National Health Information Technology Adoption Act

        [Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2710 Introduced in Senate (IS)]

108th CONGRESS
2d Session
S. 2710

To amend the Public Health Service Act to improve the quality and
efficiency of health care delivery through improvements in health care
information technology, and for other purposes.

_______________________________________________________________________

IN THE SENATE OF THE UNITED STATES

July 21, 2004

Mr. Gregg (for himself, Mr. Sessions, and Mr. Frist) introduced the
following bill; which was read twice and referred to the Committee on
Health, Education, Labor, and Pensions

_______________________________________________________________________

A BILL

To amend the Public Health Service Act to improve the quality and
efficiency of health care delivery through improvements in health care
information technology, and for other purposes.

Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``National Health Information
Technology Adoption Act''.

SEC. 2. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by
adding at the end thereof the following:

``TITLE XXIX--HEALTH CARE INFORMATION TECHNOLOGY

``SEC. 2901. DEFINITIONS.

``In this title:
``(1) Coverage area.--The term `coverage area' means the
boundaries of a local health information infrastructure.
``(2) Demographic data.--The term `demographic data' means
data that includes race, ethnicity, socio-economic status, and
primary language.
``(3) Director.--The term `Director' means the Director of
the Office of Health Information Technology.
``(4) Health care provider.--The term `health care
provider' means a hospital, skilled nursing facility, home
health entity, health care clinic, community health center,
group practice (as defined in section 1877(h)(4) of the Social
Security Act, including practices with only 1 physician), and
any other facility or clinician determined appropriate by the
Director.
``(5) Local health information infrastructures.--The term
`local health information infrastructure' means an independent
organization of health care entities established for the
purpose of linking health information systems to electronically
share information. A local health information infrastructure
may not be a single business entity.
``(6) Office.--The term `Office' means the Office of Health
Information Technology established under section 2902.

``SEC. 2902. OFFICE OF HEALTH INFORMATION TECHNOLOGY.

``(a) Establishment.--There is established within the Office of the
Secretary an Office of Health Information Technology. The Office shall
be headed by a Director to be appointed by the Secretary after
consultation with the President. The Director shall report directly to
the Secretary.
``(b) Purpose.--It shall be the purpose of the Office to--
``(1) improve the quality and increase the efficiency of
health care delivery through the use of health information
technology;
``(2) provide national leadership relating to, and
encourage the adoption of, health information technology;
``(3) direct all health information technology activities
within the Department of Health and Human Services;
``(4) act as the lead entity responsible for coordinating
the health information technology efforts of the Federal
Government; and
``(5) facilitate the interaction between the Federal
Government and the private sector relating to health
information technology development and use.
``(c) Duties and Responsibilities.--The Office shall be responsible
for the following:
``(1) Federal leadership.--The Office shall--
``(A) serve as the principle advisor to the
Secretary concerning health information technology;
``(B) direct all health information technology
activity within the Department of Health and Human
Services;
``(C) work with public and private health
information technology stakeholders to implement a
strategic plan for the establishment of a National
Health Information Infrastructure; and
``(D) ensure that health information technology is
utilized as fully as practicable in carrying out health
surveillance efforts.
``(2) Coordination.--The Office shall--
``(A) encourage the development and adoption of
clinical, messaging, and decision support health
information data standards, pursuant to the
requirements of section 2903;
``(B) ensure the maintenance and implementation of
the data standards described in subparagraph (A);
``(C) oversee and coordinate the health information
technology efforts of the Federal Government;
``(D) ensure the compliance of the Department of
Health and Human Services with Federally adopted health
information technology data standards;
``(E) serve as the representative of the Department
of Health and Human Services with respect to the
Consolidated Health Informatics Initiative;
``(F) ensure that the Federal Government consults
and collaborates on decision making with respect to
health information technology with the private sector
and other interested parties; and
``(G) in consultation with private sector, adopt
certification and testing criteria to determine if
electronic health information systems interoperate.
``(3) Communication.--The Office shall--
``(A) act as the point of contact for the private
sector with respect to the use of health information
technology; and
``(B) work with the private sector to collect and
disseminate best health information technology
practices.
``(4) Evaluation and dissemination.--The Office shall
coordinate with the Agency for Health Research and Quality and
other Federal agencies to--
``(A) evaluate and disseminate information relating
to evidence of the costs and benefits of health
information technology and to whom those costs and
benefits accrue;
``(B) evaluate and disseminate information on the
impact of health information technology on the quality
and efficiency of patient care; and
``(C) review Federal payment structures and
differentials for health care providers that utilize
health information technology systems.
``(5) Technical assistance.--The Office shall utilize
existing private sector quality improvement organizations to--
``(A) promote the adoption of health information
technology among healthcare providers; and
``(B) provide technical assistance concerning the
implementation of health information technology to
healthcare providers.
``(d) Resources.--The Secretary shall make available to the Office,
the resources, both financial and otherwise, necessary to enable the
Director to carry out the purposes of, and perform the duties and
responsibilities of the Office under, this section.
``(e) Detail of Federal Employees.--Upon the request of the
Director, the head of any Federal agency is authorized to detail,
without reimbursement from the Office, any of the personnel of such
agency to the Office to assist it in carrying out its duties under this
section. Any such detail shall not interrupt or otherwise affect the
civil service status or privileges of the Federal employee.

``SEC. 2903. PROMOTING THE INTEROPERABILITY OF HEALTH CARE INFORMATION
TECHNOLOGY SYSTEMS.

``(a) Development, and Federal Government Adoption, of Standards.--
``(1) Adoption.--
``(A) In general.--Not later than 2 years after the
date of the enactment of this title, the Director shall
provide for the adoption by the Federal Government of
national data and communication health information
technology standards that promote the efficient
exchange of data between varieties of provider health
information technology systems. In carrying out the
preceding sentence, the Director may adopt existing
standards. Standards adopted under this section shall
be voluntary for private sector entities.
``(B) Grants or contracts.--The Director may
utilize grants or contracts to provide for the private
sector development of standards for adoption by the
Federal Government under subparagraph (A).
``(2) Requirements.--The standards developed and adopted
under paragraph (1) shall be designed to--
``(A) enable health information technology to be
used for the collection and use of clinically specific
data;
``(B) promote the interoperability of health care
information across health care settings; and
``(C) facilitate clinical decision support through
the use of health information technology.
``(3) Public private partnership.--Consistent with
activities being carried out on the date of enactment of this
title, including the Consolidated Health Informatics
initiative, health information technology standards shall be
adopted by the Director under paragraph (1) at the conclusion
of a collaborative process that includes consultation between
the Federal Government and private sector health care and
information technology stakeholders.
``(4) Privacy and security.--The regulations promulgated by
the Secretary under part C of title XI of the Social Security
Act (42 U.S.C. 1320d et seq.) and sections 261, 262, 263, and
264 of the Health Insurance Portability and Accountability Act
of 1996 (42 U.S.C. 1320d-2 note) with respect to the privacy,
confidentiality, and security of health information shall apply
to the implementation of programs and activities under this
title.
``(5) Pilot tests.--To the maximum extent practical, the
Director shall pilot test the health information technology
data standards developed under paragraph (1) prior to their
implementation under this section.
``(6) Dissemination.--
``(A) In general.--The Director shall ensure that
the standards adopted under paragraph (1) are widely
disseminated to interested stakeholders.
``(B) Licensing.--To facilitate the dissemination
and implementation of the standards developed and
adopted under paragraph (1), the Director may license
such standards, or utilize other means, to ensure the
widespread use of such standards.
``(b) Implementation of Standards.--
``(1) Purchase of systems by the secretary.--Effective
beginning on the date that is 5 years after the date of
enactment of this title, the Secretary shall not purchase any
health care information technology system unless such system is
in compliance with the standards adopted under subsection (a).
``(2) Recipients of federal funds.--Effective on the date
described in paragraph (1), the Secretary shall require that
funds not appropriated under this title that are designated for
Federal health information technology purposes shall be used to
purchase health care information technology systems that are in
compliance with the standards adopted under subsection (a).
``(c) Modification of Standards.--The Director shall provide for
ongoing oversight of the health information technology standards
developed under subsection (a) to--
``(1) identify gaps or other shortcomings in such
standards; and
``(2) modify such standards when determined appropriate or
develop additional standards, in collaboration with standard
setting organizations.

``SEC. 2904. LOAN GUARANTEES FOR THE ADOPTION OF HEALTH INFORMATION
TECHNOLOGY.

``(a) In General.--The Director shall guarantee payment of the
principal of and the interest on loans made to eligible entities to
enable such entities--
``(1) to implement local health information infrastructures
to facilitate the development of interoperability across health
care settings to improve quality and efficiency; or
``(2) to facilitate the purchase and adoption of health
information technology to improve quality and efficiency.
``(b) Eligibility.--To be eligible to receive a loan guarantee
under subsection (a) an entity shall--
``(1) with respect to an entity desiring a loan guarantee--
``(A) under subsection (a)(1), be a coalition of
entities that represent an independent consortium of
health care stakeholders within a community that--
``(i) includes--
``(I) physicians (as defined in
section 1881(r)(1) of the Social
Security Act), including physicians
that provide services to low income and
underserved populations;
``(II) hospitals (including
hospitals that provide services to low
income and underserved populations);
and
``(III) group health plans or other
health insurance issuers (as such terms
are defined in section 2791); and
``(ii) may include any other health care
providers; or
``(B) under subsection (a)(2) be a health care
provider that provides health care services to low-
income and underserved populations;
``(2) to the extent practicable, adopt the national health
information technology standards adopted under section 2903;
and
``(3) prepare and submit to the Director an application at
such time, in such manner, and containing such information as
the Director may require.
``(c) Use of Funds.--Amounts received under a loan guarantee under
subsection (a) shall be used--
``(1) with respect to a loan guarantee described in
subsection (a)(1)--
``(A) to develop a plan for the implementation of a
local health information infrastructure under this
section;
``(B) to establish systems for the sharing of data
in accordance with the national health information
technology standards developed under section 2903;
``(C) to purchase directly related integrated
hardware and software to establish an interoperable
health information technology system that is capable of
linking to a local health care information
infrastructure; and
``(D) to train staff, maintain health information
technology systems, and maintain adequate security and
privacy protocols;
``(2) with respect to a loan or loan guarantee described in
subsection (a)(2)--
``(A) to develop a plan for the purchase and
installation of health information technology;
``(B) to purchase directly related integrated
hardware and software to establish an interoperable
health information technology system that is capable of
linking to a local health care information
infrastructure; and
``(C) to train staff, maintain health information
technology systems, and maintain adequate security and
privacy protocols; and
``(3) to carry out any other activities determined
appropriate by the Director.
``(d) Special Considerations.--In awarding loan guarantees under
this section to local health information infrastructures, the Director
shall give special consideration to eligible entities that--
``(1) include at least 50 percent of the patients living in
the designated coverage area;
``(2) incorporate public health surveillance and reporting
into the overall architecture of the proposed infrastructure;
and
``(3) link local health information infrastructures.
``(e) Areas of Specific Interest.--In awarding loan guarantees
under this section, the Director shall include--
``(1) entities with a coverage area that includes an entire
State; and
``(2) entities with a multi-state coverage area.
``(f) Administrative Provisions.--
``(1) Aggregate amount.--
``(A) In general.--Except as provided in
subparagraph (B), the aggregate amount of principal of
loans guaranteed under subsection (a) with respect to
an eligible entity may not exceed $5,000,000. In any
12-month period the amount disbursed to an eligible
entity under this section (by a lender under a
guaranteed loan) may not exceed $5,000,000.
``(B) Exception.--The cumulative total of the
principal of the loans outstanding at any time to which
guarantees have been issued under subsection (a) may
not exceed such limitations as may be specified in
appropriation Acts.
``(2) Protection of federal government.--
``(A) In general.--The Director may not approve an
application for a loan guarantee under this section
unless the Director determines that--
``(i) the terms, conditions, security (if
any), and schedule and amount of repayments
with respect to the loan are sufficient to
protect the financial interests of the United
States and are otherwise reasonable, including
a determination that the rate of interest does
not exceed such percent per annum on the
principal obligation outstanding as the
Director determines to be reasonable, taking
into account the range of interest rates
prevailing in the private market for loans with
similar maturities, terms, conditions, and
security and the risks assumed by the United
States; and
``(ii) the loan would not be available on
reasonable terms and conditions without the
enactment of this section.
``(B) Recovery.--
``(i) In general.--The United States shall
be entitled to recover from the applicant for a
loan guarantee under this section the amount of
any payment made pursuant to such loan
guarantee, unless the Director for good cause
waives such right of recovery, and, upon making
any such payment, the United States shall be
subrogated to all of the rights of the
recipient of the payments with respect to which
the loan was made.
``(ii) Modification of terms.--Any terms
and conditions applicable to a loan guarantee
under this section may be modified by the
Director to the extent he determines it to be
consistent with the financial interest of the
United States.
``(3) Defaults.--The Director may take such action as the
Director deems appropriate to protect the interest of the
United States in the event of a default on a loan guaranteed
under this section, including taking possession of, holding,
and using real property pledged as security for such a loan
guarantee.
``(g) Authorization of Appropriations.--
``(1) In general.--There is authorized to be appropriated
to carry out this section, $50,000,000 for each of fiscal years
2005 through 2010.
``(2) Availability.--Amounts appropriated under
subparagraph (A) shall remain available for obligation until
expended.

``SEC. 2905. GRANTS FOR THE PURCHASE OF HEALTH INFORMATION TECHNOLOGY.

``(a) In General.--The Director may award competitive grants to
eligible entities--
``(1) to implement local health information infrastructures
to facilitate the development of interoperability across health
care settings; or
``(2) to facilitate the purchase and adoption of health
information technology.
``(b) Eligibility.--To be eligible to receive a grant under section
(a) an entity shall--
``(1) demonstrate financial need to the Director;
``(2) with respect to an entity desiring a grant--
``(A) under subsection (a)(1), represent an
independent consortium of health care stakeholders
within a community that--
``(i) includes--
``(I) physicians (as defined in
section 1881(r)(1) of the Social
Security Act), including physicians
that provide services to low income and
underserved populations;
``(II) hospitals (including
hospitals that provide services to low
income and underserved populations);
and
``(III) group health plans or other
health insurance issuers (as such terms
are defined in section 2791); and
``(ii) may include any other health care
providers; or
``(B) under subsection (a)(2) be a health care
provider that provides health care services to low-
income and underserved populations;
``(3) adopt the national health information technology
standards developed under section 2903;
``(4) prepare and submit to the Director an application at
such time, in such manner, and containing such information as
the Director may require; and
``(5) agree to provide matching funds in accordance with
subsection (d).
``(c) Use of Funds.--Amounts received under a grant under
subsection (a) shall be used to--
``(1) with respect to a grant described in subsection
(a)(1)--
``(A) to develop a plan for the implementation of a
local health information infrastructure under this
section;
``(B) to establish systems for the sharing of data
in accordance with the national health information
technology standards developed under section 2903;
``(C) to implement, enhance, or upgrade a
comprehensive, electronic health information technology
system; and
``(D) to maintain adequate security and privacy
protocols;
``(2) with respect to a grant described in subsection
(a)(2)--
``(A) to develop a plan for the purchase and
installation of health information technology;
``(B) to purchase directly related integrated
hardware and software to establish an interoperable
health information technology system that is capable of
linking to a local health care information
infrastructure; and
``(C) to train staff, maintain health information
technology systems, and maintain adequate security and
privacy protocols;
``(3) maintain adequate security and privacy protocols; and
``(4) to carry out any other activities determined
appropriate by the Director.
``(d) Matching Requirement.--
``(1) In general.--The Director may not make a grant under
this section to an entity unless the entity agrees that, with
respect to the costs to be incurred by the entity in carrying
out the infrastructure program for which the grant was awarded,
the entity will make available (directly or through donations
from public or private entities) non-Federal contributions
toward such costs in an amount equal to not less than 20
percent of such costs ($1 for each $5 of Federal funds provided
under the grant).
``(2) Determination of amount contributed.--Non-Federal
contributions required under paragraph (1) may be in cash or in
kind, fairly evaluated, including equipment, technology, or
services. Amounts provided by the Federal Government, or
services assisted or subsidized to any significant extent by
the Federal Government, may not be included in determining the
amount of such non-Federal contributions.
``(e) Authorization of Appropriations.--
``(1) In general.--There is authorized to be appropriated
to carry out this section, $50,000,000 for each of fiscal years
2005 through 2010.
``(2) Availability.--Amounts appropriated under paragraph
(1) shall remain available for obligation until expended.

``SEC. 2906. REPORTS.

``(a) In General.--Not later than 1 year after the date of
enactment of this title, and annually thereafter, an entity that
receives a grant or loan guarantee under this title shall submit to the
Director a report on the activities carried out under the grant or loan
guarantee involved. Each such report shall include--
``(1) a description of the financial costs and benefits of
the project involved and of the entities to which such costs
and benefits accrue;
``(2) a description of the impact of the project on health
care quality and safety; and
``(3) a description of any reduction in duplicative or
unnecessary care as a result of the project involved.
``(b) Preference.--In awarding grants and loan guarantees under
this title, the Director may give a preference to eligible entities
that agree to electronically submit reports on a daily basis.''.

SEC. 3. STANDARDIZED MEASURES OF QUALITY HEALTH CARE AND DATA
COLLECTION.

Title XIX of the Public Health Service Act, as added by section 2,
is amended by adding at the end the following:

``SEC. 2907. STANDARDIZED MEASURES OF QUALITY HEALTH CARE.

``(a) In General.--
``(1) Collaboration.--The Secretary of Health and Human
Services, the Secretary of Defense, and the Secretary of
Veterans Affairs (referred to in this section as the
`Secretaries') shall establish uniform health care quality
measures to assess the effectiveness, timeliness, patient self-
management, efficiency, and safety of care delivered across all
federally supported health delivery programs, including those
in which health care services are delivered to health disparity
populations.
``(2) Development of measures.--Relying on earlier work by
the Secretary of Health and Human Services or other Federal
departments or agencies and with an emphasis on health
conditions disproportionately affecting health disparity
populations and taking into account health literacy and primary
language and cultural factors, the Secretaries shall develop
standardized sets of quality measures for--
``(A) 5 common health conditions by not later than
January 1, 2006; and
``(B) an additional 10 common health conditions by
not later than January 1, 2007.
``(3) Pilot testing.--Each federally supported health
delivery program may conduct a pilot test of the quality
measures developed under paragraph (2) that shall include a
collection of patient-level data and a public release of
comparative performance reports.
``(b) Public Reporting Requirements.--The Secretaries shall work
collaboratively to establish public reporting requirements for
clinicians, institutional providers, and health plans in each of the
federally supported health delivery program described in subsection
(a).
``(c) Full Implementation.--The Secretaries shall work
collaboratively to implement all sets of quality measures and reporting
systems developed under subsections (a) and (b) by not later than
January 1, 2009.
``(d) Progress Report.--The Secretary of Health and Human Services
shall prepare an annual progress report that details the collaborative
efforts carried out under subsection (a).
``(e) Comparative Quality Reports.--Beginning on January 1, 2008,
in order to make comparative quality information available to health
care consumers, including members of health disparity populations,
health professionals, public health officials, researchers, and other
appropriate individuals and entities, the Secretaries shall provide for
the pooling, analysis, and dissemination of quality measures collected
under this section. Nothing in this section shall be construed as
modifying the privacy standards under the Health Insurance Portability
and Accountability Act of 1996 (Public Law 104-191).
``(f) Ongoing Evaluation of Use.--The Secretary of Health and Human
Services shall ensure the ongoing evaluation of the use of the health
care quality measures established under this section.
``(g) Existing Activities.--Notwithstanding any other provision of
law, the measures and reporting activities described in this section
shall replace, to the extent practicable and appropriate, any
duplicative or redundant existing measurement and reporting activities
currently utilized by federally supported health care delivery
programs.
``(h) Evaluation and Regulations.--
``(1) Evaluation.--
``(A) In general.--The Secretary shall, directly or
indirectly through a contract with another entity,
conduct an evaluation of the collaborative efforts of
the Secretaries to establish uniform health care
quality measures and reporting requirements for
federally supported health care delivery programs as
required under this section.
``(B) Report.--Not later than 2 years after the
date of enactment of this title, the Secretary of
Health and Human Services shall submit a report to the
appropriate committees of Congress concerning the
results of the evaluation under subparagraph (A).
``(2) Regulations.--
``(A) Proposed.--Not later than 18 months after the
date on which the report is submitted under paragraph
(1)(B), the Secretary shall publish proposed
regulations regarding the application of the uniform
health care quality measures and reporting requirements
described in this section to federally supported health
delivery programs.
``(B) Final regulations.--Not later than 3 years
after the date on which the report is submitted under
paragraph (1)(B), the Secretary shall publish final
regulations regarding the uniform health care quality
measures and reporting requirements described in this
section.
``(i) Definitions.--In this section, the term `federally supported
health delivery program' means a program that is funded by the Federal
Government under which health care items or services are delivered
directly to patients.

``SEC. 2908. DATA COLLECTION.

``The Secretary shall--
``(1) ensure that demographic data collected under the
medicare program are accurate and available for inclusion in
the National Health Disparities Report;
``(2) enforce existing State demographic data collection
and reporting requirements for enrollees in the medicaid
program under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) and the State Children's Health Insurance Program
under title XXI of such Act (42 U.S.C. 1397aa et seq.), promote
and encourage the collection of such demographic data in those
States that do not have existing demographic data collection
and reporting requirements under these programs, and ensure
that such demographic data are available for inclusion in the
National Health Disparities Report;
``(3) ensure that any new Federal program initiatives--
``(A) collect and report demographic data and
provide technical assistance to promote compliance;
``(B) address technological difficulties;
``(C) ensure privacy and confidentiality of
demographic data collected; and
``(D) disseminate an analysis of the demographic
data collection to appropriate stakeholders;
``(4) work with insurers, providers, agencies and the
public to reassure and inform such entities of the importance
of demographic data collection regarding health disparity
populations to improving health care access and quality; and
``(5) support research on existing best practices for data
collection.''.
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