I 

108TH CONGRESS 

1ST SESSION H. R. 2915

To provide for a National Health Information Infrastructure and data and 

communication standards for health information system interoperability. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 25, 2003

Mrs. JOHNSON of Connecticut (for herself, Mr. GREENWOOD, Mr. NUSSLE, 

Mr. ENGLISH, Mr. WELDON of Florida, Mr. RYAN of Wisconsin, and Mr. 

BURGESS) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL

To provide for a National Health Information Infrastructure 

and data and communication standards for health information system interoperability.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘National Health Infor5 mation Infrastructure Act of 2003’’. 

6 SEC. 2. NATIONAL HEALTH INFORMATION INFRASTRUC7 TURE. 

8 (a) NATIONAL HEALTH INFORMATION OFFICER.—
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1 (1) APPOINTMENT.—By not later than 6 

2 months after the date of the enactment of this Act, 

3 the Secretary of Health and Human Services (in this 

4 Act referred to as the ‘‘Secretary’’) shall appoint an 

5 individual as the National Health Information Offi6 cer for the Department of Health and Human Serv7 ices. 

8 (2) GENERAL DUTIES.—Such Officer shall re9 port directly to the Secretary and shall be respon10 sible for developing and maintaining ongoing na11 tional leadership in the planning, development, and 

12 adoption of a national health information infrastruc13 ture. The Secretary may assign to the Officer other 

14 duties that would promote the goals of this Act. 

15 (3) STRATEGIC PLAN.—Not later than 6 

16 months after the date of the enactment of this Act, 

17 the National Health Information Officer shall, in co18 operation with key stakeholders, develop a strategic 

19 plan to create a comprehensive national health infor20 mation infrastructure that encompasses public-sector 

21 and private-sector health information activities. Such 

22 plans shall include a national agenda to guide policy23 making, technology investments, research, and inte24 gration with ongoing public health, healthcare, and 

25 health information technology activities and a 
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1 timeline for the specific duties described in sub2 section (d)(1). 

3 (4) LIMITED TERM OF OFFICE.—The National 

4 Health Information Officer shall serve for a term of 

5 5 years, after which, unless extended by Act of Con6 gress, the office shall terminate. 

7 (b) GOALS.—The goals of the national health infor8 mation infrastructure are—

9 (1) to maximize positive outcomes in clinical 

10 care; 

11 (2) to minimize preventable medical errors, es12 pecially in hospitals and in the administration of 

13 contraindicated drugs; 

14 (3) to reduce redundant paperwork, such as the 

15 repeated taking of patient histories; 

16 (4) to decrease costs from duplicative or other17 wise unnecessary testing or procedures; and 

18 (5) to establish a compatible information tech19 nology architecture that increases health care quality 

20 and cost-savings, enhances security of information, 

21 and avoids the financing and development of health 

22 information technology systems that are not readily 

23 compatible. 

24 (c) COLLABORATION WITH STAKEHOLDERS.—
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1 (1) IN GENERAL.—The Secretary shall assure 

2 that activities of the Department of Health and 

3 Human Services that relate to the national health 

4 information infrastructure are undertaken after con5 sultation with and based on the recommendations of 

6 the parties described in paragraph (3). 

7 (2) PERIODIC MEETINGS.—The Secretary, 

8 through the National Health Information Officer, 

9 shall convene as a group the parties described in 

10 paragraph (3). Such group shall meet periodically 

11 and collaborate to make recommendations to such 

12 Officer and the Secretary on the matters described 

13 in subsection (d). 

14 (3) PARTIES REPRESENTED.—The parties de15 scribed in this paragraph are experts from the fields 

16 of medical information, information technology, med17 ical continuous quality improvement, and medical 

18 records security and privacy, appropriate staff ex19 perts from Federal agencies (including those within 

20 the Department of Health and Human Services) and 

21 representatives of the following: 

22 (A) The National Committee on Vital and 

23 Health Statistics, the National Institutes of 

24 Standards and Technology, the National Li-
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1 brary of Medicine, and the Agency for 

2 Healthcare Research and Quality. 

3 (B) Individual and institutional health care 

4 clinical providers, including a teaching hospital 

5 and physicians. 

6 (C) Clinical and health services research7 ers. 

8 (D) Health care purchasers. 

9 (E) Private organizations with expertise in 

10 medical informatics. 

11 (F) Patient groups. 

12 (G) A State or local public health depart13 ment. 

14 (H) The health care information tech15 nology industry and national alliances formed 

16 to achieve standards-based health care informa17 tion systems. 

18 (d) DUTIES.—In carrying out subsection (a), the Na19 tional Health Information Officer shall advise the Sec20 retary on the following, in order to promote the goals de21 scribed in subsection (b): 

22 (1)(A) Not later than 1 year after the date of 

23 the enactment of this Act, an assessment of—
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1 (i) the best current practices in the devel2 opment, purchase, and maintenance of medical 

3 information technology; and 

4 (ii) currently existing legal requirements 

5 for communication standards. 

6 (B) Not later than 2 years after the date of the 

7 enactment of this Act, recommendations for a uni8 form health information system interface, and meth9 ods for its adoption, to ensure compatibility between 

10 and among old and new information systems. 

11 (C) Recommendations for health and healthcare 

12 data standards (such as vocabulary and messaging), 

13 communications standards, and other medical stand14 ards (including a common lexicon) necessary to 

15 achieve the interoperability of health information 

16 systems. 

17 (2) Coordination of the evolution of the national 

18 health information infrastructure and working with 

19 other key stakeholders in the public and private sec20 tors to develop a strategic plan that will ensure the 

21 interoperability of all elements of such infrastruc22 ture. 

23 (3) Coordination of spending across Federal 

24 agencies relating to the establishment of such infra25 structure. 
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1 (4) Development of policies to ensure compli2 ance with all standards adopted under part C of title 

3 XI, including promotion of patient control of pro4 tected health information. 

5 (5) Avoidance of confusion and potential non6 compliance with currently existing legal require7 ments. 

8 (e) DETAIL OF FEDERAL EMPLOYEES.—Upon the 

9 request of the Secretary, the head of any Federal agency 

10 is authorized to detail, without reimbursement from the 

11 National Health Information Officer, any of the personnel 

12 of such agency to such Officer to assist the Officer in car13 rying out duties of the Officer under this section. Any such 

14 detail shall not interrupt or otherwise affect the civil serv15 ice status or privileges of the Federal employee. 

16 (f) USE OF FUNDS CONSISTENT WITH NATIONAL

17 AGENDA.—The Secretary shall develop a process (such as 

18 requiring the approval of the National Health Information 

19 Officer) to assure that to the greatest extent feasible funds 

20 of the Department of Health and Human Services granted 

21 or spent for health information systems are used to fur22 ther the national agenda developed pursuant to subsection 

23 (a)(3). 

24 (g) AUTHORIZATION OF APPROPRIATIONS AND SUN25 SET.—There are authorized to be appropriated such sums 
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1 as may be necessary for each fiscal year beginning with 

2 fiscal year 2004 to carry out this section. 

3 SEC. 3. DATA AND COMMUNICATIONS STANDARDS FOR 

4 INTEROPERABILITY. 

5 (a) IN GENERAL.—Based on the recommendations 

6 provided under section 2(d)(1)(B), the Secretary shall de7 velop or adopt (and shall periodically review and update) 

8 voluntary, national data and communications standards 

9 that promote the interoperability of health information 

10 technology systems across all public and private health 

11 care settings. The Secretary shall ensure thorough testing 

12 of data and communications standards before their imple13 mentation. In developing or adopting such standards, the 

14 Secretary shall take into account—

15 (1) the ability of such standards to enable clini16 cally-specific data collection in order to promote evi17 dence-based medicine and the electronic exchange of 

18 patient medical record information; and 

19 (2) the costs of compliance and the savings and 

20 other benefits from improved efficiency and quality 

21 in health care delivery. 

22 (b) REPORTS.—

23 (1) INITIAL REPORT.—No later than 12 months 

24 after the date of the enactment of this Act, the Sec25 retary shall submit to Congress a report that in-
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1 cludes a comprehensive national health information 

2 infrastructure strategic plan and information on 

3 progress on the assessments, the recommendations 

4 for the interface, and the recommendations for 

5 standards, under section 2(d). 

6 (2) SUBSEQUENT REPORTS.—During each of 

7 the 2 years after the year in which the report is sub8 mitted under paragraph (1), the Secretary shall sub9 mit to Congress an annual report relating to addi10 tional recommendations, best practices, results of in11 formation technology improvements, analyses of pri12 vate sector efforts to implement the data and com13 munications standards established under this sec14 tion, and such other matters as may help ensure the 

15 most rapid dissemination of best practices in health 

16 care information technology. 

17 (c) CONTRACT AUTHORITY.—The Secretary is au18 thorized to enter into contracts—

19 (1) for services and activities necessary to carry 

20 out this section and section 2; and 

21 (2) to the extent practicable, to test the stand22 ards under consideration under this section. 

23 (d) DISSEMINATION.—The Secretary shall provide 

24 for the reviewing, updating, and disseminating the stand25 ards developed under this section. 
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1 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated such sums as may be 

3 necessary for each fiscal year beginning with fiscal year 

4 2004 to carry out this section.

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