Special Notice / Hearing: None
Vote Required: 4/5ths
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Rich Bailey, Chief Information Officer, San Mateo County Health
Subject: Amendment to the Agreement with Epic Systems Corporation and Epic Hosting, LLC to Expand the Electronic Medical Record System to Additional Divisions, Amendment to the Master Salary Resolution 0813165 to Add Thirty-Five Positions, and Appropriation Transfer Request Increasing the FY2025-26 Adopted Budget
RECOMMENDATION:
title
Recommendation to:
A) Adopt a resolution:
1. Authorizing an amendment to the agreement with Epic Systems Corporation to expand the Electronic Health Medical Record system to additional divisions within San Mateo County Health, increasing the County’s fiscal obligation by $21,620,589, for a total amount not to exceed $85,079,673; and
2. Authorizing an amendment to the agreement with Epic Hosting LLC to expand the Electronic Health Medical Record system to additional divisions within San Mateo County Health, increasing the County’s fiscal obligation by $2,983,000, for a total amount not to exceed $17,830,484; and
3. Authorizing an amendment to Master Salary Resolution 081316 to add thirty-five positions to the General Fund; and
B) Authorizing an Appropriation Transfer Request (ATR) increasing unanticipated revenue by $7,058,660, Fixed Assets by $5,362,779, Other Financing Uses by $1,695,881 for Capital Projects Fund and increasing unanticipated revenue by $2,833,827, Salaries and Benefits by $1,896,577, Other Charges by $750,000, Dept Employee Training Expense by $187,250 for the General Fund for the second phase of implementation of the Electronic Health Record.
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BACKGROUND:
San Mateo County Health’s (SMCH) mission is to help San Mateo County residents live longer and better lives. The services that SMCH offers to Medi-Cal and uninsured low-income residents are the backbone of that work through San Mateo Medical Center (SMMC) and its outpatient clinics; Public Health, Policy and Planning (PHPP), which includes multiple clinics; Family Health Services (FHS); Behavioral Health and Recovery Services (BHRS); Aging and Disability Services (ADS); and Correctional Health Services (CHS). The latter six SMCH divisions until recently utilized multiple, electronic health record (EHR) systems or paper charts to maintain patient and client information. This fragmentation made it difficult for providers to obtain a current and comprehensive view of the patient/client record at the point of care. The use of multiple record-keeping systems complicated data sharing and coordination between inpatient and outpatient care, mental health and substance use disorder treatment, social services, and community partners.
On December 13, 2022, this Board approved an agreement with Epic Systems Corporation and Epic Hosting LLC (Epic) to provide the EHR system for SMCH.
On November 2, 2024, SMCH went live with the new EHR system for the following divisions: SMMC, PHPP (except for Public Health Lab), and CHS. Over the next nine months, the application teams and staff within the latter divisions worked on stabilization and learning the new enterprise EHR system.
On June 24, 2025, Master Salary Resolution No. 081316, adopted by this Board, specified the number of and provided compensation and benefits for persons employed by the County of San Mateo, set appropriate rules and regulations, and repealed all inconsistent ordinances and resolutions. Throughout the year, the salary resolution was amended from time to time to meet the needs of the County.
DISCUSSION:
To minimize disruption to SMCH staff and the community, the rollout of the EHR system was planned in two phases. Phase I implemented Epic’s core software and applications within five divisions: SMMC, CHS, Health Coverage Unit, Health IT, and PHPP’s clinic services. These divisions are now live on the new system. We are now moving into Phase II, which will bring BHRS, ADS, PHPP’s Public Health Lab, and FHS onto the Epic platform.
Under the existing agreements, Epic provides SMCH with software licenses, data hosting, and use of its EHR system. Epic has also supported the County with implementation services.
This action includes funding for staffing resources for full-time San Mateo County employees and is incorporated into the updated ten-year budget. The proposed staffing model supports Epic’s operational needs and innovation, adds critical capacity for continued expansion of the integrated system, and ensures compliance with federal, state, and industry standards.
This Board is also considering temporary/as-needed staffing resources for Phase II, provided by Computer Task Group, Incorporated.
The staffing model requires a total of 35 positions. The Master Salary Resolution is amended accordingly, as outlined below.
55600 Health IT
Action A: Add: Twenty-three V400S, Electronic Health Record Analyst Series
Biweekly Salary: $4,184.00 - $6,536.80.
Action B: Add: Five V402, Electronic Health Record Analyst III
Biweekly Salary: $5,620.00 - $7,022.40
Action C: Add: Two V403, Electronic Health Record Supervisor
Biweekly Salary: $5,984.00 - $7,478.40
Action D: Add: Two D017, Health Information Systems and Technology Manager
Biweekly Salary: $6,892.00 - $8,616.00
Action E: Add: One V274, IS Data Specialist III (IS Support Series)
Biweekly Salary: $5,351.20 - $6,688.00
Action F: Add: One E029, Administrative Assistant I
Biweekly Salary: $3,240.80 - $4,051.20
Action G: Add: One E337, Office Specialist
Biweekly Salary: $2,528.80 - $3,160.00
These actions represent a monthly salary and benefits cost of approximately $767,576, calculated at the highest step of the salary range.
The agreement and resolution have been reviewed and approved by the County Attorney as to form.
The Technology Services Department has reviewed and approved the IT component of this agreement.
The resolution contains the County’s standard provisions allowing amendment of the County fiscal obligations by a maximum of $25,000 (in aggregate).
It is anticipated that 100% of all SMCH divisions - excluding Health Administration (HA), Emergency Medical Services (EMS), and Environmental Health Services (EHS) - will be using a single unified EHR system. Such a system facilitates improved patient access, medical accuracy, cost spending, and operational efficiency, which leads to greater client and patient satisfaction as well as greater financial accountability for SMCH.
PERFORMANCE MEASURE:
|
Measure |
FY 2025-26 Actual |
FY 2026-27 Estimated |
|
Percentage of all SMCH divisions (excluding HA, EMS, and EHS) that will be using a single unified EHR system |
63% |
100% |
Community Impact:
The use of an integrated EHR across additional divisions within SMCH will benefit a broad population of patients and clients. The integrated EHR will improve coordination of services across all points of care, reduce service duplication, and help providers make informed clinical decisions. Demographically, over the past 18 months, the largest groups of specialty care patients at SMMC were female (52%), Hispanic or Latino (63%), and primarily Spanish-speaking (55%). Using a single EHR allows SMCH service providers to track their patients and clients across different levels of care, from community outreach and engagement to intensive case management and residential placement. Patients and clients are more likely to experience smoother transitions between providers and facilities, ensuring that critical health information follows them throughout SMCH divisions.
FISCAL IMPACT:
The term of the agreement with Epic Systems Corporation is from December 6, 2022, through June 30, 2032, for a maximum cost of $85,079,673. The term of the Epic Hosting LLC agreement is from December 6, 2022, through December 5, 2029, for a maximum cost of $17,830,484.
The Epic agreements are both funded as part of the EHR budget unit, which is covered by proportional contributions from all County Health divisions, which may include some Net County Cost, depending on the composition of each division’s contribution.
The addition of the positions will result in an estimated monthly salary and benefits cost of $767,576 or an annual cost of $9.21 million.
Phase II implementation is estimated at $58 million and will be funded by divisions within SMCH. This ATR increases the EHR and Health IT budgets to begin Phase II. Funding for the remainder of the implementation will be included in future budget requests.