,,ii  #aad? ,,congress  #b;d ,session   
,s4 #beaa  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,febru>y #h1 #bjaf ,mr4
 ,alex&] 7= himself1 ,mrs4 ,murray1 ,mr4
 ,cassidy1 ,mr4 ,:iteh\se1 ,mr4 ,hat*1 &
 ,mr4 ,b5net7 introduc$ ! foll[+ bill2  
:i* 0 read twice & ref]r$ to !          
,committee on ,heal?1 ,education1       
,labor1 & ,p5sions  ,a ,,bill  ,to      
improve ,f$]al requirem5ts relat+ to !  
developm5t & use ( electronic heal?     
records te*nology4  #a4 ,%ort title     
,?is ,act may be cit$ z ! ,improv+      
,heal? ,in=mation ,te*nology ,act4  #b4 
,assi/+ doctors & hospitals 9 improv+ ! 
quality ( c>e = pati5ts  7a7 ,9 g5]al   
,"p #a ( subtitle ,a ( title ,,xiii ( ! 
,heal? ,in=mation ,te*nology = ,economic
 & ,cl9ical ,heal? ,act 7,public ,law   
#aaa-e7 is am5d$ by add+ at ! end !     
foll[+3  #acajc4 ,assi/+ doctors &      
hospitals 9 improv+ ! quality ( c>e =   
pati5ts  7a7 ,r$uction 9 burd5s goal ,! 
,secret>y ( ,heal? & ,human ,s]vices    
7ref]r$ to 9 ?is section z ! ,secret>y71

 9 consultation ) provid]s ( heal?      
s]vices1 heal? c>e suppli]s ( s]vices1  
heal? c>e pay]s1 heal? pr(essional      
societies1 heal? in=mation te*nology    
develop]s1 heal? c>e quality            
organizations1 heal? c>e accr$itation   
organizations1 public heal? entities1   
,/ates1 & o!r appropriate entities1     
%all1 9 accordance ) subsection 7b7--   
7#a7 e/abli% a goal ) respect to !      
r$uction ( regulatory or adm9i/rative   
burd5s 7su* z docum5tation requirem5ts7 
relat+ to ! use ( electronic heal?      
records2  7#b7 develop a /rategy = meet+
 ! goal e/abli%$ "u p>agraph 7#a72 &    
7#c7 develop recomm5dations = meet+ !   
goal e/abli%$ "u p>agraph 7#a74  7b7    
,/rategy & recomm5dations  7#a7 ,9 g5]al
 ,to a*ieve ! goals e/abli%$ "u         
subsection 7a77#a71 ! ,secret>y1 9      
consultation ) ! entities describ$ 9 su*
 subsection1 %all1 n lat] ?an #ab mon?s 
aft] ! date ( enactm5t ( ?is section1   
develop a /rategy & recomm5dations to   
meet ! goals 9 accordance ) ?is         

subsection4  7#b7 ,/rategy ,! /rategy   
develop$ "u p>agraph 7#a7 %all address !
 regulatory & adm9i/ration burd5s 7su* z
 docum5tation requirem5ts7 relat+ to !  
use ( electronic heal? records4 ,su*    
/rategy %all include broad public comm5t
 & %all prioritize burd5s relat$ to--   
7,a7 ! ,m$ic>e & ,m$icaid ,,ehr         
,mean+ful ,use ,inc5tive programs or !  
,m]it-bas$ ,inc5tive ,paym5t ,sy/em1 !  
,alt]native ,paym5t ,models1 ! ,hospital
 ,value-,bas$ ,pur*as+ ,program1 & o!r  
value-bas$ paym5t programs det]m9$      
appropriate by ! ,secret>y2  7,b7 heal? 
in=mation te*nology c]tification        
programs2  7,c7 /&>ds1 & implem5tation  
specifications1 z appropriate2  7,d7    
activities t provide individuals access 
to _! electronic heal? in=mation2  7,e7 
activities relat$ to protect+ ! privacy 
( electronic heal? in=mation2  7,f7     
activities relat$ to protect+ ! security
 ( electronic heal? in=mation2  7,g7    
activities relat$ to facilitat+ heal? & 
cl9ical rese>*2  7,h7 activities relat$ 

to public heal?2  7,i7 activities relat$
 to align+ & simplify+ quality measures 
across ,f$]al programs & o!r pay]s2     
7,j7 activities relat$ to report+       
cl9ical data = adm9i/rative purposes2 & 
7,k7 o!r areas det]m9$ appropriate by ! 
,secret>y4  7#c7 ,recomm5dations ,!     
recomm5dations develop$ "u p>agraph 7#a7
 %all address-- 7,a7 actions t improve !
 cl9ical docum5tation exp]i5ce2  7,b7   
actions t improve pati5t c>e2  7,c7     
actions to be tak5 by ! ,secret>y & by  
o!r entities2 &  7,d7 o!r areas det]m9$ 
appropriate by ! ,secret>y to r$uce !   
report+ burd5 requir$ ( heal? c>e       
provid]s4  7#d7 ,,faca ,! ,f$]al        
,advisory ,committee ,act 7#e ,u4,s4,c4 
,app47 %all n apply to ! developm5t ( ! 
goal1 /rategies1 or recomm5dations      
describ$ 9 ?is section4  7c7            
,application ( c]ta9 regulatory         
requirem5ts  ,a physician 7z def9$ 9    
section #ahfa7r77#a7 ( ! ,social        
,security ,act7 may delegate electronic 
m$ical record docum5tation requirem5ts  

specifi$ 9 regulations promulgat$ by !  
,dep>tm5t ( ,heal? & ,human ,s]vices to 
a p]son :o is n su* physician if su*    
physician has sign$ & v]ifi$ !          
docum5tation4  4  7b7 ,c]tification (   
heal? in=mation te*nology = m$ical      
specialties & sites ( s]vice ,section   
#cjja7;c77#e7 ( ! ,public ,heal? ,s]vice
 ,act 7#db ,u4,s4,c4                    
#cjj;jj-#aa7;c77#e77 is am5d$ by add+ at
 ! end ! foll[+3  7,c7 ,heal? in=mation 
te*nology = m$ical specialties & sites (
 s]vice  7i7 ,9 g5]al ,! ,national      
,coord9ator %all enc\rage1 keep1 or     
recognize1 ?r\gh exi/+ au?orities1 !    
volunt>y c]tification ( heal? in=mation 
te*nology "u ! program develop$ "u      
subp>agraph 7,a7 = use 9 m$ical         
specialties & sites ( s]vice = :i* no   
su* te*nology is available or :]e m     
te*nological advancem5t or integration  
is ne$$4  7ii7 ,specific m$ical         
specialties ,! ,,hit ,policy & ,/&>ds   
,committees %all make recomm5dations on 
specific m$ical specialties & sites (   

s]vice1 9 addition to ^? describ$ 9     
clause 7iii71 applicable "u ?is         
p>agraph4  7iii7 ,c]tifi$ heal?         
in=mation te*nology = p$iatrics ,n lat] 
?an #ah mon?s aft] ! date ( enactm5t (  
?is subp>agraph1 ! ,,hit ,policy &      
,/&>ds ,committees1 9 consultation )    
relevant /akehold]s1 %all make          
recomm5dations = ! volunt>y c]tification
 ( heal? in=mation te*nology = use by   
p$iatric heal? provid]s to support !    
heal? c>e ( *ildr54 ,n lat] ?an #bd     
mon?s aft] ! date ( enactm5t ( ?is      
subp>agraph1 ! ,secret>y %all adopt     
c]tification crit]ia 7"u section #cjjd7 
to support ! volunt>y c]tification (    
heal? in=mation te*nology = use by      
p$iatric heal? provid]s to support !    
heal? c>e ( *ildr54  4  7c7 ,mean+ful   
use /ati/ics  7#a7 ,9 g5]al ,n lat] ?an 
#f mon?s aft] ! date ( enactm5t ( ?is   
,act1 ! ,secret>y ( ,heal? & ,human     
,s]vices %all submit to ! ,,hit ,policy 
,committee ( ! ,(fice ( ! ,national     
,coord9ator = ,heal? ,in=mation         

,te*nology1 a report conc]n+ atte/ation 
/ati/ics = ! ,m$ic>e & ,m$icaid ,,ehr   
,mean+ful ,use ,inc5tive programs to    
assi/ 9 in=m+ /&>ds adoption & relat$   
practices4 ,su* /ati/ics %all include   
atte/ation in=mation del9eat$ by ,/ate1 
includ+ ! numb] ( provid]s :o did n meet
 ! m9imum crit]ia necess>y to atte/ = ! 
,m$ic>e & ,m$icaid ,,ehr ,mean+ful ,use 
,inc5tive programs = a cal5d> ye>1 &    
%all be made publicly available on !    
,int]net website ( ! ,secret>y on at    
lea/ a qu>t]ly basis4  7#b7 ,au?ority to
 alt] =mat ,! ,secret>y ( ,heal? &      
,human ,s]vices may alt] ! =mat ( !     
reports on ! atte/ation ( eligible heal?
 c>e pr(essionals foll[+ ! fir/ p]=mance
 ye> ( ! ,m]it-bas$ ,inc5tive ,paym5t   
,sy/em to acc\nt = *anges aris+ f !     
implem5tation ( su* paym5t sy/em4  #c4  
,transp>5t rat+s on usability & security
 to trans=m in=mation te*nology  7a7    
,enhancem5ts to c]tification  ,section  
#cjja7;c77#e7 ( ! ,public ,heal? ,s]vice
 ,act 7#db ,u4,s4,c4 #cjj;jj-#aa71 z    

am5d$ by section #b7;b71 is fur!r       
am5d$--  7#a7 9 subp>agraph 7,a7-- 7,a7 
by /rik+ ,! ,national ,coord9ator &     
ins]t+ ! foll[+3  7i7 ,volunt>y         
c]tification program ,! ,national       
,coord9ator  2 &  7,b7 by add+ at ! end 
! foll[+3  7ii7 ,transp>5cy ( program   
7,i7 ,9 g5]al ,to enhance transp>5cy 9 !
 compliance ( heal? in=mation te*nology 
) c]tification crit]ia & o!r requirem5ts
 adopt$ "u ?is subtitle1 ! ,national    
,coord9ator1 9 coord9ation ) au?oriz$   
c]tification bodies1 may make in=mation 
demon/rat+ h[ heal? in=mation te*nology 
meets su* c]tification crit]ia or o!r   
requirem5ts publicly available4 ,su*    
in=mation may include summ>ies1         
scre5%ots1 video demon/rations1 or any  
o!r in=mation ! ,national ,coord9ator   
det]m9es appropriate4  7,,ii7           
,protection ( propriet>y in=mation ,!   
,national ,coord9ator %all take         
appropriate measures to ensure t !re are
 9 effect effective proc$ures to prev5t 
! unau?oriz$ disclosure ( any trade     

secret or confid5tial in=mation t is    
obta9$ by ! ,secret>y pursuant to ?is   
section4  2  7#b7 9 subp>agraph 7,b71 by
 add+ at ! end ! foll[+3 ,beg9n+ #ah    
mon?s aft] report+ crit]ia are f9aliz$  
"u section #cjji;,a1 c]tification       
crit]ia %all include1 9 addition to     
crit]ia to e/abli% t ! te*nology meets  
su* /&>ds & implem5tation               
specifications1 crit]ia consi/5t )      
section #cjji;,a7b7 to e/abli% t        
te*nology meets applicable security     
requirem5ts1 incorporates us]-c5t]$     
design1 & a*ieves int]op]ability42 &    
7#c7 by add+ at ! end ! foll[+3  7,d7   
,conditions ( c]tification ,beg9n+ #a   
ye> aft] ! date ( enactm5t ( ! ,improv+ 
,heal? ,in=mation ,te*nology ,act1 !    
,secret>y %all require1 z a condition ( 
c]tification & ma9t5ance ( c]tification 
= programs ma9ta9$ or recogniz$ "u ?is  
p>agraph1 t--  7i7 ! heal? in=mation    
te*nology develop] or entity does n take
 any action t con/itutes in=mation      
block+ ) respect to heal? in=mation     

te*nology2  7ii7 ! heal? in=mation      
te*nology develop] or entity p]mits     
unimp$$ communication among & betwe5    
heal? in=mation te*nology us]s1 & = !   
purposes ( heal? in=mation te*nology    
us]s communicat+ ) an au?oriz$          
c]tification body1 ! ,(fice ( !         
,national ,coord9ator1 & ! ,(fice ( !   
,inspector ,g5]al1 ! heal? in=mation    
te*nology develop] or entity p]mits     
unimp$$ communication reg>d+ !          
usability1 int]op]ability1 security1    
bus9ess practices1 or o!r relevant      
in=mation ab\t ! heal? in=mation        
te*nology or us]s' exp]i5ce ) ! heal?   
in=mation te*nology2  7iii7 heal?       
in=mation f su* te*nology may be        
ex*ang$1 access$1 & us$ ?r\gh ! use (   
application programm+ int]faces or      
successor te*nology or /&>d z provid$ = 
"u applicable law2  7iv7 ! heal?        
in=mation te*nology develop] or entity  
provides to ! ,secret>y an atte/ation t 
! develop] or entity--  7,i7 has n      
engag$ 9 any ( ! conduct describ$ 9     

clause 7i72  7,,ii7 all[s =             
communication z describ$ 9 clause 7ii72 
&  7,,iii7 ensures t its te*nology all[s
 = heal? in=mation to be ex*ang$1       
access$1 & us$1 9 ! mann] describ$ 9    
clause 7iii72 &  7v7 ! heal? in=mation  
te*nology develop] or entity submits    
report+ crit]ia 9 accordance ) section  
#cjji;,a7f74  4  7b7 ,heal? in=mation   
te*nology rat+ program ,subtitle ,a (   
title ,,xxx ( ! ,public ,heal? ,s]vice  
,act 7#db ,u4,s4,c4 #cjj;jj-#aa et seq47
 is am5d$ by add+ at ! end ! foll[+3    
#cjji;,a4 ,heal? in=mation te*nology    
rat+ program  7a7 ,e/abli%m5t ,n lat]   
?an #ahj days aft] ! date ( enactm5t ( !
 ,improv+ ,heal? ,in=mation ,te*nology  
,act1 ! ,secret>y %all recognize a      
developm5t c\ncil made up ( "o          
repres5tative f ea* ( ! c]tification    
bodies au?oriz$ by ! ,(fice ( !         
,national ,coord9ator & ! te/+          
laboratories accr$it$ "u section        
#acbja7;b7 ( ! ,heal? ,in=mation        
,te*nology = ,economic & ,cl9ical ,heal?

 ,act 7#db ,u4,s4,c4 #agiaa7;b771 "o    
repres5tative f ! ,national ,in/itute ( 
,/&>ds & ,te*nology1 & "o repres5tative 
f ! ,(fice ( ! ,national ,coord9ator4 ,!
 developm5t c\ncil %all meet z ne$$ = ! 
purposes ( c>ry+ out its activities 9   
accordance ) ?is section4  7b7 ,report+ 
crit]ia  7#a7 ,9 g5]al ,! ,secret>y     
%all1 us+ ! proc$ures prescrib$ 9 ?is   
subsection1 issue rules e/abli%+ report+
 crit]ia = heal? in=mation te*nology    
products4  7#b7 ,conv5+ ( /akehold]s ,n 
lat] ?an #a ye> aft] ! date ( enactm5t (
 ! ,improv+ ,heal? ,in=mation ,te*nology
 ,act1 ! ,secret>y1 9 consultation ) !  
developm5t c\ncil describ$ 9 subsection 
7a71 %all conv5e /akehold]s z describ$ 9
 p>agraph 7#c7 = ! purpose ( develop+ ! 
report+ crit]ia 9 accordance ) p>agraph 
7#d74  7#c7 ,developm5t ( report+       
crit]ia ,! report+ crit]ia "u ?is       
subsection %all be develop$ ?r\gh a     
public1 transp>5t process t reflects    
input f relevant /akehold]s1 includ+--  
7,a7 heal? c>e provid]s1 includ+ prim>y 

c>e & specialty c>e heal? c>e           
pr(essionals2  7,b7 hospitals & hospital
 sy/ems2  7,c7 heal? in=mation te*nology
 develop]s2  7,d7 pati5ts1 consum]s1 &  
_! advocates2  7,e7 data %>+ networks1  
su* z heal? in=mation ex*anges2  7,f7   
au?oriz$ c]tification bodies & te/+     
laboratories2  7,g7 security exp]ts2    
7,h7 relevant manufactur]s ( m$ical     
devices2  7,i7 exp]ts 9 heal? in=mation 
te*nology m>ket economics2  7,j7 public 
& private entities engag$ 9 ! evaluation
 ( heal? in=mation te*nology p]=mance2  
7,k7 quality organizations1 includ+ !   
cons5sus bas$ entity describ$ 9 section 
#ahij ( ! ,social ,security ,act2  7,l7 
exp]ts 9 human factors eng9e]+ & !      
measurem5t ( us]-c5t]$ design2 &  7,m7  
o!r entities or p]sons1 z ! ,secret>y1 9
 consultation ) ! developm5t c\ncil1    
det]m9es appropriate4  7#d7             
,consid]ations = report+ crit]ia ,!     
report+ crit]ia develop$ "u ?is         
subsection-- 7,a7 %all include measures 
t reflect categories includ+1 ) respect 

to ! te*nology--  7i7 security2  7ii7   
usability & us]-c5t]$ design2  7iii7    
int]op]ability2  7iv7 con=mance to      
c]tification te/+2 &  7v7 o!r categories
 z appropriate to measure ! p]=mance (  
heal? in=mation te*nology2  7,b7 may    
include measures su* z--  7i7 enabl+ !  
us] to ord] & view ! results (          
laboratory te/s1 imag+ te/s1 & o!r      
diagno/ic te/s2  7ii7 submitt+1 edit+1 &
 retriev+ data f regi/ries su* z        
cl9ician-l$ cl9ical data regi/ries2     
7iii7 access+ & ex*ang+ in=mation & data
 f & ?r\gh ,heal? ,in=mation ,ex*anges2 
7iv7 access+ & ex*ang+ in=mation & data 
f m$ical devices2  7v7 access+ & ex*ang+
 in=mation & data held by ,f$]al1 ,/ate1
 & local ag5cies & o!r applicable       
entities useful to a heal? c>e provid]  
or o!r applicable us] 9 ! fur!rance (   
pati5t c>e2  7vi7 access+ & ex*ang+     
in=mation f o!r heal? c>e provid]s or   
applicable us]s2  7vii7 access+ &       
ex*ang+ pati5t g5]at$ in=mation2  7viii7
 provid+ ! pati5t or an au?oriz$        

designee ) a complete copy ( _! heal?   
in=mation f an electronic record 9 a    
computable =mat2  7ix7 provid+ accurate 
pati5t in=mation = ! correct pati5t1    
includ+ ex*ang+ su* in=mation1 & avoid+ 
! duplication ( pati5ts records2 &  7x7 
o!r appropriate functionalities2 &  7,c7
 %all be design$ to ensure t small &    
/>t-up heal? in=mation te*nology        
develop]s are n unduly disadvantag$ by !
 report+ crit]ia or rat+ scale          
me?odology4  7#e7 ,consid]ation (       
developm5t c\ncil recomm5dations ,9     
promulgat+ propos$ rules "u ?is         
subsection1 includ+ modifications to su*
 rules "u subsection 7e71 ! ,secret>y   
may accept1 reject1 or modify !         
recomm5dations ( ! developm5t c\ncil1 b 
may n promulgate a propos$ rule t does n
 repres5t a complete recomm5dation ( su*
 c\ncil4  7#f7 ,public comm5t ,9        
promulgat+ propos$ rules "u ?is         
subsection1 ! ,secret>y %all conduct a  
public comm5t p]iod ( n less ?an #fj    
days dur+ :i* any memb] ( ! public may  

provide comm5ts on ! propos$ report+    
crit]ia & ! me?odology = ! rat+ body    
7def9$ 9 subsection 7g77 to use 9       
det]m9+ ! /> rat+s4  7#g7 ,f9al rules ,!
 f9al rule promulgat$ "u ?is subsection 
%all be accompani$ by timely responses  
to ! public comm5ts describ$ 9 p>agraph 
7#f74  7#h7 ,,faca ,! ,f$]al ,advisory  
,committee ,act 7#e ,u4,s4,c4 ,app47    
%all n apply to ! developm5t c\ncil     
describ$ 9 ?is section4  7c7 ,fe$back   
7#a7 ,9 g5]al ,! ,secret>y1 9           
consultation ) ! developm5t c\ncil1 %all
 e/abli% a process = ! rat+ body        
7describ$ 9 subsection 7g77 to collect &
 v]ify confid5tial fe$back f--  7,a7    
heal? c>e provid]s1 pati5ts1 & o!r us]s 
( c]tifi$ heal? in=mation te*nology on !
 usability1 security1 & int]op]ability (
 heal? in=mation te*nology products2 &  
7,b7 develop]s ( c]tifi$ heal? in=mation
 te*nology on practices ( heal?         
in=mation te*nology us]s t may inhibit  
int]op]ability4  7#b7 ,pap]work         
,r$uction ,act ,! ,pap]work ,r$uction   

,act 7#dd ,u4,s4,c4 #ceja et seq47 %all 
n apply to ! collection ( fe$back       
describ$ 9 ?is subsection4  7d7         
,me?odology ,! ,secret>y1 9 consultation
 ) ! developm5t c\ncil1 %all develop a  
me?odology to be us$ by ! rat+ body     
describ$ 9 subsection 7g7 to calculate !
 /> rat+s = c]tifi$ heal? in=mation     
te*nology describ$ 9 subsection 7a74 ,! 
me?odology %all use ! report+ crit]ia   
develop$ 9 subsection 7b71 & !          
confid5tial fe$back collect$ "u         
subsection 7c74 ,9 develop+ su*         
me?odology1 ! ,secret>y1 9 consultation 
) ! developm5t c\ncil1 %all--  7#a7     
provide = appropriate weight+ ( us]     
fe$back submitt$ "u subsection 7c7 &    
report+ crit]ia submitt$ "u subsection  
7f71 includ+ consid]ation ( ! numb] (   
us]s :o submitt$ su* fe$back2  7#b7     
consid] ! impact ( cu/omization or      
adaptation by us]s ( c]tifi$ heal?      
in=mation te*nology on p]=mance2  7#c7  
acc\nt = ! int5d$ function1 scope1 &    
type ( c]tifi$ heal? in=mation          

te*nology2  7#d7 9 consultation ) !     
developm5t c\ncil & aft] seek+ comm5t f 
develop]s ( heal? in=mation te*nology 9 
a mann] t ensures appropriate indu/ry   
fe$back1 e/abli% a timeframe1 b 9 no    
case less frequ5t ?an once e #c ye>s1 = 
! submission ( report+ crit]ia "u       
subsection 7f72 &  7#e7 e/abli% a       
timeframe = incorporat+ us] fe$back     
submitt$ "u subsection 7c7 & report+    
crit]ia submitt$ "u subsection 7f7 into 
! /> rat+s = c]tifi$ heal? in=mation    
te*nology t acc\nts = updates to su*    
te*nology 9 ord] to enc\rage innovation 
& maximize ! utility ( ! /> rat+s4  7e7 
,modifications  7#a7 ,to ! numb] ( />s 9
 ! rat+ program ,! developm5t c\ncil may
 modify ! numb] ( /> rat+s employ$ by ! 
sy/em1 b n m frequ5tly ?an e #d ye>s4 ,9
 no case %all ! rat+ sy/em employ few]  
?an #c />s4  7#b7 ,to ! report+ crit]ia 
,aft] ! f9al report+ crit]ia h be5      
e/abli%$ "u ?is section1 ! ,secret>y1 9 
consultation ) ! developm5t c\ncil1 may 
conv5e /akehold]s & conduct a public    

report+ p]iod = ! purpose ( modify+ !   
report+ crit]ia develop$ "u subsection  
7b7 & me?odology = det]m9+ ! /> rat+s   
propos$ "u subsection 7e74  7#c7 ,to !  
me?odology ,aft] ! f9al me?odology to be
 us$ by ! rat+ body is e/abli%$ "u      
subsection 7e71 ! ,secret>y1 9          
consultation ) ! developm5t c\ncil1 may 
modify ! me?odology us$ to calculate !  
/> rat+s = c]tifi$ heal? in=mation      
te*nology us+ ! report+ crit]ia develop$
 "u subsection 7b7 & ! confid5tial      
fe$back collect$ "u subsection 7c74     
7#d7 ,consid]ation ( ,,gao report ,!    
,secret>y & ! developm5t c\ncil %all    
take into acc\nt ! recomm5dations f !   
,comptroll] ,g5]al "u subsection 7k71   
:]e available1 = ! purposes ( ?is       
p>agraph4  7f7 ,p>ticipation ,z a       
condition ( ma9ta9+ _! c]tification "u  
section #cjja7;c77#e77;,d71 a develop] (
 c]tifi$ heal? in=mation te*nology %all 
report on ! crit]ia develop$ "u         
subsection 7b7 = all su* c]tifi$        
te*nology (f]$ by su* develop] pursuant 

to ! timeframe e/abli%$ "u subsection   
7d74  7g7 ,rat+ body  7#a7 ,9 g5]al ,!  
,national ,coord9ator %all recognize an 
indep5d5t entity ) appropriate exp]tise 
to c>ry out ! rat+ program e/abli%$ by !
 developm5t c\ncil "u subsection 7a7 &  
%all r$et]m9e su* recognition at lea/ e 
#d ye>s4  7#b7 ,consultation ,! entity  
recogniz$ "u p>agraph 7#a7 may consult )
 organizations ) exp]tise 9 ! measurem5t
 ( int]op]ability1 usability1 & security
 ( heal? in=mation te*nology 9 c>ry+ out
 activities "u ?is section4  7h7 ,"o /> 
rat+ ,ea* heal? in=mation te*nology     
develop]1 or entity (f]+ heal? in=mation
 te*nology = c]tification1 t receives a 
#a /> rat+ %all take action1 ?r\gh an   
improvem5t plan develop$ ) ! rat+ body &
 approv$ by ! ,secret>y1 to improve !   
heal? in=mation te*nology rat+ )9 a     
timeframe t ! ,secret>y det]m9es        
appropriate4  7i7 ,dec]tification  7#a7 
,m&atory ,! ,secret>y %all dec]tify     
heal? in=mation te*nology if ! develop] 
or entity (f]+ heal? in=mation te*nology

 does n submit report+ crit]ia 9        
accordance ) subsection 7f7 )9 #ij days 
( ! timel9e e/abli%$ "u subsection 7d74 
7#b7 ,o!r dec]tification ,! ,secret>y   
may dec]tify heal? in=mation te*nology  
if-- 7,a7 ! heal? in=mation te*nology   
does n improve f a "o /> rat+ )9 !      
timeframe e/abli%$ "u subsection 7h72 or
  7,b7 9 o!r circum/ances1 z ! ,secret>y
 det]m9es appropriate4  7j7 ,,gao       
reports ,dur+ ! #ab-ye> p]iod beg9n+ on 
! date ( enactm5t ( ! ,improv+ ,heal?   
,in=mation ,te*nology ,act1 !           
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit to ,congress a report e #d  
ye>s on ! rat+ scale me?odology develop$
 pursuant to subsection 7d71 provid+    
obs]vations on ! appropriat5ess ( !     
curr5t me?odology & recomm5dations =    
*anges to ! me?odology4 ,! ,developm5t  
,c\ncil %all recomm5d to ,congress & !  
,secret>y if additional reports are ne$$
 aft] ! expiration ( su* #ab-ye> p]iod4 
7k7 ,int]net ,website ,on ! ,int]net    
website ( ! ,(fice ( ! ,national        

,coord9ator1 ! ,secret>y %all publi% !  
crit]ia & me?odology us$ to det]m9e ! />
 rat+s1 &1 = ea* c]tifi$ heal? in=mation
 te*nology1 ! f9al /> rat+1 & a report  
outl9+ su* te*nology's p]=mance ) reg>d 
to ! report+ crit]ia develop$ "u        
subsection 7b71 & if an improvem5t plan 
has be5 adm9i/]$4 ,foll[+ ! report+     
describ$ 9 subsection 7f71 ! rat+ body  
%all h #cj days to calculate & submit   
updat$ rat+s to ! ,secret>y & ea*       
develop] ( heal? in=mation te*nology1 & 
updat$ rat+s %all be publi%$ on su*     
,int]net website n lat] ?an #cj days    
foll[+ su* submission1 not)/&+ an appeal
 ( a rat+ by a develop] or entity ?r\gh 
! process develop$ "u subsection 7m74   
7l7 ,h>d%ip exemption ,dec]tification ( 
an adopt$ heal? in=mation te*nology     
product "u subsection 7i7 %all be       
consid]$ a significant h>d%ip result+ 9 
a blanket exemption f ! paym5t adju/m5t 
pursuant to section #ahdh7;a77#g77;,b7 (
 ! ,social ,security ,act = eligible    
pr(essionals1 section                   

#ahhf7;b77#c77;ix77,,ii7 ( su* ,act =   
eligible hospitals1 & #ahad7l77#d77;,c7 
( su* ,act = critical access hospitals4 
7m7 ,notification & ,appeals ,!         
,secret>y %all e/abli% a process :]eby  
any heal? in=mation te*nology develop]1 
or entity (f]+ heal? in=mation          
te*nology1 is notifi$ n less ?an #cj    
days be=e be+ made public & c appeal--  
7#a7 ! heal? in=mation te*nology        
product's /> rat+2 or  7#b7 !           
,secret>y's decision to dec]tify a      
product1 z applicable4  4  #d4          
,in=mation block+ ,subtitle ,c ( title  
,,xxx ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #cjj;jj-#ea et seq47 is  
am5d$ by add+ at ! end ! foll[+3  #cjbb4
 ,in=mation block+  7a7 ,def9ition  7#a7
 ,9 g5]al ,! t]m in=mation block+       
means-- 7,a7 ) respect to a heal?       
in=mation te*nology develop]1 ex*ange1  
or network1 bus9ess1 te*nical1 or       
organizational practices t--  7i7 except
 z requir$ by law or specifi$ by !      
,secret>y1 int]f]es )1 prev5ts1 or      

mat]ially disc\rages access1 ex*ange1 or
 use ( electronic heal? in=mation2 &    
7ii7 ! develop]1 ex*ange1 or network    
kn[s1 or %\ld "k1 are likely to int]f]e 
) or prev5t or mat]ially disc\rage !    
access1 ex*ange1 or use ( electronic    
heal? in=mation2 &  7,b7 ) respect to a 
heal? c>e provid]1 ! p]son or entity    
kn[+ly & unreasonably re/ricts          
electronic heal? in=mation ex*ange =    
pati5t c>e or o!r priorities z det]m9$  
appropriate by ! ,secret>y4  7#b7       
,rulemak+ ,! ,secret>y %all1 ?r\gh      
rulemak+-- 7,a7 id5tify reasonable &    
necess>y activities t d n con/itute     
in=mation block+ = purposes ( p>agraph  
7#a77;,a72 &  7,b7 id5tify actions t    
meet ! def9ition ( in=mation block+ )   
respect to heal? c>e provid]s = purposes
 ( p>agraph 7#a77;,b74  7b7 ,inspector  
g5]al au?ority  7#a7 ,9 g5]al ,!        
,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices may inve/igate any   
claim t--  7,a7 a heal? in=mation       
te*nology develop] (1 or o!r entity (f]+

 c]tifi$ heal? in=mation te*nology--    
7i7 submits a false atte/ation made "u  
section #cjja7;c77#e77;,d72 or  7ii7    
engag$ 9 in=mation block+ ) respect to !
 use ( su* heal? in=mation te*nology by 
a heal? c>e provid]1 unless = a         
legitimate purpose specifi$ by !        
,secret>y2  7,b7 a heal? c>e provid]    
engag$ 9 in=mation block+ ) respect to  
access or ex*ange ( c]tifi$ heal?       
in=mation te*nology1 unless = a         
legitimate purpose specifi$ by !        
,secret>y2 &  7,c7 a heal? in=mation    
network or ex*ange provid] engag$ 9     
in=mation block+ ) respect to ! access1 
ex*ange1 or use ( su* c]tifi$ heal?     
in=mation te*nology1 unless = a         
legitimate purpose specifi$ by !        
,secret>y4  7#b7 ,jurisdiction ( !      
,inspector ,g5]al ,= purposes ( ?is     
section1 ! ,(fice ( ! ,inspector ,g5]al 
%all h jurisdiction ) respect to        
ex*anges & networks1 z well z any       
develop] or entity (f]+ heal? in=mation 
te*nology = c]tification "u a program or

 programs kept or recogniz$ by !        
,national ,coord9ator "u section        
#cjja7;c77#e74 ,! ,national ,coord9ator 
%all notify develop]s ( heal? in=mation 
te*nology z appropriate reg>d+ !        
jurisdiction ( ! ,inspector ,g5]al "u   
?is p>agraph4  7#c7 ,p5alty  7,a7       
,develop]s1 networks1 & ex*anges ,)     
respect to a heal? in=mation te*nology  
develop]1 ex*ange1 or network1 a p]son  
or entity det]m9$ by ! ,inspector ,g5]al
 to h committ$ in=mation block+ z       
describ$ 9 subp>agraph 7,a7 or 7,c7 (   
p>agraph 7#a7 %all be subject to a civil
 monet>y p5alty 9 an am\nt det]m9$1     
?r\gh notice-&-comm5t rulemak+1 by !    
,secret>y :i* may take into acc\nt      
factors su* z ! ext5t & duration ( !    
in=mation block+ & ! numb] ( pati5ts &  
provid]s pot5tially affect$4  7,b7      
,provid]s ,) respect to heal? c>e       
provid]s1 any p]son or entity det]m9$ by
 ! ,inspector ,g5]al to h committ$      
in=mation block+ z describ$ 9           
subp>agraph 7,b7 ( p>agraph 7#a7 %all be

 subject to appropriate inc5tives &     
dis9c5tives us+ au?orities "u applicable
 ,f$]al law1 z det]m9$ appropriate by ! 
,secret>y ?r\gh notice & comm5t         
rulemak+4  7,c7 ,proc$ure ,! provisions 
( section #aabh;,a ( ! ,social ,security
 ,act 7o!r ?an subsections 7a7 & 7b77   
%all apply to a civil money p5alty      
appli$ "u ?is subsection 9 ! same mann] 
z su* provisions apply to a civil money 
p5alty or proce$+ "u section            
#aabh;,a7a74  7,d7 ,recov]y ( funds     
,not)/&+ section #ccjb ( title #ca1     
,unit$ ,/ates ,code1 or any o!r         
provision ( law affect+ ! cr$it+ (      
collections1 ! ,inspector ,g5]al ( !    
,dep>tm5t ( ,heal? & ,human ,s]vices may
 receive & reta9 = curr5t use any am\nts
 recov]$ "u subp>agraphs 7,a7 & 7,c74 ,9
 addition to am\nts o!rwise available to
 ! ,inspector ,g5]al1 funds receiv$ by !
 ,inspector ,g5]al "u ?is p>agraph %all 
be deposit$1 z an (fsett+ collection1 to
 ! cr$it ( any appropriation available =
 purposes ( c>ry+ out ?is subsection &  

%all be available )\t fiscal ye>        
limitation & )\t fur!r appropriation4   
7#d7 ,resolution ( claims  7,a7 ,9 g5]al
 ,! ,(fice ( ! ,inspector ,g5]al1 if su*
 ,(fice det]m9es t a simple consultation
 reg>d+ ! heal? privacy & security rules
 promulgat$ "u section #bfd7;c7 ( !     
,heal? ,insurance ,portability &        
,acc\ntability ,act ( #aiif 7#db        
,u4,s4,c4 #acbj;d-#b note7 w resolve !  
claim at issue1 may ref] in/ances (     
in=mation block+ to ! ,(fice = ,civil   
,rights ( ! ,dep>tm5t ( ,heal? & ,human 
,s]vices = resolution4  7,b7 ,limitation
 on liability ,if a heal? in=mation     
te*nology develop] makes in=mation      
available bas$ on a good fai? reliance  
on consultations ) ! ,(fice = ,civil    
,rights ( ! ,dep>tm5t ( ,heal? & ,human 
,s]vices ) respect to su* in=mation1 !  
develop] %all n be liable = su*         
disclosure4  7c7 ,id5tify+ b>ri]s to    
ex*ange ( c]tifi$ heal? in=mation       
te*nology  7#a7 ,tru/$ ex*ange def9$ ,9 
?is section1 ! t]m tru/$ ex*ange )      

respect to c]tifi$ heal? in=mation      
te*nology means t ! c]tifi$ heal?       
in=mation te*nology has ! te*nical      
capability to enable secure heal?       
in=mation ex*ange betwe5 us]s & multiple
 c]tifi$ heal? in=mation te*nology      
sy/ems4  7#b7 ,guidance ,! ,national    
,coord9ator1 9 consultation ) ! ,(fice =
 ,civil ,rights ( ! ,dep>tm5t ( ,heal? &
 ,human ,s]vices1 %all issue guidance on
 common legal1 gov]nance1 & security    
b>ri]s t prev5t ! tru/$ ex*ange (       
electronic heal? in=mation4  7#c7       
,ref]ral ,! ,national ,coord9ator & !   
,(fice = ,civil ,rights ( ! ,dep>tm5t ( 
,heal? & ,human ,s]vices may ref] to !  
,inspector ,g5]al in/ances or patt]ns ( 
refusal to ex*ange heal? in=mation ) an 
individual or entity us+ c]tifi$ heal?  
in=mation te*nology t is te*nically     
capable ( tru/$ ex*ange & "u conditions 
:5 ex*ange is legally p]missible4  7#d7 
,,hit /&>ds committee consid]ation ,n   
lat] ?an #a ye> aft] ! date ( enactm5t (
 ! ,improv+ ,heal? ,in=mation ,te*nology

 ,act1 ! ,,hit ,/&>ds ,committee %all   
beg9 consid]ation ( issues relat$ to    
tru/$ ex*ange4  4  #e4 ,int]op]ability  
7a7 ,def9ition ,section #cjjj ( !       
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;jj7 is am5d$--  7#a7 by  
r$esignat+ p>agraphs 7#aj7 ?r\gh 7#ad71 
z p>agraphs 7#aa7 ?r\gh 7#ae71          
respectively2 &  7#b7 by ins]t+ aft]    
p>agraph 7#i7 ! foll[+3  7#aj7          
,int]op]ability ,! t]m int]op]ability ) 
respect to heal? in=mation te*nology    
means su* heal? in=mation te*nology t   
has ! ability to securely ex*ange       
electronic heal? in=mation ) & use      
electronic heal? in=mation f o!r heal?  
in=mation te*nology )\t special ef=t on 
! "p ( ! us]4  4  7b7 ,support =        
int]op]able network ex*ange ,section    
#cjja7;c7 ( ! ,public ,heal? ,s]vice    
,act 7#db ,u4,s4,c4 #cjj;jj-#aa7;c77 is 
am5d$ by add+ at ! end ! foll[+3  7#i7  
,support = int]op]able networks ex*ange 
7,a7 ,9 g5]al ,! ,national ,coord9ator  
%all1 9 collaboration ) ! ,national     

,in/itute ( ,/&>ds & ,te*nology & o!r   
relevant ag5cies )9 ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices1 = ! purpose ( ensur+
 full network-to-network ex*ange ( heal?
 in=mation1 conv5e public-private &     
public-public p>tn]%ips to build        
cons5sus & develop a tru/$ ex*ange      
framework1 includ+ a common agreem5t    
among heal? in=mation networks          
nationally4 ,su* conv5tion may occur at 
a frequ5cy det]m9$ appropriate by !     
,secret>y4  7,b7 ,e/abli%+ a tru/$      
ex*ange framework  7i7 ,9 g5]al ,n lat] 
?an six mon?s aft] ! date ( enactm5t (  
?is p>agraph1 ! ,national ,coord9ator   
%all conv5e appropriate public & private
 /akehold]s to develop a tru/$ ex*ange  
framework = tru/ policies & practices & 
= a common agreem5t = ex*ange betwe5    
heal? in=mation networks4 ,! common     
agreem5t may include--  7,i7 a common   
me?od = au!nticat+ tru/$ heal? in=mation
 network p>ticipants2  7,,ii7 a common  
set ( rules = tru/$ ex*ange2  7,,iii7   
organizational & op]ational policies to 

enable ! ex*ange ( heal? in=mation among
 networks1 includ+ m9imum conditions =  
su* ex*ange to occur2 &  7,,iv7 a       
process = fil+ & adjudicat+             
noncompliance ) ! t]ms ( ! common       
agreem5t4  7ii7 ,te*nical assi/ance ,!  
,national ,coord9ator1 9 conjunction ) !
 ,national ,in/itute ( ,/&>ds &         
,te*nology1 %all provide te*nical       
assi/ance on h[ to implem5t ! tru/$     
ex*ange framework & common agreem5t "u  
?is p>agraph4  7iii7 ,pilot te/+ ,!     
,national ,coord9ator1 9 collaboration )
 ! ,national ,in/itute ( ,/&>ds &       
,te*nology1 %all provide = ! pilot te/+ 
( ! tru/$ ex*ange framework & common    
agreem5t e/abli%$ "u ?is subsection 7z  
au?oriz$ "u section #acbja ( ! ,heal?   
,in=mation ,te*nology = ,economic &     
,cl9ical ,heal? ,act74 ,! ,national     
,coord9ator1 9 collaboration ) !        
,national ,in/itute ( ,/&>ds &          
,te*nology1 may delegate pilot te/+     
activities "u ?is clause to indep5d5t   
entities ) appropriate exp]tise4  7,c7  

,publication ( a tru/$ ex*ange framework
 & common agreem5t ,n lat] ?an "o ye>   
aft] conv5+ /akehold]s "u subp>agraph   
7,a71 ! ,national ,coord9ator %all      
publi% on its public ,int]net website1 &
 9 ! ,f$]al regi/]1 ! tru/$ ex*ange     
framework & common agreem5t develop$ "u 
subp>agraph 7,b74 ,su* tru/$ ex*ange    
framework & common agreem5t %all be     
publi%$ 9 a mann] t protects propriet>y 
& security in=mation1 includ+ trade     
secrets & any o!r protect$ intellectual 
prop]ty4  7,d7 ,directory ( p>ticipat+  
heal? in=mation networks  7i7 ,9 g5]al  
,n lat] ?an two ye>s aft] conv5+        
/akehold]s "u subp>agraph 7,a71 &       
annually !reaft]1 ! ,national           
,coord9ator %all publi% on its public   
,int]net website a li/ ( ^? heal?       
in=mation networks t h adopt$ ! common  
agreem5t & are capable ( tru/$ ex*ange  
pursuant to ! common agreem5t develop$  
"u p>agraph 7,b74  7ii7 ,process ,!     
,secret>y %all1 ?r\gh notice-&-comm5t   
rulemak+1 e/abli% a process = heal?     

in=mation networks t volunt>ily elect to
 adopt ! tru/$ ex*ange framework &      
common agreem5t to atte/ to su* adoption
 ( ! framework & agreem5t4  7,e7        
,application ( ! tru/$ ex*ange framework
 & common agreem5t ,z appropriate1      
,f$]al ag5cies contract+ or ent]+ into  
agreem5ts ) heal? in=mation ex*ange     
networks may require t z ea* su* network
 upgrades heal? in=mation te*nology or  
tru/ & op]ational practices1 x may      
adopt1 :]e available1 ! tru/$ ex*ange   
framework & common agreem5t publi%$ "u  
subp>agraph 7,c74  7,f7 ,rule (         
con/ruction  7i7 ,g5]al adoption ,no?+ 9
 ?is p>agraph %all be con/ru$ to require
 a heal? in=mation network to adopt !   
tru/$ ex*ange framework or common       
agreem5t4  7ii7 ,adoption :5 ex*ange (  
in=mation is )9 network ,no?+ 9 ?is     
p>agraph %all be con/ru$ to require a   
heal? in=mation network to adopt ! tru/$
 ex*ange framework or common agreem5t = 
! ex*ange ( electronic heal? in=mation  
betwe5 p>ticipants ( ! same network4    

7iii7 ,exi/+ frameworks & agreem5ts ,!  
tru/$ ex*ange framework & common        
agreem5t publi%$ "u subp>agraph 7,c7    
%all take into acc\nt exi/+ tru/$       
ex*ange frameworks & agreem5ts us$ by   
heal? in=mation networks to avoid !     
disruption ( exi/+ ex*anges betwe5      
p>ticipants ( heal? in=mation networks4 
7iv7 ,application by ,f$]al ag5cies     
,not)/&+ clauses 7i71 7ii71 & 7iii71    
,f$]al ag5cies may require ! adoption ( 
! tru/$ ex*ange framework & common      
agreem5t publi%$ "u subp>agraph 7,c7 =  
heal? in=mation ex*anges contract+ ) or 
ent]+ into agreem5ts pursuant to        
subp>agraph 7,e74  7v7 ,consid]ation (  
ongo+ "w ,9 c>ry+ out ?is p>agraph1 !   
,secret>y %all ensure ! consid]ation (  
activities c>ri$ out by public & private
 organizations relat$ to ex*ange betwe5 
heal? in=mation ex*anges to avoid       
duplication ( ef=ts4  4  7c7 ,provid]   
digital contact in=mation index  7#a7 ,9
 g5]al ,n lat] ?an #cf mon?s aft] ! date
 ( enactm5t ( ?is ,act1 ! ,secret>y (   

,heal? & ,human ,s]vices %all ei!r      
directly1 or ?r\gh a p>tn]%ip ) a       
private entity1 e/abli% a provid]       
digital contact in=mation index to      
provide digital contact in=mation =     
heal? pr(essionals1 heal? facilities1 & 
o!r individuals or organizations4  7#b7 
,use ( exi/+ index ,9 e/abli%+ ! initial
 index "u p>agraph 7#a71 ! ,secret>y (  
,heal? & ,human ,s]vices may utilize an 
exi/+ provid] directory to make su*     
digital contact in=mation available4    
7#c7 ,contact in=mation ,an index       
e/abli%$ "u ?is subsection %all ensure t
 contact in=mation is available at !    
individual heal? c>e provid] level & at 
! heal? facility or practice level4     
7#d7 ,rule ( con/ruction  7,a7 ,9 g5]al 
,! purpose ( ?is subsection is to       
enc\rage ! ex*ange ( electronic heal?   
in=mation by provid+ ! mo/ useful1      
reliable1 & compreh5sive index (        
provid]s possible4 ,9 fur!r+ su*        
purpose1 ! ,secret>y ( ,heal? & ,human  
,s]vices %all include all heal?         

pr(essionals1 heal? facilities1 & o!r   
individuals or organizations applicable 
to provide a useful1 reliable1 &        
compreh5sive index = use 9 ! ex*ange (  
heal? in=mation4  7,b7 ,limitation ,9 no
 case %all exclusion f ! index (        
provid]s be us$ z a measure to a*ieve   
objectives o!r ^? describ$ 9 subp>agraph
 7,a74  7d7 ,/&>ds developm5t           
organizations ,section #cjjd ( ! ,public
 ,heal? ,s]vice ,act 7#db ,u4,s4,c4     
#cjj;jj-#ad7 is am5d$ by add+ at ! end !
 foll[+3  7c7 ,def]5ce to /&>ds         
developm5t organizations ,9 adopt+ &    
implem5t+ /&>ds "u ?is section1 !       
,secret>y %all give def]5ce to /&>ds    
publi%$ by ,/&>ds ,developm5t           
,organizations & volunt>y cons5sus-bas$ 
/&>ds bodies4  4  #f4 ,lev]ag+ heal?    
in=mation te*nology to improve pati5t   
c>e  7a7 ,requirem5t relat+ to regi/ries
  7#a7 ,9 g5]al ,to be c]tifi$ 9        
accordance ) title ,,xxx ( ! ,public    
,heal? ,s]vice ,act1 heal? in=mation    
te*nology 7z def9$ by section #cjjj7e7 (

 ! ,public ,heal? ,s]vice ,act 7#db     
,u4,s4,c4 #cjj;jj7#e777 %all be capable 
( transmitt+ to1 & :]e applicable1      
receiv+ & accept+ data f regi/ries 9    
accordance ) /&>ds recogniz$ by ! ,(fice
 ( ! ,national ,coord9ator = ,heal?     
,in=mation ,te*nology1 includ+          
cl9ician-l$ cl9ical data regi/ries1 t   
are also c]tifi$ to be te*nically       
capable ( receiv+ & accept+ f1 & :]e    
applicable1 transmitt+ data to c]tifi$  
heal? in=mation te*nology 9 accordance )
 su* /&>ds4  7#b7 ,rule ( con/ruction   
,no?+ 9 ?is subsection %all be con/ru$  
to require ! c]tification ( regi/ries   
beyond ! te*nical capability to ex*ange 
data 9 accordance ) applicable endors$  
/&>ds4  7b7 ,def9ition ,= purposes ( ?is
 ,act 7includ+ am5dm5ts made to title   
,,xxx ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #cjj;jj et seq4771 ! t]m 
cl9ician-l$ cl9ical data regi/ry means a
 cl9ical data repository--  7#a7 t is   
e/abli%$ & op]at$ by a cl9ician-l$ or   
controll$1 tax-exempt 7pursuant to      

section #eja7;c7 ( ! ,int]nal ,rev5ue   
,code ( #aihf71 pr(essional society or  
o!r simil> cl9ician-l$ or -controll$    
organization1 or su* organization's     
controll$ affiliate1 devot$ to ! c>e ( a
 population def9$ by a p>ticul> disease1
 condition1 exposure or !rapy2  7#b7 t  
is design$ to collect detail$1 /&>diz$  
data on an ongo+ basis = m$ical         
proc$ures1 s]vices1 or !rapies =        
p>ticul> diseases1 conditions1 or       
exposures2  7#c7 t provides fe$back to  
p>ticipants :o submit reports to !      
repository2  7#d7 t meets /&>ds = data  
quality includ+--  7,a7 sy/ematically   
collect+ cl9ical & o!r heal? c>e data1  
us+ /&>diz$ data elem5ts & has proc$ures
 9 place to v]ify ! complet5ess &       
validity ( ^? data2 &  7,b7 be+ subject 
to regul> data *ecks or audits to v]ify 
complet5ess & validity2 &  7#e7 t       
provides ongo+ p>ticipant tra9+ &       
support4  7c7 ,treatm5t ( heal?         
in=mation te*nology develop]s ) respect 
to pati5t safety organizations  7#a7 ,9 

g5]al ,9 apply+ "p ,c ( title ,,ix ( !  
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bii;b-#ba et seq471 a heal?  
in=mation te*nology develop] %all be    
treat$ z a provid] 7z def9$ 9 section   
#iba ( su* ,act7 = purposes ( report+ & 
conduct+ pati5t safety activities       
conc]n+ improv+ cl9ical c>e ?r\gh ! use 
( heal? in=mation te*nology t c\ld      
result 9 improv$ pati5t safety1 heal?   
c>e quality1 or heal? c>e outcomes4     
7#b7 ,report ,n lat] ?an #dh mon?s aft] 
! date ( enactm5t ( ?is ,act1 !         
,secret>y ( ,heal? & ,human ,s]vices    
%all submit to ! ,committee on ,heal?1  
,education1 ,labor1 & ,p5sions ( !      
,s5ate & ! ,committee on ,en]gy &       
,comm]ce ( ! ,h\se ( ,repres5tatives1 a 
report conc]n+ be/ practices & curr5t   
tr5ds volunt>ily provid$1 & )\t id5tify+
 individual provid]s or disclos+ or us+ 
protect$ heal? in=mation or individually
 id5tifiable in=mation1 by ,pati5t      
,safety ,organizations to improve !     
integration ( heal? in=mation te*nology 

into cl9ical practice4  #g4 ,emp[]+     
pati5ts & improv+ pati5t access to _!   
electronic heal? in=mation  7a7 ,use (  
heal? in=mation ex*anges = pati5t access
 ,section #cjji ( ! ,public ,heal?      
,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj-#ai7
 is am5d$ by add+ at ! end ! foll[+3    
7c7 ,promot+ pati5t access to electronic
 heal? in=mation ?r\gh heal? in=mation  
ex*anges  7#a7 ,9 g5]al ,! ,national    
,coord9ator1 9 coord9ation ) ! ,(fice = 
,civil ,rights ( ! ,dep>tm5t ( ,heal? & 
,human ,s]vices1 %all use exi/+         
au?orities to enc\rage p>tn]%ips betwe5 
heal? in=mation ex*ange organizations & 
networks & heal? c>e provid]s1 heal?    
plans1 & o!r appropriate entities to (f]
 pati5ts access to _! electronic heal?  
in=mation 9 a s+le1 longitud9al =mat t  
is easy to und]/&1 secure1 & may update 
su* in=mation automatically4  7#b7      
,education ( provid]s ,! ,national      
,coord9ator1 9 coord9ation ) ! ,(fice = 
,civil ,rights ( ! ,dep>tm5t ( ,heal? & 
,human ,s]vices1 %all--  7,a7 educate   

heal? c>e provid]s on ways 9 :i* to     
lev]age ! capabilities ( heal? in=mation
 ex*anges 7or o!r relevant plat=ms7 to  
provide pati5ts ) access to _!          
electronic heal? in=mation2  7,b7 cl>ify
 misund]/&+s by heal? c>e provid]s ab\t 
us+ heal? in=mation ex*anges 7or o!r    
relevant plat=ms7 = pati5t access to    
electronic heal? in=mation2 &  7,c7 to !
 ext5t practicable1 educate provid]s    
ab\t heal? in=mation ex*anges 7or o!r   
relevant plat=ms7 t employ "s or all ( !
 capabilities describ$ 9 p>agraph 7#a74 
7#c7 ,requirem5ts ,9 c>ry+ out p>agraph 
7#a71 ! ,national ,coord9ator1 9        
coord9ation ) ! ,(fice = ,civil ,rights1
 %all issue guidance to heal? in=mation 
ex*anges relat$ to be/ practices to     
ensure t ! electronic heal? in=mation   
provid$ to pati5ts is--  7,a7 private & 
secure2  7,b7 accurate2  7,c7 v]ifiable2
 &  7,d7 :]e a pati5t's au?orization to 
ex*ange is requir$ by law1 easily       
ex*ang$ pursuant to su* au?orization4   
7#d7 ,rule ( con/ruction ,no?+ 9 ?is    

subsection %all be con/ru$ to preempt   
,/ate laws applicable to pati5t cons5t =
 ! access ( in=mation ?r\gh a ,heal?    
,in=mation ,ex*ange 7or o!r relevant    
plat=ms7 t provide protections to       
pati5ts t are great] ?an ! protections  
o!rwise provid$ = "u applicable ,f$]al  
law4  7d7 ,ef=ts ,to promote access to  
heal? in=mation ,! ,national ,coord9ator
 & ! ,(fice = ,civil ,rights ( !        
,dep>tm5t ( ,heal? & ,human ,s]vices    
%all jo9tly1 ?r\gh ! developm5t (       
policies t support dynamic te*nology    
solutions1 promote pati5t access to     
heal? in=mation 9 a mann] t w\ld ensure 
t su* in=mation is available 9 a =m     
conv5i5t = ! pati5t1 9 a reasonable     
mann]1 & )\t burd5+ ! heal? c>e provid] 
involv$4  7e7 ,accessibility ( ,pati5t  
,records  7#a7 ,accessibility & updat+ (
 in=mation  7,a7 ,9 g5]al ,! ,secret>y1 
9 consultation ) ! ,national            
,coord9ator1 %all promote policies t    
ensure t a pati5t's electronic heal?    
in=mation is accessible to t pati5t1 &  

_! designees1 9 a mann] t facilitates   
communication ) ! pati5t's heal? c>e    
provid]s & su* pati5t's cons5t1 includ+ 
) respect to rese>*4  7,b7 ,updat+      
education on access+ & ex*ang+ p]sonal  
heal? in=mation ,to promote aw>5ess t an
 individual has a "r ( access to        
inspect1 obta9 a copy (1 & transmit to a
 ?ird p>ty a copy ( protect$ heal?      
in=mation pursuant to ! ,heal?          
,in=mation ,portability & ,acc\ntability
 ,act ,privacy ,rule 7#de ,c4,f4,r4     
#afd4ebd et seq471 ! ,director ( !      
,(fice = ,civil ,rights1 9 consultation 
) ! ,national ,coord9ator1 %all assi/   
individuals & heal? c>e provid]s 9      
und]/&+ a pati5t's rights to access &   
protect _! p]sonal heal? in=mation "u ! 
,heal? ,insurance ,portability &        
,acc\ntability ,act ( #aiif 7,public    
,law #ajd-aia71 includ+ provid+ be/     
practices = reque/+ p]sonal heal?       
in=mation 9 a computable =mat1 includ+  
us+ pati5t portals or ?ird-p>ty         
applications & common cases :5 a provid]

 is p]mitt$ to ex*ange & provide access 
to heal? in=mation4  7#b7 ,c]tify+      
usability = pati5ts ,9 c>ry+ out        
c]tification programs "u section        
#cjja7;c77#e71 ! ,national ,coord9ator  
%all require1 :]e applicable1 t su*     
program or programs require ! foll[+3   
7,a7 ,t c]tification crit]ia support    
pati5t access to _! electronic heal?    
in=mation1 includ+ 9 a s+le longitud9al 
=mat t is easy to und]/&1 secure1 & may 
be updat$ automatically4  7,b7 ,t       
develop]s ( heal? in=mation te*nology   
support pati5t access to an electronic  
heal? record 9 a longitud9al =mat t is  
easy to und]/&1 secure1 & may be updat$ 
automatically4  7,c7 ,t c]tification    
crit]ia support pati5t access to _!     
p]sonal electronic heal? in=mation =    
rese>* at ! option ( ! pati5t4  7,d7 ,t 
c]tification crit]ia support pati5t &   
heal? c>e provid] communication1        
includ+-- 7i7 ! ability = ! pati5t to   
electronically communicate pati5t       
report$ in=mation 7su* z family hi/ory &

 m$ical hi/ory72 &  7ii7 ! ability = !  
pati5t to electronically %>e pati5t     
heal? in=mation1 at ! option ( ! pati5t4
  7,e7 ,t c]tifi$ heal? in=mation       
te*nology us$ = heal? programs :]e      
c]tifi$ heal? in=mation te*nology is    
requir$1 include ! function = pati5t    
access to _! own heal? in=mation1       
includ+--  7i7 ensur+ t1 z a condition (
 c]tification1 heal? c>e provid]s h     
options = mak+ su* in=mation accessible 
= pati5ts2  7ii7 ensur+ t pati5ts h     
options = access+ su* in=mation2 &      
7iii7 ensur+ t pati5ts h access to      
in=mation reg>d+ _! legal rights &      
responsibilities1 z well ! options      
available to !m = access+ _! electronic 
heal? in=mation4  7,f7 ,t ! ,,hit ,/&>ds
 ,committee develop & prioritize /&>ds1 
implem5tation specifications1 &         
c]tification crit]ia requir$ to help    
support pati5t access to electronic     
heal? in=mation1 pati5t usability1 &    
support = te*nologies t (f] pati5ts     
access to _! electronic heal? in=mation 

9 a s+le1 longitud9al =mat t is easy to 
und]/&1 secure1 & may be updat$         
automatically4  4  7b7 ,access to       
in=mation 9 an electronic =mat ,section 
#acdje7;e7 ( ! ,heal? ,in=mation        
,te*nology = ,economic & ,cl9ical ,heal?
 ,act 7#db ,u4,s4,c4 #agice7 is am5d$-- 
7#a7 9 p>agraph 7#a71 by /rik+ & at !   
end2  7#b7 by r$esignat+ p>agraph 7#b7 z
 p>agraph 7#c72 &  7#c7 by ins]t+ aft]  
p>agraph 7#a71 ! foll[+3  7#b7 if !     
individual makes a reque/ to a bus9ess  
associate = access to1 or a copy (1     
protect$ heal? in=mation ab\t !         
individual1 or if an individual makes a 
reque/ to a bus9ess associate to grant  
su* access to1 or transmit su* copy     
directly to1 a p]son or entity designat$
 by ! individual1 a bus9ess associate   
may provide ! individual ) su* access or
 copy1 :i* may be 9 an electronic =m1 or
 grant or transmit su* access or copy to
 su* p]son or entity designat$ by !     
individual2 &  4  #h4 ,,gao /udy on     
pati5t mat*+  7a7 ,9 g5]al ,n lat] ?an  

#a ye> aft] ! date ( enactm5t ( ?is     
,act1 ! ,comptroll] ,g5]al ( ! ,unit$   
,/ates %all conduct a /udy to review !  
policies & activities ( ! ,(fice ( !    
,national ,coord9ator = ,heal?          
,in=mation ,te*nology & o!r relevant    
/akehold]s to ensure appropriate pati5t 
mat*+ to protect pati5t privacy &       
security ) respect to electronic heal?  
records & ! ex*ange ( electronic heal?  
in=mation4  7b7 ,areas ( conc5tration ,9
 conduct+ ! /udy "u subsection 7a71 !   
,comptroll] ,g5]al %all-- 7#a7 evaluate 
curr5t me?ods us$ 9 c]tifi$ electronic  
heal? records = pati5t mat*+ bas$ on    
p]=mance relat$ to factors su* z--  7,a7
 ! privacy ( pati5t in=mation2  7,b7 !  
security ( pati5t in=mation2  7,c7      
improv+ mat*+ rates2  7,d7 r$uc+ mat*+  
errors2 &  7,e7 r$uc+ duplicate records2
 &  7#b7 det]m9e :e!r ! ,(fice ( !      
,national ,coord9ator = ,heal?          
,in=mation ,te*nology c\ld improve      
pati5t mat*+ by tak+ /eps includ+--     
7,a7 def9+ additional data elem5ts to   

assi/ 9 pati5t data mat*+2  7,b7 agree+ 
on a requir$ m9imum set ( elem5ts t ne$ 
to be collect$ & ex*ang$2  7,c7 requir+ 
electronic heal? records to h ! ability 
to make c]ta9 fields requir$ & use      
specific /&>ds2 or  7,d7 o!r options    
recomm5d$ by ! relevant /akehold]s      
consult$ pursuant to subsection 7a74    
7c7 ,report ,n lat] ?an #b ye>s aft] !  
date ( enactm5t ( ?is ,act1 !           
,comptroll] ,g5]al %all submit to !     
appropriate committees ( ,congress a    
report conc]n+ ! f9d+s ( ! /udy conduct$
 "u subsection 7a74