CS/HB 637

1	A bill to be entitled
2	An act relating to electronic health records; amending s.
3	395.3025, F.S.; expanding access to a patient's medical
4	records to facilitate electronic exchange of data between
5	certain health care facilities, practitioners, and
6	providers and attending physicians; revising terminology
7	regarding disclosure of patient records to conform to
8	changes made by the act; amending s. 408.05, F.S.;
9	removing responsibility of the Agency for Health Care
10	Administration for monitoring certain grants and health
11	care data; creating s. 408.051, F.S.; creating the
12	"Florida eHealth Initiative Act"; providing legislative
13	intent; providing definitions; requiring the agency to
14	award and monitor grants to certain health information
15	organizations; providing rulemaking authority regarding
16	establishment of eligibility criteria; authorizing the
17	agency to operate an Electronic Medical Records System
18	Adoption Loan Program, subject to a specific
19	appropriation; providing eligibility criteria; providing
20	rulemaking authority regarding terms and conditions for
21	the granting of loans; creating the Florida Health
22	Information Exchange Advisory Council; providing for
23	purpose, membership, terms of office, and duties of the
24	council; requiring the Florida Center for Health
25	Information and Policy Analysis to provide staff support;
26	requiring reports to the Governor and Legislature;
27	providing for future repeal of s. 408.051, F.S., and
28	abolition of the council; providing duties of the agency
29	with regard to availability of specified information on
30	the agency's Internet website; requiring the agency to
31	develop and implement a plan to promote participation in
32	regional and statewide health information exchanges;
33	requiring the Office of Program Policy Analysis and
34	Government Accountability to complete an independent
35	evaluation of the grants program administered by the
36	agency and submit the report to the Governor and
37	Legislature; amending s. 408.062, F.S.; removing
38	responsibility of the agency for developing an electronic
39	health information network; amending s. 483.181, F.S.;
40	expanding access to laboratory reports to facilitate
41	exchange of data between certain health care practitioners
42	and providers; providing an effective date.
43
44	Be It Enacted by the Legislature of the State of Florida:
45
46	Section 1.  Subsection (4) of section 395.3025, Florida
47	Statutes, is amended to read:
48	395.3025  Patient and personnel records; copies;
49	examination.--
50	(4)  Patient records are confidential and must not be
51	disclosed without the consent of the patient or his or her legal
52	representative person to whom they pertain, but appropriate
53	disclosure may be made without such consent to:
54	(a)  Licensed facility personnel, and attending physicians,
55	or other health care practitioners and providers currently
56	involved in the care or treatment of the patient for use only in
57	connection with the treatment of the patient.
58	(b)  Licensed facility personnel only for administrative
59	purposes or risk management and quality assurance functions.
60	(c)  The agency, for purposes of health care cost
61	containment.
62	(d)  In any civil or criminal action, unless otherwise
63	prohibited by law, upon the issuance of a subpoena from a court
64	of competent jurisdiction and proper notice by the party seeking
65	such records to the patient or his or her legal representative.
66	(e)  The department agency upon subpoena issued pursuant to
67	s. 456.071, but the records obtained thereby must be used solely
68	for the purpose of the department agency and the appropriate
69	professional board in its investigation, prosecution, and appeal
70	of disciplinary proceedings. If the department agency requests
71	copies of the records, the facility shall charge no more than
72	its actual copying costs, including reasonable staff time. The
73	records must be sealed and must not be available to the public
74	pursuant to s. 119.07(1) or any other statute providing access
75	to records, nor may they be available to the public as part of
76	the record of investigation for and prosecution in disciplinary
77	proceedings made available to the public by the department
78	agency or the appropriate regulatory board. However, the
79	department agency must make available, upon written request by a
80	practitioner against whom probable cause has been found, any
81	such records that form the basis of the determination of
82	probable cause.
83	(f)  The department of Health or its agent, for the purpose
84	of establishing and maintaining a trauma registry and for the
85	purpose of ensuring that hospitals and trauma centers are in
86	compliance with the standards and rules established under ss.
87	395.401, 395.4015, 395.4025, 395.404, 395.4045, and 395.405, and
88	for the purpose of monitoring patient outcome at hospitals and
89	trauma centers that provide trauma care services.
90	(g)  The Department of Children and Family Services or its
91	agent, for the purpose of investigations of cases of abuse,
92	neglect, or exploitation of children or vulnerable adults.
93	(h)  The State Long-Term Care Ombudsman Council and the
94	local long-term care ombudsman councils, with respect to the
95	records of a patient who has been admitted from a nursing home
96	or long-term care facility, when the councils are conducting an
97	investigation involving the patient as authorized under part II
98	of chapter 400, upon presentation of identification as a council
99	member by the person making the request. Disclosure under this
100	paragraph shall only be made after a competent patient or the
101	patient's representative has been advised that disclosure may be
102	made and the patient has not objected.
103	(i)  A local trauma agency or a regional trauma agency that
104	performs quality assurance activities, or a panel or committee
105	assembled to assist a local trauma agency or a regional trauma
106	agency in performing quality assurance activities. Patient
107	records obtained under this paragraph are confidential and
108	exempt from s. 119.07(1) and s. 24(a), Art. I of the State
109	Constitution.
110	(j)  Organ procurement organizations, tissue banks, and eye
111	banks required to conduct death records reviews pursuant to s.
112	395.2050.
113	(k)  The Medicaid Fraud Control Unit in the Department of
114	Legal Affairs pursuant to s. 409.920.
115	(l)  The Department of Financial Services, or an agent,
116	employee, or independent contractor of the department who is
117	auditing for unclaimed property pursuant to chapter 717.
118	(m)  A regional poison control center for purposes of
119	treating a poison episode under evaluation, case management of
120	poison cases, or compliance with data collection and reporting
121	requirements of s. 395.1027 and the professional organization
122	that certifies poison control centers in accordance with federal
123	law.
124	Section 2.  Subsection (4) of section 408.05, Florida
125	Statutes, is amended to read:
126	408.05  Florida Center for Health Information and Policy
127	Analysis.--
128	(4)  TECHNICAL ASSISTANCE.--
129	(a)  The center shall provide technical assistance to
130	persons or organizations engaged in health planning activities
131	in the effective use of statistics collected and compiled by the
132	center. The center shall also provide the following additional
133	technical assistance services:
134	1.  Establish procedures identifying the circumstances
135	under which, the places at which, the persons from whom, and the
136	methods by which a person may secure data from the center,
137	including procedures governing requests, the ordering of
138	requests, timeframes for handling requests, and other procedures
139	necessary to facilitate the use of the center's data. To the
140	extent possible, the center should provide current data timely
141	in response to requests from public or private agencies.
142	2.  Provide assistance to data sources and users in the
143	areas of database design, survey design, sampling procedures,
144	statistical interpretation, and data access to promote improved
145	health-care-related data sets.
146	3.  Identify health care data gaps and provide technical
147	assistance to other public or private organizations for meeting
148	documented health care data needs.
149	4.  Assist other organizations in developing statistical
150	abstracts of their data sets that could be used by the center.
151	5.  Provide statistical support to state agencies with
152	regard to the use of databases maintained by the center.
153	6.  To the extent possible, respond to multiple requests
154	for information not currently collected by the center or
155	available from other sources by initiating data collection.
156	7.  Maintain detailed information on data maintained by
157	other local, state, federal, and private agencies in order to
158	advise those who use the center of potential sources of data
159	which are requested but which are not available from the center.
160	8.  Respond to requests for data which are not available in
161	published form by initiating special computer runs on data sets
162	available to the center.
163	9.  Monitor innovations in health information technology,
164	informatics, and the exchange of health information and maintain
165	a repository of technical resources to support the development
166	of a statewide health information exchange network.
167	(b)  The agency shall administer, manage, and monitor
168	grants to not-for-profit organizations, regional health
169	information organizations, public health departments, or state
170	agencies that submit proposals for planning, implementation, or
171	training projects to advance the development of a health
172	information network. Any grant contract shall be evaluated to
173	ensure the effective outcome of the health information project.
174	(b)(c)  The agency shall initiate, oversee, manage, and
175	evaluate the integration of health care data from each state
176	agency that collects, stores, and reports on health care issues
177	and make that data available to any health care practitioner
178	through a statewide state health information exchange network.
179	Section 3.  Section 408.051, Florida Statutes, is created
180	to read:
181	408.051  Florida eHealth Initiative Act.--
182	(1)  SHORT TITLE.--This section may be cited as the
183	"Florida eHealth Initiative Act."
184	(2)  LEGISLATIVE INTENT.--The Legislature recognizes that
185	the exchange of electronic medical records will benefit
186	consumers by increasing the quality and efficiency of health
187	care throughout the state. It is the intent of the Legislature
188	that the state promote and coordinate the establishment of a
189	secure, privacy-protected, and interconnected statewide health
190	information exchange.
191	(3)  DEFINITIONS.--As used in this section, the term:
192	(a)  "Electronic medical record" means a record of a
193	person's medical treatment created by a licensed health care
194	provider and stored in an interoperable and accessible digital
195	format.
196	(b)  "Electronic medical records system" means an
197	application environment composed of at least two of the
198	following systems: a clinical data repository; clinical decision
199	support; controlled medical vocabulary; computerized provider
200	order entry; pharmacy; or clinical documentation. The
201	application must be used by health care practitioners to
202	document, monitor, and manage health care delivery within a
203	health care delivery system and must be capable of
204	interoperability within a health information exchange.
205	(c)  "Health information exchange" means an electronic
206	system used to acquire, process, and transmit electronic medical
207	records that can be shared in real time among authorized health
208	care providers, health care facilities, health insurers, and
209	other recipients, as authorized by law, to facilitate the
210	provision of health care services.
211	(d)  "Health information organization" means an entity with
212	a formal structure and established policies and procedures that
213	serves as a neutral convener of local stakeholders to enable the
214	secure and reliable exchange of electronic medical records among
215	authorized health care stakeholders within a defined geographic
216	region to facilitate improvements in health care quality,
217	safety, and coordination of care.
218	(4)  MATCHING GRANTS.--
219	(a)  Subject to a specific appropriation, the agency shall
220	award and monitor matching grants to health information
221	organizations that submit proposals that advance the development
222	of a statewide health information exchange. Funds awarded under
223	this subsection shall be awarded on the basis of matching each
224	$1 of state funds with $1 of local or private funds. Local or
225	private funds may be provided in the form of cash or in-kind
226	support or services. Grants may be awarded within the following
227	categories: development, operation, and collaboration.
228	(b)  The agency shall, by rule, establish specific
229	eligibility criteria for a health information organization to
230	qualify for a grant under this subsection. These criteria shall
231	include, at a minimum, documentation of the following:
232	1.  For development grants, the proposed organizational
233	structure, the level of community support, including a list of
234	key participants, a demonstration of available local or private
235	matching funds, a timeline for development of the health
236	information exchange, and proposed goals and metrics.
237	2.  For operation grants, a demonstration of available
238	local or private matching funds and a detailed business plan,
239	which shall include a timeline for implementation of the health
240	information exchange, policies and procedures to protect the
241	privacy and security of electronic medical records, and proposed
242	goals and metrics.
243	3.  For collaboration grants, a demonstration of available
244	local or private matching funds, memoranda of understanding
245	between at least two health information organizations for the
246	exchange of electronic medical records, a demonstration of
247	consistent utilization of the health information exchange by
248	members within each participating health information
249	organization, and a detailed business plan, which shall include
250	a timeline for the implementation of the exchange of electronic
251	medical records between participating health information
252	organizations, policies and procedures to protect the privacy
253	and security of electronic medical records, and proposed goals
254	and metrics.
255	(c)  Beginning July 1, 2008, the agency shall not award a
256	health information organization more than 6 aggregate years of
257	funding.
258	(d)  The agency shall award grants in consultation with the
259	Florida Health Information Exchange Advisory Council.
260	(5)  ELECTRONIC MEDICAL RECORDS SYSTEM ADOPTION LOAN
261	PROGRAM.--
262	(a)  Subject to a specific appropriation, the agency shall
263	operate an Electronic Medical Records System Adoption Loan
264	Program for the purpose of providing a one-time, no-interest
265	loan to eligible physicians licensed under chapter 458 or
266	chapter 459 or to an eligible business entity whose shareholders
267	are licensed under chapter 458 or chapter 459 for the initial
268	costs of implementing an electronic medical records system.
269	(b)  In order to be eligible for a loan under this
270	subsection, each physician must demonstrate that he or she has
271	practiced continuously within the state for the previous 3
272	years.
273	(c)  The agency shall not provide a loan to a physician who
274	has or a business entity whose physician has:
275	1.  Been found guilty of violating s. 456.072(1) or been
276	disciplined under the applicable licensing chapter in the
277	previous 5 years.
278	2.  Been found guilty of or entered a plea of guilty or
279	nolo contendere to a violation of s. 409.920 or s. 409.9201.
280	3.  Been sanctioned pursuant to s. 409.913 for fraud or
281	abuse.
282	(d)  A loan may be provided to an eligible physician or
283	business entity in a lump-sum amount to pay for the costs of
284	purchasing hardware and software, subscription services,
285	professional consultation, and staff training. The agency shall
286	provide guidance to loan recipients by providing, at a minimum,
287	a list of electronic medical records systems recognized or
288	certified by national standards-setting entities as capable of
289	being used to communicate with a health information exchange.
290	(e)  The agency shall distribute a minimum of 25 percent of
291	funds appropriated to this program to physicians or business
292	entities operating within a rural county as defined in s.
293	288.106(1)(r).
294	(f)  The agency shall, by rule, develop standard terms and
295	conditions for use in this program. At a minimum, these terms
296	and conditions shall require:
297	1.  Loan repayment by the physician or business entity
298	within a reasonable period of time, which may not be longer than
299	72 months after the funding of the loan.
300	2.  Equal periodic payments that commence within 3 months
301	after the funding of the loan.
302	3.  The eligible physician or business entity to execute a
303	promissory note and a security agreement in favor of the state.
304	The security agreement shall be a purchase-money security
305	interest pledging as collateral for the loan the specific
306	hardware and software purchased with the loan proceeds. The
307	agency shall prepare and record a financing statement under
308	chapter 679. The physician or business entity shall be
309	responsible for paying the cost of recording the financing
310	statement. The security agreement shall further require that the
311	physician or business entity pay all collection costs, including
312	attorney's fees.
313	(g)  The agency shall further require the physician or
314	business entity to provide additional security under one of the
315	following subparagraphs:
316	1.  An irrevocable letter of credit, as defined in chapter
317	675, in an amount equal to the amount of the loan.
318	2.  An escrow account consisting of cash or assets eligible
319	for deposit in accordance with s. 625.52 in an amount equal to
320	the amount of the loan. If the escrow agent is responsible for
321	making the periodic payments on the loan, the required escrow
322	balance may be diminished as payments are made.
323	3.  A pledge of the accounts receivables of the physician
324	or business entity. This pledge shall be reflected on the
325	financing statement.
326	(h)  All payments received from or on behalf of a physician
327	or business entity under this program shall be deposited into
328	the agency's Administrative Trust Fund to be used to fund new
329	loans.
330	(i)  If a physician or business entity that has received a
331	loan under this section ceases to provide care or services to
332	patients, or if the physician or business entity defaults in any
333	payment and the default continues for 30 days, the entire loan
334	balance shall be immediately due and payable and shall bear
335	interest from that point forward at the rate of 18 percent
336	annually. Upon default, the agency may offset any moneys owed to
337	the physician or business entity from the state and apply the
338	offset against the outstanding balance.
339	(j)  If a physician defaults in any payment and if the
340	default continues for 30 days, the default shall constitute
341	grounds for disciplinary action under chapter 458 or chapter 459
342	and s. 456.072(1)(k).
343	(6)  FLORIDA HEALTH INFORMATION EXCHANGE ADVISORY
344	COUNCIL.--
345	(a)  The Florida Health Information Exchange Advisory
346	Council is created as an adjunct to the agency. The council is
347	subject to the requirements of s. 20.052, except that only state
348	officers and employees shall be reimbursed for per diem and
349	travel expenses pursuant to s. 112.061.
350	(b)  The purpose of the council is to:
351	1.  Promote participation in regional and statewide health
352	information exchanges and adoption of health information
353	technology to support the infrastructure capacity for regional
354	and statewide health information exchanges.
355	2.  Conduct outreach and convene forums to educate
356	stakeholders regarding the benefits of utilizing a health
357	information exchange.
358	3.  Provide guidance to stakeholders regarding the
359	effective use of health information exchanges and standards for
360	protecting the privacy and security of electronic medical
361	records.
362	(c)  The council shall consist of the following members:
363	1.  The Secretary of Health Care Administration, or his or
364	her designee.
365	2.  The State Surgeon General, or his or her designee.
366	3.  Two members appointed by and serving at the pleasure of
367	the Governor, of which:
368	a.  One member must be from the health insurance industry.
369	b.  One member must be a consumer who is a resident of the
370	state.
371	4.  Four members appointed by and serving at the pleasure
372	of the President of the Senate, of which:
373	a.  One member must be from a hospital utilizing an
374	electronic medical records system.
375	b.  One member must be a physician utilizing an electronic
376	medical records system in his or her practice.
377	c.  One member must be a representative of an operating
378	health information organization in the state.
379	d.  One member must be from a federally qualified health
380	center or other rural health organization utilizing an
381	electronic medical records system.
382	5.  Four members appointed by and serving at the pleasure
383	of the Speaker of the House of Representatives, of which:
384	a.  One member must be from a hospital utilizing an
385	electronic medical records system.
386	b.  One member must be a physician utilizing an electronic
387	medical records system in his or her practice.
388	c.  One member must be a representative of an operating
389	health information organization in the state.
390	d.  One member must be from a federally qualified health
391	center or other rural health organization utilizing an
392	electronic medical records system.
393	(d)  A member who is a representative of an operating
394	health information organization in the state must recuse himself
395	or herself during discussion, evaluation, or recommendation of a
396	grant application.
397	(e)  Each member of the council subject to appointment
398	shall be appointed to serve for a term of 4 years following the
399	date of appointment. A vacancy shall be filled by appointment
400	for the remainder of the term. Appointments shall be made within
401	45 days after the effective date of this section.
402	(f)  The council may meet at the call of the chair or at
403	the request of a majority of its membership, but the council
404	must meet at least quarterly. Meetings of the council may be
405	held via teleconference or other electronic means.
406	(g)  Members shall elect a chair and vice chair annually.
407	(h)  A majority of the members constitutes a quorum and the
408	affirmative vote of a majority of a quorum is necessary to take
409	action.
410	(i)  The council's duties and responsibilities include, but
411	are not limited to, developing recommendations to:
412	1.  Establish standards for all state-funded health
413	information exchange efforts. Such standards shall include, but
414	are not limited to, policies and procedures to protect the
415	privacy and security of electronic medical records.
416	2.  Remove barriers, including, but not limited to,
417	technological, regulatory, and financial barriers, that limit
418	participation by health care providers, health care facilities,
419	and health insurers in a health information exchange.
420	3.  Remove barriers that prevent consumers from having
421	access to their electronic medical records.
422	4.  Provide incentives to promote participation by health
423	care providers, health care facilities, and health insurers in
424	health information exchanges.
425	5.  Identify health care data held by state agencies and
426	remove barriers to making that data available to authorized
427	recipients through health information exchanges in a private and
428	secure manner.
429	6.  Increase state agency participation in health
430	information exchanges.
431	7.  Partner with other state, regional, and federal
432	entities to promote and coordinate health information exchange
433	efforts.
434	8.  Create a long-term plan for an interoperable statewide
435	network of health information organizations.
436
437	The council shall establish ad hoc issue-oriented technical
438	workgroups on an as-needed basis to make recommendations to the
439	council.
440	(j)  The Florida Center for Health Information and Policy
441	Analysis within the agency shall provide, within existing
442	resources, staff support to enable the council to carry out its
443	responsibilities under this section.
444	(k)  Beginning July 1, 2009, the council shall annually
445	provide a report to the Governor, the President of the Senate,
446	the Speaker of the House of Representatives, and the chairs of
447	the appropriate substantive committees of the Senate and the
448	House of Representatives that includes, but is not limited to,
449	the recommendations regarding the council's duties and
450	responsibilities. In addition, by July 1, 2010, the council
451	shall recommend a long-term plan to create an interoperable
452	statewide network of health information organizations to the
453	Governor, the President of the Senate, the Speaker of the House
454	of Representatives, and the chairs of the appropriate
455	substantive committees of the Senate and the House of
456	Representatives.
457	(l)  This section is repealed and the council shall stand
458	abolished July 1, 2012, unless reviewed and saved from repeal
459	through reenactment by the Legislature.
460	(7)  AGENCY FOR HEALTH CARE ADMINISTRATION; DUTIES.--
461	(a)  The agency shall develop and maintain on its Internet
462	website the following information:
463	1.  Federal and private sector health information exchange
464	funding programs, including analyses of successful local and
465	state recipients of the programs, as well as unsuccessful local
466	and state applicants of the programs.
467	2.  A clearinghouse of state and national legislative,
468	regulatory, and public awareness activities related to health
469	information exchanges.
470	(b)  The agency shall develop and implement a plan that
471	promotes, at a minimum, participation in regional and statewide
472	health information exchanges and the adoption of electronic
473	medical records systems by physicians through the Electronic
474	Medical Records System Adoption Loan Program, in consultation
475	with the Florida Health Information Exchange Advisory Council,
476	organizations representing allopathic and osteopathic practicing
477	physicians, the Board of Medicine, and the Board of Osteopathic
478	Medicine.
479	(8)  PROGRAM EVALUATION; REPORT.--The Office of Program
480	Policy Analysis and Government Accountability shall complete an
481	independent evaluation of the grants program administered by the
482	agency. The evaluation must include, at a minimum, assessments
483	of the grant evaluation and distribution process; the way in
484	which grant dollars are spent; the level of participation by
485	entities within each grantee's project; the extent of clinical
486	data exchange among entities within each grantee's project; the
487	sources of funding for each grantee; and the feasibility of each
488	grantee achieving long-term sustainability without state grant
489	funding. The evaluation must assess the level at which the
490	current grants program is advancing the development of a
491	statewide health information exchange and recommend other
492	programs that may accomplish the same goal. The report shall be
493	submitted to the Governor, the President of the Senate, the
494	Speaker of the House of Representatives, and the chairs of the
495	relevant committees in the Senate and the House of
496	Representatives no later than July 1, 2009.
497	Section 4.  Subsection (5) of section 408.062, Florida
498	Statutes, is amended to read:
499	408.062  Research, analyses, studies, and reports.--
500	(5)  The agency shall develop and implement a strategy for
501	the adoption and use of electronic health records, including the
502	development of an electronic health information network for the
503	sharing of electronic health records among health care
504	facilities, health care providers, and health insurers. The
505	agency may develop rules to facilitate the functionality and
506	protect the confidentiality of electronic health records. The
507	agency shall report to the Governor, the Speaker of the House of
508	Representatives, and the President of the Senate on legislative
509	recommendations to protect the confidentiality of electronic
510	health records.
511	Section 5.  Subsection (2) of section 483.181, Florida
512	Statutes, is amended to read:
513	483.181  Acceptance, collection, identification, and
514	examination of specimens.--
515	(2)  The results of a test must be reported directly to the
516	licensed practitioner or other authorized person who requested
517	it, and appropriate disclosure may be made by the clinical
518	laboratory without a patient's consent to other health care
519	practitioners and providers involved in the care or treatment of
520	the patient for use in connection with the treatment of the
521	patient. The report must include the name and address of the
522	clinical laboratory in which the test was actually performed,
523	unless the test was performed in a hospital laboratory and the
524	report becomes an integral part of the hospital record.
525	Section 6.  This act shall take effect upon becoming a law.

CODING: Words stricken are deletions; words underlined are additions.