BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                      SB 19


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          SENATE THIRD READING


          SB  
          19 (Wolk)


          As Amended  August 31, 2015


          Majority vote


          SENATE VOTE:  40-0


           ------------------------------------------------------------------ 
          |Committee       |Votes|Ayes                  |Noes                |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Health          |19-0 |Bonta, Maienschein,   |                    |
          |                |     |Bonilla, Burke,       |                    |
          |                |     |Chávez, Chiu, Gomez,  |                    |
          |                |     |Gonzalez, Roger       |                    |
          |                |     |Hernández, Lackey,    |                    |
          |                |     |Nazarian, Patterson,  |                    |
          |                |     |Ridley-Thomas,        |                    |
          |                |     |Rodriguez, Santiago,  |                    |
          |                |     |Steinorth, Thurmond,  |                    |
          |                |     |Waldron, Wood         |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Judiciary       |10-0 |Mark Stone, Weber,    |                    |
          |                |     |Wagner, Alejo, Chau,  |                    |
          |                |     |Chiu, Gallagher,      |                    |
          |                |     |Cristina Garcia,      |                    |
          |                |     |Maienschein, Thurmond |                    |








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          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Appropriations  |17-0 |Gomez, Bigelow,       |                    |
          |                |     |Bloom, Bonta,         |                    |
          |                |     |Calderon, Chang,      |                    |
          |                |     |Nazarian, Eggman,     |                    |
          |                |     |Gallagher, Eduardo    |                    |
          |                |     |Garcia, Holden,       |                    |
          |                |     |Jones, Quirk, Rendon, |                    |
          |                |     |Wagner, Weber, Wood   |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
           ------------------------------------------------------------------ 


          SUMMARY:  Requires the Emergency Medical Services Authority  
          (EMSA) to establish and operate a California POLST eRegistry  
          Pilot to collect Physician Orders for Life Sustaining Treatment  
          (POLST), and disseminate the information to authorized users,  
          including health care providers.  Specifically, this bill:  


          1)Requires EMSA to establish and operate the California POLST  
            eRegistry once sufficient non-state funds are available to  
            allow for the development of the registry and any related  
            startup and evaluation costs.


          2)Requires EMSA to coordinate the POLST eRegistry which will be  
            operated by, and as part of, the health information exchange  
            (HIE) networks, an independent contractor, or a combination  
            thereof; allows the Pilot to operate in a single geographic  
            area, or multiple areas, and to test various methods of making  
            POLST information available electronically.  Requires the  
            design of the Pilot to be sufficiently robust, and based on  
            the success of the Pilot, to inform the permanent, statewide  
            operation of a POLST eRegistry. 










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          3)Requires EMSA to adopt guidelines for the operation of the  
            eRegistry Pilot, and in developing the guidelines to seek  
            input from interested parties and hold at least one public  
            meeting.


          4)Exempts the adoption, amendment or repeal of the guidelines  
            from the Administrative Procedure Act.  Requires the  
            guidelines to include, but not be limited to the following:


             a)   The means by which POLST information may be submitted or  
               withdrawn from the eRegistry, including a method for  
               electronic delivery of the information and the use of  
               electronic signatures;


             b)   Appropriate and timely methods for the information to be  
               disseminated to an authorized user;


             c)   Procedures for verifying the identity of an authorized  
               user;


             d)   Procedures to ensure the accuracy of, and appropriately  
               protect the confidentiality of, POLST information submitted  
               to the POLST eRegistry Pilot; and,


             e)   The ability of the patient, or his/her legally  
               recognized health care decision maker, with his or her  
               health care provider to modify or withdraw POLST  
               information on the POLST eRegistry Pilot.


          5)Requires the operation of the POLST eRegistry Pilot to comply  
            with state and federal privacy and security laws and  
            regulations, including but not limited to the federal Health  








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            Insurance Portability and Accountability Act.


          6)Requires a physician or his/her designee who completes a POLST  
            with a patient or his/her legally recognized health care  
            decision maker to include the POLST information in the  
            patient's official electronic health record, and to submit a  
            copy of the POLST form to the eRegistry Pilot, unless the  
            patient or the legally recognized health care decision maker  
            chooses not to participate in the eRegistry.


          7)Requires physicians, hospitals, and HIEs, when the POLST  
            eRegistry is operable, to make electronic POLST information  
            available to all heath care providers outside of their health  
            information exchange networks, through the POLST eRegistry  
            pilot, for use during emergencies.


          8)Provides that a health care provider who honors a patient's  
            request regarding resuscitative measures obtained from the  
            POLST eRegistry Pilot is not subject to criminal prosecution,  
            civil liability, discipline for unprofessional conduct, or  
            administrative sanction.


          9)Requires an evaluation of the POLST eRegistry Pilot to be done  
            by an independent contractor approved by EMSA.


          10)Specify that the provisions of this bill will remain in  
            effect only until January 1, 2020.


          FISCAL EFFECT:  According to the Assembly Appropriations  
          Committee, costs likely exceeding $1 million per year for two  
          years (non-state funds) for system development.  The California  
          Health Care Foundation (CHCF) has commissioned a feasibility  
          report to examine the concept of a POLST registry.  According to  








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          a draft of the report, it would cost about $2.5 million to  
          develop a statewide information technology system for an  
          online-accessible registry and set up the program; costs in the  
          hundreds of thousands of dollars per year to staff, maintain,  
          and market the registry pilot for the course of the pilot  
          (General Fund or other unknown fund source); and, unknown  
          potential cost savings due to avoided unwanted medical care  
          (various fund sources).


          COMMENTS:  According to the author, a POLST is a form that  
          contains a doctor's orders to ensure that a patient's wishes are  
          honored regarding medical treatment towards the end of life.   
          The author notes, currently, the POLST form is a paper document,  
          and as such, is oftentimes a key barrier to its effectiveness  
          given that it can be misplaced and there isn't a central  
          database or registry that first responders can access in an  
          emergency situation.  The author states, a statewide electronic  
          POLST registry in California would help ensure immediate access  
          to vital medical orders by emergency medical personnel in an era  
          of ever-increasing technology and federal funding available to  
          specifically support electronic health records.  The author  
          concludes, several states are developing and a few states have  
          already completed a statewide registry to access POLST forms  
          more effectively.


          California Pilot Project.  In early 2014, CHCF interviewed a  
          wide range of health care stakeholders and POLST leaders  
          regarding the adoption of a POLST registry in California.  Those  
          interviewed included representatives of hospital emergency  
          departments, acute care facilities, hospices, skilled nursing  
          facilities, emergency medical services, and other care  
          providers.  Next steps identified by interviewees included:   
          piloting the registry in a community, with the intent to scale  
          rapidly; developing a technology platform for the registry that  
          supports multiple forms of input and output, from paper to fax  
          to mobile devices; expand existing POLST education  
          infrastructure to include education about the registry; engaging  








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          state administrative leadership and consider development of an  
          independently operated registry, based on the approaches of  
          other successful California health registries, such as the  
          California Cancer Registry; and, identifying funding sources to  
          build and sustain the registry. 


          CHCF is currently exploring the idea of sponsoring a POLST pilot  
          project.  They have received nine community proposals,  
          representing seven counties throughout California - north and  
          south. The next step is for CHCF to meet with the sponsors of  
          the proposals and assess the level of engagement of the provider  
          community - hospitals, nursing homes and emergency medical  
          services.  A decision by CHCF's Board on whether to move forward  
          is not expected until September or December 2015. 


          What are Health Information Exchange Networks?  HIE networks are  
          standards, services and policies that will help move healthcare  
          from a system where patient information is stored within in  
          paper medical records and carried from one doctor's office to  
          the next to a process where information is stored and shared  
          securely and electronically.  HIE Networks rely on linking  
          centers that use the same electronic record systems.  Many  
          providers are getting in on the ground floor with HIEs as a  
          means of safely and securely exchanging patient information with  
          clinicians within their network and also with those outside the  
          network.  While Electronic Health Record (EHR) technology is  
          well established HIEs is newer and still developing.  Some HIEs  
          are repositories that store information as well as transmit it  
          while others are just pipelines.  Because health systems are in  
          the process of consolidating their EHRs this is a good time to  
          also establish the POLST information as part of changing ways in  
          which health information is being shared electronically and  
          securely. 












                                                                      SB 19


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          Analysis Prepared by:                                             
                          Lara Flynn / HEALTH / (916) 319-2097  FN:  
          0001713