They do not anticipate labor force changes. The nurse wills continue to be employed by the hospital if they are general surgery trained. The current surgeon wills continue to practice at other area hospitals. The an thesology Group Service wills continue to be provided for other surgical procedures st. Marys. And golden gate profusion wont be providing the services at st. Marys anymore, but they have contracts with other area hospitals as well. So in conclusion, despite st. Marys low surgical volume and a general trend in having min cally invasive technology, San Francisco has a growing older Adult Population and Cardiovascular Services will be increasingly more important. And, accumulation with the residual impacts like i said before of the closure and that the complexity of patients able to be seen by the remaining cardiologists at st. Marys may be impacted. And then finally, there will be an average of, as we said, at least 35 Cardiovascular Surgery patients annually who will no longer be able to choose st. Marys as a location of the complete cardiac care. So the closure of st. Marys Cardiovascular Surgery program is a reduction in services in San Francisco and for the aforementioned reasons, it will have a detrimental impact on the community. The memo that you ul a received included draft resolutions for the closure, but that concludes my comments on the issue. I will take any questions at this time. I did not receive any Public Comment requests for this item. Could we have st. Marys representatives speak to this issue . Thank you very much. And thanks to the commission. Really appreciate it, dr. Colfax and dr. Baba and appreciate secretary and claire lindsays assistance for a great presentation. We appreciate the confidence that enough st. Marys and saint francis. I am dr. David klein, the president of both. Saint francis for three years and st. Marys for three weeks, so im fairly new to the role at st. Marys, but i have been in touch with the plans for the closure through my leadership role in dignity health. I think that was a very nice outline of the pertinent fact, and i dont want to be repetitive, but i think a couple of points are worth repeating. Its been a tail of i a trigs at st. Marys. Of attrition at st. Marys. 12 years ago they were doing 1200 cases and was the leader in the market. And now we are down to this year looks like we will close the year with 15 heart surgeries. There is a number of reasons for it. One of them, of course, all the programs are seeing diminishments in the number of heart surgeries due to the new technology. Moving to a minimally invasive world, which is, in fact, better for patients in a lot of cases and the number of open procedures is decreasing. We currently only have three physicians that are practicing and doing open heart surgery at st. Marys. There has been a number of attempts to recruit more doctors in that role, and just not available as was pointed out. The number of cardiovascular surgeons are diminishing in the country as that surgery gives way to the minimally invasive techniques that are out there. And as a former surgeon, it is for such complicated surgery that required an integrated team with a lot of experience working together, the low volume as was mentioned does not support high quality. Even though the quality results have stood up with the test of time, as we see diminishment in the number of case, it is hard to maintain staff proficiency. This is a very well oiled machine and if they do one or two a nt mo, you can imagine it is hard for it to always come out the way we would like it to, so the optimal skills of our very experienced team is being challenged as our volumes drop. We plan to continue to be in the cardiac business and a robust cath lab and hybrid suite and those procedures can be done for the most part and proven nationally that you can go those procedures without an open heart program. We have arranged for an emergency transport to a number of institutions pointed out on the map including parnassis which is a few minutes down the road in the event that we need to have an emergency transferred. As was also mentioned, we anticipate no reduction in the f. T. E. S. All the employees that were working on the cardiac surgery because we had such low volume have other skills and other duties and have all been and will be reassigned to other areas in the hospital, so we see no reduction plan. And i think lastly and importantly, just the fact that we are asking for closure at this point doesnt preclude us in the feature if things change in the nature of the business changes where it makes sense, we can always adapt the technology and resume surgery in the future, but for right now we believe its in the best interest of the community and facility to terminate those procedures. Happy to answer any questions. Thank you. It is now in the hands of commissioners. Commissioners, questions . There was no Public Comment . There was no Public Comment on this item. Commissioner green. Yes. I do have a few questions. Thank you for your information. Have you seen an increase in the number of with the number of case that was dropped . What is your standoff doing to increase the uptake of the noninvasive. I cant speak to st. Marys directly as to whether they have seen a volume increase and i can speak nationally the number of minimally invasive procedures have increased. I think that probably realistically we will see a slight decrease in the Cath Lab Procedures because there are some physicians who feel they may need an open heart team to pack them up and we are anticipating some decrease in the complicated Cath Lab Procedures as we close the program. That is a great question. If i am understanding this correctly t cardiac surgeons have prifr ledges in other hospitals. They do. And is there a plan to enable the cardiologists to do the same . In other words, to be able to have the continuity of a team even in different hospital sites and there seems to be enough room to absorb the patient volume that you would have to transfer. Is that true . Also a great question. I think in the cardiac surgeon, they have privileges elsewhere and wouldnt be able to with the amount of business they do at st. Marys. I think many of the cardiologists do follow patients and have privileges, but i think there might be some gaps, and we certainly would have those discussions as to if they would like to follow the patients and need to have privileges, particularly at the centers we will be transferring patients to. I think that is important. One other question. When i was looking at the data, the last time they did the complication rates and the publication was 2016 and you have had a halving of the number of cases since 2016. Do you have any updated data . Is a surgeon knowing about volume and with the complications and with the minimal volume. I can. I will have to come back on august 6 with the actual data from st. Marys. I am not aware of a big shift of quality concerns. I think we have a good team, but i think as we persist with lower and lower volumes, i think that is a real question. I will try to get you the exact numbers when we come back. Thank you, commissioner. And first one follow up on the cardiologists. And you say the cardiologists use your hospital and use the cardiac lab and anticipate the immediate for cardiac surgery sometimes and really do have privileges at the other hospitals . We certainly can. As you look at what is left in San Francisco, there is actually only one other private hospital, and i assume that staff who made this really meant pernassis or only mission bay that is doing card i cant go surgery. It is both. Its both. They do open heart surgery. Its both. Lets clarify that in the document because otherwise it sounds like there is even less. Kazer is not available to the kaiser is open to commercial cases. Are you aware of this . I think in emergency situation, obviously if a patient is having an acute m. I. Or a heart attack, they can go to kaiser and from a transfer standpoint, that is not the case because they tend to be restricted to their patients in their but we are not at all sure and it might be an emergency and then they would need to actually be either out of network because the nonkaiser patient would be out of network. That is exactly right. Any emergency, every hospital, every general hospital, has to care for a patient in an emergency whether they are in network or out of network. Yes, i understand. An i think in the situation of st. Marys we are closest to the ucsf pernassis campus. An i think we should in terms of information and the severity of this change actually have that from our staff and in terms of what actually happens in this case. Very similar to other cases in which we have talked about out of Network Hospitals because now were limited to only, you know, facilities that certain commercial programs may not, in fact, be in network. And can we then assure that these people are not hurt . If they are, then this could be added information concerning adversity of closing the unit. I am very saddened that going from 1200 because i was part of watching and being part of participating and having our patients from our different my own affiliated plans really use st. Marys. And before you got there, i am sure you knew that a world Status Program was created, which also included actually assisting the city of shanghai in part of its cardiac work. And to watch this program then as you say decline so, it used to be the top and i am glad you brought that out. I think we should note that. That st. Marys had a premier program and that this closure is really tragic if it is going to be occurring because for whatever reason, we have lost that opportunity. I am also troubled by one of our physicians who have written in public testimony to us concerning and that goes with this cardiology problem, but he also brings up an important issue. Dr. Chan who then submitted to us a letter indicating that his letters from china town have been triaged to st. Marys because people find him as the cardiologist that they can approach and trust within their ethnicity and language capacity. And he and i certainly know that his colleagues. They have used st. Marys and at this point you see about 47 of the asians. I am concerned how the asian population will then receive that same treatment. Can our staff find out cpmc or kaiser is going to accept them . Or anyway, i think thats another negative. Sadly, for whatever reason, st. Marys has been unable to grow the volume to where its needed. I dont question your ability or i mean your data, of course, and in terms of higher volume creating Better Outcomes and is commendable that has not occurred at st. Marys, or that, in fact, you have been able to achieve the continuation of a superb program. That makes it even more difficult to say that you are closing. Yes, sir. Commissioner i think most of these are questions for staff to try to clarify. I think you would probably also and the increase of noninvasive, because even pcca is invasive, but certainly, a decrease of the use of cardiac surgely andpy pass in terms of the well, for cardiac disease that while that has occurred and may be increasing, it really according to the data has not been a decrease of morbidity but increase in quality of life that has actually brought that. That is correct. And when, in fact, we were looking or need to look at the question of quality, of trying to look at improvement in mortality, cardiac surgery is still a problem. And we point out very well we will have a shortage of cardiac surgery science and then cardiac surgeons and which may be one of the reasons that you are having problems and i think we need to note not that the newer techniques as replacing this and we have to put that balance back in in our document. Great. Director, does that make any sense . The emphasis i am trying to lay here, and i understand the Business Case that you are offering. It is very sad to hear that. But i think then this also calls for us to be much more vigilant about this problem. Lastly, i thought it would be important to quantify what the remaining facility do have with Services Available and the capacity to accept even 30 patients more per year. And we have heard about the o. B. Problems already throughout the city. And i think it would be good to have documentation for that because as we go into the future, this would be helpful in understanding and another one of the needs of the city. And the procedures and acute versus planned. With the presence in San Francisco, it is possible that some of the cases are going to another center of excellence in the region. And so i would be curious and as we look at how much capacity we need in San Francisco proper and i think we need to focus on those who might need the surgery acutely because that feeds into the transports to other hospitals and the whole cascade of changing teams and availability of the actual procedures. The other question i had is, have you analyzed at all its more than just the operating room and is also the Supportive Care after surgery and the postop care. You are really talking about much larger team of individuals to have positive outcomes. Have you thought about that. Ok. The second hearing today is about the closure of the spine center so, i do want to say that before i begin to note that, due to the recent alignment between the health and Catholic Health initiatives the California Attorney general is required to review and approve the closure of the spine center and so when saint marys submits the letter requesting the attorney general review, the attorney general will have 90 days to review and decide whether or not they approve of the closure. So, because of the attorney general timeline, the spine center will likely be closing after july 31st. Saint marys will keep staff and the commission abreast of any updates to that timeline about the closure. So, the spine center, like i said earlier, is a licensed clinical Outpatient Clinic and it function as a joint operation between dignity, Saint Marys Medical Center and the San Francisco spine Surgeons Group and ill probably refer to them as the group as we go on. So the group is a single physician practice that is made up of four Healthcare Providers and they specialize in the treatment of spine disorders and orthopedic surgery. The spine center is located at Saint Marys Medical Center in suite 450. The spine center averages 1800 individual patients a year and their Services Include less invasive treatments like exercise, manual manipulation, nutritional counseling to minutially treatments and spine surgery. So here is some information on patient demographics of the spine center. The majority of patients have commercial insurance followed by medicare. Medical is less than 1 of the Patient Population thats seen at the spine center. 43 of the spine Center Patients are between 41 and 65 and 38 are age 65 and above. So in late 2018, saint marys organized discussions with the San Francisco spine Surgeons Group to adjust the current staffing so that the spine center itself operated like a traditional hospital out patient clinic and prior to this, these conversations, the s. F. Spine group provided all of the Physician Services and then half of all non Physician Services so that left saint maries to utilize Hospital Administration for the other half of the clinic. And they node fight they would open a clinic. The location has moved, its a private clinic its moved from suite 450 to suite 600 at 1 shader street. Both saint maries and the San Francisco spine group dont anticipate any interruption or change in Heath Care Services provided to current or featured patients of the spine center. Specifically the group has confirmed that theyre going to be carrying over the same insurance contracts and they will continue to accept patients from their current payer mix which includes medical. They will maintain Emergency Department call coverage and the group will also provide outpatient Spine Services to their existing patients and maintain the same volume seen at the spine center. As i just mentioned, its not anticipated that this closure will have an impact on patients and there will not be an interruption in services nor the type or amount of services that are provided. The labor impact is not known yet. The spine center has not shared whether or not theyre going to be retaining all of the saint marys employees as administrative staff in the new clinic office. So, st. Johns marys said theyy mitigate and layoff. So in conclusion, should the sf spine group maintain the level of care provided through the spine center currently at their new clinic and should saint marys reassign any impacted employees in mitigate any layoffs then this closure should not have a detrimental impact on the community of San Francisco. That concludes my comments on that. Any comments . I think that was nicely summarized. This is different than the cardiac Surgery Program if that services arent going to change. Were sitting from a hospital operated to a private group. We did attempt to recruit some neuro surgeons from ucsf but as we look at it it makes sense to just leave it in the hands of the surgeons that have been carrying for these patients for years. As also, the closure date as isa little bit fussy, its a 90day process. Were finding in other hospitals it could take up to six months so it will take a while. Regardless of how they determine i meant the intent to the prop q hearings and well keep the commission informed of any changes or updates to the closure as they occur. Glad to answer any questions. Any Public Comment . No Public Comment for this item. Its in the hands of the commission. Dr. Green. The spine center has a stellar reputation and for giving multi disciplinary care for people with back pain. We have the issue with pain and pan management from everything i know theyve done an excellent job dealing with the Opioid Crisis issues and helping people deal with back issues in non medicine case. Theyre enhanced in this new setting and resources and said this private group would not hold them back from expanding the services and continuing to give this multi disciplinary care. I agree. The care could actually improve. Its care. Yes. Dr. Chung. Yes, thank you. I appreciate the clarity of the presentation. Its all different from when weve had other hospitals coming and they had a service which was fully hospital controlled and then moved it on. Nevertheless, i think when we asked that there be a followup it would be appropriate to have a followup to be sure that the allege lack of reduction of services and availability, i mean, that the promise to say they will continue to accept the same patients theyve always had and such access is available actually has occurred. Granted that since we dont know when the a. G. Will, if it does, approve your changed, it would be something we probably need to put into be contingent upon if such changes would occur. Its more problematic because you have a set of employees and i guess the best we can do here, if staff is suggesting if there werent an impact on staff, then from their point of view, this would not be detrimental because all these services would remain valuable. Im wondering, within the timeframe or is it that saint marys would continue to perhaps send some sort of report also at the time this occurs as to what happened to staff so that if we were doing a sort of it is not detrimental contingent the way its stated this would be a followup saying that, well, this is actually what has happened. Were happy to do that. We have five impacted employees. Originally i think it was stated as six but one position was reduced in 2017. Of the five, two have been given positions at our raidology department. Throw of them and theyre waiting to determine, what the spine group will utilize them. I feel confident they will need staff to run that office. Right now they havent made the staffing decisions but we have three and theyre in the balance and we will be glad to give you a followup on what happens with them. So, what would be the best way to handle this . I was wondering when you come back will you have a better sense . We might. It will be a month and we might have a better idea of their Operational Plan and well report on that at that time. Thank you. Thank you. Mrs. Lindsey, do you have anything you want to add to your report . No, thats it. Thank you, very much. Thank you, everyone. Item 8 is the laguna hospital gifts fund budget. This is an action item. You will approve the budget for the fiscal year 1920. Im the Program Director for the Program Manager for the laguna hospital. I appreciate the opportunity to address you today. I want to give thanks to mark norwits for getting me here today. La gina honda hospital seeks the 20192020 gift fund budget. Laguna honda hospital proposes a budget totaling 426,170 to support programs and 15 programming categories. The cover memo to this agenda item the gift fund balance was 2 million 2. 77 million with a year to date expenditures of 252,500 as of january 27th. Those totals will change slightly as we close the books on fiscal year 1819. Our approach to budgeting is to aim high so we have have flexibility and meet the needs of our residents. However, we maintain mindfulness and we maintain financial stewardship of this valuable resource. And i wish to take my direction from you as the information you require or what you are most interested. Any Public Comment . No Public Comment requested. Its in the hands of the commission. Commissioners please. Thank you. The year to date is actually the full fiscal year to june 30th so a number of these items were not fully expended. Thats correct. And so is there some reason that youve maintained the level that you think theyre at . I mean there were reasons that you believe those programs need that much allocations and are there any new programs you all considered and did or did not well, you obviously didnt fund them because theyre not in here. No new programs. We have some of the challenges that we face in expending the budget fully. And are also opportunities for i improvement. We have the implementation of people soft. We were unable to access funds until after august 24th this past fiscal year because of a budget rollover maneuver. Another element is the friends of la gon laguna honda have chad their modes. Instead of paying for services and materials directly they have made donations to the gift fund. Because of the extent, we have to get a board of supervisors approval and we go the extra mile by getting your approval before we do that. Some of these programs are going to be a carry over such as in memory care. Were looking to work on a Music Program that will enhance cognitive function and memory in our dementia residents. Our Technology Programs we are taking that over into the new fiscal year and some of the things that were working on, some of the challenges that were facing with that is Program Management or account management, we have several ipads at the hospital available for resident use but to manage those accounts has been piecemeal in the past and were seeing if we can get a comprehensive approach to that. Centers of excellence wish list shows b that we meet halfway on that. Bit end, when the books are closed, well finish off at about 35,000 expenditure for that. There was one piece of equipment on our wish list which was over 10,000 and that is forcing us to take that into Capital Equipment process. Those are some of the challenges that we face. Again, we do shoot high, in case we need to the needs a arrive. Some of the programs i want to point out to you and the endoflife care, we developed programs over the past year. That is a transportation assistance program. We would allow a resident at the end of life, if they wish to, to return to their Home Community outside of the bay area to pass or they could have a Family Member come to San Francisco to be with them at the end of life. We also started a program this year to provide cremation assistance to a resident who dont have the means to pay for burial. In this past year, we didnt have the opportunity the need did not come but we still budget for that in case it does. I home im explaining myself well. I think i understand. You actually have developed these programs and theyre fully funded last year and you are asking that these be continued to be funded because were going to educate the reasons why it took a while to get some of them started. You would like to be able to continue these programs that have been ready for action. The nature of the gift is considered a continuing fund its not an appropriated fund so its always there and its that pot of money thats always there. Our expenditures over the past five years have risen by my calculations 43 . A little bit skewed this year because of the influx of money that came from the friends of laguna honda. The Previous Year 1518, the increase has been 25 . We are diligent at spending the money to benefit our residents and were increasing that commitment and we look forward to continuing that process. Im done with questions. Commissioners. Commissioner grown many of. Thank you. Im really curious if you have a sense of which of these programs you think have the greatest impact on residents or perhaps those in which more residents participate. Is there a relationship between the budget and the number of residents that really benefit from the programs . Are there any that you really would prioritize as the most effective top programs that improved the call o quality of r the residents . The programs that are most impactful on the residents are the active therapy programs. I want you to keep in mind that these are programs above and beyond what the department usually provides because they have been operating funds. So i think those programs reach more residents. I also think that the special foods is another program that is enjoyed by the residents and impact quite a few. Some of the programs i want to point out to you are contracted programs. They have a long history and laguna honda hospital its not an art therapy program, its an art experience program and its a wonderful presence there at the hospital and we always look to expand resident participation there and one of the newer programs that we have is we feel like its cutting edge is the medical Clown Program and its all about Receipt Department engagement so we have clowns come to engage our residents to bring them out and can have them engage. I hope im answering your question as far as those are the ones that i believe that are impactful. Certainly, again, going back to the activity therapy programs, the community doubting programs and i think are very important and i know that department strives to make sure that residents have good opportunities to get out. So its not just a few. Its as many as possible that are able to get out to the community. Thank you, very much. The one that we over spent on in the rehabilitation program. We went over budget there. I may have discussed with you last year or at least you may remember donation from a private citizen of 180,000 for assisted technology. This provides technology, ipads, other forms of technology to residents specifically the most disabled residents that we have so they can have a greater control over there environment. The first year or two, we struggled because were taking the opportunity that was presented to us and trying to create an infrastructure and i am quite proud of what were able to do this past year. With that, weve got a lot of equipment in the hands of residents and its making a big difference to them. Weve tried to be as lean as possible and that is one program that im especially proud of of our accomplishments there. Thank you for your presentation. Twopart question, first of all, you talked about how your budget aims high as aspirational and you mentioned some of the challenges and the barriers that you have in making those expenditures. The first question is that consistent over the years that youve had sort of this difference between the budgeted amount and your expenditures and the second part would be are there any things that can be done to help remove the barriers or charge thats you could be facing and delivering these as budgeted . I believe that we have consistently come in well under budget over the years but weve always maintained that approach. So we dont necessarily are procedure indicates that anything that is unbudgeted we need to com come back to you. Thats why we aim high. I cant think of anything in forecast we have our everyday challenges, again, people soft has been a challenge and new funding approach with the friends of laguna honda. I cant think of anything that would contribute and that we already dont know and we need to improve on and we welcome to you come to laguna honda. We have a meeting every month on the third friday and we would love to have you. We would love you be part of the process and ask questions there. Thank you. Did i answer your question . Thank you. Commissioners, if there are no other questions, theres a motion to adopt and approve of the request for administration of laguna honda gift fund is in order. So moved. Second. All those in favor signify by saying aye. Aye. Thank you, very much. Thank you, everyone. Item 9 and ill note there was no Public Comment request. Number nine is dph it and epic project update. Good afternoon, im so happy this afternoon to say that i am no longer the acting c. I. O. Im delighted to welcome eric as our new c. I. O. Im looking forward to personally helping him on his journey and seeing his vision go forward as i know all of i. T. Does. Welcome to you. So i want to start out with our where we are with epic and im very happy today to be able to present this because we actually have good news for you. To start out with, our i. T. Accomplishments and in terms of what i reported to you our average network time for 2019 is at 99. 98 of the time. We have updates on these device roll outs so weve been deploying our goal is to have actually now were at 4,755 devices that we will roll out in preparation for epic. We currently have 4,565, roughly about 190 left to do and they were delayed in delivery and those are going out for laguna honda and well complete those this week. Were completing our roll out of devices by the end of this week and also our testing. So just to give you a taste of what the testing is, its every single end point its in the department of publichealth that will talk to epic whether its a printer, work station, bar code scanner or scanner so we have scenarioses 2 to test those ande have tested over 44,000 scripts on those devices over the last few months to make sure theyre going to work in preparation for epic. We also rolled out our service now which is our new ticketing system that is robust enough to handle the epic ticketing when we go live. It gives our staff a lot better in sight into the tickets and management of them. So our timeline, which youve been seeing all along, we did have some delays of our configuration. We did have some delays of our integrated testing. Our training remained on track and continues to be on track and will wrapup at the end of this week. I do want to point out the blue stabilization bar. We will be in a stabilization period from the go live until the end of december. We will be making anything that involves safety or regulatory changes during that time period and we have two epic upgrades to do. So its important time that we all reflect and look at how were using the system before we begin optimization of epic. So some of the accomplishments over 24,000 configuration changes to make it unique for d. P. H. To function the way we node to. During our direction setting we made almost 2,000 decisions, 120 interfaces in and out of epic and during our testing we identified 2100 problems we corrected in preparation of being 100 ready and we have 18 days to go live. I did tell you we would make august 3rd and we will make august 3rd. Our training, justify to give you a taste of this, as of july 8th, we had trained 6,827 out of a total of 7,297 and you may say i thought you had 10,000 people to train and as you duplicated our u credit sf staff they were 7,297. We have more than one class so you see the total of 9,206 classes and a pre wreck what sit is that they do elearnings and there are 97,000elearnings as of july 8th. The Training Team really accomplished this in the time they needed through some significant hurdles. So thank you to eric shaffer. Key activities, status, this is the part im happy to report on because i had to tell you, last time we were a little behind. So i will say what our current outgoing epic Program Director said which is its nail biting when you have a team who is the Fourth Quarter team. Our team really rallied and we finished these up. We finished up our configuration. Our testing was done and our training is on target. Interfaces are all tested and infrastructure you see were completing bit 19th of this month and nile biting but were there and go live is still on august 3rd. Our contract and budgeting, i reported yellow 100 of the time because were diligently monitoring our contracts and i want to manage those consultant dollars. So our go live will have a hub and pub model of command centers. I. T. Will be the hub and well have a command center and am bough lar tory so with the exception of revenue cycle, these are 24 hour command centers. Were looking at going 24 7 the first two weeks and well evaluate the tickets and the volume of tickets to determine if we can start to scale down, however, we are prepared to step all the way through the month of august. In our command centers, we have a set time that well be doing communications, communication lines that are open and we have a Patient Safety coordinators that each of the command centers as well as in the i. T. Command centers and theres specific k. P. I. S theyll be looking for and a Patient Safety dashboard theyll be looking for to help monitor them. Were going live on august 3rd but were starting early. On july 20th, were over that weekend, its a saturday, our staff will come in and we begin to do entry into epic for our future appointments after augus. 70 of the future appointments we were able to automate but the 30 need interpretation from the people that are doing the appointments and so theyre coming in which is great practice for them because come monday, every patient who needs an appointment, those people will put those appointments in epic. Were actually a live on appointments. Yeah, and for laguna honda we begin the back load of their inhouse patients pulling data out of our system so they can enter medications and along with orders and allergies and things like that that they need to have in their epic instance when we go live. We start the back load for sucker burg on august 2nd for all of their inhouse patients and then august 3rd at 12 00 a. M. , well flip those third party, 120 interfaces in and out of epic over from the previous systems into epic. Well be validating those and validating everything is back loaded to our final safety checks and if all goes well, well go live at 7 00 a. M. On august 3rd. Were doing a dry run of that. How long it takes for people to enter the data of doing the chart ab traction so w abstract. But right now thats our timeframe. So, i wanted to give you a sam sampling of the k. P. I. And dashboard for Patient Safety and just sort of a. Our leadership was asked what they want as a benefit and what benefit do they want to realize implementing epic. We have done some baselining on these with our count systems and well be comparing when we go live on epic how were doing on these metrics over time. At this point, im going to ask rolland to talk about to preparing for future. This is a transformational in d. P. H. And how are we doing, rolland . Good afternoon. Were doing fine. Were great. So, as you remember, when we started the discussion about moving towards a new e. H. R. Six years ago, we did our Due Diligence and spoke to many of the organizations that have gone before us like ucsf and several of the other institutions in the city and they all said the same thing. Make sure you structure this so its not an i. T. Project but one of operations of the clinical enterprise and thats exactly what weve done. So to that extent, this slide really represents a recent safety. Recently, we did a work flow walk through event at zuckerberg where we have that first opportunity to show extravaganza what working in the epic environment would look like. Doing this epic work flow walk through, dr. Jeff critchfield, who many of you know, memorialized experiences when he reflected on the story about his 105yearold grandmother at the celebration of her latest birthday. At that event, she shared with her guest about the time her whole small town gathered to see the first airplane fly over the town. And she described it as they all stood there together at the small light went across the sky. And so the doctor like end this epic walk through to her experience that were all standing together as the d. P. H. Team watching the future of epic fly right before us. While our staff is anxious about the implementations, they also have remained very excited through this whole process and so were really looking forward to a successful operational implementation of epic projects. Thank you. I have one last person who is extremely important to not only our implementation now as he observes that and participates and i went to interest our new epic Program Director. We have chad who has been with us a year but he is a contractor so im delighted to say we have a permanent director and he is many years doing epic implementation so i want to welcome him. Thats the conclusion of my presentation. Do you have questions for me . Any Public Comment . I have not received any requests. Before we put it in the hands i want to thank you for the service as a c. I. O. For zuckerberg. We know doing two jobs can be a real challenge and you did them and you did them well. Thank you, very much. [applause] commissioners i am wondering, i think the benefit realization metrics is really neat. Is that kind of a score card for the future to see what is happening and what efficiencies and savings we are reaching . If so, im trying to figure out which ones are clinically orient and which ones are cost oriented and versus what is good Patient Experience and is that how you chose these. I want to be clear i did not chose them theyre chosen by leadership but these are not the only metrics that were looking at. When you look to the screen prior to that, when we talked about monitoring success, there are a lot of Key Performance indicators that the hospitals have chosen that theyre going to monitor overtime and they are more safety oriented as well as organizational efficiency. While some of these benefits realizations look a little heavy on the revenue side, there are many other metrics that were looking at. All right. So that leads to the question of the followup, in terms of as we go live and it becomes a reality, what would be you anticipate would be the next report that we would receive. You are scheduled to have a report in september. So that you will see how did we actually doing during live. Even with all this preparation what happened to us during live with our organization being ready from our training. I did want to mention too when we do the roll out here when we go live, we will have Something Like 383 super users that are deployed and we have another 300 or so, 308 at the elbow which are contractors that come in and help organizations go live and assist at the elbow so theyre help us. Despite all this preparations, we still need to report back to you what was the experience like and how did it go and what are we doing on our next wave . Ok. Thank you. I look forward to that. Thank you. Any other questions . Congratulations on this massive undertaking in the way youve really come up from behind and made this a reality. This is a remarkable accomplishment. Very, very impressive echoing what the commissioner said about us understanding better the metrics that you will focus on and the timetable for the medicine tricks, providing a productivity will fall before it rises and i wonder if in addition to giving us a report, we can get a time table for the Research Building and the expectation and get the metrics and get this data and have a volume of date and share them and i think dividing clinical from financial would also be very helpful. So, we will net that and look at the metrics and from their perspective and we can bring this back and show you what was base lined and some of these are happening pretty real time around safety. A lot of it will be overtime. It will be monitoring that and trying to do improvements. Yes, there may be. We scheduled for that. Its very minor in terms of the provider the expectation pretty much is well be back. Theyre automated right now. Most providers are using a system today. Thank you. Mr. Chow. I have a followup but commissioner green reminded us theres a huge task behind this. You have shown that your timetable has stayed right on the target as she said, you know, we come from behind but weve done actually even better by taking our time and were really merging this as part of the culture rather than just imposing an i. T. Solution upon practice which seems to be what wove done with private practice, right. This sounds like its going to be quite different. I do think that we need to think of a way of measuring the remaining costs. Where have we been. How much we primed w promised we going to be using. How much money is in the allocated budget for the whole i. T. Project which i think was over a 10year program so now that weve got this will done, just like following bond issues we should follow how well were doing. Having a look at cost and projection over the life of the contract. I just wanted to join my colleague thanking you. Youve been a fixture here since i joined the commissioner and its been a ride. Im getting goose bumps thinking about august 3rd coming up and while our next commissioner meeting is too early to get up dates. Thank you for everything. We really loved having you and welcome to jeff and jeff to join the team. Thank you for everything. Thank you so much. Its been great hearing for you regularly as we