UCSF Medical Center CTG – April 3, 2014 Project: e-Form/e-Signature (Proof of Concept) BCD Project Manager: Sheryl Shah UCSF Medical Center

2 The presenter(s): Objective: Sheryl Shah, PMO Project Manager, Ryan Mendonca (APeX Optime) and Cora Hardin (APeX Optime) and our Kryptiq/DocuSign partners Demonstrate outcome of the “technical proof of concept” to confirm maturity/functionality of e-Form/e-Signature vendor solution prior to developing a full business case and implementation strategy.  Scope:  Proof of Concept  Create digital form with discreet data fields (patient demographics) with integration from APeX  Dual e-signature & workflow (Patient and Provider) of a surgical consent inside and outside of the organization  Integration of Consent Status in Apex so provider/staff easily know that the consent has been signed. Electronic Signature Platform Healthcare Workflow Integration

3 “Is”“Is Not” Focus on Surgical Consent Form OnlyAdmission/Registration forms Other Consents forms Demonstrating Use of Mobile Platform within UCSF “Virtual” e-sig/e-form (ie) via , My Chart Focused on “in person” consent review and signature and dual signature (patient/physician) “Virtual” e-sig/e-form (ie) via , My Chart Uni-directional Integration with APeX within Anesthesiologist workflow once consent is signed and Update OpTime Status board Bi-directional interface between APeX and Krytiq/Docu-sign for patient demographics, procedure information, etc. Signed form stored in APeXSigned form stored in ECM Today’s Prototype Demo:

Scanning Signed Forms: Kidney & Liver Transplant 5 Dept Volume of pts # of consents per pt Min spent scanning/consent Total annual minutes spent Total annual hours Pre Kidney Pre Kidney- LD DWUI Pre Kidney- LD DWUII Pre Liver Other issues to consider: Cost of transporting forms from outreach clinics Cost of potential lost documentation (regulatory) Potential HIPAA issues- scanned under wrong patient Unfulfilling busy work for staff

6 Demo

Patient Forms requiring Signature Terms & Condition of Admission ** Authorization for Surgery/Special Dx Procedure ** Terms and Condition of Service ** Notice of Privacy Practices ** Patient Financial Responsibilities ** MediCare Rights Advance Directives Physician Order of Life Sustaining Treatment (POLST) Dog Therapy Consent Form (Peds Only) Patient Consent for Electronic Exchange Patient Consent to Photograph Patient Property Record Transfusion Consent Consent to receive IM ECMO Consent Observer Consent Form (to watch surgery)** Post Emergency Care Stabilization Form Refusal to permit medication Refusal to allow eye treatment Refusal to permit blood transfusion Leave Hospital Against Medical Advice Authorization for Release of Medical Record Transplant ** UNOS Multiple Listing Form ** Consent for Unusual Kidney ** OB/GYN Hysterectomy Consent Consent for Sterilization Forms included in Transplant man hour estimate in prior slide** 7

8 Next Steps: Based on successfully completing a “technical” proof of concept  Determine High-level direction today.  Prioritization of impacted areas: ROI, High Risk Areas Identify business representatives to participate in planning efforts  Focus on specific use cases: Operational workflows to guide technical development needs  Determine opportunities to lean processes and drive to standardiza tion Determine full cost estimates for further development and implementation Present back to CTG in June 2014