,,ii  #aadth ,,congress  #b;d ,session  
,s4 #beaa  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,february #h1  
#bjaf ,mr4 ,alexander 7for himself1     
,mrs4 ,murray1 ,mr4 ,cassidy1 ,mr4      
,whitehouse1 ,mr4 ,hatch1 and ,mr4      
,bennet7 introduced the following bill2 
which was read twice and referred to the
 ,committee on ,health1 ,education1     
,labor1 and ,pensions  ,a ,,bill  ,to   
improve ,federal requirements relating  
to the development and use of electronic
 health records technology4  #a4 ,short 
title  ,this ,act may be cited as the   
,improving ,health ,information         
,technology ,act4  #b4 ,assisting       
doctors and hospitals in improving the  
quality of care for patients  7a7 ,in   
general  ,part #a of subtitle ,a of     
title ,,xiii of the ,health ,information
 ,technology for ,economic and ,clinical
 ,health ,act 7,public ,law #aaa-e7 is  
amended by adding at the end the        
following3  #acajc4 ,assisting doctors  
and hospitals in improving the quality  

of care for patients  7a7 ,reduction in 
burdens goal ,the ,secretary of ,health 
and ,human ,services 7referred to in    
this section as the ,secretary71 in     
consultation with providers of health   
services1 health care suppliers of      
services1 health care payers1 health    
professional societies1 health          
information technology developers1      
health care quality organizations1      
health care accreditation organizations1
 public health entities1 ,states1 and   
other appropriate entities1 shall1 in   
accordance with subsection 7b7--  7#a7  
establish a goal with respect to the    
reduction of regulatory or              
administrative burdens 7such as         
documentation requirements7 relating to 
the use of electronic health records2   
7#b7 develop a strategy for meeting the 
goal established under paragraph 7#a72  
and  7#c7 develop recommendations for   
meeting the goal established under      
paragraph 7#a74  7b7 ,strategy and      
recommendations  7#a7 ,in general ,to   

achieve the goals established under     
subsection 7a77#a71 the ,secretary1 in  
consultation with the entities described
 in such subsection1 shall1 not later   
than #ab months after the date of       
enactment of this section1 develop a    
strategy and recommendations to meet the
 goals in accordance with this          
subsection4  7#b7 ,strategy ,the        
strategy developed under paragraph 7#a7 
shall address the regulatory and        
administration burdens 7such as         
documentation requirements7 relating to 
the use of electronic health records4   
,such strategy shall include broad      
public comment and shall prioritize     
burdens related to--  7,a7 the ,medicare
 and ,medicaid ,,ehr ,meaningful ,use   
,incentive programs or the ,merit-based 
,incentive ,payment ,system1 the        
,alternative ,payment ,models1 the      
,hospital ,value-,based ,purchasing     
,program1 and other value-based payment 
programs determined appropriate by the  
,secretary2  7,b7 health information    

technology certification programs2  7,c7
 standards1 and implementation          
specifications1 as appropriate2  7,d7   
activities that provide individuals     
access to their electronic health       
information2  7,e7 activities related to
 protecting the privacy of electronic   
health information2  7,f7 activities    
related to protecting the security of   
electronic health information2  7,g7    
activities related to facilitating      
health and clinical research2  7,h7     
activities related to public health2    
7,i7 activities related to aligning and 
simplifying quality measures across     
,federal programs and other payers2     
7,j7 activities related to reporting    
clinical data for administrative        
purposes2 and  7,k7 other areas         
determined appropriate by the           
,secretary4  7#c7 ,recommendations ,the 
recommendations developed under         
paragraph 7#a7 shall address-- 7,a7     
actions that improve the clinical       
documentation experience2  7,b7 actions 

that improve patient care2  7,c7 actions
 to be taken by the ,secretary and by   
other entities2 and  7,d7 other areas   
determined appropriate by the ,secretary
 to reduce the reporting burden required
 of health care providers4  7#d7 ,,faca 
,the ,federal ,advisory ,committee ,act 
7#e ,u4,s4,c4 ,app47 shall not apply to 
the development of the goal1 strategies1
 or recommendations described in this   
section4  7c7 ,application of certain   
regulatory requirements  ,a physician   
7as defined in section #ahfa7r77#a7 of  
the ,social ,security ,act7 may delegate
 electronic medical record documentation
 requirements specified in regulations  
promulgated by the ,department of       
,health and ,human ,services to a person
 who is not such physician if such      
physician has signed and verified the   
documentation4  4  7b7 ,certification of
 health information technology for      
medical specialties and sites of service
 ,section #cjja7;c77#e7 of the ,public  
,health ,service ,act 7#db ,u4,s4,c4    

#cjj;jj-#aa7;c77#e77 is amended by      
adding at the end the following3  7,c7  
,health information technology for      
medical specialties and sites of service
  7i7 ,in general ,the ,national        
,coordinator shall encourage1 keep1 or  
recognize1 through existing authorities1
 the voluntary certification of health  
information technology under the program
 developed under subparagraph 7,a7 for  
use in medical specialties and sites of 
service for which no such technology is 
available or where more technological   
advancement or integration is needed4   
7ii7 ,specific medical specialties ,the 
,,hit ,policy and ,standards ,committees
 shall make recommendations on specific 
medical specialties and sites of        
service1 in addition to those described 
in clause 7iii71 applicable under this  
paragraph4  7iii7 ,certified health     
information technology for pediatrics   
,not later than #ah months after the    
date of enactment of this subparagraph1 
the ,,hit ,policy and ,standards        

,committees1 in consultation with       
relevant stakeholders1 shall make       
recommendations for the voluntary       
certification of health information     
technology for use by pediatric health  
providers to support the health care of 
children4 ,not later than #bd months    
after the date of enactment of this     
subparagraph1 the ,secretary shall adopt
 certification criteria 7under section  
#cjjd7 to support the voluntary         
certification of health information     
technology for use by pediatric health  
providers to support the health care of 
children4  4  7c7 ,meaningful use       
statistics  7#a7 ,in general ,not later 
than #f months after the date of        
enactment of this ,act1 the ,secretary  
of ,health and ,human ,services shall   
submit to the ,,hit ,policy ,committee  
of the ,office of the ,national         
,coordinator for ,health ,information   
,technology1 a report concerning        
attestation statistics for the ,medicare
 and ,medicaid ,,ehr ,meaningful ,use   

,incentive programs to assist in        
informing standards adoption and related
 practices4 ,such statistics shall      
include attestation information         
delineated by ,state1 including the     
number of providers who did not meet the
 minimum criteria necessary to attest   
for the ,medicare and ,medicaid ,,ehr   
,meaningful ,use ,incentive programs for
 a calendar year1 and shall be made     
publicly available on the ,internet     
website of the ,secretary on at least a 
quarterly basis4  7#b7 ,authority to    
alter format ,the ,secretary of ,health 
and ,human ,services may alter the      
format of the reports on the attestation
 of eligible health care professionals  
following the first performance year of 
the ,merit-based ,incentive ,payment    
,system to account for changes arising  
from the implementation of such payment 
system4  #c4 ,transparent ratings on    
usability and security to transform     
information technology  7a7             
,enhancements to certification  ,section

 #cjja7;c77#e7 of the ,public ,health   
,service ,act 7#db ,u4,s4,c4            
#cjj;jj-#aa71 as amended by section     
#b7;b71 is further amended--  7#a7 in   
subparagraph 7,a7-- 7,a7 by striking    
,the ,national ,coordinator and         
inserting the following3  7i7 ,voluntary
 certification program ,the ,national   
,coordinator  2 and  7,b7 by adding at  
the end the following3  7ii7            
,transparency of program  7,i7 ,in      
general ,to enhance transparency in the 
compliance of health information        
technology with certification criteria  
and other requirements adopted under    
this subtitle1 the ,national            
,coordinator1 in coordination with      
authorized certification bodies1 may    
make information demonstrating how      
health information technology meets such
 certification criteria or other        
requirements publicly available4 ,such  
information may include summaries1      
screenshots1 video demonstrations1 or   
any other information the ,national     

,coordinator determines appropriate4    
7,,ii7 ,protection of proprietary       
information ,the ,national ,coordinator 
shall take appropriate measures to      
ensure that there are in effect         
effective procedures to prevent the     
unauthorized disclosure of any trade    
secret or confidential information that 
is obtained by the ,secretary pursuant  
to this section4  2  7#b7 in            
subparagraph 7,b71 by adding at the end 
the following3 ,beginning #ah months    
after reporting criteria are finalized  
under section #cjji;,a1 certification   
criteria shall include1 in addition to  
criteria to establish that the          
technology meets such standards and     
implementation specifications1 criteria 
consistent with section #cjji;,a7b7 to  
establish that technology meets         
applicable security requirements1       
incorporates user-centered design1 and  
achieves interoperability42 and  7#c7 by
 adding at the end the following3  7,d7 
,conditions of certification ,beginning 

#a year after the date of enactment of  
the ,improving ,health ,information     
,technology ,act1 the ,secretary shall  
require1 as a condition of certification
 and maintenance of certification for   
programs maintained or recognized under 
this paragraph1 that--  7i7 the health  
information technology developer or     
entity does not take any action that    
constitutes information blocking with   
respect to health information           
technology2  7ii7 the health information
 technology developer or entity permits 
unimpeded communication among and       
between health information technology   
users1 and for the purposes of health   
information technology users            
communicating with an authorized        
certification body1 the ,office of the  
,national ,coordinator1 and the ,office 
of the ,inspector ,general1 the health  
information technology developer or     
entity permits unimpeded communication  
regarding the usability1                
interoperability1 security1 business    

practices1 or other relevant information
 about the health information technology
 or users' experience with the health   
information technology2  7iii7 health   
information from such technology may be 
exchanged1 accessed1 and used through   
the use of application programming      
interfaces or successor technology or   
standard as provided for under          
applicable law2  7iv7 the health        
information technology developer or     
entity provides to the ,secretary an    
attestation that the developer or       
entity--  7,i7 has not engaged in any of
 the conduct described in clause 7i72   
7,,ii7 allows for communication as      
described in clause 7ii72 and  7,,iii7  
ensures that its technology allows for  
health information to be exchanged1     
accessed1 and used1 in the manner       
described in clause 7iii72 and  7v7 the 
health information technology developer 
or entity submits reporting criteria in 
accordance with section #cjji;,a7f74  4 
7b7 ,health information technology      

rating program ,subtitle ,a of title    
,,xxx of the ,public ,health ,service   
,act 7#db ,u4,s4,c4 #cjj;jj-#aa et seq47
 is amended by adding at the end the    
following3  #cjji;,a4 ,health           
information technology rating program   
7a7 ,establishment ,not later than #ahj 
days after the date of enactment of the 
,improving ,health ,information         
,technology ,act1 the ,secretary shall  
recognize a development council made up 
of one representative from each of the  
certification bodies authorized by the  
,office of the ,national ,coordinator   
and the testing laboratories accredited 
under section #acbja7;b7 of the ,health 
,information ,technology for ,economic  
and ,clinical ,health ,act 7#db         
,u4,s4,c4 #agiaa7;b771 one              
representative from the ,national       
,institute of ,standards and            
,technology1 and one representative from
 the ,office of the ,national           
,coordinator4 ,the development council  
shall meet as needed for the purposes of

 carrying out its activities in         
accordance with this section4  7b7      
,reporting criteria  7#a7 ,in general   
,the ,secretary shall1 using the        
procedures prescribed in this           
subsection1 issue rules establishing    
reporting criteria for health           
information technology products4  7#b7  
,convening of stakeholders ,not later   
than #a year after the date of enactment
 of the ,improving ,health ,information 
,technology ,act1 the ,secretary1 in    
consultation with the development       
council described in subsection 7a71    
shall convene stakeholders as described 
in paragraph 7#c7 for the purpose of    
developing the reporting criteria in    
accordance with paragraph 7#d74  7#c7   
,development of reporting criteria ,the 
reporting criteria under this subsection
 shall be developed through a public1   
transparent process that reflects input 
from relevant stakeholders1 including-- 
7,a7 health care providers1 including   
primary care and specialty care health  

care professionals2  7,b7 hospitals and 
hospital systems2  7,c7 health          
information technology developers2  7,d7
 patients1 consumers1 and their         
advocates2  7,e7 data sharing networks1 
such as health information exchanges2   
7,f7 authorized certification bodies and
 testing laboratories2  7,g7 security   
experts2  7,h7 relevant manufacturers of
 medical devices2  7,i7 experts in      
health information technology market    
economics2  7,j7 public and private     
entities engaged in the evaluation of   
health information technology           
performance2  7,k7 quality              
organizations1 including the consensus  
based entity described in section #ahij 
of the ,social ,security ,act2  7,l7    
experts in human factors engineering and
 the measurement of user-centered       
design2 and  7,m7 other entities or     
persons1 as the ,secretary1 in          
consultation with the development       
council1 determines appropriate4  7#d7  
,considerations for reporting criteria  

,the reporting criteria developed under 
this subsection-- 7,a7 shall include    
measures that reflect categories        
including1 with respect to the          
technology--  7i7 security2  7ii7       
usability and user-centered design2     
7iii7 interoperability2  7iv7           
conformance to certification testing2   
and  7v7 other categories as appropriate
 to measure the performance of health   
information technology2  7,b7 may       
include measures such as--  7i7 enabling
 the user to order and view the results 
of laboratory tests1 imaging tests1 and 
other diagnostic tests2  7ii7           
submitting1 editing1 and retrieving data
 from registries such as clinician-led  
clinical data registries2  7iii7        
accessing and exchanging information and
 data from and through ,health          
,information ,exchanges2  7iv7 accessing
 and exchanging information and data    
from medical devices2  7v7 accessing and
 exchanging information and data held by
 ,federal1 ,state1 and local agencies   

and other applicable entities useful to 
a health care provider or other         
applicable user in the furtherance of   
patient care2  7vi7 accessing and       
exchanging information from other health
 care providers or applicable users2    
7vii7 accessing and exchanging patient  
generated information2  7viii7 providing
 the patient or an authorized designee  
with a complete copy of their health    
information from an electronic record in
 a computable format2  7ix7 providing   
accurate patient information for the    
correct patient1 including exchanging   
such information1 and avoiding the      
duplication of patients records2 and    
7x7 other appropriate functionalities2  
and  7,c7 shall be designed to ensure   
that small and start-up health          
information technology developers are   
not unduly disadvantaged by the         
reporting criteria or rating scale      
methodology4  7#e7 ,consideration of    
development council recommendations ,in 
promulgating proposed rules under this  

subsection1 including modifications to  
such rules under subsection 7e71 the    
,secretary may accept1 reject1 or modify
 the recommendations of the development 
council1 but may not promulgate a       
proposed rule that does not represent a 
complete recommendation of such council4
  7#f7 ,public comment ,in promulgating 
proposed rules under this subsection1   
the ,secretary shall conduct a public   
comment period of not less than #fj days
 during which any member of the public  
may provide comments on the proposed    
reporting criteria and the methodology  
for the rating body 7defined in         
subsection 7g77 to use in determining   
the star ratings4  7#g7 ,final rules    
,the final rule promulgated under this  
subsection shall be accompanied by      
timely responses to the public comments 
described in paragraph 7#f74  7#h7      
,,faca ,the ,federal ,advisory          
,committee ,act 7#e ,u4,s4,c4 ,app47    
shall not apply to the development      
council described in this section4  7c7 

,feedback  7#a7 ,in general ,the        
,secretary1 in consultation with the    
development council1 shall establish a  
process for the rating body 7described  
in subsection 7g77 to collect and verify
 confidential feedback from--  7,a7     
health care providers1 patients1 and    
other users of certified health         
information technology on the usability1
 security1 and interoperability of      
health information technology products2 
and  7,b7 developers of certified health
 information technology on practices of 
health information technology users that
 may inhibit interoperability4  7#b7    
,paperwork ,reduction ,act ,the         
,paperwork ,reduction ,act 7#dd         
,u4,s4,c4 #ceja et seq47 shall not apply
 to the collection of feedback described
 in this subsection4  7d7 ,methodology  
,the ,secretary1 in consultation with   
the development council1 shall develop a
 methodology to be used by the rating   
body described in subsection 7g7 to     
calculate the star ratings for certified

 health information technology described
 in subsection 7a74 ,the methodology    
shall use the reporting criteria        
developed in subsection 7b71 and the    
confidential feedback collected under   
subsection 7c74 ,in developing such     
methodology1 the ,secretary1 in         
consultation with the development       
council1 shall--  7#a7 provide for      
appropriate weighting of user feedback  
submitted under subsection 7c7 and      
reporting criteria submitted under      
subsection 7f71 including consideration 
of the number of users who submitted    
such feedback2  7#b7 consider the impact
 of customization or adaptation by users
 of certified health information        
technology on performance2  7#c7 account
 for the intended function1 scope1 and  
type of certified health information    
technology2  7#d7 in consultation with  
the development council and after       
seeking comment from developers of      
health information technology in a      
manner that ensures appropriate industry

 feedback1 establish a timeframe1 but in
 no case less frequent than once every  
#c years1 for the submission of         
reporting criteria under subsection 7f72
 and  7#e7 establish a timeframe for    
incorporating user feedback submitted   
under subsection 7c7 and reporting      
criteria submitted under subsection 7f7 
into the star ratings for certified     
health information technology that      
accounts for updates to such technology 
in order to encourage innovation and    
maximize the utility of the star        
ratings4  7e7 ,modifications  7#a7 ,to  
the number of stars in the rating       
program ,the development council may    
modify the number of star ratings       
employed by the system1 but not more    
frequently than every #d years4 ,in no  
case shall the rating system employ     
fewer than #c stars4  7#b7 ,to the      
reporting criteria ,after the final     
reporting criteria have been established
 under this section1 the ,secretary1 in 
consultation with the development       

council1 may convene stakeholders and   
conduct a public reporting period for   
the purpose of modifying the reporting  
criteria developed under subsection 7b7 
and methodology for determining the star
 ratings proposed under subsection 7e74 
7#c7 ,to the methodology ,after the     
final methodology to be used by the     
rating body is established under        
subsection 7e71 the ,secretary1 in      
consultation with the development       
council1 may modify the methodology used
 to calculate the star ratings for      
certified health information technology 
using the reporting criteria developed  
under subsection 7b7 and the            
confidential feedback collected under   
subsection 7c74  7#d7 ,consideration of 
,,gao report ,the ,secretary and the    
development council shall take into     
account the recommendations from the    
,comptroller ,general under subsection  
7k71 where available1 for the purposes  
of this paragraph4  7f7 ,participation  
,as a condition of maintaining their    

certification under section             
#cjja7;c77#e77;,d71 a developer of      
certified health information technology 
shall report on the criteria developed  
under subsection 7b7 for all such       
certified technology offered by such    
developer pursuant to the timeframe     
established under subsection 7d74  7g7  
,rating body  7#a7 ,in general ,the     
,national ,coordinator shall recognize  
an independent entity with appropriate  
expertise to carry out the rating       
program established by the development  
council under subsection 7a7 and shall  
redetermine such recognition at least   
every #d years4  7#b7 ,consultation ,the
 entity recognized under paragraph 7#a7 
may consult with organizations with     
expertise in the measurement of         
interoperability1 usability1 and        
security of health information          
technology in carrying out activities   
under this section4  7h7 ,one star      
rating ,each health information         
technology developer1 or entity offering

 health information technology for      
certification1 that receives a #a star  
rating shall take action1 through an    
improvement plan developed with the     
rating body and approved by the         
,secretary1 to improve the health       
information technology rating within a  
timeframe that the ,secretary determines
 appropriate4  7i7 ,decertification     
7#a7 ,mandatory ,the ,secretary shall   
decertify health information technology 
if the developer or entity offering     
health information technology does not  
submit reporting criteria in accordance 
with subsection 7f7 within #ij days of  
the timeline established under          
subsection 7d74  7#b7 ,other            
decertification ,the ,secretary may     
decertify health information technology 
if-- 7,a7 the health information        
technology does not improve from a one  
star rating within the timeframe        
established under subsection 7h72 or    
7,b7 in other circumstances1 as the     
,secretary determines appropriate4  7j7 

,,gao reports ,during the #ab-year      
period beginning on the date of         
enactment of the ,improving ,health     
,information ,technology ,act1 the      
,comptroller ,general of the ,united    
,states shall submit to ,congress a     
report every #d years on the rating     
scale methodology developed pursuant to 
subsection 7d71 providing observations  
on the appropriateness of the current   
methodology and recommendations for     
changes to the methodology4 ,the        
,development ,council shall recommend to
 ,congress and the ,secretary if        
additional reports are needed after the 
expiration of such #ab-year period4  7k7
 ,internet ,website ,on the ,internet   
website of the ,office of the ,national 
,coordinator1 the ,secretary shall      
publish the criteria and methodology    
used to determine the star ratings1 and1
 for each certified health information  
technology1 the final star rating1 and a
 report outlining such technology's     
performance with regard to the reporting

 criteria developed under subsection    
7b71 and if an improvement plan has been
 administered4 ,following the reporting 
described in subsection 7f71 the rating 
body shall have #cj days to calculate   
and submit updated ratings to the       
,secretary and each developer of health 
information technology1 and updated     
ratings shall be published on such      
,internet website not later than #cj    
days following such submission1         
notwithstanding an appeal of a rating by
 a developer or entity through the      
process developed under subsection 7m74 
7l7 ,hardship exemption ,decertification
 of an adopted health information       
technology product under subsection 7i7 
shall be considered a significant       
hardship resulting in a blanket         
exemption from the payment adjustment   
pursuant to section #ahdh7;a77#g77;,b7  
of the ,social ,security ,act for       
eligible professionals1 section         
#ahhf7;b77#c77;ix77,,ii7 of such ,act   
for eligible hospitals1 and             

#ahad7l77#d77;,c7 of such ,act for      
critical access hospitals4  7m7         
,notification and ,appeals ,the         
,secretary shall establish a process    
whereby any health information          
technology developer1 or entity offering
 health information technology1 is      
notified not less than #cj days before  
being made public and can appeal--  7#a7
 the health information technology      
product's star rating2 or  7#b7 the     
,secretary's decision to decertify a    
product1 as applicable4  4  #d4         
,information blocking ,subtitle ,c of   
title ,,xxx of the ,public ,health      
,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ea
 et seq47 is amended by adding at the   
end the following3  #cjbb4 ,information 
blocking  7a7 ,definition  7#a7 ,in     
general ,the term information blocking  
means-- 7,a7 with respect to a health   
information technology developer1       
exchange1 or network1 business1         
technical1 or organizational practices  
that--  7i7 except as required by law or

 specified by the ,secretary1 interferes
 with1 prevents1 or materially          
discourages access1 exchange1 or use of 
electronic health information2 and  7ii7
 the developer1 exchange1 or network    
knows1 or should know1 are likely to    
interfere with or prevent or materially 
discourage the access1 exchange1 or use 
of electronic health information2 and   
7,b7 with respect to a health care      
provider1 the person or entity knowingly
 and unreasonably restricts electronic  
health information exchange for patient 
care or other priorities as determined  
appropriate by the ,secretary4  7#b7    
,rulemaking ,the ,secretary shall1      
through rulemaking-- 7,a7 identify      
reasonable and necessary activities that
 do not constitute information blocking 
for purposes of paragraph 7#a77;,a72 and
  7,b7 identify actions that meet the   
definition of information blocking with 
respect to health care providers for    
purposes of paragraph 7#a77;,b74  7b7   
,inspector general authority  7#a7 ,in  

general ,the ,inspector ,general of the 
,department of ,health and ,human       
,services may investigate any claim     
that--  7,a7 a health information       
technology developer of1 or other entity
 offering certified health information  
technology--  7i7 submits a false       
attestation made under section          
#cjja7;c77#e77;,d72 or  7ii7 engaged in 
information blocking with respect to the
 use of such health information         
technology by a health care provider1   
unless for a legitimate purpose         
specified by the ,secretary2  7,b7 a    
health care provider engaged in         
information blocking with respect to    
access or exchange of certified health  
information technology1 unless for a    
legitimate purpose specified by the     
,secretary2 and  7,c7 a health          
information network or exchange provider
 engaged in information blocking with   
respect to the access1 exchange1 or use 
of such certified health information    
technology1 unless for a legitimate     

purpose specified by the ,secretary4    
7#b7 ,jurisdiction of the ,inspector    
,general ,for purposes of this section1 
the ,office of the ,inspector ,general  
shall have jurisdiction with respect to 
exchanges and networks1 as well as any  
developer or entity offering health     
information technology for certification
 under a program or programs kept or    
recognized by the ,national ,coordinator
 under section #cjja7;c77#e74 ,the      
,national ,coordinator shall notify     
developers of health information        
technology as appropriate regarding the 
jurisdiction of the ,inspector ,general 
under this paragraph4  7#c7 ,penalty    
7,a7 ,developers1 networks1 and         
exchanges ,with respect to a health     
information technology developer1       
exchange1 or network1 a person or entity
 determined by the ,inspector ,general  
to have committed information blocking  
as described in subparagraph 7,a7 or    
7,c7 of paragraph 7#a7 shall be subject 
to a civil monetary penalty in an amount

 determined1 through notice-and-comment 
rulemaking1 by the ,secretary which may 
take into account factors such as the   
extent and duration of the information  
blocking and the number of patients and 
providers potentially affected4  7,b7   
,providers ,with respect to health care 
providers1 any person or entity         
determined by the ,inspector ,general to
 have committed information blocking as 
described in subparagraph 7,b7 of       
paragraph 7#a7 shall be subject to      
appropriate incentives and disincentives
 using authorities under applicable     
,federal law1 as determined appropriate 
by the ,secretary through notice and    
comment rulemaking4  7,c7 ,procedure    
,the provisions of section #aabh;,a of  
the ,social ,security ,act 7other than  
subsections 7a7 and 7b77 shall apply to 
a civil money penalty applied under this
 subsection in the same manner as such  
provisions apply to a civil money       
penalty or proceeding under section     
#aabh;,a7a74  7,d7 ,recovery of funds   

,notwithstanding section #ccjb of title 
#ca1 ,united ,states ,code1 or any other
 provision of law affecting the         
crediting of collections1 the ,inspector
 ,general of the ,department of ,health 
and ,human ,services may receive and    
retain for current use any amounts      
recovered under subparagraphs 7,a7 and  
7,c74 ,in addition to amounts otherwise 
available to the ,inspector ,general1   
funds received by the ,inspector        
,general under this paragraph shall be  
deposited1 as an offsetting collection1 
to the credit of any appropriation      
available for purposes of carrying out  
this subsection and shall be available  
without fiscal year limitation and      
without further appropriation4  7#d7    
,resolution of claims  7,a7 ,in general 
,the ,office of the ,inspector ,general1
 if such ,office determines that a      
simple consultation regarding the health
 privacy and security rules promulgated 
under section #bfd7;c7 of the ,health   
,insurance ,portability and             

,accountability ,act of #aiif 7#db      
,u4,s4,c4 #acbj;d-#b note7 will resolve 
the claim at issue1 may refer instances 
of information blocking to the ,office  
for ,civil ,rights of the ,department of
 ,health and ,human ,services for       
resolution4  7,b7 ,limitation on        
liability ,if a health information      
technology developer makes information  
available based on a good faith reliance
 on consultations with the ,office for  
,civil ,rights of the ,department of    
,health and ,human ,services with       
respect to such information1 the        
developer shall not be liable for such  
disclosure4  7c7 ,identifying barriers  
to exchange of certified health         
information technology  7#a7 ,trusted   
exchange defined ,in this section1 the  
term trusted exchange with respect to   
certified health information technology 
means that the certified health         
information technology has the technical
 capability to enable secure health     
information exchange between users and  

multiple certified health information   
technology systems4  7#b7 ,guidance ,the
 ,national ,coordinator1 in consultation
 with the ,office for ,civil ,rights of 
the ,department of ,health and ,human   
,services1 shall issue guidance on      
common legal1 governance1 and security  
barriers that prevent the trusted       
exchange of electronic health           
information4  7#c7 ,referral ,the       
,national ,coordinator and the ,office  
for ,civil ,rights of the ,department of
 ,health and ,human ,services may refer 
to the ,inspector ,general instances or 
patterns of refusal to exchange health  
information with an individual or entity
 using certified health information     
technology that is technically capable  
of trusted exchange and under conditions
 when exchange is legally permissible4  
7#d7 ,,hit standards committee          
consideration ,not later than #a year   
after the date of enactment of the      
,improving ,health ,information         
,technology ,act1 the ,,hit ,standards  

,committee shall begin consideration of 
issues related to trusted exchange4  4  
#e4 ,interoperability  7a7 ,definition  
,section #cjjj of the ,public ,health   
,service ,act 7#db ,u4,s4,c4 #cjj;jj7 is
 amended--  7#a7 by redesignating       
paragraphs 7#aj7 through 7#ad71 as      
paragraphs 7#aa7 through 7#ae71         
respectively2 and  7#b7 by inserting    
after paragraph 7#i7 the following3     
7#aj7 ,interoperability ,the term       
interoperability with respect to health 
information technology means such health
 information technology that has the    
ability to securely exchange electronic 
health information with and use         
electronic health information from other
 health information technology without  
special effort on the part of the user4 
4  7b7 ,support for interoperable       
network exchange ,section #cjja7;c7 of  
the ,public ,health ,service ,act 7#db  
,u4,s4,c4 #cjj;jj-#aa7;c77 is amended by
 adding at the end the following3  7#i7 
,support for interoperable networks     

exchange  7,a7 ,in general ,the         
,national ,coordinator shall1 in        
collaboration with the ,national        
,institute of ,standards and ,technology
 and other relevant agencies within the 
,department of ,health and ,human       
,services1 for the purpose of ensuring  
full network-to-network exchange of     
health information1 convene             
public-private and public-public        
partnerships to build consensus and     
develop a trusted exchange framework1   
including a common agreement among      
health information networks nationally4 
,such convention may occur at a         
frequency determined appropriate by the 
,secretary4  7,b7 ,establishing a       
trusted exchange framework  7i7 ,in     
general ,not later than six months after
 the date of enactment of this          
paragraph1 the ,national ,coordinator   
shall convene appropriate public and    
private stakeholders to develop a       
trusted exchange framework for trust    
policies and practices and for a common 

agreement for exchange between health   
information networks4 ,the common       
agreement may include--  7,i7 a common  
method for authenticating trusted health
 information network participants2      
7,,ii7 a common set of rules for trusted
 exchange2  7,,iii7 organizational and  
operational policies to enable the      
exchange of health information among    
networks1 including minimum conditions  
for such exchange to occur2 and  7,,iv7 
a process for filing and adjudicating   
noncompliance with the terms of the     
common agreement4  7ii7 ,technical      
assistance ,the ,national ,coordinator1 
in conjunction with the ,national       
,institute of ,standards and            
,technology1 shall provide technical    
assistance on how to implement the      
trusted exchange framework and common   
agreement under this paragraph4  7iii7  
,pilot testing ,the ,national           
,coordinator1 in collaboration with the 
,national ,institute of ,standards and  
,technology1 shall provide for the pilot

 testing of the trusted exchange        
framework and common agreement          
established under this subsection 7as   
authorized under section #acbja of the  
,health ,information ,technology for    
,economic and ,clinical ,health ,act74  
,the ,national ,coordinator1 in         
collaboration with the ,national        
,institute of ,standards and            
,technology1 may delegate pilot testing 
activities under this clause to         
independent entities with appropriate   
expertise4  7,c7 ,publication of a      
trusted exchange framework and common   
agreement ,not later than one year after
 convening stakeholders under           
subparagraph 7,a71 the ,national        
,coordinator shall publish on its public
 ,internet website1 and in the ,federal 
register1 the trusted exchange framework
 and common agreement developed under   
subparagraph 7,b74 ,such trusted        
exchange framework and common agreement 
shall be published in a manner that     
protects proprietary and security       

information1 including trade secrets and
 any other protected intellectual       
property4  7,d7 ,directory of           
participating health information        
networks  7i7 ,in general ,not later    
than two years after convening          
stakeholders under subparagraph 7,a71   
and annually thereafter1 the ,national  
,coordinator shall publish on its public
 ,internet website a list of those      
health information networks that have   
adopted the common agreement and are    
capable of trusted exchange pursuant to 
the common agreement developed under    
paragraph 7,b74  7ii7 ,process ,the     
,secretary shall1 through               
notice-and-comment rulemaking1 establish
 a process for health information       
networks that voluntarily elect to adopt
 the trusted exchange framework and     
common agreement to attest to such      
adoption of the framework and agreement4
  7,e7 ,application of the trusted      
exchange framework and common agreement 
,as appropriate1 ,federal agencies      

contracting or entering into agreements 
with health information exchange        
networks may require that as each such  
network upgrades health information     
technology or trust and operational     
practices1 it may adopt1 where          
available1 the trusted exchange         
framework and common agreement published
 under subparagraph 7,c74  7,f7 ,rule of
 construction  7i7 ,general adoption    
,nothing in this paragraph shall be     
construed to require a health           
information network to adopt the trusted
 exchange framework or common agreement4
  7ii7 ,adoption when exchange of       
information is within network ,nothing  
in this paragraph shall be construed to 
require a health information network to 
adopt the trusted exchange framework or 
common agreement for the exchange of    
electronic health information between   
participants of the same network4  7iii7
 ,existing frameworks and agreements    
,the trusted exchange framework and     
common agreement published under        

subparagraph 7,c7 shall take into       
account existing trusted exchange       
frameworks and agreements used by health
 information networks to avoid the      
disruption of existing exchanges between
 participants of health information     
networks4  7iv7 ,application by ,federal
 agencies ,notwithstanding clauses 7i71 
7ii71 and 7iii71 ,federal agencies may  
require the adoption of the trusted     
exchange framework and common agreement 
published under subparagraph 7,c7 for   
health information exchanges contracting
 with or entering into agreements       
pursuant to subparagraph 7,e74  7v7     
,consideration of ongoing work ,in      
carrying out this paragraph1 the        
,secretary shall ensure the             
consideration of activities carried out 
by public and private organizations     
related to exchange between health      
information exchanges to avoid          
duplication of efforts4  4  7c7         
,provider digital contact information   
index  7#a7 ,in general ,not later than 

#cf months after the date of enactment  
of this ,act1 the ,secretary of ,health 
and ,human ,services shall either       
directly1 or through a partnership with 
a private entity1 establish a provider  
digital contact information index to    
provide digital contact information for 
health professionals1 health facilities1
 and other individuals or organizations4
  7#b7 ,use of existing index ,in       
establishing the initial index under    
paragraph 7#a71 the ,secretary of       
,health and ,human ,services may utilize
 an existing provider directory to make 
such digital contact information        
available4  7#c7 ,contact information   
,an index established under this        
subsection shall ensure that contact    
information is available at the         
individual health care provider level   
and at the health facility or practice  
level4  7#d7 ,rule of construction  7,a7
 ,in general ,the purpose of this       
subsection is to encourage the exchange 
of electronic health information by     

providing the most useful1 reliable1 and
 comprehensive index of providers       
possible4 ,in furthering such purpose1  
the ,secretary of ,health and ,human    
,services shall include all health      
professionals1 health facilities1 and   
other individuals or organizations      
applicable to provide a useful1         
reliable1 and comprehensive index for   
use in the exchange of health           
information4  7,b7 ,limitation ,in no   
case shall exclusion from the index of  
providers be used as a measure to       
achieve objectives other those described
 in subparagraph 7,a74  7d7 ,standards  
development organizations ,section #cjjd
 of the ,public ,health ,service ,act   
7#db ,u4,s4,c4 #cjj;jj-#ad7 is amended  
by adding at the end the following3  7c7
 ,deference to standards development    
organizations ,in adopting and          
implementing standards under this       
section1 the ,secretary shall give      
deference to standards published by     
,standards ,development ,organizations  

and voluntary consensus-based standards 
bodies4  4  #f4 ,leveraging health      
information technology to improve       
patient care  7a7 ,requirement relating 
to registries  7#a7 ,in general ,to be  
certified in accordance with title ,,xxx
 of the ,public ,health ,service ,act1  
health information technology 7as       
defined by section #cjjj7e7 of the      
,public ,health ,service ,act 7#db      
,u4,s4,c4 #cjj;jj7#e777 shall be capable
 of transmitting to1 and where          
applicable1 receiving and accepting data
 from registries in accordance with     
standards recognized by the ,office of  
the ,national ,coordinator for ,health  
,information ,technology1 including     
clinician-led clinical data registries1 
that are also certified to be           
technically capable of receiving and    
accepting from1 and where applicable1   
transmitting data to certified health   
information technology in accordance    
with such standards4  7#b7 ,rule of     
construction ,nothing in this subsection

 shall be construed to require the      
certification of registries beyond the  
technical capability to exchange data in
 accordance with applicable endorsed    
standards4  7b7 ,definition ,for        
purposes of this ,act 7including        
amendments made to title ,,xxx of the   
,public ,health ,service ,act 7#db      
,u4,s4,c4 #cjj;jj et seq4771 the term   
clinician-led clinical data registry    
means a clinical data repository--  7#a7
 that is established and operated by a  
clinician-led or controlled1 tax-exempt 
7pursuant to section #eja7;c7 of the    
,internal ,revenue ,code of #aihf71     
professional society or other similar   
clinician-led or -controlled            
organization1 or such organization's    
controlled affiliate1 devoted to the    
care of a population defined by a       
particular disease1 condition1 exposure 
or therapy2  7#b7 that is designed to   
collect detailed1 standardized data on  
an ongoing basis for medical procedures1
 services1 or therapies for particular  

diseases1 conditions1 or exposures2     
7#c7 that provides feedback to          
participants who submit reports to the  
repository2  7#d7 that meets standards  
for data quality including--  7,a7      
systematically collecting clinical and  
other health care data1 using           
standardized data elements and has      
procedures in place to verify the       
completeness and validity of those data2
 and  7,b7 being subject to regular data
 checks or audits to verify completeness
 and validity2 and  7#e7 that provides  
ongoing participant training and        
support4  7c7 ,treatment of health      
information technology developers with  
respect to patient safety organizations 
7#a7 ,in general ,in applying part ,c of
 title ,,ix of the ,public ,health      
,service ,act 7#db ,u4,s4,c4 #bii;b-#ba 
et seq471 a health information          
technology developer shall be treated as
 a provider 7as defined in section #iba 
of such ,act7 for purposes of reporting 
and conducting patient safety activities

 concerning improving clinical care     
through the use of health information   
technology that could result in improved
 patient safety1 health care quality1 or
 health care outcomes4  7#b7 ,report    
,not later than #dh months after the    
date of enactment of this ,act1 the     
,secretary of ,health and ,human        
,services shall submit to the ,committee
 on ,health1 ,education1 ,labor1 and    
,pensions of the ,senate and the        
,committee on ,energy and ,commerce of  
the ,house of ,representatives1 a report
 concerning best practices and current  
trends voluntarily provided1 and without
 identifying individual providers or    
disclosing or using protected health    
information or individually identifiable
 information1 by ,patient ,safety       
,organizations to improve the           
integration of health information       
technology into clinical practice4  #g4 
,empowering patients and improving      
patient access to their electronic      
health information  7a7 ,use of health  

information exchanges for patient access
 ,section #cjji of the ,public ,health  
,service ,act 7#db ,u4,s4,c4            
#cjj;jj-#ai7 is amended by adding at the
 end the following3  7c7 ,promoting     
patient access to electronic health     
information through health information  
exchanges  7#a7 ,in general ,the        
,national ,coordinator1 in coordination 
with the ,office for ,civil ,rights of  
the ,department of ,health and ,human   
,services1 shall use existing           
authorities to encourage partnerships   
between health information exchange     
organizations and networks and health   
care providers1 health plans1 and other 
appropriate entities to offer patients  
access to their electronic health       
information in a single1 longitudinal   
format that is easy to understand1      
secure1 and may update such information 
automatically4  7#b7 ,education of      
providers ,the ,national ,coordinator1  
in coordination with the ,office for    
,civil ,rights of the ,department of    

,health and ,human ,services1 shall--   
7,a7 educate health care providers on   
ways in which to leverage the           
capabilities of health information      
exchanges 7or other relevant platforms7 
to provide patients with access to their
 electronic health information2  7,b7   
clarify misunderstandings by health care
 providers about using health           
information exchanges 7or other relevant
 platforms7 for patient access to       
electronic health information2 and  7,c7
 to the extent practicable1 educate     
providers about health information      
exchanges 7or other relevant platforms7 
that employ some or all of the          
capabilities described in paragraph     
7#a74  7#c7 ,requirements ,in carrying  
out paragraph 7#a71 the ,national       
,coordinator1 in coordination with the  
,office for ,civil ,rights1 shall issue 
guidance to health information exchanges
 related to best practices to ensure    
that the electronic health information  
provided to patients is--  7,a7 private 

and secure2  7,b7 accurate2  7,c7       
verifiable2 and  7,d7 where a patient's 
authorization to exchange is required by
 law1 easily exchanged pursuant to such 
authorization4  7#d7 ,rule of           
construction ,nothing in this subsection
 shall be construed to preempt ,state   
laws applicable to patient consent for  
the access of information through a     
,health ,information ,exchange 7or other
 relevant platforms7 that provide       
protections to patients that are greater
 than the protections otherwise provided
 for under applicable ,federal law4  7d7
 ,efforts ,to promote access to health  
information ,the ,national ,coordinator 
and the ,office for ,civil ,rights of   
the ,department of ,health and ,human   
,services shall jointly1 through the    
development of policies that support    
dynamic technology solutions1 promote   
patient access to health information in 
a manner that would ensure that such    
information is available in a form      
convenient for the patient1 in a        

reasonable manner1 and without burdening
 the health care provider involved4  7e7
 ,accessibility of ,patient ,records    
7#a7 ,accessibility and updating of     
information  7,a7 ,in general ,the      
,secretary1 in consultation with the    
,national ,coordinator1 shall promote   
policies that ensure that a patient's   
electronic health information is        
accessible to that patient1 and their   
designees1 in a manner that facilitates 
communication with the patient's health 
care providers and such patient's       
consent1 including with respect to      
research4  7,b7 ,updating education on  
accessing and exchanging personal health
 information ,to promote awareness that 
an individual has a right of access to  
inspect1 obtain a copy of1 and transmit 
to a third party a copy of protected    
health information pursuant to the      
,health ,information ,portability and   
,accountability ,act ,privacy ,rule 7#de
 ,c4,f4,r4 #afd4ebd et seq471 the       
,director of the ,office for ,civil     

,rights1 in consultation with the       
,national ,coordinator1 shall assist    
individuals and health care providers in
 understanding a patient's rights to    
access and protect their personal health
 information under the ,health          
,insurance ,portability and             
,accountability ,act of #aiif 7,public  
,law #ajd-aia71 including providing best
 practices for requesting personal      
health information in a computable      
format1 including using patient portals 
or third-party applications and common  
cases when a provider is permitted to   
exchange and provide access to health   
information4  7#b7 ,certifying usability
 for patients ,in carrying out          
certification programs under section    
#cjja7;c77#e71 the ,national            
,coordinator shall require1 where       
applicable1 that such program or        
programs require the following3  7,a7   
,that certification criteria support    
patient access to their electronic      
health information1 including in a      

single longitudinal format that is easy 
to understand1 secure1 and may be       
updated automatically4  7,b7 ,that      
developers of health information        
technology support patient access to an 
electronic health record in a           
longitudinal format that is easy to     
understand1 secure1 and may be updated  
automatically4  7,c7 ,that certification
 criteria support patient access to     
their personal electronic health        
information for research at the option  
of the patient4  7,d7 ,that             
certification criteria support patient  
and health care provider communication1 
including-- 7i7 the ability for the     
patient to electronically communicate   
patient reported information 7such as   
family history and medical history72 and
  7ii7 the ability for the patient to   
electronically share patient health     
information1 at the option of the       
patient4  7,e7 ,that certified health   
information technology used for health  
programs where certified health         

information technology is required1     
include the function for patient access 
to their own health information1        
including--  7i7 ensuring that1 as a    
condition of certification1 health care 
providers have options for making such  
information accessible for patients2    
7ii7 ensuring that patients have options
 for accessing such information2 and    
7iii7 ensuring that patients have access
 to information regarding their legal   
rights and responsibilities1 as well the
 options available to them for accessing
 their electronic health information4   
7,f7 ,that the ,,hit ,standards         
,committee develop and prioritize       
standards1 implementation               
specifications1 and certification       
criteria required to help support       
patient access to electronic health     
information1 patient usability1 and     
support for technologies that offer     
patients access to their electronic     
health information in a single1         
longitudinal format that is easy to     

understand1 secure1 and may be updated  
automatically4  4  7b7 ,access to       
information in an electronic format     
,section #acdje7;e7 of the ,health      
,information ,technology for ,economic  
and ,clinical ,health ,act 7#db         
,u4,s4,c4 #agice7 is amended--  7#a7 in 
paragraph 7#a71 by striking and at the  
end2  7#b7 by redesignating paragraph   
7#b7 as paragraph 7#c72 and  7#c7 by    
inserting after paragraph 7#a71 the     
following3  7#b7 if the individual makes
 a request to a business associate for  
access to1 or a copy of1 protected      
health information about the individual1
 or if an individual makes a request to 
a business associate to grant such      
access to1 or transmit such copy        
directly to1 a person or entity         
designated by the individual1 a business
 associate may provide the individual   
with such access or copy1 which may be  
in an electronic form1 or grant or      
transmit such access or copy to such    
person or entity designated by the      

individual2 and  4  #h4 ,,gao study on  
patient matching  7a7 ,in general ,not  
later than #a year after the date of    
enactment of this ,act1 the ,comptroller
 ,general of the ,united ,states shall  
conduct a study to review the policies  
and activities of the ,office of the    
,national ,coordinator for ,health      
,information ,technology and other      
relevant stakeholders to ensure         
appropriate patient matching to protect 
patient privacy and security with       
respect to electronic health records and
 the exchange of electronic health      
information4  7b7 ,areas of             
concentration ,in conducting the study  
under subsection 7a71 the ,comptroller  
,general shall-- 7#a7 evaluate current  
methods used in certified electronic    
health records for patient matching     
based on performance related to factors 
such as--  7,a7 the privacy of patient  
information2  7,b7 the security of      
patient information2  7,c7 improving    
matching rates2  7,d7 reducing matching 

errors2 and  7,e7 reducing duplicate    
records2 and  7#b7 determine whether the
 ,office of the ,national ,coordinator  
for ,health ,information ,technology    
could improve patient matching by taking
 steps including--  7,a7 defining       
additional data elements to assist in   
patient data matching2  7,b7 agreeing on
 a required minimum set of elements that
 need to be collected and exchanged2    
7,c7 requiring electronic health records
 to have the ability to make certain    
fields required and use specific        
standards2 or  7,d7 other options       
recommended by the relevant stakeholders
 consulted pursuant to subsection 7a74  
7c7 ,report ,not later than #b years    
after the date of enactment of this     
,act1 the ,comptroller ,general shall   
submit to the appropriate committees of 
,congress a report concerning the       
findings of the study conducted under   
subsection 7a74