To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Amendment #23-905 with Epic Systems Corporation
Recommendation: Recommendation of the County Administrator
RECOMMENDATIONS:
RATIFY the Health Services Director’s designee’s April 1, 2026 execution of an Amendment to License (Amendment #23-905) with Epic Systems Corporation, a corporation, amending License and Support Agreement, dated February 17, 2011, for Contra Costa Health’s (CCH) participation in the Epic Base Payer Platform Network for Providers for the period from August 10, 2026, until terminated by County.
FISCAL IMPACT:
Approval of this action does not impact the payment limit of $19,500 funded 100% by Hospital Enterprise Fund I revenues.
BACKGROUND:
The Epic Nexus Qualified Health Information Network (QHIN™) Agreement and Letter Agreement meets the needs of the County by incorporation of its terms regarding CCH’s access to the TEFCA network. TEFCA™ operates in the United States as a nationwide framework for health information sharing created by the U.S. Department of Health & Human Services Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) to remove barriers for sharing health records electronically among healthcare providers, patients, public health agencies, and payers. TEFCA serves to coordinate disparate, disconnected networks of information together. ASTP/ONC is a federal administration health Information Technology effort and is a resource to the entire health system to support the adoption of health IT and the promotion of nationwide, standards-based health information exchange to improve health care. ASTP/ONC is organizationally located within the Office of the Secretary for the U.S. Department of Health and Human Services and the principal federal entity charged with nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. The position of National Coordinator was created in 2004 through an Executive Order and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009. The 21st Century Cures Act (Cures Act), enacted in 2016, called on the United States to “develop or support a trusted exchange framework, including a common agreement among health information networks nationally” (Section 4003(b) of the Cures Act. TEFCA fulfills that mandate as a public-private supported network by providing a standardized approach for secure, seamless, and interoperable health information exchange across the nation. To participate in TEFCA, the County has engaged with QHIN, Epic Nexus, allowing the County’s connection to the TEFCA network.
As a QHIN, Epic Nexus, Inc., is a health information network designated and approved to exchange data under TEFCA, allowing the secure exchange of data with participants in any other QHIN. QHINs connect directly to each other to facilitate nationwide electronic health information exchange. Each QHIN connects its participants, who in turn connect sub participants, such as healthcare providers, health plans, or technology partners. In seconds, a patient’s information can securely move where it needs to go because all these entities work together under the same set of agreements and in accordance with the same set of technical requirements. This shortens the process for connections, decreases paperwork for providers and patients, and supports more informed shared decision making between providers and patients.
To govern CCH’s use of Epic’s Electronic Health Records management system, County and Epic entered into a License and Support agreement dated February 17, 2011, for the County to license substantially all the (then current) software and services offered by Epic. This action ratifies execution of Amendment to License Agreement by HSD Chief Information Officer, Rajiv Pramanik, as designee of the HSD Director, to add Base Payer Platform Network for Providers as an Item of Program Property licensed under the Agreement, and to add conforming changes to the Agreement, all as set forth in the Amendment.
This Contract supports the County's uninterrupted access to Epic's Electronic Health Records management system, allowing patient’s access to their electronic health information through the individual access services exchange purpose, securely and in compliance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations. A summary of service contract deliverables, including measurable outcomes required of the vendor to be monitored by the department in compliance with Section III(B)(6) of the Purchasing Policy (AB600.3), includes County’s access to the TEFCA network. This Contract was approved by Health Services Personnel to ensure there is no conflict with labor relations.
Under Contract #23-905, the parties executed a QHIN Participation Agreement and Letter Agreement (including a HIPAA Business Associate Exhibit) for CCH’s access to TEFCA, to allow Epic to provide services through December 31, 2027. This action ratifies the execution of an amendment to License and Support agreement dated February 17, 2011, between Epic and County. Epic Nexus’ total liability to the County under the agreement shall not exceed two million dollars ($2,000,000) per incident and five million dollars ($5,000,000) aggregate per year. This agreement is being ratified due to Epic Systems Corporation requiring County’s signature allowing the County to be eligible to join Epic Nexus’ QHIN™. As a part of the TEFCA exchange hierarchy, QHINs route queries and responses across the TEFCA exchange. TEFCA is a federally mandated framework that certain networks and participants must adopt to participate in nationwide electronic health information exchange. Epic is CCH’s hosted electronic health records management system software provider.
CONSEQUENCE OF NEGATIVE ACTION:
If this recommendation is not approved, CCH will not have the proper approval for access to TEFCA which aims to bridge participating QHIN’s as well as their members. Without this network CCH patients’ access to their own data may be delayed, negatively affecting patient care.