1. UCSF Medical Center CTG – August 7, 2014 Project: e-Form/e-Signature Pilot BCD Project Manager: Sheryl Shah UCSF Medical Center

2. 2 The presenter(s): The ask: Request CTG approval to move forward with the E-form/E-signature pilot in Inpatient Admitting / ED.  Scope:  Inpatient Admitting and ED pilot (Parnassus and Mission Bay)  Integration between Apex, DocuSign for Patient, and Image Now/ECM.  In person signature process via mobile platform. Remote signing (offsite) is out of scope for the pilot.  Size (IT/CS): Medium / 917 hours  Costs: $304,246 for pilot + $29,920 / year for vendor license renewal (DocuSign for Patient product)  Funding: IT/CS Capital and Operating Budget  Timeline: August 2014 – February 2015  Go-lives: Parnassus – December 2014; Mission Bay – February 2015 Sheryl Shah, PMO Project Manager

3. 3 Project Drivers: Increase operational efficiency Streamline e-signature capture  Mobile device accessible  Remote signing capabilities (Future: NOT part of initial pilot) Seamless integration with Apex and Image Now

4. Operational Impact: Admitting & ED  Affected Locations:  Inpatient Admitting and ED  Parnassus  Mission Bay (Bedside Admitting, Surgical Waiting Area and Birthing Center)  Personnel Impacted:  Patient Access Staff  Training Required:  Who: Admitting and ED Super Users  Method: Classes, Tip Sheets 4

5. 5 Implementation Plan: Admitting / ED Pilot would:  Build the core foundation to integrate all products (Apex, DocuSign for Patient, Image Now)  Demonstrate Tablet Integration  Address any issues before expanding the infrastructure to other departmental areas In parallel to this development, the project team would partner with operational stakeholders to:  Determine workflows for capturing electronic signatures for surgical consents. Determine additional development & training costs. Determine timeline.

6. 6 Recap: We are requesting CTG to move forward with the E-form/E-signature pilot in Inpatient Admitting / ED.  Scope:  Inpatient Admitting and ED pilot (Parnassus and Mission Bay)  Integration between Apex, DocuSign for Patient, and Image Now/ECM.  In person signature process via mobile platform. Signing remotely (offsite) is out of scope for the pilot.  Size (IT/CS): 917 hours  Costs: $304,246 for pilot + $29,920 / year for vendor license renewal (DocuSign for Patient product)  Funding: IT/CS Capital and Operating Budget  Timeline: August 2014 – February 2015  Golives: Parnassus – December 2014; Mission Bay – February 2015

7. Appendix 7

8. Funding/Costs Summary Software licenses and initial integration with Apex, DocuSign for Patient, and Image Now/ECM 8 Assumptions: 1)Vendor costs are a one-time fee for the e-signature platform and development of the transport mechanism to pass files from DocuSign for Patient to Image Now. IT infrastructure built as part of the Admitting / ED pilot will be reused for other departments. 2)Requirements for subsequent department implementations will need to be analyzed for additional IT/CS development and training costs. 3)Above estimates do not include signing devices (ie, ipads), tablet accessories, or MDM licenses that departments would need to purchase. Funded by : IT / CS Vendor Hardware/Software & Labor Cost (Funding via Capital funds) Vendor: Kryptiq$149,601 Vendor: Perceptive$28,000 Vendor: ECM Contractor$9,000 Total Vendor Cost (Capital Funds)$186,601 IT/CS Labor by Team (Labor costs absorbed in current operating budgets) IT Interface Team (30 hours)$4,050 IT Server Team (100 hours)$13,500 CS APeX Access Team (30 hours)$4,050 IT ECM Team (190 hours)$19,500 IT QA/Testing Team (80 hours)$10,800 CS Training Team (87 hours)$11,745 CS PMO (400 hours)$54,000 Total IT/CS Labor (Operating Funds)$117,645 Total cost of software & integration development for Admitting / ED Pilot for PARN and Mission Bay $304,246 Annual Maintenance $29,920

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