competing against you know other cabs and other drivers at the slowest times i can also is on behalf of green cab where i work that these medallions allow for flexible scheduling of drivers i don't know how other companies work if an s medallion or green cab want to work a 8 or 6 hour shift we craft other shifts around that because they don't have to be on the street all the time so it really allows for a lot of flexibility it is why companies are still paying s medallion holders inform their medallions and why other companies and most as been said the larger keypads most of smaller companies support the continuation of this.

>> thank you. >> (calling names). >> last speaker is steering. >> the everywhere cal hallow it interesting we can't consider it anything we have highway 101 in the middle of our commercial district the peak hours their backed up to laguna their backed up to almost doyle already what people are not realizing is that we have is special event all the time it may not be in our neighborhood reis marin and the opening of the opera

sports events and art shows everything in downtown they go to downtown so we - and we have an interesting situation about our peak hours because it is depends on how many events happening in san francisco when we are backed up greenwich is backed up and francisco is backed up up royally and i think when you start doing cookie cutter approaches some may be right and some wrong i've not been expressed with the way it is presented to the neighborhood and the neighborhood people i'd like to i ask director reiskin for a conversation with him concerning this i want you to look this very, very closely you must do a cumulative study of both streets and a cumulative study of the event and what is happening and

going to happen in the future it will focus the presidio - and i would like you to really think about this thank you. >> >> >> thank you. next speaker, please. >> and (calling names). >> i'm brad a marina originally at franklin and chestnut a stoplight i've lived there for 6 years during that time i witnessed several traffic accidents as motorcyclists accelerate through the traffic light to beat the red light we moved a block down chestnut to an area where there is only stop signs this is a park and a middle school and a library you

know a lot of kids on the street you also know the part of cellist nut is residential in nature my view and shared by the residents allowing the busses to drive quickly through the area allows cars to drive quibble and as a result endanger our children i know we need to make it a family-friendly city making san francisco more family friendly city i'm not familiar with the legislative process i understand not on the dockets today, i urge you when it goes on the docket to vote against it and keep the streets safe for our children thank you. >> thank you. next speaker, please. >> (calling names). >> the thing is i am in the taxi

industry the attitude with the drivers i've indicted to alarm you it is ridiculous and hope times their alexander's like dictators the time to rove the thing from the taxi i was an innovator our to bring the taxi to you started 15 years as the medallion idea started idea of selling the medallions and now i'm saying we should move the one to the tmc and the taxi on their website page like lyft like 5 years this is the medallion is a good deal with lyft their driving 10 and 40 hours can we approach them

negotiate with them and talk with them and get somehow taxi with them and that will change the scenario of your medallion, your medallion can go skoekt and deal with that in a smart business stop not like a resolution. >> and some other issues i had a conversation with director reiskin he was kind enough to listen i'm passing it on to you and please look at it and try to like the issues but the main thing get rid of the fly wheel and for the taxi and the medallion benefits thank you. >> thank you. next speaker, please. >> mary maguire the last speaker card. >> the congestion we all know how we can eliminate the congestion with 20000 tmcs they

drive down the street look at the congestion didn't loop that will happen i know you would support is it i was in portland and downtown portland a tuesday not any traffic congestion congestion on the freeways but you can study what they're doing it was all around their union square ear and it was very novice i also want to thank you for you're adding more transit lanes and i saw the conversation you had at the last meeting i urge to have someone to lobby sacramento and take photos of moving vehicles as well as the double parking and i would like to address you really have a need to eliminate at least southbound the private cars from sutter on powell from sutter on

down to alice if you go down there it is private cars and tmcs they're making u-turns the combash can't get through and st. francis had a policy to drop off the luggage and those folks ignore their double parking and dropping people off and taking bags out of the trunk and you need to talk about to the muni drivers about the u-turns one cab driver counted 40 u-turns in the castro if 10:00 p.m. to 1015 you need to address it, it is true not cabs will be allowed to drop off at the super bowl and then to the super bowl committee that is disgraceful it is sad. >> anyone else here to address

the board seeing none. >> mr. chairman that concludes public comment the only remainder of director reiskin report on the united. >> thank you, mr. chair maybe i'll ask tom maguire the sustainable streets director to give us a brief update on super bowl. >> okay. thank you directors so i know a few years ago my clael pete gave a brief overview i'll give you updated budgeted estimates and tell you how we are communicating and changing the downtown to the public as we find the objectives will continue be keeping the city

save towards shakespeare week and the one million visitors to get around safely on, on the transit while the residents of san francisco those who travel everyday continue to have a reliable and save trip despite of events some of the features include reroutes that the transit network and we're going to be not moving one or two bus lines but make sure that all the reputes that currently services market street and downtown will have an alternative and continue to serve market street and downtown we'll be putting an entirely new schedule you'll get reliable information from the bus to the shelters on the smart phones and no early should you with the period and adding service on the fine to

fisherman's wharf and the ferry building will be replacement bus service on the between the castro and the ferry building a lot of things to make that a transit family-friendly bus a couple of busines the 2 and 31 passersby will be stopping several blocks further on market street for for all the bus routines alternatives in place for 31 riders and the rapid and 31 b x will continue to run so that as many people as possible will have the routes we know what we have there will be suggestions for cars encouraging san francisco's whether their everyday commuter to please leave their cars at home and use

the mass transit 90 parking control officers working hours downtown a major condominium conversion of forces working to keep muni working and prevent the block the box from happening and continue to endorsing the rules and working with the host committee and the nfl on a credenti credentialing system to a loading dock for transit on

only-$2.3 million the large majority for supplemental and rerouted muni service and parking control officers to make sure that that service is we'll be more reliable for our passengers and finally we've been doing a lot of work to get the message out to all the travelers on the system and a few of the web resources are listed on the screen we'll have super bowl 50 page an sftv.org foreclose to a month with information the best place to go for information but but the communications team have just in the last week met with

many organizations and san francisco bicycle coalition and san francisco chamber of commerce and fisherman's wharf and mayor's office on disability and partners with the transit so a week's worth of meetings their committed by district liaisons for density we're trying to get out there with the message will transit services is reliable the best way to get downtown with the super bowl week and get the people the information to get around. >> to the board questions or comments. >> just one it is going to be fascinating to see what that level of pco coverage of downtown i know one of the ways that you know we're tried to make the market street with the pcos that will be faichltd to see if we have so many pcos we have absolute compliance by the

car drivers to see what f that impact spaed out so i'm looking forward to seeing this i know it is a good test of what we can do. >> thank you. >> yeah. as we have from eye other major events we've certainly learn a lot and we'll be making adjustment as we learn as well. >> a few other items thank you. >> just wanted to give you updates one the agency has received the w t s the women seminar the bay area is the year of the award it honors an organization for pertaining the events of the women in the transportation and recognized because of our recent initiatives and pharynx and involvement in the f t s the

national groups it is a great honor to be awarded by our chapter the award will be presented at the annual event this spring and will be submitting our nomination to the international with regards competition to great recognize there and on to more menu detain things perhaps with regard to the state budget last week comboesh unveiled his 2016-2017 state budget it is past one a robust budget that tell us the fiscal year restraint to strengthen the economy and resubmit for the transportation in last year's special session that didn't yield go anything

that the legislation didn't end up acting so resmimentsd the same proposal which includes things like the $65 road improvement charge for the vehicle as well as gas tax, additional cap & trade precedes and other things generally it is his budgeted is strong on transportation it does slightly decrease the state transit assistance program slightly that is currently $351 million one of the states sources we have in our operating budget for you on the board recall this was cut back in 2009, 2010 so this is not a significant cut

we're still hopeful that gets bumped up as the burlthd budget goes through the process the proposal that he put forward in the special session is back on the table as part of whole budget with something that happens outside of the budget so a little bit unknown so the budget will go to the hearings and next milestone will be revised that is the governs revised budget we'll he'll put out in may and hopefully on time recently so i guess descent in terms of the big picture the governor is focused on the transportation so we'll keep you posted on things of relevance with the budget process.

>> no 1950 rail. >> he's proposing generally a greater cap & trade investment so the main funding space will think cap & trade formally get 25 percent of cap & trade fund so the amount of sxad funds available increases the portion that goes to the amounthat goes to california high speed rail so he's remained fully committed to the high speed rail. >> are you unable diesels wanted to let you know we're switched from bio to renewable diesel it is cleaner and easy on business engines and so moving from traditional diesels what a good step forward for

maintenance but with the emergence of renewable diesel as a substitute we get all the same benefits without the challenges in terms of air quality and lower green house gas emissions which will help over process more reliable it requires less maintenance here and the filters were getting clogged by the bio diesel had to be replaced so we wanted to do that just if you want to get technical both of the fields use bio feed sources that is oils and they're proud through different processes so this fuel will allow us to get the benefits from the bio disposal without the downside the mayor calls the whole city to do and kind of jumped to get to the front of the line with the benefits we saw from it so

citywide it should reduce the green house gas emissions by 50 percent. >> sound like a big number anyway we're glad to be a part good furiously and the city last item update you on the newer technology for the taximeters the states regulate oversees previewed the first meter last month in is not k pc but the regulation for taximeters here in san francisco were the first city to get them all in one hardware and software mr. chairman for the taxis a number of firs for the smart phones gps technology to calculate the

distances traveled as well as the fair and they use the tire are taxation's to do that and this combines the meter and the payment system into one - they can if they choose to place expensive updated equipment and reduce the cluster on the dashboard for the smart phone for rider so it should be a smooshth experience and make things like fair that splitting easier apparently the new electronic meertsz are less for fraud and single simple to use device allows for flexibilities

in terms of shifts, faster disbursement for credit cards and modification to gate fees so it should make the system more be flexible and dynamic the standards the state agency given the flooerl approval for the gps based taking operating system for meeshtsz statewide with a full certification after that it is kind of a conditional certification for the time being any licensed taxi in california has the option to use this technology now it certified and those meters start 200 and 26 of the fly wheel taxi company so what will start to see those roll out and up to the rest of the industry whether they adopt

it a step forward and president's report. >> thank you director reiskin. >> questions or comments. >> members of the public questions or comments. >> yes. mr. gru beggars on topics that were address by director reiskin only. >> yeah. i'd like to comment on the super bowl and first like to say i think that i and others in the industry are greatly appreciate of the thoughts and attention to the providing taxi service to people who are going to the san francisco events specifically the nfl experience and the sustainable events i just a word of caution that where there are street

restrictions and closures and taxis and other authorized vehicles are the ones public school allowed to use those streets there needs to be enforcement and enforcement in the zone around those restrictions because i can easily foresee those streets so 0 completely clogged with tmcs the vehicles that are authorized to get there including inteshgz will not to have assess they'll sit outside the restricted zones waiting for people so you know streets can't be blocked it is a simple way of putting it the other things in regards to the super bowl and what was alluded to by tom maguire i saw a news article apparently the super bowl committee reached a deal

with uber it organisms executive rights to pick up at the super bowl in what universe that can't people choose to take a taxicab to a public events i ask. >> and urge you with the utmost urgency to wire into this if it is true to get involved we cannot be shut out. >> thank you. next speaker, please. >> commenting. >> yeah. i'll agree with mark i'm wondering how to get to the transit things and what hours are the parking control officers on enforcement and i also i just don't understand if someone wants to take a taxi where will we drop them off and will be they have to walk it is outrage and i also

heard that the homeland security is the not allowing the tmcs to come in the super bowl because of not proper background checks why are they allowed executive use and what about the cabs if santa fe and the surrounding areas and uber will be surging pricing it whether cost a future maybe that's prefer to take a taxi where will we drop them off and pick up i urge you someone from the committee needs to intervene half a million dollars goes a long way and certainly those people and if they wanted to take a taxi $55 it will be cheaper for people to take a taxi and you know believe it or not they will prefer to do that

so, please someone talk to - thank you. >> anyone else's wish to address the boards? >> good afternoon. >> regarding. >> staurm please. my name is joe. >> thank you. >> the their evading their responsibilities if they took an active role to make sure that cabs are allowed to pick up riders to the super bowl that's your duty and responsibility if you are really, truly the body that is govern the cab industry regulated and such it is your absolute duty to make sure that we continue to be able to take a flag and go to the

super bowl never in our regulations i've seen ever has this happened i urge you to do your job. >> thank you. >> anyone else care to address the board. >> mr. chairman that concludes the business before you. >> i'd like to remind the members we adding to adjourn in memory of mr. 86 do you have those names. >> home share reportedly and franco. >> thank you adjourning in their memory so thank you all

>> 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 process 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 a more robust managed care environment, the consultant engagement helped us identify a few key foundational infrastructure elements that we must have in place in order to be successful. and you see those listed here. the first we just talked about, which is having an enterprise electronic health record. the second is organizational intelligence, which is a proprietary software, which is a cost accounting system that allows us to cost out services particularly at our acute care trauma center that we will need in order to set contracting rates. the third, which is network operations integration, we have several systems throughout our network that are not integrated. as you know, we have a

separate medical staff or the at san francisco general, one at laguna honda and separate credentialing process in behavioral health and from a planned contracting perspective, we're going to need to centralize and coordinate those functions so that what dealing with payers, there is a one-stop shopping as opposed to having go to each entity to provide that information. that is one key finding from our consultant engagement. finally our network branding and marketing process. again, this is something we've never had to market our services before. we have always and continue to take all comers, but if we're going to increase the number of members in our network, we're going to have to begin to market ourselves. i'm sharing this next slide with you in order to give you a perspective of our current environment in

managed care. which as previously mentioned at this point is only limited to medical managed care and of course, that excludes our programs for healthy san francisco and healthy workers. you see the numbers here. the san francisco population of that 848,000 population roughly 170,000 plus have medical and majority of which are in a medi-cal managed system through san francisco system or anthem blue cross and our network of the 150,000 managed care lives has about 62,000 to 63,000 in our network. so in this slide, it shows our planned trajectory based upon consultant engagement for expanding

beyond medi-cal. for sustainable, you remember sfhn will need to increase your patient base to 90,000 patients. i'm going to go back to the previous slide. that last number 62,000 is what we currently have in our network and we need to get up to 90,000 per the hma report in order to be financial sustainable and final financial viable. as we move to increase from 62,000 to 90,000 in the case of 618,000 san franciscans who have commercial insurance, according to the consultant report, we need to have 15-20% of our overall network population, which again, that goal is 90,000. come from those commercially insured. so in essence, we need to attract somewhere between 13,500 and 18,000 of those people with commercial

insurance into your our network. a little bit about our marketing and branding. just as we have done a lot of work in the area of managed care and increased our effort related to marketing and branding and we were fortunate to have a mayor's office fellow assigned to dph, to develop and begin implementation where feasible of a network markets marketing and branding plan. this next slide gives you a summary of some activities underway and the priorities for next year. that marketsing fellow came on board in october and has been very active in learning our network. has conducted several focus groups, including key stakeholders, patients, staff, and other systems. and has really helped us be clear about some of the steps we

can take now, but also a plan that will be in place by the time that fellow leaves us in the fall of this year. we've set some short-term goals in terms of a pilot, doing some promotion of a san francisco birth center with the obgyn service at sf gh and pursuing contractual relationships allowing for additional births at san francisco general and do the appropriate marketing and branding to go along with that. we continue to be in negotiations with chinese health plan regarding covered california contract, which is considered a commercial contracted. we will need to do the appropriate marketing regarding that contract when it comes to fruition. so from a market point of view, we have three key goals. we need to find new members,

enroll them and retain them in our network. and we need to make sure that we deliver a patient experience that encourages people to continue to allow our network to serve them throughout their lives. in addition to finalizing our strategic plan, and focusing on our true north, there is still multiple other efforts and initiatives that demand our attention and engagement. you see some of them listed here. you heard today that we brought on board our new director of general health. as know we're currently recruiting for ceo for zuckerberg san francisco and looking for appropriate leadership in our behavioral health system as we have senior leadership being ready to exit the organization. we have got to open the new hospital. we're going to have a big part in the

electronic health record, it's will be the core of our clinical delivery system and we have also got space-planning to do particularly throughout dph in terms of what is going to go on with our space, and facilities at both laguna honda and san francisco general. so both priorities also present challenges for us. obviously, we have a challenge that we must be mindful not to be impeded by overtasking our resources and staff on these multiple endeavors. and it's our hope that through using the concept of true north, we'll be able to galvanize our staff and have one guiding compass in terms of what we're focusing on. and finally, just to let you know, that in the midst of all that we are doing, with true north, managed care, marketing, and branding, we have not lost sightful our continued

commitment to integration initiatives across the network, and dph as a whole. you see many of them listed here. our enterprising mr, the continued development of our business intelligence unit, and our data warehouse. our call center expansion, which is one of the major recommendations for implementing expanded health care contracting. and we continue to integrate clinical services. you are going to hear specifically about pharmacy, but skilled nursing and rehabilitation across the network. so that concludes my part of the presentation. i'm happy to take any questions you may have, and/or feedback. >> commissioner taylor-mcghee. >> thank you very much for your presentation. i just have one little bitty issue that i would like to sort of point out in terms of your branding and marketing strategy. i would