IB 
Union Calendar No. 347 
109TH CONGRESS 
2D SESSION 
H. R. 4157 
[Report No. 109–601, Parts I and II] 
To amend the Social Security Act to encourage the dissemination, security, 
confidentiality, and usefulness of health information technology. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 27, 2005 
Mrs. JOHNSON of Connecticut (for herself, Mr. DEAL of Georgia, Mr. BLUNT, 
Mr. CANTOR, Mr. MCCRERY, Mr. SAM JOHNSON of Texas, Mr. CAMP, 
Mr. RAMSTAD, Mr. ENGLISH of Pennsylvania, Mr. HAYWORTH, Mr. 
HULSHOF, Mr. HERGER, Mr. LEWIS of Kentucky, Mr. WELLER, Mr. 
RYAN of Wisconsin, Mr. BEAUPREZ, Mr. UPTON, Mrs. WILSON of New 
Mexico, Mr. BASS, Mr. TERRY, Mr. MURPHY, Mr. BRADLEY of New 
Hampshire, Mr. BOEHLERT, Mr. CASTLE, Mrs. EMERSON, Mr. GER-
LACH, Mr. HOBSON, Mrs. KELLY, Mr. JINDAL, Mr. SCHWARZ of Michi-
gan, Mr. SHAYS, and Mr. SIMMONS) 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 provi-
sions as fall within the jurisdiction of the committee concerned 
JULY 26, 2005 
Additional sponsors: Mr. GILLMOR, Ms. HART, Mr. ROGERS of Michigan, Mr. 
EHLERS, Mrs. DRAKE, Mr. KENNEDY of Minnesota, Mr. MCHUGH, Mr. 
MCCOTTER, Mr. HASTINGS of Washington, Mr. PORTER, Mr. KUHL of 
New York, Mr. LEACH, Miss MCMORRIS, Mr. CAMPBELL of California, 
Mr. LUCAS, Mr. COLE of Oklahoma, Mr. KIRK, Mrs. MILLER of Michi-
gan, Mr. MARCHANT, Mr. FORTUN˜O, Mr. BOUSTANY, Mr. FITZPATRICK 
of Pennsylvania, Mrs. BIGGERT, Mr. NUNES, Mrs. BLACKBURN, Mr. 
HEFLEY, and Ms. GRANGER 
Deleted sponsors: Ms. JACKSON-LEE of Texas (added November 2, 2005; de-
leted June 27, 2006), and Ms. ESHOO (added December 15, 2005; de-
leted June 16, 2006) 
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JUNE 26, 2006 
Reported from the Committee on Energy and Commerce with amendments 
[Strike out all after the enacting clause and insert the part printed in italic] 
JULY 26, 2006 
Reported from the Committee on Ways and Means with an amendment; com-
mitted to the Committee of the Whole House on the State of the Union 
and ordered to be printed 
[Strike out all after the enacting clause and insert the part printed in boldface roman] 
[For text of introduced bill, see copy of bill as introduced on October 27, 2005] 
A BILL 
To amend the Social Security Act to encourage the dissemi-
nation, security, confidentiality, and usefulness of health 
information technology. 
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 ‘‘Bet-
ter Health Information System 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 Technology. 
Sec. 102. Report on the American Health Information Community. 
Sec. 103. Interoperability planning process; Federal information collection activi-
ties. 
Sec. 104. Ensuring health care providers may maintain health information in 
electronic form. 
Sec. 105. Study and report on State, regional, and community health informa-
tion exchanges. 
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Sec. 106. Grants to integrated health systems to promote health information tech-
nologies to improve coordination of care for the uninsured, 
underinsured, and medically underserved. 
Sec. 107. Demonstration program. 
TITLE II—EXPEDITED MODIFICATION PROCEDURES FOR AND 
ADOPTION OF TRANSACTIONAL STANDARDS AND CODES 
Sec. 201. Procedures to ensure timely updating of standards that enable electronic 
exchanges. 
Sec. 202. Upgrading ASC X12 and NCPDP standards. 
Sec. 203. Coding and documentation of non-medical information. 
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 services. 
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. 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 ap-
plicability of section 264(c) of the Health Insurance Port-
ability and Accountability Act of 1996 and any regulation 
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: 
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‘‘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 Coordinator 
shall be appointed by and report directly to the Secretary. 
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 INFRASTRUCTURE.— 
The National Coordinator shall perform the duties under 
subsection (c) in a manner consistent with the development 
of a nationwide interoperable health information technology 
infrastructure that— 
‘‘(1) improves health care quality, promotes data 
accuracy, reduces medical errors, increases the effi-
ciency of care, and advances the delivery of appro-
priate, evidence-based health care services; 
‘‘(2) promotes wellness, disease prevention, and 
management of chronic illnesses by increasing the 
availability and transparency of information related 
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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 effective 
infrastructure for the secure and authorized exchange 
and use of health care information; 
‘‘(8) is consistent with legally applicable require-
ments with respect to securing and protecting the con-
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