Inter-Departmental Correspondence

Information Services Department



May 12, 2011


May 24, 2011







Honorable Board of Supervisors


Chris Flatmoe, CIO/Director, Information Services

Jean S. Fraser, Chief, Health System

Steve Kaplan, Interim Director, Behavioral Health and Recovery Services


Amendment No. 4 to the Agreement with Netsmart Technologies, Inc.


Adopt a Resolution authorizing the President of the Board to execute Amendment No. 4 to the Agreement with Netsmart Technologies, Inc. for the expansion of a Management Information System and maintenance/support, increasing the Agreement’s maximum obligation by $1,288,704 to a new total maximum obligation of $5,937,147 with no change to the term of February 26, 2008 through February 28, 2015.


On February 26, 2008, your Board approved Resolution # 069291, which authorized an Agreement with Netsmart Technologies, Inc. (Netsmart) for the purchase and implementation of an Electronic Health Record (EHR) for Behavioral Health and Recovery Services (BHRS) for the term of February 26, 2008 through February 28, 2015 in the amount of $3,759,409. On October 7, 2010, the parties entered into Amendment No. 1 to update the Business Associate terms of the Agreement, and on November 1, 2010, the parties entered into Amendment No. 2 to adjust the budget allocations within the Agreement for specific services with no overall change to the term or contract amount. On November 2, 2010, your Board approved Resolution # 071125 authorizing Amendment No. 3 for $889,034 to support the acquisition and implementation of an EHR in support of the Family Health Services Division (FHS).



On September 28, 2010, your Board approved the use of Departmental Reserves to expand EHR use for BHRS Alcohol and other Drug (AOD) clients. In support of that action, Amendment No. 4 extends the Netsmart Avatar software to provide EHR services to AOD clients. The proposed solution will replace two legacy AOD information systems and will transfer paper-based case management records into an EHR. With an EHR, clients will receive expedited services, and the system will allow for seamless care for those clients receiving concurrent and/or separate mental health and substance abuse services. To the extent allowed by law, BHRS will be able to make available integrated care records for clinician review, improve care coordination, improve program efficiency and facilitate continuous improvement. The expanded system will support billing, client care and monitoring, and documentation needs of the AOD program. The scope of the project includes new AOD-specific reporting software, additional user licenses, and support services required for the expansion and operation of the system. The technology has been reviewed by ISD for compliance with County Technology Standards.


Netsmart continues compliance with the County’s Contractor Employee Jury Services 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. Risk Management has reviewed and approved Contractor’s insurance, and County Counsel has reviewed and approved the Amendment and Resolution as to form.


Approval of this Amendment contributes to the Shared Vision 2025 outcome of a Healthy Community by integrating three separate BHRS systems into a single EHR to improve coordination of care and delivery of health services through “seamless services.” It is anticipated three systems will be replaced by one by the end of FY2011-12


Performance Measures:


FY 2010-11

FY 2011-12

Systems required to provide BHRS care





The term of the Agreement under Amendment No. 4 remains February 26, 2008 through February 28, 2015. The amount of Agreement has been increased by $1,288,704

from $4,648,443 to a new total maximum obligation of $5,937,147. FY 2010-11 expenditures will be $445,516.30 from the BHRS Revised Budget and $372,777.87 from the FY 2011-12 Recommended Budget, together with $681,705.83 in BHRS and ISD costs through the use of $1.5 million from Departmental Reserves to complete expansion. BHRS will include the remaining Agreement costs of $470,409.83 in future-year budgets. The Net County Cost associated with this Amendment is estimated at 100%, or $1,288,704. An unknown percentage of costs will be recovered through BHRS’ various funding sources such as Medical Administrative Activities (MAA) and the Federal “Meaningful Use” payments through CMS Medi-care and Medi-caid programs.