Legislature(1995 - 1996)
03/28/1995 02:09 PM House HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 214: MEDICAL RECORDS IN ELECTRONIC FORM Number 087 REPRESENTATIVE GARY DAVIS, sponsor of the bill, said HB 214 will clarify that electronically stored medical records on computer terminals are legally acceptable in lieu of records on paper. Hospitals and nursing homes are moving toward paperless offices in an effort to promote efficiency. However, some providers are hesitant to implement the electronic retention and maintenance of medical records without a hard copy back up, due to the lack of explicit legal authority. REPRESENTATIVE DAVIS continued that the current statute relating to medical records neither prohibits nor permits them to be kept electronically. A legal memorandum from Legislative Legal Services indicative of health care providers concerned the ability to maintain medical records which is not clearly defined in statute or regulation. REPRESENTATIVE DAVIS said HB 214 would lend clarity to the medical records statute. The current statute just says medical records will be kept. That could be interpreted to mean records can be kept electronically or the old-fashioned way, on paper. Some institutions are hesitant to utilize the new and expanding technology of computer storage. REPRESENTATIVE DAVIS said this bill makes it legal and clarifies the statute. This is not a mandate, it only says records may be stored in this manner should the institution decide to do so. Number 236 CO-CHAIR CON BUNDE assumed where the bill says, "maintain and preserve," it means all facilities for backup will be available. This is in case the system crashes. In such a case, information will still be available somehow. REPRESENTATIVE DAVIS said the whole system would be in place to protect confidentiality through computer access. In addition, backup, the current required length of time to maintain records, and security will all be included. CO-CHAIR BUNDE said he has heard stories about hackers who challenge systems because they are there. Co-Chair Bunde assumes these systems would not be on-line and, therefore, accessible to hackers. He asked if Representative Davis had an idea about how systems might be designed to thwart hackers. REPRESENTATIVE DAVIS said discussions he has had in that regard relate to various methods of maintaining confidentiality. There are different ways to access records. There is fingerprint identification access and other types of technology available. It is the understanding of Representative Davis that since this is such a critical area in which to maintain security, the regulations would mandate the highest form of security available. REPRESENTATIVE TOM BRICE joined the meeting at 2:12 p.m., and applauded the bill. Number 411 REPRESENTATIVE NORMAN ROKEBERG asked if the provision for mandating tape backups and copies of data would be perhaps micromanagment. Representative Rokeberg asked if Representative Davis would be willing to consider that possibility. REPRESENTATIVE DAVIS thought existing regulations concerning how a hospital or nursing home keeps records are already stringent. The paperwork done now would simply be done electronically. This would include backup and all the other proper requirements. There are those who are testifying on this bill who could properly address those questions. CO-CHAIR BUNDE spoke to clarify his own understanding. Nothing in this bill would absolve the medical industry from the current provisions for guaranteeing privacy. REPRESENTATIVE DAVIS said that is the intent of this bill. CO-CHAIR BUNDE asked if it would be the responsibility of the hospital to design a system that is safe and private to insure confidentiality. REPRESENTATIVE DAVIS reiterated that is the intent of this bill. Number 530 REPRESENTATIVE BRICE said he believes that considering the advancements that take place in computer technology, to put into statute specifically how this storage will be accomplished as far as backup information would be inefficient. Any such provisions would be outdated very quickly. Considering the speed of technology development, it is probably best to leave well enough alone and understand that general computer practices dictate confidentiality to begin with. Number 598 GARY PESKA, Representative, Alaska State Hospital and Nursing Home Association (ASHNHA), said his organization supports HB 214 for all the reasons stated by Representative Davis in his sponsor statement. Mr. Peska offered to answer any questions HESS Committee members may have. Number 630 CHAR THOMPSON, President, Alaska Health Information Management Association, which was previously known as the Alaska Medical Records Association, said the AKHIMA totally supports HB 214. Ms. Thompson has provided written testimony in support of this legislation, and has listed some of the reasons her association considers this legislation to be necessary. MS. THOMPSON said computer-based patient records are being used throughout the country to improve the quality of patient care and to improve the documentation of patient care. It is necessary to provide the legal authority in this state to allow health care providers to maintain and preserve the medical records in an electronic format. However, currently, as Representative Davis noted, there is some confusion about whether or not it is legal to maintain records in an electronic format without also maintaining paper-based records also. MS. THOMPSON said computer-based records are essential to supporting the clinical decision-making process in patient care. Maintaining information in an electronic format will allow health care providers quicker access to essential information when a patient walks into the door of a medical facility. Number 724 MS. THOMPSON was sure all HESS Committee members were aware of the scenario of a patient coming into the emergency room and their records are not available for five minutes to 30 minutes. Meanwhile, the medical personnel must treat that patient without knowing, for example, that they are diabetic or have special medical conditions that need attention. MS. THOMPSON said relying on paper-based records means personnel must wait for the records to arrive in the emergency room, or there must be a reliable way to store the records in the facility, or the patient must be aware enough to provide their medical history. There are times, perhaps, when care suffers because the records are not available. Also, paper-based records rely on prompt filing of diagnostic tests. There are different case scenarios where diagnostic tests are not filed promptly, and physicians have to reorder a lab test to get the results he or she needs. MS. THOMPSON continued that electronic patient records allow health care providers to utilize clinical management computer systems which will automatically alert them if there are any drug allergies when they prescribe a medication. That will lead them to a new method of treatment. To utilize those clinical management programs, the patient's medical history must be input into the computer. Number 822 MS. THOMPSON added currently, health information management professionals are required to print out all information for computers and have the health care providers sign that form in order to file it in the paper-based medical records. This is a very time consuming and expensive process which does nothing to add to the quality of patient care or add to the quality of the documentation. MS. THOMPSON said proponents of health care reform stress it is imperative to reduce health care costs. Instead, when confined to using electronic records and then also printing the reports, having them signed and then filed, costs are added. MS. THOMPSON said there is also an increasing move toward communication between health care systems. One patient may go from a hospital to a clinic to a nursing home. Each of those facilities and health care providers keep their own paper-based records. As patients move between health care systems, electronic patient records will facilitate the continuity of medical care throughout each provider. This will be without the necessity of duplicating assessments, diagnostic tests and medical records in each facility. This will be by allowing the transfer of electronic patient information with the patient. Number 918 MS. THOMPSON noted that all of this can only come about in an efficient and effective way if the need to also maintain a paper- based medical record system can be eliminated. There were concerns expressed earlier by Co-Chair Bunde regarding the security and the access of those records. Ms. Thompson assured him she was very concerned about this also. Not only is she a proponent for electronic patient records, but she is also probably the best advocate for patient confidentiality. Her organization has worked with the Department of Health and Social Services (DHSS), Health Facility Licensing and Certification Division, to develop regulations for electronic medical records. These regulations are in draft format currently. MS. THOMPSON said these draft regulations will allow for patient information to be maintained in electronic format and provide adequate security and backup to ensure the proper retention of medical record data. There will also be provisions regarding confidentiality of patient information. Draft regulations have been developed which address essential issues relating to authentic identification, confidentiality, access, retention and security. Ms. Thompson agrees, however, that these provisions should not be in statute. As things change in the electronic industry, new technology and programs become available. She said she would like the ability to update regulations to reflect the current technology. It is much easier to update regulations than statutes. Number 1019 CO-CHAIR TOOHEY said Ms. Thompson covered that very well. Co-Chair Toohey, who is not a computer wizard, said it is a little frightening to think medical records are going to be possibly lost in cyberspace. However, Ms. Thompson has allayed those fears. MS. THOMPSON said one of the recommendations that has been made is for backup to be maintained off-site. This is in case there is an internal disaster. In such a case, a backup copy will be available off-site. One of the things that it will also do is provide more security than is currently available. Currently, if a medical record is lost due to a fire or other disaster in the hospital, there is no way of retrieving that medical record. Number 1059 CO-CHAIR TOOHEY asked if back-up material was currently kept in a fire-proof container at the hospitals. MS. THOMPSON did not exactly remember the exact regulations, but felt that was the normal procedure for a health information management organization services. Number 1096 ELMER LINDSTROM, Special Assistant to Commissioner Perdue, DHSS, said the department has reviewed HB 214 and believes that allowing health care providers to maintain medical records in an electronic format is desirable for a number of reasons. The department has noted that increasingly, health care providers are maintaining patient records, billing information and other medical records in automated systems. MR. LINDSTROM said the electronic format allows for increased productivity in updating and maintaining the records, and it also allows for multiple-site access to medical records. This has applications to tele-medicine. For those reasons, the DHSS feels this is a desirable development. MR. LINDSTROM said the DHSS will be charged under the bill with developing regulations to implement the potential law. The DHSS would be addressing the issues that have previously come up which relate to patient informed consent and records in that area, some federal records requirements, record keeping for vaccines, and so forth. However, the DHSS is confident these regulations can be promulgated to everyone's satisfaction. The DHSS appreciates the flexibility to take that approach. Number 1163 REPRESENTATIVE DAVIS said the development and cost of developing regulations is a big concern to everyone. The state watches every fiscal note that comes along. He noted that Char Thompson has some draft regulations available, and asked if those could be used on a professional consulting basis. Representative Davis asked Mr. Lindstrom if he saw those draft regulations as expediting the DHSS process of promulgating regulations. MR. LINDSTROM said the DHSS did submit a zero fiscal note for this bill. There are costs associated with developing regulations, but those can be accommodated with the existing budget. The DHSS will, of course, take advantage of every resource in the community. The resources of the association and others will be most helpful as the DHSS drafts its regulations. CO-CHAIR TOOHEY closed the meeting to public testimony and asked for the wish of the committee. She also announced that Representative Vezey had joined the meeting at 2:30 p.m. Number 1210 CO-CHAIR BUNDE made a motion to move HB 214 from committee with accompanying fiscal notes and individual recommendations. Hearing no objection, the bill passed from committee.
| Document Name | Date/Time | Subjects |
|---|