Legislature(2013 - 2014)BUTROVICH 205
04/01/2013 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB87 | |
| Health Information Technology & Telehealth | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 87 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 1, 2013
1:31 p.m.
MEMBERS PRESENT
Senator Bert Stedman, Chair
Senator Peter Micciche, Vice Chair
Senator Pete Kelly
Senator Johnny Ellis
MEMBERS ABSENT
Senator Kevin Meyer
COMMITTEE CALENDAR
PRESENTATION: HEALTH INFORMATION TECHNOLOGY & TELEHEALTH
- HEARD
SENATE BILL NO. 87
"An Act requiring screening of newborns for congenital heart
defects; and providing for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 87
SHORT TITLE: NEWBORN SCREENING FOR HEART DEFECTS
SPONSOR(s): SENATOR(s) MICCICHE
03/27/13 (S) READ THE FIRST TIME - REFERRALS
03/27/13 (S) HSS, FIN
04/01/13 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
BECKY MILLER, representing herself
Wasilla, Alaska
POSITION STATEMENT: Testified in support of SB 87.
JAMES CHRISTIANSON, Pediatric Cardiologist
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 87.
ANNAMARIE SAARINEN, Co-Founder
Newborn Coalition
Minneapolis, Minnesota
POSITION STATEMENT: Testified in support of SB 87.
DR. LILY LOU, Medical Director
Newborn Intensive Care Unit
Providence Children's Hospital
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 87.
JENNA APP, Alaska Advocacy Director
American Heart Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 87.
PAUL CARTLAND, State Health Information Coordinator
Office of the Commissioner
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Presented information on Innovation and
Change: The Use of Technology to Increase Efficiency and
Effectiveness of Health Care Access and Outcomes.
STEWARD FERGUSON, PhD., Chief Information Officer
Alaska Native Tribal Health Consortium
Anchorage, Alaska
POSITION STATEMENT: Presented information on The Impact of the
AFHCAN Telehealth Program in Alaska.
ACTION NARRATIVE
1:31:05 PM
CHAIR BERT STEDMAN called the Senate Health and Social Services
Standing Committee meeting to order at 1:31 p.m. Present at the
call to order were Senators Kelly, Ellis, and Chair Stedman.
Senator Miccicche arrived shortly thereafter.
SB 87-NEWBORN SCREENING FOR HEART DEFECTS
1:31:46 PM
CHAIR STEDMAN announced that the first order of business would
be SB 87.
1:31:54 PM
At ease
1:32:54 PM
CHAIR STEDMAN said it was the first hearing on SB 87. He noted
he did not intend to move the bill today.
SENATOR PETER MICCICHE, sponsor of SB 87, shared a personal
story about his niece who had a congenital heart condition that
was caught by pulse oximetry screening in Japan where she was
born. He stated that it is estimated that one in a hundred
children are born with a congenital heart defect. It kills more
children in their first year of life than any other birth
defect. The U.S. is moving toward adopting the same newborn
screening test procedures found in Japan and other countries.
He listed hospitals in Alaska that currently perform screening
tests: Providence, Alaska Regional, Alaska Native Medical
Center, Mat-Su Regional, Bassett Army, Fairbanks, and Central
Peninsula Hospitals. He described the screening; it utilizes
pulse oximetry equipment most hospitals and clinics already have
and is painless and noninvasive. He said the test helps detect
over 75 percent of those with heart conditions, with a
sensitivity rate of over 99 percent and a false positive rating
of less than .03 percent.
He stated that the cost of the test is under $10 and is covered
by health insurance. The cost of early detection is much lower
than the cost of late-diagnosed treatment and the cost of caring
for a disabled child later. The bill will require larger
hospitals, beginning in January 2014, to test newborns with
pulse oximetry. Birthing centers and hospitals with fewer than
50 beds will have until January 2016 to do so.
SENATOR MICCICHE pointed out that parents can opt out of the
test. In the event of abnormal results, the health care provider
will inform the parents of their options. The bill provides that
hospitals report newborn screening results to the Division of
Public Health.
He noted that the fiscal note needs work. He explained that he
wants the Department of Health and Social Services (DHSS) to
keep data showing that the test was administered and whether
there was a positive or negative result. He said he believes the
fiscal note will be much lower.
He stated that, so far, there has been no opposition to the
bill. He listed supporters of the bill: Alaska State Hospital
and Nursing Home Association, Alaska Nurses Association, Alaska
State Medical Association, Alaska Primary Care Association,
Alaska Native Tribal Health Consortium, and the insurance
industry.
He concluded that his intention with this legislation is to save
as many babies as possible. The effective date is far enough
away to ensure easy compliance. He wished to hold the bill,
pending more information from DHSS.
1:38:30 PM
CHAIR STEDMAN noted one fiscal note from DHSS for the amount of
$384,800 in which $346,300 is general funds and $38,500 is
federal receipts.
BECKY MILLER, representing herself, testified in support of SB
87. She spoke as the mother of a child with a heart defect. She
shared a personal story about her daughter. She said that over
50 percent of Alaska babies with congenital heart defects will
go undiagnosed. There are no pediatric cardiac surgeons in
Alaska and it is critical that babies are diagnosed immediately.
She stressed that a simple test can save babies' lives. Early
screening would also save the state money.
JAMES CHRISTIANSON, Pediatric Cardiologist, testified in support
of SB 87. He described heart conditions as the most common birth
defect in infants. He said the test is simple and painless and
it screens infants who may have issues later on. He stated that
out of 12,000 births per year in Alaska, about 100 children will
have congenital heart disease, and of those, about 40 will have
critical heart disease. He emphasized that pulse oximetry will
be a cost-effective method of helping newborns in Alaska.
1:42:51 PM
ANNAMARIE SAARINEN, Co-Founder, Newborn Coalition, testified in
support of SB 87. She shared a personal story about her daughter
and the two heart surgeries she survived. She stressed the
importance of the screening, which many states are adopting. The
babies in rural and remote areas are the ones most likely to go
undetected without the screening.
LILY LOU, Medical Director, Newborn Intensive Care Unit,
Providence Children's Hospital, testified in support of SB 87.
She described the test as part of a "standard of care" for
newborns. She said it makes a real difference to diagnose the
problem before damage is seen. She listed two important points
to consider. The first is that pulse oximetry is the current
gold standard and if new technology is developed, the
legislation should include a way to update practices. The bill,
as written, does not address those born at home. It should
include all babies born in Alaska.
1:46:44 PM
JENNA APP, Alaska Advocacy Director, American Heart Association,
testified in support of SB 87. She discussed the importance of
diagnosing congenital heart disease in infants as soon as they
are born. She said the screening is widely supported across the
nation.
CHAIR STEDMAN closed public testimony and set SB 87 aside.
^Health Information Technology & Telehealth
OVERVIEW: HEALTH INFORMATION TECHNOLOGY & TELEHEALTH
1:48:58 PM
CHAIR STEDMAN announced that the final order of business would
be a presentation on Health Information Technology & Telehealth.
PAUL CARTLAND, State Health Information Coordinator, Office of
the Commissioner, Department of Health and Social Services,
explained that he would present information on "Innovation and
Change: The Use of Technology to Increase Efficiency and
Effectiveness of Health Care Access and Outcomes." Health
Information Technology & Telehealth
STEWARD FERGUSON, PhD., Chief Information Officer, Alaska Native
Tribal Health Consortium (ANTHC), presented information on the
"Impact of the Alaska Federal Health Care Access Network
(AFHCAN) Telehealth Program in Alaska," which focuses on helping
to change the cost of health care delivery.
He described Alaska Native Medical Center's (ANMC) Telehealth
Specialty Services, and said that ANMC specialists completed and
billed for 22,597 "Store and Forward" Telehealth consultations
from 2003 to 2012. He reported that 11,000 of those encounters
were billed to Medicaid, or about 49 percent. Half of the 13,257
unique patients were also billed to Medicaid. During the last
ten years, ANMC received $612,798 in Medicaid payments.
1:51:51 PM
DR. FERGUSON related information about the impact of Telehealth
on patient travel. He said 75 percent of specialty cases prevent
patient travel. Travel is prevented to the nearest regional hub.
He noted that 16 percent of all patients live in regional hubs.
1:53:16 PM
DR. FERGUSON shared additional details about travel. He
concluded that the estimated annual travel savings for the ANMC
Medicaid population, from specialty care, amounts to about $1.6
million, with a total savings of $8.5 million since 2003.
He talked about telehealth primary care services. He said that
ATHS providers completed 114,000 "store and forward" telehealth
encounters from 2003 to 2012. He estimated that the travel
savings for Medicaid populations from primary care is about $2.3
million annually, with a total savings of $11.2 million since
2003.
1:55:27 PM
He estimated the travel savings for all Medicaid patients from
telehealth was about $3.9 million in 2003, with a total savings
of $18.5 million since 2013. He explained that the estimated
annual savings from telehealth for all patients amounts to about
$8.3 million, with a total savings of $38 million since 2013.
He talked about telehealth's good return on investment. Medicaid
now saves an estimated $10 to $11 in travel for every dollar
spent on specialty telehealth consultations. Another benefit of
telehealth is the ability to make diagnosis and treatment plans
for patients more quickly.
1:57:02 PM
He shared 2012 highlights of ANMC and telehealth; ANMC received
7,847 specialty consultations via the AFHCAN software in 2012 -
up from 4,559 in 2011. There were 24,687 primary care cases
statewide in 2012. He reported that ANMC transmitted 20,127
follow-up/discharge notes in 2012, up from 4,471 in 2011. He
concluded that 20,719 unique patients were served with the
AFHCAN system in 2012, including 15 percent of the Alaska Native
population.
He shared future directions of telehealth. There will be a
greatly expanded role for videoconferencing, with a statewide
desktop-based system and 24/7 support for acute care. There will
be remote patient monitoring, electronic health records, a
health information exchange, and patient portal integration. He
pointed out that agencies in Alaska are working very closely to
bring better health care to remote rural areas.
2:01:10 PM
CHAIR STEDMAN asked about bandwidth restrictions in rural areas.
DR. FERGUSON commented that Alaska will never have enough
bandwidth, but there is more than there used to be. He did not
see that as being the biggest challenge. He discussed the bigger
challenge of scheduling live videos.
SENATOR MICCICHE requested an example of how teleconferencing is
being done in remote areas today.
DR. FERGUSON explained how it works in a remote village. A
patient would go to the clinic, and if they needed to see a
specialist they could fly to Anchorage or wait for a specialist
to fly out from Anchorage, which happens only every three
months. With telehealth the data is sent to a regional physician
who forwards it to a specialist, if necessary, and the response
happens fairly rapidly.
2:03:57 PM
SENATOR ELLIS asked about the interplay between telemedicine and
implementation of electronic health records as they relate to
the Affordable Health Care Act.
DR. FERGUSON said it was a complicated question. There is a
telehealth system in place and people are using it, but now that
there are also electronic records, physicians do not want to
work in two applications. There are several ways to solve that
problem. The challenge was to make sure that patient data is
integrated and that has been done. Telehealth is now moving
toward integrating telehealth applications within electronic
health records. The next step is to have a fully integrated
system where data moves between all systems. He suggested, in
the future, the systems will be able to communicate and share
information.
2:05:58 PM
MR. CARTLAND said he would provide an overview about the use of
technology to increase the efficiency and effectiveness of
health care access and outcomes. He shared an outline of his
presentation: benefits, what's happening today, what's planned,
federal support, challenges, and next steps.
MR. CARTLAND listed the benefits of using emerging technologies,
such as improving access to, and delivery of, health services
and improving patient safety. Technology reduces costs, enhances
public health interventions, and improves clinical practice.
2:08:21 PM
MR. CARTLAND described how the Health Information Exchange (HIE)
fits together and works together in a single system for the
benefit of the health provider and the patient. He related that
DHSS is working on integrating telehealth, the electronic health
record, and the HIE, which then connects to the Division of
Public Health. He said the integration will reduce costs and
improve quality of services.
He gave an example of how HIE is being put into place in the
Alaska Psychiatric Institute (API), which is planning to
implement remote behavioral health services.
2:10:42 PM
MR. CARTLAND showed where telehealth services are currently in
place, or planning to be developed across DHSS. The Division of
Behavioral Health is using a pilot program and API is using
Alaska Native Health Consortium Network to provide consults. The
Division of Juvenile Justice is using video conferencing for
behavioral health consultation. Senior Disabilities Services is
planning on using video conferencing to support assessments and
case planning, and Public Health is planning to do consultations
using telehealth, particularly with the Veterans Administration
in Southeast Alaska where a pilot program is in place.
MR. CARTLAND showed how API has connected to the Alaska Native
Health Consortium using telehealth.
2:13:59 PM
He stressed the need for electronic health records (EHR's) in
order for telehealth to work. The federal pass-thru funds from
Medicaid and Medicare incentivize hospitals and practitioners to
adopt certified EHR's for meaningful use. He defined meaningful
use requirements as increasing in stages over the life of the
incentive program. Each stage adds requirements for additional
quality measure reporting, exchange with other health care
providers, and public health reporting.
2:15:41 PM
MR. CARTLAND explained about barriers to the program. The cost
to implement an EHR is significantly more than the overall
incentive amounts. Significant changes to business processes
must be made. He related that for a 500-bed hospital, the cost
to buy an EHR service is somewhere between $10 million and $70
million. That does not include the cost to implement the program
or the loss of productivity while the staff learns to use it.
2:18:24 PM
MR. CARTLAND related that one of the requirements of the
meaningful use of HIE is to exchange health information with an
unaffiliated provider. He described the two ways of approaching
electronic exchange of health information. Push - the doctor
sends information to another provider electronically. Pull
(query) - the patient goes to the doctor's office or the
emergency room and they ask the HIE for relevant information.
The department's original grant provided that the Pull and Push
methods be piloted in Fairbanks.
2:21:09 PM
MR. CARTLAND listed the next steps in telehealth in Alaska:
conduct planned telehealth pilots, establish personal health
record with access via MyAlaska, integrate EHR's without
interfaces into HIE, enable patient mediated exchange via
BlueButton for veterans, implement chronic disease management,
and integrate with the national database that monitors biologic
threats across the U.S.
2:24:06 PM
MR. CARTLAND spoke of challenges to the system, such as limited
bandwidth and infrastructure in some rural and remote
communities, minimal use because of limited connectivity in
communities, and staffing issues, or not having physicians to
make referrals or completed consults. Funding is a challenge,
regarding costs of required maintenance and inconsistencies of
reimbursement from private insurance companies. There is a lag
between systems development, implementation, and establishment
of appropriate polices. Currently, there is no service that
schedules telehealth appointments for patients.
2:26:55 PM
MR. CARTLAND described issues the department needs to work on:
support the use of telehealth to address costs, quality and
access issues, develop a provider directory that allows for
scheduling telehealth sessions, and remove inequities in
coverage for telemedicine for both medical and behavioral
health. Other goals are to increase connectivity in rural
communities that currently do not have sufficient bandwidth,
find a broader application of EHR's/HIE and other data reporting
systems, and support networks between urban and rural health
clinics and federal and non-federal health systems to meeting
staffing shortages.
MR. CARTLAND said he hopes he has shown ways that telehealth can
improve access to affordable and quality care in rural Alaska.
SENATOR MICCICHE asked how telehealth communicates with offices
with traditional records.
MR. CARTLAND explained that providers can fax the information or
print the information and send the file along with the patient.
With HIE there will be more options. Currently, some doctors
without HIE can receive Push messages.
CHAIR STEDMAN thanked the presenters.
2:29:50 PM
There being no further business to come before the committee,
Chair Stedman adjourned the Senate Health and Social Services
Committee at 2:29 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| DHSS HIE-Telehealth Slides.pdf |
SHSS 4/1/2013 1:30:00 PM |
Telehealth Presentation |
| AFHCAN Telehealth Report 2013 v1.pdf |
SHSS 4/1/2013 1:30:00 PM |
Telehealth Presentation |
| DHSS HIE_telehealth Handouts.pdf |
SHSS 4/1/2013 1:30:00 PM |
Telehealth Presentation |
| SB 87 ver. C.pdf |
SHSS 4/1/2013 1:30:00 PM |
SB 87 |
| SB 87 Sponsor Statement.pdf |
SHSS 4/1/2013 1:30:00 PM |
SB 87 |
| SB 87 Sectional Analysis.pdf |
SHSS 4/1/2013 1:30:00 PM |
SB 87 |
| Amercian Heart Association.pdf |
SHSS 4/1/2013 1:30:00 PM |
SB 87 |
| DHSS response to inquiry.pdf |
SHSS 4/1/2013 1:30:00 PM |
SB 87 |
| Dr. Christiansen testimony.pdf |
SHSS 4/1/2013 1:30:00 PM |
SB 87 |
| Eve's story.pdf |
SHSS 4/1/2013 1:30:00 PM |
SB 87 |
| FAQs.pdf |
SHSS 4/1/2013 1:30:00 PM |
SB 87 |
| NCSL legisbrief.pdf |
SHSS 4/1/2013 1:30:00 PM |
SB 87 |
| New Jersey article.pdf |
SHSS 4/1/2013 1:30:00 PM |
SB 87 |
| New Jersey bill.pdf |
SHSS 4/1/2013 1:30:00 PM |
SB 87 |
| Trends & Transitions article.pdf |
SHSS 4/1/2013 1:30:00 PM |
SB 87 |
| SB087-DHSS-WCFH-4-1-13.pdf |
SHSS 4/1/2013 1:30:00 PM |
SB 87 |