the cultural change i'm working to implement is to truly embrace all these elements to help us move forward in supporting our mission. this slide shows the actual element at a high level, what these would be. so starting from the bottom of the triangle, in order to meet our goals we need to have the stable infrastructure, effective capabilities within it, relative technologies, invasion and excellence that leads to long term viability and the accomplishment of our mission and guiding principles. one thing to note in terms of stable infrastructure -- you may have heard this from other city it folks discuss this as a

foundational infrastructure. without this none of the other aspect of the it vision could happen. in terms of the effective capabilities. , this really means not only having enough people, but more accurately, having the ability to perform the required task needed to meet the requirements of our organization. in terms of relevant technologies, it is to implement technologies that are relevant of our mission and only that of our mission. i believe that having those three items, we will be able to help the organization innovate and excel as well as obtain long term viability as an organization. before i go into the details of our health it vision, i'd like to go over the current state of

it. you note that we have red yellow and red. typically i'd like to see all green, but what we have is red at this time. i would break this down into three areas of what i'd consider the [inaudible] in it. first is infrastructure. today it is very unstable and slow. on average we have one out per month. also, our network is extremely slow. some of our clinics are connected to a network speed that's slower than your home network using dsl. say in these clinics there are many nurses and doctors who are trying to access files they need to support the patients. now, why is this? first of all, we have

significant amount of equipment that are end of life. number two, our who will it infrastructure design is outdated except for one lace. laguna honda is pretty new and they have a new technology. many projects are stalled or delayed in terms of initiatives and all of this leads to increasing operational cost and the question i've been asked is why is this? how could we be here? the reality is, commissioners, that as throughout the years, as we have limited resources and many initiatives and compliance that we need to meet, there are priorities that's been put on the it, however the it did not have the vision and the strategy that they could focus on. a single point of place where they could say that's the hill we need to charge to so what happens is we have all these people doing different things with well meaning efforts, but having very poor results.

in terms of the structure in governments it is in transition and therefore it's yellow. with the department going into a different model of care, the it is also moving towards the new industry standard in it government, as well as support models. we are working to define very clear roles and responsibilities, where there was very little. and we are working to change the culture to one of the empowerment and ownership. when i came here eight months ago we had a security disk issue. it wasn't a problem, but it was a security risk. and i asked a question to a room full of my immediate support directors and i said who is responsible for security. everyone in the room raised their hand. however, when i looked at the

findings under the security, we had -- i saw a lot of risks so how could it be that i have eight people in the room who are responsible for security, but we have so many risks? the reality not one single person owned and felt empowered to act on it. everything was done in a consensus manner. that's great if you have a lot of time, but when you have risk somebody has to own it and take action. more importantly people didn't feel empowered because the actual responsibility was spread out across so many people. the next bull let point is supporting capabilities. we have a lot of capabilities here. problem is, some of them we're not very good at and there's a reason behind this. first of all it organizational structure, leadership and technical skill training was supported and funding provided,

it was the actual program itself wasn't thought out from an it leadership perspective. let me explain. if you send a person to a training and spend several thousand dollars and you train them and they come back, but they are unable to use that skill for a year, maybe two years, maybe three, how effective would that skill be? how relevant would that skill really be? the reason why that is is because the roles and responsibilities were so separated, many of the skills they learned were rarely used. on top of that, it was not their responsibility. the other areas where we have support and capabilities gap is clinical staff training and system operations. we are lacking a team within the healthcare organization

called clinical team. the core function is to train our clinical staff, provide support, work with the clinical staff and optimize the work flow as well as the information technology behind it. and it is a formal program that is taken with extreme dedication and focus. what we have today is we don't -- we do not have the clinical team. what we have in the organization are, in a very good way, the nurses assigned to those roles, but it is not a formal structure. needless to say, the team and having right leadership skill will be critical to the success out of it in terms of success

of dph. i'll bring a point of example. if you purchase any hr system for -- let's say $250 million, you do not make an investment to support that system, to train the nurses and doctors, to fully utilize that system or keep it optimized, to keep it tuned up, would you really get a full value out of that $250 million? reality is many organizations, many almost -- actually i'd say all the healthcare organizations i've worked at put significant emphasis on the functioning of that team for that sole reason. because of the capability gaps, it is unable to meet the task and projects. therefore in the current it assessment, we are red in

infrastructure, yellow in governanec. we're going to build one that fits for purpose. it's all about knowing what our purpose is and creating an infrastructure, support structure, creating the solution that's fit for us. we're going to create an infrastructure, but it's stable fast and available. good news, we have already started on it several months ago. we've actually -- just to let you know, we took our core network infrastructure and did something that was told was not possible and we did it in less than a month. we're going to tie all of our network in fiber. it's well on its way and it's going to be fast and available. available means when a network goes down, the end user will

never notice. it needs to be that type of network where fiber could disconnect because somebody was trenching, does not disrupt our patient care. organization structure will also be green. we're going to be nimble. we're going to do what's right instead of waiting for having a long consensus discussion. in a world where everybody needs to be nimble, we can fit in trying to make a decision for several years, trying to decide what is right. we're going to be accountable and accountable is really about giving credit where it's due. if someone has clear rules and responsibility and someone does a great job, we should hold them accountable, thank them, recognize the great work, but should also use accountability to find where they need help so we'll know where they're filling. in today's current situation,

this accountability doesn't exist because there's so many people owning different roles or so many people in the same roles. the next item is ability capabilities in unified health systems capabilities. this is really important to note because i would like for this organization to move away from vendor specific solutions. when we say we want to buy this because we heard it's great, it's really not about buying that chevy volt, but about buying that car. that's fit for purpose. so like wise, we want to buy the systems, build the systems, implement systems that will fit our need and not be hung up on specific vendors. we want to create a coordinated kard and continued care.

if that's going to be single platform or multiple integrated systems, that really is up to many different factors, namely our needs and money. we have a unique in dph where we have more diverse services than any other health care system i've seen which means it's very difficult to buy a single platform that will meet all our needs. in the future it could be that a single platform could do everything we need it to do. maybe they can't. but whatever it is, we're going to put in the capabilities that will meet our needs. having done all that, we will be green. the question is how long will it take to get here. in the previous slide everything was too much red. okay, here are the dates. the next two years we're going to work on building a strong infrastructure foundation. we are going to build effective

it. that means our team, not only hiring more people, which the department of health has been very great in providing support and a lieuing allowing us to hire more staff, but more importantly training them so our employees are better, more effective. but also building a clinical support team that can support our clinicians and nurses and ancillary team to use the tools we invest in, the tools we buy. having that we will be able to perform a full due diligence and planning for the next stage which is the next generation health system functions. we will not do what many organizations have tried to do and fail. many of you may know many organizations in their urgency will go ahead and sign up for an hr system, purchase it, attempt to build it and fail.

there's a very common mistake as we look at these people who failed. they did not have a blueprint of what they wanted. they had a high level requirement of what they wanted or what they thought they'd like to see, but no blueprint. it's like building a house without a blueprint. you draw your blueprint as you build your house. the probability of that succeeding or having a house that you like is probably very low compared to a full blueprint that you agree on. we need this team -- we need an effective, strong, infrastructure foundation so we could free up our team in the clinical support team we're building to no longer fire fight, but to do due diligence in planning this blueprint. once wif we have a clear blueprint across dph we will know exactly what system to buy. that will be the next

generation of electronic health system. once we put that in place we'll be able to take all the other technologies we're investing in, the technologies we have, and be able to integrate that if the hr system to provide an integrated d health hr system across integrated care. how is that different than an hr system. the hr system is place where you put records for data. an integrated health system would now create a synergy between the two technologies. we want to be able to provide integrated health across multiple forms of technologies, not only tele health, voice communication, texting and so on. so for those who are more graphically inclined i actually created a picture of what i went over in a house format.

you have the foundation, infrastructure, and more importantly the support pillars, the effective it, and the left which is operational and project management capabilities and on the right the clinical training and optimization functions under the clinical. once we have this , we can move away from fire fighting and start to build. looking from bottom to top, we can look at our work flow. we need to know what we want. not in high level, but in detail, specifics. we need to apply lean and it delivery service models that are well accepted in the industry. by then we could add a value to our processes. and then when we complete that we'll have a right solution for our blueprint. once we have that, we could

proceed in putting in unified electronic health record system. after that's done we could create inner operable blt across all systems. the last slide i'd like to really point out, what do we really need to succeed, what do we need to do differently than

what we've done. if you remember one, it's invest in foundation and i'd like to thank director barbara garcia and the directive team an commissioners for helping us invest in our people by providing train inging, helping us bring better infrastructure. more importantly as an it organization and whole organization, we need to align all efforts with business goems. we need to be doing due diligence and planning and reduce power ties. we need to be disciplined.

the collaboration, support, recall of that really has to be infused into technology into the work flow in technology otherwise the technology we buy and implement will be taking what we have today and just turning out a new version of it. we need to move beyond where we are in order to succeed in the future. that's all i have today. any questions? >> commissioners, was there any public comments before we drn -- >> i have not received any requests. >> thank you for this and thank you for the well thought out

way forward with the building blocks. i have -- and some timeframe that seems -- i mean, everybody would like to have this fixed immediately but i think you've made it clear this is going to take investment in people and processes in this integrated system at the end of the day and you point out that there are eel be analytics built into big data. are you anticipating that that will include decision making outcomes that the end user can use? >> yes. >> as well as the research endeavor? >> in my mind we need to utilize all the data we have so that can benefit not only the city, but the world. >> i think that's particularly important to talk about when you talk about team work being at a much higher level than the five levels on the unit that

the five units on the unit might add to big data that would help with decision making that could stabilize down the way. >> i think it was a very excellent report that you shared with us. i was thinking here are the problems now with the options and i think you really hit it in reference to we're not looking at specific programs to make new pathways that suddenly come up and i can name a host of them that many of them have seen over the last 15 year years. you come back and forth and say well, this is going to work it

seems rational when i think that's about the time we'll be rotating off the commission after many years and finally it happens, you know, i'm looking forward to that day but it was a really excellent presentation and i think it gives us and our colleagues, both in the department of public health a real unique opportunity to think about the timeframe in essence and also the pathways you shared with them and i know

you are part of the over all team that our director has looked at. when you're talking about coordination of systems from a to b. you have articulated it well. thank you very much. >> one thing i'd like to reemphasize. we have a very good start. 2014 to 2015 i believe we have a very good running start. we have a lot of support from the organization and i think we will meet our goals. one of the things that will dictate if we have full integration in 2018 surely is a question of funding. we have a lot of things that used to be purchased and integrated in order to provide

all the functionality that is coming down the pipe. now, having said that, there's quite a bit we could do with what we get. i think it's really being disciplined and focusing on the things we need and not focusing on the shiny things that other people want us to buy. >> thank you. >> commissioner. >> thank you mr. kim for that presentation. so what i'm hearing a lot here are really infrastructures and also, you know, like, an integrated systems to support our staff and our clinicians to do the job better. so from the patient's perspective, maybe i'm a little bit spoiled because i relate to my own experience with, you know, my own electronic medical records that i'm actually able to access that any time i want. i think that there are benefits

to that, you know. i would be able to look at the lists of medications that i've been prescribed before and also all the current lab work that i have recently done and that helps me to really improve my health literacy and be an active advocate for myself. in terms of how -- a vision for the it system how would that play out for our patients and would you call that shinny? >> i would -- let me show you a picture of my vision. this is using technology that exists today, but combining them to create additional value so imagine if you will you're a patient and just got admitted to an ed and in the ed soon as you check in the system knows

what your probability of readmission is the next 30 days. we have that capability today in the world using data such as how often you are visiting the ed, what your health status is and so on. imagine that information not going directly to your doctor or nurse, but to your case coordinator or somebody that's going to follow up with you when you go home because really what you need is better care and reminder at home. the nursing department, time to staff the nurses, no longer rely on paper showing what patient is getting what service. relying on the emr or hr system that is realtime that calculates the patient's acuity and recommends based on the

input you have and the regulations you live by, what your patient's staff and nursing staffing ratio needs to be. that exists today. all of this technology exists today. it is the technology that only happens when you have the full integrated system. that is the vision that i foresee, commissioners. >> that means that that's something we want to look forward to? >> yes. patient care should extend out

to -- outside the walls of the hospital. >> this may be the bridge to the next subject. within these -- and i think this is color coded too, right? >> yes. it is. >> so we got to get color presentations because these don't quite come out in black and white, but we're going to go from red to green, but we're talking about in the budget to be presented this afternoon as the next item, are the items that you need funded within this to do the 014 through 2015 structure? >> yes commissioner, i believe that the budget i have discussed with the cfo and the executives does support everything we need to do for