Relating to electronic health record requirements; authorizing a civil penalty, the official text

S.B. No. 1188

AN ACT

relating to electronic health record requirements; authorizing a

civil penalty.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subtitle I, Title 2, Health and Safety Code, is

amended by adding Chapter 183 to read as follows:

CHAPTER 183. ELECTRONIC HEALTH RECORDS

Sec. 183.001. DEFINITIONS. In this chapter:

(1) "Biological sex" means the biological trait that

determines whether a sexually reproducing organism produces male or

female gametes.

(2) "Covered entity" has the meaning assigned by

Section 181.001. The term includes a health care practitioner. The

term does not include:

(A) a home and community support services agency

licensed under Chapter 142;

(B) a nursing facility licensed under Chapter

242;

(C) a continuing care facility regulated under

Chapter 246;

(D) an assisted living facility licensed under

Chapter 247;

(E) an intermediate care facility licensed under

Chapter 252;

(F) a day activity and health services facility

licensed under Chapter 103, Human Resources Code; or

(G) a provider under the Texas home living

(TxHmL) or home and community-based services (HCS) waiver program.

(3) "Female" means an individual whose reproductive

system is developed to produce ova.

(4) "Health care practitioner" means an individual who

is licensed, certified, or otherwise authorized to provide health

care services in this state.

(5) "Male" means an individual whose reproductive

system is developed to produce sperm.

(6) "Sexual development disorder" means a congenital

condition associated with atypical development of internal or

external genital structures. The term includes a chromosomal,

gonadal, or anatomic abnormality.

Sec. 183.002. REQUIREMENTS FOR ELECTRONIC HEALTH RECORD

STORAGE. (a) A covered entity shall ensure that electronic health

records under the control of the entity that contain patient

information are physically maintained in the United States or a

territory of the United States. This subsection applies to:

(1) electronic health records that are stored by a

third-party or subcontracted computing facility or an entity that

provides cloud computing services; and

(2) electronic health records that are stored using a

technology through which patient information may be electronically

retrieved, accessed, or transmitted.

(b) A covered entity shall ensure that the electronic health

record information of this state's residents, other than open data,

is accessible only to individuals who require the information to

perform duties within the scope of the individual's employment

related to treatment, payment, or health care operations.

(c) Each covered entity shall implement reasonable and

appropriate administrative, physical, and technical safeguards to

protect the confidentiality, integrity, and availability of

electronic health record information.

Sec. 183.003. REQUIRED MEDICAL HISTORY INFORMATION IN

ELECTRONIC HEALTH RECORD. A covered entity shall ensure each

electronic health record maintained for an individual includes the

option for a health care practitioner to collect and record

communications between two or more covered entities related to the

individual's metabolic health and diet in the treatment of a

chronic disease or illness.

Sec. 183.004. INFORMATION RESTRICTIONS IN ELECTRONIC

HEALTH RECORD. A covered entity may not collect, store, or share

any information regarding an individual's credit score or voter

registration status in the individual's electronic health record.

Sec. 183.005. ARTIFICIAL INTELLIGENCE IN ELECTRONIC HEALTH

RECORD. (a) A health care practitioner may use artificial

intelligence for diagnostic purposes, including the use of

artificial intelligence for recommendations on a diagnosis or

course of treatment based on a patient's medical record, if:

(1) the practitioner is acting within the scope of the

practitioner's license, certification, or other authorization to

provide health care services in this state, regardless of the use of

artificial intelligence;

(2) the particular use of artificial intelligence is

not otherwise restricted or prohibited by state or federal law; and

(3) the practitioner reviews all records created with

artificial intelligence in a manner that is consistent with medical

records standards developed by the Texas Medical Board.

(b) A health care practitioner who uses artificial

intelligence for diagnostic purposes as described by Subsection (a)

must disclose the practitioner's use of that technology to the

practitioner's patients.

Sec. 183.006. ACCESS TO ELECTRONIC HEALTH RECORD OF MINOR.

(a) In this section, "minor" means an individual 17 years of age or

younger who has not had the disabilities of minority removed for

general purposes.

(b) A covered entity shall ensure each electronic health

record system the entity uses to store electronic health records of

minors allows a minor's parent or, if applicable, the minor's

managing conservator or guardian to obtain complete and

unrestricted access to the minor's electronic health record

immediately, unless access to all or part of the record is

restricted under state or federal law or by a court order.

Sec. 183.007. ELECTRONIC HEALTH RECORD REQUIREMENTS

REGARDING BIOLOGICAL SEX. (a) Notwithstanding any other law, the

commission, the Texas Medical Board, and the Texas Department of

Insurance shall jointly ensure that:

(1) each electronic health record prepared or

maintained by a covered entity in this state includes a separate

space for the entity to document:

(A) an individual's biological sex as either male

or female based on the individual's observed biological sex

recorded by a health care practitioner at birth; and

(B) information on any sexual development

disorder of the individual, whether identified at birth or later in

the individual's life; and

(2) any algorithm or decision assistance tool included

in an electronic health record to assist a health care practitioner

in making medical treatment decisions includes an individual's

biological sex as recorded in the space described by Subdivision

(1)(A).

(b) This section does not prohibit an electronic health

record from including spaces for recording other information

related to an individual's biological sex or gender identity.

Sec. 183.008. AMENDING CERTAIN BIOLOGICAL SEX INFORMATION

IN ELECTRONIC HEALTH RECORDS. (a) A covered entity may amend on an

electronic health record an individual's biological sex as recorded

in the space described by Section 183.007(a)(1)(A) only if:

(1) the amendment is to correct a clerical error; or

(2) the individual is diagnosed with a sexual

development disorder and the amendment changes the individual's

listed biological sex to the opposite biological sex.

(b) If an individual's biological sex is amended under

Subsection (a)(2), the covered entity shall include in the

individual's electronic health record information on the

individual's sexual development disorder in the space described by

Section 183.007(a)(1)(B).

Sec. 183.009. INVESTIGATION BY COMMISSION OR REGULATORY

AGENCY. The commission or the appropriate regulatory agency shall

conduct an investigation of any credible allegation of a violation

of this chapter by a covered entity. The commission or agency shall

ensure the investigation is conducted in compliance with all

applicable state and federal laws, including the Health Insurance

Portability and Accountability Act of 1996 (Pub. L. No. 104-191).

Sec. 183.010. DISCIPLINARY ACTION BY REGULATORY AGENCY.

The appropriate regulatory agency may take disciplinary action

against a covered entity that violates this chapter three or more

times in the same manner as if the covered entity violated an

applicable licensing or regulatory law. The disciplinary action

may include license, registration, or certification suspension or

revocation for a period the agency determines appropriate.

Sec. 183.011. INJUNCTIVE RELIEF; CIVIL PENALTY. (a) The

attorney general may institute an action for injunctive relief to

restrain a violation of this chapter.

(b) In addition to the injunctive relief provided by

Subsection (a), the attorney general may institute an action for

civil penalties against a covered entity for a violation of this

chapter. A civil penalty assessed under this section may not

exceed:

(1) $5,000 for each violation that is committed

negligently and that occurs in a single year, regardless of how long

the violation continues during that year;

(2) $25,000 for each violation that is committed

knowingly or intentionally and that occurs in a single year,

regardless of how long the violation continues during that year; or

(3) $250,000 for each violation in which the covered

entity knowingly or intentionally used protected health

information for financial gain.

Sec. 183.012. MEMORANDUM OF UNDERSTANDING; RULES. The

executive commissioner, the Texas Medical Board, the Texas

Department of Licensing and Regulation, the Texas Department of

Insurance, and each regulatory agency subject to this chapter shall

enter into a memorandum of understanding and, as necessary, adopt

rules to implement this chapter.

SECTION 2. (a) Except as provided by Subsection (b) of this

section, Chapter 183, Health and Safety Code, as added by this Act,

applies only to an electronic health record prepared on or after the

effective date of this Act.

(b) Section 183.002, Health and Safety Code, as added by

this Act, applies to the storage of an electronic health record on

or after January 1, 2026, regardless of the date on which the

electronic health record was prepared.

SECTION 3. If before implementing any provision of this Act

a state agency determines that a waiver or authorization from a

federal agency is necessary for implementation of that provision,

the agency affected by the provision shall request the waiver or

authorization and may delay implementing that provision until the

waiver or authorization is granted.

SECTION 4. This Act takes effect September 1, 2025.

______________________________
______________________________

President of the Senate
Speaker of the House

I hereby certify that S.B. No. 1188 passed the Senate on

April 7, 2025, by the following vote: Yeas 23, Nays 7; and that

the Senate concurred in House amendment on May 28, 2025, by the

following vote: Yeas 23, Nays 8.

______________________________

Secretary of the Senate

I hereby certify that S.B. No. 1188 passed the House, with

amendment, on May 23, 2025, by the following vote: Yeas 86,

Nays 49, three present not voting.

______________________________

Chief Clerk of the House

Approved:

______________________________

Date

______________________________

Governor