BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2260
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|AUTHOR: |Wood |
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|VERSION: |May 27, 2016 |
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|HEARING DATE: |June 22, 2016 | | |
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|CONSULTANT: |Vince Marchand |
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SUBJECT : Emergency medical services
SUMMARY : Requires the Emergency Medical Services Authority to determine
a single set of data elements and formatting for air ambulance
providers to submit to local emergency medical services
agencies.
Existing law:
1)Establishes the Emergency Medical Services Authority (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
local EMS agency (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; 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.
AB 2260 (Wood) Page 2 of ?
5)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 compliant with the
current versions of 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.
6)Prohibits a LEMSA from mandating that an emergency medical
provider use a specific electronic health record system to
collect and share data with the LEMSA.
This bill:
1)Requires EMSA, before January 1, 2018, to determine a single
set of data elements and formatting for air ambulance
providers to submit to LEMSAs.
2)Requires EMSA to convene interested stakeholders for the
purpose of determining the single set of data elements and
formatting, requires stakeholders to include representatives
of the LEMSAs and air ambulance providers, and permits 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
NEMSIS and CEMSIS electronic health records.
4)Prohibits EMSA from mandating that an air ambulance provider
use a specific electronic health record system to collect and
share data with the LEMSA.
5)Requires an air ambulance provider, in addition to submitting
data to the LEMSA, to submit data directly to EMSA if the EMSA
requests it.
6)Requires the air ambulance provider, 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
AB 2260 (Wood) Page 3 of ?
data system, so that the LEMSA may collect data from the
provider.
7)Prohibits a LEMSA, after the single data set has been
established by EMSA, from requiring additional data elements
or formatting from an air ambulance provider.
FISCAL
EFFECT : According to the Assembly Appropriations Committee:
1)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.
2)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.
PRIOR
VOTES :
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|Assembly Floor: |79 - 0 |
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|Assembly Appropriations Committee: |20 - 0 |
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|Assembly Health Committee: |19 - 0 |
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COMMENTS :
1)Author's statement. According to the author, air ambulance
providers are essential emergency service providers. They
provide services on a regional or statewide basis, crossing
AB 2260 (Wood) Page 4 of ?
county and local EMS authority lines on a regular basis. All
pre-hospital providers must submit incident and patient data
information to the local EMS agency. 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
places a significant financial burden on air ambulance
providers. This bill will require the submission of a single
data set in a consistent format. The LEMSAs will be included
in the development of the data elements to ensure their
concerns are addressed.
2)Background. EMSA is the lead agency and centralized resource
to oversee emergency and disaster medical services. EMSA is
charged with providing leadership in developing and
implementing local EMS systems (called local EMS agencies, or
LEMSAs) throughout California and setting standards for the
training and scope-of-practice of various levels of EMS
personnel. Day-to-day EMS system management is the
responsibility of the local and regional EMS agency.
California has 33 LEMSA systems that provide EMS for
California's 58 counties. Regional systems are usually
comprised of small, more rural, less-populated counties and
single-county systems generally exist in the larger and more
urban counties. There are seven regional LEMSAs that encompass
multiple counties, and 26 single-county agencies.
3)Description of problem addressed by this bill. According to
information provided by the author, air ambulances provide
services on a regional or statewide basis, crossing county and
LEMSA lines on a regular basis. For any given emergency air
transport, there may be up to three different LEMSA
jurisdictions involved, including: 1) the LEMSA where the air
ambulance is based; 2) the LEMSA where the patient was picked
up; and 3) 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 or from more than 10
different LEMSA's. A single helicopter provider with multiple
bases may, over the course of the year, provide services to or
from the majority of the 33 LEMSAs in California. According to
the author, as a result of the multiple LEMSAs, the data
requirements can be duplicative, and often the data is not
requested or reported in a uniform manner. The author argues
this places a significant financial burden on air ambulance
AB 2260 (Wood) Page 5 of ?
providers, who are asked to modify their processes and
software to comply with the specific reporting nuances for
each LEMSA. Further, the non-standardized LEMSA reporting
methodology, and formatting, results in data that is not
compatible or accessible on a regional or statewide basis.
This limitation prohibits EMSA from conducting research or
evaluation which could lead to improved patient care.
4)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
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 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.
5)Prior legislation. AB 1129 (Burke, Chapter 377, Statutes of
2015), required an EMS provider, when collecting and sharing
data with a LEMSA, to use a system compatible with NEMSIS and
CEMSIS.
AB 503 (Rodriguez, Chapter 362, Statutes of 2015), permitted a
hospital to release patient-identifiable medical information
to an EMS provider, to the LEMSA, or to EMSA, for quality
assessment and improvement purposes.
AB 1621 (Lowenthal of 2014), would have required the EMSA to
adopt a single statewide standard for the collection of
information regarding pre-hospital care for CEMSIS, required
AB 2260 (Wood) Page 6 of ?
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.
SB 535 (Nielsen of 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.
6)Support. This bill is sponsored by the California Association
of Air Medical Services (CAAMS), which states that under the
current system, most LEMSAs place varying data reporting
requirements on EMS providers, including air ambulance
providers, who may enter their jurisdiction to pick up or
deliver a patient. CAAMS states that the data requirements can
be duplicative, and is often not requested or reported in a
uniform manner. CAAMS states that this places a financial
burden on air ambulance providers who are asked to modify
their processes and software to comply with the specific
reporting nuances for each LEMSA. CAAMS states that this bill
will provide a single data submission standard and eliminate
the duplication amongst LEMSAs. California Shock Trauma Air
Rescue, PHI Air Medical, and Mercy Air/Air Methods also all
support this bill in order to coordinate and make consistent
the data that they must submit to LEMSAs.
7)Opposition. EMSA opposes this bill, stating that it would
impose non-absorbable costs to EMSA in administrative and
technical costs relating to supplementing CEMSIS. EMSA states
that moreover, the intended creation of an air
ambulance-specific dataset can be achieved administratively,
and that it has engaged stakeholders through its Executive
Data Advisory Group to improve data collection, quality, and
use. According to EMSA, this workgroup is discussing how to
address the collection and submission of data elements for all
EMS providers.
SUPPORT AND OPPOSITION :
Support: California Association of Air Medical Services
AB 2260 (Wood) Page 7 of ?
(sponsor)
Mercy Air/Air Methods
California Shock Trauma Air Rescue
PHI Air Medical
Oppose: Emergency Medical Services Authority
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