Be able to retire those systems and our contracts and so that is our hospital, and inpatient and billing system, it is our ambulatory care and our primary care and ehr that is in the primary care and other supporting products that we are purchasing and so both the new cost. And so that i think my point, really is, right now you have a net total cost of 181 million. I am just thinking, that what you have not incorporated in through the city is not really a savings, but you would have to come up with it a new system that is going to cost you money. So, it is not truly, 181 million that you have to spend the extra. Because you would have to spend the money to have the new system. Absolutely. And that the cost of that new system is on the cost side, so you will see that there is added cost of 340 million and partially offset and so it is a net cost to us that we have been working on applying for. Thank you. Supervisor, tang . Thank you very much for the explanation and i think that again, it is very clear the need for a new system, and one that is clearly a lot more integrated. Since the item before us is about waving a competitive so listation process, i was wondering that there have been concerns about not Going Forward with the rfp process and could you talk about why dph decided or is bringing north this item. Sure. Thank you for the question. And i do want to say, we understand that and we get the benefits of an rfp and i have never asked for this type of permission before i dont expect to, again. But it really is because of the unique nature of this situation that we are in. So i think that the way that we are really thinking about it is, this is not a situation where you have vendors that can provide you a product that all can kind of do it and you are going out, and looking for the best cost for a similar product or the best quality. That is part of what is out there. And that could be where we end up at some point. But what we are really doing proposing here, and the way that we are looking at this, is this is kind of a different route, instead of just buying a product from a vendor, we are proposing to say, lets take a different approach and go with a government to government agreement where we are leveraging both their system and their operations. And the reason that we are doing that, is because we have kind of come to realize, that by virtue of that partnership, and not by virtue of what the software is or what the system is, it is the partnership itself, that we can do something good for our patient and that we can contribute to the medical research, and the popular, Health Management of the city and since it is by virtue of the partnership itself, there is by definition, not really another path that we can take to achieve those benefits for a patient population, so you kind of have an apples to oranges situation where there is really only one path that we can take that gets us all of those things that we see that are available to us. And so, seeing that, in front of us, if you are doing an rfp process where you are comparing apples to oranges, you kind of have a strange situation where you are either focusing our rfp just to capture those things and you can only get in one place, or you are putting yourself at risk for getting something that will be less than opt mal for your patients. And so seeing that situation, we determined that we wanted to come bring this to the board. And say here is what we see, we think that there is a unique opportunity to do things in a different way that will have real benefitsor health system, and seek your support to pursue that alternative. If we did not, or if we were not able to achieve what we opened that we will be able to achieve with the ucsf whether for the financial reasons or the technical reasons or whatever it will be, i think that we will be back in a more standard place, where we will be building our own system and it will be more of a scenario where we are saying, that we need our system, which is the best product for us to go out and purchase. So i think that i get that, distinction and so, what if, and lets just say that you were to do an rfp, would that also be the process or the place for you to explore, whether this partnership, would work out . Well, it is a good question. And i think that there are a couple of concerns that we have about that route. We did think about this. And evaluate it. The first is, that we are again, proposing to negotiate with ucsf, they have a system that they have bought from a vendor, but our negotiations and ultimately our agreement would be with ucsf and not a vendor, so there is not a precedent that i am aware of for the governmental entity to bid and compete through an rfp process of this nature, ucsf bids on the patient, Community Care contracts with us, but those are service contracts. This is unchartered territory of how the government to government, partnership will work, the second issue is if we were to go through a process of your standard rfp process, what does that look like . We want a vendor that will, be or provider of care and especially services for the population that trains our figureses. And if we did, and there will really only be one respondent and cap able. And meeting those criteria, if we dont include those and then we dont capture those benefits in our evaluation. And so that was our logic and our thinking on why, because this is such a unique, situation, it does not lend itself to the normal process that is thank you. Okay. If no other questions fl rose could we go to your report, please . Yes, mr. Chairman. The members of the committee, on page 17 of our report we note that the actual projected expenditures from july, first 2010, to june, 30, under the existing contract, the Electronic Healthcare system, between dph, is 52. 3 million, and that is shown on table one, and again, on page, 176 our report. And the board of supervisors has appropriate ated the general fund moneys for the existing contract. We also know that as shown in table two on page 17, of our report, dph estimates that the contract with ucsf will cost estimated 341,919,891, over the nine to ten years and dph and anticipates the savings of 160 million. And from the discontinuation of the existing systems, and reduced to the growth in the cost for the services which will result in the total net cost of 181 million. And for the contract. And again that is shown in the table two. On page, 19, of our report, we do know that a competitive request for the proposals and process will insure that all eligible vendors are able to apply and strengthen the citys after ability to secure the most qualified price for the needed services. And our recommendations on page 20, recommend that you amend the proposal that dph, issue a request for the proposals. If dph is unable to attain the sufficient assurances that ucsf will be able to meet the criteria, and we consider it as amended to be the policy matter for the board of supervisors. Thank you, there rose. No other questions, we will open it up to Public Comment. I have a number of speaker cards. Sue car lyle and jim marks, and cluade and kneel, and hedie and dr. Church well. Good morning, supervisors. Good morning. I am the vice dean for the school of medicine. And today, i strongly urge you to support director cer garcia request to allow the negotiation to begin, for an net cost expansion of the epic system to include, dph. There have been extensive as you have heard, internal and external evaluations of this, and a con ses sense has been achieved. And the ucsf, city and county of San Francisco, partnership, has spanned nearly, 150 years, and together as we prepare to go into the opening of our magnificent, new and Mark ZuckerbergSan Francisco, trauma center, i urge you to exercise the necessity of the timely, implementation of technologies that will insure the best care for our patients, the adoption of the epic system for the did. Ph will not only benefit, our patients but also enhance our practice environment for the 1,000 physicians and 900 trainees, many of which are already, trained to use the system. As you have heard there is also, significant opportunities for increased revenue through improved efficiencies and better documentation. So again, i strongly urge you to consider this proposal. Thank you. Next speaker, please . Good afternoon, supervisors my name is jim marks and i am the chief of 1,000 plus, medical staff. At San Francisco, general and with my colleagues i am here in support for the ordinance to acquire an emr with the unique features that best serve our patients and providers. You have heard that we use paper electronic, and records as well as over 60 different records. And fk, when i care for the critically ill patients i cannot see the care or the medications that they have received in the emergency department. And we are making and the regulatory challenges in the environment in which we practice and, we now have the opportunity to solve these challenges by negotiating the acquisition of apex and ucsf, implementation of epic and going this route, offers the substantial benefits to the patients and staff, compared to the other alternatives. And as you have heard, half of our physicians work at ucsf, and regularly use apex and this reduces the training costs and more importantly, increases safety because the physicians do not have to know and use two different emrs. And simply, all of our resident and fellow trainees know and use it with the same advantages, i cannot over emphasize the importance of this and insuring the Patient Safety with a workforce that moves back and forth between the two thank you very much. Appreciate it, next speaker please . Good afternoon. I am the chief of neurology and the director at San Francisco general. Integrated Electronic Health record is a required tool of the trade for the doctors and nurses to get the care for the inpatients and outpatients when i announced at our faculty meeting that the director garcia was seeking to bring it to the hospital, the faculty actually applauded and the residents say thank you, and i am inspired on a daily basis for the dedication of the providers on behalf of the patients across the care, continuum from the emergency, fair treatment, and implementation of the ehr is a major undertaking and having the enthusiasm and the engagement in the medical staff is critical to success and we have it for director garcias proposal. They need to spend the time not learning a no. Uhr and it is a safety, issue, when the provider, works in the hospitals as most of the doctors do is treating a stroke, patient in the emergency, department and when the minutes mean brain cells, any delay, brought by the infa familiarity is unacceptable, and when the doctor follows a patient in the outpatient, clinic it is at a different hospital that day and they need to be able to seamlessly, access the patients medical record from off site. And it is a mission, issue. The it is a special place and the link, will insure that the patients are at the center of our commitments to the patient care, and medical education and, research. On behalf of the service, and medical staff, i urge you to support this ordinance. Thank you. Thank you. Next speaker. Good morning. I am neil and a physician and a chief of medicine. And we are the Largest Department and we take care of people in this city, with heart attacks and diabetes and high Blood Pressure and hiv. If you have an iphone, imagine if you were forced to use an android this month and an ifor enin april and android in april and iphone in june and android in july. You would become, quickly frustrated. You might make a mistake, dialling or texting the wrong phone number because you are not familiar with the Software Features that is what it is like for the 1,000, ucsf physicians at San Francisco general who provide, primary and Specialty Care to 123,000 San Francisco residents. And they have to toggle between the two different Electronic Health records. Systems. One at ucsf and a totally different one at San Francisco general as they go back and forth boetween the institutions losing your bearing in the Electronic Health record is not as trivia as texting the wrong phone and saying excuse me, it could mean the delays in care and patient harm and death for a patient treated by a physician, having to use, two widely different information systems. Imagine ordering the wrong medication because of unfamiliar arty with two systems. And not only a human cost for the adults. Or the children, like the ones that were just in this chamber, but there is also, the grief for providers and unnecessary cofor tax payers and you have the power to prevent this. And behalf of the chiefs of service i ask you to support this noncompetitive process. To advance the health and wellbeing of San Francisco residents. Thank you. Next speaker, please. Hello, Heidi Collins and iment the Vice President of ucfhealth for the Health Record and the systems, at 5 hospitals and over 160 hospital and Community Based clinics. And i wanted to give the historical background on ucsf road to the successful implementation. And prior to epic, it undertook a nine year journey to implement the functionality, this project had multiple stops and starts. Thanks, the next speaker, please . Good afternoon, i am scott kene senior director and general manager with the Health Services a division of the corporation, required. The services february of 2015, it has been the Electronic Health and partner for dph for 20 plus years and we value our relationship. I am here today, in support of the letter flanagan shared with the board of supervisors regarding the waving of the competitive process requirements. For the selection of a new ehr and naming ucsf as the preferred contractor. We believe that it is not in the publics best interest to wave the competitive process and allow the sole source of the complex and high risk, 342 million dollar, Information Technology contract. We are asking that the competitive process remain in place, the competitive process, provides, dph the opportunity to fairly evaluate the key factors which include, an integrated system that meets the unique needs of the dph across the full care. And in addition to the exchange of information, with nonaffiliated epic partners, Service Level agreements for out time, warranty and support levels and a fixed fee implementation and the total cost of ownership. There are no examples of two organizations as large as ucsf and dph with Different Service lines and government structures coming together in a shared system. This is a very important long term project and we urge the board of supervisors to reject the wave request and follow the normal competitive process, that will allow dph to select a supplier that can meet their unique needs. Thank you. Next speaker, please . Good afternoon, supervisors, my name is eloise and i am a San Francisco resident and i do not have a slew of initials behind my name as t the ladies and gentlemen before me. It is a great need and it needs to happen and no one has the passion of the members of the San Francisco community more than i do. This goes far beyond the project. The concern is that we are being asked to wave administrative code 21. 1, which actually is a protection for business . San francisco, and dph even stated this is for the business of health. Well the business and Small Business of San Francisco, have not had the opportunity to engage with anyone. To partner with anyone. And to move forward to be able to be included in this process. This sets a dangerous precedent. And as we move forward, this is a significant amount of money to the sole source of individuals and not to mention that the data that ucsf is going to be able to accrue and going to be of a great value to them and provide, more dollars into the network as we move forward and we begin to negotiate and negate 21. 1, then all of the other contracts that are other larger constitutional contracts that are coming down the way will get much more scrutiny than this one is appears is getting right now. So, i absolutely urge you to reject this as and provide a waiver, and absolutely encourage you to move forward do a competitive process as this administrative code was desiepd to do. Thank you. Thank you. Next speaker. If you are searching for your Health Records i am sure that you will find the information there. If you are searching for Health Records systems. I am sure you will find it helpful safe in there. Thank you. Any other members of the public wish to comment . Okay. Seeing none, Public Comment is closed. I will just say from my point of view, i never, we dont like doing these, and or it is not of the preference to do these type of source things but from the process perspective that is why we have the ability to wave it if we need to. And i am, very conscious of the economics here and i will say from my perspective. The integration, here from the doctors and the Health Department and i will just say that a personal experience and my folks over the last few years, the integrated system at ucsf and it is, critical. And i cannot imagine and i would not be in conscious not voting for it. Knowing how critical that it has been to their personal healthcare. And not being able to give everybody else the opportunity to do that. So, i understand all of the other kernshz i get it. But from my perspective, when it comes to it all, it trumps it all, i am prepared to approve this right now, and we are going to have the full contract before us and we can evaluate it at that time. That is why we have this procedure in place right n