The intent of SB 850 is relatively simple, its author Mark Leno (D-San Francisco) said yesterday at a Senate Judiciary Committee hearing.
"Specifically, the bill requires the electronic health record to log a change or deletion, and that change or deletion note needs to include the identity of whoever made the change," Leno said, adding "Without these requirements and protections, there could be real concern for the well-being of the patient."
Changes to an EHR can go unnoticed and can be harder to trace than changes made to paper records, according to Leno.
"The electronic health record.... this is going to be a revolutionary process in the next few years," Leno said. "So it's critical that the accuracy and integrity of the electronic health record remain high."
Teresa Stark of Kaiser Permanente had a different point of view, though.
"Kaiser's EHR is a billion-dollar investment," Stark said. "There is a log already maintained in it, that's already required."
The issue, she said, is that SB 850 as it's written could require copious amounts of data to be included up front, as part of the patient's EHR.
"I would liken it to online banking," Stark said. "Where we can see all of our deposits and withdrawals, but we don't see the back end, in terms of the people who touch our transactions."
Requiring every adjustment to be noted in the medical record itself could create an unwieldy document, she said. And, it would require a new level of administration in electronic systems.
"Our system can't do that, and we're not aware of any system that can," Stark said, adding, "Given the level of investment required to bring our EHR up to that level, is this really what we want to be spending our money on?"
The California Medical Association also raised concerns, saying the bill could conceivably set up two standards for EHRs -- one for federal law, one for state.
"This is new territory for us, so we do want to get this right," Leno said. "The devil is in the details, but what we're trying to do here is to make sure standards for paper records are just as stringent for EHR."
The measure passed the Senate Judiciary Committee yesterday in a 3-2 vote.