BILL ANALYSIS �
SB 850
Page 1
SENATE THIRD READING
SB 850 (Leno)
As Amended June 22, 2011
Majority vote
SENATE VOTE :21-15
HEALTH 14-0 JUDICIARY 7-2
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|Ayes:|Monning, Ammiano, Atkins, |Ayes:|Feuer, Atkins, Dickinson, |
| |Bonilla, Eng, Gordon, | |Beth Gaines, Huber, |
| |Hayashi, | |Monning, Wieckowski |
| |Roger Hern�ndez, Bonnie | | |
| |Lowenthal, Mitchell, | | |
| |Nestande, Pan, | | |
| |V. Manuel P�rez, Williams | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
| | |Nays:|Wagner, Jones |
| | | | |
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APPROPRIATIONS 12-5
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|Ayes:|Fuentes, Blumenfield, |
| |Bradford, Charles |
| |Calderon, Campos, Davis, |
| |Gatto, Hall, Hill, Lara, |
| |Mitchell, Solorio |
| | |
|-----+--------------------------|
|Nays:|Harkey, Donnelly, |
| |Nielsen, Norby, Wagner |
| | |
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SUMMARY : Requires an electronic health record (EHR) system or
electronic medical record (EMR) system to automatically record
any change or deletion of any electronically stored medical
information. Specifically, this bill :
1)Replaces the term medical "records" with the term medical
"information" in existing law which requires medical records
to be handled in a manner that preserves the confidentiality
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of the information.
2)Requires an EHR or EMR system to protect and preserve the
integrity of electronic medical information, and automatically
record and preserve any change or deletion of any
electronically stored medical information.
3)Requires the record of any change or deletion to include the
identity of the person who accessed and changed the medical
information, the date and time the medical information was
accessed, and the change that was made to the medical
information.
4)Requires a patient's right to access or receive a copy of his
or her electronic medical records upon request to be
consistent with current applicable state and federal laws
governing patient access to, and the use and disclosure of,
medical information.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, negligible state fiscal impact. This bill mirrors
recently released and pending federal regulations that create
new minimum data integrity and consumer access standards for
data stored in EHR/EMR systems.
COMMENTS : According to the author, in 2009, the U.S. Congress
passed the Health Information Technology for Economic and
Clinical Health (HITECH) Act sections of the American
Reinvestment and Recovery Act (ARRA). HITECH allocates $44,000
in Medicare incentives to each individual provider in order to
promote the use of EHRs and to address the significant financial
obstacles to the adoption and use of such systems, particularly
among smaller or independent physician offices. Beginning in
2015, physicians who elect not to use an EHR will be penalized,
starting with a 1% Medicare fee reduction. In 2017 this penalty
grows to 3%. As a result of these incentives, it is expected
that there will be a dramatic increase in the use of EHRs by
individual physician practices. A recent study published in the
Journal of Health Affairs found that less than one in five
physicians, or 18%, reported having at least a basic EHR system.
By 2015 it is expected that most physicians will begin doing
so. The author states that this bill is intended to ensure that
regulations governing medical records appropriately account for
the inherent differences between paper and electronic record
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systems. The author asserts that an electronic format makes it
possible for medical information or errors to be deleted or
changed, without those deletions or changes being reflected in
the medical record.
According to the author, at Stanford Hospital, doctors failed to
treat a patient who suffered from complications following a
surgery; and as a result, she died. The patient's surviving
family members had to request records from Stanford six times
only to be told the information did not exist. The author
states that further investigations revealed that many records
were not produced because of a technicality and because several
records were destroyed after the error was made and the patient
had died. In other situations, patients have received
conflicting records when requesting their records from their
health care provider. Another example provided by the author is
that in Northern California, a patient had requested his records
three times because there was no record of a particular visit to
a doctor. It was not until the third request that this visit
was reflected in his records, with no explanation as to why the
record was initially missing.
This bill is sponsored by the Consumer Attorneys of California
(CAC) to ensure that information that was previously accessible
to the patient in a paper format continues to be available to
the patient in an electronic format. According to CAC, paper
records have traditionally included a clear record of a change
made to the record but EHR systems do not use the same protocols
and only reference a change in the audit trail which is not
accessible or readable to a patient - and the original entry may
be lost. CAC believes that neither health reform nor subsequent
regulations related to certified EHRs have done much to ensure
the integrity and accuracy of a patient's medical record is
preserved. CAC states that some providers have unscrupulously
taken advantage of these shortfalls to cover-up errors by
modifying or deleting entries. CAC argues that deletions and
modifications of a record put a patient's safety at risk whether
intentional or unintentional. A simple inadvertent mistake,
such as deleting entire entries from a patient's multiple visits
to the doctor while undergoing a series of treatment, which did
occur at a San Diego medical specialist's office, can have
detrimental effects in the future, writes CAC.
SB 850
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Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097
FN: 0001940