health care 
                                providers;
                                  (V) one member shall be a 
                                representative of health plans 
                                or other third party payers;
                                  (VI) one member shall be a 
                                representative of information 
                                technology vendors; and
                                  (VII) one member shall be a 
                                representative of purchasers or 
                                employers.
                  (B) National coordinator.--The National 
                Coordinator shall be a member of the 
                Partnership and act as a liaison among the 
                Partnership, the community, and the Federal 
                Government.
          (2) Chairperson and vice chairperson.--The 
        Partnership shall designate one member to serve as the 
        chairperson and one member to serve as the vice 
        chairperson of the Partnership.
          (3) Participation.--In appointing members under 
        paragraph (1)(A), and in developing the procedures for 
        conducting the activities of the Partnership, the 
        Partnership shall ensure a balance among various 
        sectors of the health care system so that no single 
        sector unduly influences the recommendations of the 
        Partnership.
          (4) Terms.--Members appointed under paragraph (1)(A) 
        shall serve for 3 year terms, except that any member 
        appointed to fill a vacancy for an unexpired term shall 
        be appointed for the remainder of such term. A member 
        may serve for not to exceed 180 days after the 
        expiration of such member's term or until a successor 
        has been appointed.
          (5) Outside involvement.--The Partnership shall 
        ensure an adequate opportunity for the participation of 
        outside advisors, including individuals with expertise 
        in--
                  (A) health information privacy;
                  (B) health information security;
                  (C) health care quality and patient safety, 
                including individuals with expertise in 
                utilizing health information technology to 
                improve health care quality and patient safety;
                  (D) medical and clinical research data 
                exchange; and
                  (E) developing health information technology 
                standards and new health information 
                technology.
          (6) Quorum.--Two-thirds of the members of the 
        Partnership shall constitute a quorum for the purpose 
        of conducting votes.
    (c) Standards and Implementation Specifications.--
          (1) Schedule.--Not later than 90 days after the date 
        of enactment of this title, the Partnership shall 
        develop a schedule for the assessment of standards and 
        implementation specifications under this section. The 
        Partnership shall update such schedule annually. The 
        Secretary shall publish such schedule in the Federal 
        Register and on the Internet website of the Department 
        of Health and Human Services.
          (2) First year recommendations.--Consistent with the 
        schedule published under paragraph (1) and not later 
        than 1 year after date of enactment of this title, the 
        Partnership shall recommend, and the Secretary shall 
        review, such standards and implementation 
        specifications.
          (3) Ongoing recommendations.--The Partnership shall 
        review and modify, as appropriate but at least 
        annually, adopted standards and implementation 
        specifications and continue to recommend additional 
        standards and implementation specifications, consistent 
        with the schedule published pursuant to paragraph (1). 
        The Secretary shall review such modifications and 
        recommendations.
          (4) Recognition of private entities.--The 
        Partnership, in consultation with the Secretary, may 
        recognize a private entity or entities for the purpose 
        of developing and updating standards and implementation 
        specifications to achieve uniform and consistent 
        implementation of the standards adopted by the 
        President under this title. Such entity or entities 
        shall make recommendations to the Partnership 
        consistent with this section.
          (5) Publication.--All recommendations made by the 
        Partnership pursuant to this section shall be published 
        in the Federal Register and on the Internet website of 
        the Office of the National Coordinator.
          (6) Pilot testing.--The Secretary may conduct, or 
        recognize a private entity or entities to conduct, a 
        pilot project to test the standards and implementation 
        specifications developed under this section in order to 
        provide for the efficient implementation of the 
        standards and implementation specifications described 
        in this subsection prior to issuing such 
        recommendations.
          (7) Public input.--The Partnership shall conduct open 
        public meetings and develop a process to allow for 
        public comment on the schedule and recommendations 
        described in this section. Such process shall ensure 
        that such comments will be submitted within 30 days of 
        the publication of a recommendation under this section.
          (8) Federal action.--Not later than 90 days after the 
        issuance of a recommendation from the Partnership under 
        this subsection, the Secretary, the Secretary of 
        Veterans Affairs, and the Secretary of Defense, in 
        collaboration with representatives of other relevant 
        Federal agencies as determined appropriate by the 
        President, shall jointly review such recommendation. If 
        appropriate, the President shall provide for the 
        adoption by the Federal Government of any standard or 
        implementation specification contained in such 
        recommendation. Such determination shall be published 
        in the Federal Register and on the Internet website of 
        the Office of the National Coordinator within 30 days 
        after such determination is made.
          (9) Consistency.--The standards and implementation 
        specifications described in this subsection shall be 
        consistent with the standards for information 
        transactions and data elements developed pursuant to 
        the regulations promulgated under section 264(c) of the 
        Health Insurance Portability and Accountability Act of 
        1996.
    (d) Certification.--
          (1) Developing criteria.--The Partnership, in 
        consultation with the Secretary, may recognize a 
        private entity or entities for the purpose of 
        developing and recommending to the Partnership criteria 
        to certify that appropriate categories of health 
        information technology products that claim to be in 
        compliance with applicable standards and implementation 
        specifications adopted under this title have 
        established such compliance.
          (2) Adoption of criteria.--The Secretary, based upon 
        the recommendations of the Partnership, shall review, 
        and if appropriate, adopt such criteria.
          (3) Conducting certification.--The Secretary may 
        recognize a private entity or entities to conduct the 
        certifications described under paragraph (1) using the 
        criteria adopted by the Secretary under this 
        subsection.
    (e) Rule of Construction.--Nothing in this section shall be 
construed as disrupting existing activities described in 
subsection (c) or (d).
    (f) Requirement to Consider Recommendations.--In carrying 
out the activities described in subsections (c) and (d), the 
Partnership shall adopt and integrate the recommendations of 
the Community that are adopted by the Secretary.
    (g) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section, $2,000,000 for 
each of the fiscal years 2008 and 2009.

SEC. 3004. AMERICAN HEALTH INFORMATION COMMUNITY--POLICIES.

    (a) Establishment.--There is established a committee to be 
known as the American Health Information Community. The 
Community shall--
          (1) provide advice to the Secretary and the heads of 
        any relevant Federal agencies concerning the policy 
        considerations related to health information 
        technology;
          (2) not later than 1 year after the date of enactment 
        of this title, and annually thereafter, make 
        recommendations concerning a policy framework for the 
        development and adoption of a nationwide interoperable 
        health information technology infrastructure;
          (3) not later than 1 year after the date of enactment 
        of this title, and annually thereafter, make 
        recommendation concerning national policies for 
        adoption by the Federal Government, and voluntary 
        adoption by private entities, to support the widespread 
        adoption of health information technology, including--
                  (A) the protection of individually 
                identifiable health information, including 
                policies concerning the individual's ability to 
                control the acquisition, uses, and disclosures 
                of individually identifiable health 
                information;
                  (B) methods to protect individually 
                identifiable health information from improper 
                use and disclosures and methods to notify 
                patients if their individually identifiable 
                health information is wrongfully disclosed;
                  (C) methods to facilitate secure access to 
                such individual's individually identifiable 
                health information;
                  (D) the appropriate uses of a nationwide 
                health information network including--
                          (i) the collection of quality data 
                        and public reporting;
                          (ii) biosurveillance and public 
                        health;
                          (iii) medical and clinical research; 
                        and
                          (iv) drug safety;
                  (E) fostering the public understanding of 
                health information technology;
                  (F) strategies to enhance the use of health 
                information technology in preventing and 
                managing chronic disease;
                  (G) policies to incorporate the input of 
                employees of health care providers in the 
                design and implementation of health information 
                technology systems; and
                  (H) other policies determined to be necessary 
                by the Community; and
          (4) serve as a forum for the participation of a broad 
        range of stakeholders to provide input on improving the 
        effective implementation of health information 
        technology systems.
    (b) Publication.--All recommendations made by the Community 
pursuant to this section shall be published in the Federal 
Register and on the Internet website of the National 
Coordinator. The Secretary shall review all recommendations and 
determine which recommendations shall be endorsed by the 
Federal Government and such determination shall be published on 
the Internet website of the Office of the National Coordinator 
within 30 days after the date on which such endorsement is 
made.
    (c) Membership.--
          (1) In general.--The Community shall be composed of 
        members to be appointed as follows:
                  (A) 3 members shall be appointed by the 
                Secretary, 1 of whom shall be a representative 
                from the Department of Health and Human 
                Services.
                  (B) 1 member shall be appointed by the 
                Secretary of Veterans Affairs who shall 
                represent the Department of Veterans Affairs.
                  (C) 1 member shall be appointed by the 
                Secretary of Defense who shall represent the 
                Department of Defense.
                  (D) 1 member shall be appointed by the 
                majority leader of the Senate.
                  (E) 1 member shall be appointed by the 
                minority leader of the Senate.
                  (F) 1 member shall be appointed by the 
                Speaker of the House of Representatives.
                  (G) 1 member shall be appointed by the 
                minority leader of the House of 
                Representatives.
                  (H) Nine members shall be appointed by the 
                Comptroller General of whom--
                          (i) one member shall be advocates for 
                        patients or consumers;
                          (ii) one member shall represent 
                        health care providers;
                          (iii) one member shall be from a 
                        labor organization representing health 
                        care workers;
                          (iv) one member shall have expertise 
                        in privacy and security;
                          (v) one member shall have expertise 
                        in improving the health of vulnerable 
                        populations;
                          (vi) one member shall represent 
                        health plans or other third party 
                        payers;
                          (vii) one member shall represent 
                        information technology vendors;
                          (viii) one member shall represent 
                        purchasers or employers; and
                          (ix) one member shall have expertise 
                        in health care quality measurement and 
                        reporting.
          (2) Chairperson and vice chairperson.--The Community 
        shall designate one member to serve as the chairperson 
        and one member to serve as the vice chairperson of the 
        Community.
          (3) National coordinator.--The National Coordinator 
        shall be a member of the Community and act as a liaison 
        among the Community, the partnership, and the Federal 
        Government.
          (4) Participation.--The members of the Community 
        appointed under paragraph (1) shall represent a balance 
        among various sectors of the health care system so that 
        no single sector unduly influences the recommendations 
        of the Community.
          (5) Terms.--
                  (A) In general.--The terms of members of the 
                Community shall be for 3 years except that the 
                Comptroller General shall designate staggered 
                terms for the members first appointed.
                  (B) Vacancies.--Any member appointed to fill 
                a vacancy in the membership of the Community 
                that occurs prior to the expiration of the term 
                for which the member's predecessor was 
                appointed shall be appointed only for the 
                remainder of that term. A member may serve 
                after the expiration of that member's term 
                until a successor has been appointed. A vacancy 
                in the Community shall be filled in the manner 
                in which the original appointment was made.
          (6) Outside involvement.--The Community shall ensure 
        an adequate opportunity for the participation of 
        outside advisors, including individuals with expertise 
        in--
                  (A) health information privacy and security;
                  (B) improving the health of vulnerable 
                populations;
                  (C) health care quality and patient safety, 
                including individuals with expertise in 
                measurement and the use of health information 
                technology to capture data to improve health 
                care quality and patient safety;
                  (D) ethics;
                  (E) medical and clinical research data 
                exchange; and
                  (F) developing health information technology 
                standards and new health information 
                technology.
          (7) Quorum.--Ten members of the Community shall 
        constitute a quorum for purposes of voting, but a 
        lesser number of members may meet and hold hearings.
    (d) Federal Agencies.--
          (1) Staff of other federal agencies.--Upon the 
        request of the Community, the head of any Federal 
        agency may detail, without reimbursement, any of the 
        personnel of such agency to the Community to assist in 
        carrying out the duties of the Community. Any such 
        detail shall not interrupt or otherwise affect the 
        civil service status or privileges of the Federal 
        employee involved.
          (2) Technical assistance.--Upon the request of the 
        Community, the head of a Federal agency shall provide 
        such technical assistance to the Community as the 
        Community determines to be necessary to carry out its 
        duties.
          (3) Other resources.--The Community shall have 
        reasonable access to materials, resources, statistical 
        data, and other information from the Library of 
        Congress and agencies and elected representatives of 
        the executive and legislative branches of the Federal 
        Government. The chairperson or vice chairperson of the 
        Community shall make requests for such access in 
        writing when necessary.
    (e) Application of FACA.--The Federal Advisory Committee 
Act (5 U.S.C. App.) shall apply to the Community, except that 
the term provided for under section 14(a)(2) of such Act shall 
be not longer than 7 years.
    (f) Sunset.-- The provisions of this section shall not 
apply after September 20, 2014.
    (g) Authorization of Appropriations.--There is authorized 
to be appropriated to carry out this section, $2,000,000 for 
each of fiscal years 2008 and 2009.

SEC. 3005. FEDERAL PURCHASING AND DATA COLLECTION.

    (a) Coordination of Federal Spending.--
          (1) In general.--Not later than 1 year after the 
        adoption by the President of a recommendation under 
        section 3003(c)(6), a Federal agency shall not expend 
        Federal funds for the purchase of any new health 
        information technology or health information technology 
        system for clinical care or for the electronic 
        retrieval, storage, or exchange of health information 
        if such technology or system is not consistent with 
        applicable standards adopted by the Federal Government 
        under section 3003.
          (2) Rule of construction.--Nothing in paragraph (1) 
        shall be construed to restrict the purchase of minor 
        (as determined by the Secretary) hardware or software 
        components in order to modify, correct a deficiency in, 
        or extend the life of existing hardware or software.
    (b) Voluntary Adoption.--
          (1) In general.--Any standards and implementation 
        specifications adopted by the Federal Government under 
        section 303(c)(6) shall be voluntary with respect to 
        private entities.
          (2) Requirement.--Private entities that enter into a 
        contract with the Federal Government shall adopt the 
        standards and implementation specifications adopted by 
        the Federal Government under this section for the 
        purpose of activities under such Federal contract.
          (3) Rule of construction.--Nothing in this section 
        shall be construed to require that a private entity 
        that enters into a contract with the Federal Government 
        adopt the standards and implementation specifications 
        adopted by the Federal Government under this section 
        with respect to activities not related to the contract.
    (c) Coordination of Federal Data Collection.--Not later 
than 3 years after the adoption by the Federal Government of a 
recommendation as provided for in section 303(c)(6), all 
Federal agencies collecting health data in an electronic format 
for the purposes of quality reporting, surveillance, 
epidemiology, adverse event reporting, research, or for other 
purposes determined appropriate by the Secretary, shall comply 
with the standards and implementation specifications adopted 
under such subsection.

SEC. 3006. QUALITY AND EFFICIENCY REPORTS.

    (a) Purpose.--The purpose of this section is to provide for 
the development of reports based on Federal health care data 
and private data that is publicly available or is provided by 
the entity making the request for the report in order to--
          (1) improve the quality and efficiency of health care 
        and advance health care research;
          (2) enhance the education and awareness of consumers 
        for evaluating health care services; and
          (3) provide the public with reports on national, 
        regional, and provider- and supplier-specific 
        performance, which may be in a provider- or supplier-
        identifiable format.
    (b) Procedures for the Development of Reports.--
          (1) In general.--Notwithstanding section 552(b)(6) or 
        552a(b) of title 5, United States Code, not later than 
        12 months after the date of enactment of this section, 
        the Secretary, in accordance with the purpose described 
        in subsection (a), shall establish and implement 
        procedures under which an entity may submit a request 
        to a Quality Reporting Organization for the 
        Organization to develop a report based on--
                  (A) Federal health care data disclosed to the 
                Organization under subsection (c); and
                  (B) private data that is publicly available 
                or is provided to the Organization by the 
                entity making the request for the report.
          (2) Definitions.--In this section:
                  (A) Federal health care data.--The term 
                ``Federal health care data'' means--
                          (i) deidentified patient enrollment 
                        data, reimbursement claims, and survey 
                        data maintained by the Secretary or 
                        entities under programs, contracts, 
                        grants, or memoranda of understanding 
                        administered by the Secretary; and
                          (ii) where feasible, other 
                        deidentified patient enrollment data, 
                        reimbursement claims, and survey data 
                        maintained by the Federal Government or 
                        entities under contract with the 
                        Federal Government.
                  (B) Quality reporting organization.--The term 
                ``Quality Reporting Organization'' means an 
                entity with a contract under subsection (d).
    (c) Access to Federal Health Care Data.--
          (1) In general.--The procedures established under 
        subsection (b)(1) shall provide for the secure 
        disclosure of Federal health care data to each Quality 
        Reporting Organization.
          (2) Update of information.--Not less than every 6 
        months, the Secretary shall update the information 
        disclosed under paragraph (1) to Quality Reporting 
        Organizations.
    (d) Quality Reporting Organizations.--
          (1) In general.--
                  (A) Three contracts.--Subject to subparagraph 
                (B), the Secretary shall enter into a contract 
                with 3 private entities to serve as Quality 
                Reporting Organizations under which an entity 
                shall--
                          (i) store the Federal health care 
                        data that is to be disclosed under 
                        subsection (c); and
                          (ii) develop and release reports 
                        pursuant to subsection (e).
                  (B) Additional contracts.--If the Secretary 
                determines that reports are not being developed 
                and released within 6 months of the receipt of 
                the request for the report, the Secretary shall 
                enter into contracts with additional private 
                entities in order to ensure that such reports 
                are developed and released in a timely manner.
          (2) Qualifications.--The Secretary shall enter into a 
        contract with an entity under paragraph (1) only if the 
        Secretary determines that the entity--
                  (A) has the research capability to conduct 
                and complete reports under this section;
                  (B) has in place--
                          (i) an information technology 
                        infrastructure to support the database 
                        of Federal health care data that is to 
                        be disclosed to the entity; and
                          (ii) operational standards to provide 
                        security for such database;
                  (C) has experience with, and expertise on, 
                the development of reports on health care 
                quality and efficiency; and
                  (D) has a significant business presence in 
                the United States.
          (3) Contract requirements.--Each contract with an 
        entity under paragraph (1) shall contain the following 
        requirements:
                  (A) Ensuring beneficiary privacy.--
                          (i) HIPAA.--The entity shall meet the 
                        requirements imposed on a covered 
                        entity for purposes of applying part C 
                        of title XI and all regulatory 
                        provisions promulgated thereunder, 
                        including regulations (relating to 
                        privacy) adopted pursuant to the 
                        authority of the Secretary under 
                        section 264(c) of the Health Insurance 
                        Portability and Accountability Act of 
                        1996 (42 U.S.C. 1320d-2 note).
                          (ii) Privacy.-- The entity shall 
                        provide assurances that the entity will 
                        not use the Federal health care data 
                        disclosed under subsection (c) in a 
                        manner that violates sections 552 or 
                        552a of title 5, United States Code, 
                        with regard to the privacy of and 
                        individual's individually identifiable 
                        health information.
                  (B) Proprietary information.--The entity 
                shall provide assurances that the entity will 
                not disclose any negotiated price concessions, 
                such as discounts, direct or indirect 
                subsidies, rebates, and direct or indirect 
                remunerations, obtained by health care 
                providers or suppliers or health care plans, or 
                any other proprietary cost information.
                  (C) Disclosure.--The entity shall disclose--
                          (i) any financial, reporting, or 
                        contractual relationship between the 
                        entity and any health care provider or 
                        supplier or health care plan; and
                          (ii) if applicable, the fact that the 
                        entity is managed, controlled, or 
                        operated by any health care provider or 
                        supplier or health care plan.
                  (D) Component of another organization.--If 
                the entity is a component of another 
                organization--
                          (i) the entity shall maintain Federal 
                        health care data and reports separately 
                        from the rest of the organization and 
                        establish appropriate security measures 
                        to maintain the confidentiality and 
                        privacy of the Federal health care data 
                        and reports; and
                          (ii) the entity shall not make an 
                        unauthorized disclosure to the rest of 
                        the organization of Federal health care 
                        data or reports in breach of such 
                        confidentiality and privacy 
                        requirement.
                  (E) Termination or nonrenewal.--If a contract 
                under this section is terminated or not 
                renewed, the following requirements shall 
                apply:
                          (i) Confidentiality and privacy 
                        protections.--The entity shall continue 
                        to comply with the confidentiality and 
                        privacy requirements under this section 
                        with respect to all Federal health care 
                        data disclosed to the entity and each 
                        report developed by the entity.
                          (ii) Disposition of data and 
                        reports.--The entity shall--
                                  (I) return to the Secretary 
                                all Federal health care data 
                                disclosed to the entity and 
                                each report developed by the 
                                entity; or
                                  (II) if returning the Federal 
                                health care data and reports is 
                                not practicable, destroy the 
                                reports and Federal health care 
                                data.
          (4) Competitive procedures.--Competitive procedures 
        (as defined in section 4(5) of the Federal Procurement 
        Policy Act) shall be used to enter into contracts under 
        paragraph (1).
          (5) Review of contract in the event of a merger or 
        acquisition.--The Secretary shall review the contract 
        with a Quality Reporting Organization under this 
        section in the event of a merger or acquisition of the 
        Organization in order to ensure that the requirements 
        under this section will continue to be met.
    (e) Development and Release of Reports Based on Requests.--
          (1) Request for a report.--
                  (A) Request.--
                          (i) In general.--The procedures 
                        established under subsection (b)(1) 
                        shall include a process for an entity 
                        to submit a request to a Quality 
                        Reporting Organization for a report 
                        based on Federal health care data and 
                        private data that is publicly available 
                        or is provided by the entity making the 
                        request for the report. Such request 
                        shall comply with the purpose described 
                        in subsection (a).
                          (ii) Request for specific 
                        methodology.--The process described in 
                        clause (i) shall permit an entity 
                        making a request for a report to 
                        request that a specific methodology, 
                        including appropriate risk adjustment, 
                        be used by the Quality Reporting 
                        Organization in developing the report. 
                        The Organization shall work with the 
                        entity making the request to finalize 
                        the methodology to be used.
                          (iii) Request for a specific qro.--
                        The process described in clause (i) 
                        shall permit an entity to submit the 
                        request for a report to any Quality 
                        Reporting 0rganization.
                  (B) Release to public.--The procedures 
                established under subsection (b)(1) shall 
                provide that at the time a request for a report 
                is finalized under subparagraph (A) by a 
                Quality Reporting Organization, the 
                Organization shall make available to the 
                public, through the Internet website of the 
                Department of Health and Human Services and 
                other appropriate means, a brief description of 
                both the requested report and the methodology 
                to be used to develop such report.
          (2) Development and release of report.--
                (A) Development.--
                          (i) In general.--If the request for a 
                        report complies with the purpose 
                        described in subsection (a), the 
                        Quality Reporting Organization may 
                        develop the report based on the 
                        request.
                          (ii) Requirement.--A report developed 
                        under clause (i) shall include a 
                        detailed description of the standards, 
                        methodologies, and measures of quality 
                        used in developing the report.
                  (B) Review of report by secretary to ensure 
                compliance with privacy requirement.--Prior to 
                a Quality Reporting Organization releasing a 
                report under subparagraph (C), the Secretary 
                shall review the report to ensure that the 
                report complies with the Federal regulations 
                (concerning the privacy of individually 
                identifiable beneficiary health information) 
                promulgated under section 264(c) of the Health 
                Insurance Portability and Accountability Act of 
                1996 and sections 552 or 552a of title 5, 
                United States Code, with regard to the privacy 
                of individually identifiable beneficiary health 
                information. The Secretary shall act within 30 
                business days of receiving such report.
                  (C) Release of report.--
                          (i) Release to entity making 
                        request.--If the Secretary finds that 
                        the report complies with the provisions 
                        described in subparagraph (B), the 
                        Quality Reporting Organization shall 
                        release the report to the entity that 
                        made the request for the report.
                          (ii) Release to public.--The 
                        procedures established under subsection 
                        (b)(1) shall provide for the following:
                                  (I) Updated description.--At 
                                the time of the release of a 
                                report by a Quality Reporting 
                                Organization under clause (i), 
                                the entity shall make available 
                                to the public, through the 
                                Internet website of the 
                                Department of Health and Human 
                                Services and other appropriate 
                                means, an updated brief 
                                description of both the 
                                requested report and the 
                                methodology used to develop 
                                such report.
                                  (II) Complete report.--Not 
                                later than 1 year after the 
                                date of the release of a report 
                                under clause (i), the report 
                                shall be made available to the 
                                public through the Internet 
                                website of the Department of 
                                Health and Human Services and 
                                other appropriate means.
    (f) Annual Review of Reports and Termination of 
Contracts.--
          (1) Annual review of reports.--The Comptroller 
        General of the United States shall review reports 
        released under subsection (e)(2)(C) to ensure that such 
        reports comply with the purpose described in subsection 
        (a) and annually submit a report to the Secretary on 
        such review.
          (2) Termination of contracts.--The Secretary may 
        terminate a contract with a Quality Reporting 
        Organization if the Secretary determines that there is 
        a pattern of reports being released by the Organization 
        that do not comply with the purpose described in 
        subsection (a).
    (g) Fees.--
          (1) Fees for secretary.--The Secretary shall charge a 
        Quality Reporting Organization a fee for--
                  (A) disclosing the data under subsection (c); 
                and
                  (B) conducting the review under subsection 
                (e)(2)(B).
        The Secretary shall ensure that such fees are 
        sufficient to cover the costs of the activities 
        described in subparagraph (A) and (B).
          (2) Fees for qro.--
                  (A) In general.--Subject to subparagraphs (A) 
                and (B), a Quality Reporting Organization may 
                charge an entity making a request for a report 
                a reasonable fee for the development and 
                release of the report.
                  (B) Discount for small entities.--In the case 
                of an entity making a request for a report 
                (including a not-for-profit) that has annual 
                revenue that does not exceed $10,000,000, the 
                Quality Reporting Organization shall reduce the 
                reasonable fee charged to such entity under 
                subparagraph (A) by an amount equal to 10 
                percent of such fee.
                  (C) Increase for large entities that do not 
                agree to release reports within 6 months.--In 
                the case of an entity making a request for a 
                report that is not described in subparagraph 
                (B) and that does not agree to the report being 
                released to the public under clause (ii)(II) of 
                subsection (e)(2)(C) within 6 months of the 
                date of the release of the report to the entity 
                under clause (i) of such subsection, the 
                Quality Reporting Organization shall increase 
                the reasonable fee charged to such entity under 
                subparagraph (A) by an amount equal to 10 
                percent of such fee.
                  (D) Rule of construction.--Nothing in this 
                paragraph shall be construed to effect the 
                requirement that a report be released to the 
                public under clause (ii)(II) of subsection 
                (e)(2)(C)(ii)(II) by not later than 1 year 
                after the date of the release of the report to 
                the requesting entity under clause (i) of such 
                subsection.
    (h) Coordination.--Not later than 1 year after the date of 
enactment of this title, the Secretary shall submit a report 
(including recommendations) to the appropriate committees of 
Congress concerning the coordination of existing Federal health 
care quality initiatives.
    (i) Regulations.--Not later than 6 months after the date of 
enactment of this section, the Secretary shall prescribe 
regulations to carry out this section.

SEC. 3007. RESEARCH ACCESS TO HEALTH CARE DATA AND REPORTING ON 
                    PERFORMANCE.

    The Secretary shall permit researchers that meet criteria 
used to evaluate the appropriateness of the release data for 
research purpose (as established by the Secretary) to--
          (1) have access to all Federal health care data (as 
        defined in section 3006(b)(2)(A)); and
          (2) report on the performance of health care 
        providers and suppliers, including reporting in a 
        provider- or supplier-identfiable format.

           *       *       *       *       *       *       *

SEC. 3008. FACILITATING THE WIDESPREAD ADOPTION OF INTEROPERABLE HEALTH 
                    INFORMATION TECHNOLOGY.

    (a) Competitive Grants for Adoption of Technology.--
          (1) In general.--The Secretary may award competitive 
        grants to eligible entities to facilitate the purchase 
        and enhance the utilization of qualified health 
        information technology systems to improve the quality 
        and efficiency of health care.
          (2) Eligibility.--To be eligible to receive a grant 
        under paragraph (1) an entity shall--
                  (A) submit to the Secretary an application at 
                such time, in such manner, and containing such 
                information as the Secretary may require;
                  (B) submit to the Secretary a strategic plan 
                for the implementation of data sharing and 
                interoperability measures;
                  (C) adopt the standards adopted by the 
                Federal Government under section 3005;
                  (D) implement the measures adopted under 
                section 3010 and report to the Secretary on 
                such measures;
                  (E) agree to notify individuals if their 
                individually identifiable health information is 
                wrongfully disclosed;
                  (F) take into account the input of employees 
                and staff who are directly involved in patient 
                care of such health care providers in the 
                design, implementation, and use of qualified 
                health information technology systems;
                  (G) demonstrate significant financial need;
                  (H) provide matching funds in accordance with 
                paragraph (4); and
                  (I) be a--
                          (i) public or not for profit 
                        hospital;
                          (ii) federally qualified health 
                        center (as defined in section 
                        1861(aa)(4) of the Social Security 
                        Act);
                          (iii) individual or group practice 
                        (or a consortium thereof); or
                          (iv) another health care provider not 
                        described in clause (i) or (ii);
                  that serves medically underserved 
                communities.
          (3) Use of funds.--Amounts received under a grant 
        under this subsection shall be used to--
                  (A) facilitate the purchase of qualified 
                health information technology systems;
                  (B) train personnel in the use of such 
                systems;
                  (C) enhance the utilization of qualified 
                health information technology systems (which 
                may include activities to increase the 
                awareness among consumers of health care 
                privacy protections); or
                  (D) improve the prevention and management of 
                chronic disease.
          (4) Matching requirement.--To be eligible for a grant 
        under this subsection an entity shall contribute non-
        Federal contributions to the costs of carrying out the 
        activities for which the grant is awarded in an amount 
        equal to $1 for each $3 of Federal funds provided under 
        the grant.
          (5) Preference in awarding grants.--In awarding 
        grants under this subsection the Secretary shall give 
        preference to--
                  (A) eligible entities that will improve the 
                degree to which such entity will link the 
                qualified health information system to local or 
                regional health information plan or plans; and
                  (B) with respect to awards made for the 
                purpose of providing care in an outpatient 
                medical setting, entities that organize their 
                practices as a patient-centered medical home.
    (b) Competitive Grants for the Development of State Loan 
Programs to Facilitate the Wide-spread Adoption of Health 
Information Technology.--
          (1) In general.--The Secretary may award competitive 
        grants to States for the establishment of State 
        programs for loans to health care providers to 
        facilitate the purchase and enhance the utilization of 
        qualified health information technology.
          (2) Establishment of fund.--To be eligible to receive 
        a competitive grant under this subsection, a State 
        shall establish a qualified health information 
        technology loan fund (referred to in this subsection as 
        a ``State loan fund'' and comply with the other 
        requirements contained in this subsection. Amounts 
        received under a grant under this subsection shall be 
        deposited in the State loan fund established by the 
        State. No funds authorized by other provisions of this 
        title to be used for other purposes specified in this 
        title shall be deposited in any such State loan fund.
          (3) Eligibility.--To be eligible to receive a grant 
        under paragraph (1) a State shall--
                  (A) submit to the Secretary an application at 
                such time, in such manner, and containing such 
                information as the Secretary may require;
                  (B) submit to the Secretary a strategic plan 
                in accordance with paragraph (4);
                  (C) establish a qualified health information 
                technology loan fund in accordance with 
                paragraph (2);
                  (D) require that health care providers 
                receiving loans under the grant--
                          (i) link, to the extent practicable, 
                        the qualified health information system 
                        to a local or regional health 
                        information network;
                          (ii) consult, as needed, with the 
                        Health Information Technology Resource 
                        Center established in section 914(d) to 
                        access the knowledge and experience of 
                        existing initiatives regarding the 
                        successful implementation and effective 
                        use of health information technology;
                          (iii) agree to notify individuals if 
                        their individually identifiable health 
                        information is wrongfully disclosed; 
                        and
                          (iv) take into account the input of 
                        employees and staff who are directly 
                        involved in patient care of such health 
                        care providers in the design and 
                        implementation and use of qualified 
                        health information technology systems;
                  (E) require that health care providers 
                receiving loans under the grant adopt the 
                standards adopted by the Federal Government 
                under section 3005;
                  (F) require that health care providers 
                receiving loans under the grant implement the 
                measures adopted under section 3010 and report 
                to the Secretary on such measures; and
                  (G) provide matching funds in accordance with 
                paragraph (8).
          (4) Strategic plan.--
                  (A) In general.--A State that receives a 
                grant under this subsection shall annually 
                prepare a strategic plan that identifies the 
                intended uses of amounts available to the State 
                loan fund of the State.
                  (B) Contents.--A strategic plan under 
                subparagraph (A) shall include--
                          (i) a list of the projects to be 
                        assisted through the State loan fund in 
                        the first fiscal year that begins after 
                        the date on which the plan is 
                        submitted;
                          (ii) a description of the criteria 
                        and methods established for the 
                        distribution of funds from the State 
                        loan fund;
                          (iii) a description of the financial 
                        status of the State loan fund and the 
                        short-term and long-term goals of the 
                        State loan fund; and
                          (iv) a description of the strategies 
                        the State will use to address 
                        challenges in the adoption of health 
                        information technology due to limited 
                        broadband access.
          (5) Use of funds.--
                  (A) In general.--Amounts deposited in a State 
                loan fund, including loan repayments and 
                interest earned on such amounts, shall be used 
                only for awarding loans or loan guarantees, or 
                as a source of reserve and security for 
                leveraged loans, the proceeds of which are 
                deposited in the State loan fund established 
                under paragraph (1). Loans under this section 
                may be used by a health care provider to--
                          (i) facilitate the purchase of 
                        qualified health information technology 
                        systems;
                          (ii) enhance the utilization of 
                        qualified health information technology 
                        systems (which may include activities 
                        to increase the awareness among 
                        consumers of health care of privacy 
                        protections and privacy rights); or
                          (iii) train personnel in the use of 
                        such systems.
                  (B) Limitation.--Amounts received by a State 
                under this subsection may not be used--
                          (i) for the purchase or other 
                        acquisition of any health information 
                        technology system that is not a 
                        qualified health information technology 
                        system;
                          (ii) to conduct activities for which 
                        Federal funds are expended under this 
                        title, or the amendments made by the 
                        Wired for Health Care Quality Act; or
                          (iii) for any purpose other than 
                        making loans to eligible entities under 
                        this section.
          (6) Types of assistance.--Except as otherwise limited 
        by applicable State law, amounts deposited into a State 
        loan fund under this subsection may only be used for 
        the following:
                  (A) To award loans that comply with the 
                following:
                          (i) The interest rate for each loan 
                        shall be less than or equal to the 
                        market interest rate.
                          (ii) The principal and interest 
                        payments on each loan shall commence 
                        not later than 1 year after the date on 
                        which the loan was awarded, and each 
                        loan shall be fully amortized not later 
                        than 10 years after such date.
                          (iii) The State loan fund shall be 
                        credited with all payments of principal 
                        and interest on each loan awarded from 
                        the fund.
                  (B) To guarantee, or purchase insurance for, 
                a local obligation (all of the proceeds of 
                which finance a project eligible for assistance 
                under this subsection) if the guarantee or 
                purchase would improve credit market access or 
                reduce the interest rate applicable to the 
                obligation involved.
                  (C) As a source of revenue or security for 
                the payment of principal and interest on 
                revenue or general obligation bonds issued by 
                the State if the proceeds of the sale of the 
                bonds will be deposited into the State loan 
                fund.
                  (D) To earn interest on the amounts deposited 
                into the State loan fund.
          (7) Administration of state loan funds.--
                  (A) Combined financial administration.--A 
                State may (as a convenience and to avoid 
                unnecessary administrative costs) combine, in 
                accordance with State law, the financial 
                administration of a State loan fund established 
                under this subsection with the financial 
                administration of any other revolving fund 
                established by the State if not otherwise 
                prohibited by the law under which the State 
                loan fund was established.
                  (B) Cost of administering fund.--Each State 
                may annually use not to exceed 4 percent of the 
                funds provided to the State under a grant under 
                this subsection to pay the reasonable costs of 
                the administration of the programs under this 
                section, including the recovery of reasonable 
                costs expended to establish a State loan fund 
                which are incurred after the date of enactment 
                of this title.
                  (C) Guidance and regulations.--The Secretary 
                shall publish guidance and promulgate 
                regulations as may be necessary to carry out 
                the provisions of this subsection, including--
                          (i) provisions to ensure that each 
                        State commits and expends funds 
                        allotted to the State under this 
                        subsection as efficiently as possible 
                        in accordance with this title and 
                        applicable State laws; and
                          (ii) guidance to prevent waste, 
                        fraud, and abuse.
                  (D) Private sector contributions.--
                          (i) In general.--A State loan fund 
                        established under this subsection may 
                        accept contributions from private 
                        sector entities, except that such 
                        entities may not specify the recipient 
                        or recipients of any loan issued under 
                        this subsection.
                          (ii) Availability of information.--A 
                        State shall make publicly available the 
                        identity of, and amount contributed by, 
                        any private sector entity under clause 
                        (i) and may issue letters of 
                        commendation or make other awards (that 
                        have no financial value) to any such 
                        entity.
          (8) Matching requirements.--
                  (A) In general.--The Secretary may not make a 
                grant under paragraph (1) to a State unless the 
                State agrees to make available (directly or 
                through donations from public or private 
                entities) non-Federal contributions in cash 
                toward the costs of the State program to be 
                implemented under the grant in an amount equal 
                to not less than $1 for each $1 of Federal 
                funds provided under the grant.
                  (B) Determination of amount of nonfederal 
                contribution.--In determining the amount of 
                non-Federal contributions that a State has 
                provided pursuant to subparagraph (A), the 
                Secretary may not include any amounts provided 
                to the State by the Federal Government.
          (9) Preference in awarding grants.--The Secretary may 
        give a preference in awarding grants under this 
        subsection to States that adopt value-based purchasing 
        programs to improve health care quality.
          (10) Reports.--The Secretary shall annually submit to 
        the Committee on Health, Education, Labor, and Pensions 
        and the Committee on Finance of the Senate, and the 
        Committee on Energy and Commerce and the Committee on 
        Ways and Means of the House of Representatives, a 
        report summarizing the reports received by the 
        Secretary from each State that receives a grant under 
        this subsection.
    (c) Competitive Grants for the Implementation of Regional 
or Local Health Information Technology Plans.--
          (1) In general.--The Secretary may award competitive 
        grants to eligible entities to implement regional or 
        local health information plans to improve health care 
        quality and efficiency through the electronic exchange 
        of health information pursuant to the standards, 
        implementation specifications and certification 
        criteria, and other requirements adopted by the 
        Secretary under section 3010.
          (2) Eligibility.--To be eligible to receive a grant 
        under paragraph (1) an entity shall--
                  (A) demonstrate financial need to the 
                Secretary;
                  (B) demonstrate that one of its principal 
                missions or purposes is to use information 
                technology to improve health care quality and 
                efficiency;
                  (C) adopt bylaws, memoranda of understanding, 
                or other charter documents that demonstrate 
                that the governance structure and 
                decisionmaking processes of such entity allow 
                for participation on an ongoing basis by 
                multiple stakeholders within a community, 
                including--
                          (i) health care providers (including 
                        health care providers that provide 
                        services to low income and underserved 
                        populations);
                          (ii) pharmacists or pharmacies;
                          (iii) health plans;
                          (iv) health centers (as defined in 
                        section 330(b)) and federally qualified 
                        health centers (as defined in section 
                        1861(aa)(4) of the Social Security Act) 
                        and rural health clinics (as defined in 
                        section 1861(aa) of the Social Security 
                        Act), if such centers or clinics are 
                        present in the community served by the 
                        entity;
                          (v) patient or consumer organzations;
                          (vi) organizations dedicated to 
                        improving the health of vulnerable 
                        populations;
                          (vii) employers;
                          (viii) State or local health 
                        departments; and
                          (ix) any other health care providers 
                        or other entities, as determined 
                        appropriate by the Secretary;
                  (D) demonstrate the participation, to the 
                extent practicable, of stakeholders in the 
                electronic exchange of health information 
                within the local or regional plan pursuant to 
                subparagraph (C);
                  (E) adopt nondiscrimination and conflict of 
                interest policies that demonstrate a commitment 
                to open, fair, and nondiscriminatory 
                participation in the health information plan by 
                all stakeholders;
                  (F) adopt the standards adopted by the 
                Secretary under section 3005;
                  (G) require that health care providers 
                receiving such grants--
                          (i) implement the measures adopted 
                        under section 3010 and report to the 
                        Secretary on such measures; and
                          (ii) take into account the input of 
                        employees and staff who are directly 
                        involved in patient care of such health 
                        care providers in the design, 
                        implementation, and use of health 
                        information technology systems;
                  (H) agree to notify individuals if their 
                individually identifiable health information is 
                wrongfully disclosed;
                  (I) facilitate the electronic exchange of 
                health information within the local or regional 
                area and among local and regional areas;
                  (J) prepare and submit to the Secretary an 
                application in accordance with paragraph (3);
                  (K) agree to provide matching funds in 
                accordance with paragraph (5); and
                  (L) reduce barriers to the implementation of 
                health information technology by providers.
          (3) Application.--
                  (A) In general.--To be eligible to receive a 
                grant under paragraph (1), an entity shall 
                submit to the Secretary an application at such 
                time, in such manner, and containing such 
                information as the Secretary may require.
                  (B) Required information.--At a minimum, an 
                application submitted under this paragraph 
                shall include--
                          (i) clearly identified short-term and 
                        long-term objectives of the regional or 
                        local health information plan;
                          (ii) a technology plan that complies 
                        with the standards, implementation 
                        specifications, and certification 
                        criteria adopted under section 
                        3003(c)(6) and that includes a 
                        descriptive and reasoned estimate of 
                        costs of the hardware, software, 
                        training, and consulting services 
                        necessary to implement the regional or 
                        local health information plan;
                          (iii) a strategy that includes 
                        initiatives to improve health care 
                        quality and efficiency, including the 
                        use and reporting of health care 
                        quality measures adopted under section 
                        3010;
                          (iv) a plan that describes provisions 
                        to encourage the implementation of the 
                        electronic exchange of health 
                        information by all health care 
                        providers participating in the health 
                        information plan;
                          (v) a plan to ensure the privacy and 
                        security of individually identifiable 
                        health information that is consistent 
                        with Federal and State law;
                          (vi) a governance plan that defines 
                        the manner in which the stakeholders 
                        shall jointly make policy and 
                        operational decisions on an ongoing 
                        basis;
                          (vii) a financial or business plan 
                        that describes--
                                  (I) the sustainability of the 
                                plan;
                                  (II) the financial costs and 
                                benefits of the plan; and
                                  (III) the entities to which 
                                such costs and benefits will 
                                accrue;
                          (viii) a description of whether the 
                        State in which the entity resides has 
                        received a grant under section 319D, 
                        alone or as a part of a consortium, and 
                        if the State has received such a grant, 
                        how the entity will coordinate the 
                        activities funded under such section 
                        319D with the system under this 
                        section; and
                          (ix) in the case of an applicant 
                        entity that is unable to demonstrate 
                        the participation of all stakeholders 
                        pursuant to paragraph (2)(C), the 
                        justification from the entity for any 
                        such nonparticipation.
          (4) Use of funds.--Amounts received under a grant 
        under paragraph (1) shall be used to establish and 
        implement a regional or local health information plan 
        in accordance with this subsection.
          (5) Matching requirement.--
                  (A) In general.--The Secretary may not make a 
                grant under this subsection to an entity unless 
                the entity agrees that, with respect to the 
                costs to be incurred by the entity in carrying 
                out the infrastructure program for which the 
                grant was awarded, the entity will make 
                available (directly or through donations from 
                public or private entities) non-Federal 
                contributions toward such costs in an amount 
                equal to not less than 50 percent of such costs 
                ($1 for each $2 of Federal funds provided under 
                the grant).
                  (B) Determinatiion of amount contributed.--
                Non-Federal contributions required under 
                subparagraph (A) may be in cash or in kind, 
                fairly evaluated, including equipment, 
                technology, or services. Amounts provided by 
                the Federal Government, or services assisted or 
                subsidized to any significant extent by the 
                Federal Government, may not be included in 
                determining the amount of such non-Federal 
                contributions.
    (d) Reports.--Not later than 1 year after the date on which 
the first grant is awarded under this section, and annually 
thereafter during the grant period, an entity that receives a 
grant under this section shall submit to the Secretary a report 
on the activities carried out under the grant involved. Each 
such report shall include--
          (1) a description of the financial costs and benefits 
        of the project involved and of the entities to which 
        such costs and benefits accrue;
          (2) an analysis of the impact of the project on 
        health care quality and safety;
          (3) a description of any reduction in duplicative or 
        unnecessary care as a result of the project involved; 
        and
          (4) other information as required by the Secretary.
    (e) Authorization of Appropriations.--
          (1) In general.--For the purpose of carrying out this 
        section, there is authorized to be appropriated 
        $139,000,000 for fiscal year 2008 and $139,000,000 for 
        fiscal year 2009.
          (2) Availability.--Amounts appropriated under 
        paragraph (1) shall remain available through fiscal 
        year 2012.

           *       *       *       *       *       *       *

SEC. 3009. DEMONSTRATION PROGRAM TO INTEGRATE INFORMATION TECHNOLOGY 
                    INTO CLINICAL EDUCATION.

    (a) In General.--The Secretary may award grants to eligible 
entities or consortia under this section to carry out 
demonstration projects to develop academic curricula 
integrating qualified health information technology systems in 
the clinical education of health professionals or analyze 
clinical data sets to discover quality measures. Such awards 
shall be made on a competitive basis and pursuant to peer 
review.
    (b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity or consortium shall--
          (1) submit to the Secretary an application at such 
        time, in such manner, and containing such information 
        as the Secretary may require;
          (2) be or include--
                  (A) a health professions school;
                  (B) a school of nursing; or
                  (C) an institution with a graduate medical 
                education program;
          (3) provide for the collection of data regarding the 
        effectiveness of the demonstration project to be funded 
        under the grant in improving the safety of patients and 
        the efficiency of health care delivery; and
          (4) provide matching funds in accordance with 
        subsection (d).
    (c) Use of Funds.--
          (1) In general.--With respect to a grant under 
        subsection (a), an eligible entity or consortium shall 
        use amounts received under the grant in collaboration 
        with 2 or more disciplines.
          (2) Limitation.--An eligible entity or consortium 
        shall not award a grant under subsection (a) to 
        purchase hardware, software, or services.
    (d) Matching Funds.--
          (1) In general.--The Secretary may award a grant to 
        an entity under or consortium this section only if the 
        entity of consortium agrees to make available non-
        Federal contributions toward the costs of the program 
        to be funded under the grant in an amount that is not 
        less than $1 for each $2 of Federal funds provided 
        under the grant.
          (2) Determination of amount contributed.--Non-Federal 
        contributions under paragraph (1) may be in cash or in 
        kind, fairly evaluated, including equipment or 
        services. Amounts provided by the Federal Government, 
        or services assisted or subsidized to any significant 
        extent by the Federal Government, may not be included 
        in determining the amount of such contributions.
    (e) Evaluation.--The Secretary shall take such action as 
may be necessary to evaluate the projects funded under this 
section and publish, make available, and disseminate the 
results of such evaluations on as wide a basis as is 
practicable.
    (f) Reports.--Not later than 1 year after the date of 
enactment of this title, and annually thereafter, the Secretary 
shall submit to the Committee on Health, Education, Labor, and 
Pensions and the Committee on Finance of the Senate, and the 
Committee on Energy and Commerce and the Committee on Ways and 
Means of the House of Representatives a report that--
          (1) describes the specific projects established under 
        this section; and
          (2) contains recommendations for Congress based on 
        the evaluation conducted under subsection (e).
    (g) Authorization of Appropriations.--There is authorized 
to be appropriated to carry out this section, $2,000,000 for 
each of fiscal years 2008 and 2009.
    (h) Sunset.--This provisions of this section shall not 
apply after September 30, 2012.

           *       *       *       *       *       *       *

SEC. 3010. FOSTERING DEVELOPMENT AND USE OF HEALTH CARE QUALITY 
                    MEASURES.

    (a) In General.--The Secretary shall provide for the 
development and use of health care quality measures (referred 
to in this title as ``quality measures'') for the purpose of 
measuring the quality and efficiency of health care that 
patients receive.
    (b) Designation of, and Arrangement With, Organization.--
          (1) In general.--Not later than 90 days after the 
        date of enactment of this title, the Secretary shall 
        designate, and have in effect an arrangement with, a 
        single organization that meets the requirements of 
        subsection (c) under which such organization shall 
        promote the development of quality measures and provide 
        the Secretary with advice and recommendations on the 
        key elements and priorities of a national system for 
        healthcare performance measurement.
          (2) Responsibilities.--The responsibilities to be 
        performed by the organization designated under 
        paragraph (1) (in this title referred to as the 
        ``designated Organization'') shall include--
                  (A) establishing and managing an integrated 
                national strategy and process for setting 
                priorities and goals in establishing quality 
                measures;
                  (B) coordinating and harmonizing the 
                development and testing of such measures;
                  (C) establishing standards for the 
                development and testing of such measures;
                  (D) endorsing national consensus quality 
                measures;
                  (E) recommending, in collaboration with 
                multi-stakeholder groups, quality measures to 
                the Secretary for adoption and use;
                  (F) promoting the development and use of 
                electronic health records that contain the 
                functionality for automated collection, 
                aggregation, and transmission of performance 
                measurement information; and
                  (G) providing recommendations and advice to 
                the Partnership regarding the integration of 
                quality measures into the certification process 
                outlined under section 3003 and the Community 
                regarding national policies outlined under 
                section 3004.
    (c) Requirements Described.--The requirements described in 
this subsection are the following:
          (1) Private entity.--The organization shall be a 
        private nonprofit entity that is governed by a board of 
        directors and an individual who is designated as 
        president and chief executive officer.
          (2) Board membership.--The members of the board of 
        directors of the entity shall include representatives 
        of--
                  (A) health care providers or groups 
                representing providers;
                  (B) health plans or groups representing 
                health plans;
                  (C) patients or consumers enrolled in such 
                plans or groups representing individuals 
                enrolled in such plans;
                  (D) health care purchasers and employers or 
                groups representing purchasers or employers; 
                and
                  (E) organizations that develop health 
                information technology standards and new health 
                information technology.
          (3) Other membership requirements.--The membership of 
        the board of directors of the entity shall be 
        representative of individuals with experience with--
                  (A) urban health care issues;
                  (B) safety net health care issues;
                  (C) rural or frontier health care issues;
                  (D) quality and safety issues;
                  (E) State or local health programs;
                  (F) individuals or entities skilled in the 
                conduct and interpretation of biomedical, 
                health services, and health economics research 
                and with expertise in outcomes and 
                effectiveness research and technology 
                assessment; and
                  (G) individuals or entities involved in the 
                development and establishment of standards and 
                certification for health information technology 
                systems and clinical data.
          (4) Open and transparent.--With respect to matters 
        related to the arrangement with the Secretary under 
        subsection (a)(l), the organization shall conduct its 
        business in an open and transparent manner, and provide 
        the opportunity for public comment and ensure a balance 
        among disparate stakeholders, so that no member 
        organization unduly influences the work of the 
        organization.
          (5) Voluntary consensus standards setting 
        organizations.--The organization shall operate as a 
        voluntary consensus standards setting organization as 
        defined for purposes of section 12(d) of the National 
        Technology Transfer and Advancement Act of 1995 (Public 
        Law 104-113) and Office of Management and Budget 
        Revised Circular A-119 (published in the Federal 
        Register on February 10, 1998).
          (6) Participation.--If the organization requires a 
        fee for membership, the organization shall ensure that 
        such fee is not a substantial barrier to participation 
        in the entity's activities related to the arrangement 
        with the Secretary.
    (d) Requirements for Measures.--The quality measures 
developed under this title shall comply with the following:
          (1) Measures.--The designated organization, in 
        promoting the development of quality measures under 
        this title, shall ensure that such measures--
                  (A) are evidence-based, reliable, and valid;
                  (B) include--
                          (i) measures of clinical processes 
                        and outcomes, patient experience, 
                        efficiency, and equity; and
                          (ii) measures to assess 
                        effectiveness, timeliness, patient 
                        self-management, patient centeredness, 
                        and safety; and
                  (C) include measures of underuse and overuse.
          (2) Priorities.--In carrying out its responsibilities 
        under this section, the designated organization shall 
        ensure that priority is given to--
                  (A) measures with the greatest potential 
                impact for improving the performance and 
                efficiency of care;
                  (B) measures that may be rapidly implemented 
                by group health plans, health insurance 
                issuers, physicians, hospitals, nursing homes, 
                long-term care providers, and other providers;
                  (C) measures which may inform health care 
                decisions made by consumers and patients;
                  (D) measures that apply to multiple services 
                furnished by different providers during an 
                episode of care;
                  (E) measures that can be integrated into 
                certification process described in section 
                3003; and
                  (F) measures that may be integrated into the 
                decision support function of qualified health 
                information technology as defined by this 
                title.
          (3) Risk adjustment.--The designated organization, in 
        consultation with performance measure developers and 
        other stakeholders, shall establish procedures to 
        ensure that quality measures take into account 
        differences in patient health status, patient 
        characteristics, and geographic location, as 
        appropriate.
          (4) Maintenance.--The designated organization, in 
        consultation with owners and developers of quality 
        measures, shall require the owners or developers of 
        quality measures to update and enhance such measures, 
        including the development of more accurate and precise 
        specifications, and retire existing out-dated measures. 
        Such updating shall occur not more often than once 
        during each 12-month period, except in the case of 
        emergency circumstances requiring a more immediate 
        update to a measure.
    (e) Grants for Performance Measure Development.--The 
Secretary, acting through the Agency for Healthcare Research 
and Quality, may award grants, in amounts not to exceed $50,000 
each, to organizations to support the development and testing 
of quality measures that meet the standards established by the 
designated organization.

SEC. 3011. ADOPTION AND USE OF QUALITY MEASURES; REPORTING.

    (a) In General.--For purposes of carrying out activities 
authorized or required by this title to ensure the use of 
quality measures and to foster uniformity between health care 
quality measures utilized by private entities, the Secretary 
shall--
          (1) select quality measures for adoption and use, 
        from quality measures recommended by multi-stakeholder 
        groups and endorsed by the designated organization; and
          (2) ensure that standards adopted under section 3005 
        integrate the quality measures endorsed, adopted, and 
        utilized under this section.
    (b) Relationship With Programs Under the Social Security 
Act.--The Secretary shall ensure that the quality measures 
adopted under this section--
          (1) complement quality measures developed by the 
        Secretary under programs administered by the Secretary 
        under the Social Security Act, including programs under 
        titles XVIII, XIX, and XXI of such Act; and
          (2) do not conflict with the needs and priorities of 
        the programs under titles XVIII, XIX, and XXI of such 
        Act, as set forth by the Administrator of the Centers 
        for Medicare & Medicaid Services.
    (c) Reporting.-- The Secretary shall implement procedures, 
consistent with generally accepted standards, to enable the 
Department of Health and Human Services to accept the 
electronic submission of data for purposes of performance 
measurement, including at the provider level, using the quality 
measures developed, endorsed, and adopted pursuant to this 
title.
    (d) Dissemination of Information.--In order to make 
comparative performance information available to health care 
consumers, health professionals, public health officials, 
oversight organizations, researchers, and other appropriate 
individuals and entities, after consultation with multi-
stakeholder groups, the Secretary shall promulgate regulations 
to provide for the dissemination, aggregation, and analysis of 
quality measures collected pursuant to this title.

           *       *       *       *       *       *       *

SEC. 3013. ENSURING PRIVACY AND SECURITY.

    (a) Privacy Protections Apply to Health Information 
Electronic Databases.--An operator of a health information 
electronic database shall be deemed to be a ``covered entity'' 
for purposes of sections 1171 through 1179 of the Social 
Security Act and the regulations promulgated under section 
264(c) of the Health Insurance Portability and Accountability 
Act of 1996 (42 U.S.C. 1320d-2 note) (referred to in this 
section as the ``HIPAA privacy regulations'').
    (b) Health Information Electronic Database Defined.--In 
this section, the term ``operator of a health information 
electronic database'' means an entity that--
          (1) is constituted, organized, or chartered for the 
        primary purpose of maintaining or transmitting 
        protected health information in a designated record set 
        or sets;
          (2) receives valuable consideration for maintaining 
        or transmitting protected health information in a 
        designated record set or sets; and
          (3) is not a health plan, healthcare clearinghouse, 
        or healthcare provider who transmits any health 
        information in electronic form in connection with a 
        transaction referred to in section 1173(a)(1) of the 
        Social Security Act.
    (c) Right of Individuals To Inspect Their Medical Records 
Maintained in Electronic Format.--To the extent provided for 
under the HIPAA privacy regulations with respect to protected 
health information, an individual shall have a right of access 
to inspect and obtain a copy of protected health information 
about the individual stored in electronic format.
    (d) Rights of Individuals Who Are Victims of Medical 
Fraud.--To the extent provided for under the HIPAA privacy 
regulations and under the conditions specified in such 
regulations, with respect to protected health information, an 
individual who is a victim of medical fraud or who believes 
that there is an error in their protected health information 
stored in an electronic format shall have the right--
          (1) to have access to inspect and obtain a copy of 
        protected health information about the individual, 
        including the information fraudulently entered, in a 
        designated record set; and
          (2) to have a covered entity amend protected health 
        information or a record about the individual, including 
        information fraudulently entered, in a designated 
        electronic record set for as long as the protected 
        health information is maintained in the designated 
        electronic record set to ensure that fraudulent and 
        inaccurate health information is not shared or re-
        reported.
    (e) Rule of Construction.--Nothing in this section shall be 
construed to supercede or otherwise limit the provisions of any 
contract that provides for the application of privacy 
protections that are greater than the privacy protections 
provided for under the regulations promulgated under section 
264 of the Health Insurance Portability and Accountability Act 
of 1996.

           *       *       *       *       *       *       *

                                  

```