I 
113TH CONGRESS 
1ST SESSION 
H. R. 116 
To encourage the use of medical checklists through research, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 3, 2013 
Mr. HOLT (for himself and Mrs. CAPPS) introduced the following bill; which 
was referred to the Committee on Energy and Commerce 
A BILL 
To encourage the use of medical checklists through research, 
and for other purposes. 
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 ‘‘Medical Checklist Act 
of 2013’’. 
SEC. 2. RESEARCH INTO MEDICAL CHECKLIST DEVELOP-
MENT AND EFFICACY. 
(a) STUDY.—The Director of the Agency for 
Healthcare Research and Quality, acting through the Cen-
ter for Quality Improvement and Patient Safety, shall con-
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duct research and a study, in accordance with the require-
ments of this section, regarding the development and effi-
cacy of medical checklists. 
(b) CONTENTS.—In carrying out subsection (a), the 
Director shall conduct research and a study regarding the 
following: 
(1) Testing of different models of medical 
checklists to measure the effect of checklist format, 
length, and design for different clinical tasks on— 
(A) adoption of checklists by health care 
professionals; 
(B) time spent by health care professionals 
on the clinical task of interest; and 
(C) reliable completion of health care pro-
cedures. 
(2) Examination of checklist development and 
use in other industries, such as commercial aviation 
and nuclear power, and the feasibility of applying 
and adapting methodology developed in those indus-
tries to the health care industry in a way that would 
result in health care quality improvement. 
(3) Identification of organizational characteris-
tics needed to effectively implement the use of med-
ical checklists in health care settings. 
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(4) Measurement of the effects of the use of 
medical checklists on patient safety and health out-
comes. 
(5) Identification of health care procedures for 
which the development and use of medical checklists 
would be beneficial. 
(6) Investigation of the development, implemen-
tation, and use of available medical checklists, in-
cluding checklists for safe surgery and central line 
insertion and maintenance, to inform further med-
ical checklist development. 
(c) SCOPE.—The Director shall ensure that each as-
pect of the research and study conducted under subsection 
(a) is examined across a variety of health care provider 
characteristics, medical procedures, patient populations, 
and other factors that could affect the use of medical 
checklists. 
(d) DISSEMINATION.—The Director shall make avail-
able to the public the results of the study conducted under 
subsection (a) and shall disseminate such results to pa-
tient safety organizations listed pursuant to section 924(d) 
of the Public Health Service Act (42 U.S.C. 299b–24(d)). 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
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such sums as may be necessary for each of fiscal years 
2014 through 2017. 
SEC. 
3. 
COORDINATING 
MEDICAL 
CHECKLISTS 
AND 
HEALTH INFORMATION TECHNOLOGY SYS-
TEMS. 
(a) IN GENERAL.—The HIT Policy Committee in the 
Office of the National Coordinator for Health Information 
Technology (as established in section 3002 of the Public 
Health Service Act (42 U.S.C. 300jj–12)) shall develop 
policy recommendations regarding— 
(1) the extent to which the use of medical 
checklists should be incorporated into health infor-
mation technology systems; and 
(2) measures to determine the effectiveness of 
such use. 
(b) AREAS
OF CONSIDERATION.—In making rec-
ommendations under subsection (a), the HIT Policy Com-
mittee may consider the following areas: 
(1) The ease with which medical checklists in 
electronic formats can be used by health care profes-
sionals. 
(2) The effect of the availability of medical 
checklists in electronic formats on the adoption and 
use of medical checklists by health care profes-
sionals. 
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(3) The effect of the use of medical checklists 
in electronic formats on the time spent by health 
care professionals on medical procedures. 
(4) The ability of the health information tech-
nology system to collect data on patient safety and 
health outcomes that could be analyzed to aid in the 
design and update of medical checklists. 
(5) The ease with which medical checklists in 
electronic formats can be updated on an ongoing 
basis based on evidence from medical research and 
local experience. 
(6) The capability of health information tech-
nology systems to collect data, where applicable, re-
garding the use of medical checklists by health care 
clinicians and providers, and any relation between 
that use and patient safety and health outcomes. 
SEC. 4. INSTITUTE OF MEDICINE STUDY ON FURTHER MED-
ICAL CHECKLIST RESEARCH. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall enter into an agreement with the 
Institute of Medicine and the National Academy of Engi-
neering of the National Academies to conduct a study in 
accordance with this section. 
(b) STUDY.—The Secretary shall ensure that the 
study conducted under this section— 
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(1) reviews available medical checklists and 
similar quality improvement techniques, data on the 
adoption and use of such techniques by health care 
professionals, and evidence of the efficacy of such 
techniques in relation to patient safety and health 
outcomes; 
(2) identifies areas of research needed to im-
prove medical checklists in order to increase the 
adoption and efficacy of medical checklists; 
(3) analyzes organizational impediments to the 
adoption and use of medical checklists; 
(4) reviews the degree to which there is suffi-
cient evidence with which to develop new medical 
checklists and, if such evidence is insufficient, identi-
fies areas requiring further study in order to develop 
such evidence; and 
(5) determines whether the availability of an in-
creased number of medical checklists would improve 
patient safety and health outcomes and, if so, identi-
fies methods for using recent medical research to de-
velop new medical checklists. 
(c) METHODOLOGY OF STUDY.— 
(1) SCOPE.—The Secretary shall ensure that 
the agreement entered into under subsection (a) pro-
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vides that the study conducted under such sub-
section will consider the perspectives of— 
(A) various types of health care profes-
sionals in various types of health care settings; 
(B) individuals conducting academic re-
search in health care quality; and 
(C) patients. 
(2) CONSULTATION WITH RELEVANT ORGANIZA-
TIONS.—The Secretary shall ensure that the agree-
ment entered into under subsection (a) provides that 
relevant agencies and organizations with expertise 
on medical checklists will be consulted during the 
study conducted under such subsection, including 
the following: 
(A) The Agency for Healthcare Research 
and Quality. 
(B) The American Nurses Association. 
(C) The Institute for Healthcare Improve-
ment. 
(D) The American Hospital Association. 
(E) The American Medical Association. 
(F) The World Health Organization. 
(G) The National Committee for Quality 
Assurance. 
(H) The Joint Commission. 
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(I) The American Academy of Physician 
Assistants. 
(d) REPORT.—The Secretary shall ensure that the 
agreement entered into under subsection (a) provides that 
not later than 18 months after the date of the enactment 
of this Act, a report providing the findings and rec-
ommendations made in the study conducted under such 
subsection will be submitted to the Secretary, the Com-
mittee on Energy and Commerce of the House of Rep-
resentatives, and the Committee on Health, Education, 
Labor, and Pensions of the Senate. 
SEC. 5. DEFINITIONS. 
In this Act, the following definitions apply: 
(1) HEALTH CARE PROFESSIONAL.—The term 
‘‘health care professional’’ means an individual who 
provides health care services, including a physician, 
physician assistant, nurse practitioner, clinical nurse 
specialist (as those terms are defined in section 
1861 of the Social Security Act (42 U.S.C. 1395x)), 
and such other individuals as the Secretary of 
Health and Human Services determines appropriate. 
(2) HEALTH CARE SETTING.—The term ‘‘health 
care setting’’ means a facility at which health care 
services are provided, including a hospital providing 
inpatient hospital services (as that term is defined in 
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section 1861 of the Social Security Act (42 U.S.C. 
1395x)), an ambulatory surgical center (meeting the 
standards specified under section 1832(a)(2)(F)(i) 
of the Social Security Act (42 U.S.C. 1395k)), and 
such other settings as the Secretary of Health and 
Human Services determines appropriate. 
(3) HEALTH
CARE
PROVIDER.—The term 
‘‘health care provider’’ means a health care profes-
sional or a health care setting. 
(4) MEDICAL CHECKLIST.—The term ‘‘medical 
checklist’’ means a predetermined, evidence-based, 
well-defined set of steps that should be completed 
during a designated medical clinical encounter or 
medical procedure, as further defined by the Direc-
tor of the Agency for Healthcare Research and 
Quality in consultation with the Institute of Medi-
cine and the National Academy of Engineering of 
the National Academies. 
Æ 
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