California Tightens EHR Security

California governor Jerry Brown recently signed two bills that define how electronic health records (EHRs) and telehealth technology will be used by healthcare delivery organizations. Beginning January 1, 2012, hospitals, physician practices, and other healthcare stakeholders that manage patient information will be required to track and log any changes that are made to information stored in EHRs, as well as protect the confidentiality of medical information contained in EHRs.

Passage of SB 850, the Confidentiality of Medical Information Act, establishes rules for securely managing changes to patient information contained in EHRs. It comes amid a number of well-publicized breaches of computerized patient information.

The law requires that every healthcare provider, healthcare service plan, pharmaceutical company, and contractor who creates, maintains, preserves, stores, abandons, destroys, or disposes of medical records do so in a manner that preserves the confidentiality of the information contained in the record. The law also says that "negligence in conducting these activities may result in damages or an administrative fine or civil penalty, as specified."

"SB 850 gives California state regulators more power to ensure quality healthcare is available throughout the state in a private and secure manner," Dave Roberts, VP of government relations for the Healthcare Information and Management Systems Society (HIMSS), told InformationWeek Healthcare.

[Legally, EHRs are double-edged swords: They protect clinicians from malpractice litigation but also put them at greater risk. See Electronic Records May Increase Malpractice Lawsuit Risk.]

In a document that examines how the bill will impact providers, HIMSS focused on that part of the legislation that requires an EHR system to "automatically record and preserve any change or deletion of electronically stored medical information, and would require the record to include, among other things, the identity of the person who accessed and changed the medical information and the change that was made to the medical information."

According to HIMSS, SB 850 could have an impact on costs to providers when requests are made for EHR records, but the law is similar to existing federal laws. Providers should be mindful that:

-- Upon request, lawyers may be able to access these change/deletion logs, even though patients will not receive them. Additional discovery request costs may be incurred to the provider in these instances.

-- Changes and deletions to patient records shall include the identity of the person who accessed and changed the medical information; the date and time the medical information was accessed; and the change, if any, that was made to the medical information.

"We note that the format of these logs could vary between vendors and therefore [are] not standardized for readability or content; this law might serve as an entry point for the state to move in that direction, further complicating the 50 states, 50 rules scenario which is also a factor in the pharmaceutical labeling and packaging domains," HIMSS said in its statement.

This month, Gov. Brown also signed AB 415, the Telehealth Advancement Act of 2011. It broadens the range of practitioners who can practice telehealth to include all licensed healthcare professionals. The bill also removes restrictions on reimbursement of services provided via email or telephone, expands the number of telehealth care settings, and makes it easier for California hospitals to establish medical credentials for telehealth providers.

A report from the Center for Connected Health Policy said that implementing the provisions in AB 415 could lower the cost of care for Medi-Cal, California's Medicaid program, by more than $1.3 billion each year. For example, these savings would come from disease management programs that use electronic home monitoring systems to track patients' vital signs or medication adherence, which are measures that can help prevent hospital readmissions for patients with chronic diseases.

In his reaction to the passage of AB 415, Jon Linkous, CEO of the American Telemedicine Association (ATA), said that by eliminating outdated requirements that restrict a patient's ability to receive remote health services via video or store and forward, the law will let healthcare providers in California use modern technology to improve care, increase access, and lower costs. He also said the ATA estimates that the use of telehealth technologies has doubled in the last two years and is growing at a fast clip. The law, therefore, addresses the expanded use of telehealth as a way to improve the quality of care.

"California's new law is a significant step forward for telehealth and serves as a challenge for other states to adopt similar legislation," Linkous told InformationWeek Healthcare. "While several states have adopted legislation expanding the use of telehealth, California has clearly taken the lead and the residents of the state will benefit from its leadership in this area."