Inter-Departmental Correspondence

Health System



November 29, 2010


January 11, 2011







Honorable Board of Supervisors


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


Agreement with InferMed, Ltd.



Adopt a Resolution:


Waiving the Request for Proposals process and authorizing the President of the Board to execute an Agreement with InferMed, Ltd. to provide software and support for a Smart Referral System to integrate with the Electronic Medical Record System at San Mateo Medical Center for the term October 1, 2010 through September 30, 2013, for a maximum obligation of $169,980; and



Authorizing the Chief of the Health System or designee to execute contract amendments which modify the County’s maximum fiscal obligation by no more than $25,000 (in aggregate), and/or modify the contract term and/or services so long as the modified term or services is/are within the current or revised fiscal provisions



San Mateo Medical Center’s (SMMC) data collection and analysis of the ongoing problems patients face in accessing Specialty Clinics services led to the creation of a grant proposal that was accepted and funded by the Kaiser Foundation. One strategy is called the Smart Referral System (SRS), and is a solution to the problem of inconsistent methods for scheduling appointments and a lack of standardized guidelines for referrals. SMMC’s goal was to minimize the changes to provider workflow patterns, integrate Specialty-based clinical guidelines, automate the referral criteria, and standardize the process by which patients are approved and scheduled for appointments. The first step was to establish an agreement to collaborate with our Ambulatory Electronic Medical Record System (AEMR) vendor, eClinicalWorks (eCW), in order to enhance or upgrade the existing eCW referral module.



Providers will be able to chart all patient encounters through the AEMR SRS. The ability to make quick and appropriate referrals will be dependent on the requirement that SRS be stable, reliable and secure. SMMC conducted extensive research and review of numerous referral technology platforms in use at various institutions, including San Francisco General Hospital, Santa Clara Valley Medical, and Cook County Hospital (Chicago).


SMMC’s research identified InferMed’s Arezzo software platform as a tried and tested technology. It is in use by the United Kingdom’s National Health Service for managing urgent referrals from primary to specialty care. It was designed to integrate “clinical decision support,” in the form of evidence-based guidelines, into the electronic referral and appointment scheduling process. The Arezzo decision support module is easily customizable by the user to reflect variations in referral criteria and data gathering requirements. For this reason, a waiver to the County’s Request for Proposals process is recommended.


The Agreement and Resolution have been reviewed and approved by County Counsel as to form. The Contractor’s insurance has been reviewed and approved by Risk Management. Delay in submission of this Agreement is due to the extensive negotiation process. An invoice from the vendor in the amount of $20,000 was paid on July 12, 2010, using the Kaiser grant funds and is included in the maximum fiscal obligation.


The contractor has no employees in the State of California or San Mateo County, and so contractor is not covered by the County’s Contractor Employee Jury Service Ordinance. The contractor has otherwise assured compliance with 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 Agreement contributes to the Shared Vision 2025 outcome of a Healthy Community by providing County residents access to quality health care and seamless services. There are 2,519 patients referred to Specialty Clinics who do not have appointments. It is anticipated that the number of patients waiting for appointments will be reduced by 40% (to 1511).


Performance Measure:


FY 2010-11

FY 2011-12

Patients Awaiting Specialty Primary Care Appointment





The term of the Agreement is October 1, 2010 through September 30, 2013, and the maximum obligation is $169,980. Funds for this project have been provided by the Kaiser Grant for the Specialty Care Initiative. There is no Net County Cost. Funds in the amount of $61,580 are included in the SMMC FY 2010-11 Adopted Budget. 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.