what these contracts related to basically is the infrastructure, the plumbing, if you will, of a network that meets all the codes which we're required to if you're a health institution which is much different than if you're a retail store for the obvious reasons, and so we heard -- we approved those contract and recommended them to be approved here which i guess we need to vote on in a second, but i think what was most encouraging for me was the depth of thought from the team at sfdph regarding how they're going to stage the investments and how to prepare for the future and how they talked about it so that was super encouraging. >> if i may elaborate. briefly the sexual orientation guidelines commissioners will come before you for approval for the second so you will have an

opportunity to look at that and the contracts will be folded into an it presentation at the august 19 meeting so you can hear about those two. >> and do we need to vote on those formally today? >> in the consent calendar next item you voten mass for all of them. >> yes commissioner. >> yes. i was wondering if there is discussion on the siemens renewal. >> yes. >> and was there any conclusion pertaining to are -- we in fact -- i mean siemens has had a contract with the department for a number of years including certain different pathways that should have been done or done well, et cetera, et cetera and i am wondering if there are substantial discussions on what the outcomes have been and in

particular i thought before we had a three, four year limit and when i looked at this initially there was a fairly long duration and i wonder if this was brought in the discussion. again i am not knocking siemens per se but we used to ask these questions and i am wondering -- >> some of the questions were asked and some weren't. to give context on the contract we're talking about and if bill is here -- >> unfortunately he's not here at the moment. >> let me try and anyone else can jump in. so we are moving in the general -- the new general hospital in about two years. in a perfect world we would have also used as an opportunity five years ago let's get a state of the art medical system in the san francisco general hospital then and it's

unclear to me whether siemens would have been a candidate for being that vendor or not. i think it's up in the air but most talk about two other vendors when we ask them, but that decision wasn't made so we have the practical reality when we move into the san francisco general hospital we need to have electronic medical records and the reality is we just need to move the siemens system over there and that is what this contract is basically to do, and that is a non trivial exercise, but in addition we have struggled as a group here on the whole future of emr, rhr city wide for our work and we're beginning to see in these contracts thoughtful strategic investment to get ready for that. as we all know it's a very big number, but it's kind

of table stakes for the new health care environment so we have to do it and as soon as we can. the joint commission talked about it when they surveyed the san francisco general hospital and made it absolutely clear in order to stay compliant et cetera, et cetera it's hard to think of a reason not to move quickly on this but regarding siemens' past performance on contracts we did not talk about that. >> no, no. again as i said when i sort of skimmed through and i apologize because of the amount of time and as i said in some of the early stages going way back for both our senior programs at laguna honda and at general it required a visit from their senior officers flying in from back east and europe to appear before the committee to answer questions that were generated because this was a significant amount of

investment and we wanted to clarify and make sure that we all understood what in fact the parameters were and the projected outcomes and that and i am glad to see we're still carrying that out. >> director. >> if i may commissioners our information technology director mr. kim acknowledged exactly what you're saying commissioner and had called senior leadership of siemens into the room to have that discussion and is completely confident that a candid discussion will yield better results this time. thank you. >> thank you. >> and i would say while the numbers are fairly large in the contracts which we're recommending they are nothing compared to what we have to approve in the near future. >> and i think commissioner sanchez i could echo what commissioner singer was saying because we've all participated

-- you and i in these same discussions and in this case our director has indicated that definitely this is a platform that's needed to be brought over and that siemens are the people to do it. and they can do it competently and that this was part of that roadway that we're building. it's necessary to move that all over at this point because there is no substitute that's a valuable by the time we move in, so i was personally satisfied. >> good. >> any other questions to our interim finance chair who did a great job. although you have chaired in the past a joint conference. i just want you to remember. >> strike that for the record. >> however, further questions on any of the contracts or we can move on to the next item.

>> item six is the consent calendar. >> okay. in the consent calendar has on it our contracts report the three contracts that -- so we've already had a discussion. if somebody wants to eliminate again or i should say pull off of the consent calendar the calendars before us for voting and so all those in -- unless there is an extraction we will move on to vote. all those in favor say aye. >> aye. >> all those opposed. so the consent calendar has been adopted. >> thank you commissioners. item 7 is the health care service master plan consistency determination application review for healthright360. >> it's a mouthful. good afternoon commissioners. i am

here before you to talk about the first consistency determination application under the health care services master plan which the commission endorsed in september of 2013, and the board of supervisors adopted -- sorry -- yes, 2013, and the board of supervisors adopted in december of 2013. so the ordinance was introduced in 2010 and became effective in 2011 and i should say since it's been a while since you had the health care services master plan in front of you i will give an overview of the process for your consistency determination and do an overview of healthright360's application. so the ordinance was passed in 2010 and effective in 2011. the purpose is listed here in quotes which is to provide the health commission,

the planning commission and the board of supervisors with information and public policy recommendations to guide their decisions to promote the city's land use and policy goals developed in the plan such as distribution and access to health care services. as i mentioned it was endorsed by the health commission in september of 2013 and adopted by the board in december of 2013. the master plan really identifies current and future health care needs in san francisco and makes recommendations on how to achieve and maintain access to health care services. the commission may remember it was the as a result of a year long community engagement process which was the foundation for our community city bide health improvement plan. so it's intended to be a road map for bettering health and well being in san francisco and it takes a specific focus on access to care for particularly for san francisco's most vulnerable

populations and geographic areas, low income folks and people with high health care disparities. the way the plan is structured it has quite a bit of information and then at the end it has recommendations and guidelines so there are nine recommendations, each with guidelines underneath them that are specific to each recommendation so the recommendations are listed here and they follow the community health improvement plan's three priorities. the commission may remember the plan prioritizes safe and healthy living environments, access to healthy eating and physical activity, and also quality access to health care services. of course since this is about where to place health care services in san francisco most of the recommendations fall under that third priority, and you can see here that 1.1 really addresses healthing living environments. 2.1 addressing eating and

physical activity and the remainder talk about quality health care services so there is a focus on vulnerable populations, also promoting behavioral health access, ensuring the access of long-term care options for the aging population. make sure that we have the linguistic capacity to meet the needs of our population. access to transportation options for people in areas that are further from health care services. ensuring collaboration between existing health networks. making sure that we have sustainable information technology that increase access to health and wellness services. that we collect data on our residents and our patient population so we know what the health care -- the health needs of our population are and we promote the development of cost effective care. those summarize the nine recommendations that

are part of the health care services master plan. so the health care services master plan really has two parts. it's sort of a road map for what our -- the current health care inventory and needs into the future and then it requires that projects that are being proposed in the city if they meet certain requirements they're compared against the master plan to determine whether they're consistent or not with the recommendations and the guidelines in the master plan so what you have before is a consistency application determination by healthright360 and so i'm going to go over a little bit about the projects and the process that follows. so projects that are subject to a consistency determination are those that are for medical use and i will define medical use in a second, that are more than

10,000 square feet so you're changing from some other use like a retail use to a medical use that is more than 10,000 square feet or expanding an existing use by 5,000 square feet and expanding a clinic there and adding another 5,000 square feet that is also subject to a determination and medical use is basically any place where services are offered by health care professionals that are licensed by a state board, so physicians, surgeons, dentists, et cetera. includes clinics providing out patient care and it also includes hospitals. there are three possible -- to the way that we structured the health care services master plan there are three possible outcome frs any project secretary to a consistency determination. >> >> the first it's consistent and recommended fortives. this

means the projects that are qualified and on balance meet the recommendations in the master plan eligible for incentives and those eligible for incentives are those that at an actual facility by the correction of its project can seek to accomplish, so for example increasing information -- improving information technology. it's not necessary that a specific project build is going to increase information technology access but it might increase vulnerable populations so that's why it's eligible for incentives and others might not be eligible for incentives. the second outcome is just consistent so it's on balance, positively going to impact health care access in san francisco. doesn't necessarily meet any of the guidelines highlighted for instance or doesn't meet them to a sufficient extent and then finally they could be

inconsistent. those that don't address any of the recommendations or guidelines in the master plan or adversely affect a service as needed in san francisco. and i should say -- i should have said in the last slide consistent and eligible for incentives means incentives in the planning process so in the entitlement process managed by the planning department and we have a representative here should you have any questions about incentives or the planning process. so the review process is as follows. applicant submit an application so healthright360 submitted to us an application for consistency determination. the planning department -- they submit to the planning department staff. planning looks at it and makes sure they meet the requirements for the project. do they meet the size threshold? are they changing medical use? if they do they

forward that application to the health department and the third step in the process is the health department reviews the application and the accompanying justification to determine whether it is or isn't consistent with the master plan. when we brought the master plan to you for your review and endorsement you asked us to deal with the three different types of determinations in this way, so consistent applications, those that are plain consistent will be presented to the health commission as an informational item and forwarded to the planning department so the department of public health's recommendation would stand and you would be informed of our recommendation and finding. for those consistent and recommended for incentives however we would present the items to you for public review and your final determination at a public hearing and the same for applications and if the

department considers it inconsistent and deem its that way we would have a public hearing and you would make the determination. that's an overview of the process. now i will get into healthright360's specific application. healthright360 is proposing to relocate two of its sites. the current site on mission to a new site at mission and van ness. it is two and three blocks away respectfully from the sites they're relocate to the new site and expected to open in june of 2016 and will have 50,000 square feet. 30,000 is medical services. 10,000 is social services and 10,000 will be administration. healthright360 has long been a partner of the department of public health so you may know some of the data already but they have a long

history of providing care to low income and vulnerable populations in our city. as an example they provided information on their current patient population at their clinic at 1735 mission and in 2013 they served approximately 3,000 patients at that clinic. nearly 70% of them were below 100% of the poverty level and [inaudible] were below 200% of the poverty level. the vast majority were uninsured and a third were residents of two zip codes listed and that is important because the data on health disparities and vulnerable populations in those zip codes show great disparityings which i will go over in a moment. so what are they proposed to provide and to whom? they propose to provide 18,000 medical visits, 5,000 dental visits -- i won't go

through all of them listed here. more alcohol and medical services and they propose to add new providers. >> >> four medical providers, two dental providers and behavioral health staff. they will have multilanguage capacity and they provide in spanish and portuguese and will have additional languages available and will care for low income and vulnerable populations and based on medi-cal eligibility and necessity and their residents of those two zip codes will combliez about a third of the population of patients. this shows the patient population and the disparities that exist for

the population they propose to serve so in the very left darker bar is the 94103 bar and then the 94102 zip code and orange is san francisco overall and the zip codes that conprize a third of the patient population and more individuals under 200% of poverty and 125% below poverty and likely to rely on food stamps and other funds. they are likely to have medi-cal or no insurance coverage and on par with the city is the diversity of these neighborhoods language other than english spoken at home and foreign born are on par with the diversity across the city. south of market residents

also experience disparitys in health care and crime, so the graph on the left shows preventible emergency room visits. this is often an indicator of limited access to primary care. the theory being if you had access to primary care you would avoid san francisco general hospital visits and you can see in the south of. >> >> market here and the identified in this area there are far higher rates of preventible emergency room visits among the population there. crime is also another one of the indicators that is part of the recommendation and guidelines and you can see that in the southern district station that includes the south of market area the rate of violent crimes far exceeds that anywhere across the city. and this is just another snapshot of a few

health indicators to indicate health disparities exist for these populations. the emergency room rates for alcohol abuse exceed the city's average as well as asthma and copd. also san francisco general hospitalization rates due to heart failure, copd and diabetes -- i didn't list them all but this shows some of the health disparities in these areas and not only do they propose to serve these zip codes they're in the 94103 zip code. so this is the final slide and it contains our recommendations. the department of public health staff recommend a finding of consistent and recommended for incentives for healthright360. we believe that this proposed project increases the availability of and

accessibility of primary care in these neighborhoods and rates with higher health disparities that the plan identified. it increases the availability and accessibility of culturally competent primary area in the areas and availability and accessibility of dental care and demonstrates the commitment that healthright360 demonstrated the commitment to give access and care through the transportation programs and that they will expand community behavioral health ?fers the area that needs them so you have also a resolution for your consideration that was attached to your memo that would agree with this recommendation and the executive director of healthright360 is here if you have questions and also staff from the planning department. >> and i will note that the vote will take place on

november 2. it will want happen today. >> would the executive director of hr -- sorry, of 360 like to make some comments. and as you're commenting and the findings show the services you're providing but i see it you're moving from two buildings that have 67,000 square feet to a smaller area and -- [inaudible] from findings of staff. >> thank you. i am the ceo for healthright360 and i am actually honored to be the first application before you and i want to say in when the master plan came before you i was

anxious because i thought it was hard for organizations and [inaudible] facilities and serve the population we're committed to serving and i thought it was going to be an impediment and going through the experience i don't think it is and i know you support us and i am glad to be the test case. our intent -- we rent the properties in the two locations on mission street. we rent those properties. we will vacate one of them and reducing our usage of the 1735 mission site and we have other services that we will be moving from other locations into the 1735 site so there is no reduction of services. there will be an expansion in enhanced care. that is the plan. some expansion and

enhancement of care and this will facilitate the clients that come to us for any service to access the other service. for example some of the social services mentioned have to do with housing and employment supports, educational supports for people who come to our care typically for behavioral health locate it where a primary care is and primary patients want to access the housing hospitals and they can do that so it will facilitate care so there is no reduction but expansion. >> thank you. commissioners any questions? sure please commissioner. you're first. >> thank you very much. i appreciate the fact what you're taking on is huge and i commend

you for the services that you provide for vulnerable populations. when we look at sort of the number of objectives none of them seem to be measure annual. for example with the increase of culturally competent care and providers and i also note in the resolution you will be asked to come back in a year and give a report on that, so what i am curious about in the interim how do you do that? what specific kinds of activities -- and you don't have to give me a big picture here but i am looking for a big picture -- [inaudible] but how do you do that because it seems to me when we think about the declining number of culturally competent providers in this particular health care environment i am curious how do you make that happen and what kinds of measures do you use to do that?

>> well, we define it broadly so it's linguistic capacity. it's providers that come from the population we serve. we do have -- we have -- given a lot of client vs history of substance abuse disorder or a conflict with the law so we have a fair number of our staff members are former consumers. we probably have a higher number than other organizations of consumers and we have a continued commitment to do that so by increasing services we add the opportunity for consumers to be employed in our service. in terms of how we measure that we do keep data -- demographic data on the staff and where they came and by what path they came to us, so we would be able to report on that and if you're interested in a change we could benchmark that today and operate as usual and look at it when we

come back a year from now and these are the changes that happened as a result of us occupying the site. >> right. but in this particular marketplace currently that we're in is that a challenge to find culturally competent providers? i mean what is the marketplace -- >> it is a challenge because we are dependent on public funds and often our contracts stay the same dollar amount but the demand for folks, the salary requirements have gone up higher so it's increasingly a challenge. it's a challenge to find primary care providers period. i think all of us in health care find that as a major challenge so to the degree they're multilingual the cost goes up so it's a challenge but we have been fairly successful.

people come because they love the mission and the clients. what we're unable to provide in salary we have people that really want to do that work. it's not easy. it demands a particular commitment. >> thank you. all right. commissioner singer. >> congratulations. >> thank you. >> we see very few organizations that find buildings in the area that you secured a new building in the current economic climate for the work you're doing so i think that is great and seems like it's tucked up closer to the tenderloin area which is not yet quite as vibrant as the soma area. i was wondering if i remember colleen's slide correctly there were high 38 or