I 
109TH CONGRESS 
2D SESSION 
H. R. 5559 
To improve the exchange of health information by encouraging the creation, 
use, and maintenance of lifetime electronic health records in independent 
health record banks, by using such records to build a nationwide health 
information technology infrastructure, and by promoting participation 
in health information exchanges by consumers through tax incentives. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 8, 2006 
Mr. RYAN of Wisconsin (for himself, Mr. SESSIONS, Mr. MOORE of Kansas, 
and Mr. HERGER) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committee 
on Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To improve the exchange of health information by encour-
aging the creation, use, and maintenance of lifetime elec-
tronic health records in independent health record banks, 
by using such records to build a nationwide health infor-
mation technology infrastructure, and by promoting par-
ticipation in health information exchanges by consumers 
through tax incentives. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Independent Health 
Record Bank Act of 2006’’. 
SEC. 2. PURPOSE. 
It is the purpose of this Act to provide for the estab-
lishment of a nationwide health information technology 
network that— 
(1) improves health care quality, reduces med-
ical errors, increases the efficiency of care, and ad-
vances the delivery of appropriate, evidence-based 
health care services; 
(2) promotes wellness, disease prevention, and 
the management of chronic illnesses by increasing 
the availability and transparency of information re-
lated to the health care needs of an individual; 
(3) ensures that appropriate information nec-
essary to make medical decisions is available in a us-
able form at the time and in the location 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 information; 
(5) promotes a more effective marketplace, 
greater competition, greater systems analysis, in-
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creased choice, enhanced quality, and improved out-
comes in health care services; 
(6) 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 information; and 
(7) ensures that the confidentiality of individ-
ually identifiable health information of a patient is 
secure and protected. 
SEC. 3. DEFINITIONS. 
In this Act: 
(1) ACCOUNT.—The term ‘‘account’’ means an 
electronic health record of an individual contained in 
an independent health record bank. 
(2) ELECTRONIC HEALTH RECORD.—The term 
‘‘electronic health record’’ means a longitudinal col-
lection of personal health information concerning a 
single individual, entered or accepted by health care 
providers, and stored electronically. 
(3) HEALTH CARE ENTITY.—The term ‘‘health 
care entity’’ includes health care consumers, health 
care providers, and health care payers, government 
agencies, pharmaceutical companies, laboratories, 
and health care research institutes. 
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(4) HIPAA REGULATIONS.—The term ‘‘HIPAA 
regulations’’ means the regulations promulgated 
under section 264(c) of the Health Insurance Port-
ability and Accountability Act of 1996 (42 U.S.C. 
1320d-2 note). 
(5) INDIVIDUALLY IDENTIFIABLE HEALTH IN-
FORMATION.—The term ‘‘individually identifiable 
health information’’ has the meaning given such 
term in section 1171(6) of the Social Security Act 
(42 U.S.C. 1320d(6)). 
(6) 
NONIDENTIFIABLE
HEALTH
INFORMA-
TION.—The term ‘‘nonidentifiable health informa-
tion’’ means any list, description, or other grouping 
of consumer information (including publicly available 
information pertaining to them) that is derived with-
out using personally identifiable information that is 
not publicly available. 
(7) PARTIALLY IDENTIFIABLE HEALTH INFOR-
MATION.—The term ‘‘partially identifiable health in-
formation’’ means any list, description, or other 
grouping of consumer information (including pub-
licly available information pertaining to them) that 
is derived using any personally identifiable informa-
tion that is not publicly available. 
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(8) PROTECTED HEALTH INFORMATION.—The 
term ‘‘protected health information’’ shall have the 
meaning given such term for purposes of HIPAA 
regulations. 
(9) BOARD OF GOVERNORS.—The term ‘‘Board 
of Governors’’ means the Board of Governors of the 
Federal Reserve System. 
SEC. 4. INDEPENDENT HEALTH RECORD BANKS. 
(a) PURPOSE.—It is the purpose of this section to 
provide for the establishment of independent health record 
banks to achieve financial savings in the health care sys-
tem and improvements in the provision of health care 
through— 
(1) the creation and storage of lifetime indi-
vidual electronic health records for individuals that 
may contain health plan and debit card functionality 
and that serves the interests of all health care enti-
ties; 
(2) the utilization of a technological infrastruc-
ture with the goal of connecting health records to 
build a national health information network; 
(3) the provision of health information data 
sets, within distinct authorization boundaries, based 
on usage needs, including— 
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(A) the sale of approved data for research 
and other consumer purposes as provided for 
under section 6(b); 
(B) the provision of data for emergency 
health care as provided for under section 6(c); 
and 
(C) the provision of data for all other 
health care needs determined appropriate by 
the Board of Governors (in accordance with the 
protections provided for under section 6); 
(4) the offering of incentives to employers that 
face rising employee health costs, to encourage em-
ployee participation in independent health record 
banks; and 
(5) the creation of a source of tax-free income 
to support the operations of the independent health 
record banks, and, through revenue sharing, to pro-
vide incentives to independent health record bank ac-
count holders, health care providers, and fee payers 
to contribute health information. 
(b) ESTABLISHMENT.— 
(1) IN
GENERAL.—Not later than one year 
after the date of the enactment of this Act, the 
Board of Governors shall prescribe standards for the 
establishment and certification of independent health 
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record banks to carry out the purpose described in 
subsection (a). 
(2) REQUIREMENT OF NON-PROFIT ENTITY.— 
Under the standards under paragraph (1), a non- 
profit entity may establish an independent health 
record bank as a cooperative entity that operates for 
the benefit and in the interests of the membership 
of the bank as a whole. Such bank shall be owned 
and controlled by its members. 
(3) FOR-PROFIT ENTITIES.—Under the stand-
ards under paragraph (1), a for-profit entity may 
not participate in the establishment and operation of 
an independent health record bank, except to the ex-
tent that such entity is by contract employed to as-
sist in carrying out the operations of the bank. 
(4) TREATMENT AS COVERED ENTITY FOR PUR-
POSES OF HIPAA REGULATIONS.—To the extent that 
an independent health record bank (or associated 
vendor) is engaged in receiving or transmitting pro-
tected health information, the bank shall be consid-
ered to be a HIPAA covered entity for purposes of 
HIPAA regulations with respect to such informa-
tion. 
(c) MEMBERSHIP.— 
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(1) IN GENERAL.—To be eligible to be a mem-
ber of an independent health record bank, an indi-
vidual shall obtain or have obtained a product or 
service from a covered entity that is to be used pri-
marily for personal, family, or household purposes, 
or that individual’s legal representative. 
(2) NO LIMITATION ON MEMBERSHIP.—Nothing 
in this subsection shall be construed to permit an 
independent health record bank to restrict member-
ship. 
(d) RIGHTS RELATING
TO INFORMATION
IN
THE 
BANK.— 
(1) INDIVIDUAL CONSUMERS.— 
(A) GENERAL RIGHT.—An individual who 
has a health record contained in an independent 
health record bank shall maintain ownership 
over the entire health record and shall have the 
right to review the contents of the entire record 
at any time during the normal business oper-
ating hours of the bank. 
(B) ADDITIONAL INFORMATION AND LIMI-
TATION.—An individual described in subpara-
graph (A) may add personal health information 
to the health record of that individual, except 
that such individual shall not falsify informa-
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tion and shall not alter information that is en-
tered into the health record by a health care en-
tity. Such an individual shall have the right to 
propose an amendment to information that is 
entered by a health care entity pursuant to 
standards prescribed by the Board of Governors 
for purposes of correcting such information. 
(2) OTHER HEALTH CARE ENTITIES.—A health 
care entity (other than the individual who maintains 
ownership over the health record involved) shall 
serve as the custodian of only information that has 
been added by such entity to the health record. Such 
entity may be permitted to have access to other 
specified information contained in such health record 
(including the entire record if appropriate) if such 
access is granted by the independent health record 
bank and the individual involved (pursuant to stand-
ards prescribed by the Secretary relating to access 
to information). 
(e) FINANCING OF ACTIVITIES.— 
(1) IN
GENERAL.—An independent health 
record bank may generate revenue to pay for the op-
erations of the bank through— 
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(A) charging health care entities, including 
individual account holders, account fees for use 
of the bank; 
(B) the sale of nonidentifiable and par-
tially identifiable health information contained 
in the bank for research purposes (as provided 
for in section 6(b)); and 
(C) the conduct of any other activities de-
termined appropriate by the Board of Gov-
ernors. 
(2) SHARING OF REVENUE.—Revenue derived 
under paragraph (1)(B) shall be shared with inde-
pendent health record bank account holders, and 
may be shared with health care providers and pay-
ers, in accordance with this Act. 
(3) TREATMENT OF INCOME.—For purposes of 
the Internal Revenue Code of 1986, any revenue de-
scribed in this subsection shall not be included in 
gross income of any independent health record bank, 
independent health record bank account holder, 
health care provider, or payer described in this sub-
section. 
SEC. 5. HEALTH CARE CLEARINGHOUSE ACTIVITIES. 
(a) APPLICATION OF SECTION.—This section shall 
apply to an independent health record bank (and associ-
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ated vendors) with respect to activities undertaken by such 
bank in operating as a health care clearinghouse (as such 
term is defined in section 1171(2) of the Social Security 
Act (42 U.S.C. 1329d(2)). 
(b) ACCREDITATION.— 
(1) IN GENERAL.—To be eligible to carry out 
clearinghouse activities under this section, an inde-
pendent health record bank (and associated vendors 
performing clearinghouse functions) shall be accred-
ited by a national standards development organiza-
tion, utilizing the criteria described in paragraph 
(2), that is properly authenticated and registered 
with the Attorney General and the Federal Trade 
Commission pursuant to the provisions of the Na-
tional Cooperation Research and Production Act of 
1993 (15 U.S.C. 4301 et seq.). 
(2) CRITERIA.—The criteria to be used by a na-
tional standards development organization in the ac-
creditation of an independent health record bank 
under this section shall be designed to measure the 
competency, assets, practices, and procedures of the 
bank for purposes of conducting clearinghouse ac-
tivities. Such criteria shall include— 
(A) the technical capacity and electronic 
facilities of the bank for the receipt, trans-
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