BILL ANALYSIS Ó
AB 1129
Page 1
Date of Hearing: April 21, 2015
ASSEMBLY COMMITTEE ON PRIVACY AND CONSUMER PROTECTION
Mike Gatto, Chair
AB 1129
(Burke) - As Amended April 6, 2015
SUBJECT: Emergency medical services: data and information
system
SUMMARY: Sets standards for the electronic patient record
systems that emergency medical services (EMS) providers in
California use. Specifically, this bill:
1)Requires EMS providers to use electronic patient record
systems that:
a) Meet California Emergency Medical Services Information
System (CEMSIS) data standards; and
b) Can be integrated with a Local Emergency Medical
Services Agency (LEMSA), so that the LEMSA can collect data
from the EMS provider.
2)Prohibits a LEMSA from mandating an EMS provider use a
specific system (i.e., specific software or hardware) to
collect and share electronic patient records with the LEMSA.
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EXISTING LAW:
1)Authorizes counties to develop an EMS program and designate a
LEMSA responsible for planning and implementing an EMS system
and authorizes LEMSAs to plan, implement and oversee
day-to-day EMS. (Health and Safety Code (HSC) Section
1797.200, et seq.)
2)Establishes the state Emergency Medical Services Authority
(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 EMS system.
(HSC 1797.100, et seq.)
3)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. (HSC
1797.102)
4)Prohibits, under the State Confidentiality of Medical
Information Act (CMIA), providers of health care, health care
service plans, or contractors, as defined, from sharing
medical information without the patient's written
authorization, subject to exceptions, including among others,
certain research. (Civil Code Section 56, et seq.)
5)Protects, under the federal Health Insurance Portability and
Accountability Act (HIPAA), the privacy of patients' health
information and generally provides that a covered entity, as
defined (health plan, health care provider, and health care
clearing house), may not use or disclose "protected," i.e.,
individually identifiable, health information except as
specified or as authorized by the patient in writing. (45
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Code of Federal Regulations Section 160, et seq.)
FISCAL EFFECT: None. This bill has been keyed non-fiscal by the
Legislative Counsel.
COMMENTS:
1)Purpose of this bill . This bill is intended to help ensure
that LEMSAs can collect data from and oversee EMS providers by
requiring them to use electronic data collection and sharing
systems that are compliant with that CEMSIS and NEMSIS. While
the bill sets data system standards for EMS providers, it
specifically prohibits LEMSAs from requiring EMS providers to
use a specific data system, so that EMS providers are not
inadvertently forced to maintain two or more separate data
systems - one for each of the LEMSAs the EMS provider serves.
This bill is sponsored by the California Ambulance
Association.
2)Author's statement . According to the author, "A key
requirement for any electronic patient record is compatibility
with CEMSIS and NEMSIS standards to ensure that both the state
and federal authorities can track EMS trends accurately. There
are currently 60 different software packages that are NEMSIS
compliant. Over 90% of California's EMS providers already have
a NEMSIS compatible data system in place. In many areas, EMS
providers can choose the electronic patient record software
that best meets their needs and budget, so long as it is
NEMSIS compatible."
"However, without guidelines in law, LEMSAs are able to
require EMSs in their jurisdiction to purchase specific
software or hardware for electronic patient records and data
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collection. While that may be acceptable for EMS providers
that only serve a single LEMSA, for providers, like air
ambulance providers, that cover multiple LEMSAs specific LEMSA
requirements for software and or hardware can be an
unnecessary and costly burden."
3)EMSA, NEMSIS, and CEMSIS . Prior to 1980, California did not
have a central state agency responsible for coordinating EMS
services (ambulance, fire, emergency helicopter services)
statewide. The Legislature established 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. EMSAS provides
leadership and direction to California's 33 LEMSAs that
provide EMS for California's 58 counties.
One of EMSA's goals is to ensure that data systems in EMS are
positioned for the electronic capture of data and transmission
to the hospital in real time. Specifically, EMSA's
responsibilities for data collection include the development
and maintenance of an aggregated statewide pre-hospital
database, the establishment and maintenance of core measure
data set for California emergency services, and the provision
of guidance and technical assistance to LEMSAs for the
development and improvement of local EMS data collection
systems.
According to the EMSA website, CEMSIS is a demonstration
project for improving EMS data analysis across California.
CEMSIS offers a secure, centralized data system for collecting
data about individual EMS requests, patients treated at
hospitals, and EMS provider organizations. When LEMSAs send
data to CEMSIS, they gain access to digital tools for running
comprehensive reports on their own data at no cost. However,
participation in CEMSIS is voluntary, and currently less than
half - 14 of 33 - LEMSAs submit data to CEMSIS. According to
EMSA, the authority for the creation of CEMSIS stems from the
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general statutory authority granted to EMSA to "asses
each...LEMSA service area to determine the need for additional
EMS services, coordination of EMS services, and the
effectiveness of EMS services." (HCS 1797.102)
NEMSIS was formed in 2001 by the National Association of State
EMS Directors, in conjunction with the National Highway
Traffic Safety Administration and the Trauma/EMS Systems
program of the Health Resources and Services Administration's
Maternal Child Health Bureau, in order to develop a national
EMS database. NEMSIS is the national repository that will be
used to potentially store EMS data from every state in the
nation, and was developed to help states collect more
standardized elements to allow submission to the national
database.
In order to improve local data quality and prepare California
EMS providers for the new federal health information exchange,
EMSA recently adopted a new data standard known as NEMSIS
Version 3, which provides a set of tools that EMS
professionals can use to integrate EMS patient care data with
electronic medical records at hospitals, leading to better
patient outcomes and a smarter system of care.
4)Medical privacy . In California, 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 by law. Under federal law, HIPAA
requires the protection and confidential handling of protected
health information. HIPAA provides federal protections for
personal health information held by covered entities and gives
patients an array of rights with respect to that information.
Disclosure of personal health information is permitted when
needed for patient care and other important purposes. On the
other hand, HIPAA specifies a series of administrative,
physical, and technical safeguards for covered entities to use
to assure the confidentiality, integrity, and availability of
electronic data.
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The American Civil Liberties Union (ACLU), Electronic Frontier
Foundation, and the Consumer Federation of California have
opposed prior legislation, AB 1621 (Lowenthal) of 2014, on the
grounds that EMSA and CEMSIS may not be entities covered under
CMIA or HIPAA.
5)Comments and questions for the Committee . As local EMS
providers adopt systems that meet CEMSIS and NEMSIS standards,
the state will be able to collect more comprehensive data
about EMS care provided to patients throughout California.
With 100% participation, EMSA estimates CEMSIS will receive
more than three million EMS events every year. EMSA plans to
use the data to develop and coordinate high quality emergency
medical care in California through activities such as health
care quality programs that monitor patient care outcomes,
agency collaboration across jurisdictional boundaries, and
public health surveillance.
While improving the quality of emergency care in California
through statewide reporting of EMS patient data is a worthy
goal, policymakers should also have the objective of ensuring
the data held in statewide databases is protected - both under
current privacy laws and also against cyber security breaches.
The author and the Committee may wish to consider whether
legislation is needed to require EMSA to assess and address
the privacy and data security issues associated with
maintaining a comprehensive database of all EMS transactions
in the state, such as: the extent to which CEMSIS data is
protected under current medical privacy laws, data retention
standards, and limits on sharing personally identifiable
information.
6)Arguments in support . The California Ambulance Association
states in support of AB 1129, "EMS data collection practices
are inconsistent with and contrary to the goal of NEMSIS,
which is the setting of a standard for the exchange of health
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care information among different providers and agencies. It
is not meant, nor necessary, to mandate particular software to
meet the NEMSIS standards."
The Los Angeles County Ambulance Association writes, "Mandating
specific software creates the need for duplicative systems
because many providers serve multiple counties throughout the
state."
According to AmbuServe, "A goal of federal healthcare reform is
to hold costs down? If each LEMSA has a different software
requirement for sharing healthcare information, an EMS or
other health care provider would essentially have to run
duplicate systems, all at great cost to the private sector."
7)Arguments in opposition . The Emergency Medical Services
Administrators Association of California (EMSAAC) and the EMS
Medical Directors Association of California (EMDAC) state in
opposition to this bill that, "EMSAAC and EMDAC are generally
supportive of the concept of expanding the use of electronic
emergency medical services data; however, we are ]opposed to
AB 1129's prohibition that?LEMSAs?may not adopt a single
system-wide patient care record system?While it is not common
for a LEMSA to mandate a single system-wide patient care
record system, such an approach may clearly be in the best
interest of patients in order to assure the transfer and
continuity of patient care data from and to prehospital
providers, receiving hospitals, and specialty care centers."
The California Right to Life Committee, Inc. opposed this bill
on the basis this bill "could eventually include the data on a
statewide Physicians' Orders for Life Sustaining Treatment
Registry (POLST) and other similar end of life registries.
CRLC is opposed to the POLST type form of end of life decision
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making in which medical or non-medical personnel complete a
form and the patient does not have to sign or verify its
statements?The person's name on such a registry or data base
could negate the patient's true choices for end of life
treatment."
8)Author's amendment . The author would like to accept the
following minor amendment to address the concerns expressed by
some opponents:
On Page 6, line 2, strike out "is compliant" and insert:
exports data in a format that is compatible
9)Prior legislation . AB 1621 (Lowenthal) of 2014 would have
required the EMSA to adopt a single statewide standard for the
collection of information regarding pre-hospital care for its
CEMSIS. Would have required EMSA to develop standards for
electronic patient care records systems used LEMSAs and local
pre-hospital EMS providers to ensure compatibility with
CEMSIS, and required local EMS agencies to submit patient
information to EMSA utilizing the single statewide standard in
a timely manner. AB 1621 was held on the Senate Appropriations
Committee suspense file.
AB 1975 (R. Hernández) of 2014 would require 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), of 2013 would have increased the membership
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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.
10)Double-referral . This bill was double-referred to the
Assembly Health Committee where it was heard on April 14,
2015, and passed on a 16-0 vote.
REGISTERED SUPPORT / OPPOSITION:
Support
California Ambulance Association (CAA)
AmbuServe Ambulance
Los Angeles County Ambulance Association, Inc.
Care Ambulance Service
Shoreline Ambulance
Emergency Ambulance Service
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Opposition
California Right to Life Committee, Inc.
EMS Medical Directors Association of California (EMDAC)
Emergency Medical Services Administrators Association of
California
Analysis Prepared by:Jennie Bretschneider / P. & C.P. / (916)
319-2200