By the authority vested in me
as President by the Constitution and the laws of the United
States, and in order to promote federally led efforts to
implement more transparent and high-quality health care, it is
hereby ordered as follows:
Section 1. Purpose. It is
the purpose of this order to ensure that health care programs
administered or sponsored by the Federal Government promote
quality and efficient delivery of health care through the use of
health information technology, transparency regarding health
care quality and price, and better incentives for program
beneficiaries, enrollees, and providers. It is the further
purpose of this order to make relevant information available to
these beneficiaries, enrollees, and providers in a readily
useable manner and in collaboration with similar initiatives in
the private sector and non-Federal public sector. Consistent
with the purpose of improving the quality and efficiency of
health care, the actions and steps taken by Federal Government
agencies should not incur additional costs for the Federal
Government.
Sec. 2. Definitions. For
purposes of this order:
(a) "Agency" means an
agency of the Federal Government that administers or sponsors a
Federal health care program.
(b) "Federal health care
program" means the Federal Employees Health Benefit Program, the
Medicare program, programs operated directly by the Indian
Health Service, the TRICARE program for the Department of
Defense and other uniformed services, and the health care
program operated by the Department of Veterans Affairs. For
purposes of this order, "Federal health care program" does not
include State operated or funded federally subsidized programs
such as Medicaid, the State Children's Health Insurance Program,
or services provided to Department of Veterans' Affairs
beneficiaries under 38 U.S.C. 1703.
(c) "Interoperability"
means the ability to communicate and exchange data accurately,
effectively, securely, and consistently with different
information technology systems, software applications, and
networks in various settings, and exchange data such that
clinical or operational purpose and meaning of the data are
preserved and unaltered.
(d) "Recognized
interoperability standards" means interoperability standards
recognized by the Secretary of Health and Human Services (the
"Secretary"), in accordance with guidance developed by the
Secretary, as existing on the date of the implementation,
acquisition, or upgrade of health information technology systems
under subsections (1) or (2) of section 3(a) of this order.
Sec. 3. Directives for
Agencies. Agencies shall perform the following functions:
(a) Health Information
Technology.
(1) For Federal Agencies.
As each agency implements, acquires, or upgrades health
information technology systems used for the direct exchange of
health information between agencies and with non-Federal
entities, it shall utilize, where available, health information
technology systems and products that meet recognized
interoperability standards.
(2) For Contracting
Purposes. Each agency shall require in contracts or agreements
with health care providers, health plans, or health insurance
issuers that as each provider, plan, or issuer implements,
acquires, or upgrades health information technology systems, it
shall utilize, where available, health information technology
systems and products that meet recognized interoperability
standards.
(b) Transparency of Quality
Measurements.
(1) In General. Each agency
shall implement programs measuring the quality of services
supplied by health care providers to the beneficiaries or
enrollees of a Federal health care program. Such programs shall
be based upon standards established by multi-stakeholder
entities identified by the Secretary or by another agency
subject to this order. Each agency shall develop its quality
measurements in collaboration with similar initiatives in the
private and non-Federal public sectors.
(2) Facilitation. An agency
satisfies the requirements of this subsection if it participates
in the aggregation of claims and other appropriate data for the
purposes of quality measurement. Such aggregation shall be based
upon standards established by multi-stakeholder entities
identified by the Secretary or by another agency subject to this
order.
(c) Transparency of Pricing
Information. Each agency shall make available (or provide for
the availability) to the beneficiaries or enrollees of a Federal
health care program (and, at the option of the agency, to the
public) the prices that it, its health insurance issuers, or its
health insurance plans pay for procedures to providers in the
health care program with which the agency, issuer, or plan
contracts. Each agency shall also, in collaboration with
multi-stakeholder groups such as those described in subsection
(b)(1), participate in the development of information regarding
the overall costs of services for common episodes of care and
the treatment of common chronic diseases.
(d) Promoting Quality and
Efficiency of Care. Each agency shall develop and identify, for
beneficiaries, enrollees, and providers, approaches that
encourage and facilitate the provision and receipt of
high-quality and efficient health care. Such approaches may
include pay-for-performance models of reimbursement consistent
with current law. An agency will satisfy the requirements of
this subsection if it makes available to beneficiaries or
enrollees consumer-directed health care insurance products.
Sec. 4. Implementation
Date. Agencies shall comply with the requirements of this order
by January 1, 2007.
Sec. 5. Administration and
Judicial Review.
(a) This order does not
assume or rely upon additional Federal resources or spending to
promote quality and efficient health care. Further, the actions
directed by this order shall be carried out subject to the
availability of appropriations and to the maximum extent
permitted by law.
(b) This order shall be
implemented in new contracts or new contract cycles as they may
be renewed from time to time. Renegotiation outside of the
normal contract cycle processes should be avoided.
(c) This order is not
intended to, and does not, create any right or benefit,
substantive or procedural, enforceable at law or in equity
against the United States, its departments, agencies, or
entities, its officers, employees, or agents, or any other
person.
GEORGE W. BUSH
THE WHITE HOUSE,
August 22, 2006.