COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Information Services Department

DATE:

March 3, 2011

BOARD MEETING DATE:

March 29, 2011

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

Chris Flatmoe, CIO/Director, Information Services

Jean S. Fraser, Chief, Health System

Susan Ehrlich, MD, MPP, CEO/San Mateo Medical Center

SUBJECT:

Amendment 5 to the Agreement with eClinicalWorks, LLC (eCW)

RECOMMENDATION:

Adopt a Resolution authorizing the:

1. President of the Board to execute Amendment No. 5 to the Agreement with eClinicalWorks, LLC (eCW) to provide additional applications and services related to the eClinicalWorks Ambulatory Electronic Medical Record (AEMR) system installed at San Mateo Medical Center (SMMC), with no change to the maximum fiscal obligation of $2,990,000; and

2. Chief Information Officer or his designee to execute subsequent amendments to the Agreement for modifications to the terms, scope, and conditions up to the not to exceed amount of $2,990,000.

BACKGROUND:

On January 8, 2008, your Board approved Resolution Number 069209, which authorized a seven-year Agreement with eClinicalWorks, LLC (eCW) to install and maintain an Ambulatory Electronic Medical Record (AEMR) system at San Mateo Medical Center (SMMC). eCW was selected through the Request for Proposal process. The initial implementation has been completed and currently over 200 providers throughout all 15 County outpatient clinics are using the AEMR. This Agreement was amended on March 17, 2009, September 22, 2009, February 11, 2010, and July 7, 2010 to include more licensure and functionality. In October, 2010, eCW received Electronic Health Record (EHR) certification by the Certification Commission for Health Information Technology. This certification means that eCW supports the Meaningful Use measures required to qualify eligible providers and hospitals for funding under the American Recovery and Reinvestment Act (ARRA).

DISCUSSION:

This Amendment will authorize the implementation of additional applications and services. Specifically:

• Dental EMR – This will provide EMR for use by the dentists and support staff at SMMC. The eCW Dental EMR is integrated with a software product developed by Open Dental. The County has entered into a related Agreement with Open Dental for use of their software product.

• Enterprise Business Optimizer – This will provide additional reporting and integration capabilities.

• Patient Portal – This will allow patients to access their own healthcare information contained in the AEMR over the Internet through a hosted portal site.

• eClinicalMobile – This will allow clinicians to access the AEMR through the use of mobile devices (e.g., Smartphones-iPhones, iPads).

• Assessment and Training of Meaningful Use, ICD-10 codes and HIPAA 5010 – eCW will perform an assessment of and provide training for the ARRA provisions related to ambulatory meaningful use requirements, implementation of the transition from ICD-9 healthcare coding record structure to the new ICD-10 standard and compliance with new HIPAA 5010 data format and transmission.

• Infermed Smart Referral Integration – The County has already approved an Agreement with InferMed for the use of their Smart Referral software application. This amendment will provide the integration of that application with eCW AEMR.

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 Manager has approved extending the contract term past three years. Risk Management has reviewed and approved Contractor’s insurance, and County Counsel has reviewed and approved the Resolution and Amendment as to form.

Approval of this Amendment contributes to the Shared Vision 2025 outcome of a Healthy Community by efficiently improving chronic disease management and quality of care. It is anticipated that SMMC will meet its OBM measure of reducing cost per adjusted patient day.

Performance Measure(s):

Measure

FY 2009-10
Actual

FY 2010-11
Projected

SMMC cost per adjusted patient day

$991

$872

FISCAL IMPACT:

The projected additional costs for the applications and services included in this amendment are $350,855 over the remaining term of the Agreement. No increase in the not to exceed is required as the assumptions for start dates for certain fees in projecting the current not to exceed occurred later than anticipated. Funding remains available in this contract. Funds have been included in the Adopted FY2010-11 Budget. Expenses at SMMC are covered by fees 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. The term of this Agreement will not change.