I 

110TH CONGRESS 

1ST SESSION H. R. 1368 

To establish a program to provide financial incentives to encourage the 

adoption and use of interactive personal health records. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 7, 2007 

Mr. KENNEDY (for himself, Mr. REICHERT, and Mr. SMITH of Washington) 

introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and 

Means, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To establish a program to provide financial incentives to 

encourage the adoption and use of interactive personal 

health records. 

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 ‘‘Personalized Health 

5 Information Act of 2007’’. 


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1 SEC. 2. PERSONAL HEALTH RECORD (PHR) INCENTIVE 

2 PROGRAM. 

3 (a) ESTABLISHMENT.—The Secretary of Health and 

4 Human Services (in this section referred to as the ‘‘Sec5 retary’’) shall establish a program (in this section referred 

6 to as the ‘‘program’’) to provide financial incentives for 

7 the use of interactive qualifying personal health records 

8 by Medicare and other patients and their health care pro9 viders in order to— 

10 (1) provide patients (or their authorized rep11 resentatives) access to and control over their per12 sonal health data and information and educational 

13 information so as to become healthier and more in14 formed and engaged health care consumers; 

15 (2) make available to authorized health care 

16 providers a more accurate minimum data set of pa17 tient information at all points of care; 

18 (3) protect patient security and privacy; 

19 (4) improve patients’ adherence to evidence20 based care guidelines, preventive care, and screening 

21 protocols, thereby improving health outcomes and 

22 lowering health care costs; 

23 (5) improve medication adherence by patients, 

24 thereby improving health outcomes and lowering 

25 health care costs; 


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1 (6) provide patients with more accurate, timely, 

2 and appropriate information related to their health 

3 care benefits and related administrative information; 

4 (7) improve the quality and efficiency of com5 munication between health care providers and pa6 tients; 

7 (8) create a direct communications channel to 

8 patients in the event of health emergencies; and 

9 (9) provide access with appropriate privacy 

10 safeguards to de-identified health care information 

11 to evaluate and advance public health and health re12 search goals. 

13 (b) INCENTIVE PAYMENTS.— 

14 (1) IN GENERAL.—Under the program, each 

15 qualified physician (as defined in subsection (c)) 

16 that has a qualifying patient (as defined in sub17 section (d)) shall receive an incentive payment from 

18 the PHR Incentive Fund established under sub19 section (f). In the case of such a patient of more 

20 than one physician, each such physician (who does 

21 not share in the same group practice, as defined by 

22 the Secretary, with another qualifying physician of 

23 that patient) may receive such a payment. 

24 (2) AMOUNT OF PAYMENT.— 


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1 (A) IN GENERAL.—Except as otherwise 

2 provided, the amount of the incentive payment 

3 to a qualifying physician under the program 

4 shall be at least $3 per year for each qualifying 

5 patient of the physician. 

6 (B) ADJUSTMENT; LIMITATION.—The Sec7 retary shall annually retrospectively set the in8 centive payment amount based on the amount 

9 of the contributions into the PHR Incentive 

10 Fund. The Secretary shall pay PHR incentives 

11 payments only from such Fund. 

12 (C) ANNUAL LIMITATION.—The Secretary 

13 shall establish a maximum annual payment 

14 under this section to any qualifying physician. 

15 (3) DURATION.—Payments shall be made under 

16 the program during a 3-year period beginning on the 

17 date of implementation of the program, except that 

18 the Secretary may continue the program for an addi19 tional two years if the Secretary determines that 

20 continuation of the program for such period would 

21 be a cost-effective way of achieving the goals of this 

22 Act. 

23 (4) PROGRAM EDUCATION.— 

24 (A) PUBLICATION OF NAMES QUALIFYING

25 PHYSICIANS.—In order to assist patients in 


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1 identifying health care providers that use quali2 fying personal health records, Secretary shall 

3 publish on the official website for the Centers 

4 for Medicare & Medicaid Services (CMS), or 

5 other online locations of the Secretary’s choos6 ing, a list of qualifying physicians who partici7 pate in the Medicare program and who have re8 ceived incentive payments under this section. 

9 (B) EDUCATION.— 

10 (i) PATIENT EDUCATION.—The Sec11 retary shall, in consultation with appro12 priate organizations that represent health 

13 care consumers, take steps to educate 

14 Medicare beneficiaries and other patients 

15 about the health and convenience benefits 

16 of qualifying personal health records. 

17 (ii) PROVIDER EDUCATION.—The Sec18 retary shall take steps to educate Medicare 

19 providers about the patient, provider and 

20 overall health care benefits of using quali21 fying personal health records. 

22 (c) QUALIFIED PHYSICIAN DEFINED.—For purposes 

23 of this section, the term ‘‘qualified physician’’ means a li24 censed physician (or other licensed health care provider, 

25 such as a clinic, designated by the Secretary) that meets 


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1 the following requirements, with respect to a qualifying 

2 patient of that physician and the qualifying personal 

3 health record of that patient: 

4 (1) The physician (or provider), or authorized 

5 representative, uses the QPHR for patient registra6 tion for encounters, including taking demographic 

7 information, insurance information, medication list, 

8 problems list, family history, and other information 

9 included within the QPHR. 

10 (2) The physician (or provider), or authorized 

11 representative or a QPHR service provider (as de12 fined in subsection (e)(2)), updates the diagnosis 

13 and medication list (including all current medica14 tions and new medications prescribed or provided as 

15 samples) in the QPHR after each patient encounter, 

16 if appropriate and authorized by the patient, either 

17 by direct entry or through a data sharing arrange18 ment using an appropriate electronic means, such as 

19 an electronic medical record or e-prescribing. 

20 (3) The physician (or provider), or authorized 

21 representative, uses the QPHR as appropriate and 

22 authorized by the patient to communicate appro23 priate patient education and care management mes24 sages. 


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1 (4) There is submitted to the Secretary by the 

2 physician (or by the administrator of the QPHR on 

3 the physician’s behalf) on a regular basis, but no 

4 less frequently than annually, a report documenting 

5 the number of such qualifying patients of the physi6 cian (or provider) and the use of QPHRs of such pa7 tients. 

8 (5) The physician (or provider) meets other re9 quirements as the Secretary may establish. 

10 (d) QUALIFYING PATIENT DEFINED.—For purposes 

11 of this section, the term ‘‘qualifying patient’’ means an 

12 individual for whom a qualifying personal health record 

13 has been established and is in operation under the pro14 gram and who is a Medicare beneficiary or is covered 

15 under a health benefits or other plan the sponsor of which 

16 is participating as a Fund partner under this section. 

17 (e) QUALIFYING PERSONAL HEALTH RECORD

18 (QPHR); QPHR SERVICE PROVIDER.— 

19 (1) DEFINITION.—For purposes of this section, 

20 the terms ‘‘qualifying personal health record’’ and 

21 ‘‘QPHR’’ mean a record of health care related infor22 mation that meets the following requirements: 

23 (A) ACCESS TO THE RECORD.— 

24 (i) ACCESS RIGHTS.—Access to the 

25 record is controlled solely by the patient 


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1 (or the patient’s authorized representa2 tive), with the patient (or the patient’s au3 thorized representative) able to access on4 line, print, copy to electronic media, or 

5 provide online access to authorized third 

6 parties, including health care providers, to 

7 all individually identifiable health informa8 tion held in the record at any time. 

9 (ii) TERMINATION RIGHTS.—The 

10 record allows a patient (or the patient’s 

11 authorized representative) to terminate the 

12 further use of the record service at any 

13 time, including elimination of the patient’s 

14 personal health information in the control 

15 of the QPHR service provider. Nothing in 

16 this clause shall require a health care pro17 vider to eliminate a patient’s personal 

18 health information included in the QPHR 

19 that is in a medical record maintained by 

20 the provider. 

21 (iii) TRANSPORTABILITY.—The pa22 tient’s rights to control access to the 

23 record under this subparagraph are not af24 fected by changes in relationships with 

25 particular providers or health plans. 


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1 (B) SECURITY.—The record meets min2 imum security standards, including the rules 

3 promulgated under section 264(c) of the Health 

4 Insurance Portability and Accountability Act of 

5 1996 (HIPAA) and other such minimum stand6 ards as identified by the Secretary under para7 graph (3), and the QPHR service provider com8 plies with any security and privacy standards, 

9 policies, and practices adopted under such para10 graph. 

11 (C) INTEROPERABILITY.—The record is 

12 capable of exchanging standards-based clinical 

13 and patient data with other sources and users 

14 of health data, including other QPHRs, elec15 tronic health records used by hospitals and phy16 sicians and other providers, pharmacies, phar17 macy benefit managers, and health plans. 

18 (D) WEB-BASED.—The record is web19 based and capable of sharing information be20 tween patients and their providers, and ena21 bling patient-provider communication. 

22 (E) MESSAGING CAPABILITIES.— 

23 (i) EDUCATION REMINDERS.—Subject 

24 to clause (v), the QPHR service provider is 

25 capable of sending patient-specific patient 


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1 education, reminders, and clinical messages 

2 to patients based upon data in the QPHR, 

3 but such messages shall not be sent unless 

4 such messages comply with standards 

5 adopted under paragraph (4). The Sec6 retary shall work with the Secretary of 

7 Homeland Security and the Director of the 

8 Centers for Disease Control and Preven9 tion to optimize the public health and 

10 emergency response capabilities of the net11 works created by QPHRs. 

12 (ii) FEDERAL REMINDERS.—Subject 

13 to clause (v), the QPHR service provider 

14 provides for the sending on behalf of Fed15 eral agencies of objective, accurate, pa16 tient-specific messages to patients con17 cerning their health care or benefits, but 

18 such messages shall not be sent unless the 

19 messages comply with standards adopted 

20 under paragraph (4). 

21 (iii) FUND PARTNER MESSAGES.— 

22 Subject to clause (v), the QPHR service 

23 provider provides for the sending, on be24 half of Fund partners who contribute to 

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1 sages to consumers (with whom such part2 ners have pre-existing relationships) con3 cerning the patients’ health care, medica4 tions, treatments, medical devices or bene5 fits, but such messages shall not be sent 

6 unless such messages comply with stand7 ards adopted under paragraph (4). A fund 

8 partner may not send a message to a pa9 tient about a product or service unless that 

10 product or service has already been pre11 scribed or recommended to the patient by 

12 a health care provider. 

13 (iv) HEALTH PLAN NOTIFICATION.— 

14 The QPHR service provider notifies, no 

15 less frequently than quarterly, each Fund 

16 partner that operates a health benefit plan 

17 of the individuals who have received mes18 sages sent on behalf of the Fund partner 

19 under this section. 

20 (v) LIMITATION ON COMMERCIAL SO21 LICITATION.—The QPHR service provider 

22 does not allow messages to be sent to pa23 tients unless— 

24 (I) the patient is a patient or 

25 beneficiary of the sender or source of 


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1 the message, uses the sender’s or 

2 source’s product with a prescription 

3 or recommendation of a provider, or 

4 has some other pre-existing relation5 ship (as defined by the Secretary) 

6 with the sender or source, or the 

7 sender or source is a public health 

8 agency; 

9 (II) the message contains infor10 mation directly related to the patient’s 

11 health or health care and does not in12 clude marketing or commercial solici13 tations; 

14 (III) the message complies with 

15 standards adopted under paragraph 

16 (3); and 

17 (IV) the message clearly identi18 fies the source of the content and the 

19 sender of the message. 

20 (vi) PATIENT OPT-OUT.—The QPHR 

21 service provider allows a patient (or pa22 tient’s authorized representative) to opt 

23 out of receiving messages entirely or from 

24 particular sources. 


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1 (F) PUBLIC HEALTH ANALYSIS AND RE2 SEARCH.—The QPHR service provider is capa3 ble of providing de-identified data for public 

4 health analysis and for research purposes. The 

5 Secretary shall consult with the Commissioner 

6 of the Food and Drug Administration, the Di7 rector of the National Institutes of Health, the 

8 Director of the Centers for Disease Control and 

9 Prevention, and the Administrator of the Agen10 cy for Healthcare Research and Quality to opti11 mize the public health and post-market surveil12 lance capabilities of QPHRs. 

13 (G) AUTHENTICATION.—The record in14 cludes functionality to authenticate the pa15 tient’s identity prior to the record’s use to re16 ceive electronic data feeds of personal health in17 formation (other than actual authentication in18 formation) from third party sources, such as 

19 pharmacies, pharmacy benefit managers, lab20 oratories, and health plans, including the Medi21 care program. 

22 (2) QPHR SERVICE PROVIDER DEFINED.—For 

23 purposes of this section, the term ‘‘QPHR service 

24 provider’’ means an entity that operates or admin25 isters a QPHR or part of a QPHR and has access 


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1 to patients’ individually identifiable health informa2 tion contained in the QPHR. 

3 (3) PRIVACY AND CONSUMER PROTECTION

4 STANDARDS.— 

5 (A) IN GENERAL.—The Secretary shall set 

6 minimum security, privacy and data use stand7 ards for QPHRs, in addition to such standards 

8 as required under regulations promulgated 

9 under section 264(c) of the Health Insurance 

10 Portability and Accountability Act of 1996 

11 (HIPAA), in order to optimally protect and 

12 safeguard patient health care information. Such 

13 standards shall include a required plain lan14 guage notice of patients’ privacy rights with re15 spect to personal health records. 

16 (B) TREATMENT OF QPHR SERVICE PRO17 VIDER AS COVERED ENTITY.—A QPHR service 

18 provider shall be treated as a covered entity for 

19 purposes of applying the HIPAA regulations re20 ferred to in subparagraph (A). 

21 (C) CONSUMER PROTECTION BOARD.—The 

22 Secretary shall establish a consumer protection 

23 board, a majority of whose members represent 

24 health care consumers, including individuals 


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1 with chronic diseases and with mental and ad2 dictive disorders. Such board shall— 

3 (i) recommend to the Secretary min4 imum standards to protect patient-identifi5 able information stored in or transmitted 

6 from a QPHR; 

7 (ii) recommend procedures to ensure 

8 the objectivity, relevance, and accuracy of 

9 messages sent to patients via their 

10 QPHRs; and 

11 (iii) have the right to request and re12 view the security and privacy capabilities, 

13 policies and practices of those entities ad14 ministering QPHRs. 

15 (D) NOTIFICATION OF BREACH.—A QPHR 

16 service provider must disclose any breach of the 

17 security of individually identifiable personal 

18 health information contained in a QPHR to any 

19 individual whose individually identifiable per20 sonal health information was, or is reasonably 

21 believed to have been, acquired by an unauthor22 ized person and to the Secretary in a manner 

23 to be specified by the Secretary. 

24 (E) AVAILABILITY OF INDIVIDUAL HEALTH

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1 tive beginning on January 1, 2010, an indi2 vidual who requests a copy of the individual’s 

3 individually identifiable health information pur4 suant to the HIPAA regulations referred to in 

5 subparagraph (A) shall be entitled to receive 

6 that information in electronic form capable of 

7 being imported into a QPHR, if such informa8 tion was maintained in electronic form by the 

9 entity from which the information is requested. 

10 (4) MESSAGE STANDARDS.—The Secretary 

11 shall establish minimum standards to ensure the ob12 jectivity, accuracy and relevance of messages sent to 

13 individual patients under paragraph (1)(E) from a 

14 QPHR and to protect against the use of such mes15 sages by Fund partners for commercial solicitations 

16 or marketing. Such standards shall incorporate ex17 isting standards governing communications to con18 sumers established by the Food and Drug Adminis19 tration or other Federal agencies. 

20 (f) PHR INCENTIVE FUND.— 

21 (1) IN GENERAL.—The Secretary shall establish 

22 a PHR Incentive Fund (in this section referred to 

23 as the ‘‘PHR Incentive Fund’’ or ‘‘Fund’’). The 

24 Fund may receive contributions from Fund partners 

25 for the sole purpose of paying PHR incentives under 


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1 subsection (a), conducting annual studies under sub2 section (g), and otherwise carrying out the program. 

3 (2) FUNDING PARTNERS.— 

4 (A) IN GENERAL.—The Secretary may 

5 enter into contracts with public or private pay6 ers, drug manufacturers, device manufacturers, 

7 or other public or private entities (in this sec8 tion referred to as ‘‘Fund partners’’) to allow 

9 the Fund to receive contributions in accordance 

10 with this subsection and other terms deter11 mined by the Secretary. 

12 (B) FEDERAL PARTNERS.—The Secretary 

13 shall seek the involvement and contributions of 

14 the Food and Drug Administration, the Centers 

15 for Disease Control and Prevention, the Agency 

16 for Healthcare Research and Quality, and the 

17 Department of Homeland Security to maximize 

18 the effectiveness of the QPHRs in meeting the 

19 health, national security, emergency response, 

20 biosurveillance, and research goals of the Fed21 eral government in a manner consistent with 

22 this Act. 

23 (C) PARTNER ACCOUNTS.—The Fund shall 

24 include an account for each Fund partner, in25 cluding Medicare, separately accounting for 


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1 each Fund partner’s contributions to the Fund. 

2 Incentive payments shall be debited from each 

3 account in accordance with this subsection. 

4 Amounts in the account of a Fund partner that 

5 are not paid in fiscal year remain available for 

6 payment from such account in the subsequent 

7 fiscal year. 

8 (D) CONTRIBUTION LEVELS.—Contribu9 tion levels to the Fund by Fund partners shall 

10 be set annually by the Secretary, except that 

11 the contribution level for the first year shall be 

12 as follows: 

13 (i) MEDICARE CONTRIBUTION.—The 

14 Secretary shall contribute $3 for each 

15 Medicare beneficiary for whom any PHR 

16 incentive payment is made during such 

17 year by transferring the appropriate 

18 amount from the Medicare trust funds 

19 under parts A and B of the Medicare pro20 gram, in such proportion as the Secretary 

21 may specify. 

22 (ii) FDA-MESSAGING CONTRIBU23 TIONS.—Each manufacturer shall con24 tribute $3 for each qualifying patient for 

25 each medication adherence program for 


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1 which one or more messages are sent 

2 under subsection (e)(1)(E)(iii) in the year. 

3 (iii) OTHER CONTRIBUTIONS.—Any 

4 other fund partner shall contribute $3 for 

5 each qualifying patient for whom a PHR 

6 incentive payment is made, except that the 

7 Secretary may establish other contribution 

8 levels for device manufacturers or other 

9 Fund partners that employ messages sent 

10 under subsection (e)(1)(D)(iii). 

11 (E) CHARGING FUND PARTNERS.—Each 

12 Fund partner’s account shall be debited accord13 ing to the same formula with which contribu14 tions were determined. In the event that a 

15 Fund partner’s account does not have a suffi16 cient balance to cover the Fund partner’s liabil17 ity, the Fund partner shall make a supple18 mental contribution to the Fund to cover the 

19 shortfall plus such penalty as the Secretary may 

20 assess. 

21 (F) LIMITATION ON BENEFITS.—Contribu22 tions by a Fund partner to the Fund shall con23 fer no preferential access to data or information 

24 or any other benefit to the partner other than 

25 public acknowledgment under paragraph (5) 


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1 and the ability to have messages sent to quali2 fying patients under subsection (e)(1)(D)(iii). 

3 (3) PUBLICATION OF FUND CONTRIBUTORS.— 

4 The Secretary shall publish on the official website of 

5 the Centers for Medicare & Medicaid Services a list 

6 of Fund partners that have contributed to the Fund. 

7 (g) ANNUAL STUDY.— 

8 (1) IN GENERAL.—The Secretary shall provide 

9 for an annual study to assess the level of patient en10 gagement in their QPHR, patients’ management of 

11 their health (including adherence to prescribed medi12 cations and recommended preventive care), changes 

13 in health outcomes, and cost savings resulting from 

14 implementation of the program. The study shall in15 clude collection of aggregate data documenting the 

16 number of qualifying patient, number and kind of 

17 messages sent to patients, the percentage of mes18 sages opened by patients, and other measures of the 

19 program’s effectiveness. 

20 (2) FUNDING.—There are available from the 

21 PHR Incentive Fund not to exceed $2,000,000 each 

22 year to pay for the annual study under paragraph 

23 (1). Amounts so used shall be debited from each 

24 Fund partner’s account on a pro-rata basis. 

Æ 


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