any company, any agency, to make a transformative change such as we have. all of our consumers as users of epic are getting accustomed to the system and day by day are getting proficient with its use. it takes a little bit of time and we're not even three months in yet. i do want to assure you that we have a systematic process in place, a good-governance program, so we can monitor and improve based on the information we glean from epic. what i mean by that is epic is not just a system we put things in, we're seeing a return on information and not just in the form of reports, but information about how we're using epic, some of this in near-real time, so we can understand how we're making best use of this very large investment. so a handful of cocktail party

starters. i maybe lead you to the fourth ring, next to the last on the right, and that 21 systems were consolidated that bring wave one of epic to life. that's important because that's a really large number of systems. it's also important because it speaks to our readiness in the coming year to decommission those systems, which has been part of our financing plan. so what did we implement? i think you have all sat through several briefings. across the top row of items is our traditional electronic charting infrastructure, the support systems like lab, pharmacy, radiology, how we handle the revenue cycle, as well as scheduling. the first one on the bottom is health information exchange which may not have come to mind. that's the bi-directional

sharing from and to our organizations and others. as a result of epic, we are now part of an industry consortium of two or three dozen other organizations that make electronic health records. we all agree we are able to share information with one another. i will show you some statistics for that in a few minutes. i also mentioned briefly that there's a lot of information we're getting out of epic, and it's beyond the standard analytical tools. it is striking the progress that electronic health record systems have made in my 20-plus years of working with them. where we are today is that we are really starting to learn not just about how we can improve in real time by giving managers dashboards to use, but as i mentioned in my opening remarks, how we're actually using the

software. it tells us how well we're doing and it provides areas where we can say focus enhanced training and other learning experiences to help our teams become as expert with epic as they can. i'll keep saying it, we've given access to our clients and patien patients access to their own health records. i'm glad to say we're off to a good start. where did we implement? no real surprises. i draw your attention to the lasting point and that we have gone mobile. we have gone into is is a new place with being able to access the capabilities that epic provides for us. i mentioned that over 1,500 of our clients are now using the mychart application. if any of you are getting your health care in the bay area, you are likely using epic mychart. that is the same tools our

clients are using. for the providers, they can chart on a mobile device using hayku. for business partners and many others, you can log into epic and share in the care experience that we're providing. we're letting a lot of business partners in to have and to share in the experience that we have launched. we have, for a number of years, have been able to do the same thing the other way. so i mentioned how we know how we're doing. i wanted to just take one moment to share a slide with you. the numbers in the slide aren't terribly important at this time. this was a first cut at an epic leader dashboard. this one is for primary care, but i wanted to share with you that we don't have to do anything special to create a

dashboard like this. it's something that we get more or less out of the box, and all we have to do is tune it to our needs. in the past we've had to make a significant investment to deploy a dashboard like this. the nice thing about epic is that there are about five or six dozens of these dashboards that are available for us to use. they are very straightforward, and we are able to customize them to an extent to reflect the kinds of outcome measures and key performance indicators that are relevant to us to represent our true north strategic goals. nothing is perfect. going live with an electronic health record that is now in use by more than -- well, nearly 9,000 people, there are going be issues. we have closed thousands of them since august 3. where we are now is dealing with some of our more complex concerns. they deal a little bit more with

software, but we really deal more with workflow, people, process, technology, that intersection. as an example, we've always been spending a lot of time at sgfg tackling the topic of patient movement. how do they move from the emergency department to the intensive care department. in the past we had people and process and the technology didn't tell us much. today the technology can tell us a lot. epic can share a lot of information about what's going on and how to effectively manage that transition from one venue to another. when we first saw it, and i'm in this camp too, i didn't really believe what i was looking at. for the last month or so, there's been a really intense effort to understand how we can get utilize the information that the information system gives back to us to inform our process and a lot of strides have been

made there. there's a handful of other workflow examples where we're diving in deep. it's not about epic, but epic is forcing us to have the conversations and focus on problem solving. the second issue that we're having, and this was more or less expected, is our ability to deliver against many types of reports and outcomes measures that we have for regulatory purposes that are in support of value-based care. when you move from one information system to another, you are reporting all the way up to the last day that you had that tool. when you start in a new information system such as we did on august 3, we didn't go into it with a fully populated database. we did it with a mostly new database. so we prepared how we would begin to use the new data as folks come in our doors after august 3.

but we have to go through a validation process in order to ensure what we're looking at and that all of the pre-work we did to produce all of these measures is going to be valid and stand up to our data integrity checklist. we are close. hoping in the next 30 to 60 days to be completely back on course. it was expected that we would have a delay, and we had a bit of a delay. i want to be up front about that. the nice thing is epic is friendly about us taking the data out. that has been a real struggle with our electronic platforms, and that's not the case with what we have today. we've talked about benefits realizations before. i mentioned decommissions systems. that work is beginning in earnest at the beginning of the calendar year and will take us to july, where we expect to spin

down, which is something i.t. people don't like to do. we like to keep old systems on as heaters. but we plan to demission our legacy health record system by the end of the fiscal year. the great news about that is we don't need them anymore. the second piece of good news is we won't be paying for them anymore. that's been part of the budget and financial plan for epic since the beginning. i'd like to take a few moments, and i know we're getting towards the end of our time today, to talk about the our in our records, patient record exchange, something i mentioned at the beginning. since august 3 up through october 1, we have exchanged health information with 215 other healthcare organizations across the united states. it's possible there are some international ones in there. i didn't dive deep enough to double-check. if you look on the bottom left, you will see who our

highest-volume information exchange partners are. i don't think there are any surprises there. what's really powerful is in basically just shy of two months of being live with epic, 43,000 of our clients have had their records appended by healthcare information from other healthcare organizations. this is pretty powerful stuff. in addition to that, nearly 14,000 of our patients, their information has been requested and sent across this trust framework that i mentioned before with this industry consortium that epic is a member of to augment the records of our clients in other places. so really very powerful. we don't have to do anything special for this to happen, it just happens. so our epic journey, we spent a number of years in what i would call a get-ready phase. we're definitely past that. we're coming up to the tail end of our get-going phase, where there's been a strong focus on

having a really good governance program for epic, for having a great go live, which we did. now we're in this period of time which we call stabilization and we'll be there for the next few months. during this time of stabilization is where we process people, process, and technology, the couple of examples i shared with you before. what's really exciting is as we march into the new calendar year, we're getting ready to get better. getting better means tuning our governance process even more so we can do two activities in parallel. one of them is beginning the optimization of the epic environment so it can do things it's not doing today. we have a straightforward implementation and without violating our principles of sticking to that, we can still make it better. so we're going to begin that process. in parallel, we will be locking in the scope and schedule for wave two and three of epic. when we're done with that in a

few years, we'll be in a continuous improvement environment, where we will bank on everything that we learned and all of the good governance that's in place so we can keep getting better. so epic is both hard and it has been very rewarding. i just want to share with you the message that we're sharing with all of our staff because not every day is a great day with epic. it's okay to feel frustrated. this is the first message that we're sharing with our staff because we have really changed a lot. more than a thousand changes were made in order to get ready and learn epic. sometimes you look at the screen and you're like i'm not sure i remember how to do this, which is a reminder that we're all in this together. when i go in front of epic, i look at the screen and i'm befuddl

befuddl befuddled. the good information is we continue to help and train and build tip sheets which are in the epic user's first pane when you log in. you go to a place called "my learning home." that's where you go when you log into epic. we are an organization of helpers. i think during go live this was really evident and a lot of people could see how well everyone reached out and was supporting everyone, and that's the environment that we need to continue to maintain as we move forward with more change in epic. so we've asked staff to be there for one another because some day you're going to need some support as well. with that, i'm happy to take your questions. >> i have not received public comment request for this item. >> my question is -- i'm an epic user and a frustrated epic user

at times -- >> we're all in this together. >> yes. what is your i.t. or your help line for an epic provider? what is the response time for someone to be on the line to be able to help one walk through whatever the issue is? i mean, is it five minutes? is it ten minutes? i mean -- and what is -- do you have the adequate staff to be able to help those that are a bit befuddled, especially with epic going live? >> so we have a lot of support across the board. a program that we set up for the go live was to establish a super user program, where we could have people much closer to where the value is being generated and the work is being done who are actually super users.

we have team of infomaticists who can dive in. with regard to actually calling on the phone, when you call on the phone to our service desk, you're calling the general i.t. service desk, and the pickup times are less than two minutes now to get you in there and get your issue noted. many of the items that are coming in are being redirected to analysts on my team who are resolving these items in just a day or two. that's not all of the items, but we've reached that point where the number of items coming into our service during the day and the number of items we're resolving, we've worked down a significant amount of the go live backlog. >> okay. thank you. >> thank you. >> thank you so much. i don't think we can overstate the significance of this

accomplishment, having been through the same epic process, and the potential to improve patient compliance and care coordination. i've had about six patients almost that i've shared with doctors of the county and at u.c. and being able to reach into these records and really do a much better job for the patient, it's astonishing, how having these systems that used to be siloed and vulcanized be all one. it makes such a difference in a great outcome. i want to congratulate everyone involved and say as the few epic go lives that i've seen have been -- your team is spectacular and awesome. i think there's a show where there's a gold buzzer or something -- i think you deserve a gold buzzer. >> thank you. i'll happily try and accept that

comment, having only been here myself only 90 or 100 days. but it's obvious what a full court press there was by every part of this organization to be ready for epic and it totally paid off. >> if i may add to that, i do think it's important that we recognize the people who aren't in the room and worked on this for many years and no longer with d.p.h. i want to acknowledge director garcia's leadership. alice chen who was committed to this and made a lot of this happen. and also wynona medolovich who was acting c.e.o. for many months. i think it's important that as we move forward and go into the next stage that was spoken about, that we recognize the reason we're at this point today is the incredibly hard work of

literally hundreds, i think in some cases thousands of people to make this work. it was really that leadership, including the leaders i just mentioned, that helped us get to where we are today. >> thank you [ indiscernible ] -- >> my question was from the patient perspective, when patients come in and they're told they are able to access their records on their mobile device, for example, is there any kind of orientation offered to them or a guide they might receive, or are they more figuring it out on their own? >> i can't totally answer your question. i'm not sure if anyone is out in the audience who may be able to assist. doctor, i think you can address this better than i can. >> in terms of signing up for the patient portal, we have

information support for the patients to get into the portal. once they get onto the portal and they have access navigating through the site or submitting a quarterback with he have a contract with an outside vendor that specializing in providing the first-tier support. obviously if they need to ask about lab results, that would be routed back to our desk. >> is it an in-app chat function or a phone call? >> it is a phone call to the service, person to person. they would help the patient navigate real time because they know how to access the portal. >> thank you. >> thank you. i'm just going to ask if presumably the app is better than the ucsf?

[ laughter ]. >> that app is really a problem. [ overlapping speakers ] -- >> is there a language capability? >> yeah, that's a great question. right now it is limited in terms of other languages. so no to answer your question. >> that could be one of the -- whether they -- in wave two, three, four, or five, in this community it would be useful with the diverse languages we have. >> no doubt, as well as other epic communities where they serve large communities of multiple languages. that certainly is a push that all of these epic users is going to be pushing. especially with my chart and the patient portal piece of the technology is being so readily available and enabling to the patient and client, we have to push that. there's no ifs, ands, or buts

about that. >> no, you're correct. it's a nation-wide issue that really would make sense for epic. more towards our own problems and within the time frame and i forget on schedules -- could you remind us because you've done a great job getting this all together and having the basic epic work. now in terms of the optimization so to speak, we know that laguna is a challenge. do you have some time frame upon which you would be able to i guess enhance it and optimize laguna's use on a long-term basis, trying to close the chart out -- when they talk about in terms of years versus days, right.

secondly, our mental health programs and avatar and the timing in terms of trying to unify those records. >> maybe i'll go backwards. we'll start with the behavioural health. so behavioural health is slated for wave three which is -- i don't want to commit to a firm schedule. it's after wave two which will likely go live in 2021. so it's in late 2022 or 2023 before we're fully in place with the replacement to the community behavioural health function -- i mean the electronic health record. to your first question about optimizations for laguna honda, part of the process is to be inclusive. we had a domain structure presented several months ago. the idea with that domain structure is it's a place that has almost no i.t. people

engaged, which is probably a great thing, and it's all about the line of business being able to bring items together that can be prioritized that are based on how do we not just get better against our performance outcomes, how are we getting better for how folks are engaging in the system. that is the process that we've been using so far. i'd be happy to take more information about the laguna honda concerns and make sure that we get that roped into our governance process, so that as we approach making epic better for all of us, that we can address those. >> yeah, the thing i raise there is mostly because it is sort of different from most epic acute care, that there seems to be an issue of having it flow in as

seamlessly as it does at the hospital. i don't know where all the priorities are. i do think laguna or its joint conference should understand what is happening there so we can understand the challenges staff had in terms of trying to optimize the use of an electronic record over there. >> sure. laguna honda is the largest long-term care facility in epic's customer base. sonch >> so i think a report back to there would be quite useful. >> commissioners, other questions? thank you very much. congratulations again. >> thank you. >> commissioners, item 10 is other business and we have several public comment requests for this item. just so you know making comments, i have a timer. when the buzz -- buzz ergos off

that's time for you to end your sentence. >> good evening, commissioners. my name is nathan dang, this is holly and kyle. we have pharmacy students from san francisco joined by some of our classmates in the back. we are here to bring attention to a current pharmacy related issue, pertaining to reimbursement rates authorized by the 2013 california senate bill 493. so the services affect patients all over california, but especially in san francisco.

so sb-419 had expanded the practice for pharmacists that authorized them to perform additional services such as nicotine replacement therapy, as well as participating with other providers in the evaluation and management of various disease states. this bill, however, didn't address payment or reimbursement for these services. >> my name is kyle merchant. really what we're just advocating for is support in implementing additional codes so that pharmacists can be reimbursed appropriately for services, because not every patient is as straightforward as come in, let's have a discussion, and here is what you're looking for. sometimes we have more complex situations and medical histories that need to be taken, discussions that need to be had with patients.

i think this will be especially important as we move towards the implementation of prep being made available in pharmacies. >> so as you know, people [ indiscernible ] -- this is to expand the ability for pharmacists to furnish prep which is proflax sis for h.i.v. we can give a 60-day supply in our practice. in the spirit of getting zero, i believe -- i also have -- >> we'll give you a 30-second extension. >> thank you so much. i think it's paramount that we include reimbursement for the pharmacist counselling because the adherence to these medications is critical and the only way this will be happening is counselling in the scope of the community.

>> thank you. hello, my name is manuel and i'm a pharmacist student as well. this is my first time at this hearing. thank you for this opportunity. i just want to start by addressing that i know we're trying to understand and address mental health issues, specifically those that may be untreated, it's dr. hammer and ms. martinez mentioned in the presentation a while back. i want to bring to light the implicit biases in the government and also officials, the sfpd as well as local security guards, their attitudes they may have towards a subset of our population and those afflicted with mental health conditions. i'm wondering what kind of steps the condition plans to take in order to mold the attitudes of our city to humanize attitudes to be more empathetic when interacting with the subset of

homeless individuals, perhaps less likely to incarcerate them and more so aiding them and escorting them to hospitals, social support systems, as well as shelters. if we start with the city employees, we can expand on that towards the population of our residents. so they will no longer see someone on the streets and think they are crazy, because that's really not the case. but it's just that they're not intentionally being disruptive. it's just some underlying mental illness that's not been resolved. >> thank you. >> hello. my name is jane. i'm also a pharmacy student from ucsf. currently i also intern at the santa clara hospital down in south bay.

i have a lot of counselling sessions with the patients there. a lot of them are homeless and they end up being discharged back to the streets. beyond the counselling sessions, we also talk about -- go on tangents and about their personal lives. what i hear from patients they're struggling to access public washroom facilities, they're not clean or not accessible. a lot of them travel around the city as well. this is something i wanted to bring up because i wanted to bring attention to how feasible it is to increase access public washrooms in the city, that we're helping the homeless population to improve their health hygiene, but also to increase the cleanliness. i wanted to bring it up and see

if it is feasible in the city budget. >> good evening, commissioners. my name is franceska okala and i am also a second-year pharmacy student at ucsf but also expressing some of my concerns. there was a bill signed into law that allows h.i.v. post-exposure proflax sis and pre-exposure proflax sis to be in pharmacies. my comment today is this access to medication is extremely important to several of the vulnerable populations we've been discussing all throughout the session today, including homeless patients who might be

using injectable drugs of abuse. my concern i wanted to bring up to the commission is how exactly the department of public health wants to implement these services in the coming year and how it's going to be advertised to these vulnerable populations to make sure they get access to these resources. >> good evening, commissioners. i am also a second-year pharmacy student at ucsf and a pharmacy intern. i am also here representing just my own self and concerns and beliefs. as was just mentioned the bill was recently passed, but beyond promoting this new accessibility of two of the most vulnerable populations, i also wanted to ask the commissioners to explore potential ways to help promote training for our pharmacists as well. under sb-159 in order to make

pre-exposure and post-exposure proflax sis available, pharmacists are meant to attend training. i would ask that we provide this training in san francisco department of health as well as make resources available to ensure that we have enough resources for that. thank you. >> seeing no other new business, do we have a motion to adjourn? >> i had one quick comment. >> are you sure? do we have a motion to adjourn? >> so moved. >> do we have a second. >> second. >> all in favour. >> aye. >> we're adjourned. [♪]

good morning everybody. i am the general manager of this beautiful new grand hyatt. it is my pleasure to welcome you to our new hotel here. we are so proud to be here. it is a privilege to introduce a true labor of love not only for granhyatt but for the entire construction team and the city of san francisco. as many special guests i want to acknowledge. of course, the san francisco mayor, london breed. welcome. thank you for being here.

airport director. thank you for being here as well. we have some airport commissioners. it is a pleasure having you here. hyatt's purpose is to care for people so they can be their best. it is our incredible team standing all-around here going to make this come to life. i couldn't be more proud of this team having opened this amazing building. [applause.] >> i want to thank them from the bottom of my heart for what they have done and what is to come in this amazing knowledge. we will welcome so many amazing guests from around the world and our local community, of course. we look forward to welcoming all of you to our beautiful hotel in the future. without anything further i would like to welcome mr. pete sears, group president of hyatt for the

americas. [applause.] >> good morning. thank you all for joining us on this very special occasion. on behalf of the hyatt family, we are so proud today alongside with our partners and supporters to help make this happen today. director saterro. arts commission and mayor breed and so many others. i would like to thank you for your support and trust over the last few years. the cooperation and collaboration between hyatt and sfo is nothing short of amazing. i want to thank you. i couldn't be prouder to be a partner. thank you. (applause). i would also like to congratulate and thank henning

and this amazing team with the hotel for a very short period of time. the beauty of this remarkable building is self-evident. it is this team that will bring it to life. you will see hundreds of thousands of guests in the building every day. your spirit will bring that to life. we are with you and congratulations. [applause.] grand hyatt and sfo is one of the most highly anticipated projects through the bold and vibrant design and architecture, the hotel tells the story of the evolution of air travel with the northern california spirit. we are very thrilled to introduce the grand hyatt brand to sfo. we know it will be a tremendous success. this is evident from my recent

travel in asia. i had a number of questions about the grand hyatt at the san francisco airport. it is good news there is a lot of interest and a lot of people looking for the success of this hotel. hyatt was founded in 1957 with airport hotels with the goal of making air travel more comfortable and more convenient. 60 years later we are thrilled to partner with sfo with the shared goal to lead the world in air travel experiences. grand hyatt hotels are all over the world with new york and tokyo. they reflect the unique culture of each location by celebrating destination and delivering moments of more. we are to celebrate with you and our visitors everything that making san francisco the greatest and most iconic city in the world and what makes sfo the

greatest airport in the world. thank you for being with us to support this new hotel. we look forward to welcoming you in these doors shortly. thank you all. (applause). >> opening hotels is a difficult task. thanks to you, we did it. we were part of an sfo community. that is very special. it is my pleasure to welcome the leader of this amazing community up to the podium. [applause.] >> is this this is an incredibly exciting day for us, and mayor london breed, thank you for being here to celebrate the ribbon-cutting. our commissioners and vice president of the commission, rich animal come.

it is -- and it is unfortunate the president of the commission wasn't able to make it. i have to acknowledge the incredible leadership and persistence larry showed over the years to have an incredible hotel at a world class airport. we owe larry a debt of gratitude if we can give him a big round of applause. [applause.] this is a vision, the culmination of a vision from 30 years ago when we tore down the previous hotel to make room for the construction. i think about the desire to get here. today is the date and it is exciting. you can see just how incredible the design is and how incredible the care for the passengers is. i brought my mom here for a

latte on sunday and had to show off the total. the hyatt team was caring and gracious and took good care of us. we thank you for that. the food offerings. we hope this will be a destination. the food is incredible. you have to meet the chef. no one mor more park -- i think about the care of the community this hotel represents. we had over 1500 construction workers involved in the construction of this hotel. it provides up to 300 new permanent jobs for the community. it is a major economic benefit. we are pleased to have san mateo county supervisor per visor. thank you for being here.

it is such an important part of our community. thinking about the care of the community. this is a lead gold hotel. it is 30% more efficient than baseline hotels. it is very important to the city and airport and very important to hyatt. i have so many things to give. thankings to the airport team. incredible work. [applause.] tire less work. mckr construction managers. i have to thank the hyatt. what an incredible partner. pete, jordan, henning. without henning the last six months wouldn't have come about as they have today. thank you for your tire less work as well. we want to thank web core

builders. wsp on the air train station. we are proud to be here. 30 years in the making. thank you all for being here. let's hear from our mayor. i am so proud. here is mayor london breed. [applause.] >> you do the work, i cut the ribbon. first of all, let me just say i am excited to be here today. i remember when i was on the board of supervisors and we approved the believe of this new hotel -- the building of this new hotel. we worked with mayor ed lee. he was here during the groundbreaking and would have been so proud of this major

accomplishment. what is so exciting today is that no only do we celebrate opening the hotel. it is a new milestone in the future of sfo and what it will deliver for millions who come through those gates on a regular basesis. the fact this is so close to the airport, connections through air tran and how people will come here to stay here in order to get to the airport on time in the mornings, it is going to be an incredible persons. especially people who come from all over to the take flights. i want to thank the project managers, construction team, people who worked on delivering this hotel on time and budge get. almost on budget and the hard

work you put into really making this a beautiful place for each and every one of us. i hope to stop by. i heard about the restaurants and the food is supposed to be absolutely incredible. what is being offered here is definitely an example of what you would get all over san francisco. i know we are not directly in the city and county of san francisco. we have an opportunity to make sure a taste of san francisco is experienced right here in sfo. i am excited about that and the fact this is such an incredible environmentally friendly hotel with the solar roof panels, charging stations for electric vehicles. we thought about everything in the future of what hotels should

be like all over the country. not to mention the incredible artwork to really represent the bay area here is a true testament to a great partnership between the client and the city of san francisco. i do want to take a moment to acknowledge the work that was done to do outreach to higher people from this community to work in this hotel. the outreach that is continuing to happen to reach out to people to work in this hotel. yes, we are still hiring. the office of economic and work force development put out an announcement today to outreach to communities to let people know that we are open for business, looking for great local workers and what an

incredible thing to do today. i am excited to cut this ribbon, to get this place opened, and to make sure we are making money to pay to san francisco so we can continue to do all of the support we provide and thank you all for your work, partner ship and this incredible milestone here today. thank you. (applause). >> thank you, mayor. may i have the speakers up on the stage to cut the ribbon. five, four, three, two, one. (applause)

>> once i got the hang of it a little bit, you know, like the first time, i never left the court. i just fell in love with it and any opportunity i had to get out there, you know, they didn't have to ask twice. you can always find me on the court. [♪] >> we have been able to participate in 12 athletics wheelchairs. they provide what is an

expensive tool to facilitate basketball specifically. behind me are the amazing golden state road warriors, which are one of the most competitive adaptive basketball teams in the state led by its captain, chuck hill, who was a national paralympic and, and is now an assistant coach on the national big team. >> it is great to have this opportunity here in san francisco. we are the main hub of the bay area, which, you know, we should definitely have resources here. now that that is happening, you know, i i'm looking forward to that growing and spreading and helping spread the word that needs -- that these people are here for everyone. i think it is important for people with disabilities, as well as able-bodied, to be able to see and to try different sports, and to appreciate trying different things. >> people can come and check out this chairs and use them.

but then also friday evening, from 6:00 p.m. until 8:00 p.m., it will be wheelchair basketball we will make sure it is available, and that way people can no that people will be coming to play at the same time. >> we offer a wide variety of adaptive and inclusion programming, but this is the first time we have had our own equipment.

>> good morning and welcome to the transportation authority's meeting for today, election day, tuesday, november 5th, 2019. our clerk is mr. alberto kinta nix a. role call. pai(role call).