TX SB 1188: Relating to electronic health record requirements; authorizing a civil penalty.

In one paragraph

Texas's SB 1188 is an electronic health record (EHR) law. Health care practitioners may use AI for diagnostic purposes, including recommendations on a diagnosis or course of treatment based on a patient's medical record, if acting within their license, the use is not otherwise restricted by law, and they review all AI-created records consistent with Texas Medical Board standards; they must disclose that use to patients. EHRs must be kept physically in the U.S. or a U.S. territory (for storage from January 1, 2026), and EHR algorithms that aid treatment decisions must include the recorded biological sex. AG civil penalties apply. Signed June 20, 2025; effective September 1, 2025.

Plain-English summary, written with AI assistance. The official text controls.

What it means for business

Practitioners using AI for diagnosis must stay within their license, review AI-created records under Texas Medical Board standards and tell patients. Covered entities must keep EHRs physically in the U.S. or a U.S. territory from Jan. 1, 2026, subject to AG civil penalties and agency discipline.

Key provisions

1. 1A health care practitioner may use AI for diagnostic purposes, including AI recommendations on a diagnosis or course of treatment based on a patient's medical record, if the practitioner acts within the scope of their license, certification or authorization; the particular use is not otherwise restricted or prohibited by state or federal law; and the practitioner reviews all records created with AI consistent with Texas Medical Board medical records standards (Health & Safety Code § 183.005(a))
2. 2A practitioner who uses AI for diagnostic purposes must disclose the use of that technology to their patients (§ 183.005(b))
3. 3The Health and Human Services Commission, Texas Medical Board and Texas Department of Insurance must jointly ensure each EHR has a separate space for biological sex (male or female, as observed and recorded by a practitioner at birth) and for any sexual development disorder, and that any algorithm or decision assistance tool in an EHR that helps practitioners make treatment decisions includes the recorded biological sex (§ 183.007); that entry may be amended only for a clerical error or a diagnosed sexual development disorder (§ 183.008)
4. 4Covered entities (including health care practitioners; excluding home and community support agencies, nursing, assisted living and certain other facilities) must keep EHRs containing patient information physically in the U.S. or a U.S. territory, including records held by third-party or cloud providers; this applies to storage on or after January 1, 2026, whenever the record was prepared (§ 183.002; Section 2(b))
5. 5Other rules: EHR access limited to those who need it for treatment, payment or health care operations, with reasonable safeguards; an option to record communications on metabolic health and diet in treating chronic disease; no credit score or voter registration status in EHRs; parents, managing conservators or guardians get complete, immediate access to a minor's EHR unless restricted by law or court order (§§ 183.002-183.004, 183.006)
6. 6Enforcement: HHSC or the regulatory agency must investigate credible allegations; agencies may discipline covered entities with three or more violations, including license suspension or revocation; the Attorney General may seek injunctions and civil penalties of up to $5,000 per negligent violation and $25,000 per knowing or intentional violation in a single year, and $250,000 per violation knowingly or intentionally using protected health information for financial gain (§§ 183.009-183.011)
7. 7Signed by the Governor June 20, 2025 (Chapter 1002); effective September 1, 2025; the chapter applies to EHRs prepared on or after that date, except § 183.002 (U.S. storage, access limits and safeguards), which applies to storage on or after January 1, 2026, whenever the record was prepared; an agency may delay a provision while seeking a needed federal waiver or authorization

Latest legislative action

Jun 20, 2025. Signed by the Governor; effective on 9/1/25