standards more tallied and deeper dive so to my second comment this report is the not people don't know this is not about cleanliness and picking up litter but diversity maintenance in the park system and the scott weiner is reflective of the deferred maintenance and some of the parks with the lower scores are parks with different maintenance issues and so 24 will continue to guide your capital investments but the program is a low scott weiner park under renovation so we hope to see that the skiers for that park that district 10 alice a low scoring playground with merced that is typically a challenged park and bayview is slated it get phase one of commissioner

mcdonnell talked about this we need strategies to invest it was brought up over the weekend so i'm not sure what the funding by the way, a track for equipment and more ball 2350e8dz 3 don't take care of the playground but some investments it has been helpful tool perhaps we mind or want to thank lydia and others it is really helpful in getting into the weeds us and very, very proud of this report. >> commissioner mcdonnell. >> just briefly a appreciate the report and the diligence around the transparent and the commitment to the accountability it calls for it lob helpful goord not only the

mechanism the rhythm of wanting to have ongoing updates for the annually is good so have it closer to realtime like you just did you know each of the parks are so quite candidly to see the parks on the southeast side of city and kind of want to win that race (laughter) and so to have again, i don't know the right rhythm not every single meeting but as capital planning happens and here's where parks are in the cue that would be helpful in response commission we're happy to cook with you know we can provide a marrow and a bed-and-breakfast

package but the annual report comes out once a year but come back in mid-year with an update in the next item you'll hear an overview of the ballot measure and one of the things we've committed to doing in the ballot measure to lay out what are called metrics and we'll end upbringing them to the commission in the next year and we will before i applying apply those equality measures to the expenditure report that are tied to the strategic plan and those equality metrics call for a little bit of a deeper dive into you know areas in parks where we have been caged so you'll see that in a mr. haney and requirement we have to embrace as part of revenue stabilization

like this morning that feedback loop came back built into that you'll see a lot more of that. >> i know this is a discussion only item i wanted to add i'm sorry commissioner bonilla. >> oh, i wanted to ask how do we disseminate this report and request feedback from all the park users on this report and commission the report scores are very public but the one the website and the controllers website the board of supervisors will often have a hearing about them so feedback on the scores is absent tricky bylaecause those

serious methodology to actually doing the elevations you are staff and the staff r is trained to do them a lot of these feedback loops about the conditions of our parks and that includes 311 and a myriad of feedback mechanisms when things are wrong the report is discussed by the prozac representation and it is out tell you so it gets okay - great that's all i wanted to hear and i want to echo commissioner mcdonnell remarks although he didn't want to say it we love you are district but show for love to district 10 and 11 it is starting but have to embrace that i share commissioner mcdonnell concerns that district 10 and 11 the third year of the

report they're showing they need more attendance more love whether through more community involvement or engagement be open and focus on those two districts what we can do more in those areas. >> thank you, thank you we're on item 8 the rec and park budget for fiscal year 2016-2017 and 20 2017 and 2018. >> indulge me as i set up my power point. >> good morning, commissioners

kate happy new year to you all. >> happy new year i'm here this morning with our initial presentation on the our budget development for 2016-2017 and 2017, 2018 i'll start with the summer of mayors budget instructions talk about the interim control amendment and take us to a high-level of the current fiscal year. >> the two year outcome was a little bit mixed the mayor's office it projecting that revenues will remain strong is growth in $75 million in each the next two years, however, the mayor is anticipating that growth and expenditures will steady the growth and revenue as

the wage increases all told her the mayor's office anticipated there will be a 99 mom and dad's scombrvd shortfall next year and a cumulative deficit of 200 and $40 million the year after that given those shortfall projects the mayor's instructions asked the general fund support in each the next two years in the form 6 ongoing not one time cuts the mayor has issued policy instructions including the guidance that the dptsd should reflect their strategy plan priorities and goals the department support the modern responsive and engaged government that the departments minimize any service impacts from budget reductions we pursue the costs departmental

collaborations. >> so the department is actually in a pretty unique position this year as we prepare our budget sums there is a charter amendment spends at the board of supervisors navigate that's where phil and i were at at rules committee to create a general baseline for the department the measure guarantees the department a stable level of general fund support by saying the substance about not drop blow the level the general fund support in the current year furthermore the measure increases the general fund support by $3 million a year fyi for the next 10 years and then the general fund support will grow e.r. decrease based on the percentage that the overall general fund grows or

contracts the department will then be protected if having to make reductions to our general fund support in order to help balance citywide diversities however, 24 protection comes with a cost the department must absorb all the revenue changes within it's new baseline and all one time expenditures such capital and equipment that that previously funded by the general fund but now be covered within the base bulb in this? approved placed on the ballot for june at june election so the mayor's office has instructed to us develop our budget with the assumption that the charter amendment passed that means we're exempt from making this one and a half percentage cut to the general fund the savings of about seven hundred plus thousand dollars in

the next two fiscal years so this charter amendment puts us in a new budget world and changes the way the staff and i track our budget and accountant account for the changes in the budget we prepare to sentiment to the mayor's office instead of reaching a cut target has been the case in the past we are balancing now to a total enhanced amount of general fund support and this is what this table lace out but before i walk you through the table i encourage you to ask questions as i move through the presentation we want to note from my standpoint what i think the benefits of the proposed charter amendment first and foremost this will provide the stability to the department and

make us master in our destiny one of the city encounters the next session rec and park will not be required to reduce the general fund subsidy you been to balance the general fund deficit so gone the day's of making a millions of or 12 millions of dollars to help the city balanced the general fund budget and secondly, the charter amendment gives me the department the opportunity to maintain our general fund capital budget antes at $15 million year after year after year a historic amount and the level the will not likely achieve under the general fund so walk through first of all, we start the amount of general fund

the department will be guaranteed in the next two fiscal years $67.2 million next year and 70 plus the year after that the general fund is 64 million dollars if you add $3 million to that it is $67 million next year and $70 million in year two right now in the city's budget system we have $47.9 million in the base budget in general fund support for next year and 43 plus million dollars after that so if you do do basic subtraction that leaves us with over $9 million in general fund expense we can add for next year and $15.7 million the year after that so we have to as i said cover our costs increases in a a

base including the equipment the department proposing to budget at least $15 million in general fund in each the next two fiscal years and we are also proposing an equipment budget of one million dollars to achieve those goals we have is allocate approximately $8.9 million of the available $9.2 million in 2016-2017 and $16. million of the money 2, 3, 42016-2017 and absorb those cost increases and budget corrections in each the next two years that leaves us what a small deficit of $42,000 in 2015-2016 and a slightly larger surplus in 2017, 2018

please note those figures don't include the cost increases in the work orders like heat and power and workers' compensation and gasoline we will know more about what those costs look like in 46 weeks the bottom line will change so to boil all this did you observe once the department has covered it's wage and benefit increases and if you wanted the capital and equipment at at proposed levels largely extended owe expended the resources by the charter amendment the $3 million in guaranteed growth in the general fund will not fund substantial increases inform our operating budget in the next two years, however, has we have in the past several years assess the congregate in the earned general fund revenue

and the open space fund and be able to apply that growth to increase in our operating bud t budget. >> got that and (laughter). >> one more time. >> the open space portion one more time. >> we know there is as property tax increases we know there will be ungrowth in the open space fund that is not currently budgeted uh-huh. >> so the controller's office will give us a sense in the next couple of weeks what we anticipate the open space fund to look like in the next fiscal year and the year after that if there as i expect some under budgeted grow in open space revenue we can budget new operating expense against that new revenue. >> so we can use open space

revenue to offset the operation expense. >> enhancements. >> okay. >> if we wish you know this a policy conversation new expenditure items we want to add to the budget increase the number the garden apprentices. >> this is uses for a variety of purposes for some for referred for maintenance but to support. >> operation and maintenance for open space so basically what katie is flagging you if look at the hectic 3 bucket of revenue that is general fund, subsidy, open space growth, and earned revenue the general fund bucket is now going to have a baseline and it will grow by $3 million a

year and can't fall blow the baseline 3e7b8d against that we'll absorb our own expenses the other two biscuits will eaten into operation as over budget into operations does that sound accurate katie. >> we're obviously aware that just as much we plan for increases in revenue and increases in the open space fund just as possible there decreases that can come from those two sources as well. >> the way the charter amendment is structured for the next 10 years baring official budget news for the city the

department guaranteed $3 million a year every year an additional growth in the general fund baseline open space yes is the it is fluid certainly over the history of the open space fund and we've seen pretty extraordinary growth. >> katie as you're being the director a decrease. >> yeah. so, you know, in the great recession. >> 08, 09 and 10 that is because the controller's office is conservative they know that people will be affected like the brotherhoods. >> there's a lag time too. >> there is decreases in value that decreases in revenue is realized sometimes later and later yeah.

>> commissioner harrison yeah. thank you katie actually, i don't know did we interrupt our presentation. >> i'm certainly not done but definitely a new way of looking at the budget it has taken me a while to get our heads around. >> commissioner harrison. >> so with funds like our earned income at open space dollars i have the flexibility of putting that into capital or into maintenance. >> i do as the department we could make the decision we want to take some amount of growth in open space and budget that for capital. >> budget it for operations. >> can that go into an

acquisition. >> sureality the open space fund as you may know were charter mandated for acquisitions but it is within the department and the commission purview to make the recommendation go to the mayor's office we spend more on an acquisition if we choose to do so. >> thank you commissioner bonilla. >> yes. i certainly hope that is not happened but the question is with regards to charter amendments i know what the reductions or instructs are you're planning around the passage of the charter amendment than what happens from the charter didn't pass are we put in a situation we have to ref down the expenses for the next

two years where do we go from there. >> commissioners to the twaushth twaushth it will not look terribly different but if whether we had the charter amendment not on the table a percent and a half in instruction to be cut we will probably solve for that through revenue so as katie is explaining with the $3 million in the first year we're going to have to absorb our expenses not like $3 million to spend so really over budget our operating budget really will not look dissimilar this year regardless over time if i summarize we get

our arms around our budget this year and generally might be the 3 strikes of the measure long-term stability and the growing you arguably we're still coming out of the decision that you were challenged to support as a commission that can only 09 were some of the worst budget years this will smooth that scenario from happening a really good thing and a planned small credential growth to our general fund subsidy over time we'll see how that pans out in year one not allow us to make significant investment but the based on grow over a period of time 3 340r7 a lot ofs you've touched on the maintenance and capital the baseline includes what was

for 2015-2016 a very, very healthy be year of support in of general fund capital dollars that is achieved through the city's capital improvement plan committee i think your history has shown we have averaged somewhere in the 6 to $10 million of general fund capital through that process in 2015-2016 the department was supported in the general fund of 21st century million dollars of capital and that allows us to do is as we plan for that to have bigger buckets of funding for many of the deferred maintenance needs some are sexy and some not allow bigger buckets and to you know we do grass fields and things like that some are less sexy

allows us more erosion issues and other things but all in all this is actually this is a good part of this measure we will be having frankly have a bicker pot of dollars to tackle some of the things and result in some of the issues in the parks scores you saw. >> i've heard the grumbling about this charter amendment not park equality allocation that this funding will provide how do we address that concern and coordinate an allocation of funds. >> through a series of no more than 15 series now a amble language that again calls for us

to develop a set of equality metrics which we might end up being one of the first rec and park. >> what's the equality metrics. >> a data point we have we're going to be relying on some assistance from them in developing some benchmarks for example, commission you sat ants playground commissioner mcdonnell. >> commissioner mcdonnell. >> and when you were slaement which playgrounds you know scored the highest i were considering how to allocate those dollars looking at the protecting and we're looking we don't know but come back to you by way of just so you know what at charter amendment says we'll

not going to develop new equality metrics that will guide us develop and bring them to you for approval the plan calls for some of this was in old language in the charter we went throat strategy planning conversation by update it every 4 years we have the liberty to amend it between the 5 year circles that will ended up go the board of supervisors for upside down vote they'll support it or say go back and try it again and developing an annual operations plan and an annual capital expenditure plan that comes to you so we are taking on and embracing a significant amount of planning and reporting and other all of those plans needs to incorporate

some of the equality analysis in the planning. >> sorry did we take you off your presentation. >> absolutely not this is all very important. >> let's get back on track. >> moving right along so just to remind our budget in the current fiscal year is if we did for a context as we made choices around the changes for the coming two fiscal years in the current year our total budget is one and $78.7 million a with an and $47 million of that is operations and $31 million funds capital and this budget support nine hundred and 33 budget and funded positions

as phil discussions our budget is support by a 3 legged stool the open space at 26 percent and 36 percent of our budget supported through earned revenue and 38 percent is supported there general fund subsidies and saving you are digesting subsidy is at a 20-year hive of 64 $.2 million this is a particular good year in the baseline. >> the. >> (speaking chinese.) fund continues to grow as you can see just on this slide between last fiscal year and the current year we added 2 about the $1 million in the open space fund the general fund subsidy $14 million more this year than last year and then prior revenue and savings down a little bit this year versus last year

as you may know for many, many years generated revenue to support our operations from the parking facilities and outland and nationals in the park and many more 63 $.6 million in earned income budgeted in the current fiscal year our actual earned revenue this shows not the budget but where we end the fiscal year excluding the other category shows a very strong growth since 2008, 9 we did experience a slight downturn between 2014-20152013-2014 and 2014-2015 as a result the reduced income from 9 stadium

and a reduction in whereof at the marina. >> so how do we spend you'll that money well, almost 50 percent of our budget is allocated to park maintenance gardener and integrated past management etc. and reaction programming is about a quarter of our budget and the maintenance and facilities by the structural maintenance yard is 12 percent or 11 percent beg your pardon we allocate for administration it andth and payroll, etc. the general manager and property management etc. one percent of budgeted supports the marina and the zoo and two percent for planning and volunteers and 3 percent for park safety

the vast majority of our bucket thirds support salaries and fringe benefits and i'll say that there were the mayor's office is expecting significant growth in benefits in the coming fiscal year primary in preparedness this is a result of a couple of factors the city lost a lawsuit by retirees and so we're now required to provide cost of living adjustment at at a higher level than anticipated the city's retirement system as retiree employees are living longer so the cost of retirement is going up for those folks so pension is definitely going to be a cost driver in the next few years the mayor's office and the

controller's office office anticipate the pension costs will level out and then see the benefits of that we next largest slice of pie at 15 percent of services of other departments we've talked about that everything we buy from the department telephone services and sewer and water and light, heat, and power and workers' compensation we allocate 5 percent of uh over budget on the supplies and equipment 5 percent on debt service which is we are are repaying a loan for the reconstruction of western part of the marina and the debt service that on the earner revenue bonds for the open space in 2006 and 2007 3 percent of our budget goes to help support zoo operations through our management an agreement with the zoo

metrological society and to the clubhouse operation so the restaurant, all the starts associated with the golfer and then 4 percent of budget for services garbage pickup and software licensing and copyers etc. as you may know we completed our 5 year strategic plan many past june the plan includes 5 strategies and 16 objectives and services as a road map that helps the department prioritize the staff time and resources the stream plan will be the primary document that guides our decisions as we make the investment in the next two fiscal years so strategy one to inspire public space, strategy two inspire play, strategy 3 inspire

investment, strategy 4 to inspire stewardship and stream 4 to inspire our team as we talked about a little bit earlier we expect going to be revenue growth in open space and in our earned revenue to help us fund enhancements in our operating budget my early analysis suggests that we will have growth in concessions and japan tea garden and to keep on growing pretty remarkable a tower elevator i supplemented e expect we'll budget additional revenue and have some good news in the parking garage particularly the civic center that is jammed and then growth in the open space fund

as always we will reach out to the staff and stakeholders the community and city policymakers as we work through our budget this year we'll do brown bag lunches with staff and be more informal hopefully folks will come out and hear about our good news and then two community budget meetings the first budget community meeting is on february the 3rd at play from 6 to 7:30 and then the next meeting is the week after that jean friend from 6 to 7:30 i'll be back front of the the operations committee with an update on february the fourth and back to all of you for your request for your approval at the bucket before we anytime to the

mayor's office i'll be here unit february 18th and the budget is due on february the 22 any public comment? okay seeing none, public comment is closed. >> just wanted to say thank you to the general manager and particularly katie for keeping us balanced. (laughter) we're on item 10 general public comment continued from item 4 is there anyone that didn't make general public comment on item 4 that wants to seeing none, public comment is closed. you have commissioners matters commissioners. >> none. >> public comment? >> none any public comment on that item? item 12 new agenda setting.

>> any public comment? seeing none, public comment is closed item 13 communications is there any public comment? seeing none, public comment is closed and 14 is adjournment >> so moved. >> >> all in favor, say i. >> i. >> thank you. >> thank you. >>

>> edward a chow, cecilia chung judith karshmer david pating and all those in favor say aye; all those opposed say no.

i have one addition.that would be under the gift report and after the comment on the action taken if you would note that if i had said to the chair that we would be sending these notes to these organizations. it would then record that we actually normally would be doing that. if that is okay. in addition, i see that we have approved the minutes with the addition and just to be sure all those in favor just say aye, all those opposed say no.

you have the directors report in front of you. i want to add a couple of things. we want to welcome dr. lisa pratt, the director of health services many of us know her background and were very excited. she is a certified internist and addiction specialist. she works at the-- cclinic and she has a position at san quentin state prison and she is bringing some leadership to us and we are very excited she has given 2 decades us. i want you to know that because of the weather we have been working very hard with our distort organizations and human

services and we have several shelters that we're looking at for providing for people that are homeless during this time. we have an expansion of our existing shelters. we can expand over 80 to 90 beds they are. we have also opened up some temporary shelters at the recreation centers. i want to thank this weekend eileen watkins, amanda patrick, and there is work being done with the shelter and this is going to be a permanent shelter very soon. we hope that by providingthe shelters we are providing some shelter to the people in el camino.

we are meeting on a regular basis to do some planning and reporting and we are also working on the super bowl and trying to repair for that. i will leave it there. i had one concern about the shelters. how long would we maintain the shelters? >> that depends on the team. we do have protocol as to the amount of rain and also the amount of - so these were opening up depending on what these weather conditions are.

we will be opening these up this weekend. one concern is our health team of doctors and nurses have found that there have been some people that have not been in the care certain a great opportunity he to share. and this is quite the process to go through and a lot of this is based on the weather and the rain and this is protocol and it really just depends on the availability of the people and i believe these did a great job and we are excited to open the shelters. a number of people have been under this care before so will be interesting to track the people that were put under care and not only is it temporary to help achieve, but

this is to help these people to learn to care for themselves. yes we have a combination of these and once i have a combination of these are be happy to share these with you >> thank you. do you have any questions for the commission? i have one about the super bowl. in terms of how we would be able to secure the safety of the public that is there. either in a emergency services were more importantly-- and not just more importantly, but you notice the environmental health, how would the environmental health be able to achieve let's say purity food products amongst so many vendors that are out there. and, it looks like a huge area that will be available for these vendors.

>> all vendors must have a permit that is given by the department. we already have told them what is not permitted and we have a process of the how we will confiscate burkhart for example. we have had 2 meetings and this is for those vendors that want to get licenses and to refresh them to the goal, and we should be doing that to make sure that those vendors are well. and we will not have any tolerance for unpermitted vendors. our health inspectors are getting ready and are prepared, and we note that they have been putting in extra hours and extra days to be able to

assure. so what we also have treated it with the health department to keep a lookout for those non-permitted vendors. >> [inaudible] >> i know in terms of if we had a boss issue or a multiple casualty we will have that today and we also have people that come bus people to the emergency room and also, people will not be taking vacations for that period of time in case we have to go into emergency settings if we need to. it will be a lot of people and a lot of activities and for the department, we will be looking on the weekend at our department of emergency management we will have our pio's at the emergency settings to make sure that the public

gets that emergency information. >> i assume, and i know there probably is some communication needed with these counties because this is a unique-- well, it is unique because the 49ers are not playing in san francisco they are playing in san mateo. santa clara has their networks gullwing but so does the city and over the yearsthere has been some misunderstanding about the counties down south especially when these major companies came and made some major impacts and i understand that has been resolved but again, we are the key anchor and in a sense, a lot of people will be starting from here. but not all of them.

we will have 200 or 300 buses-- wow! going down, all the way down to some of these hotels and motels, from multiple counties and cities etc. i'm sure they are doing some really excellent coordination because in terms of -- this is something that we want to look at when it comes towards your area and we want to be involved in positive outcomes rather than wait-- >> dr. brown, are counselor is already having these conversations to ensure that is happening. >> thank you. any further questions? if not, thank you. we will go on to the next item

please >> we have a public comment. we have mr. perry light. mr. light i will put 2 min. on the beeper. >> good afternoon commissioners, my name is perry lang. i am with the american health equity council and i would like to take a minute or 2 to raise a couple issues around african-american health. i want to do this to take this opportunity to say inc. you to director garcia and to the department. i am quick to come up when something wrong i think

that is part of my job but i also want to come up when something is right and i also want to thank the leadership in the department for all of their help. what i am getting to is the new rsq; the black health initiative that is anchored i this commission. and i think this is captured in spirit to what should be done to capture african-american health. however i have seen this before along with members of the african-american community, haven't seen those funds be increased. over the past 5 years they have covered about 1.9; i'm talking about dollars devoted to the african american initiative. we are at a tipping point in regards to

african-american health. i am asking you to support the riqwhich i know you will do. but i want you to look into your own pockets and make sure that that dollar amount matches our rhetoric. a lot of times you tell a company worried businesses priorities by looking at their budget. what you're looking at is a budget that is truly dedicated to american health. that is all i had. thank you. >> thank you very much. there being no further public comment on the list should we go over our next item? >> item 5, on the public health committee. >> today we had an integrated

discussion on our health division around smoking and cessation health. we would like to share our revolation that we will be sharing at our next meeting. we will be sharing with smokers at our san francisco health centers, 48% have been screened and 49% have been screened for care. the quality initiative under the departments true aspirations as well as what was mandated by --. within one year, health members had increased the screening of tobacco from 48 to 58%. as a whole, some clinics

were reaching 9598%. some other clinics have made significant approvement. if you look at all of the clinics moving forward, there are set goals. we would like to represent this as a wonderful step forward. we want to make sure that everyone that is smoking tobacco is offered a screening and offered a counsel and treatment if it is needed. regarding treatment and counseling we offer a three-year plan within each clinic. once we have identified the person is a smoker, we began some

motivational interviewing and upon that we mix some referrals and some counseling and/or medication. we do not have the data on the medication jet but the system is working on that. we have definitely seen some improvements with the screening and referral rates. we are just giving time. currently,we are in the 50% bracket. we are giving referrals for needed tobacco measures. so we wanted to mention that going forward. any questions before i talk about our population curtailed

who are smoking? you have any questions for the clinic? let's go on to our tobacco 21 initiative. we have our community and health environment initiative. smoking is our number 1 health-related morbidity and mortality. 14% are smokers and according to the institute of medicine, they just came out with a report in 2015, if the smoking age is raised to 21 we will be able to increase the smoking rate by 12%. this occurred because age 19 seems to be a very important

transition age in which people are introduced to tobacco before the age of 19 and they continue a lifelong pattern of tobacco use. the majority of smokers today start smoking before the age of 19. this has a direct impact on [inaudible]in the last 2 years >> currently, new york, hawaii and santa clara, have raised the age for buying tobacco to 21. you have to be 21 before it you can be sold tobacco to. we are working on an initiative to prevent retailers from selling tobacco products to people that are 18, 19 or 20.

i would like to conclude that supervisor wiener is in support of the resolution. and we did not have any community questions regarding the resolution. is that part of our meeting at all? >> i think the health data that we have really supports the resolution. i highly recommend that the commission approve it. >> did we have a discussion as to whether the language concluded any nicotine products that were developed. we are reassuring what the language around tobacco use is. do you

have any questions about any questions we have raised? >> why did we include age 18, 19, and 20. why did we say those ages specifically for tobacco sales? that is because if we said that we would prohibit under the age of 21 sales. >> let me jump in dr. chow. >> that recommendation should

have a specific impact on san francisco. >> thank you because the way it was written it wasn't clear. they just didn't come out and say 21 and up. now you have explained the legality issues and right we do not want to be in conflict with the state law but this could be in addition to the state law. that makes a lot of sense. >> great. >> any other questions? that was a very well presented summary of the proposed component. >> this is an opportunity to see how our health commission has been collaborating aand we see this is useful. we see this with emergency response and we see this with dental

care. again we are appreciative to both positions because they are very important health measures. >> any further questions on the report? if not, we'll move on to our next item please. >> our next item is the revolution and support of dr. pokes solicitation process that will provide a electronic and secure health monitoring system that will allow us to enter into secure negotiations with the judge him. again this is an action item today >> this is one we would be working to pass today.

>> it is my understanding that mr. kim, going forward towards the board are with this. okay. good afternoon, commissioners. cio for the department of public health and before you is a resolution for your action, as stated. it is a mouthful, so i won't read the title. this proposed resolution is for our new modern, secure and fully integrated health electronic health records system. so this presentation that you are looking at, before you and it's actually a mirror copy or summarized copy of the resolution before you and i will summarize as opposed to going word by word as i'm assured you have read the resolution. there is actually two major components to this resolution that

we're seeking: the resolution is basically to in support of the director of health, director of health decisions to seek approval for the board of supervisors that the competitive solicitation process will not apply in the procurement of a modern ehr for dph. that is part 1. part 2 allows the department to enter into negotiations exclusive ly with uc for the ehr system. part 2 of the second component is if the director is unable to obtain sufficient assurance that uc and dph is able to reach a fair and reasonable agreement within the six months from negotiations, the director may also enter into negotiations with turner

corporation directly. the next two slides actually goes into some summaries of why we are asking for this resolution. if you would like, i could go over this with you, or if you like, i could answer any questions that you have. ? >> why don't you briefly walk us through the two items. >> first of all, the slide recognizes the business needs and as you know we have aging ehr systems and we have a need in order to compete in the modern health care world for an integrated ehr system, to really better fulfill the dph mission to promote and protect the health of san franciscans. basically by coordinating better care. the next part is really about we need this system because our current system does not meet the

ability to comply with federally-mandated requirements. this also mitigates risks associated with loss of vendor support for our current electronic health records system. which is scheduled to end in 2019, if we have the 2-year extension. why the preferred solution? why are we asking to negotiate directly with ucsf? first of all, i would like to bring to your attention the industry position on ehr, statistics by dhhs, as well as consulting firms, gardner and klas clearly shows that the market leader in the ambulatory and hospital centers are turner. why epic? why ucsf? treasone of the two ehr systems that can meet our needs, but more

importantly brings a benefit to us. during our research we have learned that we have a unique opportunity to leverage with ucsf, specifically the pre-existing familiarity by shared physicians and residents will enable a clinical care coordination, and patient safety across continuum care, not only within dph, but within the two organizations. this will improve clerk clinical implementation and adoption and support because as our physicians and residents would also be familiar with the project and decrease our costs, as well as allow research that we'll be sharing information with ucsf. that is all i have for that main component of the resolution. now what i have before you is a timeline. should this resolution be approved, we are still looking at approximately a year-and-a-half before we can actually have the

contracting done. now having said that, it may move much faster, but we don't know at this time, as it's very early in the process. but we are going to be doing our best to actually decrease the amount of time we'll spend in contracting. this timeline shows we're planning to add the new ehr system implemented in two phases before the end of our existing ehr support. that is all i have. >> bill, if i may? when we talk about we should define "contracting" because contracting is also the amount of time in negotiations as well. >> yes, it is. contracting the whole ess would not only include the paperwork for contracting, but negotiations under very large contract >> so from the timeline, could you show us or try to point out when the system would actually be

until operation and use? >> yes. >> and therefore, what areas of this would be our stop-gap support or continuation of what we have currently? or is this a gradual thing? what colors go where? >> the gold-colored bars actually represents the implementation and the stars represent the goal life. as you can see the goal life -- the implementation, as well as goal life actually overlap. by doing this manner, we are actually able to leverage the number of teams we have in order to cover all of dph. we can't do a big-bang, because that would be a huge resource drain on the organization. now having said that, our current contract is scheduled to end in 2017 -- our primary ehr and we have an option to extend for two years. so that would bring us to 2019. we do need to have this system up and running prior to 2019. so

we could actually run them in parallel and sunset, minimizing the risk of not having an ehr system that is fully functioning. >> that is not what is on the chart here. yours is a timeline on implementing ehr, but it does not show; right? the continuation of the current programs that we have? >> that does not show. it's just assumes that -- this just assumes when we have to have it in by. >> so we can continue our existing programs, and as best as we can, meet whatever requirements we need to do while heading for what looks like a july implementation on at the acute and ambulatory. >> that is correct. >> commissioner >> just a more fundamental question, perhaps. we're choosing epic, is that what this is implying? >> yes. >> and we're not only

choosing epic, but ucsf's version of epic or allowing us to be under the ucsf? >> yes to both. we'll be using their version of epic, as much as we can use in our work flow. >> okay. so do we contract separately with epic or are we contracting with ucsf? >> we'll be contracting with ucsf. >> as a subcontractor? >> yes. >> interesting. okay. >> that would include -- >> i want to clarify to you is that what this resolution is allowing us to do is negotiate a contract with ucsf. >> under their epic contract their epic system to us and has to be agreement with our principal negotiating partner is ucsf? >> yes. >> and the clause that is sort of a bailout clause if everything falls apart? >> absolutely as a business

plan, we always have to have a plan b. we're going to try to do the first phase and get through that and try to have a positive outcome of that, but just in case we don't have go back through another process that would take a lot of time. we needed to have a plan b. >> okay, i assume we'll have a direct foothold or hand in the negotiations, because it's a third-party negotiating through someone else, we may not get the preferential rates that we're wanting. we'll have direct contact with epic in this process? >> we'll be working through ucsf for that. >> commissioner. >> commissioners, we do have two public testimonies. so perhaps what we should do is take the public testimony and then we'll have further questions. so that we -- >> do you want me to wait? >> if you would, please. >> unless there is some

sort of technical thing, i do realize that we have two speakers. so bill, why don't you wait a moment then. >> thank you. >> let me get the two speakers. first dr. carlyle from ucsf anddina long. >> three minutes on the timer, everyone. >> thank you. good afternoon commissioners. i'm here as my position of vice dean at ucsf to speak to you and today i'm here to strongly urge to support this resolution to allow us to negotiate with ucsf for implementation of epic through the dph system. there have been extensive studies both internally and externally to look at need for enterprise ehr for the dph and there is no question that we need do this. it has also been widely looked at and we have come to consensus

that the best way to be successful in the implementation of an ehr throughout the system is not just to go with epic, but to go with epic that is installed on their license, and installed and maintained by ucsf. that is what this contract would include. this would enable a number of things. no. 1, improve patient safety throughout the system. as all of you know many of our patients go to other places either because they get sick in other places or because we're on diversion or more many reasons they end up in other parts of the system. having the same system as uc medical center, kaiser, the sutter system and stanford, as well as 80% of the rest of the country would allow us to seamlessly receive and give information on our patients

in a highly-protected manner. it would also decrease costs, because we would not have to duplicate many of the tests, and other measures that we have to do on our patients when we can't get information in a timely fashion. as mr. kim mentioned we also would decrease costs of training because many of our dph providers both at the hospital and throughout the system, are already trained with epic, either through the ucsf medical center or through other places, throughout the country, where they have worked. lastly, i would like to point out that almost every system in the entire country that has installed epic has found that they have improved their revenue cycles immensely. and in this era of health care reform, we definitely need to do that in our systems as well. so

we expect that it would not only decrease our costs overall, but allow us to be more efficient in producing revenue for the system. the other reason is that the uc team has done this implementation a couple of times already, and are very expert. they are actually here today to help us answer questions; and so using them, we would not have to reinvent the wheel. so i urge you to consider this for the safety of the our patients in our city. thank you. >> thank you. our next speaker, please. >> hello i'mdina long, the vice president of policy and advocacy at san francisco community clinic consortium. we serve roughly 10% of san francisco's population with primary care through nine health clinics and work really closely with dph and when our patients are hospitalized, many

are hospitalized at general and many see specialists at the general. we fully support that the department is seeking the best option for a modern, secure and fully integrated ehr system. i'm here to just ask that early on in the process, assuming this goes forward, that the community clinicks are included in some of the thinking about how this is going to be fully integrated system? because we are part of the system. so we want to make sure that information can flow freely back and forth in best, efficient and most protected way, when one of our patient is hospitalized at the general as one example. many other examples, as you know we have worked very closely with the department on things, like, making the specialty care, primary care referral system much more efficient. so we just want to continue that work, but we feel like instead of an afterthought that the community clinics could be considered as an important part of the system from the beginning. and we also just share -- have a

little concern that i'm sure is shared by others by what is going to happen in the meantime? as you know, we have an aging system, and it's kind of creeping along and there has been some particular problems recently. and you know, two years is a long time go with a system that may not be working properly. so while we're all excited about having a brand-new system that works better, that we need to make sure there are plans in place for dealing with patients before we get there. thank you. >> thank you. mr. kim, i kind of interrupted you at this slide, and the explanation of this important topic and getting into some of the details. did you have some other comments prior to us continuing the questions? >> commissioner, the only comment is that the one-and-a-half years outlined in the purple bar below the green seems long.

that is for this whole process of resolution, the ordinance, negotiations, contracts, reaching the terms, and signing of the contract. what i would like to add is that we'll be doing our best to shorten that timeline. however, at this time, we do not have -- it is a very large contract. i will take any questions that you may have. >> okay. so we'll go back to commissioner taylor-mcghee. >> thank you. thank you for your presentation. i don't have to say this is a really an important decision to make. so having said that, what is paramount in the decision to forego the competitive process? is it time and cost? is it market availability and

capability? what would you say is more paramount? >> well, actually i'm glad you asked that question, because that is the decision that we have been -- the question we have been asking for some time. obviously there is always a question about affordability. can we afford it? because in reality it's not only about putting the system in, but supporting it. i think even beyond that the most important thing what has to ask of something of this magnitude in terms of investment is how successful? and will the organization be using this new product? what value will we get out of it? when we look at the partnership that we have with ucsf, one of the things that we know we had over 100 years' of relationship. having said that, we also have many physicians and many patients that go back and forth between. we actually would benefit significantly, benefit the

city, if we can share that information seamlessly, as opposed to just sharing a top-level basic patient care information. so i think there are many benefits to partnering, but the most important benefits that i see is the ability to seamlessly integrate between the two partner organizations. which we cannot have if we went directly with epic, it would be difficult, and not as easy. if you went with any other vendor, it would be the same situation. >> thank you. >> commissioner pating? >> first of all i want to lodge a complaint that a topic this big, i'm not sure i feel like we're getting an adequate briefing. there has been lots of issues that we have looked at over the last six months in terms of cost,

quality, amortizing out and i'm not sure if i had to complain this to my grandmother why epic was chosen other than ucsf and in terms of cost and quality and other things that we looked at and when you weigh against turner, what were the major issues that stacked up? because cost was driving a lot of the conversation before. and now you have settled here. so i'm just -- to me, it's a question that we should have spent a little more time with a little more data in preparation. so it's a little bit similar to what is -- what commissioner taylor-mcghee is asking, really looking for other than ucsf likes and the integration, but feasibility? who is going to maintain this? is it going to be your staff? ucsf's staff? if ucsf has a

problem with it does it affect us and the issue of coalition? there are lots of dinner different questions on something this technical. >> if you would like, i could answer those questions. >> and how you make the best of basic decisions of epic versus turner? >> would you like me to at least try to answer those questions now? >> yes, please. >> we spent i would say approximately 2-plus years looking at various options in terms of researching. we needed to understand what system was out there that would be a good match for us? a good fit? we know this is a one-time deal. you don't make decisions like this twice. it's a multi-hundred-million-dollar project. when we looked at the products out there, doing the research, we looked at the industry leaders. not from a vendor perspective, but we looked at the independent

researchers, that looks at the quality, the performance, the support, the ability to implement, but more importantly, ability to deliver on promises. as well as future vision of their product. it was very clear that only two major products that actually existed in the world. there were epic and cerner. having said that, they both have different boists -- benefits and this is without ucsf in the picture that i'm speaking of. having said that, we actually went to industry analysts and asked, what are the key components that will allow you to succeed or fail in such an endeavor? one part is that you underestimate your own internal it capabilities or you overestimate it. another component that allows you to

fail or succeed is the rate of a doption. how willing is your organization to adopt this administrative massive change in the organization? those are two major key criteria and looking at failed and succeeded ehr implementation and adoption, those two items always come up at the top. the reality, these two vendors are very highly regarded and these solutions have been around for a long time. the question is which one is actually the best fit for us based on current it infrastructure? current it support model? and our budget? and our physicians' ability to absorb yet another ehr system? on top of that, we asked, what ehr system would be reasonable in terms of data-sharing across california and we did not ignore the fact

that epic has the largest share in this area. if we intend to share patients through ed, or through specialities, we have to take into account that we are going to share data and not sharing data at the highest-level in very basic summaries, but in detailed diagnostic-level, so we could avoid costs, but more importantly provide information readily to the physicians so they can take action. when we looked at all of that, withless r -- with the ability of our physicians knowing very well how the system works and the proven track record of the ucsf team and their ability to implement, which they have already done several times outside of their own organization.

if you stack the pros and cons of the solution, which would be most beneficial to us, but just as importantly, which would be the largest or -- which solution would have the most mitigative factors in terms of risk-management? because at the end of the day, if you choose to buy a solution that will not be adopted by your physicians, that they will have challenges, because now they are being asked to learn two different systems or more importantly that the work flow is completely different than what we are used to. and it's at the highest-level as opposed to detail-level. you have to ask are we buying the right product? that i believe is actually, least in terms of my team, and the leadership, one of the biggest questions we constantly asked and reasked and we came back with the same answer. this is the right solution for us. i hope that answer yours questions.

if you need details how we got that, as you know, we looked at financials and modules and support modules in detail. >> could we take a moment to hear about the financial investment? >> i was going ask if mr. wagner our cfo could describe how he feels this is a viable financial product for us? >> i would just like to add, that we're going into negotiation so select. >> right. >> so we have not selected yet. this allows us to go into negotiations. so some of the questions you were asking about how this is going to work, that is what is going to happen in our negotiations and we'll be bringing some of those concerns and updates to you as we go through this negotiation. >> those are still concerns on the table and this would be to allow

negotiations without a competitive bidding process. and on that, also, we might look at how long would our competitive bidding process take if we had to do a competition? >> we reviewed that and we would be very late. at this point we already did that timeline and it would put us out of the park in terms of not being able to meet the timelines,, nor the continuation of our systems. >> so in essence, either way, you would actually be asking -- you came out with wanting to negotiate with epic, but you would really be asking for the ability to waive that because of our time constraints at this point? >> correct. >> yes. mr. wagner, please. >> craig wagner chief financial officer and my initial response will be as barbara said, we not have contract and we're asking permission to negotiate a contract and financial

terms will be part of that negotiation. as bill indicated we have done quite a bit of industry research leading up to this moment and tried to look at some of the costs. we do believe that we are in a place that we have a financial strategy, where we can accommodate this course forward and would not do it if we did not. some of the major factors involved is what would be required in any scenario in terms of our internal staffing? the issues there are the costs, but it is also our administrative capacity to ramp-up at the level that we would need to, if we had an internal-intensive

staffing process and that leads to another factor that bill mentioned which is financial risk-mitigation, that has do with our ability to deliver the product efficiently, and on-time. and also, our ability to have a stable, financial model for the maintenance and operation of that product other issues that factor in this raised earlier is our ability to leverage revenue cycle capability from the product, and lastly, our ability to potentially leverage philanthropic dollars to support the project. and we think that there is a likelihood that given that we have some of these kind of cutting-edge patient care advantages that we can get out of this system, that there may be some philanthropic support that we can bring in to help

improve the financials on the project. so we have spent some time. there is more work to do on it. we have had two outside consultant engagements to do some research and give us some thoughts of what we should be expecting orders of magnitude and we're at a point that we're comfortable that we have a financial model that will allow us to move forward. we have been working with the mayor's office, and the controller's office on what that looks like, and how we fall into the city's five-year financial projections? >> thank you. we do have another public testimony which i will take at this time and then we'll continue with our questioning. our chief of staff at sf general. >> thank you, commissioners. i will be brief. so clarifications of reasons so move forward

with this resolution. first of all is quality and safety for the patients that we serve. as commissioners chow and karshmer are aware our system pose safety and quality issues for our patients and we need to get an integrated system and we need to move with a sense of urgency and we cannot wait, which is why we need to move forward with the sole source process and in addition, to the quality and safety point of view, all of the hospitals in the bay area, that our patients end up were on epic, a compelling reason to have the same ehr system and the second point i would like to emphasize what bill kim said. we're about to undertake one of the most expensive journeys and most important tasks that the dph will face in the next decade. we need to get it right. we won't get a second chance and that requires moving with a vendor that has done this before; that has the technical expertise to make

it work, and that can compliment the expertise that exists within the dph. and as mr. kim also said, getting the providers on-board as has been shown, probably the singlemost important thing other than having the expertise, that determines the success and then implementation. 18 service chiefs at san francisco general have all gone on record as supporting implementation ucsf's instance of epic at the dph. doing an implementation is extremely challenging even with everyone on-board. doing it under other circumstances will only make it more challenging and increase the probability of failure. thank you >> commissioner sanchez. >> i just want to say that

is really an unique opportunity for the department to move forward. we are not tonight- we are not approving the contract per se. this is a continuum with a specific block of time, so we could come to integrated consensus to move forward. the uniqueness of this, there are many positive outcomes, because of the affiliation. no. 1 our patients are seen by ucsf partners, et cetera, et cetera. they have already been trained in a number of these pathways pertaining to records, et cetera, et cetera. there will still a number of things to be worked out because we are a city and county and we are a department? >> yes. >> and over the years we have sat with our partners at ucsf

pertaining to unfortunately suits, because of different issues involving both the department, or sf gh or laguna honda or the regents and it takes a lot of work and understanding. all i'm saying is due diligence and patience and the director is asking for a resolution to proceed on, and to negotiate. i would hope that we would not just look at the positive outcomes,which are more than substantial, but you know, there is also, perhaps, some areas that we need to be aware of that might be under the radar because of this. i'm sure ucsf has thoughts and the regents have thoughts and the city and county and so on. it's going to take additional discussion and i look forward to the recommendation from the director, hopefully at the 6 -month period or

before then. so we can move on. because this is a key, critical part on how, in fact, we're going to provide comprehensive integrated services. this isn't just for sf gh, but laguna honda and it's our benchmark, but we need to have the final package brought for our approval, to have full public discussion, and vote it out when the contract is presented. >> right. >> commissioner, you are right. i just want to echo what has been stated before. this is not to have you approve the contract. we have much work to do. we would at least need six months to come to terms and agreement as to what the basic -- shall i say show-stopper issues have been addressed? even then we expect another six months to get the contract

done. we are far from reaching the end of the road in terms of implementing. this is just for us, dph director asking may we move forward? because when we looked at all options during our research, this seems to be the most viable. as commissioner taylor-mcghee has stated she asked about the timing? yes timing is an issue. we don't want the timing to drive what decision we make. however, time is an issue in this situation. now is timing such that we cannot -- we don't have any other option? the realitis, we do have other options. okay? but it is for the benefit of dph and the city, for us to take the right decision and move forward, as opposed to wasting or spending another year or two years spinning the cycle to get to the same conclusion we already know is inevitable.

>> just to be clear about the resolution. it is asking to you support my decision novforward on this. i do have authority in the contracting process and i'm asking for your support of our decision. >> correct. >> dr. pating and commissioner taylor-mcghee. >> i'm trying to get a narrative, so again, when i go home, i can sleep tonight around this. director garcia, you always have my support. so you don't need to put it in a resolution. i'm look at four factors, quality, cost k feasibility and integration and i'm hearing either way we're going win with this. feasibility you worked out a really elegant solution that saves staffing, effort, time, and i just really want to applaud you on that. >> thank you. >> to hear mr. wagner on

costs and then hear you on integration one more time. >> yes. >> the last episode and i don't think i have missed any tv shows here, my recollection on cost we're worried about a $20 million a year amortization that we had to keep paying out kind of indefinitely and with the cerner product was going to be smaller and tradingoff cost and quality. what happened to the gap? have you closed it enough? i'm pleased that the mayor is weighing in and feels that you have done good work here, but i'm still in the last episode we didn't have enough to pay for the product. so [kwha-pd/] to what happened to that? >> thank you, commissioner. as you know, it's been a long process this. is a heavy-lift for the department to figure out how we're going to finance that and that is indifferent to the solution that it is. so we have been doing a lot of

work and again, i want to emphasize that we are asking for the authority to negotiate the contract. and so the actual cost will be depending on what we're able to negotiate. if we're unable to negotiate something that is to our financial satisfaction, and fits within our financial model, that will be one of the criteria we use to decide whether this can go forward? >> that hasn't gone away. it's still there and we're trying to work with it. >> there are a couple. again, a couple of factors that are mitigating factors. so you have as you look at this, you have the cost of the contract that you'll have for the system. and you have the cost of your staffing that will be required, your internal infrastructure, that will be required to support it. you have the cost of training and cost of physician adoption and your relationship with your physician

model. again, in this particular case, a significant factor is what we may have access to in terms of philanthropy and fundraising. so with all of those factors put together, when you look at this at the end of the day, we have seen in the studies that we have done and also in the research that we have done, independently, that there are different ways that you can look at the cost. where one is higher or lower in the short-term, but over time, the general consensus is that on an order of magnitude-level, that they are comparable costs once you take into contract and internal staffing costs. there has been estimated gap that we have looked at and that has been moving over time. but we do think a couple of the significant advantages that

we can leverage through this approach are what we can generate in terms of revenues? what we can general in terms of philanthropy and risk-mitigation of not having to start fresh with our own internal costs and our own internal risks associated with building from scratch. by leveraging the ucsf build, we can get a significantly cheaper product than if we actually went to epic directly and built it ourselves using our internal staff and hiring contractors. so there are a lot of moving factors in the analyses. we have thought about it very closely, but again, i have been one the people who has been very wanting to take a very cautious approach to make sure that we have the funding model in place that we believe that this is at the point that we're ready

to move forward. and i do think that we are at the point where we have got a financial model outlined that makes the potential pathways comparable financially. and where we have a quality and a patient care and a public health benefit from leveraging the partnership with ucsf. again, we will be negotiating the contract with the financial terms, and we will negotiate -- we will not accept a contract that ends in a form in such a way that does not fit with our financial authority within the budget. and within the city's 5-year plan. >> that is very, very reassuring. thank you very much. mr. kim, last question. with regards to the thing uc is a little more integrated, more centralized. we're very dispersed, as well as we have a lot of contract facilities with mental health

contracted out and consortium, our partners. how do we integrate with that? are they responsible within your model or are we responsible for providing the desktops and linkage and technical support? >> from a technical perspective, i think i would like to go over -- approach it from a high-level. first of all, what we will build based on the current ucsf ehr is going to be built with our partners in mind, not just ucsf, but everyone that we work with. i think that has to be foremost. for this to be successful for dph, all of our partners leverage our ehr system has to be part of the equation, okay? having said that, one of the benefits of choosing this solution is that is twofold, epic is the

prodominant leader in this area, making information going from one organization to another much easier to accomplish. but more importantly, ucsf also has partnership with other organizations that we may be interested in looking at their data from a public health perspective. now all of this has to be negotiated, and reviewed. but i think the opportunity is very unique. i hope that answers your questions. >> sounds like the partners will be brought in early and at the ground-level. >> in our governance model and when we designed this, we are actually even including a group of patients to be part of the government's model. so they could help us build the patient portals. we're not going build this in a silo. we're going build with all stakeholders, including the

patients in mind. >> commissioner taylor-mcghee. >> thank you very much. i want to thank bill kim, and mr. wagner for answering the questions. it for my clarification, i just wanted to say, this is what i got out of what you said, okay? this is compatibility with the market, making for a greater opportunity for seamless integration, patient safety, thorough cost analyses, and also, easier to adopt with the current it system. i think the other one that was important is timeliness and urgency. so given what you have said, i think it makes sense for me. i'm comfortable. >> commissioner taylor-mcghee, i

would like to make one tiny correction. >> sure. >> the adoption is not -- most technologies today, the 2 ehr, 3 ehr vendors at the top of the market we can adopt them, but the question is how much burden will you put on the existing users? when we look at systems, most it folks will look at how great the system itself is, without thinking that the system must include the end-users. the question is if you were asked to drive -- i just learned to drive a manual stick shift gear that i will use an as example. if you already drive an automatic car, and someone came to you and said you are going to have to add another car to your family and why don't you just get a manual? now you have to drive an automatic and a manual. would that be much easier to adopt and trouble-free as opposed to getting another automatic or visa versa? if you already had a manual,

would you get another manual? i think the burden in this situation to the physicians when they taking care of patients in a trauma setting to learn a brand-new system and expecting them to be effective and efficient from the get-go could be very challenging. one of the biggest challenges i have seen is an organization trying to get to the value, dollar per dollar, out of a system, arch after they have just make this gigantic investment, because they are being asked to add another technology system to their belt. >> both of those cars are safer than your motorcycle. >> i have gotten rid of my motorcycle, director pating and drive in a very save, air-bag surrounded car. >> we are very happy for that. >> both of these computer systems are better than what we have already. >> i think that we all agree. >> i began to envision airbag as round your motorcycle, but that is

okay. commissioners i think you raised all the issues important in the process of negotiations. again, this is a resolution, which for those who have read the first iteration of our agenda, looked like we were going vote next week, but, in fact, the final agenda indicated that today we will do the voting. so that our director has our support. if we choose to offer that support, in order to begin the actual negotiations for all the reasons that i think we have heard. least from what i heard is timeliness, discussing this issue for many months, if not years, and the very careful and very prolonged process that has occurred in doing vetting of all of the different systems, and the advantages and disadvantages and the abilities to

really articulate why you would then like to move forward, not only with the waiver of a competitive bid, but with a specific system that has all of the advantages as you see it that would allow much quicker adoption at a lower cost. and with the understanding that the department feels that having worked out with also the administration, that these are doable. i think that that is where we are at today, if the commission will remember the questions as obviously the contracts come forward. those will have to be answered. >> commissioner chow, would i like to add that we're not asking for a waiver, but one-time exception ordinance to the city administrative code. >> and we also need board of supervisors approval. >> more formally, the competitive solicitation process.

>> be waived? >> yes. >> one-time wafer. >> i would go ahead and move the resolution. there are some typos on page 2 that i think are easy to correct. again, i'm reading the story as higher quality at comparable costs, which i think is a good trade-off here and [#3450-ez/] when you present this to us in the future, remember what we are asking, because i think it would have been presented with the factual basis that we needed to help support the resolution. we commend you on your work. >> we appreciate that, commissioner. >> i heard a motion and second from commissioner sanchez. do we have any further discussion? if not, we're prepared for the vote. all those in favor of the resolution in support of the director of health's position to seek approval from the board, from the competitive solicitation process, for the fully integrated ehr, please say aye? >> aye. >> all those opposed? the resolution has passed

unanimously. thank you very much everyone. >> thank you. >> thank you, commissioners. item 7 our next item is the san francisco health network update with the pharmacy update. >> thank you everybody. >> good afternoon,

commissioners. roland pickens director of the san francisco health network. so it's my pleasure this evening to provide you with this update on the development of the network. my goal today is to share with you some of the key tasks, and focus areas we have undertaken over the last six months that will help shape the evolution of our network in the coming years. in my presentation today i will not revisit our previously adopted way-forward measures which we reported on. as you know from our last report, most of those initiatives, those measures were actually achieved, and we sunset those in june of 2015, which was the end of the first 18 months of the network's

lifecycle. instead today, i will focus on key strategic initiatives of both the network, and department, that will help us transform our clinical delivery system into a high-functioning care organization. after i have finished my presentation, i'll be happy to answer your questions and receive your feedback. at the conclusion of that process, i will then invite to the podium dr. david woods our dph director of pharmaceutical services, and he will provide a very brief overview showing the organization of pharmaceutical services across the network and the department in order to give you a more tangible example of our ongoing efforts at integration. so in terms of the first area of strategic visioning for the network, as part of our overall dph initiative to spread the lean

management system across the department, the san francisco health network conducted our first strategic visioning session utilizing the lean methodology. in september 2015 over 30 staff from across the network and the department along with commissioner pating came together and utilized the lean methodology to establish the three most critical strategic pillars to guide the development of a network and those are our mission, our vision and our true north and it's true north metrics. after much deliberation, we reached consensus on our shared mission, vision, which you see before you, our mission col that we provide high-quality health care that enables all san franciscans to live vibrant, health yip lives and to be first choice for every san

francisco's health care and well-being. while most of us are familiar with develop is recommending an organization's mission and vision statement and the idea of developing a true north was a new concept for many of us. we first learned about the concept of true north when we visited the health care system in wisconsin. theta care is well-renowned for being one of the most successful health care delivery systems to adopted lean methodologis to drive operational efficiencies. simply put true north is that small set of goals which can be articulated by everyone within the organization that represents the organization's unwavering and highly focused commitment to fulfilling its mission and vision. i emphasize small set of goals because true north is not meant to envision -- to encompass, nor replace the hundreds of

projects and initiatives, metrics and dashboard reporting processes that occur throughout all levels of the network. instead, the beauty of our network true north is that it's succinctly identifies those key goals that the organization has committed to focus on above all others. in in addition to our network true north, each division in the network has already or is in the process of finalizing its own true north statements and areas. currently we are working to, as much as possible standardizing these metrics across the network. you will note that our true north goals allows the network to be aligned across our divisions, while still allowing each division the flexibility to tailor the melt metrics to their specific needs. in the back of the documents we provided to you, you have a

draft showing not only true north of the network, but also some of the proposed true norths of the various divisions. for each true north goal we're developing no more than two metrics, monitoring the progress towards obtaining those goals and we will be reporting these on a quarterly dashboard. in order to finalize our network true north metrics and develop our implementation plan, or what is called the x matrix and lean management system, we'll have our second strategic visioning session march 8-9 to finalize that and we'll report to you in our next update. in addition to strategic visioning, we have focused a lot of our efforts over the past 6-12 months on our strategy of managed care. you will remember that in 2012, the health readiness assessment by hma made the recommendation that in order

to ensure the financial health of the dph delivery system, we would need to increase the number of patients within our network. in next few slides, i'm going focus on two of the tactics recommended in that hma health readiness report. the first tactic is the growth of our patient population served by the network. the tactic asks that we consider securing additional commercial health plan contracts in order to increase our network membership and the second tactic to initiate a de novo outreach marketing and branding for our network, something that we have not done before. in order to move forward with these two tactics, we have already started that process, and the two specific outcomes.

first, we have developed a plan or roadmap for showing how we're going progress from having only medical managed care contracts currently to having commercial and other value-based payment arrangements and contracts. in this regard, we have worked with an external consultant to develop our managed care roadmap, which you see depicted in this diagram. it shows where we are today, and starting with 2015, only having a medical managed care contract, and showing progression over time, based upon the consultant's expertise in terms of how can we build a sustainable system to support managed care contracting? knowing it's something that you can't turn a switch on and go from no commercial contracts to commercial contractors overnight. so in order to lay the groundwork for successful entry into