BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1621
AUTHOR: Lowenthal and Rodriguez
AMENDED: June 9, 2014
HEARING DATE: June 18, 2014
CONSULTANT: Marchand
SUBJECT : Emergency medical services: data and information
system.
SUMMARY : Requires the Emergency Medical Services Agency (EMSA)
to adopt a single statewide standard for the collection of
information regarding pre-hospital care for its California
Emergency Medical Services Information System (CEMSIS), requires
EMSA to develop standards for electronic patient care records
systems used by local emergency medical services (EMS) agencies
and local pre-hospital EMS providers to ensure compatibility
with CEMSIS, and requires local EMS agencies to submit patient
information to EMSA utilizing the single statewide standard in a
timely manner.
Existing law:
1.Establishes EMSA, which is responsible for the coordination
and integration of all state activities concerning EMS,
including the establishment of minimum standards, policies,
and procedures.
2.Requires EMSA, utilizing regional and local information, to
assess each EMS area or the system's service area for the
purpose of determining the need for additional emergency
services, and the coordination and effectiveness of EMS.
3.Requires EMSA to develop planning and implementation
guidelines for EMS systems which address specified components,
including communications, system organization and management,
and data collection and evaluation.
4.Authorizes counties to develop an EMS program and designate a
Local Emergency Medical Services Agency (LEMSA) responsible
for planning and implementing an EMS system, which includes
day-to-day EMS system operations.
5.Establishes an 18-member Commission on EMS, within the
California Health and Human Services Agency (HHSA). Defines
Continued---
AB 1621 | Page 2
the duties of the Commission to include reviewing regulations,
standards, and guidelines developed by EMSA; advising EMSA on
a data collection system; advise on emergency facilities and
services, emergency communications, medical equipment,
personnel training, and various aspects of the EMS system;
and, to make recommendations for further development of the
EMS system.
This bill:
1.Requires EMSA, in order to fulfill its responsibility to
assess emergency medical services and their effectiveness, to
utilize its CEMSIS and adopt a single statewide standard for
the collection of information regarding pre-hospital care to
determine and monitor the quality and effectiveness of the
statewide emergency medical services system, compliant with
the most current National Emergency Medical Services
Information System (NEMSIS) standards, and to avoid
unnecessary duplication of data collection at the local level.
2.Requires EMSA to develop regulations and standards for
electronic patient care records systems used by LEMSAs and
local pre-hospital EMS providers to ensure compatibility with
CEMSIS, including, but not limited to, a common data
dictionary, integration of first responder data, transport
provider data, and patient outcome data, and compliant with
current NEMSIS standards and privacy requirements in state and
federal law.
3.Requires the privacy requirements of the electronic patient
care records systems to ensure that all patient data obtained
from EMS providers for the purpose of this bill is subject to
legal privacy and security standards consistent with privacy
and security standards consistent with privacy and security
protections for personal health data in the possession of EMS
providers under state and federal law.
4.Requires the regulations and standards developed by EMSA on
the electronic patient care records systems to describe
standards for the purpose of standardizing data collection.
5.Requires the regulations and standards developed by EMSA on
the electronic patient care records systems to allow the use
of any pre-hospital electronic patient record system, provided
that the system is compatible with CEMSIS, compliant with
NEMSIS, and meets the standards set by EMSA.
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3
6.Requires EMSA to consult with stakeholders in the development
of standards and compatibility with CEMSIS, including air
ambulance providers and other entities not included in the
California Commission on Emergency Medical Services members.
7.Requires LEMSAs and local pre-hospital EMS providers that
upgrade or purchase an electronic patient care record system
on or after the date EMSA issues final guidance on the
regulations and standards for electronic patient care records
systems to ensure that the system complies with the standards
contained in that guidance.
8.Requires LEMSAs to submit patient information consistent with
the requirements of this bill regarding a single statewide
standard to EMSA in a timely manner, using NEMSIS standards
and electronic transfer when available.
9.Requires EMSA, in order to exercise the powers and duties
conferred upon it by this bill and related provisions of law,
to adopt, amend or repeal any rules, regulations, or standards
as may be necessary.
10.Requires EMSA to post any proposed rules promulgated under
this bill on its public Internet Web site no later than 90
calendar days prior to the effective date of the proposed
rule, and to also include notification to the public regarding
how members of the public may comment, including the date by
which those comments must be received in order to be
considered by EMSA.
11.Specifies that this bill and any rules and regulations
adopted under this bill will only be implemented to the extent
that funds are made available through an appropriation in the
annual Budget Act.
12.Requires EMSA to comply with the provisions of this bill on
or before July 1, 2016.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1.One-time information technology costs in the range of
$300,000. The requirements of the system are not specified in
detail, and would be elucidated through the regulatory
process.
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2.One-time administrative costs to EMSA in the range of $300,000
to develop standards and regulations, and minor ongoing
administrative costs.
PRIOR VOTES :
Assembly Health: 19- 0
Assembly Appropriations:17- 0
Assembly Floor: 79- 0
COMMENTS :
1.Author's statement. According to the author, accurate and
timely data collection is a critical component of any system
designed to evaluate the effectiveness of a program. While
EMSA is charged in statute with overseeing and coordinating
EMS throughout the state and has utilized its CEMSIS to
collect data from the 33 LEMSAs to do so, submission of
information by local agencies is voluntary, and historically
inconsistent. A review in 2013 found that approximately half
of the LEMSAs are not reporting data to EMSA.
As EMS providers transition to electronic patient records, it
will be essential that data collection is consistent across
various platforms, that LEMSAs have clear guidelines for
system components and data points, that any electronic
platform has the ability to securely track patient care and
outcome data, and that statewide and local standards take into
account system limitations, and remain compatible with
national data collection standards to ensure that we have an
accurate picture of EMS across the state.
2.NEMSIS and CEMSIS. NEMSIS was formed in 2001 by the National
Association of State EMS Directors, in conjunction with the
National Highway Traffic Safety Administration and the
Trauma/EMS Systems program of the Health Resources and
Services Administration's Maternal Child Health Bureau, in
order to develop a national EMS database. NEMSIS is the
national repository that will be used to potentially store EMS
data from every state in the nation, and was developed to help
states collect more standardized elements to allow submission
to the national database.
According to EMSA, CEMSIS is a demonstration project for
improving EMS data analysis across California. CEMSIS offers a
secure, centralized data system for collecting data about
individual EMS requests, patients treated at hospitals, and
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EMS provider organizations. EMSA states that at least 14 of
California's 33 LEMSAs currently send a variety of local data
collections to CEMSIS on a voluntary basis, and in return,
these local agencies gain access to digital tools for running
comprehensive reports on their own data at no cost. EMSA
states when fully operational with 100 percent local
participation, it is estimated that CEMSIS will catalogue more
than three million EMS events per year. According to EMSA, it
will use the data to develop and coordinate high quality
emergency medical care in California through activities such
as healthcare quality programs that monitor patient care
outcomes, agency collaboration across jurisdictional
boundaries, and public health surveillance.
In order to improve local data quality and prepare California
EMS for health information exchange, EMSA is planning to adopt
new data standards known as NEMSIS Version 3, which will
provide a set of tools that EMS professionals can use to
integrate EMS patient care data with electronic medical
records at hospitals, leading to better patient outcomes and a
smarter system of care. EMSA's website states that it is
targeting transition to NEMSIS Version 3 no later than the end
of this year.
3.Related legislation. AB 1975 (R. Hern�ndez) would require
LEMSAs to contract with the American College of Surgeons every
five years to conduct a comprehensive assessment of their
regional trauma system. AB 1975 was held on the Assembly
Appropriations Committee suspense file.
4.Prior legislation. SB 535 (Nielsen), of 2013, would have
increased the membership of the EMS Commission from 18 to 20
members, and required the additional members to be an air
ambulance representative appointed by the Senate Committee on
Rules, and representative appointed by the Speaker of the
Assembly from a public agency that provides air rescue and
transport. SB 535 was vetoed by the Governor.
5.Support. This bill is supported by a number of ambulance
organizations. American Medical Response states that adopting
a single statewide standard for the collection of pre-hospital
care information would provide important data needed to assess
existing EMS systems and establish performance indicators and
quality initiatives across the state. The California Ambulance
Association states that collecting and analyzing data gives us
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enormous potential to look for trends, discover new therapies
and find ways to improve care and operations. Paramedics Plus
states that patient care is enhanced when all EMS providers
and stakeholders follow uniform statewide EMS reporting
standards. This bill is also supported by the California
Hospital Association (CHA), which states that advances in
technology are bringing new opportunities to vastly improve
communication and transfer of patient data, and that effective
use of health information exchange among California's EMS
providers is of critical importance in day-to-day operations.
6.Opposition. The Emergency Medical Services Administrators
Association of California (EMSAAC), which represents the 33
LEMSAs, states in opposition that recent amendments requiring
a single statewide standard would upend the existing EMS
statutory structure whereby EMSA establishes statewide minimum
standards that LEMSAs may exceed based on locally identified
needs. According to EMSAAC, by mandating a single statewide
standard and depending on how it is crafted, rural LEMSAs
could find the standard too cumbersome or urban LEMSAs could
find it too basic to meet their complex system needs. EMSAAC
also states it remains opposed to the mandate that LEMSAs
submit patient data to EMSA, stating that a requirement in
statute to submit patient information would prove onerous on
stretched-thin LEMSAs. Finally, EMSAAC notes that without a
requirement that hospitals provide patient disposition and
outcome data to LEMSAs, there would be huge amount of critical
information missing from the uniform standards this bill seeks
to ensure.
The Regional County Representatives of California state in
opposition that many LEMSAs already have these systems in
place or have plans to do so, and that this bill is not
necessary since it will only impose costs to those rural
LEMSAs that can least afford it. San Joaquin County Health
Care Services Agency states that the requirements imposed by
this bill would limit local flexibility and increase the
difficulty in managing the costs associated with implementing
electronic patient care record software in local EMS systems.
7.Drafting concerns.
a. Conflict with single statewide standard. On page 4,
lines 1-4, this bill requires LEMSAs to submit
information consistent with the requirements of paragraph
(1) of subdivision (a), which is the single statewide
standard that is to be developed by this bill. The bill
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7
then goes on to state that LEMSAs can use NEMSIS
standards when available. A single statewide standard,
even while it is required to be compliant with NEMSIS, is
not necessarily the same thing as a NEMSIS standard. To
correct this possible conflict, the following amendment
is suggested:
(c) Local EMS agencies shall submit patient
information
consistent with the requirements of paragraph (1) of
subdivision
(a) to the authority in a timely manner, using
national NEMSIS
standards and electronic transfer when available.
a. Unnecessary duplication of the rulemaking authority.
On page 4, lines 5-9, this bill gives rulemaking
authority to EMSA. However, existing law already contains
this same broad rulemaking authority (Health and Safety
Code 1797.107). Additionally, on page 4, lines 10-16,
this bill requires this rulemaking process to include
certain requirements that are duplicative of the existing
Administrative Procedures Act. These two subdivisions
(page 4, lines 5-16) should be deleted from the bill.
1.Policy comment. The introduced version of this bill included
provisions requiring hospitals to include LEMSAs in health
information exchange development with the objective of
exchanging critical patient data with EMS providers, and to
provide patient disposition information to LEMSAs for purposes
of quality improvement. These provisions were amended out in
the Assembly. However, the handoff of patients from ambulances
to emergency departments is a critical and
information-dependent moment in the care of a patient. Being
able to transfer patient data from the field to the emergency
department electronically prior to arrival would be of obvious
benefit to patient care. Similarly, having information
regarding the ultimate disposition of the patient provided
back to the LEMSA would help LEMSAs to evaluate the
effectiveness of the care provided by the EMS providers prior
to delivering the patient to the hospital. While standardizing
the reporting of EMS patient data to EMSA is an important
first step, making sure hospitals are fully included in the
exchange of this information should be an objective for
policymakers.
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SUPPORT AND OPPOSITION :
Support: American Federation of State, County and Municipal
Employees, AFL-CIO
American Medical Response
California Ambulance Association
California Association of Air Medical Services
California Hospital Association
Paramedics Plus
PHI Air Medical
Oppose: California State Association of Counties
County Health Executives Association of California
Emergency Medical Services Administrators Association
of California
Rural County Representatives of California
San Joaquin County Health Care Services Agency
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