to discuss this item and the presentation at this point. questions from commissioner chung looks like -- >> [inaudible]. >> ok. let me start with -- looking at your last numbers, as you said, you had a 21 positive, $1 million for 18-19 and then went the other route for the second year. in our budget planning -- well i should say in our financial planning meetings last month, we discussed the trends and the possibilities of our need to actually be prudent as we move forward. how does this match within the five-year or the projected change that we are anticipating in terms of overall city revenues?

-- what we're working on right now and what you will see at the next hearing is we're looking at a couple things, we're looking at one-time funds that we could use that are coming out of the current year or one-time reven revenues to budget in the two-year timeline horizon that would allow us to pre-fund some activities, including expenses with the electronic health

records initiative and that allows us to move more costs into that first year and smooth out the transition out to the second year. so i anticipate by that the time we get to the completed submission from the mayor's office that we should be at a place to hit the general fund targets that we discussed in the commission's five-year financial planning session. >> okay, commissioner, is there an impact on our budget in terms of the revised in terms what we'll do and will we receive any additional revenue based on that or not? >> the biggest issue in the proposed governor's budget is that there's a proposal to end the 340b pricing program and that would have a negative impact on us so that's the biggest one that we're watching.

and other than that, there are some moving parts but nothing that's on that order of magnitude so that's the biggest one and its potential downside. >> thank you. >> so while we wait for another question i'll go to the affiliation and the issue, will we get clarification with its impact on our e.h.r. program. >> yeah, so the -- as you will recall from the prior budgets, when we put together the funding plan for the e.h.r. it was predicated on a number of things. there was the one-time sources that we programmed into it and there was general fund support from the city and there was a package of cost-saving measures that we had programmed to offset the costs associated with the e.h.r. and one of those was the funding levels for the u.c. affiliation agreement and

because of the initiative that you have seen in front of you beginning in the year two which is additional unanticipated general fund dollars in the five-year financial plan and so let me -- before i get into that -- i want to clarify that there are two parts to it and of that $14 million, about $4 million was an anticipated in the mayor's projection and the other $10 million was not and so it was partially in anticipatedd partially not. so there's the unexpected growth in costs that we need to cover within our budget submission to the mayor's office so what we're looking at is, again, similar to the answer to your question of how do we balance between the two years, is there a way that we could pre-fund an additional amount of the e.h.r. costs with one-time dollars which would allow us to relieve some costs in the outyears of the program and could we reshuffle the dollars to essentially give us

enough cushion that we can implement the program comfortably but have some cost relief in the out years? so that's the model that we're looking at and you'll see more on that in the next two weeks but where we are right now is that we think that we probably have the ability to make some of those changes as we're getting costs analysis in as part of the due diligence on the continued due diligence and the planning on the e.h.r. implementation. it does look like we could use more funding in the early years when we're in the thick of the implementation and that's where the tightness is in our budget so if we can program some dollars earlier that will give us a little bit more room to maneuver while we go through that intensive implementation period. and then we will need less contingency in the project once we get stagized and we go to our operating phase. so that's kind of the model that we're looking at to deal with that situation and we'll be presenting proposal to you on that at the next hearing. but it will make things tighter in the outyears and tell give us

less room to work but i think that we'll be able to come up with something that allows us to manage the project. >> okay. under c-1, is that the same medical delivery system that the contracts and the finance committee took up today? >> i'm sorry -- >> jenny wasn't in the earlier meeting. yes, it is exactly. so the expenditure dollars that you see associated with that initiative are related to the types of contracts that we approved at finance committee today and the revenues are also. so there are expenditures for contracts and revenues from the billing that we'll be able to do under the drug medical waiver and there's an imbalance there but essentially what is happening is that when you look back we put together a budget for this as jenny said two years ago when we were kind of

projecting forward and anticipating and now that we actually got the program ready to roll out we have done our r.f.p.s and negotiated some of those contracts which you saw were chewing up the budget to reflect what the actual expenditures and the revenues that we think that we're going to achieve under the program are and that's the reason for the changes. so we still are getting a positive revenue impact overall from the program, but we're tweaking it a little bit in the other direction based on the reality of the costs and the contracts. >> so, i see i'm going backwards here. in terms of the manner in which -- i and appreciate how you're now taking out the population, of those not aware in the past, the central office expenditured used to be in population health and that sort of distorted the whole question, right, of how much was actually spent. and i assume that the new

acronym is added to our initial theories, about the let me ask you why primary care is separated -- and it's good that it is probably because we might ask you what's in the health network services, but what's the rationale since the san francisco health network services at least on an outpatient basis, i would assume, is within this $225 million and how do we distinguish that from the primary care services? >> yeah, that's a great question. one of the things -- one of our purchases was as we're looking at the conversion to this new financial system we wanted to sort of set up the bones of the right structure and there's things that we didn't want to keep and there's some things that we wanted to keep. but we decided to phase in our conversion to this new structure over time just given the challenge of actually converting the expenditures and the data

and the conversion itself was so complex and challenging. we didn't want to do major moves that we weren't entirely sure of and because primary care was fine as it is, we said, let's just get the move done and then let's see also what the system is capable of doing in terms of its reporting abilities because there are enhancements from the former famous program. so what we want to do is to sort of set a good foundation but we also didn't want to completely reinvent the wheel until we got a better sense of the system. so i expect that we'll be looking at the structure and possibly making additional changes in the future. >> because on the quarterlies, the primary is sort of separate right now from the two large hospitals and so are you going to be changing your quarterlies to sort of match this type of -- >> yes, we have -- yes.

>> commissioners, further questions or requests that you might want to see in the budget or further explanations that can come at the february 20th meeting? i have one. which is actually fairly small. because for years i have talked about the issue of tuberculosis and i know that it's great that you're backfilling something that the government feds are taking away. i'm still wondering -- and i would like to hear that the people who are doing the t.b. surveillance feel that -- is there something that we -- we need to actually then even make a greater impact on what is probably our most long-standing chronic disease that is almost number one amongst major cities in the united states. >> i will -- we will engage with that section with our health

officer and the population health division and review that. >> i mean, i do appreciate that we're backfilling something already but i wanted to see if there's an opportunity to continue to try to impact that. >> we'll review that, we'll review that. >> thank you. further questions at this point? i would invite the members of the commission that may then as you think about this to have some thoughts, certainly, we can contact the department either by way of mark or directly over to greg and to get those questions over there so that we can have them answered in our next hearing. is that right? there are, therefore, no further questions and we proceed to our next item. thank you very much. i did also want to commend the department for this continuation of how you're presenting the budget and though there were lesser numbers of initiatives i think that over the years has

been really been clear so that's why you don't -- we don't have quite as many questions even about what the issue was that you were placing before us. and i think that really makes a difference and i'm going to really commend our finance department, all of you, for the work that you have put into it to make it so clear for us. thank you. >> thank you. >> clerk: item 9 the update focused on the electronic health records. >> good evening, commissioners. i guess that i have a kind of a tall order to fill now since they did such a good job. i'll give it a shot. my name is bill kim for those that i have not met with yet and i am the chief information officer for the department of public health and i'm very happy to be up here and giving you an update. and we go forth and slide show.

technology is challenging for me. health commission i.t. update. i wanted to bring to your attention this is really an i.t. and e.h.r. electronic health records system update because they are so integrated and dependent on each other. if you will allow me i'm going to actually go back in time about four years for those commissioners who have not been here and to focus on one slide before we get into the updates. so this is the agenda and today i'll go over the strategic roadmap as presented in 2014 and i'll also be presenting you with the roadmap on how it looks today as well as going over the electronic health records overall timeline and diving deeper into this and going over the project phases, the current

project budget, and the e.h.r. governance structure which allows us to stay on target and stay on budget in terms of timeline as well as the scope. as well as the accomplishments up to date and we really started this project about a month ago officially. and the next steps in risk and i'll be more than happy to take any questions that you have. first of all, many of you may have already seen this. this health diagram was presented approximately four years ago after having -- spending about six months in dialogue with the health commission as well as the d.p.h. leadership in terms of the addition and the future strategic roadmap of the organization. based on that and understanding the weaknesses and the strength of d.p.h.i.t. and its ability to support the business i have come up with help of some of the consultants who have done work before i got here to put this

together. so the right way to read this document for those commissioners who haven't seen this is to look at it from bottom up. so if you look at it, one of the priorities was to actually put in a foundation of reliable and cost-effective i.t. infrastructure. for those who have not been here we were -- we did a lot of good things here but it was not in my opinion or in the opinion of the business adequate for the future state of e.h.r. the columns, the effective i.t. and the clinical, clinician training was identified as something that we'll have to put in place for us to effectively execute the new e.h.r. and to more importantly adopt it into the organization. and in the middle we have the green box, the yellow box, and the light blue box, the green box actually starts to fill in the content of the house,

basically, the right blue print, the mean and the i.t. delivery service model. as you know we have been very much engaged in doing that work as well as the electronic health record in the yellow box and what i call value-added technology that ride on top of the e. had remembe h.r. and the. and i want to note again that the e.h.r. is an important part of our electronic ecosystem. it is the foundation of our ecosystem. however, towards the value-added, for the business and the clinical and the non-clinical it's important that we have the technologies to ride on top of that and for those in the finance and the committee we have that were not e.h.r. but they bring a lot of value to the

business. and i want t won't go into a lof detail, but we're trying to get to equity in access and long-term viability and excellence in health care and population and wellness management and as you can manage without innovation and seamless collaboration, the integrated care across is not really possible as an organization. and so three years ago we presented this and everybody said that looks fine and where are we today? 2018, this slide actually translates what we were saying that we would do four years ago into what we are executing today. so you can see that we have medical grade infrastructure as our foundation. and that is actually in play in the environment at general hospital, zuikerberg general hospital as their foundation technology. we are in the process of rolling that out across al, and in termf

the customer service, we have made dramatic changes to the services that i.t. provides and we have been collecting customer satisfaction score and i want to commend my team and the business for participating in surveys and all of the work they've done and i'm happy to report that over the last many months that we're averaging about 4.7 out of 5, which is pretty phenomenal considering where we were four years ago. so we're not there yet in terms of where we need to be to really adopt and to support our end user, but we are on the way and we believe that we will be able to meet the high standards that we are aspiring to achieve. now in terms of clinical and dramatics we spend a significant amount of resources building that team and they're working on the epic project today. and i have special thanks to albert and ranona for putting

that together. one of the things that you will hear more is that we're moving our field services and help desk to be more customer centered, that means they'll be working much more closely with the business and being clinical or non-clinical and working to support their needs as opposed to -- oops -- 20 years from today, fewer services and the help desk will be equipment centric and we'll ask to install the software and we're looking at what is the true value that you're looking for as a customer. that's what we'll be focusing on. the other part that you will see is that there's a lot of due diligence that is not in the green box and that actually has passed and we have done due diligence on what is the right e.h.r. for us and we have done a lot of focus on i.t. service delivery model, not only for the organization but also for the i.t. and where we are today is at the yellow box. we are now working on kicking

off our epic e.h.r. and more importantly we are in the process of kicking off all of the other things that you see here that i necessarily won't go through but you can see that we have business analytics and intelligence and device integration and to ensure that our patient record is the same patient and in complete order. and we are also working on electronic content management to go electronic and to take the paper and scan it in and digitize it and sort it and make it available because the paper as you know, if you have a thousand pages, where do you start? electronically you see that it's been sorted properly ca you can have access to it. on top of that we're additionally working on unified communication to ride on top of our environment, alert management, analytics and help and information exchange to communicate with other

organizations as well as multiagency care coordination systems that we are working with the other cities. we hope that all of this will bring the right information anytime, anywhere for all of our business, including clinicians and non-clinicians alike and our partners. and for the folks who didn't hear this before i thought that this would be a helpful frame of reference. great. let's talk about where we are overall timeline. as you can see on this slide we are here in the first quarter of january as we have said that in the past where we will be. we have finished contracting with epic and it has been executed and they are now on the ground standing up the project team and they have a lot of things that i will share with you shortly that they have done and we are still and we continue to be on track to deliver the go live in mid 2019 as you can see

on this timeline. okay, this is -- for those who haven't seen this, there are multiple bars because the yellow, gray and the blue bar actually shows you what we said that we were going to do, what we say that we think that we're going to do and what we thought that we were going to do. kind of give you a history of what we originally anticipated so you know that if we are slipping that you can see by the bars that if we are indeed slipping or maybe we are ahead. this is actually a more detailed -- not quite detailed but more detailed view of what the first phase getting to the first go live in 2019 will look like. currently we're in the groundwork phase. the groundwork phase is really about standing up all of the necessary team, hundreds of people, from all parties, myriads of vendors, including and the d.h.p. teams to work together to set up the structure

to have the right governance and make sure that we're working in concert to get to the endgame. the direct insetting that you see there is really about viewing and assessing the off-the-shelf epic reference model and then deciding as an organization what we will be able to accept or what we will not be able to accept in order to move forward in terms of our build. the adoption setting is actually a mixture of several things. one is the actual build and the implementation of the epic environment as well as course corrections and any changes that we need to make so we could actually adopt the product. and as you with see we have a lengthy phase because we will have over a hundred third-party systems that we'll be integrating and testing and those third-party systems as you may be aware are the things of

what i call value-added technology that adds value to epic or our e.h.r. and then we have a very aggressive, right before we go live training and go live. and the reason for that is very simple. you can't train people 12 months out because they will forget. the training will happen very, very quickly before it happens. and then, obviously, we'll have post-live optimization because despite the fact that we may think that we have the best product implemented we may want to optimize it for us. okay. so here's another view, i won't necessarily go through every one of these line items but this is actually what dates, we have firm dates on when some of these things will start and end and this is reflective of the previous slide as well in terms of the phases. current budget projection, i will not go into detail and if you ask questions i'll be forced to ask mr. wagner to come up

here and to go over the details. but originally approximately mid last year we said that the original t.c.o. for 10 years is about $377 million. currently we are tracking below that and mainly because we had a significant contingency and it's good that we had a significant contingency because we realized that we had unknowns and those unknowns are the third-party value-added technology like business analytics and like empi and data storage for electronic content management. those contracts which originally we started with approximately 150 contracts are now down to approximately under 70 because we were able to compress some of them. and i know that some of you had concerns with so many contracts which takes many, many months how we could do it before epic go live. i'm happy to report that one of the things that i am able to say

is that, yes, it is a very big list for the legal team and the contracted team and the business, but we are on track to meet the timeline of having those ready by march and may. all right, so that's a lot of money, a lot of different activities. this is a high-level governance structure to ensure that we stay on top financially, scope-wise and timeline wise. you can see at the top that we have an e.h.r. executive oversight committee that meets on a weekly basis and represented by the key division leaders and below that we have the program steering committee and the transformation executive team. that's the business leadership, the c.e.o.s and the c.o.o.s, and the other leadership of the organization who are going to be -- who are very much involved and have been involved over the many, many months. this structure actually has largely been stood up and i will point out the ones that we are

standing up now. so each executive oversight committee is up and running and the program steering committee is up and running, transformation executive team is up and running and meeting on a regular basis. and e.h.r. program management office, that actually is now up and running and we just went up in early january and they actually will be tracking every single vendor and every single activity and every single dollar and ensuring that we are on track and we are on budget. and the next team, because there will be many decisions that we will have to make, actually of the council that is being stood up as we speak and they will basically provide guidance on what d.p.h. will be -- would want this product to be. now, obviously, if we took every decision up to the e.h.r. executive team we probably won't have this product in place for another 10 years because we're looking at hundreds and hundreds of decisions. so the philosophy end approach

is to push down the decisions to the frontline as much as possible and then escalate up things that cannot be decided effectively. so with that in mind the team and the programs and the service-mind area teams which are represented by physicians and nurses and other business leaders and subject matter experts will be guiding the e.h.r. program and the project team in the build itself. that is how we intend to accomplish this project in 18 months. i will quickly go over this,and these are the accomplishments. phase zero which is the groundwork implementation began on january 2nd, shortly after we signed a contract. and the project management team contract has been signed and the team has been stood up. the third-party contract, again, that was one of our biggest risks if you recall from the december/november time frame and

that is trending green. i am very much involved in some of these contracts because they are very large contracts and sometimes they do get stuck but we are green. approximately special thanks to h.r. and my associate c.i.o. and 70 internal candidates have been identified to fill the 56 projected positions for the c.h.r. if you recall a while back one of the big concerns is how we transition our existing employees so they don't get left behind. we're not going to leave anybody behind, okay, that's one of our main focus. they are going through the -- they have gone through assessments or are going through assessments and we'll be providing the training for those who we have concluded can actually succeed and want to succeed. the administrative program office has launched tools to track all changes in projects. commissioners, one of the

complexities of this is that most of you have seen project management plans in microsoft project or something like that, and imagine if you will that you have -- you overlay 150 dependencies which each of them are representative of a project. it is an extremely complex project because every one of those dependencies impact the epic go live so we're tracking that and loading all of that into one place. now epic -- epic has the e.h.r. contracts signed and they're very thrilled about that and they have project leadership team assigned to us and we have engaged them. epic has hosted a kickoff meeting to go over their overview with our project leadership. they have delivered a project plan which we will be finalizing over the next few months. and they have also delivered their direction-setting schedule so we could start scheduling our people to meet and go over the direction setting. (please stand by).

but we're going to make sure everybody is on the same page. we'll be on boarding the employees that will be transfering to this effort. groupwork and key organizational scoping questions are being answered right now. preparation for direction setting, that is happening at this time. so we have a lot of work to get ready to build. but we have to have a lot of

questions answered and we have to get everybody ready. so, we do have some risk. and the leadership is aware of this. so, i believe this is something that we could manage and what is a risk -- this is not a show-stopper risk, but one other big risk is the upcoming direction setting session will require significant time commitment from subject matter expert across d.p.h. and that ad has been a consistent message to them so they can champion and support their subject matter experts to participate and the other one, which i believe we are also green and trending is the implementation of the team. and largely, unfortunately largely that depends on how much of our internal team can pass the assessment test from the bare minimum. those are the two risks. other than that, things are looking very hectic, but things are on schedule and on budget.

commissioner, i'll take any questions you may have at this time. >> thank you. that is a very comprehensive report over your promise the last four years and formally started last month. commissioner, questions at this point? we will be receiving a regular report as this is a $370 million project or so -- >> $77 million, commission kerr. [laughter] >> right. we're happy that you're thinking it could be lower and we'll be tracking this along and this is just the beginning of the journey. but you are feeling confident that we are going to stay on track and as you say, begin in mid 2019 in using the -- having a functional e.h.r. along with all the work you are doing to

connect all the i.t. >> commissioner chow, to answer that very honestly, yes, i'm very confident that we'll be able to meet our goals. namely because we have a strong executive support as well as leadership support over at the divisions. especially the c.n.o.s. but i want to do a special shout-out for winona and albert who -- and alice and rowman who has been really exceptional. now having said all that good stuff, i want to make sure we understand this clearly. epic is the foundation of the ecosystem. there will be many, many things that we could add on to make it better and more super. but that means the work still has to continue so our journey won't end here. this is just the start. but i think you are going to to

be very please wased where we'll be in a few years. >> and commissioner, thank you for your leadership for incredibly competent leadership and he's changed for our i.t. needs and particularly for our patient needs and our electronic health records. i want to thank him for that. >> thank you. the biggest thing should go to barbara and greg and jenny for making the financing happen. [laughter] >> thank you. they'll supply the resources and you will put it together. thank you. commissioners, any further questions? anything you would like to see at the next presentation. otherwise, we're scheduling these, what, every quarter -- >> quarter. >> quarterly, right. so, soon you'll start seeing this timeline become more defined and the contracts

committee already saw three contracts come through that began to fill out. for the implementation and supplementation of epic itself. >> great. thank you. >> thank you again. our next item, please. >> sure. other business, item 10. if you note on your contracts, the elections are on march 20. other than that, we don't have any special meetings or events coming up anytime soon. >> commissioners, any further business that you might like to bring up at this point that we should target or remember? your calendar is before you. there is softness to some of the items but you can see that we have a fairly filled calendar. i encourage everybody to be sure that when mark is asking you for the days of absence because of the fact that we do

have several commissioners that -- well, certainly dr. pating is no longer here so we're down to our six commissioners again. and several have other commitments that we know during the course of the months. so i'll be sure that we have an appropriate quorum for each of our meetings, including the committee meetings. i do want to thank the commissioners for that. and once again, also the fact that our interim mayor felt that he wanted to stay the course and i appreciate the reappointment in order to have us continue to do that. i see that as our charge now is to continue the effectiveness of this department under our very esteemed leader. so, with that, i do ask you that also if you see other

items on the calendar that perhaps we've left out or hasn't quite been addressed yet and are on a list of to-dos that you think should be arising, but it looks like mark has taken care of most of the special requests since they're blank this time. i appreciate that. we are open and since it is no longer two officers but one, i'm pleased to work with mark to see that your requests are fulfilled. thank you. we can proceed to the next item, then. >> sure. item 11 is the report back from the january 23, 2018 sfghj.c.c. meeting and dr. khou, i believe that you were going to give the update. >> yeah. we received the agenda. key on the reports was the true north score card and quality core measures.

which actually are now really fairly well defined. there are a number of areas that we can identify as improvement and there are areas that still need to be worked on but we follow that on a quarterly basis. so, that, along with our routine reports, might note that they also noted that we're moving forward on the hiring of vacancy. there was public comment, i believe, the staffing. was it raidology? >> raidology. >> and we took that under advisement. we'll continue to monitor that their concerns were properly responded to because it also appears that we do train a number of people who are on temp and then those

well-trained people find other issues and it's under arbitration. we took that as public comment and will monitor it. and i believe that was the -- commissioner sanchez, did you have any other items? >> no. that's fine. great. thank you. we did our usual approval of the medical staff department which i think this time was just looking through here, just for the sake of completing this that we did review and approve their bylaws. i forgot actually which department we did review. was it dental? i'm looking through here. >> sorry. i don't have it in front of me, dr. chow. >> just a minute. for the record, we should actually put that in. >> i can note it in the minutes if you'd like, commissioner

chow. >> oh, oral emacilllary surgery. >> thank you. >> commissioner, the next item is a closed session so consideration of that closed session, there is no public comment request for that item. >> ok. so, a motion to go into closed session. and a second. >> second. all those in favour please say aye? >> aye. >> and we shall now go into closed session. thank you. >> open session and the question is whether to disclose or not disclose the discussions in the closed session. >> not to disclose what we discussed in the closed session. >> second. >> and there is a second. all those in favour of not disclosing the discussions, say aye. >> aye. >> all those opposed? we shall not disclose the discussions. is there any further business? if not -- yes, commissioner sanchez. >> yes.

i'd like to recommend that the commission close in memory of one of our great physicians at san francisco general hospital. dr. mitch grossmann who passed away. last week. dr. grossmann was my first boss as a general in '69-70 and was the associate dean and also the chair of pediatrics. and then from there, he went on to astounding efforts, but he always kept the focus on the kids and our trainees, our undergraduate med students and our residents and our junior faculty and we has a number of sons and daughters and a number of them are health providers and his wife was key in many of the unique projects. they develop key programmes for childhood prevention.

he was also served as a number of numerous positions nationally, internationally and was really a symbol of what the heart and soul and passion is of san francisco general commitment, duty and integrity. he really practiced what, in fact, he preached. and we lost a real exceptional, caring human physician. but he did leave a legacy of family and many, many providers and throughout not only general, but throughout the nation. because of his leadership and commitment. >> thank you. a motion to close in dr. grossmann's memory. yes, commissioner bernal. >> i think i speak for my fellow commissioners also in expressing grat tuesdayed to mayor farrell for his wisdom in reappointing dr. chow and

ensuring continued leadership on the commission. let's enter that into into the record as well. [laughter] >> ok. we'll enter that into the record and get back to talking -- and we realise that dr. grossmann has been one of those pillars at san francisco general. thank you for your comments. any further discussion -- was there a second to that? >> yes. second. >> ok. any discussion on that? all in favour of closing in memory of dr. grossmann, please say aye. >> aye. >> this meeting -- so a motion for adjournment is in order. and a second. >> second. >> all those in favour please say aye. >> aye. >> ok. this meeting is now adjourned in memory of dr. grossmann. [gavel][music]

>> san francisco city clinic provides a broad range of sexual health services from stephanie tran medical director at san francisco city clinic. we are here to provide easy access to conference of low-cost culturally sensitive

sexual health services and to everyone who walks through our door. so we providestd checkups, diagnosis and treatment. we also provide hiv screening we provide hiv treatment for people living with hiv and are uninsured and then we hope them health benefits and rage into conference of primary care. we also provide both pre-nd post exposure prophylactics for hiv prevention we also provide a range of women's reproductive health services including contraception, emergency contraception. sometimes known as plan b. pap smears and [inaudible]. we are was entirely [inaudible]people will come as soon as were open even a little before opening. weight buries a lip it could be the first person here at your in and out within a few minutes. there are some days we do have a pretty considerable weight. in general, people can just walk right in and register with her front desk seen that day.

>> my name is yvonne piper on the nurse practitioner here at sf city clinic. he was the first time i came to city clinic was a little intimidated. the first time i got treated for [inaudible]. i walked up to the redline and was greeted with a warm welcome i'm chad redden and anna client of city clinic >> even has had an std clinic since all the way back to 1911. at that time, the clinic was founded to provide std diagnosis treatment for sex workers. there's been a big increase in std rates after the earthquake and the fire a lot of people were homeless and there were more sex work and were homeless sex workers. there were some public health experts who are pretty progressive for their time thought that by providing std diagnosis and treatmentsex workers that we might be able to get a handle on std rates in san francisco. >> when you're at the clinic you're going to wait with whoever else is able to register at the front desk first. after you register your

seat in the waiting room and wait to be seen. after you are called you come to the back and meet with a healthcare provider can we determine what kind of testing to do, what samples to collect what medication somebody might need. plus prophylactics is an hiv prevention method highly effective it involves folks taking a daily pill to prevent hiv. recommended both by the cdc, center for disease control and prevention, as well as fight sf dph, two individuals clients were elevated risk for hiv. >> i actually was in the project here when i first started here it was in trials. i'm currently on prep. i do prep through city clinic. you know i get my tests read here regularly and i highly recommend prep >> a lot of patients inclined to think that there's no way they could afford to pay for prep. we really encourage people to come in and talk to one of our prep navigators. we find that we can help almost

everyone find a way to access prep so it's affordable for them. >> if you times we do have opponents would be on thursday morning. we have two different clinics going on at that time. when is women's health services. people can make an appointment either by calling them a dropping in or emailing us for that. we also have an hiv care clinic that happens on that morning as well also by appointment only. he was city clinic has been like home to me. i been coming here since 2011. my name iskim troy, client of city clinic. when i first learned i was hiv positive i do not know what it was. i felt my life would be just ending there but all the support they gave me and all the information i need to know was very helpful. so i

[inaudible] hiv care with their health >> about a quarter of our patients are women. the rest, 75% are men and about half of the men who come here are gay men or other men who have sex with men. a small percent about 1% of our clients, identify as transgender. >> we ask at the front for $25 fee for services but we don't turn anyone away for funds. we also work with outside it's going out so any amount people can pay we will be happy to accept. >> i get casted for a pap smear and i also informed the contraceptive method. accessibility to the clinic was very easy. you can just walk in and talk to a registration staff. i feel i'm taken care of and i'm been supportive. >> all the information were collecting here is kept confidential. so this means we can't release your information without your explicit permission get a lot of folks

are concerned especially come to a sexual health clinic unless you have signed a document that told us exactly who can receive your information, we can give it to anybody outside of our clinic. >> trance men and women face really significant levels of discrimination and stigma in their daily lives. and in healthcare. hiv and std rates in san francisco are particularly and strikingly high were trans women. so we really try to make city clinic a place that strands-friendly trance competent and trans-welcoming >> everyone from the front desk to behind our amazement there are completely knowledgeable. they are friendly good for me being a sex worker, i've gone through a lot of difficult different different medical practice and sometimes they weren't competent and were not friendly good they kind of made me feel like they slapped me on the hands but living the sex life that i do. i have been coming here for seven years. when i come here i know they my services are going to be met.

to be confidential but i don't have to worry about anyone looking at me or making me feel less >> a visit with a clinician come take anywhere from 10 minutes if you have a straightforward concern, to over an hour if something goes on that needs a little bit more help. we have some testing with you on site. so all of our samples we collect here. including blood draws. we sent to the lab from here so people will need to go elsewhere to get their specimens collect. then we have a few test we do run on site. so those would be pregnancy test, hiv rapid test, and hepatitis b rapid test. people get those results the same day of their visit. >> i think it's important for transgender, gender neutral people to understand this is the most confidence, the most comfortable and the most knowledgeable place that you can come to. >> on-site we have condoms as well as depo-provera which is also known as [inaudible] shot. we can prescribe other forms of

contraception. pills, a patch and rain. we provide pap smears to women who are uninsured in san francisco residents or, to women who are enrolled in a state-funded program called family pack. pap smears are the recommendation-recommended screening test for monitoring for early signs of cervical cancer. we do have a fair amount of our own stuff the day of his we can try to get answers for folks while they are here. whenever we have that as an option we like to do that obviously to get some diagnosed and treated on the same day as we can. >> in terms of how many people were able to see in a day, we say roughly 100 people.if people are very brief and straightforward visits, we can sternly see 100, maybe a little more. we might be understaffed that they would have a little complicated visits we might not see as many folks. so if we reach our target number of 100

patients early in the day we may close our doors early for droppings. to my best advice to be senior is get here early.we do have a website but it's sf city clinic.working there's a wealth of information on the website but our hours and our location. as well as a kind of kind of information about stds, hiv,there's a lot of information for providers on our list as well. >> patients are always welcome to call the clinic for there's a lot of information for providers on our list as well. >> patients are always welcome to call the clinic for 15, 40 75500. the phones answered during hours for clients to questions. >> >>

>> they tend to come up here and drive right up to the vehicle and in and out of their car and into the victim's vehicle, i would say from 10-15 seconds is all it takes to break into a car and they're gone. yeah, we get a lot of break-ins in the area. we try to -- >> i just want to say goodbye. thank you. >> sometimes that's all it takes. >> i never leave anything in my car. >> we let them know there's been a lot of vehicle break-ins in this area specifically, they target this area, rental cars or vehicles with visible items. >> this is just warning about vehicle break-ins. take a look at it. >> if we can get them to take it with them, take it out of the cars, it helps.

>> good evening, everybody. san francisco unified school district january 23, 2018 this meeting is now called to order. roll call, please. [roll call] >> thank you. please join me for the pledge of allegiance. [pledge of allegiance]