BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    AB 2260


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          ASSEMBLY THIRD READING


          AB  
          2260 (Wood)


          As Amended  May 27, 2016


          Majority vote


           ------------------------------------------------------------------ 
          |Committee       |Votes|Ayes                  |Noes                |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Health          |19-0 |Wood, Maienschein,    |                    |
          |                |     |Bonilla, Burke,       |                    |
          |                |     |Campos, Chiu,         |                    |
          |                |     |Dababneh, Gomez,      |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |                |     |Roger Hernández,      |                    |
          |                |     |Lackey, Nazarian,     |                    |
          |                |     |Olsen, Patterson,     |                    |
          |                |     |Ridley-Thomas,        |                    |
          |                |     |Rodriguez, Santiago,  |                    |
          |                |     |Steinorth, Thurmond,  |                    |
          |                |     |Waldron               |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Appropriations  |20-0 |Gonzalez, Bigelow,    |                    |
          |                |     |Bloom, Bonilla,       |                    |
          |                |     |Bonta, Calderon,      |                    |
          |                |     |Chang, Daly, Eggman,  |                    |
          |                |     |Gallagher, Eduardo    |                    |








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          |                |     |Garcia, Roger         |                    |
          |                |     |Hernández, Holden,    |                    |
          |                |     |Jones, Obernolte,     |                    |
          |                |     |Quirk, Santiago,      |                    |
          |                |     |Wagner, Weber, Wood   |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
           ------------------------------------------------------------------ 


          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.  Specifies that the stakeholders include  
            representatives of LEMSAs, air ambulance providers, and EMSA,  
            and allows EMSA to reconvene the stakeholders annually to  
            modify the elements and formatting of the data.


          2)Requires the data elements and formatting to comply with the  
            National EMS Information System (NEMSIS) and California EMS  
            Information System (CEMSIS) electronic health record.


          3)Prohibits EMSA from requiring an air ambulance provider to use  
            a specific electronic health record system to collect and  
            share data with LEMSAs.


          4)Requires air ambulance providers, in addition to submitting  
            data to LEMSAs, to submit data directly to EMSA if requested.










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          5)Requires air ambulance providers, when submitting data to the  
            LEMSA, to ensure that the electronic health record system can  
            be integrated with the LEMSA's NEMSIS and CEMSIS compliant  
            data system, so the LEMSA can collect data from the provider.


          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.


          FISCAL EFFECT:  According to the Assembly Appropriations  
          Committee, one-time General Fund (GF) cost pressure for staff  
          and consulting costs of $100,000 per year for two years, to  
          support the stakeholder and regulatory process to create  
          standardized data elements.  If EMSA's Information Technology  
          (IT) systems need to be modified in order to handle increased  
          data reporting as a result developing standardized data elements  
          specific to air ambulance providers, potential GF cost pressure  
          in the range of $350,000 for IT changes.  The current CEMSIS is  
          already compatible with national standards, but may need to be  
          customized to allow additional data elements to be reported.   
          This cost estimate is approximate; the need for IT changes, the  
          extent of changes, and the corresponding costs would depend on  
          the outcome of the data standardization effort required by this  
          bill.  


          COMMENTS:  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.  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 LEMSAs, 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.  This  
          duplication places a significant financial burden on air  








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          ambulance providers, which this bill will ease by requiring the  
          submission of a single data set in a consistent format.  


          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.  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.


          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.


          NEMSIS was formed in 2001 by the National Association of State  
          EMS Directors.  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.  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  








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          to digital tools for running comprehensive reports on their own  
          data at no cost.


          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.




          Analysis Prepared by:                                             
                          Lara Flynn / HEALTH / (916) 319-2097  FN:  
          0003226