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1. STRATEGIC PLANNING AND HEALTH IT SITE EXECUTIVE. The Siemens Information Technology Site

Executive (Site Exec) provides for the overall day-to-day oversight of the information technology environment including Applications, Servers, Desktops, Data Center Operations, and Help Desk, as well as strategic and tactical planning. The Site Exec will report to Customer's Chief Financial Officer (CFO) and work with the ISD Health IT Director.

1.1 Scope of Services. In accordance with the responsibilities set forth in the Siemens Site Exec

Responsibilities Matrix in Section 3, below, the Site Exec will provide oversight of and planning services for

Applications, Servers, Desktops, Data Center Operations, and Help Desk, which includes assisting with strategic and tactical planning and implementation, budgeting and reporting. Siemens will not directly manage Customer staff, will work with the ISD Health IT Director to utilize Customer staff and will act in an advisory role. Siemens will provide the following to meet its responsibilities:

1.1.1 Provide a dedicated on-site Site Exec Monday through Friday from 8am – 5pm each day (subject to reasonable work-related or personal absences, as communicated to Customer) who shall also be available remotely for

emergencies to manage the delivery of IT services to Customer. Additional Siemens staff (the “Managed Services Staff”) will be onsite as needed as outlined in relation to specific projects/requests, including in relation to the responsibilities outlined in the Siemens Site Exec Responsibilities Matrix, below.

1.1.2 Participate in the ongoing governance processes to assist Customer in managing the business, technology and end-user environments to support the HIT strategic and tactical objectives.

1.1.3 Review and participate in the establishment of methodologies, tools and processes to track and manage HIT operations to include: enhancement/improvement processes, IT asset management, event/change management processes, service desk processes, project management processes, and security management.

1.1.4 Provide an analysis of Customer’s current HIT budget and establish benchmarks on what the HIT budget should be.

1.1.5 Provide monthly reporting on budgets, HIT operations and the status of all major Customer HIT projects. Siemens will review the ASP storage and provide recommendations on how to stay within the Base Data Storage limits.

1.1.6 Provide a monthly written status report describing accomplishments for the prior month, plans for the current month and any issues requiring Customer attention to the Customer CFO or other designated SMMC Executive, ISD Chief Information Officer and ISD HIT Director

1.1.7 Provide hands-on knowledge transfer and education to the ISD Health IT Director, and other ISD staff where appropriate, in order to leave a legacy within ISD.

1.1.8 Provide oversight of projects listed in section 1 above.

1.1.9 Provide a transition team (the Managed Services Staff) that will provide the following services during the first twelve months with the outcome that ISD and Customer are more self-supporting in these areas:

Establish an IT governance process within Customer Establish an IT strategic plan for Customer

Establish an IT tactical plan for Customer

Implement the following IS Managed Services Standards and Policies:

Backup and Recovery Management - to include the definition of a Business Continuity Plan test

Break/Fix Management

Change Management

Event Management

Continuous Improvement Process

Provide Business Intelligence and DSS strategy and governance Deliver a roadmap for Business Intelligence and DSS

Oversee development of DSS for Business Intelligence needs

Establish a gap analysis to determine where ISD and Customer application staff need training Identify a roadmap for how to fill those gaps and leave a legacy of knowledge

Provide a knowledge transfer to the appropriate ISD and Customer staff to leave a legacy

2. GOVERNANCE. The governance process provides the framework for communication, direction, and

management of the business relationship between Customer executive management, department users, ISD, and other IT vendors. It also provides for the overall management of the information technology environment. The performance structure and requirements shall comply with Section 19.4 of this Amendment.

2.1 Scope of Services. In accordance with the responsibilities set forth in Siemens Site Exec Responsibilities

Matrix below, the Site Exec will provide site management and planning services, which includes participation in Customer’s strategic and tactical planning and implementation, budgeting and reporting, and the management of day- to-day operations of HIT services. Siemens will provide the following to meet its governance responsibilities:

2.1.1 Participate in and support Customer’s HIPAA and other regulatory efforts, as mutually agreed.

2.1.2 Participate in the development of an HIT Strategic Plan that directly supports Customer's business initiatives. The Customer HIT Strategic Plan will use the Countywide IT Strategic Plan as a base, will cover a three- to five-year period, and will be continually updated throughout the Managed Services Term to reflect changes in the County of San Mateo Health System’s strategic vision.

2.1.3 Participate in the annual development of an HIT Tactical Plan that directly supports the Customer HIT Strategic Plan. The Customer HIT Tactical Plan will cover a 6- to 18-month period and will be updated throughout the

Managed Services Term to reflect changes in Customer’s priorities.

3. HELP DESK SERVICES. Help Desk Services provides Customer with a centralized Help Desk across the healthcare enterprise for Customer’s end-user information technology needs. Help Desk aims to provide a single point of contact for all end-user computing needs in an effort to reduce end-user uncertainty and streamline internal collection and dissemination of information to internal support providers. Help Desk Services is responsible to resolve as many events as possible on initial contact with the end-user. The Help Desk Service will use the Siemens

Managed Services Event Management Methodology as the standard for processing all events, which includes Issue Management, Problem Management, Request for Service Management, and Knowledge Management.

3.1 Scope of Services. In accordance with the responsibilities set forth in Appendix C, Help Desk

Responsibilities Matrix, Siemens will provide Help Desk Services with the goal of managing the documentation, prioritization, escalation, and final disposition of all IT events. The assignment of these specific tasks to Siemens in Appendix C, supersedes the Support Exhibit in the Agreement to the extent those tasks now assigned to Siemens were described as Customer responsibilities. Siemens will provide the following to meet its responsibilities for Help Desk Services:

3.1.1 Provide Help Desk Services in a manner that meets or exceeds the applicable services as defined in Appendix A – Service Level Specifications.

3.1.2 Support for all IT systems as identified in Appendix B, 24 hours per day, 7 days per week, 365 days per year. 3.1.3 Up to 100 events per month beginning April 1, 2012 increasing to 200 on June 1, 2013 will be recorded and managed through to their final disposition.

If the average number of events is 10% more than or less than the base number for a period of three continuous months, the base number will be adjusted to the new average number of HD events. The Monthly Fee will be increased or decreased , as applicable, at an amount equal to the number of events increased or decreased

multiplied by the current cost per event. . The Service Level Metrics in Appendix A do not apply in any given month if the HD event volume is 10% greater than the contracted volume specified above in 3.1.3

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4. APPLICATIONS SERVICES. Siemens Application Services, in support of the Customer’s tactical and

strategic IT objectives, will provide services that will help maintain and/or help improve the functionality and operability of the Customer's application environment using documented, and measurable best practices based upon industry standards and validated by other Siemens customers.

4.1 Scope of Services. In accordance with the responsibilities set forth in Appendix C, Applications

Responsibilities Matrix, Siemens will be responsible to provide day-to-day management of the application

environment identified in Appendix B - Applications Table. This service includes the ongoing support management, maintenance of existing applications, and timely version control. Additionally, Siemens will assist Customer with enhancing and improving utilization of existing applications and Siemens will assume responsibility for Customer’s IT implementation activities of new applications included within the scope of this SLA. Siemens will provide the following to meet its responsibilities for Applications Services:

4.1.1 Provide application support services in a manner that meets or exceeds the applicable services as defined in Appendix A – Service Level Specifications.

4.1.2 Support applications and systems as identified in Appendix B – Applications Table, 24 hours per day, 7 days per week, 365 days per year.

4.1.3 Provide up to 11,100 Applications project hours from February 1, 2012 through December 31, 2012: up to 12,595 Applications project hours from January 1, 2013 through December 31, 2013; and up to 2,738 Applications project hours from January 1, 2014 through May 31, 2014 for the implementation then for Soarian Clinicals including Clinicals Access, Common Clinicals, Clinical Team Physician Module (CPOE), Embedded Analytics Clinicals, Metrics That Matter, AIS, HIM Completion Management, HIM Online Medical Record, Healthcare Query, Decision Support Clinical Performance Manager, Decision Support Process Performance Manager, Cost Accounting and Budgeting, Enterprise Document Management and Soarian Quality Measures, Applications listed in Section 2 of this

Amendment. Beginning June 1, 2014, Siemens will provide 138 hours per month for activities related to Requests for Service categorized as general or tactical projects for these applications

4.1.4 Provide up to 222 hours per month for the implementation and support of Decision support business

intelligence beginning April 1, 2012 for 24 months and then 148 hours per month for support and activities related to Requests for Service categorized as general or tactical projects. Projects are delivered according to the priorities set by the Information Technology Operations Committee held jointly by Customer and Siemens.

Hours above the prescribed yearly allocation will require Siemens and Customer approval and will be provided in accordance with the Change Order Process.

APPENDIX A – SERVICE LEVEL SPECIFICATIONS

Siemens will provide services throughout the term of this Service Agreement in a manner that meets or exceeds the applicable Service Level Specifications. These Service Level Specifications are identified as follows:

Legend:

G Governance

HD Help Desk Services

A Applications Services Ref Service Level Business Objective Performance

Standard Exceptions Assumptions

Stabilization Period Measurement Formula Meas. Reporting Period Data Source(s) Baseline Method & Period Owner G1 Customer Satisfaction To gauge Customer satisfaction with IT services and to provide an objective forum for Customer to provide feedback to Siemens On an annual basis, Siemens will rate “Very Satisfied” or “Satisfied” Survey responses categorized as outliers

End-users will take part on a volunteer basis.

Siemens and Customer mutually agree upon survey target audience

The number of responses with a “very satisfied” or “satisfied” rating divided by the total number of responses equals the percentage service level attained Annual Answered surveys

Initial survey Site Executive G2 Event-Based Customer Satisfaction To determine whether the IT services provided/delivered to Customer’s end- users are satisfactory Overall customer satisfaction rating of 3.5 or higher HD is single point of contact for all IT events

Customer participates in the event based survey process – minimal survey response >=4% of monthly surveys sent Customer participates in the ongoing education and marketing of the HD process 60 days post- live of Help Desk Services Total Possible Survey Points divided by Actual Survey Points where the measurement scale is 1 – 5 5 = very satisfied 4 = satisfied 3 = neither dissatisfied or satisfied 2 = dissatisfied 1 = very dissatisfied

Monthly GEMS Site

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