BILL ANALYSIS Ó
AB 2260
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Date of Hearing: April 12, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 2260
(Wood) - As Amended April 5, 2016
SUBJECT: Emergency medical services.
SUMMARY: Requires the Emergency Medical Services Authority
(EMSA) to, before January 1, 2018, determine a single set of
data elements and formatting for air ambulance providers to
submit to local emergency medical services agencies (LEMSAs).
Specifically, this bill:
1)Requires EMSA to convene interested stakeholders for the
purpose of determining the single set of data elements and
formatting.
2)Specifies that the stakeholders include representative of
LEMSAs, air ambulance providers, and EMSA, and allows EMSA to
reconvene the stakeholders annually to modify the elements and
formatting of the data.
3)Requires the data elements and formatting to comply with the
National EMS Information System (NEMSIS) and California EMS
Information System (CEMSIS) electronic health record.
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4)Prohibits EMSA from requiring an air ambulance provider to use
a specific electronic health record system to collect and
share data with LEMSAs.
5)Requires air ambulance providers, in addition to submitting
data to LEMSAs, to submit data directly to EMSA if requested.
6)Prohibits a LEMSA from requiring additional data elements or
formatting from an air ambulance provider, once the single set
of data elements and formatting has been established as
described in 1) above.
EXISTING LAW:
1)Establishes EMSA, which coordinates and integrates 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
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California Health and Human Services Agency. 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;
and, to make recommendations for further development of the
EMS system.
5)Requires an EMS provider, when collecting and sharing data
with a LEMSA, to use a system compatible with CEMSIS and
NEMSIS standards. Prohibits a LEMSA from mandating that an
EMS provider use a specific system to collect and share this
data.
FISCAL EFFECT: This bill has not been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, air ambulance
providers are essential EMS providers who provide services on
a regional or statewide basis, crossing county and local EMS
authority lines on a regular basis. The author states, all
pre-hospital providers must submit incident and patient data
information to the LEMSA with jurisdiction over each service
call. As a result of the multiple LEMSA's, air ambulance
providers submit patient data to multiple providers. This can
be duplicative, and often the data is not requested or
reported in a uniform manner. The author asserts this
duplication places a significant financial burden on air
ambulance providers, which this bill will ease by requiring
the submission of a single data set in a consistent format.
The author also notes LEMSAs will be included in the
development of the data elements to ensure their concerns are
addressed.
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2)BACKGROUND.
a) EMSA and LEMSAs. EMSA is charged with providing
leadership in developing and implementing EMS systems
throughout California and setting standards for the
training and scope of practice of various levels of EMS
personnel. EMSA also has responsibility for promoting
disaster medical preparedness throughout the state, and,
when required, coordinating and supporting the state's
medical response to major disasters.
The 33 LEMSAs throughout the state are responsible for
planning, implementing, and managing local trauma care
systems, including assessing needs, developing the system
design, designating trauma care centers, collecting trauma
care data, and quality assurance.
b) Air ambulance providers. Air ambulances provide
services on a regional or statewide basis. For any given
emergency air transport, there may be up to three different
LEMSA jurisdictions involved, including the LEMSA where the
Air Ambulance is based; the LEMSA where the patient was
picked up; and, the LEMSA where the receiving hospital is
located. All of these LEMSAs may have a reasonable basis
for obtaining and reviewing the electronic health record.
A single helicopter base may provide services to and from
more than 10 different LEMSAs. A single helicopter
provider with multiple bases may, over the course of the
year, provide services to and from the majority of the 33
LEMSAs.
c) 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
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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.
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 3 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
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new data standards known as NEMSIS Version 3 (V3), 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 NEMESIS V3 EMS data to the national
repository using field and state level software "certified
compliant" with the 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.
d) LEMSA reporting requirements. Existing law requires an
EMS provider to use an electronic health record system that
exports data in a format that is compliant with the current
versions of CEMSIS and NEMSIS and includes the data
elements that are required by the LEMSA, and specifies that
a LEMSA must not mandate that a provider use a specific
system to collect and share the data. As noted by the
author and sponsors, many LEMSAs have different data
reporting requirements.
3)SUPPORT. The California Association of Air Medical Services
(CAAMS) is the sponsor of this bill and states, all
prehospital EMS providers are coordinated through the 33
LEMSAs in California and overseen by EMSA. CAAMS notes that
multiple LEMSAs requesting data in multiple formats require
air ambulance providers to modify their processes and software
to comply with each LEMSAs specific reporting requirements.
CAAMS also notes that the non-standardized LEMSA reporting
methodology and formatting results in data that is not
compatible or accessible on a region-wide or statewide basis
and this limitation prohibits EMSA from conducting research or
evaluation which could lead to improved patient care.
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4)PREVIOUS LEGISLATION.
a) AB 1129 (Burke), Chapter 377, Statutes of 2015, requires
an EMS provider, when collecting and sharing data with a
LEMSA, to use a system compatible with CEMSIS and NEMSIS
standards. Prohibits a LEMSA from mandating that an EMS
provider use a specific system to collect and share this
data.
b) AB 1621 (Lowenthal) of 2014, would have required 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.
c) SB 535 (Nielsen) of 2013 would have revised the
membership of the Commission on EMS by adding one
representative from a public agency that provides air
rescue and transport to be appointed by the Speaker of the
Assembly and one air ambulance representative appointed by
the Senate Committee on Rules from a list of three names
submitted by CAAMS. SB 535 was vetoed by the Governor.
REGISTERED SUPPORT / OPPOSITION:
Support
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California Association of Air Medical Services (sponsor)
California Shock Trauma Air Rescue
Mercy Air/Air Methods
PHI Air Medical
Opposition
None on file.
Analysis Prepared by:Lara Flynn / HEALTH / (916) 319-2097