BILL ANALYSIS �
AB 2059
Page 1
Date of Hearing: April 22, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 2059 (Muratsuchi) - As Introduced: February 20, 2014
SUBJECT : Medical records: electronic delivery.
SUMMARY : Requires a medical provider, as specified, or their
employer to provide an electronic copy of the requested medical
record when an attorney presents written authorization signed by
the patient or patient's representative when the medical record
exists in a digital or electronic format that can be delivered
electronically.
EXISTING LAW :
1)Requires health care providers to make a patient's medical
records available for inspection and copying by an attorney,
prior to the filing of any action or the appearance of a
defendant in an action, when the attorney presents written
authorization from an adult patient, the guardian or
conservator of his or her person or estate, or the personal
representative or an heir of a deceased patient. In the case
of a minor, written authorization from a parent or guardian of
the minor,
2)Prohibits a health care provider or their agent from copying
requested medical records when the requesting attorney has
employed a professional photocopier registered, or anyone
exempt from being required to register as a professional
photocopier, as specified.
3)Makes the person or entity having custody of the medical
records liable for all reasonable expenses, including
attorney's fees, incurred in any proceeding when the medical
records are not made available during business hours within
five days of the written request.
4)Permits all reasonable costs incurred by a health care
provider in making patient records available to be paid by the
person whose written authorization required the availability
of the records.
5)Defines "reasonable cost" to include $0.10 per page for
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standard sized reproduction of documents, $0.20 per page for
copying from microfilm, actual costs for the reproduction of
oversize documents or those requiring special processing, and
$16 per hour per person for clerical costs incurred in
locating and making the records available, actual postage
charges, and actual costs, if any, charged to the witness by a
third person for the retrieval and return of records held by
that third person.
6)Limits the fees, where the records are delivered to the
attorney for inspection or photocopying at the record
custodian's place of business, to $15, plus actual costs, if
any, charged to the witness by a third person for the
retrieval and return of records held by that third person.
7)Establishes, as part of the federal American Reinvestment and
Recovery Act (ARRA), the Health Information Technology for
Economic and Clinical Health (HITECH) Act, to provide grants
to states to promote the electronic movement and use of health
information among organizations using nationally recognized
interoperability standards and incentive payments to providers
for HIT and health information exchange (HIE) adoption.
FISCAL EFFECT : None.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill will
update existing law to reflect the use of electronic medical
records (EMRs), also commonly referred to as electronic health
records (EHRs), and that current law has failed to keep pace
with the rapidly changing nature of technology. The author
states that charging patients per page is impractical when
medical records are being sent through electronic delivery.
According to the author, 10 other states have amended their
statutes to address EMRs: Delaware; Illinois; Louisiana;
Maine; Michigan; Missouri; New Mexico; North Dakota; Oklahoma;
and, Texas.
2)BACKGROUND . According to the Centers for Medicaid and
Medicare Services, an EHR is an electronic version of a
patient's medical history, that is maintained by the provider
over time, and may include all of the key administrative
clinical data relevant to that person's care under a
particular provider, including demographics, progress notes,
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problems, medications, vital signs, past medical history,
immunizations, laboratory data, and radiology reports.
3)HITECH/ARRA . President Obama signed ARRA on February 17,
2009. The HITECH Act was a portion of the ARRA that promoted
the adoption and meaningful use of HIT. The HITECH Act
included $36 billion in federal funding to states in order to
implement wide-scale use and sharing of EHRs. The HITECH Act
stipulates that, beginning in 2011, healthcare providers will
be offered financial incentives for demonstrating meaningful
use of EHRs and creates a loan program that allows states to
make loans to healthcare providers to prepare for the adoption
of EHRs. SB 337 (Alquist), Chapter 180, Statutes of 2009,
adopted the provisions related to HIE including authorizing
the Governor to apply for federal funds available for HIE and
HIT. This allowed California to take advantage of $38 million
in federal funding to coordinate the development of a
sustainable electronic HIT infrastructure statewide.
4)SUPPORT . The Consumer Attorneys of California (CAOC) is the
sponsor of this bill. According to CAOC this bill would
modernize current law, which allows an attorney, with
authorization, to request the medical records of a patient.
This code section has not been updated to reflect the reality
of EMRs and contains outdated cost reimbursement and time
frame structures. CAOC argues that current law contains no
reference to EMRs; instead, a per page charge of $0.10 is
allowed. However, that per page cost does not make sense when
the medical records are sent via electronic delivery. The
American Federation of State, County and Municipal Employees,
AFL-CIO writes in support of this bill that if a patient's
attorney has written authorization to inspect and copy a
medical record, it's common sense that it should be delivered
as such, rather than using a professional photocopier.
5)DOUBLE REFERRAL . This bill is double referred, upon passage
in this Committee; it will be referred to the Assembly
Judiciary Committee.
6)PREVIOUS LEGISLATION .
a) SB 588 (Emmerson) of 2013 would have increased the fees
medical providers are allowed to charge attorneys for
copying medical records, removed the prohibition on medical
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providers performing the copying when the attorney has
employed a professional photocopier, and limited the
attorney to employ a professional photocopying service only
when the records are in paper form. SB 588 passed the
Senate Health Committee but was never set for hearing in
the Senate Judiciary Committee.
b) SB 1543 (Emmerson) of 2012, was similar to SB 588, and
would have eliminated the ability of attorneys or their
agents to make their own copies, while SB 588 would have
allowed attorney's or their agents to make their own copies
of paper records. SB 1543 was never heard in a committee.
c) SB 337 authorizes the California Health and Human
Services Agency to apply for federal funds available for
HIT and HIE, and establishes a state fund for purposes of
HIT/HIE. Authorizes the Governor to alternatively
designate an entity to apply for federal HIT funding, and
establishes governance requirements for the entity. SB 337
also makes clarifying changes to requirements governing
reporting of unauthorized access to, or use or disclosure
of, patients' medical information, and provides limited
exemptions for law enforcement investigations.
REGISTERED SUPPORT / OPPOSITION :
Support
Consumer Attorneys of California (sponsor)
American Federation of State, County and Municipal Employees,
AFL-CIO
California Association for Health Services at Home
Opposition
None on file.
Analysis Prepared by : Patty Rodgers / HEALTH / (916) 319-2097