BILL ANALYSIS Ó
AB 503
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Date of Hearing: April 7, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 503
(Rodriguez) - As Amended March 23, 2015
SUBJECT: Emergency medical services.
SUMMARY: Allows a health facility to release
patient-identifiable medical information to an emergency medical
services (EMS) provider and to a local emergency medical
services agency (LEMSA) when specific data elements are
requested for the purpose of quality assessment and improvement.
Requires the Emergency Medical Services Authority (EMSA) to
develop minimum standards for the implementation of this data
collection system. Specifically, this bill:
1)Allows a health facility, as defined, to release
patient-identifiable medical information, upon request, to the
EMS provider that provided treatment or transported the
patient, when those data elements are to be used for quality
assessment and improvement.
2)Allows a health facility, as defined, to release
patient-identifiable medical information, upon request, to
EMSA or to the LEMSA when those data elements are to be used
for quality assessment and improvement.
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3)Limits the data elements that an EMS provider, LEMSA, or EMSA
may request to those that are minimally necessary, in
compliance the Health Insurance Portability and Accountability
Act of 1996 (HIPAA).
4)Requires EMSA to develop minimum standards for the
implementation of a data collection system to monitor patient
outcomes and performance quality improvement.
5)Defines, for the purposes of this bill, an EMS provider as an
organization employing an Emergency Medical Technician (EMT)
I, Advanced EMT, or EMT Paramedic for the delivery of
emergency medical care to the sick and injured at the scene of
an emergency, during transport, or during an interfacility
transfer.
6)States that it is the intent of the Legislature to encourage
data sharing between EMS providers and hospitals in order to
improve system effectiveness, quality of care, and the impact
of EMS on death and disability.
EXISTING LAW:
1)Establishes the state EMSA which is responsible for the
coordination and integration of all state activities
concerning EMS, including establishing the minimum standards
for the policies and procedures necessary for medical control
of the statewide EMS system.
2)Requires EMSA, utilizing local and regional information to
asses each EMS area or LEMSA service area to determine the
need for additional EMS services, coordination of EMS
services, and the effectiveness of EMS services.
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3)Authorizes counties to develop an EMS program and designate a
LEMSA responsible for planning and implementing an EMS system.
4)Establishes the 16-member EMS Commission within the California
Health and Human Services Agency, specifies its membership and
appointing authorities, and defines the duties.
5)Defines "prehospital EMS providers" to include: an authorized
registered nurse or mobile intensive care nurse; EMT-I;
EMT-II; EMT-paramedic; lifeguard; firefighter; or, peace
officer, as defined, or a physician and surgeon who provides
prehospital emergency medical care or rescue services.
6)Establishes under federal law, HIPAA, which among various
provisions, mandates industry-wide standards for health care
information on electronic billing and other processes; and,
requires the protection and confidential handling of protected
health information.
7)Establishes under state law the Confidentiality of Medical
Information Act (CMIA) which governs the disclosure of medical
information by health care providers, Knox-Keene Health Care
Service Plan Act of 1975 (Knox-Keene) regulated plans, health
care clearinghouses, and employers.
FISCAL EFFECT: This bill has not been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS
BILL. According to the author, prehospital providers of
emergency medical care or transport, such as ambulance
companies, need patient-identifiable outcomes in order to
evaluate the effectiveness of their clinical and operational
procedures to improve patient care and outcomes. The author
further states that public policy should permit and encourage
quality improvement and systems effectiveness between
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hospitals and prehospital emergency service providers. The
author argues that while federal law allows this to occur,
state law does not and this bill would allow such disclosures
to occur under state law.
2)BACKGROUND. In 2012, EMSA received a grant from the California
HealthCare Foundation (CHCF) to increase the accessibility and
accuracy of prehospital data for public, policy, academic and
research purposes to facilitate system evaluation and
improvement. The grant included a review of EMSA's existing
system, the development of a core measures program, and
engagement with LEMSAs to facilitate uniform reporting. As
part of the project, EMSA has begun implementation of the new
national data standards and integrating electronic health
information systems.
The CHCF-funded projected revealed: a) that the existing
system had a number of weaknesses that made it difficult for
EMSA to validate EMS information for reporting, impacting its
suitability for statewide sustainability and transition to the
new national data standards; b) that variability in data
collection methodology (in some cases related to the use of
paper vs. electronic patient records) limited the usefulness
of data submitted; and, c) the lack of hospital outcome data,
particularly for cardiac arrest cases limited the ability of
LEMSAs to obtain universal outcome data. The capacity of the
current system was also assessed by the Health Services
Advisory Group, an External Quality Review Organization
network contractor, which found similar weaknesses to those
identified in the CHCF core measures project. The
recommendations for EMSA included better standardization of
data collection from LEMSAs.
3)CALIFORNIA'S EMS
SYSTEM. California operates on a two-tiered EMS system. EMSA
is the lead agency and centralized resource to oversee
emergency and disaster medical services. EMSA is charged with
providing leadership in developing and implementing LEMSAs
throughout California, and in setting standards for the
training and scope of practice of various levels of EMS
personnel. California has 32 LEMSAs that provide EMS for
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California's 58 counties. (Seven regional EMS systems
comprised of 33 counties and 25 single-county agencies provide
the services.) Regional systems are usually comprised of
small, rural, less-populated counties, and single-county
systems generally exist in the larger and more urban counties.
LEMSAs are responsible for planning, implementing, and
managing local trauma care systems, including assessing needs,
developing the system design, designating trauma care centers,
collecting trauma care data, and providing quality assurance.
4)MEDICAL
PRIVACY.
a) CMIA. In California, the CMIA governs the disclosure of
medical information by health care providers, Knox-Keene
regulated plans, contractors, health care clearinghouses,
and employers. Specifically, the CMIA prohibits a provider
of health care, health plan, or contractor from disclosing
medical information regarding a patient or an enrollee or
subscriber without first obtaining an authorization, unless
the disclosure is permitted.
b) HIPAA. HIPAA, among various provisions, requires the
protection and confidential handling of protected health
information (this is commonly referred to as HIPAA Privacy
Rules). The HIPAA Privacy Rules provide federal
protections for personal health information (PHI) held by
covered entities and give patients an array of rights with
respect to that information. Disclosure of PHI is
permitted when needed for patient care and other important
purposes. On the other hand, HIPAA's Security Rule
specifies a series of administrative, physical, and
technical safeguards for covered entities to use to assure
the confidentiality, integrity, and availability of
electronic PHI.
5)SUPPORT. The sponsor of this bill, the California Hospital
Association (CHA), writes in support that prehospital EMS
providers, such as ambulance companies, need
patient-identifiable outcome information to evaluate the
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effectiveness of their clinical and operational procedures to
improve their patent safety and quality outcomes, particularly
for emergency services programs such as trauma, stroke, and
STEMI (ST segment elevation myocardial infarction - a type of
heart attack). CHA maintains that public policy should permit
and encourage quality improvement activities between providers
and hospitals to improve quality and patient safety and
ultimately improve emergency patient survival rates.
According to CHA, HIPAA regulations permit hospitals to
release patient-identifiable medical information to
prehospital EMS providers for quality assessment and
improvement purposes
6)RELATED
LEGISLATION.
a) AB 70 (Waldron) changes the reporting requirement that
EMSA report annually to the Legislature on the
effectiveness of the statewide trauma system to once every
five years. AB 70 is currently pending hearing in the
Assembly Health Committee.
b) AB 430 (Roger Hernández) requires EMSA to develop a
statewide trauma plan that addresses all aspects of a
trauma care system and report the status the plan to the
Legislature no later than March 31, 2016. Requires LEMSAs
implementing trauma care systems to commission an
independent nonprofit organization or governmental entity
qualified to assess trauma systems to conduct a
comprehensive regional assessment of equitability and
access to its trauma system at least once every five years.
AB 430 is currently pending hearing in the Assembly Health
Committee.
c) AB 1129 (Burke) requires an emergency medical care
provider, when collecting and sharing data with a LEMSA, to
use a system compatible with California Emergency Medical
Services Information System and National Emergency Medical
Services Information System standards, as specified.
Prohibits a LEMSA from mandating that a provider use a
specific system to collect and share this data. AB 1129 is
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currently pending hearing in the Assembly Health Committee.
7)PREVIOUS
LEGISLATION.
a) AB 1975 (Roger Hernández) of 2014 would have required
LEMSAs to contract with the American College of Surgeons
every five years to conduct a comprehensive assessment of
the county trauma system. AB 1975 was held on the Suspense
file in the Assembly Appropriations Committee.
b) AB 1621 (Lowenthal and Rodriguez), also of 2014, would
have required EMSA to develop the State Emergency Medical
Services Data and Information System in order to assess
each EMS area or LEMSAs service area to determine the need
for additional EMS services, coordination of EMS services,
and the effectiveness of EMS. AB 1621 was held on the
Suspense file in the Senate Appropriations Committee.
c) SB 266 (Romero) of 2005 would have required EMSA to
establish a trauma care advisory committee and required the
committee to develop a statewide trauma care plan by
January 1, 2007. SB 266 was vetoed by Governor
Schwarzenegger, stating " I am directing EMSA, informed by
its Trauma Advisory Committee, to complete its statewide
trauma care plan and provide me recommendations by no later
than June 1, 2006."
d) AB 1988 (Diaz), Chapter 333, Statutes of 2002, requires
EMSA to convene a task force to study the delivery and
provision of EMS. Requires the task force, among other
things, to develop a plan to ensure that all Californians
are served by appropriate coverage areas for emergency and
trauma services and that sufficient numbers of emergency
departments and trauma centers exist to serve each area's
population.
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REGISTERED SUPPORT / OPPOSITION:
Support
California Hospital Association (sponsor)
California Ambulance Association
California Fire Chiefs Association
Fire Districts Association of California
Opposition
None on file.
Analysis Prepared by:Patty Rodgers / HEALTH / (916) 319-2097
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