1. UCSF Medical Center CTG – February 6, 2014 Project: e-Form/e-Signature (Proof of Concept) BCD Project Manager: Sheryl Shah UCSF Medical Center

2. 2 The presenter(s): The ask: Sheryl Shah, PMO Project Manager, Pamela Hudson, Executive Director. Irene Brezman, Director Request CTG approval to move forward with a “technical proof of concept” to confirm maturity/functionality of e-Form/e-Signature vendor solution prior to developing a full business case.  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.  Prove of Concept Proposed Timeline: February to end of March 2014.  Proof of Concept Cost : $29,920 (to vendor) but will be credited back against license/subscription fee if we move forward with implementation  Proof of Concept Funding: CS operating budget

3. 3 Background: Its been a journey..... Missing consent forms = delay patient care and waste (muda) :  Inappropriate/Over Processing  Unnecessary Motion  Wait Time Solution must integrate with Apex and ImageNow (ECM). Various vendor solutions reviewed, including:  BottomLine  EPIC  Docu-Sign/Kryptiq

4. Recommended Vendor: Benefits of the DocuSign for Patient include:  DSP is optimized for healthcare organizations by utilizing: DocuSign platform for:  Creation/Management of document templates  e-signature/authentication  Virtual distribution of e-form Kryptic for workflow management and EMR integration :  Centricity, Allscripts, NextGen and Greenway  Device management at point-of-care (PC, Tablet) Partnership Approach:  In recognition of opportunity to partner with UCSF to: Integrate with APeX (Epic) and ImageNow Extend workflow solution to Inpatient/Procedural areas  Kryptiq is offering UCSF a significant discount on an enterprise licens e 4 Electronic Signature Platform Healthcare Workflow Integration

5. 5 Proof of Concept Use Case: Surgical Consent Form  Develop e-Form with discreet patient demographic fields from APeX.  Validate Dual E-Signature workflow: Patient and Physician  Integration of Consent Form “status” into Apex to inform consent was signed  Storage of signed e-form in BLOB server and long-term into ImageNow Impacted Application Resources (*Sunny Bang, Andrew Robinson, Khiang Seow) Need Business Partners Participation for requirements/validation  Dr. Robinowitz, Others: Nursing, Prepare Clinic Tar get Completion Date: March 31, 2014 InterfaceAppl Soln Arch*OpThesia

6. Product Costs: 6 DocuSign/Kryptiq has provided a reduced pricing quote  One-time Perpetual License of $149,601 (-20% from Proof of Concept)  Yearly maintenance fee of $29,920. Includes:  Enterprise wide software license  Initial package of standard forms  Kryptiq development for integration points with ImageNow and Apex.  Client training on best practices for developing forms  No restriction on amount of forms that can be built Further Costs: (Total Cost Ownership TBD - - pending successful completion of Proof of Concept)  Hardware: Server  Cost for installing DSP software onto Server  Tablets  Labor for UCSF staff

7. 7 Next Steps: Based on successfully completing a “technical” proof of concept  Determine future roadmap for e-Form/e-Signature initiative Based on ImageNow (ECM) project research, UCSF has approximately 2000 forms. Identify business representatives to participate in planning efforts  Prioritization of impacted areas: ROI, High Risk Areas  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 May or June

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