BILL ANALYSIS                                                                                                                                                                                                    Ó






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                                   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:









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          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.







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          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  







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            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
          







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          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







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          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  







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          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  







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            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


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