Board backs Epic MOSAIC Phase 2 to unify county health records despite timing concerns
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Summary
San Mateo County approved expansion of the Epic electronic health record into specialty and community divisions (Phase 2/MOSAIC), authorizing staff conversions and temporary contractor capacity. Health leaders said completing the platform will reduce long‑term costs and improve care coordination; supervisors pressed for fiscal detail given state and federal funding uncertainty.
San Mateo County supervisors voted Jan. 27 to advance Phase 2 of Epic MOSAIC, an expansion of the county’s electronic health‑record system into behavioral health, aging and disability services, family health services and other county health programs.
County Health Director Colleen Chawla and CIO Rich Bailey told the board that Phase 1 delivered measurable operational gains — a 25% increase in cash flow from improved revenue processes and substantially shorter pharmacy wait times — and that completing MOSAIC would unify clinical records so care teams across settings can work from a single trusted record. Health leaders said the work is time sensitive because legacy systems such as Netsmart (Avatar) must be transitioned to avoid data‑loss and rising costs.
The proposal sought: conversion of 17 limited‑term implementation roles into permanent county positions, addition of roughly 18 new permanent FTEs for MOSAIC operations, and an up‑to amount of $29 million for temporary contractor staffing (CTG) during implementation. Health staff characterized the $29 million as a ceiling and said they intend not to expend the full amount where county staff can perform the work. They also presented budget context: Phase 1 implementation cost $52.1 million; FY22–25 spending was $87.9 million. The county estimates redirecting and sunsetting legacy systems could reduce future costs by about $52.3 million over five years.
Supervisors pressed for more concrete dollar‑for‑dollar quantification of the savings and the immediate fiscal exposure given federal HR1 and pending state budget decisions that change Medi‑Cal funding. Supervisor Canova and others asked whether the 35 total permanent positions were necessary and asked for clearer metrics tying the promised revenue and cost redirects to the requested investments; health staff committed to returning with more detailed financial analyses and tracking metrics.
Public commenters raised privacy and non‑delegation concerns and asked for clear limits on secondary data use. After extended discussion, the board approved Phase 2 and the CTG temporary staffing agreement (Item 7 and 8) by roll call votes. County staff said next steps include implementation planning, application rationalization to retire legacy systems, monitoring revenue and operational results, and regular reporting to the board.