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The original documents are located in Box 57, folder "9/28/76 HR3348 VA Exchange of
Medical Information Program" of the White House Records Office: Legislation Case Files
at the Gerald R. Ford Presidential Library
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. Gerald R. Ford donated to the United
States of America his copyrights in all of his unpublished writings in National Archives collections.
Works prepared by U.S. Government employees as part of their official duties are in the public
domain. The copyrights to materials written by other individuals or organizations are presumed to
remain with them. If you think any of the information displayed in the PDF is subject to a valid
copyright claim, please contact the Gerald R. Ford Presidential Library.
Exact duplicates within this folder were not digitized.
89/28/16
APPROVED
ACTION
THE WHITE HOUSE
Last Day: September 29
WASHINGTON
MEMORANDUM FOR
THE PRESIDENT
Posted
FROM:
JIM CANNON
9/29/76
SUBJECT:
H.R. 3348 - VA Exchange of
Medical Information Program
archives 19/29/76
Attached for your consideration is H.R. 3348, sponsored by
Representative Satterfield.
The enrolled bill extends through fiscal year 1979, and increases,
the authorization for the program of exchange of medical
information between the Veterans Administration and the
medical community. The appropriation authorization for this
program expired on June 30, 1975.
A discussion of the provisions of the enrolled bill is provided
in OMB's bill report at Tab A.
OMB, Max Friedersdorf, Counsel's Office (Kilberg) and I
recommend approval of the enrolled bill.
RECOMMENDATION
That you sign H.R. 3348 at Tab B.
Digitized from Box 57 of the White House Records Office Legislation Case Files at the Gerald R. Ford Presidential Library
OF THE
RESIDENT
EXECUTIVE OFFICE OF THE PRESIDENT
CHECK
OFFICE OF MANAGEMENT AND BUDGET
STATES
WASHINGTON, D.C. 20503
SEP 23 1976
MEMORANDUM FOR THE PRESIDENT
Subject: Enrolled Bill H.R. 3348 - VA Exchange of Medical
Information Program
Sponsor - Rep. Satterfield (D) Virginia
Last Day for Action
September 29, 1976 - Wednesday
Purpose
Extends through fiscal year 1979, and increases, the
authorization for the program of exchange of medical
information between the Veterans Administration (VA)
and the medical community.
Agency Recommendations
Office of Management and Budget
Approval
Veterans Administration
Approval
Discussion
H.R. 3348 would extend through fiscal year 1979 VA's
Exchange of Medical Information (EMI) program which
authorizes VA to enter into agreements with medical
schools, hospitals, medical centers and individual members
of the medical profession for the mutual exchange of
medical information. The appropriation authorization
for this program expired on June 30, 1975.
The EMI program, originally enacted in 1966, was
intended to authorize grants and pilot projects for the
sharing of modern medical facilities, equipment and
information, particularly where VA hospitals had no
regular affiliation with medical schools or were otherwise
unable to take advantage of the latest medical technology
2
because of outlying location, small size or lack of
resources. According to VA, all of its 171 hospitals
have participated in the program, either as "core"
institutions from which new medical information and
technology has been transmitted to outlying hospitals
and other medical institutions, or as recipients of
this information.
In April 1975, the VA submitted draft legislation to the
Congress to extend the EMI program for one fiscal year
at a level of $3.5 million. The purpose of the single-
year extension was to allow VA to evaluate the program's
accomplishments and to determine whether the program
should be extended further, modified or terminated.
Congress failed to act on the extension legislation, but
has continued funding the program; the VA appropriation
bill for fiscal year 1977 includes $3.5 million for this
purpose.
H.R. 3348 would authorize appropriations of $4.0 million
annually for fiscal years 1977 through 1979, and would
also provide that fees collected by VA for furnishing
medical information to the medical community be credited
to the applicable VA appropriation instead of being
deposited directly to the Treasury as miscellaneous
receipts as under current law. While we believe generally
that crediting receipts to the Treasury is the better
fiscal practice, we have no serious objections to this
provision.
VA is currently conducting an evaluation of the EMI
program which is scheduled for completion later this
fall. We intend to use the results of this evaluation
and the fall budget process to determine an appropriate
level of funding for the EMI program for, fiscal year
1978 and future years.
Paul H. O'Neill Ohein
Acting Director
Enclosures
EXECUTIVE OFFICE OF THE PRESIDENT
UNITED
OFFICE OF MANAGEMENT AND BUDGET
STATEMENT
STATE
WASHINGTON, D.C. 20503
SEP 23 1976
MEMORANDUM FOR THE PRESIDENT
Subject: Enrolled Bill H.R. 3348 - VA Exchange of Medical
Information Program
Sponsor - Rep. Satterfield (D) Virginia
Last Day for Action
September 29, 1976 - Wednesday
Purpose
Extends through fiscal year 1979, and increases, the
authorization for the program of exchange of medical
information between the Veterans Administration (VA)
and the medical community.
Agency Recommendations
Office of Management and Budget
Approval
Veterans Administration
Approval
Discussion
H.R. 3348 would extend through fiscal year 1979 VA's
Exchange of Medical Information (EMI) program which
authorizes VA to enter into agreements with medical
schools, hospitals, medical centers and individual members
of the medical profession for the mutual exchange of
medical information. The appropriation authorization
for this program expired on June 30, 1975.
The EMI program, originally enacted in 1966, was
intended to authorize grants and pilot projects for the
sharing of modern medical facilities, equipment and
information, particularly where VA hospitals had no
regular affiliation with medical schools or were otherwise
unable to take advantage of the latest medical technology
THE WHITE HOUSE
ACTION MEMORANDUM
WASHINGTON
LOG NO.:
Date:
Time:
September 23
600pm
FOR ACTION: David Lissyo
on
CC (for information): Jack Marsh
Max Friedersdorf on
Jim Connor
Bobbie Kilberg
on
Ed Schmults
FROM THE STAFF SECRETARY
DUE: Date: September 24
Time: 500pm
SUBJECT:
H.R. 3348-VA Exchange of Medical Information Program
ACTION REQUESTED:
For Necessary Action
For Your Recommendations
Prepare Agenda and Brief
Draft Reply
X For Your Comments
Draft Remarks
REMARKS:
PLEASE ATTACH THIS COPY TO MATERIAL SUBMITTED.
If you have any questions or if you anticipate a
delay in submitting the required material, please
K. R. COLE, JR.
telephone the Staff Secretary immediately.
For the President
REVOLUTION
VETERANS ADMINISTRATION
ATION
OFFICE OF THE ADMINISTRATOR OF VETERANS AFFAIRS
AMERICAN
BICENTENNIAL
WASHINGTON, D.C. 20420
1776-1976
©
1930
September 21, 1976
The Honorable
James T. Lynn
Director, Office of
Management and Budget
Washington, D. C. 20503
Dear Mr. Lynn:
This will respond to your request for the views
and recommendations of the Veterans Administration on the
enrolled enactment of H.R. 3348, 94th Congress, a bill "To
amend title 38, United States Code, in order to extend and
improve the program of exchange of medical information be-
tween the Veterans' Administration and the medical community,
and for other purposes.'
The subject bill would amend title 38, United States
Code, section 5055 (c), to provide for continuation of funding
for the exchange of medical information program through fis-
cal year 1979. The program was authorized by Public Law
89-785, which authorized funding through fiscal year 1971,
and extended by Public Law 92-69, which authorized its con-
tinuing support through fiscal year 1975. The following
sums would be authorized: $3.5 million for fiscal year 1976;
$1.7 million for the period beginning July 1, 1976, and
ending September 30, 1976; $4 million for each fiscal year
1977 through 1979.
Moreover, the subject bill would also amend section
5054 (b) of title 38, to require that any proceeds to the
Government received for providing medical information to the
medical community under this program be credited to the appli-
cable Veterans Administration medical appropriation. Under
current law, the VA is authorized to charge a fair and equi-
table fee for providing medical information to the medical
community. In each instance, however, the monies received
for such services go directly to the Treasury as miscella-
neous receipts since in the enactment of the program,
language was inadvertently omitted which would have provided
that receipts go back into the appropriation from which the
program was funded.
The bill also provides that any funds appropriated
to the Veterans Administration remain available until ex-
pended to the extent provided in title 38 or an Appropriations
act. Currently, there is no substantive law in title 38
authorizing the continued availability of appropriated funds.
Enactment of this legislation would prevent a proposed VA
appropriation bill from being subject to a point of order.
No cost is involved in the enactment of this provision.
The exchange of medical information program has
enabled the VA to harness technological advances in commu-
nications to the educational process and thus to engage in,
and support, innovative pilot projects which have as their
objective the strengthening of those Veterans Administration
hospitals located remote from medical centers. The program
has helped attract and retain highly trained and qualified
members of the medical profession at such hospitals. It
has aided in achieving the ultimate purpose of making avail-
able the best and most up-to-date medical care for the vet-
eran patients at VA hospitals remote from medical teaching
centers.
Exchange of medical information projects have been
conducted involving all VA hospitals. These hospitals are
either "core" institutions from which information flows to
outlying hospitals or are recipients of this information.
In every instance, the programs are designed as instruments
for the improvement of the delivery and the quality of health
care at peripheral locations.
Grants authorized under this program are provided
to medical schools, hospitals, and research centers, while
the pilot programs not funded by grants are conducted at VA
2.
hospitals. These activities vary in concept, scope, and
content although each has as its objectives the investiga-
tion, development, and implementation of innovative programs
in exchange of medical information.
We favor the provisions of the enrolled enactment.
Therefore, I recommend that the President approve H.R. 3348.
Sincerely
Associate Deputy Administrator Address - in the absence
off
RICHARD L. ROUDEBUSH
Administrator
3.
THE WHITE HOUSE
ACTION MEMORANDUM
WASHINGTON
LOG NO.:
Date: September 23
Time:
600pm
FOR ACTION: David Lissy
CC (for information): Jack Marsh
Max Friedersdorf
Jim Connor
Bobbie Kilberg
Ed Schmults
FROM THE STAFF SECRETARY
DUE: Date: September 24
Time: 500pm
SUBJECT:
H.R. 3348-VA Exchange of Medical Information Program
ACTION REQUESTED:
For Necessary Action
For Your Recommendations
Prepare Agenda and Brief
Draft Reply
X For Your Comments
Draft Remarks
REMARKS:
Recommend 9.24 approval
and
PLEASE ATTACH THIS COPY TO MATERIAL SUBMITTED.
If you have any questions or if you anticipate a
delay in submitting the required material, please
the
Ct-ff
Secretary
immediately
James M. Cannon
THE WHITE HOUSE
ACTION MEMORANDUM
WASHINGTON
LOG NO.:
Date: September 23
Time: 600pm
FOR ACTION: David Lissy
cc (for information): Jack Marsh
Max Friedersdorf
Jim Connor
Bobbie Kilberg
Ed Schmults
FROM THE STAFF SECRETARY
DUE: Date: September 24
Time: 500pm
SUBJECT:
H.R. 3348-VA Exchange of Medical Information Program
ACTION REQUESTED:
For Necessary Action
For Your Recommendations
Prepare Agenda and Brief
Draft Reply
X For Your Comments
Draft Remarks
REMARKS:
approve fillay 9/24/76
PLEASE ATTACH THIS COPY TO MATERIAL SUBMITTED.
If you have any questions or if you anticipate a
delay in submitting the required material, please
11.
immediately
James M. Cannon
THE WHITE HOUSE
WASHINGTON
September 24, 1976
MEMORANDUM FOR:
JIM CAVANAUGH
FROM:
MAX L. FRIEDERSDORF m.f. 6.
SUBJECT:
HR 3348 - VA Exchange of Medical
Information Program
The Office of Legislative Affairs concurs with the agencies
that the
subject bill be signed.
Attachments
94TH CONGRESS
HOUSE OF REPRESENTATIVES
REPORT
1st Session
No. 94-286
EXTEND THE AUTHORITY OF THE ADMINISTRATOR OF VETERANS'
AFFAIRS TO ESTABLISH AND CARRY OUT A PROGRAM OF EX-
CHANGE OF MEDICAL INFORMATION
JUNE 12, 1975.-Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
Mr. ROBERTS, from the Committee on Veterans' Affairs,
submitted the following
REPORT
[To accompany H.R. 3348]
The Committee on Veterans' Affairs, to whom was referred the bill
(H.R. 3348) to amend title 38, United States Code, in order to extend
and improve the program of exchange of medical information between
the Veterans' Administration and the medical community, and for
other purposes, having considered the same by unanimous voice vote,
report favorably thereon with amendments and recommend that the
bill as amended do pass.
The amendments are as follows:
Page 2, line 6, strike out "$4,500,000" and insert "$4,000,000".
Page 2, line 6, strike out "$5,000,000" and insert "$4,000,000".
INTRODUCTION
Recognizing that modern technology can contribute greatly in
bringing the latest medical information to locations remote from medi-
cal teaching centers, Congress enacted Public Law 89-785 on Novem-
ber 7, 1966, Section 5055 (c) (1) of the enabling legislation author-
ized funding of the Exchange of Medical Information Program
through fiscal year 1971. On August 6, 1971, the President signed
legislation (Public Law 92-69) which authorized its continued sup-
port through fiscal year 1975. The legislation provided authority for
the Veterans' Administration to engage in and support pilot projects
which have as their objectives the strengthening of those Veterans'
Administration hospitals located remote from medical teaching cen-
ters, as well as fostering the widest cooperation and consultation
among all members of the medical profession, whether within or out-
side of the Veterans' Administration.
Initial funding for the program was provided in fiscal year 1968
at a level of $942,000 for the first year of operation. The support of
38-006
3
2
in fiscal years 1970, 1971, and 1972. In fiscal year 1973, support of the
the program increased to $974,000 in fiscal year 1969 and to $2 million
1970-1975 Center for Continuing Health Education (Mountain States).
1970-1975 Collaborative Dental Program.
1970-1975 Instructional Resources Center (VAH Chicago WS)
been million was authorized for each year. The funds provided 1975, have
$3 program was increased to $2,500,000. In fiscal years 1974 and
1970-1972 Utilization of New Health Auxiliaries for Health Delivery Systems.
1970-1971 Demonstration Project for Educationally Focused Field Experience
established, rapidly make contributions in increased measure once to
fully expended and well invested in pilot programs which,
Units in Social Work.
1970-1971 Educational Film on Holography.
patient care.
1970-1971 Radiology Assistant Training Project.
1970-1971 Physicians, Dentists, and Nurses Project in Advanced Clinical
REVIEW OF THE PROGRAM
Education.
1970 Education Telephone/Radio Conference at Remote Hospitals.
system 171 hospitals and more than 200 outpatient clinics is
The Veterans' of Administration's unparalleled health care delivery
1970 Open Broadcast of Videotapes (Sheridan, Wyoming).
1971-1975 Dial Access for Physicians and Nurses.
1971-1972 Medical Information System via Telephone in Alabama.
established nationwide resource as well as integral part of the an
1972-1975 Nuclear Medicine Network in Missouri and Illinois.
the munity health care delivery system in each population center in which com-
1972-1975 Endoscopy in Television (VAH Lake City)
this Veterans' Administration has a medical facility. The operation of
1972-1974 Self-Pacing Instructions for Nursing Assistants.
vast to system carries with it a mandate to provide the best possible
1973-1975 Applications Technology Satellite-6.
1973-1975 Regionalized Computerized Consultation Fluid and Electrolytes.
care every individual who comes to a Veterans' Administration
1973-1975 Veterans Educational Training and Extramural Regional Audio-
facility regardless of its location. This means that the
visual Network (in Missouri and Illinois).
to constantly look to the latest scientific and technological developments agency must
1974-1975 Interactive Telecommunications System for Central Maine.
medical determine care. what impact each may have on the delivery of quality
1974-1975 Tel-Communicology in Alabama (for Patients with Communicative
Disorders)
now it is technologically possible for all physicians and other SO health that
The barriers of time and distance have largely disappeared
The EMI Program will conclude its 8th year of operation in fiscal
year 1975. During fiscal year 1974, 18 pilot projects were conducted
professional milieu.
care professionals throughout the United States to operate in one
involving all VA hospitals either as "core" hospitals from which in-
formation flowed to outlying institutions or as recipients of informa-
For example, the day is approaching when physicians in the
tion. In every instance the projects were designed as instruments for
mote parts of our country have immediately available to them the most re-
the improvement of the delivery and quality of patient care at the in-
that teaching centers. The technology to do this is available. colleagues in
medical consultants and other professional resources as do their same
volved VA hospitals. The activities vary in concept, scope, and con-
tent, although each has as its objective the investigation, development,
and in remains is to harness it to our needs in ways that are cost All
and implementation of innovative programs in exchange of medical
other Program (EMI) is the vehicle through which this Medical
Information the best interests of the patient. The Exchange of effective
information. The following are typical of the pilot projects conducted
under this program.
Since advances its in bio-medical communications are being and
(1) Participation in a series of biomedical communication experi-
Program centers and through grants to medical schools, hospitals, and research EMI
variety innovative activities have been supported under covering the a
of inception in fiscal year 1968, over 50 projects accomplished.
ments via a satellite which was launched in April 1974 by the National
Aeronautics and Space Administration. This satellite, known as Ap-
plications Technology Satellite-F (ATS-F), provides a unique oppor-
via direct funding to VA hospitals.
tunity for the VA to explore new modalities of information exchange
involving ten VA hospitals located in the Appalachian region of the
MAJOR PROJECTS
United States. ATS-F is an attempt to broaden, through experimen-
1968-1975 VA/Nebraska CCTV network.
1968-1975 Single Concept Films in Dentistry.
tation, the scope of health services through long distance, simultane-
1968-1975 Muskogee, Program Okla. of Educational Assistance and Enrichment at VAH
ous, low-cost, interactive transmission of consultations and pertinent
clinical and educational materials. The Veterans Administration, with
1968-1971 1968-1974 Videotape Guest Lecture Program (Medical Media
its nationwide hospital system, is the agency which stands to benefit
University. Instructional Television Fixed Service, VAH Network). Durham-Duke
most from development of effective delivery of medical information
1968-1969 Information. National Distribution System for Dissemination of Medical
via satellite and concomitantly, it is the Veterans Administration
which can most effectively demonstrate the efficacy of satellite-con-
1969-1975 eral Hospital). Telemedicine/Teleconsultation (VAH Bedford-Massachusetts Gen-
ducted experiments in medical communications.
1969-1970 1969-1970 Physicians-in-Residence. Manpower Research and Curriculum Building in Social Work.
(2) Establishment of a pilot Nuclear Medicine Network consisting
of the four VA institutions in eastern Missouri and southern Illinois.
1969 1969-1970 Special Self-administered, Comprehensive Examination in
The participating hospitals are Marion, Ill.; Poplar Bluff, Mo.; St.
Speech Pathology). Training and Information Gathering Equipment Gastroenterology. (Audiology and
Louis (John Cochran Division), Mo.; and St. Louis (Jefferson Bar-
1969 State-wide Tumor Registry for Alabama.
1969 Conversion of Videotaped Courses in Physical Medicine.
racks Division), Mo. This is a patient care oriented project which will,
when fully operational, investigate the feasibility of utilizing a geo-
H.R. 286
H.R. 286
4
5
graphic electronic network to provide diagnostic nuclear medicine
services. The major impediment to the establishment of nuclear medi-
cine services in outlying hospitals has been the lack of trained pro-
practice in underserved areas of low population density. Involved is a
fessional and technical nuclear medicine personnel in these institu-
consortium of five hospitals, including the VA facility at Togus,
Maine.
tions. The Nuclear Medicine Network is a plan to provide the highest
level of nuclear medicine services through the use of computer com-
Center for Continuing Health Education. Development of coordi-
nated educational program fulfilling a variety of needs at eight VA
munications technology and without the need for a professional spe-
hospitals in Colorado, Wyoming, Montana, Idaho, and Nevada.
cialist in residence at the remote hospitals. These services include dy-
Regional Computerized Consultation: Fluid and Electrolytes. Ex-
namic and static imaging, in vitro procedures, and in vivo function
tension of immediate clinical consultation to VA hospitals remote from
and volume measurements. All the major items of nuclear medicine
urban medical centers.
equipment have been installed. The procurement of the computer
Dial Access for Physicians and Nurses. Over 400 lectures for physi-
equipment is in process and various necessary instructional materials
cians and nurses available nationally by dialing a single number.
have been prepared SO as to ensure effective utilization of the Nuclear
Endoscopy in Television. Utilization of closed circuit television for
Medicine Network.
visualization and documentation of endoscopic findings developed at
(3) Development of a Center for Continuing Health Education
VAH Lake City, Florida.
(CCHE) in the Rocky Mountain Region through a grant with the
VA/Nebraska Television Network. Two-way closed circuit tele-
University of Utah Medical Center. Initially the VA Hospitals at
vision system between University of Nebraska Medical Center, Uni-
Boise, Idaho; Fort Harrison, Mont.; Grand Junction, Colo-; Reno,
versity of Nebraska College of Dentistry, Creighton University School
Nev.; Salt Lake City, Utah; and Sheridan, Wyo., were included in
of Medicine, and VAH's Omaha, Lincoln, and Grand Island.
the project. During fiscal year 1973, the VA Hospitals at Cheyenne,
State-wide Tumor Registry. Establishment of automated, computer-
Wyo.; Fort Lyon, Colo.; and Miles City, Mont., became active partici-
ized state-wide tumor registry in Alabama encompassing University
pants in the network. The major purpose of this project is to create
of Alabama Medical Center and the four VA hospitals in Alabama.
an environment conducive to the delivery of the best possible patient
Telemedicine/Teleconsultation. Closed circuit television system be-
care at the participating hospitals by fostering educational programs
tween VAH Bedford, Massachusetts and Massachusetts General Hos-
which meet the hospitals' needs. In keeping with the intent of the
pital used for therapy and consultation.
Exchange of Medical Information legislation, development of the
The Exchange of Medical Information Program and the concept of
CCHE is also directed toward improvement in the quality of patient
regionalization, as it is being applied in the Department of Medicine
care delivered to all residents of each community in which the par-
and Surgery, seeks the common goal of enabling every VA hospital
ticipating VA hospitals are located. The impact of the CCHE ac-
to offer the advantages of the latest developments in medical care to
tivities on patient care in the isolate locales of the participating hos-
its patients. To further carry out the intent of the enabling legislation.
pitals is demonstrable. During fiscal year 1973 high priority was
Exchange of Medical Information activities are being made available
given to programs that represent continuing needs, were hospital
to health professions in 97 communities surrounding VA hospitals.
based, and were considered most likely to influence day-to-day patient
care.
EXPLANATION OF THE BILL
(4) In fiscal year 1973 a project was approved and initiated under
the rubric, the Veterans Educational Training and Extramural Re-
The Committee believes that the exchange of medical information
gional Audiovisual Network (VETERAN). This is a conceptual
program continues to be highly beneficial to the Agency's hospitals
merger of the Exchange of Medical Information Program and the
and to the surrounding medical and scientific communities. Although
regionalization policy of the Agency. When fully developed it will
the Agency has recommended a 1-year extension of the program, the
provide for access and exchange of medical information via television
Committee is of the opinion that there is adequate justification for
between the VA Hospitals in St. Louis, Mo.; Poplar Bluff, Mo.; and
extending this authority for four additional years.
Marion. III., as well as with the medical schools and other major
The bill also provides that any proceeds to the Government received
health care delivery facilities in the St. Louis area. Thus, it will serve
under the program shall be credited to the applicable Veterans Admin-
to bring those VA hospitals which are in the district, but remote
istration medical appropriation. Under current law, the VA is author-
from urban medical centers. within one orbit educationally and clini-
ized to charge a fair and equitable fee for providing medical informa-
cally bv facilitating cost effective exchange of medical information.
tion to the medical community under the program. In each instance,
It will also provide the opportunity for close cooperation between
however, the monies received for such services go directly to the Treas-
the VA medical programs and other public and private health care
ury as miscellaneous receipts.
delivery agencies in the region.
COST
Other notable examples of EMI projects include:
Interactive Telecommunications System for Central Maine. The
The bill would authorize an appropriation of $3,500,000 for fiscal
project is designed to train family practice physicians who live and
year 1976; $1,700,000 for the period beginning July 1, 1976 and ending
September 30, 1976; $4 million for fiscal year 1977 $4 million for fiscal
year 1978, and $4 million for fiscal year 1979. As introduced, H.R. 3348
H.R. 286
H.R. 286
6
7
would have authorized $4,500,000 for fiscal year 1978 and $5 million for
fiscal year 1979. It was the feeling of the Committee that the authoriza-
and $1,700,000 for the period beginning July 1, 1976, and ending
tion should not exceed $4 million.
September 30, 1976. The reason for providing $1,700,000 for the period
beginning July 1, 1976, and ending September 30, 1976, is that Title V
REQUIREMENTS OF CLAUSES (1) (3) AND 2(1) (4) OF RULE XI
of Public Law 93-344 prescribes an October 1-September 30 fiscal
year, effective with fiscal year 1977.
In compliance with clauses 2(1) (3) and 2(1) (4) of Rule XI of the
The exchange of medical information program has enabled the VA
made: Rules of the House of Representatives, the following statements are
to harness technological advances in communications to the educa-
tional process and thus to engage in, and support, innovative pilot
With regard to subdivision (A) of clause 3 (relating to oversight
projects which have as their objective the strengthening of those Vet-
findings), the Committee, in its review of the Exchange of Medical
erans' Administration hospitals not affiliated with medical schools or
Information Program believes the program continues to be highly
those located remote from medical centers. The program has helped
beneficial to the Veterans Administration's hospitals and to the sur-
attract and retain highly trained and qualified members of the medical
rounding medical and scientific communities, especially those in remote
profession at such hospitals. It has aided in achieving the ultimate
areas.
purpose of making available the best and most up-to-date medical care
With respect to subdivision (C) of clause 3, no cost estimate or com-
for the veteran patients at VA hospitals not affiliated with medical
parison has been submitted by the Congressional Budget Office relative
schools.
to the provisions of H.R. 3348.
Exchange of medical information projects have been conducted in-
In regard to subdivision (D) of clause 3, no oversight findings have
volving all VA hospitals. These hospitals are either "core" institu-
been submitted to the Committee by the Committee on Government
tions from which information flows to outlying hospitals or are
Operations.
recipients of this information. In every instance, the programs are de-
With respect to clause (1) (4), relating to the inflationary impact of
signed as instruments for the improvement of the delivery and the
the reported bill, the Committee is of the opinion the funds authorized
quality of health care at peripheral locations. Exchange of medical
to be appropriated are not inflationary. The $3,500,000 authorized for
information activities is also being made available to health profes-
fiscal year 1976 is only $500,000 more than the amount obligated for
sionals in communities surrounding VA hospitals. This is of par-
fiscal year 1975. It is felt the modest increases authorized for fiscal year
ticular benefit to those members of medical communities located re-
1977, 1978 and 1979 would have no appreciable impact on the economy.
mote from medical teaching centers.
Grants authorized under this program are provided to medical
AGENCY REPORT
schools, hospitals, and research centers, while the pilot programs not
funded by grants are conducted at VA hospitals. These activities vary
The Veterans Administration transmitted a draft bill to the Con-
in concept, scope, and content although each has as its objectives the
gress on April 15, 1975. The Agency's comments and the draft bill
follow:
investigation, development, and implementation of innovative pro-
grams in exchange of medical information. They cover a wide spec-
VETERANS' ADMINISTRATION,
trum of activity. Funds provided for the program have been fully
OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS,
expended and well invested in pilot programs which, once established,
Washington, D.C., pril 15, 1975.
rapidly make contributions in increased measure to patient care.
Hon. CARL ALBERT,
We are advised by the Office of Management and Budget that there
Speaker of the House of Representatives,
Washington, D.C.
is no objection to the presentation of this draft bill to the Congress
from the standpoint of the Administration's program.
DEAR MR. SPEAKER: There is transmitted herewith a draft bill "To
Sincerely,
amend title 38, United States Code, in order to extend and improve
RICHARD L. ROUDEBUSH,
the program of exchange of medical information between the Veter-
Administrator.
ans' Administration and the medical community, and for other pur-
Enclosure.
poses", with the request that it be introduced and considered for
enactment.
[94th Cong., 1st sess.]
The subject bill would amend title 38, United States Code, section
A BILL To amend title 38, United States Code, in order to extend and improve
5055 (c), to provide for continuation of funding for the exchange of
the program of exchange of medical information between the Veterans' Admin-
istration and the medical community, and for other purposes
medical information program through September 30, 1976. The pro-
gram was authorized by Public Law 89-785, which authorized fund-
Be it enacted by the Senate and House of Representatives of the
ing through fiscal year 1971, and extended by Public Law 92-69,
United States of America in Congress assembled, That subsection
which authorized its continuing support through fiscal year 1975. The
(c) (1) of section 5055 of title 38, United States Code, is amended by
following sums would be authorized $3,500,000 for fiscal year 1976;
striking out "$3 million for each fiscal year 1968 through 1971, and
such sums as may be necessary for each fiscal year 1972 through 1975,"
H.R. 286
H.R. 286
9
8
sultation among all members of the medical profession in such com-
and inserting in lieu thereof "$3,500,000 for fiscal year 1976, and
munity, the educational facilities and programs established at Vet-
$1,700,000 for the period beginning July 1, 1976, and ending Septem-
erans' Administration hospitals and the electronic link to medical
ber 30, 1976,".
centers shall be made available for use by surrounding medical commu-
nity. The Administrator may charge a fee for such services (on an-
CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
nual or like basis) at rates which he determines, after appropriate
study, to be fair and equitable. The financial status of any user of
In compliance with clause 3 of Rule XIII of the Rules of the House
such services shall be taken into consideration by the Administrator in
of Representatives, changes in existing law made by the bill, H.R.
establishing the amount of the fee to be paid. Any proceeds to the Gov-
3348, as reported, are shown as follows (existing law proposed to be
ernment received therefrom shall be credited to the applicable Vet-
omitted is enclosed in black brackets, new matter is printed in italics,
erans' Administration medical appropriation.
existing law in which no change is proposed is shown in roman)
§ 5055. Pilot programs; grants to medical schools
TITLE 38, UNITED STATES CODE
(a) The Administrator may establish an Advisory Subcommittee
on Programs for Exchange of Medical Information, of the Special
*
Medical Advisory Group, established under section 4112 of this title,
to advise him on matters regarding the administration of this section
PART VI-ACQUISITION AND DISPOSITION OF
and to coordinate these functions with other research and education
PROPERTY
programs in the Department of Medicine and Surgery. The Assistant
Chief Medical Director for Research and Education in Medicine shall
be an ex officio member of this Subcommittee.
(b) The Administrator, upon the recommendation of the subcom-
CHAPTER 81-ACQUISITION AND OPERATION OF HOS-
mittee, is authorized to make grants to medical schools, hospitals, and
PITAL AND DOMICILIARY FACILITIES; PROCURE-
research centers to assist such medical schools, hospitals, and research
centers in planning and carrying out agreements authorized by section
MENT AND SUPPLY
5054 of this title. Such grants may be used for the employment of
personnel, the construction of facilities, the purchasing of equipment
*
when necessary to implement such programs, and for such other pur-
Subchapter IV-Sharing of Medical Facilities, Equipment, and
poses as will facilitate the administration of this section.
(c) (1) There is hereby authorized to be appropriated an amount
Information
not to exceed [$3,000,000 for each fiscal year 1968 through 1971, and
such sums as may be necessary for each fiscal year 1972 through 1975,]
$3,500,000 for fiscal year 1976; $1,700,000 for the period beginning
§ 5054. Exchange of medical information
July 1, 1976, and ending September 30, 1976; $4,000,000 for fiscal year
1977; $4,000,000 for fiscal year 1978; and $4,000,000 for fiscal year
(a) The Administrator is authorized to enter into agreements with
1979, for the purpose of developing and carrying out medical infor-
medical schools, hospitals, research centers, and individual members
mation programs under this section on a pilot program basis and for
of the medical profession under which medical information and tech-
the grants authority in subsection (b) of this section. Pilot programs
niques will be freely exchanged and the medical information services
authorized by this subsection shall be carried out at Veterans' Admin-
of all parties to the agreement will be available for use by any party to
istration hospitals in geographically dispersed areas of the United
the agreement under conditions specified in the agreement. In carry-
States.
ing out the purposes of this section, the Administrator shall utilize
(2) Funds authorized under this section shall not be available to
recent developments in electronic equipment to provide a close educa-
pay the cost of hospital, medical, or other care of patients except to
tional, scientific, and professional link between Veterans' Administra-
the extent that such cost is determined by the Administrator to be
tion hospitals and major medical centers. Such agreements shall be
incident to research, training, or demonstration activities carried out
utilized by the Administrator to the maximum extent practicable to
under this section.
create, at each Veterans' Administration hospital which is a part of
(d) The Administrator, after consultation with the subcommittee
any such agreement, an environment of academic medicine which will
shall prescribe regulations covering the terms and conditions for mak-
help such hospital attract and retain highly trained and qualified mem-
ing grants under this section.
bers of the medical profession.
(e) Each recipient of a grant under this section shall keep such
(b) In order to bring about utilization of all medical information
records as the Administrator may prescribe, including records which
in the surrounding medical community, particularly in remote areas,
fully disclose the amount and disposition by such recipient of the
and to foster and encourage the widest possible cooperation and con-
H.R. 286
H.R. 286
10
proceeds of such grant, the total cost of the project or undertaking in
connection with which such grant is made or used, and the amount of
that portion of the cost of the project or undertaking supplied by
other sources, and such records as will facilitate an effective audit.
(f) The Administrator and the Comptroller General of the United
States, or any of their duly authorized representatives, shall have
access, for the purpose of audit and examination, to any books, docu-
ments, papers, and records of the recipient of any grant under this
section which are pertinent to any such grant.
*
*
*
*
*
*
H.R. 286
Calendar No. 847
94TH CONGRESS
2d Session
}
{
REPORT
SENATE
No. 94-891
EXTENDING AND IMPROVING THE
PROGRAM OF EXCHANGE OF
MEDICAL INFORMATION
BETWEEN THE
VETERANS' ADMINISTRATION
AND THE
MEDICAL COMMUNITY
REPORT
OF THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
TO ACCOMPANY
H.R. 3348
MAY 14, 1976.-Ordered to be printed
U.S. GOVERNMENT PRINTING OFFICE
57-010
WASHINGTON : 1976
Calendar No. 847
94TH CONGRESS
i
SENATE
REPORT
2d Session
No. 94-891
EXTENDING AND IMPROVING THE PROGRAM OF EXCHANGE OF
MEDICAL INFORMATION BETWEEN THE VETERANS' ADMINISTRA-
TION AND THE MEDICAL COMMUNITY
COMMITTEE ON VETERANS' AFFAIRS
VANCE HARTKE, Indiana, Chairman
HERMAN E. TALMADGE, Georgia
CLIFFORD P. HANSEN, Wyoming
JENNINGS RANDOLPH, West Virginia
STROM THURMOND, South Carolina
ALAN CRANSTON, California
ROBERT T. STAFFORD, Vermont
MAY 14, 1976.-Ordered to be printed
RICHARD (DICK) STONE, Florida
JOHN A. DURKIN, New Hampshire
FRANK J. BRIZZI, Staff Director
Guy H. MCMICHAEL III, General Counsel
Mr. CRANSTON (for Mr. HARTKE), from the Committee on Veterans'
Affairs, submitted the following
SUBCOMMITTEE ON HEALTH AND HOSPITALS
REPORT
ALAN CRANSTON, California, Chairman
JENNINGS RANDOLPH, West Virginia
STROM THURMOND, South Carolina
RICHARD (DICK) STONE, Florida
CLIFFORD P. HANSEN, Wyoming
[To accompany H.R. 3348]
JOHN A. DURKIN, New Hampshire
(II)
The Committee on Veterans' Affairs, to which was referred the bill
(H.R. 3348) to amend title 38, United States Code, in order to extend
and improve the program of exchange of medical information between
the Veterans' Administration and the medical community, and for
other purposes, having considered the same, reports favorably thereon
with an amendment and recommends that the bill, as amended, do pass.
COMMITTEE AMENDMENT
The amendment is as follows:
On page 2, after line 7, add the following new section:
SEC. 2. (a) Subchapter I of chapter 3 of title 38, United
States Code, is amended by adding at the end thereof the
following new section:
"§ 203. Availability of appropriations
"Any funds appropriated to the Veterans' Administra-
tion may, to the extent provided in this title or an Appropri-
ations act, remain available until expended.".
(1)
3
2
(b) The table of sections for subchapter I of chapter 3 of
The basic purpose of H.R. 3348 is to permit the continued growth
title 38, United States Code, is amended by adding at the end
and development of the Department of Medicine and Surgery's Ex-
thereof the following new item
change of Medical Information (EMI) program by authorizing,
through fiscal year 1979, expenditures to support grants and pilot
"203. Availability of appropriations.".
programs in this field. The bill also provides that proceeds to the Gov-
Thus, the text of the bill as reported is as follows (insert the mate-
ernment received under the EMI program shall be credited to the ap-
rial printed in italic) :
plicable VA medical appropriation, instead of being returned to the
That subchapter IV of chapter 81 of title 38, United States Code, is
Treasury as miscellaneous receipts (as under current law).
amended as follows:
Specifically, H.R. 3348 as reported would
(1) By inserting at the end of section 5054(b) the following new
(1) Amend section 5054 (b) of title 38 to require that any pro-
sentence: "Any proceeds to the Government received therefrom shall
ceeds to the Government received for providing medical informa-
be credited to the applicable Veterans' Administration medical ap-
tion to the medical community under the EMI program be cred-
propriation."; and
ited to the applicable VA medical appropriation;
(2) By striking out in section 5055 (c) (1) "$3,000,000 for each fiscal
(2) Amend section 5055 (c) of title 38 (authorizing appropria-
year 1968 through 1971, and such sums as may be necessary for each
tions to carry out EMI programs) to authorize expenditures for
fiscal year 1972 through 1975," and inserting in lieu thereof "$3,500,000
the EMI program of $3,500,000 for fiscal year 1976, $1,700,000 for
for fiscal year 1976; $1,700,000 for the period beginning July 1, 1976,
the transition quarter beginning July 1 and ending September 30,
and ending September 30, 1976; $4,000,000 for fiscal year 1977;
1976, and $4,000,000 annually for fiscal years 1977, 1978, and
$4,000,000 for fiscal year 1978; and $4,000,000 for fiscal year 1979,".
1979; and
SEC. 2. (a) Subchapter I of chapter 3 of title 38, United States Code,
(3) Add a clarifying technical amendment which explicitly
is amended by adding at the end thereof the following new section:
authorizes that funds appropriated to the Veterans' Administra-
"§ 203. Availability of appropriations
tion, may to the extent provided in title 38 or an Appropriations
"Any funds appropriated to the Veterans' Administration may, to
act, remain available until expended.
the extent provided in this title or an Appropriations act, remain
available until expended.".
BACKGROUND AND DISCUSSION
(b) The table of sections for subchapter I of chapter 3 of title 38,
United States Code, is amended by adding at the end thereof the
The Exchange of Medical Information Program
following new item:
To strengthen medical programs at Veterans' Administration hos-
pitals not affiliated with medical schools or in locations remote from
"203 Availability of appropriations.".
medical teaching centers, and to foster the widest possible cooperation
INTRODUCTION AND SUMMARY OF H.R. 3348, AS REPORTED
and consultation among members of the medical profession, Congress,
10 years ago enacted legislation (Public Law 89-785, the Veterans
H.R. 3348 was passed unanimously by the House of Representatives
Hospitalization and Medical Services Modernization Amendments of
on June 16, 1975, and was referred to the Senate Committee on Veter-
1966) to authorize the Administrator of Veterans' Affairs to enter into
ans' Affairs on June 17, 1975. On February 2, 1976, S. 2908, the pro-
agreements with medical schools, hospitals, medical centers, and in-
posed Veterans Omnibus Health Care Act of 1976, was introduced in
dividual members of the medical profession for the free exchange of
the Senate. Section 121 of S. 2908 contained provisions which were
medical information. The EMI program was part of a comprehensive
similar in scope and purpose to those of the House-passed H.R. 3348.
program for the sharing of medical facilities, equipment, and infor-
On February 18 and 19, the Subcommittee on Health and Hospitals
mation, now codified as subchapter IV of chapter 81 of title 38, United
held hearings on S. 2908 and other pending veterans health care leg-
States Code.
islation. In order to satisfy the reporting requirements of the Con-
The purpose of the EMI program was to bring modern medical and
gressional Budget Act of 1974 (Pub. L. 93-344), with respect to au-
communications technology to bear on the quality of services avail-
thorizing legislation, section 121 has been separated from S. 2908 and
able to veterans at VA hospitals which, for reasons of size, location,
this bill, in lieu of that section, is being reported to the Senate. (The
or lack of resources, were unable to take full advantage of the latest
Committee has also determined, as a result of its consultation with the
medical information. The 1966 legislation charged the VA with the
Senate Committee on the Budget, that the May 15 reporting deadline
responsibility to engage in pilot projects having as their objective the
is generally inapplicable to the other provisions of S. 2908, which con-
strengthening of VA hospitals through the exchange of medical in-
stitute entitlement legislation to which the May 15 required reporting
formation, and authorized annual appropriations of $3,000,000 for the
date in section 402 (a) of that Act does not apply.)
4 fiscal years ending June 30, 1971 to support projects in that area.
During the 2-week period from April 12 to April 23, the members of
Initial funding commenced in fiscal year 1968. with the appropria-
the Committee by poll voted unanimously to report favorably H.R.
tion of $942,000. This amount was increased to $974,000 in fiscal year
3348 and the amendment to it.
1969, and to $2,000,000 for each of the next 2 fiscal years.
4
5
By 1971, Congress had come to recognize the EMI program as an
tional Aeronautics and Space Administration.-This satellite, known
integral part of the VA's ongoing programs for patient care, research,
as Applications Technology Satellite-F (ATS-F), provides a unique
and medical education. In that year, legislation was enacted (Pub. L.
opportunity for the VA to explore new modalities of information
92-69) extending the authorization of appropriations for the pro-
exchange involving 10 VA hospitals located in the Appalachian region
gram for an additional 4 years, or through fiscal year 1975. Appropri-
of the United States. ATS-F is an attempt to broaden, through ex-
ations for the program increased from $2,000,000 in fiscal year 1972 to
perimentation, the scope of health services through long-distance,
$2,500,000 in fiscal year 1973, and to $3,000,000 annually for fiscal
simultaneous, low-cost, interactive transmission of consultations and
years 1974 and 1975.
pertinent clinical and educational materials.
The EMI program is now concluding its eighth year of operation.
(2) Establishment of a pilot Nuclear Medicine Network consisting
Since its beginning in 1968, over 50 projects have been supported
of the 4 VA institutions in eastern Missouri and southern Illinois.-
under the EMI program. Every one of the VA's 171 hospitals has
The participating hospitals are Marion, Ill.; Poplar Bluff, Mo.; St.
contributed to the program, either as "core" institutions from which
Louis (John Cochran Division), Mo.; and St. Louis (Jefferson Bar-
information flows to outlying hospitals or as recipients of this infor-
racks Division), Mo. This is a patient-care-oriented project which
mation. Health professionals in 100 communities in the United States
will, when fully operational, investigate the feasibility of utilizing a
have participated in and benefited from the program. The funds pro-
geographic electronic network to provide diagnostic nuclear medicine
vided have been fully expended and wisely invested in pilot programs
services. The major impediment to the establishment of nuclear medi-
which, once established, have contributed directly and significantly
cine services in outlying hospitals has been the lack of trained pro-
to patient care.
fessional and technical nuclear medicine personnel in these institutions.
The Nuclear Medicine Network is a plan to provide the highest level of
Program Accomplishments
nuclear medicine services through the use of computer communica-
The Veterans' Administration's health care system of 171 hospitals
tions technology and without the need for a professional specialist in
and more than 200 outpatient clinics is an established nationwide
residence at the remote hospitals. These services include dynamic and
resource as well as integral part of the community health care system
static imaging, in vitro procedures, and in vivo function and volume
in each population center in which the VA has a medical facility. The
measurements. All the major items of nuclear medicine equipment have
operation of this vast system carries with it a mandate to provide the
been installed. The procurement of the computer equipment is in proc-
best possible care to every individual who comes to à VA facility re-
ess and various necessary instructional materials have been prepared
gardless of its location. This means that the agency must constantly
SO as to ensure effective utilization of the Nuclear Medicine Network.
look to the latest scientific and technological developments to deter-
(3) Development of a Center for Continuing Health Education
mine what impact each may have on the delivery of quality medical
(CCHE) in the Rocky Mountain Region through a grant with the
care.
University of Utah Medical Center.-Initially the VA hospitals at
Through the development of modern electronics and communica-
Boise, Idaho; Fort Harrison, Mont.; Grand Junction, Colo.; Reno,
tions systems, the barriers of time and distance have largely dis-
Nev.; Salt Lake City, Utah; and Sheridan, Wyo., were included in
appeared. It is now technologically possible for all physicians and
the project. During fiscal year 1973, the VA hospitals at Cheyenne,
other health care professionals throughout the United States to oper-
ate in one professional milieu. For example, the day is approaching
Wyo.; Fort Lyon, Colo.; and Miles City, Mont., became active par-
when physicians in the most remote parts of our country will have
ticipants in the network. The major purpose of this project is to create
immediately available to them the same consultants and other profes-
an environment conducive to the provision of the best possible patient
sional resources as do their colleagues in medical teaching centers. The
care at the participating hospitals by fostering educational programs
which meet the hospitals' needs. In keeping with the intent of the EMI
technology to do this is available. All that remains is to harness it to our
legislation, development of the CCHE is also directed toward im-
needs in ways that are cost effective and in the best interests of the
provement in the quality of patient care rendered to all residents of
patient.
The EMI program is the vehicle through which this and other
each community in which the participating VA hospitals are located.
advances in biomedical communications are being accomplished.
The impact of the CCHE activities on patient care in the isolated
locales of the participating hospitals is demonstrable.
Since its inception in fiscal year 1968, a wide variety of innovative
activities has been supported under the EMI program through
(4) The Veterans Educational Training and Extramural Regional
Audiovisual Network (VETERAN).-This program, initiated in
grants to medical schools, hospitals, and research centers and via
direct funding to VA hospitals. The activities supported under this
1973, is a conceptual merger of the EMI and the VA's regionaliza-
tion policy. When fully developed it will provide for access and
program vary in concept, scope, and content, although each has as its
objective the investigation, development, and implementation of inno-
exchange of medical information via television between the VA hos-
vative programs in the exchange of medical information. The following
pitals in St. Louis, Mo.; Poplar Bluff, Mo.; and Marion, Ill.; as well
as with the medical schools and other major health care facilities in
are typical of the pilot projects conducted under this program.
(1) Participation in a series of biomedical communication experi-
the St. Louis area. Thus, it will serve to bring those VA hospitals
ments via a satellite which was launched in April 1974 by the Na-
which are in the district, but remote from urban medical centers,
6
7
within one orbit educationally and clinically, by facilitating cost-
effective exchange of medical information. It will also provide the
permits funds to be continued available until expended, such an
opportunity for close cooperation between the VA medical programs
Appropriations act specifying the same would be subject to point of
order on the floor of the House.
and other public and private health care agencies in the region.
Some Veterans' Administration programs authorized under title 38
(5) Interactive Telecommunications System for Central Maine.-
The project is designed to train family practice physicians who live
availability of appropriations. They include Medical and Prosthetic
already have such specific authorization with respect to multi-year
and practice in underserved areas of low populations density. In-
Research (section 216(b)) Grants to the Republic of the Philippines
volved is a consortium of 5 hospitals, including the VA facility at
(section Grants for Construction of State Extended Care
Togus, Maine.
(6) Center for Continuing Health Education.-Development of co-
Facilities (section 644(d)) ; Loan Guaranty Revolving Fund (section
1824) ; and Assistance for Health Manpower Training Institutions
ordinated educational program fulfilling a variety of needs at eight
(section 5082(b)). As to certain other VA programs, there is not such
VA hospitals in Colorado, Wyoming, Montana, Idaho, and Nevada.
a specific authorization. Accordingly, the clarifying technical amend-
(7) Regional Computerized Consultation: Fluid and Electro-
lytes.-Extension of immediate clinical consultation to VA hospitals
ment order adopted by the Committee would provide explicit authority in
to authorize the House Appropriations Committee to continue
remote from urban medical centers.
existing practice. New section 203, thus provides that funds be
(8) Dial Access for Physicians and Nurses.-Over 400 lectures for
physicians and nurses available nationally by dialing a single
specified in an Appropriations act.
available until expended either if authorized under title 38 may or SO
number.
(9) Endoscopy in Television.-Utilization of closed circuit tele-
COST ESTIMATES
vision for visualization and documentation of endoscopic findings de-
veloped at the VA hospital, Lake City, Florida.
(10) VA/Nebraska Television Network.-Two-way closed circuit
Act of 1970 (Pub. L. 91-510, 91st Congress), the Committee, estimates
In accordance with section 252(a) of the Legislative Reorganization
television system between the University of Nebraska Medical Center,
that, if all funds authorized to be appropriated are appropriated, the
University of Nebraska College of Dentistry, Creighton University
costs entailed by enactment of H.R. 3348 as reported would be:
School of Medicine, and VA hospitals, Omaha, Lincoln, and Grand
Authorize an appropriation of $3,500,000 for fiscal year 1976; $1,700,-
Island.
1976; $4 million for fiscal year 1977; $4 million for fiscal year 1978,
000 for the period beginning July 1, 1976 and ending September 30,
(11) Statewide Tumor Registry.-Establishment of an automatic,
computerized statewide tumor registry in Alabama encompassing the
and $4 million for fiscal year 1979.
University of Alabama Medical Center and the four VA hospitals in
Alabama.
TABULATION OF VOTES CAST IN COMMITTEE
(12) Telemedicine/Teleconsultation.-Closed circuit television sys-
tem between the VA hospital, Bedford, Mass., and Massachusetts
Pursuant to section 133(b) of the Legislative Reorganization Act
General Hospital used for therapy and consultation.
of 1946, as amended, the following is a tabulation of votes cast in
The EMI program complements the concept of regionalization, as
person or by proxy of the Members of the Committee on Veterans'
it is being applied in the Department of Medicine and Surgery, in
Affairs on a motion to report H.R. 3348, with an amendment, favor-
seeking the common goal of enabling every VA hospital to offer the
ably to the Senate:
advantages of the latest developments in medical care to its patients.
Yeas-9
Vance Hartke
Technical Amendment
Clifford P. Hansen
Herman E. Talmadge
Strom Thurmond
H.R. 3348 as reported would also add a clarifying technical amend-
Jennings Randolph
Robert T. Stafford
ment which explicitly authorizes that funds appropriated to the Vet-
Alan Cranston
erans' Administration may, to the extent provided in title 38 or an
Richard (Dick) Stone
Appropriations act, remain available until expended. This clarification
John A. Durkin
is apparently required because of a recent interpretation by the Parlia-
Nays-0
mentarian of the House of Representatives. For years Appropriation
acts have specified, for most VA appropriation accounts, that the
SECTION-BY-SECTION ANALYSIS OF H.R. 3348 AS REPORTED
funds appropriated may remain available until expended. The Com-
mittee understands that with respect to the fiscal year 1976 appropri-
Section 1
ations for the Veterans' Administration a parliamentary inquiry was
initiated which questioned the authority for the Appropriations Act
inserting at the end thereof a new sentence requiring that any pro-
Clause 1 amends section 5054 (b) of title 38, United States Code, by
to specify the continued availability of VA funds. The Committee fur-
ceeds to the Government received from providing medical information
ther understands that it is the position of the House Parliamentarian
that unless the substantive law authorizing the various VA programs
to the medical community under the EMI program be credited to the
applicable VA medical appropriation.
"base Entherity 1 the agency"
S. Rept. 94-891-2
8
9
Clause 2 amends section 5055 (c) of title 38 to authorize expenditures
[No. 94]
of $3,500,000 for fiscal year 1976, $1,700,000 for the transition quarter
beginning July 1 and ending September 30, 1976, and $4,000,000 an-
COMMITTEE ON VETERANS' AFFAIRS, U.S. SENATE
nually for fiscal years 1977, 1978, and 1979 for the EMI program.
Section 2
VETERANS' ADMINISTRATION,
OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS,
Subsection a amends subchapter I of chapter 3 of title 38, United
Washington, D.C., March 2, 1976.
States Code, by adding a new section 203 which provides that any
Hon. VANCE. HARTKE,
funds appropriated to the Veterans' Administration may remain avail-
Chairman, Committee on Veterans' Affairs,
able until expended to the extent provided in title 38 or an Appropria-
U.S. Senate, Washington, D.C.
tions act.
Subsection b would amend the table of sections for subchapter I of
DEAR MR. CHAIRMAN This will respond to your request for a report
chapter 3 of title 38, United States Code, to reflect the creation of new
by the Veterans' Administration on S. 2908, 94th Congress, a bill "To
amend title 38, United States Code, to improve the quality of hospital
section 203.
AGENCY REPORTS
care, medical scervices, and nursing home care in Veterans' Admin-
istration health care facilities; to require the availability of compre-
The Committee requested and received a number of reports from
hensive treatment and rehabilitative services and programs for cer-
the Veterans' Administration and the Office of Management and
tain disabled veterans suffering from alcoholism, drug dependence, or
Budget on several bills pending before the Committee which would
alcohol or drug abuse disabilities; to make certain technical and con-
extend and improve the program of exchange of medical information
forming amendments; and for other purposes."
between the VA and medical communities. These reports follow
S. 2908 contains a number of provisions directed toward extending
or clarifying the authority of the Department of Medicine and Sur-
gery to provide care to veterans. There are other provisions which
would facilitate the administration of this program. There are still
other provisions which would redirect the emphasis of veterans medi-
cal care to the service connected veteran. A complete analysis of each
of these provisions is enclosed herewith, as well as our position thereon
and a cost analysis thereof.
As can be ascertained by reading the enclosed analysis, there are
a number of provisions of this bill which we favor. Furthermore, there
are other provisions which may have some desirable features, but
which provide the type of benefit extensions with associated cost
factors which we cannot support, particularly at this time when the
need for reasonable restraint in the growth of Government spending
is being stressed. In this regard, we share the concern expressed by
Senator Cranston at the time this measure was introduced. As the
Senator suggested, we must question whether it is reasonable for the
VA health care budget to continue to expand at the rapid rate achieved
over the last 5 years, and whether the VA can continue to provide more
and more care and services to more and more veterans and still be able
to make the treatment of veterans service connected disabilities our
primary focus. Accordingly, for the reasons specified in the analysis,
we cannot support the bill as introduced.
We are advised by the Office of Management and Budget that
there is no objection to the presentation of this report from the stand-
point of the administration's program.
Sincerely,
ODELL W. VAUGHN,
Deputy Administrator,
(In the absence of
Richard L. Roudebush, Administrator).
Enclosure.
11
10
SECTION-BY-SECTION ANALYSIS OF S. 2908, 94TH CONGRESS
[No. 6]
The first section of the bill provides that the Act may be cited as
COMMITTEE ON VETERANS' AFFAIRS, U.S. SENATE
the "Veterans Omnibus Health Care Act of 1976".
VETERANS' ADMINISTRATION,
TITLE I-GENERAL VETERANS HEALTH CARE AND
OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS,
DEPARTMENT OF MEDICINE AND SURGERY AMEND-
Washington, D.C., April 15, 1975.
Hon. NELSON A. ROCKEFELLER,
MENTS
President of the Senate,
*
Washington, D.C.
Section 121 of the bill would amend subchapter IV of chapter 81 of
DEAR MR. PRESIDENT: There is transmitted herewith a draft bill
title 38.
to amend title 38, United States Code, in order to extend and improve
the program of exchange of medical information between the Veterans'
Administration and the medical community, and for other purposes,
Subsection (b) of section 121 of the bill would amend section 5054
with the request that it be introduced and considered for enactment.
of title 38 to provide that any proceeds to the Government received
The subject bill would amend title 38, United States Code, section
from utilization of the medical information furnished to the surround-
5055(c), to provide for continuation of funding for the exchange of
ing medical community, for which the Administrator is authorized to
medical information program through September 30, 1976. The pro-
charge a fee, shall be credited to the applicable VA appropriation. Un-
gram was-authorized by Public Law 89-785, which authorized funding
der current law the fees received for such services are deposited with
through fiscal year 1971, and extended by Public Law 92-69, which
the Treasury to miscellaneous receipts. The changes made in this sub-
authorized its continuing support through fiscal year 1975. The follow-
section would not be consistent with sound fiscal practice and we do not
ing sums would be authorized: $3.5 million for fiscal year 1976; and
favor its enactment.
$1.7 million for the period beginning July 1, 1976, and ending Septem-
Subsection (c) of section 121 of the bill would amend section 5055
ber 30,-1976. The reason for providing $1.7 million for the period
of title 38 in order to provide for continuation of funding for the ex-
beginning July 1, 1976, and ending September 30, 1976, is that title
change of medical information program through September 30, 1980.
'V of Public Law 93-344 prescribes an October 1-September 30 fiscal
The program was authorized by Public Law 89-785, which authorized
year, effective with fiscal year 1977.
funding through fiscal year 1971, and extended by Public Law 92-69,
The exchange of medical information program has enabled the VA
which authorized its continuing support through fiscal year 1975. The
to harness technological advances in communications to the educa-
amendment proposed here would extend the authorization of appropri-
tional process and thus to engage in, and support, innovative pilot
ation of such sums as may be necessary for each fiscal year through
projects which have as their objective the strengthening of those
1980.
Veterans' Administration hospitals not affiliated with medical schools
Exchange of medical information projects have been conducted
or those located remote from medical centers. The program has
involving all VA hospitals. These hospitals are either "core" institu-
helped attract and retain highly trained and qualified members of
tions from which information flows to outlying hospitals or are
the medical profession at such hospitals. It has aided in achieving the
recipients of this information. In every instance, the programs are
ultimate purpose of making available the best and most up-to-date
designed as instruments for the improvement of the delivery and the
medical care for the veteran patients at VA hospitals not affiliated
quality of health care at peripheral locations. Exchange of medical
with medical schools.
information activities is also being made available to health profes-
Exchange of medical information projects have been conducted
sionals in communities surrounding VA hospitals.
unvolving all VA hospitals. These hospitals are either "core" institu-
Grants authorized under this program are provided to medical
tions from which information flows to outlying hospitals or are recipi-
schools, hospitals, and research centers, while the pilot programs not
ents of this information. In every instance, the programs are designed
funded by grants are conducted at VA hospitals. These activities vary
as instruments for the improvement of the delivery and the quality of
in concept, scope, and content although each has as its objectives the
health care at peripheral locations. Exchange of medical information
investigation, development. and implementation of innovative pro-
activities is also being made available to health professionals in com-
grams in exchange of medical information. They cover a wide spec--
munities surrounding VA hospitals. This is of particular benefit to
trum of activity.
those members of medical communities located remote from medical
During fiscal year 1975 the program was funded at $3 million. It is
teaching centers.
anticipated that the program would require funding of $3.5 million
Grants authorized under this program are provided to medical
for each succeeding fiscal year. The transition quarter (the period
schools, hospitals, and research centers, while the pilot programs not
beginning July 1, 1976, and ending September 30, 1976) should be
funded by grants are conducted at VA hospitals, These activities vary
funded at approximately $1,700,000.
in concept, scope, and content although each has as its objectives the
We favor this provision of the bill provided it is limited to a 1-year
period to allow us to evaluate the program's accomplishments, to
determine whether the program should be extended further, modified,
or terminated. In accord with this recommendation, the President has
requested in his budget, the suggested funding amounts through fiscal
year 1977.
12
13
investigation, development, and implementation of innovative pro-
grams in exchange of medical information. They cover a wide spec-
§ 5054. Exchange of medical information.
trum of activity. Funds provided for the program have been fully
(a) The Administrator is authorized to enter into agreements with
rapidly make contributions in increased measure to patient care.
expended and well invested in pilot programs which, once established,
medical schools, hospitals, research centers, and individual members
We are advised by the Office of Management and Budget that there
of the medical profession under which medical information and tech-
is no objection to the presentation of this draft bill to the Congress
niques will be freely exchanged and the medical information services
of all parties to the agreement will be available for use by any party
from the Sincerely, standpoint of the administration's program.
to the agreement under conditions specified in the agreement. In carry-
ing out the purposes of this section, the Administrator shall utilize
RICHARD L. ROUDEBUSH,
recent developments in electronic equipment to provide a close educa-
Enclosure.
Administrator.
tional, scientific, and professional link between Veterans' Administra-
tion hospitals and major medical centers. Such agreements shall be
A BILL, To amend title 38, United States Code, in order to extend
utilized by the Administrator to the maximum extent practicable to
and improve the program of exchange of medical information
create, at each Veterans' Administration hospital which is a part of
between the Veterans' Administration and the medical community,
any such agreement, an environment of academic medicine which will
and for other purposes.
help such hospital attract and retain highly trained and qualified
States of America in Congress assembled, That subsection (c) (1) of section.
Be it enacted by the Senale and House of Representatives of the United
members of the medical profession.
5055 of title 38, United States Code, is amended by striking our "$3
(b) In order to bring about utilization of all medical information
be million for each fiscal year 1968 through 1971, and such sums as
in the surrounding medical community, particularly in remote areas,
lieu thereof "$3,500,000 for fiscal year 1976, and $1,700,000 for the
necessary for each fiscal year 1972 through 1975," and inserting may in
and to foster and encourage the widest possible cooperation and con-
sultation among all members of the medical profession in such com-
period beginning July 1, 1976, and ending September 30, 1976,".
munity, the educational facilities and programs established at
Veterans' Administration hospitals and the electronic link to medical
ANALYSIS OF DRAFT BILL
centers shall be made available for use by the surrounding medical
This bill would amend title 38, United States Code, to provide for
community. The Administrator may charge a fee for such services
continuation of funding for the exchange of medical information
(on annual or like basis) at rates which he determines, after
program through September 30, 1976. The following sums would be
appropriate study, to be fair and equitable. The financial status of
authorized: $3.5 million for fiscal year 1976; $1 million for the period
any user of such services shall be taken into consideration by the
beginning July 1, 1976, and ending September 30, 1976. The reason
Administrator in establishing the amount of the fee to be paid.
for providing $1 million for the period beginning July 1, 1976, and
§ 5055. Pilot programs; grants to medical schools
ending September 30, 1976, is that title V of Public Law 93-344
(a) The Administrator may establish an Advisory Subcommittee
prescribes an October 1-September 30 fiscal year, effective with fiscal
on Programs for Exchange of Medical Information, of the Special
year 1977.
Medical Advisory Group, established under section 4112 of this title,
to advise him on matters regarding the administration of this section
CHANGES IN EXISTING LAW MADE BY THE DRAFT BILL
and to coordinate these functions with other research and education
Changes in existing law made by the draft bill are shown as follows
programs in the Department of Medicine and Surgery. The Assistant
Chief Medical Director for Research and Education in Medicine shall
(existing law proposed to be omitted is enclosed in black brackets,
be an ex officio member of this Subcommittee.
new matter printed in italic, existing law in which no change is pro-
posed is shown in roman):
(b) The Administrator, upon the recommendation of the subcom-
mittee, is authorized to make grants to medical schools, hospitals, and
research centers to assist such medical schools, hospitals, and research
TITLE 38, UNITED STATES CODE
centers in planning and carrying out agreements authorized by section
5054 of this title. Such grants may be used for the employment of
Part VI-ACQUISITION AND DISPOSITION OF PROPERTY
personnel, the construction of facilities, the purchasing of equipment
when necessary to implement such programs, and for such other
purposes as will facilitate the administration of this section.
CHAPTER 81-ACQUISITION AND OPERATION OF HOSPITAL AND
(c) (1) There is hereby authorized to be appropriated an amount
DOMICILIARY FACILITIES; PROCUREMENT AND SUPPLY
not to exceed [$3 million for each fiscal year 1968 through 1971, and
such sums as may be necessary for each fiscal year 1972 through 1975,
$3,500,000 for fiscal year 1976, and $1,700,000 for the period beginning
July 1, 1976, and ending September 30, 1976, for the purpose of devel-
Subchapter IV-Sharing of Information Medical Facilities, Equipment, and
oping and carrying out medical information programs under this
section on a pilot program basis and for the grants authority in sub-
14
15
section (b) of this section. Pilot programs authorized by this subsec-
been delegated in writing by the Administrator, shall be evidence equal
tion shall be carried out at Veterans' Administration hospitals in
with the originals thereof.
geographically dispersed areas of the United States.
§ 203. Availability of appropriations
(2) Funds authorized under this section shall not be available to
pay the cost of hospital, medical, or other care of patients except to
Any funds appropriated to the Veterans' Administration may, to
the extent that such cost is determined by the Administrator to be
the extent provided in this title or an Appropriations act, remain
incident to research, training, or demonstration activities carried out
available until expended.
under this section.
(d) The Administrator, after consultation with the subcommittee
PART VI-ACQUISITION AND DISPOSITION OF
shall prescribe regulations covering the terms and conditions for
PROPERTY
making grants under this section.
CHANGES IN EXISTING LAW MADE BY H.R. 3348, AS REPORTED
CHAPTER 81-ACQUISITION AND OPERATION OF HOS-
PITAL AND DOMICILIARY FACILITIES; PROCURE-
In accordance with subsection 4 of Rule XXIX of the Standing
Rules of the Senate, changes in existing law made by the bill, as
MENT AND SUPPLY
reported, are shown as follows (existing law proposed to be omitted is
enclosed in black brackets, new matter is printed in italic, existing law
in which no change is proposed is shown in roman) :
Subchapter IV-Sharing of Medical Facilities, Equipment, and
Information
TITLE 38-UNITED STATES CODE
§ 5054. Exchange of medical information
(a) The Administrator is authorized to enter into agreements with
PART 1-GENERAL PROVISIONS
medical schools, hospitals, research centers, and individual members
of the medical profession under which medical information and tech-
niques will be freely exchanged and the medical information services
of all parties to the agreement will be available for use by any party to
CHAPTER 3-VETERANS' ADMINISTRATION; OFFICERS
the agreement under conditions specified in the agreement. In carry-
AND EMPLOYEES
ing out the purposes of this section, the Administrator shall utilize
recent developments in electronic equipment to provide a close educa-
SUBCHAPTER I-VETERANS' ADMINISTRATION
Sec.
tional, scientific, and professional link between Veterans' Administra-
201. Veterans' Administration an independent agency.
tion hospitals and major medical centers. Such agreements shall be
202. Seal of the Veterans' Administration.
utilized by the Administrator to the maximum extent practicable to
203. Availability of appropriations.
create, at each Veterans' Administration hospital which is a part of
any such agreement, an environment of academic medicine which will
help such hospital attract and retain highly trained and qualified mem-
Subchapter I-Veterans' Administration
bers of the medical profession.
§ 201. Veterans' Administration an independent agency
(b) In order to bring about utilization of all medical information
in the surrounding medical community, particularly in remote areas,
The Veterans' Administration is an independent establishment in the
and to foster and encourage the widest possible cooperation and con-
executive branch of the Government, especially created for or con-
sultation among all members of the medical profession in such com-
cerned in the administration of laws relating to the relief and other
munity, the educational facilities and programs established at Vet-
benefits provided by law for veterans, their dependents, and their
erans' Administration hospitals and the electronic link to medical
beneficiaries.
centers shall be made available for use by surrounding medical com-
§ 202. Seal of the Veterans' Administration
munity. The Administrator may charge a fee for such services (on
The seal of the Veterans' Administration shall be judicially
annual or like basis) at rates which he determines, after appropriate
noticed. Copies of any public documents, records, or papers belonging
study, to be fair and equitable. The financial status of any user of
to or in the files of the Veterans' Administration, when authenticated
such services shall be taken into consideration by the Administrator in
by the seal and certified by the Administrator or by any employee of
establishing the amount of the fee to be paid. Any proceeds to the Gov-
the Veterans' Administration to whom proper authority shall have
ernment received therefrom shall be credited to the applicable Vet-
erans' Administration medical appropriation.
16
§ 5055. Pilot programs; grants to medical schools
(a) The Administrator may establish an Advisory Subcommittee
on Programs for Exchange of Medical Information, of the Special
Medical Advisory Group, established under section 4112 of this title,
to advise him on matters regarding the administration of this section
and to coordinate these functions with other research and education
programs in the Department of Medicine and Surgery. The Assistant
Chief Medical Director for Research and Education in Medicine shall
be an ex officio member of this Subcommittee.
(b) The Administrator, upon the recommendation of the Subcom-
mittee, is authorized to make grants to medical schools, hospitals, and
research centers to assist such medical schools, hospitals, and research
centers in planning and carry out agreements authorized by section
5054 of this title. Such grants may be used for the employment of
personnel, the construction of facilities, the purchasing of equipment
when necessary to implement such programs, and for such other pur-
poses as will facilitate the administration of this section.
(c) (1) There is hereby authorized to be appropriated an amount
not to exceed [$3,000,000 for each fiscal year 1968 through 1971, and
such sums as may be necessary for each fiscal year 1972 through 1975,]
$3,500,000 for fiscal year 1976; $1,700,000 for the period beginning
July 1, 1976, and ending September 30, 1976; $4,000,000 for fiscal year
1977; $4,000,000 for fiscal year 1978; and $4,000,000 for fiscal year
1979, for the purpose of developing and carrying out medical infor-
mation programs under this section on a pilot program basis and for
the grants authority in subsection (b) of this section. Pilot programs
authorized by this subsection shall be carried out at Veterans' Admin-
istration hospitals in geographically dispersed areas of the United
States.
(2) Funds authorized under this section shall not be available to
pay the cost of hospital, medical, or other care of patients except to
the extent that such cost is determined by the Administrator to be
incident to research, training, or demonstration activities carried out
under this section.
(d) The Administrator, after consultation with the Subcommittee
shall prescribe regulations covering the terms and conditions for mak-
ing grants under this section.
(e) Each recipient of a grant under this section shall keep such
records as the Administrator may prescribe, including records which
fully disclose the amount and disposition by such recipient of the
proceeds of such grant, the total cost of the project or undertaking in
connection with which such grant is made or used, and the amount of
that portion of the cost of the project or undertaking supplied by
other sources, and such records as will facilitate an effective audit.
(f) The Administrator and the Comptroller General of the United
States, or any of their duly authorized representatives, shall have
access, for the purpose of audit and examination, to any books, docu-
ments, papers, and records of the recipient of any grant under this
section which are pertinent to any such grant.
CORRECTED SHEET
H. R. 3348
Ninety-fourth Congress of the United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Monday, the nineteenth day of January,
one thousand nine hundred and seventy-six
An Act
To amend title 38, United States Code, in order to extend and improve the pro-
gram of exchange of medical information between the Veterans' Administration
and the medical community, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled, That subchapter IV
of chapter 81 of title 38, United States Code, is amended as follows:
(1) By inserting at the end of section 5054(b) the following new
sentence: "Any proceeds to the Government received therefrom shall
be credited to the applicable Veterans' Administration medical appro-
priation."; and
(2) By striking out in section 5055 (c) (1) "$3,000,000 for each fiscal
year 1968 through 1971, and such sums as may be necessary for each
fiscal year 1972 through 1975," and inserting in lieu thereof $3,500,000
for fiscal year 1976; $1,700,000 for the period beginning July 1, 1976,
and ending September 30, 1976; $4,000,000 for fiscal year 1977;
$4,000,000 for fiscal year 1978; and $4,000,000 for fiscal year 1979,".
SEC. 2. (a) Subchapter I of chapter 2 of title 38, United States Code,
is amended by adding at the end thereof the following new section:
"§ 203. Availability of appropriations
"Any funds appropriated to the Veterans' Administration may, to
the extent provided in this title or an appropriations Act, remain avail-
able until expended.".
(b) The table of sections for subchapter I of chapter 3 of title 38,
United States Code, is amended by adding at the end thereof the fol-
lowing new item:
"203. Availability of appropriations.".
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.