REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
August 18, 2026
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Amendment No. 1 to the Elsevier Master Agreement and Amendment No. 2 to Product Specific Terms - Schedule 3 under the Elsevier Master Agreement for ClinicalKey Flex
End
RECOMMENDATION(S)
Recommendation
1. Approve Amendment No. 1 to the non-financial Master Agreement No. 24-1169 with Elsevier Inc., for continued access to Elsevier’s electronic clinical reference resources, to extend the agreement term by two additional years, for the total agreement period of December 3, 2024 through November 30, 2031.
2. Approve Amendment No. 2 to Agreement No. 19-773 with Elsevier Inc., for continued access to ClinicalKey Flex, an online clinical reference platform, increasing the total contract amount by $609,020.41, from $934,613 to $1,543,633.41, and resetting the agreement effective date to December 3, 2024, and extending the agreement term by five years, from December 3, 2024 through November 30, 2031.
(Presenter: Andrew Goldfrach, ARMC Chief Executive Officer, 580-6150)
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COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
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 $609,020.41 is funded by State Medi-Cal, Federal Medicare, private insurances, and other departmental revenue. Funding sources may change in the future pending any legislative activity related to the repeal and/or replacement of the Affordable Care Act. Adequate appropriation and revenue have been included in the Arrowhead Regional Medical Center (ARMC) 2026-27 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
ARMC utilizes ClinicalKey Flex, provided by Elsevier Inc. (Elsevier), as an online clinical reference and decision support tool for physicians, nurses, residents, students, and other clinical staff. ClinicalKey Flex provides access to evidence-based clinical content, journals, books, guidelines, multimedia, and other resources that support patient care, education, and clinical decision-making.
The Elsevier Master Agreement No. 24-1169 (Master Agreement) serves as the foundational agreement governing the procurement and use of Elsevier products and services at ARMC. The agreement establishes the general legal, administrative, and operational terms applicable to current and future Elsevier offerings, allowing ARMC to efficiently procure and manage clinical, educational, and research resources while maintaining consistent contractual terms and conditions. The proposed Amendment No. 1 extends the term of the Master Agreement through November 30, 2031, to align with the requested extension of ClinicalKey Flex and support continued access to Elsevier resources utilized throughout ARMC.
On July 26, 2016 (Item No. 6), the Board of Supervisors (Board) approved Agreement No. 16- 595 with Elsevier for the software and licensing of the ClinicalKey products in the amount of $242,964, for the period of December 1, 2016, through November 30, 2019, with a two-year option to extend.
On November 19, 2019 (Item No. 8), as the result of a non-competitive procurement, the Board approved Schedule 3 to replace Agreement No. 16-595 with Elsevier Agreement No. 19-773, for the software and licensing of the ClinicalKey Product, to increase the amount by $181,658, from $242,964 to $424,622, and extend the term for a total contract period of December 1, 2016 through November 30, 2021.
On July 13, 2021 (Item No. 14), the Board approved Amendment No. 1 to Agreement No. 19-773 with Elsevier, to increase the contract amount by $509,991, from $424,622 to $934,613, and extend the term by five years, for a total contract period of December 1, 2016 through November 30, 2026.
On December 3, 2024 (Item No. 10), as the result of a non-competitive procurement, the Board approved non-financial Master Agreement No. 24-1169 with Elsevier, including non-standard terms, for the general terms and conditions of the ClinicalKey for Nursing Software and License Agreement and subsequent software and license agreements, effective December 3, 2024 through December 2, 2029.
ARMC recommends approval of this Amendment to support the continued use of Elsevier’s ClinicalKey Flex product and to ensure continuity of services for County residents.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Bonnie Uphold, Supervising Deputy County Counsel, 387-5455) on August 6, 2026; Purchasing (Veronica Pedace, Buyer III, 387-2464) on June 10, 2026; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on July 27, 2026; and County Finance and Administration (Jenny Yang, Administrative Analyst, 387-4884) on July 28, 2026.