BILL ANALYSIS �
AB 1621
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Date of Hearing: May 7, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 1621 (Lowenthal) - As Amended: April 21, 2014
Policy Committee: HealthVote:19-0
Urgency: No State Mandated Local Program:
Yes Reimbursable: Yes
SUMMARY
This bill requires the Emergency Medical Services Authority
(EMSA) to develop a statewide data system to monitor the quality
and effectiveness of the EMS system. It also:
1)Requires prehospital EMS providers to electronically collect
and provide specified data to the local EMS agencies, and
requires local EMS agencies to report to EMSA.
2)Specifies data must meet standards prescribed by EMSA, and
requires EMSA to consult with stakeholders on the development
of standards.
3)Requires the bill and regulations pursuant to this bill be
implemented only to the extent funds are made available
through an appropriation in the annual Budget Act.
FISCAL EFFECT
1)One-time Information Technology costs of up to several million
dollars GF if a new system is required. Costs may be
significantly lower if EMSA can modify its existing system to
collect the required data. The requirements of the system are
not specified in detail, and would be elucidated through the
regulatory process.
2)One-time administrative costs to EMSA in the low hundreds of
thousands of dollars to develop standards and regulations, and
minor ongoing administrative costs.
3)Unknown, significant potential state-reimbursable mandate
costs related to the requirement for LEMSAs to report data to
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EMSA, and for public prehospital providers, such as fire
districts or local government-administered ambulance services,
to adopt electronic patient care records systems. Software
costs are in the range of $60,000 to 400,000 per public
prehospital provider, with ongoing maintenance costs of $6,000
to $200,000 per year.
4)Potential state GF cost pressure to upgrade data systems in
use by the Department of State Parks, CalFIRE, and the
California Highway Patrol, to the extent they are considered
prehospital EMS providers and existing data systems do not
meet standards developed pursuant to this bill.
5)The requirement that this bill and regulations pursuant to
this bill be implemented only to the extent funds are made
available through an appropriation in the annual Budget Act is
somewhat problematic, as the bill contains numerous
requirements on various entities and it is unclear how such a
trigger might work.
COMMENTS
1)Purpose . The author asserts EMSA's ability to fulfil its
mission to ensure quality patient care by administering an
effective, statewide system of coordinated emergency medical
care, injury prevention, and disaster medical response has
been hampered by an inadequate framework for the collection
and analysis of prehospital data. This bill is intended to
improve the consistency and quality of data collection
statewide.
2)Background . Current law requires prehospital providers to
report patient care records to their local EMS agencies. The
majority of providers, about 75%, have implemented electronic
data capture for these records, with the rest reporting they
are paper-based. However, there are numerous vendors for
electronic patient care records systems, which may not be
compatible with one another, or with EMSA's existing data
system.
EMSA currently has a data system in place that collects
reports from local EMS agencies, but given reporting is
voluntary, not all local EMS agencies report data to the
system, and among those that do, not all of them report
electronically. Among those that do report electronically,
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some do not report in a way that is compatible with EMSA's
existing data system. This data system was the subject of a
review commissioned by EMSA and released in April 2013, which
found a number of technical as well as policy challenges with
the existing system, including missing data, data quality, and
data standardization.
3)Staff Comments . This bill requires EMS providers to adopt
electronic patient care record technology. Providers and
local EMS authorities indicate that while this technology has
been implemented in many cases, it has not been implemented
across all providers. It is unclear that EMS providers,
particularly small and rural providers, have the resources to
implement this mandate, particularly according to the timeline
specified.
Currently, most local EMS agencies report data to EMSA, as
this bill requires. Putting a requirement in statute triggers
potential state-reimbursable mandate claims. There may be
other solutions to encourage reporting to EMSA that would not
result in state costs.
Additionally, many prehospital public providers, such as fire
departments, could submit mandate claims associated with this
bill's mandate for electronic reporting. This may lead to
significant state costs with relatively limited marginal
benefit, if most providers are eventually expected to adopt an
electronic record system.
As noted, EMSA has an existing data system. It is unclear
whether challenges identified by the review described above
actually require a new data system, as this bill suggests, or
whether the existing system could be modified to address the
challenges.
4)Opposition . Counties and local EMS agencies oppose the mandate
on the local EMS agencies to report, and also have concerns
requiring EMS providers to adopt electronic systems, citing
concern that many do not have the resources. Certain privacy
advocates oppose the bill unless amended to address their
concerns about data privacy.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081
AB 1621
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