as and the reasons and ends with several resolves, including endorsing the safe injection services task force recommendations, supporting assembly bill 186 and supporting the implementation of safe injection services. that is before you at this point. commissioner sanchez? >> yes. well, i -- i just want to state that when this was first brought up, the task force was under way and i just think the quality of the work that has been done, from federal to state or whatever is -- was really a horrendous task. as i read through this, the very last further resolve that the health commission supportses safe injection service. i was thinking that really this

was done with continued integrity and due diligence. and i would just like to perhaps consider adding those two words at the end of the health commission and further resolve -- this is on page eight of nine -- the health commission supports the implementation of safe injection services with continued integrity and due diligence. that really is what this whole product has been. and i just want to mention that -- not mention that, but actually stamp it as our confidence in the ability of this great community to pull together this new pathway that we will be looking at. both the positive [inaudible], but i think it might be -- again, it is a confirmation of what we validate in this effort. >> do i hear an amendment? is there a ?ekds >> second. >> there is a second for that.

is there further discussion of the amendment? mr. morris, do you want to repeat the amendment? >> sure. it's the last further resolve that the health commission supports the implementation of safe injection services with continued integrity and due diligence. >> ok. commissioners? further comments on the amendment. otherwise, we're prepared to vote on the amendment. commissioner loyce, you look like you wish to make a comment on the amendment. >> i do not. >> all right. sorry. ok. we're prepared for the vote. all those in favour of the amendment to the resolution, please say aye? all those opposed? we're now back to the resolution with the amendment. are there any further comments? commissioner loyce? >> yes. i want to commend the staff and director garcia for her commentses in the chronicle this morning that reflex this

commission's view of what safe injection drug sites should look like and i am pleased to be a part of a commission in a city that takes proactive action in support of all of our citizens and support of the health of all of our citizens. i go back to the early days of h.i.v. and aids and also looking at the importance of san francisco operating from a place ofs if commission. we're going to do something as opposed to omission, being afraid to do something. we've done the right thing. we continue to do the right thing. i'm very happy to be part of this process. thank you all from the community and most importantly as well you are a staff who have done the heavy lifting on this. >> thank you. any further comments regarding the resolution? yes. commissioner chung? >> thank you, commissioner chow. first of all, i want to congratulate every single advocate who has been work on this so diligently for a long

time to make this happen. and i know that, you know, that through all your hard work, sweat, tears, blood that you are able to get the supervisors to move on this. and to give san francisco the opportunity to lead. on this again. just like we did with the syringe access programme before it was even accepted. ments in california. i think that it is also really important to remind ourselves that we're making this decisions is because we're not judging anyone whos have to access these sites. we are not endorsing drugs, but what we are doing here as a commission is to reflect to the public and let them know that we think this is a sound and good public health decision. and for that, i think that --

and for that, i think that we have a lot to be proud of. but more importantly, to really help with the effort that we have worked so hard on as well. to reduce further the h.i.v. prevalence in the city. right now we're sitting at around 2% general. so, that is a big dip already from 4%. so, hopefully, youfn, with these new sort of radical policies, we can move the doubt even further and be the first city to get to zero. >> thank you. commissioner, did you wish to -- >> yes. first of all, i wanted to acknowledge everyone in the community who has been here and at pra*ef you meeting, i think it is really filled us as commissioners with a sense of purpose in helping to play a role in getting this done. one thing that i think has been so remarkable of this process

is the way that -- that the task force and others have really taken seriously the need to anticipate and address concerns that people may have from all of the communities, from people who would be taking advantage of these services, to the various neighbourhoods, etc. so, i think we can all be really proud of the process that not only the department, but also the task force and others have undertaken and the way that's really embraced the community. the various communitis that are served and impaxed. so, just wanted to associate myself with the remarks of my colleagues around the commission and thank everyone. >> thank you. >> i wanted to add my thanks to department and in particular to the director for the work thats in the final document on the safe injection services task force. it's one of the best pieces of work that i've read in regards to a policy decision and

implementation from our department. i see that the privilege that i have been given to continue to work with the department also reflects not so much my work, but the work of this health department and this remains an affirmation that the city needs to continue to move forward and this is another, i think, very important example that people matter and that we consider people as our product, as our responsibility. that is what our charter says. we are responsible for the health of the city. we need the people of the city and i believe this resolution, as is crafted, actually speaks to that. this is a part of our people. and we are going to suggest how we feel we should take care of these people. so, i was agreing with my colleagues that i also believe that this resolution reflects

our desire to move forward in order to assist the residents of san francisco and i will then, if there are no further comments, we'll call for the vote. all those in favour of this resolution, please say aye. >> aye. >> all those opposed? this resolution has been passed unanimously. thank you. [applause] [cheering] thank you very much. and we hope we'll get same affirmation as we move through the processes. [laughter] and some of you are -- please do not congregate outside the door because it becomes quite loud. so, celebrate down the hallway and cheer, if you would please. it's exciting, folks. it will be great.

[laughter] >> you don't take this personally, do you? >> i thought this crowd was here for me. [laughter] >> just hit exit, greg. yeah. >> all right. our budget manager jenny is on her way up so i'm looking to see if she is coming against the flow in the door. all right. just a couple of kinda introductory comments and then i'll pass it off to jenny when she comes. but just to put this in context, the way we presented this budget is a little different than we sometimes have in the past.

as we're kind of looking at the package of initiatives that we're putting in front of you today and that will add as we go into the second hearing next week, you'll notice those of you that have been around for multiple budgets, that the list is smaller than you often see. there is often a much longer list of initiatives. and i think the reason for that is just we're reflecting where we are in terms of our financial approach and our operating priorities is there are not a lot of new initiatives because we only show you incremental change, but you're seeing a huge amount of work and major initiatives that the department is focused on. they just happen to be things that we have funded in our budget over the past two to four years. so underneath the list of

initiatives is in front of you. we have the e.h.r. promise, the lean -- thon going adoption of the lien which we discussed in our finance committee today. we have a number of major changes in our behavioral health and transitions programming that we're working through. we have a number of initiatives under way to provide development opportunities for our staff. so, the budget -- the list of initiatives that you see in front of you, i think, doesn't kind of do justice to what is really included in the body of this larger budget. and the budget does reflect our big priorities and continued direction of what we're working on as a department. so i just wanded to kind of give you that context as you're looking through this. the other piece of this is, givesen the instructions from the mayor's office, we've been asked not to add f.t.e.s and do

everything that we're doing and still meet our target and we have achieved both of those goals. so we have tried to limit ourselves in taking on new initiatives both for that reason but also because we have a lot in our hands as it is. and the departments to-do list will be very full over the next two years that we're going to talk about. so, with that, i'll hand it over to jenny to go through the presentation and initiatives that are in front of you. >> good evening, commissioners. d.p.h. budgets manager. it's my pleasure to present to you the first part of our 1820 budget, proposed budgets for next year. for this first hearing, we just wanted to give a base budgets and review to give you the contexts for our larger budget and then show sort of initial set of budget initiatives that we'd like to move forward for fiscal year 18-'20. we'd love to bring forward

budgets for your actual approval. so, just the context. for the budget. big picture, g.p.h.s has a $2.2 billion budget. you might have seen a similar slide in the past, but what i'm actually pleased to show you here is our slightly new budget structure that reflects our organization as a result of the implementation of the controller's new financial system project. it looks fairly similar but the changes that i'd like to point out is first you'll see a division h.b.h. behavioral health. we've actually combined mental health and substance use into one division, which allows our managers and leadership to further sbeg rate the programmes. we have low-level details that actually tracks separately the mental health costs, for the mental health cost reports. but this enables of bigger

picture of behavioral health because they are interrelated and allows the managers to sort of control the budgets more freely. separately in the opposite direction, what we have seen in previous years, it was a very large public health division budget and that was always a little bit confusing because it was a mixture of three different things that we've separated out here. the first is population health division. and its budget is actually closer to about $100 million and it separates the work that we do for population health. the second division that we created is san francisco health network, which is basically the services that you are not seeing elsewhere. basically in the nonhospital services, nonprimary care but you're seeing the transitions programme, the office of

managed care, maternal child health and network-wide initiatives such as the call centre and our nurse advice line. and then last but -- oh, and i should also note that under the health network budget, we have a $93 million i.g.t. payment, intergovernmenttal transfer payment used to offset revenues at san francisco general. it sort of looks like a large piece of the pie in terms of the actual expenditures for services, it's actually only about half of that size. and then lastly in the public health admin sdwition where you have the central services that support all of these other divisions. so, it's h.r., i.t., finance, policy and planning, security and facilities that aren't related to the hospitals themselves. anyway, i'm pretty excited to actually be showing you a budget that aligns our

organization. i think there is going to be some more refinement as we move forward with this new system and figure out what's available but moving forward this is how you will be seeing our budget initiatives. salaries continue to be the largest portion of our expend chures in our budgets followed by nonpersonnel services. and i'm pleased to say that d.p.h. continues the work, its work to leverage revenues to offset our general sense of support and what you're seeing here is a chart by our new divisions that shows the blue bar, which the blue section is a bar, which is the revenues that we're leveraging and i'm pleased to say it far exceeds the general sections that are layered on top of all the revenues that we get.

for those who like a good table like me, just sort of summarizing the last couple of slides that we have here, just so you can see the revenue expenditures and the general fund subsidy for each division and note that, you know, we're approximately 34% funded by the general fund, which is definitely not a majority of our expend chures. at the same time, we're still receiving $. 770 million worth of general fund support from the city, which is obviously not insignificant. so as mr. wagner mentioned earlier, our focus for 1820, what you're not seeing in these new initiatives, but are continuing doing, is many of the strategic initiatives that have been adopted in prior years, you won't be seeing many new initiatives just so we're able to focus and continue the work, that we started. yeah. be rest assured we're still

continuing those initiatives, although we may not be calling them out specifically in this presentation. some of these initiatives that we're work on is consistent with our lien to north, health record and implementation and developing our people. really just investing in our workforce. and leveraging our most important resource within the department. in addition, we continue to look at whole person health care. we will be add agnew behavioral health engagement team that will be discussing shortly. a drug medi-cal organized delivery system, which continues the expansion of the drug medi-cal waiver which we'll start shortly. we hope to be opening additional beds via st. maris's and crestwood.

we continue our focus on equity as we continue our bahi initiative and we also look forward to the renovation of the southeast health centre. and we will continue our financial stewardship initiatives where we're focusing on reserves, we'll be back in core population health services, maintaining coverage for our patients, maximizing value-based payments as we move progressively toward more waivers in a value-based payment world and revenue cycle planning is part of the implementation of the new electronic health records. going nichest specifically to the initiatives that we're bringing forward for your approval, the first set are revenues. as you can see, we have some baseline revenue growth at san francisco general, laguna honda and within revenue projection.

these are based on projections by our financial officers in these divisions ands are basically the baseline growth expected. what offsets some of that good news is the loss of federal and state funding for population health in the areas of s.t.d. and t.b. emergency preparedness, sansa grant and h.i.v. set aside funding and -- there's one more, it escapes me now -- oh. hepatitis c. and so these are grants that funded core services within population health and these are services that, again, does a lot of prevention and support for our population and not an area where we would want to lose those services. so we're back filling them. all in all, we're seeing about $50 million of additional revenue that we can put up towards our initiatives and

also to meet the mayor's general fund reduction target. a budget neutral-initiative that we're moving forward is a behavioral health team that we're implementing to increase our street presence out on the street and it is a small team and we'll start to pilot it to see if it's work or not. but there's been a need for increased behavioral health presence on the street and this is how we'd like to respond to that. we're going to leverage additional whole person care payments that we believe we can draw down as a result of increased co-ordinated efforts. for emerging need, we'll be continuing the liberty system. some of you remember in the school year '17, we put forward an initiative where we would organize the delivery system. we thought we would implement

in fiscal year 15-16, but due to delays on the stateside to approve rates and finalize whole process for approval, they actually did not implement it until this year. but we have the information now. we have the rates. we've been working with our providers to become medi-cal drug certified and we'll slowly roll out this programme year by year. which you are not seeing on this slide, but will in your package that overall what we're proposing is a $3.3 million increase in our contracts for our providers to provide improved quality of service with improved coordination. and it's off set by about $2.2 million of revenue and you see that net general fund impact of about $1 million. but the goal is that we're actually going to be providing

better quality services that's actually billable for our clients. next is our sensing and staffing initiative for laguna honda hospitals and there are two related things going on here. first in the current year, what we're seeing at san francisco general is their census is actually exceeding our budgeted staffing. we budget for about 285 beds annually and we're seeing an average of about 302 beds being filled on a daily basis. and so what this is causing in the current year is an expenditure overaverage that we don't have budget authority for. on the flipside, we're also receiving revenues on the fee for service side that we haven't seen before. technically those two, you know, factors offset each other. and so what we'd like the do to

move forward, as we continue to review the census is create a $6.6 million pool of expenditures that san francisco general could tap into when its census goes above its budgets and gives it the expend -- expenditures and we would see the revenues associatesed with it. in addition laxer guana honda hospital has been seeing in their patient population an increased need for one-on-one patient coaches for their residence and this is because of an increase population that we're seeing in the last few years related to residence who need one-on-one coaches because they could be considered a danger to themselves or others and so what they're required to do is actually have a patient coach

be watching them for most of the day. so, therefore, these coachs are not part of their regular staffing model and so what we're doing is making a correction to dress the additional need of patient coaches. this correction will alow laguna honda to continue its level of admissions at san francisco general hospital which will help keep the admissions level at the current level that it iss in at san francisco general. and then lastly, we are going to be increasing our contract with the ucsf under the affiliation graement. as you know, these are services we get for providers and other clinical services at zuckerberg san francisco general. we've been contractually obligated to pay for the cost of those services. in the last few years, under

the a.c.a., they have been enjoying increased pro-fee billing that has actually enabled them to capture some revenues and, as a part of an effort to help us with our implementation in the electronic health record, they had an agreement to hold flat their costs for the affiliation agreement through 2021. but, however recently when they sort of reprojected those revenues, it turned out that they don't believe they can continue that agreement. so what we're proposing here is to increase affiliation agreement first in year one by using $ million of reserve grant funding from the san francisco health plan and it will off set $4 million of additional costs for u.c. in year two, we would increase that to a total of $4 million. and this would actually -- $3.8 million has already been assumed as part of the city's

financial projections. but the remaining $10.3, we need to look at our electronic health records project to see how -- what impact it might have if we were to transfer the funding to u.c. but overall, these are services that we need to continue at san francisco general because they are so integral to its operations. >> you really mean the title is not correct, right? it's really 18-19 to 19-20. >> yes. i apologize. the first column is supposed to be 18-19z and the second column is 19-20. for inflationary, this is similar to what you've seen in the past. our pharmaceutical costs are the bulk of these costs that continue to grow. last year, our pharmacist dave woods projecting a 10% increase overall. he's lessened it a little bit and is now projecting 8% and

this is just the cost of, you know, sort of keeping up with -- of doing business and keeping up with those increases in health expenditure costs. these costs were assumed by the mayors in the five-year financial projection and so it would not affect our target. in terms of big picture to summarize, there is 3% reduction on target is $16 million and grew to increase of $13 million in year two and there's also some revenue growth already assumed in a deficit. this is the revenue growth that helps us off set some of the other cost increases that you are not seeing, including g.p.h. staff, you know, staffing cost increases that's man dated in m.o.u.s, salary infringe and other inflationary costs and then which gave us a target of of general fund

reduction. what we're doing with all the initiatives that we brought forward is a slightly lopsided balancing plan where we're $28 million to the good in year one and $20 million until bad. if you look a fritz the two-year perspective which we have done in previous years, we're still overall to the good in terms of balancing but we'll be sort of looking at this sort of imbalance in the next week or two and we'll be hopefully bringing you something that is a little bit more -- a little bit more balanced in year two. >> ok. next up, we have an additional hearing where we'll complete our balancing plan and then will submit the budget to the mayor and controller's area on the 21st. the mayor's office where he'll submit a balanced review after

that. anyway, that is all i have. so, i'm happy to answer any questions you may have. >> thank you, commissioners. remind you today is just a discussion and on the february 20th is your vote. >> any public comment? >> i've not received any requests. >> commissioner, we're prepared 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