Public Health, Welfare and Labor Committee - Senate and House
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Speaker 1
0:00
Thank you.
Thank you.
Thank
you.
Thank you.
Thank you.
I don't know.
Thank you.
Speaker 1
8:30
Thank
you.
members would grab your seats we'll go ahead and get starting i need a motion to accept the
Representative Jeff Wardlaw
Unverified
9:11
minutes from last meeting any second all those in favor say aye all opposed eyes have it um we'll move right along to item c discussion of the state health alliance for records exchange
looks like we're going to have a couple people to the table health department if you guys would introduce yourselves for the record and y'all are recognized to present your items.
Speaker 29
10:03
Chief Science Officer, State Epidemiologist, Department of Health. Don Adams,
Speaker 30
10:08
Chief of Staff for the Health Department.
Speaker 31
10:10
Okay. Hi, everyone. I'm Ann Sanifar. I'm
Speaker 32
10:13
the Director of the Office of Health Information Technology that's now housed under the Arkansas Department of Health, and I'm just here today to tell you a little bit about our office and what we do. We are the Health Information Exchange for the State, and what that means is we connect directly to providers, hospitals and clinics, electronic medical records, and we aggregate the data at the health department.
The data comes in real time, and it's available to the patient's care team. You have to have a treatment provider that's taking care of a patient, a payment, a health plan that's paying that claim, or an operational need, so somebody that's helping coordinate the care of that patient. That's who's allowed to use our tool traditionally. The SHARE tool is meant to be used at a point of care,
so as a provider is taking care of you, if they have access to your previous medical records, Your allergies, your medications, diagnosis, any procedures you have done, that is all aggregated into a single central record, regardless of where you've been. So most EMRs traditionally don't talk to each other. So you may have heard of Care Everywhere, which is an Epic-branded platform. So Care Everywhere is just for Epic providers. There's like an Athena hub that's just for Athena user.
But these systems traditionally don't communicate with one another, and that's why health information exchanges have been established in just about, I think all 48 states have health information exchanges except for Illinois and Pennsylvania, maybe. Some states, like Texas and California, have multiple HIEs, which kind of defeats the purpose of having a central place to house all the medical records. When providers have access to this information, they are able to make faster decisions regarding your care.
They're able to hopefully reduce any duplicate tests because they already have access to the previous information. And then just better safety for us because if they see that you have an allergy to a specific drug or are on a medication that might not work with what they're trying to prescribe, they're able to make better informed decisions related to your health care. So that's share.
We are also, I should point out, Arkansas is an opt-out state, which means, if you're wondering, is my data in there? Most likely, when you completed all those documents, when you checked into your provider, there's a section on there that allows those records to be shared with SHARE. You are always welcome to opt out if you don't want your record shared electronically. But that just means your record can't be shared electronically. Your health insurance plan still has the right to request those records.
Your providers that are working on your care still have the right to access that information. So opting out just means your record's not shared electronically and instead is used either by fax or paper records. Representative Woolridge. Thank you, Mr. Chair, and thank
Representative Jeremy Wooldridge
Unverified
13:40
you for being here right in front of you. I wanted to know and maybe just start a conversation or
get your thoughts, the AI component of EHRs and medical health records.
What is that current component or what does that look like? I know that several states are talking about legislation and things that limit that component to make sure that they're still the human factor when it comes to medical decision making. Is that something you guys are working on, talking about, something we need to be looking at as we move towards the next session? I
Speaker 32
14:10
had a feeling you were going to ask about AI. So, yes, so AI is on its way to health care. It's here. I think whether we like it or not, I think we have to cautiously embrace it.
Some providers are using AI. I don't think they're using it for clinical decision-making. They're using it more. I had one provider tell me he wanted to create a treatment plan for a diabetic woman. So he put her information onto a chat GPT or whatever, and he created just a guide for this woman who is diabetic, who had very specific conditions. So I think providers are using to help them with that more than to actually make decision, clinical decisions using AI.
Representative Jeremy Wooldridge
Unverified
14:52
Follow-up, Mr. Chair. Who, I guess for lack of a better word, polices or monitors that to make sure that there are safeguards around that component in medical records?
Speaker 32
15:05
So the electronic medical record vendor would be the one that houses that AI component. I have heard, like at Mercy, for example, one way AI is being used in a positive way is doctor's notes. So you may have heard providers complain, and it's very burdensome for them to do what they call pajama notes.
So after hours, record note-taking and things like that. AI, there's a tool that Mercy uses where it's a note-taking AI bot. So the provider has a microphone. When he enters the room, he introduces himself. He introduces the people that are in the room, and then AI is able to take those notes for him. And then at the end of the day, rather than having to type up all the notes or be less engaged during the visit, he can focus more on the patient and let the AI bot take the notes.
But those are usually monitored. Like the provider would enter into a contract directly with that company, and the company together would police it. And I
Speaker 29
16:10
was just going to add, a lot of clinics and hospitals, they may have policies in place that regulate the usage of artificial intelligence for their clinical practices. So, I mean, a lot of it may be independently managed by those independent hospitals and clinics. Okay. I
Representative Jeremy Wooldridge
Unverified
16:27
appreciate that, and I appreciate the note-taking aspect of it
and understand the value there. I just wonder, from an organization standpoint, when we look at health care across the state, we would probably want some uniformity there. Who would be the agency or who would look at regulating or at least overseeing that to make sure that it's being utilized the same across the state? Um,
Speaker 32
16:50
there's been some conversations at the federal level to use AI for fraud, waste and abuse, uh, with the new administration. And I think there's a place for that. We'll just, um, if we were to engage with them, we would probably present it to the
board of health and bring that up as, because that would be a, what we call a new use case. It's not something that our data has traditionally been used for. So we would present it to the, to the board of health and let them,
Senator Fredrick J. Love
Unverified
17:21
uh, make that determination. Okay. Thank you, Mr. Chair. Senator Love. Thank you, Mr. Chair, and I'm going to stay with the same line of questioning. I just want to know about the informed consent, because it was good that you touched on the hospitals having their different, I guess, protocols,
but is there any informed consent given to the patients that you know of in regards to
AI treatment? Yeah, not that I'm aware of,
Speaker 29
17:47
Senator. in terms of patients having to provide some type of consent as to whether or not their provider can use that. Yeah, I'm not familiar with that. We can
Senator Fredrick J. Love
Unverified
17:57
look into it, though. Okay. All right. And then I want to go back just to the overall share system now.
All right, I'm familiar with – I'm trying to make sense of this. I'm familiar with the MyChart. Are you all the back end of MyChart? Is that what you're saying? You're connecting providers, like I use MyChart, somebody else could use whatever. So if
Speaker 31
18:22
you go to different providers, you probably have different MyCharts that you have to access, right? So UMS, they
Speaker 32
18:28
have Epic MyChart, but if I go to OrthoArkansas and they use Athena, that's a different, what they call a patient portal. What share is like a neutral aggregator.
So when these electronic medical records were created, you know, there was a lot of meaningful use money behind it. And they were created in a way where they don't talk to each other. So that was built in that sense. The systems don't talk to each other. So we need a neutral party, a mediator, such as an HIE-like share, to consume those records from different brands, right, of EMRs into a central location and make that available. Because otherwise our provider is not going to have a full picture of their patients.
Senator Fredrick J. Love
Unverified
19:09
Okay, got you. All right. So, yeah, all right. I'm putting it in my terms, the back
end of those systems. Okay. Secondly, let me ask about the information that is collected. None of this information is sold? Correct. Can you talk about that?
Speaker 32
19:26
Yeah, so our data is allowed to be used for TPO, so treatment, payment, or operational need. We require an existing relationship with that patient in order to view their records. So we, I don't want to say sell, but we do work with health plans, and we do provide them data back on their own members, and they do pay a fee to participate and share.
So share, the way we're funded is we get a portion of our funds from the federal government through Medicaid funding. We get a portion of it from providers who pay to participate in the exchange, and then we get a portion of our funds from payers who pay to be able to access their own member records. So, for example, like a bundled payment, right? When Medicaid pays a bundled payment, you don't see the individual visits under that patient in a claim, or you might not see lab results in a claim, but that's important
information, say, for Blue Cross. One example we do with Blue Cross is we send them all their members' A1C results. We have a lot of diabetics in Arkansas and a lot of pre-diabetics. So we send them all those A1C results on their members, and if they identify someone that's pre-diabetic, they go ahead and enroll them in a pre-diabetic prevention program. So there's things that come across our clinical data that's not available in a traditional claims that's very attractive to health plans, to private payers,
so they do engage with us we have most payers in arkansas participating in share okay
Senator Fredrick J. Love
Unverified
21:01
so is it just health plans that have access to this information or is
Speaker 31
21:06
it yeah so we do health plans or you may have heard
Speaker 32
21:09
of accountable care organizations or clinically integrated network they are like a group of providers that get together and assume risk and if there are savings they share the savings you know if there's no savings and they share the downfall but so providers get together and they say we want to create this group we're going to manage these
patients we're going to reduce their cost and then we're going to like share the savings so we do work with those organizations too they're risk-based organizations that the provider entered into a contract with and we're sharing the data back with that organization on the behalf of the provider. Okay. All right.
Speaker 63
21:53
Thank you. Thank you. Sorry. Senator Payton, you're back.
Senator John Payton
Unverified
22:00
Thank you, Madam Chair. It's very fortuitous that this has come up. I've had a little personal experience here in the last six weeks or two months that I had never dreamed that I'd have somebody right on topic sitting in front of me.
of me in committee but uh so before the databases and the computers uh we'd go to the doctor or provider and they'd have us fill out a questionnaire on paper you know and obviously they need to know all of those answers in order to treat you safely and effectively from what you described in your opening the database is supposed to uh make that available to providers for the same purpose so why
are we required to fill out the stupid form every time and and and i know it's funny but it's very aggravating so here's the thing uh i had to have surgery on my hand and so i fill out all the questionnaire and everything for Baptist health and they do the the nerve induction test and then schedule an appointment with a surgeon which was ortho Arkansas so I had to fill out another
big questionnaire for ortho Arkansas they did the surgery and I go back for the follow-up to get the stitches out and they want to force me to fill out that questionnaire again and i refused and went to my personal provider and got the stitches out but i mean it is ridiculous that you'd return within two or three weeks on a follow-up for a procedure that's been done and i can't fathom why they would force you to fill it out a second a third a fourth time
unless it's because they're getting paid two cents for every survey they turn into your group so are we incentivizing them to force this on the patients is there any medical reason to have somebody refill that out every two weeks
Speaker 31
24:08
or whatever when they're in a treatment
Speaker 32
24:10
series no i think sometimes the policy hasn't caught up with with the technology um but you know ortho arkansas and baptist are both connected to share so they're able to access each other's medical records using us so they could i think sometimes there's just hospital workflows or clinic
workflows that require somebody made this policy a while back that says you're going to come in you're going to answer these questions and then we're going to take you back to this room we're going to take your blood pressure they're not compensated by the number of um surveys they turn in i don't i don't think so i used i used to work at medicaid and i know um like for to do a depression screening sometimes you could get compensated by health plans but that was like once a year once every six months type
Senator John Payton
Unverified
24:55
of thing okay all right thank you thank you madam chair
Senator Missy Irvin
Unverified
24:57
thank you are there any other questions from members of the
committee all right okay um sorry representative long yes you're recognized
Representative Wayne Long
Unverified
25:10
thank you madam chairman um it's a little bit off the topic but y'all look like the right people to ask this question right after the governor took office she did a executive order requiring the health department to explain or at least give the data
to people that are considering taking COVID shots about the adverse reactions and I checked with a couple of health department units and they didn't know what I was talking about so I'm wondering if that never got implemented, or if they just maybe weren't not trained to distribute that information. Representative
Long, to my knowledge, we're in compliance with all the executive orders. I would
have to look specifically into this situation, and if we have a local health unit or two that are out there that aren't doing what they're supposed to do, we'd really like to look into it. Um, Mr. Gilmore may know a little bit more about this. Thank you.
Matt Gilmore
Unverified
26:17
Matt Gilmore, Department of Health, Representative Long. This is the, there was legislation and I'm familiar with it. I think the wording of the legislation spoke to, uh, posting it on our website, but we can, we can make sure that our health units have all that information specifically and we can, and I'll have to get with you about these particular, but we do the, I think the
language of the law required it to be on our website. And so that's what we're trying to make sure we're in compliance with. but
Representative Wayne Long
Unverified
26:43
we're happy to visit about any specific yeah because you know most people don't go on websites before they they visit and even if they do the health department's website's sort of hard to navigate so yes it's big i agree but uh you know if they you know if it's just a handout just so people know that like you know there's there's some people that have had adverse reactions to these shots and they might want to you know be able to make an informed consent whether or not they want to do
Matt Gilmore
Unverified
27:06
it and i may if you don't mind um i do think we um we are there are some fact
sheets we're required to give them i think and also there's an insert and that sort of thing that we're required to make sure they're aware of and that sort of thing and i don't anyway but yeah that we'll double i'll get with you after this is over and make sure we're on the same page as
Senator Missy Irvin
Unverified
27:28
far as what health units this was thank you very much i appreciate it all right and seeing any other further questions. All right. Thank you so much for your testimony. Let's see. Is there any other business to come before the committee?
Speaker 73
27:39
All right. Seeing none, I'll turn it back over to
Unknown speaker
27:41
you. See you none. We stand adjourned. Thank you.
Thank you.
Agenda
A. Call to Order
B. Consideration to Approve the July 28, 2025, Meeting Minutes [Exhibit B]
C. Discussion of Arkansas State Health Alliance for Records Exchange (SHARE) [Exhibits C1-C4]
D. Other Business
E. Adjournment
Documents
| Title | Type | Pages | Source |
|---|---|---|---|
| Agenda — PUBLIC HEALTH WELFARE AND LABOR COMMITTEE - SENATE AND HOUSE, Aug 6, 2025 | Agenda | 1 | Official source ↗ |
| Exhibit B- Draft Minutes 07-28-2025 | Exhibit | 1 | Official source ↗ |
| Exhibit C1- SHARE Fact Flyer | Exhibit | 1 | Official source ↗ |
| Exhibit C2- SHARE Summer Newsletter 2025 | Exhibit | 4 | Official source ↗ |
| Exhibit C3- Tired of waiting Handout | Exhibit | 1 | Official source ↗ |
| Exhibit C4- 24 Hour Report Flyer | Exhibit | 1 | Official source ↗ |
Speakers
Speaker 1
Speaker 16
Speaker 2
Speaker 12
Speaker 8
Speaker 20
Speaker 7
Representative Jeff Wardlaw
Unverified
Speaker 29
Speaker 30
Speaker 31
Speaker 32
Representative Jeremy Wooldridge
Unverified
Senator Fredrick J. Love
Unverified
Speaker 63
Senator John Payton
Unverified
Senator Missy Irvin
Unverified
Representative Wayne Long
Unverified
Matt Gilmore
Unverified
Speaker 73