I 
109TH CONGRESS 
2D SESSION 
H. R. 4726 
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 HOUSE OF REPRESENTATIVES 
FEBRUARY 8, 2006 
Mr. ISSA introduced the following bill; which was referred to the Committee 
on Energy and Commerce 
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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Wired for Health Care 
Quality Act’’. 
SEC. 2. IMPROVING HEALTH CARE QUALITY, SAFETY, AND 
EFFICIENCY. 
The Public Health Service Act (42 U.S.C. 201 et 
seq.) is amended by adding at the end the following:
‘‘TITLE XXIX—HEALTH INFORMA-
TION 
TECHNOLOGY 
AND 
QUALITY 
‘‘SEC. 2901. DEFINITIONS. 
‘‘In this title: 
‘‘(1) HEALTH
CARE
PROVIDER.—The term 
‘health care provider’ means a hospital, skilled nurs-
ing facility, home health entity, health care clinic, 
federally qualified health center, group practice (as 
defined in section 1877(h)(4) of the Social Security 
Act), a pharmacist, a pharmacy, a laboratory, a phy-
sician (as defined in section 1861(r) of the Social 
Security Act), a practitioner (as defined in section 
1842(b)(18)(CC) of the Social Security Act), a 
health facility operated by or pursuant to a contract 
with the Indian Health Service, a rural health clinic, 
and any other category of facility or clinician deter-
mined appropriate by the Secretary. 
‘‘(2) HEALTH INFORMATION.—The term ‘health 
information’ has the meaning given such term in 
section 1171(4) of the Social Security Act. 
‘‘(3) HEALTH
INSURANCE
PLAN.—The term 
‘health insurance plan’ means— 
‘‘(A) a health insurance issuer (as defined 
in section 2791(b)(2));
‘‘(B) a group health plan (as defined in 
section 2791(a)(1)); and 
‘‘(C) a health maintenance organization 
(as defined in section 2791(b)(3)). 
‘‘(4) INDIVIDUALLY IDENTIFIABLE HEALTH IN-
FORMATION.—The term ‘individually identifiable 
health information’ has the meaning given such term 
in section 1171 of the Social Security Act. 
‘‘(5) LABORATORY.—The term ‘laboratory’ has 
the meaning given that term in section 353. 
‘‘(6) PHARMACIST.—The term ‘pharmacist’ has 
the meaning given that term in section 804 of the 
Federal Food, Drug, and Cosmetic Act. 
‘‘(7) QUALIFIED HEALTH INFORMATION TECH-
NOLOGY.—The term ‘qualified health information 
technology’ means a computerized system (including 
hardware and software) that— 
‘‘(A) protects the privacy and security of 
health information; 
‘‘(B) maintains and provides permitted ac-
cess to health information in an electronic for-
mat; 
‘‘(C) incorporates decision support to re-
duce medical errors and enhance health care 
quality;
‘‘(D) complies with the standards adopted 
by the Federal Government under section 2903; 
and 
‘‘(E) allows for the reporting of quality 
measures under section 2907. 
‘‘(8) STATE.—The term ‘State’ means each of 
the several States, the District of Columbia, Puerto 
Rico, the Virgin Islands, Guam, American Samoa, 
and the Northern Mariana Islands. 
‘‘SEC. 2902. OFFICE OF THE NATIONAL COORDINATOR OF 
HEALTH INFORMATION TECHNOLOGY. 
‘‘(a) OFFICE OF NATIONAL HEALTH INFORMATION 
TECHNOLOGY.—There is established within the Office of 
the Secretary an Office of the National Coordinator of 
Health Information Technology (referred to in this section 
as the ‘Office’). The Office shall be headed by a National 
Coordinator who shall be appointed by the Secretary and 
shall report directly to the Secretary. 
‘‘(b) PURPOSE.—It shall be the purpose of the Office 
to coordinate with relevant Federal agencies and private 
entities and oversee programs and activities to develop a 
nationwide interoperable health information technology in-
frastructure that— 
‘‘(1) ensures that patients’ individually identifi-
able health information is secure and protected;
‘‘(2) improves health care quality, reduces med-
ical errors, and advances the delivery of patient-cen-
tered medical care; 
‘‘(3) reduces health care costs resulting from 
inefficiency, medical errors, inappropriate care, and 
incomplete information; 
‘‘(4) ensures that appropriate information to 
help guide medical decisions is available at the time 
and place of care; 
‘‘(5) promotes a more effective marketplace, 
greater competition, and increased choice through 
the wider availability of accurate information on 
health care costs, quality, and outcomes; 
‘‘(6) improves the coordination of care and in-
formation among hospitals, laboratories, physician 
offices, and other entities through an effective infra-
structure for the secure and authorized exchange of 
health care information; 
‘‘(7) improves public health reporting and facili-
tates the early identification and rapid response to 
public health threats and emergencies, including bio-
terror events and infectious disease outbreaks; 
‘‘(8) facilitates health research; and 
‘‘(9) promotes prevention of chronic diseases.
‘‘(c) DUTIES OF THE NATIONAL COORDINATOR.— 
The National Coordinator shall— 
‘‘(1) serve as the principal advisor to the Sec-
retary concerning the development, application, and 
use of health information technology, and coordinate 
and oversee the health information technology pro-
grams of the Department; 
‘‘(2) facilitate the adoption of a nationwide, 
interoperable system for the electronic exchange of 
health information; 
‘‘(3) ensure the adoption and implementation of 
standards for the electronic exchange of health infor-
mation to reduce cost and improve health care qual-
ity; 
‘‘(4) ensure that health information technology 
policy and programs of the Department are coordi-
nated with those of relevant executive branch agen-
cies (including Federal commissions) with a goal of 
avoiding duplication of efforts and of helping to en-
sure that each agency undertakes health information 
technology activities primarily within the areas of its 
greatest expertise and technical capability; 
‘‘(5) to the extent permitted by law, coordinate 
outreach and consultation by the relevant executive 
branch agencies (including Federal commissions)
with public and private parties of interest, including 
consumers, payers, employers, hospitals and other 
health care providers, physicians, community health 
centers, laboratories, vendors and other stake-
holders; 
‘‘(6) advise the President regarding specific 
Federal health information technology programs; 
and 
‘‘(7) prepare the reports described under sec-
tion 2903(i) (excluding paragraph (4) of such sec-
tion). 
‘‘(d) DETAIL OF FEDERAL EMPLOYEES.— 
‘‘(1) IN GENERAL.—Upon the request of the 
National Coordinator, the head of any Federal agen-
cy is authorized to detail, with or without reimburse-
ment from the Office, any of the personnel of such 
agency to the Office to assist it in carrying out its 
duties under this section. 
‘‘(2) EFFECT OF DETAIL.—Any detail of per-
sonnel under paragraph (1) shall— 
‘‘(A) not interrupt or otherwise affect the 
civil service status or privileges of the Federal 
employee; and
‘‘(B) be in addition to any other staff of 
the Department employed by the National Co-
ordinator. 
‘‘(3) ACCEPTANCE
OF
DETAILEES.—Notwith-
standing any other provision of law, the Office may 
accept detailed personnel from other Federal agen-
cies without regard to whether the agency described 
under paragraph (1) is reimbursed. 
‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to require the duplication of Fed-
eral efforts with respect to the establishment of the Office, 
regardless of whether such efforts were carried out prior 
to or after the enactment of this title. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
$5,000,000 for fiscal year 2006, $5,000,000 for fiscal year 
2007, and such sums as may be necessary for each of fis-
cal years 2008 through 2010. 
‘‘SEC. 2903. AMERICAN HEALTH INFORMATION COLLABO-
RATIVE. 
‘‘(a) PURPOSE.—The Secretary shall establish the 
public-private American Health Information Collaborative 
(referred to in this section as the ‘Collaborative’) to—
‘‘(1) advise the Secretary and recommend spe-
cific actions to achieve a nationwide interoperable 
health information technology infrastructure; 
‘‘(2) serve as a forum for the participation of 
a broad range of stakeholders to provide input on 
achieving the interoperability of health information 
technology; and 
‘‘(3) recommend standards (including content, 
communication, and security standards) for the elec-
tronic exchange of health information (including for 
the reporting of quality data under section 2907) for 
adoption by the Federal Government and voluntary 
adoption by private entities. 
‘‘(b) COMPOSITION.— 
‘‘(1) IN GENERAL.—The Collaborative shall be 
composed of members of the public and private sec-
tors to be appointed by the Secretary, including rep-
resentatives from— 
‘‘(A) consumer or patient organizations; 
‘‘(B) organizations with expertise in pri-
vacy and security; 
‘‘(C) health care providers; 
‘‘(D) health insurance plans or other third 
party payors; 
‘‘(E) information technology vendors; and
‘‘(F) purchasers or employers. 
‘‘(2) PARTICIPATION.—In appointing members 
under paragraph (1), and in developing the proce-
dures for conducting the activities of the Collabo-
rative, the Secretary shall ensure a balance among 
various sectors of the health care system so that no 
single sector unduly influences the recommendations 
of the Collaborative. 
‘‘(3) TERMS.—Members appointed under para-
graph (1) shall serve for 2 year terms, except that 
any member appointed to fill a vacancy for an unex-
pired term shall be appointed for the remainder of 
such term. A member may serve for not to exceed 
180 days after the expiration of such member’s term 
or until a successor has been appointed. 
‘‘(4) OUTSIDE INVOLVEMENT.—With respect to 
the functions of the Collaborative, the Secretary 
shall ensure an adequate opportunity for the partici-
pation of outside advisors, including individuals with 
expertise in— 
‘‘(A) health information privacy; 
‘‘(B) health information security; 
‘‘(C) health care quality and patient safety, 
including individuals with expertise in utilizing
health information technology to improve health 
care quality and patient safety; 
‘‘(D) data exchange; and 
‘‘(E) developing health information tech-
nology standards and new health information 
technology. 
‘‘(c) RECOMMENDATIONS AND POLICIES.—Not later 
than 1 year after the date of enactment of this title, and 
annually thereafter, the Collaborative shall recommend to 
the Secretary uniform national policies for adoption by the 
Federal Government and voluntary adoption by private en-
tities to support the widespread adoption of health infor-
mation technology, including— 
‘‘(1) protection of individually identifiable 
health information through privacy and security 
practices; 
‘‘(2) measures to prevent unauthorized access 
to health information, including unauthorized access 
through the use of certain peer-to-peer file-sharing 
applications; 
‘‘(3) methods to notify patients if their individ-
ually identifiable health information is wrongfully 
disclosed; 
‘‘(4) methods to facilitate secure patient access 
to health information;
‘‘(5) fostering the public understanding of 
health information technology; 
‘‘(6) the ongoing harmonization of industry- 
wide health information technology standards; 
‘‘(7) recommendations for a nationwide inter-
operable health information technology infrastruc-
ture; 
‘‘(8) the identification and prioritization of spe-
cific use cases for which health information tech-
nology is valuable, beneficial, and feasible; 
‘‘(9) recommendations for the establishment of 
an entity to ensure the continuation of the functions 
of the Collaborative; and 
‘‘(10) other policies (including recommendations 
for incorporating health information technology into 
the provision of care and the organization of the 
health care workplace) determined to be necessary 
by the Collaborative. 
‘‘(d) STANDARDS.— 
‘‘(1) EXISTING
STANDARDS.—The standards 
adopted by the Consolidated Health Informatics Ini-
tiative shall be deemed to have been recommended 
by the Collaborative under this section.
‘‘(2) FIRST YEAR REVIEW.—Not later than 1 
year after the date of enactment of this title, the 
Collaborative shall— 
‘‘(A) review existing standards (including 
content, communication, and security stand-
ards) for the electronic exchange of health in-
formation; 
‘‘(B) identify deficiencies and omissions in 
such existing standards; and 
‘‘(C) identify duplication and overlap in 
such existing standards; 
and recommend new standards and modifications to 
such existing standards as necessary. 
‘‘(3) ONGOING
REVIEW.—Beginning 1 year 
after the date of enactment of this title, and annu-
ally thereafter, the Collaborative shall— 
‘‘(A) review existing standards (including 
content, communication, and security stand-
ards) for the electronic exchange of health in-
formation; 
‘‘(B) identify deficiencies and omissions in 
such existing standards; and 
‘‘(C) identify duplication and overlap in 
such existing standards;
and recommend new standards and modifications to 
such existing standards as necessary. 
‘‘(4) LIMITATION.—The standards and time-
frame for adoption described in this section shall be 
consistent with any standards developed pursuant to 
the Health Insurance Portability and Accountability 
Act of 1996. 
‘‘(e) FEDERAL ACTION.—Not later than 90 days 
after the issuance of a recommendation from the Collabo-
rative under subsection (d)(2), the Secretary of Health 
and Human Services, the Secretary of Veterans Affairs, 
and the Secretary of Defense, in collaboration with rep-
resentatives of other relevant Federal agencies, as deter-
mined appropriate by the Secretary, shall jointly review 
such recommendations. If appropriate, the Secretary shall 
provide for the adoption by the Federal Government of 
any standard or standards contained in such recommenda-
tion. 
‘‘(f) COORDINATION OF FEDERAL SPENDING.— 
‘‘(1) IN GENERAL.—Not later than 1 year after 
the adoption by the Federal Government of a rec-
ommendation as provided for in subsection (e), and 
in compliance with chapter 113 of title 40, United 
States Code, no Federal agency shall expend Federal 
funds for the purchase of any new health informa-
tion technology or health information technology sys-
tem for clinical care or for the electronic retrieval, 
storage, or exchange of health information that is 
not consistent with applicable standards adopted by 
the Federal Government under subsection (e). 
‘‘(2) RULE
OF
CONSTRUCTION.—Nothing in 
paragraph (1) shall be construed to restrict the pur-
chase of minor (as determined by the Secretary) 
hardware or software components in order to mod-
ify, correct a deficiency in, or extend the life of exist-
ing hardware or software. 
‘‘(g) COORDINATION OF FEDERAL DATA COLLEC-
TION.—Not later than 3 years after the adoption by the 
Federal Government of a recommendation as provided for 
in subsection (e), all Federal agencies collecting health 
data for the purposes of quality reporting, surveillance, ep-
idemiology, adverse event reporting, research, or for other 
purposes determined appropriate by the Secretary, shall 
comply with standards adopted under subsection (e). 
‘‘(h) VOLUNTARY ADOPTION.— 
‘‘(1) IN GENERAL.—Any standards adopted by 
the Federal Government under subsection (e) shall 
be voluntary with respect to private entities. 
‘‘(2) RULE
OF
CONSTRUCTION.—Nothing in 
this section shall be construed to require that a pri-
vate entity that enters into a contract with the Fed-
eral Government adopt the standards adopted by the 
Federal Government under this section with respect 
to activities not related to the contract. 
‘‘(3) LIMITATION.—Private entities that enter 
into a contract with the Federal Government shall 
adopt the standards adopted by the Federal Govern-
ment under this section for the purpose of activities 
under such Federal contract. 
‘‘(i) REPORTS.—The Secretary shall submit to the 
Committee on Health, Education, Labor, and Pensions 
and the Committee on Finance of the Senate and the 
Committee on Energy and Commerce and the Committee 
on Ways and Means of the House of Representatives, on 
an annual basis, a report that— 
‘‘(1) describes the specific actions that have 
been taken by the Federal Government and private 
entities to facilitate the adoption of an interoperable 
nationwide system for the electronic exchange of 
health information; 
‘‘(2) describes barriers to the adoption of such 
a nationwide system; 
‘‘(3) contains recommendations to achieve full 
implementation of such a nationwide system; and
‘‘(4) contains a plan and progress toward the 
establishment of an entity to ensure the continuation 
of the functions of the Collaborative. 
‘‘(j) APPLICATION OF FACA.—The Federal Advisory 
Committee Act (5 U.S.C. App.) shall apply to the Collabo-
rative, except that the term provided for under section 
14(a)(2) shall be 5 years. 
‘‘(k) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to require the duplication of Fed-
eral efforts with respect to the establishment of the Col-
laborative, regardless of whether such efforts were carried 
out prior to or after the enactment of this title. 
‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
$4,000,000 for fiscal year 2006, $4,000,000 for fiscal year 
2007, and such sums as may be necessary for each of fis-
cal years 2008 through 2010. 
‘‘SEC. 2904. IMPLEMENTATION AND CERTIFICATION OF 
HEALTH INFORMATION STANDARDS. 
‘‘(a) IMPLEMENTATION.— 
‘‘(1) IN GENERAL.—The Secretary, based upon 
the recommendations of the Collaborative, shall de-
velop criteria to ensure uniform and consistent im-
plementation of any standards for the electronic ex-
change of health information voluntarily adopted by
private entities in technical conformance with such 
standards adopted under this title. 
‘‘(2) IMPLEMENTATION ASSISTANCE.—The Sec-
retary may recognize a private entity or entities to 
assist private entities in the implementation of the 
standards adopted under this title using the criteria 
developed by the Secretary under this section. 
‘‘(b) CERTIFICATION.— 
‘‘(1) IN GENERAL.—The Secretary, based upon 
the recommendations of the Collaborative, shall de-
velop criteria to ensure and certify that hardware 
and software that claim to be in compliance with ap-
plicable standards for the electronic exchange of 
health information adopted under this title have es-
tablished and maintained such compliance in tech-
nical conformance with such standards. 
‘‘(2) CERTIFICATION
ASSISTANCE.—The Sec-
retary may recognize a private entity or entities to 
assist in the certification described under paragraph 
(1) using the criteria developed by the Secretary 
under this section. 
‘‘(c) 
OUTSIDE
INVOLVEMENT.—The 
Secretary, 
through consultation with the Collaborative, may accept 
recommendations on the development of the criteria under
subsections (a) and (b) from a Federal agency or private 
entity. 
‘‘SEC. 2905. GRANTS TO FACILITATE THE WIDESPREAD 
ADOPTION OF INTEROPERABLE HEALTH IN-
FORMATION TECHNOLOGY. 
‘‘(a) COMPETITIVE GRANTS
TO FACILITATE
THE 
WIDESPREAD
ADOPTION
OF
HEALTH
INFORMATION 
TECHNOLOGY.— 
‘‘(1) IN GENERAL.—The Secretary may award 
competitive grants to eligible entities to facilitate the 
purchase and enhance the utilization of qualified 
health information technology systems to improve 
the quality and efficiency of health care. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a 
grant under paragraph (1) an entity shall— 
‘‘(A) submit to the Secretary an applica-
tion at such time, in such manner, and con-
taining such information as the Secretary may 
require; 
‘‘(B) submit to the Secretary a strategic 
plan for the implementation of data sharing 
and interoperability measures; 
‘‘(C) be a— 
‘‘(i) not for profit hospital, including a 
federally qualified health center (as defined
in section 1861(aa)(4) of the Social Secu-
rity Act); 
‘‘(ii) individual or group practice; or 
‘‘(iii) another health care provider not 
described in clause (i) or (ii); 
‘‘(D) adopt the standards adopted by the 
Federal Government under section 2903; 
‘‘(E) implement the measures adopted 
under section 2907 and report to the Secretary 
on such measures; 
‘‘(F) agree to notify patients if their indi-
vidually 
identifiable 
health 
information 
is 
wrongfully disclosed; 
‘‘(G) 
demonstrate 
significant 
financial 
need; and 
‘‘(H) provide matching funds in accord-
ance with paragraph (4). 
‘‘(3) USE OF FUNDS.—Amounts received under 
a grant under this subsection shall be used to facili-
tate the purchase and enhance the utilization of 
qualified health information technology systems and 
training personnel in the use of such technology. 
‘‘(4) MATCHING REQUIREMENT.—To be eligible 
for a grant under this subsection an entity shall con-
tribute non-Federal contributions to the costs of car-
rying out the activities for which the grant is award-
ed in an amount equal to $1 for each $3 of Federal 
funds provided under the grant. 
‘‘(5) PREFERENCE IN AWARDING GRANTS.—In 
awarding grants under this subsection the Secretary 
shall give preference to— 
‘‘(A) eligible entities that are located in 
rural, frontier, and other underserved areas as 
determined by the Secretary; 
‘‘(B) eligible entities that will link, to the 
extent practicable, the qualified health informa-
tion system to local or regional health informa-
tion plan or plans; and 
‘‘(C) with respect to an entity described in 
subsection (a)(2)(C)(iii), a nonprofit health care 
provider. 
‘‘(b) COMPETITIVE GRANTS TO STATES FOR THE DE-
VELOPMENT OF STATE LOAN PROGRAMS TO FACILITATE 
THE WIDESPREAD ADOPTION OF HEALTH INFORMATION 
TECHNOLOGY.— 
‘‘(1) IN GENERAL.—The Secretary may award 
competitive grants to States for the establishment of 
State programs for loans to health care providers to 
facilitate the purchase and enhance the utilization of 
qualified health information technology.
‘‘(2) ESTABLISHMENT OF FUND.—To be eligi-
ble to receive a competitive grant under this sub-
section, a State shall establish a qualified health in-
formation technology loan fund (referred to in this 
subsection as a ‘State loan fund’) and comply with 
the other requirements contained in this section. A 
grant to a State under this subsection shall be de-
posited in the State loan fund established by the 
State. No funds authorized by other provisions of 
this title to be used for other purposes specified in 
this title shall be deposited in any State loan fund. 
‘‘(3) ELIGIBILITY.—To be eligible to receive a 
grant under paragraph (1) a State shall— 
‘‘(A) submit to the Secretary an applica-
tion at such time, in such manner, and con-
taining such information as the Secretary may 
require; 
‘‘(B) submit to the Secretary a strategic 
plan in accordance with paragraph (4); 
‘‘(C) establish a qualified health informa-
tion technology loan fund in accordance with 
paragraph (2); 
‘‘(D) require that health care providers re-
ceiving such loans—
‘‘(i) link, to the extent practicable, the 
qualified health information system to a 
local or regional health information net-
work; 
‘‘(ii) consult with the Health Informa-
tion Technology Resource Center estab-
lished in section 914(d) to access the 
knowledge and experience of existing initia-
tives regarding the successful implementa-
tion and effective use of health information 
technology; and 
‘‘(iii) agree to notify patients if their 
individually identifiable health information 
is wrongfully disclosed; 
‘‘(E) require that health care providers re-
ceiving such loans adopt the standards adopted 
by the Federal Government under section 2903; 
‘‘(F) require that health care providers re-
ceiving such loans implement the measures 
adopted under section 2907 and report to the 
Secretary on such measures; and 
‘‘(G) provide matching funds in accordance 
with paragraph (8). 
‘‘(4) STRATEGIC PLAN.—
‘‘(A) IN GENERAL.—A State that receives 
a grant under this subsection shall annually 
prepare a strategic plan that identifies the in-
tended uses of amounts available to the State 
loan fund of the State. 
‘‘(B) CONTENTS.—A strategic plan under 
subparagraph (A) shall include— 
‘‘(i) a list of the projects to be as-
sisted through the State loan fund in the 
first fiscal year that begins after the date 
on which the plan is submitted; 
‘‘(ii) a description of the criteria and 
methods established for the distribution of 
funds from the State loan fund; and 
‘‘(iii) a description of the financial 
status of the State loan fund and the 
short-term and long-term goals of the 
State loan fund. 
‘‘(5) USE OF FUNDS.— 
‘‘(A) IN GENERAL.—Amounts deposited in 
a State loan fund, including loan repayments 
and interest earned on such amounts, shall be 
used only for awarding loans or loan guaran-
tees, or as a source of reserve and security for 
leveraged loans, the proceeds of which are de-
posited in the State loan fund established under 
paragraph (1). Loans under this section may be 
used by a health care provider to facilitate the 
purchase and enhance the utilization of quali-
fied health information technology and training 
of personnel in the use of such technology. 
‘‘(B) LIMITATION.—Amounts received by a 
State under this subsection may not be used— 
‘‘(i) for the purchase or other acquisi-
tion of any health information technology 
system that is not a qualified health infor-
mation technology system; 
‘‘(ii) to conduct activities for which 
Federal funds are expended under this 
title, or the amendments made by the 
Wired for Health Care Quality Act; or 
‘‘(iii) for any purpose other than mak-
ing loans to eligible entities under this sec-
tion. 
‘‘(6) TYPES OF ASSISTANCE.—Except as other-
wise limited by applicable State law, amounts depos-
ited into a State loan fund under this subsection 
may only be used for the following: 
‘‘(A) To award loans that comply with the 
following:
‘‘(i) The interest rate for each loan 
shall be less than or equal to the market 
interest rate. 
‘‘(ii) The principal and interest pay-
ments on each loan shall commence not 
later than 1 year after the loan was award-
ed, and each loan shall be fully amortized 
not later than 10 years after the date of 
the loan. 
‘‘(iii) The State loan fund shall be 
credited with all payments of principal and 
interest on each loan awarded from the 
fund. 
‘‘(B) To guarantee, or purchase insurance 
for, a local obligation (all of the proceeds of 
which finance a project eligible for assistance 
under this subsection) if the guarantee or pur-
chase would improve credit market access or re-
duce the interest rate applicable to the obliga-
tion involved. 
‘‘(C) As a source of revenue or security for 
the payment of principal and interest on rev-
enue or general obligation bonds issued by the 
State if the proceeds of the sale of the bonds 
will be deposited into the State loan fund.
‘‘(D) To earn interest on the amounts de-
posited into the State loan fund. 
‘‘(7) 
ADMINISTRATION
OF
STATE
LOAN 
FUNDS.— 
‘‘(A) COMBINED FINANCIAL ADMINISTRA-
TION.—A State may (as a convenience and to 
avoid unnecessary administrative costs) com-
bine, in accordance with State law, the financial 
administration of a State loan fund established 
under this subsection with the financial admin-
istration of any other revolving fund established 
by the State if otherwise not prohibited by the 
law under which the State loan fund was estab-
lished. 
‘‘(B) COST
OF
ADMINISTERING
FUND.— 
Each State may annually use not to exceed 4 
percent of the funds provided to the State 
under a grant under this subsection to pay the 
reasonable costs of the administration of the 
programs under this section, including the re-
covery of reasonable costs expended to establish 
a State loan fund which are incurred after the 
date of enactment of this title. 
‘‘(C) GUIDANCE AND REGULATIONS.—The 
Secretary shall publish guidance and promul-
gate regulations as may be necessary to carry 
out the provisions of this subsection, includ-
ing— 
‘‘(i) provisions to ensure that each 
State commits and expends funds allotted 
to the State under this subsection as effi-
ciently as possible in accordance with this 
title and applicable State laws; and 
‘‘(ii) guidance to prevent waste, fraud, 
and abuse. 
‘‘(D) PRIVATE SECTOR CONTRIBUTIONS.— 
‘‘(i) IN GENERAL.—A State loan fund 
established under this subsection may ac-
cept contributions from private sector enti-
ties, except that such entities may not 
specify the recipient or recipients of any 
loan issued under this subsection. 
‘‘(ii) 
AVAILABILITY
OF
INFORMA-
TION.—A State shall make publicly avail-
able the identity of, and amount contrib-
uted by, any private sector entity under 
clause (i) and may issue letters of com-
mendation or make other awards (that 
have no financial value) to any such entity. 
‘‘(8) MATCHING REQUIREMENTS.—
‘‘(A) IN
GENERAL.—The Secretary may 
not make a grant under paragraph (1) to a 
State unless the State agrees to make available 
(directly or through donations from public or 
private entities) non-Federal contributions in 
cash toward the costs of the State program to 
be implemented under the grant in an amount 
equal to not less than $1 for each $1 of Federal 
funds provided under the grant. 
‘‘(B) DETERMINATION
OF
AMOUNT
OF 
NON-FEDERAL CONTRIBUTION.—In determining 
the amount of non-Federal contributions that a 
State has provided pursuant to subparagraph 
(A), the Secretary may not include any 
amounts provided to the State by the Federal 
Government. 
‘‘(9) PREFERENCE
IN
AWARDING
GRANTS.— 
The Secretary may give a preference in awarding 
grants under this subsection to States that adopt 
value-based purchasing programs to improve health 
care quality. 
‘‘(10) REPORTS.—The Secretary shall annually 
submit to the Committee on Health, Education, 
Labor, and Pensions and the Committee on Finance 
of the Senate, and the Committee on Energy and
Commerce and the Committee on Ways and Means 
of the House of Representatives, a report summa-
rizing the reports received by the Secretary from 
each State that receives a grant under this sub-
section. 
‘‘(c) COMPETITIVE GRANTS FOR THE IMPLEMENTA-
TION OF REGIONAL OR LOCAL HEALTH INFORMATION 
TECHNOLOGY PLANS.— 
‘‘(1) IN GENERAL.—The Secretary may award 
competitive grants to eligible entities to implement 
regional or local health information plans to improve 
health care quality and efficiency through the elec-
tronic exchange of health information pursuant to 
the standards, protocols, and other requirements 
adopted by the Secretary under sections 2903 and 
2907. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a 
grant under paragraph (1) an entity shall— 
‘‘(A) demonstrate financial need to the 
Secretary; 
‘‘(B) demonstrate that one of its principal 
missions or purposes is to use information tech-
nology to improve health care quality and effi-
ciency;
‘‘(C) adopt bylaws, memoranda of under-
standing, or other charter documents that dem-
onstrate that the governance structure and de-
cisionmaking processes of such entity allow for 
participation on an ongoing basis by multiple 
stakeholders within a community, including— 
‘‘(i) physicians (as defined in section 
1861(r) of the Social Security Act), includ-
ing physicians that provide services to low 
income and underserved populations; 
‘‘(ii) hospitals (including hospitals 
that provide services to low income and un-
derserved populations); 
‘‘(iii) pharmacists or pharmacies; 
‘‘(iv) health insurance plans; 
‘‘(v) health centers (as defined in sec-
tion 330(b)) and Federally qualified health 
centers (as defined in section 1861(aa)(4) 
of the Social Security Act); 
‘‘(vi) rural health clinics (as defined in 
section 1861(aa) of the Social Security 
Act); 
‘‘(vii) patient or consumer organiza-
tions; 
‘‘(viii) employers; and
‘‘(ix) any other health care providers 
or other entities, as determined appro-
priate by the Secretary; 
‘‘(D) demonstrate the participation, to the 
extent practicable, of stakeholders in the elec-
tronic exchange of health information within 
the local or regional plan pursuant to para-
graph (2)(C); 
‘‘(E) adopt nondiscrimination and conflict 
of interest policies that demonstrate a commit-
ment to open, fair, and nondiscriminatory par-
ticipation in the health information plan by all 
stakeholders; 
‘‘(F) adopt the standards adopted by the 
Secretary under section 2903; 
‘‘(G) require that health care providers re-
ceiving such grants implement the measures 
adopted under section 2907 and report to the 
Secretary on such measures; 
‘‘(H) agree to notify patients if their indi-
vidually 
identifiable 
health 
information 
is 
wrongfully disclosed; 
‘‘(I) facilitate the electronic exchange of 
health information within the local or regional 
area and among local and regional areas;
‘‘(J) prepare and submit to the Secretary 
an application in accordance with paragraph 
(3); and 
‘‘(K) agree to provide matching funds in 
accordance with paragraph (5). 
‘‘(3) APPLICATION.— 
‘‘(A) IN GENERAL.—To be eligible to re-
ceive a grant under paragraph (1), an entity 
shall submit to the Secretary an application at 
such time, in such manner, and containing such 
information as the Secretary may require. 
‘‘(B) 
REQUIRED
INFORMATION.—At 
a 
minimum, an application submitted under this 
paragraph shall include— 
‘‘(i) clearly identified short-term and 
long-term objectives of the regional or local 
health information plan; 
‘‘(ii) a technology plan that complies 
with the standards adopted under section 
2903 and that includes a descriptive and 
reasoned estimate of costs of the hardware, 
software, training, and consulting services 
necessary to implement the regional or 
local health information plan;
‘‘(iii) a strategy that includes initia-
tives to improve health care quality and ef-
ficiency, including the use and reporting of 
health care quality measures adopted 
under section 2907; 
‘‘(iv) a plan that describes provisions 
to encourage the implementation of the 
electronic exchange of health information 
by all physicians, including single physician 
practices and small physician groups par-
ticipating in the health information plan; 
‘‘(v) a plan to ensure the privacy and 
security of personal health information 
that is consistent with Federal and State 
law; 
‘‘(vi) a governance plan that defines 
the manner in which the stakeholders shall 
jointly make policy and operational deci-
sions on an ongoing basis; 
‘‘(vii) a financial or business plan that 
describes— 
‘‘(I) the sustainability of the 
plan; 
‘‘(II) the financial costs and ben-
efits of the plan; and
‘‘(III) the entities to which such 
costs and benefits will accrue; and 
‘‘(viii) in the case of an applicant enti-
ty that is unable to demonstrate the par-
ticipation of all stakeholders pursuant to 
paragraph (2)(C), the justification from 
the entity for any such nonparticipation. 
‘‘(4) USE OF FUNDS.—Amounts received under 
a grant under paragraph (1) shall be used to estab-
lish and implement a regional or local health infor-
mation plan in accordance with this subsection. 
‘‘(5) MATCHING REQUIREMENT.— 
‘‘(A) IN
GENERAL.—The Secretary may 
not make a grant under this subsection to an 
entity unless the entity agrees that, with re-
spect to the costs to be incurred by the entity 
in carrying out the infrastructure program for 
which the grant was awarded, the entity will 
make available (directly or through donations 
from public or private entities) non-Federal 
contributions toward such costs in an amount 
equal to not less than 50 percent of such costs 
($1 for each $2 of Federal funds provided 
under the grant).
‘‘(B) DETERMINATION
OF
AMOUNT
CON-
TRIBUTED.—Non-Federal 
contributions 
re-
quired under subparagraph (A) may be in cash 
or in kind, fairly evaluated, including equip-
ment, technology, or services. Amounts provided 
by the Federal Government, or services assisted 
or subsidized to any significant extent by the 
Federal Government, may not be included in 
determining the amount of such non-Federal 
contributions. 
‘‘(d) REPORTS.—Not later than 1 year after the date 
on which the first grant is awarded under this section, 
and annually thereafter during the grant period, an entity 
that receives a grant under this section shall submit to 
the Secretary a report on the activities carried out under 
the grant involved. Each such report shall include— 
‘‘(1) a description of the financial costs and 
benefits of the project involved and of the entities to 
which such costs and benefits accrue; 
‘‘(2) an analysis of the impact of the project on 
health care quality and safety; 
‘‘(3) a description of any reduction in duplica-
tive or unnecessary care as a result of the project in-
volved;
‘‘(4) a description of the efforts of recipients 
under this section to facilitate secure patient access 
to health information; and 
‘‘(5) other information as required by the Sec-
retary. 
‘‘(e) REQUIREMENT TO ACHIEVE QUALITY IMPROVE-
MENT.—The Secretary shall annually evaluate the activi-
ties conducted under this section and shall, in awarding 
grants, implement the lessons learned from such evalua-
tion in a manner so that awards made subsequent to each 
such evaluation are made in a manner that, in the deter-
mination of the Secretary, will result in the greatest im-
provement in quality measures under section 2907. 
‘‘(f) LIMITATION.—An eligible entity may only receive 
one non-renewable grant under subsection (a), one non- 
renewable grant under subsection (b), and one non-renew-
able grant under subsection (c). 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) IN
GENERAL.—For the purpose of car-
rying out this section, there is authorized to be ap-
propriated $116,000,000 for fiscal year 2006, 
$141,000,000 for fiscal year 2007, and such sums 
as may be necessary for each of fiscal years 2008 
through 2010.
‘‘(2) 
AVAILABILITY.—Amounts 
appropriated 
under paragraph (1) shall remain available through 
fiscal year 2010. 
‘‘SEC. 2906. DEMONSTRATION PROGRAM TO INTEGRATE IN-
FORMATION TECHNOLOGY INTO CLINICAL 
EDUCATION. 
‘‘(a) IN GENERAL.—The Secretary may award grants 
under this section to carry out demonstration projects to 
develop academic curricula integrating qualified health in-
formation technology systems in the clinical education of 
health professionals. Such awards shall be made on a com-
petitive basis and pursuant to peer review. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
‘‘(1) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require; 
‘‘(2) submit to the Secretary a strategic plan 
for integrating qualified health information tech-
nology in the clinical education of health profes-
sionals and for ensuring the consistent utilization of 
decision support software to reduce medical errors 
and enhance health care quality; 
‘‘(3) be— 
‘‘(A) a health professions school;
‘‘(B) a school of nursing; or 
‘‘(C) an institution with a graduate med-
ical education program; 
‘‘(4) provide for the collection of data regarding 
the effectiveness of the demonstration project to be 
funded under the grant in improving the safety of 
patients, the efficiency of health care delivery, and 
in increasing the likelihood that graduates of the 
grantee will adopt and incorporate health informa-
tion technology, and implement the quality measures 
adopted under section 2907, in the delivery of health 
care services; and 
‘‘(5) provide matching funds in accordance with 
subsection (c). 
‘‘(c) USE OF FUNDS.— 
‘‘(1) IN GENERAL.—With respect to a grant 
under subsection (a), an eligible entity shall— 
‘‘(A) use grant funds in collaboration with 
2 or more disciplines; and 
‘‘(B) use grant funds to integrate qualified 
health information technology into community- 
based clinical education. 
‘‘(2) LIMITATION.—An eligible entity shall not 
use amounts received under a grant under sub-
section (a) to purchase hardware, software, or serv-
ices. 
‘‘(d) MATCHING FUNDS.— 
‘‘(1) IN GENERAL.—The Secretary may award 
a grant to an entity under this section only if the 
entity agrees to make available non-Federal con-
tributions toward the costs of the program to be 
funded under the grant in an amount that is not 
less than $1 for each $2 of Federal funds provided 
under the grant. 
‘‘(2) DETERMINATION
OF
AMOUNT
CONTRIB-
UTED.—Non-Federal contributions under paragraph 
(1) may be in cash or in kind, fairly evaluated, in-
cluding equipment or services. Amounts provided by 
the Federal Government, or services assisted or sub-
sidized to any significant extent by the Federal Gov-
ernment, may not be included in determining the 
amount of such contributions. 
‘‘(e) EVALUATION.—The Secretary shall take such 
action as may be necessary to evaluate the projects funded 
under this section and publish, make available, and dis-
seminate the results of such evaluations on as wide a basis 
as is practicable. 
‘‘(f) REPORTS.—Not later than 1 year after the date 
of enactment of this title, and annually thereafter, the Sec-
retary shall submit to the Committee on Health, Edu-
cation, Labor, and Pensions and the Committee on Fi-
nance of the Senate, and the Committee on Energy and 
Commerce and the Committee on Ways and Means of the 
House of Representatives a report that— 
‘‘(1) describes the specific projects established 
under this section; and 
‘‘(2) contains recommendations for Congress 
based on the evaluation conducted under subsection 
(e). 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
$5,000,000 for fiscal year 2007, and such sums as may 
be necessary for each of fiscal years 2008 through 2010. 
‘‘(h) SUNSET.—This section shall not apply after 
September 30, 2010. 
‘‘SEC. 2907. QUALITY MEASURES. 
‘‘(a) IN GENERAL.—The Secretary shall develop 
quality measures, including measures to assess the effec-
tiveness, timeliness, patient self-management, patient 
centeredness, efficiency, and safety, for the purpose of 
measuring the quality of care patients receive. 
‘‘(b) REQUIREMENTS.—The Secretary shall ensure 
that the quality measures developed under this section 
comply with the following:
‘‘(1) MEASURES.— 
‘‘(A) REQUIREMENTS.—In developing the 
quality measures under this section, the Sec-
retary shall, to the extent feasible, ensure 
that— 
‘‘(i) such measures are evidence 
based, reliable, and valid; 
‘‘(ii) such measures are consistent 
with the purposes described in section 
2902(b); 
‘‘(iii) such measures include measures 
of clinical processes and outcomes, patient 
experience, efficiency, and equity; and 
‘‘(iv) such measures include measures 
of overuse and underuse of health care 
items and services. 
‘‘(2) PRIORITIES.—In developing the quality 
measures under this section, the Secretary shall en-
sure that priority is given to— 
‘‘(A) measures with the greatest potential 
impact for improving the quality and efficiency 
of care provided under this Act; 
‘‘(B) measures that may be rapidly imple-
mented by group health plans, health insurance 
issuers, physicians, hospitals, nursing homes,