BILL ANALYSIS
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|Hearing Date:June 25, 2001 |Bill No:AB |
| |1589 |
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SENATE COMMITTEE ON BUSINESS AND PROFESSIONS
Senator Liz Figueroa, Chair
Bill No: AB 1589Author:Simitian
As Amended:April 30, 2001 Fiscal:Yes
SUBJECT: Healing arts: electronic transmission of
prescriptions.
SUMMARY: Requires the Medical Board in consultation with
the Board of Pharmacy to conduct a study on the electronic
transmission of prescriptions by physicians.
Existing law:
1)Establishes the Medical Board of California within the
Department of Consumer Affairs to regulate and license
physicians and surgeons and to perform various duties
relating to other healing arts practitioners.
2)Establishes the California State Board of Pharmacy to
regulate and license the practice of pharmacy.
3)Prohibits dangerous drugs or devices from being sold or
furnished without a prescription, and defines a
"prescription" as an oral, written, or electronic
transmission order issued by licensed prescribers, as
specified. Further defines "electronic transmission
prescription" as including both image prescriptions
(facsimile) and date prescriptions electronically
transmited from a licensed prescriber to a pharmacy.
4)Requires generally that an oral or an electronic data
transmission be reduced to writing by the pharmacist as
soon as practicable, or recorded and stored
electronically under specified circumstances.
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5)Allows the patient to have an electronically transmitted
prescription to a pharmacy of their choice or to have a
written prescription.
6)Permits a prescriber to electronically enter a
prescription into a pharmacy's or hospital's computer
from any location outside of the pharmacy or hospital
with the permission of the pharmacy or hospital, unless
the prescription is for specified controlled substances.
7)Provides that it is the intention of the Legislature that
pharmacies in this state have the ability to adopt new
technologies involving the electronic transmission of
prescriptions to reduce the occurrence of dispensing
errors and to improve service to California.
This bill:
1)Makes Legislative findings that in 1993, approximately
7,000 deaths occurred in the United States as a result of
medication errors.
2)Makes further findings that illegible prescriptions
result in more than 150 million inquiries each year by
pharmacists for clarification of the prescription and
that while technology exists or electronic transmission
of prescriptions, less than 5 percent of physicians and
surgeons use this technology.
3)Requires the Medical Board to consult with the Board of
Pharmacy and commission a study that evaluates the
electronic transmission of prescriptions by physicians
and surgeons and report its results to the Legislature on
or before January 1, 2003.
4)Specifies that the reports should include recommendations
to encourage physicians and surgeons to use this method
to transmit prescriptions and identify systems to protect
patients, including the issuance of a "digital
certification."
5)Defines "digital certification" as an electronic
signature that verifies the identity of the physician and
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surgeon who is transmitting the prescription
electronically.
FISCAL EFFECT: According to the Assembly Appropriations
Committee Analysis dated May 16, 2001, minor one-time costs
to the Medical Board ranging from $50,000 to $100,000
(Medical Board Contingent Fund), to commission the study.
COMMENTS:
1.Purpose. This bill is sponsored by the author.
According to the author, the Assembly Health Committee
has been researching various E-health issues, including
E-prescription issues. The Palo Alto Medical Foundation
has begun testing a new Web-based system that allows
patients to view their own medical records, request
appointments and renew prescriptions on line. The author
further explains that New Jersey is considering new rules
to allow physicians to E-mail prescriptions to a
pharmacy, a move aimed at reducing errors caused by
illegible handwriting. Also, as the industry explores
options to make health care delivery more efficient and
cost-effective, there is a need to develop standard
protocols regarding signature verification, security, and
interfacing with current requirements relative to
prescribing drugs or oversight of drug prescription will
become unsound.
2.Studies Indicate a Need for More Efficient Practices and
Processes to Prescribe Medications and Transmit
Prescriptions. In November of 1999, the Institute of
Medicine (IOM) released a report, "To Err is Human:
Building a Safer Health System," which found that
approximately 7,000 hospital patients die annually across
the country from preventable medication-related errors.
The IOM report found that 2 out of every 100 hospital
patients will die or be injured as a result of
preventable medication errors, and that each medication
error increases the cost of a hospital stay by an average
of $4,700. The IOM report included several
recommendations to address the medication-related errors,
including that health care organizations and the
professionals affiliated with them establish patient
safety programs which incorporate well-understood safety
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principles, such as standardizing and simplifying
equipment, supplies, and processes, and that health care
organizations implement proven medication safety
practices .
A white paper from the Institute for Safe Medications
Practices (ISMP) called for the elimination of
handwritten prescriptions within 3 years. The ISMP paper
stated that the health care industry has been slow to
adopt new technologies, and that prescription writing is
perhaps the most important paper transaction remaining in
our increasingly digital society. The ISMP argues that
the hurdles until very recently have been clinicians'
reticence about computers, a lack of hardware and
software that would conveniently allow prescribers to
select medications electronically, and fear of the costs
associated with such technology. The ISMP asserts that
fortunately, the advent of wireless hand-held devices is
making it increasingly possible to solve the "handwriting
crisis," perhaps on all three counts.
3.Arguments in Support. The California Medical Association
(CMA) is in support of this measure and indicates that
the CMA continues to examine methods whereby physicians
can reduce medical errors through their Project SAFE CARE
(Strategic Alliance for Effective Care and Reduction of
Errors) Task Force. The Project is currently reviewing
several vendors that may have the capacity for
electronically prescribing medications in order to
develop important criteria that physicians may consider
when taking advantage of this technology. It is the
belief of the CMA that this bill will assist physicians
in accomplishing their goal of ensuring patient safety
and reducing medical errors.
The California State Board of Pharmacy (Board) is also in
support of this bill and indicates that electronic
prescribing has been proven to substantially reduce the
incidence of medication errors and has the potential to
bring substantial operating efficiencies to prescribing
and dispensing processes. As explained by the Board,
electronic prescribing has begun to take hold in the
hospital setting and experience in one hospital found a
50% reduction in medication errors and a two hour
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reduction in the time required to process the order and
administer the drug to the patient. A study required by
this bill will provide recommendations on how to speed up
the adoption of this technology in other settings.
4.Support if Amended. The California Optometric Association
(COA) expresses its support for this measure if it is
amended to be provider neutral. The COA is concerned
that the language limits the study to recommendations
pertaining physicians and surgeons and that there are
other health care providers who issue prescriptions and
should be included in the study as well.
They suggest that the term "physicians and surgeons" be
replaced by " licensed health care providers acting within
the scope of their license ."
NOTE: Double-referral to the Senate Judiciary Committee.
SUPPORT AND OPPOSITION:
Support : California Medical Association
California State Board of Pharmacy
Support if Amended : California Optometric Association
Opposition :None Received
Consultant:Bill Gage