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Approve the seventh amendment with Netsmart Technologies, Inc. for $391,562 for a total contract amount of $4,925,450 through June 30, 2022 to include additional software licenses for Avatar Electronic Health Record, Order Connect, and Plexus Cloud Hosting licenses, and the implementation of electronic Prescribing Controlled Substances tokens and licenses and the Key Performance Index dashboard; and Authorize the County Administrator to execute the amendment and any future amendments that remain within budgeted appropriations
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Published Notice Required? Yes _____ No __X__
Public Hearing Required? Yes _____ No __X__
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services (H&SS) recommends that the Board approve the seventh amendment with Netsmart Technologies, Inc. for $391,562 for a total contract amount of $4,925,450 through June 30, 2022 to include additional software licenses for Avatar Electronic Health Record (EHR), Order Connect, and Plexus Cloud Hosting licenses, and the implementation of electronic Prescribing Controlled Substances (ePCS) tokens and licenses and the Key Performance Index (KPI) dashboard; and Authorize the County Administrator to execute the amendment and any future amendments that remain within budgeted appropriations.
SUMMARY:
Netsmart Technologies, Inc. provides the County’s Avatar Electronic Health Record (EHR) and houses and manages the work of the Behavioral Health Division, maintaining client records, and allowing the Division to submit claims for Medi-Cal reimbursable mental health services. The proposed amendment: expands the number of Avatar electronic health record (EHR) user licenses and associated annual maintenance fees; expands the number of Order Connect user licenses and associated annual maintenance fees to support e-prescribing; supports the implementation of electronic Prescribing Controlled Substance (ePCS) tokens and associated licenses and maintenance fees for the ePCS tokens which will allow eligible prescribers to order controlled substances (stimulant medication) securely in lieu of using a prescription pad; expands Plexus Cloud Hosting licenses, and supports the implementation and ongoing maintenance for the Key Performance Index (KPI) dashboard which allows for high level data analysis from the Avatar EHR.
FISCAL IMPACT:
Funding for the County’s Avatar Electronic Health Record systems and licenses has been approved by the MHSA Steering Committee and stakeholders as part of the MHSA Three-Year Integrated Plan (FY2017/18 to FY2019/20). MHSA funding under the Capital Facilities and Technology Needs (CFTN) component and Short Doyle Federal Administration revenues provide the funding for this contract amendment. As CFTN funding for MHSA will be depleted before this agreement terminates, Welfare and Institutions Code Section 5892 (b) allows counties to transfer up to 20% of funding from the Community Supports and Services (CSS) component to other MHSA components. The current MHSA Three-Year Integrated Plan includes transferring CSS monies to CFTN to cover the costs associated with the Netsmart contract when the CFTN funding is exhausted.
DISCUSSION:
Mental Health Services Act (MHSA) programs address a broad continuum of prevention, early intervention and direct services along with the necessary infrastructure, technology and training elements to effectively support the mental health system.
The proposed Netsmart amendment will allow for the expansion of Avatar users licenses needed to align with the number of current Behavioral Health providers, both County and contractor, who need access to the Avatar system in order to chart services rendered and to enter services for State and federal billing purposes.
Order Connect software is a separate electronic platform software, provided by Netsmart, Inc., used only by approved prescribing staff and their selected non-prescribing staff to document medications being prescribed to mental health consumers and to electronically submit medication orders to local pharmacies. The contract amendment will allow for the increase in authorized use of Order Connect to include both approved County staff and well as contract providers operating the Crisis Stabilization Unit. Electronic Prescribing Controlled Substance (ePCS) tokens (equipment) and associated user licenses allow authorized prescribers including physician assistants, nurse practitioners, and psychiatrists, to order controlled substances (stimulant medication) securely in lieu of using a prescription pad. The ePCS tokens are part of a new Behavioral Health Division policy to limit the need for paper prescriptions, which will mitigate risk and County liability of paper prescriptions being lost or stolen. For each ePCS user an associated Order Connect license is required as well as a subscription fee for ongoing use.
The 7th amendment includes additional software access for 40 prescriber Order Connect subscriptions, 25 non-prescriber Order Connect subscriptions, ePCS tokens and subscription services to accommodate all Behavioral Health approved staff and contract providers.
Netsmart is the owner and sole provider of the Avatar software and services, including ePCS tokens and licenses. The proprietary nature of the Avatar software precludes other vendors from providing Avatar services. Netsmart has the ePCS tokens and licenses integrated in the County EHR, which allows psychiatric providers to generate a random, secure code, that when entered as part of the prescription, allows the pharmacy to verify that the prescription is legitimately from a County provider via the Order Connect component of the contract, which directly communicates with the pharmacy.
Amendment 7 includes acquisition of additional Plexus Cloud Hosting licenses needed to support ongoing maintenance, software upgrades, nightly back-ups and regular daily applications, ultimately reducing redundancy and freeing up County DoIT staff time to assist with other projects.
Background:
On November 22, 2011, H&SS entered into a contract with Netsmart Technologies, Inc. for $1,830,632 to implement and maintain an Avatar EHR system for the Behavioral Health Division including mental health services and substance abuse programs. The first amendment was effective on September 26, 2012 to increase the contract dollar amount by $4,804 to address maintenance costs. On April 29, 2013, the second amendment was amended to change the terms of payment with no changes to the total dollar amount. On August 13, 2013 the contract was amended a third time to increase the total amount by $35,382 to purchase cache licenses. On June 17, 2014, the contract was amended a fourth time to modify the budget to increase the Project Management Services line item. No additional funding was added to the fourth amendment. On September 26, 2014 the contract was amended a fifth time to extend the contract term through June 30, 2017 and increase the contract amount by $520,578 to purchase additional Order Connect prescriber and non-prescriber subscription accounts. On December 13, 2016, the sixth amendment to the contract transferred the Avatar system to a cloud based solution, which includes maintenance, software upgrades, nightly back-ups and regular daily applications and increased the contract amount by $2,142,491. Due to the proprietary nature of Netsmart services, the sixth amendment also included an extended contract term of five years extending the contract through June 30, 2022.
Exhibit A to the contract amendment includes additional Avatar licenses, Order Connect subscriptions and hosting licenses needed for our growing list of providers, as well as one-time charges to implement these additions. Exhibit B outlines current Avatar components that the County uses and includes items purchased via purchase order or terms agreed upon via a side letter, such as Key Performance Index (KPI) Subscription, Order Connect Subscriptions and additional maintenance charges for Avatar licenses. Exhibit C outlines all ePCS subscriptions purchased via purchase order. Exhibit D outlines the one-time charges associated with purchasing each ePCS token and shipping charges. Exhibit C and Exhibit D represent a bulk of what was previously purchased with purchase orders and/or allowing funds to be available for ordering ePCS tokens in the future as needed.
ALTERNATIVES:
The Board may choose not to approve the amendment with Netsmart. This is not recommended as this will result in Behavioral Health not having the necessary licenses to support the maintenance of medical records or ability to submit billing to the State in order to generate revenue. Additionally, continuous use of paper prescription pads places the County at risk for theft and false prescriptions being written.
OTHER AGENCY INVOLVEMENT:
The operation of Avatar was approved by Mental Health Services Stakeholders as reflected in its Three-Year MHSA Plan. County Counsel has reviewed the contract amendment for legal sufficiency.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION