II 

110TH CONGRESS 

1ST SESSION 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. 

IN THE SENATE OF THE UNITED STATES 

JUNE 26, 2007 

Mr. KENNEDY (for himself, Mr. ENZI, Mrs. CLINTON, Mr. HATCH, Mr. 

OBAMA, Mr. GREGG, Mr. ALEXANDER, Mr. BURR, Mr. ROBERTS, and 

Mr. ISAKSON) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

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. 

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 ‘‘Wired for Health Care 

5 Quality Act’’. 


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1 TITLE I—IMPROVING THE 

2 INTEROPERABILITY OF 

3 HEALTH INFORMATION TECH4 NOLOGY 

5 SEC. 101. IMPROVING HEALTH CARE QUALITY, SAFETY, 

6 AND EFFICIENCY.. 

7 The Public Health Service Act (42 U.S.C. 201 et 

8 seq.) is amended by adding at the end the following: 

9 ‘‘TITLE XXX—HEALTH INFOR10 MATION TECHNOLOGY AND 

11 QUALITY 

12 ‘‘SEC. 3001. DEFINITIONS; REFERENCE. 

13 ‘‘(a) IN GENERAL.—In this title: 

14 ‘‘(1) COMMUNITY.—The term ‘Community’ 

15 means the American Health Information Community 

16 established under section 3004. 

17 ‘‘(2) HEALTH CARE PROVIDER.—The term 

18 ‘health care provider’ means a hospital, skilled nurs19 ing facility, home health entity, health care clinic, 

20 federally qualified health center, group practice (as 

21 defined in section 1877(h)(4) of the Social Security 

22 Act), a pharmacist, a pharmacy, a laboratory, a phy23 sician (as defined in section 1861(r) of the Social 

24 Security Act), a practitioner (as defined in section 

25 1842(b)(18)(CC) of the Social Security Act), a 


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1 health facility operated by or pursuant to a contract 

2 with the Indian Health Service, a rural health clinic, 

3 and any other category of facility or clinician deter4 mined appropriate by the Secretary. 

5 ‘‘(3) HEALTH INFORMATION.—The term ‘health 

6 information’ has the meaning given such term in 

7 section 1171(4) of the Social Security Act. 

8 ‘‘(4) HEALTH PLAN.—The term ‘health plan’ 

9 has the meaning given such term in section 1171(5) 

10 of the Social Security Act. 

11 ‘‘(5) INDIVIDUALLY IDENTIFIABLE HEALTH IN12 FORMATION.—The term ‘individually identifiable 

13 health information’ has the meaning given such term 

14 in section 1171 of the Social Security Act. 

15 ‘‘(6) LABORATORY.—The term ‘laboratory’ has 

16 the meaning given such term in section 353. 

17 ‘‘(7) NATIONAL COORDINATOR.—The term ‘Na18 tional Coordinator’ means the National Coordinator 

19 of Health Information Technology appointed pursu20 ant to section 3002. 

21 ‘‘(8) PARTNERSHIP.—The term ‘Partnership’ 

22 means the Partnership for Health Care Improve23 ment established under section 3003. 

24 ‘‘(9) QUALIFIED HEALTH INFORMATION TECH25 NOLOGY.—The term ‘qualified health information 


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1 technology’ means a computerized system (including 

2 hardware and software) that— 

3 ‘‘(A) protects the privacy and security of 

4 health information; 

5 ‘‘(B) maintains and provides permitted ac6 cess to health information in an electronic for7 mat; 

8 ‘‘(C) with respect to individually identifi9 able health information maintained in a des10 ignated record set, preserves an audit trail of 

11 each individual that has gained access to such 

12 record set; 

13 ‘‘(D) incorporates decision support to re14 duce medical errors and enhance health care 

15 quality; 

16 ‘‘(E) complies with the standards adopted 

17 by the Federal Government under section 3003; 

18 ‘‘(F) has the ability to transmit and ex19 change information to other health information 

20 technology systems and, to the extent feasible, 

21 public health information technology systems; 

22 and 

23 ‘‘(G) allows for the reporting of quality 

24 measures adopted under section 3010. 


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1 ‘‘(10) STATE.—The term ‘State’ means each of 

2 the several States, the District of Columbia, Puerto 

3 Rico, the Virgin Islands, Guam, American Samoa, 

4 and the Northern Mariana Islands. 

5 ‘‘(b) REFERENCES TO SOCIAL SECURITY ACT.—Any 

6 reference in this section to the Social Security Act shall 

7 be deemed to be a reference to such Act as in effect on 

8 the date of enactment of this title. 

9 ‘‘SEC. 3002. OFFICE OF THE NATIONAL COORDINATOR FOR 

10 HEALTH INFORMATION TECHNOLOGY. 

11 ‘‘(a) ESTABLISHMENT.—There is established within 

12 the office of the Secretary, the Office of the National Co13 ordinator of Health Information Technology. The Na14 tional Coordinator shall be appointed by the Secretary in 

15 consultation with the President, and shall report directly 

16 to the Secretary. 

17 ‘‘(b) PURPOSE.—The Office of the National Coordi18 nator shall be responsible for— 

19 ‘‘(1) ensuring that key health information tech20 nology initiatives are coordinated across programs of 

21 the Department of Health and Human Services; 

22 ‘‘(2) ensuring that health information tech23 nology policies and programs of the Department of 

24 Health and Human Services are coordinated with 

25 such policies and programs of other relevant Federal 


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1 agencies (including Federal commissions and advi2 sory committees) with a goal of avoiding duplication 

3 of efforts and of helping to ensure that each agency 

4 undertakes activities primarily within the areas of its 

5 greatest expertise and technical capability; 

6 ‘‘(3) reviewing Federal health information tech7 nology investments to ensure that Federal health in8 formation technology programs are meeting the ob9 jectives of the strategic plan published by the Office 

10 of the National Coordinator of Health Information 

11 Technology to establish a nationwide interoperable 

12 health information technology infrastructure; 

13 ‘‘(4) providing comments and advice regarding 

14 specific Federal health information technology pro15 grams, at the request of Office of Management and 

16 Budget; and 

17 ‘‘(5) enhancing the use of health information 

18 technology to improve the quality of health care in 

19 the prevention and management of chronic disease 

20 and to address population health. 

21 ‘‘(c) ROLE WITH COMMUNITY AND THE PARTNER22 SHIP.—The Office of the National Coordinator shall— 

23 ‘‘(1) serve as an ex officio member of the Com24 munity, and act as a liaison between the Federal 

25 Government and the Community; 


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1 ‘‘(2) serve as an ex officio member of the Part2 nership and act as a liaison between the Federal 

3 Government and the Partnership; and 

4 ‘‘(3) serve as a liaison between the Partnership 

5 and the Community. 

6 ‘‘(d) REPORTS AND WEBSITE.—The Office of the 

7 National Coordinator shall— 

8 ‘‘(1) develop and publish a strategic plan for 

9 implementing a nationwide interoperable health in10 formation technology infrastructure; 

11 ‘‘(2) maintain and frequently update an Inter12 net website that— 

13 ‘‘(A) publishes the schedule for the assess14 ment of standards for significant use cases; 

15 ‘‘(B) publishes the recommendations of the 

16 Community; 

17 ‘‘(C) publishes the recommendations of the 

18 Partnership; 

19 ‘‘(D) publishes quality measures; 

20 ‘‘(E) identifies sources of funds that will 

21 be made available to facilitate the purchase of, 

22 or enhance the utilization of, health information 

23 technology systems, either through grants or 

24 technical assistance; and 


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1 ‘‘(F) publishes a plan for a transition of 

2 any functions of the Office of the National Co3 ordinator that should be continued after Sep4 tember 30, 2014; 

5 ‘‘(3) prepare a report on the lessons learned 

6 from major public and private health care systems 

7 that have implemented health information tech8 nology systems, including an explanation of whether 

9 the systems and practices developed by such systems 

10 may be applicable to and usable in whole or in part 

11 by other health care providers; and 

12 ‘‘(4) assess the impact of health information 

13 technology in communities with health disparities 

14 and identify practices to increase the adoption of 

15 such technology by health care providers in such 

16 communities. 

17 ‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec18 tion shall be construed as requiring the duplication of Fed19 eral efforts with respect to the establishment of the Office 

20 of the National Coordinator for Health Information Tech21 nology, regardless of whether such efforts are carried out 

22 before or after the date of the enactment of this title. 

23 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

24 is authorized to be appropriated to carry out this section, 

25 $5,000,000 for each of fiscal years 2008 and 2009. 


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1 ‘‘(g) SUNSET.—The provisions of this section shall 

2 not apply after September 30, 2014. 

3 ‘‘SEC. 3003. PARTNERSHIP FOR HEALTH CARE IMPROVE4 MENT-STANDARDS AND TECHNOLOGY. 

5 ‘‘(a) ESTABLISHMENT.— 

6 ‘‘(1) IN GENERAL.—There is established a pub7 lic-private Partnership for Health Care Improvement 

8 to— 

9 ‘‘(A) provide advice to the Secretary and 

10 the Nation and recommend specific actions to 

11 achieve a nationwide interoperable health infor12 mation technology infrastructure; 

13 ‘‘(B) make recommendations concerning 

14 standards, implementation specifications, and 

15 certification criteria for the electronic exchange 

16 of health information (including for the report17 ing of quality data under section 3010) for 

18 adoption by the Federal Government and vol19 untary adoption by private entities; 

20 ‘‘(C) serve as a forum for the participation 

21 of a broad range of stakeholders with specific 

22 technical expertise in the development of stand23 ards, implementation specifications, and certifi24 cation criteria to provide input on the effective 


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1 implementation of health information tech2 nology systems; and 

3 ‘‘(D) develop and maintain an Internet 

4 website that— 

5 ‘‘(i) publishes established governance 

6 rules (including a subsequent appointment 

7 process); 

8 ‘‘(ii) publishes a business plan; 

9 ‘‘(iii) publishes meeting notices at 

10 least 14 days prior to each meeting; 

11 ‘‘(iv) publishes meeting agendas at 

12 least 7 days prior to each meeting; and 

13 ‘‘(v) publishes meeting materials at 

14 least 3 days prior to each meeting. 

15 ‘‘(2) LIMITATION.—The Partnership shall not 

16 meet or take any action until an advisory committee 

17 charter has been filed with the Secretary and with 

18 the appropriate committees of the Senate and House 

19 of Representatives for the Community described in 

20 section 3004. 

21 ‘‘(b) MEMBERSHIP.— 

22 ‘‘(1) APPOINTMENTS.— 

23 ‘‘(A) IN GENERAL.—The Partnership shall 

24 be composed of members to be appointed as fol25 lows: 


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1 ‘‘(i) 2 members shall be appointed by 

2 the Secretary. 

3 ‘‘(ii) 1 member shall be appointed by 

4 the majority leader of the Senate. 

5 ‘‘(iii) 1 member shall be appointed by 

6 the minority leader of the Senate. 

7 ‘‘(iv) 1 member shall be appointed by 

8 the Speaker of the House of Representa9 tives. 

10 ‘‘(v) 1 member shall be appointed by 

11 the minority leader of the House of Rep12 resentatives. 

13 ‘‘(vi) Seven members shall be ap14 pointed by the Comptroller General of 

15 whom— 

16 ‘‘(I) one member shall be a rep17 resentative of consumer or patient or18 ganizations; 

19 ‘‘(II) one member shall be a rep20 resentative of organizations with ex21 pertise in privacy; 

22 ‘‘(III) one member shall be a rep23 resentative of organizations with ex24 pertise in security; 


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1 ‘‘(IV) one member shall be a rep2 resentative of health care providers; 

3 ‘‘(V) one member shall be a rep4 resentative of health plans or other 

5 third party payers; 

6 ‘‘(VI) one member shall be a rep7 resentative of information technology 

8 vendors; and 

9 ‘‘(VII) one member shall be a 

10 representative of purchasers or em11 ployers. 

12 ‘‘(B) NATIONAL COORDINATOR.—The Na13 tional Coordinator shall be a member of the 

14 Partnership and act as a liaison among the 

15 Partnership, the community, and the Federal 

16 Government. 

17 ‘‘(2) CHAIRPERSON AND VICE CHAIRPERSON.— 

18 The Partnership shall designate one member to 

19 serve as the chairperson and one member to serve as 

20 the vice chairperson of the Partnership. 

21 ‘‘(3) PARTICIPATION.—In appointing members 

22 under paragraph (1)(A), and in developing the pro23 cedures for conducting the activities of the Partner24 ship, the Partnership shall ensure a balance among 

25 various sectors of the health care system so that no 


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1 single sector unduly influences the recommendations 

2 of the Partnership. 

3 ‘‘(4) TERMS.—Members appointed under para4 graph (1)(A) shall serve for 3 year terms, except 

5 that any member appointed to fill a vacancy for an 

6 unexpired term shall be appointed for the remainder 

7 of such term. A member may serve for not to exceed 

8 180 days after the expiration of such member’s term 

9 or until a successor has been appointed. 

10 ‘‘(5) OUTSIDE INVOLVEMENT.—The Partner11 ship shall ensure an adequate opportunity for the 

12 participation of outside advisors, including individ13 uals with expertise in— 

14 ‘‘(A) health information privacy; 

15 ‘‘(B) health information security; 

16 ‘‘(C) health care quality and patient safety, 

17 including individuals with expertise in utilizing 

18 health information technology to improve health 

19 care quality and patient safety; 

20 ‘‘(D) medical and clinical research data ex21 change; and 

22 ‘‘(E) developing health information tech23 nology standards and new health information 

24 technology. 


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1 ‘‘(6) QUORUM.—Two-thirds of the members of 

2 the Partnership shall constitute a quorum for the 

3 purpose of conducting votes. 

4 ‘‘(c) STANDARDS AND IMPLEMENTATION SPECIFICA5 TIONS.— 

6 ‘‘(1) SCHEDULE.—Not later than 90 days after 

7 the date of enactment of this title, the Partnership 

8 shall develop a schedule for the assessment of stand9 ards and implementation specifications under this 

10 section. The Partnership shall update such schedule 

11 annually. The Secretary shall publish such schedule 

12 in the Federal Register and on the Internet website 

13 of the Department of Health and Human Services. 

14 ‘‘(2) FIRST YEAR RECOMMENDATIONS.—Con15 sistent with the schedule published under paragraph 

16 (1) and not later than 1 year after date of enact17 ment of this title, the Partnership shall recommend, 

18 and the Secretary shall review, such standards and 

19 implementation specifications. 

20 ‘‘(3) ONGOING RECOMMENDATIONS.—The Part21 nership shall review and modify, as appropriate but 

22 at least annually, adopted standards and implemen23 tation specifications and continue to recommend ad24 ditional standards and implementation specifications, 

25 consistent with the schedule published pursuant to 


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1 paragraph (1). The Secretary shall review such 

2 modifications and recommendations. 

3 ‘‘(4) RECOGNITION OF PRIVATE ENTITIES.— 

4 The Partnership, in consultation with the Secretary, 

5 may recognize a private entity or entities for the 

6 purpose of developing and updating standards and 

7 implementation specifications to achieve uniform and 

8 consistent implementation of the standards adopted 

9 by the President under this title. Such entity or enti10 ties shall make recommendations to the Partnership 

11 consistent with this section. 

12 ‘‘(5) PUBLICATION.—All recommendations 

13 made by the Partnership pursuant to this section 

14 shall be published in the Federal Register and on 

15 the Internet website of the Office of the National 

16 Coordinator. 

17 ‘‘(6) PILOT TESTING.—The Secretary may con18 duct, or recognize a private entity or entities to con19 duct, a pilot project to test the standards and imple20 mentation specifications developed under this section 

21 in order to provide for the efficient implementation 

22 of the standards and implementation specifications 

23 described in this subsection prior to issuing such 

24 recommendations. 


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1 ‘‘(7) PUBLIC INPUT.—The Partnership shall 

2 conduct open public meetings and develop a process 

3 to allow for public comment on the schedule and rec4 ommendations described in this section. Such proc5 ess shall ensure that such comments will be sub6 mitted within 30 days of the publication of a rec7 ommendation under this section. 

8 ‘‘(8) FEDERAL ACTION.—Not later than 90 

9 days after the issuance of a recommendation from 

10 the Partnership under this subsection, the Secretary, 

11 the Secretary of Veterans Affairs, and the Secretary 

12 of Defense, in collaboration with representatives of 

13 other relevant Federal agencies as determined ap14 propriate by the President, shall jointly review such 

15 recommendation. If appropriate, the President shall 

16 provide for the adoption by the Federal Government 

17 of any standard or implementation specification con18 tained in such recommendation. Such determination 

19 shall be published in the Federal Register and on 

20 the Internet website of the Office of the National 

21 Coordinator within 30 days after such determination 

22 is made. 

23 ‘‘(9) CONSISTENCY.—The standards and imple24 mentation specifications described in this subsection 

25 shall be consistent with the standards for informaVerDate Aug 31 2005 03:55 Jun 27, 2007 Jkt 059200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S1693.IS S1693

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1 tion transactions and data elements developed pur2 suant to the regulations promulgated under section 

3 264(c) of the Health Insurance Portability and Ac4 countability Act of 1996. 

5 ‘‘(d) CERTIFICATION.— 

6 ‘‘(1) DEVELOPING CRITERIA.—The Partner7 ship, in consultation with the Secretary, may recog8 nize a private entity or entities for the purpose of 

9 developing and recommending to the Partnership 

10 criteria to certify that appropriate categories of 

11 health information technology products that claim to 

12 be in compliance with applicable standards and im13 plementation specifications adopted under this title 

14 have established such compliance. 

15 ‘‘(2) ADOPTION OF CRITERIA.—The Secretary, 

16 based upon the recommendations of the Partnership, 

17 shall review, and if appropriate, adopt such criteria. 

18 ‘‘(3) CONDUCTING CERTIFICATION.—The Sec19 retary may recognize a private entity or entities to 

20 conduct the certifications described under paragraph 

21 (1) using the criteria adopted by the Secretary 

22 under this subsection. 

23 ‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec24 tion shall be construed as disrupting existing activities de25 scribed in subsection (c) or (d). 


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1 ‘‘(f) REQUIREMENT TO CONSIDER RECOMMENDA2 TIONS.—In carrying out the activities described in sub3 sections (c) and (d), the Partnership shall adopt and inte4 grate the recommendations of the Community that are 

5 adopted by the Secretary. 

6 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated to carry out this section, 

8 $2,000,000 for each of the fiscal years 2008 and 2009. 

9 ‘‘SEC. 3004. AMERICAN HEALTH INFORMATION COMMU10 NITY—POLICIES. 

11 ‘‘(a) ESTABLISHMENT.—There is established a com12 mittee to be known as the American Health Information 

13 Community. The Community shall— 

14 ‘‘(1) provide advice to the Secretary and the 

15 heads of any relevant Federal agencies concerning 

16 the policy considerations related to health informa17 tion technology; 

18 ‘‘(2) not later than 1 year after the date of en19 actment of this title, and annually thereafter, make 

20 recommendations concerning a policy framework for 

21 the development and adoption of a nationwide inter22 operable health information technology infrastruc23 ture; 

24 ‘‘(3) not later than 1 year after the date of en25 actment of this title, and annually thereafter, make 


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1 recommendation concerning national policies for 

2 adoption by the Federal Government, and voluntary 

3 adoption by private entities, to support the wide4 spread adoption of health information technology, 

5 including— 

6 ‘‘(A) the protection of individually identifi7 able health information; 

8 ‘‘(B) methods to notify individuals if their 

9 individually identifiable health information is 

10 wrongfully disclosed; 

11 ‘‘(C) methods to facilitate secure access to 

12 such individual’s individually identifiable health 

13 information; 

14 ‘‘(D) the appropriate uses of a nationwide 

15 health information network including— 

16 ‘‘(i) the collection of quality data and 

17 public reporting; 

18 ‘‘(ii) biosurveillance and public health; 

19 ‘‘(iii) medical and clinical research; 

20 and 

21 ‘‘(iv) drug safety; 

22 ‘‘(E) fostering the public understanding of 

23 health information technology; 


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1 ‘‘(F) strategies to enhance the use of 

2 health information technology in preventing and 

3 managing chronic disease; 

4 ‘‘(G) policies to incorporate the input of 

5 employees of health care providers in the design 

6 and implementation of health information tech7 nology systems; and 

8 ‘‘(H) other policies determined to be nec9 essary by the Community; and 

10 ‘‘(4) serve as a forum for the participation of 

11 a broad range of stakeholders to provide input on 

12 improving the effective implementation of health in13 formation technology systems. 

14 ‘‘(b) PUBLICATION.—All recommendations made by 

15 the Community pursuant to this section shall be published 

16 in the Federal Register and on the Internet website of the 

17 National Coordinator. The Secretary shall review all rec18 ommendations and determine which recommendations 

19 shall be endorsed by the Federal Government and such 

20 determination shall be published on the Internet website 

21 of the Office of the National Coordinator within 30 days 

22 after the date on which such endorsement is made. 

23 ‘‘(c) MEMBERSHIP.— 

24 ‘‘(1) IN GENERAL.—The Community shall be 

25 composed of members to be appointed as follows: 


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1 ‘‘(A) 3 members shall be appointed by the 

2 Secretary, 1 of whom shall be a representative 

3 from the Department of Health and Human 

4 Services. 

5 ‘‘(B) 1 member shall be appointed by the 

6 Secretary of Veterans Affairs who shall rep7 resent the Department of Veterans Affairs. 

8 ‘‘(C) 1 member shall be appointed by the 

9 Secretary of Defense who shall represent the 

10 Department of Defense. 

11 ‘‘(D) 1 member shall be appointed by the 

12 majority leader of the Senate. 

13 ‘‘(E) 1 member shall be appointed by the 

14 minority leader of the Senate. 

15 ‘‘(F) 1 member shall be appointed by the 

16 Speaker of the House of Representatives. 

17 ‘‘(G) 1 member shall be appointed by the 

18 minority leader of the House of Representa19 tives. 

20 ‘‘(H) Nine members shall be appointed by 

21 the Comptroller General of whom— 

22 ‘‘(i) one member shall be advocates 

23 for patients or consumers; 

24 ‘‘(ii) one member shall represent 

25 health care providers; 


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1 ‘‘(iii) one member shall be from a 

2 labor organization representing health care 

3 workers; 

4 ‘‘(iv) one member shall have expertise 

5 in privacy and security; 

6 ‘‘(v) one member shall have expertise 

7 in improving the health of vulnerable popu8 lations; 

9 ‘‘(vi) one member shall represent 

10 health plans or other third party payers; 

11 ‘‘(vii) one member shall represent in12 formation technology vendors; 

13 ‘‘(viii) one member shall represent 

14 purchasers or employers; and 

15 ‘‘(ix) one member shall have expertise 

16 in health care quality measurement and re17 porting. 

18 ‘‘(2) CHAIRPERSON AND VICE CHAIRPERSON.— 

19 The Community shall designate one member to serve 

20 as the chairperson and one member to serve as the 

21 vice chairperson of the Community. 

22 ‘‘(3) NATIONAL COORDINATOR.—The National 

23 Coordinator shall be a member of the Community 

24 and act as a liaison among the Community, the 

25 partnership, and the Federal Government. 


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1 ‘‘(4) PARTICIPATION.—The members of the 

2 Community appointed under paragraph (1) shall 

3 represent a balance among various sectors of the 

4 health care system so that no single sector unduly 

5 influences the recommendations of the Community. 

6 ‘‘(5) TERMS.— 

7 ‘‘(A) IN GENERAL.—The terms of mem8 bers of the Community shall be for 3 years ex9 cept that the Comptroller General shall des10 ignate staggered terms for the members first 

11 appointed. 

12 ‘‘(B) VACANCIES.—Any member appointed 

13 to fill a vacancy in the membership of the Com14 munity that occurs prior to the expiration of 

15 the term for which the member’s predecessor 

16 was appointed shall be appointed only for the 

17 remainder of that term. A member may serve 

18 after the expiration of that member’s term until 

19 a successor has been appointed. A vacancy in 

20 the Community shall be filled in the manner in 

21 which the original appointment was made. 

22 ‘‘(6) OUTSIDE INVOLVEMENT.—The Commu23 nity shall ensure an adequate opportunity for the 

24 participation of outside advisors, including individ25 uals with expertise in— 


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1 ‘‘(A) health information privacy and secu2 rity; 

3 ‘‘(B) improving the health of vulnerable 

4 populations; 

5 ‘‘(C) health care quality and patient safety, 

6 including individuals with expertise in measure7 ment and the use of health information tech8 nology to capture data to improve health care 

9 quality and patient safety; 

10 ‘‘(D) ethics; 

11 ‘‘(E) medical and clinical research data ex12 change; and 

13 ‘‘(F) developing health information tech14 nology standards and new health information 

15 technology. 

16 ‘‘(7) QUORUM.—Ten members of the Commu17 nity shall constitute a quorum for purposes of vot18 ing, but a lesser number of members may meet and 

19 hold hearings. 

20 ‘‘(d) FEDERAL AGENCIES.— 

21 ‘‘(1) STAFF OF OTHER FEDERAL AGENCIES.— 

22 Upon the request of the Community, the head of any 

23 Federal agency may detail, without reimbursement, 

24 any of the personnel of such agency to the Commu25 nity to assist in carrying out the duties of the ComVerDate Aug 31 2005 03:55 Jun 27, 2007 Jkt 059200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\S1693.IS S1693

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1 munity. Any such detail shall not interrupt or other2 wise affect the civil service status or privileges of the 

3 Federal employee involved. 

4 ‘‘(2) TECHNICAL ASSISTANCE.—Upon the re5 quest of the Community, the head of a Federal 

6 agency shall provide such technical assistance to the 

7 Community as the Community determines to be nec8 essary to carry out its duties. 

9 ‘‘(3) OTHER RESOURCES.—The Community 

10 shall have reasonable access to materials, resources, 

11 statistical data, and other information from the Li12 brary of Congress and agencies and elected rep13 resentatives of the executive and legislative branches 

14 of the Federal Government. The chairperson or vice 

15 chairperson of the Community shall make requests 

16 for such access in writing when necessary. 

17 ‘‘(e) APPLICATION OF FACA.—The Federal Advisory 

18 Committee Act (5 U.S.C. App.) shall apply to the Commu19 nity, except that the term provided for under section 

20 14(a)(2) of such Act shall be not longer than 7 years. 

21 ‘‘(f) SUNSET.—The provisions of this section shall 

22 not apply after September 20, 2014. 

23 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

24 is authorized to be appropriated to carry out this section, 

25 $2,000,000 for each of fiscal years 2008 and 2009. 


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1 ‘‘SEC. 3005. FEDERAL PURCHASING AND DATA COLLEC2 TION. 

3 ‘‘(a) COORDINATION OF FEDERAL SPENDING.— 

4 ‘‘(1) IN GENERAL.—Not later than 1 year after 

5 the adoption by the President of a recommendation 

6 under section 3003(c)(6), a Federal agency shall not 

7 expend Federal funds for the purchase of any new 

8 health information technology or health information 

9 technology system for clinical care or for the elec10 tronic retrieval, storage, or exchange of health infor11 mation if such technology or system is not consistent 

12 with applicable standards adopted by the Federal 

13 Government under section 3003. 

14 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

15 paragraph (1) shall be construed to restrict the pur16 chase of minor (as determined by the Secretary) 

17 hardware or software components in order to mod18 ify, correct a deficiency in, or extend the life of exist19 ing hardware or software. 

20 ‘‘(b) VOLUNTARY ADOPTION.— 

21 ‘‘(1) IN GENERAL.—Any standards and imple22 mentation specifications adopted by the Federal 

23 Government under section 303(c)(6) shall be vol24 untary with respect to private entities. 

25 ‘‘(2) REQUIREMENT.—Private entities that 

26 enter into a contract with the Federal Government 


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1 shall adopt the standards and implementation speci2 fications adopted by the Federal Government under 

3 this section for the purpose of activities under such 

4 Federal contract. 

5 ‘‘(3) RULE OF CONSTRUCTION.—Nothing in 

6 this section shall be construed to require that a pri7 vate entity that enters into a contract with the Fed8 eral Government adopt the standards and implemen9 tation specifications adopted by the Federal Govern10 ment under this section with respect to activities not 

11 related to the contract. 

12 ‘‘(c) COORDINATION OF FEDERAL DATA COLLEC13 TION.—Not later than 3 years after the adoption by the 

14 Federal Government of a recommendation as provided for 

15 in section 303(c)(6), all Federal agencies collecting health 

16 data in an electronic format for the purposes of quality 

17 reporting, surveillance, epidemiology, adverse event report18 ing, research, or for other purposes determined appro19 priate by the Secretary, shall comply with the standards 

20 and implementation specifications adopted under such 

21 subsection. 

22 ‘‘SEC. 3006. QUALITY AND EFFICIENCY REPORTS. 

23 ‘‘(a) PURPOSE.—The purpose of this section is to 

24 provide for the development of reports based on Federal 

25 health care data and private data that is publicly available 


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1 or is provided by the entity making the request for the 

2 report in order to— 

3 ‘‘(1) improve the quality and efficiency of 

4 health care and advance health care research; 

5 ‘‘(2) enhance the education and awareness of 

6 consumers for evaluating health care services; and 

7 ‘‘(3) provide the public with reports on national, 

8 regional, and provider- and supplier-specific per9 formance, which may be in a provider- or supplier10 identifiable format. 

11 ‘‘(b) PROCEDURES FOR THE DEVELOPMENT OF RE12 PORTS.— 

13 ‘‘(1) IN GENERAL.—Notwithstanding section 

14 552(b)(6) or 552a(b) of title 5, United States Code, 

15 not later than 12 months after the date of enact16 ment of this section, the Secretary, in accordance 

17 with the purpose described in subsection (a), shall 

18 establish and implement procedures under which an 

19 entity may submit a request to a Quality Reporting 

20 Organization for the Organization to develop a re21 port based on— 

22 ‘‘(A) Federal health care data disclosed to 

23 the Organization under subsection (c); and 


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1 ‘‘(B) private data that is publicly available 

2 or is provided to the Organization by the entity 

3 making the request for the report. 

4 ‘‘(2) DEFINITIONS.—In this section: 

5 ‘‘(A) FEDERAL HEALTH CARE DATA.—The 

6 term ‘Federal health care data’ means — 

7 ‘‘(i) deidentified patient enrollment 

8 data, reimbursement claims, and survey 

9 data maintained by the Secretary or enti10 ties under programs, contracts, grants, or 

11 memoranda of understanding administered 

12 by the Secretary; and 

13 ‘‘(ii) where feasible, other deidentified 

14 patient enrollment data, reimbursement 

15 claims, and survey data maintained by the 

16 Federal Government or entities under con17 tract with the Federal Government. 

18 ‘‘(B) QUALITY REPORTING ORGANIZA19 TION.—The term ‘Quality Reporting Organiza20 tion’ means an entity with a contract under 

21 subsection (d). 

22 ‘‘(c) ACCESS TO FEDERAL HEALTH CARE DATA.— 

23 ‘‘(1) IN GENERAL.—The procedures established 

24 under subsection (b)(1) shall provide for the secure 


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1 disclosure of Federal health care data to each Qual2 ity Reporting Organization. 

3 ‘‘(2) UPDATE OF INFORMATION.—Not less than 

4 every 6 months, the Secretary shall update the infor5 mation disclosed under paragraph (1) to Quality Re6 porting Organizations. 

7 ‘‘(d) QUALITY REPORTING ORGANIZATIONS.— 

8 ‘‘(1) IN GENERAL.— 

9 ‘‘(A) THREE CONTRACTS.—Subject to sub10 paragraph (B), the Secretary shall enter into a 

11 contract with 3 private entities to serve as 

12 Quality Reporting Organizations under which 

13 an entity shall— 

14 ‘‘(i) store the Federal health care data 

15 that is to be disclosed under subsection (c); 

16 and 

17 ‘‘(ii) develop and release reports pur18 suant to subsection (e). 

19 ‘‘(B) ADDITIONAL CONTRACTS.—If the 

20 Secretary determines that reports are not being 

21 developed and released within 6 months of the 

22 receipt of the request for the report, the Sec23 retary shall enter into contracts with additional 

24 private entities in order to ensure that such reVerDate Aug 31 2005 03:55 Jun 27, 2007 Jkt 059200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S1693.IS S1693

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1 ports are developed and released in a timely 

2 manner. 

3 ‘‘(2) QUALIFICATIONS.—The Secretary shall 

4 enter into a contract with an entity under paragraph 

5 (1) only if the Secretary determines that the enti6 ty— 

7 ‘‘(A) has the research capability to conduct 

8 and complete reports under this section; 

9 ‘‘(B) has in place– 

10 ‘‘(i) an information technology infra11 structure to support the database of Fed12 eral health care data that is to be disclosed 

13 to the entity; and 

14 ‘‘(ii) operational standards to provide 

15 security for such database; 

16 ‘‘(C) has experience with, and expertise on, 

17 the development of reports on health care qual18 ity and efficiency; and 

19 ‘‘(D) has a significant business presence in 

20 the United States. 

21 ‘‘(3) CONTRACT REQUIREMENTS.—Each con22 tract with an entity under paragraph (1) shall con23 tain the following requirements: 

24 ‘‘(A) ENSURING BENEFICIARY PRIVACY.— 


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1 ‘‘(i) HIPAA.—The entity shall meet 

2 the requirements imposed on a covered en3 tity for purposes of applying part C of title 

4 XI and all regulatory provisions promul5 gated thereunder, including regulations 

6 (relating to privacy) adopted pursuant to 

7 the authority of the Secretary under sec8 tion 264(c) of the Health Insurance Port9 ability and Accountability Act of 1996 (42 

10 U.S.C. 1320d–2 note). 

11 ‘‘(ii) PRIVACY.—The entity shall pro12 vide assurances that the entity will not use 

13 the Federal health care data disclosed 

14 under subsection (c) in a manner that vio15 lates sections 552 or 552a of title 5, 

16 United States Code, with regard to the pri17 vacy of and individual’s individually identi18 fiable health information. 

19 ‘‘(B) PROPRIETARY INFORMATION.—The 

20 entity shall provide assurances that the entity 

21 will not disclose any negotiated price conces22 sions, such as discounts, direct or indirect sub23 sidies, rebates, and direct or indirect remunera24 tions, obtained by health care providers or supVerDate Aug 31 2005 03:55 Jun 27, 2007 Jkt 059200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\S1693.IS S1693

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1 pliers or health care plans, or any other propri2 etary cost information. 

3 ‘‘(C) DISCLOSURE.—The entity shall dis4 close— 

5 ‘‘(i) any financial, reporting, or con6 tractual relationship between the entity 

7 and any health care provider or supplier or 

8 health care plan; and 

9 ‘‘(ii) if applicable, the fact that the 

10 entity is managed, controlled, or operated 

11 by any health care provider or supplier or 

12 health care plan. 

13 ‘‘(D) COMPONENT OF ANOTHER ORGANIZA14 TION.—If the entity is a component of another 

15 organization— 

16 ‘‘(i) the entity shall maintain Federal 

17 health care data and reports separately 

18 from the rest of the organization and es19 tablish appropriate security measures to 

20 maintain the confidentiality and privacy of 

21 the Federal health care data and reports; 

22 and 

23 ‘‘(ii) the entity shall not make an un24 authorized disclosure to the rest of the or25 ganization of Federal health care data or 


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1 reports in breach of such confidentiality 

2 and privacy requirement. 

3 ‘‘(E) TERMINATION OR NONRENEWAL.—If 

4 a contract under this section is terminated or 

5 not renewed, the following requirements shall 

6 apply: 

7 ‘‘(i) CONFIDENTIALITY AND PRIVACY

8 PROTECTIONS.—The entity shall continue 

9 to comply with the confidentiality and pri10 vacy requirements under this section with 

11 respect to all Federal health care data dis12 closed to the entity and each report devel13 oped by the entity. 

14 ‘‘(ii) DISPOSITION OF DATA AND RE15 PORTS.—The entity shall— 

16 ‘‘(I) return to the Secretary all 

17 Federal health care data disclosed to 

18 the entity and each report developed 

19 by the entity; or 

20 ‘‘(II) if returning the Federal 

21 health care data and reports is not 

22 practicable, destroy the reports and 

23 Federal health care data. 

24 ‘‘(4) COMPETITIVE PROCEDURES.—Competitive 

25 procedures (as defined in section 4(5) of the Federal 


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1 Procurement Policy Act) shall be used to enter into 

2 contracts under paragraph (1). 

3 ‘‘(5) REVIEW OF CONTRACT IN THE EVENT OF

4 A MERGER OR ACQUISITION.—The Secretary shall 

5 review the contract with a Quality Reporting Orga6 nization under this section in the event of a merger 

7 or acquisition of the Organization in order to ensure 

8 that the requirements under this section will con9 tinue to be met. 

10 ‘‘(e) DEVELOPMENT AND RELEASE OF REPORTS

11 BASED ON REQUESTS.— 

12 ‘‘(1) REQUEST FOR A REPORT.— 

13 ‘‘(A) REQUEST.— 

14 ‘‘(i) IN GENERAL.—The procedures 

15 established under subsection (b)(1) shall 

16 include a process for an entity to submit a 

17 request to a Quality Reporting Organiza18 tion for a report based on Federal health 

19 care data and private data that is publicly 

20 available or is provided by the entity mak21 ing the request for the report. Such re22 quest shall comply with the purpose de23 scribed in subsection (a). 

24 ‘‘(ii) REQUEST FOR SPECIFIC METH25 ODOLOGY.—The process described in 


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1 clause (i) shall permit an entity making a 

2 request for a report to request that a spe3 cific methodology, including appropriate 

4 risk adjustment, be used by the Quality 

5 Reporting Organization in developing the 

6 report. The Organization shall work with 

7 the entity making the request to finalize 

8 the methodology to be used. 

9 ‘‘(iii) REQUEST FOR A SPECIFIC

10 QRO.—The process described in clause (i) 

11 shall permit an entity to submit the re12 quest for a report to any Quality Report13 ing Organization. 

14 ‘‘(B) RELEASE TO PUBLIC.—The proce15 dures established under subsection (b)(1) shall 

16 provide that at the time a request for a report 

17 is finalized under subparagraph (A) by a Qual18 ity Reporting Organization, the Organization 

19 shall make available to the public, through the 

20 Internet website of the Department of Health 

21 and Human Services and other appropriate 

22 means, a brief description of both the requested 

23 report and the methodology to be used to de24 velop such report. 


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1 ‘‘(2) DEVELOPMENT AND RELEASE OF RE2 PORT.— 

3 ‘‘(A) DEVELOPMENT.— 

4 ‘‘(i) IN GENERAL.—If the request for 

5 a report complies with the purpose de6 scribed in subsection (a), the Quality Re7 porting Organization may develop the re8 port based on the request. 

9 ‘‘(ii) REQUIREMENT.—A report devel10 oped under clause (i) shall include a de11 tailed description of the standards, meth12 odologies, and measures of quality used in 

13 developing the report. 

14 ‘‘(B) REVIEW OF REPORT BY SECRETARY

15 TO ENSURE COMPLIANCE WITH PRIVACY RE16 QUIREMENT.—Prior to a Quality Reporting Or17 ganization releasing a report under subpara18 graph (C), the Secretary shall review the report 

19 to ensure that the report complies with the 

20 Federal regulations (concerning the privacy of 

21 individually identifiable beneficiary health infor22 mation) promulgated under section 264(c) of 

23 the Health Insurance Portability and Account24 ability Act of 1996 and sections 552 or 552a of 

25 title 5, United States Code, with regard to the 


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1 privacy of individually identifiable beneficiary 

2 health information. The Secretary shall act 

3 within 30 business days of receiving such re4 port. 

5 ‘‘(C) RELEASE OF REPORT.— 

6 ‘‘(i) RELEASE TO ENTITY MAKING RE7 QUEST.—If the Secretary finds that the re8 port complies with the provisions described 

9 in subparagraph (B), the Quality Report10 ing Organization shall release the report to 

11 the entity that made the request for the re12 port. 

13 ‘‘(ii) RELEASE TO PUBLIC.—The pro14 cedures established under subsection (b)(1) 

15 shall provide for the following: 

16 ‘‘(I) UPDATED DESCRIPTION.— 

17 At the time of the release of a report 

18 by a Quality Reporting Organization 

19 under clause (i), the entity shall make 

20 available to the public, through the 

21 Internet website of the Department of 

22 Health and Human Services and 

23 other appropriate means, an updated 

24 brief description of both the requested 


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1 report and the methodology used to 

2 develop such report. 

3 ‘‘(II) COMPLETE REPORT.—Not 

4 later than 1 year after the date of the 

5 release of a report under clause (i), 

6 the report shall be made available to 

7 the public through the Internet 

8 website of the Department of Health 

9 and Human Services and other appro10 priate means. 

11 ‘‘(f) ANNUAL REVIEW OF REPORTS AND TERMI12 NATION OF CONTRACTS.— 

13 ‘‘(1) ANNUAL REVIEW OF REPORTS.—The 

14 Comptroller General of the United States shall re15 view reports released under subsection (e)(2)(C) to 

16 ensure that such reports comply with the purpose 

17 described in subsection (a) and annually submit a 

18 report to the Secretary on such review. 

19 ‘‘(2) TERMINATION OF CONTRACTS.—The Sec20 retary may terminate a contract with a Quality Re21 porting Organization if the Secretary determines 

22 that there is a pattern of reports being released by 

23 the Organization that do not comply with the pur24 pose described in subsection (a). 

25 ‘‘(g) FEES.— 


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1 ‘‘(1) FEES FOR SECRETARY.—The Secretary 

2 shall charge a Quality Reporting Organization a fee 

3 for— 

4 ‘‘(A) disclosing the data under subsection 

5 (c); and 

6 ‘‘(B) conducting the review under sub7 section (e)(2)(B). 

8 The Secretary shall ensure that such fees are suffi9 cient to cover the costs of the activities described in 

10 subparagraph (A) and (B). 

11 ‘‘(2) FEES FOR QRO.— 

12 ‘‘(A) IN GENERAL.—Subject to subpara13 graphs (A) and (B), a Quality Reporting Orga14 nization may charge an entity making a request 

15 for a report a reasonable fee for the develop16 ment and release of the report. 

17 ‘‘(B) DISCOUNT FOR SMALL ENTITIES.—In 

18 the case of an entity making a request for a re19 port (including a not-for-profit) that has annual 

20 revenue that does not exceed $10,000,000, the 

21 Quality Reporting Organization shall reduce the 

22 reasonable fee charged to such entity under 

23 subparagraph (A) by an amount equal to 10 

24 percent of such fee. 


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1 ‘‘(C) INCREASE FOR LARGE ENTITIES

2 THAT DO NOT AGREE TO RELEASE REPORTS

3 WITHIN 6 MONTHS.—In the case of an entity 

4 making a request for a report that is not de5 scribed in subparagraph (B) and that does not 

6 agree to the report being released to the public 

7 under clause (ii)(II) of subsection (e)(2)(C) 

8 within 6 months of the date of the release of 

9 the report to the entity under clause (i) of such 

10 subsection, the Quality Reporting Organization 

11 shall increase the reasonable fee charged to 

12 such entity under subparagraph (A) by an 

13 amount equal to 10 percent of such fee. 

14 ‘‘(D) RULE OF CONSTRUCTION.—Nothing 

15 in this paragraph shall be construed to effect 

16 the requirement that a report be released to the 

17 public under clause (ii)(II) of subsection 

18 (e)(2)(C)(ii)(II) by not later than 1 year after 

19 the date of the release of the report to the re20 questing entity under clause (i) of such sub21 section. 

22 ‘‘(h) COORDINATION.—Not later than 1 year after 

23 the date of enactment of this title, the Secretary shall sub24 mit a report (including recommendations) to the approVerDate Aug 31 2005 03:55 Jun 27, 2007 Jkt 059200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\S1693.IS S1693

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1 priate committees of Congress concerning the coordination 

2 of existing Federal health care quality initiatives. 

3 ‘‘(i) REGULATIONS.—Not later than 6 months after 

4 the date of enactment of this section, the Secretary shall 

5 prescribe regulations to carry out this section. 

6 ‘‘SEC. 3007. RESEARCH ACCESS TO HEALTH CARE DATA 

7 AND REPORTING ON PERFORMANCE. 

8 ‘‘The Secretary shall permit researchers that meet 

9 criteria used to evaluate the appropriateness of the release 

10 data for research purpose (as established by the Sec11 retary) to— 

12 ‘‘(1) have access to all Federal health care data 

13 (as defined in section 3006(b)(2)(A)); and 

14 ‘‘(2) report on the performance of health care 

15 providers and suppliers, including reporting in a 

16 provider- or supplier-identifiable format.’’. 


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1 TITLE II—FACILITATING THE 

2 WIDESPREAD ADOPTION OF 

3 INTEROPERABLE HEALTH IN4 FORMATION TECHNOLOGY 

5 SEC. 201. FACILITATING THE WIDESPREAD ADOPTION OF 

6 INTEROPERABLE HEALTH INFORMATION 

7 TECHNOLOGY. 

8 Title XXX of the Public Health Service Act, as added 

9 by section 101, is amended by adding at the end the fol10 lowing: 

11 ‘‘SEC. 3008. FACILITATING THE WIDESPREAD ADOPTION OF 

12 INTEROPERABLE HEALTH INFORMATION 

13 TECHNOLOGY. 

14 ‘‘(a) COMPETITIVE GRANTS FOR ADOPTION OF

15 TECHNOLOGY.— 

16 ‘‘(1) IN GENERAL.—The Secretary may award 

17 competitive grants to eligible entities to facilitate the 

18 purchase and enhance the utilization of qualified 

19 health information technology systems to improve 

20 the quality and efficiency of health care. 

21 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

22 grant under paragraph (1) an entity shall— 

23 ‘‘(A) submit to the Secretary an applica24 tion at such time, in such manner, and conVerDate Aug 31 2005 03:55 Jun 27, 2007 Jkt 059200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\S1693.IS S1693

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1 taining such information as the Secretary may 

2 require; 

3 ‘‘(B) submit to the Secretary a strategic 

4 plan for the implementation of data sharing 

5 and interoperability measures; 

6 ‘‘(C) adopt the standards adopted by the 

7 Federal Government under section 3005; 

8 ‘‘(D) implement the measures adopted 

9 under section 3010 and report to the Secretary 

10 on such measures; 

11 ‘‘(E) agree to notify individuals if their in12 dividually identifiable health information is 

13 wrongfully disclosed; 

14 ‘‘(F) take into account the input of em15 ployees and staff who are directly involved in 

16 patient care of such health care providers in the 

17 design, implementation, and use of qualified 

18 health information technology systems; 

19 ‘‘(G) demonstrate significant financial 

20 need; 

21 ‘‘(H) provide matching funds in accord22 ance with paragraph (4); and 

23 ‘‘(I) be a— 

24 ‘‘(i) public or not for profit hospital; 


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1 ‘‘(ii) federally qualified health center 

2 (as defined in section 1861(aa)(4) of the 

3 Social Security Act); 

4 ‘‘(iii) individual or group practice (or 

5 a consortium thereof); or 

6 ‘‘(iv) another health care provider not 

7 described in clause (i) or (ii); 

8 that serves medically underserved communities. 

9 ‘‘(3) USE OF FUNDS.—Amounts received under 

10 a grant under this subsection shall be used to— 

11 ‘‘(A) facilitate the purchase of qualified 

12 health information technology systems; 

13 ‘‘(B) train personnel in the use of such 

14 systems; 

15 ‘‘(C) enhance the utilization of qualified 

16 health information technology systems (which 

17 may include activities to increase the awareness 

18 among consumers of health care privacy protec19 tions); or 

20 ‘‘(D) improve the prevention and manage21 ment of chronic disease. 

22 ‘‘(4) MATCHING REQUIREMENT.—To be eligible 

23 for a grant under this subsection an entity shall con24 tribute non-Federal contributions to the costs of car25 rying out the activities for which the grant is awardVerDate Aug 31 2005 03:55 Jun 27, 2007 Jkt 059200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\S1693.IS S1693

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1 ed in an amount equal to $1 for each $3 of Federal 

2 funds provided under the grant. 

3 ‘‘(5) PREFERENCE IN AWARDING GRANTS.—In 

4 awarding grants under this subsection the Secretary 

5 shall give preference to— 

6 ‘‘(A) eligible entities that will improve the 

7 degree to which such entity will link the quali8 fied health information system to local or re9 gional health information plan or plans; and 

10 ‘‘(B) with respect to awards made for the 

11 purpose of providing care in an outpatient med12 ical setting, entities that organize their prac13 tices as a patient-centered medical home. 

14 ‘‘(b) COMPETITIVE GRANTS FOR THE DEVELOPMENT

15 OF STATE LOAN PROGRAMS TO FACILITATE THE WIDE16 SPREAD ADOPTION OF HEALTH INFORMATION TECH17 NOLOGY.— 

18 ‘‘(1) IN GENERAL.—The Secretary may award 

19 competitive grants to States for the establishment of 

20 State programs for loans to health care providers to 

21 facilitate the purchase and enhance the utilization of 

22 qualified health information technology. 

23 ‘‘(2) ESTABLISHMENT OF FUND.—To be eligi24 ble to receive a competitive grant under this sub25 section, a State shall establish a qualified health inVerDate Aug 31 2005 03:55 Jun 27, 2007 Jkt 059200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\S1693.IS S1693

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1 formation technology loan fund (referred to in this 

2 subsection as a ‘State loan fund’) and comply with 

3 the other requirements contained in this subsection. 

4 Amounts received under a grant under this sub5 section shall be deposited in the State loan fund es6 tablished by the State. No funds authorized by other 

7 provisions of this title to be used for other purposes 

8 specified in this title shall be deposited in any such 

9 State loan fund. 

10 ‘‘(3) ELIGIBILITY.—To be eligible to receive a 

11 grant under paragraph (1) a State shall— 

12 ‘‘(A) submit to the Secretary an applica13 tion at such time, in such manner, and con14 taining such information as the Secretary may 

15 require; 

16 ‘‘(B) submit to the Secretary a strategic 

17 plan in accordance with paragraph (4); 

18 ‘‘(C) establish a qualified health informa19 tion technology loan fund in accordance with 

20 paragraph (2); 

21 ‘‘(D) require that health care providers re22 ceiving loans under the grant— 

23 ‘‘(i) link, to the extent practicable, the 

24 qualified health information system to a 


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1 local or regional health information net2 work; 

3 ‘‘(ii) consult, as needed, with the 

4 Health Information Technology Resource 

5 Center established in section 914(d) to ac6 cess the knowledge and experience of exist7 ing initiatives regarding the successful im8 plementation and effective use of health in9 formation technology; 

10 ‘‘(iii) agree to notify individuals if 

11 their individually identifiable health infor12 mation is wrongfully disclosed; and 

13 ‘‘(iv) take into account the input of 

14 employees and staff who are directly in15 volved in patient care of such health care 

16 providers in the design and implementation 

17 and use of qualified health information 

18 technology systems; 

19 ‘‘(E) require that health care providers re20 ceiving loans under the grant adopt the stand21 ards adopted by the Federal Government under 

22 section 3005; 

23 ‘‘(F) require that health care providers re24 ceiving loans under the grant implement the 


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1 measures adopted under section 3010 and re2 port to the Secretary on such measures; and 

3 ‘‘(G) provide matching funds in accordance 

4 with paragraph (8). 

5 ‘‘(4) STRATEGIC PLAN.— 

6 ‘‘(A) IN GENERAL.—A State that receives 

7 a grant under this subsection shall annually 

8 prepare a strategic plan that identifies the in9 tended uses of amounts available to the State 

10 loan fund of the State. 

11 ‘‘(B) CONTENTS.—A strategic plan under 

12 subparagraph (A) shall include— 

13 ‘‘(i) a list of the projects to be as14 sisted through the State loan fund in the 

15 first fiscal year that begins after the date 

16 on which the plan is submitted; 

17 ‘‘(ii) a description of the criteria and 

18 methods established for the distribution of 

19 funds from the State loan fund; 

20 ‘‘(iii) a description of the financial 

21 status of the State loan fund and the 

22 short-term and long-term goals of the 

23 State loan fund; and 

24 ‘‘(iv) a description of the strategies 

25 the State will use to address challenges in 


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1 the adoption of health information tech2 nology due to limited broadband access. 

3 ‘‘(5) USE OF FUNDS.— 

4 ‘‘(A) IN GENERAL.—Amounts deposited in 

5 a State loan fund, including loan repayments 

6 and interest earned on such amounts, shall be 

7 used only for awarding loans or loan guaran8 tees, or as a source of reserve and security for 

9 leveraged loans, the proceeds of which are de10 posited in the State loan fund established under 

11 paragraph (1). Loans under this section may be 

12 used by a health care provider to— 

13 ‘‘(i) facilitate the purchase of qualified 

14 health information technology systems; 

15 ‘‘(ii) enhance the utilization of quali16 fied health information technology systems 

17 (which may include activities to increase 

18 the awareness among consumers of health 

19 care of privacy protections and privacy 

20 rights); or 

21 ‘‘(iii) train personnel in the use of 

22 such systems. 

23 ‘‘(B) LIMITATION.—Amounts received by a 

24 State under this subsection may not be used— 


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1 ‘‘(i) for the purchase or other acquisi2 tion of any health information technology 

3 system that is not a qualified health infor4 mation technology system; 

5 ‘‘(ii) to conduct activities for which 

6 Federal funds are expended under this 

7 title, or the amendments made by the 

8 Wired for Health Care Quality Act; or 

9 ‘‘(iii) for any purpose other than mak10 ing loans to eligible entities under this sec11 tion. 

12 ‘‘(6) TYPES OF ASSISTANCE.—Except as other13 wise limited by applicable State law, amounts depos14 ited into a State loan fund under this subsection 

15 may only be used for the following: 

16 ‘‘(A) To award loans that comply with the 

17 following: 

18 ‘‘(i) The interest rate for each loan 

19 shall be less than or equal to the market 

20 interest rate. 

21 ‘‘(ii) The principal and interest pay22 ments on each loan shall commence not 

23 later than 1 year after the date on which 

24 the loan was awarded, and each loan shall 


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1 be fully amortized not later than 10 years 

2 after such date. 

3 ‘‘(iii) The State loan fund shall be 

4 credited with all payments of principal and 

5 interest on each loan awarded from the 

6 fund. 

7 ‘‘(B) To guarantee, or purchase insurance 

8 for, a local obligation (all of the proceeds of 

9 which finance a project eligible for assistance 

10 under this subsection) if the guarantee or pur11 chase would improve credit market access or re12 duce the interest rate applicable to the obliga13 tion involved. 

14 ‘‘(C) As a source of revenue or security for 

15 the payment of principal and interest on rev16 enue or general obligation bonds issued by the 

17 State if the proceeds of the sale of the bonds 

18 will be deposited into the State loan fund. 

19 ‘‘(D) To earn interest on the amounts de20 posited into the State loan fund. 

21 ‘‘(7) ADMINISTRATION OF STATE LOAN

22 FUNDS.— 

23 ‘‘(A) COMBINED FINANCIAL ADMINISTRA24 TION.—A State may (as a convenience and to 

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1 bine, in accordance with State law, the financial 

2 administration of a State loan fund established 

3 under this subsection with the financial admin4 istration of any other revolving fund established 

5 by the State if not otherwise prohibited by the 

6 law under which the State loan fund was estab7 lished. 

8 ‘‘(B) COST OF ADMINISTERING FUND.— 

9 Each State may annually use not to exceed 4 

10 percent of the funds provided to the State 

11 under a grant under this subsection to pay the 

12 reasonable costs of the administration of the 

13 programs under this section, including the re14 covery of reasonable costs expended to establish 

15 a State loan fund which are incurred after the 

16 date of enactment of this title. 

17 ‘‘(C) GUIDANCE AND REGULATIONS.—The 

18 Secretary shall publish guidance and promul19 gate regulations as may be necessary to carry 

20 out the provisions of this subsection, includ21 ing— 

22 ‘‘(i) provisions to ensure that each 

23 State commits and expends funds allotted 

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1 ciently as possible in accordance with this 

2 title and applicable State laws; and 

3 ‘‘(ii) guidance to prevent waste, fraud, 

4 and abuse. 

5 ‘‘(D) PRIVATE SECTOR CONTRIBUTIONS.— 

6 ‘‘(i) IN GENERAL.—A State loan fund 

7 established under this subsection may ac8 cept contributions from private sector enti9 ties, except that such entities may not 

10 specify the recipient or recipients of any 

11 loan issued under this subsection. 

12 ‘‘(ii) AVAILABILITY OF INFORMA13 TION.—A State shall make publicly avail14 able the identity of, and amount contrib15 uted by, any private sector entity under 

16 clause (i) and may issue letters of com17 mendation or make other awards (that 

18 have no financial value) to any such entity. 

19 ‘‘(8) MATCHING REQUIREMENTS.— 

20 ‘‘(A) IN GENERAL.—The Secretary may 

21 not make a grant under paragraph (1) to a 

22 State unless the State agrees to make available 

23 (directly or through donations from public or 

24 private entities) non-Federal contributions in 

25 cash toward the costs of the State program to 


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1 be implemented under the grant in an amount 

2 equal to not less than $1 for each $1 of Federal 

3 funds provided under the grant. 

4 ‘‘(B) DETERMINATION OF AMOUNT OF

5 NON-FEDERAL CONTRIBUTION.—In determining 

6 the amount of non-Federal contributions that a 

7 State has provided pursuant to subparagraph 

8 (A), the Secretary may not include any 

9 amounts provided to the State by the Federal 

10 Government. 

11 ‘‘(9) PREFERENCE IN AWARDING GRANTS.— 

12 The Secretary may give a preference in awarding 

13 grants under this subsection to States that adopt 

14 value-based purchasing programs to improve health 

15 care quality. 

16 ‘‘(10) REPORTS.—The Secretary shall annually 

17 submit to the Committee on Health, Education, 

18 Labor, and Pensions and the Committee on Finance 

19 of the Senate, and the Committee on Energy and 

20 Commerce and the Committee on Ways and Means 

21 of the House of Representatives, a report summa22 rizing the reports received by the Secretary from 

23 each State that receives a grant under this sub24 section. 


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1 ‘‘(c) COMPETITIVE GRANTS FOR THE IMPLEMENTA2 TION OF REGIONAL OR LOCAL HEALTH INFORMATION

3 TECHNOLOGY PLANS.— 

4 ‘‘(1) IN GENERAL.—The Secretary may award 

5 competitive grants to eligible entities to implement 

6 regional or local health information plans to improve 

7 health care quality and efficiency through the elec8 tronic exchange of health information pursuant to 

9 the standards, implementation specifications and 

10 certification criteria, and other requirements adopted 

11 by the Secretary under section 3010. 

12 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

13 grant under paragraph (1) an entity shall— 

14 ‘‘(A) demonstrate financial need to the 

15 Secretary; 

16 ‘‘(B) demonstrate that one of its principal 

17 missions or purposes is to use information tech18 nology to improve health care quality and effi19 ciency; 

20 ‘‘(C) adopt bylaws, memoranda of under21 standing, or other charter documents that dem22 onstrate that the governance structure and de23 cisionmaking processes of such entity allow for 

24 participation on an ongoing basis by multiple 

25 stakeholders within a community, including— 


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1 ‘‘(i) health care providers (including 

2 health care providers that provide services 

3 to low income and underserved popu4 lations); 

5 ‘‘(ii) pharmacists or pharmacies; 

6 ‘‘(iii) health plans; 

7 ‘‘(iv) health centers (as defined in sec8 tion 330(b)) and federally qualified health 

9 centers (as defined in section 1861(aa)(4) 

10 of the Social Security Act) and rural 

11 health clinics (as defined in section 

12 1861(aa) of the Social Security Act), if 

13 such centers or clinics are present in the 

14 community served by the entity; 

15 ‘‘(v) patient or consumer organiza16 tions; 

17 ‘‘(vi) organizations dedicated to im18 proving the health of vulnerable popu19 lations; 

20 ‘‘(vii) employers; 

21 ‘‘(viii) State or local health depart22 ments; and 

23 ‘‘(ix) any other health care providers 

24 or other entities, as determined appro25 priate by the Secretary; 


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1 ‘‘(D) demonstrate the participation, to the 

2 extent practicable, of stakeholders in the elec3 tronic exchange of health information within 

4 the local or regional plan pursuant to subpara5 graph (C); 

6 ‘‘(E) adopt nondiscrimination and conflict 

7 of interest policies that demonstrate a commit8 ment to open, fair, and nondiscriminatory par9 ticipation in the health information plan by all 

10 stakeholders; 

11 ‘‘(F) adopt the standards adopted by the 

12 Secretary under section 3005; 

13 ‘‘(G) require that health care providers re14 ceiving such grants— 

15 ‘‘(i) implement the measures adopted 

16 under section 3010 and report to the Sec17 retary on such measures; and 

18 ‘‘(ii) take into account the input of 

19 employees and staff who are directly in20 volved in patient care of such health care 

21 providers in the design, implementation, 

22 and use of health information technology 

23 systems; 


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1 ‘‘(H) agree to notify individuals if their in2 dividually identifiable health information is 

3 wrongfully disclosed; 

4 ‘‘(I) facilitate the electronic exchange of 

5 health information within the local or regional 

6 area and among local and regional areas; 

7 ‘‘(J) prepare and submit to the Secretary 

8 an application in accordance with paragraph 

9 (3); 

10 ‘‘(K) agree to provide matching funds in 

11 accordance with paragraph (5); and 

12 ‘‘(L) reduce barriers to the implementation 

13 of health information technology by providers. 

14 ‘‘(3) APPLICATION.— 

15 ‘‘(A) IN GENERAL.—To be eligible to re16 ceive a grant under paragraph (1), an entity 

17 shall submit to the Secretary an application at 

18 such time, in such manner, and containing such 

19 information as the Secretary may require. 

20 ‘‘(B) REQUIRED INFORMATION.—At a 

21 minimum, an application submitted under this 

22 paragraph shall include— 

23 ‘‘(i) clearly identified short-term and 

24 long-term objectives of the regional or local 

25 health information plan; 


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1 ‘‘(ii) a technology plan that complies 

2 with the standards, implementation speci3 fications, and certification criteria adopted 

4 under section 3003(c)(6) and that includes 

5 a descriptive and reasoned estimate of 

6 costs of the hardware, software, training, 

7 and consulting services necessary to imple8 ment the regional or local health informa9 tion plan; 

10 ‘‘(iii) a strategy that includes initia11 tives to improve health care quality and ef12 ficiency, including the use and reporting of 

13 health care quality measures adopted 

14 under section 3010; 

15 ‘‘(iv) a plan that describes provisions 

16 to encourage the implementation of the 

17 electronic exchange of health information 

18 by all health care providers participating in 

19 the health information plan; 

20 ‘‘(v) a plan to ensure the privacy and 

21 security of individually identifiable health 

22 information that is consistent with Federal 

23 and State law; 

24 ‘‘(vi) a governance plan that defines 

25 the manner in which the stakeholders shall 


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1 jointly make policy and operational deci2 sions on an ongoing basis; 

3 ‘‘(vii) a financial or business plan that 

4 describes— 

5 ‘‘(I) the sustainability of the 

6 plan; 

7 ‘‘(II) the financial costs and ben8 efits of the plan; and 

9 ‘‘(III) the entities to which such 

10 costs and benefits will accrue; 

11 ‘‘(viii) a description of whether the 

12 State in which the entity resides has re13 ceived a grant under section 319D, alone 

14 or as a part of a consortium, and if the 

15 State has received such a grant, how the 

16 entity will coordinate the activities funded 

17 under such section 319D with the system 

18 under this section; and 

19 ‘‘(ix) in the case of an applicant entity 

20 that is unable to demonstrate the partici21 pation of all stakeholders pursuant to 

22 paragraph (2)(C), the justification from 

23 the entity for any such nonparticipation. 

24 ‘‘(4) USE OF FUNDS.—Amounts received under 

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1 lish and implement a regional or local health infor2 mation plan in accordance with this subsection. 

3 ‘‘(5) MATCHING REQUIREMENT.— 

4 ‘‘(A) IN GENERAL.—The Secretary may 

5 not make a grant under this subsection to an 

6 entity unless the entity agrees that, with re7 spect to the costs to be incurred by the entity 

8 in carrying out the infrastructure program for 

9 which the grant was awarded, the entity will 

10 make available (directly or through donations 

11 from public or private entities) non-Federal 

12 contributions toward such costs in an amount 

13 equal to not less than 50 percent of such costs 

14 ($1 for each $2 of Federal funds provided 

15 under the grant). 

16 ‘‘(B) DETERMINATION OF AMOUNT CON17 TRIBUTED.—Non-Federal contributions re18 quired under subparagraph (A) may be in cash 

19 or in kind, fairly evaluated, including equip20 ment, technology, or services. Amounts provided 

21 by the Federal Government, or services assisted 

22 or subsidized to any significant extent by the 

23 Federal Government, may not be included in 

24 determining the amount of such non-Federal 

25 contributions. 


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1 ‘‘(d) REPORTS.—Not later than 1 year after the date 

2 on which the first grant is awarded under this section, 

3 and annually thereafter during the grant period, an entity 

4 that receives a grant under this section shall submit to 

5 the Secretary a report on the activities carried out under 

6 the grant involved. Each such report shall include— 

7 ‘‘(1) a description of the financial costs and 

8 benefits of the project involved and of the entities to 

9 which such costs and benefits accrue; 

10 ‘‘(2) an analysis of the impact of the project on 

11 health care quality and safety; 

12 ‘‘(3) a description of any reduction in duplica13 tive or unnecessary care as a result of the project in14 volved; and 

15 ‘‘(4) other information as required by the Sec16 retary. 

17 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.— 

18 ‘‘(1) IN GENERAL.—For the purpose of car19 rying out this section, there is authorized to be ap20 propriated $139,000,000 for fiscal year 2008 and 

21 $139,000,000 for fiscal year 2009. 

22 ‘‘(2) AVAILABILITY.—Amounts appropriated 

23 under paragraph (1) shall remain available through 

24 fiscal year 2012. 


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1 ‘‘SEC. 3009. DEMONSTRATION PROGRAM TO INTEGRATE IN2 FORMATION TECHNOLOGY INTO CLINICAL 

3 EDUCATION. 

4 ‘‘(a) IN GENERAL.—The Secretary may award grants 

5 to eligible entities or consortia under this section to carry 

6 out demonstration projects to develop academic curricula 

7 integrating qualified health information technology sys8 tems in the clinical education of health professionals or 

9 analyze clinical data sets to discover quality measures. 

10 Such awards shall be made on a competitive basis and 

11 pursuant to peer review. 

12 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

13 under subsection (a), an entity or consortium shall— 

14 ‘‘(1) submit to the Secretary an application at 

15 such time, in such manner, and containing such in16 formation as the Secretary may require; 

17 ‘‘(2) be or include— 

18 ‘‘(A) a health professions school; 

19 ‘‘(B) a school of nursing; or 

20 ‘‘(C) an institution with a graduate med21 ical education program; 

22 ‘‘(3) provide for the collection of data regarding 

23 the effectiveness of the demonstration project to be 

24 funded under the grant in improving the safety of 

25 patients and the efficiency of health care delivery; 

26 and 


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1 ‘‘(4) provide matching funds in accordance with 

2 subsection (d). 

3 ‘‘(c) USE OF FUNDS.— 

4 ‘‘(1) IN GENERAL.—With respect to a grant 

5 under subsection (a), an eligible entity or consortium 

6 shall use amounts received under the grant in col7 laboration with 2 or more disciplines. 

8 ‘‘(2) LIMITATION.—An eligible entity or consor9 tium shall not award a grant under subsection (a) 

10 to purchase hardware, software, or services. 

11 ‘‘(d) MATCHING FUNDS.— 

12 ‘‘(1) IN GENERAL.—The Secretary may award 

13 a grant to an entity under or consortium this section 

14 only if the entity of consortium agrees to make avail15 able non-Federal contributions toward the costs of 

16 the program to be funded under the grant in an 

17 amount that is not less than $1 for each $2 of Fed18 eral funds provided under the grant. 

19 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB20 UTED.—Non-Federal contributions under paragraph 

21 (1) may be in cash or in kind, fairly evaluated, in22 cluding equipment or services. Amounts provided by 

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1 ernment, may not be included in determining the 

2 amount of such contributions. 

3 ‘‘(e) EVALUATION.—The Secretary shall take such 

4 action as may be necessary to evaluate the projects funded 

5 under this section and publish, make available, and dis6 seminate the results of such evaluations on as wide a basis 

7 as is practicable. 

8 ‘‘(f) REPORTS.—Not later than 1 year after the date 

9 of enactment of this title, and annually thereafter, the Sec10 retary shall submit to the Committee on Health, Edu11 cation, Labor, and Pensions and the Committee on Fi12 nance of the Senate, and the Committee on Energy and 

13 Commerce and the Committee on Ways and Means of the 

14 House of Representatives a report that— 

15 ‘‘(1) describes the specific projects established 

16 under this section; and 

17 ‘‘(2) contains recommendations for Congress 

18 based on the evaluation conducted under subsection 

19 (e). 

20 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

21 is authorized to be appropriated to carry out this section, 

22 $2,000,000 for each of fiscal years 2008 and 2009. 

23 ‘‘(h) SUNSET.—This provisions of this section shall 

24 not apply after September 30, 2012.’’. 


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1 TITLE III—IMPROVING THE 

2 QUALITY OF HEALTH CARE 

3 SEC. 301. CONSENSUS PROCESS FOR THE ADOPTION OF 

4 QUALITY MEASURES FOR USE IN THE NA5 TIONWIDE INTEROPERABLE HEALTH INFOR6 MATION TECHNOLOGY INFRASTRUCTURE. 

7 Title XXX of the Public Health Service Act, as 

8 amended by section 201, is further amended by adding 

9 at the end the following: 

10 ‘‘SEC. 3010. FOSTERING DEVELOPMENT AND USE OF 

11 HEALTH CARE QUALITY MEASURES. 

12 ‘‘(a) IN GENERAL.—The Secretary shall provide for 

13 the development and use of health care quality measures 

14 (referred to in this title as ‘quality measures’) for the pur15 pose of measuring the quality and efficiency of health care 

16 that patients receive. 

17 ‘‘(b) DESIGNATION OF, AND ARRANGEMENT WITH, 

18 ORGANIZATION.— 

19 ‘‘(1) IN GENERAL.—Not later than 90 days 

20 after the date of enactment of this title, the Sec21 retary shall designate, and have in effect an ar22 rangement with, a single organization that meets the 

23 requirements of subsection (c) under which such or24 ganization shall promote the development of quality 

25 measures and provide the Secretary with advice and 


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1 recommendations on the key elements and priorities 

2 of a national system for healthcare performance 

3 measurement. 

4 ‘‘(2) RESPONSIBILITIES.—The responsibilities 

5 to be performed by the organization designated 

6 under paragraph (1) (in this title referred to as the 

7 ‘designated organization’) shall include— 

8 ‘‘(A) establishing and managing an inte9 grated national strategy and process for setting 

10 priorities and goals in establishing quality 

11 measures; 

12 ‘‘(B) coordinating and harmonizing the de13 velopment and testing of such measures; 

14 ‘‘(C) establishing standards for the devel15 opment and testing of such measures; 

16 ‘‘(D) endorsing national consensus quality 

17 measures; 

18 ‘‘(E) recommending, in collaboration with 

19 multi-stakeholder groups, quality measures to 

20 the Secretary for adoption and use; 

21 ‘‘(F) promoting the development and use 

22 of electronic health records that contain the 

23 functionality for automated collection, aggrega24 tion, and transmission of performance measure25 ment information; and 


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1 ‘‘(G) providing recommendations and ad2 vice to the Partnership regarding the integra3 tion of quality measures into the certification 

4 process outlined under section 3003 and the 

5 Community regarding national policies outlined 

6 under section 3004. 

7 ‘‘(c) REQUIREMENTS DESCRIBED.—The require8 ments described in this subsection are the following: 

9 ‘‘(1) PRIVATE ENTITY.—The organization shall 

10 be a private nonprofit entity that is governed by a 

11 board of directors and an individual who is des12 ignated as president and chief executive officer. 

13 ‘‘(2) BOARD MEMBERSHIP.—The members of 

14 the board of directors of the entity shall include rep15 resentatives of— 

16 ‘‘(A) health care providers or groups rep17 resenting providers; 

18 ‘‘(B) health plans or groups representing 

19 health plans; 

20 ‘‘(C) patients or consumers enrolled in 

21 such plans or groups representing individuals 

22 enrolled in such plans; 

23 ‘‘(D) health care purchasers and employers 

24 or groups representing purchasers or employers; 

25 and 


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1 ‘‘(E) organizations that develop health in2 formation technology standards and new health 

3 information technology. 

4 ‘‘(3) OTHER MEMBERSHIP REQUIREMENTS.— 

5 The membership of the board of directors of the en6 tity shall be representative of individuals with expe7 rience with— 

8 ‘‘(A) urban health care issues; 

9 ‘‘(B) safety net health care issues; 

10 ‘‘(C) rural or frontier health care issues; 

11 ‘‘(D) quality and safety issues; 

12 ‘‘(E) State or local health programs; 

13 ‘‘(F) individuals or entities skilled in the 

14 conduct and interpretation of biomedical, health 

15 services, and health economics research and 

16 with expertise in outcomes and effectiveness re17 search and technology assessment; and 

18 ‘‘(G) individuals or entities involved in the 

19 development and establishment of standards 

20 and certification for health information tech21 nology systems and clinical data. 

22 ‘‘(4) OPEN AND TRANSPARENT.—With respect 

23 to matters related to the arrangement with the Sec24 retary under subsection (a)(1), the organization 

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1 parent manner, and provide the opportunity for pub2 lic comment and ensure a balance among disparate 

3 stakeholders, so that no member organization unduly 

4 influences the work of the organization. 

5 ‘‘(5) VOLUNTARY CONSENSUS STANDARDS SET6 TING ORGANIZATIONS.—The organization shall oper7 ate as a voluntary consensus standards setting orga8 nization as defined for purposes of section 12(d) of 

9 the National Technology Transfer and Advancement 

10 Act of 1995 (Public Law 104–113) and Office of 

11 Management and Budget Revised Circular A–119 

12 (published in the Federal Register on February 10, 

13 1998). 

14 ‘‘(6) PARTICIPATION.—If the organization re15 quires a fee for membership, the organization shall 

16 ensure that such fee is not a substantial barrier to 

17 participation in the entity’s activities related to the 

18 arrangement with the Secretary. 

19 ‘‘(d) REQUIREMENTS FOR MEASURES.—The quality 

20 measures developed under this title shall comply with the 

21 following: 

22 ‘‘(1) MEASURES.—The designated organization, 

23 in promoting the development of quality measures 

24 under this title, shall ensure that such measures— 


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1 ‘‘(A) are evidence-based, reliable, and 

2 valid; 

3 ‘‘(B) include— 

4 ‘‘(i) measures of clinical processes and 

5 outcomes, patient experience, efficiency, 

6 and equity; and 

7 ‘‘(ii) measures to assess effectiveness, 

8 timeliness, patient self-management, pa9 tient centeredness, and safety; and 

10 ‘‘(C) include measures of underuse and 

11 overuse. 

12 ‘‘(2) PRIORITIES.—In carrying out its respon13 sibilities under this section, the designated organiza14 tion shall ensure that priority is given to— 

15 ‘‘(A) measures with the greatest potential 

16 impact for improving the performance and effi17 ciency of care; 

18 ‘‘(B) measures that may be rapidly imple19 mented by group health plans, health insurance 

20 issuers, physicians, hospitals, nursing homes, 

21 long-term care providers, and other providers; 

22 ‘‘(C) measures which may inform health 

23 care decisions made by consumers and patients; 


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1 ‘‘(D) measures that apply to multiple serv2 ices furnished by different providers during an 

3 episode of care; 

4 ‘‘(E) measures that can be integrated into 

5 certification process described in section 3003; 

6 and 

7 ‘‘(F) measures that may be integrated into 

8 the decision support function of qualified health 

9 information technology as defined by this title. 

10 ‘‘(3) RISK ADJUSTMENT.—The designated orga11 nization, in consultation with performance measure 

12 developers and other stakeholders, shall establish 

13 procedures to ensure that quality measures take into 

14 account differences in patient health status, patient 

15 characteristics, and geographic location, as appro16 priate. 

17 ‘‘(4) MAINTENANCE.—The designated organiza18 tion, in consultation with owners and developers of 

19 quality measures, shall require the owners or devel20 opers of quality measures to update and enhance 

21 such measures, including the development of more 

22 accurate and precise specifications, and retire exist23 ing outdated measures. Such updating shall occur 

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1 riod, except in the case of emergency circumstances 

2 requiring a more immediate update to a measure. 

3 ‘‘(e) GRANTS FOR PERFORMANCE MEASURE DEVEL4 OPMENT.—The Secretary, acting through the Agency for 

5 Healthcare Research and Quality, may award grants, in 

6 amounts not to exceed $50,000 each, to organizations to 

7 support the development and testing of quality measures 

8 that meet the standards established by the designated or9 ganization. 

10 ‘‘SEC. 3011. ADOPTION AND USE OF QUALITY MEASURES; 

11 REPORTING. 

12 ‘‘(a) IN GENERAL.—For purposes of carrying out ac13 tivities authorized or required by this title to ensure the 

14 use of quality measures and to foster uniformity between 

15 health care quality measures utilized by private entities, 

16 the Secretary shall— 

17 ‘‘(1) select quality measures for adoption and 

18 use, from quality measures recommended by multi19 stakeholder groups and endorsed by the designated 

20 organization; and 

21 ‘‘(2) ensure that standards adopted under sec22 tion 3005 integrate the quality measures endorsed, 

23 adopted, and utilized under this section. 


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1 ‘‘(b) RELATIONSHIP WITH PROGRAMS UNDER THE

2 SOCIAL SECURITY ACT.—The Secretary shall ensure that 

3 the quality measures adopted under this section— 

4 ‘‘(1) complement quality measures developed by 

5 the Secretary under programs administered by the 

6 Secretary under the Social Security Act, including 

7 programs under titles XVIII, XIX, and XXI of such 

8 Act; and 

9 ‘‘(2) do not conflict with the needs and prior10 ities of the programs under titles XVIII, XIX, and 

11 XXI of such Act, as set forth by the Administrator 

12 of the Centers for Medicare & Medicaid Services. 

13 ‘‘(c) REPORTING.—The Secretary shall implement 

14 procedures, consistent with generally accepted standards, 

15 to enable the Department of Health and Human Services 

16 to accept the electronic submission of data for purposes 

17 of performance measurement, including at the provider 

18 level, using the quality measures developed, endorsed, and 

19 adopted pursuant to this title. 

20 ‘‘(d) DISSEMINATION OF INFORMATION.—In order to 

21 make comparative performance information available to 

22 health care consumers, health professionals, public health 

23 officials, oversight organizations, researchers, and other 

24 appropriate individuals and entities, after consultation 

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1 gate regulations to provide for the dissemination, aggrega2 tion, and analysis of quality measures collected pursuant 

3 to this title.’’. 

4 TITLE IV—PRIVACY AND 

5 SECURITY 

6 SEC. 401. PRIVACY AND SECURITY. 

7 Title XXX of the Public Health Service Act, as 

8 amended by section 301, is further amended by adding 

9 at the end the following: 

10 ‘‘SEC. 3013. ENSURING PRIVACY AND SECURITY. 

11 ‘‘(a) PRIVACY PROTECTIONS APPLY TO HEALTH IN12 FORMATION ELECTRONIC DATABASES.—An operator of a 

13 health information electronic database shall be deemed to 

14 be a ‘covered entity’ for purposes of sections 1171 through 

15 1179 of the Social Security Act and the regulations pro16 mulgated under section 264(c) of the Health Insurance 

17 Portability and Accountability Act of 1996 (42 U.S.C. 

18 1320d-2 note) (referred to in this section as the ‘HIPAA 

19 privacy regulations’. 

20 ‘‘(b) HEALTH INFORMATION ELECTRONIC DATABASE

21 DEFINED.—In this section, the term ‘operator of a health 

22 information electronic database’ means an entity that— 

23 ‘‘(1) is constituted, organized, or chartered for 

24 the primary purpose of maintaining or transmitting 


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1 protected health information in a designated record 

2 set or sets; 

3 ‘‘(2) receives valuable consideration for main4 taining or transmitting protected health information 

5 in a designated record set or sets; and 

6 ‘‘(3) is not a health plan, healthcare clearing7 house, or healthcare provider who transmits any 

8 health information in electronic form in connection 

9 with a transaction referred to in section 1173(a)(1) 

10 of the Social Security Act. 

11 ‘‘(c) RIGHT OF INDIVIDUALS TO INSPECT THEIR

12 MEDICAL RECORDS MAINTAINED IN ELECTRONIC FOR13 MAT.—To the extent provided for under the HIPAA pri14 vacy regulations with respect to protected health informa15 tion, an individual shall have a right of access to inspect 

16 and obtain a copy of protected health information about 

17 the individual stored in electronic format. 

18 ‘‘(d) RIGHTS OF INDIVIDUALS WHO ARE VICTIMS OF

19 MEDICAL FRAUD.—To the extent provided for under the 

20 HIPAA privacy regulations and under the conditions spec21 ified in such regulations, with respect to protected health 

22 information, an individual who is a victim of medical fraud 

23 or who believes that there is an error in their protected 

24 health information stored in an electronic format shall 

25 have the right— 


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1 ‘‘(1) to have access to inspect and obtain a copy 

2 of protected health information about the individual, 

3 including the information fraudulently entered, in a 

4 designated record set; and 

5 ‘‘(2) to have a covered entity amend protected 

6 health information or a record about the individual, 

7 including information fraudulently entered, in a des8 ignated electronic record set for as long as the pro9 tected health information is maintained in the des10 ignated electronic record set to ensure that fraudu11 lent and inaccurate health information is not shared 

12 or re-reported. 

13 ‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec14 tion shall be construed to supercede or otherwise limit the 

15 provisions of any contract that provides for the application 

16 of privacy protections that are greater than the privacy 

17 protections provided for under the regulations promul18 gated under section 264 of the Health Insurance Port19 ability and Accountability Act of 1996.’’. 

20 TITLE V—MISCELLANEOUS 

21 PROVISIONS 

22 SEC. 501. GAO STUDY. 

23 Not later than 12 months after the date of enactment 

24 of this Act, the Comptroller General of the United States 

25 shall submit to Congress a report on the circumstances 


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1 in which it is necessary and workable to require health 

2 plans (as defined in section 1171 of the Social Security 

3 Act (42 U.S.C. 1320d)), health care clearinghouses (as de4 fined in such section 1171), and health care providers (as 

5 defined in such section 1171) who transmit health infor6 mation in electronic form, to notify individuals if their in7 dividually identifiable health information (as defined in 

8 such section 1171) is wrongfully disclosed. 

9 SEC. 502. HEALTH INFORMATION TECHNOLOGY RESOURCE 

10 CENTER. 

11 Section 914 of the Public Health Service Act (42 

12 U.S.C. 299b–3) is amended by adding at the end the fol13 lowing: 

14 ‘‘(d) HEALTH INFORMATION TECHNOLOGY RE15 SOURCE CENTER.— 

16 ‘‘(1) IN GENERAL.—The Secretary, acting 

17 through the Director, shall develop a Health Infor18 mation Technology Resource Center (referred to in 

19 this subsection as the ‘Center’) to provide technical 

20 assistance and develop best practices to support and 

21 accelerate efforts to adopt, implement, and effec22 tively use interoperable health information tech23 nology in compliance with sections 3003 and 3010. 

24 ‘‘(2) PURPOSES.—The purposes of the Center 

25 are to— 


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1 ‘‘(A) provide a forum for the exchange of 

2 knowledge and experience; 

3 ‘‘(B) accelerate the transfer of lessons 

4 learned from existing public and private sector 

5 initiatives, including those currently receiving 

6 Federal financial support; 

7 ‘‘(C) assemble, analyze, and widely dis8 seminate evidence and experience related to the 

9 adoption, implementation, and effective use of 

10 interoperable health information technology; 

11 ‘‘(D) provide for the establishment of re12 gional and local health information networks to 

13 facilitate the development of interoperability 

14 across health care settings and improve the 

15 quality of health care; 

16 ‘‘(E) provide for the development of solu17 tions to barriers to the exchange of electronic 

18 health information; and 

19 ‘‘(F) conduct other activities identified by 

20 the States, local, or regional health information 

21 networks, or health care stakeholders as a focus 

22 for developing and sharing best practices. 

23 ‘‘(3) SUPPORT FOR ACTIVITIES.—To provide 

24 support for the activities of the Center, the Director 

25 shall modify the requirements, if necessary, that 


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1 apply to the National Resource Center for Health 

2 Information Technology to provide the necessary in3 frastructure to support the duties and activities of 

4 the Center and facilitate information exchange 

5 across the public and private sectors. 

6 ‘‘(4) RULE OF CONSTRUCTION.—Nothing in 

7 this subsection shall be construed to require the du8 plication of Federal efforts with respect to the estab9 lishment of the Center, regardless of whether such 

10 efforts were carried out prior to or after the enact11 ment of this subsection. 

12 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

13 is authorized to be appropriated, such sums as may be 

14 necessary for each of fiscal years 2008 and 2009 to carry 

15 out this section.’’. 

16 SEC. 503. FACILITATING THE PROVISION OF TELEHEALTH 

17 SERVICES ACROSS STATE LINES. 

18 Section 330L of the Public Health Service Act (42 

19 U.S.C. 254c–18) is amended to read as follows: 

20 ‘‘SEC. 330L. TELEMEDICINE; INCENTIVE GRANTS REGARD21 ING COORDINATION AMONG STATES. 

22 ‘‘(a) FACILITATING THE PROVISION OF TELE23 HEALTH SERVICES ACROSS STATE LINES.—The Sec24 retary may make grants to States that have adopted re25 gional State reciprocity agreements for practitioner licenVerDate Aug 31 2005 03:55 Jun 27, 2007 Jkt 059200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\S1693.IS S1693

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1 sure, in order to expedite the provision of telehealth serv2 ices across State lines. 

3 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—For the 

4 purpose of carrying out subsection (a), there are author5 ized to be appropriated such sums as may be necessary 

6 for each of the fiscal years 2008 and 2009.’’. 

Æ 


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