Special Notice / Hearing: None__
Vote Required: 4/5ths
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Stephen Dean, Chief Information Officer, San Mateo County Health
Subject: Appropriation Transfer Request Increasing the FY 2022-23 Adopted Budget
RECOMMENDATION:
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Approve an Appropriation Transfer Request (ATR) increasing unanticipated revenue by $22,273,248 and Salaries and Benefits by $3,374,366 and Services and Supplies by $18,898,882 for the implementation of the Electronic Health Record for FY 2022-23.
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BACKGROUND:
San Mateo County Health (SMCH) is responsible for providing necessary medical care to its medically indigent population. SMCH operates San Mateo Medical Center (SMMC) and its outpatient clinics; Public Health, which includes several clinics: Family Health Services; Behavioral Health and Recovery Services; Aging and Adult Services and Correctional Health Services. These six SMCH divisions utilize multiple, outdated, electronic health record (EHR) systems or paper charts to maintain patient information.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- and out-patient care, mental health and substance use disorder treatment, social services, and community partners.
On December 6, 2022, this board approved an agreement with Epic Systems Corporation (Epic) to provide a license to its software and to host SMCH associated hardware and data, and implementation services and staff to assist SMCH in building an EHR system and ensure a successful implementation.
Also approved with the Epic agreement was the authority for the Chief of County Health or their designee to approve additional agreements with: 1) Up-To-Date; 2) Intelligent Medical Objects (IMO); and 3) CareSelect.
DISCUSSION:
The new integrated EHR system will allow SMCH to provide a modernized coordination of care and ensure that patient health information is accurate and easily accessible. Such a system will also improve patient access, medical accuracy, cost spending, and operational efficiency, which leads to greater patient satisfaction and greater financial accountability for SMCH. This system will be implemented in a phased approach to all SMCH divisions. This Appropriation Transfer Request (ATR) increases SMCH’s budget for the expenses associated with EHR implementation.
It is anticipated that 100% of medical clinical information systems users from SMCH divisions will be using a single unified EHR system by the end of the initial 24-month project period, with plans to integrate non-medical information systems in the following years. Such a system facilitates improved patient access, medical accuracy, cost spending, and operational efficiency, which leads to greater patient satisfaction and greater financial accountability for SMCH.
PERFORMANCE MEASURE:
|
Measure |
FY 2022-23 Estimated |
FY 2024-25 Projected |
|
Percentage of medical clinical information systems users from SMCH divisions that are using a single unified EHR system |
0% |
100 % (1132 users) |
FISCAL IMPACT:
The net three-year implementation costs for this project, including associated personnel are estimated at $119,000,000. Of this amount, one-time costs of $76,000,000 are funded from SMCH reserves, $10,000,000 from the General Fund, $4,000,000 anticipated from the Health Plan of San Mateo - California Advancing and Innovating Medi-Cal Incentive Payment Program, $4,000,000 from PATH Funding (Providing Access and Transforming Health), $300,000 from California Department of Health Care Services’ Projects for Assistance in Transition from Homeless, and other anticipated federal funds of $1,000,000. The remaining balance of $23,700,000 will be funded from the participating SMCH divisions. All patient/client-serving divisions of County Health will contribute to the ongoing costs based on projected use. This ATR increases the budget for activities expected during FY 2022-23. Expenses for subsequent years will be included in future budget requests.