Transcripts For SFGTV Health 20240704

To prepare our hospital and team for successful recertification. Our goal is to apply for and secure recertification before the september 19th date. We continue to make strides in making the nez changes in cms program. The 90 day cms survey number 3 took place in june of this year and resulted in 33 findings of noncompliance this is significant improvement from the first survey in November December of last year had 124 findings of insufficient operations. Our goal is to have all action plan mile stones completed by september first. So that laguna honda is recertification ready. That includes all mile stones related to the Monitoring Survey number throw. And mile stones related to nonmonitorings survey statements of deficiencies 2567s this are routinely received due to regular operations. The action plans for Monitoring Survey 3 has 290 mile stones. And the proposed action plan for nonmonterror findings has 85 file stones. Those are proposed as we are waiting final approval from cms they have not begin us comments asking you to make minor corrections to our first submission which we are submitting and hope to have approval. We started working on the mile stones in anticipation they will be approved. All of the mile stones are under way. Also Important Note they build on all improvements going back to survey number one of the analysis done in january in the initial 5 huh human mile stones that came over the last 6 months. Again our goal is to have all mile stones completed by september first so laguna honda is ready for recertification. On behalf of the team work at laguna honda i thank you, commission for your support over the last year. We could not have been in a place today without your support and advocacy. Let me know the appropriate time and happy to answer questions related this resolution. Thank you. We do need a motion to approve and like to yield to the chair of the laguna honda hospital joint committee who may want to move the resolution. I appreciate that president bernal come i would like to move approval of the resolution. To apply for recertification for laguna honda. Second. Secretary, Public Comment. Is there Public Comment in the room . Any folks on the line . Press star 3. I want to know that we had audio problem and is will ask the commission to do general Public Comment in a later time so the folks on the line have an opportunity on this and the minutes. So jeanette, unmute the caller. [inaudible] can you hear me . Yes. I hoped you will go back to the start of the agenda. This is item 5. Way out of order. The second to the last further resolve clause submits proposed resolution. There is concern. When it says the Commission Approves the laguna honda [inaudible] recertified a dual certified to [inaudible] and [inaudible]. This commission should explain publicly how a dual certified [inaudible] nursing facility may be different from a part and or as a distinct part [inaudible]. Laguna hondas state license is for 759 beds Skilled Nursing facility. Well, laguna honda submit the application for recertification immediately after adoption of this resolution today . Alternatively, will we have [inaudible] submitted by september first . Or will it have to be submitted after the expected fourth, 90 day Monitoring Survey that is askeded for september . In either case, this commission should tell the public today when the actual plan date is application will will you believe submitted. Is there a plan to split [inaudible] versus nursing facility care at laguna honda . Or use laguna honda [inaudible] or non[inaudible] and nonnursing facility purposes . Is there still a plan to put the [inaudible] parent cohort one laguna honda parent in the [inaudible] Behavioral Health cohort in the second patient [inaudible]. We need answers to these questions before you vote passing this resolution and return to the published Meeting Agenda im shocked you are taking it so out of order. And other members of the public may not be aware of this switcharoo with the agenda. That was the only handum. Is there someone else on the line . Do we have questions for mr. Pickens . Commissioner guillermo. I want to be on record in commending mr. Pickens and the laguna honda hospital staff and management for getting us to the point where we are able to apply for recertification. And in a timely fashion to meet the concerns about funding and relocation, so but you know having said that, i do want to make sure that we you understand how supportive we have been. Of all of the efforts over a year now. And for the staff that we dont get to see. How hard they worked and how difficult it has been in the circumstances. Again, support the application for recertification. And wish you the best luck in preparing it. Thank you. In commissioner chow. Yes. Thank you, mr. Pickens for all the work you have done over the years and i think it has shown not from the number of mile stones the severity of the citations from the surveys. If i recall the first had a large number that was really in the must do category. And now it looks like may be there is only one or 2 out of the 30 some odd surveys. See that the efforts that you put in over this period of time have shown itself now. In the duplicative survey process for number one and three to be really positive to allow us to mutual forward on the resolution. We know that the time that will take order to i think you referred to the application already sort of created and now you are all really please federal we get a sign off from the feds that your corrective action plans are acceptable. Which sounds like you feel it will be what we will be applying before the september 19th deadline. I do think that perhaps we should understand. Because this is a complex series of well resolve each look like we are not just asking for recertification but recognition on medicaid and medicare and whether well be a distinct part. Perhaps you can explain when well need to do to get us become to where we were in next for that question. We are applying to make laguna honda whole. As if it were before the decertification happened. The snf is a part Skilled Nursing facility the nf is nursing facility. Within the medicaid world, there are people who have Skilled Nursing needs and there are people who have nursing needs that are not skilled who are known as custodial and people who may have had the needs when first admitted and then improved in function and no longer have the needs. Those are the ones who will discharge to the communities. Because we laguna honda is licensed as acute Care Hospital because of the 11 beds. Any Skilled Nursing level is being done as a part because of those acute care beds. If the beds not at laguna honda we could apply as a sniff or nif or both. Because we have aushg cute care we are applying as an acute Care Hospital. Acute Care Hospital section is not under the cloud. It remained acute carement. And thats why we dont apply for acute care. And that therefore, each are required in order to get us back to where we were. It does not speak to. The whole issue of numbers of beds that is a difference from licensure . Right. You said after we get the license back, well say, and of course it is all the beds we had. Absolutely. And then work on if the feds did not agree with that all the the new task, which is to see we get a restoration of the beds. Thats correct. Okay. This is the first step to get relicensed like we were before. And to have the right medicare and medicaid recognition so that we are where we were before the decertification. In anticipation of approval of this resolution, irrelevant it it is a statement of the commissions commitment to the residents at laguna honda and a statement of gratitude and pride in off the hard work that every one of the Staff Members at laguna honda has done. They approached everything mile stone and every new task with professionalism and that same commitment providing care to residents we could not be more will grateful to all of the staff to our Labor Union Partner and mr. Pickens. A long process and we are proud to cast our vote for this resolution. The resolution passs. Thank you, mr. Pickens. Apologize for the make up on the agenda. There have been 2 versions and the version people may have work off of was not in the same order we proceeded we will go back quickly to offer Public Comment. About this on the minutes and yes or no be approximately comment again. Anybody here in the chamber on the phone would like to comment first. On the minutes. Will take those. Comments and well move in general Public Comment. So. I see a hand for the minutes janet please. Thank you. Mr. More winds. The minutes are misleading. Mr. Pickens commented extensively on the july 18th meeting about the medical director recruitment. [inaudible] what pickens [inaudible] the Current Practice involved per time employment and duties for medical directors at other Skilled Nursing facilities that is complete nonsense. Pickens lacks real longterm Care Experience. Laguna honda is not a hundred bed typical nursing home. Uniquely complex. 780 bed facility. Comparing other n will not enlighten pickens about the medical director po vision should be a full time job. The roll problems. Needing over do [inaudible]. Deserves a Board Certified medical director who will have a strong [inaudible] parents and for compliance. Rather than a mindless find someone with back fwround and experience to handle that provision. They will be starting [inaudible]. Pickens play book limited initial page. Disappointing but not surprising all laguna honda longterm Care Medicine are member and manager and [inaudible] in a Skilled Nursing facility. Without having. Time is up. Now general Public Comment for anyone who missed the opportunity. Unmute. Thank you. During the Public Comment on the direction [inaudible] not on todays agenda. Dont cut me off. During past meetings pickens stated an other will [inaudible] and or Sf Health Network are conducting a study expanding blafrl health in San Francisco. Is that working Group Meetings open to the public . How often do they mead if they are not Public Meetings why not. For pickens to statements during Commission Open session meetings, that work group is reportedly [inaudible] and considering whether or not to use space at laguna honda hospital by placing separate cohorts in laguna hondas 2 patient [inaudible]. Traditional patient in one tower and behavioral healing parents in the other. Is that plot still being considered . Actively . Is that work group issued a report yet . Will a report be presented in open session to the Health Commission or to some other Health Commission subcommittee. What other governing body within the Health Commission is the sponsor of that study and when will the public find out about it . After . You rearrange beds on the titanic . And beds at laguna honda. You need to come clean with this, commissioners. And im talk to youing commissioner bernal. Thank you. Please mute. Thats only Public Comment. Back on track with the agenda we will go to the directors report we have naveena bobba. Thank you. Good afternoon, commissioners. Naveena bobba. I will highlight a couple items in the directors report one i want to highlight the fact that the home health has licensing [inaudible] during it. It was a survey done over 7 days. There were only 3 minor deficiency found. A tribute to home health program. And they were commended for the ability to meet the needs of patients throughout the pandemic. Supporting patient who is had limited resource. And another item that was related that was not mentioned the [inaudible] had a revisit from cms as you recall. Came out a couple months ago and this was a follow up survey. They got an excellent recommendation. And relicensing resurvey from cms. Congratulations to those and steams. The other thing i wanted to call attention to is that our Population Health division is working with a fill mg and culture product to produce a Short Documentary about the covid pregnancy. This focuses on the community efforts. I saw preview of this and it was wornful to see all the commune out as well as to seat documentary and see again relive that experience the Community Coming together to protect those that were impacted by covid this is the official launch of this film and will be 3 screenings throughout san pran and urge people to see it. Really to support the community and cell brit and the work they have done. The other itemil talk about the sfg got a star from cms. This is something to celebrate. Achieving an extra star is hard for safety net hospitals to do. Because they are not as well funded and patients are very complex. They managed do this by highlighting several things they are done, including lower than upon expected death rates including the hospital that handles high vol um patients. And the Care Experience exceptional. And it is above the means for clean liness and recommend it as a hospital. Care scored better not that National Mean for low infection rate and reduced spread of infection and care with almost 99. 9 of staff vaccinated for covid and the ability to keep staff Health Employment toed congratulate the team. It was a well deserved star and really grateful to the work they do. I will end the report with a covid update. Im sure you are seen that there is a [inaudible] up tick a local up tick. In wastewater results. Our will team does montort sure virus Alert Network and seen increase rates the rates are lower than when we had seen prior. However issue given this during the summer people are garth and more travel wore getting the message out if you have not got your booster you should do so much those over 65 may be also eli didnt believe for a sect booster they should check. And maintain some of if you are concerned about corid maintain when we talked about throughout the pandemic masking and if you are vulnerable. May be avoiding crowded areas and if you get sick are eligible talking to doctor about medications. So happy to answer questions. Secretary, do we are Public Comment. We are on item 40 directors report. I see a hand. Unmute the caller. Excuse me. Sorry. The directors report just presented stated in background file posted line. 90 day Monitoring Survey and another nonMonitoring Survey. Conduct in the june. 290 additional Monitoring Survey mile stones and 85 nonmonitor mile stones the total a combined 375 additional mile stones. After may 13th deadline of the in the now 1 mont period, between today august first and september first. This does not bode well for the recertification application being submitted to in time in the summer and end quote. If it ran promised for a long time. I noticed the application has not been submitted by temperatured during this june 20 meeting picken stated laguna honda had initial low 220 mile stones which [inaudible] over 520 mile stones. By the time all mile stones would robbery completed by may 13th. Now laguna honda almost 400 more mile stones [inaudible]. Important andly, demonstrate the mile stones are release the root cause for port 5 and 6. After all. The two ies 6 monitor report dated july 10, stated on page one, that [inaudible] implied address form 2567 [inaudible] by june 59. 90 day monstore survey number 6 addressed the form [inaudible] plan from three complaint related surveyed. Conducted between march 13 and march 17th and other surveys involving complaintos april 4 and 19th. You need to time is up. Mute him. I will make sure there was no Public Comment in the room. Okay. That is all the Public Comment on this item. Comments or questions on the directors report . Vice president green. Thank you for the encouraging things in the report t. Wonderful the star award exclude my understanding of the jcc the star award is based on data from a few years ago. Some may have been during the pandemic. There have been steps the staff the general taken to improve and this statistics we have seen on parameters that go in the star rating continue to being better i would not be surprised if we gained one more star. There is a lag temperature is exciting we got this and i think we feel based on what we see there are more to come. Extend our gratitude to everyone there. It is markable deserves 5 stars as far as we are concerned. I agree Vice President green. Other quick comment the access documentary screened we like to know when and where that is happening if the secretary can find out and see if we can participate in that. Would be great. No other comments on the directors report we have already voted on the resolution regarding laguna honda recertification. Now move on to item 6 and back on track for the healing Information Technology quarter low review. Welcome our chief Information Officer eric raffin. Good afternoon commissioners. Erible raffin chief Information Officer my pleasure to deliver the quarter low update from the division. There will be 3 parts revisit the topic the last time on californias Data Exchange framework. And well dive in and celebrate the launch of the Behavioral Health service epic project and where that is headed the next several months. And then well address how we are doing with epic project finance as we wrapped up the most recent fiscal year. Okay. The Data Exchange framework is result of the passage of a b 133. In july of 21. Wham it does is establishes a framework per vision of the program for every californian. And all of the health and Human Services organizations that care and serve those individuals to have access to usable information and electronic information that ultimate low improves the Service Provide as well as improving let being of those being served. It is a lofty vision. It does not just say Health Care Information it said Human Service information that is important because the state never really taken on both areas and made a commit to crediting i Data Exchange environment where we find a way to share health and Human Service information across all health care and Human Services functions and entity and agencies and Health System across california. The data am Exchange Framework housed in the health and Human Service agency in the centers for data innovation and insights. This is important because chhs where the 3 aways of health and Human Services are housed in the department of Public Health. Conditional of Health Care Services and social services. Society cdii organization is on the top reporting to the secretary for health and Human Service in that agency in the state. High willful program of we were required as we were all Health Care Organization in california to sign the states new data sharing agreement part of the new Data Exchange framework we did so in february of this year. Only Health Care Organizations were required to sievenlt Human Services organizations and Public Health jurisdictions were not required in the lawful as mandatory. There are many signatoryys in place we are look to what come next that is supposed to be Information Exchange. By january of 2024. The good news is what all almost all Health Care Organizations in california are participating in Data Exchange already. And i shared statistics to your commission in the past we have been on epic we are transacting millions of records. Some are rust us querying all of the Health Care Organizations to share information for folks that we comanage. And then sometimes we respond to other Health Care Organizations who are comanagering people we serve. Again the biggest challenge i dont think will be dph in compliance. It will be how am Human Service organizations share information. My advocacy so far i served on the data sharing agreement subcommittee for the state and now the policy and Procedure Committee i tried to be very involved as a lot of times safety net organizations are not well represented. We tried make our case strong low we already do in our environment today include some social service information. Specific low from the d. Homelessness and Supportive Housing and we will be on board to a program called unite us. Which you may have heard of. Online Community Resource directory that will be reachable through epic and provide close loop referrals to Community Based organizations. Imagine a Health Care Provider able to open and complete a referral and able to track if i contact was made with the program that provider referred a patient to. It is exciting. And we are hoping the state am get serious about how to open up the Human Service system so we have Meaningful Exchange with health and Human Service. A handful of benefits today that may be close and easy to realize as a result of this framework would be first developing automated [inaudible] an important partner of xours we believe that there may be opportunity to automate the way we share information with the healing plan versus a manual process we use today taking bundles of information and securely sharing those bundles of information in the time Data Exchange envisioned by state; it would flow epitoedically. You would receive the information we establish. That is a possibility. There are really interesting opportunity with emergency medical services. So, emergency medical Service Provide eshs, bes paramedics, they use an Electronic Health record. Pc r. And there is a tool that was developed in part of a federal pilot in san diego and other municipalities several years ago allows to be Information Exchange when paramedics arrive on the scene of a medical emergency to electric up the patients information and be able to query the same network we use today to exchange Health Care Information and enroute to the hospital and transmit a report that gets filed in the Emergency Department system. Directly in the a sap product. From the ambulance. This is in accomplice in counties in Central California and san diego and we see an opportunity there as we learn more about what the data framework have in store. I mentioned what we like to do we like to see with human or social services organizations. Looking forward to that and left but not least when we talk about expanding the exchange of data well is always a door this opens for po terrible low improving surveillance. Being able to reach out to organizations that may not be participating but as a result of the Data Exchange framework might start and if connected correct low we may get more close to role time instead of waiting to it to travel through the state Surveillance System and back and reflected to us. Commissioner giraudo. Both government and nonprofit and private sector and all of the state. Edges. Knows no boundary. You also were curious about the methodology. How to Exchange Information and if it is similar to how we use epic care every where tool. Allows all epic er systems to talk with onanother and the 2 other frame works care equality and e health exchange. That allows you to connect to the Health Care Systems and medical practice across the country and with federal like the veteran affairs, department of defense, Indian Health services and Social Security security information we envision leveraging the path ways and it would work similarly. You dont have to attend to the system for the Information Exchange. It would be predetermined in the information would flow and happy later on to take more questions on that. Okay. Before bee dive in had is happening with Behavioral Health service i wanted have a language update. There are good news. This is always a front and center item for your commission. And we had some new release of software and i will share 3 areas where we see Language Access on the rise. The first is with the completion of roll out of the tool in epic welcome. The name suggests. A thool is used when we are first, interacting with patient when is they come in the door. Used in inpatient setting like collecting electronic signature for consent forms. It is used in ambulance settings to help with check in processes, assessments and et cetera. If is completeod an i pad. Thats when we use and we finished out. Good news is this tool is serving cross 6 languages. Thank you very much hen a goal to make sure we could per wade our provider along with many other organizations to think with these yet ponent languages in the United States make them part of our experience this tool is in accomplice and the languages are available. The second item, how we text message clointss. This is the same type of texts you receive the day before your appointmentful remember, have you an appointment tomorrow, and if you like to click here can you do an electronic check in. Now we are in an interim platform that support 3 languages but we are wrapping up the contractual processes to implement the epic systems text message. Hello word. Im not sure but that is what it is call exclude when we are implementing the good news all 6 languages will be offered on those text messages. Decreasing the friction of the experience having to have member else look at your phone. And interpret. Make sure that every where we go we provide that Language Access. Last but not least frequently tool is epic my chart. Have you commented you use that yourself. And for those of you that are treating providers you are seeing interactions use that tool. Good news is since the dawn of epic my chart gabe in english and spanish. In about less than it a year the epic update well implement will have chinese. This has been a bilt of a mission that jeff our deputy cio and i have been on sending notices and letters and requests and explaining how powerful a change this would be. I think it opens the door wider for epic to considering the rest the languages that are important to us in San Francisco and lots of other languages cross the country. Okay. So. You are looking at a slide from last time guiding prince pels for the epic dhs project. On june 20 we laurened a week kickoff week for the epic project with doctor conin and her team gent and he her team and we are off and rung. Where we are and please dont try read all this it is tiny print. Upon point i want to make there are 4 columns in this chart. Before june 20 we were in the first column to your left. Which is a readiness state. Where we were getting ready for all of the things that are not epic. Making sure if we needed to create wifi in clinics and if we need to tackle readiness objectives and securing all of the subject matter expertise and leadership and governors of the process we know who will make decision. We did that workup and through our kickoff week in june. We are in the second column from the left. Which is work 3 and configuration. Fun terms emic likes what it means is we are starting to build the solution build what behavioral Healing Service will see in epic. That involved time from subject Matter Experts. As well as our epic team in dph and the experts at the epic vender. This will take us through the fall. And then the final 2 phases of the workful involve a lot of system and Network Readiness and testing. And adoption. To make sure what what is being built is what is expected that it all works. You would be amazed how much testing we have to do. It takes at least 23 months wrap that up. As we move in 2024, moving in our training and go live phase with a go live plan for Early Program of 2024. We are excited and really glad we are outstanding partners both in the Behavioral Health pace and in our official organizations which is novelty just finance but also where our Health Information management function lives the management of medical records. Okay. This is the famous wheel or do nut. I forgot which we were referring today i will go with wheel. Budget wheel. That explains where we are with our spend against the epic project budget and where we are is where we were the last time. Which is we are projecting we will be a few percent under spent the end of our 10 year project life cycle. If you look at the wheel, you will seat individual spend percentage as you move clock wise the first is personnel expense and a small sliver for work orders and the larger and largest are the nonpersonal expenses thats where the epic contract costs and are all of agreements and supplies and things we are spending notaies or not work order. Sending another department in San Francisco money to help us with i project. For epic this is meant working with the department of technology and helping with construction and cabling. Most of that was pleasured for wave one launch of epic we are not spending a lot there. Commissioner chow you mentioned that you would like ton what the break downs of spends the last year. I will give you statistics for the personnel spend which is tracking the blue segment of the wheel. For fiscal 2223, 18. 5 million in personnel costs and salary and beg your pardons. For w orders, it is a much smaller amount. We are not spending a lot there. 133 thousand dollars and change. Most going to out fit wifi service in jails. And finally, on the nonpersonnel, you come around the gray segment of the wheel. That is the largest spend. This is safe because of the contracts were most low in a maintenance mode spept for the epic agreement we add a new tool like epic welcome. For the most part a stable item that came in a shade under 22 million dollars. Over the last fiscal year. I share this quote with you because we therein is a lot going on in our Organization Today and it is involved with a lot of the different components of the work. And so we adopted this mantra, do what you can with what you got where you are. Attributed 3 dover roosevelt an aquaintance of his. We feel we are doing everything we can. And powering our energies squarely as need. Im happy to take questions. Thank you. We are excite when we see a go live. That is a big thing. Look forward to that. Do we have Public Comment . No one in the roomful anyone online like to make Public Comment press star 3 now. I dont see a hand. Commissioner giraudo. Thank you for answer my questions i have a bit more with the information sharing. Is there a cost to the participating institutions like in care every where . Great question. And this came up in the policy and Procedure Group at the state level. Because it was absent in the statute. The short answer s if we need to connect to a different provider for exchange service, which is possible. Then, yes, could be a participation fee. Much like there is for care e questions of lawity special healing exchange. One of my occurrence for some institutions that i deal with the cost has been impediments they dont participate. That is one of that. My other question also on the information sharing what about hipa . The data framework statute and the policies and sxroers data sharing agreement were built based off the federal standard, trusted Exchange Framework and Certificate Authority or agreement. And it is completely alined with hipa employed framework cannot supercede hipa. And only one of several statutes. So a lot of what we expect to see with just other Health Care Information sharing is similar to what we see today. Follows the same rules. You had a question which i missed about restricting and protecting records. A 42cfr2. And yes. All of the ehrs have the ability to restrict the records and providers can individually mark records as confidential. And when you set that up you can stop those records from leaving your ehr and going anywhere. That was by my big question. Because i had issues i mean. With that with teenagers. And when they have their own my help online and parents want their password. And take away and unless the password is shared. There is a concern. I have done my f92 and my notes they have not been shared. I wanted make sure that is in there. But also universally communicated to that providers. That, that is possible. I think that it is in dth and a local controlled function the data change framework is an information system. It is just think of it as scaffolding that allows organizations to use mostly existing path way and resdrekt them to organizations that they dont share with today. We have extensive policy and procedure on the like minor access to ehr and it is that is the most complex scenario. I referred to as had roll says out. Yes. The same. Exactly. The same protections. Yep. The same protections will be there. That is a part of the first phase of prework understanding the regular requirements. We started working on regulatory work before starting a project we needed to get on stop top of that and working with doctor and his teach physician and nurses. We made headway. With the Behavioral Health service team. Weer solid footing. I have to do this every day. Back to the dxf, with certain institutions on care every where, when lets say im assessing stan ford health care. I need to have a special access code. Is that going to be within the system . In order to you know access the other reference . I deally, no. The idea with the Data Exchange framework is to remove barriers to access. Between organizations that via hipa are allowed to share information based on the treatment, payment and operation models for information sharing that guide access, use and disclosure of Health Care Information. The idea would be instead of you need to log on to epic care to view records and having work in the san mateo we had the issue providers had to have individual. The idea would be to avoid that. In its entirety. About smaller Health Care Organizations today that may not know either how to hop on the Data Exchange process or dont have the budget to participate in a large information sharing framework, i think that remains an outstanding issue. There is Technical Assistance money made available to get overnight bump and there is grand money going on in at least 3 phases we are in the second phase of the state accepting proposals for grant funds to help get over that herred emthey are all subscriptions. Thank you very much. I have the same privacy questions. And other questions i did not share but throughout unite us program were you doing referral Community Based resource system there a certification for the Community Based resources that patients are referred to . Community or county funded nonprofits. Or how does one ensure that the resource the people are referred to are credible . I dont know photocopy this process is used boy the Companies Across the country that support Community Resources they do have a standard for being allow in the their network. Of Community Based organizations and. In no different than us participating in our own Information Exchange. I dont know what the stoornsd are. We can get them and follow up after. Yea. Sure. Upon commissioner guillermo yoochl thank you for your report. I think good news. To hear. And when i think about you know 1520 years ago when divisions of access to Health Care Information by every individual to their medical record, and to information that would help with well being and coordinate with providers, at their own well being that this is the nfrmgsz exchange big step and glad to see San Francisco is active. And a part of leadership. In california around that. Thank you. I had a question about the individuals. Every california part of the vision. How does the framework allow for individuals to be able to benefit from this on an individual basis or through their provider they will be able to benefit from the dxf . So, certainly, some of the benefit is already being realized for anyone who is using the my chart tool. Where i think there is room to grow in which is why we are considering that we might need to connect with another more regionalish, local healing Information Organization is because the access then for the client would probably be a pretty low bar. Or no cost at all. Most of the Health Information organization when we think, it is not a hospital, not a clinic. It it is usually a stand alone organization the reason they exist is to bring Health Information and make it available both to individuals and across the other big data sharing networks. Nothing written in stone yet. There is a lot written about how the ideal is to make sure everyone who wants to have access can. And not to make the process complicated or costly. The issue is will there be enough healing organizations to serve the states needs. There are not that many of them. I imagine an area for advocacy on the part of groups and those who are interested in empower self empowerment if involving social services and Human Service information. Because most the [inaudible] come to newly to being able to have that Information Available to them. Through a provider and provider will be new and being able to be part of an exchange. I think any advocacy at the state level with regard to being able to make sure there is reasonable Affordable Access to the information would really be helpful. One other question. Going to the last slide on the spending. It relates but in terms of the personnel costs. By the way, congratulations on being in the new [inaudible]. Under spinlding by that 3 percent. The personnel this we need to be able to implement our participation within this framework and the expansion of all of our data systems and information system. Are we going to have issues being able to recruit . Qualified personnel in order to be able to carry out all of the visions of Data Exchange . Glad to hear your opt niche. Agree. The next big step for the state put the body together for the Data Exchange to move out of planning mode and the get it done mode. Thats what im look forward to next. Thank you. Why Vice President green. Thank you for this positive report. And also for take thanksgiving ltd. Ership roll to the state and advocating for youor safety net patient and language needs, really congratulate you and very reassured to know your participating at a high level. Hi 2 questions if i understand you right a lot of what we are tuck burglar is management on an individual level and meeting needs. But as we look at Data Exchange. Whatever the goals in Population Health . If you get information how do we develop best practice in areas in Behavioral Health. Are there goal in terms how the data that will come together on i global base i then and there local. Are there goals or who is developing how we may use it to create best practices for populations in general. And another question is i know when epic started kiez everybody was instrumental in helping write their cost software. I wonder if there is off the shelf or software that epic credited already in the Behavioral Health space or are we a pilot are we building this from scratch or does epic have experience to help us make sure that we efficient low develop our own programs and also you know if there have been errors in the pedestrian we is k avoid and manpower and cost savings. Good questions go in reverse i forgot parts of your first question. With regard to how we have been approaching the behavioral Healing Services project. Epic has other customers Behavioral Health. Contare costa Healing Services met live on epic and have been on epic for a decade. They have twice as much experience as we do and gone live. We are in close contract and sharing the epic resources who were a part of the contare costa build of their community Behavioral Health solution with us. So we are look forward to avoiding pitfalls as we move forward. The programs are relatively similar. Of we are larger. Im look forward to avoiding some of the struggles that we have seenful i know Santa Clara County also went through a challenging behavioral Healing Service build out using their and epic. There were a lot of Lessons Learned that was several years ago. We are trying to do the best we can with the partners we know and epic is bringing other resources to their. Grit to hear. Thank you. Why go become to the first. As the Data Exchange and information come toward the state from various areas are there plans to use those data to understand the challenges we face in Population Health . Etch great questions. Where we are now is this a lot of our strategic objectives in dph centered around having the data to increase how we manage populations. And so i see part of my roll is it find as much did thea relevant as i can and help create a space terror for this data experts epidemiologist or Population Health leader, to be able to take advantage of that data. There are tool in epic. This can help us with that. And we also make the Data Available for more pufl tools. So we can conduct but folks in the Population Health division and within population Behavioral Health as well. So we are already embarkod a number of projects based on the work now in San Francisco with the policy shifts. And different types of work that is going on around over dose along with all of the drug market accysttivity and this work. We have been bring data together and joining it with other data. We bring Behavioral Health data and homelessness data and all the medical record data in a data mart already. More then and there one part of dph can tap in resource. We added data from street over dose response and street medicine programs so we can start to look at more of a complete person when we are looking at the data and then arch up to a higher level cross population whats share situations or attributes. I hate to give you too many assign ams your level of the state i hope you helped them prioritize as they garth more data they prioritize. Thanks. Commissioner chow yoochl thank you. And thank you for this really exciting update. Because i think it continues to fulfill can now we are 6 years out of the 10 we have all envisioned and it is amazing you know looking at our budget and thank you for the data and staying within it. I when you mentioned Human Resource, sharing of data. Im childrened patient privacy i know you talked about hipa. We dont upon often share data with Human Resource in the broad definition. They deal with handing out money. And providing other service. And i could see really how does the ph i work in so. A patient may have information they dont realliment the social worker to know. So if we open up to and not talking about social work in the system talking about a social work in list or Something Like that. If we have an open system. How does the patient feel comfortable that all this data is shared with ultimately big gentleman. Great question. My wife is a social worker. He says eric, we dont have this information how people are doing we know this somebody want to an appointment and thats it. I knowledge what will happen is that there will be a lot of community advocacy. And a lot of attorneys who are going to help us navigate this access using disclosure set of questions that how hipa governs the sharing of information. If we are able to say, say that mull than Services Agency in a county or one of their cbos they are contracted with is part of our stream or operations. Then we would be able to construct sharing. There are all a number of statute this is protect social welfare programs at the federal and state level and those all need to be navigated. The example i use side Cal Fresh Program for snap benefits this is a very, very protected program. And it would benefit Health Care Providers to understand if the patient is enroll in the this program. I think well is a way to go to understands if that can be med sharable. I will not make those decisions if i could i would not be asking for your advice. I think this question will come up frequently. Im waiting for the state to say we are red to get in implementation need. So many lus to deal with. Nice if you continue to update us on the privacy question and how people access it. So i want to go become to a question that was raised how does a patient individually access his data and how far. Today my chart you go to the institution that it came from which you click in it to get your data. How would a patient be able to access this . This is a question. Patients and the patient access. Ways we do it today and a slight low different way. Going forward. The way we do it today is, yes. The Health Care Organization where you are affiliated maintains the records sets in the terminology used that is the information that organization knows about you. And any time you make a request to get all of it. Because my chart it is difficult to give you every bit of information you would not navigate all of us. The rules but what i see with Data Exchange if implemented successfully you would be able to go to one of the Health Information organizations whose reason for being is to provide access both health care and hopefully human Service Providers and individual californian, access to everything. Which would mean not just the information that may reside where you get care today. It would be anywhere you received care. I dont know and like a good question i dont know if that will allow to extend beyond the bound easier of california that may be different it will make sense. There already advocacy how to provide that lowest bar that low friction experience to get your information. It is your information. Right. And i think that all tie in with the issue and you believe can or cant disclose and interesting to be updated on both sides. How provide and patient can reach or limit. The only other question i not really a question it is kind of that congratulations again on the fact this we are purke out to the threshold of languages. Manage i think well, when we all started this and i remember talking to you a bit about this at s footwork general when you first came on to it. How we would get there. And now you have gone there and so my comment only is that im sure with you have been careful to decide you will use simplified chinese. And i think that the challenge there and i noticed that on a number of platforms that have been trying to translate chinese that it is complicated. I found one that and realized they were using cantonese and mandarin has a slightly different syntax and manner of writing and simplified national the chosen where marine of people live admit world using simplified chinese today. In the bay area we have a Large Population that im told by the older parents cannot resimplify chinese. Many are using manned xrin more manage over are being more into simplified. They cant read the other. So it is something had you need to solve to be aware. You know all sides complain they cant read it. And you need to make a selection as to which one. I can see in the corporate world each is making. I believe the city is using traditional chinese. For voting ballots. Some other private agencies using simplified. Small issue perhaps for a lot of people but you know a number of the Healing Network people are going to look forward to this Language Accessibility. I appreciate t. Was not our choice. However we are going to maintain alternate ways a proxy in epic my chart. 91 of that is going and the interceptor service will be something coming as well. We than it is imperfect. But reason to advocate with our Vendor Community to be mindful of the difference. Sure being thank you. No other comments. Thank you for your update. Good to see and you look fared to go live in february. April. Yao will hear from us. Move it up a little. Sure. Thank you. All right. Next item on the agenda is our fy2223 gift report. We are welcome drew murell. Welcome. Why good afternoon. Or dph controller thank you, commissioners. Here with a sum row report of gifts accepted and received the last fiscal year. One note they have been accepted and received pursuant to admin code they have been accepted no action is required today. Highway lights include 31 2 million gifts the vast majority are state donations of test kits. And another highlight it is now, consistents with the mem righthandum approved by the commission in may we are reporting gift from thes Public Health foundation in this report. And this brings us in alinement with controllers by names and the new mou. You have a fuel detail gift and happy to take questions. Thank you. Secretary, Public Comment . Folks on the line if you like to comment on item 7. Press star 3. No hand. Commissioner chow. Yes. Want to thank you for this gift report t. Is expensive and interesting. Does this incorporate the laguna honda gift fund or is in separate in it does anywhere gives are received if gifts are above 25,000 the direction for the patients, those are accepts separate low and not in this. For the gifts received individually less than 25,000 the majority those are reported. So, the you have a donation in kind that are on here that are larger. Great catchment those have been accepted pursuant to mayors declaration 9 under covid this waived the threshold for gifts to require board approval and related covid. You will see all of those were donations of covid good test kits from state and dl adoination. Covid have an exception. The next time you let us see this you might note that these are for those that are under 25,000 and that remainder looked at already. Commissioners . Thank you for the report. Thank you. Next item is 8. Etches health code 38 rules of regulations. For this we welcome our environmental healing branch jonathan piakis. Welcome. Good afternoon, commissioners. Senior industrial hygienist with environmental healing branch the department that 10 years now and the majority of the time was involved with Health Code Article 38 we are here to discuss today. A couple of quick notes on this before we get started. The rules and regulations for Health Code Article 38 dont require a formal vote. Are being share said as Important Information to demonstrate the many ways that dph is protecting vulnerable populations. One are thing to note on the time line, these rules and regulations were draft in the january. Of 2020. And slated be presented at the Health Commission after that time nose plans were deried by the pandemic. The rules were put on hold until this year. I can say we are now excited finally be here and presenting this today we have been waiting a long time. Happy to be here. Next slide. To go over the orientation of where we fall in the organizational structure of dph. Environmental Health Branch under the Health Division and we are acting as the enforcement arm of the Health Department. That enforces a variety of local laws and health codes. So this is this small are box that was circled broke down a bit. The environmental healing branch is structured. We are structured in organized by programful into various programs each with different authorities for the health codes. Article threat program, discussing today is currently under the super vision of jennifer who could not be here to present today. Im here in her place and we have a vacancy in the principle inspector over see thanksgiving program i assure you that the program is in good hands with our assistant director involved since it was originally inception in 2008. Quick over vow on what we will cover today. We will go over background. On healing code 38. Talk about air pollow an exposure zone and how it has grown over time. Rowel and regulations amended to clarify an administrative clean up that resulted from a lot of our Community Feedback and engage am with them example talk about that Community Engagement and Public Comment process we have gone through numerous times now. So. Health code article 38 what is if and how does it help us protect the public . Requires new sensitive use buildings enhanced ventilation system removing harmful fine particles from the air and prevents them from going from outside and reaching our sensitive use populations in the New Buildings. Does this by requiring that an enhance said vent ligz system meetings designs equal it a merv 13 rated. Fitters rateod merv scale. The merv 13 part is a highway low fortunate filter. High low efficiency in the fit are means removes more and finer particles than the standard one. Well are other designs using positive pressure ensure this unfitered air stay the out of the building. We do this through the thing we called the air pollutant exposure zone map we developed. Not only article 38 uses the air pollutant zone map. There are other codes and other city agencies that also use this map. A couple examples are in front of you today. Environmental code use the air pollutant zone to determine which public work projects need to include only the mrooen cleanest Construction Equipment available in their projects. In addition the planning upon dealt uses the exposure zone map performing Environmental Review under ceqa or California Environmental act. Next slide. Lets become up a bit to 2 where are 08. It is when article 38 was first enacted in to law. At this time the law included the specific ventilation filter environments and design criteria that projects needed to comply with to be considered compliant. Exposed Design Standards developed through a bunch of out reach and subject Matter Experts we worked with to ensure the populations were protected. At the time that applied only to new residential buildings of 10 units or more. In 2008. The exposure zone was not always the exposure zone we know today. Was not calld that it was the potential roadway exposure map. Which is there before you today this map was very different. It only took in the data we had which was vehicle countos roads to create the map. The map was not used in the same way it was a screening tool that said if you have a project that is in the screening map that would have to go through and perform additional Site Specific parcel pacific modeling to determine if you needed comply with article threat. It was quite a process. Put a lot of will requirements and the Development Community and it is one of the many lessons we learned i will get into in a bit as well. On this note, we value continue improvement and equity net Health Department. With article 38 we are aadopters of both. 2014 had 6 years with the program. We learned quite a bit. We learned through experience of our own impelementing the law and from feedback from the Development Community. Community organizations and at this time, we felt appropriateed introduce amendments to the code that would help us protect populations better than we were doing it. How can we protect people and people that may not have been protected as the law was written. So a couple of the things that we saw we need not all were protected equal low under this law and needed to make sure that it roached the population include sensitive uses in the code. Which include childcare, school, day care, adult day care. Rehab centers and any licensed Health Care Facility or building associated with a licensed Health Care Facility. 2008 residential buildings grirt than 10 unit this is presented a problem. Did in the make sense someone would be projected in know 11 unit building next to the freeway while the building next was a 3 unit building and in the offerd that protection. We learn third degree and moved improve upon that and reducing that threshold. Lets see. We also heard a bit from the developers. Some things they struggled about. Most low dog that air quality modelings. We go out and hire a consultant to do that. And submit a report to us. The modeling done was not always consistent we saw that in addition it was time intensive on the develop and cost them additional money that we felt like we could improve on that process. Instead of that on the developers, then time and money. We can take this on as the city partnered with California Air Resource Board. Bay area air Quality Management district and other experts and decide we will go ahead and model the city with the best available criteria from the state and this is when we did. I will show you the map in a second that all of the efforts paid off. It was a cost savings for developers. Know how expensive it can be and if we can improve upon that and make housing affordable that is i good thing. We also clarified in the code which projects mode to comply with the code. Was not just New Buildings being built. There was a stipulation in for anything under going what is defined i major renovation with the Green Building code. They would have to comply with article 38 and put in that vent lagz system. Planning Department Permanent change of use. If you have a ground floor commercial use in a building and that was being develop in the a day care. That necessary low would not have been caught originally now degree this with Planning Department of change of use review those specific low and would be required comply and have that enhandled ventilation for a day care going in a space that was not originally a sensitive use. Those of code changes today we are not talking about code changes we are claire fighting the rowels. We started our largest stake holder engage am processes. It took a total of 69 months. We worked with numerous neighborhood organizations. And Community Benefit groups. We visited multiple commissions and committees met with different groups of developers. Local in San Francisco mechanical engineers and around the area. Met with off the building departments that had a step in the permitting process to ensure it was the smooth transition and to chafe off time we could in that process. And all met with a number of building associations. Small Builders Association the large developments we had feed become from them and got them from the mid rise and low rise buildings as well. Next slide. And this is what we came out with. This was the exposure zone the first version in 2014. Identified the areas our modeling the modeling with the best Available Technology indicated could be higher levels of pollutants. That was established in rowelless within the code at the time. Also with these amendments there was a requirement to update the exposure zone every 5 years. We also with the equity lens included Health Vulnerable locations. Locations in the city where we identified them as a location for 5 zip codes locked at a bunch of data that included hospitalization records for cardiovascular and mortality. Identified with all of the zip code in the city and onces vulnerable were top 5 like civic center, tenderloin, soma, bayview issue treasure island, what those vulnerable locations reduced the thresholds for the modeling that would be included in the air pollutant exposure zone. With a lens it ensured the locations were properly protected. And fast forward it 2020. Part of in the code was we had to update the map 5 years start in the 2019. And result instead 202014 zone. The changes were due to some significantly more restrictive e mission factors that were assigned at the state level when we did the air modeling applied the new e mission factors to the modeling. That is part of why we want to include the 5 updates including the best Available Technology we have. In addition we were able to identify other sources of pollution to include in the model. In 2008 and 14 include more the most is from vehicle traffic. We were also able to include in this stationary sources. Permitted stationary source the management district has a data base of. And we were able to include merry time source fer and hes ships that contributed to the expanded air pollute an exposure zone we are using continued commune engage am effort in 201920 this is similar to 2047. One of the comments from the Development Community locked at did not have an easy way to look up if their parcel they are considering is included in the map. I showed you the map hard to get down to a granular level. Feedback if the development upon community than i understand why we are doing this and want to protect the vulnerable populations. They need to know about the requirements early as possible. They are thinking of potential low developing a parcel they can go there and know everything this will be required. A large improve am efforts that shows why our commune engage am process is a benefit in the longterm. The other thing we heard from Development Communities they wanted further clarification bring you to when we were here to talk about today the rowels and regulations. That we slightly amended for the purposes. A lot of administrative clean and up clarification on how we do certain things. We do have a whole report of how everything was developed. It is called assessment and support. It is technical. Very. We dont expect people to be able to read through the 30 pages developed with the modelers from air Quality Management we dont expect them to go through this the rules are a tool we have to help clarify everything. What was the criteria and the locations and if information is needed we have the document. Include experiments standards the merv 13 filtration before and the filter this must be introduced in those enhanced system. Other tools with be used like positive robber with hallways not fitters. Includes a number of certification and licensing requirements built out more on who is able to create. Can be done for mall are projects or i large are project by a licensed engineer. Definitions needed to be clarified we are hope to clarify and understood. Also on what properties need to comply, has changed since the original. We want to be clear on that. What is require toed design the ventilation but to maintain it. We want to be sure who i we approve it and 5 years down the line tell offer protection. There are Disclosure Requirements and maintenance criteria that distinguishers and have to comply with. We have an additional 30day review period. Did our Community Engage am efforts like in 2015ful prepandemic. We want to remind our stake holders that these other rus this we drafted and invite them to give you Public Comment. We are about in the middle of 30day Public Comment period and in the received additional comment or feedback yet. That is all i have and happy to i than is a lot you heard a lot. You am happy to take questions thank you. We will go to Public Comment first. I have a person on the line let us know if you would like to comment on item 8. I appreciate the information map used our building. Initials do you have questions. Vice president grown this is interesting. Thank you. I was wondering how often you revisit the air pollution zones and how you incorporate the 2030 goal not for from the california Resource Board of kuthing e missions down 40 in 1990 and on the oppositent slime change and incorporate the projection in your decisions, models and time. We have experts rely on with the california board and air Quality Management district we update it every 5 years and staying in communication with the experts to give us a heads up what is coming down the pipeline as far as sources to add and additional restriksz on e mission factors like in 2020. This is independent of other efforts there to louis pollution in general. This is protecting people when that is happening or the sources are there. The goal of this program from the inception to have this map to reduce pollution and make cleaner technology with thank yous. Our idea is this air pollutant explosure joan to shrink up. Thats okay. That is a bump in the road that is manage this we know is okay if we want to have that, that is Available Technology for the air quality modeling. That is more established now we want to see that air pollutant zone shrink. All included this in we love to see that shrink over time vehicle i was impressed the wellingness of your group to the input of stake hold and adjust rules and regulations. It is really an organization that listens to the public and listens to everyone that is involved in i complex decision tree. Thank you. I appreciate that. Manage we are proud of. Our Community Engage am testimony felt like we were part of a band concert touring with groups meeting up with over the process. It was well worth it. And i think they appreciate today. Thank you. Commissioner guillermo. That was my questions i want to comment. And thank you for the report. And this is very informative and gives me an appreciation of the other parts of the department this we dont hear from and how well our at least San Francisco is being protected by the whole range of things the department is responsible for thank you very much. Commissioner chow. Yes. I want to thank you i found the maps exciting. You know i was look to see where my house was. Fop that must be all the wind we get. I was worning and i asked doctor, probably. How we are integrating all this information in our population. And how does this also help inform. Will be interesting to hear the department is using the information are all of their units and Environmental Health is one this is always interested in ever that has other benefits to it. In terms of you know the working here around the potential for cancer risk and other things. I would defer to vipiral healing or others how this getings shared out. And if incorporated in other ways that is something that is important to the community and you know asthma and other things that occur with pollution. Jonathan do you have around answer we work with other group and an example is healing vulnerable locations will not have been possible for us to garth and pour over all that data to identify where the health vulner locations were to create that lower threshold for them. We worked with our did thea team and population Healing Division in addition to other branches in the Health Department to garth that hospital vision and mortality data to do that. The wildfires, we worked with and working on that to identify where are there the potential clean air places that people may go if we have a very large event wildfire event. So we were able to provide that data. These other approved areas or buildings or parcels that have these vent lagz systems we were able to approve and built and in are communities centers. Some of them are libraries that we were able to enhance the system a bit. The sharing of the data goes both ways. Having this communication to the groups within population and within the Health Department has been key in identifying the things that come up like wildfire response. I think one daldz be interesting when the Health Network presents to tie this information also in it. Saying that. It sounds like they might have helped inform this. And this information might lead to programs. Or Community Type out reach which they have been having. And just to see how everything is tying together and working at this time. That was again to thank you. For really the work. You may thank you is a technical document. Really i think shows the depth of work we were all doing here. Appreciate it. Thank you. Thank you. Commissioners, any other questions or comments in all right. Thank you very much. Thank you. Next item for discussion is finance and Planning Committee update. We will be getting commissioner chow. Thank you. Commissioner chung was not able to chair. Or be in the attendance so i was asked to try to hold the fort. It was a very interesting meeting. And the contracts you actually have the details from the dollar amounts. I think this was important is this these were all really related to types of service that we are all doing. I will describe there are 8 continuing or new contracts of services this are being disconditioned. The first, which was 1 and 3 from what luna health is Administrative Services that relate to hiv and std and covid. They were the administration arch that helps work with subcontractors to deliver these important service. Item 2 was the hospice care from matria . Aids hospice well known for years renewal of their contract. Renews or extend its for 3 year. The first item for the Health Administrative contract extends of hiv and std services for one year. Item 4 is from mission neighborhood. Another known agency of ours. This is an extension up to 10 years. They were given a 4 year contract. Good time to reminds us that commissions policy while we will grant a contract for up to 10 years we like to see it in mid contract to see that services are rendered and this is one of those contracts that says they have been doing a good job and center for aids and taking care of clients. This is a 6 year extension. Item 5 is canyon manner. Which is in nevada. I want to get it correct. This is a Mental Health unit that is taking care of the very vulnerable and very difficult parents we have. We have about 810 there in their 89 bed wards. Bed facility. We were asking because the patients we could use more beds that we have here that whether we get more and they said that actually it is a competition throughout the state to place the parents. And in fact when we have one of our patients be ail to be discharged we want to use that we cannot a block in patients there that could have helped our city. It is contract we want to recommend approval, also. Item 6 from ucsf and vouchers for veggies for the homeless and vulnerable population. This is new well, they have been doing vouchers but under the new San Francisco health plan pip program part of the this is the performance improve am program that brings in some extra dollars for quality of work. And this is not just for San Francisco Health Plan Members but anyone in the communities. So it is funding from the health plans that allows you to do that. Item 7 is the ward 86 condition transact for ucsf professional service. We know about the hiv way 86 was started and a continuation of this. And item 8 on the contract report is horizon. An extension for 2 years. And it is taking care of primary Preventive Services for issues of Substance Use in youth including elementary and middle schools. So. Those are the contracts. There was a now contract for housing. For both the covid and for the manage alcohol . Trying it get the name of it. For those who are you needing a home for respite it is renting 5, upon 87 eddie street. With 31 rooms . And several of the rooms used for administration of the program. But the cost is actually quite extensive within00 thousand dollars a month. But it is place am at the of a vulnerable population. The w they have done they have been tracking the data so that while this is expensive and may be Cost Effective they reduced the use of the ed for the patients and residents that are there by 4 fold. And in alcohol sobering programs also they have been able to reduce by twofold getting to the well, twofold being hospitalized it appears to be an effective program. They would like to look for a more economical facility. At the mobile home they were asking for a 1 year contract. April year. Im looking for it now there was a here it it is. Called htl587 because 587 eddie street. For 31 bed and rooms and services those actually are probably the service of the hotel. Definitely not our service because our services are actually paid separate low and the medical support service are differentful so much continue, there is 10 month with an option to extend another 10 months. The department is looking at more economical options. That is the contracts report. We did see a report of sole source you reviewed. Turns out there are 2 different factors chap 6724 is the sunshine ordinance. I think you were all distributed the break down we asked for. And those are really professional source contracts and commodities. You know if you are doing Software Licensing they fall in this category and i think michelle put together a summary what the different types of contracts are. Then meanwhile, and and the new report also then looks at not just a news sole source we modified a sole source that had to be reported. That was new. Now chapter also was on sole source grant agreements. These are not really grant agreements they are contracts. The term grant agreements is used in the ordinance. And there you see also very nicely written the types of agreements that these would be either exemptions because it was not a waiver was not required from the Health Commission it was already designated a board of supervisors contract. Putting money back in a community agency. And then there are those sole source grant agreements you passed a list of the sole source organizations that would be eligible. You see in fiscal 22 23, we only used the sole source that you should category, eight times. Three for those where clis solicitation was not feasible. Might have been a now initiative and would be put out to bid in the future. To get it started or this there was a time gap and as you know then we were able to fund. Getting out a now rfp or Something Like that. In the back there are sort of the over all values. Many extend more then and there one year. We did am and locked at had might be the of sole source used for nonprofit contracts. Thats our receiving the reports. I dont know if commissioner guillermo has more. You did a great job. If you have questions. First well take Public Comment. On item 90 finance and planning. Make a comment by pressing star 3. Comments or questions. We will move on to consent we can take it on one motion. Moved. Second. Fimay check Public Comment. Person on line if you like to comment on 10 consent press star 3. No hands all right. Any commissioner comments . Discussion. All in favor . Aye opposed . Motion passes. Consent approved joint Conference Committee and other committee reports. Back to commissioner chow. On. Jcc met on july 25th. We were introduced to our new chief of staff doctor ortiz. Who presented the medical staff report. Gave a very stirring, person history how he became a physician dp at San Francisco general. We then useless discussed a probust and data driven presentation on the hospital true north for access and flow. And discussioned standard reports the roll report and Human Resource report. In closed session, proved considerables and pips minutes report. Why all right Public Comment on this item . Person on the line weer item 11 press star 3 if you like to comment. Comments or questions in thank you. Our next is other business. Do we have Public Comment . Press star 3 if you like to comment on item 12 other business. Okay. We are on the last item which is adjournment do we have a motion. Move. Second. All in favor . Aye. Opposed. We are adjourned. indiscernible i just know it. Excuse me boys, but does anybody have sun block to block this skin from the sun . Yes. Thats right, i need to get my indiscernible many of us last summer indiscernible reapplying sun screen is like getting the second dose of mpox vaccine. Wait, two doses indiscernible isnt it too late to get my second dose . Girl, it is like sun screen, never too late to put more sun screen on. Thats right, i need to get my second dose of mpox vaccine before the summer starts. Lets indiscernible 21201 to find the closest location to get the vaccine or go to sf. Gov mpox. Thank you for the information indiscernible excuse me boys, do you mind checking please . Sure. That doesnt look like a sun burn, you might want to getd it checked out. What do you mean clecked out . Checked out. I was told if i got my second m pox vaccine i would have less severe symptoms. indiscernible maybe i schedule the second dose just to be safe from mpox. Most vackeens offer you a level of protections, just like sun block. Sometimes you need to reapply for more protection. The m pox vaccine is based on two shots several weeks apart to provide the strongest level of protection. Visit sf. Gov mpox to get yours. Thank you boys for that reminder make sure your are fully vaccinated for m pox this summer. Text summer vibes to 21201, to get shared spaces have transformed San Franciscos adjacent sidewalks, local business communities are more resilient and their Neighborhood Centers are more vibrant and mildly. Sidewalks and parking lanes can be used for outdoor seating, dining, merchandising, and other community activities. Were counting on operators of shared spaces to ensure their sites are safe and accessible for all. People with disabilities enjoy all types of spaces. Please provide at least 8 feet of open uninterrupted sidewalk so everyone can get through. Sidewalk diverter let those who have low vision navigate through dining and other activity areas on the sidewalk. These devices are rectangular planters or boxes that are placed on the sidewalk at the ends of each shared space and need to be at least 12 inches wide and 24 inches long and 30 inches tall. They can be on wheels to make it easy to bring in and out at the start and the end of each day. But during business hours, they should be stationary and secure. Please provide at least one Wheelchair Accessible dining table in your shared space so the disability people can patronize your business. To ensure that wheelchair users can get to the Wheelchair Accessible area in the park area, provide an adequate ramp or parklet ramps are even with the curb. Nobody wants to trip or get stuck. Cable covers or cable ramps can create tripping hazards and difficulties for wheelchair users so they are not permitted on sidewalks. Instead, electrical cables should run overhead at least ten feet above sidewalk. These updates to the shared Spaces Program will help to ensure safety and accessibility for everyone, so that we can all enjoy these public spaces. More information is available at sf. Govt shared spaces. Television. In 1948 swensens ice cream used to make ice cream in the navy and decided to open up an ice cream shop it it takes time for the parent to put money down and diane one of the managers at zen citizen in arena hills open and serve oldfashioned ice cream. Over 20 years. Yeah. Had my own business i was a firefighter and came in in 1969 her dad had ice cream and left here still the owner but shortly after um, in here became the inc. Maker the manager and lead and branded the store from day to day and in the late 90s was obvious choice he sold it to him and he called us up one night and said im going to sell the Ice Cream Store what you you talking about diane came and looked at the store and something we want to do and had a history of her dad here and growing up here at the Ice Cream Store we decided to take that business on. And have it in the family i didnt want to sell it. To keep it here in San Francisco. And unintelligible . Share worked there and worked with all the people and a lot of customers come in. A round hill in the adjoining areas loved neither ice cream shop in this area and support russia hills and have clean up day and give them free ice cream because that is those are the people that keep us the opportunity to stick around here four so many years next generations have been coming her 20 er thirty or 40 years and we have the ingredients something it sold and, you know, her dad said to treat the customers right and people will keep on coming back and 75 or 74 years, you know, that is quite an accomplishment i think of it as our first 75 years and like to see that, you know, going into the future um, that ice cream shop will be around used to be 4 hundred in the United States and all gone equipment for that one that is the first and last were proud of that were Still Standing and people people are you tell people its been around in 50 years and dont plan on my background is in engineering. I am a Civil Engineer by training. My career has really been around government service. When the opportunity came up to serve the city of San Francisco, that was just an opportunity i really needed to explore. [ ] [ ] i think it was in junior high and really started to do well in math but i faced some really interesting challenges. Many young ladies were not in math and i was the only one in some of these classes. It was tough, it was difficult to succeed when a teacher didnt have confidence in you, but i was determined and i realized that engineering really is what i was interested in. As i moved into college and took engineering, preengineering classes, once again i hit some of those same stereotypes that women are not in this field. That just challenged me more. Because i was enjoying it, i was determined to be successful. Now i took that drive that i have and a couple it with public service. Often we are the Unsung Heroes of technology in the city whether it is delivering Network Services internally, or for our Broadband Services to low income housing. Free wifi for all of the residents here so that folks have access to do job searches, housing searches, or anything else that anyone else could do in our great city. We are putting the plant in the ground to make all of the City Services available to our residents. It is difficult work, but it is also very exciting and rewarding our team is exceptional. They are very talented engineers and analysts who work to deliver the data and the services and the Technology Every day. I love working with linda because she is fun. You can tell her anything under the sun and she will listen and give you solutions or advice. She is very generous and thoughtful and remembers all the special days that you are celebrating. I have seen recent employee safety and cyber security. It is always a top priority. I am always feeling proud working with her. What is interesting about my work and my family is my experience is not unique, but it is different. I am a single parent. So having a career that is demanding and also having a child to raise has been a challenge. I think for parents that are working and trying to balance a career that takes a lot of time, we may have some interruptions. If there is an emergency or that sort of thing then you have to be able to still take care of your family and then also do your service to your job. That is probably my take away and a lot of Lessons Learned. A lot of parents have the concern of how to do the balance i like to think i did a good job for me, watching my son go through school and now enter the job market, and he is in the medical field and starting his career, he was always an intern. One of the things that we try to do here and one of my takeaways from raising him is how important internships are. And here in the department of technology, we pride ourselves on our interns. We have 20 to 25 each year. They do a terrific job contributing to our outside plant five or work or our Network Engineering or our finance team. This last time they took to programming our reception robot, pepper, and they added videos to it and all of these sort of things. It was fun to see their creativity and their innovation come out. Amazing. Intriguing. The way i unwind is with my photography and taking pictures around the city. When i drive around california, i enjoy taking a lot of landscapes. The weather here changes very often, so you get a beautiful sunset or you get a big bunch of clouds. Especially along the waterfront. It is spectacular. I just took some photos of big server and had a wonderful time, not only with the water photos, but also the rocks and the bushes and the landscapes. They are phenomenal. [ ] my advice to young ladies and women who would like to move into stem fields is to really look at why you are there. If you are if you are a problem solver, if you like to analyse information, if you like to discover new things, if you like to come up with alternatives and invent new practice, it is such a fabulous opportunity. Whether it is Computer Science or engineering or biology or medicine, oh, my goodness, there are so many opportunities. If you have that kind of mindset i have enjoyed working in San Francisco so much because of the diversity. The diversity of the people, of this city, of the values, of the talent that is here in the city. It is stimulating and motivating and inspiring and i cannot imagine working anywhere else but in sannnnnnnnnnnnnnnnnnnnnnn this meeting will come to order. Welcome to monday july 24, 2023 meeting of rules of the board of supervisors im supervisor dorsey chair. Im joined by vice chair walton and member safai is running late bull join us shortly. With this our 90