Research IT Request Form » Integrated Data Repository Research Services » Clinical and Translational Science Institute

IT Builds Request Form

We look forward to learning more about your project! We cannot provide letters of support without scoping your project. To this end, this form will help us to accurately scope your project and provide you with the best information and estimates possible. Completion of this form will substantially reduce the number of meetings and communications we will otherwise need to engage in with you to scope your project, so we recommend being as thorough as possible.

Research Team Members

UF Principal Investigator

Full name(Required)

Email(Required)

College and Department(Required)

Point of Contact

Is the PI also the point of contact?

Yes

Full name(Required)

Email(Required)

College and Department

Names of UF CO-Investigators

Project Title(Required)

Brief Project Description(Required)

~3-4 sentences max; Please use lay terms (avoid discipline-specific acronyms; avoid clinical jargon when possible).

What is the research question or hypothesis for this project? How does the RIT Build help answer this research question/hypothesis?

~3-4 sentences max; Please use lay terms (avoid discipline-specific acronyms; avoid clinical jargon when possible).

Overall Project Goal(Required)

At the end of this current project, we will hope to have achieved (e.g., “a successful usability test of the ABC clinical decision support tool to provide pilot data”; “improved asthma diagnosis at UF Jacksonville Family Medicine clinics via implementation of a best practice alert”; etc.):

What is the current workflow or process for this?

What would your most ideal workflow or process look like?

Workflow Diagram

Max. file size: 125 MB.

Please enter your workflow diagram in this section. Identify type of project. iI patient facing, draw process out (how will the data ideally flow from patient to EHR?).

Build Details

Overall Build Type(Required)

Best practice alert

Risk prediction

MyChart Questionnaire

Push Alert

App

Other

Build Details – App

Build Details – Other

Scope of the Current Project for which you are applying for funding(Required)

Sandbox build only (e.g., for pilot, usability testing, etc.)

Full implementation into clinical care

Systems and tasks involved(Required)

Type of Funding Seeking for Project

Funding Source(Required)

Federal grant (e.g., NIH, AHRQ, PCORI, etc.)

State Funding (e.g., Florida Department of Health, etc.)

Institutional funding (e.g., CTSI, department, etc.)

Other

Federal grant (e.g., NIH, AHRQ, PCORI, etc.)

State Funding (e.g., Florida Department of Health, etc.)

Institutional funding (e.g., CTSI, department, etc.)

Other

Funding Type(Required)

Grant

Cooperative Agreement

Contract

Other

Submission Type(Required)

New (First time submitting this project for funding)

Resubmission (whether same or different study section)

Submitting previously rejected proposal to new agency/RFP

Administrative supplement or revision to existing funded project

No cost extension or renewal of existing funded project

Other

Have you worked with UFHealth Research IT on this project previously?

Yes

N/A – First time submitting this project

Proposal Details

Are any other universities or institutions involved in this project?(Required)

Yes

If Yes, please list the other universities/institutions involved:

If Yes, is UF the primary or sub?(Required)

Primary

Sub

N/A – No other universities or institutions involved

If UF is Sub, what is the name and institutional affiliation of the overall project PI?

If yes, do you plan to share the IT solution to also implement at this university/institution?(Required)

Yes

If yes, will this university/institution be sharing the IT solution with us?(Required)

Yes

Are any subcontractors or consultants involved?(Required)

Yes

If Yes, please list name of companies involved:

If Yes, please list roles of these companies in the project:

Timeframes

Date proposal due to sponsor(Required)

Anticipated state date of grant (if funded)(Required)

Anticipated end date of grant (if funded)

Anticipated date of IRB submission (if funded)

Anticipated date of RIT build implementation (if funded)

Anticipated date of RIT build de-implementation (if funded)(Required)

Preliminary work, if any(Required)

User-centered design in progress or completed

Usability testing in progress or completed

Other type of stakeholder involvement in progress or completed

Proof of concept for tool created

Tool is in EPIC sandbox (indicate EPIC version)

Tool has already been developed using EPIC (indicate EPIC version)

Tool has previously been implemented at another institution with EPIC (indicate EPIC version)

Other

Tool is in EPIC sandbox (indicate EPIC version)

Tool has already been developed using EPIC (indicate EPIC version)

Tool has previously been implemented at another institution with EPIC (indicate EPIC version)

Other

IRB

Will you submit the RIT Build component of this project to IRB as research or usual clinical care?(Required)

Research

Usual clinical Care

Unsure

Usual clinical Care (Note: if your build is deemed usual clinical care, there are several requirements and policies around data availability that must be followed, e.g., data must be part of the legal record and must be available to clinicians who request it within the scope of their clinical duties. Please contact us with questions.)

What locations will be affected?(Required)

Gainesville

Jacksonville

Central Florida

Other

Which of the following will be impacted?(Required)

Single Department/Clinic/Specialty

Multiple Departments/Clinics/Specialties

Single Hospital

Multiple Hospitals

All Hospitals in UF Health

Colleges

Institutes

Other

Single Department/Clinic/Specialty

Multiple Departments/Clinics/Specialties

Single Hospital

Multiple Hospitals

All Hospitals in UF Health

Colleges

Institutes

Other

List the roles that would be impacted by this project. Confirm whether you already have leadership/stakeholder buy-in in impacted departments.

Role (e.g., physicians, nurses, etc.)

Department

Buy-In? Yes/No

Patient-Facing Components

Is there a patient-facing component to this build (e.g., patient mobile app, patient MyChart app, etc.)?(Required)

Yes

Sample Size

Across UF, how many patients do you anticipate will be enrolled into the study as users?(Required)

No patients are involved as users of the tool

Across UF, how many providers/clinical staff do you anticipate will be enrolled into the study as users?(Required)

No providers/clinical staff are involved as users of the tool

Requests to RIT for Proposal

Untitled(Required)

Budget for RIT build and/or implementation

Letter of support

Other

Is there anything else you wish to share that you think will help us evaluate the scope of your project?

If you have already discussed this project with Information Technology team members, please include their names below.