i am >> my name is julie maw. i am a captain in the san wall but taxis an noopgs francisco fire department. 234506gs we or working with the i didn't grow up thinking i would be a firefighter. i didn't realize it was an industry on this that might look option. i didn't see other people who in the 70 and preparing for the looks like me in the fire service, so i didn't have an future of air taxis and one of idea that this was a possibility our big initiative to engage the for me. what inspired me is i had a few friends from the hip -- hawaiian broader region in the developments we have to have community who were applying for the job at the time and they policies that address the air encouraged me to apply as well. taxis innovation we are we are a pretty tightknit community. we are like a family, the fire conducting with berkley transportation center and service is like a family. engaging the industry and engaging decision makers and the food is essential -- is central to our gatherings in the fire region in helping to develop policies will give us a service as well. and teamwork and being part of framework for addressing the air something bigger than yourself taxis that's a step for the next and really having community. that is what inspired me to be several years. thank you. ivar part of the fire department. when i was applying for this job satero director of sfo for sharing the information for san and i was going down that route francisco international airport we appreciate the time you've of the hiring process, i looked given us and thank you. around and i started looking at >> we'll be back with another the different engines and the rigs driving around the street

one i'm chris thank you for and i said, you know what, there is somebody that looks like me. there is somebody that looks like me. to me, that was really important. and that representation, what i saw, the light bulbs went on and i could see myself in the job. for me, being in this position as a captain, and being on the track and going around to her neighborhood, even when we are >> october 1, 2024 meeting. doing the most mundane of tasks, secretary will you call the it is important that they see me roll. >> secretary: commissioner. in the role, right? asian pacific islander woman in a leadership position, that i am >> present. >> present. >> and commissioner jer ado. >> present. in this job. and even ringing the bell for the kids in the neighborhood, >> commissioner chow will read they see me, they cs, they see the land acknowledgment. my crew and it is huge. >> we are acknowledge that we're on the unceded homeland that lightbulbs can go off for them as well like it went on for of ramaytush ohlone who are the me. it truly is important to me to original ip hab tants of the be part of an organization that san francisco peninsula. supports diversity and representation. being in a job where we serve

the community is really as the indigenous stewards of this land, they have never important that we represent the seeded, lost nor forgotten community. i think visibility, representation is key to opening their responsibilities as the care takers of this place as well as for all people who doors for others, other people reside in their traditional of color, other women, other territory. as guests, we recognize that we people in the asian pacific benefit from living and working islander community and say, on their traditional homeland. hey,, that could be need too. we wish to pay our sekts by i could be here serving the acknowledging the ancestors, community and being a firefighter. [♪♪♪] elders and relatives of the ramaytush ohlone community and acknowledging their rights as first people. >> thank you. >> i'm eric tanaka. >> you have the minutes before you, >> i did receive a edit, i'll fourth generation japanese american born and raised in san francisco i work for the san read you what it says and what

he recommended. francisco fire department station 10, truck 10 as a firefighter. it's commissioner christian i think about my journey i think comment, she thanks mr. sin about my family. independent haw with the my grandfather came to san confidence that he inhabited, francisco in 1917 we have been commissioner chow recommended here for over 100 years. that the word inhabited be married my grand mother they changed to exhibited. >> perfect. were in the japanese camps. >> wonderful. prior he was a successful business owner in the city. >> and i gather there is no when he started to start over he public comment? >> oh i apologize. was murdered. >> we need to entertain a and i never met my grandfather. motion to move the minutes first and second. my grand mother and my mother and then we'll take public comment. >> so moved. were left to raise me, brother >> second. >> now public comment. >> and this is public comment and sister my father was around but work. on the minutes. it was very challenging for me so you'll be making comment on growing up as a young kid in the the actual document of the minutes. >> i think it's item 3. city. trying to find my identity. >> okay, it's the next item. and so i got myself in a lot of >> we can take in-person vote. trouble. trying to defend myself and my >> all in favor say aye. >> aye. >> wonderful, the minutes heritage. that i was -- raised to be proud

approved. now the next item is general of. and there was a time i was public comment director. ashamed. you know, thinking about and >> come on up. at this time, members of the understanding my family's strug public may address the and he will had my grand mother commissioners of item of and grandfather went through i interest that are within the was ignited a fire to keep jurisdiction of the commission that are not on this meeting agenda. moving forward. each member of the public may i decided to dedicate my life to address the commission for up service. to three minutes. servicing my family and from taking action or community and the city. discussing any item not o one of my goal in life is to paring on the posted agenda reach out to our community youth including those raised. and support them so they mack one opportunity to speak per myself the potential to finds item to read statement frz careers they never thought they were capable of. other individuals unable to when i want my family tong of me i want to be proud. attend the meeting. the word health commission whenever career i chos is not about the money it is providing dotdph at sf--if you wish to a life that is honorable and spell your name for the minutes, you may do so. please note that city policies thoughtful. so that -- the generations along with local law prohibit behind us see how hard my family worked make sure we have been discriminatory.

i will put three minutes on the able to sustain and thrive in timer when the buzzard goes san francisco. off, please note that your time community is huge to me. it helped me become the person i is off. >> good afternoon, my name is am today. malita, i am campaign and our department. associates with walk san we got one of the busiest francisco, advocacy group in stations in the in addition, station 3. san francisco. we have a surf rescue program and i'm here today representing more than 30 community base program cliff rescue program. we have so many things to be organizations nonprofit and proud of as a department. civic group that are part of i can't say this enough, there division zero coalition, they is honestly no words to say how represent diverse of our community, lighthouse for the proud i am to work for the blind and san francisco marin department and serve the community that i grew up in. medicine. we believe in vision zero as an approach and goal to end severe [music] and fatal crashes in san francisco. our city was able to launch a preventative database approach to vision zero because of the department of public health and its incredible work analyzing traffic injuries and death have been crucial. because of the department of public health, the city has identified highly injury

network where 68 percent of streets, or 12 percent of crashes newer. this means that they can prioritize where the need is the greatest. and they can identify trends at who is most at-risk from violence and reducing crashes. and we need progress. over 500 people continue to be hurt and killed in the crashes and the numbers are strag [music] staggering for those outside of vehicle. for the size and depth of the problem. >> opening this space with my that's why we are calling on the department of public health to not just recommit to vision sister, and being able to continue the very deep literary zero but recommit to being a leading partner in this effort. lineage that exist in the mission is part of the fabric the greatest efforts is dph is database approach and reporting. of the neighborhood. what is working what is not this is neighborhood of poets working where crashes are happening and who is being killed and in crashes. and litary readings. you see the writers from the this shows the department needs to be investing more resources neighborhood, their books are and staffing for this effort

because when this work slows, here. paul flores books are here. it slows the overall progress on get to go saoer o.last --that is what we are doing, keeping the litary lineage mobsinger the coalition shared alive and going, you know? recommendations on how the city can excel progress to director colfax. i have a copy for you and i'll [music] leave them on that table and we >> san francisco is actually the only place that i can do have them online vision zero platform. we are asking you to use your this. in its quite way, something i oversight in leadership to push can actually do that is a the department of public health to be a leading partner. thank you all very much. benefit. sure, i like to open up a really cool well curateed spot. >> thank you, you can wlaefsh that over here. it would be beneficial but not >> thank you for your comments, the same beneficial it is here. much appreciated. >> and there is no remote when i say young folks that public comment. >> thank you very much, so the remind me of us, when we were next on the agenda and standing that young, and they come in in for director colfax today. here, they can relax. nobody is following them around like they are going to steal >> good evening, commissioners it's my pleasure to report on the reports and we have anything. that means they can be a little wonderful news to share. more free and little more of the first is h.i.v. report that

themselves and i can do some comes out, some wonderful news, small thing that helps them do san francisco has soon a 20 that and that is part of what percent decrease since 2022 and lets me know i'm doing exactly the number of diagnosises and they were specifically what i want and need to do. decreases reported among the latino population. as well as there was an [music] improvement in viral suppression as well as linkage >> we have events here that to care. some of the efforts that have lead to this have included focus on the deep neighborhood expanded services such as the history here on the artists and take me home program. i will note that the h.i.v. writers. if you look now there is report will come to the commission in december for a antany, his exhibit and focus full review and i'm happy to is on neighborhood people. answer any questions that you have. but i wanted you to know that that did come out. artists muralist, the space was the second piece of news in basically a gift given to us in terms of being able to continue a really weird way. we had to work our asses off for, but it was that higher hosted a nurses hiring opportunity for me that chance event which was successful with more than 32 candidates. to be that link in the long in attendance. literary chain of the neighborhood. there were several members cfg it is a blessing to be here.

present and we heard it was a [music] successful event and we look forward to continue to hire and retain our very important nursing staff. the next this was done primarily through ph.d and dr. bertha hernandez within ph.d lead a full day saturday event where pull matist were able to learn about the current work happening as well as future opportunities and it was a way for the department to thank them for this work. i can certainly say that the pull month tory work was essential in getting the word out and getting testing out and getting all the different needs met in the community.

>> the next item is project reach which is a joint program between integrated care. the two, areas were given a grant of $100,000 to really address the surgical needs of people expensing homelessness, this money will be utilized to really improve our work for this population that has high surgical needs but probably needs a different way to approach how we treat and care for them including open access appointments, drop in appointments. so looking forward to learn how this new design approach goes and the improvement and care that we can document. and then finally, i do want to recognize that between the weeks of september 8th through 14th was evs week. evs workers are essential to

all hospitals sometimes they go unrecognized doing really hard work but our critical to ensuring that the hospital maintains its regulatory status as well its patient customer service. so very appreciative of all of the workers across dph. there are a couple of items that i wunt to highlight that are breaking news. one is on friday, the governors signed ab1225 which is a piece assembly bill sponsored by matt hainy but also by dph and a lot of work was done by dph. ab12115 does two things t increases access to methadone for take home. so 72 hours can be taken home and that can be done in the hospital setting or in clinics. and then the second is, it allows federal rules of the level to go into affect which

california had not adopted yet. and because it was put in with an urgency cause it goes immediately into affect. both of our bridge clinic and hospital as well, some of the hospital treatment beds are looking to implement right away. and finally, i'm sure you have heard it's a hot day today and we are under a heat advisory today and tomorrow and will probably be hot for the rest of the week. our dp o.c. is activated and coordinator dph monitoring and response to the heat as well as externally coordinating with other hospital systems to ensure that san francisco residents, the message is out there about the heat and how to take care of yourself but how to monitor any surge events coming from our communities. and we'll be happy to report out on how those activities will go at the next health

commission. >> thank you for the the report and the great news. >> is there a public comment? >> yes, and i apologize there was one person remotely who was given permission for comment and that person has their hand up. hi, this is mark with commission secretary, can you please let me know who is there? >> speaker: this is ramona i want today make a general comment and i missed the process of putting star-3. >> yes, president green, this is something that would like to make a general public comment, can this person do this during this item or should we wait until you all discuss the director's report. >> why don't we discuss the general's report. >> i'll come back to you after the commissioners make their comment on this item. thank you for your patience. >> all right, commissioner

girando. >> thank you. i saw that it will be updated with the new vaccine as well. my other question is, is the state department of public health or you know, really rolling out some sort of media campaign? we're hearing it, they're not old, somehow we're able to get the word out or the state is? >> i cannot speak but san francisco dph is going to start rolling out next around the covid vaccine and that's anybody six months or older should be getting the vaccine

so we can take a local approach as i hear, either about gray area approach which a lot of times, they put out a media statement around flu and covid version and we will definitely share that. >> great, because >> too many people don't understand, six months and above you can be vaccinated. thank you. >> commissioner comments? commissioner chow? >> yes, i was interested in your latter report concerning this heat wave. what is it we're expecting to do? and early this morning, some of us maybe, got some sort of test alert, it said test alert, but now you're telling me that

there is actually a >> yes, maybe that was mainly practice to ensure that people responded to the test alert. but for the heat wave there is multiple things that we do first of all. monitor the temperatures because there are areas that we have to close because it's too hot for the staff as well as patients. we have alerted all of our am bulatory care sites and there is messaging, about the heat. and precaution to see take around the heat. the other thing we do is they've had hospital calls to ensure that the hospitals are well prepared.

we know as temperatures go above and it will hit the 100 degree mark most infrastructure is not suited even newer infrastructure, so it can still feel very hot even if there is air conditioning. the last time that we had a heat wave where it impacted, it happened very quickly so. just really staying on top of that message and check ining with them to ensure that everybody is being taken care of. now in terms we massaged, population especially our elderly and young, are really vulnerable during heat waves so get thating out to meal programs and all the cbos that work with the elderly and that is done through our dos program. and then on the youth and familiar side, so there is a

whole city wide response. the teams that are out and the community, they usually have water and they can, they usually have some shelter that they can direct people to. so those are multiple ways that we try to get people to get around heat. >> please do xy andzthat's another way that dm message to the general public comment. >> okay, thank you. >> thank you. any other commissioner questions or comments. all right, seeing none, we'll go to the next agenda on item.

which is health information update. >> the public comment that was from general public comment. >> i'm so sorry. >> no that's okay, this is somewhat out of order. i have three minutes on the clock and you have three minutes to talk. when i buzz, please know that your time is up. >> speaker: thank you, my name is ramona mayon and i'm a resident of san francisco safe park day by day view. sxif two concerns, the on thursday last week, the navy and the epa had a press conference and discussed that they were issuing the rod which stands for record of decisions about cleaning up parcel f which is a point shipyard that we're talking about here. it's the water and that 300 yards away at the beginning of

august and all of us that have gone insofar testing for about the type of heavy metals and some are extremely high. i personally have breast cancer, our health is highly at-risk and now that the rod is finished for partial f, grant that there is not going to be a clean up until 2027 but i would stay that it establishes a very toxic bad location to put

people out here. there are other locations, we're very very close to a super fun site and i would like to put that on the agenda for future. i know the dr. has had an article published in the bay view. and dangerous to look at, looks dangerous to look at him, but he's terrified i'm not going to cry while i say this, he's deaf, he's already treated very badly and wrapped his rv in black plastic because he's in direct line in this dirt, the amount of dirt and dr. sing stopped by calling the area quality control people, but

it's not covered properly there is not enough tarps. so the wind is very bad in the afternoon and he's just terrified, he's anxiety is off the chart. my friend is disabled and next door to andrew and it's just really bad and we cannot get anyone to pay attention to what our fitting to and we understand it's because we're homeless. >> i'm sorry your time is up and that's a very important comment. i'm going to email you, the documents from the last time this was presented to commission and you can write me with more comments. >> absolutely, thank you for your comments. and we do read all the emails. i know secretary will forward

us the information as soon as you have it. i apologize for not remembering. now, we'll do the health information technology update with eric who is our ceo and deputy cio. and we're looking towards this topical discussion. >> well good afternoon, president commissioners, deputy and jeff, our deputy information officer we're excited to bring you, news from the land information technology. alyssa if you don't mind moving the next slide.

i'm going to let jeff, take over here and walk through our epic update and i'll come back for a few minutes so we can talk about a i. thank you. >> next slide. >> so we've been busy with epic, it seems like every time i talk to you it's on that subject. and we've recently had our biggest project since we originally went live in 2019. this project focused on behavioral health services, mental health. next slide. so may 22, we had our go live that included civil service clinics as well as over 70 community clinics who went live on our epic system, so it was quite a few locations going

live. one main focal point is that behavioral health if you divide that into two, it would be mental health services and substance use services. those are now on two separate systems. so our mental made the transition to epic, services did not and still remain on abtar and methadone. next slide. all right in this message here, it was a big project for us. i think what you're seeing is culmination of 3 years, over 1400 staff ended up using the new system. and you can see some numbers here that focus on a few points, everybody received training. we wanted to make sure that nobody was left out in the cold when it comes to new systems.

we had a lot of support out there. most of it was in-person but we had virtual support lines to ensure that everybody could reach support. we wanted to make sure that everybody had the right equipment. cbo community base organization to gather the data that tells us what service right side happening in the city. and finally, that last message with go-live is we were busy. we can do some numbers about what came in across the month and the support that was provided in the command center to our staff using the new system. next slide there, alyssa. with the new system in place, we don't just want to have a goal. we want to make sure that we have a system and that we're using it. so we pulled some pointed statistics is the way i'll refer to that to show we are

measuring the use of the system, as well as ensuring that the system tells us the right information that we need to run our business. so this is where i'm going to hint a couple of questions that you asked previously. you asked 92 are closed within a few days. what does that mean, if you discuss treatment during that. within three days, they dropped the charges, they've finalized any orders that need to go in preparation and everything is out the door. if we compare that to what it was previously. our policy was to do that within 30 days. want to give kudos to lisa and her team of behavioral operation to see really push the staff in changing the policies that say, when your information is not available until 30 days later, that impedes care and also impedes processes that help us complete

our mission, aka billing. so you asked how is it that we're collecting 113 percent of charges but taking longer to bill. that 118 percent of charges really ties in to this 3-ofinger tied up neatly with a bow, because the information is more fresh in the minds of our providers who are treating our patients. we are actually dropping more dollars worth of charges that actually go off to medical and bring that money back from the state to san francisco to further the issues that we need to work on here. next slide. so leaving you with a closing message, been a long journey with us with a lot of lot and the message is we're still not do. apic is a long message.

new programs that have opened up new funding opportunities in jails. and plethora of other new modules from epic that have yet to be rolled out. in the same thing, behavioral is not done so you can see that we're in the midst of rolling out. and part of what we are tracking about our outcomes. so with that in terms of keeping busy, i want to turn it over to eric, there is a topic that has been keeping us busy

and that's artificial intelligence. >> thank you, jeff, next slide, please. >> we can take questions on the epic side of things. >> please turn on your microphone commissioner. >> i just wanted to separate it out. on slide 4, is one of my questions is all the data including substance use, from the cbos on epic for is is it through care everywhere integrated into the epic chart? >> i want to answer cautiously and say about 98 percent. we do 7 groups right now that

are community agency that chose to use their own hers and in terms of scheduling they want today make sure that they still had their own systems driving that process. even when they are using their own systems, we do have data collected through care link as well to ensure if you're talking about assessment or some of the mild stone checks, those get up dated in care links, so linearly tracking the process. that does still wind up in epic even when they're using another system. it's a 98 percent. there would be data that only lives within the community systems but again, key data element that's we're using to track our population, we still upload.

>> so then, it's up to the cbo, and their relationship with their patients, i assume that it is fine for their behavioral health information data to be loaded into epic? it's on an individual cbo basis? let's say i'm a patient of health rights 360 and my health my mental health information would automatically be entered into epic if in fact that's their policy or if it's not, then it's up to the individual cbo, am i correct? >> it's a requirement for all the cb os. so there is two piece that's have to happen no matter if you go one of the cbos that uses their own system or not.

so that what happened during the encounter and having the state be reimbursed for medical and the second part would be certain assessments where we have the responsibility, the local department to report that information to the state, so can can and blanking on a few other assessments. >> but hq9 and all of that would be automatically loaded in? >> correct. >> i would not say automatically but it is loaded in. >> okay, thank you, that was very helpful i know it's a question. >> commissioner christian. >> thank you for pausing to take a few questions here. on page, on the page that title what is next, on the bhs part 2, first line is over 80 optimization s bar submitted

and then the first bullet to identify a path forward. can you just elaborate a little bit on those two phrases? and what the first phrase means and then, explain a little bit about substance use to identify a path forward, is it a path forward towards epic or integration with mental health information? because in the world that i touch, i would say at least 96 percent of the people those things are intertwined and i imagine the difficulty of my colleagues in a clinical space with having to break it down into billing. >> certainly, i'm going to break it down into two parts. s bar stands for recommendation recommendation, it's a process that we ask folks to raise your hand and ask for something new.

it's an on going process that we ask for all of those areas that say it's never done. there is always new needs, needs are changing, we may need to collect different data. so what wooer trying to hint out, we went live in may, since then, 80 requests have come in for we need something else, to reflect xy and it's sort of a constant effort for us to make sure that we're keeping up with those. so since in that time, we made progress in a number that we submitted and working our way through as part of the going live on may understanding what it looks like, it's different when you get to use it and our groups have had new asks for us. it's smaller efforts, sometimes in the range of 40 to couple hundred hours in order to complete those versus a multi-year project where you're seeing some of the larger pieces that we called out.

with that, substance use. that's a really big one for us. substance use was originally included in our vhs project, they got about halfway through the journey and decided to hit the stop button the subway there and get off at the next stop. why? is a really big part of that. 42csr and, it's not that our epic system does not accommodate privacy, it does, however, there are different fields of interpretation regarding what it means in terms of interpretation. our system looks at things like a medicine list and problem list and their view is a medist is a medist, they're not going to filter the medication from the view of somebody looking at a med list.

they want providers to have the complete and full med list. some substance use areas across here in california and across the country have, as long as i keep the note what may have caused these challenges, that information is protected by 43cfa and i will separate but i will share my med list because it's important to know for other prescribers. we chose a different interpretation, which is to say, no no no, that's information that needs to be kept completely separate. so in that sense, it's an interpretation that caused us to say we're not comfortable in moving forward at this time. when we say identify a path forward what we're trying to stress is we're on an aging system that has not been kept up-to-date which we're using for mental health, substance

use remains on it because again, we got off the train. that does not mean that standing still will address our challenges in terms of collecting and using the systems to understand things in a same way. we're going to have to make changes in the same area and we need to work with our substance use teams to identify what that path forward is. could be the cal mesa system which is provided by a third party and used by counties across the state. we do need to identify what our path forward is and begin to take action because standing still is one of those things that will not be an option for us. >> thank you that's really helpful. question you may not be able to answer but with the 42cfr and the the challenges that we

continue to see for functional, use going as things go forward, that there always seems to be and, aspect of 43cf r does not necessarily help the project that people are engaged with. is there any discussion about trying to talk to the federal government about the reality of mental health and substance use disorders being intertwined and the complexity of people getting treatment in the community and providers being able to engage with their needs? i don't know if there is any talk like that. and i also wonder where is the department's interpretation come from? is that a conversation with the

medical teams and the city attorney? or how does that come to fruition? >> i'm going to be cautious not to over reach the it guy and have one of our clinicians come up and help. >> they're very well informed ita. >> i was going to do the policy and turn it over. you bring up a good point. historically we understand the reasons there is so much stigma around substance use and even from the medical world can be harmful to the patient. but it has the ability to i think put the patient in the center of their care team. so this is been a long on going struggle that has been brought up, and i think nationally dr. kunings has talked about how we had these discussion sxz there is a lot of fush and pull,

actually did slightly loosen some of those but has been stated there is still a lot of road blocks beinger i think a long on going discussion and we're actively wanting to advocate so again patients can get the best care they need. so i appreciate you raising that because it is one of the difficulties that we continue to face in multiple ways. >> thank you very much. >> i'm the interim cln and part-time inphamatic, we've had wonderful partnership to help us develop ways. while engaging with our clients because i think one of the key parts of this is making sure that they get a voice and understanding the benefits of

and being able to see the information on the patient portal. by designing a universal consent, they can understand that we can then use to educate and get content like we do with our teams or clinic or some of our clinic sites that are using this consent form. it will does allow us to meet as much as see of our part two if you can with our patience consent and knowledge and to share that information so we're working on a revised version of that, in light of new flexible with the rule adjustments. that will be helping with a lost current programs that are on epic that are really, the bridging programs that cult with the medical and links between traditional health and behavioral health. >> thank you very much.

>> commissioner chan. >> yes, i, i sure was wondering from commissioner christian's question whether this interpretation in where others have separated medication from from the clinical, notes came from? did it come from our city attorney? or was that a consensus from the it group? >> i would be cautious to say that it does not drive the process. we work close with our medical teams, it's not just an organizational level impact, the providers who are providing the treatment are actually held accountable for compliance with 42cfr so ttsz their medical license that is on the line in

terms of come lie --compliance which is critical to involve those individuals and their medical license is responsible need to be involved interpretations. so that represents how did we get here. >> so, did you also consult with our attorneys? >> yes, they were profits of compliance and privacy that dr. rutunda mentioned. we had the medical teams focus on substance use involved in those discussions. >> okay, good. we were informed that epic is now able to accept and has enrolled people with different language capabilities.

so my question is simple, if i was using mandarin or cantonese as a native language, would i be able to access epic in that language or would it respond in that language either verbally? >> i think patient portal that's where the patience would go access their own medical report and information. >> right. >> that is current available in english, spanish and chinese simple characters. from that regard all the navigation menu including some of our results information problems that are documented in your problem those again use the chinese simple characters to communicate for that native language user. however if you use that, ask a

dr. feature where you want to write into your provider and ask a question, that does not support the chinese characters at this time. and a lot has to do with who is on the other side. while we're also not ready, we're not ready to use a i to translate medical questions and advise. there is a lot going on with a i but to rely to be that accurate, we're not there yet. so again the questions that you ask, must use sort of the going to forget the technical term but i'll call it the spanish and english site. >> have you had feedback using

versus traditional or a compromise i guess where many have been then using both? >> we have had a lot of feedback you're correct and we were not really given a choice. that translation of all the software is provided by our epic vendor in wisconsin and it was provided in chinese simple. it was not a choice that dph drove. >> i was thinking, like the city uses traditional in much of its government, was that a lot. and the high majority of those here in san francisco use traditional. but, i guess everybody will learn simplified, thank you for those answers. >> i have a question. substance use information. let's say a patient in the

health network ends up in the emergency room in saint francis? how do the physicians know that they may # methadone, do you do a toxic screen? how do they get that information? who has access to that information? if it's important to know if somebody comes in with a prolonged qt, there is a lot of things that could be important. >> it's extremely complicated and i'm not sure i can summarize that, kind of on the fly here. long story short, it's very difficult and we often don't some of those restrictions around, there are exceptions with 43cfr that allow you to share the information in an emergent scenario but you would need to declare the providers would have to be available 24-7

to release and that's where the complications come in. so in that sense, we are not good at it and that does create difficulties across the emergency care scenario, not just within the city but across the healthcare system. >> thank you, i appreciate that. and are there any other questions on the ethic portion of presentation, we'll then we'll invite him to come back to talk about a i. >> thank you, jeff. and moving from a highly regulated space to a little bit more a wild west let's dive into artificial intelligence, although that regular story space is changing and we'll talk about that. next slide please. so the number of slides in here. i'm going to move through them pretty quickly. but, for this afternoon, i want

to talk about our approach to ai, the policy that you have as well as our plan, what are we doing and what is coming next? next slide please. is so the last time i shared information with you about our merging a i program, this is the slide i shared with you and i bring it back to you today because nothing has changed. this is still the high level for what is guiding a i. we realize that it would be extremely difficult for us to become an organization and actually develop around plat forms systems, and it would probably be terribly unaffordable to buy. we're going to continue partnering with interstate leaders to acquire a i systems as a demand increases.

and in order to do that, safely and to do it with full disclosure and transparency, i want to talk a little bit more about few point forward about how we're going to approach. our a i investment will be as well as our development tied to our dph objectives. as well as--so for going. we'll talk about this a little bit.

by provider and also retained. in addition to understanding the risk of biases that are on the way that the ai model is trained, we also need to be careful and caution about how our own data that is input in the systems may be used by the companies that they're going 20 do business with. i want to address a handful of questions to make sure that i don't leave without addressing them. the first one, commissioner

girando, you said policy, we're trying to cover things at a broad level. but what we're doing is setting up a governorance program and we'll talk about in such a few minutes. will bias continue to exist knowing that existed in data sets historically. when we look at a i solutions is to make sure how we these third parties that we do work with, such as epic wisconsin and providing our health record, we have to learn a lot

about how they are looking at the data that is training the a i algorithms and you had another question that is about, from a similar angle about how general purpose a i may also risk in coding biases of race gender ethnicity and et cetera. and the way that we're looking at general purposes or generative a i today. to make sure that we're checking ourselves as we use

those plat forms. as we start to consider investments. how we tackling these issues. and we are already, we already have some experience working just dwaoen using broad data set and then niche data set and how that has an impact on how an a i system would project an outcome for us. next slide please. these the 8 principles that are outlined in our a i policy, i just wanted to say these are they and i'm not going to walk through all of these, i'm going to highlight a few of them that stand out as really really terribly important to us.

next slide, please. we can't leave the excitement from why we do what we do, because there is a lot of excitement around the potential and promise of a i but just like, i mentioned a moment ago about making sure that we tag our investment and do the work that we're doing and how they tie to our objectives, we have to make sure that these systems are helping us close gaps and we're not introducing any new issues or new problems as a result of using a i. so that is going to take a lot of thoughtful work and then our governorance function is getting ramped upright now to start taking that kind of work on. next slide, please.

okay. malefacence and non malefecnec big words i had trouble spelling. who is it beneficial for? so when we're dealing with a technology that has the capacity to learn, we have to make sure that we don't fall into the trap of information bias where how we look at how a i system gives us answers and then assume that's always right. because, artificial systems are designed by human beings, built and operated by human beings for human beings, so the important we've got to remember is the preference of us as a human that we have to keep front and center and so as we look at how we're going to make investments in ai, we need to keep how we want to make sure, that the system is truly

beneficial to all of the people we serve regardless of what type of system it is and what type of a i it is. because there is a lot of different kinds of ai and we're already using two or three types of a i and dph today. next slide, please. we have to be able to ask the right questions, and not be center shy about pushing providers of ai to allow us to understand the data sources that are used to train the systems, as well as how the algorithms work. this is a reminder they are designed by human beings. the ai did not create its own

algorithm but still reasonable expectation for us to be able to ask how did the system get from input a to outcome b? and those are the types of things that our a i governorance group is going to be focused on to make sure that we understand how this is all come together before we put a i solutions into the organization. next slide, please. the timing with the govern signing and a de tailing a slurry of bills, half of the information is not correct or it's not complete. so there is no guidance on the, they published a well package together program as the health organization.

and on planet earth is in the eu whether it's in the extensive very complete, good night table reading a i law. i'm not sure where we're headed nationally, this will be a challenge because we're in a in an election cycle beinger i don't think anything magical is going to happen in the next few months. but in california, a lot of things have happened in just the last month, i believe if i've got it right, 17 pieces of legislation have been enacted in the last month or two that deal with a i. there are three of them that are healthcare related and healthcare adjacent and they're not the ones that you're looking at on the screen. the assembly bill that you see, quoted at the bottom, deal with some serious ai topic like using or reusing the digital likeness of a person, what

happens when the person is deceased and how long you can use their likeness et cetera. and then there is a number of other components in some of the other assembly bills that deal with political advertising and deep fakes, the risk of misrepresenting a person and their likeness and words and their speech. those are things that passed but that was, you know, the beginning of last week when i wrapped up that work. since then the number of things have happened. the first was the passage of a b3030 which is artificial intelligence act and it requires the use of ai disclosures when healthcare organizations and that's providing a message to the consumer to the patients to the client that a i was used here here and here and here.

they have to make sure it's not just looking at abstract administrative data or simple democratic but it will be the clinical records. and there is a third law, and i apologize, i don't have the number reference, but it deals website describers or visitors over a million, so over a million folks using a service

online that all of the ai content has to be labeled on that website. that will have implications because we have do have activities. okay, next slide, please. i can't really provide on where we have the program called information governorance. it's our way of handling everything that is associated with information and data and dph. has representation finance, id, off to plans and privacy affairs and several member representative from the san francisco health network.

prioritization of request for analytics, helping become a more data driven organization making sure that we're up to speed with regulatory affairs and making the right kind of adjustments and also ai so we created an ai committee and the ai subcommittee is where the ai governorance will happen. the first order of business is improving the policy that you had in your packet this week and now we're putting to test work that was done by the folks like rotana and a number of others to help us use a layered

model of governorance so that we don't reinvent the wheel about we get and understand the need of folks who need assistance with information systems, with projects and now we have one universal layer of governorance over ai where we're start to go ask the hard questions things about transparency and explain ability. so we know for sure that ai system do need an additional layer of review. maybe ten years from now, that may not be the case but because this is new and because there is a lot of players and so many different kinds of a i we felt

very strongly that we need to have a review that is on top of the genre view to say for instance, i have an it project that i need help with. and understanding how that particular solution is going to have an impact in our organization and understand all the tidbits. i mentioned that it's layered and we're not trying to change the whole organizations approach but we're going to add this additional layer. we're learning how to get out of the technical space of what

we've been talking about this afternoon and understanding the providence and how the data is used. and the other reason, is that ai is new which means it's not budgeted. nobody is budgeted. so right now ai is extremely expensive, i don't know in a few years what it's going to look like but if it's like any other change in techology, it's going to woven in how we pay for xyz solution. in other cases, it may be like a basis every time that we complete a blank piece of clinical documentation, that costs so much pennies, so we're

really aware and want to make sure that every one who is bringing forward, potential ai solutions understands that there is a lot of ways that we may have to pay for it and as of today, we don't have anything new in a budget to say this is all covered, because this is a sustaining investment. not like so many other things that we may one-time funding to help. and productability like spread sheets. a i is going to be just the same.

and what wao*efb working on to date, has been with their generative solution and making sure that we find a way to allow data to be used in that generative solution. and it's just, one of those things that has a lot of legal right turns and left turns, so i've been shepherding that process along with city attorney and they're reviewing proposal from us so that we can make the school which is basically a private, but the only people that can see what is going on is within your own company and the idea is that, we would be able to share sensitive information in this private environment. and that has a lot of

implications for scenarios where there is preresearch work can i look and ask questions about large identified data set. and we've made that part of the process. and that requires a agreement. so there is work there. we also have been working for sometime and this is something that dr. rotana lead, is how we're working with research and ensuring along the way and now na we have a i that we are treating that similarly and making sure that we have a timely review of research

protocols that are coming forward to us that have ai under pinings or expected use of some sort of ai solution. and we're going to do our best to be timely and to be able to meet their needs as well. next slide please. very quickly, this is just a view of the four front doors that we have in dph where individuals can make an ask, express and need for work around it, data, research and

includes a i. they're all pretty well oiled machines at this point. and then we're going to create a category to ensure where the a i is happening because we don't have that today. thankfully the demand. at some point we'll be doing and having an a i and somebody is going to propose another one and we're not going to want to steer people back to the solutions that have already been vetted and are in use. what are the activities going

on? so the first one is generative ai that is the experience that some of you may have experienced. i know i use it pretty frequently. some of the tools are coming to ehr, from where we likely see benefits from ai and documents summarizization and automatic responses to say messages from patients in the patient portal and then larger and more involved programs like notes solution which is where provider and a reported, generative solution then produces draft documentation from that visit.

the experience you can have is different if you don't have to spend a lot of time keeping and instead you can be really engaged in the conversation. and how we can become better with prevepting accept sis. and last but not certainty least is imaging a i this is one of the fastest growing areas imaging is something that already digital. so the capability of ai that has been well trained to see things that we may not always see, because the accuity of the ai is sharper than ours.

so there is a lot of work going on in a couple of areas with regards to diagnostic and notice it's complimentary diagnostic, it's the ai saying, this is what i saw saw, what did you see? and early detection of conditions. so if you have a screening examination for something, and an ai can look at it in 35 seconds and give you, a view that says i'm 80 percent certain that we should do a diagnostic imagining, you can do that while the patient is still with you and say, we would really like to follow-up right now. so these the types of projects that are happening. this list is only going to grow but for now, that's where we are and i'll leave with you one

last slide, please. a slide about change from somebody that we all know about, it seems appropriate for what we're did diving into with ai and with that, i'm happy to could do* my best with your questions. >> thank you for that informative information. is there any public comment. >> no public comment but i would like to say thank you to alyssa for doing the slides and happy birthday. >> happy birthday. we'll entertain commissioner questions. >> thank you. i have a question about policies and procedure. each paragraph says something and uses, must sometimes, uses should sometimes.

i must breathe. so i am concerned about how a person reading this policy where it says, particularly for instance, in equity and justice, ai should strife to reduce health disparities, that leads it to the person that says i should do this but i cannot do this right now but i'm not going to. >> is there a question. >> just in case you don't know. >> commissioner christian is an attorney.

>> thank you and i'm aware. >> she apologizes for that. >> no apology necessary. i think the reason behind the definitive, this has to happen versus this should happen. we're not sure that every ai thing we're going to do is designed to do that. an example may be in revenue cycle so there is going to be a lot of a i tools that help us respond automatically to denial letters and help us become more facebook, efficient with billing.

there were some struggles and what i would say, like anything, we're always trying to get better what we do, happy to like receive for immediate back about it, more direct feedback if we may not have time to walk tlut examples today. >> i understand that we don't have. should strife to reduce authorities. should strife to do x. so that does not really, have it's not really applicable here. my gut is whatever it is you're doing, will determine whether or not you can strife to do that.

equity and justice and system and equality when it comes to gender and race and all of those things that are systemic everywhere that we are peddling back from the must and doing the should when if somebody is trying to do something it will become apparent whether or not this thing can be done in this context. no one is back peddling on those commitment. so assuming that we can do anything. for instance, we're evaluating generative ai solutions right now, we have a pilot project and has nothing to do with healthcare it just has to do

with staff getting comfortable using the tool. so i think the group, did not feel confident that they can use the more, powerful language that it deserves just because we're not totally sure. so i think we have a way to make that more declaretive. >> i agree, this is document that the policy and procedures. not to engage that they will not change.

and i have said in meetings for weeks on weeks on end to try to figure this out. but i'm not trying that concerned about whether or not there may be something about that we're not thinking about right now where this would not apply because then it does not apply. i just think that it is critical to be as careful and as focused on the need to address these issues we must strife basically we always must drive to, reduce health disparities. and then you know, i have this

thing in front of me. you this is how we make coffee in the department. this is what we do and does not really apply on, so i can say okay, there is nothing that there is no task; there is no there is no project. i don't think that it is, i don't see it as this really superficial look, i don't see it as a problem. >> it's helpful feedback, thank you. >> thank you. thank you for the work. >> commissioner girando. >> please turn on your microphone, commissioner. >> on the ai governorance with the data request, research that includes ai and the applications, there is specific

staff assigned to these four modules. yes. >> and within your department. >> more than just it people for sure, yes. >> okay, and then, these people somehow somewhere are in the budget. >> right all of those processes exist, have been functioning for quite sometime and the ai level is again other people who are here who are volunteering their time being in this committee who will be committing that. so the budget issue is not related to those processes of having good governorance. >> right but you've got staff? that are assigned to those? >> yes. >> as part of that. and they're being paid. >> yes.

>> they have other roles but there are roles that include this are in the current budget. >> yes. >> that's what i'm asking for as we're looking at budget issues. >> yeah. >> thank you. >> commissioner chung. >> thank you for the presentation, so i think when it comes to ai we have different ideas what we use ai for. but i want to make sure that when we talk about ai here, it is no means by replacing anyone in the workforce, is that correct? >> we don't see something that is going to i am pack our world real soon. >> that's the conversation i had with somebody else, recently, i used to be a court interpreter. so if ai could be doing simultaneous interpretations better than a person, a human being could, does it mean that

all the court interpreters are going to be out of their job for instance? and the other thing that i think is really important to like for to us remind ourselves that ai does not come with emotion. so it does not know how to empathize, that's a key to helping healthcare that is trying to improve health come to ensure that ai is only a tool. it's not there to replace the human connection. so whether that works or not, really depends on the people themselves. the last but not least, i think we have not really, i mean the whole world has not been talking about the ethical use of ai, you know, because it's such a new technology but i think that these are the conversations that we will

sooner or later, have to have, you know, like for ourselves, for those who are in the healthcare industries, who are looking at you know, like what is constitute ethical. >> people have to be part of the flow and we cannot release the ai to be without a connection to the humans that are doing the work. this is a huge accelerater for us but it is not going to, a lot of people say it's going to fundamentally change how we deliver healthcare, it might but it does not change the fact that human beings have to be associated with all of the work just like they are today. so it's nothing like the terminator?

>> no sky is not upon us. >> commissioner chow. >> yes, i really appreciate this document because i think it begins and is very patient centered. i think commissioner green's answers are not answered to me, on how you will try to look at and have a way in which the research is being created be able to solve the problem of any quality. a lot of data already either is lacking information on the population that we take care and it's just not fair. how do you then, heavily biases

and now they're trying to get a more worldwide approach. and that's something that is almost very difficult for a very small organization like ours compared to say a pharmaceutical company that has access throughout the continents. and this is certainly not just a san francisco problem, so how do we address that or do we say then that the best data we have is this and we're going to go with this and add information that would then help to? because if it's not there yet but we don't work on it it will not get there, right?

so it's kind of a conundrum. >> and we're always on this journey because there is so much time to check a box or type something in or use the drop down menu to have the most complete data possible. but at the end of the day, in our organization, the way that a lot of algorithms work is because they're being trained on a specific set and if they're trained on our data set of similar organizations that have face the same sort of challenges we do with health and racial equity and the same types of gaps and care and the self determinants of health, we may be able to incorporate some of that data into our views and there is capabilities that epic offers that allow us to see data from other organizations and deidentified manner where we can actually do, if you will

some hunting and pecking to see if we can, if there is enough information out there, for us to be able to say, we want to do our own research against a very large data set and that's a very special thing that never existed before, it's well over 100 million records and it's super powerful and we have not absolutely had the time to go in and explore how we can make use of a capability like that. but now that we have a i, we have a big reason to consider it. having our own data is good, but we're not a huge system. so we'll benefit if we have thaoz that benefit. some of this is stuff that we can take on as this as well.

and that's making a commitment to approaching the work with more data which is something that i'm a huge proponent and part of our journey of being a driven organization means that we take care of those sources in order to broaden the data that we may give to an ai providers and say this is the data. the appearance of bias is so much smaller, we have to develop what that confident level it. --is. but i don't think today we have all of that figured out. >> well it sounds like you at least know what the issues are

and the organization is actually actively looking to respond to it and i understand the nuances of must and should but overall, it's a very very patient oriented approach. thank you. >> thank you. >> yeah, i did have a few questions based on your excellent presentation. when is commissioner girando, started to talk about this. what about the modeling to allow investment in ai will have to proof that we're saving in some other ways. so things like revenue cycle and denies and so forth. do we have an approach where we say hey, we do this algorithms. we'll be able to justify

further work in the area. >> so i'm going to say a couple of quick comments. and i think there will be some very clear winners that show up in that space that are using tools where bias is not really the issue, it's really about processing and understanding this complex world of healthcare reimbursement. that does not really touch on the clinical spaces and the more human spaces, it's really administrative. the other thing is about bending cost curves and sometimes, i've heard, eric that's not really savings, of course there is. so if we can find a way to flatten it or take a different

trajectory downward, that's how you can look at perhaps solutions that are more clinically driven where we can say, as a result of doing this thing, we avoided this many days in the icu or avoid this many trips to the hospital. those all have values that we can rely on. >> some of the features, is those feature, give me a summary as a provider i don't have three hours to prepare for one visit. give me that summary but it's also massively expensive, that costs 25 cents every time we ask the computer servers to do it which ends up 1,000 per user per year, and we have about 7

and a half thousand users and it comes to the conversation who gets the benefits who are the roles within our organizations that we want to have those types of time savings and tools? but also, we don't have a magic pot of three quarter million dollars to be able to pay for all 7 and a half,000 of them to take advantage of that. so it really comes down to, you can provide a richer background, you can improve you can have a more patient focus conversation taking that background into account but you're going to have scenarios where erik talked about where there is a financial driver and some where we have to look at that something that we want to absorb into the cost of providing healthcare.

but it's a challenge especially with the newness and expense of the a i that three quarter of a million only covers one feature, it's not even the cost of ai, that is one feature and you can see the projects just keep coming. >> it took three months to get verse off the ground. i can see two issues, one that we're doing little niche replicating things that other people found because so many are working on this. on the other side, you have the collaboration across the country and across the world. on the other hand, we'll in

segregation in mental health if some of these regulatory agencies, come a long, i know for example, that ucsf and research side is only sharing information and it gets to the whole issue of the cybersecurity. so there are some, i would hope that, you're working on that and i don't know it seems like it's such a pass work now where the leadership arising and where the research is being done and where the organizations are. i'm curious if you were to put out your crystal ball and say in three years, who is going to regulate? what will the regulations be? and who are the going to be leaders, both companies that you can trust. and that's the other thing, you

read about ais and it seems like the christ o crisis all rolled up in one. you read that open ai released several programs that many people have left the organization because they felt they were released premature. so i'm curious to think where we'll all be. >> i think we're in a period of dramatic explosive growth both companies that are offering all sorts of different solutions, some of them may be outstanding and some may not stand up to the test. i go into the policy side is to make sure, there is no reason for us to be first because the resources are scarce.

so we need to make for whatever we do, we're not the first thing to do it. as things start to settle down and all the excitement around being able your kids are writing book reports with chat and all of these things happening, that is actually in my mind, that's great because people are getting comfortable with the capability but the real question in business is, what is going to be the most affective use of scarce resource to see deliver the best gain for people we serve. it's just being in a place where we have to understand a lot more about how the solution works, versus i keep using the example of building a building,

it's become really, people understand how buildings get built now because there is a lot of transparency, right. and you can watch it happen. as wpz talk about what may be, secret sauce, because we don't know how to do it as a consumer. we don't understand how it's working and how the data is being used to train your algorithms and seeing outcomes. and where we actually do a approve of concept. we'll and then we, will evaluate or review it and if it's not working out for us, we're going to part ways.

and we don't do that a lot. it turned out it was a really outstanding solution and we use it fair amount in our day-to-day today. but that's what i see as a possible without having to make a huge sink of investment where the solution is. >> i would like to see if there is any other questions for you? [laughter]. >> gpt listening? >> any other commissioner questions? >> absolutely. >> i do, i want to thank eric and the committee, this is our first attempt to very large issue that is going to be facing us the globe. i do just want to comment on he

--equity issues. i know that our systems are biased in general. and also if we're collecting data, that data can be biased. and have segregated people in different categories that are not biologically based. so we want to be very careful that they're not disproportionately worsening and having that knowledge and that thought as we go into that. so our office of health equity has been involved and we will continue to ensure that equity is at the for front here, because that's our mission and our goal is to serve population that's have not been traditionally been able to achieve the best health. >> thank you so much for bringing that up. and i think when you come back to speak, we'll be the number one element that we'll be interested in update.

because so many systems are past claims and past population that we're caring for. that will be very interesting to us. and this is a very exciting area and i don't think any of us en view you having this responsibility but we look forward to your next support and we share all of this information. thank you so much. >> you're quite welcome. thank you. >> wonderful. so the next item on the agenda is the finance and planning committee from commissioner chung who is it our chair. >> yes, good afternoon, commissioners. the finance committee met and we discussed the contract reports as well new grant agreement with tied incentive for delivering innovation what they call dish. and the long name is delivering

innovation in supportive housing. and it's on the consent calendar, we did bring up a couple of discussion items for future. it seems like you know, looking at contract and how many of them, we think that mie be a conversation that we need to continue to have. staff, you know, to make the to be more traem line. i think that mitchel has said that, most of the contracts currently so not all have to be

piled on top of each other. so we'll see how the system is improved. that's the maine interest we have so far. >> thank you, we've all been concerned about that timing, any questions or comments on the report? >> then we'll go to the conference committee. >> yes, thank you. the committee, during the ceo report. as the commissioners gave feedback to dr. earlic as we're looking at new data to strategic goals.

with did review the presentation on true north metrics which are then going to be sort of a concurrent review of where they are each quarter and as expected, the hospital team has developed a thoughtful goals and metrics continue to push the hospital for its evolution. we're going to be reviewing the different types of reports that the, that then in order to determine which ones are most helpful for us. recommends that the full commission approve the laboratory medicine rules and regulations which are on

today's consent calendar and in close session the committee approved the credentials report. >> thank you. are there any commissioners questions or comments on that report? i would like to say the laboratory medicine presentation was incredible. that division has so much responsibility and does such a fantastic job, we're so lucky we get these colorful power points from each department and seems like every month, the department before is better. we can be very very proud of what goes on at the laboratory medicine. so that was a really wonderful thing to hear. so next thing is our consent calendar we have the items as

well as zsfg. there a motion to approve the consent calendar. >> so moved. >> and since there is no public comment, we can take a vote all in favor. >> aye. >> aye. >> wonderful. and any other business? all right, i see no other business so we will move to adjournment. >> is there a motion to adjournment. >> so moved. >> all in favor. >> aye. >> aye. >> thank you every one, great meeting. >> give me a second to take us out. good night, every one.

>> my name is julie maw.