Personal Health Record Act of 2009 - Amends the Public Health Service Act to require the National Coordinator for Health Information Technology, in developing a nationwide health information technology infrastructure, to allow individuals to access their individually identifiable health information.
Requires the inclusion in the Federal Health IT Strategic Plan objectives, milestones, and metrics related to the interoperability of a personal health record with an electronic health record (EHR).
Directs the National Coordinator to develop guidelines for making EHRs interoperable with personal health records for the purpose of improving health care quality, reducing medical errors, and advancing the delivery of patient-centered medical care and health management.
Requires the National Coordinator to report to the appropriate congressional committees on: (1) personal health records, including the extent to which the use of personal health records improve communication between individuals and covered entities and improve patient health management; and (2) issues related to an individual's control of the personal health record.
Requires the HIT Policy Committee to make recommendations for standards and implementation specifications for the interoperability of personal health records and EHRs.
Amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to establish as an eligibility requirement for an incentive payment for the meaningful use of EHR technology that a health professional, hospital, or Medicaid provider must demonstrate the availability of certified EHR technology to and use of such technology by individuals furnished items and services by such professional, hospital, or provider in the form of electronic and personal health records.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4216 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 4216
To amend the Public Health Service Act and titles XVIII and XIX of the
Social Security Act to establish guidelines to enhance the meaningful
use and interoperability of electronic medical records with personal
health records, including for purposes of Medicare and Medicaid payment
incentives.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 7, 2009
Mr. Kennedy (for himself and Mr. Reichert) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend the Public Health Service Act and titles XVIII and XIX of the
Social Security Act to establish guidelines to enhance the meaningful
use and interoperability of electronic medical records with personal
health records, including for purposes of Medicare and Medicaid payment
incentives.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Personal Health Record Act of
2009''.
SEC. 2. ENHANCING MEANINGFUL USE OF ELECTRONIC HEALTH RECORDS THROUGH
INTEROPERABILITY.
(a) Definitions.--
(1) In general.--Section 3000 of the Public Health Service
Act (42 U.S.C. 300jj) is amended by adding at the end the
following:
``(15) Electronic exchange.--The term `electronic exchange'
shall include the automated transfer of individual health
information between electronic medical records and personal
health records, and between electronic medical records,
personal health records, and other electronic systems.
``(16) Personal health record.--The term `personal health
record' means an electronic record of PHR identifiable health
information (as defined in section 13407(f)(2) of the HITECH
Act) of an individual that--
``(A) complies with appropriate data content
standards;
``(B) enables the individual, an authorized
representative, vendor of personal health records (as
defined in section 318.2(j) of title 16, Code of
Federal Regulations, as in effect as of November 1,
2009), any covered entity (as defined for purposes of
HIPAA privacy and security law, as defined in section
3009(a)(2)), or an entity to the extent that it engages
in activities as a business associate (as defined for
such purposes) of such a covered entity, to retrieve
data from or input data into the electronic record; and
``(C) is portable and capable of electronic
communication between such individual and the relevant
covered entity, business associate described in
subparagraph (B), or vendor of personal health records
of such individual that is managed, shared, and
controlled by or primarily for the individual.''.
(2) Conforming amendment.--Section 13400(11) of the HITECH
Act (42 U.S.C. 17921(11)) is amended to read as follows:
``(11) Personal health record.--The term `personal health
record' has the meaning given such term in section 3000(16) of
the Public Health Service Act.''.
(b) Access to Individually Identifiable Health Information.--
Section 3001(b) of the Public Health Service Act (42 U.S.C. 300jj-
11(b)) is amended--
(1) in the matter preceding paragraph (1), by inserting
``electronic'' before ``exchange'';
(2) in paragraph (6)--
(A) by inserting ``individuals,'' after ``physician
offices,''; and
(B) by inserting ``electronic'' before ``exchange
of health care information'';
(3) in paragraph (10), by striking at the end ``and'';
(4) in paragraph (11), by striking the period and inserting
``; and''; and
(5) by adding at the end the following new paragraph:
``(12) allows for an individual to have access to their
individually identifiable health information.''.
(c) Strategic Plan Relating to Personal Health Records.--Section
3001(c)(3)(A) of the Public Health Service Act (42 U.S.C. 300jj-
11(c)(3)(A)) is amended by adding at the end the following new clause:
``(ix) The interoperability of a personal
health record with an electronic health
record.''.
(d) Guidelines Relating to Personal Health Records.--Section
3001(c) of the Public Health Service Act (42 U.S.C. 300jj-11(c)) is
amended by adding at the end the following new paragraph:
``(9) Guidelines for personal health records.--Not later
than the date that is 12 months after the date of the enactment
of the Personal Health Record Act of 2009, the National
Coordinator shall develop guidelines for making electronic
health records interoperable with personal health records for
the purpose of improving health care quality, reducing medical
errors, and advancing the delivery of patient-centered medical
care and health management. Such guidelines shall include--
``(A) standards based on the recommendations
provided in section 3002(b)(2)(B)(ix), including for
purposes of requiring electronic health records to be
made available through electronic exchange and
interoperable with personal health records for purposes
of demonstrating meaningful use of an electronic health
record under sections 1848(o)(2)(A)(i),
1886(n)(3)(A)(i), and 1903(t)(6)(C)(i)(II) of the
Social Security Act;
``(B) recommendations for applying such a
requirement of making electronic health records
available, with respect to community and behavioral
health programs, in the form of personal health records
to improve the effective and efficient electronic
exchange and management of information between the
individual (or authorized representative of the
individual), including those in medically underserved
communities (as defined in section 799B(6)), and
community health centers and behavioral health service
providers;
``(C) required components of a personal health
record, which shall include--
``(i) information on medical history,
including diagnoses and procedures, including
updates if diagnosis or procedures change after
each provider encounter;
``(ii) information on recent laboratory
results, diagnostic examinations, and
radiologic procedures, if available in
electronic format;
``(iii) information on medications and
prescriptions, both current and historical,
including updates if medications change after
each provider encounter;
``(iv) information on allergies, both
medication and environmental, including the
specific reaction;
``(v) privacy, security, and electronic
informed consents for disclosing individually
identifiable health information;
``(vi) computer programming standards
determined by the National Coordinator that
allow interoperability of individually
identifiable health information and
communications between covered entities (as
defined for purposes of HIPAA privacy and
security law, as defined in section
3009(a)(2)), entities to the extent that they
engage in activities as business associates of
such covered entities, individuals, and vendors
of personal health records;
``(vii) portability of the personal health
record by the individual between covered
entities, business associates described in
clause (vi), or vendors of personal health
records;
``(viii) ability to use such record as part
of the patient intake process;
``(ix) accurate attribution of the source
of all data in the personal health record,
including the source of the information, the
date that such information was entered into the
personal health record, and standards-based
protection of data provided by the health care
provider (such as health care provider clinic
notes, laboratory results, diagnostic
examinations, and radiologic procedures) from
changes;
``(x) notification of the individual
involved or the authorized representative of
such individual of the risks of withholding
medical information from a medical provider;
and
``(xi) health services communication tools,
including those which offer online secure
communication with covered entities (as defined
for purposes of HIPAA privacy and security law,
as defined in section 3009(a)(2)) and entities
to the extent that they engage in activities as
business associates (as defined for such
purposes) of such a covered entity;
``(D) other possible components for consideration
of a personal health record, including--
``(i) an audit trail to monitor who has
accessed the personal health record of the
individual;
``(ii) automated appointment, care
reminders, and health self-management tools;
``(iii) the ability to provide education
tools;
``(iv) the ability of the individual or
authorized representative involved to annotate
(without changing) health care provider
records, such as to provide feedback to health
care providers of the individual;
``(v) protection of clinical records in the
personal health record which are imported from
or exported to a covered entity, business
associate described in clause (i), or vendor of
personal health records from being changed by
the individual, authorized representative of
the individual, vendor of personal health
records, the covered entity, or business
associate;
``(vi) the ability to allow comments by the
individual, authorized representative, and
covered entity within an area of the personal
health record that is separate from the
clinical record imported from or exported to a
covered entity; and
``(vii) emergency access procedures for
medical personnel, with respect to the record,
for clinical care in cases that the individual
or authorized representative is not able to
give consent; and
``(E) security, privacy, and electronic informed
consents for disclosing individually identifiable
health information for personal health records,
including the recommendations described in paragraph
(6)(F).
In the case that the Secretary determines that any standard or
component for personal health records included under the
guidance under this paragraph is not adequate pursuant to the
report submitted under paragraph (6)(F), the Secretary shall
notify the National Coordinator and the HIT Standards Committee
in accordance with section 3004(a)(2)(B) and the National
Coordinator may revise such standard or component,
respectively.''.
(e) Reports.--Section 3001(c)(6) of such Act (42 U.S.C. 300jj-
11(c)(6)) is amended by adding at the end the following new
subparagraphs:
``(F) Monitoring personal health records.--Not
later than the date that is 24 months after the date of
the enactment of the Personal Health Record Act of 2009
and annually thereafter, the National Coordinator, in
consultation with the Administrator of the Centers for
Medicare & Medicaid Services, shall submit to the
appropriate committees of jurisdiction of Congress an
annual report on--
``(i) the extent to which personal health
records have been integrated into the
meaningful use of electronic health records
for purposes of sections 1848(o)(2),
1886(n)(3), and 1903(t)(6) of the Social
Security Act;
``(ii) the extent to which the use of
personal health records improve communication
between individuals and covered entities (as
defined for purposes of HIPAA privacy and
security law, as defined in section 3009(a)(2))
and improve patient health management,
including documentation of the extent to which
there are cost savings;
``(iii) the extent to which the use of
personal health records, with respect to
community health centers and behavioral health
services, improve the effective and efficient
exchange and management of information between
the individual involved (or authorized
representative of the individual), including
those in medically underserved communities, and
community health centers and behavioral health
service providers;
``(iv) status of the standards implemented
in paragraph (9)(A) and the need to revise or
include new standards;
``(v) the adequacy of the components of a
personal health record described in paragraph
(9)(C); and
``(vi) the affect of having an individual
with full access to the medical records of such
individual through use of a personal health
record, including--
``(I) a prospective study analyzing
health care utilization (including the
impact of personal health records on
health care provider efficiency, health
care provider reimbursement for time
spent interacting with individuals as a
result of personal health records, and
defensive medicine practices);
``(II) the extent that such access
affects communications by means of such
records between various health care
providers of the individual (including
the use of provider notations);
``(III) a prospective study
analyzing the affect of such access on
the patient-health care provider
relationship; and
``(IV) the risks and benefits of an
individual having full access to
medical records of the individual
through the use of personal health
records.
``(G) Recommendation relating to security and
privacy of personal health records.--Not later than 6
months after the date of the enactment of the Personal
Health Record Act of 2009, the National Coordinator
shall submit to the appropriate committees of
jurisdiction of Congress a report, including
recommendations, on the technological, medicolegal,
medical safety, and other pertinent issues related to
an individual's control of the personal health record
of such individual and shall establish guidelines for
such control. The National Coordinator shall ensure the
participation in such a report of health care
consumers, vendors of personal health records, and
covered entities (as defined for purposes of HIPAA
privacy and security law, as defined in section
3009(a)(2)), along with other health care stakeholders.
The report shall encompass at least the following
issues:
``(i) the rights of an individual utilizing
a personal health record with respect to the
individual's own individually identifiable
health information contained in such; and
``(ii) the security and privacy of an
individual utilizing a personal health record,
including--
``(I) defining who has right of
access to an individual's personal
health record in the case of a personal
health record provided by a covered
entity;
``(II) security and privacy issues
following medical emergency access of
information in a personal health record
by health care providers;
``(III) the impact of an individual
restricting medical information access
in a personal health record of such
individual to health care providers on
patient care and safety;
``(IV) the risks and benefits of
health care provider notification if
the personal health record of an
individual is restricted by the
individual;
``(V) the uses and disclosures of
the information of an individual
contained in a personal health record
that should be authorized or required
by a vendor of personal health records
providing and maintaining such record;
``(VI) electronic informed consents
for disclosing individually
identifiable health information;
``(VII) the use of an audit trail
of who has entered, removed, and
changed data within a personal health
record; and
``(VIII) the dissemination of
abnormal laboratory results, diagnostic
examinations, and radiological
procedures into personal health records
prior to notification of the
abnormality by the health care
provider.''.
(f) Personal Health Record Standards Included in HIT Policy
Committee Recommendations.--
(1) In general.--Section 3002(b)(2)(B) of the Public Health
Service Act (42 U.S.C. 300jj-12(b)(2)(B)) is amended by adding
at the end the following new clause:
``(ix) Standards and implementation
specifications for the interoperability of
personal health records and electronic health
records.''.
(2) Conforming changes relating to hit standards committee
recommendations.--
(A) Deadline for submission of recommendations to
national coordinator.--Section 3003(b)(1)(A) of such
Act (42 U.S.C. 300jj-13(b)(1)(A)) is amended by adding
at the end the following: ``Not later than the date
that is 6 months after the date of the enactment of the
Personal Health Record Act of 2009, the HIT Standards
Committee shall recommend to the National Coordinator
standards and implementation specifications described
in section 3002(b)(2)(B)(ix). The HIT Standards
Committee shall update such recommendations and make
new recommendations as appropriate, including in
response to notification sent under section
3004(a)(2)(B).''.
(B) Forum.--Section 3003(b)(2) of such Act (42
U.S.C. 300jj-13(b)(2)) is amended by inserting before
the period the following: ``, including for the
adoption of interoperability of personal health records
and electronic health records''.
(3) Conforming changes relating to adoption of initial set
of standards.--Section 3004(b)(1) of such Act (42 U.S.C. 300jj-
14(b)(1)) is amended by inserting ``(other than clause (ix))''
after ``section 3002(b)(2)(B)''.
(g) Application of Guidelines to Meaningful Use Requirements of
Electronic Medical Records Under Medicare.--
(1) Eligible professional payment incentives.--Section
1848(o)(2)(A)(i) of the Social Security Act (42 U.S.C. 1395w-
4(o)(2)(A)(i)) is amended by inserting before the period at the
end the following: ``and shall include demonstrating the
availability of such technology to and use of such technology
by individuals furnished items and services by such
professional in the form of electronic and personal health
records consistent with guidelines established by the National
Coordinator under section 3001(c)(9)(A) of the Public Health
Service Act''.
(2) Eligible hospital payment incentives.--Section
1886(n)(3)(A)(i) of such Act (42 U.S.C. 1395ww(n)(3)(A)(i)) is
amended by inserting before the period at the end the
following: ``, which shall include demonstrating the
availability of such technology to and use of such technology
by individuals furnished items and services by such hospital in
the form of electronic and personal health records consistent
with guidelines established by the National Coordinator under
section 3001(c)(9)(A) of the Public Health Service Act''.
(h) Application of Guidelines to Meaningful EHR Use Requirements
Under Medicaid.--Section 1903(t)(6)(C)(i)(II) of the Social Security
Act (42 U.S.C. 1396b(t)(6)(C)(i)(II)) is amended--
(1) by striking ``and'' before ``that may be based''; and
(2) by inserting before the period at the end the
following: ``, and which shall include demonstrating the
availability of such technology to and use of such technology
by individuals furnished items and services by such Medicaid
provider in the form of electronic and personal health records
consistent with guidelines established by the National
Coordinator under section 3001(c)(9)(A) of the Public Health
Service Act''.
(i) Relationship to Other Laws.--Section 13421 of the HITECH Act
(42 U.S.C. 17951) is amended by adding at the end the following new
subsection:
``(c) Health Information Portability and Accountability Act, Health
Care Providers, and Personal Health Records.--Nothing in this subtitle
or the provisions of or amendments made by the Personal Health Record
Act of 2009 shall affect the ability of a health care provider involved
in the direct care of an individual to obtain pertinent information on
the medical history of such individual from another health care
provider involved in the medical care of the individual, in accordance
with HIPAA privacy and security law (as defined in section 3009(a)(2)
of the Public Health Service Act) as in effect before the date of the
enactment of the Personal Health Record Act of 2009.''.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E2897)
Referred to House Energy and Commerce
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to House Ways and Means
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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