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