That tool. When you start in a new Information System such as we did on august 3, we didnt go into it with a fully populated database. We did it with a mostly new database. So we prepared how we would begin to use the new data as folks come in our doors after august 3. But we have to go through a validation process in order to ensure what were looking at and that all of the prework we did to produce all of these measures is going to be valid and stand up to our data integrity checklist. We are close. Hoping in the next 30 to 60 days to be completely back on course. It was expected that we would have a delay, and we had a bit of a delay. I want to be up front about that. The nice thing is epic is friendly about us taking the data out. That has been a real struggle with our electronic platforms, and thats not the case with what we have today. Weve talked about benefits realizations before. I mentioned decommissions systems. That work is beginning in earnest at the beginning of the calendar year and will take us to july, where we expect to spin down, which is something i. T. People dont like to do. We like to keep old systems on as heaters. But we plan to demission our Legacy Health record system by the end of the fiscal year. The great news about that is we dont need them anymore. The second piece of good news is we wont be paying for them anymore. Thats been part of the budget and Financial Plan for epic since the beginning. Id like to take a few moments, and i know were getting towards the end of our time today, to talk about the our in our records, patient record exchange, something i mentioned at the beginning. Since august 3 up through october 1, we have exchanged Health Information with 215 other Healthcare Organizations across the united states. Its possible there are some international ones in there. I didnt dive deep enough to doublecheck. If you look on the bottom left, you will see who our highestvolume Information Exchange partners are. I dont think there are any surprises there. Whats really powerful is in basically just shy of two months of being live with epic, 43,000 of our clients have had their records appended by Healthcare Information from other Healthcare Organizations. This is pretty powerful stuff. In addition to that, nearly 14,000 of our patients, their information has been requested and sent across this trust framework that i mentioned before with this Industry Consortium that epic is a member of to augment the records of our clients in other places. So really very powerful. We dont have to do anything special for this to happen, it just happens. So our epic journey, we spent a number of years in what i would call a getready phase. Were definitely past that. Were coming up to the tail end of our getgoing phase, where theres been a strong focus on having a really Good Governance program for epic, for having a great go live, which we did. Now were in this period of time which we call stabilization and well be there for the next few months. During this time of stabilization is where we process people, process, and technology, the couple of examples i shared with you before. Whats really exciting is as we march into the new calendar year, were getting ready to get better. Getting better means tuning our governance process even more so we can do two activities in parallel. One of them is beginning the optimization of the epic environment so it can do things its not doing today. We have a straightforward implementation and without violating our principles of sticking to that, we can still make it better. So were going to begin that process. In parallel, we will be locking in the scope and schedule for wave two and three of epic. When were done with that in a few years, well be in a Continuous Improvement environment, where we will bank on everything that we learned and all of the Good Governance thats in place so we can keep Getting Better. So epic is both hard and it has been very rewarding. I just want to share with you the message that were sharing with all of our staff because not every day is a great day with epic. Its okay to feel frustrated. This is the first message that were sharing with our staff because we have really changed a lot. More than a thousand changes were made in order to get ready and learn epic. Sometimes you look at the screen and youre like im not sure i remember how to do this, which is a reminder that were all in this together. When i go in front of epic, i look at the screen and im befuddl befuddl befuddled. The good information is we continue to help and train and build tip sheets which are in the epic users first pane when you log in. You go to a place called my learning home. Thats where you go when you log into epic. We are an organization of helpers. I think during go live this was really evident and a lot of people could see how well everyone reached out and was supporting everyone, and thats the environment that we need to continue to maintain as we move forward with more change in epic. So weve asked staff to be there for one another because some day youre going to need some support as well. With that, im happy to take your questions. I have not received Public Comment request for this item. My question is im an epic user and a frustrated epic user at times were all in this together. Yes. What is your i. T. Or your help line for an epic provider . What is the Response Time for someone to be on the line to be able to help one walk through whatever the issue is . I mean, is it five minutes . Is it ten minutes . I mean and what is do you have the adequate staff to be able to help those that are a bit befuddled, especially with epic going live . So we have a lot of support across the board. A program that we set up for the go live was to establish a super user program, where we could have people much closer to where the value is being generated and the work is being done who are actually super users. We have team of infomaticists who can dive in. With regard to actually calling on the phone, when you call on the phone to our service desk, youre calling the general i. T. Service desk, and the pickup times are less than two minutes now to get you in there and get your issue noted. Many of the items that are coming in are being redirected to analysts on my team who are resolving these items in just a day or two. Thats not all of the items, but weve reached that point where the number of items coming into our service during the day and the number of items were resolving, weve worked down a significant amount of the go live backlog. Okay. Thank you. Thank you. Thank you so much. I dont think we can overstate the significance of this accomplishment, having been through the same epic process, and the potential to improve patient compliance and care coordination. Ive had about six patients almost that ive shared with doctors of the county and at u. C. And being able to reach into these records and really do a much better job for the patient, its astonishing, how having these systems that used to be siloed and vulcanized be all one. It makes such a difference in a great outcome. I want to congratulate everyone involved and say as the few epic go lives that ive seen have been your team is spectacular and awesome. I think theres a show where theres a gold buzzer or something i think you deserve a gold buzzer. Thank you. Ill happily try and accept that comment, having only been here myself only 90 or 100 days. But its obvious what a full court press there was by every part of this organization to be ready for epic and it totally paid off. If i may add to that, i do think its important that we recognize the people who arent in the room and worked on this for many years and no longer with d. P. H. I want to acknowledge director garcias leadership. Alice chen who was committed to this and made a lot of this happen. And also wynona medolovich who was acting c. E. O. For many months. I think its important that as we move forward and go into the next stage that was spoken about, that we recognize the reason were at this point today is the incredibly hard work of literally hundreds, i think in some cases thousands of people to make this work. It was really that leadership, including the leaders i just mentioned, that helped us get to where we are today. Thank you [ indiscernible ] my question was from the patient perspective, when patients come in and theyre told they are able to access their records on their mobile device, for example, is there any kind of orientation offered to them or a guide they might receive, or are they more figuring it out on their own . I cant totally answer your question. Im not sure if anyone is out in the audience who may be able to assist. Doctor, i think you can address this better than i can. In terms of signing up for the Patient Portal, we have Information Support for the patients to get into the portal. Once they get onto the portal and they have access navigating through the site or submitting a quarterback with he have a contract with an outside vendor that specializing in providing the firsttier support. Obviously if they need to ask about lab results, that would be routed back to our desk. Is it an inapp chat function or a phone call . It is a phone call to the service, person to person. They would help the patient navigate real time because they know how to access the portal. Thank you. Thank you. Im just going to ask if presumably the app is better than the ucsf . [ laughter ]. That app is really a problem. [ overlapping speakers ] is there a language capability . Yeah, thats a great question. Right now it is limited in terms of other languages. So no to answer your question. That could be one of the whether they in wave two, three, four, or five, in this community it would be useful with the diverse languages we have. No doubt, as well as other epic communities where they serve large communities of multiple languages. That certainly is a push that all of these epic users is going to be pushing. Especially with my chart and the Patient Portal piece of the technology is being so readily available and enabling to the patient and client, we have to push that. Theres no ifs, ands, or buts about that. No, youre correct. Its a nationwide issue that really would make sense for epic. More towards our own problems and within the time frame and i forget on schedules could you remind us because youve done a great job getting this all together and having the basic epic work. Now in terms of the optimization so to speak, we know that laguna is a challenge. Do you have some time frame upon which you would be able to i guess enhance it and optimize lagunas use on a longterm basis, trying to close the chart out when they talk about in terms of years versus days, right. Secondly, our Mental Health programs and avatar and the timing in terms of trying to unify those records. Maybe ill go backwards. Well start with the Behavioural Health. So Behavioural Health is slated for wave three which is i dont want to commit to a firm schedule. Its after wave two which will likely go live in 2021. So its in late 2022 or 2023 before were fully in place with the replacement to the community Behavioural Health function i mean the Electronic Health record. To your first question about optimizations for laguna honda, part of the process is to be inclusive. We had a domain structure presented several months ago. The idea with that domain structure is its a place that has almost no i. T. People engaged, which is probably a great thing, and its all about the line of business being able to bring items together that can be prioritized that are based on how do we not just get better against our performance outcomes, how are we Getting Better for how folks are engaging in the system. That is the process that weve been using so far. Id be happy to take more information about the laguna honda concerns and make sure that we get that roped into our governance process, so that as we approach making epic better for all of us, that we can address those. Yeah, the thing i raise there is mostly because it is sort of different from most epic acute care, that there seems to be an issue of having it flow in as seamlessly as it does at the hospital. I dont know where all the priorities are. I do think laguna or its joint conference should understand what is happening there so we can understand the challenges staff had in terms of trying to optimize the use of an electronic record over there. Sure. Laguna honda is the largest longterm care facility in epics customer base. Sonch so i think a report back to there would be quite useful. Commissioners, other questions . Thank you very much. Congratulations again. Thank you. Commissioners, item 10 is other business and we have several Public Comment requests for this item. Just so you know making comments, i have a timer. When the buzz buzz ergos off thats time for you to end your sentence. Good evening, commissioners. My name is nathan dang, this is holly and kyle. We have pharmacy students from San Francisco joined by some of our classmates in the back. We are here to bring attention to a current pharmacy related issue, pertaining to reimbursement rates authorized by the 2013 California Senate bill 493. So the services affect patients all over california, but especially in San Francisco. So sb419 had expanded the practice for pharmacists that authorized them to perform Additional Services such as nicotine replacement therapy, as well as participating with other providers in the evaluation and management of various disease states. This bill, however, didnt address payment or reimbursement for these services. My name is kyle merchant. Really what were just advocating for is support in implementing additional codes so that pharmacists can be reimbursed appropriately for services, because not every patient is as straightforward as come in, lets have a discussion, and here is what youre looking for. Sometimes we have more complex situations and medical histories that need to be taken, discussions that need to be had with patients. I think this will be especially important as we move towards the implementation of prep being made available in pharmacies. So as you know, people [ indiscernible ] this is to expand the ability for pharmacists to furnish prep which is proflax sis for h. I. V. We can give a 60day supply in our practice. In the spirit of getting zero, i believe i also have well give you a 30second extension. Thank you so much. I think its paramount that we include reimbursement for the pharmacist counselling because the adherence to these medications is critical and the only way this will be happening is counselling in the scope of the community. Thank you. Hello, my name is manuel and im a pharmacist student as well. This is my first time at this hearing. Thank you for this opportunity. I just want to start by addressing that i know were trying to understand and address Mental Health issues, specifically those that may be untreated, its dr. Hammer and ms. Martinez mentioned in the presentation a while back. I want to bring to light the implicit biases in the government and also officials, the sfpd as well as local security guards, their attitudes they may have towards a subset of our population and those afflicted with Mental Health conditions. Im wondering what kind of steps the condition plans to take in order to mold the attitudes of our city to humanize attitudes to be more empathetic when interacting with the subset of homeless individuals, perhaps less likely to incarcerate them and more so aiding them and escorting them to hospitals, social support systems, as well as shelters. If we start with the city employees, we can expand on that towards the population of our residents. So they will no longer see someone on the streets and think they are crazy, because thats really not the case. But its just that theyre not intentionally being disruptive. Its just some underlying Mental Illness thats not been resolved. Thank you. Hello. My name is jane. Im also a pharmacy student from ucsf. Currently i also intern at the santa clara hospital down in south bay. I have a lot of counselling sessions with the patients there. A lot of them are homeless and they end up being discharged back to the streets. Beyond the counselling sessions, we also talk about go on tangents and about their personal lives. What i hear from patients theyre struggling to access public washroom facilities, theyre not clean or not accessible. A lot of them travel around the city as well. This is something i wanted to bring up because i wanted to bring attention to how feasible it is to increase access public washrooms in the city, that were helping the Homeless Population to improve their health hygiene, but also to increase the cleanliness. I wanted to bring it up and see if it is feasible in the city budget. Good evening, commissioners. My name is franceska okala and i am also a secondyear pharmacy student at ucsf but also expressing some of my concerns. There was a bill signed into law that allows h. I. V. Postexposure proflax sis and preexposure proflax sis to be in pharmacies. My comment today is this access to medication is extremely important to several of the vulnerable populations weve been discussing all throughout the session today, including homeless patients who might be using injectable drugs of abuse. My concern i wanted to bring up to the commission is how exactly the department of Public Health wants to implement these services in the coming year and how its going to be advertised to these vulnerable populations to make sure they get access to these resources. Good evening, commissioners. I am also a secondyear pharmacy student at ucsf and a pharmacy intern. I am also here representing just my own self and concerns and beliefs. As was just mentio