Florida Senate - 2022                                     SB 998
       
       
        
       By Senator Rodriguez
       
       
       
       
       
       39-00782B-22                                           2022998__
    1                        A bill to be entitled                      
    2         An act relating to enhancing patient care continuums;
    3         amending s. 381.026, F.S.; defining the term “patient
    4         care continuum”; revising the purpose of the patient’s
    5         bill of rights; providing that patients have a right
    6         to expect their health care records to be shared
    7         between their health care providers; conforming
    8         provisions to changes made by the act; amending s.
    9         381.0405, F.S.; revising the purpose and functions of
   10         the Office of Rural Health; amending s. 381.0406,
   11         F.S.; revising legislative findings; revising the
   12         definition of the term “health care provider”;
   13         defining the term “patient care continuum”; requiring
   14         rural health networks to use health information
   15         exchange systems for specified purposes; amending s.
   16         381.04065, F.S.; revising criteria for Department of
   17         Health approval of certain cooperative agreements in
   18         certified rural health networks; amending s. 395.1052,
   19         F.S.; requiring hospitals to use health information
   20         exchange systems to provide certain notification to a
   21         patient’s primary care provider, if any; requiring
   22         hospitals to inform each patient of the right to
   23         request the hospital’s treating physician consult with
   24         any provider within the patient’s care continuum,
   25         rather than only the primary care provider or a
   26         specialist provider, when developing the patient’s
   27         plan of care; requiring the treating physician to make
   28         a reasonable effort to consult with such provider, if
   29         requested; amending s. 395.3015, F.S.; requiring
   30         certain hospitals to require use of an electronic
   31         system for patient medical records; amending s.
   32         408.05, F.S.; revising membership requirements for the
   33         State Consumer Health Information and Policy Advisory
   34         Council; amending s. 408.051, F.S.; defining and
   35         revising terms; requiring health care facilities to
   36         use health information exchange systems to exchange
   37         electronic health records; providing requirements for
   38         the exchange of electronic health records and minimum
   39         requirements for such records; prohibiting vendors of
   40         certified electronic health record technologies from
   41         charging health care facilities and health care
   42         practitioners more than a specified amount for
   43         building an interface with a health information
   44         exchange system; requiring such vendors to provide
   45         system upgrades and software updates free of charge to
   46         health care facilities and health care practitioners
   47         who purchase the technology; amending s. 408.0611,
   48         F.S.; requiring the Agency for Health Care
   49         Administration to provide health information exchange
   50         systems with access to the electronic prescribing
   51         clearinghouse for a specified purpose; amending s.
   52         456.057, F.S.; requiring certain records owners to use
   53         a health information exchange system to provide
   54         patient records to health care practitioners and
   55         providers; amending ss. 381.4018 and 456.42, F.S.;
   56         conforming cross-references; providing an effective
   57         date.
   58  
   59         WHEREAS, laws and rules should allow health care
   60  practitioners to practice to the full extent of their
   61  professional training and expertise throughout a patient’s care
   62  continuum through the secure electronic exchange of the
   63  patient’s health records between private, local, and state
   64  health information exchange systems, and
   65         WHEREAS, laws and rules should allow health care providers
   66  to deliver primary, acute, tertiary, quaternary, long-term, and
   67  palliative health care services based on real-time data created
   68  by health care providers throughout a patient’s care continuum
   69  to improve patient outcomes and quality of life, and
   70         WHEREAS, all types of health care providers who create or
   71  own a patient’s health records should be free to share such
   72  health information without the constraints of costly interfaces
   73  imposed by certified electronic health record technology
   74  vendors, and
   75         WHEREAS, patients have a right to expect robust
   76  communication between all of the health care providers within
   77  their care continuums, and
   78         WHEREAS, laws and rules should not allow or create
   79  mechanisms that block the owner of health records from sharing
   80  or exchanging such records with health care providers in a
   81  patient’s care continuum, and
   82         WHEREAS, laws and rules should not add burdens or barriers
   83  beyond what is required by state and federal health information
   84  privacy laws, focusing only on those policies that prevent
   85  patient harm rather than policies that are overly prescriptive
   86  and unnecessarily restrict communication between a patient’s
   87  health care providers, and
   88         WHEREAS, laws and rules should allow Medicaid and other
   89  public health programs to share a defined set of patient health
   90  information to support the care continuum throughout the life of
   91  a patient, NOW, THEREFORE,
   92  
   93  Be It Enacted by the Legislature of the State of Florida:
   94  
   95         Section 1. Present paragraphs (d) and (e) of subsection (2)
   96  of section 381.026, Florida Statutes, are redesignated as
   97  paragraphs (e) and (f), respectively, a new paragraph (d) is
   98  added to that subsection, and subsection (3), paragraph (b) of
   99  subsection (4), and subsection (6) of that section are amended,
  100  to read:
  101         381.026 Florida Patient’s Bill of Rights and
  102  Responsibilities.—
  103         (2) DEFINITIONS.—As used in this section and s. 381.0261,
  104  the term:
  105         (d) “Patient care continuum” means an integrated system of
  106  health care which follows a patient through time or through a
  107  range of services and requires health care providers and other
  108  providers to document care more thoroughly over time and to
  109  share patient data across specialties, offering a more unified
  110  patient care approach and facilitating the seamless transition
  111  of the patient’s care between specialists and other providers.
  112  The term includes, but is not limited to, an interdisciplinary
  113  or case management team involving health care providers and
  114  nonmedical administrators who collaborate to document the
  115  patient’s progression of care and assist in day-to-day health
  116  care provider decisions to ensure that the patient receives the
  117  highest possible quality of care.
  118         (3) PURPOSE.—It is the purpose of this section to promote
  119  the interests and well-being of the patients of health care
  120  providers and health care facilities and to promote better
  121  communication between the patient and the patient’s health care
  122  providers throughout the patient’s care continuum provider. It
  123  is the intent of the Legislature that health care providers
  124  understand their responsibility to give their patients a general
  125  understanding of the procedures to be performed on them; and to
  126  provide information pertaining to their health care so that they
  127  may make decisions in an informed manner after considering the
  128  information relating to their condition, the available treatment
  129  alternatives, and substantial risks and hazards inherent in the
  130  treatments; and to provide the necessary follow-up care and
  131  information after the procedures are performed on them. It is
  132  the intent of the Legislature that patients have a general
  133  understanding of their responsibilities toward health care
  134  providers and health care facilities. It is the intent of the
  135  Legislature that the provision of such information to a patient
  136  eliminate potential misunderstandings between patients and
  137  health care providers. It is a public policy of the state that
  138  the interests of patients be recognized in a patient’s bill of
  139  rights and responsibilities and that a health care facility or
  140  health care provider may not require a patient to waive his or
  141  her rights as a condition of treatment. This section may shall
  142  not be used for any purpose in any civil or administrative
  143  action and neither expands nor limits any rights or remedies
  144  provided under any other law.
  145         (4) RIGHTS OF PATIENTS.—Each health care facility or
  146  provider shall observe the following standards:
  147         (b) Information.—
  148         1. A patient has the right to know the name, function, and
  149  qualifications of each health care provider who is providing
  150  medical services to the patient. A patient may request such
  151  information from his or her responsible provider or the health
  152  care facility in which he or she is receiving medical services.
  153         2. A patient in a health care facility has the right to
  154  know what patient support services are available in the
  155  facility.
  156         3. A patient has the right to be given by his or her health
  157  care provider information concerning diagnosis, planned course
  158  of treatment, alternatives, risks, and prognosis, unless it is
  159  medically inadvisable or impossible to give this information to
  160  the patient, in which case the information must be given to the
  161  patient’s guardian or a person designated as the patient’s
  162  representative. A patient has the right to refuse this
  163  information.
  164         4. A patient has the right to expect his or her health care
  165  records to be shared, in accordance with any applicable state
  166  and federal privacy regulations, among health care providers and
  167  other providers involved in the patients care continuum for the
  168  purpose of facilitating a seamless transition of the patient’s
  169  care between specialists and other providers.
  170         5. A patient has the right to refuse any treatment based on
  171  information required by this paragraph, except as otherwise
  172  provided by law. The responsible provider shall document any
  173  such refusal.
  174         6.5. A patient in a health care facility has the right to
  175  know what facility rules and regulations apply to patient
  176  conduct.
  177         7.6. A patient has the right to express grievances to a
  178  health care provider, a health care facility, or the appropriate
  179  state licensing agency regarding alleged violations of patients’
  180  rights. A patient has the right to know the health care
  181  provider’s or health care facility’s procedures for expressing a
  182  grievance.
  183         8.7. A patient in a health care facility who does not speak
  184  English has the right to be provided an interpreter when
  185  receiving medical services if the facility has a person readily
  186  available who can interpret on behalf of the patient.
  187         9.8. A health care provider or health care facility shall
  188  respect a patient’s right to privacy and should refrain from
  189  making a written inquiry or asking questions concerning the
  190  ownership of a firearm or ammunition by the patient or by a
  191  family member of the patient, or the presence of a firearm in a
  192  private home or other domicile of the patient or a family member
  193  of the patient. Notwithstanding this provision, a health care
  194  provider or health care facility that in good faith believes
  195  that this information is relevant to the patient’s medical care
  196  or safety, or safety of others, may make such a verbal or
  197  written inquiry.
  198         10.9. A patient may decline to answer or provide any
  199  information regarding ownership of a firearm by the patient or a
  200  family member of the patient, or the presence of a firearm in
  201  the domicile of the patient or a family member of the patient. A
  202  patient’s decision not to answer a question relating to the
  203  presence or ownership of a firearm does not alter existing law
  204  regarding a physician’s authorization to choose his or her
  205  patients.
  206         11.10. A health care provider or health care facility may
  207  not discriminate against a patient based solely upon the
  208  patient’s exercise of the constitutional right to own and
  209  possess firearms or ammunition.
  210         12.11. A health care provider or health care facility shall
  211  respect a patient’s legal right to own or possess a firearm and
  212  should refrain from unnecessarily harassing a patient about
  213  firearm ownership during an examination.
  214         (6) SUMMARY OF RIGHTS AND RESPONSIBILITIES.—Any health care
  215  practitioner as defined in s. 456.001 provider who treats a
  216  patient in an office or any health care facility licensed under
  217  chapter 395 that provides emergency services and care or
  218  outpatient services and care to a patient, or admits and treats
  219  a patient, shall adopt and make available to the patient, in
  220  writing, a statement of the rights and responsibilities of
  221  patients, including the following:
  222  
  223                SUMMARY OF THE FLORIDA PATIENT’S BILL              
  224                   OF RIGHTS AND RESPONSIBILITIES                  
  225  
  226         Florida law requires that your health care provider or
  227  health care facility recognize your rights while you are
  228  receiving medical care and that you respect the health care
  229  provider’s or health care facility’s right to expect certain
  230  behavior on the part of patients. You may request a copy of the
  231  full text of this law from your health care provider or health
  232  care facility. A summary of your rights and responsibilities
  233  follows:
  234         A patient has the right to be treated with courtesy and
  235  respect, with appreciation of his or her individual dignity, and
  236  with protection of his or her need for privacy.
  237         A patient has the right to a prompt and reasonable response
  238  to questions and requests.
  239         A patient has the right to know who is providing medical
  240  services and who is responsible for his or her care.
  241         A patient has the right to know what patient support
  242  services are available, including whether an interpreter is
  243  available if he or she does not speak English.
  244         A patient has the right to bring any person of his or her
  245  choosing to the patient-accessible areas of the health care
  246  facility or provider’s office to accompany the patient while the
  247  patient is receiving inpatient or outpatient treatment or is
  248  consulting with his or her health care provider, unless doing so
  249  would risk the safety or health of the patient, other patients,
  250  or staff of the facility or office or cannot be reasonably
  251  accommodated by the facility or provider.
  252         A patient has the right to know what rules and regulations
  253  apply to his or her conduct.
  254         A patient has the right to be given by the health care
  255  provider information concerning diagnosis, planned course of
  256  treatment, alternatives, risks, and prognosis.
  257         A patient has the right to expect communication between
  258  health care providers involved in the patient’s care continuum.
  259         A patient has the right to refuse any treatment, except as
  260  otherwise provided by law.
  261         A patient has the right to be given, upon request, full
  262  information and necessary counseling on the availability of
  263  known financial resources for his or her care.
  264         A patient who is eligible for Medicare has the right to
  265  know, upon request and in advance of treatment, whether the
  266  health care provider or health care facility accepts the
  267  Medicare assignment rate.
  268         A patient has the right to receive, upon request, before
  269  prior to treatment, a reasonable estimate of charges for medical
  270  care.
  271         A patient has the right to receive a copy of a reasonably
  272  clear and understandable, itemized bill and, upon request, to
  273  have the charges explained.
  274         A patient has the right to impartial access to medical
  275  treatment or accommodations, regardless of race, national
  276  origin, religion, handicap, or source of payment.
  277         A patient has the right to treatment for any emergency
  278  medical condition that will deteriorate from failure to provide
  279  treatment.
  280         A patient has the right to know if medical treatment is for
  281  purposes of experimental research and to give his or her consent
  282  or refusal to participate in such experimental research.
  283         A patient has the right to express grievances regarding any
  284  violation of his or her rights, as stated in Florida law,
  285  through the grievance procedure of the health care provider or
  286  health care facility which served him or her and to the
  287  appropriate state licensing agency.
  288         A patient is responsible for providing to the health care
  289  provider, to the best of his or her knowledge, accurate and
  290  complete information about present complaints, past illnesses,
  291  hospitalizations, medications, and other matters relating to his
  292  or her health.
  293         A patient is responsible for reporting unexpected changes
  294  in his or her condition to the health care provider.
  295         A patient is responsible for reporting to the health care
  296  provider whether he or she comprehends a contemplated course of
  297  action and what is expected of him or her.
  298         A patient is responsible for following the treatment plan
  299  recommended by the health care provider.
  300         A patient is responsible for keeping appointments and, when
  301  he or she is unable to do so for any reason, for notifying the
  302  health care provider or health care facility.
  303         A patient is responsible for his or her actions if he or
  304  she refuses treatment or does not follow the health care
  305  provider’s instructions.
  306         A patient is responsible for assuring that the financial
  307  obligations of his or her health care are fulfilled as promptly
  308  as possible.
  309         A patient is responsible for following health care facility
  310  rules and regulations affecting patient care and conduct.
  311         Section 2. Subsection (2), paragraph (a) of subsection (3),
  312  and paragraph (c) of subsection (4) of section 381.0405, Florida
  313  Statutes, are amended to read:
  314         381.0405 Office of Rural Health.—
  315         (2) PURPOSE.—The Office of Rural Health shall actively
  316  foster the provision of health care services in rural areas and
  317  serve as a catalyst for improved patient care continuums and
  318  health services provided to citizens in rural areas of this the
  319  state.
  320         (3) GENERAL FUNCTIONS.—The office shall:
  321         (a) Integrate policies related to physician workforce,
  322  hospitals, public health, and state regulatory functions, and
  323  the secure exchange of electronic patient health records between
  324  health information exchange systems as defined in s. 408.051(2).
  325         (4) COORDINATION.—The office shall:
  326         (c) Foster the creation of regional health care systems
  327  that promote cooperation, rather than competition, to support
  328  patient care continuums.
  329         Section 3. Paragraph (c) of subsection (1) and subsections
  330  (2) and (9) of section 381.0406, Florida Statutes, are amended
  331  to read:
  332         381.0406 Rural health networks.—
  333         (1) LEGISLATIVE FINDINGS AND INTENT.—
  334         (c) The Legislature further finds that the availability of
  335  a continuum of quality health care services, including
  336  preventive, primary, secondary, tertiary, and long-term, and
  337  palliative care, is essential to the economic and social
  338  vitality of rural communities.
  339         (2) DEFINITIONS.—As used in ss. 381.0405-381.04065, the
  340  term:
  341         (c)(a) “Rural” means an area with a population density of
  342  less than 100 individuals per square mile or an area defined by
  343  the most recent United States Census as rural.
  344         (a)(b) “Health care provider” means any individual, group,
  345  or entity, public or private, that provides health care,
  346  including: preventive health care, primary health care,
  347  secondary and tertiary health care, palliative health care, in
  348  hospital health care, public health care, and health promotion
  349  and education.
  350         (b)“Patient care continuum” means an integrated system of
  351  health care which follows a patient through time or through a
  352  range of services and requires health care providers and other
  353  providers to document care more thoroughly over time and to
  354  share patient data across specialties, offering a more unified
  355  patient care approach and facilitating the seamless transition
  356  of the patient’s care between specialists and other providers.
  357  The term includes, but is not limited to, an interdisciplinary
  358  or case management team involving health care providers and
  359  nonmedical administrators who collaborate to document the
  360  patient’s progression of care and assist in day-to-day health
  361  care provider decisions to ensure that the patient receives the
  362  highest possible quality of care.
  363         (d)(c) “Rural health network” or “network” means a
  364  nonprofit legal entity, consisting of rural and urban health
  365  care providers and others, that is organized to plan and deliver
  366  health care services on a cooperative basis in a rural area,
  367  except for some secondary and tertiary care services.
  368         (9) Networks shall establish standard protocols, coordinate
  369  and share patient records, and develop patient information
  370  exchange systems using health information exchange systems as
  371  defined in s. 408.051(2) to support patient care continuums.
  372         Section 4. Subsection (2) of section 381.04065, Florida
  373  Statutes, is amended to read:
  374         381.04065 Rural health network cooperative agreements.—
  375         (2) DEPARTMENT APPROVAL.—Providers who are members of
  376  certified rural health networks who seek to consolidate services
  377  or technologies or enter into cooperative agreements shall seek
  378  approval from the Department of Health, which may consult with
  379  the Department of Legal Affairs. The department shall determine
  380  that the likely benefits resulting from the agreement outweigh
  381  any disadvantages attributable to any potential reduction in
  382  competition resulting from the agreement and issue a letter of
  383  approval if, in its determination, the agreement reduces or
  384  moderates costs and meets any of the following criteria:
  385         (a) Consolidates services or facilities in a market area
  386  used by rural health network patients to avoid duplication.;
  387         (b) Promotes cooperation between rural health network
  388  members in the market area.;
  389         (c) Encourages cost sharing among rural health network
  390  facilities.;
  391         (d) Enhances the quality of rural health care.; or
  392         (e) Improves utilization of rural health resources and
  393  equipment.
  394         (f) Improves the secure exchange of electronic patient
  395  health records between health information exchange systems as
  396  specified in s. 408.051 to support the patient care continuum.
  397         Section 5. Subsections (1) and (2) of section 395.1052,
  398  Florida Statutes, are amended to read:
  399         395.1052 Patient access to primary care and specialty
  400  providers; notification.—A hospital shall:
  401         (1) Notify each patient’s primary care provider, if any,
  402  within 24 hours after the patient’s admission to the hospital,
  403  using a health information exchange system for exchanging
  404  electronic health records as specified in s. 408.051.
  405         (2) Inform the patient immediately upon admission that he
  406  or she may request to have the hospital’s treating physician
  407  consult with the patient’s primary care provider, or specialist
  408  provider, or other provider within the patient’s care continuum,
  409  if any, when developing the patient’s plan of care. Upon the
  410  patient’s request, the hospital’s treating physician shall make
  411  reasonable efforts to consult with the patient’s primary care
  412  provider, or specialist provider, or other specified provider
  413  when developing the patient’s plan of care.
  414         Section 6. Section 395.3015, Florida Statutes, is amended
  415  to read:
  416         395.3015 Patient records; form and content.—Each hospital
  417  operated by the agency or by the Department of Corrections shall
  418  require the use of an electronic a system of problem-oriented
  419  medical records for its patients, which system must shall
  420  include the following elements: basic client data collection; a
  421  listing of the patient’s problems; the initial plan with
  422  diagnostic and therapeutic orders as appropriate for each
  423  problem identified; and progress notes, including a discharge
  424  summary. The agency shall, by rule, establish criteria for such
  425  problem-oriented medical record systems in order to ensure
  426  comparability among facilities and to facilitate the compilation
  427  of statewide statistics.
  428         Section 7. Paragraphs (a) and (b) of subsection (6) of
  429  section 408.05, Florida Statutes, are amended to read:
  430         408.05 Florida Center for Health Information and
  431  Transparency.—
  432         (6) STATE CONSUMER HEALTH INFORMATION AND POLICY ADVISORY
  433  COUNCIL.—
  434         (a) There is established in the agency the State Consumer
  435  Health Information and Policy Advisory Council to assist the
  436  center. The council consists of the following members:
  437         1. An employee of the Executive Office of the Governor, to
  438  be appointed by the Governor.
  439         2. An employee of the Office of Insurance Regulation, to be
  440  appointed by the director of the office.
  441         3. An employee of the Department of Education, to be
  442  appointed by the Commissioner of Education.
  443         4. Ten persons, to be appointed by the Secretary of Health
  444  Care Administration, representing other state and local
  445  agencies, state universities, business and health coalitions,
  446  local health councils, professional health-care-related
  447  associations, entities responsible for operating health
  448  information exchange systems as defined in s. 408.051(2),
  449  consumers, and purchasers.
  450         (b) Each member of the council shall be appointed to serve
  451  for a term of 2 years following the date of appointment. A
  452  vacancy shall be filled by appointment for the remainder of the
  453  term, and each appointing authority retains the right to
  454  reappoint members whose terms of appointment have expired. A
  455  member may not serve for more than 8 years.
  456         Section 8. Section 408.051, Florida Statutes, is amended to
  457  read:
  458         408.051 Florida Electronic Health Records Exchange Act.—
  459         (1) SHORT TITLE.—This section may be cited as the “Florida
  460  Electronic Health Records Exchange Act.”
  461         (2) DEFINITIONS.—As used in this section, the term:
  462         (b)(a) “Electronic health record” means a record of a
  463  person’s medical treatment which is created by a licensed health
  464  care provider and stored in an interoperable and accessible
  465  digital format.
  466         (b)“Qualified electronic health record” means an
  467  electronic record of health-related information concerning an
  468  individual which includes patient demographic and clinical
  469  health information, such as medical history and problem lists,
  470  and which has the capacity to provide clinical decision support,
  471  to support physician order entry, to capture and query
  472  information relevant to health care quality, and to exchange
  473  electronic health information with, and integrate such
  474  information from, other sources.
  475         (a)(c) “Certified electronic health record technology”
  476  means a technology that can maintain qualified electronic health
  477  records record that is certified pursuant to s. 3001(c)(5) of
  478  the Public Health Service Act as meeting standards adopted under
  479  s. 3004 of such act which are applicable to the type of record
  480  involved, such as an ambulatory electronic health record for
  481  office-based physicians or an inpatient hospital electronic
  482  health record for hospitals, and that can share patient data for
  483  every patient encounter, transition, or referral and records
  484  stored or maintained in the technology using a secure node
  485  within a health information exchange system.
  486         (c) “Health care facility” means any facility listed in s.
  487  408.802.
  488         (d)“Health care practitioner” has the same meaning as in
  489  s. 456.001.
  490         (e)“Health information exchange system” means a privately,
  491  locally, or state-held software technology that uses secure
  492  nodes to allow a two-way exchange of information across a broad
  493  network of unaffiliated providers, including those using
  494  different certified electronic health record technologies, and
  495  that does not exclude providers from its exchange system. Such
  496  systems must use, at a minimum, the United States Core Data for
  497  Interoperability, Version 2, and the Health Level Seven
  498  International Messaging Standard, Version 2, to provide the
  499  capability of including, at a minimum, patient demographics,
  500  encounter information, care team members, allergies and
  501  intolerances, medications, immunizations, clinical problems,
  502  clinical notes, diagnostic imaging, and laboratory results in
  503  electronic health records, and must follow a structured
  504  hierarchy of coding information with respect to the facility,
  505  the patient, each patient encounter, clinical information, and
  506  clinical results.
  507         (f)(d) “Health record” means any information, recorded in
  508  any form or medium, which relates to the past, present, or
  509  future health of an individual for the primary purpose of
  510  providing health care and health-related services.
  511         (g)(e) “Identifiable health record” means any health record
  512  that identifies the patient or with respect to which there is a
  513  reasonable basis to believe the information can be used to
  514  identify the patient.
  515         (h) “Node” means a communication endpoint within a network
  516  which is an interface exposed by certified electronic health
  517  record technology.
  518         (i)(f) “Patient” means an individual who has sought, is
  519  seeking, is undergoing, or has undergone care or treatment in a
  520  health care facility or by a health care practitioner provider.
  521         (j)(g) “Patient representative” means a parent of a minor
  522  patient, a court-appointed guardian for the patient, a health
  523  care surrogate, or a person holding a power of attorney or
  524  notarized consent appropriately executed by the patient granting
  525  permission to a health care facility or health care practitioner
  526  provider to disclose the patient’s health care information to
  527  that person. In the case of a deceased patient, the term also
  528  means the personal representative of the estate of the deceased
  529  patient; the deceased patient’s surviving spouse, surviving
  530  parent, or surviving adult child; the parent or guardian of a
  531  surviving minor child of the deceased patient; the attorney for
  532  the patient’s surviving spouse, parent, or adult child; or the
  533  attorney for the parent or guardian of a surviving minor child.
  534         (3) ELECTRONIC HEALTH RECORDS EXCHANGE.—Health care
  535  facilities shall use health information exchange systems to
  536  exchange electronic health records. Any exchange of electronic
  537  health records must reflect a complete account, providing all
  538  context, of the patient encounter at the facility, including all
  539  patient data collected by the facility for that encounter. The
  540  electronic health records must include, at a minimum, patient
  541  demographics, encounter information, care team members,
  542  allergies and intolerances, medications, immunizations, clinical
  543  problems, clinical notes, diagnostic imaging, and laboratory
  544  results and must follow a structured hierarchy of coding
  545  information with respect to the facility, the patient, each
  546  patient encounter, clinical information, and clinical results.
  547         (4) EMERGENCY RELEASE OF IDENTIFIABLE HEALTH RECORD.—A
  548  health care practitioner provider may release or access an
  549  identifiable health record of a patient without the patient’s
  550  consent for use in the treatment of the patient for an emergency
  551  medical condition, as defined in s. 395.002(8), when the health
  552  care practitioner provider is unable to obtain the patient’s
  553  consent or the consent of the patient representative due to the
  554  patient’s condition or the nature of the situation requiring
  555  immediate medical attention. A health care practitioner provider
  556  who in good faith releases or accesses an identifiable health
  557  record of a patient in any form or medium under this subsection
  558  is immune from civil liability for accessing or releasing an
  559  identifiable health record.
  560         (5)(4) UNIVERSAL PATIENT AUTHORIZATION FORM.—
  561         (a) By July 1, 2010, The agency shall develop forms in both
  562  paper and electronic formats which may be used by a health care
  563  practitioner provider to document patient authorization for the
  564  use or release, in any form or medium, of an identifiable health
  565  record.
  566         (b) The agency shall adopt by rule the authorization form
  567  and accompanying instructions and make the authorization form
  568  available on the agency’s website, pursuant to s. 408.05.
  569         (c) A health care practitioner who receives provider
  570  receiving an authorization form containing a request for the
  571  release of an identifiable health record shall accept the form
  572  as a valid authorization to release an identifiable health
  573  record. A health care practitioner provider may elect to accept
  574  the authorization form in either electronic or paper format or
  575  both. The individual or entity that submits the authorization
  576  form containing a request for the release of an identifiable
  577  health record must submit the form in a shall determine which
  578  format is accepted by the health care practitioner provider
  579  prior to submitting the form.
  580         (d) An individual or entity that submits a request for an
  581  identifiable health record is not required under this section to
  582  use the authorization form adopted and distributed by the
  583  agency.
  584         (e) The exchange by a health care practitioner provider of
  585  an identifiable health record upon receipt of an authorization
  586  form completed and submitted in accordance with agency
  587  instructions creates a rebuttable presumption that the release
  588  of the identifiable health record was appropriate. A health care
  589  practitioner who provider that releases an identifiable health
  590  record in reliance on the information provided to the health
  591  care practitioner provider on a properly completed authorization
  592  form does not violate any right of confidentiality and is immune
  593  from civil liability for accessing or releasing an identifiable
  594  health record under this subsection.
  595         (f) A health care practitioner who provider that exchanges
  596  an identifiable health record upon receipt of an authorization
  597  form may shall not be deemed to have violated or waived any
  598  privilege protected under the statutory or common law of this
  599  state.
  600         (6)(5) PENALTIES.—A person who does any of the following
  601  may be liable to the patient or a health care practitioner who
  602  provider that has released an identifiable health record in
  603  reliance on an authorization form presented to the health care
  604  practitioner provider by that the person for compensatory
  605  damages caused by an unauthorized release, plus reasonable
  606  attorney attorney’s fees and costs:
  607         (a) Forges a signature on an authorization form or
  608  materially alters the authorization form of another person
  609  without the person’s authorization.; or
  610         (b) Obtains an authorization form or an identifiable health
  611  record of another person under false pretenses.
  612         (7)CERTIFIED ELECTRONIC HEALTH RECORD TECHNOLOGY VENDORS.
  613  A vendor of a certified electronic health record technology may
  614  not charge a health care facility or health care practitioner
  615  more than $10,000 to build an interface that allows the facility
  616  or practitioner to integrate into a health information exchange
  617  system. A vendor of a certified electronic health record
  618  technology shall provide any available system upgrades or
  619  software updates free of charge to a health care facility or
  620  health care practitioner who purchases such technology.
  621         Section 9. Subsection (5) is added to section 408.0611,
  622  Florida Statutes, to read:
  623         408.0611 Electronic prescribing clearinghouse.—
  624         (5) The agency shall provide health information exchange
  625  systems as defined in s. 408.051(2) with access to the
  626  electronic prescribing clearinghouse under this section for the
  627  purpose of supporting patient care continuums.
  628         Section 10. Subsection (11) of section 456.057, Florida
  629  Statutes, is amended to read:
  630         456.057 Ownership and control of patient records; report or
  631  copies of records to be furnished; disclosure of information.—
  632         (11) Records owners are responsible for maintaining a
  633  record of all disclosures of information contained in the
  634  medical record to a third party, including the purpose of the
  635  disclosure request. The record of disclosure may be maintained
  636  in the medical record. The third party to whom information is
  637  disclosed is prohibited from further disclosing any information
  638  in the medical record without the expressed written consent of
  639  the patient or the patient’s legal representative. Records
  640  owners who provide patient records to a health care practitioner
  641  or provider must do so using a health information exchange
  642  system as defined in s. 408.051(2).
  643         Section 11. Paragraph (a) of subsection (4) of section
  644  381.4018, Florida Statutes, is amended to read:
  645         381.4018 Physician workforce assessment and development.—
  646         (4) PHYSICIAN WORKFORCE ADVISORY COUNCIL.—There is created
  647  in the department the Physician Workforce Advisory Council, an
  648  advisory council as defined in s. 20.03. The council shall
  649  comply with the requirements of s. 20.052, except as otherwise
  650  provided in this section.
  651         (a) The council shall consist of 19 members. Members
  652  appointed by the State Surgeon General shall include:
  653         1. A designee from the department who is a physician
  654  licensed under chapter 458 or chapter 459 and recommended by the
  655  State Surgeon General.
  656         2. An individual who is affiliated with the Science
  657  Students Together Reaching Instructional Diversity and
  658  Excellence program and recommended by the area health education
  659  center network.
  660         3. Two individuals recommended by the Council of Florida
  661  Medical School Deans, one representing a college of allopathic
  662  medicine and one representing a college of osteopathic medicine.
  663         4. One individual recommended by the Florida Hospital
  664  Association, representing a hospital that is licensed under
  665  chapter 395, has an accredited graduate medical education
  666  program, and is not a statutory teaching hospital.
  667         5. One individual representing a statutory teaching
  668  hospital as defined in s. 408.07 and recommended by the Safety
  669  Net Hospital Alliance.
  670         6. One individual representing a family practice teaching
  671  hospital as defined in s. 395.805 and recommended by the Council
  672  of Family Medicine and Community Teaching Hospitals.
  673         7. Two individuals recommended by the Florida Medical
  674  Association, one representing a primary care specialty and one
  675  representing a nonprimary care specialty.
  676         8. Two individuals recommended by the Florida Osteopathic
  677  Medical Association, one representing a primary care specialty
  678  and one representing a nonprimary care specialty.
  679         9. Two individuals who are program directors of accredited
  680  graduate medical education programs, one representing a program
  681  that is accredited by the Accreditation Council for Graduate
  682  Medical Education and one representing a program that is
  683  accredited by the American Osteopathic Association.
  684         10. An individual recommended by the Florida Association of
  685  Community Health Centers representing a federally qualified
  686  health center located in a rural area as defined in s.
  687  381.0406(2) s. 381.0406(2)(a).
  688         11. An individual recommended by the Florida Academy of
  689  Family Physicians.
  690         12. An individual recommended by the Florida Alliance for
  691  Health Professions Diversity.
  692         13. The Chancellor of the State University System or his or
  693  her designee.
  694         14. A layperson member as determined by the State Surgeon
  695  General.
  696  
  697  Appointments to the council shall be made by the State Surgeon
  698  General. Each entity authorized to make recommendations under
  699  this subsection shall make at least two recommendations to the
  700  State Surgeon General for each appointment to the council. The
  701  State Surgeon General shall name one appointee for each position
  702  from the recommendations made by each authorized entity.
  703         Section 12. Subsection (3) of section 456.42, Florida
  704  Statutes, is amended to read:
  705         456.42 Written prescriptions for medicinal drugs.—
  706         (3) A health care practitioner licensed by law to prescribe
  707  a medicinal drug who maintains a system of electronic health
  708  records as defined in s. 408.051(2) s. 408.051(2)(a), or who
  709  prescribes medicinal drugs as an owner, an employee, or a
  710  contractor of a licensed health care facility or practice that
  711  maintains such a system and who is prescribing in his or her
  712  capacity as such an owner, an employee, or a contractor, may
  713  only electronically transmit prescriptions for such drugs. This
  714  requirement applies to such a health care practitioner upon
  715  renewal of the health care practitioner’s license or by July 1,
  716  2021, whichever is earlier, but does not apply if:
  717         (a) The practitioner and the dispenser are the same entity;
  718         (b) The prescription cannot be transmitted electronically
  719  under the most recently implemented version of the National
  720  Council for Prescription Drug Programs SCRIPT Standard;
  721         (c) The practitioner has been issued a waiver by the
  722  department, not to exceed 1 year in duration, from the
  723  requirement to use electronic prescribing due to demonstrated
  724  economic hardship, technological limitations that are not
  725  reasonably within the control of the practitioner, or another
  726  exceptional circumstance demonstrated by the practitioner;
  727         (d) The practitioner reasonably determines that it would be
  728  impractical for the patient in question to obtain a medicinal
  729  drug prescribed by electronic prescription in a timely manner
  730  and such delay would adversely impact the patient’s medical
  731  condition;
  732         (e) The practitioner is prescribing a drug under a research
  733  protocol;
  734         (f) The prescription is for a drug for which the federal
  735  Food and Drug Administration requires the prescription to
  736  contain elements that may not be included in electronic
  737  prescribing;
  738         (g) The prescription is issued to an individual receiving
  739  hospice care or who is a resident of a nursing home facility; or
  740         (h) The practitioner determines that it is in the best
  741  interest of the patient, or the patient determines that it is in
  742  his or her own best interest, to compare prescription drug
  743  prices among area pharmacies. The practitioner must document
  744  such determination in the patient’s medical record.
  745  
  746  The department, in consultation with the Board of Medicine, the
  747  Board of Osteopathic Medicine, the Board of Podiatric Medicine,
  748  the Board of Dentistry, the Board of Nursing, and the Board of
  749  Optometry, may adopt rules to implement this subsection.
  750         Section 13. This act shall take effect July 1, 2022.