BILL ANALYSIS Ó SB 850 Page 1 SENATE THIRD READING SB 850 (Leno) As Amended September 1, 2011 Majority vote SENATE VOTE :21-15 HEALTH 14-0 JUDICIARY 7-2 ----------------------------------------------------------------- |Ayes:|Monning, Ammiano, Atkins, |Ayes:|Feuer, Atkins, Dickinson, | | |Bonilla, Eng, Gordon, | |Beth Gaines, Huber, | | |Hayashi, | |Monning, Wieckowski | | |Roger Hernández, Bonnie | | | | |Lowenthal, Mitchell, | | | | |Nestande, Pan, | | | | |V. Manuel Pérez, Williams | | | | | | | | |-----+--------------------------+-----+--------------------------| | | |Nays:|Wagner, Jones | | | | | | ----------------------------------------------------------------- APPROPRIATIONS 12-5 -------------------------------- |Ayes:|Fuentes, Blumenfield, | | |Bradford, Charles | | |Calderon, Campos, Davis, | | |Gatto, Hall, Hill, Lara, | | |Mitchell, Solorio | | | | |-----+--------------------------| |Nays:|Harkey, Donnelly, | | |Nielsen, Norby, Wagner | | | | -------------------------------- SUMMARY : Requires an electronic health record (EHR) system or electronic medical record (EMR) system to automatically record any change or deletion of any electronically stored medical information. Specifically, this bill : 1)Replaces the term medical "records" with the term medical "information" in existing law which requires medical records to be handled in a manner that preserves the confidentiality SB 850 Page 2 of the information. 2)Requires an EHR or EMR system to protect and preserve the integrity of electronic medical information, and automatically record and preserve any change or deletion of any electronically stored medical information. 3)Requires the record of any change or deletion to include the identity of the person who accessed and changed the medical information, the date and time the medical information was accessed, and the change that was made to the medical information. 4)Requires a patient's right to access or receive a copy of his or her electronic medical records upon request to be consistent with current applicable state and federal laws governing patient access to, and the use and disclosure of, medical information. 5)Provides that this bill applies to an EMR or EHR that meets the definition of EHR, as that term is defined in a specified federal law. FISCAL EFFECT : According to the Assembly Appropriations Committee, negligible state fiscal impact. This bill mirrors recently released and pending federal regulations that create new minimum data integrity and consumer access standards for data stored in EHR/EMR systems. COMMENTS : According to the author, in 2009, the U.S. Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act sections of the American Reinvestment and Recovery Act (ARRA). HITECH allocates $44,000 in Medicare incentives to each individual provider in order to promote the use of EHRs and to address the significant financial obstacles to the adoption and use of such systems, particularly among smaller or independent physician offices. Beginning in 2015, physicians who elect not to use an EHR will be penalized, starting with a 1% Medicare fee reduction. In 2017 this penalty grows to 3%. As a result of these incentives, it is expected that there will be a dramatic increase in the use of EHRs by individual physician practices. A recent study published in the Journal of Health Affairs found that less than one in five physicians, or 18%, reported having at least a basic EHR system. SB 850 Page 3 By 2015 it is expected that most physicians will begin doing so. The author states that this bill is intended to ensure that regulations governing medical records appropriately account for the inherent differences between paper and electronic record systems. The author asserts that an electronic format makes it possible for medical information or errors to be deleted or changed, without those deletions or changes being reflected in the medical record. According to the author, at Stanford Hospital, doctors failed to treat a patient who suffered from complications following a surgery; and as a result, she died. The patient's surviving family members had to request records from Stanford six times only to be told the information did not exist. The author states that further investigations revealed that many records were not produced because of a technicality and because several records were destroyed after the error was made and the patient had died. In other situations, patients have received conflicting records when requesting their records from their health care provider. Another example provided by the author is that in Northern California, a patient had requested his records three times because there was no record of a particular visit to a doctor. It was not until the third request that this visit was reflected in his records, with no explanation as to why the record was initially missing. This bill is sponsored by the Consumer Attorneys of California (CAC) to ensure that information that was previously accessible to the patient in a paper format continues to be available to the patient in an electronic format. CAC argues that deletions and modifications of a record put a patient's safety at risk whether intentional or unintentional. A simple inadvertent mistake, such as deleting entire entries from a patient's multiple visits to the doctor while undergoing a series of treatment, which did occur at a San Diego medical specialist's office, can have detrimental effects in the future, writes CAC. Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097 FN: 0002446 SB 850 Page 4