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 ****