Health Commission backs director's plan to negotiate with UCSF for Epic-based EHR

The San Francisco Health Commission on Jan. 19 unanimously approved a resolution supporting the Department of Public Health director's decision to pursue exclusive negotiations with UCSF to adopt UCSF's instance of the Epic electronic health record (EHR) system and to seek board approval for a one-time exception to the city's competitive procurement process.

The commission's vote authorizes the director to negotiate exclusively with UCSF for up to six months; if the parties cannot reach assurances within that time, staff said the department may open negotiations with Cerner or Epic directly as alternatives. Bill Kim, DPH chief information officer, told commissioners the department has studied market options for more than two years and concluded that Epic and Cerner are the market leaders most likely to meet clinical and operational needs.

The department framed the request as a risk-mitigation and patient-safety measure. Kim said the current EHR environment is a patchwork of aging systems that will lose vendor support within the coming years, and that a shared UCSF Epic instance would reduce training and implementation costs because many DPH clinicians and trainees already use Epic at UCSF. Greg Wagner, DPH chief financial officer, said the department has developed a financing strategy and engaged outside consultants; he added that final financial terms will be negotiated and that the department will not accept a contract that fails to fit within the city's financial authority and five-year plan.

Clinical leaders and partner organizations urged the commission to support the negotiation. Dr. Carlisle, speaking as vice dean at UCSF, said leveraging UCSF's Epic instance would improve patient safety, reduce duplicate testing and lower training costs. Dr. Jim Marks, chief of staff at San Francisco General Hospital, said the hospital's service chiefs support implementation tied to UCSF's Epic because it increases the likelihood of successful adoption and interoperability with regional systems.

Community clinic leaders urged early inclusion in planning. Dina Laan of the San Francisco Community Clinic Consortium said community clinics serve roughly 10 percent of the city's population and asked that clinics be included early so information can exchange efficiently between clinics and hospitals.

Commissioners pressed staff on the rationale for asking a one-time exception to the competitive process, the expected timeline and the financial trade-offs versus other vendors. Kim and Wagner said timing is a crucial factor to avoid lapses in vendor support, that the UCSF partnership reduces operational and adoption risk, and that final price and maintenance responsibilities will be resolved through negotiation. The department also committed to involve stakeholders, governance representatives and patients in the implementation and to return to the commission with contracting details.

The commission moved the resolution, recorded no opposing votes and passed it by voice vote. The next steps identified by staff are to seek Board of Supervisors approval for the procurement exception and to proceed with negotiations and further reporting to the commission as contract terms are developed.