County of Santa Clara
Santa Clara Valley Health & Hospital System
Agency Administration
Information Services
84855
DATE:
February 28, 2017
TO:
Board of Supervisors
FROM:
Lee Herrmann, Interim Chief Information Officer
SUBJECT: Various Actions Related to Agreement with Epic Systems Corporation
RECOMMENDED ACTION
Consider recommendations relating to Agreement with Epic Systems Corporation.
Possible action:
a. Accept donation of $11,900 from Epic Systems Corporation on behalf of Santa Clara
Valley Health and Hospital System (SCVHHS).
b. Authorize President to forward letter of appreciation to Kelly Pasztor, Epic Systems
Corporation.
c. Approve delegation of authority to Chief Healthcare Technology Officer, SCVHHS, or
designee, to negotiate, execute, amend, terminate, and take any and all necessary or
advisable actions relating to modifying the license and support agreement with Epic
Systems Corporation, increasing the maximum contract amount by up to $2,000,000
from $64,683,200 to $66,683,200, for period March 1, 2017 through January 11, 2022,
following approval by County Counsel as to form and legality, and approval by the
Office of the County Executive. Delegation of authority shall expire on January 11,
2022.
FISCAL IMPLICATIONS
Approval of the recommended actions would not require modification to the current Boardapproved budget for Santa Clara Valley Medical Center (SCVMC). Board approval of the
acceptance of donation will allow SCVMC to receive $11,900 from Epic Systems
Corporation.
The funds required to support the delegation are included in the appropriations for SCVHHS
Information Services. The current maximum financial obligation for the Agreement with
Epic Systems Corporation is $64,683,200. Approval of the delegation would allow the Chief
Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian
County Executive: Jeffrey V. Smith
Page 1 of 7
Healthcare Technology Officer to increase the maximum contract amount by up to
$2,000,000 for future amendments needed through January 11, 2022.
CONTRACT HISTORY
On January 10, 2012, the Board of Supervisors awarded a contract to Epic Systems
Corporation for the license, implementation and support of the Enterprise Core Healthcare
Information System, known as HealthLink, for period January 11, 2012 through January 11,
2022. The maximum financial obligation for the term of the Agreement was $59,000,000.
On May 1, 2012, the Board approved the First Amendment to the Agreement relating to the
acquisition of Clinical Practice Model Content in an amount not to exceed $1,700,000 for
period April 11, 2012 through January 11, 2022. The maximum financial obligation was
revised to not exceed $60,700,000.
On September 11, 2012, the Board approved the Second Amendment to the Agreement
which allowed for the acquisition of Epic’s Tapestry Benefit Enrollment and Maintenance
Interface in an amount not to exceed $51,250 for period September 11, 2012 through January
11, 2022. The maximum financial obligation for the term of the Agreement was revised to
not exceed $60,751,250.
On February 26, 2013, the Board approved the Third Amendment to the Agreement with
Epic relating to adding three interfaces for HealthLink in an amount not to exceed $65,000
for period February 26, 2013 through January 11, 2022. The maximum financial obligation
for the term of Agreement was revised to not exceed $60,816,250.
In March 2013, SCVHHS executed the Fourth Amendment to the Agreement with Epic
relating to changing the name of the interfaces in the Third Amendment. It was an
administrative amendment and there was no change in the maximum contract amount of
$60,816,250, and no change to the January 11, 2022 end date of the Agreement.
On August 13, 2013, the Board approved the Fifth Amendment relating to providing a patient
abstractor program for HealthLink with no change to the maximum contract amount of
$60,816,250, and no change to the January 11, 2022 end date of the Agreement.
On August 13, 2013, the Board approved the Sixth Amendment to the Agreement with Epic
relating to terminating one interface license and replacing it with a new interface license
required for biomedical device data integration with no change to the maximum contract
amount of $60,816,250, and no change to the January 11, 2022 end date of the Agreement.
On September 24, 2013, the Board approved the Seventh Amendment which added two
pharmacy interfaces in an amount not to exceed $77,500 for period September 24, 2013
through January 11, 2022. The maximum financial obligation for the term of the Agreement
was revised to not exceed $60,893,750.
Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian
County Executive: Jeffrey V. Smith
Agenda Date: February 28, 2017
Page 2 of 7
On September 24, 2013, the Board approved the Eighth Amendment to the Agreement with
Epic relating to providing operational support for SCVMC Patient Business Services
Department and implementation support for the Ambulatory Go-Live increasing the
maximum contract amount by $1,120,600 for period September 24, 2013 through January 11,
2022. The maximum financial obligation for the term of the Agreement was revised to not
exceed $62,014,350.
The Ninth Amendment to the Agreement with Epic was drafted, but SCVHHS decided to not
move forward with executing the Amendment. Epic has requested to keep the numbering of
the Ninth Amendment on file to avoid any potential confusion in the future.
On November 26, 2013, the Board approved the Tenth Amendment with Epic relating to
providing outgoing scheduling interface in an amount not to exceed $23,500 for period
November 26, 2013 through January 11, 2022. The maximum financial obligation for the
term of the Agreement was revised to not exceed $62,037,850.
In July 2014, the County Executive executed the Eleventh Amendment with Epic relating to
terminating the Outgoing Clinical Flowsheet Interface and replacing it with the Outgoing
Syndromic Data Interface. There was no change in the maximum contract amount of
$62,037,850, and no change to the January 11, 2022 end date of the Agreement. The Board
of Supervisors ratified the Eleventh Amendment at the next available Board Meeting on
August 5, 2014.
On November 4, 2014, the Board approved the Twelfth Amendment to the Agreement
relating to providing two interface licenses in an amount not to exceed $45,125 for period
November 4, 2014 through January 11, 2022. The maximum financial obligation was
revised to not exceed $62,082,975.
On November 3, 2015, the Board approved the Thirteenth Amendment to the Agreement
with Epic relating to providing implementation services for the Custody Health Services
Electronic Health Record Project, increasing the maximum contract amount by $1,696,000
from $62,082,975 to $63,778,975, with no change to the term of the Agreement.
On November 3, 2015, the Board approved the Fourteenth Amendment with Epic relating to
providing licensing and implementation services for EpicCare Infection Control Module.
The maximum contract amount was increased by $383,000 from $63,778,975 to
$64,161,975, with no change to the January 11, 2022 end date of the Agreement.
On March 22, 2016, the Board approved the Fifteenth Amendment relating to terminating the
Outgoing Electronic Script Orders Interface and adding the Incoming Ancillary Results and
Orders Interface with no change to the maximum contract amount of $64,161,975, and no
change to the January 11, 2022 end date of the Agreement.
On March 22, 2016, the Board approved the Sixteenth Amendment to the Agreement with
Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian
County Executive: Jeffrey V. Smith
Agenda Date: February 28, 2017
Page 3 of 7
Epic relating to providing licensing and implementation services for Blood Product
Administration Module in an amount not to exceed $31,600 for period March 22, 2016
through January 11, 2022. The maximum financial obligation for the term of Agreement was
revised to not exceed $64,193,575.
On March 22, 2016, the Board approved the Seventeenth Amendment relating to providing
subscription services for Care Everywhere – Carequality Exchange with no change to the
maximum contract amount of $64,193,575, and no change to the January 22, 2022 end date
of the Agreement.
On March 22, 2016, the Board approved the Eighteenth Amendment relating to providing
licensing and implementation services for EpicCare Wisdom General Dentistry Module,
increasing the maximum contract amount by $327,052 from $64,193,575 to $64,520,627,
with no change to the term of the Agreement.
On March 22, 2016, the Board approved the Nineteenth Amendment with Epic relating to
providing web services to facilitate communication between Epic and Cisco Call Center
System, increasing the maximum contract amount by $39,000 for period March 22, 2016
through January 11, 2022. The maximum financial obligation for the term of Agreement was
revised to not exceed $64,559,627.
On April 12, 2016, the Board approved the Twentieth Amendment relating to providing
licensing and implementation services for a copy of a bidirectional Coding Interface,
increasing the maximum contract by $14,406, from $64,559,627 to $64,574,033, with no
change to the term of the Agreement.
On April 12, 2016, the Board approved the Twenty-First Amendment relating to adding four
interfaces, increasing the maximum contract amount by $37,967, from $64,574,033 to
$64,612,000, with no change to term of the Agreement.
On April 12, 2016, the Board approved the Twenty-Second Amendment with Epic relating to
providing web services for medical imaging decision support content, in an amount not to
exceed $47,200 with no change to term of the Agreement. The maximum financial
obligation was revised to not exceed $64,659,200.
On November 15, 2016, the Board approved the Twenty-Third Amendment relating to
providing licensing and implementation services for Spirometry Integration Module in an
amount not to exceed $24,000 with no change to the January 11, 2022 end date of the
Agreement. The maximum financial obligation was revised to not exceed $64,683,200.
REASONS FOR RECOMMENDATION
Donation from Epic
Pursuant to Santa Clara County Ordinance Code Section A2-17 Acceptance of Gifts, gifts
Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian
County Executive: Jeffrey V. Smith
Agenda Date: February 28, 2017
Page 4 of 7
valued over $10,000 from a single donor must be formally accepted and approved by the
Board of Supervisors before being received by the department and agency.
Epic Systems Corporation has donated a stipend in the amount of $11,900 to reimburse
SCVMC for registration fees relating to the 2016 Users Group Meeting and travel to
Madison, Wisconsin.
Delegation of Authority
Although delegations of authority are discouraged except under certain circumstances, on
November 7, 2016, Administration recommended that the department request a delegation of
authority to allow necessary adjustments to the Agreement without having to bring numerous
legislative files to the Board for approval for each amendment. Since the Board of
Supervisors’ approval of the Agreement with Epic Systems Corporation on January 11, 2012,
twenty-three (23) amendments have been approved by the Board with seven (7) of those
being no-cost amendments.
SCVHHS is requesting that the Board of Supervisors approve a delegation of authority to the
Chief Healthcare Technology Officer to assist SCVHHS in providing timely execution of
amendments pertaining to licensing updates, services, and maintenance provided by Epic in
an amount not to exceed $2,000,000 for the remaining term of the Agreement for period
March 1, 2017 through January 11, 2022. Approval of this recommendation would reduce
the number of legislative files requiring Board approval.
SCVHHS and Epic are currently negotiating the Twenty-Fourth, Twenty-Fifth, and TwentySixth Amendments which would use $364,460 of the requested $2,000,000 delegation
amount.
Twenty-Fourth Amendment – Caboodle, Predictive Analytics and Healthy Planet
The Twenty-Fourth Amendment will add licensing and subscription for Caboodle Data
Warehouse, Predictive Analytics and Healthy Planet and will increase the contract maximum
by $250,000 from $64,683,200 to $64,933,200.
Caboodle Data Warehouse, previously known as Cogito, is Epic’s data warehouse and
analytical tool used to store and retrieve large amounts of clinical data. The data can be
queried to provide all manner of reporting to support decisions, manage costs, and identify
trends. Other data can be brought in from non-Epic systems, and then used along with Epic
data to provide reporting results.
Epic’s Predictive Analytics will provide a tool to analyze current data to make predictions
about the future to yield better outcomes. Models for Predictive Analytics include inpatient
length of stay, risk of patient no show, and risk of hypertension.
The Healthy Planet application is a case management registry that will coordinate care across
a community of providers. Healthy Planet provides a suite of reports, dashboards, and
workflow tools that allow Care Managers to manage patient populations, and will assist
SCVHHS to deliver better care for a given population of patients.
Twenty-Fifth Amendment – Standard Interfaces and Data Connectors
Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian
County Executive: Jeffrey V. Smith
Agenda Date: February 28, 2017
Page 5 of 7
Epic has developed a new licensing structure for standard interfaces and data connectors.
The Twenty-Fifth Amendment will delete the Original Interface Licensing Structure and
replace it with the Standard Interfaces and Data Connectors list. The contract maximum will
need to be increased by $114,460, from $64,933,200 to $65,047,660 to include the increase
in monthly maintenance cost by $1,940 per month.
Twenty-Sixth Amendment – Push Notifications
The Twenty-Sixth Amendment will enable licensing to allow Push Notifications for Epic
mobile applications. Push Notifications are instant, clickable messages which appear directly
on mobile devices for users who have enabled to receive notifications. This is a no-cost
amendment.
A Twenty-Seventh Amendment with Epic is also being developed for Healthy Planet, but no
further details are available at this time.
The delegation aligns with SCVHHS’s Strategic Road Map as it relates to the Triple Aim
Plus Objective by improving system integration and delivering coordinated/integrated
personalized care which will lead to timely, equitable, effective and efficient care.
CHILD IMPACT
The recommended action will have no/neutral impact on children and youth.
SENIOR IMPACT
The recommended action will have no/neutral impact on seniors.
SUSTAINABILITY IMPLICATIONS
The recommended action will have no/neutral sustainability implications.
BACKGROUND
SCVHHS Information Services’ HealthLink Team is currently active with the
implementation of Wave 3, which will be delivered in two phases. Phase 1 includes OpTime
(Surgery), Anesthesia, Radiant (Radiology), Clinical Case Management, and Infection
Control will go live February 25, 2017. Phase 2 includes Kaleidoscope (Ophthalmology),
Nurse Triage and Wisdom (Dental). These projects are targeted to go live on May 22, 2017.
Additionally, HealthLink is coming to Custody Health Services (CHS) and Behavioral
Health Services Department (BHSD). In a phased approach, CHS and BHSD will be
replacing their current documenting tools with HealthLink.
HealthLink Implementation Timeline:
1/10/2012
Board of Supervisors awarded a contract to Epic for HealthLink
5/4/2013 and 5/7/2013
HealthLink go-live at SCVMC, hospital outpatient departments
and two primary care clinics (Bascom and Moorpark)
8/20/2013 and 10/15/2013
Ambulatory go-live
2/24/2014
Wave 1 completed with implementation of Beacon for
Oncology and Infusion Center
Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian
County Executive: Jeffrey V. Smith
Agenda Date: February 28, 2017
Page 6 of 7
6/3/2014
Initial Healthy Planet go-live to facilitate population health
management and patient engagement
7/12/2014
Major upgrade completed to Epic version 2014
7/25/2015
Wave 2 go-live of Beaker for Laboratory and Willow
Ambulatory for pharmacy
11/6/2016 and 11/7/2016
Epic 2015 upgrade completed; Custody Health Services Juvenile Hall go-live
2/25/2017
Wave 3, Phase 1 go-live for OpTime, Anesthesia, Radiant,
Clinical Case Management, and Infection Control
5/22/2017
Wave 3, Phase 2 go-live for Kaleidoscope, Nurse Triage and
Wisdom; Custody Health Services – Adult Custody go-live
11/6/2017
Behavioral Health Services go-live
CONSEQUENCES OF NEGATIVE ACTION
Failure to approve the recommended actions may impact SCVMC from accepting a donation
from Epic Systems Corporation.
Failure to approve the delegation of authority will result in the department being required to
continue submitting legislative files for each amendment to the Board of Supervisors for
approval.
STEPS FOLLOWING APPROVAL
Please send notification of MinuteTraq processing of this legislative file to Susan Quillinan,
SCVHHS Information Services.
Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Ken Yeager, S. Joseph Simitian
County Executive: Jeffrey V. Smith
Agenda Date: February 28, 2017
Page 7 of 7