HomeMy WebLinkAboutHealth Monitoring Systems Inc.-Real Time Public Health Surveillance System_A-22-580 A-18-494.pdf COU Y Count of Fresno Hall of Records, Room 301
2281 Tulare Street
Fresno,California
Board of Supervisors 93721-2198
O� 185 0 Telephone:(559)600-3529
PR Minute Minute Order Toll Free: 1-800-742-1011
www.co.fresno.ca.us
December 13, 2022
Present: 5- Supervisor Steve Brandau, Supervisor Nathan Magsig, Supervisor Buddy Mendes,
Chairman Brian Pacheco,and Vice Chairman Sal Quintero
Agenda No. 56. Public Health File ID:22-1079
Re: Approve and Authorize the Chairman to execute Amendment I to Agreement with Health Monitoring
Systems (HMS), Inc.,to revise the fee schedule to include connection and reconnection fees for
ambulatory clinics to connect to HMS'epidemiological surveillance system,with no change to the
term of August 18, 2018,through August 17, 2023, or compensation maximum of$125,625
APPROVED AS RECOMMENDED
Ayes: 5- Brandau, Magsig, Mendes, Pacheco, and Quintero
Agreement No.22-580
County of Fresno Page 58
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Board Agenda Item 56
O 1856 O
DATE: December 13, 2022
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Amendment I to Agreement with Health Monitoring Systems, Inc.
RECOMMENDED ACTION(S):
Approve and Authorize the Chairman to execute Amendment I to Agreement with Health Monitoring
Systems (HMS), Inc., to revise the fee schedule to include connection and reconnection fees for
ambulatory clinics to connect to HMS' epidemiological surveillance system, with no change to the
term of August 18, 2018, through August 17, 2023, or compensation maximum of$125,625.
There is no additional Net County Cost associated with the recommended action. Approval of the
recommended action will allow the Department continued access to real-time electronic health record
(HER)data from emergency departments of local hospitals and introduce access to data from two
ambulatory clinics. Both Family HealthCare Network and United Health Centers are interested in providing
and accessing data through Health Monitoring Systems, Inc. EpiCenter Bio-syndromic surveillance system.
This collaboration will further support mandates under Chapter 45 and 42, Code of Federal Regulations
(CFR) in regard to significant public health threats and meaningful use requirements. This item is county
wide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended action, ambulatory clinic connection and reconnection
fees would not be added to the fee schedule and the County could not pay fees associated with connection
of these types of facilities. Additionally, the county would not have access to the two ambulatory clinics data
in real time.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. All costs associated
with this agreement will be paid for with the California Department of Public Health (CDPH) Public Health
Emergency Preparedness (PREP)grant funding. Adjustments to the existing contract's fee schedule are
necessary to capture the ambulatory clinic connection and reconnection fees and increase the maximum
annual compensation from $46,125 to$56,125. As this is the final year of the agreement, the annual
maximum compensation adjustment does not impact the total contract compensation amount of$125,625.
Sufficient appropriations and estimated revenues are included in the Department's Org 5620 FY 2022-23
Adopted Budget.
DISCUSSION:
Pursuant to meaningful use requirements contained in 45 CFR and 42 CFR, public health departments are
required to be able to receive medical information via electronic health records(EHR)from applicable
medical providers. The Department has contracted with HMS to receive EHR data since 2007.
County of Fresno Page 1 File Number:22-1079
File Number:22-1079
Agreement No. 18-494 allows the Department to utilize real-time EHR data from local hospital emergency
departments,where significant public health threats are likely to be identified in patients, through HMS'
EpiCenter Surveillance System. EpiCenter is a secure health data system that links hospitals and public
health departments by receiving, analyzing, and displaying real-time data, thereby allowing epidemiological
surveillance monitoring of chronic, acute, and other public health conditions of interest enabling the
Department's epidemiologists to target specific disease symptoms. EpiCenter also allows alerts to be set if
certain conditions are presented at area emergency departments at greater frequency than expected.
The Agreement includes a provision to allow for additional area hospitals or other types of facilities to
connect to HMS with fees for such connection being paid for by the Department, thereby allowing the
Department to gain surveillance data from newly connected facilities. However, the agreement failed to
include the associated fee schedule for adding facilities that are not hospitals. Recently, two ambulatory
clinics which include multiple locations within Fresno County, have expressed interest in connecting or
reconnecting to HMS, provided the County pays the initial and annual connection fees.These two clinics
include 32 locations within Fresno County, serving greater than 140,000 patients annually.
The Department believes that including these ambulatory clinics would provide an important addition to its
surveillance capabilities as many residents experiencing symptoms that may indicate a more serious public
health threat may choose to seek treatment at an ambulatory clinic rather than an emergency department,
especially if the symptoms do not appear to be life threatening.
The amendment also increases the maximum annual compensation by$10,000, from $46,125 to$56,125.
During years 1 through 4 of the agreement the Department did not add any additional facilities or request
any"Optional Services". Annual expenses were$17,375 ($11,375 for"Service Fees"and $6,000 for
"Facilities Connected Previous Years"), resulting in a balance of remaining contract funds available for year
5 of$56,125. All unspent funds during years 1 through 4 have been re-budgeted in year 5 to include the
new connection and reconnection fees and to allow for potential optional services. The total agreement
amount of$125,625 is unchanged.
REFERENCE MATERIAL:
BAI#36, August 21, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk-Amendment I to Agt. No. 18-494
CAO ANALYST:
Ronald Alexander
County of Fresno Page 2 File Number:22-1079
Agreement No. L1-bdU
1 AMENDMENT NO. 1 TO AGREEMENT NO. 18-494
2 This Amendment No. 1 to Agreement No. 18-494 ("Amendment No. 1") is dated
3 December 13, 2022 and is between Health Monitoring Systems, Inc., a Pennsylvania
4 corporation (HMS) ("Contractor"), and the County of Fresno, a political subdivision of the State
5 of California ("County").
6 Recitals
7 A. On August 21, 2018, the County and the Contractor entered into Agreement No. 18-494
8 (Agreement), for access to Contractor's EpiCenter bio-syndromic surveillance system which
9 collects, manages, and analyzes emergency room and other data from local hospitals and other
10 healthcare providers, standardized, annotates, and processes data from these sources, and
11 which allows County access to this data in real time health for review and further analysis.
12 B. The County's ability to receive and analyze this data enhances its ability to identify and
13 respond to potentially significant public health threats, and this ability is further enhanced if more
14 providers connect to Contractor's bio-syndromic surveillance system as this makes more data
15 available.
16 C. Agreement No. 18-494 allows for County to authorize and pay associated connection
17 fees for additional providers, defined in the agreement as "Customer Users", to access and
18 contribute data to Contractor's bio-syndromic surveillance system, however, Exhibit B, the fee
19 schedule, did not identify the connection and other relevant fees associated with adding
20 Ambulatory Facilities.
21 D. Two Ambulatory Facilities have recently expressed interest in connecting to Contractor's
22 bio-syndromic surveillance system provided County will pay the associated connection and
23 other fees to Contractor. As a result, County desires to amend the Agreement to include these
24 fees so that County has a mechanism to pay these fees to Contractor.
25 E. The County and the Contractor now desire to amend the Agreement to include
26 Ambulatory Facilities connection and other associated fees in order to provide a mechanism to
27 pay these fees to Contractor, facilitating additional facilities connections to the bio-syndromic
28 surveillance system.
1
1 The parties therefore agree as follows:
2 1. In Section 5, COMPENSATION, Page 4, Lines 5 through 7, the sentence which states
3 'Total compensation amount not to exceed Forty Six Thousand One Hundred Twenty Five and
4 No/100 Dollars ($46,125) during a given year" is deleted in its entirety and replaced with the
5 following:
6 'Total compensation amount not to exceed Fifty Six Thousand One Hundred
7 Twenty Five and No/100 Dollars ($56,125)during a given year'
8 2. Exhibit B of the agreement is deleted in its entirety and replaced with Revised Exhibit B,
9 which is attached to this amendment.
10 3. When both parties have signed this Amendment No. 1, the Agreement and this
11 Amendment No. 1 together constitute the Agreement.
12 4. The Contractor represents and warrants to the County that:
13 a. The Contractor is duly authorized and empowered to sign and perform its obligations
14 under this Amendment.
15 b. The individual signing this Amendment on behalf of the Contractor is duly authorized
16 to do so and his or her signature on this Amendment legally binds the Contractor to
17 the terms of this Amendment.
18 5. The parties agree that this Amendment may be executed by electronic signature as
19 provided in this section.
20 a. An "electronic signature" means any symbol or process intended by an individual
21 signing this Amendment to represent their signature, including but not limited to (1) a
22 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
23 electronically scanned and transmitted (for example by PDF document) version of an
24 original handwritten signature.
25 b. Each electronic signature affixed or attached to this Amendment (1) is deemed
26 equivalent to a valid original handwritten signature of the person signing this
27 Amendment for all purposes, including but not limited to evidentiary proof in any
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1 administrative or judicial proceeding, and (2) has the same force and effect as the
2 valid original handwritten signature of that person.
3 c. The provisions of this section satisfy the requirements of Civil Code section 1633.5,
4 subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part
5 2, Title 2.5, beginning with section 1633.1).
6 d. Each party using a digital signature represents that it has undertaken and satisfied
7 the requirements of Government Code section 16.5, subdivision (a), paragraphs (1)
8 through (5), and agrees that each other party may rely upon that representation.
9 e. This Amendment is not conditioned upon the parties conducting the transactions
10 under it by electronic means and either party may sign this Amendment with an
11 original handwritten signature.
12 6. This Amendment may be signed in counterparts, each of which is an original, and all of
13 which together constitute this Amendment.
14 7. The Agreement as amended by this Amendment No. 1 is ratified and continued. All
15 provisions of the Agreement and not amended by this Amendment No. 1 remain in full force and
16 effect.
17 [SIGNATURE PAGE FOLLOWS]
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1 The parties are signing this Amendment No. 1 on the date stated in the introductory
2 clause.
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Health Monitoring Systems, COUNTY OF FRESNO
4
6 Ke in J. Hutchi n, Pr i e -t & C O Brian Pacheco, Chairman of the Board of
7 700 River Ave., Suite 30
Supervisors of the County of Fresno
Pittsburgh, PA 15212 Attest:
8 Bernice E. Seidel
Clerk of the Board of Supervisors
9 County of Fresno, State of California
10 /
By:
11 Deputy
12 For accounting use only:
13 Org No.: 56201621
Account No.: 7295
14 Fund No.: 0001
Subclass No.: 10000
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Revised Exhibit B, Page 1 of 2
Fresno County Year 1 Year 2 Year 3 Year 4 Year 5
Service Fees
Annual EpiCenter Service Fee $ 75,000 $ 75,000 $ 75,000 $ 75,000 $ 75,000
Discount (65,625) (65,625) (65,625) (65,625) (65,625)
Insurance 2,000 2,000 2,000 2,000 2,000
$ 11,375 $ 11,375 $ 11,375 $ 11,375 $ 11,375
Hospital Facility Connections
Participating Data Source Initiation Fee-Amount
per hospital facility to be connected* $ $ - $ - $ - $ 5,000
Estimated(max.)new hospitals - 1
$ - $ - $ - $ - $ 5,000
Annual Participating Data Source Initiation Fee-
Amount per facility to be connected** $ 1,000 $ 1,000 $ 1,000 $ 1,000 $ 1,000
Facilities Connected Previous Years 6 6 6 6 6
$ 6,000 $ 6,000 $ 6,000 $ 6,000 $ 6,000
Ambulatory Facility Connections
Amount per network new connection fee:*** $ 3,000
New network:Family HealthCare Network 1
(Additional new network Ambulatory Facilities may be added at the same rates.) $ 3,000
Amount per network annual connection fee: $ -
(Annual connection fee not applicable during first year)
Annual Participating Eligible Professional Fee:
Eligible Professionals(total) 445
$0 per first 25 Eligible Professionals 25
$50 per next 50 Eligible Professionals 50
$25 per next 100 Eligible Professionals 100
$10 per each remaining Eligible Professional 269
$ 7,690
Amount per network to be reconnected fee**** $ 2,500
Existing network:United Health Centers 1
Reconnection fee to be pro-rated based on portion of remaining contract year. $ 2,500
Annual per network annual connection fee: $ -
(Annual connection fee not applicable during first year of reconnection)
Annual Participating Eligible Professional Fee:
Eligible Professionals(total) 91
$0 per first 25 Eligible Professionals 25
$50 per next 50 Eligible Professionals 50
$25 per next 100 Eligible Professionals 16
$10 per each remaining Eligible Professional -
$ 2,900
Other Services To Be Provided*****
Optional services $ $ $ $ $ 17,660
$ $ $ - $ $ 17,660
Revised Exhibit B, Page 2 of 2
Total Costs $ 17,375 $ 17,375 $ 17,375 $ 17,375 $ 56,125
Other Items To Be Budgeted
Third Party vendor fees(est.) $ 3,500 $ 3,500 $ 3,500 $ 3,500 $ 3,500
Estimated(max.)new hospitals - - - - -
Total Budget $ 17,375 $ 17,375 $ 17,375 $ 17,375 $ 56,125
*Amount per Hospital Facility to be Connected costs are shown as$5,000 each. Is is estimated that no additional new Hospital
Facilities will be connected in Year 5,but cost per new facility is identied in the fee schedule in the event this changes. New
Hospital Facilities could be connected at any time within the contract period.Actual connection costs will be incurred during the
year the new facility is connected. Should any new connections be added,associated costs will be abosorbed by funding available
within the"Other Services to be Provided"section,or through contract amendment approved prior to expenditures being incurred.
** Existing Hospital Facility Maintenance costs are shown as$1,000 per connected facility. Though no additional Hospitali Facilities
are anticipated to be added during Year 5,if new connections are added,the same fee will apply to each additional facility. Should
this occur,associated costs will be absorbed by funding available within the"Other Services to be Provided"section,or through
contract amendment approved prior to expenditures being incurred.
***New Ambulatory Facility connection fee is$3,000 each. Only one facility new facility connection fee is anticipated during Year
5, but an additional new connection fee will apply if additional new facilities are connected. Eligible Professional fees are subject to
change on an annual basis as Eligible Professionals may be added to or subtracted from facilities.
****Ambulatory Facility reconnection fee is$2,500 and will be prorated for portion of the contract year remaining at time of
reconnection. If a full contract year remains following reconnection,the prorated reconnection fee will apply for the remaining
portion of Year 4 and the annual connection fee will apply for Year 5.
***Optional Services were not provided in Years 1 through 4. It is estimated a maximum of$20,160 of Optional Services may be
provided during Year 5.Optional Services will not be provided without prior written authorization from COUNTY.
Note:"Participating Eligible Professionals"are defined as physicians participating in the surveillance system(submitting data).