Travis County Commssioners Court
February 10, 2004
The Closed Caption log for this Commissioners Court agenda item is provided by Travis County Internet Services. Since this file is derived from the Closed Captions created during live cablecasts, there are occasional spelling and grammatical errors. This Closed Caption log is not an official record the Commissioners Court Meeting and cannot be relied on for official purposes. For official records please contact the County Clerk at (512) 854-4722.
Item 34
Number 34 to consider and take appropriate action to fund the Travis County portion of a new practice management and medical management system for the five Travis County rural community health centers in the amount of -- this says $86,312 and a note that we received from stephen williams yesterday the amount is actually a little bit more, right, stephen?
>> yes, judge. The amount is 97,480. What you might want to do is say up to $100,000 just in case there is some slight difference in that.
>> can I ask how long this item is going to take? Because I have a luncheon that I need to get to, it means travelling and it's like-- is this a 10 minute item.
>> should be less than 10 minutes.
>> I'm cool.
>> basically i've come you to -- when the item was initially put on the agenda, we had not identified a funding source within health and human services and we came forward asking for money from the capital asset serve [papers shuffling - audio interference] internal funding source. But essentially the current system that we have within the -- within the city of Austin and county clerks to -- to manage those clinics, signature, is going away. That current system will actually expire in August of 2005. Renewing the license with the signature is not really an option. So therefore it creates a situation where we need to develop a practice, we need to get a new practice management system for not only the county clinics, but the total clinic operations. Essentially, the practice management system will help monitor patient medical history and health assessment information. Laboratory testing and medications. The system also includes components for appointments scheduling, for generated bills for services, for monitoring the collection of balances for which the patient is responsible and for filing claims with the payers such as medicaid and medicare. The county and the city's proposal is being charged a percentage for their total cost of the system. That's based on the number of -- the percentage of clients that are actually Travis County clients within the total system and that percentage is less than 10 and a half percent. The practice management system is being configured over the next two months and deployment to all sites should begin in April through June of 2004. The electronic medical records systems project should begin in July with the deployment during the third and fourth quarter of 2004. There are certain benefits from going and transitioning from the current system to this practice management system being proposed by the city staff. We will enhance collections of patient responsible balances, we are looking at --
>> what does that mean?
>> you will have a more accurate accounting of -- of the debt that's owed by the clients within the system, so therefore we can have a concerted effort to actually let the -- collect the patient's part of the bill.
>> so we won't automatically get more money, we will have a better idea of who owes it.
>> yes, who owes it and how much they owe. It should be more up to date. Reduced prescription, lab board and documentation, basically because you won't have to manually enter those. Once you enter it the first time it will be captured throughout the system. Access to patient charts at all sites. If it's on a system, if -- if the patient moves from del valle to Pflugerville, it will still be on the same system and you can access that information on that centralized system. We are hoping that that would result in some level of reduced operating costs. And this next highlight I think is very important. Interface into the indigent care collaboration data base to track patient visits at er hospital and non-city managed indigent as much as clinics. We know that was indigent care collaboration. They were collecting data from a number of providers within the community. So therefore were able to -- we will be able to ensure that we know exactly how many visits our clients are having at the e.r., The hospital and maybe other clinics. Enhanced reporting to support the fqhc status and basically there are a number of reports that we have -- that the clinic systems have to give the feds in order to maintain the fqhc status and this automated system would enable us to do that. Essentially, what I'm coming forward to you today is to get permission to move forward to transition from this current signature system to the proposed practice management system. Also I'm asking you that you allow us to some internal funds to fund this system. Basically, we have some dollars that haven't -- we have gotten back from the feds through our 4 a arrangements with them regarding child care. I'm proposing that we take that money and use it to fund our Texas migrant council contract and that we use the -- we take the county dollars that is allocated for the Texas migrant council contract and use part of that to fund this -- this patient management system. We will also look at our postal service contracts to see whether there are some balances within some of those contracts that we -- that we can use in order to fund this system.
>> [indiscernible] one question. [indiscernible] system that you are looking to deploy in place [indiscernible], is there a basic time line whereby we can really look at the performance and the measurements of what we are investing here by a certain date to see if -- well, to see the effectiveness and the efficiency of this particular upgrade? Is there a certain --
>> yes, I think that there is some -- some concrete things that you could look for.
>> what --
>> terms of data. I highlighted some of that. Just having access to a client's file without having to send it by courier from del valle and Pflugerville is one concrete example of that -- that I think that I can give and support that. The bottom line that is the current system that we have that supports the current system is going away we need to find a replacement. Therefore I'm asking your approval to --
>> I'm not arguing the point. I'm making sure when we invest the money the maximum mile advantage is realized. I do see the effectiveness and the efficiencies of this particular deal is rather in place. I guess when you really want to put your hand on it, say, well, by this certain time that this is what we have actually done in this particular version, stuff like that, this is when we can really realize that particular efficiency and effectiveness ratio that we are referring to, I wanted to tie it down to a time. That's what I was looking for.
>> is there an answer?
>> well, I don't have a specific answer to that. Except to just look at the implementation time line, which I kind of highlighted in the -- in the one-page document that I gave you, which is really a summary of this issue.
>> right.
>> Commissioner Daugherty?
>> stephen was this amount just omitted from the budget?
>> no.
>> or did you just not know that it was --
>> we didn't know the exact amount. I had discussions with the city of Austin staff in relationship to this practice management system. As I can remember, while some of the budget deliberations were occurring, we just did not know the amount and also -- I have a vague memory of this to be honest with you. I was thinking the timing would be in fiscal year '05, that's why I didn't include it in my budget request for this current year.
>> then the thing that got my attention the most is being asked to come out and carve versus the contingency amount, $500,000 allotted for perhaps overruns from hhs, why wouldn't that -- that's what that account was there for, is it not?
>> it is. But this is really a one-time expenditure. The ongoing maintenance fee is already in my budget. The -- when we use the -- the reserve, $500,000, that in all likelihood would be recurring expenses that -- so therefore I would want to use the $500,000 that's in reserve for those expenses that we know would recur. Essentially this --
>> direct services [indiscernible]
>> it will be.
>> so what stephen is asking for are directions so he can go and try to identify source money. One thing that he did was there is funding coming from other programs, right?
>> yes.
>> and that those federal funds can be used to fund a program that county money now funds, so substitute those two would pick up quite a bit of the $100,000.
>> yes.
>> and the other part, I think, by this -- by just looking at the amount that's usually left over from prior years social services contracts, we could probably get the other amount. Those are one-time sources. That mey won't reoccur.
>> well, I agree. I think that the $500,000 was intended for direct services. But there is also something that got my attention. That can't be left out of a budget. Because it's got to come from somewhere. And I -- either that or we have $500,000 set aside for this, we have $100,000 set aside for things that I didn't think was going to happen. So wherever we put it. But I think it needed to be budgeted.
>> okay.
>> the ongoing expenses is already budgeted because we are paying about $9,000 for signature. With this new system I think the approximate cost is about $6,000.
>> there's still a lot of unanswered questions, I'm glad jose is there. The auditor's office laid out a lot of things that are unresolved. If what we are being asked today is sounds reasonable and logical, conceptually.
>> that's all that I'm asking.
>> but more work to get locked down related to what the auditor needs, what fixed assets needs, line items --
>> I think the staff should work it out before we bring an interlocal back to you. I don't see -- I'm asking for general direction. I think staff should go back and work out some of those details and upon getting your direction, I will weigh in -- until I get that direction I don't see that it is appropriate.
>> I don't see any of these things as being like we can't get past them. They are issues in terms of where you stash things in line items, what sources of fundings are.
>> I'm sure that they will work that out.
>> totally logical questions about the numbers of licenses, et cetera. So that can be a very short discussion then if all we are being asked to say is yes conceptually.
>> that's all that I'm asking you for.
>> clearly [multiple voices]
>> [inaudible - no mic]
>> but also like in y 2 k, when computer systems are dying and we don't have the opportunity to keep the old system, we have to kind of move ahead and get it resolved, what is on our plate right now, which is cyd you are absolutely right, but we didn't get that opportunity so we have to make the best of what we have got right now, lock down those things that are a huge interest to us related to fixed assets, related to licenses, represented to it, all of these issues.
>> I just wanted to make sure that was understood. He's just asking for the funding, where it's coming from. We have the issues, we are going into an interlocal to make sure that we cover all of these issue that's we have.
>> I see no problem with that.
>> the backup that we've got -- so what's in blue writing is from whom?
>> it's from our office, basically we asked to go over these issue was all of these persons in this matter and then just the updates of where we are right now. We are still continuing to work on these issues. Hopefully we will get them all resolved. But there's still some outstanding issues to deal with.
>> [multiple voices]
>> I think that we should come back with a draft interlocal with most of those issues worked out. As I said I haven't even weighed in on those. My staff has. For instance there's an issue concerning [indiscernible], that's really not a big issue in that we fund [indiscernible] even if a percentage of the moneys that we are allocating did pay for part of their support it would be appropriate, but I haven't even talked to staff about that. I purposely just wanted to come and get your input so that we could hammer out what I consider staffing issues in another cities.
>> what I was asking is this one of those interlocals that needs to be discussed by the hhs committee that the court appointed so we could address all issues on interlocals?
>> think that would be appropriate.
>> we need to meet.
>> okay.
>> come to the microphone please.
>> [indiscernible]
>> what we had discussed was because of the time limit that it's going to take to do those three main interlocals that the court had directed stephen to do, that since the city is ready to install this on the machines tomorrow, that we might do a very small interlocal just to take care of this immediate need. And that when we go back and look at the big one, somehow incorporate it into it.
>> the city would small the system in the city clinics and county clinics.
>> yes, as we did in the signature system that we are currently using.
>> okay. Who on county staff would monitor implementation to ensure that Travis County receives the benefits that you describe in your one-page memo.
>> my staff would.
>> and so stephen williams.
>> me or my staff, yes. [laughter]
>> you have 300 people.
>> I might be able to find one that -- [laughter]
>> stephen williams is the name that I'm writing down. [laughter]
>> so what you are saying really is our system is so intwined with the city of Austin it doesn't make sense for them to have one automation and us the other.
>> we don't have a system. The signature system actually belongs to the city of Austin. What we do is pay a proportionate share to install it within our cluster. This is the same deal, they own the system.
>> we have a system we don't own it.
>> we just help pay for it.
>> no.
>> as to the future, it makes sense for both of us to be on the same system. The city of Austin has gone out issued an r.f.p. Selected a vendor and a system I guess and now they are saying you do roughly 10% of the business, we want you to pay 10% of the cost.
>> yes.
>> right.
>> so you are asking today for us to give directions to proceed and come back later with an identification of source of funding. I'm not sure that I think that you ought to take contract funds intended for hopefully direct services.
>> right.
>> and -- there are other ways to get it done, though.
>> totally open to that.
>> all right.
>> what else do we need to discuss today?
>> nothing.
>> but what I'm hearing, too, is not we standing the lateness of the hour in terms of decision making, auditor's office, purchasing, legal, it, get with the city.
>> yeah.
>> other affected county departments and put together an appropriate contract.
>> yeah.
>> okay.
>> second.
>> that's the motion to cover all of the data. The -- not only doing this, but doing it in a collaborative matter that we often articulate support for.
>> any more discussion? All in favor? That passes by unanimous vote. Thank you all very much.
>> thank you.
Last Modified: Tuesday, February 10, 2004 6:44 PM