REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
November 18, 2025
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Amendment to Agreement with Epic Corporation for the Purchase of an Electronic Health Record System Module
End
RECOMMENDATION(S)
Recommendation
1. Approve Amendment No. 7 to Agreement No. 19-557 with Epic Systems Corporation, for the addition of the Epic Wisdom Orthodontics software module, licensing, implementation services, go-live support, and travel expenses related to the Electronic Health Record system, increasing the amount by $12,632, from $44,272,165 to $44,284,797, with no change to the term of August 6, 2019, until terminated with 90 day notice to the other party.
2. Direct the Clerk of the Board of Supervisors to maintain the confidentiality of the Amendment with Epic Systems Corporation pursuant to the confidentiality provision in Agreement No. 19-557.
(Presenter: Andrew Goldfrach, ARMC Chief Executive Officer, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally-Responsible and Business-Like Manner.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost). The cost of $12,632 is funded by the Centers for Disease Control and Prevention (CDC) Public Health Infrastructure grant. Adequate appropriation and revenue have been included in the Arrowhead Regional Medical Center (ARMC) 2025-26 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
The amendment with Epic Systems Corporation (Epic) will allow ARMC to implement the Orthodontics module which will provide orthodontic treatment planning appliance documentation, and tools to review the patient's course of treatment to date. Epic’s Wisdom Orthodontics module will be acquired to support the Community Connect Program (CCP), a partnership between ARMC and the Department of Public Health (DPH) aimed at expanding the County’s Electronic Health Record (EHR) system. The cost is funded by the CDC's Public Health Infrastructure Grant (PHIG) which provides funding through a five-year grant from December 1, 2022 through November 30, 2027. The grant gives health departments the flexibility to direct funds towards specific organizational and community needs that strengthen public health outcomes. The Orthodontics module will integrate dental and orthodontic care into Epic, enhancing documentation, care coordination, and patient outcomes across departments. This action supports integrated, patient-centered care and advances the County’s health equity goals.
On August 6, 2019 (Item No. 9), as the result of formal solicitation No. ARMC117-ARMC-2510, the Board of Supervisors (Board) approved Agreement No. 19-557 with Epic for the purchase, installation and maintenance of a fully integrated EHR system at ARMC with an estimated five-year cost not to exceed $29,738,425 beginning August 6, 2019, until terminated with 90 days’ notice to the other party.
On March 9, 2021 (Item No. 3), the Board approved Amendment No. 1 to Agreement No. 19-557 with Epic, increasing the estimated five-year not-to-exceed amount by $448,000, from $29,738,425 to $30,186,425, for additional implementation services and travel expenses related to the EHR system, with no change to the term beginning August 6, 2019, until terminated with 90 days’ notice to the other party.
On October 5, 2021 (Item No. 15), the Board approved Amendment No. 2 to Agreement No. 19-557 with Epic, including the incorporated additional terms to the agreement, for additional software modules, licensing, implementation services, go-live support and travel expenses related to the EHR, increasing the estimated five-year not-to-exceed amount by $9,974,190, from $30,186,425 to $40,160,615, with no change to the term beginning August 6, 2019, until terminated with 90 days’ notice to the other party.
On April 25, 2023, pursuant to authority delegated by the Board, the ARMC Chief Executive Officer approved Amendment No. 3 to Agreement No. 19-557 with Epic, to incorporate the Nebula feature and integrate maps and geocoded data into Epic workflows. The non-financial amendment added a program property that is already licensed under Agreement No. 19-577, at no additional cost and with no change to the term beginning August 6, 2019, until terminated with 90 days’ notice to the other party.
On June 13, 2023 (Item No. 17), the Board approved Amendment No. 4 to Agreement No. 19-557 with Epic for the addition of Epic Hello World SMS and Cheers Call Center modules, additional software modules, licensing, implementation services, go-live support and travel expenses related to the EHR system, increasing the amount by $1,111,550, from $40,160,615 to $41,272,165, with no change to the term beginning August 6, 2019, until terminated with 90 days’ notice to the other party.
On November 5, 2024, pursuant to authority delegated by the Board, the ARMC Chief Executive Officer approved Amendment No. 5 to Agreement No. 19-557 with Epic, to incorporate the Base Payer Platform Network for Providers, at no additional cost, that will help Providers facilitate certain population health, treatment, healthcare operations and payment activities that will reduce unnecessary services and reduce administrative costs while improving the quality of healthcare with no change to the term.
On June 10, 2025 (Item No. 19), the Board approved Amendment No. 6 to Agreement No. 19-557 with Epic, for the addition of Care Management and Value Based Care, Gallery Document Management System, Epic Generative AI Suite, Guesthouse Contracted Vendor Portal, SecureChat, Willow Ambulatory Pharmacy and Inventory Supply Tracking, and upgrade to the MyChart Patient Experience Platform, licensing, implementation services, go-live support, and travel expenses related to the EHR system, increasing the amount by $3,000,000 from $41,272,165 to $44,272,165, with no change to the term of August 6, 2019, until terminated with 90 day notice to the other party.
Pursuant to Agreement No. 19-557, the County is obligated to maintain the confidentiality of information that Epic identifies as confidential and proprietary, including its pricing. The County may incur liability from failing to disclose information pursuant to a California Public Records Act request or open public meeting requirements (Brown Act and County Sunshine Ordinance). This liability may be offset by the indemnification obligations that Epic has agreed to undertake. In addition, the County could be deemed in breach of agreement and incur liability to Epic for disclosure of Epic’s information, including non-redacted versions of the agreement, regardless of whether the disclosure is intentional or inadvertent, which could exceed the agreement amount.
ARMC recommends approval of this amendment to provide for the safety, health and social service needs of County residents by supporting the goals of the CCP to deliver coordinated, comprehensive care across departments, improve patient outcomes, and advance the County’s commitment to health equity and efficient healthcare delivery.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Bonnie Uphold, Supervising Deputy County Counsel, 387- 5455) on October 17, 2025; Purchasing (Veronica Pedace, Buyer III, 387-2198) on October 17, 2025; Innovation and Technology (Lynn Fyhrlund, Chief Information Officer, 388-5501) on October 21, 2025; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on October 24, 2025; and County Finance and Administration (Jenny Yang, Administrative Analyst, 387-4884) on October 28, 2025.