BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1129
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|AUTHOR: |Burke |
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|VERSION: |June 23, 2015 |
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|HEARING DATE: |July 1, 2015 | | |
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|CONSULTANT: |Vince Marchand |
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SUBJECT : Emergency medical services: data and information
system.
SUMMARY : Requires an emergency medical care provider, when submitting
data to a local emergency medical services agency (LEMSA), to
use an electronic health record system that is compatible with
specified standards, and that includes those data elements that
are required by the LEMSA. Prohibits a LEMSA from mandating that
a provider use a specific electronic health record system.
Existing law:
1)Establishes the Emergency Medical Services Agency (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.
2)Requires EMSA to develop planning and implementation
guidelines for EMS systems which address specified components,
including communications, system organization and management,
and data collection and evaluation.
3)Authorizes counties to develop an EMS program and designate a
LEMSA responsible for planning and implementing an EMS system,
which includes day-to-day EMS system operations.
4)Establishes an 18-member Commission on EMS, within the
California Health and Human Services Agency (HHSA). Defines
the duties of the Commission to include reviewing regulations,
standards, and guidelines developed by EMSA; advising EMSA on
a data collection system; advise on emergency facilities and
services, emergency communications, medical equipment,
personnel training, and various aspects of the EMS system;
AB 1129 (Burke) Page 2 of ?
and, to make recommendations for further development of the
EMS system.
This bill:
1)Requires an emergency medical care provider to do both of the
following when collecting and submitting data to a LEMSA:
a) Use an electronic health record system that
exports data in a format that is compatible with the
California Emergency Medical Services Information
System (CEMSIS) and the National Emergency Medical
Services Information System (NEMSIS) standards and
includes those data elements that are required by the
LEMSA; and,
b) Ensure that the electronic health record
system can be integrated with the LEMSA's data system,
so that the LEMSA can collect data from the provider.
2)Prohibits a LEMSA from mandating that a provider use a
specific electronic health record system to collect and share
data with the LEMSA.
3)Prohibits this bill from modifying or affecting an existing
contract or agreement executed before January 1, 2016, between
a LEMSA and an emergency medical care provider.
FISCAL
EFFECT : This bill has been keyed non-fiscal.
PRIOR
VOTES :
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|Assembly Floor: |77 - 0 |
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|Assembly Health Committee: |16 - 0 |
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COMMENTS :
1)Author's statement. According to the author, this bill
ensures that California has an accurate picture of its EMS
programs across the state, improves our coordination with
national efforts, and provides local EMS providers with the
guidance and flexibility they need to deploy electronic
AB 1129 (Burke) Page 3 of ?
patient record systems, without placing an unnecessary burden
on local EMS providers, particularly those that cover multiple
LEMSAs. 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. However, without
guidelines in law, LEMSAs are able to require EMS providers in
their jurisdiction to purchase specific software or hardware
for electronic patient records and data collection. While
that may be acceptable for EMS providers that only serve a
single LEMSA, for providers that cover multiple LEMSAs, such
as air ambulance providers, specific LEMSA requirements for
software and/or hardware can be an unnecessary and costly
burden. The author states that 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. For smaller EMS providers, changing software due
to a LEMSA change in requirements is very expensive and
additional training will be required of EMS personnel. This
bill helps ensure the consistency and quality of data
collection across California by requiring the data collected
by EMS providers to be consistent with both NEMSIS and CEMSIS
data standards for EMS services, and compliant with the
LEMSA's system, but allows the EMS provider to select the data
collection system, hardware, or software to use.
2)NEMSIS and CEMSIS. 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.
According to EMSA, 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. EMSA states that at least 14 of
AB 1129 (Burke) Page 4 of ?
California's 33 LEMSAs currently send a variety of local data
collections to CEMSIS on a voluntary basis, and in return,
these local agencies gain access to digital tools for running
comprehensive reports on their own data at no cost. EMSA
states when fully operational with 100% local participation,
it is estimated that CEMSIS will catalogue more than three
million EMS events per year. According to EMSA, it will use
the data to develop and coordinate high quality emergency
medical care in California through activities such as
healthcare quality programs that monitor patient care
outcomes, agency collaboration across jurisdictional
boundaries, and public health surveillance.
In order to improve local data quality and prepare California
EMS for health information exchange, EMSA is planning to adopt
new data standards known as NEMSIS Version 3, which will
provide 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. On October 1, 2014, the NEMSIS
Technical Advisory Committee announced that California was the
first state to successfully transmit NEMSIS Version 3 EMS data
to the national repository using field and state level
software "certified compliant" with the NEMSIS V3 standard.
According to EMSA, through its partnership with the Inland
Counties Emergency Medical Agency, test data from three
different software vendors was sent to NEMSIS.
3)Related legislation. AB 503 (Rodriguez), would permit a
hospital to release patient-identifiable medical information
to an EMS provider, to the LEMSA, or to the Emergency Medical
Services Agency, for quality assessment and improvement
purposes.
AB 503 is set for hearing on July 1, 2015 in this committee.
4)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
Committee suspense file.
AB 1129 (Burke) Page 5 of ?
AB 1975 (R. Hernández, 2014),would have required local EMS
agencies 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.
5)Double referral. This bill is double referred. Should it pass
out of this committee, it will be referred to the Senate
Judiciary Committee.
6)Support. According to the author, this bill is sponsored by
the Ambulance Association of Orange County (AAOC), which
states that this bill would preclude a LEMSA from mandating
any particular software or hardware on ambulance companies or
fire departments, and instead, only require compatibility with
NEMSIS and CEMSIS programs. AAOC states that the goal of
NEMSIS is to set a standard for the exchange of healthcare
information among different providers and agencies, and that
it is not meant, nor is it necessary, to mandate a particular
software to meet this standard. AAOC states that mandating a
particular software platform creates the need for duplicative
systems because many providers serve multiple counties
throughout the state. The City of Ontario states in support
that this bill is simple, yet effective. The City of Ontario
states that requiring EMS providers to collect data in a
system compatible with CEMSIS and NEMSIS ensures that data can
easily be transferred across agencies, and that in emergency
situations, fluidity of data transfer can have a significant
effect on a medical provider's ability to care for patients.
The California Professional Firefighters states in support
that this bill will ensure California has an accurate picture
of its EMS programs across the state, improves coordination
with national efforts, and provides local EMS providers with
the guidance they need to deploy electronic patient record
systems.
AB 1129 (Burke) Page 6 of ?
7)Opposition. The County of San Bernardino (County) states in
opposition that its overall concern with this bill is the lack
of clarity and specificity regarding the "data" to be shared,
and that it is unclear what data a medical care provider is
collecting and sharing with the LEMSA. The County states that
if this bill is intended to apply to the real-time data passed
from a care provider's system to a LEMSA live data system with
the intent to create and update live electronic patient care
records, rather than reporting data after-the-fact to meet
state mandates for records, there is a high likelihood of
suffering data integrity issues when a centralized LEMSA
system attempts to assimilate real-time data from a different
system utilized by a provider. The County states in order for
ICEMA (the LEMSA for San Bernardino, Inyo and Mono Counties)
to provide this functionality, the systems would have to be
re-designed, reconfigured and redeployed as a new system while
trying to concurrently maintain the existing systems to
accommodate the decentralized approach for allowing care
providers to use different systems. According to the County,
its experience in trying to collect vital patient data from
disparate sources has demonstrated that it is extremely
complicated and difficult to merge the elements of system
compatibility and data integrity, and that a single system is
crucial to managing patient care and safety not only in San
Bernardino County, but in the other counties across the state
submitting data through its system.
This bill is also opposed by the California Right to Life
Committee, which states that it is concerned that the data
systems required by this bill could eventually include data on
a statewide Physicians' Orders for Life Sustaining Treatment
(POLST) registry or other similar end of life registries, and
it is opposed to the POLST type of form on end of life
decision-making.
SUPPORT AND OPPOSITION :
Support: Ambulance Association of Orange County (sponsor)
AmbuServe Ambulance
California Ambulance Association
California Fire Chiefs Association
California Professional Firefighters
Care Ambulance Service
Chino Valley Fire District
City of Ontario
Emergency Ambulance Service
AB 1129 (Burke) Page 7 of ?
Los Angeles County Ambulance Association
Shoreline Ambulance
Oppose: California Right to Life Committee
County of San Bernardino
EMS Medical Directors Association of California
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