BILL ANALYSIS Ó
SENATE JUDICIARY COMMITTEE
Senator Hannah-Beth Jackson, Chair
2015-2016 Regular Session
AB 503 (Rodriguez)
Version: July 7, 2015
Hearing Date: July 14, 2015
Fiscal: Yes
Urgency: No
NR
SUBJECT
Emergency medical services
DESCRIPTION
This bill would authorize a health facility to release
patient-identifiable medical information to an emergency medical
services (EMS) provider, a local EMS agency, and the Emergency
Medical Services Authority (EMSA), to the extent specific data
elements are requested for quality assessment and improvement
purposes. This bill would also require the EMSA to develop
minimum standards for the implementation of this data
collection.
BACKGROUND
Prior to 1980, California did not have a central state agency
responsible for coordinating Emergency Medical Services (EMS)
statewide. The Legislature established the Emergency Medical
Services Authority (EMSA) as a lead agency to oversee emergency
and disaster medical services throughout California. EMSA is one
of thirteen departments within California's Health and Human
Services Agency. EMSA provides leadership and direction to
California's 33 local emergency medical services agencies
(LEMSAs) that provide EMS for California's 58 counties.
Specifically, EMSA is charged with the coordination and
integration of all state activities concerning EMS, including
the establishment of minimum standards, policies, and
procedures.
Reviewing EMS requires the evaluation of medical data, the
sharing of which is regulated by both federal and state law. The
Health Insurance Portability and Accountability Act (HIPAA),
enacted in 1996, guarantees privacy protection for individuals
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with regards to specific health information. (Pub.L. 104-191,
110 Stat. 1936.) Generally, protected health information is any
information held by a covered entity which concerns health
status, provision of healthcare, or payment for healthcare that
can be connected to an individual. HIPAA privacy regulations
require healthcare providers and organizations to develop and
follow procedures that ensure the confidentiality and security
of personal health information when it is transferred, received,
handled, or shared. HIPAA further requires reasonable efforts
when using, disclosing, or requesting protected health
information, to limit disclosure of that information to the
minimum amount necessary to accomplish the intended purpose.
California's Confidentiality of Medical Information Act (CMIA)
(Civ. Code Sec. 56 et seq.) allows adult patients in California
to keep personal health information confidential and decide
whether and when to share that information. While HIPAA
expressly authorizes the sharing of medical information to
pre-hospital EMS providers for quality assessment and
improvement purposes, California law is silent. This bill,
sponsored by the California Hospital Association, seeks to
ensure hospitals can share this information with pre-hospital
EMS providers, by expressly allowing such an exchange of
information under California law.
CHANGES TO EXISTING LAW
Existing law , the California Constitution, provides that all
people have inalienable rights, including the right to pursue
and obtain privacy. (Cal. Const., art. I, Sec. 1.)
Existing federal law , the Health Insurance Portability and
Accountability Act (HIPAA), specifies privacy protections for
patients' protected health information and generally provides
that a covered entity, as defined (health plan, healthcare
provider, and healthcare clearinghouse), may not use or disclose
protected health information except as specified or as
authorized by the patient in writing. (45 C.F.R. Sec. 164.500
et seq.)
Existing law prohibits, under the State Confidentiality of
Medical Information Act (CMIA), providers of healthcare,
healthcare service plans, or contractors, as defined, from
sharing medical information without the patient's written
authorization, subject to certain exceptions. (Civ. Code Sec.
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56 et seq.)
Existing law establishes the Emergency Medical Services
Authority (EMSA), which is responsible for the coordination and
integration of all state activities concerning emergency medical
services (EMS), including the establishment of minimum
standards, policies, and procedures. (Health & Saf. Code Sec.
1797 et seq.)
Existing law requires EMSA to develop planning and
implementation guidelines for specified EMS systems including
communications, system organization, and management, and data
collection and evaluation. (Health & Saf. Code Sec. 1797.103.)
Existing law authorizes counties to develop an EMS program and
designate a local emergency medical services agency (LEMSA)
responsible for planning and implementing an EMS system, which
includes day-to-day EMS system operations. (Health & Saf. Code
Sec. 1797.217.)
Existing law establishes an 18-member Commission on EMS to
review regulations, standards, and guidelines developed by EMSA;
advise EMSA on various aspects of the EMS system; and, to make
recommendations for further development of the EMS system.
(Health & Saf. Code Sec. 1799 et seq.)
This bill would allow a general acute care or psychiatric
hospital to release patient-identifiable medical information
under the following circumstances:
to an EMS provider, information regarding a patient who was
treated, or transported to the hospital by, that EMS provider,
to the extent that specific data elements are requested for
quality assessment and improvement purposes; and,
to EMSA or to the LEMSA, to the extent that specific data
elements are requested for quality assessment and improvement
purposes.
This bill would define an "EMS provider," for purposes of this
bill, as an organization employing an Emergency Medical
Technician-I, Advanced Emergency Medical Technician, or
Emergency Medical Technician-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.
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This bill would limit an EMS provider, LEMSA, or EMSA to
requesting only those data elements that are minimally
necessary, in compliance with specified provisions of federal
regulations governing the Health Insurance Portability and
Accountability Act (HIPAA).
This bill would require EMSA to develop minimum standards for
the implementation of data collection for system operation,
patient outcome, and performance quality improvement.
COMMENT
1.Stated need for the bill
According to the author:
Pre-hospital emergency medical services providers, such as
ambulance companies, need patient-identifiable outcome
information to evaluate the effectiveness of their clinical
and operational procedures in order to improve patient care
outcomes. Hospitals also rely on such information to improve
their patient safety and quality outcomes, particularly for
emergency service programs such as trauma, Stroke, and STEMI
(ST segment elevation myocardial infarction).
Health Insurance Portability and Accountability Act (HIPAA)
regulations permit hospitals to release patient-identifiable
medical information to pre-hospital emergency medical services
providers for quality assessment and improvement purposes
about a patient that the hospital and the pre-hospital
provider have in common. HIPAA regulations also permit
hospitals to release patient-identifiable medical information
to government healthcare oversight agencies. However, state
law does not explicitly permit such disclosures to EMS
providers. This bill seeks to explicitly permit these EMS
disclosures in state law.
2.Codifying a common practice authorized under federal law
The Health Insurance Portability and Accountability Act (HIPAA)
expressly authorizes hospitals to release patient-identifiable
medical information to pre-hospital emergency medical services
providers for "healthcare operations" purposes if it regards a
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patient that the hospital and the pre-hospital provider have in
common. (See 45 C.F.R. Sec. 164.506(c)(4).) "Healthcare
operations," refers to a range of management functions of
covered entities, including quality assessment, practitioner
evaluation, student training programs, insurance rating,
auditing services, and business planning and development. (45
C.F.R. Sec. 164.501.) HIPAA also permits hospitals to release
patient-identifiable medical information to government
healthcare oversight agencies. (See 45 C.F.R. Sec. 164.512(d).)
The Confidentiality of Medical Information Act (CMIA) does not
expressly authorize the sharing of patient-identifiable medical
information with EMS or the EMSA for requested for quality
assessment and improvement purposes, although it is undisputed
that this information is routinely shared so that the EMSA may
fulfill its responsibility to collect data and establish
guidelines and procedures for EMS.
This bill, consistent with HIPAA and other authorizations to
share patient identifiable information the Legislature has
approved, would limit both the type of information, and the
purpose for which it is shared. Specifically, the information
shared would be limited to specific data elements requested for
quality assessment and improvement purposes. Further, the
information could only be shared with EMS providers, the EMSA,
and/or local EMS agencies. Accordingly, this bill should help
ensure that the EMSA and other healthcare providers do not incur
liability for the appropriate sharing of information that serves
the public policy of improving healthcare services.
3.Opposition's concerns
In opposition, the Emergency Medical Services Administrators
Association of California (EMSAAC) expresses concern that this
bill will actually limit a LEMSA's access to hospital data.
EMSAAC writes:
LEMSAs rely extensively on dispatch, pre-hospital care
records, hospital records and trauma registries to fulfill
their statutory mandate to evaluate the local EMS system and
improve the speed and effectiveness of pre-hospital, receiving
hospital and specialty care center services. If AB 503
becomes law, hospitals (as the bill's language allows) may
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choose not to provide LEMSAs with the hospital patient
treatment data needed to effectively evaluate the EMS system,
including critical trauma registry data.
The author responds, "This bill was introduced at the request of
the hospitals to expressly clarify that hospitals have
permission to release patient-identifiable medical information
to EMS providers. Hospitals in California want to release data
to EMS providers so that patient care and survival may be
improved, however current law is ambiguous and confusing leading
the hospitals to request the clarification provided by this
bill. The opposition's claim that hospitals would become so
inundated with requests that they would deny information is not
realistic as most hospitals are served by a limited number EMS
providers. Under this measure, LEMSAs will be able to request
the same information as all other providers to fulfill their
statutory obligation."
Support : Association of California Healthcare Districts;
California Ambulance Association; Dignity Health; Paramedics
Plus
Opposition : Emergency Medical Services Administrators
Association of California
HISTORY
Source : California Hospital Association
Related Pending Legislation : AB 1129 (Burke), would prohibit a
LEMSA from mandating that a provider use a specific electronic
health record system.
Prior Legislation :
AB 1621 (Lowenthal, 2014), would have required the EMSA to adopt
a single statewide standard for the collection of information
regarding pre-hospital care for CEMSIS, required EMSA to develop
standards for electronic patient care records systems used by
LEMSAs and local pre-hospital EMS providers to ensure
compatibility with CEMSIS, and required LEMSAs to submit patient
information to EMSA utilizing the single statewide standard in a
timely manner. AB 1621 was held on the Senate Appropriations
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Committee suspense file.
AB 1975 (R. Hernández, 2014) would have required LEMSAs to
contract with the American College of Surgeons every five years
to conduct a comprehensive assessment of their regional trauma
system. AB 1975 was held on the Assembly Appropriations
Committee suspense file.
SB 535 (Nielsen, 2013) would have increased the membership of
the EMS Commission from 18 to 20 members, and required the
additional members to be an air ambulance representative
appointed by the Senate Committee on Rules, and representative
appointed by the Speaker of the Assembly from a public agency
that provides air rescue and transport. SB 535 was vetoed by the
Governor.
Prior Vote :
Senate Health Committee (Ayes 8, Noes 0)
Assembly Floor (Ayes 78, Noes 0)
Assembly Appropriations Committee (Ayes 16, Noes 0)
Assembly Health Committee (Ayes 17, Noes 0)
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