IB 

Union Calendar No. 24

108TH CONGRESS 

1ST SESSION H. R. 877

[Report No. 108–31, Part I] 

To amend title XI of the Social Security Act to improve patient safety. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 25, 2003

Mrs. JOHNSON of Connecticut (for herself, Mr. STARK, Mr. THOMAS, Mr. 

CAMP, Mr. LEWIS of Kentucky, Mr. MCINNIS, Mr. HOUGHTON, Mr. 

HERGER, Mr. WELLER, Mr. SMITH of New Jersey, Mr. ENGLISH, and 

Mr. PETERSON of Pennsylvania) introduced the following bill; which was 

referred to the Committee on Ways and Means, and in addition to the 

Committee on Energy and Commerce, 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 

MARCH 11, 2003

Reported from the Committee on Ways and Means with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

MARCH 11, 2003

Referral to the Committee on Energy and Commerce extended for a period 

ending not later than March 13, 2003

MARCH 13, 2003

Additional sponsors: Mr. PORTMAN, Mr. MCCRERY, and Mr. POMEROY

MARCH 13, 2003

Committee on Energy and Commerce discharged; committed to the Committee 

of the Whole House on the State of the Union and ordered to be printed 
2

•HR 877 RH 

[For text of introduced bill, see copy of bill as introduced on February 25, 2003] 

A BILL

To amend title XI of the Social Security Act to improve 

patient safety.

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the ‘‘Pa5 tient Safety Improvement Act of 2003’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of this 

7 Act is as follows:

Sec. 1. Short title; table of contents. 

Sec. 2. Patient safety improvements. 

‘‘PART D—PATIENT SAFETY IMPROVEMENTS

‘‘Sec. 1181. Voluntary reporting of patient safety data; definitions. 

‘‘Sec. 1182. Confidentiality and peer review protections. 

‘‘Sec. 1183. Center for Quality Improvement and Patient Safety. 

‘‘Sec. 1184. Interoperability standards for health care information technology systems. 

‘‘Sec. 1185. Voluntary adoption of methods to improve patient safety. 

‘‘Sec. 1186. Evaluation and report. 

Sec. 3. Medical Information Technology Advisory Board.

8 SEC. 2. PATIENT SAFETY IMPROVEMENTS. 

9 Title XI of the Social Security Act is amended by add10 ing at the end the following new part: 
3

•HR 877 RH 

1 ‘‘PART D—PATIENT SAFETY IMPROVEMENTS

2 ‘‘VOLUNTARY REPORTING OF PATIENT SAFETY DATA; 

3 DEFINITIONS

4 ‘‘SEC. 1181. (a) COLLECTION AND VOLUNTARY RE5 PORTING OF PATIENT SAFETY DATA.—In order to improve 

6 patient safety and the quality of health care delivery, a 

7 health care provider (as defined in subsection (d)) may vol8 untarily collect and develop patient safety data (as defined 

9 in subsection (e)) and report such data to one or more pa10 tient safety organizations (as defined in subsection (f)) in 

11 a manner that is confidential and privileged (as described 

12 in section 1182). 

13 ‘‘(b) USE OF PATIENT SAFETY DATA BY PATIENT

14 SAFETY ORGANIZATIONS.—Patient safety organizations 

15 shall analyze the patient safety data reported and develop 

16 (and report back to health care providers) information to 

17 improve patient safety and the quality of health care deliv18 ery and shall submit non-identifiable information derived 

19 from such data in a uniform manner to the Center for 

20 Quality Improvement and Patient Safety (for inclusion in 

21 the Patient Safety Database, if applicable). Such non-iden22 tifiable information may be disclosed and shared with other 

23 patient safety organizations. Identifiable patient safety 

24 data may be disclosed to other patient safety organizations 
4

•HR 877 RH 

1 with the explicit authorization for each such disclosure by 

2 the reporting provider involved. 

3 ‘‘(c) FUNCTIONS OF CENTER.—The Center for Quality 

4 Improvement and Patient Safety conducts patient safety 

5 activities consistent with section 1183. 

6 ‘‘(d) HEALTH CARE PROVIDERS COVERED.—For pur7 poses of this part, the term ‘health care provider’ means 

8 a provider of services (as defined in section 1861(u) and 

9 including a hospital, skilled nursing facility, home health 

10 agency, and hospice program) that provides services for 

11 which payment may be made under part A of title XVIII 

12 and the provider’s employees, and includes physicians inso13 far as they furnish health care services in the health care 

14 provider. 

15 ‘‘(e) PATIENT SAFETY DATA COVERED.—

16 ‘‘(1) IN GENERAL.—For purposes of this part, 

17 the term ‘patient safety data’ means any data, re18 ports, records, memoranda, analyses, deliberative 

19 work, statements, or root cause analyses that are col20 lected or developed to improve patient safety or health 

21 care quality and that— 

22 ‘‘(A) are collected or developed by a health 

23 care provider for the purpose of reporting to a 

24 patient safety organization and that are reported 

25 on a timely basis to such an organization; 
5

•HR 877 RH 

1 ‘‘(B) are collected or developed by a patient 

2 safety organization or by (or on behalf of) the 

3 Center for Quality Improvement and Patient 

4 Safety, regardless of whether the data are trans5 mitted to the health care provider that reported 

6 the original data; or 

7 ‘‘(C) describes corrective actions taken by a 

8 health care provider in response to the provider’s 

9 reporting of data to that organization, regardless 

10 of whether the organization has transmitted 

11 under subsection (f)(2) information to the health 

12 care provider that reported the original data, 

13 and that are reported on a timely basis to such 

14 an organization. 

15 ‘‘(2) CONSTRUCTION REGARDING USE OF

16 DATA.—

17 ‘‘(A) INTERNAL USE PERMITTED TO IM18 PROVE PATIENT SAFETY, QUALITY, AND EFFI19 CIENCY.—Nothing in this part shall be construed 

20 to limit or discourage a health care provider 

21 from developing and using patient safety data 

22 within the provider to improve patient safety, 

23 health care quality, or administrative efficiency 

24 of the provider. 
6

•HR 877 RH 

1 ‘‘(B) TREATMENT.—Information that is col2 lected or developed as patient safety data is not 

3 disqualified from being treated as patient safety 

4 data because of its development or use for the 

5 purposes described in subparagraph (A) and 

6 such development or use shall not constitute a 

7 waiver of any privilege or protection established 

8 under section 1182 or under State law. 

9 ‘‘(f) QUALIFICATIONS OF PATIENT SAFETY ORGANIZA10 TIONS.—

11 ‘‘(1) IN GENERAL.—For purposes of this part, 

12 the term ‘patient safety organization’ means a private

13 or public organization that conducts activities to im14 prove patient safety and the quality of health care 

15 delivery by assisting health care providers that report 

16 to such organizations and that has been certified by 

17 the Secretary as—

18 ‘‘(A) performing each of the activities de19 scribed in paragraph (2); and 

20 ‘‘(B) meets the other requirements of para21 graphs (3) through (5). 

22 ‘‘(2) ACTIVITIES DESCRIBED.—The activities re23 ferred to in paragraph (1)(A) are the following: 

24 ‘‘(A) The collection and analysis of patient 

25 safety data that are voluntarily reported by more 
7

•HR 877 RH 

1 than one health care provider on a local, re2 gional, State, or national basis. 

3 ‘‘(B) The development and dissemination of 

4 information to health care providers and other 

5 patient safety organizations with respect to im6 proving patient safety, such as recommendations, 

7 protocols, or information regarding best prac8 tices. 

9 ‘‘(C) The utilization of patient safety data 

10 to carry out activities under this paragraph to 

11 improve patient safety and to provide assistance 

12 to health care providers to minimize patient 

13 risk. 

14 ‘‘(3) CONDUCT OF ACTIVITIES.—In conducting 

15 activities under paragraph (2), a patient safety orga16 nization shall—

17 ‘‘(A) maintain confidentiality with respect 

18 to individually identifiable health information; 

19 ‘‘(B) submit non-identifiable information to 

20 the Center for Quality Improvement and Patient 

21 Safety in a format established by the Secretary; 

22 and 

23 ‘‘(C) maintain appropriate security meas24 ures with respect to patient safety data. 
8

•HR 877 RH 

1 ‘‘(4) ORGANIZATION REQUIREMENTS.—The re2 quirements of this paragraph for an organization are 

3 that—

4 ‘‘(A) the organization is managed, con5 trolled, and operated independently from health 

6 care providers which report patient safety data 

7 to it under this part; 

8 ‘‘(B) if the organization no longer qualifies 

9 as a patient safety organization, with respect to 

10 any patient safety data that it received from a 

11 health care provider, the organization shall do 

12 one of the following: 

13 ‘‘(i) with the approval of the provider 

14 and another patient safety organization, 

15 transfer such data to such other organiza16 tion; 

17 ‘‘(ii) if practicable, return the data to 

18 the provider; or 

19 ‘‘(iii) destroy the patient safety data; 

20 ‘‘(C) if the organization charges a fee for the 

21 activities it performs with respect to health care 

22 providers, the fee shall be uniform among all 

23 classes or types of health care providers (taking 

24 into account the size of the health care provider); 
9

•HR 877 RH 

1 ‘‘(D) the organization seeks to collect data 

2 from health care providers in a standardized 

3 manner that permits valid comparisons of simi4 lar cases among similar health care providers; 

5 and 

6 ‘‘(E) the organization meets such other re7 quirements as the Secretary may by regulation 

8 require. 

9 For purposes of subparagraph (A), an organization is 

10 controlled by a health care provider if the provider is 

11 able to significantly influence or direct the actions or 

12 policies of the organization. 

13 ‘‘(5) LIMITATION ON USE OF PATIENT SAFETY

14 DATA BY PATIENT SAFETY ORGANIZATIONS.—A pa15 tient safety organization may not use patient safety 

16 data reported by a health care provider in accordance 

17 with this part to take regulatory or enforcement ac18 tions it otherwise performs (or is responsible for per19 forming) in relation to such provider. 

20 ‘‘(6) TECHNICAL ASSISTANCE.—The Secretary 

21 may provide technical assistance to patient safety or22 ganizations in providing recommendations and ad23 vice to health care providers reporting patient safety 

24 data under this part. Such assistance shall include 

25 advice with respect to methodology, communication, 
10

•HR 877 RH 

1 dissemination of information, data collection, secu2 rity, and confidentiality concerns. 

3 ‘‘(g) CONSTRUCTION.—Nothing in this part shall be 

4 construed to limit or discourage the reporting of informa5 tion relating to patient safety within a health care provider. 

6 ‘‘CONFIDENTIALITY AND PEER REVIEW PROTECTIONS

7 ‘‘SEC. 1182. (a) IN GENERAL.—Notwithstanding any 

8 other provision of law, patient safety data shall be privi9 leged and confidential in accordance with this section. 

10 ‘‘(b) SCOPE OF PRIVILEGE.—Subject to the succeeding 

11 provisions of this section, such data shall not be—

12 ‘‘(1) subject to a civil or administrative sub13 poena; 

14 ‘‘(2) subject to discovery in connection with a 

15 civil or administrative proceeding; 

16 ‘‘(3) disclosed pursuant to section 552 of title 5, 

17 United States Code (commonly known as the Freedom 

18 of Information Act) or any other similar Federal or 

19 State law; or 

20 ‘‘(4) admitted as evidence or otherwise disclosed 

21 in any civil or administrative proceeding. 

22 ‘‘(c) CLARIFICATION OF SCOPE.—The privilege estab23 lished by this section with respect to patient safety data 

24 described in section 1181(e)(1)(A) shall apply to informa25 tion, such as records of a patient’s medical diagnosis and 

26 treatment, other primary health care information, and 
11

•HR 877 RH 

1 other information, to the extent that such information was 

2 collected or developed for the purpose specified in such sec3 tion and is reported in accordance with such section. Such 

4 privilege shall not apply to information merely by reason 

5 of its inclusion, or the fact of its submission, in a report 

6 under such section. Information available from sources 

7 other than a report made under such section may be discov8 ered or admitted in a civil or administrative proceeding, 

9 if discoverable or admissible under applicable state law. 

10 ‘‘(d) INFORMATION NOT SUBJECT TO PRIVILEGE.—

11 The privilege established by this section shall not apply to 

12 one or more of the following:

13 ‘‘(1) MEDICAL RECORDS AND OTHER PRIMARY

14 HEALTH RECORDS.—Records of a patient’s medical 

15 diagnosis and treatment and other primary health 

16 records of a health care provider. Such privilege shall 

17 not apply to such information by reason of its inclu18 sion within patient safety data. 

19 ‘‘(2) NON-IDENTIFIABLE INFORMATION USED BY

20 DATABASE.—Non-identifiable information from a pa21 tient safety organization to the Patient Safety Data22 base and the further disclosure of such data by the 

23 Center for Quality Improvement and Patient Safety. 

24 ‘‘(e) REPORTER PROTECTION.—
12

•HR 877 RH 

1 ‘‘(1) IN GENERAL.—A health care provider may 

2 not use against an individual in an adverse employ3 ment action described in paragraph (2) the fact that 

4 the individual in good faith reported—

5 ‘‘(A) to the provider with the intention of 

6 having it reported to a patient safety organiza7 tion, or 

8 ‘‘(B) directly to a patient safety organiza9 tion, 

10 information that would constitute patient safety data 

11 under section 1181(e)(1)(A) if the provider were to 

12 have submitted it on a timely basis to a patient safe13 ty organization in accordance with such section. 

14 ‘‘(2) ADVERSE EMPLOYMENT ACTION.—For pur15 poses of this subsection, an ‘adverse employment ac16 tion’ includes—

17 ‘‘(A) the failure to promote an individual or 

18 provide any other employment-related benefit for 

19 which the individual would otherwise be eligible; 

20 ‘‘(B) an evaluation or decision made in re21 lation to accreditation, certification, 

22 credentialing or licensing of the individual; and 

23 ‘‘(C) a personnel action that is adverse to 

24 the individual concerned. 
13

•HR 877 RH 

1 ‘‘(3) REMEDIES.—The provisions of the first sen2 tence of section 1128A(a) shall apply with respect to 

3 a health care provider’s violation of paragraph (1) in 

4 the same manner as they apply to an act referred to 

5 in section 1128A(a)(7). 

6 ‘‘(f) PENALTY.—

7 ‘‘(1) PROHIBITION.—It is unlawful for any per8 son to disclose any patient safety data in violation of 

9 the provisions of this section. 

10 ‘‘(2) AMOUNT.—Any person who violates para11 graph (1) shall be subject to a civil monetary penalty 

12 of not more than $10,000 for each such violation in13 volved. The provisions of section 1128A (other than 

14 subsections (a) and (b)) shall apply to a civil money 

15 penalty under this paragraph in the same manner as 

16 they apply to a penalty or proceeding under section 

17 1128A(a). 

18 ‘‘(3) RELATION TO HIPAA.—The penalty under 

19 paragraph (2) for a disclosure in violation of para20 graph (1) does not apply if the person would be sub21 ject to a penalty under section 264(c) of the Health 

22 Insurance Portability and Accountability Act of 1996 

23 (Public Law 104–191; 110 Stat. 2033), or any regu24 lation promulgated under such section, for the same 

25 disclosure. 
14

•HR 877 RH 

1 ‘‘(g) RULES OF CONSTRUCTION.—

2 ‘‘(1) NO LIMITATION OF OTHER PRIVILEGES.—

3 Subject to paragraph (2), nothing in this section shall 

4 be construed as affecting other privileges that are 

5 available under Federal or State laws that provide 

6 greater peer review or confidentiality protections than 

7 the peer review and confidentiality protections pro8 vided for in this section. 

9 ‘‘(2) NO EFFECT ON STATE MANDATORY REPORT10 ING REQUIREMENTS.—Nothing in this part shall be 

11 construed as preempting or otherwise affecting any 

12 State law mandatory reporting requirement for health 

13 care providers. 

14 ‘‘(h) APPLICATION OF PRIVACY REGULATIONS.—For 

15 purposes of applying the regulations promulgated pursuant 

16 to section 264(c) of the Health Insurance Portability and 

17 Accountability Act of 1996 (Public Law 104–191; 110 Stat. 

18 2033)—

19 ‘‘(1) patient safety organizations shall be treated 

20 as business associates; 

21 ‘‘(2) activities of such organizations described in 

22 section 1181(f)(2)(A) in relation to a health care pro23 vider are deemed to be health care operations of the 

24 provider; and 
15

•HR 877 RH 

1 ‘‘(3) the disclosure of identifiable information 

2 under the voluntary program under this part by such 

3 an organization shall be treated as necessary for the 

4 proper management and administration of the orga5 nization. 

6 Nothing in this section shall be construed to alter or affect 

7 the implementation of such regulation or such section 

8 264(c). 

9 ‘‘(i) WAIVERS.—Nothing in this part shall be con10 strued as precluding a health care provider from waiving 

11 the privilege or confidentiality protections under this sec12 tion. 

13 ‘‘(j) CONTINUATION OF PRIVILEGE.—Patient safety 

14 data of an organization that is certified as a patient safety 

15 organization shall continue to be privileged and confiden16 tial, in accordance with this section, if the organization’s 

17 certification is terminated or revoked or if the organization 

18 otherwise ceases to qualify as a patient safety organization 

19 until the data are otherwise disposed of in accordance with 

20 section 1181(f)(4). 

21 ‘‘(k) SURVEY AND REPORT.— 

22 ‘‘(1) SURVEY.—The Comptroller General of the 

23 United States shall conduct a survey of State laws 

24 that relate to patient safety data peer review systems, 

25 including laws that establish an evidentiary privilege 
16

•HR 877 RH 

1 applicable to data developed in such systems, and 

2 shall review the manner in which such laws have been 

3 interpreted by the courts and the effectiveness of such 

4 laws in promoting patient safety. 

5 ‘‘(2) REPORT.—Not later than 9 months after the 

6 date of enactment of this section, the Comptroller 

7 General shall prepare and submit to Congress a re8 port concerning the results of the survey conducted 

9 under paragraph (1). 

10 ‘‘CENTER FOR QUALITY IMPROVEMENT AND PATIENT

11 SAFETY

12 ‘‘SEC. 1183. (a) IN GENERAL.—The Secretary shall en13 sure that the Center for Quality Improvement and Patient 

14 Safety (in this section referred to as the ‘Center’) supports 

15 public and private sector initiatives to improve patient

16 safety for items and services furnished through health care 

17 providers. 

18 ‘‘(b) DUTIES.—

19 ‘‘(1) IN GENERAL.—The Secretary shall ensure 

20 that the Center carries out the following duties: 

21 ‘‘(A) Provide for the certification and recer22 tification of patient safety organizations in ac23 cordance with subsection (d). 

24 ‘‘(B) Collect and disseminate information 

25 related to patient safety. 
17

•HR 877 RH 

1 ‘‘(C) Establish a Patient Safety Database to 

2 collect, support, and coordinate the analysis of 

3 non-identifiable information submitted to the 

4 Database in accordance with subsection (e). 

5 ‘‘(D) Facilitate the development of con6 sensus among health care providers, patients, 

7 and other interested parties concerning patient 

8 safety and recommendations to improve patient 

9 safety. 

10 ‘‘(E) Provide technical assistance to States 

11 that have (or are developing) medical errors re12 porting systems, assist States in developing 

13 standardized methods for data collection, and 

14 collect data from State reporting systems for in15 clusion in the Patient Safety Database. 

16 ‘‘(2) CONSULTATION.—In carrying out the duties 

17 under paragraph (1) (including the establishment of 

18 the Database), the Secretary shall consult with and 

19 develop partnerships, as appropriate, with health care 

20 organizations, health care providers, public and pri21 vate sector entities, patient safety organizations, 

22 health care consumers, and other relevant experts to 

23 improve patient safety. 

24 ‘‘(c) CERTIFICATION AND RECERTIFICATION PROC25 ESS.—
18

•HR 877 RH 

1 ‘‘(1) IN GENERAL.—The initial certification and 

2 recertification of a patient safety organization under 

3 subsection (b)(1)(A) shall be made under a process 

4 that is approved by the Secretary and is consistent 

5 with criteria published by the Secretary. 

6 ‘‘(2) REVOCATION.—Such a certification or re7 certification may be revoked by the Secretary upon a 

8 showing of cause (including the disclosure of data in 

9 violation of section 1182). 

10 ‘‘(3) TERMINATION.—Such a certification pro11 vided for a patient safety organization shall termi12 nate (subject to recertification) on the earlier of—

13 ‘‘(A) the date that is 3 years after the date 

14 on which such certification was provided; or 

15 ‘‘(B) the date on which the Secretary re16 vokes the certification. 

17 ‘‘(d) IMPLEMENTATION AND CONSULTATION.—In car18 rying out subsection (c)(1), the Secretary shall— 

19 ‘‘(1) facilitate the development of patient safety 

20 goals and track the progress made in meeting those 

21 goals; and 

22 ‘‘(2) ensure that data submitted by a patient 

23 safety organization to the Patient Safety Database, as 

24 provided for under subsection (e), are comparable and 

25 useful for research and analysis and that the research 
19

•HR 877 RH 

1 findings and patient safety alerts that result from 

2 such analyses are presented in clear and consistent 

3 formats that enhance the usefulness of such alerts. 

4 ‘‘(e) PATIENT SAFETY DATABASE.—

5 ‘‘(1) IN GENERAL.—The Secretary shall—

6 ‘‘(A) establish a Patient Safety Database to 

7 collect non-identifiable information concerning 

8 patient safety that is reported on a voluntary 

9 basis; and 

10 ‘‘(B) establish common formats for the vol11 untary reporting of data under subparagraph 

12 (A), including the establishment of necessary 

13 data elements, common and consistent defini14 tions, and a standardized computer interface for 

15 the processing of such data. 

16 ‘‘(2) DATABASE.—In carrying out this sub17 section, the Secretary— 

18 ‘‘(A) shall establish and modify as necessary 

19 criteria to determine the organizations that may 

20 voluntarily contribute to, and the data that com21 prises, the Patient Safety Database; 

22 ‘‘(B) shall ensure that the Patient Safety 

23 Database is only used by qualified entities or in24 dividuals as determined appropriate by the Sec-
20

•HR 877 RH 

1 retary in accordance with criteria applied by the 

2 Secretary; and 

3 ‘‘(C) may enter into contracts for the ad4 ministration of the Database with private and 

5 public entities with experience in the adminis6 tration of similar databases. 

7 ‘‘(3) NON-IDENTIFIABLE INFORMATION.—For 

8 purposes of this part, the term ‘non-identifiable infor9 mation’ means information that is presented in a 

10 form and manner that prevents the identification of 

11 any health care provider, patient, and the reporter of 

12 the information. 

13 ‘‘(f) FUNDING.—The Secretary shall transfer from the 

14 Federal Hospital Insurance Trust Fund established under 

15 section 1817 such sums as are necessary for each fiscal year 

16 to carry out this section. 

17 ‘‘INTEROPERABILITY STANDARDS FOR HEALTH CARE

18 INFORMATION TECHNOLOGY SYSTEMS

19 ‘‘SEC. 1184. (a) IN GENERAL.—By not later than 2 

20 years after the date of the enactment of this part, the Sec21 retary shall develop or adopt (and shall periodically review 

22 and update) voluntary, national standards that promote 

23 the interoperability of health care information technology 

24 systems across all health care settings. In promulgating reg25 ulations to carry out this section, the Secretary shall take 

26 into account the cost that meeting such standards would 
21

•HR 877 RH 

1 have on providing health care in the United States and the 

2 increased efficiencies in providing such care achieved under 

3 the standards. 

4 ‘‘(b) CONSULTATION AND COORDINATION.—The Sec5 retary shall develop and update such standards in consulta6 tion with (and with coordination between)—

7 ‘‘(1) the National Committee for Vital and 

8 Health Statistics, and 

9 ‘‘(2) the Medical Information Technology Advi10 sory Board (established under section 3 of the Patient 

11 Safety Improvement Act of 2003). 

12 ‘‘(c) DISSEMINATION.—The Secretary shall provide for 

13 the dissemination of the standards developed and updated 

14 under this section.

15 ‘‘(d) FUNDING.—The Secretary shall transfer from the 

16 Federal Hospital Insurance Trust Fund established under 

17 section 1817 such sums as are necessary for each fiscal year 

18 to carry out this section. 

19 ‘‘VOLUNTARY ADOPTION OF METHODS TO IMPROVE PATIENT

20 SAFETY

21 ‘‘SEC. 1185. The Secretary shall encourage health care 

22 providers to adopt appropriate evidence-based methods to 

23 improve patient safety. Such methods shall not constitute 

24 national practice guidelines. 
22

•HR 877 RH 

1 ‘‘EVALUATION AND REPORT

2 ‘‘SEC. 1186. (a) EVALUATION.—The Comptroller Gen3 eral of the United States shall conduct a comprehensive 

4 evaluation of the implementation of this part. Such evalua5 tion shall include an examination of the following: 

6 ‘‘(1) The health care providers that reported pa7 tient safety data under this part and the patient safe8 ty organizations to which they reported the informa9 tion. 

10 ‘‘(2) What types of events were so reported on. 

11 ‘‘(3) The usefulness of the analyses, information, 

12 and recommendations provided by patient safety or13 ganizations in response to such reported information. 

14 ‘‘(4) The response of health care providers to 

15 such analyses, information, and recommendations, in16 cluding a survey of providers to obtain estimates of 

17 the percentage of providers by category who have 

18 adopted specific error-reduction methods and, if ap19 plicable, reasons for not adopting specific practices. 

20 ‘‘(5) The effectiveness of the program under this 

21 part in reducing medical errors. 

22 ‘‘(b) REPORT.—Not later than 5 years after the date 

23 the provisions of this part are first implemented, the Comp24 troller General shall submit to Congress a report on the 

25 evaluation conducted under subsection (a).’’. 
23

•HR 877 RH 

1 SEC. 3. MEDICAL INFORMATION TECHNOLOGY ADVISORY 

2 BOARD. 

3 (a) ESTABLISHMENT.—

4 (1) IN GENERAL.—Not later than 3 months after 

5 the date of the enactment of this Act, the Secretary of 

6 Health and Human Services (in this section referred 

7 to as the ‘‘Secretary’’) shall appoint an advisory 

8 board to be known as the ‘‘Medical Information Tech9 nology Advisory Board’’ (in this section referred to as 

10 the ‘‘MITAB’’). 

11 (2) CHAIRMAN.—The Secretary shall designate 

12 one member as chairman. The chairman shall be an 

13 individual affiliated with an organization having ex14 pertise creating American National Standards Insti15 tute (ANSI) accepted standards in health care infor16 mation technology and a member of the National 

17 Committee for Vital and Health Statistics. 

18 (b) COMPOSITION.—

19 (1) IN GENERAL.—The MITAB shall consist of 

20 not more than 17 members that include—

21 (A) experts from the fields of medical infor22 mation, information technology, medical contin23 uous quality improvement, medical records secu24 rity and privacy, individual and institutional 

25 health care clinical providers, health researchers, 

26 and health care purchasers; 
24

•HR 877 RH 

1 (B) one or more staff experts from each of 

2 the following: the Centers for Medicare & Med3 icaid Services, the Agency for Healthcare Re4 search and Quality, and the Institute of Medi5 cine of the National Academy of Sciences; 

6 (C) representatives of private organizations 

7 with expertise in medical infomatics; 

8 (D) a representative of a teaching hospital; 

9 and 

10 (E) one or more representatives of the health 

11 care information technology industry. 

12 (2) TERMS OF APPOINTMENT.—The term of any 

13 appointment under paragraph (1) to the MITAB 

14 shall be for the life of the MITAB. 

15 (3) MEETINGS.—The MITAB shall meet at the 

16 call of its chairman or a majority of its members. 

17 (4) VACANCIES.—A vacancy on the MITAB shall 

18 be filled in the same manner in which the original 

19 appointment was made not later than 30 days after 

20 the MITAB is given notice of the vacancy and shall 

21 not affect the power of the remaining members to exe22 cute the duties of the MITAB. 

23 (5) COMPENSATION.—Members of the MITAB 

24 shall receive no additional pay, allowances, or bene25 fits by reason of their service on the MITAB. 
25

•HR 877 RH 

1 (6) EXPENSES.—Each member of the MITAB 

2 shall receive travel expenses and per diem in lieu of 

3 subsistence in accordance with sections 5702 and 

4 5703 of title 5, United States Code. 

5 (c) DUTIES.—

6 (1) IN GENERAL.—The MITAB shall on an ongo7 ing basis advise, and make recommendations to, the 

8 Secretary regarding medical information technology, 

9 including the following: 

10 (A) The best current practices in medical 

11 information technology. 

12 (B) Methods for the adoption (not later 

13 than 2 years after the date of the enactment of 

14 this section) of a uniform health care informa15 tion system interface between and among old 

16 and new computer systems. 

17 (C) Recommendations for health care vocab18 ulary, messaging, and other technology standards 

19 (including a common lexicon for computer tech20 nology) necessary to achieve the interoperability 

21 of health care information systems for the pur22 poses described in subparagraph (E). 

23 (D) Methods of implementing—

24 (i) health care information technology 

25 interoperability standardization; and 
26

•HR 877 RH 

1 (ii) records security. 

2 (E) Methods to promote information ex3 change among health care providers so that long4 term compatibility among information systems 

5 is maximized, in order to do one or more of the 

6 following: 

7 (i) To maximize positive outcomes in 

8 clinical care—

9 (I) by providing decision support 

10 for diagnosis and care; and 

11 (II) by assisting in the emergency 

12 treatment of a patient presenting at a 

13 facility where there is no medical 

14 record for the patient.

15 (ii) To contribute to (and be consistent 

16 with) the development of the patient assess17 ment instrument provided for under section 

18 545 of the Medicare, Medicaid, and SCHIP 

19 Benefits Improvement and Protection Act of 

20 2000, and to assist in minimizing the need 

21 for new and different records as patients 

22 move from provider to provider. 

23 (iii) To reduce or eliminate the need 

24 for redundant records, paperwork, and the 
27

•HR 877 RH 

1 repetitive taking of patient histories and 

2 administering of tests. 

3 (iv) To minimize medical errors, such 

4 as administration of contraindicated drugs. 

5 (v) To provide a compatible informa6 tion technology architecture that facilitates 

7 future quality and cost-saving needs and 

8 that avoids the financing and development 

9 of information technology systems that are 

10 not readily compatible. 

11 (2) REPORTS.—

12 (A) INITIAL REPORT.—No later than 18 

13 months after the date of the enactment of this 

14 Act, the MITAB shall submit to Congress and the 

15 Secretary an initial report concerning the mat16 ters described in paragraph (1). The report shall 

17 include—

18 (i) the practices described in para19 graph (1)(A), including the status of health 

20 care information technology standards being 

21 developed by private sector and public-pri22 vate groups; 

23 (ii) recommendations for accelerating 

24 the development of common health care ter25 minology standards; 
28

•HR 877 RH 

1 (iii) recommendations for completing 

2 development of health care information sys3 tem messaging standards; and 

4 (iv) progress toward meeting the dead5 line described in paragraph (1)(B) for 

6 adoption of methods described in such para7 graph. 

8 (B) SUBSEQUENT REPORTS.—During each 

9 of the 2 years after the year in which the report 

10 is submitted under subparagraph (A), the 

11 MITAB shall submit to Congress and the Sec12 retary an annual report relating to additional 

13 recommendations, best practices, results of infor14 mation technology improvements, analyses of 

15 private sector efforts to implement the interoper16 ability standards established in section 1184 of 

17 the Social Security Act, and such other matters 

18 as may help ensure the most rapid dissemination 

19 of best practices in health care information tech20 nology. 

21 (d) STAFF AND SUPPORT SERVICES.—

22 (1) EXECUTIVE DIRECTOR.—

23 (A) APPOINTMENT.—The Chairman shall 

24 appoint an executive director of the MITAB. 
29

•HR 877 RH 

1 (B) COMPENSATION.—The executive director 

2 shall be paid the rate of basic pay for level V of 

3 the Executive Schedule. 

4 (2) STAFF.—With the approval of the MITAB, 

5 the executive director may appoint such personnel as 

6 the executive director considers appropriate. 

7 (3) APPLICABILITY OF CIVIL SERVICE LAWS.—

8 The staff of the MITAB shall be appointed without re9 gard to the provisions of title 5, United States Code, 

10 governing appointments in the competitive service, 

11 and shall be paid without regard to the provisions of 

12 chapter 51 and subchapter III of chapter 53 of such 

13 title (relating to classification and General Schedule 

14 pay rates). 

15 (4) EXPERTS AND CONSULTANTS.—With the ap16 proval of the MITAB, the executive director may pro17 cure temporary and intermittent services under sec18 tion 3109(b) of title 5, United States Code. 

19 (e) POWERS.—

20 (1) HEARINGS AND OTHER ACTIVITIES.—For the 

21 purpose of carrying out its duties, the MITAB may 

22 hold such hearings and undertake such other activities 

23 as the MITAB determines to be necessary to carry out 

24 its duties. 
30

•HR 877 RH 

1 (2) DETAIL OF FEDERAL EMPLOYEES.—Upon the 

2 request of the MITAB, the head of any Federal agency 

3 is authorized to detail, without reimbursement, any of 

4 the personnel of such agency to the MITAB to assist 

5 the MITAB in carrying out its duties. Any such de6 tail shall not interrupt or otherwise affect the civil 

7 service status or privileges of the Federal employee. 

8 (3) TECHNICAL ASSISTANCE.—Upon the request 

9 of the MITAB, the head of a Federal agency shall pro10 vide such technical assistance to the MITAB as the 

11 MITAB determines to be necessary to carry out its 

12 duties. 

13 (4) OBTAINING INFORMATION.—The MITAB may 

14 secure directly from any Federal agency information 

15 necessary to enable it to carry out its duties, if the 

16 information may be disclosed under section 552 of 

17 title 5, United States Code. Upon request of the 

18 Chairman of the MITAB, the head of such agency 

19 shall furnish such information to the MITAB. 

20 (f) TERMINATION.—The MITAB shall terminate 30 

21 days after the date of submission of its final report under 

22 subsection (c)(2)(B). 

23 (g) APPLICABILITY OF FACA.—The provisions of the 

24 Federal Advisory Committee Act (5 U.S.C. App.) shall 

25 apply to the MITAB. 
31

•HR 877 RH 

1 (h) FUNDING.—The Secretary shall transfer from the 

2 Federal Hospital Insurance Trust Fund established under 

3 section 1817 of the Social Security Act (42 U.S.C. 1395i) 

4 such sums as are necessary for each fiscal year to carry 

5 out this section.
Union Calendar No. 24

108TH CONGRESS 

1ST SESSION H. R. 877

[Report No. 108–31, Part I] 

A BILL

To amend title XI of the Social Security Act to 

improve patient safety. 

MARCH 13, 2003

Committee on Energy and Commerce discharged; committed to the Committee of the Whole House on the 

State of the Union and ordered to be printed