‘‘(B) INTERMEDIATE.—In addition to com-
plying with subparagraph (A), the use of three 
or more of the following: 
‘‘(i) An electronic systems to maintain 
patient records (EHRs). 
‘‘(ii) Clinical-decision support tools. 
‘‘(iii) Electronic order for prescrip-
tions and lab tests (e-prescribing). 
‘‘(iv) Patient reminders. 
‘‘(v) E-consults (communication be-
tween patient-physician or other provider) 
when an identifiable medical service is pro-
vided. 
‘‘(vi) Managing patients with multiple 
chronic illnesses. 
‘‘(C) ADVANCED.—In addition to com-
plying with subparagraphs (A) and (B), the use 
by a practice of an electronic system that— 
‘‘(i) is interconnected and is interoper-
able with other electronic systems; 
‘‘(ii) uses nationally accepted medical 
code sets; and 
‘‘(iii) can automatically send, receive, 
and integrate data, such as lab results and 
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medical histories, from other organizations’ 
systems. 
‘‘(4) CERTIFICATION
OF
TECHNOLOGY.—The 
technology used under paragraph (3) must meet 
such guidelines for functionality as may be developed 
by the Secretary. In the case of technology for elec-
tronic health records (EHRs), technology that has 
been certified by the Certification Commission for 
Healthcare Information Technology (CCHIT) shall 
be considered as having met such guidelines. 
‘‘(5) EXEMPTION FROM BUDGET NEUTRALITY 
UNDER THE PHYSICIAN FEE SCHEDULE.—Any in-
creased expenditures pursuant to this section shall 
be treated as additional allowed expenditures for 
purposes of computing any update under section 
1848(d). 
‘‘(d) SMALL
MEDICARE
CARE
PROVIDER
DE-
FINED.—In this part, the term ‘small medical care pro-
vider’ means a medical care provider (as defined in section 
179(e)(2)(B) of the Internal Revenue Code of 1986) that 
has an average of 10 or fewer full-time equivalent employ-
ees during the period involved. 
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‘‘OPTIONAL FINANCIAL INCENTIVES TO SMALL MEDICAL 
CARE PROVIDERS AND ENTITIES TO IMPLEMENT A 
NATIONAL HEALTH INFORMATION INFRASTRUCTURE 
‘‘SEC. 1182. (a) IN GENERAL.—The Secretary may 
utilize any, all, or a combination of financial incentives 
thereof, to assure small medical care providers have the 
capability to move toward a national health care informa-
tion infrastructure by acquiring electronic health record 
systems and other health information technologies that 
meet the standards adopted or modified by the Secretary. 
‘‘(b) CONDITIONS FOR QUALIFICATION.—As a condi-
tion of qualifying for financial incentives described in this 
section, the Secretary shall grant the use of financial in-
centives to assure that such technologies are consistent 
with the goals of creation of a national health information 
infrastructure, such as— 
‘‘(1) voluntary participation in studies or dem-
onstration projects to evaluate the use of such sys-
tems to measure and report quality data based on 
accepted clinical performance measures; 
‘‘(2) voluntary participation in studies to dem-
onstrate the impact of such technologies on improv-
ing patient care, reducing costs and increasing effi-
ciencies; and 
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‘‘(3) voluntary participation in studies and dem-
onstration projects on providing patient-centered 
care coordinated by a patient’s personal physician 
(as defined by the Institute of Medicine), using elec-
tronic systems that enable and facilitate care coordi-
nation and sharing of information among the physi-
cian and other treating health care professionals, 
family caregivers, and the patient. 
‘‘(c) GRANTS TO SMALL MEDICAL CARE PROVIDERS 
AND ENTITIES FOR EXPENDITURES RELATING TO THE 
IMPLEMENTATION OF A NATIONAL HEALTH INFORMA-
TION INFRASTRUCTURE.— 
‘‘(1) IN GENERAL.—The Secretary is authorized 
to make grants to small medical care providers, in-
cluding physicians and others in clinical practice, for 
the purpose of assisting such entities to acquire and 
adopt patient registries, evidence-based clinical deci-
sion support tools at the point of care, electronic 
health records, secure email, and other health infor-
mation technologies defined by the Secretary as a 
key component of a national health care information 
infrastructure. 
‘‘(2) AMOUNT OF GRANT.—The grant amount 
made to small medical care providers and entities to 
implement a national health care information infra-
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