looking at a project by itself. now we understand the dialysis and public health lab -- the space of the rehab department moving in the third floor of building five that is available to start construction until it can move out fully licensed. then we can start the project for public health lab. that's the reason why there's such a huge gap for the two projects in particular. >> i can tell you also, commissioners, the nature of this one very different than some of the projects then we've done in the past where you've seen this type of schedule. the reason is what joe is saying we did the leg work up front to estimate the time line but until we got in the detailed programming and scheduling of different pieces, there was no way to have a schedule as

realistic as you would have seen for example on building 25 or one building and we get to make choices about how things are sequenced more accurately. have you so this things dependent on a previous project to move, it took a lot of leg work and effort to get us to the point where we had a realistic schedule. so the red lines you're seeing here are kind of more reflective of what our best guess was before we were able to do that technical work and really set a schedule that's realistic and so we are watching the time line compared to the past but some of those that moved it was because we didn't have enough information to set a realistic time line and so we had to reset and say now that we've done the scheduling, the sequencing and technical work we have a real

baseline to measure against the projects. >> thank you. >> that's why i think this is good. the ucsf building, do your time lines match -- most of you -- the department has it on our program schedule and then you have it on your ucsf schedule. are those two matching? >> we have nicer colors on ours. >> we had more money. >> we incorporated it into our framework so we're aligning exactly the same and i think teri said it best, we're concerned about the south side of the building that's adjacent to the parking lot because that's where they're going to be building. so michael and i worked out a pretty coordinated phased

roadway where we temporarily moved things out about 75 feet from the building and then comes new construction and it creates that separation between our building and his building. so the good news is the city attorney's office looks like they'll complete the title of the mcinnerny act which allows the ground lease to be signed and escrow to be completed and then we can start the roadway work before we start the building, which is optimal. as mark said, getting the south side of building five done first frees that to happen without

interference. so i think we're in a good state. i will add that we, like you, are affected by the lack of construction resources and we have four buildings in construction now and it's tough, it's really tough. we're all having to take these unfortunate circumstances into account. any further questions at this point? i appreciate your update. thank you for -- for all three of you coming and we'll see you in a quarter. thank you. >> item 11 is the epic organization change management update.

>> good afternoon i'm winona mindolovich. i'll give you a three-part update on i.t. first is on i.t. itself, our accomplishments, status, some of our challenges and a look ahead. then i'll give you an update on the epic project and dr. albert yu will give you an update on organizational change management key to the success and implementation. this say -- is a visual of our network closets before and after. i hope you can see the state it was in before which was full of clutter and lots of wires hanging out of it and afterwards we not only cleaned up our own equipment but the extra stuff stored in that closet. so we have 77 of these network closets throughout dph.

we upgraded 38 and plan to complete the rest by 2019. this provides better connectivity for the devices in that particular area and replaced the uninterrupted power source so if the power's out we'll have the connectivity. we've got our workplace and printers and have virtualization and keeping the lights on and we have lots of staff that are keeping the lights on for other systems and maintenance. in terms of other epic readiness, we have been working on the wireless networking. we have done asurvey of 100 areas over the first wave of live. now we know what we need to do. the cables have been oornd -- ordered so we can have readiness before we go live.

we have a new network between zuckerberg general to give us greater bandwidth and we had virtualized over 800 servers. we have about 75 left to go. this provides easier maintenance and more redundancy for users and less outages overall. because of the server -- we worked on virtualization of the work point and we did that at zuckerberg and hond da and to give you an example of what that means to the end user it was taking 88 seconds when you booted up your work station. it's now taking 31. it used to take 157 seconds to get if the first application. it now takes 71. so they've seen a faster response and they're using their badge to time in and they get

multiple applications. the application has been successfully submitted for 52 metrics. we recorded performance. and dph can now look at the incentive payments for that. and network remains at 99.93%. the next slide you'll see a change from 2015 to 2018. in 2015 we did not have a tool to measure uptime and that will now so that will be the benchmark going forward what we did have is an mod event, a manager on duty so if a system was out or had a large outage it was escalated to the manager. that's been reduced from 2015 an average of 11 outages in one month escalated to a manager on duty to an average of 2.67.

so drastic reduction. that points to the work done on the infrastructure. unresolved ticketing. we had over 5,000 tickets last month on the service desk. in 2015 we had 40% unresolved and we're continuing to work that down. we did random sampling and it's down from 38% satisfied with the service desk to 88% in 2018. so significant improvements in our customer service focussed on standardization and training for them. information governance is not a function but it's critical and necessary to utilize the wealth of data from h.r. systems that are going to be decommission and

data to optimize patient care and further research objectives. the epic install is the actual opportunity to do the governance we didn't do before. so this governance steering committee was brought up over 18 months ago and you'll see a number that ensure data and access. -- data integrity and access. the data governance groups worked with a group to determine what data we'd migrate to epic and what we have to legally archive and score. that was time sensitive to do sampling of that conversion into epic and that's started. there's been a managing of aligning with the city's digital service to make sure we have the same look and feel and provide a service rather than just putting

up data people may not be interested in and the first change you'll see over time is the website will be rebuilt. a welcomed change. probably the greatest challenge now is i.t. staffing. we have over 51 open positions right now. we're working closely with h.r. to close those and make sure we have a qualified applicant tool. i reported our priority was hiring a chief information security officer. we're in the process of closing that posting and we'll do an additional assessment and we're working with a hippa audit

coming in. we're kicking that off and we have an external consultant existing us with framework setup so we're being careful about security. it's high priority for us. >> and d.t. is city wide. >> technology, sorry. and the wave one epic program director and chad is very successful and in his last install which is four hospitals in oregon using epic foundation. we're happy to have him. problem is chad does not want it stay long term. he wants to stay in oregon so we are recruiting for a long-term epic program director we want a transition as long as we have chad here. we've been ensuring good candidate scores.

and they're doing an effic install. we have consulting companies to try to recruit them after they go live. we want to work on how to retrain those staff and looking at telecommuting and things with hr to keep them here. over the next years 17% of staff will be eligible to retire. we're working on succession planning and we have a very robust program that bill kim start and we're continuing that process and we're working with other colleges and university to do interim perhaps to do a path of -- programs to do a path of people coming in. not only construction is having problems but so are we in term

of hiring people. in the next few months with virtualizati virtualization we have to be metric driven in how we're staffing. epic install we staffed looking at lots of implementation. input from our consultants that we are also getting feedback that we're complex and we need to relook at our model for ongoing live, sustaining effort. we'll be looking at that over the next month or so. what's head for ic. and in general management is hard because everything has an

application. every single we have 55 systems to decommission and we're focussed on security, as mentioned. in 2014, bill kim came to you with a strategic plan. we have succeeded in that plan and we're looking ahead for the next three years and we'll be coming back to you for what it looks like and how we're professionaling with that plan. we're installing a new service management tool to handle incident and service requests an changes and that will be piloted later this month. to the project update. we're in wave one of the epic rollout. the first includes zuckerberg san francisco general and laguna honda hospital and phase three clinics and there's an adoption and build configuration through direct setting and the initial adoption sessions an now we have completed,000 and subject

matter. the team is configuring the systems and there's over 21,000 to make and the sessions that are going on now and the decisions being made are how we make it unique to dph. they're downloading our financial classes, clinics, orders and master sets and on and on. the current efforts, the time line is short from january and now it's less than a year from august 3 when we go live. we're using epics foundation. that's a tried and true model and chat is -- chad is bringing experience so i'm sure we'll make the live date. right now the focus on the build

has to complete by november 28. testing will be coming and we go live august 3 of 2019 with post-live august 5 through november 8. we debated a lot about what to give you. if you want more detail on the slide we're happy to change this and do that but we tried to keep it simple where we are with the time line. a little bit about epic, the staff went for training in january. we began the procurement of the 85 third-partee -- third-party systems and then a logistical challenge with 230 changes with

subject matter experts that attended. our team as i reported in july, our of our staff 100% that went to epic to be trained and went to wisconsin and they all passed and are currently working on the project. super proud of the team. the project plan was completed and operations and orientation or the orientation happened with operations team as they got to see what epics looked like. we're currently in phase two the content build which are build buckets one through three. adoption sessions one and two happened and groups were established. this is our status report. green indicates we're on track and yellow is on the watch it state and there's no red which would mean we're in a critical state.

the design and build is current currently green but it hovers on yellow because it's not would a lot of focussed effort we retain the green status and sure we will at the end as well. it's absolutely critical. they're in phases of the build and there's a number we have to do to have testing successfully. we have contingencies in place. the teams are working on testing scripts and we have a testing manager engaged and it looks like it will be successful. training is yellow because the initial site that was going to house most of our training -- we've ran into difficulties in work out how to do that. we're focussing on how to get that back on track and believe we can do that with the site and

have our training rooms ready. interfaces are green. they're on track. we have 125 interfaces with epic. are teamed are prepared and have been doing testing. technology has been on track and i've talked about the success. good live is green because there's nothing to stop it and contract and budget are in a watch state. the changes were up to 72 contracts have been completed and we have a few that are in the medium to high risk. so we're still watching those. we don't have anything stopping the project now but it's been tough it get all the contracts through. budget review process is in -- we have the budget review in progress right now when we're assessing our initial estimates. so to make it real, we're adjusting that and will bring it back to you.

next wave the maternal and a adolescent health and there's material health and lab and now to doctor yu to talk to you. >> good evening, commissioners. so i think it was you, dr. ciao who -- dr. chow, how we're engaging staff in the implementation process and i'll walk you through the structure and how we're engaging our staff and leaders in that process. we before we signed we knew it was an operation project not >> t project. that means planning the installation and training to make sure the user understands how to do the daily work. not so much navigating through

an electronic record system. they're primarily service lines end to end the continuum of that particular service whether there's an emergency room service or patient environment. on the right side you can see they're relate to revenue cycle service lines where there's medical record, billing and chart or patient and scheduling registration. those are current domain groups. there are certain pieces because we have to have adequate input from the business. this give you a sense of the governance of how we are managing, planning, monitoring and tracking it. i'll start on the top and i'll walk you through the bottom. then i'll wrap around how ocm and leaders and star are part of the governance. at the top is the executive

team. a handful of people including craig, wagner, roland pickins, allison chan and winona and myself around obviously our vendor consultants and next is the transition executive team. this includes the top executives of each divisional tower and hr., i.t., that teem is the ultimate authority on epic configuration, built, design, training, go-live, planning. any decision around that. there's a program management office administered through kpmg. the yellow boxes are important those are leaders and frontline staff we organize into four

groups. patient care includes clinical operations as well as patient access and leadership team. i take that back, it includes clinical and operative administratorive folks and the council is charge, capture and h.i.m. information governance and the technical council interfaces integration, >> t infrastructure and the council charged with those types of decisions. the two parallel tracks that are vertical are important. the green is the project team. that's where we have loss of new hires and the project teams are designed around the modules an applications. this is the methodology whether it's the emergency service team or labor and delivery each are

staffed by epic hire or technical leads and workforce analysts that have been transitioned in into the roles to support the discovery of that content that needs to be build and configured. on the left side are the domain groups i highlighted in an earlier slide. on the bottom there are clinical champions and supervisors and we'll start identifying the super user and they become available when we go live as well as with training. here's what we have stood up in the last year and a half or two,

the office of informatics team is housed and represent and as well as the ocm organizational change manage plan. they're managers and make sure when they identify a gap how it gets tracked and input from the business to inform how we prepare staff to be ready when we go live. that's what the ocm managers and groups are trained to do. i'll walk you through some high level target to look at how leaders have been engaged in the

process and so in the groundwork phase we we had high-level executive leaders making key organizational scoping decisions. there were 94. they also identified 12 of 30 benefit realization project indicators that epic asks customers to commit to and post live to track and we have 133 senior and executive leaders to organize around that phase to do the initial planning. in the direction setting, winona alouded to the session and we have 962 subject matter expert participates in those three-day events in the month of april. and we had about 1900 or 2000 or so work flow-related decisions made during the direction

setting. during this phase, which we're still in. clinical system design sessions are the peptic -- epic project team work a handful or so frontline staff to tell us how you're organized, how many providers and room and those are the sessions to build it. and we had experts that are participating in the variation domain groups i highlighted two slides earlier. over 23,000 that winona referenced and as of this point, there may be more, this number will likely change, we've identified 115 gaps or so in the various domains meaning how we currently operate to where we need to be come august 3 next year.

we anticipate 80 trainers based on our organizational size and typical recommendation is 1-10 ratio per staff. we have about 10,000 end users we have to train and estimate 9,000 plus or minus a little bit more. we have the ucf folks and dph employees. as of now, we're finalizing the training schedule and curriculum. we're anticipating an average number of hours per staff to go through training is 23. that's an average. some will have a lot more and some will have much less. we anticipate a total of 230,000 training hours across the organization. the training is currently anticipated to be organized around learning modules an they're online. sort of completion about 300 and

165 in-person training. that gives you a high-level summary of how staff and leaders are being engaged in this planning. so right now the current state is we typically schedule patients and then we do the registration and medication at check-in. we try to do a little about that and the patient financial unit tries to do some insurance verification in advance but doesn't hit everyone who shows up. so what we did during the groundwork phases, epic typically recommend as a combined process of doing scheduling and then doing the registration verification at the same time. that's the ideal state because it ensures when the patient shows up have you the payer to get paid nor -- for the service

and they'll do best practice recommendation and we're trying to figure out where our gaps are and vulnerability and make sure staff are trained to do that. during the direction setting, we wanted to demonstrate what registration work flow looks like so the subject matter experts the 900 or so essentially the relevant people saw that and began to say what are the right adoption decisions we need to make during the adoption phase and how do we begin to prioritize and do due diligence around that? and during the adoption phase the domain groups are identifying the right champions an subject matter expert to inform the build and identify the gaps. we broke them out into four major areas. either there are gaps in what people do now or gaps in not

having the right people. the current project in terms of how different it is from the future. technology integration is critical in registration because there are -- the 85 or so contracts winona referenced, there's a number where our schedulers or staff really have to interact to ensure eligibility whether they go outside or check does this person truly have this insurance. there's technology integration that we are uncovering that needs to be incorporated into the training or work flow. and all that gap are being identified prioritized and work through to next april when they'll have a hard stop and is a no more gap closure. we need to sift everybody to training. during the next phase we'll make sure the domain groups and subject matter experts validate

the training curriculum. the content to be taught so our staff understands what they'll be using, how they'll be using it and how they will be accessing information or communicating information to the next person down the work flow stream. and as well as confirming the super users so it will be the domain groups to identify who are the influential leaders in that particular program who actually would make a good super user and then finally during the training, the domain group is going to make sure all staff complete the required training because nay don't they won't have ac stoes -- access to epic as well as make sure the daily management system team is ready for go live because they'll play a critical role when we go live in what issues are poupg -- are popping up and how to triage and hopeful

hopefully that help you understand how we're forming the overall planning. that's about all in terms of the ocm program. >> thank you. was there any public comment? >> i did not receive request for public comment. >> i think one question i did have overall was and you can demonstrate that later, in comparison to our prior schedules, i'm assuming because your go live date is still the same, august 30shgs 30 -- august 30, it would be nice to know where we go with what we have. and your program has keyed out certain areas but as a visual, >> i can give you more of the

grids but the schedule set in january we have not deviated from. we're on schedule. we intend to make our go-live. so far we are on track. >> when we transition from an extensive schedule with blocks and where we are now, it looks like pretty much what you got -- and these may be your new baselines that we're going to follow. and it will be just something that we can follow. >> you can kind of see how it compares but it's identical. >> one is how much time -- i'm

looking at the numbers for training and i'm trying to figure out how many hours do you anticipate the learning modules versus in-person sessions. do you have any sense for who will need which type and how that's going to allocate and anticipated changes in patient flow as you not only train but go live. it's clear several individuals in the system will be spending time well before august working on this and i'm just wondering what the projections are in your various clinics as well as e.r.s and what your anticipated additional staff will be naurngsd -- nursing and provider side and account for the hours in these various activities. >> great question. i'll take the first one first with how much learning versus

person. we are trying to map epic against our h.r. personnel pool in terms of what type of staff fits into what type of training. we have a complement of team in cha -- what content is relative for the training. a lot of that content is getting captured and incorporate into the training curriculum. we don't have specific yet but in the next month or so we'll have clarity for who needs how much elearning versus in-person training and how much will be nurses versus docs versus critical staff in the front desk. we're working through that.

second question, we have an article published that has a command centerers -- command centers and support to to backfill the training. while we currently don't have exact answers or even the vendors to provide the services, we anticipate to start onboarding by march or april or there about so when we hit training in may with all the resources are available to make sure staff can go to training and still maintain the lights on for patient access as well as be available at the time of go-life with support. -- go-live with support. the answers on the other two

with specificity because we're working through those. >> commissioner brannel. >> first your images of the closests before and after are relatable. on slide 3 you're talking about the i.t. improvements and you've increased customer satisfaction and are these the same mortgage you'll be uses once have you it fully implemented or will have you a new set of measures? >> we can continue to do m.o.d.l. but we're changing that program as well so it's more operational direct mangers doing that. we're implementing a knew tool

to measure things -- a new tool differently and better. some will change. i will prefer to give you what our network uptime is going forward now that we have a tool but this is all i had to go back to 2015. going forward, i think we'll use the more modern, accurate tools for measuring to looking at a system up is your customer service better and managing tickets better. >> and it will be actual staff using the system, correct? >> yeah. >> thank you. >> we're looking at usage and satisfaction and around the live environment. >> these are great results so we look forward to seeing the next wave.

>> it was a very extensive report and we continue to be on track. >> i want to acknowledge winona and albert for their work on this. the e.r. program i worked up close how many balls their keeping up in the air and coordinating resources of a huge not only the big project team but keep them engaged. i want to acknowledge what they've done and i wanted to thank commissioner green who came came and spent time with

the team and lessons learned in the process to watch out for. that was appreciate. thank you, commissioner. >> they brought the highest level of leadership from cnp to the meeting and i was grateful because they added more than what one clinician could add. they brought clinical people as well as hospitalists so it was useful. >> greatly appreciate it. commissioner green, thank you for making the contracts an getting the information. it's clear our project is in good hand at the moment. we appreciate your work. >> on that there's no public comment and can move to item 12 which is the human resources update.

>> thank you. good evening commissioners. director of human resources for public health. i'm going to take just a minute to introduce a couple numbers of my team. we've had a lot of turnover in the last year so back here we have rhonda simmons. she's now the director of labor relations an diversity. then we have karen hill, she is over merit and operations. she also does the line -- lien

project for us and elaine lee does peoplsoft and e-learning. we have two other staff, luis brooks houston for the honda central office area and hailey albert over eeo and ava. i want to take a moment to introduce them and we have representatives from laguna honda and zuckerberg and ambulatory care. those are our customers. i'll give you a quick update and answer any questions you have. i want to talk about ep thangd electronic -- epic electronic health records and we have a key role and we're getting more spent on epic and ehr. phase one we did a lot of hiring

and phase two and we have a lot of h.r. work to do. one is what are called vacation plaqueout dates. so because we need to train up to 10,000 people on 300 online modules an 100 in-person courses, we're asking people to restrict vacation from early may to the end of september. so we need to meet to negotiate in terms of something reasonable. right now we're delaying approvals. so that's getting a lot of attention from our unions an staff. what's holding us up is the training modules an the ability to schedule them in the electronic learning system. the other thing is as we redesign the work in the clinics and other areas to do the eligibility and registration, we'll have to change some of our classification and have more class fictions. we'll have to work with unions on that as well.

so hailey albert works for rhonda simmons. these are just what we had noticed is we didn't have enough staff management cases and disability accommodation so we've staffed up as you can see we went from three staff to 10. and hailey has done a lot of with the staffing to help us respond more quickly to complaints. that allows us to reduce risk. so showing the complaints where it comes from and where the complaints come from and it pretty well mirrors the size of the organization for example, zuckerberg you would expect more because it's a larger piece of our organization. you recall or probably saw there was a hearing in september on racism and discrimination in the

workplace and a lot of the management here listened to the complaints an these are some of the activities we're doing working towards a more fair and equitable workplace and we're taking initiatives at zuckerberg and dr. bennet is doing work on in the same area and will give a presentation at an upcoming mighting. labor relations. that's under rhonda simmons. we have bargain this year it starts about march and ends in may to be approved by the board of supervisors. this is a breakdown of unions and the largest is over just

4,000 in the miscellaneous group and if you add nurses it's about 6,000 staff. they looked at the work we're doing and this gives the idea of the work. we always look at the lowest form of conduct so counselling and last thing you want to do is terminate or do a suspension but we do use that as a tool as well. we needed a whistleblower complaint to work on lean. that work is now going to be done by karen hill because she had done it at zuckerberg and will do it for the rest of the department. they worked with the office and

worked with maggie rakowski. we also have done a lot of work in hiring to create more path ways. we looked at black nurses conference to recruit diversity and make sure once we recruit them we have a program for mentoring and support to have a retention rate. and here's an example of the gross period and then the number of transactions. win payroll it's like other things in h.r. you don't hear about until you make a mistake. they don't make a lot of mistakes but emain is -- elaine is working for quality assurance to make sure we have metrics in

place. merit does a lot of postings an recruit manies. -- recruitments. the job market has tightened so you'll see let applicants. we're screening out those who don't qualify. we're getting better about screening and job posting and the job market is tightening so you'll see less applications overall. this is new hires and processing. this is what we hire most in which is nursing and other classifications you may find of interest.

karen has created a leaves team to manage the complex leaves. it's better for the customer those employee because they have somebody being responsive and better for us because it reduces liability because we make sure you get your protected leave but don't take more than your eligible to receive. performance appraisals is a big push and want to see people complete their appraisals and gotten better at getting mangers to do that. we have a big push right now to ramp up the last period which was ending the last fiscal year. with have workforce development which say training we now have a

training function and we have a service awards program for non hospital employees and career coaching has been popular. any questions. >> no public comment. >> commissioner green. >> how many leave now has that been stable? >> it's gone up because the state and federal have created more and it's become fairly

stable and we want to give you what you are owed and deserve and in the past there was not good control once you went out at leave to come back promptly at then of the period so we're getting better and it's fairly constant. operation managers and executives want us to rein that in and we work with them to do that. other question or thoughts. >> we looked at how things would work out and is already giving

us insight into the areas of responsibility. i want to congratulation you and your staff. you're doing an exceptional job in meeting the continuing challenges pertaining to the workforce. thank you to you and your team. >> thank you for those comments. >> we received a number of updates which show the comprehensiveness to the other areas same question in a way.

we have a 2017 analytics on your slide eight. it would be good to know whether woe have more or less and whether it's meaningful to relate it to just simple numbers or is it to a number per thousands of employees that we have? and where we might go in the future. what benchmarks we have and what objectives we would like to do, in other words, if there's 113 written warnings -- maybe we should have more written warnings and less dismissals. i don't know. it would be something that would allow to us understand how well we're doing on labor and where

we have successes an needs. also, when you get to diversity, where are we with diversity in terms of what goals do we want? and we have spoken about it can't just be simple numbers and so there's a tricky number but at least as we're looking at data, is the employee workforce gaining latinos. and that's the next iteration of the reports would be helpful. this will be benchmark and the

demographics, we did do some early demographics work and we will be able to pull that together. we will be able to do some comparison so the next report we'll able to do labor and demographic. >> it enhances your report. >> other questions or comments? >> any other questions? for the update today this is helpful in understanding where we are this year in the department and we appreciate that. commissioners, item 13 is other business. if you look at your calendars i'd like to point out one thing. the meeting on november 7 has been canceled so note that for your calendars an the november 6 meeting is the annual meeting and december 16 is the annual laguna honda hospital meeting so

noted that in terms of location. >> do you have a question earlier from a commissioner. i thought it may have been on the calendar but it's not. >> when do we plan to get the mayor's instructions for commissioners to have an idea? >> so we will get a schedule anytime now for the mayor's five-year financial forecast. that's the high-level deficit projection. and so as we go through that, we'll report back to you the issues on that. generally the mayor's office will issue that and we'll be

able to see what the projected definite numbers are for the coming five years and two-year budget cycle and long with that comes the budget instruction. i would anticipate we'll have meetings in the months of january and february to the commission to discuss proposals. >> thank you. >> we'll look at december as possible interview dates for the

potential cant -- candidates an possibly into january depending on the availability of the candidates in terms of the search process. sometimes it's probably easier to say not this week. any other announcements? >> through the chair. >> yes. >> i want to state the san francisco general