Of the Civil Service roles as you do with the normal the ones that take 253 days. When you do that, that one youve got to get the approvals, post it, then theres an appeal period, then you have an exam, then theres an appeal period and all of that with the exam. You can speed all of that up. To do that we would have to get approval of the d. H. R. And the union. I think they would understand. I would say the other possibility is what is called a Civil Service exemption 12, which is an expert. So we did that with i. T. We now hire some of our i. T. Staff under the Civil Service exemption which is a 12. We hired the project manager in h. R. Hired on average everybody in six weeks using the epic hire using category 12s and category 18s. I would say if you want the speed of hiring for Something Like this, i would go with Civil Service exempt positions, work it out with d. H. R. And the union. The lean process improvement, thats going to take a while. We dont control a lot of whats going to be changed. Its d. H. R. Is the Civil Service roles. But the existing category 12s and 18s, we could do as fast as six weeks. Thats what i would recommend for that. What was your other question . I was wondering if you could give us your assessment. Oh, the assessment. I think that we still have you know, this is really a sensitive area because to say we appear to be overrepresented with certain populations of staff does not make those staff feel very good or are very happy about it. So but i think the numbers sort of speak for themselves. We still have areas. We need to recruit more africanamericans, for example, and we need to recruit them into higherlevel positions. The disparity is we hire them into the lower classifications and they never work up to the higher classifications. I want to work on pay equity. Again i was saying if we want to break up these pathways causing us to be lopsided in our diversity, we take away the managers right to determine where the person comes in at their pay level. I think the only way to break up that is h. R. Has to decide and we have to decide that based on pay equity. Im going to have to staff up to do that. What i would like to do is that payroll would do an analysis before we make the offer what were going to hire you at, i want to make sure we see what we hired everyone else at and bring you in at the appropriate level. Right now its done by the manager and they say step one. Unless someone knows better, he says i want to bring him in at step four and theyll justify it. Lots of people dont know to do that. Thats how we end up with the pay disparities. Can you give us more details about the types of positions that we have the greatest challenges. Its one thing to see the diversity charts and another thing to better understand. We have certain issues hiring nurses versus other employees in the d. P. H. If you break nursing out, which has a whole set of different concerns and brought to us information about the other subcategories of employees and how youre going to approach hiring and diversity in those jobs. We can do that. I know weve looked at it in the past and going to look specifically at each classification. Yeah, we can do that. Thank you. Looking at the new hires chart, page number 11, you mentioned there was a dip in new highers in august and september of this year because trainers were needed to really engage in the epic go live and training there. I know we had reviewed a number of contracts for Surge Staffing and other things related to epic and when to when these needs came up. Was this not anticipated or contemplated in the staffing when you were looking at when you might need folks to come in with Surge Staffing . So i think it was i didnt of course do those contracts, but i think they did look into what they tried to do is make sure we used our money wisely. What they had done is brought in a surge of trainers and said, look, by midjuly, were going to be at the point where everybody is pretty well trained except for new people. Were going to cut loose 100 trainers. Were going to keep the core trainers, but were going to need them to get this launched on august 3. Once thats done they can return to training the new staff. We asked them to get people into the orientations in august and july because there wouldnt be one in september. Whether they anticipated this way back im not sure. It wouldnt have made sense to bring on those extra trainers. It was a dip in our hiring, but we will make that up. Thank you. Looking at that disciplinary table again, it makes me wonder what is the gender parity of our workfor workforce, especially when there is no real way to know from these tables the size of our transgender workforce, you know, in d. P. H. , transgender men and women. Its kind of like a yeah, im just like my head is filled with questions, like where how they placed in those city tables. So we just started tracking based on there was a directive six months ago or so or maybe earlier, they want to give us the option of tracking gender and transgender in all forms. Were starting to track that. We may be able to have that going forward. Were about 75 female and 25 male. Something like that. Its been a while since i looked at those numbers. Thats not unusual for a health department. We can refine that. Thats a good point. I will talk to d. H. R. This is their information, but i think it would be a good point to track that. I was disappointed to see that we dont have those data, especially given the departments work on sogi. Were asking it of the people that we serve, but were not doing the work we need to inwardly as a reflection. Certainly its a priority to work to get this data that youre asking for. Commissioners, other questions . Thank you very much. All right. Thank you. All right, everyone, we move on to item 9, which is the epic post go live update. Commissioners and directors. I am the chief Information Officer for d. P. H. Id like to start by sharing a number with you. 8,800. More than 8,800 people have gained credentials and used epic since our go live on august 23, 2019. That includes over 1,500 of our clients. My takehome message for you this evening is we had a great golive experience, everything from the support of your commission all the way down to all 7,500 people who participated in classroom training and took proficiency exam to be able to effectively use the new tools. It was across the board an outstanding effort. We had support from across the city. We had support from a number of vendors in addition to epic. And of course we had the support of all of our organization, as we know that it takes attacks on any company, any agency, to make a transformative change such as we have. All of our consumers as users of epic are getting accustomed to the system and day by day are getting proficient with its use. It takes a little bit of time and were not even three months in yet. I do want to assure you that we have a systematic process in place, a goodgovernance program, so we can monitor and improve based on the information we glean from epic. What i mean by that is epic is not just a system we put things in, were seeing a return on information and not just in the form of reports, but information about how were using epic, some of this in nearreal time, so we can understand how were making best use of this very large investment. So a handful of Cocktail Party starters. I maybe lead you to the fourth ring, next to the last on the right, and that 21 systems were consolidated that bring wave one of epic to life. Thats important because thats a really large number of systems. Its also important because it speaks to our readiness in the coming year to decommission those systems, which has been part of our financing plan. So what did we implement . I think you have all sat through several briefings. Across the top row of items is our traditional electronic charting infrastructure, the support systems like lab, pharmacy, radiology, how we handle the revenue cycle, as well as scheduling. The first one on the bottom is Health Information exchange which may not have come to mind. Thats the bidirectional sharing from and to our organizations and others. As a result of epic, we are now part of an Industry Consortium of two or three dozen other organizations that make Electronic Health records. We all agree we are able to share information with one another. I will show you some statistics for that in a few minutes. I also mentioned briefly that theres a lot of information were getting out of epic, and its beyond the standard analytical tools. It is striking the progress that Electronic Health record systems have made in my 20plus years of working with them. Where we are today is that we are really starting to learn not just about how we can improve in real time by giving managers dashboards to use, but as i mentioned in my opening remarks, how were actually using the software. It tells us how well were doing and it provides areas where we can say focus enhanced training and other learning experiences to help our teams become as expert with epic as they can. Ill keep saying it, weve given access to our clients and patien patients access to their own Health Records. Im glad to say were off to a good start. Where did we implement . No real surprises. I draw your attention to the lasting point and that we have gone mobile. We have gone into is is a new place with being able to access the capabilities that epic provides for us. I mentioned that over 1,500 of our clients are now using the mychart application. If any of you are getting your health care in the bay area, you are likely using epic mychart. That is the same tools our clients are using. For the providers, they can chart on a mobile device using hayku. For Business Partners and many others, you can log into epic and share in the Care Experience that were providing. Were letting a lot of Business Partners in to have and to share in the experience that we have launched. We have, for a number of years, have been able to do the same thing the other way. So i mentioned how we know how were doing. I wanted to just take one moment to share a slide with you. The numbers in the slide arent terribly important at this time. This was a first cut at an epic leader dashboard. This one is for primary care, but i wanted to share with you that we dont have to do anything special to create a dashboard like this. Its something that we get more or less out of the box, and all we have to do is tune it to our needs. In the past weve had to make a significant investment to deploy a dashboard like this. The nice thing about epic is that there are about five or six dozens of these dashboards that are available for us to use. They are very straightforward, and we are able to customize them to an extent to reflect the kinds of Outcome Measures and Key Performance indicators that are relevant to us to represent our true north strategic goals. Nothing is perfect. Going live with an Electronic Health record that is now in use by more than well, nearly 9,000 people, there are going be issues. We have closed thousands of them since august 3. Where we are now is dealing with some of our more complex concerns. They deal a little bit more with software, but we really deal more with workflow, people, process, technology, that intersection. As an example, weve always been spending a lot of time at sgfg tackling the topic of patient movement. How do they move from the Emergency Department to the intensive care department. In the past we had people and process and the technology didnt tell us much. Today the technology can tell us a lot. Epic can share a lot of information about whats going on and how to effectively manage that transition from one venue to another. When we first saw it, and im in this camp too, i didnt really believe what i was looking at. For the last month or so, theres been a really intense effort to understand how we can get utilize the information that the Information System gives back to us to inform our process and a lot of strides have been made there. Theres a handful of other workflow examples where were diving in deep. Its not about epic, but epic is forcing us to have the conversations and focus on problem solving. The second issue that were having, and this was more or less expected, is our ability to deliver against many types of reports and outcomes measures that we have for regulatory purposes that are in support of valuebased care. When you move from one Information System to another, you are reporting all the way up to the last day that you had that tool. When you start in a new Information System such as we did on august 3, we didnt go into it with a fully populated database. We did it with a mostly new database. So we prepared how we would begin to use the new data as folks come in our doors after august 3. But we have to go through a validation process in order to ensure what were looking at and that all of the prework we did to produce all of these measures is going to be valid and stand up to our data integrity checklist. We are close. Hoping in the next 30 to 60 days to be completely back on course. It was expected that we would have a delay, and we had a bit of a delay. I want to be up front about that. The nice thing is epic is friendly about us taking the data out. That has been a real struggle with our electronic platforms, and thats not the case with what we have today. Weve talked about benefits realizations before. I mentioned decommissions systems. That work is beginning in earnest at the beginning of the calendar year and will take us to july, where we expect to spin down, which is something i. T. People dont like to do. We like to keep old systems on as heaters. But we plan to demission our legacy Health Record system by the end of the fiscal year. The great news about that is we dont need them anymore. The second piece of good news is we wont be paying for them anymore. Thats been part of the budget and Financial Plan for epic since the beginning. Id like to take a few moments, and i know were getting towards the end of our time today, to talk about the our in our records, patient record exchange, something i mentioned at the beginning. Since august 3 up through october 1, we have exchanged Health Information with 215 other Healthcare Organizations across the united states. Its possible there are some international ones in there. I didnt dive deep enough to doublecheck. If you look on the bottom left, you will see who our highestvolume Information Exchange partners are. I dont think there are any surprises there. Whats really powerful is in basically just shy of two months of being live with epic, 43,000 of our clients have had their records appended by Healthcare Information from other Healthcare Organizations. This is pretty powerful stuff. In addition to that, nearly 14,000 of our patients, their information has been requested and sent across this trust framework that i mentioned before with this Industry Consortium that epic is a member of to augment the records of our clients in other places. So really very powerful. We dont have to do anything special for this to happen, it just happens. So our epic journey, we spent a number of years in what i would call a getready phase. Were definitely past that. Were coming up to the tail end of our getgoing phase, where theres been a strong focus on having a really Good Governance program for epic, for having a great go live, which we did. Now were in this period of time which we call stabilization and well be there for the next few months. During this time of stabilization is where we process people, process, and technology, the couple of examples i shared with you before. Whats really exciting is as we march into the new calendar year, were getting ready to get better. Getting better means tuning our governance process even more so we can do two activities in parallel. One of them is beginning the optimization of the epic environment so it can do things its not doing today. We have a straightforward implementation and without violating our principles of sticking to that, we can still make it better. So were going to begin that process. In parallel, we will be locking in the scope and schedule for wave two and three of epic. When were done with that in a few years, well be in a Continuous Improvement environment, where we will bank on everything that we learned and all of the Good Governance thats in place so we can keep Getting Better. So epic is both hard and it has been very rewarding. I just want to share with you the message that were sharing with all of our staff because not every day is a great day with epic. Its okay to feel frustrated. This is the first message that were sharing with our staff because we have really changed a lot. More than a thousand changes were made in order to get ready and learn epic. Sometimes you look at the screen and youre like im not sure i remember how to do this, which is a reminder that were all in this together. When i go in front of epic, i look at the screen and im befuddl befuddl befuddled. The good information is we continue to help and train and build tip sheets which are in the epic users first pane when you log in. You go to a place called my learning home. Thats where you go when you log into epic. We are an organization of helpers. I think during go live this was really evident and a lot of people could see how well everyone reached out and was supporting everyone, and thats the environment that we need to continue to maintain as we move forward with more change in epic. So weve asked staff to be there for one another because some day youre going to need some support as well. With that, im happy