CSSB 133(FIN): "An Act creating a statewide electronic health information exchange system; and providing for an effective date."

00 CS FOR SENATE BILL NO. 133(FIN) 01 "An Act creating a statewide electronic health information exchange system; and 02 providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. The uncodified law of the State of Alaska is amended by adding a new section 05 to read: 06 LEGISLATIVE INTENT. It is the intent of the legislature to create a secure electronic 07 health information exchange system that 08 (1) ensures that the confidentiality of individually indentifying health 09 information of a patient is secure and protected; 10 (2) improves health care quality, reduces medical errors, increases the 11 efficiency of care, and advances the delivery of appropriate, evidence-based health care 12 services; 13 (3) promotes wellness, disease prevention, and management of chronic 14 illnesses by increasing the availability and transparency of information related to the health

01 care needs of an individual for the benefit of the individual; 02 (4) ensures that appropriate information needed to make medical decisions is 03 available in a usable form at the time and in the location that the medical service is provided; 04 (5) produces greater value for health care expenditures by reducing health care 05 costs that result from inefficiency, medical errors, inappropriate care, and incomplete 06 information; 07 (6) promotes a more effective marketplace, greater competition, greater 08 systems analysis, increased choice, enhanced quality, and improved outcomes in health care 09 services; and 10 (7) improves the coordination of information and the provision of health care 11 services through an effective infrastructure for the secure and authorized exchange and use of 12 health care information. 13 * Sec. 2. AS 18.23 is amended by adding new sections to read: 14 Article 4. Electronic Health Information Exchange System. 15 Sec. 18.23.300. Creation of health information exchange system. (a) The 16 department shall establish and implement a statewide electronic health information 17 exchange system and ensure the interoperability and compliance of the system with 18 state and federal specifications and protocols for exchanging health records and data. 19 (b) The system established under this section must 20 (1) include infrastructure planning that involves 21 (A) the designation by the commissioner of a qualified entity or 22 combination of qualified entities in the state that 23 (i) has an advisory or governing body made up of health 24 system stakeholders that include members identified under (d) of this 25 section; 26 (ii) applies for available federal and state funding for 27 planning and implementation of the system authorized by the 28 commissioner; 29 (iii) submits an annual budget for approval of the 30 commissioner; 31 (iv) complies with nondiscrimination and conflict of

01 interest policies; 02 (v) meets and complies with federal and state health 03 information policies and standards; 04 (vi) provides cost and cost saving data associated with 05 the development and use of the system to the department; 06 (B) the development of statewide infrastructure to support the 07 electronic health information exchange system established under this section 08 and to connect electronic health records to the infrastructure; 09 (C) the development of a statewide technology plan, with the 10 participation of identified stakeholders, to promote the implementation and 11 sustained use by public and private health care payors and providers of 12 electronic health records and the system established under this section in order 13 to ensure interoperability among government-operated health information 14 systems and other public and private health information and reporting systems; 15 (D) the development of policies and standards, consistent with 16 federal and state law, to safeguard the privacy and security of health 17 information; 18 (E) the development of a training and workforce development 19 plan for implementing and serving the system; 20 (F) an estimate of costs of the hardware, software, services, and 21 support needed to implement and maintain the technical infrastructure; and 22 (2) include implementation measures that 23 (A) provide for installation and training on the use of the 24 system; 25 (B) set out a plan to encourage health care provider, payor, and 26 patient use of electronic records over a sustained period of time; 27 (C) provide support to providers for workflow redesign, quality 28 improvement, and care management services; 29 (D) provide for participation by all identified stakeholders in 30 the planning and implementation of the system; 31 (E) comply with federal and state health information policies;

01 and 02 (F) provide for periodic evaluation and improvement of the 03 system. 04 (c) The department may enter into contracts, seek and accept available federal 05 and private funds and equipment, and adopt regulations necessary to carry out the 06 purposes of this section. 07 (d) The designee under (b)(1)(A) of this section may be a private for-profit or 08 nonprofit entity or entities under contract with the state. The advisory or governing 09 body of the designee must include 10 (1) the commissioner; and 11 (2) eight other individuals, each of whom represents one of the 12 following interests: 13 (A) hospitals and nursing home facilities; 14 (B) private medical care providers; 15 (C) community-based primary care providers; 16 (D) federal health care providers; 17 (E) Alaska tribal health organizations; 18 (F) health insurers; 19 (G) health care consumers; 20 (H) employers or businesses. 21 Sec. 18.23.305. Department; duties. In carrying out its duties under 22 AS 18.23.300, the department shall 23 (1) in accordance with federal recommendations, determine the 24 manner in which the system is developed and operated; 25 (2) provide oversight and technical assistance needed for planning and 26 implementing the system; 27 (3) authorize and facilitate applications for available federal funding 28 for planning and implementing the system; 29 (4) ensure compliance with applicable federal and state health 30 information policies and standards; 31 (5) ensure compliance with federal and state law and standards that

01 safeguard the privacy and security of health information; 02 (6) ensure that the health information exchange system becomes self- 03 sustaining through a combination of user fees and other private and public funding 04 sources. 05 Sec. 18.23.310. Confidentiality and security of information. (a) The 06 department shall establish appropriate security standards to protect the transmission 07 and receipt of individually identifiable information contained in the system established 08 under AS 18.23.300. The standards must 09 (1) include controls over access to and collection, organization, and 10 maintenance of records and data that protect the confidentiality of the individual who 11 is the subject of a health record; 12 (2) include a secure and traceable electronic audit system for 13 identifying access points and trails; 14 (3) meet the most stringent applicable federal or state privacy law 15 governing the protection of the information contained in the system. 16 (b) A person may not release or publish individually indentifying health 17 information from the system for purposes unrelated to the treatment or billing of the 18 patient who is the subject of the information. Use or distribution of the information for 19 a marketing purpose is strictly prohibited. 20 (c) The department shall establish procedures for a patient who is the subject 21 of a health record contained in the system to 22 (1) opt out of the system; 23 (2) consent to the distribution of the patient's records contained in the 24 system; 25 (3) be notified of a violation of the confidentiality provisions required 26 under this section; 27 (4) on request to the department, view an audit report created under 28 this section for the purpose of monitoring access to the patient's records. 29 Sec. 18.23.315. Health information exchange system report to the 30 legislature. The department shall provide to the legislature, on or before December 31 31 of each year, an annual report on the progress of the health information exchange

01 system in the state, including a specific set of recommendations for long-term 02 participation and financial support by the state. 03 Sec. 18.23.320. Contract conditions. A contract entered into to carry out the 04 purposes of AS 18.23.300 must require that the contractor meet applicable federal and 05 state requirements for protecting health information privacy and security and 06 nationally recognized standards for interoperability of health information technology. 07 Sec. 18.23.325. Definitions. In AS 18.23.300 - 18.23.325, 08 (1) "commissioner" means the commissioner of health and social 09 services; 10 (2) "department" means the Department of Health and Social Services; 11 (3) "system" means the statewide electronic health information 12 exchange system established under AS 18.23.300. 13 * Sec. 3. This Act takes effect July 1, 2009.