Inter-Departmental Correspondence

Health System



March 2, 2009


May 19, 2009







Honorable Board of Supervisors


Jean S. Fraser, Chief, Health System
Susan Ehrlich, MD, MPP, Interim Chief Executive Officer,
San Mateo Medical Center



Second Amendment to the Agreement with Webmedx



Adopt a Resolution authorizing the President of the Board to execute a second amendment with Webmedx, Inc. for medical transcription services, extending the existing term by one year, though April 30, 2010, and increasing the funding by $1,345,000, from $4,030,000 to a new maximum fiscal obligation of $5,375,000.



Commitment: Ensure basic health and safety for all.

Goal 5: Provide residents access to healthcare and preventive care.

The Agreement contributes to this commitment and goal by providing high quality patient information for care and administrative purposes including reimbursement.


Performance Measure:


FY 2008-09

FY 2009-10

Reduced transcription volume





In 2005 San Mateo Medical Center (SMMC) published a Request for Proposals (RFP) for medical record transcription services, and on May 2, 2006, Webmedx, Inc. (Webmedx) was selected to provide those services. In 2006 SMMC published another RFP for an electronic signature software package to replace the physical signature process then in place for medical records. Webmedx was selected to provide these services, and the Board approved an amendment to the agreement with Webmedx to implement the new electronic signature software. This new software eliminated the problem of incomplete charts which impacted the quality of patient care and resulted in a backlog of unrealized SMMC revenue. SMMC is implementing fully-electronic patient records; however, there is still an ongoing need for medical transcription services for dictated notes.



In a continued effort to improve the medical record process, SMMC is implementing an Ambulatory Electronic Medical Record (AEMR). The new AEMR system will allow for direct entry of patient information by patient providers into an electronic medical record.

SMMC will continue transition to the AEMR system during the course of FY 2009-10. The reduction in dictation volumes during this transition is estimated to be 25%. A one-year extension to the existing three-year contract with Webmedx for medical transcription services is recommended for this transitional year while actual volume reductions are determined.

Following full implementation of the AEMR, the post-implementation need for medical transcription will be assessed, and a new RFP will be published for transcription services. Cost calculations for transcription services are influenced in part by work volumes, and the transition to the AEMR system may result in a substantial reduction in such costs due to the anticipated decrease in transcription. The one-year extension may enable the County to reduce the cost of the post-implementation transcription agreement.


The Contractor has assured compliance with the County's Contractor Employee Jury Service Ordinance, as well as all other contract provisions that are required by County ordinance and administrative memoranda, including but not limited to insurance, hold harmless, non-discrimination, and equal benefits.


The County Counsel has reviewed and approved this Amendment.



The original term of the Agreement is February 1, 2006 through April 30, 2009, and will be extended by this amendment through April 30, 2010. The maximum amount of the Agreement will be increased by $1,345,000, from $4,030,000 to a new maximum of $5,375,000. Funds in the amount of $1,343,749 are included in SMMC’s FY 2008-09 Adopted Budget and $1,007,818 will be included in the Recommended Budget for FY 2009-10. Expenses at SMMC are covered by fees for services or third-party payors whenever possible. The portion of expenses for services provided to the medically indigent or to those covered by programs that do not meet the full costs of care are covered by the County’s General Fund contribution to SMMC.