BILL ANALYSIS                                                                                                                                                                                                    



                                                                  AB 329
                                                                  Page  1

          Date of Hearing:   April 17, 2007

                   ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
                                   Mike Eng, Chair
                   AB 329 (Nakanishi) - As Amended:  March 29, 2007
           
          SUBJECT  :   Chronic diseases: telemedicine.

           SUMMARY  :   Requires the Medical Board of California (MBC) to  
          establish a pilot program to expand the practice of  
          telemedicine, as specified.  Specifically,  this bill  :  

          1)Authorizes MBC to implement the pilot program by convening a  
            working group of interested parties from the public and  
            private sectors, including state health-related agencies,  
            health care providers, health plan administrators, information  
            technology groups, and groups representing health care  
            consumers.

          2)Requires members of the working group to discuss the means of  
            delivering health care to those with chronic diseases, and  
            assist in developing a plan for offering the best practices in  
            a telemedicine model in order to reach all Californians, using  
            innovative health information technologies as a means by which  
            to share nationally accepted chronic disease management  
            techniques throughout the state.

          3)Requires MBC to make a report with its recommendations  
            regarding its findings to the Legislature on or before January  
            1, 2009, and requires the report to include an evaluation of  
            the improvement and affordability of health care services and  
            the reduction in the number of complications achieved by the  
            pilot program. 

           EXISTING LAW  :

          1)Provides for the licensing and regulation of dentists by the  
            Dental Board of California, podiatrists by the California  
            Board of Podiatric Medicine, psychologists by the Board of  
            Psychology and marriage and family therapists and licensed  
            clinical social workers by the Board of Behavioral Sciences.

          2)Defines "telemedicine" as the practice of health care  
            delivery, diagnosis, consultation, treatment, transfer of  
            medical data, and education using interactive audio, video, or  








                                                                  AB 329
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            data communications.  Neither a telephone conversation nor an  
            electronic mail message between a health care practitioner and  
            patient constitutes telemedicine.

          3)Defines "interactive" as an audio, video, or data  
            communication involving a real time (synchronous) or near real  
            time (asynchronous) two-way transfer of medical data and  
            information.

          4)Provides that the term "health care practitioner" includes a  
            physician and surgeon, podiatrist, clinical psychologist,  
            marriage and family therapist, licensed clinical social  
            worker, or dentist.

           FISCAL EFFECT  :   Unknown

           COMMENTS  :   

           Purpose of this bill  .  According to the author's office:   
          "Chronic diseases, such as diabetes and obesity, cost California  
          tens-of-billions of dollars annually.  For example, over 2  
          million Americans currently suffer from diabetes, with this  
          number expected to double by 2025.  Similarly, obesity  
          constitutes the second leading cause of preventable death in  
          California, and costs the State $28.5 billion annually in health  
          care costs, lost productivity, and workers' compensation.   
          Consequently, developing a state-wide best practices model by  
          which to manage these and other chronic diseases could result in  
          thousands of saved lives and significant cost reductions within  
          the State's health care system.  

          "Assembly Bill 329 would require the Medical Board of California  
          to convene health care providers and information technology  
          groups in order to develop a mechanism by which to deliver  
          health care, and deliver information about disease management  
          best practices, using a telemedicine model.  By establishing  
          such a system, significant cost savings would be accrued due to  
          more expedient and professional care as well as a reduction in  
          the number of medical errors resulting from inaccessible or  
          inadequate disease management guidelines.  Furthermore, such as  
          system would both increase investment in rural health care  
          economies and improve access to expert treatment within those  
          communities.  Ultimately, such a system would save more than  
          23,000 lives and $4 billion annually within the State."









                                                                  AB 329
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           Background  .  The 1996 "Telemedicine Development Act" (Act)  
          declares that lack of primary care, specialty providers, and  
          transportation are significant barriers to access to health  
          services in medically underserved rural and urban areas, and  
          that these areas of California have difficulty attracting and  
          retaining health professionals, as well as supporting local  
          health facilities to provide a continuum of health care.  The  
          Act also declares that many health care providers to medically  
          underserved rural and urban areas are isolated from mentors,  
          colleagues and the information resources necessary to support  
          them personally and professionally.  Telemedicine is part of a  
          multifaceted approach to address the problem of provider  
          distribution and the development of health systems in medically  
          underserved areas by improving communication capabilities and  
          providing convenient access to up-to-date information,  
          consultations, and other forms of support.  

          The Act specifies a number of requirements that must be followed  
          by health care practitioners prior to delivery of health care  
          via telemedicine, including the professional review of specified  
          healing arts licensees by a peer review body, as defined,  
          including a medical or professional staff of any licensed health  
          care facility or clinic, health care service plan, specified  
          health professional societies, or a committee organized by any  
          entity that functions as a body to review the quality of  
          professional care provided by specified health care  
          practitioners.  The licentiates included are physicians,  
          podiatrists, clinical psychologists, marriage and family  
          therapists, clinical social workers, and dentists.

           REGISTERED SUPPORT / OPPOSITION  :   

           Support 
           
          None on file.

           Opposition 
           
          None on file.
           
          Analysis Prepared by  :    Ross Warren / B. & P. / (916) 319-3301