To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera 707-565-4774
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
FirstWatch Services Agreement
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Recommended Action:
Recommended action
Authorize the Director of Health Services, or designee, to execute an agreement with FirstWatch Solutions, Inc. to provide emergency medical services system performance monitoring services for a period through five years from the agreement effective date for an amount not-to-exceed $277,329.
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Executive Summary:
The Coastal Valleys Emergency Medical Services Agency (CVEMSA), which is a section within the Sonoma County Department of Health Services (hereinafter, “DHS” or “the Department”), has identified a need to enter into an agreement for emergency medical services (EMS) system performance monitoring services. The proposed agreement includes the provision of FirstWatch data aggregation and analytics platform, FirstPass clinical data benchmarking and quality monitoring system and the Online Compliance Utility module for EMS response time compliance in addition to training and access to data system support services needed to support local area ambulance service operations.
Discussion:
State law requires that each county designate a Local Emergency Medical Services Agency (LEMSA) as the entity responsible for oversight and regulation of the local Emergency Medical Services (EMS) System. Sonoma County Code of Ordinances, Section 28-4(a), designates DHS as the LEMSA for Sonoma County. EMS Agency functions are the responsibility of Coastal Valleys EMS Agency, which is organized within the Public Health Division of DHS. In 1991, the LEMSA, under direction of the Sonoma County Board of Supervisors, established an Emergency Operations Area (EOA), now known as EOA-1, to serve the cities of Santa Rosa, Sebastopol, Rohnert Park, Cotati, and the surrounding unincorporated areas.
FirstWatch Agreement
The LEMSA is requesting to enter into a contract to provide emergency medical services system performance monitoring services for a period through five years from the agreement effective date for an amount not-to-exceed $277,329. This amount includes implementation and year 1 costs of $158,537; $28,395 for year 2; $29,246 for year 3; $30,124 for year 4; and $31,027 for year 5. The contract includes the provision of FirstWatch data aggregation and analytics platform, FirstPass clinical data benchmarking and quality monitoring system and the Online Compliance Utility module for EMS response time compliance monitoring in addition to training and access to data system support services.
The FirstWatch Solutions Inc. tool is a comprehensive EMS operational and clinical performance monitoring data system. The system will consume data from the REDCOM 911 Computer Aided Dispatch system and the EMS System patient care reporting platform. The system will provide the means to monitor ambulance contractors’ compliance and the performance of the wider EMS system that serves the County. The data aggregated by the system will have other Health Services programmatic uses to those programs that work with vulnerable and underserved populations typically represented disproportionately in the EMS system data.
The FirstWatch system tool will be used for performance monitoring of Exclusive Operating Area (EOA) contractors as well as general EMS system monitoring to fulfill CCR Title 22 requirements as the system regulator. The Online Compliance Utility (OCU) is the system that will consume 911 Computer-Aided Dispatch data including response times and apply contract performance rules to identify variances. This information will then be used by the OCU to generate compliance reports showing the contractor’s performance relative to the contract expectations. The OCU is a third-party system that will take the place of the current American Medical Response (AMR) proprietary system that has served as the LEMSA tool to verify contract compliance.
The current EOA vendor is required to report response time performance. The next EOA contract will additionally require clinical performance reporting. FirstPass will enable benchmarking and reporting on clinical key indicators. In addition to the contract compliance use, the LEMSA will implement this reporting tool system wide to support medical control oversight and clinical quality improvement efforts.
The system that collects the data must interface with the patient care reporting system used by the LEMSA to aggregate EMS clinical data as well as the Computer-Aided Dispatch systems that perform the dispatching functions for EMS units, both first response and transport. FirstWatch is the only commercially available system we are aware of for performance and clinical monitoring. The recent RFP for ambulance service provider in central Sonoma County names FirstWatch as the desired system for performance monitoring. The DHS contract with Bell’s Healdsburg Ambulance Service has similar mandates that may be met with the OCU and clinical counterpart, FirstPass, as our tools for monitoring provider. The Bell’s agreement also has these mandates.
EMS/FirstWatch Agreement
The Emergency Medical Services (EMS) Agency facilitated a Homeland Security Grant acquisition of FirstWatch for Sonoma County in 2007; REDCOM Joint Powers Authority subsequently became the contracting entity. EMS retains access to the system and can incorporate the data linkage into a new DHS-FirstWatch agreement. This is a key linkage and difficult to achieve due to the REDCOM Computer-Aided Dispatch being part of the Sonoma County Public Safety Consortium managed Computer-Aided Dispatch system which has high security law enforcement requirements for data linkages.
Mendocino County contracted in 2016 for data system integration between FirstWatch and the Sonoma County managed ImageTrend EMS electronic medical records system.
FirstWatch is used widely among California LEMSAs for contract compliance and in some cases clinical performance monitoring. Current users include Napa, Contra Costa, Alameda, Santa Clara, and San Mateo Counties.
Strategic Plan:
N/A
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
N/A
Fiscal Summary
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Expenditures |
FY23-24 Adopted |
FY24-25 Projected |
FY25-26 Projected |
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Budgeted Expenses |
$158,537 |
$28,395 |
$29,246 |
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Additional Appropriation Requested |
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Total Expenditures |
$158,537 |
$28,395 |
$29,246 |
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Funding Sources |
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General Fund/WA GF |
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State/Federal |
$158,537 |
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Fees/Other |
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Use of Fund Balance |
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Contingencies |
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Total Sources |
$158,537 |
$28,395 |
$29,246 |
Narrative Explanation of Fiscal Impacts:
First year implementation funds will be drawn from the Future of Public Health (FoPH) grant. State of California Budget Act of 2022 for budget year 2022-2023 (Health and Safety Code 101320, 101320.3, and 101320.5) provides a total of $200,400,000 annually to local health jurisdictions throughout California for public health workforce and infrastructure, referred to as the Future of Public Health Funding. These funds are considered ongoing and part of the ongoing baseline state budget.
Subsequent years will be partially offset by proportionate contributions from the contracted providers. The proposed agreement year one cost is $158,537, year two cost is $28,395, year three $29,246, year four $30,124, and year five $31,027, for a total cost of $277,329. The Department already contains appropriations within the Adopted FY 2023-2024 Budget for this expenditure.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
None
Attachments:
Attachment 1 - Agreement with FirstWatch Solutions, Inc.
Related Items “On File” with the Clerk of the Board:
N/A