Health Information Technology: Promoting Electronic Connectivity in Healthcare

CRS Report for Congress
Health Information Technology: Promoting
Electronic Connectivity in Healthcare
April 13, 2005
C. Stephen Redhead
Specialist in Life Sciences
Domestic Social Policy Division

Congressional Research Service ˜ The Library of Congress

Health Information Technology:
Promoting Electronic Connectivity in Healthcare
Summary
The Institute of Medicine, the National Committee on Vital and Health
Statistics, and other expert panels have identified information technology (IT) as one
of the most powerful tools for reducing medical errors, lowering health costs, and
improving the quality of care. However, the U.S. health care industry lags far behind
other sectors of the economy in its investment in IT, despite growing evidence that
electronic information systems can play a critical role in addressing the many
challenges the industry faces. Adoption of health IT systems faces significant
financial, legal, and technical obstacles.
Congress and the Administration have taken a number of important steps to
promote health IT. The 2003 Medicare Modernization Act instructed the HHS
Secretary to adopt electronic prescription standards and establish a Commission for
Systemic Interoperability. The Commission is charged with developing a
comprehensive strategy for implementing data and messaging standards to support
the electronic exchange of clinical data. On April 27, 2004, President Bush called
for the widespread adoption of interoperable electronic health records (EHRs) within
10 years and established the position of National Coordinator for Health Information
Technology. Pursuant to the President’s order, the National Coordinator has
developed a strategic 10-year plan outlining steps to transform the delivery of health
care by adopting EHRs and developing a National Health Information Infrastructure
(NHII) to link such records nationwide.
The strategic plan identifies several potential policy options for providing
incentives for EHR adoption. They include: providing grants to stimulate EHRs and
regional information exchange systems; offering low-rate loans and loan guarantees
for EHR adoption; amending federal rules (e.g., Medicare physician self-referral law)
that may unintentionally impede the development of electronic connectivity among
health care providers; and using Medicare reimbursement to reward EHR use.
Health IT has broad bipartisan support among lawmakers. The 109^th Congress
is likely to consider legislation to boost federal investment and leadership in health
IT and provide incentives both for EHR adoption and for the creation of regional
health information networks, which are seen as a critical step towards the goal of
interconnecting the health care system nationwide. Several health IT bills were
introduced during the last Congress and, to date, two bills (H.R. 747, S. 16) have
been introduced this year. Congress laid the groundwork for establishing an NHII
when it enacted the 1996 Health Insurance Portability and Accountability Act
(HIPAA). HIPAA instructed the HHS Secretary to develop privacy standards to give
patient more control over the use of their medical information, and security standards
to safeguard electronic patient information against unauthorized access, use, or
disclosure.

Contents
In troduction ......................................................1
Information Technology and Health Care Quality.........................2
Electronic Health Record (EHR)..................................2
Clinical Decision Support (CDS)..................................3
Computerized Physician Order Entry (CPOE).......................3
Health Information Exchange....................................3
Barriers to the Adoption of Health IT..................................4
Standards ....................................................4
Financial Challenges...........................................6
Legal Barriers.................................................7
National Framework for Strategic Action...............................7
Health IT Legislation (108^th and 109^th Congress).........................9
Appendix A.....................................................22
Congressional Hearings (2002–2005).............................22
GAO Reports and Testimony (2003–2005).........................23
Internet Resources............................................23
List of Tables
Table 1. Summary of Health Care Information Technology (IT) Provisions
in the Medicare Modernization Act (P.L. 108-173)...................10
Table 2. Comparison of Bills to Encourage the Adoption of Health
Information Technology (IT)....................................12
Table 3. Summary of Health Information Technology (IT) Legislation
Introduced in the 108^th Congress.................................14
Table 4. Summary of Health Information Technology (IT) Legislation
Introduced in the 109^th Congress.................................20

Health Information Technology: Promoting
Electronic Connectivity in Healthcare
Introduction
The Institute of Medicine (IOM), the National Committee on Vital and Health
Statistics (NCVHS), and other expert panels have identified information technology
(IT) as one of the most powerful tools for reducing medical errors, lowering health
costs, and improving the quality of care.¹ They recommend that health care
organizations adopt IT systems to support the electronic collection and exchange of
patient information. The goal is for these systems to operate seamlessly as part of a
national health information infrastructure (NHII), which would enable health care
providers anywhere in the country to access patient information at the point of care.
While supporting the delivery of high-quality patient care, experts emphasize that a
NHII must also meet the nation’s needs for public health surveillance, biodefense,
and biomedical research, and protect the privacy of individuals.
The U.S. health care industry lags well behind other sectors of the economy in
its investment in IT, despite growing evidence that electronic information systems
can play a critical role in addressing the many challenges the industry faces. There
are significant financial, legal, and technical obstacles to the adoption of health IT
systems. The issue for Congress, in which there is broad bipartisan support for health
IT, is how best to create incentives for the adoption of IT throughout the health care
industry.
Congress and the Administration have already taken a number of important
steps to promote health IT. The 2003 Medicare Modernization Act instructed the
HHS Secretary to adopt electronic prescription standards and establish a Commission
for Systemic Interoperability. The Commission is charged with developing a
comprehensive strategy for implementing data and messaging standards to support
the electronic exchange of clinical data. On April 27, 2004, President Bush called
for the widespread adoption of interoperable electronic health records (EHRs) within
10 years and established the Office of the National Coordinator for Health
Information Technology (ONCHIT). ONCHIT has developed a strategic 10-year
plan outlining steps to transform the delivery of health care by adopting EHRs and
developing a National Health Information Infrastructure (NHII) to link such records
nationwide. The strategic plan identifies several potential policy options for

¹U.S. Department of Health and Human Services, Information for Health: A Strategy for
Building the National Health Information Infrastructure, Report and Recommendations
from the National Committee on Vital and Health Statistics, Nov. 15, 2001, available online
at [http://www.ncvhs.hhs.gov]; and, Institute of Medicine, Crossing the Quality Chasm: A^st
New Health System for the 21 Century, Washington, DC: National Academy Press, 2001.

providing incentives for EHR adoption. They include: providing grants to stimulate
EHRs and regional information exchange systems; offering low-rate loans and loan
guarantees for EHR adoption; amending federal rules (e.g., Medicare physician self-
referral law) that may unintentionally impede the development of electronic
connectivity among health care providers; and using Medicare reimbursement to
reward EHR use.
Lawmakers in the 109^th Congress are likely to consider legislation to boost
federal investment and leadership in health IT and provide incentives both for EHR
adoption and for the creation of regional health information networks, which are seen
as a critical step towards the goal of interconnecting the health care system
nationwide. Congress laid the groundwork for establishing an NHII when it enacted
the 1996 Health Insurance Portability and Accountability Act (HIPAA). HIPAA
instructed the HHS Secretary to develop privacy standards to give patients more
control over the use of their medical information, and security standards to safeguard
electronic patient information against unauthorized access, use, or disclosure.
This report summarizes recently proposed and enacted legislation to promote
the use of EHRs and the development of the NHII. It begins with a brief discussion
of some of the benefits of broadening the application of information technology (IT)
in health care, as well as the significant financial, technical, and legal barriers to the
adoption of health IT. That is followed by a summary of the goals articulated in the
federal government’s strategic framework for health IT adoption. The report
concludes with a set of tables summarizing health IT legislation in the 108^th and 109^th
Congresses. Appendix A provides additional background information on health IT,
including a list of congressional hearings, GAO reports, and online resources.
Information Technology and Health Care Quality
In its June 2004 report, Revolutionizing Health Care Through Information
Technology, the President’s Information Technology Advisory Committee (PITAC)
proposed a framework for a NHII composed of four elements.²
Electronic Health Record (EHR)
The EHR provides a clinician with real-time access to patient information, as
well as a complete longitudinal record of care. A fully integrated EHR enables a
physician to update clinical and other information about a patient on a continuous
basis. Such an integrated system permits a physician, for example, to view a history
of the patient’s medical condition and visits to health providers (with submenus for
notes from those visits), images and reports of diagnostic procedures, current
medications, functional status and social service eligibility, schedule of preventive
services, allergies, and contact information for family caregivers.

²Report can be obtained at [http://www.nitrd.gov/pitac].

Clinical Decision Support (CDS)
Linking a patient’s EHR to a computerized CDS system provides clinicians with
real-time diagnostic and treatment recommendations. CDS systems, which include
a range of technologies from simple clinical alerts and warnings of prescription drug
interactions to detailed clinical protocols and procedures, facilitate the practice of
evidence-based medicine by providing clinicians with state-of-the-art medical
knowledge at the point of care.
Computerized Physician Order Entry (CPOE)
CPOE minimizes handwriting and other communication errors by having
physicians and other providers enter orders into a computer system. Originally
designed for ordering medications, more advanced CPOE systems include orders for
x-rays and other diagnostic procedures, referrals, discharges, and transfers. CPOE
may also be linked to a patient’s EHR and various decision support functions.
Health Information Exchange
The final and most important element of a NHII is electronic connectivity (via
the Internet and other networks) enabling health care providers to exchange patient
health information. Networks that permit electronic communication among providers
must be secure in order to safeguard the information from unauthorized access, use,
and disclosure. They also require the development of data and messaging standards
to establish the critical goal of interoperability, that is, the ability of two or more IT
systems (computers, networks, software, and other IT components) to communicate
with one another and make sense of the data they exchange. A small but growing
number of communities and health care systems around the country have developed
EHRs and established secure platforms for the exchange of health data among
providers, patients, and other authorized users (e.g., the Veterans Health
Administration, the Indiana Network for Patient Care, the Santa Barbara County Care
Data Exchange, and the New England Healthcare Electronic Data Interchange
Network).
The IOM’s March 2001 report on health care quality, Crossing the Quality
Chasm: A New Health Care System for the 21^st Century, emphasized the need for
improvement in six key areas: safety, effectiveness, responsiveness to patients,
timeliness, efficiency, and equity. A growing number of published studies suggest
that IT can play a key role in improving the quality of care in each of these areas. In
the area of safety, CPOE systems with decision support functions can reduce errors
in drug prescribing and dosing. Clinical decision support systems have been shown
to improve efficiency, for example, by reducing redundant lab tests. They can also
improve the effectiveness of care by promoting compliance with clinical practice
guidelines. Health IT may be especially beneficial for inner-city and rural
populations and other medically underserved areas. Real-time access to specialty
information, including consultations between rural physicians and leading specialists
at academic medical centers, helps promote an equitable health care system by
reducing the geographic variability in access to the best quality care. The secure
transmission of patient information among physicians will significantly improve the

coordination of care among the 60 million Americans with multiple chronic
conditions. Studies have shown that poor coordination of care among Medicare
beneficiaries with multiple chronic conditions leads to unnecessary hospitalization,
duplicate tests, conflicting clinical advice, and adverse drug reactions as a result of
over-medication.
An IT infrastructure has great potential to contribute to achieving other
important national objectives, such as homeland security and improved public health
services. Linked health information networks are key to reducing the time it takes
to detect and respond to disease outbreaks, whether they are naturally occurring or
the result of a bioterrorist attack. They are also an important tool for helping
organize and execute large-scale vaccination campaigns and for monitoring the health
of the population. Finally, health IT is becoming increasingly important for various
forms of biomedical and health services research, and for translating research
findings into clinical practice more quickly. By some estimates it may take as long
as 17 years for new research findings to be fully integrated into general medical
pract i ce.³
Barriers to the Adoption of Health IT
The U.S. health care industry, which represents about 15% of GDP, lags far
behind other sectors of the economy in its investment in IT, despite growing evidence
that electronic information systems can play a critical role in addressing many of the
challenges the industry faces. There are significant obstacles to the adoption of
EHRs and the creation of a NHII, some of which are briefly discussed below.
Standards
Enormous amounts of data needed for clinical care, patient safety, and quality
improvement currently reside on computers. However, EHRs and community-based
health information networks have been slow to develop because of a lack of
interoperability standards to support electronic data exchange. Physicians and other
providers are hesitant to invest in IT systems, fearing that they might not be able to
exchange patient information with local pharmacies, hospitals, or even other
physicians. Common standards for organizing, representing, and encoding health
information permit the efficient exchange of clinical and patient safety data. They
also support the assimilation of external data sources into decision support tools for
providers (e.g., alerts for possible drug-drug interactions).
The federal government is playing a leading role in encouraging the
development and adoption of interoperability standards for health information
throughout the U.S. health care system. The Departments of Health and Human
Services (HHS), Defense (DOD), and Veterans Affairs (VA) are partners in the
Consolidated Health Informatics (CHI) initiative, one of 24 eGov initiatives to

³E. Andrew Balas and Suzanne A. Boren, “Managing Clinical Knowledge for Health Care
Improvement,” in Yearbook of Medical Informatics 2000: Patient-Centered Systems, pp. 65-

70.

support President Bush’s Management Agenda. The goal of the CHI initiative is to
establish federal health information interoperability standards both to promote
information sharing across the three federal departments that deliver health care
services and to serve as a model for the private sector. To date, the agencies have
adopted 20 sets of standards developed by private-sector Standards Development
Organizations (SDOs). They include messaging standards, standards for the
electronic exchange of clinical lab results, standards for retail pharmacy transactions,
and standards for the retrieval and transfer of images and associated diagnostic
information. HHS has also signed an agreement to license Systematized
Nomenclature of Medicine — Clinical Terms (SNOMED CT), a standardized
medical vocabulary developed by the College of American Pathologists and available
for free to users in the United States. SNOMED CT, which is now available through
the National Library of Medicine,⁴ is the most comprehensive clinical vocabulary
available and covers most aspects of clinical medicine. It will help structure and
computerize the medical record and reduce variability in the way the data are
captured, encoded and used for clinical care of patients and for medical research.
In May 2003, HHS requested that the IOM provide guidance to the agency on
a set of basic “functionalities” that an EHR should possess, that is, the types of
information that should be available to providers when making clinical decisions
(e.g., diagnoses, allergies, lab results), and the types of decision-support capabilities
that should be present (e.g., alerts to potential drug-drug interactions).” The IOM did
not address specific data standards (e.g., terminology, messaging standards,
diagnostic codes). Health Level Seven (HL7), a leading SDO working on the
development of an EHR standard, has taken the core functionalities identified by the
IOM and incorporated them into its draft standard, which has been approved and is
undergoing a two-year trial before it becomes an official standard.⁵
Coordinating the care a patient receives from multiple providers does not
require the transmission of the entire EHR with each referral. In most cases the
physician to whom a patient is referred needs only the most relevant and timely facts
about the patient’s condition. ASTM International, in collaboration with the
Massachusetts Medical Society, the Health Information Management and Systems
Society, and the American Academy of Family Physicians, is developing the
Continuity of Care Record (CCR) to meet that need. The CCR is intended to be a
national standard for all relevant information necessary for continuity of care. It
consists of a minimum data set that includes provider information, insurance
information, patient’s health status (e.g., allergies, medications, vital signs,
diagnoses, recent procedures), recent care provided, as well as recommendations for
future care and reasons for referral or transfer. The data contained within the CCR
are a subset of the patient’s full record that exists in an EHR. Each new provider that
sees the patient is able to access the CCR and update the information as necessary.
Thus the CCR provides a vehicle for exchanging clinical information among

⁴SNOMED CT is available online at [http://umlsinfo.nlm.nih.gov].
⁵Information on the HL7 EHR standard is available online at [http://www.hl7.org/ehr].

providers, institutions, or other entities. It may also be used by the patient as a brief
summary of recent care.⁶
Congress laid the groundwork for establishing an NHII when it enacted the
HIPAA, P.L. 104-191 in 1996. HIPAA instructed the HHS Secretary to issue
electronic format and data standards for several routine administrative transactions
between health care providers and health plans (e.g., reimbursement claims) and
adopt security standards to safeguard electronic patient information against
unauthorized access, use, or disclosure. Developing a secure platform to protect
confidential health data is central to the growth of an NHII. Under HIPAA, HHS has
also issued health privacy standards that give individuals the right of access to their
medical information and prohibit plans and providers from using or disclosing such
information without the patient’s authorization, except for routine health care
operations and other specified purposes. The growing use and exchange of electronic
health data raises serious privacy concerns among the public and some lawmakers,
who question whether the privacy standards are sufficiently broad in scope to protect
confidential patient information.
Financial Challenges
There are two key financial obstacles to the adoption of EHR and the
development of an NHII: investment costs, and the misalignment between costs and
benefits. Investment in IT is expensive and must compete with other priorities,
including new buildings as well as other technologies with more direct application
to clinical care and greater certainty for increased revenues. A full clinical IT system
that includes CPOE and an EHR, coupled with clinical decision support functions,
can cost tens of millions of dollars for a large hospital. And that does not include the
costs of training and systems support.
The start-up and maintenance costs of IT systems may be especially burdensome
for small physician practices. While those costs vary tremendously, depending on
the nature of the practice and the applications involved, the average cost of an EHR
can range from $16,000 to $36,000. The complexity of the technology, the time to
complete implementation, and the changes in office workflow patterns create
additional barriers to adopting IT systems. But perhaps the most critical issue for
physicians is the perception that the IT-related benefits of improved efficiency and
quality of care accrue largely to the payers and patients, not to the providers who bear
most of the implementation costs.
Rather than reward quality, most physician reimbursement systems emphasize
volume of services. Physicians are paid for each procedure or service they provide,
regardless of its quality. This approach encourages providers to see as many patients
as possible and to emphasize the provision of a billable service, such as an MRI, over
technology that might improve the quality of many services. A physician group that
invests in a clinical IT system to improve the way it manages the care of patients with
chronic conditions can reduce the number of complications and the hospitalization

⁶For a more detailed discussion of the development of the CCR, go to [http://www.astm.org/
COMMIT / E31_ConceptPaper.doc].

rate. But unless the change results in additional office visits, only the payer sees a
financial benefit. One potential solution to this problem is to provide direct payments
to physicians who use IT systems. Another is to adopt a pay-for-performance scheme
that rewards clinicians who deliver the best quality of care, according to standardized
measures, as opposed to the highest volume of care.
Legal Barriers
Health IT experts have identified several federal laws that may unintentionally
impede the development of electronic connectivity in health care. Because these
laws do not directly address health IT, health care providers are uncertain about what
would constitute a violation or create the risk of litigation. The Medicare physician
self-referral (Stark) law (42 U.S.C. § 1395nn) and the anti-kickback law (42 U.S.C.
§ 1320a-7b(b)), which covers all federal health care programs, are of chief concern.
Both are intended to counter fraud and abuse.⁷
The Stark law prohibits physicians from referring patients to any entity for
certain health services if the physician has a financial relationship with the entity, and
prohibits entities from billing for any services resulting from such referrals, unless
an exception applies. The law discourages physicians from accepting IT resources
(e.g., hardware and software) from a hospital or other health care entity out of
concern that they would be in violation if they subsequently referred patients to that
entity. The anti-kickback law, like the self-referral law, also impedes arrangements
between health care entities that promote the adoption of health IT. It prohibits an
individual or entity from knowingly or willfully offering or accepting remuneration
of any kind to induce a patient referral for or purchase of an item or service covered
by any federal health care program.
On March 26, 2004, the Centers for Medicare and Medicaid Services (CMS)
published a final interim rule creating several new exceptions under the physician
self-referral law, including one for IT items and services furnished to physicians to
enable them to participate in “community-wide health information systems.”⁸
Experts have questioned whether this term is sufficiently inclusive to cover all the
various health IT arrangements. They have also criticized the lack of a parallel
exception under the anti-kickback law.
National Framework for Strategic Action
On April 27, 2004, President Bush called for the widespread adoption of
interoperable EHRs within 10 years and signed Executive Order 13335, which
established the position of National Coordinator for Health Information Technology

⁷The Government Accountability Office (GAO) discussed various potential legal obstacles
to health IT in its recent report HHS’s Efforts to Promote Health Information Technology
and Legal Barriers to Its Adoption, GAO-04-991R, Aug. 13, 2004, available online at
[ h t t p : / / www.ga o.gov] .
⁸69 Federal Register 16053, Mar. 26, 2004.

within HHS. Secretary Tommy Thompson appointed David Brailer, MD, PhD, one
of the country’s foremost health IT experts, to serve in the new position. The
Executive Order directed the National Coordinator within 90 days to develop a
strategic 10-year plan outlining steps to transform the delivery of health care by
adopting EHRs and developing a NHII to link such records nationwide.
On July 21, 2004, Brailer and Thompson released a Framework for Strategic
Action entitled, The Decade of Health Information Technology: Delivering
Consumer-Centric and Information-Rich Health Care.⁹ Although the federal
government has taken the lead in setting the health IT agenda, the framework sets out
a bottom-up approach in which the role of HHS is to promote and encourage the
private sector to build community-level networks. Adopting interoperability
standards will over time permit these local networks to connect with one another to
form an NHII. The framework identified four major goals, with strategic action areas
for each:
!Inform clinical practice. This goal focuses on bringing EHRs into clinical
practice by providing incentives for EHR adoption, reducing the risk of EHR
investment, and promoting EHR diffusion in rural and medically underserved
areas.
!Interconnect physicians. This goal centers on building an interoperable health
information infrastructure so that EHRs follow the patient, and clinicians have
access to critical health information when treatment decisions are being made.
The strategies for realizing this goal involve fostering community-based health
information exchange projects, developing a national health information
network, and coordinating federal health information systems.
!Personalize health care. This goal involves using health IT to help
individuals manage their own wellness and become more involved in personal
health decisions.
!Improve population health. The final goal requires the timely collection,
analysis, and dissemination of clinical information to improve the evaluation
of health care delivery, public health monitoring, and biosurveillance. It also
helps accelerate research and the translation of research findings into clinical
products and practice.
The framework identifies several potential policy options for providing
incentives for EHR adoption. They include:
!regional grants and contracts to stimulate EHRs and community information
exchange systems;
!improving the availability of low-rate loans for EHR adoption;
!updating federal rules on physician self-referral that may unintentionally
restrict the development of health information networks;

⁹The strategic plan, along with an accompanying fact sheet and press release, is available
online at [http://www.hhs.gov/onchit/framework].

!using Medicare reimbursements to reward the use of EHRs; and
!funding Medicare pay-for-performance demonstration programs.
Health IT Legislation (108^th and 109^th Congress)
The Medicare Prescription Drug, Improvement, and Modernization Act (MMA),
which the President signed into law on December 8, 2003 (P.L. 108-173), included
provisions for electronic prescribing standards. The bill requires the standards to
include not just electronic script writing, but also the patient’s medication history and
decision support for identifying potential drug-to-drug interactions. In addition, the
MMA called for the establishment of a commission to develop a comprehensive
strategy for the adoption and implementation of health IT data standards. Finally, the
bill authorized IT grants for physicians and established demonstration projects to
determine how to improve the quality of care through the adoption of IT. Table 1,
beginning on page 10, provides a summary of the IT-related provisions in the MMA.
In the 108^th Congress, the House and Senate passed competing versions of the
Patient Safety and Quality Improvement Act (H.R. 663, S. 720). Despite broad
bipartisan support for the legislation, no further action took place before adjournment
in December 2004. On March 9, 2005, the Senate Committee on Health, Education,
Labor, and Pensions (HELP) unanimously approved a new patient safety bill (S.
544), which is identical to last year’s Senate-passed measure. The patient safety
legislation is intended to encourage the voluntary reporting of information on medical
errors by establishing federal evidentiary privilege and confidentiality protections for
such information. For more information on the patient safety legislation, see CRS
Report RL31983, Health Care Quality: Improving Patient Safety by Promoting
Medical Errors Reporting.
S. 544 also requires the HHS Secretary to adopt voluntary, national
interoperability standards for the electronic exchange of health care information.
H.R. 663, in the 108^th Congress, contained a similar requirement, as well as several
additional health IT provisions, none of which are included in S. 544. The House-
passed bill authorized health IT grants for physicians and hospitals, and mandated the
creation of a Medical Information Technology Advisory Board (MITAB).
During the 108^th Congress, lawmakers introduced a number of bills (i.e., H.R.
2915, H.R. 4880, S. 2003, S. 2421, S. 2710, S. 2907) to boost federal investment and
leadership in IT in an effort to promote the adoption of EHRs and the development
of a NHII. With the exception of H.R. 2915, these measures also contained quality-
of-care provisions. They included devising standardized measures of physician
performance and using them as the basis of pay-for-performance initiatives. So far
in the 109^th Congress, lawmakers have introduced two health IT bills. Representative
Gonzalez has introduced the National Health Information Incentive Act of 2005
(H.R. 747), and Senator Kennedy has reintroduced S. 2907 as Title II of the
Affordable Health Care Act (S. 16). Table 2, beginning on page 12, compares the
incentives in each of those health IT bills. Tables 3 and 4 provide more detailed
summaries of the major provisions in the patient safety and health IT bills introduced
in the 108^th and 109^th Congresses, respectively.

CRS-10
Table 1. Summary of Health Care Information Technology (IT) Provisions in the Medicare Modernization Act
(P.L. 108-173)
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^av^ailab^ility^o^f^lo^w^e^r-^co^{st, th}^erap^eu^tically^ap^p^r^o^p^r^{iate altern}^ativ^{e d}^r^u^g^s^.^A^d^d^itioⁿ^a^lly^,^th^e^stan^d^a^rd^s^m^u^st^acco^m^m^o^d^a^te^th^{e m}^e^ssa^gi^{ng o}^f
ⁱⁿ^f^o^r^m^atioⁿ^ab^o^u^{t ap}^p^r^o^p^r^{iate p}^r^escr^ibⁱⁿ^g^o^f^d^r^u^g^s^to^av^oⁱ^d^ad^v^e^r^s^{e d}^r^u^gⁱⁿ^ter^actioⁿ^s^aⁿ^d^a^l^l^o^w^a^b^eⁿ^e^fⁱ^ciar^y⁽^c^oⁿ^sisten^{t w}^ith^th^eir
^pres^cri^p^tⁱ^oⁿ^dru^g^pl^an^{) t}^o^desⁱ^gⁿ^a^t^e^{a part}ⁱ^c^u^l^ar^p^h^a^r^m^a^c^y^t^o^di^s^p^en^s^e^{a pres}^cri^b^{ed dru}^g^.^Fⁱⁿ^a^l^l^y^{, t}^h^{e prog}^ram^m^u^s^t^provⁱ^d^{e f}^o^{r t}^h^e
^electr^oⁿⁱ^{c tr}^an^sm^{ittal o}^f^th^{e p}^a^tien^t^’^s^m^e^dⁱ^c^a^l^hⁱ^s^t^o^r^y^.^Disclo^su^r^e^o^fⁱⁿ^f^o^r^m^atioⁿ^m^u^{st m}^{eet th}^{e r}^e^q^u^ir^em^en^{ts o}^f^th^{e HI}^P^A^A^p^rⁱ^v^acy^ru^le
^an^d^,^to^th^{e ex}^ten^t^f^easib^{le, b}^e^oⁿ^anⁱⁿ^ter^activ^{e, r}^eal-^tim^{e b}^a^{sis. Req}^u^ir^{es th}^e^Secr^etar^y^to^p^r^o^m^u^l^g^a^teⁱⁿ^{itial stan}^d^a^r^d^{s b}^y^S^ept^e^m^b^{er 1, 2005.}
^P^r^io^r^to^th^{e p}^r^o^m^u^l^g^a^tioⁿ^o^f^fⁱⁿ^a^{l stan}^d^a^r^d^{s, th}^e^Secr^etar^y^m^u^st^en^{ter in}^{to v}^o^luⁿ^t^ary^ag^reem^en^ts^w^ith^ph^y^s^ician^s^an^{d ph}^arm^acies^t^o^c^o^nd^uc^t
^{a pilot proj}^{ect du}^rin^g^{2006 to tes}^t^th^{e in}^{itial s}^t^an^dards^.^T^h^{e S}^ecretary^m^u^s^t^th^en^ev^alu^a^{te th}^{e pilot proj}^{ect an}^{d report to C}^oⁿ^g^r^{ess n}^o^{t later}
^t^h^an^A^p^ri^l^{1, 2007. Bas}^e^{d on}^t^h^{e ev}^al^u^a^tⁱ^oⁿ^an^{d n}^o^t^l^a^t^e^{r t}^h^an^A^p^ri^l^{1, 2008, t}^h^{e S}^ecret^ary^m^u^s^t^prom^u^l^g^a^t^e^fⁱⁿ^a^l^s^t^an^dards^t^o^tak^e^ef^f^ect
ⁱ^{ki/CRS-RL32858}^w^ithⁱⁿ^oⁿ^{e y}^ear^{. A}^l^so^{, r}^e^q^u^ir^{es th}^{e Secr}^etar^y^to^estab^lish^{a saf}^e^h^a^r^b^o^r^f^r^o^m^p^eⁿ^a^{lties u}ⁿ^d^er^th^{e an}^ti-^kⁱ^ck^b^ack^statu^t^e⁽⁴²^U^.^S.C.^{1320a–7b(b))}^an^d^an^ex^ceptⁱ^oⁿ^t^o^Medi^{care l}ⁱ^mⁱ^t^a^tⁱ^oⁿ^s^on^ph^y^sⁱ^cⁱ^aⁿ^s^e^l^f^-^r^ef^erral^{(42 U}^.^S^.^C^.^{§ 1395n}ⁿ⁽^{e)) f}^o^r^t^h^e^provⁱ^sⁱ^oⁿ^of^h^ardw^are,
^g/w^s^o^f^t^w^a^{re, an}^{d oth}^e^{r tech}ⁿ^o^log^y^an^{d train}ⁱⁿ^g^s^e^rv^ices^u^s^{ed in}^elect^ronⁱ^{c pres}^cribin^g^.^T^h^{at w}^o^u^l^{d allow}^,^f^o^{r ex}^am^{ple, a}^h^o^s^p^ital^t^o^provⁱ^d^e
^s^.or^s^u^ch^techⁿ^o^logⁱ^es^an^{d s}^e^rv^ices^{to its}^m^e^{dical s}^t^af^f^,^an^d^Medicar^{e A}^d^v^aⁿ^t^ag^{e plan}^s^{to prov}^{ide s}^u^ch^techⁿ^o^logⁱ^es^an^{d s}^e^rv^ices^to^ph^arm^acies
^le^ak^an^{d pres}^cri^bⁱⁿ^g^h^eal^t^h^{care prov}ⁱ^d^ers^.^[N^ot^e:^C^M^S^,^ah^{ead of}^s^c^h^e^du^l^e^{, rel}^e^a^s^{ed i}^t^s^propos^al^f^o^{r e-}^pres^cri^bⁱⁿ^g^s^t^an^dards^on^Ja^nua^r^y²⁷^,
^{2005. T}^h^{e propos}^{ed ru}^l^e^w^a^s^pu^blⁱ^s^h^e^{d i}ⁿ^t^h^e^Feder^a^{l Regis}^t^er^{, F}^e^bru^a^ry^{4, 2005.]}
^://wiki
^h^ttp^an^ts^{to Ph}^ysⁱ^cⁱ^aⁿ^s^{to I}^m^p^l^em^en^t^A^u^th^o^r^{izes th}^{e Secr}^etar^y^to^m^a^k^e^g^r^an^{ts to}^p^h^y^s^ician^s^to^h^e^lp^def^r^ay^th^{e cos}^t^s^of^pu^rch^a^sⁱⁿ^g^an^{d in}^s^t^alli^ng^com^p^u^t^{er s}^y^s^t^em^s⁽ⁱ^nc^l^u^dⁱ^ng
^{ectronic Pres}^{cription Program}^s^haⁿ^d^h^e^l^d^d^e^vⁱ^c^e^s⁾^,^up^gr^a^dⁱ^{ng e}^xⁱ^s^tⁱ^{ng sy}^st^e^m^s,^aⁿ^d^p^r^o^vⁱ^dⁱ^{ng e}^d^uc^a^tⁱ^o^{n a}ⁿ^d^t^r^aⁱⁿⁱ^{ng t}^o^st^a^{ff o}ⁿ^t^h^e^use^o^f^t^e^c^hno^l^o^gy^t^oⁱ^m^p^l^e^m^en^{t an}
^ecti^oⁿ¹⁰⁸⁾^el^ect^ronⁱ^{c pres}^cri^p^tⁱ^oⁿ^p^r^o^g^r^a^m^.^R^e^quⁱ^r^es^t^h^{e S}^ecret^ary^t^o^gⁱ^v^e^pref^eren^{ce t}^o^ph^y^sⁱ^cⁱ^aⁿ^s^w^h^{o s}^e^rv^{e a di}^s^p^roportⁱ^oⁿ^a^t^e^l^y^l^a^rg^e^Medicare
^popu^l^a^tⁱ^oⁿ^,^as^w^e^l^l^as^ph^y^sⁱ^cⁱ^aⁿ^s^w^h^{o s}^e^rv^{e ru}^ral^{or m}^e^di^cal^l^y^uⁿ^d^ers^e^rv^{ed areas}^.^R^e^quⁱ^r^es^g^r^an^t^ees^t^o^provⁱ^d^e^a^50%^m^a^t^c^hⁱⁿ^g^coⁿ^t^rⁱ^b^u^tioⁿ
^{to cov}^e^{r all th}^{e cos}^t^s^of^im^plem^en^tin^g^th^eir^electronⁱ^{c pres}^cribin^g^prog^ram^.^A^u^th^orizes^{$50 m}^illion^f^o^{r FY}^{2007, an}^{d s}^u^ch^s^u^m^s^as^m^a^y^be
ⁿ^eces^s^a^ry^f^o^{r F}^Y^{2008 an}^{d F}^Y^2009.
^e^{dicare Care M}^a^nagem^e^nt^R^e^qu^ires^th^{e Secretary}^t^o^e^s^t^a^b^lⁱ^s^{h a th}^ree-^y^{ear dem}^oⁿ^s^tration^pr^o^g^r^a^m^w^ith^p^h^y^s^ician^s^to^m^{eet th}^{e n}^eed^{s o}^f^b^eⁿ^e^fⁱ^ciar^{ies th}^r^o^u^{gh t}^h^e
^a^{nce Dem}^o^ns^tration^adoption^an^{d u}^s^{e of}^h^ealth^IT^an^{d ev}^iden^ce-^bas^e^{d ou}^tcom^{e m}^eas^u^r^es^t^o^prom^ot^{e c}^oⁿ^tⁱⁿ^uⁱ^t^y^o^f^c^a^r^{e, h}^e^{lp s}^t^{abilize m}^e^{dical con}^d^iti^on^s^,
^ecti^oⁿ⁶⁴⁹⁾^p^r^ev^en^{t o}^r^mⁱⁿⁱ^mⁱ^{ze acu}^{te ex}^acerb^a^tioⁿ^s^o^f^ch^roⁿⁱ^{c co}ⁿ^d^itioⁿ^s^{, an}^d^red^u^{ce ad}^v^e^{rse h}^ealth^o^u^tco^m^{es. A}^u^th^o^r^{izes f}^o^u^r^d^e^m^oⁿ^s^trati^oⁿ^sites:
^tw^{o u}^r^ba^n,^oⁿ^e^r^u^{ral, an}^{d on}^{e in}^{a s}^t^{ate th}^{at m}^eets^certain^s^p^ecifⁱ^cation^s^(m^os^{t lik}^ely^A^r^k^aⁿ^s^as^{). P}^h^y^s^ician^s^m^u^s^t^m^{eet certai}ⁿ^p^r^actice
^stan^d^a^r^d^{s, in}^clu^dⁱⁿ^g^th^{e ab}^ility^to^estab^lish^an^d^m^aⁱⁿ^tain^h^ealth^I^T^sy^stem^{s. Dir}^{ects th}^e^Secr^etar^y^to^p^a^y^a^p^e^r^b^eⁿ^e^fⁱ^ciar^y^a^m^o^uⁿ^t^to^each
^p^a^rticip^atin^g^p^h^y^s^ician^w^h^o^m^{eets o}^r^ex^ceed^{s sp}^ecifⁱ^{c p}^e^rf^o^r^m^aⁿ^{ce stan}^d^a^rd^{s reg}^a^rdⁱⁿ^g^clin^{ical q}^u^ality^an^d^o^u^tco^m^es.

CRS-11
^{nic Ca}^{re Im}^pro^v^e^m^e^nt^Under^R^e^qu^ires^th^{e Secretary}^{to dev}^e^{lop, tes}^t^{, im}^plem^en^{t an}^d^ev^alu^a^te^{a ch}^ronⁱ^{c care im}^prov^em^en^{t prog}^ram^(C^C^I^P⁾^{to im}^prov^{e th}^{e qu}^alit^y^of^care
^e^{dicare Fee-for-S}^{ervice (Section}^f^o^r^b^eⁿ^e^fⁱ^ciar^{ies liv}ⁱⁿ^g^w^ith^ch^r^oⁿⁱ^{c illn}^{esses b}^y^h^e^lpⁱⁿ^g^th^em^m^aⁿ^a^g^e^th^eir^coⁿ^d^itioⁿ^s^an^d^en^co^u^r^agⁱⁿ^g^b^e^tter^co^o^r^dⁱⁿ^a^ted^car^e^{. In}^s^t^ru^ct^s
^th^{e Secr}^etar^y^w^ithⁱⁿ¹²^m^oⁿ^t^h^s^to^en^terⁱⁿ^toⁱⁿ^{itial th}^r^ee-^y^ear^coⁿ^t^r^{acts w}^ith^v^a^rⁱ^o^u^{s ch}^r^oⁿⁱ^{c car}^{e im}^p^r^o^v^em^en^{t o}^r^g^aⁿⁱ^z^a^tⁱ^oⁿ^s^,ⁱⁿ^clu^dⁱⁿ^g
^dⁱ^{sease m}^aⁿ^a^g^e^m^eⁿ^t^o^r^g^aⁿⁱ^zatioⁿ^s^{, h}^ealthⁱⁿ^su^r^e^r^s^,^p^h^y^s^ician^g^r^o^u^p^p^r^{actices an}^d^o^t^h^e^r^en^{tities th}^{e Secr}^etar^y^d^eem^{s ap}^p^r^o^p^r^iate^{. R}^e^qu^ired
^e^l^e^m^eⁿ^t^s^o^f^a^c^h^r^oⁿⁱ^c^c^a^r^eⁱ^m^p^r^o^v^e^m^eⁿ^t^p^l^aⁿⁱⁿ^c^l^ud^e^t^h^e^use^o^f^m^oⁿⁱ^t^o^rⁱ^{ng t}^e^c^hⁿ^o^l^o^gⁱ^e^s^t^h^a^t^eⁿ^a^b^l^e^p^a^tⁱ^e^nt^gui^d^a^nc^e^t^h^r^o^{ugh t}^h^e^use^o^f
^decisⁱ^on^s^u^{pport tools}^,^an^{d th}^{e dev}^e^lopm^en^t^of^{a clin}^{ical in}^f^o^rm^ation^databas^e^{to tr}^ack^an^{d m}^oⁿ^{itor each}^participan^{t acros}^s^s^e^t^tⁱ^{ngs a}ⁿ^d
^ev^alu^a^{te o}^u^tco^m^{es. Req}^u^ir^{es in}^d^e^p^eⁿ^d^en^{t ev}^alu^a^tioⁿ^o^f^th^{e in}^{itial co}ⁿ^t^r^{acts b}^a^sed^oⁿ^th^e^f^o^llo^wⁱⁿ^g^f^acto^r^{s: q}^u^ality^im^p^r^o^v^em^eⁿ^t^m^eas^u^r^es^;
^b^eⁿ^e^fⁱ^ciar^y^an^d^p^r^o^v^id^er^satisf^actioⁿ^;^h^ealth^o^u^tco^m^{es; an}^d^fⁱⁿ^aⁿ^c^{ial o}^u^tco^m^{es (}ⁱⁿ^c^lu^dⁱⁿ^g^co^{st sav}ⁱⁿ^g^s⁾^.^Su^b^s^eq^u^eⁿ^t^to^th^{e ev}^a^lu^atioⁿ^,^th^e
^Secretary^can^ex^pan^d^th^{e C}^C^I^P^or^ch^oos^e^to^im^plem^en^t^th^e^prog^ra^m^oⁿ^{a n}^a^tioⁿ^a^{l b}^a^{sis. Ex}^p^aⁿ^s^ioⁿ^canⁿ^o^{t b}^e^gⁱⁿ^ear^lier^th^an^tw^o^y^ears^af^ter
^th^{e in}^{itial p}^r^o^g^r^a^m^{is u}ⁿ^d^er^tak^eⁿ^an^dⁿ^o^{t later}^th^an^six^m^oⁿ^t^h^s^af^ter^th^{e in}^{itial p}^r^o^g^r^a^m^{is co}^m^p^leted^.^A^u^th^o^r^{izes su}^ch^su^m^s^a^{s m}^a^y^b^e
^ne^c^e^s^s^a^r^y^fo^r^t^h^{e C}^C^IP^{, n}^o^{t to ex}^{ceed $100 m}^illion^ov^{er th}^r^{ee y}^ears^.^In^f^o^rm^ation^on^th^{e C}^C^IP^is^av^ailable^a^t
^[^h^t^t^p^:^/^/^www.^c^m^s^.^h^h^s^.^g^o^v^/^m^e^dⁱ^c^a^r^e^r^e^f^o^r^m/^c^cⁱ^p^]^.
^m^mⁱ^ssioⁿ^oⁿ^Sy^st^e^m^ic^R^e^qu^ires^th^{e Secretary}^{to es}^tablis^h^{a C}^o^m^mⁱ^s^sⁱ^on^on^Sy^s^t^em^ic^In^{teroperability}^{to dev}^e^{lop a com}^p^reh^eⁿ^s^iv^{e s}^t^rateg^y^f^o^{r th}^{e adopt}^ioⁿ^an^d
^{teroperability (Section 1012)}ⁱ^m^pl^em^en^t^a^tⁱ^oⁿ^of^h^eal^t^h^{care IT}^s^t^an^dards^.^Mem^b^ers^of^t^h^{e C}^o^m^mⁱ^s^sⁱ^on^{are t}^o^{be appoi}ⁿ^t^{ed by}^t^h^{e Pres}ⁱ^d^en^t^,^t^h^{e S}^eⁿ^a^t^e^Maj^o^ri^t^{y a}ⁿ^d
ⁱ^{ki/CRS-RL32858}^Min^o^rity^L^eaders^,^an^{d th}^{e Hou}^s^{e Speak}^{er an}^{d Min}^o^rity^L^{eader. In}^dev^e^lopin^g^its^s^t^rateg^y^{, t}^h^{e C}^o^m^mⁱ^s^sⁱ^on^m^u^s^t^con^s^{ider th}^{e cos}^t^{s a}ⁿ^d^ben^e^f^its^of^th^e^s^t^an^dards^,^th^e^cu^rren^t^dem^aⁿ^d^onⁱⁿ^du^s^t^ry^res^o^u^r^ces^{to im}^plem^en^{t th}^es^{e an}^{d oth}^e^{r electron}ⁱ^{c s}^t^an^dards^,^an^{d th}^e^m^o^{st c}^o^st-
^g/w^ef^f^ectⁱ^v^{e an}^{d ef}^fⁱ^ci^en^t^m^ean^s^ofⁱ^m^pl^em^en^t^a^tⁱ^oⁿ^.^T^h^{e C}^o^m^mⁱ^s^sⁱ^on^m^u^s^t^report^t^o^t^h^{e S}^ecret^ary^an^{d C}^oⁿ^g^r^es^s^by^O^c^t^ober^{31, 2005.}^Th^e
^s^.or^C^o^mmi^s^sⁱ^oⁿ^’^s^we^b^sⁱ^t^eⁱ^s^a^t^[^h^t^t^p^:^/^/^www.ⁿ^l^m.ⁿⁱ^h^.^g^o^v^/^c^sⁱ^/^c^sⁱ^_^h^o^m^e^.^h^t^ml^]^.

^le^ak
^://wiki
^h^ttp

CRS-12
Table 2. Comparison of Bills to Encourage the Adoption of Health Information Technology (IT)
¹⁰⁸^th^Congres^s
^H.R^.^{4880 (Ken}ⁿ^e^d^y^{, P.)}^S^{. 2003 (C}^lⁱⁿ^ton⁾^S^.^{2710 (G}^regg)
^dera^{l co}^o^r^dina^tⁱ^oⁿ^R^e^qu^ires^th^{e Secretary}^{to provi}^{de tech}ⁿⁱ^cal^Estab^lish^e^{s an}^{HHS Of}^fⁱ^{ce o}^f^Natioⁿ^a^l^Estab^lish^e^{s an}^{HHS Of}^fⁱ^{ce o}^f^H^ealth^Iⁿ^f^o^r^m^atioⁿ
^d^ership^as^sⁱ^s^t^aⁿ^{ce on}^th^{e creation}^of^regⁱ^on^{al h}^ealth^Health^car^{e I}ⁿ^f^o^r^m^atioⁿ^Iⁿ^f^r^astr^u^c^tu^r^e^to^d^e^v^e^lo^p^T^e^c^hno^l^o^gy^t^o^a^d^vi^se^t^h^e^Secretary^,^{direct all IT}
ⁱⁿ^f^o^r^m^atioⁿⁱⁿ^f^r^astr^u^c^tu^r^e^s.^{a NHII s}^t^rategⁱ^{c plan}^.^activ^{ities w}^ithⁱⁿ^{HHS, an}^d^im^p^l^e^m^en^{t a NHI}^I
^s^t^rategⁱ^{c plan}^.
^ero^pera^bilit^y^{Directs th}^{e Secretaries o}^f^{HHS, DOD,}^an^d^VA^,^Dⁱ^rect^s^t^h^{e S}^ecret^ary^t^o^adoptⁿ^a^tⁱ^oⁿ^a^l^,^v^o^l^uⁿ^t^ary^Dⁱ^rect^s^t^h^{e O}^f^fⁱ^c^e^t^o^adoptⁿ^a^tⁱ^oⁿ^a^l^,^v^o^l^uⁿ^t^ary
^nda^rds^bas^e^d^on^th^{e recom}^m^eⁿ^d^ation^s^of^{a w}^o^rkⁱⁿ^g^h^ealth^IT^s^t^an^dards^.^h^ealth^IT^s^t^an^dards^.
^g^r^ou^{p, t}^o^adopt^h^eal^t^h^IT^s^t^an^dards^.
^an^ts^{, l}^oan^s^,^an^d^A^u^th^orizes^{$55 m}^illioⁿ^f^o^{r FY2005}^,^a^{nd $167}^A^u^th^orizes^{$20 m}^illion^f^o^r^each^of^{FY2004 an}^d^A^u^th^orizes^{$50 m}^illion^each^y^{ear f}^o^r^F^Y²⁰^05-
^gu^aran^tees^m^illion^f^o^{r each}^of^FY2006-^FY2008,^f^o^r^g^r^an^ts^F^Y^{2005 f}^o^{r gr}^aⁿ^t^s^t^o^h^o^s^pⁱ^t^a^l^s^an^{d ot}^h^e^r^F^Y^{2010 f}^o^{r g}^r^an^t^s^t^o^es^t^a^blⁱ^s^h^l^o^cal^h^eal^t^h
ⁱ^{ki/CRS-RL32858}^to^estab^lish^r^e^gⁱ^oⁿ^{al h}^ealthⁱⁿ^f^o^r^m^atioⁿⁱⁿ^f^r^as^tru^c^tu^res^.^A^u^th^orize^s^{$400 m}^illion^each^p^r^o^v^id^er^{s to}^p^a^y^f^o^r^h^ealth^I^T^sy^stem^{s. Req}^u^ir^es⁵⁰^%^m^a^t^c^hi^{ng fund}^s.ⁱⁿ^f^o^r^m^atioⁿⁱⁿ^f^r^astr^u^c^tu^r^e^{s an}^d^to^p^u^r^c^h^a^{se h}^ealth^I^T^sy^st^e^m^s.^Re^q^uⁱ^r^e^s²⁰^%^m^a^t^c^hi^{ng fund}^s^.
^g/w^y^{ear f}^o^{r F}^Y^2009-^F^Y^{2013 t}^o^m^aⁱⁿ^t^aⁱⁿ^/^u^pg^rade^A^u^th^orizes^th^e^s^a^m^e^am^ouⁿ^t^f^o^{r loan}^g^u^a^ran^t^ees^f^o^r
^s^.or^ex^istiⁿ^gⁿ^e^tw^o^r^k^s^an^d^estab^lishⁿ^e^w^oⁿ^es.^t^h^{e s}^a^m^e^pu^rpos^es^.
^le^ak^A^u^th^o^r^{izes lo}^an^{s to}^p^r^o^v^id^e^ad^d^itioⁿ^a^l^f^uⁿ^dⁱⁿ^g
^://wiki^{to g}^r^an^tees^.
^h^ttp^Directs^th^{e Secretary}^t^o^adj^u^s^t^Medicare^N^o^provⁱ^sⁱ^oⁿ^s^.^R^e^q^ui^r^e^s^{a rev}ⁱ^ew^of^f^e^deral^reⁱ^m^b^u^r^s^e^m^eⁿ^t^fo^r
^bursem^e^nt^p^a^y^m^en^{ts to}^p^r^o^v^id^er^{s w}^h^o^u^s^{e h}^ealth^I^T^an^d^to^p^r^o^v^id^er^{s th}^{at u}^{tilize h}^ealth^I^T^sy^stem^s.
^prov^{ide m}^a^tchⁱⁿ^g^{Medicaid pay}^m^en^ts^{to s}^t^ates
^t^h^a^t^fund^r^e^gi^oⁿ^a^l^he^a^l^t^h^I^T^ne^t^w^o^r^ks.
^s^u^{rance m}^a^ndates^N^o^provⁱ^sⁱ^oⁿ^s^.^N^{o prov}ⁱ^sⁱ^oⁿ^s^.^N^{o prov}ⁱ^sⁱ^oⁿ^s^.
^{gal barriers}^Cr^{eates a saf}^e^h^a^r^b^o^r^f^r^o^m^p^eⁿ^a^lties^uⁿ^d^e^r^th^e^N^o^provⁱ^sⁱ^oⁿ^s^.^N^{o prov}ⁱ^sⁱ^oⁿ^s^.
^an^ti-^kⁱ^ck^back^s^t^atu^t^{e an}^{d an}^e^x^ception^to
^Medⁱ^car^{e lim}^itatioⁿ^s^oⁿ^p^h^y^s^ician^self^-^r^ef^er^r^a^l
^f^o^{r t}^h^{e prov}ⁱ^sⁱ^oⁿ^of^h^eal^t^h^IT^equi^pm^en^t^an^d
^s^e^rv^ices^.
^e^arch^N^o^provⁱ^sⁱ^oⁿ^s^.^Iⁿ^s^t^r^u^c^t^s^A^H^R^Q^an^{d N}^I^H^t^o^con^d^u^c^t^an^d^s^u^pport^N^o^provⁱ^sⁱ^oⁿ^s^.

^r^e^sear^ch^oⁿ^th^{e u}^s^{e o}^f^I^Tⁱⁿ^im^p^r^o^vⁱⁿ^g^h^e^a^lth
^care.

CRS-13
¹⁰⁸^th^Congres^s¹⁰⁹^th^Congres^s
^S^.^{2421, T}ⁱ^tl^{e I}^(Kenⁿ^e^d^y⁾^H^.R^{. 747 (G}^on^zal^{ez, C}^.⁾^S^{. 16, T}ⁱ^tl^{e I}^I^(Kenⁿ^e^d^y⁾
^dera^{l co}^o^r^dina^tⁱ^oⁿ^No^p^r^o^v^isioⁿ^s^.^E^stab^lish^e^{s an}^Of^fⁱ^{ce o}^f^th^{e Natio}ⁿ^a^l^Co^o^r^dⁱⁿ^a^t^o^r^Es^tablis^h^e^s^an^Of^fⁱ^{ce of}^Health^In^f^o^rm^ati^oⁿ
^d^ership^f^o^r^Health^Iⁿ^f^o^r^m^atioⁿ^T^echⁿ^o^lo^g^y^w^ithⁱⁿ^th^e^T^echⁿ^o^lo^g^y^w^ithⁱⁿ^th^{e Ex}^ecu^tiv^{e Of}^fⁱ^{ce o}^f^th^e
^Ex^ecu^tiv^e^O^f^fⁱ^{ce of}^th^{e P}^r^es^iden^{t to be h}^{eaded by}^P^r^esⁱ^d^eⁿ^t^{to adv}ⁱ^s^e^th^{e P}^r^es^iden^{t, direct all}
^{a Director w}^h^{o reports}^directly^{to th}^{e P}^r^es^iden^t.^h^ealth^I^T^activ^{ities w}^ithⁱⁿ^th^{e f}^e^d^e^r^a^l
^g^o^v^e^rn^m^e^{nt, an}^{d im}^plem^en^{t a NHII s}^t^rategⁱ^c
^pl^an^.
^ero^pera^bilit^y^Dⁱ^rect^s^t^h^{e S}^ecret^ary^t^o^adoptⁿ^a^tⁱ^oⁿ^a^l^h^eal^t^h^IT^Dⁱ^r^e^c^t^s^t^h^e^S^e^c^r^e^t^a^r^y^t^o^a^dopt^aⁿ^d^t^e^s^tⁿ^a^tⁱ^oⁿ^a^l^Dⁱ^rect^s^t^h^e^O^f^fⁱ^{ce t}^o^adoptⁿ^a^tⁱ^oⁿ^a^l^,^v^o^l^uⁿ^t^ary
^nda^rds^staⁿ^d^a^r^d^s.^h^ealth^IT^s^t^an^dards^.^h^ealth^IT^s^t^an^dards^.
^an^ts^{, l}^oan^s^,^an^d^l^oan^A^u^th^orizes^s^u^c^h^s^u^m^s^as^m^a^y^{be n}^eces^s^a^ry^f^o^r^A^u^th^orizes^s^u^ch^s^u^m^s^as^m^a^y^{be n}^eces^s^a^ry^f^o^r^A^u^th^orizes^s^u^ch^s^u^m^s^as^m^a^y^beⁿ^eces^s^a^ry^f^o^r
^aran^tees^g^r^an^ts^{, loan}^s^,^an^{d loan}^gua^r^aⁿ^t^ees^{to in}^s^t^{all an}^d^g^r^an^ts^an^d^r^e^v^o^lvⁱⁿ^g^lo^an^{s f}^o^r^sm^{all h}^ealth^car^e^F^Y^2006-^F^Y^{2011 f}^o^{r g}^r^an^t^s^aⁿ^d^l^o^aⁿ
^im^plem^en^{t clin}^{ical IT}^s^y^s^t^em^s^th^{at m}^{eet n}^a^tion^a^l^prov^iders^{to acqu}ⁱ^{re EHR}^s^an^{d oth}^e^{r h}^ealth^IT^.^g^u^aran^tees^{to es}^tablis^h^{local h}^ealth
^st^aⁿ^d^a^r^d^s.^Re^q^uⁱ^r^e^s¹⁰^%^ma^t^c^hi^{ng fund}^{s fo}^r^C^r^eates^{a tax}^credi^t^f^o^{r ph}^y^s^ician^s^w^h^{o acqu}ⁱ^reⁱⁿ^f^o^r^m^atioⁿⁱⁿ^f^r^astr^u^c^tu^r^e^{s an}^d^to^p^u^r^c^h^a^se
ⁱ^{ki/CRS-RL32858}^g^r^an^{ts to}^co^m^m^uⁿ^ity^h^ealth^cen^ter^s^{, an}^d²⁰^%^EH^R^s^an^{d ot}^h^e^{r h}^eal^t^h^I^T^,^equ^a^l^t^o^10%^of^t^h^e^h^ealt^h^I^T^s^y^s^t^em^s^.^R^e^qu^ires^{20% m}^a^tchⁱⁿ^g
^g/w^m^a^t^c^hi^{ng fund}^{s fo}^r^gr^aⁿ^t^s^t^o^o^t^he^r^no^n-p^r^o^fⁱ^t^am^ouⁿ^t^s^{paid du}^rin^g^th^{e tax}^a^{ble y}^ear.^fund^{s fo}^r^I^T^gr^aⁿ^t^s^.
^s^.or^h^ealth^car^e^f^acilities^an^d^f^o^r^p^h^y^s^ician^p^r^actices.
^le^ak^Man^d^a^t^esⁱⁿ^creas^esⁱⁿ^f^e^{deral h}^ealth^prog^ram^In^s^t^ru^cts^th^{e Secreta}^r^y^{to prov}^{ide Medicare}^M^aⁿ^d^ates^recom^m^eⁿ^d^ation^s^an^{d an}
^://wiki^bursem^e^nt^rei^m^bu^rs^em^en^t^f^o^{r prov}ⁱ^d^ers^w^h^{o i}^m^pl^em^en^t^clin^{ical I}^T^sy^ste^m^{s co}ⁿ^s^isten^t^w^ithⁿ^a^tioⁿ^a^l^p^a^y^m^en^tⁱⁿ^cen^tiv^es^to^h^e^lp^sm^{all p}^r^o^v^id^er^{s acq}^uⁱ^r^e^EHR^s^an^d^o^t^he^r^h^ealth^IT^{, s}^u^ch^as^add-^on^im^plem^en^tation^plan^f^o^{r ch}^an^g^e^s^{to f}^e^d^e^ral^reim^bu^rs^em^en^{t an}^{d pay}^m^en^{t s}^t^ru^ctu^r^{e to}
^h^ttp^stan^d^a^r^d^s^an^d^w^h^o^c^a^r^r^y^o^u^t^q^u^ality^pay^m^en^t^s^f^o^{r of}^fⁱ^{ce v}ⁱ^sⁱ^t^s^s^u^pport^e^{d by}^h^eal^t^h^IT^,^prom^ot^{e t}^h^{e adopt}ⁱ^oⁿ^of^h^eal^t^h^IT^.
^im^p^r^o^v^em^en^{t ac}^tⁱ^v^{ities. Man}^d^{ates d}^ecr^{eases in}^an^d^p^a^y^m^en^{ts f}^o^r^e-^m^a^{il co}ⁿ^s^u^ltatioⁿ^s^.
^r^e^im^b^u^r^s^em^en^{t f}^o^r^p^r^o^v^id^er^{s w}^h^o^f^a^il^to^m^eet
^th^os^{e requ}^irem^en^ts^.
^s^u^{rance m}^a^ndates^R^e^quⁱ^r^es^g^r^ou^{p h}^e^a^l^t^h^p^l^aⁿ^s^an^{d i}ⁿ^s^u^rers^t^o^N^o^provⁱ^sⁱ^oⁿ^s^.^N^{o prov}ⁱ^sⁱ^oⁿ^s^.
^im^plem^en^t^com^p^u^t^{erized s}^y^s^t^em^s^f^o^{r claim}^s
^proces^sⁱⁿ^g^(w^ith^real-^tim^{e detection}^of^f^r^au^d^an^d
^a^b^use⁾^,^aⁿ^d^fo^r^m^a^ki^{ng i}ⁿ^fo^r^m^a^tⁱ^o^{n a}^b^o^u^t
^ben^e^fi^t^s^an^{d claim}^s^av^{ailable to patien}^t^s
^electronⁱ^cally^.^R^e^qu^ires^th^{e Secretary}^to
^es^t^a^blⁱ^s^h^pay^-^f^o^r-^perf^orm^aⁿ^c^{e s}^t^an^dards^an^d
^prov^ides^f^o^{r h}^ealth^{care pay}^e^rs^{to inc}^r^e^a^s^e
^pay^m^en^ts^{to prov}^iders^th^{at m}^{eet th}^{e s}^t^an^dards^.
^{gal barriers}^N^o^provⁱ^sⁱ^oⁿ^s^.^N^{o prov}ⁱ^sⁱ^oⁿ^s^.^N^{o prov}ⁱ^sⁱ^oⁿ^s^.
^e^arch^N^o^provⁱ^sⁱ^oⁿ^s^.^N^{o prov}ⁱ^sⁱ^oⁿ^s^.^N^{o prov}ⁱ^sⁱ^oⁿ^s^.

CRS-14
Table 3. Summary of Health Information Technology (IT) Legislation Introduced in the 108^th Congress
^B^{ills pa}^{ssed by}^t^h^{e H}^o^{use a}^{nd Sena}^t^e
^en^{t s}^a^{fety: rep}^ortiⁿ^g^{H.R. 663 (B}^ilirak^is^{) Patient}^Safety^{and Q}^u^{ality I}^m^provem^e^{nt Act.}^Oⁿ^March^{12, 2003, t}^h^{e H}^o^u^s^{e pas}^s^e^{d H}^.^R^.^{663 (H}^.R^ept^.^108-^{28) on}^{a v}^o^t^e
^e^{dical errors}^of^418-^6.^H^.^R^.⁶⁶³^w^a^sⁱⁿ^t^eⁿ^d^{ed t}^o^en^cou^r^ag^{e t}^h^{e v}^o^l^uⁿ^t^ary^reportⁱⁿ^g^an^{d an}^al^y^sⁱ^s^of^m^e^di^cal^errors^by^prot^ectⁱⁿ^g^s^u^chⁱⁿ^f^o^rm^a^tioⁿ^f^r^o^m^leg^a^l^a
^dis^c^ov^ery^an^{d adm}ⁱ^s^sⁱ^onⁱⁿ^civ^{il an}^d^a^d^mⁱ^nis^t^rativ^{e proceedi}ⁿ^g^s^{, an}^{d f}^r^om^Freedom^of^In^f^o^rm^ation^A^c^{t (FOIA}⁾^requ^es^ts^.^T^h^{e b}^{ill w}^o^u^l^d^h^a^v^e
^r^e^q^u^ir^ed^th^{e A}^g^en^cy^f^o^r^Health^car^e^Resear^ch^an^d^Qu^ality⁽^A^HRQ)^to^cer^tif^y^p^a^tien^t^saf^e^ty^o^r^g^aⁿⁱ^zatioⁿ^s⁽^P^SOs)^to^co^{llect an}^d^an^aly^{ze in}^f^o^rm^ation
^report^e^{d by}^h^eal^t^h^{care prov}ⁱ^d^ers^.^PS^O^s^w^o^u^l^{d t}^h^en^dev^e^l^{op an}^{d di}^s^s^e^mⁱⁿ^a^t^e^recom^m^eⁿ^d^atⁱ^oⁿ^s^f^o^{r s}^y^s^t^em^s^-^bas^e^d^so^l^u^tⁱ^oⁿ^s^t^oⁱ^m^pr^ov^{e pat}ⁱ^eⁿ^t
^s^a^f^e^ty^an^{d h}^ealth^{care qu}^ality^{. H.R}^.^{663 als}^o^w^o^u^l^{d h}^a^v^e^requ^ir^{ed A}^H^R^Q^to^dev^e^lop^v^o^luⁿ^t^aryⁿ^a^tion^a^{l s}^t^an^dards^{to prom}^{ote th}^eⁱⁿ^ter^o^p^e^r^a^b^ility
^o^f^h^ealth^I^T^sy^stem^s.^Iⁿ^ad^d^itioⁿ^,^th^e^b^ill^w^o^u^l^d^h^a^v^e^au^th^o^r^ized^g^r^an^{ts to}^p^h^y^s^ician^s^an^d^h^o^sp^{itals f}^o^r^electr^oⁿⁱ^{c p}^r^escr^ibⁱⁿ^g^an^d^o^t^h^e^rⁱⁿ^f^o^r^m^atioⁿ
^t^echⁿ^o^l^o^g^y^t^o^prev^en^t^errors^{. F}ⁱⁿ^a^l^l^y^{, H}^.^R^.^{663 w}^o^u^l^{d h}^a^v^e^creat^{ed a Medi}^cal^In^f^o^rm^atⁱ^oⁿ^T^echⁿ^o^l^o^g^y^A^d^vⁱ^s^o^ry^Board^t^o^m^a^k^e^rec^o^m^m^e^nd^a^tⁱ^o^ns
^t^o^H^H^S^an^{d C}^oⁿ^g^r^es^s^on^f^o^s^t^eriⁿ^g^t^h^{e dev}^e^l^opm^en^t^an^{d u}^s^{e of}^h^ealth^IT^{to redu}^{ce m}^e^{dical errors}^.
^S^.⁷²⁰^(Jefford^s⁾^Pati^en^{t S}^a^{fety an}^d^Q^u^alⁱ^t^y^I^m^p^r^ovem^eⁿ^t^A^c^t.^Oⁿ^Ju^l^y^{23, 2003, t}^h^{e S}^eⁿ^a^t^e^H^eal^t^h^{, Edu}^catⁱ^oⁿ^,^L^a^{bor, an}^{d Pen}^sⁱ^oⁿ^s^(H^EL^P)
^C^o^m^mⁱ^t^t^{ee approv}^{ed S}^.^{720 (S}^.R^ept^.^108-^{196), w}^hⁱ^c^h^w^a^s^broadl^y^sⁱ^mⁱ^l^a^{r t}^o^t^h^{e H}^o^u^s^{e m}^eas^u^r^{e. O}ⁿ^Ju^l^y^{22, 2004, t}^h^e^S^eⁿ^a^t^e^t^ook^u^p^H^.^R^.^663,
^str^u^c^k^the^la^ngua^ge^a^p^p^r^o^v^e^d^b^y^the^Ho^use^aⁿ^d^sub^s^titute^d^{it w}^{ith a}ⁿ^a^m^eⁿ^d^e^d^ve^r^s^io^{n o}^f^S.^{720, t}^h^en^pas^s^e^{d t}^h^{e m}^eas^u^r^{e by}^uⁿ^aⁿⁱ^m^o^u^s^con^s^en^t^.
ⁱ^{ki/CRS-RL32858}^Uⁿ^lⁱ^k^{e H}^.^R^.^{663 as}^pa^sse^d^b^y^t^h^{e H}^o^u^s^{e, t}^h^{e S}^eⁿ^a^t^e^v^e^rsⁱ^oⁿ^di^{d n}^o^tⁱⁿ^cl^u^d^{e h}^eal^t^h^IT^g^r^an^t^s^{or t}^h^{e es}^t^a^blⁱ^s^h^m^en^t^of^{a Medi}^cal^Iⁿ^f^o^r^m^a^tioⁿ^th
^g/w^T^e^c^hno^l^o^gy^A^d^vi^so^r^y^B^o^a^r^d^.^T^h^e^r^e^w^a^{s no}^fur^t^he^r^a^c^tⁱ^o^{n o}ⁿ^p^a^tⁱ^eⁿ^t^s^a^f^e^t^y^l^e^gi^sl^a^tⁱ^o^{n i}ⁿ^t^h^e¹⁰⁸^Coⁿ^g^r^{ess. Fo}^r^m^o^r^eⁱⁿ^f^o^r^m^atioⁿ^,^{see CRS}
^s^.or^R^e^port^R^L^31983,^Hea^lth^Ca^{re Qu}^a^lity:^I^m^p^r^o^vⁱⁿ^g^Pa^tien^t^S^a^f^{ety b}^y^Pro^m^o^tin^g^Medⁱ^ca^{l Erro}^{rs Rep}^o^r^tin^g^.
^le^ak^Int^r^o^{duced B}^{ills (}^N^o^legⁱ^sla^t^iv^{e a}^c^tⁱ^vⁱ^t^y⁾
^://wiki^e^dⁱ^care^I^T^gran^ts^H.R^.^{3035 (Hou}^gh^ton⁾^{, S}^.^{1729 (G}^rah^a^m^,^{B.) M}^e^dⁱ^cati^on^E^rror^R^e^d^u^c^ti^on^A^c^t.^A^u^th^o^r^{izes g}^r^an^{ts to}^h^o^sp^{itals an}^d^Medⁱ^car^eⁿ^u^r^sin^g^h^o^m^e^s,
^h^ttp^kⁿ^o^wⁿ^{as sk}^illedⁿ^u^r^sin^g^f^{acilities (}^S^NFs)^{, to}^p^u^r^c^h^a^{se o}^r^im^p^r^o^v^{e co}^m^p^u^t^e^rⁱ^z^e^d^sy^stem^{s th}^{at h}^e^lp^r^e^d^u^{ce m}^e^dⁱ^catioⁿ^er^r^o^r^s^{, an}^d^t^o^provⁱ^d^e
^ed^u^catioⁿ^an^d^tr^ainⁱⁿ^g^to^staf^f^oⁿ^p^a^tien^t^saf^e^ty^p^r^o^g^r^a^m^s^{. T}^h^{e b}^{ill sets asid}^{e 2}⁰^%^o^f^th^{e f}^uⁿ^d^{s f}^o^r^r^u^r^a^{l p}^r^o^v^id^er^s.^H^o^s^pⁱ^t^a^l^s^aⁿ^d^{SNFs w}^h^o^s^e
^patⁱ^eⁿ^t^popu^l^a^tⁱ^oⁿ^sⁱⁿ^cl^u^d^e^a^hⁱ^g^h^percen^t^a^g^e^of^Medi^{care, Medi}^cai^{d, an}^{d S}^C^H^I^{P ben}^e^fⁱ^ci^ari^e^s^{are t}^o^{be g}ⁱ^v^eⁿ^s^p^eci^al^con^sⁱ^d^erat^ion^w^h^en^aw^ardin^g
^g^r^an^ts^{. Gran}^{t aw}^ards^m^a^yⁿ^o^{t ex}^{ceed $750,000 f}^o^{r h}^o^s^p^itals^{, an}^{d $200,000 f}^o^{r S}^N^F^s^{. A}^u^th^orizes^{appropriation}^s^f^r^om^th^{e Medicar}^{e P}^a^{rt A}^T^r^u^s^t
^Fuⁿ^d^of^{$93 m}^illion^{per y}^{ear f}^o^{r FY2004-}^FY2013^f^o^r^m^a^kⁱⁿ^g^g^r^an^ts^to^h^o^s^p^itals^,^an^d^$4.5^m^illion^per^y^{ear ov}^{er th}^{e s}^a^m^e^{period f}^o^r^m^a^ki^{ng gr}^aⁿ^t^s
^to^SNFs.
^ti^on^al^Heal^th^Iⁿ^form^ati^oⁿ^H.R^.^{2915 (Joh}ⁿ^s^on^,^N^.⁾^N^a^ti^on^al^Heal^th^Iⁿ^form^ati^oⁿ^Iⁿ^fras^tru^c^tu^{re A}^c^t.^In^s^t^ru^ct^s^t^h^{e S}^ecret^ary^t^o^appoiⁿ^t^{a N}^a^tⁱ^oⁿ^a^l^H^eal^t^h^In^f^o^rm^atⁱ^oⁿ
^fras^tru^c^tu^{re (NHI}^I⁾^,^Of^fⁱ^{cer f}^o^{r a f}ⁱ^v^e^-^y^{ear term}^{to prov}^{ide n}^a^tioⁿ^a^{l lead}^er^sh^ip^f^o^r^th^{e d}^e^v^e^lo^p^m^en^{t o}^f^{a NHI}^I^.^Req^u^ir^{es th}^{e Of}^fⁱ^cer^{, w}^ithⁱⁿ^six^m^o^nt^hs,^t^o^d^e^ve^l^o^p^a
^l^t^h^{IT st}^a^nda^rds^{NHII s}^t^rategⁱ^{c plan}^{, f}^o^llow^e^{d by}^an^as^s^e^s^s^m^en^{t of}^bes^t^practicesⁱⁿ^th^{e dev}^e^lopm^en^{t an}^{d pu}^rch^a^s^e^of^m^e^{dical IT}^{, as}^w^e^{ll as}^reco^m^m^e^nd^a^tⁱ^o^{ns fo}^r
^h^ealth^d^a^{ta stan}^d^a^r^d^{s to}^ach^iev^eⁱⁿ^ter^o^p^e^r^a^b^ility^o^f^h^ealth^I^T^sy^stem^{s. Dir}^{ects th}^{e Secr}^etar^y^,^b^a^sed^oⁿ^th^o^s^{e r}^eco^m^m^eⁿ^d^atioⁿ^s^,^t^o^adopt^v^o^l^uⁿ^t^ary^,
ⁿ^a^tioⁿ^a^{l h}^ealth^d^a^{ta an}^d^co^m^m^uⁿⁱ^catioⁿ^s^stan^d^a^r^d^s.

CRS-15
^th^I^T^gran^ts^an^d^l^oan^s^,^H.R^.⁴⁸⁸⁰^(Kenⁿ^e^d^y^,^{P.) Q}^u^alⁱ^t^{y, E}^f^fi^ci^en^{cy, S}^t^an^d^a^rd^s^,^an^d^T^echⁿ^o^l^{ogy for Heal}^th^C^a^re^T^r^an^s^f^orm^a^ti^on^A^c^t.^{(1) A}^u^th^orizes^th^{e Secretary}
^nda^r^d^s,^le^g^a^l^sa^f^e^ha^r^b^o^r^,^to^aw^ar^d^u^p^to²⁰^,^f^o^u^r^-^y^ear^“^P^h^a^{se I}^”^g^r^an^{ts to}^h^ealthⁱⁿ^f^o^r^m^atioⁿⁱⁿ^f^r^astr^u^c^tu^r^e^o^r^g^aⁿⁱ^zatioⁿ^s^to^d^e^v^e^lo^p^an^d^im^p^l^em^en^{t an}ⁱⁿ^t^e^roperabl^{e h}^eal^t^h
^e^{dicare reim}^burs^e^m^e^nt,ⁱⁿ^f^o^rm^atⁱ^oⁿⁿ^e^t^w^ork^,^bas^e^d^on^{a reg}ⁱ^on^al^h^eal^t^h^IT^pl^an^approv^ed^by^th^{e Secretary}^.^A^u^th^orizes^th^{e Secretary}^,^af^{ter f}^o^u^r^y^ears^,^{to aw}^ard^“^P^h^a^s^e
^e^{dicaid federal m}^a^tch,^{II” g}^r^an^ts^{to s}^t^ates^th^{at ag}^{ree to fund}^s^u^c^h^o^r^g^aⁿⁱ^z^a^tⁱ^o^{ns t}^o^m^aⁱⁿ^t^aⁱⁿ^aⁿ^d^up^gr^a^d^e^e^xⁱ^s^tⁱ^{ng ne}^t^w^o^r^{ks a}ⁿ^d^d^e^ve^l^o^p^ne^w^oⁿ^e^s^.^A^u^t^h^o^rizes^th^e
^t^{-effectivenes}^s^res^earch,^Secretary^,^af^ter^f^o^u^r^m^o^re^y^ears^,^{to aw}^{ard “}^P^h^a^s^e^{III” m}^aⁱⁿ^ten^aⁿ^ce^g^r^an^ts^to^s^t^atesⁱⁿ^w^h^ich^{at leas}^{t 75% of}^h^ealth^{care prov}^id^er^{s ar}^{e p}^a^r^ticip^atin^g
^tcom^es^an^d^q^u^a^lⁱ^t^y,ⁱⁿ^{a n}^e^tw^ork^.^R^e^qu^ires^th^{e Secretary}^{to prov}^{ide tech}ⁿⁱ^{cal as}^sⁱ^stan^{ce o}ⁿ^th^{e cr}^eatioⁿ^o^f^h^ealthⁱⁿ^f^o^r^m^atioⁿⁱⁿ^f^r^astr^u^c^tu^r^e^{s an}^d^directs^AH^R^Q^t^o
^a^nce^es^t^a^blⁱ^s^h^aⁿ^a^tⁱ^oⁿ^a^l^t^echⁿⁱ^cal^as^sⁱ^s^t^an^{ce cen}^t^e^{r t}^o^h^e^l^p^ph^y^sⁱ^cⁱ^aⁿ^s^(es^p^eci^al^l^yⁱⁿ^s^m^al^l^practⁱ^ces^{) adopt}^h^eal^t^h^IT^an^d^partⁱ^cⁱ^p^a^{te in}^r^e^gⁱ^oⁿ^{al n}^e^tw^o^r^k^s^.
^R^e^qu^ires^th^{e Secretary}^{to es}^tablis^h^{a prog}^ram^f^o^{r certif}^yⁱⁿ^g^regⁱ^on^{al h}^ealthⁱⁿ^f^o^rm^ationⁱⁿ^f^r^as^tru^c^tu^res^.^A^u^th^orizes^{$55 m}^illi^onⁱⁿ^F^Y^{2005, an}^d
^{$167 m}^illion^f^o^{r each}^of^FY2006-^{FY2008 f}^o^{r P}^h^as^{e I g}^r^an^ts^{; $400}^m^illion^f^o^r^each^of^FY2009-^{FY2013 f}^o^{r P}^h^as^{e II g}^r^an^ts^{; an}^{d s}^u^ch^s^u^ms^a^s^ma^y
^{be n}^eces^s^a^ry^f^o^{r F}^Y^{2014 an}^{d each}^s^u^bs^equ^eⁿ^t^fⁱ^s^{cal y}^{ear f}^o^{r P}^h^as^{e III g}^r^an^ts^{. (2) Directs}^th^{e S}^ecretaries^of^HHS^{, DOD, an}^{d th}^{e VA}^{, w}^ithⁱⁿ^oⁿ^e
^y^{ear an}^{d af}^{ter con}^s^iderin^g^th^{e recom}^m^eⁿ^d^ation^s^of^a^W^o^rkⁱⁿ^g^Grou^{p con}^v^eⁿ^e^{d by}^th^{e HHS Secretary}^,^{to adopt in}^{teroperability}^s^t^an^dards^f^o^{r h}^eal^t^h
^IT^s^y^s^t^em^s^.^Specifⁱ^es^th^{e m}^e^m^b^ers^h^{ip of}^th^{e W}^o^rkⁱⁿ^g^Grou^{p an}^d^requ^ires^{it to f}^o^rm^u^l^{ate recom}^m^eⁿ^d^ation^s^on^:^com^pon^en^ts^of^elect^ronⁱ^{c m}^e^dical
^records^;^cliⁿⁱ^c^{al data ex}^ch^an^g^e^an^{d term}ⁱⁿ^olog^ies^;^m^e^{dical k}ⁿ^o^w^l^edg^e^repres^en^tation^;^com^p^u^t^{erized ph}^y^s^ician^{order en}^try^;^an^{d pr}^iv^acy^an^{d s}^ecu^rity^.
^A^u^th^orizes^$5^m^illion^f^o^{r FY2005 an}^{d f}^o^{r FY2006, an}^{d $2 m}^illion^f^o^{r FY2007 an}^{d each}^s^u^bs^equ^eⁿ^t^fⁱ^s^cal^y^ear.⁽³⁾^A^u^th^orizes^th^e^Secretary^to
^m^a^k^e^lo^an^{s to}^P^h^{ase I}^an^d^P^h^{ase I}^I^g^r^an^tees,^w^ith^a^r^e^p^a^y^m^en^t^p^e^rⁱ^o^d^o^f^u^p^to¹⁰^y^ear^{s, to}^p^r^o^v^id^{e ad}^d^itioⁿ^a^{l f}^uⁿ^dⁱⁿ^g^f^o^r^activ^{ities co}^v^e^r^e^d^uⁿ^d^er
^th^e^g^r^an^ts^{. (4) C}^r^eates^{a s}^a^f^e^h^a^{rbor f}^r^om^pen^a^lties^uⁿ^d^{er th}^{e an}^ti-^kⁱ^ck^back^s^t^atu^t^{e (42 U.S.C}^.^§1320a-^{7b(b)) f}^o^{r equ}ⁱ^pm^en^{t an}^{d s}^e^rvⁱ^ces^provⁱ^d^ed
^f^o^r^d^e^v^e^lo^pⁱⁿ^g^o^r^im^p^l^em^en^tin^g^{a h}^ealthⁱⁿ^f^o^r^m^atioⁿⁱⁿ^f^r^astr^u^c^tu^r^e^uⁿ^d^er^th^{is A}^c^{t, as lo}ⁿ^g^{as th}^{e p}^r^o^v^isioⁿ^o^f^su^ch^eq^uⁱ^p^m^en^{t a}^nd^se^r^vⁱ^c^e^sⁱ^s^no^t
ⁱ^{ki/CRS-RL32858}^b^a^sed^oⁿ^th^{e am}^o^uⁿ^t^o^r^v^a^lu^{e o}^f^b^u^sin^e^{ss b}^e^tw^een^th^{e p}^a^r^{ties. (}⁵⁾^Cr^{eates an}^ex^cep^tioⁿ^to^Medⁱ^car^e^lim^itatioⁿ^s^oⁿ^p^h^y^s^ician^se^l^f^-^r^ef^erral^{(42 U.S}^.^C^.^§¹³⁹⁵ⁿⁿ⁽^e))^f^o^r^equⁱ^pm^en^t^an^d^s^e^rvⁱ^ces^provⁱ^d^ed^f^o^{r dev}^e^l^opiⁿ^g^{or i}^m^pl^em^en^tⁱⁿ^g^{a h}^eal^t^hⁱⁿ^f^o^rm^atⁱ^oⁿⁱⁿ^f^r^as^t^r^u^c^t^u^{re u}ⁿ^d^{er t}^hⁱ^s^A^c^{t, as lo}ⁿ^g^as
^g/w^t^h^e^provⁱ^sⁱ^oⁿ^of^s^u^ch^equⁱ^pm^en^t^an^d^s^e^rvⁱ^cesⁱ^sⁿ^o^t^bas^e^{d on}^t^h^{e am}^ouⁿ^t^{or v}^a^l^u^{e of}^bu^sⁱⁿ^e^s^s^bet^w^een^t^h^{e part}ⁱ^e^s^.^{(6) In}^s^t^ru^ct^s^th^{e Secretary}^to
^s^.or^m^a^k^e^ad^j^u^stm^eⁿ^t^{s in}^Medⁱ^car^{e p}^a^y^m^en^ts^t^o^p^r^o^vⁱ^d^e^r^s^w^h^o^p^a^r^ticip^{ate in}^{a cer}^tif^ied^h^ealthⁱⁿ^f^o^r^m^atioⁿⁱⁿ^f^r^astr^u^c^tu^r^e^{, o}^r^w^h^o^u^s^e^I^T^to^im^p^r^o^v^e
^le^ak^th^{e q}^u^ality^an^d^accu^racy^o^f^clin^ical^d^ecisioⁿ^s.⁽⁷⁾^In^stru^cts^th^{e Secretary}^to^m^a^k^e^m^a^tchⁱⁿ^g^Medⁱ^caid^p^a^y^m^en^{ts to}^states^th^at^p^r^o^vⁱ^d^e^fundⁱ^{ng fo}^r
^://wiki^an^approv^{ed reg}ⁱ^on^{al h}^ealth^IT^plan^{. Man}^d^ates^{a 90% f}^e^{deral m}^a^tch^du^rin^g^th^{e f}ⁱ^rs^t^th^ree^y^ears^of^s^u^ch^s^t^{ate f}^uⁿ^dⁱⁿ^g^.^{(8) A}^m^eⁿ^d^s^S^ectⁱ^oⁿ¹⁰¹³^(“^Ou^tcom^es^R^e^s^earch^{”) of}^th^{e Medicare Modern}^ization^A^c^{t (s}^ee^Ta^ble¹⁾^t^oⁱⁿ^cl^u^d^{e res}^earch^on^cos^t^-^e^f^f^ectⁱ^v^en^es^s^,^an^{d t}^o^requⁱ^r^{e t}^h^at^A^H^R^Q^adopt
^h^ttp^an^{d im}^plem^en^{t th}^{e priorities}^es^tablis^h^e^{d by}^th^{e C}^oⁿ^s^ortiu^m^f^o^{r H}^ealth^Ou^tcom^es^R^e^s^earch^P^r^iorities^.^A^u^th^orizes^$150^m^illion^f^o^{r F}^Y^{2005, $250}
^m^illion^f^o^{r FY2006, $400 m}^illion^f^o^r^{FY2007, $750 m}^illion^f^o^{r FY}^{2008, $1 b}^illion^f^o^{r FY2009,}^an^d^s^u^ch^s^u^m^s^as^m^a^y^{be n}^eces^s^a^ry^f^o^{r each}^fⁱ^s^cal
^y^ear^th^er^eaf^ter^.⁽⁹⁾^Dir^{ects A}^H^{RQ an}^d^th^e^Iⁿ^stitu^te^o^f^Medⁱ^cin^e⁽^I^OM)^to^estab^lish^{a Co}ⁿ^s^o^r^tiu^m^f^o^r^Health^Ou^tco^m^{es Resear}^ch^P^rⁱ^o^r^{ities. (}¹⁰⁾
^In^s^t^ru^ct^s^A^H^R^Q^{, i}ⁿ^col^l^a^boratⁱ^oⁿ^wⁱ^t^h^t^h^{e N}^a^tⁱ^oⁿ^a^l^Lⁱ^brary^of^Medi^ciⁿ^e^{, t}^o^es^t^a^blⁱ^s^h^a^C^eⁿ^t^er^f^o^r^C^lⁱⁿⁱ^cal^D^eci^sⁱ^on^-^S^u^pport^T^e^c^hⁿ^o^lo^g^y^to^en^ab^le
^h^ealth^{care prov}^iders^m^o^{re ef}^fⁱ^cien^tly^an^{d rapidly}^{to em}^{bed k}ⁿ^o^w^l^ed^g^e^-^b^as^{ed elem}^en^tsⁱⁿ^th^{eir clin}^{ical in}^f^o^rm^ation^s^y^s^t^em^s^.^A^u^th^o^r^{izes $}²^m^illioⁿ
^f^o^r^F^Y^{2005, an}^{d s}^u^ch^s^u^m^s^as^m^a^y^{be n}^eces^s^a^ry^f^o^{r each}^fⁱ^s^{cal y}^{ear th}^ereaf^{ter. (11)}^In^s^t^ru^cts^A^H^R^Q^to^f^uⁿ^d^s^c^h^o^lars^hⁱ^ps^f^o^r^s^t^u^d^yⁱⁿ^h^ealth^car^e
^qu^ality^an^{d patien}^t^s^a^f^e^ty^{. A}^u^th^orizes^$2^m^illion^f^o^r^FY2005,^an^d^s^u^ch^s^u^m^s^as^m^a^y^beⁿ^eces^s^a^ry^f^o^{r each}^fⁱ^s^{cal y}^{ear th}^ereaf^te^{r. (12) R}^e^quⁱ^r^es
^th^{e Co}ⁿ^s^o^r^tiu^m^,^w^ithⁱⁿ^oⁿ^{e y}^ear^{, to}^id^en^tif^y^p^r^io^r^{ities f}^o^r^d^e^v^e^lo^pⁱⁿ^g^,^id^en^tif^yⁱⁿ^g^,^an^d^en^d^o^r^sin^g^stan^d^a^r^d^ized^m^easu^r^{es o}^f^h^e^a^lth^{care prov}^id^e^r
^p^e^r^f^o^r^m^a^nc^e^.^Re^q^u^ir^e^s^t^h^e^C^oⁿ^s^o^r^tium^to^up^d^a^te^the^p^r^io^r^itie^s^a^nnua^lly^aⁿ^d^ha^ve^the^m^eⁿ^d^o^r^se^d^b^y^the^Na^tio^na^{l Qua}^lity^Fo^r^u^m⁽^N^QF).
^(...con^tin^u^e^d)

CRS-16
⁽¹³⁾^Req^u^ir^{es th}^{e Secr}^etar^y^,^w^ithⁱⁿ¹⁸^m^oⁿ^t^h^s^{, to}^estab^lish^a^claim^s^-^b^ased^p^r^actitioⁿ^e^r^p^e^r^f^o^r^m^aⁿ^ce^d^a^tab^a^se⁽^t^o^b^e^dⁱ^scoⁿ^tin^u^e^{d af}^t^e^{r 10 y}^ears⁾
^to^receiv^e^d^e^-ⁱ^d^eⁿ^tif^ied^Medⁱ^{care claim}^s^d^a^{ta an}^d^d^e^-ⁱ^d^eⁿ^tif^ied^claim^s^d^a^ta^v^o^luⁿ^t^arily^su^b^m^itted^b^y^g^r^o^u^p^h^ealth^p^l^an^{s (g}^ro^u^p^h^ealth^plan^s^th^at
^sub^m^{it such d}^a^{ta ar}^{e gr}^anted^{access to}^{all r}^{ecent Med}ⁱ^car^{e claim}^s^d^a^{ta sub}^m^itted^to^HHS)^.^Req^u^ir^{es the Secr}^etar^y^annually^to^u^{se th}^{e d}^a^{ta in}^th^e
^dat^a^bas^e^t^o^m^eas^u^r^{e t}^h^{e perf}^orm^aⁿ^{ce of}^ph^y^sⁱ^cⁱ^aⁿ^s^an^{d h}^o^s^pⁱ^t^a^l^s^{, bas}^e^{d on}^N^Q^F^-^eⁿ^dors^e^d^perf^orm^aⁿ^ce^m^eas^u^r^es^.^A^f^t^e^r^f^o^u^r^y^ears^,^m^aⁿ^d^ates^th^at
^all^g^r^o^u^p^h^ealth^p^l^an^{s su}^b^m^{it d}^e^-ⁱ^d^eⁿ^tif^ied^claim^s^d^a^{ta to}^th^{e d}^a^tab^a^{se. (}¹⁴⁾^Req^u^ir^{es th}^{e Secr}^etar^y^,^w^ithⁱⁿ¹⁸^m^oⁿ^t^h^s^,^to^est^ablis^h^{a clin}^ical-^b^as^ed
^p^r^actitioⁿ^e^{r p}^e^rf^o^r^m^aⁿ^{ce d}^a^tab^a^{se to}^receiv^e^d^e^-ⁱ^d^eⁿ^tif^ied^d^a^{ta v}^o^luⁿ^t^arily^su^b^m^itted^b^y^p^r^o^v^id^ers.^Req^u^{ires th}^{e Secretary}^anⁿ^u^a^lly^to^u^s^{e th}^{e d}^a^ta
ⁱⁿ^t^h^{e dat}^a^bas^e^t^o^m^eas^u^r^{e t}^h^{e perf}^orm^aⁿ^{ce of}^ph^y^sⁱ^cⁱ^aⁿ^s^an^{d h}^o^s^pⁱ^t^a^l^s^{, bas}^e^{d on}^N^Q^F^-^eⁿ^dors^e^{d perf}^orm^aⁿ^{ce m}^eas^u^r^es^{. (15) Re}^q^uⁱ^res^t^h^e
^Secretary^{to m}^a^k^e^pu^blicly^av^{ailable th}^{e pr}^ov^{ider perf}^orm^aⁿ^{ce m}^eas^u^r^em^en^ts^prepared^f^r^om^both^databas^e^s^.^{(16) A}^u^th^orizes^th^{e S}^ecretary^{to u}^s^e
^th^{e prov}^{ider perf}^orm^aⁿ^{ce m}^eas^u^r^em^en^ts^{to m}^a^k^e^pay^-^f^o^r-^perf^orm^aⁿ^{ce adj}^u^s^t^m^eⁿ^t^s^{to Medicare pay}^m^en^ts^{. Directs}^th^{e Medicare P}^a^y^m^e^nt^A^d^vi^so^r^y
^Co^m^mⁱ^ssi^oⁿ^t^o^m^a^ke^a^nnua^l^r^e^c^o^mmeⁿ^d^a^tⁱ^oⁿ^s^oⁿ^suc^h^p^a^y^-fo^r^-^p^e^r^f^o^r^m^a^nc^e^a^d^j^u^st^m^e^nt^s.⁽¹⁷⁾^Dⁱ^r^e^c^t^{s A}^H^RQ^,^wⁱ^t^hⁱⁿ⁵⁴^m^o^nt^hs,^t^o^c^oⁿ^du^ct^a
^stu^d^y^co^m^p^arⁱⁿ^g^th^{e tw}^o^p^r^actitioⁿ^e^r^p^e^r^f^o^r^m^aⁿ^{ce d}^a^tab^a^{ses an}^d^r^e^p^o^r^{t to}^Coⁿ^g^r^ess.
^II,^st^a^nda^r^d^s,^he^a^l^t^h^IT^S^.^{2003 (C}^lⁱⁿ^ton⁾^Heal^th^Iⁿ^form^ati^oⁿ^{for Q}^u^alⁱ^t^{y I}^m^p^r^o^v^e^m^e^{nt A}^c^t.⁽¹⁾^Estab^lish^e^{s an}^Of^fⁱ^{ce o}^f^Natioⁿ^a^{l Health}^car^{e I}ⁿ^f^o^r^m^atioⁿ
^{, chronic dis}^e^as^{e care,}^In^f^r^as^tru^c^tu^{re, h}^{eaded by}^{a Director w}^h^{o reports}^directly^{to th}^{e Secretary}^,^{to dev}^e^{lop an}^{NHII s}^t^rategⁱ^{c plan}ⁱⁿ^c^o^l^l^a^boration^w^ith^v^a^rⁱ^o^u^s
^io^{n drug}^s^t^ak^eh^ol^ders^{. (2) In}^s^t^ru^ct^s^t^h^e^S^ecret^ary^wⁱ^t^hⁱⁿ^t^w^{o y}^ears^t^o^adoptⁿ^a^tⁱ^oⁿ^a^l^,^v^o^l^uⁿ^t^ary^h^eal^t^h^dat^a^an^{d com}^m^uⁿⁱ^catⁱ^oⁿ^s^s^t^an^dar^ds^t^o^prom^ot^{e t}^h^e
^s^,^qualityⁱⁿ^ter^o^p^e^r^a^b^ility^o^f^h^ealth^I^T^sy^stem^{s. (}³⁾^A^u^th^o^r^{izes A}^H^{RQ to}^a^w^a^r^d^g^r^aⁿ^t^s^t^o^h^o^sp^{itals an}^d^o^t^h^e^r^p^r^o^v^id^er^{s to}^p^a^y^f^o^r^h^ealth^I^T^{. Estab}^lish^e^s
^e^as^u^res^{, p}^ay-for-^g^r^an^{tee reportin}^g^requ^irem^en^ts^an^{d requ}^ires^th^e^Secretary^to^repor^{t to C}^oⁿ^g^r^es^s^on^th^{e g}^r^an^{t prog}^ram^.^Gran^tees^m^u^s^t^prov^ide^at^{least 5}⁰^%^m^a^tchⁱⁿ^g
ⁱ^{ki/CRS-RL32858}^a^{nce, us}^{e of health}^o^rm^a^t^io^{n by}^pro^vⁱ^ders^fund^s^.^A^u^th^orizes^{$20 m}^illion^f^o^{r FY2004 an}^{d f}^o^{r FY2005. (4) In}^s^t^ru^cts^A^H^R^Q^an^{d NIH to es}^tablis^h^{a Medical Sy}^s^t^em^s^Saf^e^ty^Inⁱ^tⁱ^ativ^{e to}^con^d^u^c^{t an}^{d s}^u^{pport res}^earch^oⁿ^t^h^e^us^e^of^ITⁱⁿ^im^provⁱⁿ^g^an^d^adv^aⁿ^cⁱⁿ^g^h^ealth^{care. R}^e^qu^ires^th^{e Nation}^a^{l C}^o^m^m^{ittee f}^o^{r Vita}^{l an}^d^Health
^g/w^tⁱ^ent^s^{Statistics to}^{assist th}^{e Secr}^etar^yⁱⁿ^th^{e d}^e^v^e^lo^p^m^en^{t o}^f^au^th^en^ti^cation^s^t^an^dards^f^o^{r h}^ealth^record^s^.^R^e^qu^ires^th^{e Secretaries}^o^f^H^H^S^,^{DOD, an}^d
^s^.or^VA^{to im}^plem^en^{t an}^{d ev}^alu^a^{te m}^e^th^ods^th^{at en}^{able patien}^t^s^to^acces^s^an^{d appen}^d^th^{eir electron}ⁱ^{c m}^e^{dical record. Directs}^A^H^R^Q^t^{o aw}^{ard g}^r^an^ts
^le^ak^f^o^{r res}^earch^onⁱⁿⁿ^o^v^a^tiv^{e approach}^es^to^im^prov^e^patien^t^s^’^uⁿ^d^er^s^t^an^din^g^of^th^{eir electron}ⁱ^{c h}^ealth^{record. A}^u^th^orizes^{$5 m}^illⁱ^o^{n fo}^r^suc^h^gr^aⁿ^t^s
^f^o^{r F}^Y²⁰⁰⁴^,^aⁿ^d^suc^h^s^u^m^s^as^m^a^y^{be n}^eces^s^a^ry^f^o^{r each}^fⁱ^s^{cal y}^{ear th}^ereaf^{ter. (5) P}^r^oh^ibits^g^r^ou^{p h}^ealth^plan^s^an^{d h}^ealthⁱⁿ^s^u^r^ers^th^{at of}^f^e^r
^://wiki^cov^e^rag^eⁱⁿ^bot^h^t^h^{e g}^r^ou^{p an}^{d i}ⁿ^di^vⁱ^du^al^m^a^rk^et^s^f^r^om^di^s^c^ri^mⁱⁿ^a^tⁱⁿ^g^ag^ai^nstⁱⁿ^dⁱ^vi^d^u^a^l^s^t^h^at^partⁱ^cⁱ^p^at^{e i}ⁿ^approv^{ed cl}ⁱⁿⁱ^cal^tr^{ials, an}^d^f^r^o^m
^h^ttp^d^eⁿ^yⁱⁿ^g^o^r^lim^itin^g^th^{e co}^v^e^r^a^g^e^o^f^r^o^u^tin^{e p}^a^tien^t^co^{sts f}^o^r^item^s^an^d^ser^v^{ices f}^u^rⁿ^ish^e^dⁱⁿ^coⁿⁿ^ectioⁿ^w^ith^p^a^r^ticip^atioⁿⁱⁿ^su^ch^tr^{ials. (}⁶⁾^Dir^ects
^A^H^R^Q^{to aw}^{ard g}^r^an^ts^f^o^{r res}^earch^on^prim^ary^care^f^o^r^older^patien^t^s^w^ith^m^u^{ltiple ch}^ronⁱ^{c co}ⁿ^d^ition^s^{. A}^u^th^orizes^{$10 m}^illion^f^o^{r F}^Y^{2004, an}^d
^s^u^ch^s^u^m^s^as^m^a^y^beⁿ^eces^s^a^ry^f^o^{r each}^fⁱ^s^{cal y}^{ear th}^ereaf^ter.^{(7) Directs}^{NIH, in}^coordin^a^tion^w^ith^A^H^R^Q^an^{d FDA}^,^{to con}^d^u^c^t^res^earch^on^th^e
^ef^f^ectiv^en^es^s^of^certain^pres^cription^dru^g^s^an^{d prov}^{ide a prog}^re^s^s^{report to th}^{e P}^r^es^iden^{t an}^{d C}^oⁿ^g^r^es^s^ev^ery^tw^{o y}^ears^.^A^u^th^o^rizes^{$75 m}^illion
^f^o^{r F}^Y^{2004, an}^{d s}^u^ch^s^u^m^s^as^m^a^y^{be n}^eces^s^a^ry^f^o^{r each}^fⁱ^s^{cal y}^{ear th}^ere^a^f^t^e^{r. (8) R}^e^qu^ires^A^H^R^Q^{, in}^con^s^u^ltation^w^ith^v^a^riou^s^s^p^ecifⁱ^ed^b
^stak^eh^o^l^d^e^{rs, to}^ev^alu^a^{te an}^d^u^p^d^a^{te q}^u^alityⁱⁿ^dⁱ^cato^r^{s f}^o^{r each}^o^f^th^e^IOM’^{s 2}⁰^p^r^io^rity^{areas f}^o^{r im}^p^r^o^v^em^en^{t in}^h^ealth^care^q^u^ality^.^A^u^th^o^r^izes
^{$12 m}^illion^f^o^{r FY2004, an}^{d $8 m}^illion^f^o^{r each}^fⁱ^s^{cal y}^{ear th}^ereaf^{ter th}^ro^{ugh FY}^{2009. (9) R}^e^quⁱ^r^es^C^D^C^an^{d A}^H^R^Q^j^oⁱⁿ^t^l^y^t^o^a^w^ard
^dem^oⁿ^s^tration^g^r^an^ts^f^o^{r th}^{e reportin}^g^of^h^ealth^{care qu}^alityⁱⁿ^f^o^rm^ation^{at th}^{e com}^m^uⁿ^ity^lev^e^{l. A}^u^th^orizes^{$25 m}^illion^f^o^{r F}^Y^{2004, an}^{d s}^u^ch
^s^u^m^s^as^m^a^y^{be n}^eces^s^a^ry^f^o^{r each}^fⁱ^s^{cal y}^ear^th^ereaf^ter.⁽¹⁰⁾^R^e^qu^ires^A^H^R^Q^{to con}^d^u^c^{t dem}^oⁿ^s^tration^prog^ram^s^f^o^{r th}^{e collect}^ioⁿ^o^f^r^e^liab^l^e
^d^a^{ta o}ⁿ^p^a^{tient r}^ace,^ethnicity^,^and^linguis^{tic p}^r^ef^er^ences.^A^u^tho^r^{izes $}⁵^m^illio^{n f}^o^r^FY²⁰⁰⁴^an^d^f^o^{r F}^Y^{2005. (11) Man}^d^at^es^an^IO^{M s}^t^u^d^y^on
^dev^e^l^opiⁿ^g^an^{d di}^s^s^e^mⁱⁿ^a^tⁱⁿ^g^evⁱ^d^en^ce-^bas^e^{d pract}ⁱ^{ce g}^uⁱ^delⁱⁿ^es^f^o^r^h^ealth^care.^{(12) Man}^d^ates^an^{IOM s}^t^u^d^y^on^perf^orm^aⁿ^ce-^bas^{ed pay}^m^en^t
ⁱⁿ^cen^tⁱ^v^es^,ⁱⁿ^cl^u^dⁱⁿ^g^pay^m^en^t^uⁿ^d^{er Medi}^{care. (13) R}^e^quⁱ^r^es^A^H^R^Q^t^o^s^u^pport^res^earch^an^d^dem^oⁿ^s^t^r^atⁱ^oⁿ^prog^ram^s^on^u^sⁱⁿ^g^com^m^uⁿ^ity^-^b^as^ed
^an^d^v^o^luⁿ^t^ar^y^p^u^b^{lic an}^d^p^r^iv^{ate o}^r^g^aⁿⁱ^zatioⁿ^s^to^dⁱ^ssemⁱⁿ^a^{te i}ⁿ^f^o^r^m^a^tⁱ^oⁿ^a^b^o^u^{t h}^ealth^car^{e q}^u^ality^to^coⁿ^s^u^m^er^{s. A}^u^th^o^r^{izes $}⁴^m^illioⁿⁱⁿ
^{FY2004, an}^{d $2 m}^illion^f^o^{r each}^fⁱ^s^{cal y}^{ear th}^ereaf^{ter. (14) R}^e^qu^ir^es^A^H^R^Q^to^aw^ard^g^r^an^ts^f^o^{r res}^earch^{to prom}^{ote patien}^t^en^g^ag^em^en^{t in}^th^eir
^care.

CRS-17
^a^l^t^h^{IT st}^a^nda^r^d^{s a}ⁿ^d^S^.^{2421 (Ken}ⁿ^e^d^y^{) Heal}^th^C^a^{re M}^o^d^ernⁱ^z^ati^o^n,^C^o^st^R^e^d^u^c^ti^on^{, an}^d^Q^u^alⁱ^t^{y I}^m^p^r^ovem^eⁿ^t^A^c^t.^{(1) A}^u^th^orizes^g^r^an^ts^{, loan}^s^,^an^{d loan}
^aⁿ^t^s^{, reim}^bursem^e^nt^g^u^a^r^aⁿ^t^{ees f}^o^r^f^e^d^e^r^a^lly^q^u^alif^ied^h^ealth^cen^ter^s^{, h}^o^sp^{itals, SNFs, g}^r^o^u^p^p^r^{actices an}^d^o^t^h^e^rⁿ^oⁿ^p^r^o^f^{it h}^ealth^f^{acilities to}ⁱⁿ^{stall an}^d^im^p^l^e^m^eⁿ^t
^cen^ti^ves^,^p^ay-for-^clin^{ical IT}^sy^stem^{s th}^{at m}^{eet n}^a^tioⁿ^a^{l in}^tero^p^e^rab^ility^an^d^secu^r^ity^stan^d^a^rd^s.^Matchⁱⁿ^g^f^uⁿ^d^{s are req}^u^ired^to^receiv^e^{a g}^r^an^t^{: 1}⁰^%^f^o^r^co^m^m^uⁿ^ity
^a^{nce s}^t^andards^,^h^ealth^car^{e cen}^ter^s^{; an}^d²⁰^%^f^o^r^o^t^h^e^rⁿ^oⁿ^-^p^r^o^f^it^h^ealth^car^e^f^acilities^an^d^f^o^r^g^r^o^u^p^p^r^{actices. Req}^u^ir^{es th}^{e Secr}^etar^y^,ⁱⁿ^c^oⁿ^su^ltatioⁿ^w^ith^v^a^rⁱ^o^u^s
^ti^on^al^q^u^a^lⁱ^t^{y ad}^vi^s^o^ry^s^t^ak^eh^ol^ders^{, t}^o^dev^e^l^{op or adopt}ⁿ^a^tⁱ^oⁿ^a^l^s^t^an^dards^by^Jan^u^a^ry^1,^2006.^R^e^quⁱ^r^es^t^h^e^S^ecret^ary^by^Jan^u^a^ry^{1, 2007, an}^{d a}^nnua^l^l^y^t^h^e^r^e^a^f^t^e^r^,^t^o
^e^as^e-s^p^ecific^revⁱ^ew^an^d^con^s^{ider m}^odifⁱ^cation^of^th^{e s}^t^an^dards^.^A^u^th^orizes^s^u^ch^s^u^m^s^as^m^a^y^beⁿ^eces^s^a^ry^{. (2) Man}^d^atesⁱⁿ^creas^esⁱⁿ^f^e^dera^{l h}^ealth^p^r^o^g^r^a^m
^{t p}^r^ogram^s^,^p^reven^ti^ve^r^e^im^b^u^r^s^em^en^{t f}^o^r^p^r^o^vⁱ^d^e^r^s^w^h^oⁱ^m^p^l^em^en^{t clin}^{ical I}^T^sy^stem^{s co}ⁿ^s^isten^t^w^ith^th^{e n}^a^tioⁿ^a^{l stan}^d^a^r^d^{s, an}^d^w^h^o^car^r^y^o^u^{t q}^u^alityⁱ^m^prov^em^en^t
^l^t^h^activ^ities^as^defⁱⁿ^e^{d in}^th^{e A}^c^{t. In}^creas^es^begⁱⁿⁱⁿ^{2005 an}^{d are equ}^a^{l to 1%}^of^reim^bu^rs^em^en^{t, decreas}ⁱⁿ^g^{to 0.2% of}^reim^bu^rs^em^en^tⁱⁿ^2009.
^Man^d^ates^decreas^esⁱⁿ^f^e^{deral h}^ealth^prog^ram^reim^bu^r^s^e^m^eⁿ^t^fo^r^l^a^r^g^{er prov}^iders^w^h^{o f}^a^{il to im}^plem^en^{t clin}^{ical IT}^s^y^s^t^em^s^an^{d c}^arry^ou^{t s}^u^ch
^qu^ality^im^prov^em^en^{t activ}^itie^s^.^D^e^c^r^e^a^s^es^begⁱⁿⁱⁿ^{2010 an}^{d are equ}^a^{l to 0.2% of}^reim^bu^rs^em^en^{t, in}^creasⁱⁿ^g^{to 1% of}^reim^bu^rs^em^en^tⁱⁿ^2014.
^{(3) R}^e^q^uⁱ^r^e^s^gr^o^u^p^he^a^l^t^h^p^l^an^s^an^{d h}^ealthⁱⁿ^s^u^rers^th^{at of}^f^e^r^cov^e^rag^eⁱⁿ^both^th^{e g}^r^ou^{p an}^{d in}^divⁱ^du^{al m}^a^rk^ets^,^by^Decem^{ber 3}^{1, 2008, t}^o
^im^p^l^em^en^{t co}^m^p^u^t^erized^claim^s^p^r^o^cessin^g^sy^stem^{s (w}^ith^an^accu^racy^o^f^{at least}⁹⁹^%^an^d^th^{e ab}^ilityⁱⁿ^{real tim}^{e to}^d^e^{tect f}^r^au^d^an^{d abu}^s^e).
^R^e^qu^ires^g^r^ou^{p h}^ealth^plan^s^an^{d in}^s^u^rers^{, by}^Decem^{ber 31, 2008, to}^{adopt a com}^p^u^t^{erized s}^y^s^t^em^th^{at, am}^on^g^oth^e^{r th}ⁱⁿ^g^s^{, prov}^id^es^con^s^u^m^ers
^wⁱ^t^hⁱⁿ^f^o^rm^ation^abou^{t th}^{eir accou}ⁿ^t^an^{d perm}^its^th^em^{to m}^a^k^e^dedu^{ctible an}^{d cos}^t^-^s^h^a^rin^g^pay^m^en^ts^electronⁱ^cally^{, an}^{d en}^ables^p^r^o^v^id^er^{s to}
^receiv^e^claim^s^pay^m^en^ts^electronⁱ^cally^{. (4) R}^e^qu^ires^th^{e S}^e^c^r^e^t^a^r^y^,^w^ithⁱⁿ^tw^{o y}^ears^an^{d in}^con^s^u^ltation^w^ith^th^{e Nation}^a^{l Qu}^a^lity^A^d^vⁱ^so^r^y
^Co^uⁿ^c^{il (}^s^{ee b}^e^lo^w⁾^an^d^o^t^h^e^r^s^{, to}^estab^lish^q^u^ality^stan^d^a^r^d^{s f}^o^r^r^e^im^b^u^r^sⁱⁿ^g^h^ealth^car^e^p^r^o^v^id^er^s⁽ⁱ^.e.,^p^a^y^-^f^o^r^-^p^e^r^f^o^r^m^aⁿ^c^e^staⁿ^d^a^r^d^s)^.^Re^q^u^ir^e^s
^p^a^y^e^r^s^t^oⁱⁿ^c^r^e^a^s^e^p^a^y^m^eⁿ^t^s^t^o^p^r^o^vⁱ^d^e^r^s^w^h^o^a^t^t^aⁱⁿ^t^h^e^q^u^ality^stan^d^a^r^d^s^,^aⁿ^d^p^e^r^mⁱ^t^s^p^a^y^e^r^s^t^o^r^e^d^u^c^e^r^eⁱ^m^b^u^r^s^e^m^eⁿ^t^t^o^p^r^o^vⁱ^d^er^{s w}^h^o^f^a^{il to}
ⁱ^{ki/CRS-RL32858}^m^{eet th}^e^s^t^aⁿ^d^a^r^d^s^.^I^f^{a p}^r^o^v^id^er^b^e^liev^e^{s it can}^p^r^o^v^id^{e h}ⁱ^g^h^e^r^q^u^ality^car^{e at lo}^w^e^r^co^{st b}^u^{t th}^{at d}^oⁱⁿ^g^so^w^o^u^l^d^r^e^d^u^{ce th}^e^a^m^o^unt^o^f^r^eⁱ^m^b^u^r^s^e^m^eⁿ^t^t^h^a^t^w^o^u^l^d^o^t^h^e^r^wⁱ^s^e^b^e^a^v^aⁱ^l^a^b^l^e^t^o^t^h^e^p^r^o^vⁱ^d^e^r^,^t^h^e^p^a^y^e^rⁱⁿ^v^o^l^v^e^dⁱ^s^r^e^q^uⁱ^r^e^d^t^o^eⁿ^t^e^rⁱⁿ^t^o^g^ood^f^aⁱ^t^hⁿ^e^g^o^tⁱ^atioⁿ^s^w^ith^th^e
^g/w^prov^{ider to reach}^ag^reem^en^{t on}^an^altern^ativ^e^pay^m^en^t^s^y^s^t^em^.⁽⁵^{) A}^u^th^orizes^C^D^C^{to aw}^{ard g}^r^an^ts^{to s}^t^ates^{to im}^plem^en^{t a com}^p^r^e^he^nsi^v^e^p^l^aⁿ
^s^.or^f^o^{r diabetes}^con^t^{rol an}^{d prev}^en^tion^.^A^u^th^ori^{zes CDC, in}^co^llab^o^r^atioⁿ^w^ith^A^H^{RQ, to}^aw^{ard g}^r^an^ts^{to s}^t^ates^{to apply}^ev^iden^ce-^ba^s^e^{d bes}^t^practⁱ^ces
^le^ak^(iden^tif^{ied by}^th^{e Secretary}⁾^f^o^{r diabetes}^{care an}^{d prev}^en^tion^.^A^u^th^orizes^{$50 m}^illion^f^o^{r FY2005, an}^{d s}^u^ch^s^u^m^s^as^m^a^y^{be n}^e^c^es^s^a^ry^f^o^{r F}^Y^2006-
^://wiki^{FY2009. A}^u^th^orizes^{$15 m}^illion^f^o^{r FY2005, an}^{d s}^u^ch^s^u^m^s^as^m^a^y^{be n}^eces^s^a^ry^f^o^{r FY2006-}^{FY2009, to f}^uⁿ^d^{a n}^a^tion^a^{l diabetes}^ed^u^catioⁿ^p^r^o^g^r^a^m^.⁽⁶⁾^A^u^t^h^o^rⁱ^z^e^s^s^u^c^h^s^u^m^s^a^s^m^a^y^b^eⁿ^e^c^e^s^s^a^r^y^f^o^r^F^Y²⁰⁰⁵^-^F^Y^{2009 to f}^uⁿ^d^g^r^an^ts^{to s}^t^ates^to^im^plem^en^{t a com}^p^reh^eⁿ^s^iv^{e arth}^ritis
^h^ttp^con^t^rol^an^{d prev}^en^tⁱ^oⁿ^pl^an^{. A}^u^t^h^ori^zes^s^u^ch^s^u^m^s^as^m^a^y^{be n}^eces^s^a^ry^f^o^{r F}^Y^2005-^F^Y^{2009 t}^o^f^uⁿ^d^g^r^an^t^s^t^oⁿ^a^tⁱ^oⁿ^a^l^pu^blⁱ^c^{or p}^rⁱ^va^t^e^no^np^r^o^fi^t
^en^{tities to}^h^e^lp^im^p^l^em^eⁿ^t^{a n}^a^tioⁿ^a^{l arth}^{ritis co}ⁿ^t^ro^{l an}^d^p^r^ev^en^tioⁿ^strateg^y^{. A}^u^th^o^r^{izes su}^ch^su^m^s^{as m}^a^y^b^eⁿ^ecessary^f^o^r^th^{e Secretary}^to
^im^plem^en^{t a n}^a^tion^a^{l arth}^ritis^edu^cation^prog^ram^.^{(7) A}^u^th^orizes^s^u^ch^s^u^m^s^as^m^a^y^{be n}^eces^s^a^ry^f^o^{r FY2005}^{- FY2009 to f}^uⁿ^d^g^r^an^{ts to}^states
^to^im^p^l^em^en^{t str}^o^k^e^car^{e sy}^stem^{s th}^{at p}^r^o^v^id^{e h}ⁱ^g^h^-^q^u^ality^p^r^ev^en^tioⁿ^,^dⁱ^agⁿ^o^{sis, tr}^eatm^eⁿ^t^{, an}^d^r^e^h^a^b^ilitatioⁿ^.⁽⁸⁾^A^u^th^o^r^ize^s^g^r^an^ts^an^{d oth}^e^r
^p^r^o^g^r^a^m^s^to^im^p^r^o^v^{e access to}^and^{the p}^r^o^v^isioⁿ^o^f^cultur^a^lly^and^{linguistically}^ap^p^r^o^p^r^{iate car}^{e f}^o^r^p^a^{tients w}^h^o^s^{e p}^r^im^ar^y^la^ngua^geⁱ^s^no^t^E^nglⁱ^s^h.
^Re^q^u^ir^e^s^t^h^e^S^e^c^r^e^t^a^r^{y to}^p^r^o^v^id^e^a^d^d^itio^na^{l M}^e^dⁱ^c^a^r^e^p^a^y^m^eⁿ^{ts fo}^r^suc^h^c^u^ltur^a^lly^aⁿ^d^linguistic^a^lly^a^p^p^r^o^p^r^ia^te^se^r^v^ic^e^s^.^Re^qu^ires^Medicaid
^an^d^S^C^H^I^P^p^r^o^g^r^a^m^s^to^co^v^e^r⁹⁰^%^o^f^th^{e co}^{sts o}^f^p^r^o^v^idⁱⁿ^g^th^o^s^{e ser}^v^{ices. (}⁹⁾^Estab^lish^e^{s a 1}⁵^-^m^e^m^b^er^Natioⁿ^a^{l Qu}^ality^A^d^vⁱ^so^r^y^Co^uncⁱ^l^,
^appoin^t^{ed by}^GA^{O, to iden}^tif^yⁿ^a^tion^a^l^aim^s^an^d^obj^ectiv^es^f^o^{r h}^ealth^{care qu}^ality^im^prov^em^en^{t an}^{d m}^a^k^e^recom^m^eⁿ^d^ation^s^{to C}^oⁿ^g^r^e^{ss a}ⁿ^d^the
^pu^blⁱ^c^{. (10) R}^e^quⁱ^r^es^g^r^ou^{p h}^eal^t^h^pl^an^s^an^{d h}^eal^t^hⁱⁿ^s^u^rers^t^h^at^of^f^e^{r cov}^e^rag^eⁱⁿ^bot^h^t^h^{e g}^r^ou^{p an}^{d i}ⁿ^di^vⁱ^du^al^m^a^rk^et^s^t^o^c^ov^{er prev}^en^tiv^{e h}^ealth
^{care item}^s^an^{d s}^e^rv^ices^{, as}^recom^m^eⁿ^d^{ed by}^th^{e U.S. P}^r^ev^en^tiv^{e Serv}ⁱ^ces^T^a^s^k^{Force. (11) A}^u^th^orizes^s^u^ch^s^u^m^s^as^m^a^y^{be n}^eces^s^ary^f^o^{r F}^Y^2005-
^F^Y^{2010 t}^o^carry^o^u^t^v^a^ri^ou^s^prog^ram^s^t^o⁽ⁱ^{) en}^cou^r^ag^{e h}^eal^t^h^di^et^s^,^an^{d (i}ⁱ⁾ⁱⁿ^creas^{e ph}^y^sⁱ^cal^actⁱ^vⁱ^t^yⁱⁿ^s^c^h^ool^s^,^w^o^rk^sⁱ^t^e^s^,^an^d^co^m^m^uⁿ^ities.
^{(12) A}^u^t^h^ori^zes^s^u^ch^s^u^m^s^as^m^a^y^{be n}^eces^s^a^ry^f^o^{r F}^Y^2005-^F^Y^{2009 t}^o^carry^ou^t^v^a^ri^ou^s^prog^ram^s^t^oⁱ^m^prov^eⁱ^m^m^uⁿⁱ^zatⁱ^oⁿ^rat^e^s^f^o^r^adu^lts^an^d
^adol^es^cen^t^s^{. (13) A}^u^t^h^ori^zes^s^u^ch^s^u^m^s^as^m^a^y^{be n}^eces^s^a^ry^f^o^r^F^Y^2005-^F^Y²⁰⁰⁹^t^o^carry^ou^t^v^a^ri^ou^s^prog^ram^s^t^o^rai^s^{e pu}^blⁱ^c^aw^a^r^e^ne^{ss a}^b^o^u^t
^o^r^{al h}^ealth^an^d^to^im^p^r^o^v^{e th}^{e d}^e^liv^er^y^an^d^q^u^ality^o^f^o^r^{al h}^ealth^am^oⁿ^g^ad^u^{lts, in}^clu^dⁱⁿ^g^th^o^s^{e w}^ithⁱⁿ^tellectu^a^{l d}ⁱ^sab^ilities^{or ch}^ronⁱ^{c dis}^eas^e.

CRS-18
^II,^st^a^nda^r^d^s,^he^a^l^t^h^IT^S^.^{2710 (G}^{regg) N}^a^ti^on^al^Heal^th^Iⁿ^form^ati^oⁿ^T^echⁿ^o^l^{ogy A}^d^op^tⁱ^oⁿ^A^c^t^.⁽¹⁾^Estab^lish^e^{s w}^ithⁱⁿ^{HHS an}^Of^fⁱ^{ce o}^f^Health^Iⁿ^f^o^r^m^atioⁿ
^ts^an^d^l^oan^gu^aran^tees^,^T^echⁿ^o^lo^g^y^to^{: ad}^vⁱ^{se th}^{e Secr}^etar^y^oⁿ^h^ealth^I^T^{; d}ⁱ^r^{ect all h}^ealth^I^T^acti^v^ity^w^ithⁱⁿ^th^{e Dep}^a^r^t^m^eⁿ^{t; w}^o^r^k^w^ith^p^u^b^{lic an}^d^p^rⁱ^v^a^{te h}^ealth^I^T
^a^lⁱ^t^{y m}^e^as^u^res^stak^eh^o^l^d^e^r^s^to^im^p^l^em^en^{t a str}^a^tegⁱ^{c p}^l^an^f^o^r^estab^lishⁱⁿ^g^{a NHI}^I^;^an^d^en^su^r^e^th^{at h}^ealth^I^T^{is u}^tilizedⁱⁿ^h^ealth^su^r^v^e^illan^{ce. I}ⁿ^str^u^cts^t^h^e
^S^ecret^ary^t^o^appoiⁿ^t^a^Dⁱ^rect^or^t^o^h^ead^t^h^{e O}^f^fⁱ^{ce. D}ⁱ^rect^s^t^h^{e O}^f^fⁱ^{ce t}^o^en^cou^r^ag^{e t}^h^{e dev}^e^l^opm^en^t^an^{d adopt}ⁱ^oⁿ^of^h^eal^t^h^IT^staⁿ^d^a^r^d^{s a}ⁿ^d^w^o^r^k
^w^ith^th^{e priv}^{ate s}^{ector to collect an}^{d dis}^s^e^mⁱⁿ^a^{te bes}^t^h^ealth^IT^practices^{. Directs}^th^{e Of}^fⁱ^{ce to coordin}^a^{te w}^ith^A^H^R^Q^an^{d ot}^h^e^{r f}^e^{deral ag}^en^cies
^to^ev^alu^a^{te th}^{e co}^{sts an}^d^b^eⁿ^e^f^{its o}^f^h^ealth^I^T^{, in}^clu^dⁱⁿ^g^{its im}^p^{act o}ⁿ^th^{e q}^u^ality^an^d^ef^fⁱ^cien^cy^o^f^p^a^tien^t^car^e,^an^d^r^e^vⁱ^ew^f^e^deral^rei^m^bu^rs^em^en^t
^f^o^r^h^ealth^car^{e p}^r^o^v^id^er^{s th}^{at u}^{tilize h}^ealth^I^T^sy^stem^{s. (}²⁾^Req^u^ir^{es th}^{e Dir}^ecto^r^,^wⁱ^t^hⁱⁿ^t^w^o^y^e^a^r^{s an}^dⁱⁿ^co^llab^o^r^atioⁿ^wⁱ^t^h^priv^{ate s}^ector
^s^t^ak^eh^olders^{, to adopt n}^a^tion^a^{l s}^t^an^dards^{to en}^{able h}^ealth^IT^to^be^u^s^{ed in}^clin^{ical s}^e^ttin^g^s^{, to prom}^{ote th}^{e in}^{teroperability}^o^f^clin^icalⁱⁿ^f^o^r^m^atioⁿ
^a^c^r^o^s^s^h^ealth^{care s}^e^ttin^g^s^{, an}^{d to f}^{acilitate th}^{e u}^s^{e of}^clin^ical^decisⁱ^on^s^u^{pport. A}^doption^of^s^u^ch^s^t^an^dards^by^th^{e priv}^ate^s^e^c^t^{or w}^o^u^l^{d be}
^vo^l^unt^a^r^y^.^B^e^giⁿⁿⁱ^{ng fi}^ve^y^e^a^r^{s a}^f^t^e^r^eⁿ^a^c^t^m^e^nt^,^p^r^o^hⁱ^bⁱ^t^s^t^h^e^Se^c^r^et^ary^f^r^om^pu^rcha^si^ng^a^he^a^l^t^h^I^T^s^y^s^t^em^t^h^atⁱ^sⁿ^o^tⁱⁿ^com^p^lian^{ce w}^ith^th^e
^s^t^an^dards^an^{d requ}^ires^recipien^ts^of^f^e^{deral h}^ealth^IT^f^uⁿ^d^s^to^pu^rch^a^s^e^s^y^s^t^em^s^th^at^are^com^p^lian^t^w^ith^th^{e s}^t^an^dards^.^{(3) P}^r^o^v^id^{es f}^e^d^e^r^a^{l lo}^an
^g^u^a^r^aⁿ^t^{ees: (}ⁱ⁾^to^en^ab^{le n}^e^tw^o^r^k^s^o^f^p^h^y^s^ician^s^{, h}^o^sp^{itals, an}^d^g^r^o^u^p^h^ealth^p^l^an^{s an}^d^o^t^h^e^rⁱⁿ^su^r^e^r^s^t^o^d^e^v^e^lo^p^lo^{cal h}^ealthⁱⁿ^f^o^r^m^atioⁿ
ⁱⁿ^f^r^astr^u^c^tu^r^e^{s (}^L^HI^I⁾^f^o^r^sh^arⁱⁿ^g^d^a^ta;^an^d⁽ⁱⁱ⁾^to^en^ab^le^h^ealth^car^{e p}^r^o^v^id^er^{s th}^{at w}^o^r^k^w^ith^lo^w^-ⁱⁿ^co^m^e^an^d^uⁿ^d^er^ser^v^ed^p^o^p^ul^a^tⁱ^o^{ns t}^o^p^u^r^c^ha^se
^h^ealth^IT^s^y^s^t^em^s^{capable of}^lin^kⁱⁿ^g^to^aⁿ^LH^I^I^.^Aut^h^o^rⁱ^z^e^s^{$50 m}^illion^f^o^{r each}^of^FY2005-^{FY2010. No prin}^{cipal of}^{a loan}^g^u^a^ran^t^{ee m}^a^y
^ex^ceed^$⁵^m^illioⁿ^,^an^dⁱⁿ^an^y^gⁱ^v^eⁿ¹²^-^m^oⁿ^t^h^p^e^rio^dⁿ^o^am^o^uⁿ^t^dⁱ^sb^u^r^sed^to^an^elig^ib^{le en}^tity^m^a^y^ex^ceed^$⁵^m^illioⁿ^.⁽⁴^{) A}^u^th^o^rizes^g^r^an^ts^{: (i)}
^toⁿ^e^tw^o^r^k^s^o^f^p^h^y^s^ician^s^{, h}^o^sp^{itals, an}^d^g^r^o^u^p^h^ealth^p^l^an^{s an}^d^o^t^h^e^rⁱⁿ^su^r^e^r^s^to^d^e^v^e^lo^p^L^H^I^I^{s f}^o^r^sh^arⁱⁿ^g^d^a^{ta; an}^d⁽ⁱⁱ⁾^to^h^ealth^{care prov}^iders
^t^h^at^w^o^rk^wⁱ^t^h^l^o^w^-ⁱⁿ^com^e^an^{d u}ⁿ^d^ers^e^rv^{ed popu}^l^a^tⁱ^oⁿ^s^t^o^pu^rch^a^s^e^h^eal^t^h^IT^s^y^s^t^em^s^capabl^e^of^lⁱⁿ^kⁱⁿ^g^t^o^{a L}^H^{II. R}^e^quⁱ^r^es^g^r^aⁿ^t^ees^t^o^provⁱ^d^e
ⁱ^{ki/CRS-RL32858}^m^a^tchⁱⁿ^g^f^uⁿ^d^s^{to cov}^e^{r at leas}^{t 20% of}^th^e^cos^t^s^of^th^e^IT^pr^oj^{ect f}^o^{r w}^h^ich^th^{e g}^r^an^{t w}^a^s^aw^{arded. A}^u^th^orizes^{$50 m}^illion^f^o^{r each}^of^F^Y^2005-^{FY2010. (5) R}^e^qu^ires^en^tities^th^{at receiv}^e^{a g}^r^an^{t or loan}^g^u^a^ran^t^{ee to s}^u^bm^{it an}^a^nnua^l^r^e^p^o^r^t^t^o^t^h^e^Dⁱ^r^e^c^t^o^r^d^e^sc^rⁱ^bⁱ^{ng t}^h^e^fi^na^ncⁱ^a^l^c^o^st^{s a}ⁿ^d
^g/w^b^eⁿ^e^fⁱ^t^s^o^f^t^h^e^p^r^o^j^e^c^t^aⁿ^dⁱ^t^sⁱ^m^p^a^c^t^oⁿ^h^e^a^l^t^h^c^a^r^e^q^u^a^lity^an^d^saf^e^ty^.^P^e^r^mⁱ^t^s^t^h^e^Dⁱ^r^e^c^t^o^r^t^o^gⁱ^v^e^p^r^e^f^e^r^eⁿ^c^eⁱⁿ^a^w^a^r^dⁱⁿ^g^g^r^an^ts^an^{d loan}
^s^.or^g^u^a^r^aⁿ^t^{ees to}^en^{tities th}^{at ag}^r^{ee to}^su^b^m^{it r}^e^p^o^r^{ts electr}^oⁿⁱ^cally^oⁿ^{a d}^a^ily^b^a^{sis. (}⁶⁾^Req^u^ir^{es th}^{e Secr}^etar^{ies o}^f^HHS,^Def^e^nse^,^aⁿ^d^V^A^,^b^y^J^a^nua^r^y
^le^ak^{1, 2009, to dev}^e^{lop u}ⁿⁱ^f^o^rm^h^ealth^{care qu}^ality^m^eas^u^r^es^f^o^{r a}^{total of}^{15 com}^m^oⁿ^h^ealth^con^d^itioⁿ^s^an^d^{to es}^tablis^h^requ^irem^en^{ts f}^o^r^f^e^d^e^r^a^lly
^://wiki^s^u^{pported h}^ealth^{care deliv}^ery^prog^ram^s^{to report th}^os^{e qu}^ality^m^eas^u^r^es^{. R}^e^qu^ires^t^h^e^Secretaries^{to prov}^{ide f}^o^{r th}^{e poolin}^g^,^an^aly^s^is^{, an}^d^dⁱ^s^s^e^mⁱⁿ^a^tⁱ^oⁿ^o^f^r^e^p^o^r^t^e^d^q^u^ality^d^a^ta.^Re^q^uⁱ^r^e^s^t^h^e^H^H^S^S^e^c^r^e^t^a^r^y^t^o^p^r^o^vⁱ^d^e^a^p^r^o^g^r^e^s^s^r^e^p^o^r^t^t^o^C^oⁿ^g^r^e^s^s^wⁱ^t^hⁱⁿ^t^w^o^y^e^a^r^s^.^Fo^llo^wⁱⁿ^g
^h^ttp^su^b^m^issioⁿ^o^f^th^{e r}^e^p^o^r^{t to}^Coⁿ^g^r^{ess, r}^e^q^u^ir^{es th}^{e Secr}^etar^y^w^ithⁱⁿ^th^r^{ee y}^ear^{s to}^p^u^b^lish^fⁱⁿ^a^{l r}^e^g^u^l^atioⁿ^s^oⁿ^r^e^p^o^r^tin^g^uⁿⁱ^f^o^r^m^h^ealth^car^{e q}^u^ality
^m^eas^u^r^es^{. (7) R}^e^qu^ires^th^{e Secretary}^{to en}^s^u^{re th}^{at de}^m^o^gr^a^p^hi^c^{data collected u}ⁿ^d^{er Medicare are accu}^{rate an}^{d av}^{ailable f}^o^{r i}ⁿ^c^lu^sioⁿⁱⁿ^th^e^c
^Natioⁿ^a^{l Health}^Disp^ar^{ities Rep}^o^r^t,^an^{d to prom}^{ote an}^{d en}^f^o^{rce s}^t^{ate dem}^o^g^r^aphⁱ^{c data}^collection^an^{d repo}^r^tⁱⁿ^g^requ^irem^en^ts^uⁿ^d^{er Medicaid}^c

^an^d^SCHI^P^an^d^en^su^r^e^th^{at th}^o^s^{e d}^a^{ta ar}^{e also}^av^ailab^l^{e f}^o^rⁱⁿ^clu^s^ioⁿⁱⁿ^th^{e Natio}ⁿ^a^{l Health}^Disp^ar^{ities Rep}^o^r^t.

CRS-19
^II,^st^a^nda^r^d^s,^he^a^l^t^h^IT^S^.^{2907 (D}^od^d⁾^Iⁿ^form^ati^oⁿ^T^echⁿ^o^l^{ogy for Heal}^th^C^a^{re Q}^u^alⁱ^t^{y A}^c^t.⁽¹⁾^Estab^lish^e^s^w^ithⁱⁿ^th^{e Ex}^ecu^tiv^{e Of}^fⁱ^{ce o}^f^th^{e P}^r^esid^en^{t an}^Of^fⁱ^ce
^ts^an^d^l^oan^gu^aran^tees^,^o^f^Health^Iⁿ^f^o^r^m^atioⁿ^T^echⁿ^o^lo^g^y^to^{: d}^e^v^e^lo^p^{a n}^a^tioⁿ^a^{l str}^a^teg^y^f^o^r^cr^eatin^g^{a NHI}^I^;^ad^vⁱ^{se th}^{e P}^r^esid^en^{t o}ⁿ^h^ealth^I^T^{; d}ⁱ^r^e^c^{t all h}^ealth^I^T^activ^ity
^a^lⁱ^t^{y m}^e^as^u^res^w^ithⁱⁿ^th^{e f}^e^d^e^r^a^{l g}^o^v^e^rⁿ^m^eⁿ^{t; w}^o^r^k^w^ith^p^u^b^{lic an}^d^p^r^iv^{ate h}^ealth^I^T^stak^eh^o^l^d^e^r^s^to^im^p^l^em^en^t^th^{e n}^a^tioⁿ^a^{l str}^a^teg^y^{; an}^d^en^su^r^e^th^{at h}^ealth^I^T
^is^u^{tilized in}^h^ealth^s^u^rv^eillan^{ce. In}^s^t^ru^cts^th^e^P^r^es^iden^t^to^appoin^t^{a Director to h}^{ead th}^{e Of}^fⁱ^{ce. R}^e^qu^ires^f^e^{deral ag}^en^ci^es^{to s}^eek^Of^fⁱ^ce^approv^al
ⁱⁿ^{order t}^o^adopt^sⁱ^gⁿⁱ^fⁱ^can^tⁿ^e^w^h^eal^t^h^IT^polⁱ^cⁱ^e^s^.^Dⁱ^rect^s^t^h^{e O}^f^fⁱ^{ce t}^o^en^cou^r^ag^{e t}^h^{e dev}^e^l^opm^en^t^an^{d adopt}ⁱ^oⁿ^of^h^eal^t^h^I^T^staⁿ^d^a^r^d^{s a}ⁿ^d^w^o^r^k
^w^ith^th^{e priv}^{ate s}^{ector to collect an}^{d dis}^s^e^mⁱⁿ^a^{te bes}^t^h^ealth^IT^practices^{. Directs}^th^{e Of}^fⁱ^{ce to coordin}^a^{te w}^ith^A^H^R^Q^an^{d ot}^h^e^{r f}^e^{deral ag}^en^cies
^to^ev^alu^a^{te th}^{e co}^{sts an}^d^b^eⁿ^e^f^{its o}^f^h^ealth^I^T^{, in}^clu^dⁱⁿ^g^{its im}^p^{act o}ⁿ^th^{e q}^u^ality^an^d^ef^fⁱ^cien^cy^o^f^p^a^tien^t^car^e,^an^d^r^e^vⁱ^ew^f^e^deral^rei^m^bu^rs^em^en^t
^f^o^r^h^ealth^car^{e p}^r^o^v^id^er^{s th}^{at u}^{tilize h}^ealth^I^T^sy^stem^{s. Req}^u^ir^{es th}^{e Dir}^ecto^r^w^ithⁱⁿ^six^m^oⁿ^t^h^s^to^m^a^k^e^r^eco^m^m^eⁿ^d^atioⁿ^s^to^t^h^e^P^r^es^iden^{t an}^d
^th^e^Secretary^on^ch^an^g^e^s^{to f}^e^{deral reim}^bu^rs^em^en^{t an}^{d pay}^m^en^{t s}^t^ru^ctu^r^es^{to en}^cou^r^ag^{e th}^{e adoption}^of^h^ealth^IT^{. R}^e^qu^ires^th^e^Secretary^,^w^ithⁱⁿ
^{90 day}^s^of^receivⁱⁿ^g^th^{e recom}^m^eⁿ^d^ation^s^{, to}^prov^ide^C^oⁿ^g^r^es^s^w^ith^an^im^plem^en^tation^plan^{. (2) R}^e^qu^ires^th^{e Director, w}^ithⁱⁿ^t^w^o^y^ears^an^{d in}
^co^llab^o^r^atioⁿ^w^ith^p^r^iv^{ate secto}^r^s^t^a^k^e^h^o^l^d^e^r^s^,^t^o^a^d^o^p^{t n}^a^tioⁿ^a^{l stan}^d^a^r^d^{s to}^en^ab^{le h}^ealth^I^T^to^b^e^u^s^edⁱⁿ^clin^{ical settin}^g^s^{, t}^o^prom^ot^{e t}^h^e
ⁱⁿ^{teroperability}^of^clin^{ical in}^f^o^rm^ation^acr^os^s^h^ealth^{care s}^e^ttin^g^s^{, an}^{d to f}^{acilitate th}^{e u}^s^{e of}^clin^ical^decisⁱ^on^s^u^pport.^A^doptⁱ^oⁿ^of^s^u^ch^s^t^an^dards
^by^t^h^{e pri}^v^at^{e s}^ect^{or w}^o^u^l^{d be v}^o^l^uⁿ^t^ary^.^Begⁱⁿⁿⁱⁿ^g^on^{e y}^{ear af}^t^e^{r s}^t^an^dards^{are adopt}^{ed, proh}ⁱ^bⁱ^t^s^t^h^{e S}^ecret^ary^f^r^om^pu^rch^a^sⁱ^{ng a}^he^a^l^t^h^I^T
^sy^stem^th^{at is n}^o^{t in}^co^m^p^lian^{ce w}^ith^th^{e stan}^d^a^r^d^{s an}^d^r^e^q^u^ir^{es r}^ecipⁱ^en^{ts o}^f^f^e^d^e^r^a^{l h}^ealth^I^T^f^uⁿ^d^{s to}^p^u^r^c^h^a^{se sy}^stem^{s th}^at^{are com}^p^lian^t^w^ith
^th^e^stan^d^a^r^d^s.⁽³⁾^P^r^o^v^id^{es f}^e^d^e^r^a^{l lo}^an^g^u^a^r^aⁿ^t^{ees: (}ⁱ⁾^to^en^ab^{le n}^e^tw^o^r^k^s^o^f^p^h^y^s^ician^s^{, h}^o^sp^{itals, an}^d^g^r^o^u^p^h^ealth^p^l^an^s^an^{d ot}^h^e^{r i}ⁿ^s^u^rers^t^o
^d^e^v^e^lo^p^lo^{cal h}^ealthⁱⁿ^f^o^r^m^atioⁿⁱⁿ^f^r^astr^u^c^tu^r^e^{s (}^L^HI^I⁾^f^o^r^s^h^a^rⁱⁿ^g^d^a^{ta; an}^d⁽ⁱⁱ⁾^to^en^ab^{le h}^ealth^car^{e p}^r^o^v^id^er^{s to}^p^u^r^c^h^a^se^he^a^{lth I}^T^sy^ste^m^s
^capable^of^lin^kⁱⁿ^g^{to a L}^H^{II. In}^s^t^ru^cts^th^e^Director^to^gⁱ^v^e^s^p^{ecial con}^s^ideration^to^applican^ts^s^e^rvⁱⁿ^g^low^-ⁱⁿ^com^e^an^{d u}ⁿ^d^ers^erv^e^{d popu}^l^a^tⁱ^oⁿ^s^.
ⁱ^{ki/CRS-RL32858}^A^u^th^orizes^$250^m^illion^f^o^{r each}^of^FY2005-^{FY2010. No prin}^{cipal of}^{a loan}^g^u^a^ran^t^{ee m}^a^y^ex^{ceed $5 m}^illion^,^an^{d in}^an^y^gⁱ^v^eⁿ¹²^-^m^on^t^h^peri^odⁿ^o^am^o^uⁿ^t^dⁱ^sb^u^r^sed^to^an^elig^ib^le^en^tity^m^a^y^ex^ceed^$⁵^m^illioⁿ^.⁽⁴^{) A}^u^th^o^r^{izes g}^r^an^{ts: (i) to}ⁿ^e^tw^o^r^k^s^o^f^p^h^y^s^ician^s^{, h}^o^sp^ita^l^s^{, an}^{d g}^r^ou^{p h}^eal^t^h
^g/w^p^l^an^{s an}^d^o^t^h^e^rⁱⁿ^su^r^e^r^s^to^d^e^v^e^lo^p^L^H^I^I^s^f^o^r^sh^arⁱⁿ^g^d^a^{ta; an}^d⁽ⁱⁱ⁾^to^h^ealth^car^{e p}^r^o^v^id^er^{s th}^{at w}^o^r^k^w^ith^lo^w^-ⁱⁿ^co^m^e^an^d^uⁿ^d^ers^e^rv^{ed popu}^l^a^tⁱ^oⁿ^s
^s^.or^to^p^u^r^c^h^a^{se h}^ealth^I^T^sy^stem^{s cap}^ab^{le o}^f^lin^kⁱⁿ^g^to^a^L^H^I^I^.^Re^qu^ires^g^r^an^tees^{to prov}^{ide m}^a^tchⁱⁿ^g^f^uⁿ^d^s^{to cov}^e^{r at leas}^t^20%^of^th^{e cos}^t^s^of^th^e
^le^ak^IT^proj^{ect f}^o^{r w}^h^ich^th^{e g}^r^an^{t w}^a^s^aw^{arded. A}^u^th^orizes^{$250 m}^illion^f^o^{r each}^of^FY2005-^{FY2010. (5) R}^e^qu^ires^en^tities^th^at^rec^eiv^e^{a g}^r^an^{t or}
^://wiki^lo^an^g^u^a^r^aⁿ^t^ee^to^su^b^m^it^r^e^g^u^l^ar^r^e^p^o^r^ts^to^th^{e Dir}^ecto^r^d^e^scrⁱ^bⁱⁿ^g^th^{e f}ⁱⁿ^aⁿ^c^{ial co}^{sts an}^d^b^eⁿ^e^f^{its o}^f^th^{e p}^r^o^j^{ect an}^d^its^im^p^{act o}ⁿ^h^ealth^car^{e q}^u^ality^an^{d s}^a^f^e^ty^{. (6) W}^ithⁱⁿ^{18 m}^oⁿ^t^h^s^,^requ^ires^th^e^Secretaries^of^{HHS, Def}^eⁿ^s^{e, an}^{d th}^{e VA}^{, in}^{collaboration}^w^ith^oth^e^r^s^p^ecifⁱ^ed^g^r^ou^ps^{, t}^o^dev^e^l^o^p
^h^ttp^uⁿⁱ^f^o^rm^h^ealth^{care q}^u^ality^m^easu^r^{es f}^o^{r each}^o^f^th^{e IOM’}^{s 2}⁰^p^r^io^rity^{areas f}^o^{r im}^p^r^o^v^em^en^{t in}^h^ealth^care^q^u^ality^,^b^an^d^to^estab^lish^r^e^q^u^ir^em^en^ts
^f^o^r^f^e^derally^s^u^pported^h^ealth^care^deliv^ery^prog^ram^s^to^{report th}^os^{e qu}^ality^m^eas^u^r^es^{. Man}^d^ates^f^u^{ll im}^plem^en^tation^of^{all qu}^ality^m^easu^r^{es an}^d
^reportⁱⁿ^g^s^y^s^t^em^s^wⁱ^t^hⁱⁿ^on^{e y}^{ear of}^t^h^ei^{r dev}^e^l^opm^en^t^.^R^e^quⁱ^r^es^th^{e Secretaries}^{to prov}^{ide f}^o^{r th}^{e poolin}^g^,^an^aly^s^is^{, an}^{d dis}^s^e^mⁱⁿ^a^tⁱ^oⁿ^of^report^e^d
^q^u^ality^d^a^{ta. Req}^u^ir^{es th}^{e HHS}^Secr^etar^y^to^ev^alu^a^te^th^e^d^e^v^e^lo^p^m^en^t^an^d^r^e^p^o^r^tin^g^o^f^q^u^ality^m^easu^r^{es an}^d^r^e^p^o^r^{t to}^Coⁿ^g^r^ess^w^ithⁱⁿ^oⁿ^{e y}^ear^.
^Fo^llo^wⁱⁿ^g^su^b^m^issioⁿ^o^f^th^{e r}^e^p^o^r^{t to}^Coⁿ^g^r^{ess, r}^e^q^u^ir^{es th}^{e Secr}^etar^y^w^ithⁱⁿ^oⁿ^{e y}^ear^to^p^u^b^lish^fⁱⁿ^a^{l r}^e^g^u^l^atioⁿ^s^oⁿ^r^e^p^o^r^tin^{g uni}^fo^r^m^he^a^l^t^h
^car^{e q}^u^ality^m^easu^r^es.
^.^{663 w}^a^s^{reported (as}^am^en^{ded) by}^th^{e En}^erg^y^an^{d C}^o^m^m^e^rce^C^o^m^m^ittee^on^Mar.^{6, 2003. T}^h^{e W}^a^y^s^an^{d Mean}^s^C^o^m^m^{ittee appro}^v^e^{d s}ⁱ^mⁱ^l^a^{r l}^e^gⁱ^s^l^atⁱ^oⁿ^(H^.R^{. 877, H}^.^R^e^pt^.
^108-^{31) on}^{Mar. 11, 2003. W}^h^{ile th}^{e W}^a^y^s^an^{d Mean}^s^{bill w}^o^u^l^{d am}^eⁿ^d^t^h^{e Medicare s}^t^atu^t^{e an}^{d apply}^on^ly^{to h}^o^s^p^itals^an^{d oth}^e^r^h^ealth^car^{e f}^{acilities an}^d^th^eir^em^p^l^o^y^ees
^th^{at prov}^{ide h}^ealth^{care s}^e^rv^ices^uⁿ^d^{er Medicare P}^a^rt^A^,^th^e^En^erg^y^an^{d C}^o^m^m^e^{rce m}^eas^u^r^{e w}^o^u^l^{d am}^en^{d th}^e^P^u^blic^Health^Serv^ice^(PH^S^{) A}^c^t^an^{d h}^a^v^e^{broader cov}^e^rag^e^{. H}^.^R^.
^{663 w}^o^u^l^{d a}^ppl^y^t^o^aⁿ^yⁱⁿ^di^vⁱ^du^a^l^o^r^eⁿ^tity^lic^eⁿ^se^d^to^p^r^ovⁱ^d^e^h^e^a^l^t^h^c^a^r^e^s^e^rvⁱ^c^e^s^.^F^o^l^l^o^wⁱⁿ^gⁿ^e^g^o^tⁱ^a^tⁱ^oⁿ^s^be^t^w^e^eⁿ^m^e^m^b^e^r^s^o^f^b^o^t^h^p^aⁿ^e^{ls, it w}^a^{s ag}^r^eed^th^{at th}^{e n}^e^w^law
^s^h^ou^{ld be w}^r^ittenⁱⁿ^{to th}^{e P}^H^{S A}^c^{t an}^{d th}^{at th}^{e En}^erg^y^an^{d C}^o^m^m^e^{rce bill (H.R}^{. 633) w}^o^u^l^{d be bro}^ught^t^o^t^h^e^fl^o^o^r^fo^r^c^o^nsi^d^e^r^a^tⁱ^o^{n b}^y^t^h^e^ful^l^H^o^use^.
^stitu^{te o}^f^Medⁱ^cin^e^,^Pr^ior^{ity Ar}^eas^for^N^a^{tional Action:}^Tr^ans^for^m^{ing Health C}^a^r^e^Quality^(Was^hⁱⁿ^g^t^on^:^N^a^tⁱ^oⁿ^a^l^A^cadem^y^Pres^s^,^2003).
^.^L^.^106-^129,^th^e^Health^care^R^e^s^earch^an^{d Qu}^ality^A^c^{t of}^{1999, directed A}^H^R^Q^{to s}^u^bm^{it to C}^oⁿ^g^r^es^s^a^nnua^lly^a^r^e^p^o^r^{t o}ⁿ^“^d^isp^a^r^itie^{s in he}^a^{lth c}^a^r^e^d^e^live^r^y^a^s^it^r^e^la^te^s^to^r^a^cⁱ^a^l
^f^act^ors^an^{d s}^o^ci^oecon^o^mⁱ^{c f}^act^orsⁱⁿ^pri^o^ri^t^y^popu^l^a^tⁱ^oⁿ^s^{,” beg}ⁱⁿⁿⁱⁿ^gⁱⁿ^F^Y^{2003. T}^h^{e f}ⁱ^rs^t^N^a^tⁱ^o^na^l^Re^p^o^r^t^oⁿ^H^e^a^l^t^h^{care D}ⁱ^s^p^a^rities^w^a^s^releas^{ed on}^{Dec. 22. 2003, an}^{d is}
^av^ailab^l^{e o}ⁿ^lin^{e at [}^h^ttp^://q^u^a^lity^to^o^l^s.ah^r^q^.g^o^v^/d^isp^a^r^itiesRep^o^r^t/d^o^wⁿ^l^o^a^d^_^r^ep^o^r^t.asp^x^]^.

CRS-20
Table 4. Summary of Health Information Technology (IT) Legislation Introduced in the 109^th Congress
^B^{ills a}^ppro^v^e^{d by}^Co^m^mⁱ^t^t^ee
^en^{t S}^a^{fety: rep}^ortiⁿ^g^S^.^{544 (Jefford}^s⁾^Pati^en^{t S}^a^{fety an}^d^Q^u^alⁱ^t^{y I}^m^p^r^ovem^eⁿ^t^A^c^t.^Oⁿ^March^{9, 2005, t}^h^{e S}^eⁿ^a^t^e^H^eal^t^h^{, Edu}^catⁱ^oⁿ^,^L^a^{bor, an}^{d Pen}^sⁱ^oⁿ^s^(H^EL^P)
^e^{dical errors}^C^o^m^mⁱ^t^t^{ee approv}^{ed S}^.^{544, w}^hⁱ^c^hⁱ^sⁱ^d^en^tⁱ^cal^t^o^l^a^s^t^y^ear’^s^S^eⁿ^a^t^e^-^p^as^s^e^{d m}^eas^u^r^{e (S}^{. 720). S}^.⁵⁴⁴ⁱ^sⁱⁿ^t^eⁿ^d^ed^t^o^en^cou^r^ag^e^th^{e r}^e^p^o^r^tin^g^an^d
^an^aly^s^{is o}^fⁱⁿ^f^o^r^m^atioⁿ^oⁿ^m^e^dⁱ^{cal er}^r^o^r^s^b^y^d^e^sigⁿ^a^tin^g^su^chⁱⁿ^f^o^r^m^atioⁿ^{as co}ⁿ^f^id^en^{tial an}^d^p^r^o^t^ectin^g^{it f}^r^o^m^leg^a^l^dⁱ^s^c^o^v^er^y^an^{d adm}ⁱ^s^sⁱ^on
ⁱⁿ^civ^{il, adm}ⁱⁿⁱ^s^t^rativ^{e, an}^{d crim}ⁱⁿ^{al pr}^oceedin^g^s^(uⁿ^l^es^s^{a j}^u^dg^{e deter}^mⁱⁿ^e^d^t^h^a^t^th^{e in}^f^o^rm^ation^con^t^ain^e^{d ev}^iden^{ce of}^{a w}^aⁿ^t^on^an^{d crim}ⁱⁿ^al
^act^t^o^di^rect^l^y^h^a^rm^t^h^{e pat}ⁱ^eⁿ^t^{) an}^{d f}^r^om^F^r^eedom^of^In^f^o^rm^atⁱ^oⁿ^A^c^t^(F^O^I^A⁾^requ^es^t^s^{. In}^f^o^rm^atⁱ^oⁿ^on^m^e^di^cal^errors^w^o^u^l^{d be}^r^e^p^o^r^ted^to^P^a^tien^t
^Saf^e^ty^Org^aⁿⁱ^zation^s^(P^SOs⁾^{, w}^h^ich^w^o^u^l^{d an}^aly^{ze th}^{e in}^f^o^rm^ation^an^{d dev}^e^{lop an}^{d dis}^s^e^mⁱⁿ^a^{te recom}^m^eⁿ^d^ation^s^fo^r^s^y^s^t^em^s^-^bas^e^d^so^lu^tioⁿ^s
^{to im}^prov^{e patien}^t^s^a^f^e^ty^an^d^h^ealth^{care qu}^ality^{. S. 544 als}^o^w^o^u^l^{d requ}^{ire th}^{e A}^g^en^cy^f^o^{r Health}^{care R}^e^s^earch^an^{d Qu}^ality⁽^A^H^R^Q^{) t}^o^adopt
^v^o^luⁿ^t^aryⁿ^a^tion^a^{l in}^{teroperability}^s^t^an^dards^.^{For m}^o^{re in}^f^o^rm^ation^,^s^ee^C^R^S^R^e^{port R}^L^31983,^Hea^lth^Ca^{re Qu}^a^lity:^I^m^p^r^o^vⁱⁿ^g^Pa^tien^t^S^a^f^ety
^{by Pr}^om^otⁱ^{ng M}^e^di^cal^Er^r^o^r^s^Repor^tⁱⁿ^g^.
^Int^r^o^{duced bills (}^N^o^legⁱ^sla^t^iv^{e a}^c^tⁱ^vⁱ^t^y⁾
^II,^st^a^nda^r^d^s,^M^e^dic^a^r^e^H.R^.^{747 (G}^on^zal^{ez ) N}^a^ti^on^al^Heal^th^Iⁿ^form^ati^oⁿ^Iⁿ^cen^ti^ve^A^c^t^of^2005.⁽¹⁾^Estab^lish^e^{s w}^ithⁱⁿ^th^{e Ex}^ecu^tiv^{e Of}^fⁱ^{ce o}^f^th^{e P}^r^esid^en^{t an}^Of^fⁱ^ce
ⁱ^{ki/CRS-RL32858}^bursem^e^nt^{, hea}^l^t^h^IT^ts^an^d^l^oan^s^o^f^t^h^e^N^a^tioⁿ^a^{l Co}^o^r^dⁱⁿ^a^to^r^f^o^r^Health^Iⁿ^f^o^r^m^atioⁿ^T^echⁿ^o^lo^g^y⁽^ONCHI^T⁾^{, h}^ead^ed^b^y^{a Dir}^ecto^r^w^h^o^r^e^sp^oⁿ^d^s^dⁱ^r^ectly^to^th^{e P}^r^esi^den^t^{. (2)}^W^{ithin tw}^o^y^e^a^r^s,^r^e^q^u^ir^e^s^the^Se^c^r^e^t^a^r^y^,^thr^o^ugh^ONCHI^T^aⁿ^dⁱⁿ^c^o^lla^b^o^r^a^tio^{n w}^{ith the}^Co^m^mⁱ^ssioⁿ^oⁿ^Sy^ste^m^ic^Iⁿ^te^r^o^p^e^r^a^b^ility^,^t^o^adopt^t^rⁱ^a^l
^g/w^IT^s^t^an^dards^d^e^ve^l^o^p^e^d^b^y^a^ccredi^t^e^{d s}^t^an^{dard s}^e^t^tⁱⁿ^g^org^aⁿⁱ^zatⁱ^oⁿ^s^t^o^s^u^pport^t^h^{e creat}ⁱ^oⁿ^of^an^N^H^{II. R}^e^quⁱ^r^es^t^h^{e S}^ecret^ary^to^coⁿ^s^u^{lt w}^ith
^s^.orⁿ^a^tioⁿ^a^{l o}^r^g^aⁿⁱ^zatioⁿ^s^r^e^p^r^esen^tin^g^{all th}^{e m}^a^j^o^r^s^t^a^k^e^h^o^l^d^e^r^s^an^d^r^e^ly^oⁿ^th^{e r}^eco^m^m^eⁿ^d^atioⁿ^s^o^f^th^{e Natio}ⁿ^a^{l Co}^m^m^{ittee o}ⁿ^Vit^{al an}^{d Health}
^le^ak^Stati^s^tⁱ^c^s^.^S^t^an^dards^m^u^s^t^{be con}^s^is^ten^t^w^ith^th^{e HIP}^A^A^priv^acy^an^{d s}^ecu^rity^ru^{le an}^{d m}^u^s^tⁿ^o^{t im}^pos^{e an}^uⁿ^d^u^e^admⁱⁿⁱ^s^t^rativ^e^aⁿ^d^fi^na^ncⁱ^a^l
^bu^rden^on^m^e^{dical practice, particu}^l^arly^s^m^{all ph}^y^s^ician^an^{d ru}^ra^l^practices^{. R}^e^qu^ires^th^{e Secretary}^to^con^d^u^c^t^a^tw^o-^y^ear^pil^o^t^p^r^o^g^r^a^m^{at f}^acilities
^://wiki^t^h^r^o^ugho^ut^t^h^e^c^o^unt^r^y^t^o^t^e^st^t^h^e^e^ffe^c^tⁱ^v^eⁿ^e^{ss a}ⁿ^dⁱ^m^p^a^c^t^o^f^t^h^e^t^rⁱ^a^l^st^aⁿ^d^a^r^d^s.^Wⁱ^t^hⁱⁿ^oⁿ^e^y^e^a^r^o^f^c^o^m^p^l^e^tⁱ^{ng t}^h^e^pⁱ^l^o^t^p^r^og^ram^,^requⁱ^r^es^t^h^e
^h^ttp^Secretary^{to as}^s^e^s^s^th^{e prog}^ram^an^{d report to C}^oⁿ^g^r^es^s^.^Aut^h^o^rⁱ^zes^th^{e Secretary}^{to m}^odif^y^th^{e s}^t^an^dards^as^{appropriate. R}^e^qu^ir^{es in}^dⁱ^vⁱ^d^u^als
^an^{d en}^tities^th^{at u}^s^{e EHR}^s^an^{d h}^ealth^IT^{to com}^p^ly^w^ith^th^{e m}^odi^fⁱ^{ed s}^t^an^dardsⁿ^o^{t later th}^an^tw^{o y}^ears^af^{ter th}^ey^{are adopted.}^Sm^{all h}^ealth^p^l^an^s
^an^d^sm^{all p}^r^o^v^id^er^{s o}^f^ser^v^{ices (}ⁱ^{.e., f}^e^w^e^r^th^an²⁵^f^u^ll-^tim^{e eq}^uⁱ^v^a^len^t^em^p^l^o^y^ees)^h^a^v^e^an^ad^d^itioⁿ^a^l^y^ear^to^co^m^p^ly^.⁽³⁾^Iⁿ^s^t^ru^cts^th^{e Secretary}
^to^p^r^o^v^id^{e Med}ⁱ^car^{e p}^a^y^m^en^{t in}^cen^tiv^{es to}^h^e^lp^sm^{all p}^r^o^v^id^er^{s acq}^uⁱ^{re EH}^R^s^an^d^o^t^he^r^heal^t^h^IT^{, s}^u^ch^as^add-^on^pay^m^en^t^s^f^o^{r of}^fⁱ^{ce v}ⁱ^s^its
^s^u^{pported by}^h^ealth^IT^{, an}^{d pay}^m^en^ts^f^o^{r e-}^m^a^{il con}^s^u^ltation^s^{. Ex}^em^ptsⁱⁿ^c^eⁿ^tⁱ^v^e^p^a^y^m^en^ts^f^r^om^bu^dg^{et n}^e^u^t^rality^uⁿ^d^{er th}^{e ph}^y^sⁱ^cian^f^e^e
^sch^e^d^u^le.⁽⁴⁾^A^u^th^o^r^{izes g}^r^an^{ts an}^d^r^e^v^o^lvⁱⁿ^g^lo^an^{s f}^o^r^sm^{all h}^ealth^car^{e p}^r^o^v^id^er^{s to}^acq^uⁱ^r^e^EHRs^an^d^o^t^h^e^r^h^ealth^I^T^.^A^u^th^orizes^s^u^ch^s^u^m^s
^as^m^a^y^{be n}^eces^s^a^ry^f^o^{r s}^u^ch^g^r^an^ts^an^{d loan}^s^.^{(5) C}^r^eates^a^tax^{credit f}^o^{r ph}^y^s^ician^s^w^h^{o acqu}ⁱ^{re EHR}^s^an^{d oth}^e^{r h}^ealth^IT^{, e}^qu^al^t^o^10%^of^t^h^e
^am^ouⁿ^t^s^{paid du}^rin^g^th^{e tax}^a^{ble y}^ear.

CRS-21
^II,^st^a^nda^r^d^s,^he^a^l^t^h^IT^S^.^{16 (Ken}ⁿ^e^d^y^{) Afford}^ab^l^e^Heal^th^{Care Act.}⁽¹⁾^E^s^t^a^b^lⁱ^s^he^s^w^ithⁱⁿ^th^{e Ex}^ecu^tiv^{e Of}^fⁱ^{ce of}^th^{e P}^r^es^iden^{t an}^Of^fⁱ^{ce of}^Health^In^f^o^rm^ation
^ts^an^d^l^oan^gu^aran^tees^,^T^echⁿ^o^lo^g^y^to^{: d}^e^v^e^lo^p^{a n}^a^tioⁿ^a^{l str}^a^teg^y^f^o^r^cr^eatin^g^{a NHI}^I^;^ad^vⁱ^{se th}^{e P}^r^esid^en^{t o}ⁿ^h^ealth^I^T^{; d}ⁱ^r^{ect all h}^ealth^I^T^activⁱ^t^y^w^ithⁱⁿ^th^{e f}^e^d^e^r^a^l
^a^lⁱ^t^{y m}^e^as^u^res^g^o^v^e^rⁿ^m^eⁿ^t;^w^o^r^k^w^ith^p^u^b^lic^an^d^p^r^iv^{ate h}^ealth^I^T^stak^eh^o^l^d^e^r^s^to^im^p^l^em^en^{t th}^{e n}^a^tioⁿ^a^{l str}^a^teg^y^{; an}^d^en^su^r^e^th^at^h^ealth^I^Tⁱ^{s u}^tilizedⁱⁿ^h^ealth
^s^u^rv^eillan^{ce. In}^s^t^ru^cts^th^{e P}^r^es^iden^{t to appoin}^t^{a Director to}^h^{ead th}^{e Of}^fⁱ^{ce. R}^e^qu^ires^f^e^{deral ag}^en^cies^{to s}^eek^Of^fⁱ^{ce appr}^ov^alⁱⁿ^{order t}^o^adopt
^sⁱ^gⁿⁱ^fⁱ^can^{t n}^e^w^h^ealth^IT^policies^.^Directs^th^e^Of^fⁱ^ce^to^en^cou^r^ag^e^th^e^dev^e^lopm^en^t^an^d^adoption^of^h^ealth^IT^s^t^an^dards^an^{d w}^o^r^k^w^ith^th^{e p}^r^iv^ate
^s^{ector to collect an}^{d dis}^s^e^mⁱⁿ^a^{te bes}^t^h^ealth^IT^practices^.^Di^rects^th^{e Of}^fⁱ^{ce to coordin}^a^{te w}^ith^A^H^R^Q^an^d^oth^e^r^f^e^deral^ag^en^c^{ies to}^ev^alu^a^{te th}^e
^co^{sts an}^d^b^eⁿ^e^f^{its o}^f^h^ealth^I^T^{, in}^clu^dⁱⁿ^g^{its im}^p^{act o}ⁿ^th^{e q}^u^ality^an^d^ef^fⁱ^cien^cy^o^f^p^a^tien^t^car^{e, an}^d^r^e^vⁱ^ew^f^e^d^e^r^a^{l r}^e^im^b^u^r^s^e^m^eⁿ^t^f^o^{r h}^ealth^care
^p^r^o^v^id^er^{s th}^{at u}^{tilize h}^ealth^I^T^sy^stem^{s. Req}^u^ir^{es th}^{e Dir}^ecto^r^w^ithⁱⁿ^six^m^oⁿ^t^h^s^to^m^a^k^e^r^eco^m^m^eⁿ^d^atioⁿ^s^to^th^{e P}^r^esid^en^{t an}^d^th^{e Secretary}^on
^ch^an^g^e^s^{to f}^e^{deral reim}^bu^rs^em^en^{t an}^{d pay}^m^en^{t s}^t^ru^ctu^r^es^{to en}^cou^r^ag^{e th}^{e adoption}^of^h^ealth^IT^.^R^e^q^uⁱ^r^e^s^th^{e Secretary}^,^w^ithⁱⁿ^{90 day}^s^of
^receivⁱⁿ^g^th^{e recom}^m^eⁿ^d^ation^s^{, to prov}^{ide C}^oⁿ^g^r^es^s^w^ith^an^im^plem^en^tation^plan^{. (2) R}^e^qu^ires^th^{e Director, w}^ithⁱⁿ^tw^{o y}^ears^an^dⁱⁿ^co^llab^o^r^atioⁿ
^w^ith^priv^{ate s}^{ector s}^t^ak^eh^olders^{, to adopt n}^a^tion^a^{l s}^t^an^dards^{to en}^{able h}^ealth^IT^to^be^u^s^edⁱⁿ^clin^ical^s^e^ttin^g^s^{, to prom}^{ote t}^h^eⁱⁿ^ter^o^p^e^r^a^b^ility^o^f
^clin^{ical in}^f^o^rm^ation^a^c^r^os^s^h^ealth^{care s}^e^ttin^g^s^{, an}^{d to f}^acilitate^th^{e u}^s^{e of}^clin^{ical decis}ⁱ^on^s^u^{pport. A}^doption^of^s^u^ch^s^t^aⁿ^d^ards^by^t^h^{e pri}^v^at^e
^s^ect^{or w}^o^u^l^{d be v}^o^l^uⁿ^t^ary^.^Begⁱⁿⁿⁱⁿ^g^on^{e y}^{ear af}^t^e^{r s}^t^an^dards^{are adopt}^ed,^prohⁱ^bⁱ^t^s^t^h^e^S^ecret^ary^f^r^om^pu^rch^a^sⁱⁿ^g^a^h^eal^t^h^IT^sy^ste^m^tha^t^{is no}^t
ⁱⁿ^com^p^lian^{ce w}^ith^th^{e s}^t^an^dards^an^{d requ}^ires^recipien^ts^of^f^e^de^r^a^{l h}^ealth^I^T^f^uⁿ^d^{s to}^p^u^r^c^h^a^{se sy}^stem^{s th}^{at ar}^{e co}^m^p^lian^t^w^ith^th^{e s}^t^an^dards^.⁽³⁾
^P^r^o^v^id^{es f}^e^d^e^r^a^{l lo}^an^g^u^a^r^aⁿ^t^{ees: (}ⁱ⁾^to^en^ab^{le n}^e^tw^o^r^k^s^o^f^p^h^y^s^ician^s^{, h}^o^sp^{itals, an}^d^g^r^o^u^p^h^ealth^p^l^an^{s an}^d^o^t^h^e^rⁱⁿ^su^r^e^r^s^to^d^e^v^e^lo^p^lo^{cal h}^ealth
ⁱⁿ^f^o^r^m^atioⁿⁱⁿ^f^r^astr^u^c^tu^r^e^s⁽^L^HI^I⁾^f^o^r^sh^arⁱⁿ^g^d^a^{ta; an}^d⁽ⁱⁱ⁾^to^en^ab^{le h}^ealth^car^{e p}^r^o^v^id^er^{s to}^p^u^r^c^h^a^{se h}^ealth^I^T^sy^stem^{s cap}^a^b^l^e^o^f^lⁱ^nki^{ng t}^o^a
^L^H^II.^In^s^t^ru^ct^s^t^h^e^Dⁱ^rect^{or t}^o^gⁱ^v^e^s^p^eci^al^con^sⁱ^d^eratⁱ^oⁿ^t^o^applⁱ^can^t^s^s^e^rvⁱⁿ^g^l^o^w^-ⁱⁿ^com^e^an^{d u}ⁿ^d^ers^e^rv^{ed popu}^l^a^tⁱ^oⁿ^s^{. A}^u^t^h^orizes^s^u^ch^s^u^m^s
ⁱ^{ki/CRS-RL32858}^as^m^a^y^{be n}^eces^s^a^ry^f^o^{r each}^of^FY^2006-^F^Y^2011.^N^o^priⁿ^cⁱ^p^a^l^o^f^a^l^o^aⁿ^g^u^a^r^aⁿ^t^e^e^m^a^y^e^x^ceed^$⁵^m^illioⁿ^,^an^dⁱⁿ^an^y^gⁱ^v^eⁿ¹²^-^m^oⁿ^t^h^p^e^rio^dⁿ^o^am^o^uⁿ^t^dⁱ^sb^u^r^sed^to^an^elig^ib^le^en^tity^m^a^y^ex^ceed^$⁵^m^illioⁿ^.⁽⁴^{) A}^u^th^o^r^{izes g}^r^an^{ts: (i) to}ⁿ^e^tw^o^r^k^s^o^f^p^h^y^s^ician^s^{, h}^o^sp^ita^l^s^{, an}^{d g}^r^ou^{p h}^eal^t^h
^g/w^p^l^an^{s an}^d^o^t^h^e^rⁱⁿ^su^r^e^r^s^to^d^e^v^e^lo^p^L^H^I^I^s^f^o^r^sh^arⁱⁿ^g^d^a^{ta; an}^d⁽ⁱⁱ⁾^to^h^ealth^car^{e p}^r^o^v^id^er^{s th}^{at w}^o^r^k^w^ith^lo^w^-ⁱⁿ^co^m^e^an^d^uⁿ^d^ers^e^rv^{ed popu}^l^a^tⁱ^oⁿ^s
^s^.or^to^p^u^r^c^h^a^{se h}^ealth^I^T^sy^stem^{s cap}^ab^{le o}^f^lin^kⁱⁿ^g^to^a^L^H^I^I^.^Re^qu^ires^g^r^an^tees^{to prov}^{ide m}^a^tchⁱⁿ^g^f^uⁿ^d^s^{to cov}^e^{r at leas}^t^20%^of^th^{e cos}^t^s^of^th^e
^le^ak^IT^proj^{ect f}^o^{r w}^h^ich^th^{e g}^r^an^{t w}^a^s^aw^{arded. A}^u^th^orizes^s^u^ch^s^u^m^s^as^m^a^y^{be n}^eces^s^a^ry^f^o^{r each}^of^F^Y^2006-^F^Y^{2011. (5) R}^e^qu^ires^en^{tities th}^at
^://wiki^receiv^e^{a g}^r^an^{t or loan}^g^u^a^ran^t^{ee to s}^u^bm^{it reg}^u^l^{ar reports}^{to th}^{e Director des}^c^ribin^g^th^{e f}ⁱⁿ^aⁿ^c^ial^cos^t^s^an^d^ben^e^f^its^of^th^e^proj^{ect an}^{d its}^im^pact^oⁿ^h^ealth^car^{e q}^u^ality^an^d^saf^e^ty^{. (}⁶⁾^W^ithⁱⁿ¹⁸^m^oⁿ^t^h^s^{, r}^e^q^u^ir^{es th}^{e Secr}^etar^{ies o}^f^{HHS, Def}^eⁿ^s^{e, a}ⁿ^d^th^{e VA}^{, in}^co^llab^o^r^atio^{n w}ⁱ^t^h^o^t^he^r
^h^ttp^sp^ecifⁱ^ed^g^r^o^u^p^s^{, to}^d^e^v^e^lo^p^uⁿⁱ^f^o^rm^h^ealth^{care q}^u^ality^m^easu^r^{es f}^o^{r each}^o^f^th^e^IOM’^s²⁰^p^r^io^rity^{areas f}^o^{r im}^p^r^o^v^em^en^{t in}^h^e^alth^car^{e q}^u^ality^,^a
^an^{d to es}^tablis^h^requ^irem^en^ts^f^o^{r f}^e^derally^s^u^{pported h}^ealth^car^{e deliv}^ery^prog^ram^s^{to report th}^os^{e qu}^ality^m^eas^u^r^es^{. Man}^d^ates^f^u^{ll im}^p^l^em^en^tatioⁿ
^o^f^{all q}^u^ality^m^easu^r^es^an^d^r^e^p^o^r^tin^g^sy^stem^{s w}^ithⁱⁿ^oⁿ^{e y}^ear^o^f^th^eir^d^e^v^e^lo^p^m^en^{t. Req}^u^ir^{es th}^{e Secr}^etar^{ies to}^p^r^o^v^id^{e f}^o^r^th^{e poolin}^g^,^an^aly^s^is^,
^an^d^dⁱ^ssemⁱⁿ^a^tioⁿ^o^f^r^e^p^o^r^ted^q^u^ality^d^a^{ta. Req}^u^ir^{es th}^{e HHS Secr}^etar^y^to^ev^alu^a^{te th}^e^d^e^v^e^lo^p^m^en^t^an^d^r^e^p^o^r^tin^g^o^f^q^u^ality^m^e^as^u^r^es^an^d^report
^to^Coⁿ^g^r^ess^w^ithⁱⁿ^oⁿ^e^y^ear^{. Fo}^llo^wⁱⁿ^g^su^b^m^issioⁿ^o^f^th^{e r}^e^p^o^r^{t to}^Coⁿ^g^r^{ess, r}^e^q^u^ir^{es th}^{e Secr}^etar^y^w^ithⁱⁿ^oⁿ^{e y}^ear^to^p^u^b^lish^fi^na^l^r^e^gul^a^tⁱ^o^ns
^oⁿ^r^e^p^o^r^tin^g^uⁿⁱ^f^o^r^m^h^ealth^car^{e q}^u^ality^m^easu^r^es.
^stitu^{te o}^f^Medⁱ^cin^e^,^Pr^ior^{ity Ar}^eas^for^N^a^{tional Action:}^Tr^ans^for^m^{ing Health C}^a^r^e^Quality^(Was^hⁱⁿ^g^t^on^:^N^a^tⁱ^oⁿ^a^l^A^cadem^y^Pres^s^,^2003).

Appendix A
Congressional Hearings (2002–2005)
House Committee on Energy and Commerce
May 8, 2002Reducing Medical Errors
July 22, 2004Health Information Technology
(Subcommittee on Health)
House Committee on Government Reform (Subcommittee on Technology)
July 14, 2004Health Informatics, Public Health, and
Emergency Response
House Committee on Veterans’ Affairs (Subcommittee on Oversight)
May 19, 2004VA’s Role in Developing Electronic
Medical Records
House Committee on Ways and Means (Subcommittee on Health)
March 7, 2002Health Quality and Medical Errors
September 10, 2002Legislation to Reduce Medical Errors
March 18, 2004Health Care Quality
June 17, 2004Health Information Technology
July 22, 2004Electronic Prescribing
February 10, 2005Medicare Payments to Physicians
March 15, 2005Measuring Physician Quality and
Efficiency
Senate Committee on Homeland Security and Governmental Affairs
June 11, 2003Patient Safety: Instilling Hospitals
with a Culture of Continuous
Improvement
Senate Special Committee on Aging
September 23, 2003HIPAA Medical Privacy and
Transactions Rules: Overkill or
Overdue?

GAO Reports and Testimony (2003–2005)
Information Technology: Benefits Realized for Selected Health Care Functions,
GAO-04-224, October 31, 2003.
Computer-Based Patient Records: Improved Planning and Project Management
are Critical to Achieving Two-Way VA-DOD Health Data Exchange, GAO-04-

811T, May 19, 2004.

Health Care: National Strategy Needed to Accelerate the Implementation of
Health Information Technology, GAO-04-947T, July 14, 2004.
HHS’s Efforts to Promote Health Information Technology and Legal Barriers to
its Adoption, GAO-04-991R, August 13. 2004.
HHS’s Estimate of Health Care Cost Savings Resulting for the Use of Information
Technology, GAO-05-309R, February 16, 2005.
Internet Resources
Federal Government
HHS — Nat. Coordinator for Health IT[http://www.hhs.gov/healthit]
HHS — Nat. Committee on Vital and[http://www.ncvhs.hhs.gov]
Health Statistics
AHRQ — Healthcare Informatics[http://www.ahrq.gov/data/infoix.htm]
CDC — Public Health Informatics[http://www.cdc.gov/epo/dphsi/index.htm]
Professional Associations
American Academy of Family[http://www.centerforhit.org]
Physicians
American Health Information[http://www.ahima.org]
Management Association
American Medical Informatics[http://www.amia.org]
Association
Association of Medical Directors of[http://www.amdis.org]
Information Technology
Healthcare Information and[http://www.himss.org]
Management Systems Society
Public-Private Collaboratives/Research Groups/Stakeholders
eHealth Initiative[http://www.ehealthinitiative.org]
Markle Foundation[http://www.markle.org]
Connecting for Health[http://www.connectingforhealth.org]

Center for Information Technology[http://www.citl.org]
Leadership
National Alliance for Health[http://www.nahit.org]
Information Technology
National Alliance for Primary Care[http://www.napci.org]
Informatics