SEC. 2. PERSONAL HEALTH RECORD (PHR) INCENTIVE 
DEMONSTRATION PROGRAM. 
(a) ESTABLISHMENT.—Not later than one year after 
the date of the enactment of this Act, the Secretary of 
Health and Human Services (in this section referred to 
as the ‘‘Secretary’’) shall establish a demonstration pro-
gram (in this section referred to as the ‘‘demonstration 
program’’) in not more than 5 States to provide financial 
incentives during a 5-year period for the use of qualifying 
personal health records by qualifying patients and quali-
fying providers to— 
(1) provide patients (or their authorized rep-
resentatives) access to and control over their per-
sonal health data so as to become healthier and 
more informed and engaged health care consumers; 
(2) make available to such qualifying providers 
an accurate minimum data set of patient informa-
tion (as described in subsection (e)(1)(B)) at all 
points of care; 
(3) protect patient security and privacy, with 
respect to their health care information; 
(4) improve patients’ adherence to evidence- 
based health care guidelines, medication guidelines, 
preventive care, and screening protocols, thereby im-
proving health outcomes and lowering health care 
costs; 
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
(5) provide patients with more accurate, timely, 
and appropriate information related to their health 
care benefits and related administrative information; 
(6) improve the quality and efficiency of com-
munication between health care providers and pa-
tients; 
(7) create a direct communications channel to 
patients in the event of emergencies; 
(8) provide access with appropriate privacy 
safeguards to de-identified health care information 
to evaluate and advance public health and health re-
search goals; and 
(9) incentivize health information exchange net-
works to plan for and implement methods to provide 
patient access to clinical data through use of per-
sonal health records. 
(b) INCENTIVE PAYMENTS.— 
(1) IN
GENERAL.—Under the demonstration 
program, subject to paragraph (2), each qualifying 
provider (as defined in subsection (c)) that furnishes 
services to a qualifying patient (as defined in sub-
section (d)) and each health information exchange 
network (as defined in subsection (g)) shall receive 
an incentive payment, in accordance with this sub-
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
section, from the PHR Incentive Fund established 
under subsection (i). 
(2) ONE PAYMENT FOR PROVIDERS IN SAME 
GROUP PRACTICE.—In the case of a qualifying pa-
tient who receives services during a fiscal year from 
more than one qualified provider in the same group 
practice, as defined by the Secretary, only one incen-
tive payment under paragraph (1) for such fiscal 
year shall be made to such providers with respect to 
such patient. 
(3) AMOUNT OF INCENTIVE PAYMENT.— 
(A) IN
GENERAL.—Except as otherwise 
provided, the amount of the incentive payment 
under the demonstration program for a fiscal 
year— 
(i) paid to a qualifying provider shall 
be— 
(I) at least $3 for each qualifying 
patient not described in subclause 
(II); and 
(II) at least $5 for each quali-
fying patient with a covered chronic 
health condition described in subpara-
graph (C); and 
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
(ii) paid to the health information ex-
change network shall be at least $3 for 
each qualifying patient for whom such net-
work facilitates under subsection (g)(2) ac-
cess to and retrieval of clinical data into a 
qualifying personal health record. 
(B) AUTHORITY TO INCREASE AMOUNT OF 
INCENTIVE PAYMENTS.—The Secretary may in-
crease the amount of incentive payments de-
scribed in clause (i)(I), (i)(II) (including for the 
case of qualifying patients with more than one 
covered chronic health conditions described in 
subparagraph (C)), or (ii) of subparagraph (A) 
under the demonstration program for a fiscal 
year so long as such increase will not result 
in— 
(i) the total amount of such incentive 
payments under this paragraph (and the 
costs of other permissible uses described in 
subsection (i)(1) of funds in the PHR In-
centive Fund under subsection (i)) for such 
fiscal year, exceeding 
(ii) the total amount of funds in such 
PHR Incentive Fund for such fiscal year. 
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
(C) COVERED
CHRONIC
HEALTH
CONDI-
TION
DESCRIBED.—For purposes of subpara-
graph (A), a covered chronic health condition is 
any of the following: 
(i) Major mental disorder. 
(ii) Diabetes. 
(iii) Heart disease. 
(iv) Asthma. 
(v) Hypertension. 
(vi) Cancer. 
The Secretary, in consultation with the United 
States Preventive Services Task Force convened 
by the Public Health Service, may add to or 
otherwise modify the list of covered chronic 
health conditions specified under this subpara-
graph. 
(D) AUTHORITY TO INCREASE AMOUNT OF 
INCENTIVE
PAYMENTS
OR
VARY
INCENTIVES 
ACCORDING
TO
PRACTICE
SIZE
AND
GEO-
GRAPHIC LOCATION.—Subject to subparagraph 
(B), the Secretary may increase the amount of 
incentive payments described in clause (i)(I) or 
(i)(II) of subparagraph (A) under the dem-
onstration program (or provide additional or 
different incentives) for a fiscal year for quali-
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
fying providers specified by the Secretary as 
providers with small practices and qualifying 
providers located in rural areas. 
(4) PUBLICATION OF NAMES OF QUALIFYING 
PROVIDERS
AND
PATIENT
AND
PROVIDER
EDU-
CATION
ABOUT
HEALTH
INFORMATION
EX-
CHANGE.—In order to assist patients in identifying 
health care providers that use qualifying personal 
health records, and to assist patients and health 
care providers in understanding personal health 
records and health information exchange networks, 
under the demonstration program the Secretary 
shall— 
(A) provide for outreach activities, through 
the use of local methods and Internet websites 
of the Secretary’s choosing, to provide patients 
residing in a State participating in the dem-
onstration program with a list of qualifying pro-
viders who participate in the program; 
(B) in consultation with appropriate orga-
nizations that represent health care consumers, 
as well as organizations that represent health 
information exchange organizations, provide for 
activities to educate patients residing in a State 
participating in the demonstration program 
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
patients could use such technology and ex-
changes to participate more completely in their 
health care. 
(c) QUALIFYING PROVIDER DEFINED.—For purposes 
of this section, the term ‘‘qualifying provider’’ means a 
licensed physician (or other licensed health care provider 
designated by the Secretary) that meets the following re-
quirements, with respect to a qualifying patient of that 
provider and the qualifying personal health record of that 
patient: 
(1) The physician (or provider), or authorized 
representative, updates the diagnosis and medication 
list (including all current medications and new medi-
cations prescribed) in the QPHR after each patient 
encounter, if appropriate and as authorized by the 
patient, either by direct entry or through a data 
sharing arrangement using an appropriate electronic 
means, such as an electronic medical record, e-pre-
scribing, or health information exchange network. 
(2) To the extent authorized by the patient, the 
physician (or provider), or authorized representative 
ensures that the name of the physician (or provider) 
is included in the QPHR of the patient on a list of 
health care providers who furnish services to the pa-
tient. 
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
(3) The physician (or provider), or authorized 
representative complies with any security and pri-
vacy standards, policies, and practices described 
under paragraphs (1), (2), and (3) of subsection (h). 
(4) The physician (or provider), or authorized 
representative meets other requirements as the Sec-
retary may establish. 
(d) QUALIFYING PATIENT DEFINED.—For purposes 
of this section, the term ‘‘qualifying patient’’ means an 
individual— 
(1) for whom a qualifying personal health 
record has been established and is in operation 
under the demonstration program; and 
(2) who is a Medicare beneficiary or is covered 
under a health benefits or other plan the sponsor of 
which is participating as a Fund partner under sub-
section (i). 
(e) QUALIFYING PERSONAL HEALTH RECORD DE-
FINED.—For purposes of this section, the terms ‘‘quali-
fying personal health record’’ and ‘‘QPHR’’ mean a record 
of health care information, with respect to a patient, that 
meets the following requirements: 
(1) CONTENT.— 
(A) IN GENERAL.—The record— 
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
(i) shall contain at least the minimum 
data set of patient information described in 
subparagraph (B)(i); and 
(ii) may consist of such additional 
personal health information, such as family 
health history, symptoms, use of over-the- 
counter medication, diet, exercise, and 
other relevant health information and ac-
tivities, as the patient may provide in ac-
cordance with paragraph (2)(A)(ii). 
(B) MINIMUM DATA SET OF PATIENT IN-
FORMATION.—A minimum data set of patient 
information described in this paragraph, with 
respect to a qualifying patient and a qualifying 
provider authorized by the patient to access the 
QPHR of the patient, is a data set that is con-
sistent with the following: 
(i) The data set includes— 
(I) laboratory results in such a 
format as to enable the patient and 
qualifying provider to retrieve, store, 
graph, and share the results as au-
thorized by the patient; 
(II) a list of health conditions 
and allergies as contained in records 
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
of health providers involved in the 
care of the patient (in such a format 
as to enable the patient and qualifying 
provider to retrieve and store lists of 
current and previous health conditions 
and allergies of the patient); 
(III) diagnosis codes, with re-
spect to treatment for such a condi-
tion or allergy, in such a format as to 
enable the patient and qualifying pro-
vider to retrieve and store a list of 
such codes; and 
(IV) an updated list of health 
providers involved in the care of the 
patient to enable the patient and 
qualifying provider to communicate 
information about the patient to any 
provider on the list, as authorized by 
the patient, for care coordination. 
(ii) The data set provides for the abil-
ity to access the results, conditions, aller-
gies, diagnosis codes, and list described in 
clause (i) in layperson terms. 
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
(iii) The data set is portable and en-
ables the patient to move the data between 
personal health records of the patient. 
(2) ACCESS TO THE RECORD.— 
(A) ACCESS RIGHTS OF PATIENT.— 
(i) IN
GENERAL.—Access to the 
record (and each portion of the record) 
shall be controlled solely by the patient (or 
the patient’s authorized representative), 
with the patient (or the patient’s author-
ized representative) able to access the 
record through the Internet, print the 
record, copy the record to electronic media, 
and provide online access to authorized 
third parties, including health care pro-
viders, to all individually identifiable health 
information held in the record at any time, 
in accordance with this paragraph. 
(ii) ADDITION OF PERSONAL INFOR-
MATION.—The patient may add personal 
health information to the record, except 
that such patient shall not alter informa-
tion that is entered into the record by any 
qualifying provider. Such patient shall have 
the right to propose an amendment to in-
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
formation that is entered by a qualifying 
provider pursuant to standards prescribed 
by the Secretary for purposes of amending 
such information. 
(iii) IDENTIFICATION
OF
INFORMA-
TION ENTERED BY PARTICIPANT.—Any ad-
ditions or amendments made by the pa-
tient to the record shall be identified and 
disclosed within such record as being made 
by such patient. 
(B) ACCESS BY AUTHORIZED INDIVIDUALS 
OTHER THAN PATIENT.— 
(i) AUTHORIZED ACCESS ONLY.—Ex-
cept as provided under subparagraphs (C) 
and (D), access to the record (or any por-
tion of the record) by an individual other 
than the patient (or the patient’s author-
ized representative)— 
(I) may be made only if the indi-
vidual is a health care provider who is 
authorized by the patient to access 
the record; 
(II) may be made only to the 
minimum data set of the patient (as 
described in paragraph (1)(B)) and to 
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
portion is not representative of the com-
plete record relating to medications taken 
by the patient. 
(C) DEEMED AUTHORIZATION FOR ACCESS 
FOR EMERGENCY HEALTH CARE.—With respect 
to the record of the patient, the patient shall be 
deemed as providing authorization (in the form 
of affirmative consent) for health care providers 
to access, in connection with providing emer-
gency care services to the patient, a limited, au-
thenticated information set concerning the pa-
tient for emergency response purposes, unless 
the patient specifies that such information set 
(or any portion of such information set) may 
not be so accessed. Such limited information set 
shall include the minimum data set of patient 
information described in paragraph (1)(B) for 
the patient and any other information specified 
by the patient for such purposes. 
(D) PUBLIC HEALTH ANALYSIS AND RE-
SEARCH.— 
(i) IN
GENERAL.—A QPHR service 
provider operating or administering a 
QPHR may provide data included in the 
QPHR that has been de-identified con-
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
sistent with the applicable requirements of 
section 164.514 of title 45, Code of Fed-
eral Regulations, for public health analysis, 
post-market safety surveillance of prescrip-
tion drugs, and for research purposes. 
(ii) REQUIRED CONSULTATION TO OP-
TIMIZE PUBLIC HEALTH CAPABILITIES.— 
The Secretary shall consult with the Com-
missioner of the Food and Drug Adminis-
tration, the Director of the National Insti-
tutes of Health, the Director of the Cen-
ters for Disease Control and Prevention, 
and the Administrator of the Agency for 
Healthcare Research and Quality to opti-
mize the public health and post-market 
surveillance capabilities of QPHRs. 
(E) TERMINATION RIGHTS.— 
(i) IN
GENERAL.—The record shall 
allow the patient (or the patient’s author-
ized representative) to terminate at any 
time during or after the period of the dem-
onstration program— 
(I) the further use of the QPHR 
service provider operating or admin-
istering the record, including elimi-
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
nation of the patient’s personal health 
information in the control of the 
QPHR service provider and including 
in the case of a QPHR service pro-
vider that terminates its participation 
in the demonstration program or 
ceases to be a QPHR service provider; 
(II) the further access to the 
record by a qualifying provider; or 
(III) the further use of a health 
information exchange network. 
(ii) CLARIFICATION.—Nothing in this 
subparagraph shall require a health care 
provider to eliminate a patient’s personal 
health information included in the QPHR 
that is in a medical record maintained by 
the provider. 
(F) TRANSPORTABILITY.—The patient’s 
rights to control access to the record under this 
paragraph shall not be affected by changes in 
relationships with particular providers or health 
plans. 
(3) SECURITY.—The record shall at least meet 
minimum security standards, including the regula-
tions promulgated under section 264(c) of the 
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
Health Insurance Portability and Accountability Act 
of 1996 (HIPAA) (42 U.S.C. 1320d–2 note) and 
other such minimum standards as identified by the 
Secretary under subsection (h). 
(4) WEB-BASED.—The record shall be web- 
based. 
(5) AUTHENTICATION.—The record shall in-
clude functionality to authenticate the patient’s iden-
tity prior to the record’s use to receive electronic 
data of personal health information (other than ac-
tual authentication information) from third party 
sources, such as health information exchange net-
works, pharmacies, pharmacy benefit managers, lab-
oratories, and health plans, including the Medicare 
program. 
(f) QPHR SERVICE PROVIDER.— 
(1) DEFINITION.—For purposes of this section, 
the term ‘‘QPHR service provider’’ means an entity 
that— 
(A) operates or administers a QPHR or 
part of a QPHR; 
(B) has access to patients’ individually 
identifiable health information contained in the 
QPHR; 
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
(C) complies with any security and privacy 
standards, policies, and practices adopted under 
subsection (h); 
(D) not later than the date that is one 
year after the date of the enactment of this Act, 
is able to exchange standards-based clinical and 
patient data with other sources and users of 
health data, including other QPHRs and health 
information exchange organizations; 
(E) is capable of exchanging information 
with a health information exchange network 
and is capable of sharing such information be-
tween the patient involved and the health care 
providers of such patient and enabling patient- 
provider communication; and 
(F) meets the messaging requirements de-
scribed in paragraph (2) and disclosure require-
ment described in paragraph (3). 
(2) MESSAGING REQUIREMENTS.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the messaging requirements de-
scribed in this paragraph, with respect to a 
QPHR service provider that operates or admin-
isters a QPHR, are the following: 
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS
(i) EDUCATION REMINDERS.—Subject 
to clause (v), the QPHR service provider 
shall have the capability of sending pa-
tient-specific patient education messages, 
reminders, and clinical messages to quali-
fying patients based upon data in the 
QPHR. 
(ii) FEDERAL
REMINDERS.—Subject 
to clause (v), the QPHR service provider 
shall provide for the sending on behalf of 
Federal agencies of objective, accurate, pa-
tient-specific messages to qualifying pa-
tients concerning their health care or bene-
fits. 
(iii) FUND
PARTNER
MESSAGES.— 
Subject to clause (v), the QPHR service 
provider shall provide for the sending, on 
behalf of Fund partners who contribute to 
the Fund, appropriate patient-specific mes-
sages to qualifying patients (with whom 
such partners have pre-existing relation-
ships) concerning the patients’ health care, 
medications, treatments, medical devices or 
benefits. The QPHR service provider shall 
not allow a Fund partner to send a mes-
VerDate Aug 31 2005 
21:03 Jun 25, 2008
Jkt 069200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H6345.IH
H6345
wwoods2 on PRODPC68 with BILLS