And the -- what13 the care system does is, it matches14 client-level information so that it's easy15 to figure out who's therapist, who's the16 outreach worker, who's the person17 providing care across other social-service18 systems.19 Health data are not included in20 the care system.21
Not at all.25 179 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
Okay. And4 that's DSS Cares Philly, what we call5 Philly Cares now.6
The Health9 Department's electronic health records and10 the Prison electronic health records will11 be like a paper chart, as you know, that a12 doctor, a nurse practitioner, a physician13 assistant uses when providing care to a14 client.15
Okay. So16 what we're creating is another place where17 people will have to enter data that won't18 be coordinated with existing databases?19
It is depends on20 which data.21 So the challenge in the City is,22 we don't have a unique identifier for23 every citizen, so there isn't a number24 that we use to identify a citizen. And25 180 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 there are serious concerns about people's2 confidentiality if we do have such a3 unique identifier.4 But if we did, then it would be5 quite easy to when, somebody walks into6 the gas company, have their address and7 name; and when they walk into the health8 center, have their address and name and9 whatever. We don't have to share any10 other information.11
But without that,13 the challenge of trying to do that without14 a unique identifier across government is15 very large.16 So when someone comes into a17 health center, they now should only have18 to record that information once, because19 we have a registration system, and we use20 that registration system. But we hadn't21 paid for the connection between the22 care-providing registration system and the23 pharmacy registration and the laboratory24 registration system.25 181 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 So we're now making those2 connections, and those connections will3 continue, so that will be an efficiency4 for the patient.5
How much is6 that connection going to cost? In other7 words --8
Okay. We11 have software that the City owns called12 Mind Share that's capable of combining13 information from databases, allowing that14 sort of thing.15
It is. It's19 not -- the most efficient way is just to20 build -- it's not a hard thing to do.21
You can do it for23 a little money, we should be doing it, we24 will. That's not a hard one.25 182 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 And the electronic record will2 actually take care of that.3
And it will be a5 minor part of the expense actually. So6 you're right: We need to do it, it needs7 to be done soon, we'll get it done.8
In terms of9 medical records, since people do visit10 emergency rooms, our health centers,11 private doctors, et cetera, are we doing12 anything to coordinate a single system for13 the City or for providers in the City and14 its surroundings?15
So we have had16 conversations, particularly because of17 Stimulus dollars, on interconnectability.18 There are substantial issues in19 the work that's been done in other20 geographic locations with this. It's21 not -- I would say it's not for the faint22 of heart, but we are working hard to23 identify what is the information that can24 be shared for the greatest benefit for all25 183 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Philadelphians.2 One of the things we've3 identified, for instance, is prenatal care4 information. So we are looking very5 hard -- and I am talking to a lot of6 people about funding early for an7 interconnectible prenatal care registry,8 which would allow prenatal care9 information to be put in and then accessed10 at the time of the delivery. That's11 safer, more efficient, better in every12 way.13 We need to have the dollars in14 hand to build it. We actually have a15 platform in the Health Departments in our16 Immunization Registry, so we're well17 positioned. As soon as the federal18 government puts out those guidelines on19 the Stimulus, we will go there.20
I want to21 suggest maybe a different way to think22 about it because everybody could --23 essentially, you can have a blind database24 that everybody puts into and that you can25 184 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 only access your information out of, but2 when a patient walks into a emergency3 room, if that one single database existed4 at a data center in the City, everybody5 would be putting into it, even though you6 could only see your own information. And7 it can be completely private.8 And, I mean, so what you're9 talking about is actually not as -- the10 technology exists today, it's there, it's11 not difficult to do; it's just getting12 other providers to agree to put all of13 their data in that separate database.14 Even if they are keep their own systems,15 you can have it all go into one place.16
I would say it17 absolutely can be done. It's the18 maintenance cost past the initial19 investment and the decision-making about20 what's useful information, because taking21 every little piece of information, if you22 think of all of the information in the23 paper chart --24
Yeah.25 185 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
-- and dumping2 that all into an electronic -- it doesn't3 make a whole lot of sense.4 So the hard part, the heavy5 lifting on this, if you will, is6 identifying what is the necessary useful7 information, having everyone agree on that8 information, and then figuring out how to9 maintain it.10 So we're starting -- we're11 putting our toe in the water on prenatal12 care records.13
And I think we've15 done that process well, so we can actually16 achieve it.17
I mean, if18 you look at the federal government's of19 what this will save the nation in terms of20 the ability to do that, you know, my21 question would be: What will it save the22 Philadelphia medical community, especially23 if we can tie reimbursements into the same24 sort of thing so it's all electronic?25 186 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
We certainly3 can force our providers to participate in4 something like that; we have a big enough5 class. So can the State of Pennsylvania.6 And next year, perhaps we can7 have a more detailed discussion on this8 issue at budget time in terms of what9 are -- you know, 'cause we need to get --10
And I'm happy to14 do it here. I know the time constraint,15 but I'm happy to have that conversation.16 I think I have the information you need.17
Okay. Also,18 I just want to say you haven't given us19 the detail of what this EMR initiative is20 going to save, and you're going to provide21 the cost-benefit analysis, and I22 appreciate that, in detail.23 But last year at this, time we24 had a very similar discussion about that25 187 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 initiative. And what I said to you at2 that time, and everybody else, was: If3 there is a cost benefit that's positive,4 and you can show us that we're going to5 save operating costs in the future or be6 able to provide more service for the same7 amount of money, we can find you the money8 to make that investment.9 So we -- you know, why would you10 not come ask us for it rather than saying11 it's not available? Who made the12 determination that City Council won't13 appropriate the funds you need for this14 system?15
I think the answer16 to that is, the hospital tax should be17 providing it, so that in a sense, in18 partnership, we will all be able to take19 credit for it.20 I don't think anyone anticipated21 that it would take Washington this long to22 agree on our hospital tax application.23
But it will25 188 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 ultimately provide those dollars --2
It will provide --5 those plus the Stimulus will provide the6 dollars that we need.7 We are asking for some8 additional dollars from Washington to make9 sure we have it in the right timeframe and10 we get everything we need, but I believe11 we have a plan in place, that if we can12 get the hospital tax passed, we should13 have the dollars to do this.14
I would15 encourage you, because those are both16 things out of your control, whether we get17 the Stimulus dollars, whether we get the18 other dollars.19 If you don't get them by the20 time you expect, come back to City Council21 and ask for an appropriation. There is no22 reason to wait a whole 'nother year to do23 things that will save us money in the long24 run.25 189 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 I told this story the other day2 in Council, and I'm going to share it3 with. You know about George Washington,4 when they were planting frees in front of5 Mount Vernon? And he was talking about --6 I don't remember exactly, but the shade7 they'd provide and other things and how8 beautiful they were going to be.9 And the workmen that were there10 digging the hole for him said, you know,11 "But it will be 50 years before we see12 that benefit." George Washington said,13 "Well, then we better plant it now."14 You know, all through15 government, every department I hear, you16 know, "We're going to do that next year."17 These things will have ripple18 effects in the Five-Year Plan that save us19 money. We have to make the investments20 today. We might not have the money to21 make them when you want them. We can find22 money for things that have a business23 case, and this has a business case.24
I appreciate that.25 190 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 I have to say that in the last2 year, one of the things we've done is to3 make sure we're ready to go. So we have4 done the missing pieces. And, as I5 mentioned, we will release a request for6 proposals soon. It's ready to go.7 And it will mean that at the8 point when dollars are available, we're9 actually ready to roll.10
Not very long,16 actually. The final piece of it had to17 be -- we had one final consulting piece18 that happened this year that we started19 last spring. And until that information20 was in, we couldn't complete the process.21 I kicked that off last spring.22 We now have the information,23 we'll integrate it into the existing RFP,24 which is going on at the moment by the25 191 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Department of Technology, and we'll2 release.3 COUNCIL PRESIDENT VERNA:4 Councilman Green, Councilwoman Tasco has5 been patiently waiting for her turn. Are6 you about finished?7
He's10 not about finished.11 So Councilwoman Tasco, if you12 want to be recognized now.13
Well, he's14 only responding to the (inaudible) rarely15 ask any questions, although we stayed here16 till 6:30 Wednesday night, listening to17 the Prison and the Police Department.18
Monday21 night, and listening to all of the22 testimony, and asking all of these23 questions we have asked him to ask,24 because that's his charge, to find25 192 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 efficiencies 'cause he's done all his2 homework to get all the questions out, and3 we appreciate the staff answering those4 questions.5 But maybe, you know, we're not6 loud enough.7
Go ahead10 and proceed. I just have one little small11 question that's really probably not12 important to anybody 'cause it's not a13 big, overwhelming problem, but it's a14 problem that we see in our community for15 the people we serve.16
I yield to17 the Majority Leader, Madam Chair.18 (Laughter.)19
We were23 talking about access for those clients who24 have to go to other facilities for25 193 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 services. And my [indiscernible] lady2 called and wanted me to ask you this3 about, how do we get some of these4 hospitals to take other insurances?5 Some will only take one, but we6 need to be able to have them accept all7 insurances because the insurance will8 determine where the insured -- the9 uninsured will go.10
So the challenge11 here is that, remember, the insurance is12 ultimately managed at the State level.13
It's like a number15 of other issues, which, in the City, we16 would love to be able to have legislation17 intervention around. This is another18 State issue, and it's --19
Which, by20 the way, if you talk to us, we have21 relationships with our State legislators22 that we could probably ask them --23
-- to help25 194 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 us with.2
Now8 proceed, Councilman Green, because I want9 you to ask all those in-depth questions10 'cause I don't want to be chided not one11 more day for not staying here, asking all12 these hard questions about this budget.13 (Laughter.)14 COUNCIL PRESIDENT VERNA:15 Councilman Green.16
Thank you,17 Madam Chair.18 It was reported in the Business19 Journal that Pennsylvania's receiving20 $9.4 million in Economic Stimulus Funds21 for the expansion of community health22 centers termed "increased demand for23 services funds." The money is to be24 distributed to 36 federally-qualified25 195 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 health centers.2 Are we not receiving any of this3 funding?4
Because we are7 federally-qualified health-center8 lookalikes. We are not federally-9 qualified health centers, period.10
I think that's a13 very important question that we are14 actively pursuing.15
Yes,18 Councilwoman Tasco.19 COUNCILWOMAN TASCO:20 Dr. Schwarz, if -- we will talk about this21 later, but just for the record, if there's22 any opportunity, as we discuss the federal23 lookalike, that we can be helpful with you24 in Washington --25 196 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
I'm very3 active with the National League of Cities4 and --5
-- can use7 at a base as well as other organizations8 to help us move and do whatever is9 beneficial to us.10
Yes. Thank13 you.14 COUNCIL PRESIDENT VERNA:15 Councilman Green.16
Thank you.17 The budget detail indicates18 multiple categorical grants from the19 federal and State governments that the20 City has received previously but are not21 awarded in FY '10. Are these grants not22 being awarded to any recipients? And why23 aren't we getting them?24 It's Budget Detail Section 46.25 197 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
Yeah. The5 challenge with our budget -- and you6 highlight non-transparency. But in this7 case it's transparent.8 It's just -- it's difficult in9 the Health Department in part because,10 remember, I mentioned, that we are moving11 services around a bit. So we're trying to12 for efficiency, for instance, move13 prenatal-care services and family planning14 services into ambulatory health.15 What that results in is, it16 looks like a grant went away in one part17 of the budget when, in fact, it looks like18 a new grant in another part of the budget,19 and it's the same grant. There isn't an20 easy way to there isn't an easy way to21 track it for you.22
-- do a chart25 198 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 showing us what grants we lost, what2 grants we're getting --3
The good news is,10 there are some very tiny pieces that are11 going away that we plan for, we know that,12 in general, we have replaced them.13 And we have some wonderful14 exciting news about new grants like the15 new money that I mentioned coming in for16 Ryan White. So I can reassure you -- and17 I'm happy to provide the information to18 you.19
Yeah. I'd20 just like to be able to figure out where21 all of the pieces moved.22
Thank you.24 The budget detail indicates --25 199 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 this is Section 46, -- indicates2 that the Department had 31 service3 representatives at district health centers4 through the end of the FY '08, and it was5 budgeted for 27 of these positions in6 FY '09.7 As of January 2009, there were8 49 service representatives, and the FY '109 proposes -- budget proposed to increase10 the number to 51.11 What do these service12 representatives do? And why did we13 increase them?14
Okay. If you look15 at that same page -- and I don't know if16 you have it in front of you, but there's a17 series of other line items in the18 personnel page where there were19 substantial reductions; for instance,20 clerks in particular --21
Section 46,25 200 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 , okay.2
So those decreases6 represent a reclassification in that group7 of personnel in the re job spec, if you8 will, and they now appear as service9 representatives.10
I don't believe13 that there's actually a change here, but14 we can add 'em up and make sure, but it's15 my understanding that it was not intended16 to reduce staff; rather, it was intended17 to make workflow more integrated and18 assure that their job classification19 actually matches the activities that20 they're doing.21
Where else?25 201 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
And, let's see. I5 think those are the two main lines. I may6 be missing one, but I believe those are7 the two main ones.8
The budget12 detail indicates that the Department's13 contract with Scotland Yard for security14 services is increasing $100,000; from15 340,000 to 440,000. Why the dramatic cost16 increase?17
It has to do with18 the negotiated rate for Scotland Yard that19 the City negotiated. It has to do with20 the contract that was bid through21 Procurement.22 You may know that all of the23 security contracts for the City were rebid24 in the spring and a year ago. And you're25 202 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 seeing reflected in the budget the2 increase in that cost.3
Okay. The4 budget detail indicates that the5 Ambulatory Health Services Division with6 the department budget is budgeted at7 $131,025 for printing forms.8
What forms13 would be eliminated by ERM? And have you14 calculated the man-hour savings also?15
And I can actually20 give you the names of every form if you'd21 like it.22
I have them with25 203 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 me.2
If you could3 provide them to the Chair, that would4 be --5
Okay. I have the6 names. I don't have the forms; that would7 take a carton, but I have the names of the8 forms.9
Thank you.10 That is -- I have to commend11 you. That is a request that I made of12 every department in the City for all of13 their forms, I think it would have been,14 in April or May of last year. You are the15 first department to respond completely.16
Well, I'm not17 responding completely, and I appreciate18 your kudos on this, but I want to be19 honest; and that is, we're almost done.20
And it has to do22 in part, as I mentioned, with the23 reorganization of the Department. And24 there will be forms that are changing25 204 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 through that reorganization.2 So I have most of the list. I3 don't know that it's perfect but it's4 about as close as I can come particularly5 for Ambulatory Health. Some of the other6 areas we're not quite as complete.7
Okay. With8 respect to -- but what you're eliminating9 by going electronic is the data entry, the10 clerk typist-type position in the11 Department, and in the cost-benefit12 analysis that I'll see?13
There will be some14 of that. And the issue is, it won't15 happen next year. It will take a period16 of time because the paper chart will still17 be required for some period of time.18
So we're19 going to create -- I mean, I have to say,20 Doctor, DSS Cares, this was the problem21 with it; it created an additional duty for22 the people filling out forms. They had to23 fill out the paper form and then enter24 data in the database. If you do that, it25 205 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 takes more time of people's work, not2 less. It doesn't create any efficiencies.3 You have to change workflow4 processes when you implement technology,5 or you don't have savings.6
There will10 probably be some paper phased out over the11 five years of implementation. The paper12 chart, it going away, if you will, depends13 on the number of years someone has been14 coming and the complexity of the need and15 so forth.16 But the history, I'll tell you17 nationally, is that paper usually goes18 away in about 18 months.19
On the paper25 206 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 chart, there are all kinds of other paper.2 You'll see our list of all the forms of3 papers.4
All right.5 Because other departments that have done6 this have actually gone back and OCRed all7 their old records, made them a part of a8 person's file and --9
We would be10 delighted to do that. There is a11 different cost benefit, actually, because12 of the declining use, so that the cost13 benefit generally for that --14
You sound17 like you've done your homework, Doctor.18 I'll look at these.19
Thank you.21 The budget also includes a22 $135,000 contact with PHMCC to coordinate,23 integrate health services in Philadelphia24 relating to universal health care.25 207 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
This contract3 was 135 in '09 and 120 in '08. What4 services are provided under this contract?5
So you will recall6 that City Council passed an ordinance in7 2003 to develop a plan and work on8 implementing it for universal health care9 for all Philadelphians. That plan didn't10 move forward because there was no one to11 move it forward. We're now moving it12 forward.13
So this is --14 a City Council ordinance requires you to15 prepare through a Charter change?16
Do you think19 you can provide less of an answer for20 $60,000? I mean, in other words, how does21 this benefit the City of Philadelphia?22 Even though it --23
This is to -- you24 need to understand that -- and you -- this25 208 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 is to determine how to provide both access2 to care and quality health services so a3 quality monitoring plan for care for all4 Philadelphians. So it's pretty important5 stuff.6
The savings8 ultimately to all of Philadelphia -- not9 just the City, but all of Philadelphia --10 if done when done and done well, is huge.11 It's also dollars from the point12 of view of how do we get everybody to talk13 to everybody and share information.14 That's the place that we're going to begin15 the process of getting everybody at the16 table to do it, so --17
This is money you20 want us to spend too, I think.21 (Laughter.)22
I didn't want you24 to walk into it. I understand that wasn't25 209 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 a fair situation.2
If you're7 happy with it, then I'm happy with it,8 Doctor.9
No. This is the16 City's lobbying activities, which are17 essentially tithed to each department.18
So it's just25 210 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 an allocation to you --2
Okay.7 What -- well, if someone from the8 Administration could provide us with the9 total lobbying bill throughout government,10 I'd appreciate that.11
Do you know13 how many other departments include -- and14 we'd also like the Administration to15 provide how many other departments include16 funding for lobbying in their operational17 budgets.18
And is there20 any reason why we're putting it through21 your department rather than, you know, a22 clear line item under the Mayor's Office23 or Managing Director, so that it's24 transparent? I'd appreciate that.25 211 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
The budget3 also includes -- let's see. I asked that4 question.5 Is there any reason -- okay.6 The Health Federation contract.7
It includes a14 Health Federation for Grief-Assistance15 Services and Mortality Review Staff. It16 was $44,000 in FY '08, $187,000 in FY '09,17 and the proposed expenditure is $371,000?18
So here we have --19 and I apologize for this. Remember, I20 said that we are working on efficiencies21 and allocating to the appropriate place?22 So historically, the Department23 has funded much of this service and booked24 it in Maternal, Child and Family Health.25 212 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 And we've actually moved the same2 expenditures to the Medical Examiner's3 Office since this actually occurs, and the4 service is now coordinated, through the5 Medical Examiner's Office.6 So there's not a change in the7 expenditure here.8
So you're12 taking it out of somewhere else to put13 here.14
In fact, in15 keeping with your point, I think going16 forward, it will actually be more17 transparent because you will be able to18 understand, and everyone will be able to19 understand, why that service is booked20 here as opposed to somewhere else.21
Okay. I'm22 going to ask you the million-dollar23 question.24
Oh-oh.25 213 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1