Inter-Departmental Correspondence

San Mateo Medical Center



November 14, 2003


December 2, 2003



Honorable Board of Supervisors


Nancy J. Steiger, Chief Executive Officer, San Mateo Medical Center



Amendment to the Agreement with The Electric Company



Adopt a resolution authorizing the President of the Board to execute an amendment to the agreement with The Electric Company to provide medical transcription.



Transcription of interpretation of all diagnostic procedures is required by the State Department of Health Services Title XXII and the Joint Commission on the Accreditation of Healthcare Organizations and is mandated by the medical staff of the hospital. Also, reimbursement to the hospital can be delayed if transcribed reports are not provided in the medical record on a timely basis. Patient care is also adversely affected if procedure reports are not charted rapidly and made available for primary physicians.

An agreement with The Electric Company has been in effect since 1999. On December 17, 2002, your Board waived the Request for Proposals (RFP) process and approved an agreement with The Electric Company to provide medical transcription for the Radiology Department. The term of the agreement is December 1, 2002 to November 30, 2003. The Board waived the RFP process at that time pending installation of the Siemens/SMS radiology information system. The implementation of the information system was completed in two steps, one in May 2003, and the final installation in August 2003. This installation required integration of the County's network, software and workstations with the vendor-supplied dictation system.



The SMS radiology system is currently interfaced with the Core system for patient registration, billing, lifetime clinical record (chart information) and productivity reports. Any change will require additional Information Services Department (ISD) activity to set up new interfaces for these functions.

The Electric Company utilizes County supplied and maintained workstations with SMS Radiology set-up, including licenses, with connection to the County's network. This eliminates firewall issues. For security and to assure HIPAA compliance, programming of the recording system is required to read bar-coded identification of each individual procedure by unique accession number, work type and date of service rather than use patient demographic information for identification of the dictation. HIPAA language is included in the contract with The Electric Company.

ISD and Radiology staff are currently working to define necessary specifications to submit a Request for Proposals to other vendors with a target date of June 2004. This process also includes ISD assistance with alternatives to the current process. ISD is exploring ways of using internet access to SMS radiology system and/or the report file transmission into the SMS radiology system. During the analysis process for the RFP, it is necessary to extend the contract with The Electric Company for transcription of medical procedure reports.

The addition of MRI on-site services in October 2003 will generate additional transcription costs estimated to be $1,400 a month. Based on current average usage of 67,000 lines per month at $0.23 per line, the monthly average cost is $15,410 or $184,920 annually. It is necessary to increase the maximum amount of the agreement to cover the costs incurred during the additional year.

County Counsel and Risk Management have reviewed and approved this amendment.


Vision Alignment

This Contract keeps the commitment to Responsive, effective and collaborative government and goal number 20: government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain. The agreement contributes to this commitment by providing mandated transcription services and timely transcribed reports thereby making available accurate procedure reports for primary physicians.


Fiscal Impact

This Amendment extends the term of the agreement by one year making the new term of the agreement December 1, 2002 to November 30, 2004. The amendment also increases the maximum amount of the agreement by $185,000 from $173,880 to $358,880. Based on the current average usage of 67,000 lines per month at $0.23 per line, the monthly average cost is $15,410 or $184,920 annually. Funds to cover this cost have been included in San Mateo Medical Center's FY2003-04 Adopted Budget.