Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health and Recovery Services
Subject: Agreement with Netsmart Technologies, Inc., to continue Maintenance and Subscription Services Related to the myAvatar Electronic Health Record System
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with Netsmart Technologies, Inc., to continue maintenance and subscription services related to the myAvatar Electronic Health Record System for the term of July 1, 2026 through June 30, 2028, in an amount not to exceed $2,111,829, and granting a waiver of the request for proposals process under Ordinance Code 2.83.070 (b).
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BACKGROUND:
Since 2008, Netsmart Technologies, Inc. (Netsmart) has supplied an electronic health record (EHR) system, myAvatar, for Behavioral Health and Recovery Services (BHRS), which provides behavioral health and addictions treatment services, and Family Health Services (FHS), which provides health and well-being to infants, children, teens, young adults, and parents. The myAvatar system is the primary EHR system for both San Mateo County Health (SMCH) divisions to support coordination of care and data sharing as appropriate and is allowed under HIPAA regulations. The system meets Short-Doyle Act and managed care billing requirements for the State of California.
SMCH’s 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 the County’s outpatient clinics. These services are provided through SMCH’s six divisions: Public Health, Policy and Planning (PHPP), which includes multiple clinics; FHS; BHRS; Aging and Disability Services (ADS); and Correctional Health Services (CHS).
These six SMCH divisions utilize multiple outdated EHR systems or paper charts to maintain patient information. This fragmentation results in a constant struggle by providers to obtain a current and comprehensive view of the client record at the point of care. The use of multiple EHRs impedes data sharing and coordination between in patient and outpatient care, mental health and substance use disorder treatment, social services, and community partners. Thus, a Request for Proposals (RFP) to replace the current EHR systems was released in 2019, and Epic Systems Corporation & Epic Hosting LLC (Epic) was chosen as the preferred vendor. However, while the Epic contract was being negotiated and until it was fully implemented, the services provided by Netsmart for the myAvatar EHR system needed to continue. Therefore, the Board approved an agreement in September 2021 with Netsmart to continue the maintenance and subscription services related to the myAvatar EHR System for BHRS and FHS to facilitate the continuum of care for County clients for the term of July 1, 2021 through June 30, 2026.
In December 2022, the Board approved an agreement with Epic to provide the EHR system for SMCH. The implementation of the Epic EHR system began in December 2022 and was targeting a go-live of August 30, 2024, with the completion of the program on or before December 31, 2024. However, full implementation has not yet been completed.
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 two divisions worked on stabilization and learning the new enterprise EHR system.
In January 2026, the Board approved an amendment to the agreement with Epic to expand the Electronic Health Medical Record system to additional divisions within SMCH.
To minimize disruption to SMCH staff and the community, the rollout of the Epic 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 Information Technology (HIT), and PHPP’s clinic services. These divisions are now live on the new Epic system. SMCH is now in 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.
DISCUSSION:
During the Phase II implementation of the Epic EHR system, the myAvatar EHR system must continue to support BHRS and FHS for continuity of services until the Epic implementation and go-live are completed. BHRS needs to remain on myAvatar through the Epic BHRS go-live, which is currently targeted for April 2027.
This agreement enables Netsmart to continue to provide support to BHRS and FHS for maintenance, subscription services, and data conversion services related to the myAvatar EHR system needed to facilitate the continuum of care for County clients. MyAvatar is the current regulatory-compliant BHRS EHR and Electronic Laboratory Record system. Due to the delay in transitioning to Epic, there is no interim other vendor option or resource that would qualify for or meet the regulatory requirement before migration to Epic. There is also no internal measure that can be taken to the scale needed during this extension timeframe that would negate the need for an outside vendor.
The IT component of this agreement has been reviewed and approved by the Technology Services Department (TSD) and HIT for compliance with County Technology Standards.
The County Procurement Department has preliminarily approved a waiver request to this Board for the Board’s final approval of the waiver to execute this agreement for a two-year term. This Agreement is coming to this Board late due to prolonged agreement negotiations.
The resolution and Agreement have been reviewed and approved by the County Attorney as to form.
Staff is requesting a waiver of the request for proposal process pursuant to ordinance Code 2.83.070 (b).
The resolution contains the County’s standard provisions allowing amendment of the County’s fiscal obligations by a maximum of $25,000 (in aggregate).
It is anticipated that 100% of in-scope myAvatar EHR data will be successfully migrated for BHRS and FHS to the Epic EHR system.
PERFORMANCE MEASURE:
|
Measure |
FY 2026-27 Estimated |
FY 2027-28 Projected |
|
Percentage of in-scope myAvatar EHR data successfully migrated for BHRS and FHS to the Epic EHR system |
100% |
100% |
COMMUNITY IMPACT:
Using a single EHR allows SMCH service providers to continue to identify and track their patients and clients across different levels of care from community outreach and engagement to intensive case management and residential placement.
Continuing the myAvatar EHR system through the Phase II implementation of the Epic EHR system ensures uninterrupted access to clinical records, treatment documentation, and billing for the clients served by BHRS and FHS, many of whom are among the County’s most vulnerable residents, including Medi-Cal beneficiaries receiving behavioral health, substance use, and family health services. Maintaining myAvatar until Epic go-live allows staff to continue delivering and documenting care without disruption, supports the complete and accurate conversion of client records into the new integrated EHR, and preserves access to historical records required for continuity of care and regulatory compliance. Upon completion of the transition, BHRS and FHS clients will benefit from the same integrated record and coordinated care across SMCH divisions described in the Board’s prior approvals of the Epic agreements.
FISCAL IMPACT:
The term of this Agreement is July 1, 2026 through June 30, 2028. The amount of this Agreement is not to exceed $2,111,829 for the two-year term, and funds in that amount are included in the BHRS FY 2026-28 Recommended Budget. Of that amount, 100% will be funded by Net County Cost.