UCSF Medical Center CTG – February 6, 2014

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

2. The presenter(s): Sheryl Shah, PMO Project Manager, Pamela Hudson, Executive Director. Irene Brezman, Director The ask: 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. 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: Healthcare Workflow Integration Electronic Signature Platform • Benefits of the DocuSign for Patient include: • DSP is optimized for healthcare organizations by utilizing: • DocuSignplatform 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 license

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, KhiangSeow) • Need Business Partners Participation for requirements/validation • Dr. Robinowitz, Others: Nursing, Prepare Clinic • Target Completion Date: March 31, 2014

6. Product Costs: • 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. 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 standardization • Determine full cost estimates for further development and implementation • Present back to CTG in May or June

8. Appendix