69–010 

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 inVerDate Aug 31 2005 11:39 Oct 03, 2007 Jkt 069010 PO 00000 Frm 00001 Fmt 6659 Sfmt 6602 E:\HR\OC\SR187.XXX SR187

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formation. 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 


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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 


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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. 


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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 


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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 recommendaVerDate Aug 31 2005 11:39 Oct 03, 2007 Jkt 069010 PO 00000 Frm 00006 Fmt 6659 Sfmt 6602 E:\HR\OC\SR187.XXX SR187

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tion. 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 qualVerDate Aug 31 2005 11:39 Oct 03, 2007 Jkt 069010 PO 00000 Frm 00007 Fmt 6659 Sfmt 6602 E:\HR\OC\SR187.XXX SR187

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ity 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 


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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 finanVerDate Aug 31 2005 11:39 Oct 03, 2007 Jkt 069010 PO 00000 Frm 00009 Fmt 6659 Sfmt 6602 E:\HR\OC\SR187.XXX SR187

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cial 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. 


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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 


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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 communitywide 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 subVerDate Aug 31 2005 11:39 Oct 03, 2007 Jkt 069010 PO 00000 Frm 00012 Fmt 6659 Sfmt 6602 E:\HR\OC\SR187.XXX SR187

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mit 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, asVerDate Aug 31 2005 11:39 Oct 03, 2007 Jkt 069010 PO 00000 Frm 00013 Fmt 6659 Sfmt 6602 E:\HR\OC\SR187.XXX SR187

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suming 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 


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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 


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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. 


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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 


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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; 


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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, 


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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 


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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 

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use. 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 


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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 

* * * * * * * 

øSEC. 330L. ø254c–18¿ TELEMEDICINE; INCENTIVE GRANTS REGARDING 

COORDINATION AMONG STATES. 

ø(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. 

ø(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. ø299b–3¿ INFORMATION SYSTEMS FOR HEALTH CARE IMPROVEMENT. 

(a) IN GENERAL.—* * * 

* * * * * * * 

(d) HEALTH INFORMATION TECHNOLOGY RESOURCE CENTER.—


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(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. 

* * * * * * * 


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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. 


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(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; 


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(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 

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forts 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. 


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(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 


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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 

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tion 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; 


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(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; 


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(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 

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munity. 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 recVerDate Aug 31 2005 11:39 Oct 03, 2007 Jkt 069010 PO 00000 Frm 00034 Fmt 6659 Sfmt 6603 E:\HR\OC\SR187.XXX SR187

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ommendation 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.—


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(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—


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(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). 


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(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 


ebenthall on PROD1PC69 with HEARING
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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-forprofit) 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 


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(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 supplieridentfiable 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); 


ebenthall on PROD1PC69 with HEARING
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(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); 


ebenthall on PROD1PC69 with HEARING
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(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 


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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 


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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 CON- TRIBUTION.—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 


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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; 


ebenthall on PROD1PC69 with HEARING
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(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. 


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(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) nonFederal 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.—NonFederal 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 nonFederal 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—


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(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. 

* * * * * * * 


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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 


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(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 ORGANIZA- TIONS.—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 

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pitals, 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 


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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 


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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. 

* * * * * * * 

Æ 


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