HomeMy WebLinkAboutMINUTES - 07082014 - C.40RECOMMENDATION(S):
ADOPT a "Oppose" position on AB 1621 (Lowenthal), as amended: Emergency Medical Services: Data and
Information System, a bill that requires the Emergency Medical Services Authority to 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, and to develop regulations for electric patient care
records by local agencies, as recommended by the Health Services Director.
FISCAL IMPACT:
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.
2. One-time administrative costs to EMSA in the range of $300,000 to develop standards and regulations, and minor
ongoing administrative costs.
APPROVE OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
Action of Board On: 07/08/2014 APPROVED AS RECOMMENDED OTHER
Clerks Notes:
VOTE OF SUPERVISORS
AYE:John Gioia, District I Supervisor
Candace Andersen, District II
Supervisor
Mary N. Piepho, District III
Supervisor
Karen Mitchoff, District IV
Supervisor
Federal D. Glover, District V
Supervisor
Contact: L. DeLaney,
925-335-1097
I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board
of Supervisors on the date shown.
ATTESTED: July 8, 2014
David Twa, County Administrator and Clerk of the Board of Supervisors
By: Stacey M. Boyd, Deputy
cc:
C. 40
To:Board of Supervisors
From:David Twa, County Administrator
Date:July 8, 2014
Contra
Costa
County
Subject:Oppose Position on AB 1621 Emergency Medical Services: Data and Information System (Lowenthal), as amended
BACKGROUND:
The Director of Health Services has requested the County take an "Oppose" position on AB 1621. Because the
Legislation Committee does not meet again until August 7, 2014, the County Administrator's Office is referring
the bill to the Board of Supervisors for immediate action.
Current Status : 06/24/2014: In SENATE. Read second time and amended. Re-referred to Committee on
APPROPRIATIONS.
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 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.
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.
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 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. Hernandez) 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 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 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.
b. 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.
8. 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.
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
COMMENTS FROM CONTRA COSTA HEALTH SERVICES: EMSAAC is opposing AB 1621 and in its
present form of an oppressive unfunded mandate. EMSA is making a grab away of local control in these matters
and has a history of not partnering and being quite heavy handed in mandates of this type. It would be a real
problem for us if the bill passes in its present form.
Here is the breakdown of what AB1621 really does:
1) EMSA must use CEMSIS and adopt a single statewide standard for the collection of prehospital care
information.
CEMSIS must be compliant with NEMSIS
EMSA must comply with this by 7/1/16
2) a) EMSA must develop regulations & standards for ePCRs used by LEMSAs and EMS providers.
Compatible with CEMSIS
Include a data dictionary
Integration of first responder data
Transport provider data
Patient outcome data
Compliant with NEMSIS
Privacy protections consistent with state & federal law
b) Regulations & standards (developed by EMSA) must describe standards for standardizing data collection
These regulations & standards must allow the use of ANY prehospital ePCR system (as long as it’s
CEMSIS & NEMSIS compliant and meets the standards)
c) EMSA must consult with stakeholders as they develop standards and compatible with CEMSIS
d) LEMSAs and EMS providers that UPGRADE or BUY ePCR systems after EMSA releases final regulations
must comply with those standards
3) LEMSAs MUST submit patient data to EMSA using NEMSIS standards and using use electronic transfer
WHEN AVAILABLE
#1: Applies to the collection of ANY prehospital data (whether electronic or otherwise)
#2: Applies only to the collection of electronic data
#3: Applies to the collection of ANY prehospital data (whether electronic or otherwise)
CONSEQUENCE OF NEGATIVE ACTION:
Contra Costa County would not have a position on the bill.
ATTACHMENTS
AB 1621 Bill Text
AMENDED IN SENATE JUNE 9, 2014
AMENDED IN ASSEMBLY MAY 23, 2014
AMENDED IN ASSEMBLY APRIL 21, 2014
california legislature—2013–14 regular session
ASSEMBLY BILL No. 1621
Introduced by Assembly Members Lowenthal and Rodriguez
February 6, 2014
An act to add Section 1797.119 to the Health and Safety Code,
relating to emergency medical services.
legislative counsel’s digest
AB 1621, as amended, Lowenthal. Emergency medical services: data
and information system.
Existing law, the Emergency Medical Services System and the
Prehospital Emergency Medical Care Personnel Act, governs local
emergency medical service services systems. The act establishes the
Emergency Medical Services Authority, which is responsible for the
coordination and integration of all state agencies concerning emergency
medical services. Existing law also creates the Commission on
Emergency Medical Services, and requires the commission to perform
various duties regarding the authority and emergency medical services.
Existing law requires the authority to develop planning and
implementation guidelines for emergency medical services systems that
address data collection and evaluation, among other things. Existing
law requires the commission to review and approve regulations,
standards, and guidelines developed by the authority.
This bill would require the authority to utilize its California
Emergency Medical Services Information System (CEMSIS) and adopt
96
minimum standards a single statewide standard for the collection of
information regarding prehospital 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. The bill
would require the authority to develop regulations and standards for
electronic patient care record systems used by local emergency medical
services EMS agencies and local prehospital emergency medical services
EMS providers to ensure compatibility with CEMSIS. The bill would
require the authority to comply with its provisions on or before July 1,
2016. The bill would require the authority to post proposed rules and
to notify the public with regard to commenting on the proposed rules,
as specified.
The bill would also require local EMS agencies to submit specified
information to the authority. By imposing new duties on local officials,
the bill would impose a state-mandated local program.
The bill would provide that all of the above provisions and any rules
or regulations adopted pursuant to those provisions would only be
implemented to the extent that funds are made available through an
appropriation in the annual budget act.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the state.
Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these statutory
provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
The people of the State of California do enact as follows:
line 1 SECTION 1. Section 1797.119 is added to the Health and
line 2 Safety Code, to read:
line 3 1797.119. (a) (1) In order to fulfill the authority’s
line 4 responsibility to assess emergency medical services and their
line 5 effectiveness as required by Section 1797.102, the authority shall
line 6 utilize its California Emergency Medical Services Information
line 7 System (CEMSIS) and adopt minimum standards a single statewide
96
— 2 —AB 1621
line 1 standard for the collection of information regarding prehospital
line 2 care to determine and monitor the quality and effectiveness of the
line 3 statewide emergency medical services system, compliant with the
line 4 most current National Emergency Medical Services Information
line 5 System (NEMSIS) standards, and to avoid unnecessary duplication
line 6 of data collection at the local level.
line 7 (2) The authority shall comply with this section on or before
line 8 July 1, 2016.
line 9 (b) (1) The authority shall develop regulations and standards
line 10 for electronic patient care record systems used by local emergency
line 11 medical services EMS agencies and local prehospital emergency
line 12 medical services EMS providers to ensure compatibility with
line 13 CEMSIS, including, but not limited to, a common data dictionary,
line 14 integration of first responder data and data, transport provider
line 15 data, and patient outcome data, and compliant with current
line 16 NEMSIS standards and privacy requirements in state and federal
line 17 law. Privacy requirements shall ensure that all patient data obtained
line 18 from emergency medical service EMS providers for the purpose
line 19 of this section is subject to legal privacy and security standards
line 20 consistent with privacy and security protections for personal health
line 21 data in the possession of emergency medical services EMS
line 22 providers under state and federal law.
line 23 (2) The regulations and standards developed by the authority
line 24 shall describe minimum standards for the purposes purpose of
line 25 standardizing data collection and encouraging compatibility
line 26 between systems. collection. The regulations and standards shall
line 27 allow the use of any prehospital electronic patient record system,
line 28 provided that the system is compatible with CEMSIS, compliant
line 29 with NEMSIS, and meets the standards set by the authority.
line 30 (3) The authority shall consult with stakeholders in the
line 31 development of standards and compatibility with CEMSIS,
line 32 including air ambulance providers and other entities not included
line 33 in the California Commission on Emergency Medical Services
line 34 membership.
line 35 (4) Local emergency medical services EMS agencies and local
line 36 prehospital emergency medical services EMS providers that
line 37 upgrade or purchase an electronic patient care record system on
line 38 or after the date the authority issues final guidance pursuant to
line 39 paragraph (1) shall ensure that the system complies with standards
line 40 contained in that guidance.
96
AB 1621— 3 —
line 1 (c) Local EMS agencies shall submit patient information
line 2 consistent with the requirements of paragraph (1) of subdivision
line 3 (a) to the authority in a timely manner, using national NEMSIS
line 4 standards and electronic transfer when available.
line 5 (d) The authority, in order to exercise the powers and perform
line 6 the duties conferred upon it by this chapter, and in accordance with
line 7 Chapter 3.5 (commencing with Section 11340) of Part 1 of Division
line 8 3 of the Government Code, shall adopt, amend, or repeal any rules,
line 9 regulations, or standards as may be necessary.
line 10 (e) The authority shall post any proposed rules promulgated
line 11 under this section on its public Internet Web site no later than 90
line 12 calendar days prior to the effective date of the proposed rule, which
line 13 shall also include notification to the public regarding how members
line 14 of the public may comment, including the date by which those
line 15 comments must be received in order to be considered by the
line 16 authority.
line 17 (f) This section and any rules and regulations promulgated
line 18 pursuant to this section shall only be implemented only to the
line 19 extent that funds are made available through an appropriation in
line 20 the annual Budget Act.
line 21 SEC. 2. If the Commission on State Mandates determines that
line 22 this act contains costs mandated by the state, reimbursement to
line 23 local agencies and school districts for those costs shall be made
line 24 pursuant to Part 7 (commencing with Section 17500) of Division
line 25 4 of Title 2 of the Government Code.
O
96
— 4 —AB 1621