Legislature(2009 - 2010)BUTROVICH 205
03/16/2009 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
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| Start | |
| SB133 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 133 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 61 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 16, 2009
1:37 p.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Joe Paskvan, Vice Chair
Senator Johnny Ellis
Senator Fred Dyson
MEMBERS ABSENT
Senator Joe Thomas
COMMITTEE CALENDAR
SENATE BILL NO. 133
"An Act creating a statewide electronic health information
exchange system; and providing for an effective date."
HEARD AND HELD
SENATE BILL NO. 61
"An Act establishing an Alaska health care program to ensure
insurance coverage for essential health services for residents
of the state, the Alaska Health Care Board to administer the
Alaska health care program and the Alaska health care fund, the
Alaska health care clearinghouse to administer the Alaska health
care program under the direction of the Alaska Health Care
Board, and eligibility standards and premium assistance for
health care coverage of persons with low incomes; creating the
Alaska health care fund; providing for review of actions and
reporting requirements related to the health care program; and
providing for an effective date."
MOVED OUT OF COMMITTEE 3/13/09
PREVIOUS COMMITTEE ACTION
BILL: SB 133
SHORT TITLE: ELECTRONIC HEALTH INFO EXCHANGE SYSTEM
SPONSOR(s): SENATOR(s) PASKVAN
03/02/09 (S) READ THE FIRST TIME - REFERRALS
03/02/09 (S) HSS, FIN
03/16/09 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
JAKE HAMBURG
Staff to Senator Paskvan
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Commented on SB 133 for the sponsor.
PAUL SHERRY, President
Alaska Electronic Health Network (AeHN)
Alaska Native Tribal Health Consortium
POSITION STATEMENT: Supported SB 133.
BILL STEWART, Deputy Commissioner
Medicaid and Health Care Policy
Department of Health and Social Services (DHSS)
POSITION STATEMENT: Neutral position on SB 133.
REBECCA MADISON, representing herself
Fairbanks, AK
POSITION STATEMENT: Supported SB 133
PAT LUBY, Advocacy Director
AARP
Juneau, AK
POSITION STATEMENT: Supported SB 133.
ACTION NARRATIVE
1:37:53 PM
CHAIR BETTYE DAVIS called the Senate Health and Social Services
Standing Committee meeting to order at 1:37 p.m. Present at the
call to order were Senators Dyson, Paskvan, Ellis and Davis.
SB 133-ELECTRONIC HEALTH INFO EXCHANGE SYSTEM
CHAIR DAVIS announced consideration of SB 133.
1:39:00 PM
SENATOR PASKVAN, sponsor of SB 133, said this bill seeks to
modernize Alaska's health care IT infrastructure and save the
state's health care system about $250 million per year and about
$10-$12 million per year for Medicaid by developing a secure
electronic health information exchange system to improve the
safety, cost effectiveness and quality of health care in Alaska.
Many providers use only paper-based systems which contribute to
dangerous drug interactions, misdiagnoses, costly delays and
duplicate testing and administrative overhead.
He said:
This standards-based electronic health network will
allow individual Alaskans to have their own personal
health record and to authorize their health care
providers to exchange electronic medical records in a
timely and secure manner. A number of federal and
state laws already provide standards protecting a
patient's privacy as to that personal medical
information and that is the Health Insurance
Portability and Accountability Act (HIPAA) [that] most
directly and extensively impacts the health
information exchange system. This legislation also
provides strict standards to secure and protect the
confidentiality of individual identifying health
information of the patient.
JAKE HAMBURG, staff to Senator Paskvan, deferred to Paul Sherry,
who has been working with stakeholders for a number of years on
this topic to provide some background information on the issue.
1:41:14 PM
PAUL SHERRY, President of Alaska Electronic Health Network
(AeHN), Alaska Native Tribal Health Consortium, said he has been
a health care administrator in the state for about 30 years and
offered a slide presentation as follows:
Slide 1 - Alaska health care organizations are making large
investments in moving from paper to electronic medical records.
The Alaska Native Medical Center, alone, plans to spend $20
million on it. They estimate that only 20-30 percent of
providers use electronic records today, but it's growing. The
provider community in Alaska is very much behind supporting a
state wide exchange network so that patient records can be
available any time a patient presents for care. The state is a
key partner in this overall effort.
Slide 2 - The earliest health information exchange (HIE) started
in the 1990s, and it is part of an effort to build these
exchanges around the country. There are now over 50 HIEs in
various states.
Slide 3 - The federal government envisions a loose network of
the various federal health agencies connecting to state health
information exchanges.
Slide 4 - The main reason for doing this is that while Alaskans
have some great organizations, it is difficult for records to
follow patients and as a result, there is a lot of redundancy in
procedures and possible errors such as medication conflicts.
Providers see lower costs for data management with this type of
system and public health organizations have been able to
expedite their response with help from these kinds of systems.
Slide 5 - The concern is patient privacy. This is not the
creation of a centralized patient record databank; all the
providers keep their own records. The availability of patient
data happens through the exchange. HIEs makes it possible for
patients to opt out, and there are high penalties for data
breaches.
Slide 6 - The final big reason for moving ahead with these is
cost savings. A series of reports show that once an EMR system
is deployed, the industry can save a net 5 percent of total
expenses for all providers, which is huge money - a quarter
billion dollars for the state, and north of $10 million for
Medicaid.
Slide 7 - His HIE is called the Alaska eHealth Network (AeHN)
and it is a five-year $35-million effort. To date they have
secured $12 million from mostly federal sources. A half million
was appropriated by this body last year.
Slide 8 - Shows the stakeholders who will be connected to the
network.
Slide 9 - Picture of sample of online record (screen shot)
integrating pictures, lab reports, imaging reports and other
reports, vital signs, immunizations and allergies.
Slide 10 - AeHN incorporated with nonprofits last fall with the
Native Health System, the private hospitals, the primary care
providers, Primera as a payer, the department, the federal
agencies and the private physician community, and the AARP who
is interested in this from a public sector view.
Slide 11 - Presented Board members with their various skills.
Slide 12 - Progress to date: clarity at the national level about
the privacy standards to insure technological inter-operability
among these systems. GCI has been awarded a contract for
technical network design, and AeHN has $10 million in federal
money available to buy the lion's share of the technology to get
into this network. Now they need to add providers to it.
Slide 13 - The next steps 2009 -1010: they need to designate a
non-profit entity to be the HIE organization for the state. They
need to get $20 million or more from the stimulus package (from
the $19 billion available for HIT) for software.
Slide 14 - They have asked the legislature for stimulus matching
funds of $1.3 million this year and $1.0 million in. The farther
out you go, the more the state is required to match. Once the
funds are acquired, an RFP will be put out to providers of the
software and to make sure the systems align with the state's
various data centers it uses for health care. Finally, their
vision is that providers can then connect with various support
systems, like voice over Internet and teleconferencing, and get
reimbursement through FCC funding in the future.
Slide 15 - Finally, they need to insure a sustainability plan;
they estimate that the network will cost around $5 million, the
majority of which would be subcontracts for maintaining this
software. Their draft operating budget called for stakeholders
to share the costs based on their use.
Slide 16 - SB 133 is modeled after what some other states have
done.
Slide 17 - Itemized letters of support from state and federal
delegation.
Slide 18 - In summary, he urged passage of SB 133 with DHSS
oversight and matching funds.
Slide 19 - The outcomes over the long run are: timelier access
to safer health care for the Alaska community and significant
savings to the state directly for the health care services it
operates.
He added that Rebecca Madison, Network Director, was available
for questions. The key question is clarity about the respective
roles of the department and the AeHN; also, a number of minor
issues have already been identified that could provide greater
clarity. What the state's long term recurring contribution will
be also needs addressing.
1:54:38 PM
SENATOR DYSON said he wanted to hear what the administration has
been doing on this issue.
SENATOR ELLIS said he recently conducted a constituent forum,
and found one sole practitioner who was "completely beside
herself with fear" about what the federal stimulus package will
require for electronic medical records. She had no doubt about
the nationwide efficiencies this technology would provide, but
from a sole practitioner standpoint it was "a pain" and
completely counter-intuitive. He asked if this would be a help
or a hindrance to sole practitioners, and pointed out that it
looks like they will have to "pony up" a significant amount of
money.
MR. SHERRY responded that the Physicians' Alliance has been put
together to work with the Alaska physician provider community to
move forward, and there are challenges to any practice to
purchase and deploy an electronic health records system. There
is a one-time deployment cost of over $25,000 to buy the system,
but future participation has been estimated at less than $1,000
per year per practice. The real barrier is that first step. The
stimulus legislation offers some assistance, both loans and
grants, to providers to acquire the systems. The stimulus bill
also has incentives to help them recoup their investment. He
realizes that older providers are not as comfortable with the
electronic format while younger physicians expect it.
SENATOR ELLIS asked if Mr. Sherry would work with him to develop
an answer to this type of concern.
MR. SHERRY said he would be happy to do that. He added that they
think some entity needs to provide hands-on technical assistance
to providers to go electronic; and the AeHN can provide it for
Alaskans.
1:59:28 PM
BILL STEWART, Deputy Commissioner, Medicaid and Health Care
Policy, Department of Health and Social Services (DHSS), said
new opportunities are presenting themselves with the stimulus
bill including a grant program for states to develop this type
of health information exchange, a state administered loan
program for providers to purchase equipment needed for a health
system exchange, and a state administered financial assistance
program for Medicaid providers for the same. But like all new
federal opportunities, there is considerable uncertainty about
how these programs will work. The Obama administration has made
it clear that accountability for all funds spent remains with
the entity to which they are given; that is, the state will be
accountable no matter to whom the funds are assigned.
He said the department needs adequate flexibility to oversee and
understand this effort. It's important that the authority given
to the department matches its responsibilities. They want to
avoid any confusion about who is responsible for each aspect of
the work. They have concerns with the alignment of the authority
given to the nonprofit entity and the level of responsibility
remaining with the department. So for SB 133 to work as
intended, some renumbering is needed as well as another look at
where both the responsibility and the accountability are placed.
Also, the relationship between the nonprofit entity and the
state needs to be clarified; it can't stand alone as an
unsupervised entity.
MR. STEWART said he is highly supportive of the initiative to
move electronic health records forward; health information
exchange and similar technologies are the wave of the future and
will save the state a lot of money. However, the department is
neutral on this bill at this point.
2:02:39 PM
SENATOR DYSON said his office and the Department of Health and
Social Services (DHSS) have worked together on a comprehensive
on-line medical system aimed at the informed medical consumer
and asked if this system is separate from that.
MR. STEWART replied yes.
SENATOR DYSON asked what he wanted changed in SB 133.
MR. STEWART said the big concern is aligning accountability and
authority more clearly. It seems to give a lot of authority to
the non-profit entity, but a lot of the responsibility remains
with the state.
SENATOR DYSON asked if he was saying that the department does
not have as much control over where this is going as he would
like.
MR. STEWART replied yes.
2:04:48 PM
CHAIR DAVIS asked if the department has prepared anything in
writing regarding their concerns with this bill.
MR. STEWART replied no; he is working on it.
CHAIR DAVIS asked if he considered the department a part of this
network.
MR. STEWART replied yes.
2:06:34 PM
CHAIR DAVIS asked if the stimulus package had small "pots of
money" going to agencies other than state or municipal
governments.
MR. STEWART replied yes; but ultimately the responsibility for
all of the money lies with the state government.
CHAIR DAVIS asked him to provide her with the guidelines.
MR. HAMBURG agreed with the department on a couple of their
concerns. He said that language on page 2, lines 23-26, in
subsection (i) could be amended to include language that
explicitly states whom from the state government will be
included on the advisory board as well as more direct language
that requires participation.
A second change could be some clarification of the department's
responsibilities versus the nonprofit entity in subsection
(1)(b)-(2)(f) to show they those responsibilities belong to the
non-profit.
CHAIR DAVIS asked if they were working on a committee
substitute.
MR. HAMBURG replied yes.
2:08:57 PM
MR. HAMBURG went through the bill by section:
Section 1 lays out intent language that includes insuring that
the confidentiality of a patient's identifying health
information is secure. Improving health care quality and
reducing health care costs was their main concern in drafting
this language.
Section 2 is the meat of the bill and directs the department to
designate a qualified non-profit to plan and develop the health
information exchange system. Part of the reason for designating
a nonprofit to do it is so that the Department of Health and
Social Services didn't have to reinvent the wheel when a non-
profit may have spent years already doing it. Also a nonprofit
could be politically independent, widely representative of the
major stakeholders, and operate transparently. Which local and
state government interests to be included in that advisory board
could be clarified as well.
MR. HAMBURG said language on page 2, lines 23-26, talks about a
smooth process and a long-lasting implementation for the State
of Alaska. Those functions would include installation and
training on the use of the system for those who are too small to
afford it. All stakeholders need to have the ability to
participate in the system, which will always be in the state of
evolution.
2:12:00 PM
He continued to privacy and security aspects. Page 4, lines 7-
30, provide additional privacy and security requirements beyond
those already existing in state and federal law; lines 7-10
direct the department to establish appropriate security
standards to protect the individually identifiable information;
lines 11-13 require controls over the individual confidential
information, and this language was borrowed from Texas
legislation. Lines 14-15 require an electronic audit system to
determine access points and where information is being shared;
lines 16-17 require that the system always meet the most
stringent applicable federal and state privacy laws. This
specific language is from Vermont legislation. Page 4, lines 18-
21, prohibit the release of information for anything other than
treatment or billing of the patient. Line 24 requires that the
system allow for a patient to opt out. Lines 25-26 make consent
required to distribute a patient's record; lines 27-28 require
that a patient be notified of any violation of the
confidentiality; and line 29 requires that a patient be able to
view an audit report displaying who has accessed or touched
their personal records at any time.
MR. HAMBURG said additional privacy records can be found on page
5, lines 5-8, that requires that any contract entered into to
carry out HIE must require the contractor to meet applicable
federal and state privacy and security standards. Other federal
laws are applicable that govern health information technology,
he said, and he would be happy to go through some of those.
MR. HAMBURG said the biggest act that protects privacy is the
Health Insurance Portability and Accounting Act (HIPAA). Some of
the privacy protections in SB 133 describe that a patient is
able to obtain a copy of their health record at any time; they
can request corrections of errors; they can receive an
accounting of how their information is being used; they can
request limits on access to and additional protections for
particularly sensitive information; they can request
confidential communications; and they can complain to a
facilities' privacy officer if there are any problems and they
can pursue a complaint with the U.S. Department of Health of
Human Services.
2:15:35 PM
MR. HAMBURG said there are many other privacy protections.
CHAIR DAVIS said he was probably referring to federal
protections and asked if anything in the bill says the state
would have the authority to do the same.
MR. HAMBURG answered yes; language on page 5, line 5, says:
A contract to carry out the purposes must require that
the contractor meet applicable federal and state
requirements for protecting health information,
privacy and security, and nationally recognized
standards for interoperability of health information
technology.
Also language on page 4, lines 16-17, says:
...meet the most stringent applicable federal and
state privacy laws governing the protection of the
information contained in the system.
CHAIR DAVIS called for public testimony.
REBECCA MADISON, representing herself, supported SB 133 and was
available for questions. She is part of the Alaska Health
Network in Fairbanks.
2:17:50 PM
PAT LUBY, Advocacy Director, AARP, supported SB 133. He said
that health IT has enormous potential for reducing medical
errors, increasing access to medical records in emergencies,
reducing duplication of tests and redundant paperwork, engaging
consumers in managing their own care, and minimizing
inappropriate institutionalization; and it will ultimately help
providers to focus on patients instead of paperwork.
CHAIR DAVIS asked Mr. Sherry if he knew of any doctors already
doing something similar to this.
MR. SHERRY replied that a private physicians' group, the Alaska
eHR Alliance, in Anchorage is working collectively to help get
electronic health records used more broadly in the physician
community. They have agreed to come into this network.
2:20:42 PM
SENATOR PASKVAN asked him to expand on the federal match and any
dates that may be applicable for state's contribution in order
to participate.
MR. SHERRY replied that clearly the stimulus is trying to get
action in '09, and he expects the Office of the National
Coordinator that is handling all this money should be releasing
their scenario for distributing funds soon; so he wants to be in
a position to make application for those funds this spring or
summer. In early years the match requirement is substantially
less for the state, but it increases with each year. Their
target is about $20 million in federal stimulus money to the
state's revenue stream; $1.3 million in state match will
increase the state's competitiveness for other funding streams.
He informed them that he is going after as many different
sources of local and other contributions as possible for this.
He expects that the tribal health organizations should be able
to contribute soon. This thing can be moved a whole lot faster
if all the stakeholders put in their resources.
MR. SHERRY commented that this is a rapidly developing front,
and based on discussions with department, they believe some
restructuring in the bill would provide greater clarity of
responsibility and how various stakeholders are represented; and
he is happy to continue working on that.
2:23:45 PM
CHAIR DAVIS closed public testimony and said she would hold SB
133 until they get a CS to consider.
There being no further business to come before the committee,
Chair Davis adjourned the meeting at 2:24 p.m.
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