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

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