BILL ANALYSIS Ó
-----------------------------------------------------------------
|SENATE RULES COMMITTEE | AB 1129|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
-----------------------------------------------------------------
THIRD READING
Bill No: AB 1129
Author: Burke (D)
Amended: 6/23/15 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 8-0, 7/1/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth
NO VOTE RECORDED: Wolk
ASSEMBLY FLOOR: 77-0, 5/7/15 - See last page for vote
SUBJECT: Emergency medical services: data and information
system
SOURCE: Ambulance Association of Orange County
DIGEST: This bill 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. This bill
prohibits a LEMSA from mandating that a provider use a specific
electronic health record system.
ANALYSIS:
Existing law:
AB 1129
Page 2
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; advising on emergency facilities and
services, emergency communications, medical equipment,
personnel training, and various aspects of the EMS system;
and, making 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.
AB 1129
Page 3
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.
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
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
AB 1129
Page 4
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
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.
Related Legislation
AB 1129
Page 5
AB 503 (Rodriguez) permits a hospital to release
patient-identifiable medical information to an EMS provider, to
the LEMSA, or to the EMSA, for quality assessment and
improvement purposes. AB 503 is set for hearing on July 14,
2015, in the Senate Judiciary Committee.
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 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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:NoLocal: No
SUPPORT: (Verified7/8/15)
Ambulance Association of Orange County (source)
AmbuServe Ambulance
California Ambulance Association
California Fire Chiefs Association
California Professional Firefighters
AB 1129
Page 6
Care Ambulance Service
Chino Valley Fire District
City of Ontario
Emergency Ambulance Service
Los Angeles County Ambulance Association
Shoreline Ambulance
OPPOSITION: (Verified7/8/15)
California Right to Life Committee
County of San Bernardino
EMS Medical Directors Association of California
ARGUMENTS IN SUPPORT: According to the author, this bill is
sponsored by the Ambulance Association of Orange County (AAOC),
which states that this bill precludes a LEMSA from mandating any
particular software or hardware on ambulance companies or fire
departments, and instead, only requires 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.
ARGUMENTS IN OPPOSITION: The County of San Bernardino
(County) states in opposition that its overall concern with this
AB 1129
Page 7
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.
ASSEMBLY FLOOR: 77-0, 5/7/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Chang, Chau,
Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly,
Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Mark
AB 1129
Page 8
Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams,
Wood, Atkins
NO VOTE RECORDED: Campos, Roger Hernández, Steinorth
Prepared by:Vince Marchand / HEALTH /
7/8/15 16:34:11
**** END ****