OLR Bill Analysis
AN ACT CONCERNING ELECTRONIC HEALTH RECORDS AND HEALTH INFORMATION EXCHANGE.
This bill establishes a statewide health information exchange to, among other things, allow real-time, secure access to patient health information across all provider settings. The bill requires the public health (DPH) commissioner to issue a request for proposals (RFP) for nonprofit organizations to develop and operate the exchange. It specifies eligibility criteria for these organizations and required features of the exchange. It authorizes up to $50 million in bonding over four years for DPH to develop and maintain the exchange. It also establishes a nonlapsing General Fund account to be used for the exchange.
The bill sets deadlines for all licensed health care providers in the state to (1) connect to the exchange and (2) maintain electronic health record (EHR) systems that meet federal certification standards.
Among other things, the bill also:
1. requires hospitals, as a condition of licensure, to (a) maintain a certified EHR system and (b) enable bidirectional connectivity for the exchange of patient records with other providers;
2. generally restricts hospitals from charging fees to a provider to connect to their EHR systems;
3. provides a tax credit for hospitals who donate EHR-related equipment to providers;
4. provides a tax credit for providers implementing or upgrading their EHR systems to meet federal certification standards; and
5. specifies that all patient health records (electronic or otherwise) belong to the patient, and to the fullest extent practicable must be accessible to the patient and any authorized representatives or providers the patient chooses, regardless of the provider's location or affiliation (§ 1).
EFFECTIVE DATE: Upon passage, except the (1) provider tax credit is effective upon passage and applies to taxable or income years beginning on or after January 1, 2015; (2) hospital tax credit is effective July 1, 2015 and applies to income years beginning on or after January 1, 2015; and (3) bonding authorization is effective July 1, 2015.
§§ 2 - 4 – STATEWIDE HEALTH INFORMATION EXCHANGE
The bill establishes a Statewide Health Information Exchange. Its purposes include (1) empowering consumers to make health care decisions; (2) promoting patient-centered care; (3) improving health care quality, safety and value; (4) reducing waste and duplication of services; and (5) supporting clinical decision-making.
The exchange must:
1. allow real-time, secure access to patient health information across all provider settings;
2. provide patients with secure electronic access to their health information, and allow voluntary patient participation free of charge;
3. meet all state and federal privacy and security requirements; and
4. support public health reporting and academic research.
§ 2 – RFP
The bill requires the DPH commissioner to issue an RFP to eligible nonprofit organizations to develop, manage, and operate the exchange.
To be eligible, a nonprofit organization must have experience operating a similar exchange in at least one other state as the official state-designated entity to do so. That other exchange must:
1. enable the seamless exchange of patient health information among providers, health plans, and other authorized users regardless of geographic region, payment source, or technology;
2. include behavioral health and substance abuse treatment information, with proper consent;
3. support transitions of care and care coordination through real-time provider alerts and access to clinical information;
4. allow health information to follow each patient and patients to access and manage their health data; and
5. have successfully reduced costs associated with preventable readmissions, duplicative testing, and medical errors.
To be eligible, an organization also must (1) have a high level of transparency in its governance, decision-making, and operations and (2) have enough staff and appropriate expertise and experience to carry out the exchange's administrative, operational, and financial responsibilities.
The RFP must require broad local governance committed to the exchange's successful development and implementation. That governance must include all stakeholders, including hospitals, physicians, behavioral health providers, long-term care providers, health insurers, employers, patients, and state officials.
The RFP must require the organization to complete a health information exchange plan and business plan. The health information exchange plan must:
1. build upon existing infrastructure and coordinate with existing programs,
2. ensure patient information privacy and security at all levels and at least comply with all applicable state and federal privacy and security laws,
3. focus on maximizing utility with minimal cost and burden on stakeholders,
4. promote the highest level of interoperability and use of national information technology standards, and
5. be consistent with the existing statewide health information technology plan (see BACKGROUND).
The business plan must include a collaborative process that engages all stakeholders in developing recommended funding streams to support the exchange's annual operating expenses. It also must include the development of services and products to support the exchange's long-term sustainability.
§ 2 – Required Provider Participation
Under the bill, within six months after the exchange's launch, each health care provider with a certified EHR system must connect to and participate in the exchange. The bill defines a certified EHR system as one that meets the criteria for certification by the federal Office of the National Coordinator for Health Information Technology.
Within three years after the exchange's launch, each provider must (1) maintain a certified EHR system and (2) connect to and participate in the exchange.
(See section 5 for specific requirements for hospitals to maintain certified EHR systems.)
§ 3 – Bonding Authorization
The bill authorizes up to $50 million in general obligation bonding for DPH to develop and maintain the exchange, including the purchase of software and related equipment. The authorization is for up to $15 million per year in FYs 16 and 17 and up to $10 million per year the next two years.
§ 4 – Separate General Fund Account
The bill establishes the Statewide Health Information Exchange Account as a separate, nonlapsing General Fund account. DPH must use the account's funds to develop and maintain the exchange. The account must contain any funds the law requires to be deposited in it. (The bill does not specify a funding source for the account.)
§ 5 – HOSPITAL EHR SYSTEMS
The bill requires all hospitals, as a condition of licensure, to maintain a certified EHR system.
It also requires them, as a condition of licensure, to enable bidirectional connectivity for the secure exchange of patient health records between the hospital and other licensed providers with certified EHR systems that can accept these records, including laboratory and diagnostic tests, radiological and other diagnostic imaging, continuity of care documents, discharge notifications and documents, and patient care referrals. Hospitals must use any hardware, software, or other functionality or program settings existing and available within their EHR systems that would support this information exchange.
Under the bill, it is an unfair trade practice (see BACKGROUND) for a hospital to fail to take all reasonable actions needed to comply with these provisions or to otherwise unreasonably fail to facilitate the timely electronic exchange of patient health information.
The bill prohibits hospitals, unless required by federal law, from:
1. requiring providers to pay for any hardware, software, or other internal cost associated with the hospital's implementation or maintenance of its EHR system or
2. charging fees to connect to or exchange information through that system.
A violation is an unfair trade practice.
Under the bill, to the extent the exchange of patient health records between hospitals and providers, as described above, requires providers to install an interface or purchase additional software, information technology, services, or equipment, hospitals may donate these items to providers. They may do so only as allowed by federal law. (Federal regulations specify circumstances under which hospitals may donate certain EHR equipment to physicians without violating self-referral and anti-kickback laws.)
The bill allows providers to make written requests to hospitals for these donations. It requires the hospital to respond in writing within 30 days. Within 15 days after responding, the hospital must submit the request and its response to the DPH and consumer protection (DCP) commissioners.
The bill also authorizes a tax credit for hospitals that make these donations (see below).
Under the bill, if the DCP commissioner finds that a hospital has intentionally violated these provisions, he must forward his findings to the attorney general. The attorney general may investigate the complaint to determine whether the hospital violated the antitrust laws, to the extent the hospital's action constitutes a restraint of trade or an attempt to monopolize or otherwise reduces competition by dividing patients among providers, inducing patients to refuse to obtain services from certain providers, or reducing competition among providers.
§ 6 – HOSPITAL EQUIPMENT DONATION TAX CREDIT
The bill authorizes a tax credit for hospitals that donate EHR equipment to providers as specified above. The credit is against the tax on hospital net patient revenue (“hospital tax”). The credit is equal to the hospital's actual costs for the donated items, up to the amount of the hospital's tax liability for that year. The credit sunsets on January 1, 2021.
§ 7 – PROVIDER TAX CREDIT
The bill also authorizes tax credits for health care providers implementing or upgrading EHR systems. The credit is against the corporate business tax, hospital tax, or income tax.
The credit is for the provider's actual cost to implement a certified EHR system or upgrade an existing health records system to a certified system, up to the amount of the provider's liability under the applicable tax for that year. The credit sunsets on January 1, 2021.
Statewide Health Information Technology Plan
By law, the statewide health information technology plan must include (1) general standards and protocols for health information exchange, (2) electronic data standards to facilitate the development of a statewide, integrated electronic health information system for state-funded providers and institutions, and (3) pilot programs for health information exchange and the projected costs and sources of funding for these programs (CGS § 19a-25d).
PA 14-217 transferred to the social services commissioner the responsibility to implement and periodically revise the plan. He must do so in consultation with the DPH and mental health and addiction services commissioners.
Previously, this responsibility was vested in the Health Information Technology Exchange of Connecticut (HITE-CT), which the act eliminated. HITE-CT was a quasi-public agency that was also responsible for, among other things, developing a statewide health information exchange.
Connecticut Unfair Trade Practices Act (CUTPA)
This law prohibits businesses from engaging in unfair and deceptive acts or practices. CUTPA allows the DCP commissioner to issue regulations defining unfair trade practices, investigate complaints, issue cease and desist orders, order restitution in cases involving less than $5,000, enter into consent agreements, ask the attorney general to seek injunctive relief, and accept voluntary statements of compliance. It also allows individuals to sue. Courts may issue restraining orders; award actual and punitive damages, costs, and reasonable attorney's fees; and impose civil penalties of up to $5,000 for willful violations and $25,000 for violation of a restraining order.
Public Health Committee