sical screening for everyone would be one because this is what d c a is for early detection and looking at because one of the priority when i first started here was health equality what can we do to reduce disparities amongst the population that to me is the right track not so much about how many appointment and what they're doing it is great to know but as public health agency what are we doing to help disparities for the ininsured and for those who are more vulnerable. >> i'll start i think there is a lot we can do particularly in primary care and the other parts of network we use a lot of

disease registries if their heart focuses on the preventive as it relates to particular disease there's a an opportunity to leverage some of the register work and substance abuse we're providers of care we still do a lot of planning and education i agree there is an opportunity to show you some more of those types of metric i think we can easily do that. >> as a member of the new network it is important to for people to understand we're a whole new organization in terms of the network but commissioner pating did was repeat was the real role of the affordable health care act and what is measured so i'll suggest that we as the executive staff should

develop goals we'll be needing and what the policy level we should focus on the plans and bring back metric dashboard to understand you did a go back in our outcomes we could really bring together a policy level conversation regarding triple a and to see what we're doing he clinics to keep you at the level we're meeting triple a to measure the finance one that really has a solid piece to it and look at it overall in terms of the health network one from h

m a we were supposed to meet a certain patient levels to meet the neck levels we could do some of that for the commission if you have ideas about that. >> commissioner karshmer. >> thank you both for this presentation the whole package the first part spend some time updating about the branding and i think this is important because i think we get into the outcomes and i appreciate the work that has to think done internally as well as the extraordinarily i'm very - you did a really nice job of breaking apart those diverse measurement that are not in active at all the example was a very good one a couple of

thoughts you appointed in some of the reports that the numbers were down so just as reporting he said might be useful along the way that was not clear by adding into the reporting might be be helpful i can't agree more about the electronic records you'll get the analytic we'll convert those measures into a whole and i think as we think about making this a whole measure it is investing as much many the analytics with the updating data the simple question it is so variable that didn't capture it and reflect what we're about and has to be

linked to access and timeliness and the kind of work to set the stage will prepare us this is the first time how many committees do we have they are you don't have your baseline as a way forward for your way forward it is quite impressive thank you. >> commissioner sanchez i would concur with the comments of the commission that is just a major achievement undertaking and we're still under law and will be flew it brought back a number of areas when i was open about the one hundred and 12 general and the 12 we were discussing with laguna honda and i did who right to left shuns in the national statistic in the 70s and 80 responded from

medical schools how to reclarify those and those are been revised and revised and revised now down here as stated we have so many of our different subsets to make sense the data it is different whether you're on the health care versus the general versus the mission center there are variables and this is the concern way back when what about the cultural difference when cultures will make no sense at all and the same thing i want to congratulate everyone saying we're there and it is a come numb inquire and we need to dialog and input but important importantly from you who are

involved namely the quality of care and again an excellent presentation. >> thank you snrl. >> i want to picking back an what commissioner chung said to help me determine the quality health care i know the main goal obviously our healthy outcomes as we talk about disparities particularly among community of color it be would be great if we looked at quality measures to make an impact on the disparities we talked as a commission integrate it to a quality care it seems to me we should be in how to use the quality measures to help us meet or address those problems i

wanted to say that. >> i wanted to mention for example, if you drill down into some of the work of mammogram we breakdown those by race ethnic and talking to the clinics one the strategies for example is depending on the clinic the rational and ethnic groups may be different but they'll produce intents we have resources in terms of okay. they'll prioritize to get those up i forget which clinic has spatially speakers primarily the ones that are low they'll hire spanish interpreters we'll breakdown the metric in primary care and on the hospital side they're a pitch report has a

section specifically around equity. >> thank you director do i have any further comments in regards to. >> no, i wanted to commend the presentation i think for a very complex information they've given us incredible information and will continue to work on that to bring back the dashboards i believe we have a session with commissioner pating and some of the data folks to look at other systems to do that so there are areas that are very interested to we'll report open that. >> so i think you've received quite a bit of feedback from the commission in terms of where we need to go in the next six months so as i said the commission asked for a six months piloted to see how we're going to the monitoring and review the networked we've herald today where you are are

the network and how we've expressed disrespect areas which we would like to have a way to view it within the triple organization is where we've felt the department has been heading and it is important to be able to separate and review those things that are preventive in the public health side as diseases we need to grapple with the traditional way of landmarking and the whole issue it is not just quality and satisfaction and how to separate the two if we stay on target trying to work i realize the executive team has a lot to do the budget is done i'd like to see if we can in the 6 months come up and come to a consensus

on the goals and give us i think a good timeframe and i assume you work in calendar years we're able to employ some series of measurement we could then seeing how well, that is going to help assure us and the public we're doing as good a job was we can okay. thank you and thank you very much for all the work that's been put into this as we move towards the last finance meeting a numerous amount of data that wasn't there. >> item 9 the san francisco health network portal.

>> good afternoon, everyone i'm assistant clinical professor at ucsf and work and the san francisco board of appeals in medication i'm also the physician champion for the portal now in months to implementation. >> so a little bit background will the design of the portal initial efforts began in our attempts to try to demonstrates we were able to meaningful use the electronic health records those measures were developed by cms and came with financial sensitive for networks that can show we're meeting criteria

regarding the use of hr and the portal in the design phase of this our task was to think of a way to take all our systems as dr. chin talked about and combine them into a comprehensive portal i'll talk about that latter in the presentation apart from that in particular just to provide a improved care experience for our patient in the network that is a website in which patient over and over their clegd proxies look at the electronic health record and provide access to a patient education database to search tops this is not be

attorney general offer high-level things like e-mail or appointment requests we hope to integrate that into the future next slide speaks to the some of the challenges about trying to consecutive a permanently all the patient receive in the network in the end we face many challenges maine to inoperable ability we heard fragment of italy's systems trying to create one portal for the network that encompasses all information is challenging in the end we designed information only if san francisco board of appeals in patient care as well as ambulance care from our incline behavorial care was unfortunately not dmutd

the way the i don't remember and importantly example for example in primary care as a patient as a patient is enrolling their address will be entered directly into the medical record the portal is a housed through the h.r. used in primary care and at this point they'll get an overwhelm that will have instructions how to enroll and they'll create their account just to be clear both the hospital and clinics are charged us with those resources they are in the clinics you i using front deck staff to talk to people some clinics are using medical assistants and some volunteers and each clinic is trying to come up with a strategy that works best on the hospital in san francisco board of appeals we've recruited hospital volunteer to the hospital

volunteer program that talk to patient in the medical and surgeon unit about the pfrment what it is how to sign up and been trained to help patient set up an overwhelm address if this is a barrier and help them lock into the account this is they're only task this is the website what it looked like when you log in this is the main interface on the bottom left if someone is enrolled in the enrollment they can click and see their hospital records on the right is a link if they've been enrolled in the clinic they'll see their inventory record you have to enroll twice if you get their primary care

care from someplace else other than the hospital they'll have to enroll twice this is the information on the in patient side they get this information at the time of discharge and on the outpatient smurmdz and various diagnoses so we're early into the implementation face some of the general successes people are really excited about the higher levels to e-mail their doctor and ask for an appointment we'll have a benefit we see many of the patient that don't have family or connections

they've enjoyed the extra attention so this is our data two months in so as the main thing you take away there as discretion between people that provide an overwhelm they may want to enroll in the portal and number of patient that create an account the ambulatory care for san francisco board of appeals that is across the hospital i think the discrepancy difference probably have to do with the fact people are dedicated to that task in the hospital whereas in the primary care clinics if they've been charged with this they've doing that with existing staff they're

they have other competing priorities this is champs operational both settings have patients going a lot in the hospital they've being taken away with tests there's a lot of comploet priorities and integration how do you talk to people about the port authority face fall u value you type in their overwhelm this is role a conversation and integration more than typing in an e-mail and some of the barriers that our patients face really have to do with language or computer efficiency and also many of the common e-mail providers you don't hasn't and others requiring a phone number to set up on e-mail for example people are is access to a library if they don't have a finally phone

number their prevented some patient have issues regarding security and so forth on our technical side i think operation ability and integrate into one portal has been challenging the vendor wear their first clinic to combine an in patient and outpatient into one this is a challenge some of the instantaneously we have so operationally we're trying to see how we can integrate portal recruitment into primary care and san francisco board of appeals we've provide a way to designate a proxy or their unfamiliar with computer they can designate a family or friends that have

access to their records with the community organizations to bring connections to our patient population is important and the spanish language issue we hope to have a spanish portal coming in the summer on the technical end we're working closely with the vendor we have we believing meetings to address the technical issues do infrequent testing and we're starting a call center to address our patient and staff issues regarded the permanently but ultimately as mentioned having a sgrargd medical record for the entire portal will address our key measures the on horizon spanish portal how we can set up appointments and on a

leaguer scope 9 patient portals we've been approached by people to pilot digital health targeted at our population and trying to link them with resources specific to the person logging in lots of great opportunity with apparent in the future we have a link on the corner of the san francisco health website i can learner more about this thank you. >> thank you commissioners questions in terms of a potential existing enterprise yes commissioner chung. >> one of the challenges i've heard is about ceasing the

computer and you know if you have to venture into guessing i know what percentage do you think our patient actually see that the general divide as barriers to access those online portals. >> that's a tough question it varies by the language definitely being one of them more young patient that don't speak english if i was asked to enroll in a payrolling in russian i wouldn't preserve that to be a benefit to me and then i think there is some correlation with age definitely a lot of older people that can't or won't and don't have someone in their life to do that for them in terms of absolute percentages you know, i think there is a lot

of interest i can say that we enrolled a patient in the moss hospital i don't think he ever touched a computer by really, really wanted to i think a case manager helped him months ago set up on e-mail and he was excited and for someone after some basic he picked it up quickly it is pretty significant. >> i know that yeah, so this is more quickly for you i think it is more about you know those are the first time we try it and you know we're going to have a lot of restoration to hand that narrative by the way back to who wrote those policies with go

intentions it is over generally listed i think that is good we were able to do as much i also want to say i think a lot of our patient populations assess the library you know if there recent something or some partnering we can do with the library because they won't be assessing this information. >> we're