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DATE: |
October 22, 2024 |
06 |
SUBJECT
Title
AUTHORITY TO PROCURE ELECTRONIC HEALTH RECORD SYSTEM FOR HEALTH AND HUMAN SERVICES AGENCY (DISTRICTS: ALL)
Body
OVERVIEW
The County of San Diego (County) Health and Human Services Agency (HHSA), Public Health Services (PHS) and Medical Care Services (MCS) departments conduct approximately 120,000 patient visits annually across a variety of services. These include case management, physical and occupational therapy, communicable disease testing, treatment and prevention, vaccinations, and home health.
Given the volume of services provided, there is a need for PHS and MCS to use an electronic health record (EHR) system to enhance and optimize the delivery of care. An EHR system would also support other services and departments identified by HHSA and any new services established through the implementation of San Diego Advancing and Innovating Medi-Cal, the local implementation of Medi-Cal Transformation.
Today’s action requests the San Diego County Board of Supervisors (Board) authorize a single-source contract with OCHIN Inc. (OCHIN) for the procurement of Epic Systems Corporation’s (Epic) EHR system in accordance with Board Policy A-87, Competitive Procurement, Sections D-3 and D-5, and Administrative Code Section 401. OCHIN, a third-party seller of the Epic EHR system, is selected due to their focus on Local Health Jurisdictions, like the County of San Diego, and community providers that are considered to be small-to-medium in size with a focus on ambulatory care whereas Epic engages directly with larger, full-scale healthcare systems. A Board Policy A-87 exception is requested due to the unique knowledge, skill, and ability OCHIN possesses and provides as the only Epic Connect Partner that acts as a third-party seller of the Epic EHR system to Local Health Jurisdictions, Community Health Centers, and Federally Qualified Healthcare Centers without a health specialty or regional area requirement. Additionally, OCHIN is the only Epic Connect accredited vendor, which signifies that they follow and implement the EHR system in line with intended best practices, that the County qualifies for, as it does not meet the requirements of other accredited vendors.
Additionally, today’s action requests the Board authorize applications and acceptance of additional funding opportunities to support the implementation, maintenance, and operationalization of an electronic health record system.
Today’s item supports the County vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as the ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished by improving the service delivery system by implementing electronic health records, removing barriers to health portability and continuity of care, and utilizing resulting data to continually inform policies and procedures to reduce gaps in healthcare outcomes for vulnerable populations.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. In accordance with Board Policy A-87, Competitive Procurement, and Administrative Code Section 401, approve and authorize the Director, Department of Purchasing and Contracting, to enter into negotiations with OCHIN Inc., and subject to successful negotiations and determination of a fair and reasonable price, award a contract for the implementation, operation, and maintenance, and operationalization of Epic Systems Corporation’s electronic health record system across Health and Human Services Agency departments for an initial term of up to one year, with up to nine 1-year Options and up to an additional six months, if needed, subject to the availability of funds, and to amend the contract as required to reflect changes to services and funding allocations, subject to the approval of the Deputy Chief Administrative Officer, Health and Human Services Agency.
2. Authorize the Deputy Chief Administrative Officer, Health and Human Services Agency, or designee, to apply for and accept additional funding opportunities to support the implementation, maintenance, and operationalization of an electronic health record system.
EQUITY IMPACT STATEMENT
The use of OCHIN Inc.’s Epic Systems Corporation (Epic)-based electronic health record (EHR) within the County of San Diego (County) Health and Human Services Agency (HHSA) will support equitable delivery of public, medical, and health care services. The use of an EHR system promotes equity through an increased ability to conduct analyses and measure outcomes to identify differences by race, ethnicity, and place among other variables. This increased ability will inform policies and procedures aimed at addressing health outcomes among children, youth, adults, and seniors, including those who are Black, Indigenous, people of color, women, people with disabilities, immigrants, the LGBTQ community, and the economically disadvantaged.
SUSTAINABILITY IMPACT STATEMENT
Today’s action supports the County of San Diego (County) Sustainability Goal #2 to provide just and equitable access to County services and Goal #7 to reduce pollution and waste by demonstrating a reduction in consumption of resources through the use of OCHIN Inc.’s Epic Systems Corporation-based electronic health record (EHR).
Sustainability Goal #2 is achieved by bolstering the Health and Human Services Agency’s (HHSA) ability to deliver services to meet the immediate needs of individuals and families. Customer resiliency will be increased as they will be able to more easily bring their data with them to their chosen providers, ensuring a continuity of care in the services they receive.
Sustainability Goal #7 will be accomplished since HHSA operations will move away from a physical record system, reducing the amount of paper in use by the County. An EHR system will also reduce the mileage spent across the region as customers will have more flexibility in choosing the facilities they visit in addition to reducing the need to collect and/or transfer original records between County offices. Lastly, as retention periods for existing paper records come to maturity, the County facility footprint needed to store customer records will lessen as moving forward they will be digitally archived.
FISCAL IMPACT
Funds for this request are included in the Fiscal Year (FY) 2024-2026 Operational Plan in the Health and Human Services Agency. If approved, this request will result in estimated one-time costs and revenue of up to $3,700,00 in FY 2024-25 and $2,800,000 in FY 2025-26 for a total of $6,500,000. The funding sources are the Epidemiology and Laboratory Capacity Enhancing Detection Expansion Grant and any federal and State funding that might become available. There will be no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
The Health Services Advisory Board voted to support these recommendations, at its meeting on October 1st, 2024.
BACKGROUND
The Centers for Medicare and Medicaid Services has identified Electronic Health Records (EHR) as the “next step in the continued progress of healthcare that can strengthen the relationship between patients and clinicians. The data, and the timeliness and availability of it, will enable providers to make better decisions and provide better care.” Additionally, the United States Department of Health and Human Services, Office of Civil Rights, has issued a Notice of Proposed Rulemaking (NPRM), which amended the definition of health care operations to clarify the scope of care coordination and case management. The NPRM proposal defines care-coordination to include social services agencies, community-based organizations, housing, and community-based service providers, and similar third parties that provide or coordinate health-related service needs for care coordination and case management.
At the state level, the California Department of Health Care Services initiated Medi-Cal Transformation, formerly referred to as California Advancing and Innovating Medi-Cal. This initiative promotes an integrated care model of enhanced coordination, integration, and data sharing between managed care plans, physical healthcare settings, behavioral healthcare settings, community-based organizations, social services, and county agencies.
Given these drivers, the County of San Diego (County) Health and Human Services Agency (HHSA) has a comprehensive need for the Public Health Services (PHS) and Medical Care Services (MCS) departments to implement an electronic health record (EHR) system. An EHR system will enhance care coordination and is necessary for a wide range of services, including:
• Clinical Services,
• Home Visitations,
• Case Management,
• Skilled Nursing,
• Any new services established through San Diego Advancing and Innovating Medi-Cal (SDAIM), the local implementation of Medi-Cal Transformation, and
• Other services and programs identified by and within HHSA.
An EHR system will enable PHS, MCS, and other services and departments within HHSA to better respond to federal and State level requirements and establish integrated and longitudinal records to deliver coordinated, person-centered care and case management. Customers, County users, and external providers will benefit from an EHR system by establishing electronic health records and thereby increasing the capacity to coordinate and ensure continuity of care.
Based on data maintained by the PHS Public Health Preparedness and Response Branch, approximately 75% of regional health care systems are using or transitioning to an Epic Systems Corporation (Epic)-based EHR system, including the use of Epic’s CareEverywhere feature. It enables prompt interoperability by allowing Epic-based healthcare systems to access customer electronic health records from other Epic-based healthcare systems without any additional system integrations. Standardization using the Epic EHR system would minimize the lead time for the County to integrate with regional health care systems, reducing burdens for patients and providers when accessing electronic health information to receive and deliver care as desired by federal and State health care policy. This will result in widespread health information portability for County customers and providers, and providers-of-choice (e.g., primary care physicians). The inherent interoperability built into the Epic EHR system, along with the local market saturation, will allow the County to quickly shift focus to establishing integrations with the remaining quarter of health care systems that are not utilizing the Epic EHR system. In addition to the continuity of care via interoperability provided by standardization, the barrier to adoption will be significantly lowered for County staff, contractors, and partners who have existing familiarity with the system.
The Epic EHR system is requested through OCHIN Inc. (OCHIN) due to its unique knowledge, skill, and ability as the only Epic Connect partner that conducts third-party sales without a health specialty or regional area requirement. The Epic Connect accreditation is valuable to seek in a vendor as it signifies that they follow and implement the EHR system in line with intended best practices. The County would not otherwise have an Epic Connect accredited vendor to engage as it does not fit into the client profile of the others. OCHIN additionally is specially positioned to meet the needs of the County as an organization that focuses on Community Health Clinics, Federally Qualified Health Clinics, and Local Health Jurisdictions. This is especially important as HHSA is keenly aware of the impact and changes implementing an EHR system will have to customers, staff, and partners. HHSA looks to leverage OCHIN’s unique knowledge, skills, and ability to implement and operationalize the Epic EHR system inclusive of workflows, processes, and organizational change to best serve County customers.
Today’s action requests the San Diego County Board of Supervisors (Board) authorize a single-source contract with OCHIN for the procurement of Epic Systems Corporation’s EHR system in accordance with Board Policy A-87, Competitive Procurement, Sections D-3 and D-5, and Administrative Code Section 401. OCHIN, a third-party seller of the Epic EHR system, is selected due to their focus on Local Health Jurisdictions, like the County of San Diego, and community providers that are considered to be small-to-medium in size with a focus on ambulatory care whereas Epic engages directly with larger, full-scale healthcare systems. A Board Policy A-87 exception is requested due to the unique knowledge, skill, and ability OCHIN possesses and provides as the only Epic Connect Partner that acts as a third-party seller of the Epic EHR system to Local Health Jurisdictions, Community Health Centers, and Federally Qualified Healthcare Centers without a health specialty or regional area requirement. Additionally, OCHIN is the only Epic Connect accredited vendor, which signifies that they follow and implement the EHR system in line with intended best practices, that the County qualifies for, as it does not meet the requirements of other accredited vendors.
Additionally, today’s action requests the ability to apply for and accept additional funding opportunities to support the implementation, maintenance, and operationalization of an electronic health record system.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
The proposed action to procure the Epic System’s Corporation-based electronic health record system via OCHIN Inc. supports the regional vision of Live Well San Diego and aligns with the County of San Diego 2024-2029 Strategic Plan initiatives of Sustainability (Resiliency), Equity (Health), Empower (Workforce), and Community (Quality of Life) by the key discipline of Information Management in that it increases operational efficiency by using superior information technology systems to deliver County of San Diego programs and services.
Respectfully submitted,
ebony n. shelton
Chief Administrative Officer
ATTACHMENT(S)
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