Growth already assumed in a deficit. This is the Revenue Growth that helps us off set some of the other Cost Increases that you are not seeing, including g. P. H. Staff, you know, staffing Cost Increases thats man dated in m. O. U. S, salary infringe and other inflationary costs and then which gave us a target of of general fund reduction. What were doing with all the initiatives that we brought forward is a slightly lopsided balancing plan where were 28 million to the good in year one and 20 million until bad. If you look a fritz the twoyear perspective which we have done in previous years, were still overall to the good in terms of balancing but well be sort of looking at this sort of imbalance in the next week or two and well be hopefully bringing you something that is a little bit more a little bit more balanced in year two. Ok. Next up, we have an additional hearing where well complete our balancing plan and then will submit the budget to the mayor and controllers area on the 21st. The Mayors Office where hell submit a balanced review after that. Anyway, that is all i have. So, im happy to answer any questions you may have. Thank you, commissioners. Remind you today is just a discussion and on the february 20th is your vote. Any Public Comment . Ive not received any requests. Commissioner, were prepared to discuss this item and the presentation at this point. Questions from commissioner chung looks like [inaudible]. Ok. Let me start with looking at your last numbers, as you said, you had a 21 positive, 1 million for 1819 and then went the other route for the second year. In our Budget Planning well i should say in our Financial Planning meetings last month, we discussed the trends and the possibilities of our need to actually be prudent as we move forward. How does this match within the fiveyear or the projected change that we are anticipating in terms of overall city revenues . What were working on right now and what you will see at the next hearing is were looking at a couple things, were looking at onetime funds that we could use that are coming out of the current year or onetime reven revenues to budget in the twoyear timeline horizon that would allow us to prefund some activities, including expenses with the Electronic HealthRecords Initiative and that allows us to move more costs into that first year and smooth out the transition out to the second year. So i anticipate by that the time we get to the completed submission from the Mayors Office that we should be at a place to hit the general fund targets that we discussed in the commissions fiveyear Financial Planning session. Okay, commissioner, is there an impact on our budget in terms of the revised in terms what well do and will we receive any additional revenue based on that or not . The Biggest Issue in the proposed governors budget is that theres a proposal to end the 340b Pricing Program and that would have a negative impact on us so thats the biggest one that were watching. And other than that, there are some moving parts but nothing thats on that order of magnitude so thats the biggest one and its potential downside. Thank you. So while we wait for another question ill go to the affiliation and the issue, will we get clarification with its impact on our e. H. R. Program. Yeah, so the as you will recall from the prior budgets, when we put together the funding plan for the e. H. R. It was predicated on a number of things. There was the onetime sources that we programmed into it and there was general fund support from the city and there was a package of costsaving measures that we had programmed to offset the costs associated with the e. H. R. And one of those was the funding levels for the u. C. Affiliation agreement and because of the initiative that you have seen in front of you beginning in the year two which is additional unanticipated general fund dollars in the fiveyear Financial Plan and so let me before i get into that i want to clarify that there are two parts to it and of that 14 million, about 4 million was an anticipated in the mayors projection and the other 10 million was not and so it was partially in anticipatedd partially not. So theres the unexpected growth in costs that we need to cover within our budget submission to the Mayors Office so what were looking at is, again, similar to the answer to your question of how do we balance between the two years, is there a way that we could prefund an additional amount of the e. H. R. Costs with onetime dollars which would allow us to relieve some costs in the outyears of the program and could we reshuffle the dollars to essentially give us enough cushion that we can implement the program comfortably but have some cost relief in the out years . So thats the model that were looking at and youll see more on that in the next two weeks but where we are right now is that we think that we probably have the ability to make some of those changes as were getting costs analysis in as part of the Due Diligence on the continued Due Diligence and the planning on the e. H. R. Implementation. It does look like we could use more funding in the early years when were in the thick of the implementation and thats where the tightness is in our budget so if we can program some dollars earlier that will give us a little bit more room to maneuver while we go through that intensive implementation period. And then we will need less contingency in the project once we get stagized and we go to our operating phase. So thats kind of the model that were looking at to deal with that situation and well be presenting proposal to you on that at the next hearing. But it will make things tighter in the outyears and tell give us less room to work but i think that well be able to come up with something that allows us to manage the project. Okay. Under c1, is that the same medical Delivery System that the contracts and the finance committee took up today . Im sorry jenny wasnt in the earlier meeting. Yes, it is exactly. So the expenditure dollars that you see associated with that initiative are related to the types of contracts that we approved at finance committee today and the revenues are also. So there are expenditures for contracts and revenues from the billing that well be able to do under the drug medical waiver and theres an imbalance there but essentially what is happening is that when you look back we put together a budget for this as jenny said two years ago when we were kind of projecting forward and anticipating and now that we actually got the Program Ready to roll out we have done our r. F. P. S and negotiated some of those contracts which you saw were chewing up the budget to reflect what the Actual Expenditures and the revenues that we think that were going to achieve under the program are and thats the reason for the changes. So we still are getting a positive revenue impact overall from the program, but were tweaking it a little bit in the other direction based on the reality of the costs and the contracts. So, i see im going backwards here. In terms of the manner in which i and appreciate how youre now taking out the population, of those not aware in the past, the Central Office expenditured used to be in Population Health and that sort of distorted the whole question, right, of how much was actually spent. And i assume that the new acronym is added to our initial theories, about the let me ask you why primary care is separated and its good that it is probably because we might ask you whats in the Health Network services, but whats the rationale since the San FranciscoHealth Network services at least on an outpatient basis, i would assume, is within this 225 million and how do we distinguish that from the primary Care Services . Yeah, thats a great question. One of the things one of our purchases was as were looking at the conversion to this new Financial System we wanted to sort of set up the bones of the right structure and theres things that we didnt want to keep and theres some things that we wanted to keep. But we decided to phase in our conversion to this new structure over time just given the challenge of actually converting the expenditures and the data and the conversion itself was so complex and challenging. We didnt want to do major moves that we werent entirely sure of and because primary care was fine as it is, we said, lets just get the move done and then lets see also what the system is capable of doing in terms of its reporting abilities because there are enhancements from the former famous program. So what we want to do is to sort of set a Good Foundation but we also didnt want to completely reinvent the wheel until we got a better sense of the system. So i expect that well be looking at the structure and possibly making additional changes in the future. Because on the quarterlies, the primary is sort of separate right now from the two large hospitals and so are you going to be changing your quarterlies to sort of match this type of yes, we have yes. Commissioners, further questions or requests that you might want to see in the budget or further explanations that can come at the february 20th meeting . I have one. Which is actually fairly small. Because for years i have talked about the issue of tuberculosis and i know that its great that youre backfilling something that the government feds are taking away. Im still wondering and i would like to hear that the people who are doing the t. B. Surveillance feel that is there something that we we need to actually then even make a greater impact on what is probably our most longstanding chronic disease that is almost number one amongst major cities in the united states. I will we will engage with that section with our Health Officer and the Population Health division and review that. I mean, i do appreciate that were backfilling something already but i wanted to see if theres an opportunity to continue to try to impact that. Well review that, well review that. Thank you. Further questions at this point . I would invite the members of the commission that may then as you think about this to have some thoughts, certainly, we can contact the department either by way of mark or directly over to greg and to get those questions over there so that we can have them answered in our next hearing. Is that right . There are, therefore, no further questions and we proceed to our next item. Thank you very much. I did also want to commend the department for this continuation of how youre presenting the budget and though there were lesser numbers of initiatives i think that over the years has been really been clear so thats why you dont we dont have quite as many questions even about what the issue was that you were placing before us. And i think that really makes a difference and im going to really commend our finance department, all of you, for the work that you have put into it to make it so clear for us. Thank you. Thank you. Clerk item 9 the update focused on the Electronic Health records. Good evening, commissioners. I guess that i have a kind of a tall order to fill now since they did such a good job. Ill give it a shot. My name is bill kim for those that i have not met with yet and i am the chief Information Officer for the department of Public Health and im very happy to be up here and giving you an update. And we go forth and slide show. Technology is challenging for me. Health commission i. T. Update. I wanted to bring to your attention this is really an i. T. And e. H. R. Electronic Health Records system update because they are so integrated and dependent on each other. If you will allow me im going to actually go back in time about four years for those commissioners who have not been here and to focus on one slide before we get into the updates. So this is the agenda and today ill go over the strategic roadmap as presented in 2014 and ill also be presenting you with the roadmap on how it looks today as well as going over the Electronic Health records overall timeline and diving deeper into this and going over the project phases, the current project budget, and the e. H. R. Governance structure which allows us to stay on target and stay on budget in terms of timeline as well as the scope. As well as the accomplishments up to date and we really started this project about a month ago officially. And the next steps in risk and ill be more than happy to take any questions that you have. First of all, many of you may have already seen this. This health diagram was presented approximately four years ago after having spending about six months in dialogue with the Health Commission as well as the d. P. H. Leadership in terms of the addition and the future strategic roadmap of the organization. Based on that and understanding the weaknesses and the strength of d. P. H. I. T. And its ability to support the business i have come up with help of some of the consultants who have done work before i got here to put this together. So the right way to read this document for those commissioners who havent seen this is to look at it from bottom up. So if you look at it, one of the priorities was to actually put in a foundation of reliable and costeffective i. T. Infrastructure. For those who have not been here we were we did a lot of good things here but it was not in my opinion or in the opinion of the business adequate for the future state of e. H. R. The columns, the effective i. T. And the clinical, clinician training was identified as something that well have to put in place for us to effectively execute the new e. H. R. And to more importantly adopt it into the organization. And in the middle we have the green box, the yellow box, and the light blue box, the green box actually starts to fill in the content of the house, basically, the right blue print, the mean and the i. T. Delivery service model. As you know we have been very much engaged in doing that work as well as the Electronic Health record in the yellow box and what i call valueadded technology that ride on top of the e. Had remembe h. R. And the. And i want to note again that the e. H. R. Is an important part of our electronic ecosystem. It is the foundation of our ecosystem. However, towards the valueadded, for the business and the clinical and the nonclinical its important that we have the technologies to ride on top of that and for those in the finance and the committee we have that were not e. H. R. But they bring a lot of value to the business. And i want t wont go into a lof detail, but were trying to get to equity in access and longterm viability and excellence in health care and population and wellness management and as you can manage without innovation and seamless collaboration, the integrated care across is not really possible as an organization. And so three years ago we presented this and everybody said that looks fine and where are we today . 2018, this slide actually translates what we were saying that we would do four years ago into what we are executing today. So you can see that we have medical grade infrastructure as our foundation. And that is actually in play in the environment at General Hospital, zuikerberg General Hospital as their foundation technology. We are in the process of rolling that out across al, and in termf the customer service, we have made dramatic changes to the services that i. T. Provides and we have been collecting Customer Satisfaction score and i want to commend my team and the business for participating in surveys and all of the work theyve done and im happy to report that over the last many months that were averaging about 4. 7 out of 5, which is pretty phenomenal considering where we were four years ago. So were not there yet in terms of where we need to be to really adopt and to support our end user, but we are on the way and we believe that we will be able to meet the high standards that we are aspiring to achieve. Now in terms of clinical and dramatics we spend a significant amount of resources building that team and theyre working on the epic project today. And i have special thanks to albert and ranona for putting that together. One of the things that you will hear more is that were moving our Field Services and help desk to be more customer centered, that means theyll be working much more closely with the business and being clinical or nonclinical and working to support their needs as opposed to oops 20 years from today, fewer services and the help desk will be equipment centric and well ask to install the software and were looking at what is the true value that youre looking for as a customer. Thats what well be focusing on. The other part that you will see is that theres a lot of Due Diligence that is not in the green box and that actually has passed and we have done Due Diligence on what is the right e. H. R. For us and we have done a lot of focus on i. T. Service delivery model, not only for the organization but also for the i. T. And where we are today is at the yellow box. We are now working on kicking off our epic e. H. R. And more importantly we are in the process of kicking off all of the other things that you see here that i necessarily wont go through but you can see that we have Business Analytics and intelligence and device integration and to ensure that our patient record is the same patient and in complete order. And we are also working on electronic content management t