imary care commitment it actually decreases. >> a good question so to come up of moving pieces within primary care the first is associated with ramp - there's one way to look at a reduction and one way to look at it compared to where we were prior to last year's budget we included a couple of initiative a big expansion of primary care and we've seen we've gone into the current budget year there was the primary care unidentified call center we're actively implementing and other positions for revenue neutral initiative to secure an additional primary care loeblgs we had a site in mind for that one that didn't workout we

didn't pursue that and also just in terms of the total added ftes in our pace at hiring those as we looked at this we've seen we're not making the process we thought towards billing the added position we're seen as much as we or are the positive staffing doing on segment of what is the realistic hiring plan for the primary care positions and in doing that we invade made a scombruchlt 3 and a half million positions not staffed up as added in last year's budget we've pulled that out as a one time salary savings the growth by the second year of the two year budget we're not seeing a reduction only a slower rate of growth given the fact

we've not been able to expand as erupted in last year's budget we're then able to reprogram those salary savings into areas we think we'll be able to spend in the next fiscal year. >> thank you. i also appreciated that population health an additional sum of moping money was the backfill where the federal government is not doing their including some of their needed programs so i was pleased that was in the budget i was also interested and thought that for the future if the budget move forward and we're actively secretary-general having the position of the office of economic workforce development that we are able to get a followup on this especially in terms of the issue

of cultural humility and we really are support to be looking at the departments program for that and it is good to be part of that it is invites to see we're continuing to try to focus on that department wide those are part of the comments on the overall program for the commissioners the most important issue and that's why you're standing here before us is this very large request to add another $20 million to our base budget to operate the e h.r. commissioner singer has done a us a great service in enthusiastic the whole game plan for this i think tonight presentation assists us to really as the commissioners understand or if you don't and

have that question as to the validity of the plan than this is the time to ask we're going across the street with a whole program to say what we need and some of that with greg's help also has ton to try to find those methods of now intangible set of goals in order to get to the system wide program that we've all said was vital to here this is really the most important aspect of our budget as you can see otherwise moves one percentage of another way of the remaining departments i'll hope our commission feels comfortable with the presentation or has questions now directly maybe related to the it as we look at the whole budget dr. chow before we go i was

asked to make one question and absolutely. >> it follows up on your first question regarding the primary care and staffing issues so mr. wagner this is again asking commissioner singer to leave for family issues commissioner singer was asking with regards to the budget so in the bad times things get tighter he wants to ask you do we have a sense - because most of costs are working related costs do we have a sense of the long term workforce fte count over the future will we be expanding he wanted to ask if we could in particularly to the wonderful chapter the fte chart showing the fte growth or on positions

and the trend so i'm hearing you saying we kept the bottom line of $1.90 billion because of the on positions he'd like to track that particularly to project a growth that is in staffing as we go into tighter budget in the next year's. >> surely and we'll provide you with the whole commission with data on the fte count and give us step back and look at where we are on fte count globally do you see the history the u shape we went down ore over the years of the recession and now crept back up to a point that is a little bit more representative of our kind of point of status

during the stable years we're going to grow above that this is going to be due to one the exceptional it effort we're going to have to grow our staffing there and the other is that as you can see in a couple of those initiative there are some functions that were actually bringing in house that used to be outside so we'll have our nutritional services at san francisco gentle a foster care and mental health positions and that reflects in our fte count not necessarily in our care effort for the department one of the things we're conscious of and putting a lot of effort into is taking look at this growth we

know that as soon as we hit that next downturn which is probably going to come in the next two or three or 5 years so whatever that is going to be anybody we're adding today is going to be we have to ask the question do we want to add this position knowing we're going to be under the economic pressure when the next downturn hits is that that important and how are we going to put the safeguards to stabilize our are you u shamed curve we'll be getting ourselves budget policies in place that bill alluded to on the h.r. another to try to get reserve policy in place to have cushion

and internal rainy day fund so we're not having to live directing to directing every year and could a stabilizes that over time. >> maybe you can distrust with with commissioner singer and regarding our first question dr. chow it is the necessarily expenditure i'm glad it looks like savings to move the $20 million to the bottom line will be increasing if we can do that every year that would be great so we keep our total budget anothers a dollar 98 would be my preference. >> i think the last two; right? >> (laughter). >> commissioner that's why you're here just to see that happens every year commissioners other questions commissioner chung.

>> i'm curious about the 89 positions with i think of the curve i would think that you know the next 6 years would be really where that spikes because there's like a lot of technology transitioned and elapsing curve and training our computers how to seas the information that's the secrets of the curve and eventually will drop and kind of like flat line more or less because when people get accustomed to technology you know especially for commissions i know that you know like we might not meet as much like support as you know, as we would project it 89 positions is a lot of positions consider that we have to audio know benefits.

>> you're absolutely right your assessment that the staffing learning increase when we go into operations it is true if you look at the slides the 89 position it the $20 million for the 89 positions will not likely go away it is part of the right sizings of it to permitting provide a more timely service to our businesses you'll see when you start the implementation a significant amount of people one time resources had will come in the next two to three years to implement it those 90 plus people will play a part of the team so when the implements we have operational knowledge which traditionally we've done a poor job so what you see we have

people come in we don't have enough people comparison and the xoirn people leave we don't have the skills and. so we want to train the people and retain that knowledge going forward so commissions not in the slides one the things we're telegraph hill looking at to put togetheral knowledge management system we don't have a knowledge management system in dph all the people in san francisco don't have a knowledge management system that every good it system should have we keep them in our worksheets and our heads we implement 9 management system so there's a lot of foundational

part we're trying to you put into effect today so those people do their job effectively not only their job but effectively right. i hope that answers our question. >> you know i see a lot of cost estimates i'm curious when we talk about adapting technology you know like the entire department and consumers do you actually have an estimated knows timeframe to implement that effectively or like you know because we how do i ask the question not so much effectively but do you have an estimated timeframe how long it will take conditions you know to adapt to the new technology like to cease

it technology how to read you know liquor the records i know that is really a big question you know for us to sit here and say this is about cost right side at the end of the day that health literallycy is just as important and an address that i believe we'll be speaking to in it we call doumgsz e you could invest in technology whether the ininclination it is not going to be effective so part of the costs you see here and the $20 million operational as well as the one time costs a significant part it training costs that comes in the form 6 two treason he professionals we're going to hire and nurses and clinic shundz to be hired if

i'm going to come here and ask you to support literally $250 million effort we need to be sure we can train and operational lists this reason we're looking at this if i hire people later will not have enough time to implement the information but but that's a big challenge the harder part of this it is not the implementation it is really the documentation. >> commissioner karshmer. >> i want to say yeah. this is something the dimension is saying a high priority thank you for taking it seriously this investment something i think i can support thank you. >> i do want to really be clear

that when i got hired it was made clear this is the number one priority for the department of public health this and general hospital are two thanks of things that are addressed to my job having said that do you have any other questions. >> i want to comment we did the right hire prior to bill coming we looked at this issue and that report talked about over one hundred people we needed to right size it so i think we're on the right track in trying to grow our own spaekz we can bring in young individual that can grow in the department part of the workforce depth because of the competition in the community

bill and i met with one of the organizations that worked young people more the production of movies and that kind of stuff lots of combroung people with about interested in that kind of job we have opportunity the big piece we need to think about we'll be looking at $123 million for those costs we know we're looking at potential donors and one time debt service and that is going to be our biggest challenge the fact we put that into our budget let's put it into prospective ten times larger than our it it is a significant amount increase the budget by 25 percent that is necessary for the direction we

have to go i think all our staff worked hard not trying to ask for anymore we've been disciplined our our focus thank you, commissioners for the support of the direction and our i think a real focus layers focus on this issue. >> director garcia we understand the need for the quality of the operations i might recommended for this journal auditor and people of the public that is a wow. why are you spending all this money on this i recommend you put to death the documents to be able to increase the billing related to this and cost savings related to higher medi-cal and medicare there are dollars at risk if we don't do this awhile we're

looking at the quality of the operations there's a financial picture the $20 million every year i'll assume we'll get most of that back in terms of being able to bill for services that probably we're not budgeted for . >> i met with the president and vice president of the commission they asked for the revenue bar across this this a relevant question and do not do amr we another risk we need to make that case. >> i think that this speaks to both what are we going to lose you know already out there from the government in terms of what they're to take wu and the revenue we expect by better coding and better records along with what we believe is a better quality we have a uniform record

of the individuals that we're treating but i think that's where the external business needs to be made in order to justify our $20 million embedded into our new base and then going out and getting the $123 million for the brand new impetus like buying a little. >> commissioners, if i may add so we're speaking of a couple of elements number one is what is the actual return on the investment in making the huge investment we will be working with uchls to work on their revenue cycle we accounted project out using their numbers we've been at this for several years we'll have information as

to what that looks like that will be to consider the gains we know what systems will be for the commission we want to figure pretty close to the commission we want to see cost avoidance there to the question why we're doing it now it is simple would serial number in her buy saemz and the contract ending in 2019 we have to get off the system otherwise our ancillary support systems will not have an e m r my original stance a year and a half ago we could do this we could integrate them together

we don't have the option it is gone because the vendor is going to be coming here telling us you need to move off of it interesting enough that has created a perfect opportunity to talk too on the county that have's envision to see they're looking down the barrel oh, my gosh we've got to do something the county has never been pushed to find a solution so actually, it's an interesting and exciting time thank you. >> so one more question here well more of a comment so because you know like up to this point we looked at the different proprietor departments like i mentioned earlier seem to us you know we don't know how they

actually work so does it maple as we move forward you will be working with you know the different department identifying how you know are more continually looking at the software we're putting into this. >> yes. we have a very strategy goal in mind the united d m r system not the integrated but a single system a data liquidity from one place in the business to another without us having to mass acknowledge this data we need this if we're going to perform as a integrated system so from this point on i guess should i feel comfortable to ask that question every time it there's a software question and

put that on you courtney. >> that's exactly what we're looking at one of the r s q the mid wear that sgrakts those inch state of mind we can't buy a unidentified system the action system we've got to integrate that but we're looking at it as a holistic picture we'll be this is not only going to save money but perform a valuable certify to this organization. >> thank you your exactly right sfaung we've asked about the software for the it it is part of the integrated question we should be requesting that. >> you should be the one presenting that. >> actually commissioners we made that commitment about a year ago and made it clear to

anyone that want to create a system that's not possible we circleed that issue that's an important issue. >> so mr. wagner our loot slide give us the next steps what's the next steps it says an additional budget hearing and your schedule the submission to the board of supervisors but what would you like from us today. >> today, we're asking for your approval the initiatives before you at this hearing and at the february 3rd the last one that would be the list of items on the speed sheet to take the

mayor's office beyond that as bill said on the it process we're working telegraph hill to do some refinement felt program and of the court reporters so we'll anticipate another meeting here prior to the mayors budget submission to give you more explicit daily about the initiative and let me see lightning line items a subsequent process before the mayors budget we're asking for today, the commissions approval of the budget initiative on the

speed sheet impact. >> the margin is on the speed sheet and not the it program. >> correct just the summary supersede sheet and the irresponsible write ups for today and asking which i think we're hearing support for - as we're balancing so there the initiatives leaving a pot of about $19.7 million which we intend to program towards the it costs in the mayors budget. >> there's a motion and i see a second oh any public comment. >> no public comment for this item. >> okay. any other comments on the motion to move the initiatives seeing none we're prepared all in favor, say i. >> i. >> opposed? and the initiatives have been

approved thank you very much thank you, commissioners item 10 is other business this is not committee agenda those are topics you want to bring up. >> right so commissioners any other topics you would like to bring we've had a number of tufkdz brought up if not - yes. >> one topic that popdz up again, the part in the presidential budget proposing to move into the next year issues. >> we'll bring you a report. >> thank you. any other otherwise next item. >> item 11 the joint conference committee and commissioner

karshmer has said so to summarize your meeting. >> laguna 407bd honeyed commission month to month met and we approved the minutes and the rest of the meeting was in closed session we reviewed the performance improvement and the safety report. >> thank you on february 24th the 70 g h jc c met and reviewed the quality regulatory management reports and discussed the icc 10 update what was positive and reviewed the budget initiative you saw before us today and heard about the value based purchasing a complicated schedule that the organization needs to meet now with and we'll get an update to the commission once we have further information how it's

working an enormous recorded or report card and sf general and the hire process for the transits and over the course there were discussions regarding timing and weather we'll be able to hire specifically and as the rebuild it completing the hard part of the building whether we're going to have the ability to get all the inspections in and be able to start moving into some of our materials as bill was talking about such as the enter comes and all of that to presenting prepare the building to be prepared this is going to be a topic each month and report will be coming to the commission in