Legislature(2009 - 2010)SENATE FINANCE 532
04/07/2009 09:00 AM Senate FINANCE
| Audio | Topic |
|---|---|
| Start | |
| SB1 | |
| SB170 | |
| SB133 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 1 | TELECONFERENCED | |
| + | SB 170 | TELECONFERENCED | |
| + | SB 133 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE BILL NO. 133
"An Act creating a statewide electronic health
information exchange system; and providing for an
effective date."
9:31:55 AM
Senator Joe Paskvan discussed the legislation.
Alaska health care providers and patients continue to
rely on an outdated healthcare infrastructure, with many
providers using only paper based systems, which
contributes to dangerous drug interactions, missed
diagnoses, costly delays, duplicate testing and
administrative overhead. According to national studies,
these problems contribute to approximately 5% of health
care expenditures or $250 million annually in Alaska and
unnecessarily degrade the quality of health care for all
Alaskans.
SB 133 modernizes Alaska's healthcare IT infrastructure
by developing a secure electronic Health Information
Exchange (HIE) system to improve the safety, cost
effectiveness, and quality of healthcare in Alaska. 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, secure
manner.
The use of such technology requires careful and strict
privacy protection measures. Current Federal and State
laws already provide a number of standards protecting a
patient's privacy and personal information. The privacy
and security rules contained in the Health Insurance
Portability and Accountability Act (HIPAA) most directly
and extensively impact the HIE system. HIPAA establishes
individuals' right to review and obtain a copy of their
health information, requires notice of privacy practices,
limits the use of records and the disclosure of
information, and institutes strict security standards.
SB 133 establishes further strict standards to secure and
protect the confidentiality of individually identifying
health information of a patient. These standards include
a secure and traceable electronic audit system to allow
patients to see who has viewed their record, restrictions
on how information may be used, patient consent
requirements, an ability to opt out of the health
information exchange system, and notification of
confidentiality violations.
When complete, the Health Information Exchange System
will have the capability to provide any Alaskan with a
secure Personal Health Record, including authorization
for their health care providers on the network to have
access to electronic records required for continuity of
care, such as hospitalization records, prescription
information, vaccinations, allergies, imaging records,
laboratory results, etc. The Network will support
telemedicine services, the transfer of high resolution
images for patient care, video conferencing, and Voice
over Internet applications for providers.
Over 300 health organizations in Alaska are eager to
participate in the electronic Health Information Exchange
system.
JAKE HAMBURG, STAFF, SENATOR PASKVAN, presented the PowerPoint
slide show "Deploying a Health Information Exchange for
Alaskans. He began with Slide 2 "Medical Care From Paper to
Electronic":
„Alaska's health care providers are now making major
investments ($100M+) in moving from paper records to
Electronic Medical Records
„Alaska's health care providers are aligned in support of
creating a statewide Health Information Exchange network
so patient records may be securely exchanged between
providers for timely and safe patient care
„State of Alaska plays a key role as a partner in Alaska's
developing Health Information Exchange
9:33:42 AM
Mr. Hamburg discussed Slide 3, "Health Information Exchanges,
National Effort: State Solutions":
„National Health Information Network" concept created in
Bush administration and enhanced in Obama
administration through ARRA 2009 stimulus
„Successful State Models:
…DHIN - Delaware Health Information Network
„Statewide and regional health information exchanges
have developed over the last 10 years in other
states
…CalRHIO - California, Los Angeles County
…FHIN - Florida Health Information Network
…Regenstrief - Indiana Eight County Network
9:36:23 AM
Alaska eHealth Network: Slide 5:
„Provide rapid access by authorized providers to critical
patient information at the point of care
medical history allergies
medication status laboratory reports
immunization status imaging reports
„Reduce redundancy in medical testing and procedures
„Improve patient safety through reducing medication
reconciliation errors
„Reduce provider administrative costs for data management
„Expedited response to public health emergencies
9:36:56 AM
Alaska eHealth Network. Slide 6:
„Do not require centralized patient health record
repositories: health providers continue to own their
records
„Facilitate connectivity with patient's Personal Health
Record choices
„Respect patient decisions to opt-out of network
participation
„Provide significant penalties for data breaches
9:37:15 AM
Slide 7:
„Federal and private research projects 5% savings in
annual U.S. health care expenditures from full deployment
of inter-operable electronic medical records
„For Alaska's $5B health care industry, annual savings
could reach $250M.
„For the State of Alaska's $250M GF Medicaid expenditures,
annual savings could exceed $10M
Slide 8:
„5 year $35 million project to deploy a secure network
supporting the exchange of electronic health records
between all Alaska health care providers
„$12.0 million currently awarded through 2008 from Federal
Communications Commission, US Dept. of Health and Human
Services, State of Alaska, Alaska Federal Health Care
Partnership
9:37:35 AM
Board of directors. Slide 9:
„Incorporated non-profit August 2008
…Alaska Native Tribal Health Consortium (designated
lead partner)
…Alaska State Hospitals and Nursing Homes Association
…Alaska Primary Care Association
…Premera Blue Cross/Blue Shield
…State of Alaska DHSS
…Alaska Federal Health Care Partnership (DOD, VA,
USCG, Indian Health Service)
…University of Alaska
…Alaska E.H.R. Alliance (private physicians)
…American Association of Retired Persons
9:38:29 AM
Next Steps: 2009-2010. Slide 16:
„Secure $1.3M for FY2010 and $1.0M in FY2011 from State of
Alaska for network development
…Ensures match for federal stimulus funds
„Engage contractor/vendors to deploy Health Information
"bridging" software to interconnect Alaska's various
Electronic Medical Records systems
„Align the Health Information Exchange with State systems:
MMIS, API, Public Health data
„Add Internet2 connectivity for telemedicine applications,
teleconferencing, voice-over-internet, and consults from
lower-48 academic/teaching hospitals
9:39:22 AM
Sustainability: Slide 17
Establish the Alaska eHeath Network business structure to
sustain network and software services through provider
and payor contributions
AeHN Estimated recurring costs after FY11: $5.0M
$1.3M administration/business operations
$3.7M contractual HIE technical/software
services
Estimated recurring AeHN revenues after FY11: $5.0M
…$1.5M 1500+ physicians/clinicians
…$0.5M 26 Hospitals
…$0.5M Laboratories/Pharmacies/Imaging Centers
…$1.0M State of Alaska
…$1.0M Private Insurers
…$0.5M Alaska Federal Health Care partners
SB133 Facilitates HIE development: Slide 18.
„Positions Alaska for substantial stimulus funding
„Demonstrates state commitment to support and participate
in Alaska's Health Information Exchange development
„Provides for DHSS oversight, engagement, and long-term
participation plan
„Provides framework for designation of a qualified state
Health Information Exchange entity
„Ensures privacy protections
9:40:52 AM
Summary recommendations: Slide 20:
„A. Passage of SB133
„B. State DHSS oversight, support, and designation of
HIE organization
„C. Provide stimulus match of $1.3M in FY10 and $1.0M in
FY11
The outcomes: Slide 21:
„Timelier access to safer health care for Alaskans
„$1M annual State investment yields ~5% savings in future
State expenses for Medicaid, employee health care, state-
operated health care programs
Co-Chair Hoffman asked about the $5 billion spent on health
care and potential annual savings of $250 million. He
requested more information about the amounts and how much is
dedicated to personnel. He asked for the breakdown between
private entities versus the state's savings. How much of the
savings will pertain to the state.
Mr. Hamburg answered that the cost savings to the state's
healthcare system is the annual $250 million. The state's
savings is $10 to $12 million dollars annually.
9:42:46 AM
Co-Chair Hoffman requested identification of the saving's
location. Mr. Hamburg replied that the state is currently
paying for duplicate testing existing during moves from
facility to facility. Costs are reduced by the implementation
of a health information exchange system.
Senator Paskvan stated that Rebecca Madison was available to
add specific detail to answer Co-Chair Hoffman's question.
Co-Chair Stedman noted that the fiscal note reflects the
assumption that the state will accept the federal stimulus
money. He asked about the consequences of refusing the federal
funds. Senator Paskvan replied that the loss of stimulus funds
equals $13 million dollars for the current year and $7 million
for the following year.
Co-Chair Stedman asked if the amounts are reflected in the
fiscal note.
Mr. Hamburg added that the capital dollar requests are
requested in FY10 to ensure that the state qualifies for the
greatest amount of federal dollars.
9:44:35 AM
Senator Olson noted that the acceptance of federal stimulus
dollars will prolong set up of the program. He wondered what
supplemental amount the state is then responsible for in the
following year. Mr. Hamburg noted that the state's involvement
includes the capital funds and either the designated operating
cost or the user fees.
Senator Olson commented that some private practice
practitioners might have difficulty connecting to the network.
Mr. Hamburg explained that the plan requires five years for
full implementation. Senator Olson asked if a solo
practitioner will contribute via affordable fee structure. Mr.
Hamburg replied that the issue is resolved in regulation or
non-profit solution.
9:46:23 AM
Mr. Hamburg stated that the federal stimulus makes it easily
accessible for providers to access involvement in the system.
Senator Olson asked about rural clinics and their involvement
in the program. Mr. Hamburg answered that there is a native
health system developing an electronic health record system
and striving to network into the state system.
Senator Thomas understood that more than one large depository
is available. He noted the fiscal note with three dollars for
every dollar that the state has spent.
Mr. Hamburg answered that the fiscal note is based on a $54.34
million federal match for 2012 and beyond. He noted that if
the state designated the entity the cost is less and dependent
upon the user fee charged for system participation.
9:48:48 AM
WILLIAM STREUR, DEPUTY COMMISSIONER, MEDICAID & HEALTH CARE
POLICY, DEPARTMENT OF HEALTH AND SOCIAL SERVICES stated that
the administration's position on the bill is in support of the
concept and creation of a health information network. He
informed that the administration felt that too little
information is available regarding the ramifications of
accepting the stimulus funds. The administration is waiting
for additional guidance regarding acceptance of the funds.
Co-Chair Stedman requested clarification as the fiscal note is
$27.9 million. He asked if the state secures the federal
stimulus funds, will the administration go forward with the
legislation.
Mr. Streur clarified that the administration's position
regards the concept of health information exchange. Due to the
expense involved, the administration cannot take a position on
the funding itself.
9:50:55 AM
MR. SAM TRIVETTE, SELF, spoke in support of SB 133. He urged
consideration of moving the legislation forward. He noted that
legislation frequently pits one person against another, but
this bill allows everyone to win. He encouraged spending money
to save money. He relayed a personal story regarding a medical
error.
PAT LUBY, ADVOCACY DIRECTOR, ALASKA ASSOCIATION OF RETIRED
PERSONS (AARP), ANCHORAGE (testified via teleconference). He
testified in support of SB 133. He stated that SB 133 will
reduce medical errors in hospitals. He informed that the
electronic health records could provide information for a
person who might not be able to speak for themselves.
9:54:22 AM
REBECCA MADISON, ALASKA TRIBAL HEALTH CONSORTIUM (testified
via teleconference). She reported that providers in other
states with electronic health records report significant
savings to Medicaid through health information exchange.
Multiple health care agencies in Alaska support the bill
including federal agencies, the Department of Health and
Social Services, private physicians, primary care providers,
hospitals and nursing homes.
Senator Olson asked if the health corporations have weighed in
on the legislation and cost.
Ms. Madison asked if Senator Olson was referring to Alaskan
health corporations. Senator Olson concurred that he was
referring to Alaskan corporations. Ms. Madison stated that
many Alaskan corporations entered partnership agreements.
9:56:28 AM
SHELLY HUGHES, ALASKA PRIMARY CARE ASSOCIATES (testified via
teleconference). She expressed appreciation to the Senate
Finance Committee. She appreciated Senator Paskvan and his
sponsorship of the bill. She relayed that much time and
consideration has gone into the creation of SB 133. She noted
that the Primary Care Associates appreciates the protection of
the patient's confidentiality.
9:58:08 AM
Co-Chair Stedman asked about the issue of the acceptance or
refusal of the stimulus money. He asked if this is time
sensitive assuming that the administration accepts the money.
9:59:10 AM
Mr. Streur answered that the timeline for acceptance of the
money includes a 90 percent match plus 100% funding to assist
in the development during 2010 and 2011. At the end of 2011
the department returns to the Medicaid match rate of 54.24
percent.
Co-Chair Stedman asked about the six full time positions and
the capital expenditures of 27.9 million of which $25.1 are
federal. He noted that the legislature does not have to take
action on the bill. He struggled with the timing issue as
session ends soon. Does this put us in any jeopardy to
postpone accepting the money? Mr. Streur responded that he was
unable to answer the question at this time.
Co-Chair Hoffman requested the information the department is
lacking. Mr. Streur explained that the department must vet out
the information ensuring that there are no "strings attached"
to these funds prior to moving forward.
10:01:27 AM
Co-Chair Hoffman recalled Mr. Streur commenting that he
anticipated an answer. He asked who would provide the
department with the information.
Mr. Streur replied that the information would be forthcoming
from the federal government. Co-Chair Hoffman asked if a
specific person was in contact with the department.
Mr. Streur stated that the department corresponds with various
people in the center for Medicaid and Medicare services. Co-
Chair Hoffman asked when the department expects a response.
Mr. Streur answered that he would have the information by the
end of the session.
Co-Chair Stedman noted that the legislation had a large fiscal
impact. He noted concern about the legislation adopted without
the federal funds coming through. He requested more
information about the timing once the department has it.
10:02:42 AM
Mr. Streur was hopeful that a decision would be made sooner
rather than later.
SB 133 was HEARD and HELD in Committee for further
consideration.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 1 Additional Backup.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 1 |
| SB 1 Amendment 1 C.1.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 1 |
| SB133_Backup_AK_HISPC_Project_Summary.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 133 |
| SB133_Backup_Cost_Savings.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 133 |
| SB133_Backup_Media.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 133 |
| SB133_Backup_NCSL_HIT_State_Legislation.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 133 |
| SB 1 proposed CS Version C.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 1 |
| SB 170 proposed CS Version S.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 170 |
| SB133_Backup_AK_HISPC_Project_Summary.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 133 |
| SB 170 Additional Backup.pdf |
HFIN 4/8/2009 1:30:00 PM SFIN 4/7/2009 9:00:00 AM |
SB 170 |
| SB 133 Additional backup.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 133 |
| SB 170 Amendment 1 S.1.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 170 |
| SB133_Explanation_of_CS_Changes.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 133 |
| SB133_Letters_of_Support.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 133 |
| SB133_Presentation_AeHN overview April 2009.ppt |
SFIN 4/7/2009 9:00:00 AM |
SB 133 |
| SB170 frequently asked questions.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 170 |
| SB133_Sponsor Statement.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 133 |
| SB170 letters of support.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 170 |
| SB170 sponsor statement.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 170 |
| SB170 supporting information.pdf |
SFIN 4/7/2009 9:00:00 AM |
SB 170 |