Special Notice / Hearing: None
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Rich Bailey, Chief Information Officer, San Mateo County Health
Subject: Agreement with Epic Nexus to Provide Trusted Exchange Framework and Common Agreement Participation Services
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with Epic Nexus to provide participation services for the Trusted Exchange Framework and Common Agreement network, within San Mateo County Health, in an amount not to exceed $207,000.
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BACKGROUND:
The Trusted Exchange Framework and Common Agreement (TEFCA) network connects various Qualified Health Information Networks (QHINs) nationwide, enabling seamless, secure data sharing for purposes such as treatment, public health, and patient access. QHIN connections facilitate nationwide interoperability among participants, including hospitals, providers, and public health agencies.
Through TEFCA, San Mateo County Health (SMCH) can securely exchange health information with a broader range of providers, health systems, payers, and public health agencies. This enhanced interoperability reduces administrative barriers, decreases delays in accessing patient information, and supports more informed, timely clinical decision-making. As a result, SMCH patients and clients, especially those managing chronic conditions, seeking emergency care, or navigating transitions between care settings, benefit from safer, more cohesive, and more efficient care.
SMCH has centralized its Electronic Health Record (EHR) on the Epic platform. Epic's QHIN, Epic Nexus, is built for Epic databases and tailored to the Epic user community, making it the most seamless option for connecting SMCH's Epic database for the TEFCA framework. For this reason, SMCH obtained a waiver from the County’s Request for Proposal (RFP) process to implement Epic Nexus’ QHIN with minimal effort and no custom development, leveraging its full integration with our EHR and optimizing the Epic user experience.
DISCUSSION:
Epic’s QHIN, Epic Nexus, is purpose-built for Epic databases and tailored to the Epic community. It integrates with existing workflows and requires minimal implementation and maintenance from an IT perspective.
Epic Nexus also offers strategic advantages due to its direct relationship with Epic Corporation. As the only QHIN designed and maintained by Epic, Nexus is aligned with Epic’s technical roadmap, interoperability standards, and nationwide data exchange strategy. This ensures SMCH benefits from ongoing product enhancements, automatic compatibility with new TEFCA requirements, and seamless integration with upcoming Epic features. By selecting Epic Nexus, SMCH avoids the risks of vendor misalignment, reduces long-term maintenance overhead, and ensures our EHR remains connected to the broader Epic community as national exchange capabilities evolve. For these reasons, SMCH requests that this Board waive the RFP process to allow Epic Nexus to provide these services.
The agreement and resolution have been reviewed and approved by the County Attorney as to form. The County’s Procurement Department has approved a waiver request to enter into an agreement beyond five years.
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’s fiscal obligations by a maximum of $25,000 (in aggregate).
It is anticipated that with Epic Nexus’ TEFCA service, the number of external providers successfully exchanging data with SMCH will increase to 40 or more providers, and the average time it takes SMCH to retrieve external data will be reduced by 30%.
PERFORMANCE MEASURE:
|
Measure |
FY 2025-26 Estimated |
FY 2026-27 Projected |
|
Number of external providers successfully exchanging data with SMCH through Epic Nexus’ TEFCA service |
0* |
40+ providers |
|
Percentage of reduction in average time it takes SMCH to retrieve external data |
0%* |
30% reduction |
*This will be a new performance measure beginning in FY 2025-26.
Community Impact:
SMCH’s participation in TEFCA represents a significant step toward strengthening the health and well-being of the communities we serve. By joining this nationwide network for secure, standardized health information exchange, we are advancing our commitment to improved care coordination and health access.
FISCAL IMPACT:
The term of the Epic Nexus is from February 1, 2026 through December 12, 2032, for a maximum cost of $207,000. Funds in the amount of $7,000 are included in the EHR Budget Unit FY 2025-26 Adopted Budget. Similar arrangements will be made for future years.
The agreement is entirely 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.