109TH CONGRESS 
2D SESSION 
H. R. 4157
AN ACT 
To promote a better health information system.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE AND TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Health Information Technology Promotion Act of 2006’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows:
Sec. 1. Short title and table of contents. 
Sec. 2. Preserving privacy and security laws. 
TITLE I—COORDINATION FOR, PLANNING FOR, AND 
INTEROPERABILITY OF HEALTH INFORMATION TECHNOLOGY 
Sec. 101. Office of the National Coordinator for Health Information Tech-
nology. 
Sec. 102. Report on the American Health Information Community. 
Sec. 103. Interoperability planning process; Federal information collection ac-
tivities. 
Sec. 104. Grants to integrated health systems to promote health information 
technologies to improve coordination of care for the uninsured, 
underinsured, and medically underserved. 
Sec. 105. Small physician practice demonstration grants. 
TITLE II—TRANSACTION STANDARDS, CODES, AND INFORMATION 
Sec. 201. Procedures to ensure timely updating of standards that enable elec-
tronic exchanges. 
Sec. 202. Upgrading ASC X12 and NCPDP standards. 
Sec. 203. Upgrading ICD codes; coding and documentation of non-medical in-
formation. 
Sec. 204. Strategic plan for coordinating implementation of transaction stand-
ards and ICD codes. 
Sec. 205. Study and report to determine impact of variation and commonality 
in State health information laws and regulations. 
Sec. 206. Report on appropriateness of classification methodologies and codes 
for additional purposes. 
TITLE III—PROMOTING THE USE OF HEALTH INFORMATION 
TECHNOLOGY TO BETTER COORDINATE HEALTH CARE 
Sec. 301. Safe harbors to antikickback civil penalties and criminal penalties for 
provision of health information technology and training serv-
ices. 
Sec. 302. Exception to limitation on certain physician referrals (under Stark) 
for provision of health information technology and training 
services to health care professionals. 
Sec. 303. Rules of construction regarding use of consortia. 
TITLE IV—ADDITIONAL PROVISIONS 
Sec. 401. Promotion of telehealth services. 
Sec. 402. Study and report on expansion of home health-related telehealth serv-
ices.
Sec. 403. Study and report on store and forward technology for telehealth. 
Sec. 404. Ensuring health care providers participating in PHSA programs, 
Medicaid, SCHIP, or the MCH program may maintain health 
information in electronic form. 
Sec. 405. Ensuring health care providers participating in the Medicare program 
may maintain health information in electronic form. 
Sec. 406. Study and report on State, regional, and community health informa-
tion exchanges. 
Sec. 407. Promoting health information technology as a tool for chronic disease 
management.
SEC. 2. PRESERVING PRIVACY AND SECURITY LAWS. 
Nothing in this Act (or the amendments made by this 
Act) shall be construed to affect the scope, substance, or 
applicability of section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996 and any regu-
lation issued pursuant to such section. 
TITLE 
I—COORDINATION 
FOR, 
PLANNING FOR, AND INTER-
OPERABILITY OF HEALTH IN-
FORMATION TECHNOLOGY 
SEC. 101. OFFICE OF THE NATIONAL COORDINATOR FOR 
HEALTH INFORMATION TECHNOLOGY. 
(a) IN GENERAL.—Title II of the Public Health Serv-
ice Act is amended by adding at the end the following new 
part: 
‘‘PART D—HEALTH INFORMATION TECHNOLOGY 
‘‘SEC. 271. OFFICE OF THE NATIONAL COORDINATOR FOR 
HEALTH INFORMATION TECHNOLOGY. 
‘‘(a) ESTABLISHMENT.—There is established within 
the Department of Health and Human Services an Office
of the National Coordinator for Health Information Tech-
nology that shall be headed by the National Coordinator 
for Health Information Technology (referred to in this 
part as the ‘National Coordinator’). The National Coordi-
nator shall be appointed by and report directly to the Sec-
retary. The National Coordinator shall be paid at a rate 
equal to the rate of basic pay for level IV of the Executive 
Schedule. 
‘‘(b) GOALS
OF
NATIONWIDE
INTEROPERABLE 
HEALTH
INFORMATION
TECHNOLOGY
INFRASTRUC-
TURE.—The National Coordinator shall perform the du-
ties under subsection (c) in a manner consistent with the 
development of a nationwide interoperable health informa-
tion technology infrastructure that—
‘‘(1) improves health care quality, promotes 
data accuracy, reduces medical errors, increases the 
efficiency of care, and advances the delivery of ap-
propriate, evidence-based health care services; 
‘‘(2) promotes wellness, disease prevention, and 
management of chronic illnesses by increasing the 
availability and transparency of information related 
to the health care needs of an individual for such in-
dividual; 
‘‘(3) promotes the availability of appropriate 
and accurate information necessary to make medical
decisions in a usable form at the time and in the lo-
cation that the medical service involved is provided; 
‘‘(4) produces greater value for health care ex-
penditures by reducing health care costs that result 
from inefficiency, medical errors, inappropriate care, 
and incomplete or inaccurate information; 
‘‘(5) promotes a more effective marketplace, 
greater competition, greater systems analysis, in-
creased consumer choice, enhanced quality, and im-
proved outcomes in health care services; 
‘‘(6) with respect to health information of con-
sumers, advances the portability of such information 
and the ability of such consumers to share and use 
such information to assist in the management of 
their health care; 
‘‘(7) improves the coordination of information 
and the provision of such services through an effec-
tive infrastructure for the secure and authorized ex-
change and use of health care information; 
‘‘(8) provides for the confidentiality and secu-
rity of individually identifiable health information, 
consistent with legally applicable requirements with 
respect to securing and protecting the confidentiality 
of individually identifiable health information of a 
patient;
‘‘(9) promotes the creation and maintenance of 
transportable, secure, Internet-based personal health 
records, including promoting the efforts of health 
care payers and health plan administrators for a 
health plan, such as Federal agencies, private health 
plans, and third party administrators, to provide for 
such records on behalf of members of such a plan; 
‘‘(10) promotes access to and review of the elec-
tronic health record of a patient by such patient; 
‘‘(11) promotes health research and health care 
quality research and assessment; 
‘‘(12) promotes the efficient and streamlined 
development, submission, and maintenance of elec-
tronic health care clinical trial data; and 
‘‘(13) improves the availability of information 
and resources for individuals with low or limited lit-
eracy or language skills. 
‘‘(c) DUTIES OF THE NATIONAL COORDINATOR.—
‘‘(1) STRATEGIC
PLANNER
FOR
INTEROPER-
ABLE
HEALTH
INFORMATION
TECHNOLOGY.—The 
National Coordinator shall provide for a strategic 
plan for the nationwide implementation of interoper-
able health information technology in both the public 
and private health care sectors consistent with sub-
section (b).
‘‘(2) 
PRINCIPAL
ADVISOR
TO
THE
SEC-
RETARY.—The National Coordinator shall serve as 
the principal advisor to the Secretary on the develop-
ment, application, and use of health information 
technology, and shall coordinate the policies and pro-
grams of the Department of Health and Human 
Services for promoting the use of health information 
technology. 
‘‘(3) INTRAGOVERNMENTAL
COORDINATOR.—
The National Coordinator shall ensure that health 
information technology policies and programs of the 
Department of Health and Human Services are co-
ordinated with those of relevant executive branch 
agencies and departments with a goal to avoid dupli-
cation of effort, to align the health information ar-
chitecture of each agency or department toward a 
common approach, to ensure that each agency or de-
partment conducts programs within the areas of its 
greatest expertise and its mission in order to create 
a national interoperable health information system 
capable of meeting national public health needs ef-
fectively and efficiently, and to assist Federal agen-
cies and departments in security programs, policies, 
and protections to prevent unauthorized access to in-
dividually identifiable health information created,
maintained, or in the temporary possession of that 
agency or department. The coordination authority 
provided to the National Coordinator under the pre-
vious sentence shall supercede any such authority 
otherwise provided to any other official of the De-
partment of Health and Human Services. For the 
purposes of this paragraph, the term ‘unauthorized 
access’ means access that is not authorized by that 
agency or department including unauthorized em-
ployee access. 
‘‘(4) ADVISOR TO OMB.—The National Coordi-
nator shall provide to the Director of the Office of 
Management and Budget comments and advice with 
respect to specific Federal health information tech-
nology programs. 
‘‘(5) PROMOTER
OF
HEALTH
INFORMATION 
TECHNOLOGY IN MEDICALLY UNDERSERVED COMMU-
NITIES.—The National Coordinator shall—
‘‘(A) identify sources of funds that will be 
made available to promote and support the 
planning and adoption of health information 
technology in medically underserved commu-
nities, including in urban and rural areas, ei-
ther through grants or technical assistance;
‘‘(B) coordinate with the funding sources 
to help such communities connect to identified 
funding; and 
‘‘(C) collaborate with the Agency for 
Healthcare Research and Quality and the 
Health Services Resources Administration and 
other Federal agencies to support technical as-
sistance, knowledge dissemination, and resource 
development, to medically underserved commu-
nities seeking to plan for and adopt technology 
and establish electronic health information net-
works across providers.’’. 
(b) TREATMENT
OF
EXECUTIVE
ORDER
NO. 
13335.—Executive Order No. 13335 shall not have any 
force or effect after the date of the enactment of this Act. 
(c) TRANSITION FROM ONCHIT UNDER EXECUTIVE 
ORDER.—
(1) IN GENERAL.—All functions, personnel, as-
sets, liabilities, administrative actions, and statutory 
reporting requirements applicable to the old Na-
tional Coordinator or the Office of the old National 
Coordinator on the date before the date of the enact-
ment of this Act shall be transferred, and applied in 
the same manner and under the same terms and 
conditions, to the new National Coordinator and the
Office of the new National Coordinator as of the 
date of the enactment of this Act. 
(2) RULE OF CONSTRUCTION.— Nothing in this 
section or the amendment made by this section shall 
be construed as requiring the duplication of Federal 
efforts with respect to the establishment of the Of-
fice of the National Coordinator for Health Informa-
tion Technology, regardless of whether such efforts 
are carried out before or after the date of the enact-
ment of this Act. 
(3) ACTING NATIONAL COORDINATOR.—Before 
the appointment of the new National Coordinator, 
the old National Coordinator shall act as the Na-
tional Coordinator for Health Information Tech-
nology until the office is filled as provided in section 
271(a) of the Public Health Service Act, as added 
by subsection (a). The Secretary of Health and 
Human Services may appoint the old National Coor-
dinator as the new National Coordinator. 
(4) DEFINITIONS.—For purposes of this sub-
section: 
(A) NEW NATIONAL COORDINATOR.—The 
term ‘‘new National Coordinator’’ means the 
National Coordinator for Health Information 
Technology appointed under section 271(a) of
the Public Health Service Act, as added by sub-
section (a). 
(B) OLD
NATIONAL
COORDINATOR.—The 
term ‘‘old National Coordinator’’ means the 
National Coordinator for Health Information 
Technology appointed under Executive Order 
No. 13335. 
(d) STUDY OF HEALTH INFORMATION TECHNOLOGY 
IN MEDICALLY UNDERSERVED COMMUNITIES.—
(1) STUDY.—The National Coordinator for 
Health Information Technology shall conduct a 
study on the development and implementation of 
health information technology in medically under-
served communities. The study shall—
(A) identify barriers to successful imple-
mentation of health information technology in 
these communities; 
(B) examine the impact of health informa-
tion technology on providing quality care and 
reducing the cost of care to these communities; 
(C) examine urban and rural community 
health systems and determine the impact that 
health information technology may have on the 
capacity of primary health providers; and
(D) assess the feasibility and the costs of 
associated with the use of health information 
technology in these communities. 
(2) REPORT.—Not later than 18 months after 
the date of the enactment of this Act, the National 
Coordinator shall submit to Congress a report on the 
study conducted under paragraph (1) and shall in-
clude in such report such recommendations for legis-
lation or administrative action as the Coordinator 
determines appropriate. 
SEC. 102. REPORT ON THE AMERICAN HEALTH INFORMA-
TION COMMUNITY. 
Not later than one year after the date of the enact-
ment of this Act, the Secretary of Health and Human 
Services shall submit to Congress a report on the work 
conducted by the American Health Information Commu-
nity (in this section referred to as ‘‘AHIC’’), as established 
by the Secretary. Such report shall include the following: 
(1) A description of the accomplishments of 
AHIC, with respect to the promotion of the develop-
ment of national guidelines, the development of a 
nationwide health information network, and the in-
creased adoption of health information technology. 
(2) Information on how model privacy and secu-
rity policies may be used to protect confidentiality of
health information, and an assessment of how exist-
ing policies compare to such model policies. 
(3) Information on the progress in—
(A) establishing uniform industry-wide 
health information technology standards; 
(B) achieving an internet-based nationwide 
health information network; 
(C) 
achieving 
interoperable 
electronic 
health record adoption across health care pro-
viders; and 
(D) creating technological innovations to 
promote security and confidentiality of individ-
ually identifiable health information. 
(4) Recommendations for the transition of 
AHIC to a longer-term or permanent advisory and 
facilitation entity, including—
(A) a schedule for such transition; 
(B) options for structuring the entity as ei-
ther a public-private or private sector entity; 
(C) the collaberative role of the Federal 
Government in the entity; 
(D) steps for—
(i) continued leadership in the facilita-
tion of guidelines or standards;
(ii) the alignment of financial incen-
tives; and 
(iii) the long-term plan for health care 
transformation through information tech-
nology; and 
(E) the elimination or revision of the func-
tions of AHIC during the development of the 
nationwide health information network. 
(5) Recommendations on the inclusion of emer-
gency contact or next-of-kin information (including 
name and phone number) in interoperable electronic 
health records. 
SEC. 103. INTEROPERABILITY PLANNING PROCESS; FED-
ERAL INFORMATION COLLECTION ACTIVI-
TIES. 
Part D of title II of the Public Health Service Act, 
as added by section 101(a), is amended by adding at the 
end the following new section: 
‘‘SEC. 272. INTEROPERABILITY PLANNING PROCESS; FED-
ERAL INFORMATION COLLECTION ACTIVI-
TIES. 
‘‘(a) 
STRATEGIC
INTEROPERABILITY
PLANNING 
PROCESS.—
‘‘(1) ASSESSMENT
AND
ENDORSEMENT
OF 
CORE STRATEGIC GUIDELINES.—
‘‘(A) IN
GENERAL.—Not later than De-
cember 31, 2006, the National Coordinator 
shall publish a strategic plan, including a sched-
ule, for the assessment and the endorsement of 
core interoperability guidelines for significant 
use cases consistent with this subsection. The 
National Coordinator may update such plan 
from time to time. 
‘‘(B) ENDORSEMENT.—
‘‘(i) IN
GENERAL.—Consistent with 
the schedule under this paragraph and not 
later than one year after the publication of 
such schedule, the National Coordinator 
shall endorse a subset of core interoper-
ability guidelines for significant use cases. 
The National Coordinator shall continue to 
endorse subsets of core interoperability 
guidelines for significant use cases annu-
ally consistent with the schedule published 
pursuant to this paragraph, with endorse-
ment of all such guidelines completed not 
later than August 31, 2009. 
‘‘(ii) CONSULTATION.—All such en-
dorsements shall be in consultation with
the American Health Information Commu-
nity and other appropriate entities. 
‘‘(iii) 
VOLUNTARY
COMPLIANCE.—
Compliance with such guidelines shall be 
voluntary, subject to subsection (b)(1). 
‘‘(C) CONSULTATION
WITH
OTHER
PAR-
TIES.—The National Coordinator shall develop 
and implement such strategic plan in consulta-
tion with the American Health Information 
Community and other appropriate entities. 
‘‘(D) DEFINITIONS.—For purposes of this 
section: 
‘‘(i) 
INTEROPERABILITY
GUIDE-
LINE.—The term ‘interoperability guide-
line’ means a guideline to improve and pro-
mote the interoperability of health infor-
mation technology for purposes of elec-
tronically accessing and exchanging health 
information. Such term includes named 
standards, architectures, software schemes 
for identification, authentication, and secu-
rity, and other information needed to en-
sure the reproducible development of com-
mon solutions across disparate entities.
‘‘(ii) CORE INTEROPERABILITY GUIDE-
LINE.—The term ‘core interoperability 
guideline’ means an interoperability guide-
line that the National Coordinator deter-
mines is essential and necessary for pur-
poses described in clause (i). 
‘‘(iii) SIGNIFICANT
USE
CASE.—The 
term ‘significant use case’ means a cat-
egory (as specified by the National Coordi-
nator) that identifies a significant use or 
purpose for the interoperability of health 
information technology, such as for the ex-
change of laboratory information, drug 
prescribing, clinical research, and elec-
tronic health records. 
‘‘(2) NATIONAL SURVEY.—
‘‘(A) IN GENERAL.—Not later than August 
31, 2008, the National Coordinator shall con-
duct one or more surveys designed to measure 
the capability of entities (including Federal 
agencies, State and local government agencies, 
and private sector entities) to exchange elec-
tronic health information by appropriate signifi-
cant use case. Such surveys shall identify the 
extent to which the type of health information,
the use for such information, or any other ap-
propriate characterization of such information 
may relate to the capability of such entities to 
exchange health information in a manner that 
is consistent with methods to improve the inter-
operability of health information and with core 
interoperability guidelines. 
‘‘(B) DISSEMINATION
OF
SURVEY
RE-
SULTS.—The National Coordinator shall dis-
seminate the results of such surveys in a man-
ner so as to—
‘‘(i) inform the public on the capabili-
ties of entities to exchange electronic 
health information; 
‘‘(ii) assist in establishing a more 
interoperable information architecture; and 
‘‘(iii) identify the status of health in-
formation systems used in Federal agen-
cies and the status of such systems with 
respect to interoperability guidelines. 
‘‘(b) FEDERAL HEALTH INFORMATION COLLECTION 
ACTIVITIES.—
‘‘(1) REQUIREMENTS.—With respect to a core 
interoperability guideline endorsed under subsection 
(a)(1)(B) for a significant use case, the President