Health care information technology.

WORKING DRAFT
2006
STATE OF
WYOMING
06LSO-0261

SENATE FILE

NO.
SF0050

Health care information technology.

Sponsored by:
Joint Labor, Health and Social Services Interim Committee

A BILL

for

AN ACT relating to public health and safety; providing for electronic health records; providing for the designation of a regional health information organization; providing for contracting with the regional health information organization for development of a system of electronic health records; providing priorities in system development; providing protections for patient privacy; providing for development of incentives for use of the system; providing appropriations; authorizing additional positions; and providing for an effective date.

Be It Enacted by the Legislature of the State of
Wyoming
:

Section 1.
W.S. 35
‑
29
‑
101 through 35
‑
29
‑
10
6
are created to read:

CHAPTER 29
REGIONAL HEALTH INFORMATION ORGANIZATION

35
‑
29
‑
101.

Definitions.

(a)

As used in this act:

(i)

"Continuity of care record" means an electronic record which is a summary of patient health information. A continuity of care record contains the electronic health record or the portion of the electronic health record most likely to be useful to a new health care provider treating a patient and shall contain identifying information needed to associate an individual with the record and other pertinent information;

(ii)

"Department"
means the department of health
;

(iii)

"Electronic health record" means a record stored electronically containing medical and other health related information about an individual and containing identifying information needed to associate an individual with the record and any other pertinent information;

(iv)

"Electronic medical record" means a record stored electronically containing medical information about an individual, identifying information needed to associate an individual with the record and any other pertinent information. An electronic medical record is a subset of an electronic health record;

(v)

"Hub" means a centralized computer software function that receives, translates and transmits information among various electronic health record systems. A hub may also facilitate data management including but not limited to all or portions of electronic health records and may develop reports and perform other functions needed for a functioning statewide electronic health records system;

(vi)

"Personal health record" means that part of an electronic record that an individual may access and make available to others, and includes a record of the sources of information and those persons to whom it has been transferred;

(vii)

"RHIO" means the regional health information organization for
Wyoming
;

(viii)

"This act" means W.S. 35
‑
29
‑
101 through 35
‑
29
‑
10
6
.

35
‑
29
‑
102.

Regional health information organization designation; contracting with the regional health information organization.

(a)

The department, with the approval of the governor and guided by the report
from
the health care commission developed as required by 2004 Wyoming Session Laws
,
Chapter 100, Section 1(b), shall designate an organization as the RHIO for the state of
Wyoming
.

(b)

The department shall contract with the RHIO for the development and operation of systems to enable and facilitate the operation of electronic health records capable of interchanging information within the state and to the extent feasible outside the state.

(c)

The contract pursuant to subsection (b) of this section shall provide for the:

(i)

Development, installation and operation of the hub;

(ii)

Modification and updating of the hub to accommodate new applications and new national or international governmental or industry standards;

(iii)

Accommodating and integrating to the extent feasible information from electronic health record and medical record systems used by Wyoming hospitals, physicians, other Wyoming health care providers, state agencies and, if possible, federal government providers including but not limited to the veterans administration and the Indian health service;

(iv)

Safeguards and requirements set forth in W.S. 35
‑
29
‑
106;

(v)

A right for the department to terminate the contract for unsatisfactory performance.

35
‑
29
‑
103.

Regional health information organization; addition of hospitals and other health care providers.

(a)

The RHIO in consultation with the department shall select hospitals to participate in the statewide health information system via the hub. The RHIO shall divide the hospitals in the state into two (2) groups as follows:

(i)

"Group I" means those hospitals with functioning internal electronic medical records; and

(ii)

"Group II" means those hospitals without electronic medical records or with partial systems.

(b)

The RHIO in consultation with the department shall rank group I hospitals in priority order based on the following criteria:

(i)

The readiness of the hospital and its system to interface with the hub, the cost of implementing that interface and the willingness of the hospital administration to do so;

(ii)

The number of patients whose hospital medical records will be available via the hub and the expected startup and ongoing cost per patient;

(iii)

The percentage of practicing physicians and other health care providers willing and able to efficiently interface with either the hospital system directly or the hospital system via the hub and the cost per provider; and

(iv)

Any other criteria relevant to cost effective and timely connection of a hospital system to the hub.

(c)

The RHIO in consultation with the department shall rank group II hospitals in priority order based on the following criteria:

(i)

The willingness and readiness of the hospital to install an electronic medical records system to interface with the hub and the estimated cost of the installation;

(ii)

The percentage of patients whose hospital medical records will be available via the hub and the expected startup and ongoing cost per patient;

(iii)

The percentage of the physicians and other health care providers in the community ready and willing to install electronic medical records systems to interface with the hub;

(iv)

Any other criteria relevant to cost effective and timely connection of a hospital system to the hub.

(d)

The RHIO, using funds obtained pursuant to contract with the department and other available sources, shall fund, with a fifty percent (50%) local match requirement, the incremental costs of interfacing existing hospital electronic medical record systems with the hub and, where needed, purchasing and installing new or new parts for hospital electronic medical record systems that interface with other systems via the hub. The RHIO with the approval of the department may waive or partially waive the local match requirement for group II hospitals in whole or in part to the extent the size of the hospital, patient characteristics or other factors make local funding unrealistic. The RHIO shall disburse available funds based on the priority lists developed pursuant to subsections (b) and (c) of this section. To the extent practical, the RHIO shall fund at least one (1) hospital in group II for every two (2) hospitals funded from group I, but shall disregard this requirement when all willing institutions in either group are funded.

(e)

In selecting the first group of hospitals for funding, the RHIO shall select for a reasonable distribution by location and hospital size.

(f)

In making priority and funding decisions the RHIO shall not discriminate against a hospital or other provider based on its status as for profit, not for profit or governmental. However, no hospital, institution or other health care provider shall be funded which is unwilling to treat Medicaid clients, persons insured through state and local government health care programs and persons whose care is the financial responsibility of the state. Any hospital or institution which discriminates against those persons via a quota or similar system shall have the lowest priority for funding.

(g)

The RHIO with the approval of the department may fund, on a matching basis of up to fifty percent (50%), the incremental start-up and system upgrade costs for one (1) or more of the following institutions to participate in the statewide electronic health records system via the hub:

(i)

Any nonprofit community health center operating within the state;

(ii)

Any voluntary nonprofit clinic providing medical care to the poor for free or for a nominal fee;

(iii)

Rural nonprofit health clinics.

(h)

The RHIO may provide technical and consultative services to any
Wyoming
health care provider seeking to interface with the statewide electronic health care records system via the hub. Subject to the restrictions of subsection (f) of this section, the RHIO in consultation with the department may develop a pilot program of financial assistance and incentives for other health care providers in
Wyoming
including providers in private practice to install electronic health records or electronic medical records. In developing the pilot program the RHIO shall consider using incentives for providers such as personal digital assistants or other devices loaded with relevant drug formularies and the Wyoming Medicaid preferred drug list and capable of transmitting electronic prescriptions entered by the provider. The pilot program shall be implemented only with the approval of the department.

(
j
)

The RHIO may fund projects and assistance to institutions outside the priorities established pursuant to this section to meet the requirements of grant and contract funders other than the department and may, with the approval of the department, use state funds obtained via the contract to meet matching requirements in such circumstances.

35
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29
‑
104.

Electronic health care record systems; applications; interfacing with the hub.

(a)

The RHIO shall develop the following applications for the electronic health care record system interfacing via the hub:

(i)

Electronic prescribing enabling prescribers to write electronic prescriptions and have them sent electronically to pharmacies;

(ii)

Continuity of care records which shall be an electronic summary of patient health information that would be available to providers treating the patient in any setting interfacing with the hub;

(iii)

Local provider access to hospital information systems either directly or via the hub; and

(iv)

Administrative transaction processing to provide administrative functions such as a claims processing and eligibility checking service for providers to process insurance transactions electronically with their payers provided that development of this function may be discontinued if information from providers indicates existing systems are adequate and cost effective for this function without the state effort.

(b)

The RHIO shall prepare in the future, subject to funding and priorities, to implement the following functions to interface via the hub:

(i)

A registry of information on the administration of vaccine to individuals possibly as part of the continuity of care record;

(ii)

A registry of individual advance directives.

35
‑
29
‑
105.

Operating costs.

Subject to legislative appropriation, the department shall plan to meet all operating costs of the RHIO not funded through grants from other sources for the fiscal biennium commencing July 1, 2006. The RHIO shall develop a plan to cover all operating costs via earnings and provider fees once the system is fully implemented on a statewide basis. The plan shall include a schedule of the professional staff needed to operate and maintain the hub and provide technical assistance to provider and institutional users. The plan shall be submitted to the joint labor, health and social services interim committee by October 1, 2007.

35
‑
29
‑
106.

Conditions and precautions.

(a)

The statewide electronic health care records and the hub shall be compliant with the patient privacy requirements of the federal Health Insurance Portability and Accountability Act of 1996 and subsequent similar enactments
.

(b)

The hub shall be constructed so that it cannot be used by employers in their capacity as employers and insurance companies to access individual continuity of care records or inappropriate parts of individual health or medical records. Information needed to pay claims and information useful for providing care where an insurer is a health maintenance organization or similar organization that provides care is appropriate access.

(c)

The chief state information officer in his standard budget shall request funds for third party security audits of the RHIO, the hub and related systems to ensure compliance with privacy provisions and identify security weaknesses in need of improvement.

(d)

Individuals are entitled to access and copy information in their individual continuity of care record and vaccination records. The RHIO shall develop appropriate procedures to make this access practical, secure and inexpensive.

(e)

Except when the patient has opted not to make his information available, the RHIO may make information in electronic health or medical records accessed via the hub available in a de-identified form for legitimate medical, health related or public policy research. Where the research is valuable for commercial purposes, the RHIO may charge a fee which shall be used to support the operation of the RHIO. Where such research finds information of value to a patient whose de-identified data is being used, the RHIO may disclose the information to the patient either directly or via his health care provider. Where identified information is sought for research, it may be disclosed only with the consent of the person whose information is sought or his appropriate legal guardian, representative or surrogate.

Section 2.

(a)

The department shall report to the joint labor, health and social services interim committee before November 15, 2006 on the possible use of enhanced Medicaid reimbursement as an incentive for providers to use electronic medical records that interface with the hub as provided in
s
ection 1 of this act.

(b)

If the federal government, with respect to electronic prescribing of drugs for Medicare or another federal program, preempts state pharmacy law or regulations relating to prescribing of drugs, the state board of pharmacy shall promulgate regulations allowing all electronic prescribing in
Wyoming
to conform to the federal requirements. The state board of pharmacy shall report to the joint labor, health and social services interim committee regarding any conforming changes needed in state law.

Section 3.

(a)

There is appropriated from the general fund to the department of health twenty million ninety-four thousand four hundred forty dollars ($20,094,440.00) for the development, testing and implementation of the hub and the applications provided in
s
ection 1 of this act. The appropriation shall
not revert as provided in W.S. 9
‑
4
‑
207
but shall remain available until expended.

(b)

There is appropriated from the general fund to the department of health nine hundred forty-six thousand four hundred seventy-one dollars ($946,471.00) for the operating and technical assistance expenses of the RHIO established by this act.

(c)

There is appropriated from the general fund to the department of health thirty-seven million dollars ($37,000,000.00) for financial assistance to hospitals, other institutions and health care providers as provided by this act. Funds appropriated under this subsection may be encumbered by contract with the regional health information organization only before July 1, 2008.

(d)

There is appropriated from the general fund to the department of administration and information forty thousand dollars ($40,000.00) for security audits by the state chief information officer, including pre-audits during the development of the hub.

(e)

There is appropriated from the general fund to the department of health two hundred forty thousand dollars ($240,000.00) and three (3) additional positions are authorized to implement the purposes of this act.

(f)

With the approval of the department of health, the regional health information organization may move funds appropriated by subsection
s
(a) and (c) of this section and provided to the regional health information organization by the department via contract from one function to the other.

Section 4.
This act is effective immediately upon co
m
pletion of all acts necessary for a bill to become law as provided by Article 4, Section 8 of the Wyoming Constit
u
tion.

(END)

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SF0050