BILL ANALYSIS Ó
SB 19
Page 1
SENATE THIRD READING
SB
19 (Wolk)
As Amended September 4, 2015
Majority vote
SENATE VOTE: 40-0
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|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 | |
SB 19
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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 | |
| | | | |
| | | | |
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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, as defined. 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 POLST eRegistry 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
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permanent, statewide operation of a POLST eRegistry.
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.
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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
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 medical 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)Specifies that when a patient or his/her health care decision
maker are withdrawing information from the POLST eRegistry,
that the definition of a health care provider means an
individual licensed, certified, or otherwise authorized or
permitted by the law of this state to provide health care in
the ordinary course of business or practice of a profession.
8)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.
9)Specifies that when the POLST eRegistry Pilot is providing
information during emergencies to health care providers, that
the definition of health care provider means emergency
response employees, including but not limited to,
firefighters, law enforcement officers, emergency medical
technicians, paramedics, and employees and volunteer members
of legally organized and recognized organizations who are
trained in accordance with Standard adopted by EMSA.
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10)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.
11)Requires an evaluation of the POLST eRegistry Pilot to be
done by an independent contractor approved by EMSA.
12)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
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
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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
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.
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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.
Analysis Prepared by:
Lara Flynn / HEALTH / (916) 319-2097 FN:
0002092