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The Committee on Governmental Operations (Wilson) recommended the

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following amendment:

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     Senate Amendment (with title amendment)

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     Delete everything after the enacting clause

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and insert:

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     Section 1.  Subsection (4) of section 395.3025, Florida

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Statutes, is amended to read:

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     395.3025  Patient and personnel records; copies;

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examination.--

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     (4)  Patient records are confidential and must not be

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disclosed without the consent of the patient or his or her legal

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representative person to whom they pertain, but appropriate

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disclosure may be made without such consent to:

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     (a) Licensed facility personnel, and attending physicians,

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or other health care practitioners and providers currently

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involved in the care or treatment of the patient for use only in

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connection with the treatment of the patient.

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     (b)  Licensed facility personnel only for administrative

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purposes or risk management and quality assurance functions.

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     (c)  The agency, for purposes of health care cost

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containment.

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     (d)  In any civil or criminal action, unless otherwise

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prohibited by law, upon the issuance of a subpoena from a court

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of competent jurisdiction and proper notice by the party seeking

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such records to the patient or his or her legal representative.

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     (e) The department agency upon subpoena issued pursuant to

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s. 456.071, but the records obtained thereby must be used solely

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for the purpose of the department agency and the appropriate

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professional board in its investigation, prosecution, and appeal

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of disciplinary proceedings. If the department agency requests

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copies of the records, the facility shall charge no more than its

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actual copying costs, including reasonable staff time. The

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records must be sealed and must not be available to the public

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pursuant to s. 119.07(1) or any other statute providing access to

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records, nor may they be available to the public as part of the

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record of investigation for and prosecution in disciplinary

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proceedings made available to the public by the department agency

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or the appropriate regulatory board. However, the department

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agency must make available, upon written request by a

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practitioner against whom probable cause has been found, any such

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records that form the basis of the determination of probable

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cause.

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     (f) The department of Health or its agent, for the purpose

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of establishing and maintaining a trauma registry and for the

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purpose of ensuring that hospitals and trauma centers are in

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compliance with the standards and rules established under ss.

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395.401, 395.4015, 395.4025, 395.404, 395.4045, and 395.405, and

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for the purpose of monitoring patient outcome at hospitals and

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trauma centers that provide trauma care services.

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     (g)  The Department of Children and Family Services or its

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agent, for the purpose of investigations of cases of abuse,

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neglect, or exploitation of children or vulnerable adults.

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     (h)  The State Long-Term Care Ombudsman Council and the

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local long-term care ombudsman councils, with respect to the

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records of a patient who has been admitted from a nursing home or

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long-term care facility, when the councils are conducting an

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investigation involving the patient as authorized under part II

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of chapter 400, upon presentation of identification as a council

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member by the person making the request. Disclosure under this

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paragraph shall only be made after a competent patient or the

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patient's representative has been advised that disclosure may be

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made and the patient has not objected.

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     (i)  A local trauma agency or a regional trauma agency that

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performs quality assurance activities, or a panel or committee

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assembled to assist a local trauma agency or a regional trauma

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agency in performing quality assurance activities. Patient

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records obtained under this paragraph are confidential and exempt

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from s. 119.07(1) and s. 24(a), Art. I of the State Constitution.

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     (j)  Organ procurement organizations, tissue banks, and eye

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banks required to conduct death records reviews pursuant to s.

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395.2050.

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     (k)  The Medicaid Fraud Control Unit in the Department of

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Legal Affairs pursuant to s. 409.920.

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     (l)  The Department of Financial Services, or an agent,

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employee, or independent contractor of the department who is

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auditing for unclaimed property pursuant to chapter 717.

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     (m)  A regional poison control center for purposes of

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treating a poison episode under evaluation, case management of

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poison cases, or compliance with data collection and reporting

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requirements of s. 395.1027 and the professional organization

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that certifies poison control centers in accordance with federal

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law.

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     (n) A health information exchange for the sole purpose of

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processing and transmitting electronic medical records among

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persons or entities authorized to have access to those records.

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     Section 2.  Subsection (4) of section 408.05, Florida

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Statutes, is amended to read:

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     408.05  Florida Center for Health Information and Policy

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Analysis.--

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     (4)  TECHNICAL ASSISTANCE.--

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     (a)  The center shall provide technical assistance to

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persons or organizations engaged in health planning activities in

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the effective use of statistics collected and compiled by the

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center. The center shall also provide the following additional

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technical assistance services:

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     1.  Establish procedures identifying the circumstances under

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which, the places at which, the persons from whom, and the

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methods by which a person may secure data from the center,

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including procedures governing requests, the ordering of

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requests, timeframes for handling requests, and other procedures

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necessary to facilitate the use of the center's data. To the

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extent possible, the center should provide current data timely in

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response to requests from public or private agencies.

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     2.  Provide assistance to data sources and users in the

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areas of database design, survey design, sampling procedures,

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statistical interpretation, and data access to promote improved

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health-care-related data sets.

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     3.  Identify health care data gaps and provide technical

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assistance to other public or private organizations for meeting

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documented health care data needs.

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     4.  Assist other organizations in developing statistical

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abstracts of their data sets that could be used by the center.

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     5.  Provide statistical support to state agencies with

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regard to the use of databases maintained by the center.

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     6.  To the extent possible, respond to multiple requests for

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information not currently collected by the center or available

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from other sources by initiating data collection.

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     7.  Maintain detailed information on data maintained by

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other local, state, federal, and private agencies in order to

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advise those who use the center of potential sources of data

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which are requested but which are not available from the center.

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     8.  Respond to requests for data which are not available in

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published form by initiating special computer runs on data sets

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available to the center.

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     9.  Monitor innovations in health information technology,

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informatics, and the exchange of health information and maintain

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a repository of technical resources to support the development of

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a statewide health information exchange network.

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     (b) The agency shall administer, manage, and monitor grants

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to not-for-profit organizations, regional health information

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organizations, public health departments, or state agencies that

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submit proposals for planning, implementation, or training

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projects to advance the development of a health information

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network. Any grant contract shall be evaluated to ensure the

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effective outcome of the health information project.

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     (b)(c) The agency shall initiate, oversee, manage, and

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evaluate the integration of health care data from each state

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agency that collects, stores, and reports on health care issues

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and make that data available to any health care practitioner

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through a statewide state health information exchange network.

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     Section 3.  Section 408.051, Florida Statutes, is created to

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read:

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     408.051 Florida eHealth Initiative Act.--

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     (1) SHORT TITLE.--This section may be cited as the "Florida

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eHealth Initiative Act."

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     (2) LEGISLATIVE INTENT.--The Legislature recognizes that

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the exchange of electronic medical records will benefit consumers

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by increasing the quality and efficiency of health care

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throughout the state. It is the intent of the Legislature that

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the state promote and coordinate the establishment of a secure,

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privacy-protected, and interconnected statewide health

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information exchange.

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     (3) DEFINITIONS.--As used in this section, the term:

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     (a) "Electronic medical record" means a record of a

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person's medical treatment created by a licensed health care

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provider and stored in an interoperable and accessible digital

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format.

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     (b) "Electronic medical records system" means an

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application environment composed of at least two of the following

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systems: a clinical data repository; clinical decision support;

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controlled medical vocabulary; computerized provider order entry;

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pharmacy; or clinical documentation. The application must be used

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by health care practitioners to document, monitor, and manage

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health care delivery within a health care delivery system and

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must be capable of interoperability within a health information

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exchange.

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     (c) "Health information exchange" means an electronic

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system used to process or transmit electronic medical records

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that can be shared in real time among authorized health care

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providers, health care facilities, health insurers, and other

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recipients, as authorized by law, to facilitate the provision of

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health care services.

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     (d) "Health information organization" means an entity that

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has a formal structure and established policies and procedures

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and that serves as a neutral convener of local stakeholders to

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enable the secure and reliable exchange of electronic medical

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records among authorized health care stakeholders within a

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defined geographic region to facilitate improvements in health

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care quality, safety, and coordination of care.

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     (4) MATCHING GRANTS.--

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     (a) Subject to a specific appropriation, the agency shall

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award and monitor matching grants to health information

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organizations that submit proposals that advance the development

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of a statewide health information exchange. Funds awarded under

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this subsection shall be awarded on the basis of matching each $1

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of state funds with $1 of local or private funds. Local or

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private funds may be provided in the form of cash or in-kind

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support or services. Grants may be awarded within the following

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categories: development, operation, and collaboration.

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     (b) The agency shall, by rule, establish specific

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eligibility criteria for a health information organization to

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qualify for a grant under this subsection. These criteria shall

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include, at a minimum, documentation of the following:

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     1. For development grants, the proposed organizational

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structure, the level of community support, including a list of

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key participants, a demonstration of available local or private

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matching funds, a timeline for development of the health

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information exchange, and proposed goals and metrics.

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     2. For operation grants, a demonstration of available local

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or private matching funds and a detailed business plan, which

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shall include a timeline for implementation of the health

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information exchange, policies and procedures to protect the

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privacy and security of electronic medical records, and proposed

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goals and metrics.

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     3. For collaboration grants, a demonstration of available

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local or private matching funds, memoranda of understanding

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between at least two health information organizations for the

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exchange of electronic medical records, a demonstration of

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consistent utilization of the health information exchange by

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members within each participating health information

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organization, and a detailed business plan, which shall include a

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timeline for the implementation of the exchange of electronic

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medical records between participating health information

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organizations, policies and procedures to protect the privacy and

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security of electronic medical records, and proposed goals and

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metrics.

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     (c) Beginning July 1, 2008, the agency may not award a

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health information organization more than 6 aggregate years of

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funding.

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     (d) The agency shall award grants in consultation with the

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Florida Health Information Exchange Advisory Council.

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     (5) ELECTRONIC MEDICAL RECORDS SYSTEM ADOPTION LOAN

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PROGRAM.--

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     (a) Subject to a specific appropriation, the agency shall

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operate an Electronic Medical Records System Adoption Loan

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Program for the purpose of providing a one-time, no-interest loan

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to eligible physicians licensed under chapter 458 or chapter 459,

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to an eligible business entity whose shareholders are licensed

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under chapter 458 or chapter 459, or to an eligible faculty

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practice plan of a state university for the initial costs of

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implementing an electronic medical records system.

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     (b) In order to be eligible for a loan under this

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subsection, each physician must demonstrate that he or she has

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practiced continuously within the state for the previous 3 years

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or that the faculty practice plan has been established.

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     (c) The agency may not provide a loan to a physician who

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has or a business entity whose physician shareholder has:

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     1. Been found guilty of violating s. 456.072(1) or been

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disciplined under the applicable licensing chapter in the

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previous 5 years.

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     2. Been found guilty of or entered a plea of guilty or nolo

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contendere to a violation of s. 409.920 or s. 409.9201.

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     3. Been sanctioned pursuant to s. 409.913 for fraud or

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abuse.

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     (d) A loan may be provided to an eligible physician,

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business entity, or faculty practice plan in a lump-sum amount to

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pay for the costs of purchasing hardware and software,

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subscription services, professional consultation, and staff

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training. The agency shall provide guidance to loan recipients by

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providing, at a minimum, a list of electronic medical record

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systems recognized or certified by national standards-setting

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entities as capable of being used to communicate with a health

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information exchange.

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     (e) The agency shall distribute a minimum of 25 percent of

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funds appropriated to this program to physicians or business

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entities operating within a rural county as defined in s.

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288.106(1)(r).

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     (f) The agency shall, by rule, develop standard terms and

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conditions for use in this program. At a minimum, these terms and

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conditions shall require:

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     1. Loan repayment by the physician, business entity, or

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faculty practice plan within a reasonable period of time, which

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may not be longer than 72 months after the funding of the loan.

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     2. Equal periodic payments that commence within 3 months

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after the funding of the loan.

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     3. The eligible physician, business entity, or faculty

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practice plan to execute a promissory note and a security

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agreement in favor of the state. The security agreement shall be

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a purchase-money security interest pledging as collateral for the

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loan the specific hardware and software purchased with the loan

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proceeds. The agency shall prepare and record a financing

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statement under chapter 679. The physician or business entity

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shall pay the cost of recording the financing statement. The

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security agreement shall further require that the physician or

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business entity pay all collection costs, including attorney's

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fees.

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     (g) The agency shall require the physician or business

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entity to provide additional security under one of the following

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subparagraphs:

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     1. An irrevocable letter of credit, as defined in chapter

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675, in an amount equal to the amount of the loan.

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     2. An escrow account consisting of cash or assets eligible

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for deposit in accordance with s. 625.52 in an amount equal to

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the amount of the loan. If the escrow agent is responsible for

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making the periodic payments on the loan, the required escrow

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balance may be diminished as payments are made.

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     3. A pledge of the accounts receivables of the physician or

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business entity. This pledge shall be reflected on the financing

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statement.

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     (h) All payments received from or on behalf of a physician

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or business entity under this program shall be deposited into the

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agency's Administrative Trust Fund to be used to fund new loans.

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     (i) If a physician, business entity, or university whose

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faculty practice plan has received a loan under this section

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ceases to provide care or services to patients, or if the

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physician, business entity, or faculty practice plan defaults in

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any payment and the default continues for 30 days, the entire

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loan balance shall be immediately due and payable and shall bear

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interest from that point forward at the rate of 18 percent

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annually. Upon default, the agency may offset any moneys owed to

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the physician, business entity, or faculty practice plan from the

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state and apply the offset against the outstanding balance.

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     (j) If a physician defaults in any payment and if the

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default continues for 30 days, the default constitutes grounds

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for disciplinary action under chapter 458 or chapter 459 and s.

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456.072(1)(k).

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     (6) FLORIDA HEALTH INFORMATION EXCHANGE ADVISORY COUNCIL.--

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     (a) The Florida Health Information Exchange Advisory

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Council is an advisory council as defined in s. 20.03 and is

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created adjunct to the agency. The council is subject to the

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requirements of s. 20.052, except that only state officers and

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employees shall be reimbursed for per diem and travel expenses

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pursuant to s. 112.061.

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     (b) The purpose of the council is to:

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     1. Promote participation in regional and statewide health

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information exchanges and adoption of health information

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technology to support the infrastructure capacity for regional

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and statewide health information exchanges.

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     2. Conduct outreach and convene forums to educate

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stakeholders regarding the benefits of using a health information

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exchange.

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     3. Provide guidance to stakeholders regarding the effective

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use of health information exchanges and standards for protecting

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the privacy and security of electronic medical records.

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     (c) The council shall consist of the following members:

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     1. The Secretary of Health Care Administration, or his or

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her designee.

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     2. The State Surgeon General, or his or her designee.

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     3. Two members appointed by and serving at the pleasure of

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the Governor, of which:

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     a. One member must be from the health insurance industry.

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     b. One member must be a consumer who is a resident of the

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state.

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     4. Four members appointed by and serving at the pleasure of

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the President of the Senate, of which:

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     a. One member must be from a hospital using an electronic

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medical records system.

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     b. One member must be a physician using an electronic

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medical records system in his or her practice.

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     c. One member must be a representative of an operating

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health information organization in the state.

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     d. One member must be from a federally qualified health

345

center or other rural health organization utilizing an electronic

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medical records system.

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     5. Four members appointed by and serving at the pleasure of

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the Speaker of the House of Representatives, of which:

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     a. One member must be from a hospital using an electronic

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medical records system.

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     b. One member must be a physician using an electronic

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medical records system in his or her practice.

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     c. One member must be a representative of an operating

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health information organization in the state.

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     d. One member must be from a federally qualified health

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center or other rural health organization utilizing an electronic

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medical records system.

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     (d) A member who is a representative of an operating health

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information organization in the state must recuse himself or

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herself during discussion, evaluation, or recommendation of a

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grant application.

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     (e) Each member of the council subject to appointment shall

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be appointed to a term of 4 years following the date of

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appointment. A vacancy shall be filled by appointment for the

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remainder of the term. Appointments shall be made within 45 days

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after the effective date of this section.

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     (f) The council may meet at the call of the chair or at the

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request of a majority of its membership, but the council must

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meet at least quarterly. Meetings of the council may be held via

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teleconference or other electronic means.

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     (g) Members shall elect a chair and vice chair annually.

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     (h) A majority of the members constitutes a quorum and the

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affirmative vote of a majority of a quorum is necessary to take

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action.

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     (i) The council shall develop recommendations to:

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     1. Establish standards for all state-funded health

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information exchange efforts. Such standards shall include, but

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are not limited to, policies and procedures to protect the

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privacy and security of electronic medical records.

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     2. Remove barriers, including, but not limited to,

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technological, regulatory, and financial barriers, which limit

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participation by health care providers, health care facilities,

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and health insurers in a health information exchange.

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     3. Remove barriers that prevent consumers from having

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access to their electronic medical records.

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     4. Provide incentives to promote participation by health

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care providers, health care facilities, and health insurers in

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health information exchanges.

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     5. Identify health care data held by state agencies and

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remove barriers to making that data available to authorized

391

recipients through health information exchanges in a private and

392

secure manner.

393

     6. Increase state agency participation in health

394

information exchanges.

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     7. Enter into partnerships with other state, regional, and

396

federal entities to promote and coordinate health information

397

exchange efforts.

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     8. Create a long-term plan for an interoperable statewide

399

network of health information organizations.

400

     9. Consult with experts regarding the use of health

401

information in medical research to ensure that all

402

recommendations take into account the legitimate uses of health

403

care information for biomedical research, drug development,

404

clinical trials, post-approval surveillance, and public health

405

and public agency reporting requirements.

406

407

The council shall establish ad hoc issue-oriented technical

408

workgroups on an as-needed basis to make recommendations to the

409

council.

410

     (j) The Florida Center for Health Information and Policy

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Analysis within the agency shall provide, within existing

412

resources, staff support to enable the council to carry out its

413

responsibilities under this section.

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     (k) Beginning July 1, 2009, the council shall annually

415

provide a report to the Governor, the President of the Senate,

416

the Speaker of the House of Representatives, and the chairs of

417

the appropriate substantive committees of the Senate and the

418

House of Representatives which includes, but is not limited to,

419

the recommendations regarding the council's duties and

420

responsibilities. In addition, by July 1, 2010, the council shall

421

recommend a long-term plan to create an interoperable statewide

422

network of health information organizations to the Governor, the

423

President of the Senate, the Speaker of the House of

424

Representatives, and the chairs of the appropriate substantive

425

committees of the Senate and the House of Representatives.

426

     (l) This section is repealed and the council shall stand

427

abolished July 1, 2012, unless reviewed and saved from repeal

428

through reenactment by the Legislature.

429

     (7) AGENCY FOR HEALTH CARE ADMINISTRATION; DUTIES.--

430

     (a) The agency shall develop and maintain on its Internet

431

website the following information:

432

     1. Federal and private-sector health information exchange

433

funding programs, including analyses of successful local and

434

state recipients of the programs, as well as unsuccessful local

435

and state applicants of the programs.

436

     2. A clearinghouse of state and national legislative,

437

regulatory, and public awareness activities related to health

438

information exchanges.

439

     (b) The agency shall develop and implement a plan that

440

promotes, at a minimum, participation in regional and statewide

441

health information exchanges and the adoption of electronic

442

medical record systems by physicians through the Electronic

443

Medical Records System Adoption Loan Program, in consultation

444

with the Florida Health Information Exchange Advisory Council,

445

organizations representing allopathic and osteopathic practicing

446

physicians, the Board of Medicine, and the Board of Osteopathic

447

Medicine.

448

     (8) PROGRAM EVALUATION; REPORT.--The Office of Program

449

Policy Analysis and Government Accountability shall complete an

450

independent evaluation of the grants program administered by the

451

agency. The evaluation must include, at a minimum, assessments of

452

the grant evaluation and distribution process; the way in which

453

grant dollars are spent; the level of participation by entities

454

within each grantee's project; the extent of clinical data

455

exchange among entities within each grantee's project; the

456

sources of funding for each grantee; and the feasibility of each

457

grantee achieving long-term sustainability without state grant

458

funding. The evaluation must assess the level at which the

459

current grants program is advancing the development of a

460

statewide health information exchange and recommend other

461

programs that may accomplish the same goal. The report shall be

462

submitted to the Governor, the President of the Senate, the

463

Speaker of the House of Representatives, and the chairs of the

464

relevant committees in the Senate and the House of

465

Representatives no later than July 1, 2009.

466

     Section 4.  Subsection (5) of section 408.062, Florida

467

Statutes, is amended to read:

468

     408.062  Research, analyses, studies, and reports.--

469

     (5) The agency shall develop and implement a strategy for

470

the adoption and use of electronic health records, including the

471

development of an electronic health information network for the

472

sharing of electronic health records among health care

473

facilities, health care providers, and health insurers. The

474

agency may develop rules to facilitate the functionality and

475

protect the confidentiality of electronic health records. The

476

agency shall report to the Governor, the Speaker of the House of

477

Representatives, and the President of the Senate on legislative

478

recommendations to protect the confidentiality of electronic

479

health records.

480

     Section 5.  Subsection (2) of section 483.181, Florida

481

Statutes, is amended to read:

482

     483.181  Acceptance, collection, identification, and

483

examination of specimens.--

484

     (2)  The results of a test must be reported directly to the

485

licensed practitioner or other authorized person who requested it

486

and appropriate disclosure may be made by the clinical laboratory

487

without a patient's consent to other health care practitioners

488

and providers involved in the care or treatment of the patient

489

for use in connection with the treatment of the patient. The

490

report must include the name and address of the clinical

491

laboratory in which the test was actually performed, unless the

492

test was performed in a hospital laboratory and the report

493

becomes an integral part of the hospital record.

494

     Section 6.  This act shall take effect upon becoming a law.

495

496

================ T I T L E  A M E N D M E N T ================

497

And the title is amended as follows:

498

     Delete everything before the enacting clause

499

and insert:

500

A bill to be entitled

501

An act relating to electronic health records; amending

502

s. 395.3025, F.S.; expanding access to a patient's

503

medical records to facilitate electronic exchange of

504

data between certain health care facilities,

505

practitioners, and providers and attending physicians;

506

revising provisions relating to the disclosure of

507

patient records to conform to changes made by the act;

508

authorizing a health information exchange to receive

509

patient medical records without patient consent for

510

processing and transmission of electronic medical

511

records; amending s. 408.05, F.S.; removing the

512

responsibility of the Agency for Health Care

513

Administration for monitoring certain grants; creating

514

s. 408.051, F.S.; creating the "Florida eHealth

515

Initiative Act"; providing legislative intent;

516

providing definitions; requiring the agency to award

517

and monitor grants to certain health information

518

organizations; providing rulemaking authority regarding

519

establishment of eligibility criteria; establishing the

520

Electronic Medical Records System Adoption Loan

521

Program; providing eligibility criteria; providing

522

rulemaking authority regarding terms and conditions for

523

the granting of loans; creating the Florida Health

524

Information Exchange Advisory Council; providing for

525

purpose, membership, terms of office, and duties of the

526

council; requiring the Florida Center for Health

527

Information and Policy Analysis to provide staff

528

support; requiring reports to the Governor and

529

Legislature; providing for future repeal of s. 408.051,

530

F.S., and abolition of the council; providing duties of

531

the agency with regard to availability of specified

532

information on the agency's Internet website; requiring

533

the agency to develop and implement a plan to promote

534

participation in regional and statewide health

535

information exchanges; requiring the Office of Program

536

Policy Analysis and Government Accountability to

537

complete an independent evaluation of the grants

538

program administered by the agency and submit the

539

report to the Governor and Legislature by a certain

540

date; amending s. 408.062, F.S.; removing the

541

responsibility of the agency for developing an

542

electronic health information network; amending s.

543

483.181, F.S.; expanding access to laboratory reports

544

to facilitate electronic exchange of data between

545

certain health care practitioners and providers;

546

providing an effective date.

4/21/2008  1:35:00 PM     585-08129-08