commission. >> thank you. >> good morning chair chu, members of the committee. kathy with the san francisco airport. the airport is seeking your approval for a parking management contract with new south parking for a new five-year term. the contract before you would provide management and operational services for both public and employees parking facilities at the airport which includes the collection of parking fees, facilities maintenance january tourl and security services for the airport's 11 parking facilities. the way the contract is structured. the airport provides an annual compensation to the contractor that includes reimbursable costs which include office expenses, salaries, insurance, janitorial and security costs as well as an annual management fee. this brings the contract before you for the entire five-year term with it, not to exceed amount of $96 million. so that covers all of their

staffing and everything as well as the management fee. the contract before you is the result of a competitive request for proposals process with the selection of new south parking as the proposed contractor with the highest score of the three responsive proposals. the budget analyst has recommended approval but i would be happy to answer any specific questions that you might have. supervisor chu:, thank you let's go to the budget analysts report. >> madam chair and members of the committee, as shown on page 4 of the report, the total agreement would provide the contract with a not to exceed amount, over a five-year period and that includes the management fee that miswidener mentioned of $99,000. that's fixed here year at $99,000. as you can see, and incident alley, the contractor for this

agreement is the existing contractor and as ms. widener stated, they were determined through a competitive process and apparently the contractor has done a good job, as you notice on page 5 of our report in fiscal year 2010-2011, the contractor collected $81 million in parking revenues and if you exclude their costs or deduct their costs, the airport realized net revenues of $63,850,087. supervisor, we do recommend approval of this and dent alley there was a draft report where we had recommended a $30,000 reduction. i'm not sure if you got that draft report, but just for the record, we do recommend approval without the $30,000 reduction. supervisor chu: thank you. and so the original or the draft recommendation had a recommendation to reduce the amount by $30,000 roughly.

however, that, i believe, you had received information from the airport -- >> exactly. when we had that in the draft report, the airport clarified the numbers and we with drew that recommendation. supervisor chu: thank you. let's open up this item for public comment. are there any members that wish to speak on item number one? seeing none, public comment is closed. we have a motion to send the item forward with recommendation and we'll do that without objection. thank you, people number two. >> resolution authorizing the department of public health to execute a contract amendment with netsmart new york incorporated to acquire product enhancements and extend the initial term of the agreement for an amended term of august 1, 2008 through june 30, 2018. supervisor chu: thank you for this item. we have a represent from the department of health. >> i'm the i.t. for the department of public health. the item before you is a contract amendment with our

current master agreement with netsmart systems for our be hafrle health information clinical and fiscal information system. the current contract is in year four of a five-year term. so we are providing for an extension of five years on the existing contract. and also acquiring additional modules on the electronic medical records piece of the software system that he with have to accommodate new regulations and proposals for the federal electronic medical record incentive payments. the current system is implemented has been live for two years. we have near 3,000 clinical users utilizing it and 200 physicians doing electronic medical records prescribing and the current amendment allows for additional acquisitions for optional items as the health

care reform legislation kind of evolves with the federal government. i would be happy to answer any questions. supervisor chu: thank you, just a quick question for you. with regards to the implement takes you said the avatar system has been up and running for two years now? >> correct. yes, we went live on july 1 of 2010, two years will be completed in july of 2012. supervisor chu: how is that implementation going? >> we have 3,000 -- it's a combination of d.p.h., civil service employees as well as significant amount of community-based organizations that use the system. so we currently have 3,000 clinical users. in behavioral health, you can be a clinical user and not necessarily be a physician. you could be a social worker, nurse practitioner or tharmente. there is quite a kadre of individuals that use it. they transition from paper records to doing all of their clinical documentation on line. with behavioral health, there is a nuance to the billing where we need to do treatment authorizes that are tied to the

revenue and the bills that are submitted. so the electronic medical records piece is tied to the billing piece so that we can generate the become end quality reports that are needed to support the billable revenue. that seems to be going very well. supervisor chu: you said, i missed it earlier, did you say there were 3,000? >> correct. we have nearly 3,000 clinical users utilizing the system amongst all of the agencies that do that. 200 of which are physicians who prescribe medications electronically. supervisor chu: when you say clinical users, does that mean, an individual within a clinic? >> correct. supervisor chu: you may have 10 clinical users within one clinic? >> sure. i think the total number of provider sites is about 100, if you combined the civil service sites plus the community-based organizations and depending on the size of the agency. they may have anywhere from three to as many as 50 or 60 providers working there. supervisor chu: and then in

terms of the expansion, do we expect that we would grow in terms of the number of providers sites in a would have the avatar question. or do you think we have covered it pretty much? >> what we have seen in the past two years as we have it implemented, as the number of providers has grown as more and more agencies decide to come online and as the, just the expanse of wanting to do clinical documentation on line occurs as well. so we probably anticipate that over the next five years, we will be adding a nonsignificant amount of providers but additional provides. supervisor chu: just a request, we had a meeting recently with a number of community-based providers with the mayor's office talking about budget issues. one of the budget issues that came up with the department of public health that i'm sure the staff shared with you already, with the ampletation of the avatar success, just the data, the information and data that they need to kind of run their systems better to know kind of how they're billing, it's

something that is i think lackinging and it sounds like it's tied up with the state at the moment, is that right? >> is the question do we have the ability to give reports to enhance their productivity? yeah, that's a big part of this. there is quite a bit of reporting capability that comes out of the system that allows for the -- number one, for the quality indication measurements that support the revenue, but also clinical performance measures that it can be gone directly back to the directors and that sort of thing. they're just starting to take advantage of that as they're developing a little bit of baseline data, they're seeing clients and developing a little bit of a track record with the system. supervisor chu: so i guess one recommendation or one suggestion and request that they made which makes sense is whether d.p.h. can coordinate and get feedback from some of the end users so the provider sites in terms of the data that would be the reports that are generated and making showers that those reports are useful

how they can become more efficient, bill better, that kind of thing. >> as a matter of fact, what has been done before we have implemented the system is there a monthly community-based organization providers meeting that is chaired up by the director of behavioral health services and has representatives from most of the c.b.o.'s that utilize the system. specifically to get feedback on how we can make it better, implementation aspects. obviously, when you go from the paper charting to the online charting, there is always a change management piece that goes on there as well as, you know, what data might be supporting the revenue that they might have, new programs that are coming up. so that's actually done on a monthly basis now. it's been very effective. supervisor chu: and i appreciate that and i have heard that as well that there has been a strong partnership with d.p.h. and the provider sites. so i just want to make sure that i think their concern was before you finalize your reports with the state and how they present the data, it's

regulated or controlled partially by the state that they have input to make sure the reports are useful. that would just be the final piece of it. is sounds like there is already a partnership. >> to my knowledge, they're very, very involved with the scabbing tiff management from behavioral health on. that supervisor chu: thank you, supervisor kim. >> i was actually curious as to how the transition was going for, especially some of our smaller clinics that we're proving from paper to electronic. and how that work happened and how we were able to dedicate time and how that works. >> the overall phenomenon that is going on with health care and records is involving a lot of change management. everything is on paper. one of the things is the system was standized to a certain extent. every clinic has different work flows, they have done things differently over the years. part of the challenge is the training piece of it.

we're getting people familiar with the system. once they're utilizing the system, tailoring to a certain extent of how the work flows in that particular clinic. we have health care h.i.t. coaches that go and work with the providers on the site, number one, to kind of get them used to the workflows of the system, but then to see if there are any modifications or custom conversations we need to do for a particular clinic. some of the clinics have special emphasis on the clients that they see that need specific assessments done, et cetera, the client population is specific to that area supervisor kim: i imagine that's helpful for new clients. what do they do with existing clients and existing paper medical records? >> what we have are the ongoing user groups and training, so training is something that we found that we really had to invest quite heavily on. we have a training center that is set up at our behavioral

health offices at 1380 howard street. we kind of offer ongoing training as, number one, there is attributing of the staff, so they're always bringing new staff, but also as they get more proficient utilizing the electronic record, the folks need to be trained to take more advantage of it. so will is quite a lot of feature function that just out of the gate, not everyone uses, but as they mature in the use of it, we have kind of an ongoing training on different levels to make that open to the providers. supervisor kim: but i imagine that these clinics would have to dedicate some resources to just having staff members go through existing paper and transferring them to electronic as well? >> i couldn't hear the question? supervisor kim: i imagine that clinics have to dedicate staff resources and time to transfer existing paper to put them into electronic? >> part of what we were able to do to address that question is we had an obsolete system where

when we upfeed with this system. with the older one, we were able to convert the existing dbs that we had over to the new system. for the fundamental patient records, their registration, their diagnostic information, the billing histories, et cetera, we were able to bring a majority of that data forward. however, the whole idea now doing an electron medical record online is fairly new in the industry. so our old system -- there was no need to do that, so there was no capacity for a detailed patient care plan, electronic prescription administration, et cetera. so those are the pieces that are sort of new. they're building on the data that we were able to bring forward from the legacy system into the new system and have that as a baseline. supervisor kim: just for clarification, did part of the incentive for clinics to do this transition this work over to electron was the legislation

and the incentives that they provided to clinics to do this work? >> uh-huh. supervisor kim: my last question is what are the anticipated or hoped outcomes for the transition work? i can guess, but from d.p.h. perspective, what are the anticipated outcomes of this tran is significance? >> the a.r.a. legislation and the high-tech component, that's information technology for economic and clinical health, that's the piece where there were incentive payments made to eligible hospitals and eligible providers for what's called in the legislation, the meaningful use of electronic medical records. so the phase one of that involves incentive payments for the eligible hospitals and eligible providers to do this, but really i think the intent of the national health care reform movement is to transition more and more of the patient clinical data to an electronic format. that would be stage one of meaningful use. stage two would then be to

report and link provider organizations a lot more than is done now. so that's called health information exchange. phase three that's projected in the meaning for use of e.m.r.'s is to really generate quality indicator reports and do reporting for the extent to which the use of the electronic records really impact the patient care. so it's really the a.r.a. legislation really looks at about a five-year period to phase this in across the country. so we think that for d.p.h., in order to remain competitive, but also to remain mainstream in terms of the technologieses, this was a critical piece of moving forward with the integrated delivery system. supervisor kim: if i could just reiterate, so the anticipated or hoped outcome is improved patient care in the next five years through electronic record systems? >> correct. we have multiple initiatives

going on. the acute care arena and the ambulatory care arena that we operate are also moving forward with e.m.r. implementations at the same time of this to bring up all of those areas up on electronic records. because of the billing regulations that pertain specifically to behavioral health, we needed to have a specific system to do this. supervisor kim: and for just a layperson like me to understand, does improved outcomes mean increased ability for clinics to do billing, for example, which is an issue with some community clinics, is there something they're able to do, the reimbursements and what does it mean for the patient itself? what are the improvements that the patients will see through the system? >> one of the big aspects of health care reform with the high-tech regulations in phase two of meaningful use is an emphasis on patients being able to access their records electronically. that's built right into the

regulations. and we anticipate that, you know, phase one is to transition those records from paper to electronics, but phase two would be an increased emphasis on getting individuals accessing their patient records via patient portals and that sort of thing. supervisor kim: the patients will be able to access the information even if they go to a different clinic the next time? >> yes. the idea would be, especially within the dfplg p.h. framework, patients are assigned a primary care home. they have a primary care provider that they can contact and exchange information on their patient care treatment plans, medication reminders, and also have access to register for appointments, appointment scheduling, various clinics have different emphasis.

so this will be implemented not only in like our community-based primary caramel clinics, but also our hospital-based primary care clinics and specialty clinics. so the exchange of being able to have better coordination of the integrated delivery system site is a big piece of the health care reform legislation as well. supervisor kim: for the low income more transitioning pay,, if they walked into a different clickics, would that clinic be able to access their information? >> we have a strong affiliation right now with the san francisco community clinic consortium. we currently there deploy our existing system, sort of a summary record that is interactive to the community clinics now. so we find that there is quite an overlap of patients that are being seen, even though they see them, those patients or any of the community clinic

consortiums. we have a very close collaboration with them. that's part of the goal is to have this kind of common framework so we can extend, exchange the information as appropriate. supervisor kim: thank you. >> you're welcome. chupe thank you supervisor kim, just a quick question following up with health care reform. there is a lot of conversation around what is happening with the supreme court decisions. one of the pieces of the health care reform, there would be more individuals who would qualify to participate in medy cal, could that stand and we would be seeing that part of it or that with be part of a repeal potentially? >> the expansion under the 1115 waiver for the expansion of the medical services anticipating that would be more insured patients is kind of a driver, especially here locally. if the health care reform legislation is voted

differently, i did see recently, just this past week that california, governor brown said that california would like to move forward with those provisions independent of anything that would happen on the federal level. so from my perspective, but it's more of a policy question, i guess, but from my perspective, it looks like it will move forward no matter what happened. supervisor chu: thank you. i would just like to take the opportunity to welcome supervisor olague who has joined the committee. supervisor avalos. supervisor avalos: thank you, chair chu. a couple of questions related to the timeline. so the system launched, you said, in 2010? >> correct. supervisor avalos: was that actually on time? >> right. we did the r.f.p. in 2005 and got the contract negotiations finally approved and available in 2008. we actually did an 18-month

implementation for this, which was, we felt it was on time and on budget, was very, very aggressive timelines, but we wanted to make sure that we could get the billing piece -- we have an older system that wasn't supported by any hardware or software vendor and it was over 20 years old. i was concerned that, you know, we didn't hit those timelines, then there would be potential -- if we couldn't generate bills, for instance, that would have been a big problem. so we brought the system up in 18 months and -- supervisor avalos: the board approved in 2008 and 2010 launched, that was when you actually conceptualized that going to launch? >> july 2010 is when we did the conversion, went live and the clinical users began using the system and we generated bills. supervisor avalos: i'm just kind of curious, since this is such an important system to have in our public health

system, why wasn't the original contract longer? and we're doing an amendment to extend it another five years and it seems like it would make sense that we would have a longer contract frame. what was the rationale for having a shorter contract and seeking expectation whether there would be an amendment sought after before? how come there wasn't option agreements like we did with other contracts? >> it was part of the r.f.p. contracts when we did the original proposal, we proposed -- we do a five-year kind of projection on information technology every year. at that point we were required to kind of spec it out for five years. and the five-year term was sort of a standard -- as far as i understood, a standard for contracts of this type with the idea that, you know, then if in fact there were problems with the system in year three or four, you weren't locked into a

much longer timeline. now, of course, we're at the -- approaching the end of the five-year term, so it make sense for us for the implementation to expand it and we're linking it to all of the health care reform legislation as well. supervisor avalos: when it comes to the software system like this, we kind of go with the same contractor because they have proprietary information that leads to, needs to be in place for continuing that contract beyond the original scope of it. so i was just curious. >> there have been cases in the health care i.t. industry, especially when there is a billing conversion when you're doing large accounts receivable conversion where venders haven't been able to fulfill totally what they needed to do on the accounts receivable side. it's not unusual for -- it's not unprecedented i should say for a system to be evaluated in

year two or three if there is some significant revenue impacts going on. so with us, of course, that didn't happen, but in some historical areas, l.a. county i think years back had a problem with that. you see it from time to time, but, you know, generally speaking, we probably would expect that we would have the system delivered as we did and make sure that it was stwfl for -- successful for us. supervisor avalos: thank you. supervisor chu: just a question, i think this might be dating me. i remember the department of public health when we were implementing healthy san francisco, we went through the process of creating something called -- i don't know it was creating or buying off the shelf something called 1 e app to make sure that all of the clinics and folks were verifying eligibility for folks entering into healthy san francisco would sort have been connected in that application process. does that feed into the avatar system for billing him?

>> so 1 e app is an eligibility provider that is deployed electronically to our registration sites so that we can do an eligibility check for, let's say medicate eligibility, medicare eligibility, private insurance eligibilities. 1 e app allows an eligibility check for different types of programs that they may be -- patients may be eligible for like women and infant care type program, other social services programs and, yes, that's a deployed electronically through an entire network. so we currently have that live. supervisor chu: i understand that it is live and in use. i'm wondering, how does it connect to your avatar system? is there a connection and does there need to be one? >> when patients are registered electronically, we generate electronic queries out to the provider organizations as i

mentioned we have medicaid, medicare, and queries are sent via 1 e app to check on their potential qualifications for being signed up to various programs. so that's part of the standard eligibility check now for the patients. supervisor chu: right, i get that. but the avatar system i'm understanding is your maybe records information system and it sounds like you were age sage there is a component where that is connected to what you are able to bill, right? >> correct. supervisor chu: so that billing portion hypothetically, you have to have eligibility in order to draw down on certain programs. i am wondering if your 1 e app kind of synched up with this system to the patients are build up. >> they can check on the eligibility status for those programs and behavioral health patients. choich thank you. why don't we go to the budget analyst's report.

>> madam chair, members of the committee, supervisor olague, as we point out on page two of our report and as has been stated, this original agreement was awarded through a competitive process and it is a proprietary so that you are being asked to extend this agreement by four years and 11 months and to add $22 million to the original agreement without further competition and we understand that because it is a proprietary system and apparently the department has been satisfied with this system. i would also add on "page six" of our report, we point out that the actual, the operation and maintenance clause for the proposed four year and 11 month extension period is actually 81,229 less than what has been paid over the prior five years. there is also about $1.6

million in enhancements or options and d.p.h. reports to us that they plan to use, obtain nongeneral fund revenues to pay for that $8 million worth of additional costs although they have not identified specifically the nongeneral fund revenues. also on page 7 of the report, we point out that they do anticipate incentive payments from the federal government to their psychiatrists and nurse practitioners, about $63,750 per eligible psychiatrist and nurse practitioner for a cost of $1.8 million over the first three years of compliance, which would offset a portion of the system costs. we recommend that you do approve this resolution. supervisor chu: thank you, mr. rose. let's open up this item for public comment. are there any members of the public that wish to speak on

item number two. supervisor chu: thank you. thank you. >> thank you. >> ♪ i know you want to wake up in a budget that doesn't sleep ♪ ♪ to find your king of the money hill, top of the monday heap ♪ ♪ and i know you're going to make it well, these 31 now ♪ and going to bring it through to you, new york incorporated ♪ ♪ and you can make it there, you'll fix the budget everywhere ♪ ♪ it's up to you net smart new york, new york ♪ >> thank you. supervisor chu: thank you, next supervisor chu: thank you, next speaker.