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San Francisco DPH details EPIC behavioral-health rollout and privacy limits for substance-use records
Summary
DPH reported a major EPIC go-live for mental health and community clinics, noted operational gains in documentation and billing, and said substance-use treatment remains on separate systems because of 42 CFR Part 2 privacy rules; DPH plans a targeted path forward with consent processes and third-party systems evaluation.
San Francisco Department of Public Health officials told the Health Commission that the EPIC electronic health record rollout in behavioral health and community clinics has produced measurable operational gains, but that privacy rules are constraining how substance-use records are integrated.
Deputy Chief Information Officer Jeff Scarfia said the EPIC behavioral-health launch on May 22 brought mental-health services and more than 70 community clinics onto the departmentEHR. "Over 1,400 staff ended up using the new system," he said, adding that DPH provided more than $1,100,000 to community-based organizations to ensure they had equipment and support during the go-live. Scarfia said 92% of encounters are now closed within three days and that more timely documentation has been associated with stronger Medi-Cal charge capture, which he described as a reported 118% of charges being captured and billed compared with earlier practice.
But Scarfia and other staff made a point of distinguishing behavioral-health records from substance-use treatment records. "Substance use remains on Avatar and Methasoft for methadone dispensing," Scarfia said, citing 42 CFR Part 2 privacy interpretations that led DPH to pause integrating substance-use data into EPIC. He said the department is evaluating optionsincluding commercial systems such as CalMESAand will work with behavioral-health leadership to "identify a path forward." DPH interim clinical informatics and compliance staff said they are designing a universal consent form and patient education to maximize the data DPH can share while complying with federal privacy rules.
Commissioners asked how emergency clinicians would learn about a patient's methadone or Suboxone status. Scarfia said Part 2 contains exceptions for emergent scenarios but that practical access is "extremely complicated," and that operationalizing timely release in emergencies remains a challenge. Nita Ratonamaza, interim CMO and informatics lead, said DPH has worked with the Office of Compliance and Privacy Affairs and the City Attorney on consent approaches in light of recent SAMHSA flexibilities.
Scarfia also described limits to patient-portal functionality: MyChart navigation is available in English, Spanish and simplified Chinese, but some interactive features (for example, "ask a doctor") do not yet support Chinese-character queries and DPH is not relying on AI-based translation for medical advice at this time.
The commission welcomed the performance improvements but requested follow-up on the substance-use path forward and clearer procedures for clinical access in emergencies. DPH staff said they will return with details as work proceeds and as legal, clinical and privacy issues are resolved.
