To: Board of Supervisors
From: Dr. Ori Tzvieli, Interim Health Services Director
Report Title: Contract Amendment #23-511-7 with Nuance Communications, Inc.
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
APPROVE and AUTHORIZE the Interim Health Services Director, or designee, to execute on behalf of the County Order Forms (Contract Amendment #23-511-7) with Nuance Communications, Inc., a corporation, effective July 8, 2025, to increase the payment limit by $388,603, from $1,863,385 to a new payment limit of $2,251,988, and extend the termination date from December 6, 2026 to August 30, 2028 for additional software products, services, maintenance, and support for Contra Costa Regional Medical (CCRMC)’s clinical dictation services.
FISCAL IMPACT:
Approval of this Contract Amendment will result in additional annual expenditures of up to $388,603 as budgeted by the department and funded 100% by Hospital Enterprise Fund I. (Rate increase)
BACKGROUND:
This Contract Amendment meets the needs of CCRMC as part of a comprehensive suite of integrated dictation and transcription solutions designed to improve clinical documentation, collaboration, and radiology reporting utilized for diagnostic imaging operations and in support of the medical billing coding and compliance governance conducted by CCRMC. These functions are imperative to the accuracy of the diagnostic reports and for receiving the most appropriate claims for services rendered.
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)(7) of the Purchasing Policy (AB600.3), includes hosting services, technical support for the County’s use of the software under the license grant, and access to maintenance and support. This Contract was approved by Health Services Personnel as a specialized services contract to ensure there is no conflict with labor relations. This Contractor was approved by the Public Works Department’s Purchasing Department on February 19, 2025.
On September 7, 2021, the Board of Supervisors approved Contract #23-511-4 with Nuance Communications, Inc., in an amount not to exceed $551,000 for the provision of its medical transcription solution, including Clintegrity and PowerScribe One for use in CCRMC’s Radiology department to dictate reports on medical images for the period from August 1, 2020 through September 30, 2024. Contract 23-511-4 included the approval of Nuance’s Healthcare Master Agreement with an attached Business Associate Addendum. The Contract provides that County can terminate the agreement for a vendor breach, and in the event the board fails to appropriate funds for payment of the Contract in any fiscal year and limits Nuance’s liability to three times the annual amount paid under the contract except for a data breach claim, which caps Nuance’s liability at $2,000,000.00.
On December 7, 2021, the Board of Supervisors approved Contract Amendment #23-511-5 with Nuance Communications, Inc., effective December 7, 2021, to increase the total Contract payment limit by $1,312,385, to a new payment limit of $1,863,385 and to extend the termination date from September 30, 2024 to December 6, 2026 for the provision of its Dragon Medical One and Dragon Ambient eXperience software and services allowing CCRMC to address the needs of staff requests related to compliance with the American Disabilities Act by providing a tool that reduces the need for computer peripherals such as a keyboard and mouse. The Dragon Ambient eXperience tool is a comprehensive artificial intelligence powered voice-enabled solution that listens to clinician-patient conversations while offering workflow and knowledge automation to complement the electronic health record.
Approval of this Contract Amendment Agreement #23-511-7 will allow the execution of Order Forms under the Master Agreement for the Contractor to provide additional software products, maintenance, and support services for CCRMC’s clinical dictation needs through August 30, 2028.
CONSEQUENCE OF NEGATIVE ACTION:
If this Contract Amendment is not approved, CCRMC providers and patients will not have access to the latest dictation technology which allows providers to focus more on the patient instead of the keyboard, improving patient experience and provider retention.