Information Technology IT Evaluation for New Technology ...
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Information Technology IT Evaluation for New Technology Version 2.0
IT Evaluation Request Form
Technology Name:
Customer Information
Department: Request Date: Contact: Go-Live Date: Email: Estimated Cost : Phone: Funding Source:
Funding Status:
Vendor Information
Vendor: Product: Contact: Model or Version: Email: Software (Y/N): Phone: Hardware (Y/N): Web Address
Technology Description Describe the new technology & how the new technology will be used
Will the technology access, store or share PHI /PII? (Y/N)
Will the technology be used for research on human subjects? (Y/N) Will patients or research subjects directly use this technology? (Y/N)
Is this an FDA regulated device, application or system? (Y/N)
Return completed form to your IT Sponsor or if unknown email to [email protected]. For Research specific requests email to [email protected]
IT Evaluation Request Form
IT Sponsor:
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UC Davis Health SystemInformation TechnologyPreliminary Check List for New TechnologiesVersion 2.0
Technology Name:
Yes NoNetwork Technologies
Does the new system or device have network connectivity requirements?
Does the new system or device require wireless network connectivity? (Includes PCs, laptops, clinical devices, and mobile devices such as handheld scanners, smart phones and tablets)
Communication TechnologiesDoes the new system have voice, fax, telecommunications, radio communications and/or paging requirements?
System Hardware, Operating Systems, Database Management Systems, Client DevicesAre servers, storage, appliances, network switches, and/or other hardware required for the new system?
Does the new system require database management systems? (Oracle, SQL Server, MS Access, dBASE, etc)
Are workstations, display monitors, printers, scanners, and/or other client devices required for the new system?
Information Technology SecurityIs sensitive data involved? (e.g. Protected Health Information-PHI/Personably Identifiable Information-PII). Describe in "Comments"
What is the expected number of UCDHS personnel that will use the technology? Provide explaination in comments
Does a third party require a remote connection to UCDHS systems?
Data Integration and InterfacesDoes the new system require or have the ability to interface and/or integrate with Electronic Health Record or other systems or devices?
Digital Imaging TechnologiesDoes the new system capture, access and/or house digital imaging data for medical multi-media (still images, audio/video, etc.)?
IT FacilitiesDoes the new system have requirements for audio, video, overhead paging, and/or intercom systems?
Does the new system have requirements for Teleconferencing or Video Conferencing?
Does the new system require construction/facilities work to prepare for installation? (power, data cabling, equipment mounitng)
ApplicationsIs the new system hosted/provided externally to UCDHS (SAAS,ASP: partially or fully)?
If the system is web based, does it follow WCAG 2.0 guidelines for accessibility?
If the system is non-web based, does it comply with sections 504 and 508 of the Rehabilitation Act and the Americans with Disability Act?
Clinical Engineering TechnologiesAre clinical/patient care devices associated with the new system?
Data Center ResourcesAre data center resources (floor space, rack space, electric power, cooling, and/or cabling) required for the new system?
Applicable Evaluation Question "Yes" & "N/A" Additional Comments
Instructions: IT Business Operations staff working with the customer and vendor must check the applicability (Yes or No) of the following preliminary evaluation questions associated with the new technology, then complete the response for the applicable questions.
Technology Description:
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Date:
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Information Technology IT Evaluation for New Technologies Technology Questionnaire Version 2.4
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Technology Name: 43T Date: 43T
Vendor: 43T
Vendor Contact: 43T
Vendor instructions: The IT Evaluation Process is a set of activities and procedures referring to the acquisition of new applications, technology, or technology devices. It is the goal of the UC Davis Health System (UCDHS) to ensure new applications, technology, and devices adhere to current Information Technology, Clinical Engineering, and Security standards to safeguard patient privacy, enable organizational efficiencies, and provide overall protection of the Health System’s technology assets.
For the purpose of this questionnaire the term “technology” refers to any system, device, application, software or appliance, used in the new technology under review. Please answer each question fully. Incomplete answers may impede the IT Evaluation of your product and delay the purchasing process. If a question does not apply to your product, enter N/A. Certain IT functional areas may request a conference call to receive clarification on answers if necessary. Contact your IT Sponsor should you have any further questions.
Application Management
1. How many back versions of the technology are supported? (current release plus prior two releases) 2. How long has the most current release been on the market? What is the technology’s projected sunset date? Is a
new project planned? 3. Is customer/technical support available for this technology? 4. What customer/technical support hours of coverage are available for this application? 5. What are the Regulatory or third party factors to be accounted for in managing and maintaining application? (CAP,
Joint Commission, FDA) 6. As related to accessibility do you have independent certification indicating compliance with the WCAG 2.0 guidelines
or sections 504 and 508 of the Rehabilitation Act and the American Disability Act, and if so by whom? 7. As related to accessibility if not fully compliant, what is your roadmap to become complaint as addressed in the
WCAG 2.0 guidelines or sections 504 and 508 of the Rehabilitation Act and the American Disability Act. 8. Do your application/ clients able to tolerate 30ms latency? If not, please explain. 9. Do your application/clients able to tolerate the distance of 900 miles? If not, please explain
System Integration
1. Can the new technology integrate with Epic’s EMR? 2. If yes to the above question for EMR integration, be specific with the type of data that can be sent or received
(Registration-ADT, Orders, Results, and Transcriptions). If others, please specify. 3. Can the new technology be integrated with Non-EMR systems, devices existing databases or applications? 4. Does your Technology support Bi-Directional Data Integration? If not, specify which direction is supported- outgoing or
incoming, typically from which system. 5. What type of communications protocols are used by the new technology for integration?
(TCP/IP, SOAP, HTTPS, sFTP) If others or proprietary, please specify. EXAMPLE
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6. What message structures are supported by the new technology for integration? (HL7 ver2, HL7 ver3, EDI, Fixed Length, and XML) Provide a list of all, if other or proprietary, please specify.
7. How is patient identified in your technology? Do you rely on HL7’s ADT? How is the patient linked to the correct device data? Please specify.
8. Does the technology support encryption of the data (data in motion)?
Imaging & DICOM
1. What type of image? If DICOM, provide DICOM Conformance statement. 2. What is the average file size of the images? 3. How are the images acquired? (Ultrasound, Endoscopes, or other devices)
Desk Top PCs & Peripherals
1. Does the technology match UCDHS IT Technology Standards below. Please provide details (Workstation configuration, OS, printing requirements, display requirements, peripherals)
• Core Duo minimum or 64-bit (x64) processor • 4 GB RAM (64-bit) minimum • 100 GB available hard disk space minimum • DirectX 9 graphics device with WDDM 1.0 or higher driver • 1900x1600 minimum video resolution on a 22” or 24” monitor • Windows 7 Enterprise 64-bit Compatible • Internet Explorer 8 compatible • Dell Data Protection Encryption Compatible • McAfee Anti-Virus Compatible • Symantec Altiris Compatible • DDMI Compatible
2. Is there a need for desktop software or other client utilities? 3. Does your technology support mobile devices? (PDAs, tablets, Smart phones) If yes, provide specific details and list
special configuration and required software. 4. Will the technology integrate with an existing authentication store such as UCD Kerberos/CAS/Shibboleth/Active
Directory?
Communications
Wired Networking
1. Does the technology require its own dedicated or proprietary network? If so, be specific for the needs. 2. Does the technology provide for or require redundancy? Please be specific in the requirements. 3. What are the physical interface requirements? (Ethernet 10/100/1000 TX, HSSI, fiber SX/LX, FDDI, T1, T3) 4. How much bandwidth does the technology require? 5. How many number of port switches are required? 6. Will there be data access/transmissions with any entities outside of UCDHS? (Patients, Physicians, other
businesses). 7. Explain in detail how the application will send and receive data? (e-mail, web forms, FTP, telnet, secure mail, or
other)
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Information Technology IT Evaluation for New Technologies Technology Questionnaire Version 2.4
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8. What are the network latency requirements? 9. Is there a proprietary interface or TCP/IP communications via Ethernet (or other)? 10. Does the technology operate with layer 3 routing? Does the technology and devices need to be in the subnet? 11. Does the technology support, DHCP, BOOT? Please provide a list. Additionally, are static IP addresses
required? 12. Does the technology depend on IP Multicast for any functionality? If so, can it use a UCDHS assigned multicast
group IP? 13. Will the technology be managed remotely? (Maintenance activities performed by a service person via a VPN
connection?
Wireless (Wi-Fi) Networking
1. What wireless authentication methods and encryption does the technology support? (802.1x, MS-CHAP, PEAP, LEAP, WPA, WPA2)
2. Do you require your own wireless infrastructure or can the technology use shared access points with UCDHS’s existing 802.11a/bg/n Cisco infrastructure?
3. Can the technology run on a shared SSID or does it require its own dedicated SSID? 4. What radio frequencies does the technology support? Please provide specifics that include power, frequency,
modulation techniques (Bluetooth, 2.4 GHz, 5GHz, 100 milliwatts, Wi-Fi) 5. Will the vendor accept a third party wireless coverage survey or will the vendor require their own? 6. How much bandwidth does the technology require? 7. Are there implementation requirements related to best practice configurations to use Cisco Wireless LAN
Controllers? 8. Has the technology been tested with AssureWave controller versions? Please specify. 9. What are the minimum receiving signal level (RX) requirements from the AP in order for the technology to
operate successfully?
Voice Services
1. Does the technology require voice services? (Voice Over IP, POTS, Digital, T1) 2. Does the technology support or require SIP integration with Cisco call manager version 9/1? If yes, please
provide SIP configuration requirements. (Authentication, protocols) 3. Does the technology require voice communication lines? (POTS, Digital, T1) If yes, provide the requirements.
Data Management
1. What type of storage (Local, SAN, NAS) configuration and versions are required? 2. What is the estimated amount of storage needs? 3. Backup and Restoration - What data is stored and for how long? Online? Other media? Archived? Please provide
specific details. 4. Are there any regulatory requirements regarding data retention? If so, how is this accomplished? 5. Does the technology have an archive and compliance function? If so, how is this accomplished? 6. Is replication required? If so, is it application based or storage server based? Please provide details (remote vs. local) 7. Is there a defined minimum performance requirement (IOPS, throughput, latency)? Please provide specifics details. 8. Does the technology support Tivoli Storage Manager backup client?
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Information Technology IT Evaluation for New Technologies Technology Questionnaire Version 2.4
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9. Does the technology have an integral data backup capability (Backup onto removable media like tape, disk)? 10. What database products (SQL, Oracle, Cache, DB2), versions and configurations are required? Please provide
specific details. 11. What are the Database administration expectations of UCDHS versus support provided by the vendor? 12. Does the technology support encryption of the data (data at rest)? 13. Does the data stored contain PHI or PII?
Server Technology
1. Are servers required for this solution? If no, explain and continue at question #15. If yes, continue below. 2. Is the new technology hosted/provided externally to UCDHS (SAAS, ASP) partially or fully? If no, continue to #4. 3. If yes to #2, will UCDHS be expected to host any server hardware <deleted> for the technology to function
(appliances, gateway servers, interface engines)? If yes continue below, if no skip to #15. 4. If no to #2 (on-prem solution), describe the architecture for this technology.
Note: Be specific and provide a basic description of the infrastructure. Describe your support model and the components that you expect to be supported by UCDHS (Servers, databases) and which will be supported by the vendor. Include details about each application tier, any specialized hardware required and connections between application tiers. An example response: Two network load balanced (Linux, Windows, Unix) web servers connecting over a standard TCP/IP network to a (Linux, Window, Unix) application server which stores data in an (Oracle, SQL) database running on (AIX, Windows Server 2012).
5. Can UCDHS supply its own servers? If “no” provide justification. 6. Based on all components of your application (web, app, db), what methods of high availability (HA) and/or disaster
recovery (DR) are recommended or supported (ie will it run in a Microsoft cluster, can it be load balanced, can we have hot spares in a DR site, etc.)? Is there additional licensing and or cost required for this option?
7. Is there a requirement for any specialized hardware or PCI card to be installed in the server(s)? 8. What minimum system requirements for each server are required? What Operating Systems and versions are
supported for each server (Windows, UNIX, Linux, server based appliance)? Please provide the URL here, or the actual documentation for this response.
9. Is VMWare virtualization supported (if UNIX is Power VM supported)? If no, provide documentation and reason why it is not supported.
10. If the client application was to be published in Citrix, is it supported and do you have limitations on the version of Citrix? If so, provide specific details. If the client interface is web based please indicate this specific information.
11. If any part of your application (client or server) is web based, what web application platform will the application/service use? (Tomcat, Java, IIS, Websphere, Glassfish, JBoss)
12. Does any part of your application require Java or a Java virtual machine (JVM) installation to function? 13. Are there any hard-coded host names, user names or passwords in your application or required to be used to run or
install your application? 14. Are there any USB or other hardware based license keys/dongles required for your application? 15. Will all application processes run as Windows Services or does a user have to be logged in for the application to
function (foreground application)? If yes, Please provide details and the reason in the case where a user has to be logged in.
16. Can the application components be monitored with HP agent based or agentless monitors (Sitescope or Operations Manager) or do you monitor them?
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Information Technology IT Evaluation for New Technologies Technology Questionnaire Version 2.4
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IT Facilities
1. Does the technology use active or passive RFID technology? Provide specifics. 2. Does the technology require the use of bar code scanners over a wireless network? 3. Does the technology require integration with building access or physical security systems? 4. Does the technology require digital video or AV solutions? 5. Does the technology require integration with overhead paging, Vocera technology or intercom system? Any other
alarm routing (via nurse call, via wireless, via additional hardware, via pagers)? Please specify. 6. If server based, is the server equipment rack mountable in existing UCDHS Racks? 7. What are the power, space, and cooling requirements for the technology? 8. What are the cabling and cabling infrastructure needs for the technology? Any other cabling? (KVM, STP) Please
specify. 9. Are Cellular Phones supported and if so what models? (Blackberry, iPhone) 10. Has the vendor published a Sustainability or Corporate Responsibility report? 11. Has the vendor set energy reduction goals? If yes, please explain those goals. 12. Is the vendor tracking, reporting and reducing energy use, waste and emissions? 13. What are the vendor’s “green” product trends?
Clinical Engineering (Bio Med)
1. If this is an FDA-regulated technology please supply 510K, PMA or other FDA authorization to market the device. 2. Provide a network diagram and / or data flow description end-to-end for this technology. 3. Does this technology send or receive any real-time data? (Waveforms, alarms) Please be specific to include latency
requirements. 4. Are the data/waveforms in the above question cached or queued? 5. Can software or hardware not authorized by the technology manufacturer be installed on the technology? 6. Can UCDHS apply OS security patches (Microsoft patches) without medical device manufacture validation? 7. Does the technology support anti-virus software? Which anti-virus software is recommended and describe any
restrictions on the installation, use and update? 8. How frequently can the technology accept interfaced (inbound) data? Please provide specifics. 9. How frequently does the technology send data (outbound)? Please provide specifics. 10. Does the technology support IHE Integration Profiles (either directly or via an intermediary such as a gateway)? If yes,
describe and provide IHE Conformance statements and Connection results. 11. Provide a completed copy of the NEMA MDS2 form HN1-2013 and make them available via link from this document. 12. Provide a patient safety and risk assessment of the technology in a networked environment. (Provide a IEC 80001
risk assessment).
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UC Davis Health SystemInformation TechnologyVersion 3.0
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
Department Department Contact
Imaging
Integration
Client Services
Appl
icatio
nsTechnology Evaluation Summary & Recommendation
Department Information
Dept. Contact EmailComments
Research
Enterprise, Finance, HR
Tech
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Vendor Information Other Information
IT Business Operations
Unified Communications
Enterprise Data
Enterprise Systems
IT Facilities
School of Medicine
Clinical Engineering
Technology Name
IT Security
EMR/Epic
Information Technology Departmental Summaries
Technology Description
Contact Phone #
Department Systems
Proposed Go-Live Date
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UC Davis Health SystemInformation TechnologyVersion 3.0
IT Sponsor Date Submitted
Technology Evaluation Summary & Recommendation
Technology Name
Yes/ No
Yes/ No
Dated Reviewed
Approved
Approved w/ Comments
Need Additional Info
Denied
CIO Signature:
Recommended Can fully support the new technology within UCDHS
Recommended (Mitigation Required) Can support the technology with minor modifications or mitigations
Not Recommended Cannot support the new technology
Will the application/system access, store or share PHI/PII?
Will patients or research subjects use this technology?
Section Rating
CIO Review and Comment
Check Box
IT Recommendation
[ To be completed by the IT Evaluation Team]
IT Accessibility
Technology Summary
[ IT Sponsor - Please provide a narrative summary of the technology and it's expected use by the requesting customer. Ensure the following questions are addressed in your narrative]
1. What is the customer trying to accomplish with the new technology? What is their goal?2. What is the source of the request for an IT Eval? (IT Initiative, Customer Request, Strategic Initiative, StrataCap, RFP/RFI, etc.)3. Is the initiative budgeted? Are there any "hidden" or unbudgeted IT expenses to support the initiative?4. Similarity to existing or planned systems5. Explain "YES answers from above questions6. Timeline for implementation (if research specific include the duration of the study)
Comments
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UC Davis Health SystemInformation TechnologyIT Evaluation Security QuestionnaireVersion 2.0
Technology Name: Date:
Vendor:
Vendor Contact: (person completing the questionnaire)
Information Technology Security
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Is there a vendor involved? If so, what is the status of the interaction? (e.g. RFI, RFP, negotiations, other)
Does the vendor perform background checks during the hiring process?
Is the application hosted externally by a vendor/service provider or at UCDHS?
Is the system hosted at facilities controlled by the vendor? If not, who manages the systems?
How is physical access controlled?
Vendor Instructions: Please provide a comment or N/A response for each of the following evaluation questions. The vendor/manufacturer, is to complete the response for each applicable evaluation question associated with the new technology. UCDHS may contact the vendor for follow on questions as required.
Evaluation Question
Is there new data involved? How/where is it created? How often does it change?
Who sees/uses this data?
Who updates this data?
What is the data flow? From where to where?
What data is stored and for how long? Online? Other media? Archived?
Are there any regulatory requirements regarding data retention? If so, how is this accomplished?
Comment/Response
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Evaluation Question Comment/Response
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Does the contract specifically address actions due to the discovery of a security breach?
Does the contract provided for a "right to audit" in the case of data compromise or other impacting events?
Does the contract adequately address the data destruction including the disposition of data after contract termination?
What transmission security does the vendor support for data transmissions? (SFTP, FTPS, TLS)
Does the vendor utilize wireless networks? If so, how are they secured?
Are there backups? If so, are backups stored offsite? If so, are tapes encrypted?
Does the vendor have adequate BC/DR plans?
Who will manage user logins? (provisioning/de-provisioning)
Describe the vendor change/patch management process.
How is our data kept isolated from other client data?
Describe how data loss prevention (DLP) is addressed by the vendor. (i.e., how is data protected from theft by the vendor's authorized users)
Does the contract adequately address an incident response/handling process?
Is there a SSAE 16 report that UCDHS can review?
Who has access to the systems?
Will UCDHS data be stored in offshore/non-USA facilities?
Does the vendor require a remote connection to UCDHS systems? If so, what is required/expected?
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Evaluation Question Comment/Response
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43 If the system/application uses an external identity store, please describe the technology used:
Describe the security architecture planned (specific to this application and our data). For example, are there firewalls, intrusion prevention/detections systems, web application firewalls, etc.
If the system/application has an exposed interface, does it encrypt interface transmissions? (e.g. SSL, IPSec, RSA)
If the system/application does encrypt interface transmissions, what is the method of cryptography used? (Symmetric/Asymmetric/tunneling algorithm)
Does the system support encryption of data-at-rest? Please describe.
Please describe the data integrity controls (hashing, WORM storage).
Describe malicious code protection (Anti-virus) available/supported.
Does the system/application use an internal or external identity store for user IDs?
If the system/application uses an internal identity store, does it support an external identity store? If so, please describe the technologies supported:
If the system/application uses an internal identity store does it support an external provisioning system through an interface? If so, please describe the interface available:
Does the contract specifically address safeguarding PHI and overall HIPAA compliance?
Does the contract address non-disclosure or is there a separate NDA?
Was the application developed by UCDHS, a vendor, or is it Open Source software?
Has a formal vulnerability analysis been performed on the source code (software such as HP Fortify or IBM AppScan or expert third-party)? If so, please describe.
Is there a source code escrow?
Is this a new system? Replacement? Upgrade?
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Evaluation Question Comment/Response
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If the current password store uses encryption/cryptography to protect passwords, what method of cryptography is used? (hashing/symmetric and algorithm)
How will users access the system? (Web browser, thick client. input screens, output reports)
Does the system/application encrypt the transmission between the client and the system? (e.g. SSL, IPSec, RSA)
If the system/application encrypts the client transmission, what is the method of cryptography used? (Symmetric/Asymmetric/tunneling algorithm)
Does the application support adequate roles for least privilege access?
Does the system/application use an internal or external store for user passwords?
If the system/application uses an internal password store, does it support an external password store? If so, please describe the technologies supported:
If the system/application uses an external password store, please describe the technology used:
Does the password store used by the system/application support passphrases? For example, can a user password contain space characters, special characters, and be a length of more than 20 characters?
Does the new system support Federation Authentication? (e.g. SAML, Shibboleth, WS-FED)
Does the system/application have a trust relationship(s) with external realms/domains? For example, a trust relationship would allow access to services from a system in a trusted domain to a system in a trusting domain?
If the system/application has a trust relationship, please describe the trust type in use:
If the system/application has a trust relationship, please describe the role of the system in the trust relationship. For example, in a trust relationship, the system providing identity credentials is the 'Identity Provider' and the system providing the service to the requesting identity is the 'Service Provider'. The trust relationship can also be two-way where both sides are both Identity and Service providers.Is the system/application able to enforce a password policy? For example, can the system/application require that a password be a certain length, contain certain characters, have a maximum age, etc.
Does the current password store use encryption/cryptography to protect passwords?
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Evaluation Question Comment/Response
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Can we review who has accessed the system/data? (audit logs) Who has access to these logs?
If the system/application does have access logs, what methods are available to remotely retrieval/archive the logs?
What additional security considerations should be noted?
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit EMR / Epic Date Evaluation Completed 11/6/2014
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
(Enter the number 1 thru 3 in the Summary Status box to display the appropriate color)
Prepared By:
Additional Purchasing Considerations
IT Department / UnitDetailed Information and
Additional Comments
Prelude, Patient Access:
Resolute, Billing:
EpiCare, Clinicals:
Willow, Pharmacy:
Radiant, RIS:
OpTime, OR:
Tapestry, Managed Care:
Technical Rating
CommentsContact Phone #Proposed Go-Live Date
Individual IT Department /Unit Evaluation SummaryInformation Tech Department Applications
IT Department / Unit Summary
Department Department ContactDept. Contact Email
Department Information Vendor Information Other Information
Technology Evaluation - Department / Unit SummaryApplications - EMR / Epic
Technology Name
Technology Description
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit Departmental Systems Date Evaluation Completed
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
(Enter the number 1 thru 3 in the Summary Status box to display the appropriate color)
Prepared By:
Proposed Go-Live Date
IT Department / UnitDetailed Information and
Additional Comments
Technical Rating
Individual IT Department /Unit Evaluation SummaryInformation Tech Department Applications
IT Department / Unit Summary
Technology Evaluation - Department / Unit SummaryApplications - Departmental Systems
Technology Name
Technology Description
Additional Purchasing Considerations
Department Information Vendor Information Other Information
Department Department ContactDept. Contact Email
CommentsContact Phone #
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit Enterprise / Finance/ HR Date Evaluation Completed
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
(Enter the number 1 thru 3 in the Summary Status box to display the appropriate color)
Prepared By:
Proposed Go-Live Date
IT Department / UnitDetailed Information and
Additional Comments
Technical Rating
Individual IT Department /Unit Evaluation SummaryInformation Tech Department Applications
IT Department / Unit Summary
Technology Evaluation - Department / Unit SummaryApplications - Enterprise / Finannce / HR
Technology Name
Technology Description
Additional Purchasing Considerations
Department Information Vendor Information Other Information
Department Department ContactDept. Contact Email
CommentsContact Phone #
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit Enterprise Imaging Date Evaluation Completed
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
(Enter the number 1 thru 3 in the Summary Status box to display the appropriate color)
Prepared By:
Proposed Go-Live Date
IT Department / UnitDetailed Information and
Additional Comments
Technical Rating
Individual IT Department /Unit Evaluation SummaryInformation Tech Department Applications
IT Department / Unit Summary
Technology Evaluation - Department / Unit SummaryApplications - Enterprise Imaging
Technology Name
Technology Description
Additional Purchasing Considerations
Department Information Vendor Information Other Information
Department Department ContactDept. Contact Email
CommentsContact Phone #
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit Systems Integration Date Evaluation Completed
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
(Enter the number 1 thru 3 in the Summary Status box to display the appropriate color)
Prepared By:
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IT Department / UnitDetailed Information and
Additional Comments
Technical Rating
Individual IT Department /Unit Evaluation SummaryInformation Tech Department Applications
IT Department / Unit Summary
Technology Evaluation - Department / Unit SummaryApplications - Systems Integration
Technology Name
Technology Description
Additional Purchasing Considerations
Department Information Vendor Information Other Information
Department Department ContactDept. Contact Email
CommentsContact Phone #
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit N/A Date Evaluation Completed
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
(Enter the number 1 thru 3 in the Summary Status box to display the appropriate color)
Prepared By:
Proposed Go-Live Date
IT Department / UnitDetailed Information and
Additional Comments
Technical Rating
Individual IT Department /Unit Evaluation SummaryInformation Tech Department Security
IT Department / Unit Summary
Technology Evaluation - Department / Unit SummarySecurity
Technology Name
Technology Description
Additional Purchasing Considerations
Department Information Vendor Information Other Information
Department Department ContactDept. Contact Email
CommentsContact Phone #
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit Client Services Date Evaluation Completed
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
(Enter the number 1 thru 3 in the Summary Status box to display the appropriate color)
Prepared By:
Proposed Go-Live Date
IT Department / UnitDetailed Information and
Additional Comments
Technical Rating
Individual IT Department /Unit Evaluation SummaryInformation Tech Department Technology
IT Department / Unit Summary
Technology Evaluation - Department / Unit SummaryTechnology - Client Services
Technology Name
Technology Description
Additional Purchasing Considerations
Department Information Vendor Information Other Information
Department Department ContactDept. Contact Email
CommentsContact Phone #
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit Unified Communications Date Evaluation Completed
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
(Enter the number 1 thru 3 in the Summary Status box to display the appropriate color)
Prepared By:
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IT Department / UnitDetailed Information and
Additional Comments
Technical Rating
Individual IT Department /Unit Evaluation SummaryInformation Tech Department Technology
IT Department / Unit Summary
Technology Evaluation - Department / Unit SummaryTechnology - Unified Communications
Technology Name
Technology Description
Additional Purchasing Considerations
Department Information Vendor Information Other Information
Department Department ContactDept. Contact Email
CommentsContact Phone #
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit Enterprise Data Management Date Evaluation Completed
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
(Enter the number 1 thru 3 in the Summary Status box to display the appropriate color)
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IT Department / UnitDetailed Information and
Additional Comments
ESS :DBA :
Technical Rating
Individual IT Department /Unit Evaluation SummaryInformation Tech Department Technology
IT Department / Unit Summary
Technology Evaluation - Department / Unit SummaryTechnology - Enterprise Data Management
Technology Name
Technology Description
Additional Purchasing Considerations
Department Information Vendor Information Other Information
Department Department ContactDept. Contact Email
CommentsContact Phone #
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit Enterprise Systems Date Evaluation Completed
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
(Enter the number 1 thru 4 in the Summary Status box to display the appropriate color)
Prepared By:
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IT Department / UnitDetailed Information and
Additional Comments
Technical Rating
Individual IT Department /Unit Evaluation SummaryInformation Tech Department Technology
IT Department / Unit Summary
Technology Evaluation - Department / Unit SummaryTechnology - Enterprise Systems
Technology Name
Technology Description
Additional Purchasing Considerations
Department Information Vendor Information Other Information
Department Department ContactDept. Contact Email
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit IT Facilities Date Evaluation Completed
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
(Enter the number 1 thru 3 in the Summary Status box to display the appropriate color)
Prepared By:
Proposed Go-Live Date
IT Department / UnitDetailed Information and
Additional Comments
Technical Rating
Individual IT Department /Unit Evaluation SummaryInformation Tech Department Technology
IT Department / Unit Summary
Technology Evaluation - Department / Unit SummaryTechnology - IT Facilities
Technology Name
Technology Description
Additional Purchasing Considerations
Department Information Vendor Information Other Information
Department Department ContactDept. Contact Email
CommentsContact Phone #
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit N/A Date Evaluation Completed
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
(Enter the number 1 thru 3 in the Summary Status box to display the appropriate color)
Prepared By:
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IT Department / UnitDetailed Information and
Additional Comments
Technical Rating
Individual IT Department /Unit Evaluation SummaryInformation Tech Department Business Operations
IT Department / Unit Summary
Technology Evaluation - Department / Unit SummaryIT Business Operations
Technology Name
Technology Description
Additional Purchasing Considerations
Department Information Vendor Information Other Information
Department Department ContactDept. Contact Email
CommentsContact Phone #
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit N/A Date Evaluation Completed
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
4 (Enter the number 1 thru 3 in the Summary Status box to display the appropriate color)
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IT Department / UnitDetailed Information and
Additional Comments
Technical Rating
Individual IT Department /Unit Evaluation SummaryInformation Tech Department Research
IT Department / Unit Summary
Technology Evaluation - Department / Unit SummaryResearch
Technology Name
Technology Description
Additional Purchasing Considerations
Department Information Vendor Information Other Information
Department Department ContactDept. Contact Email
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit N/A Date Evaluation Completed
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
(Enter the number 1 thru 3 in the Summary Status box to display the appropriate color)
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IT Department / UnitDetailed Information and
Additional Comments
Technical Rating
Individual IT Department /Unit Evaluation SummaryInformation Tech Department School of Medicine
IT Department / Unit Summary
Technology Evaluation - Department / Unit SummarySchool of Medicine
Technology Name
Technology Description
Additional Purchasing Considerations
Department Information Vendor Information Other Information
Department Department ContactDept. Contact Email
CommentsContact Phone #
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit N/A Date Evaluation Completed
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
(Enter the number 1 thru 3 in the Summary Status box to display the appropriate color)
Prepared By:
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IT Department / UnitDetailed Information and
Additional Comments
Technical Rating
Individual IT Department /Unit Evaluation SummaryInformation Tech Department Clinical Engineering
IT Department / Unit Summary
Technology Evaluation - Department / Unit SummaryClinical Engineering
Technology Name
Technology Description
Additional Purchasing Considerations
Department Information Vendor Information Other Information
Department Department ContactDept. Contact Email
CommentsContact Phone #
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UC Davis Health SystemInformation Technology
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
IT Department Unit IT Accessibility Date Evaluation Completed
Recommended 1 Can fully support the new technology within UCDHS
Recommended (Mitigation Required) 2 Can support the technology with minor modifications or mitigationsNot Recommended 3 Cannot support the new technology
(Enter the number 1 thru 3 in the Summary Status box to display the appropriate color)
Prepared By:
Proposed Go-Live Date
IT Department / UnitDetailed Information and
Additional Comments
Technical Rating
Individual IT Department /Unit Evaluation SummaryInformation Tech Department Applications
IT Department / Unit Summary
Technology Evaluation - Department / Unit SummaryApplications - IT Accessibility
Technology Name
Technology Description
Additional Purchasing Considerations
Department Information Vendor Information Other Information
Department Department ContactDept. Contact Email
CommentsContact Phone #
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UC Davis Health SystemInformation TechnologyVersion 3.0
IT Sponsor Date Submitted
Vendor Customer's Estimated Cost Vendor Contact Hardware, Software, or Both
Vendor Contact TelephoneWebpage Address
Vendor Contact Email
Dated Reviewed
Approved
Approved w/ Comments
Need Additional Info
Denied
Departmental Purchasing Representative: Include this document with your Purchase Requisition to Purchasing
Note: This document indicates the new technology has been assessed and evaluated by the Information Technology and Clinical Engineering teams. A Technology evaluation reviews the technical stability, security, and feasibility of technology used by UCDSH or implemented within the UCDHS environment. Approval of the application, system or device is not a commitment of IT resources, implementation costs, or financial approval.
CIO Review and Comment
Check Box Comments
CommentsContact Phone #Proposed Go-Live Date
Department Department ContactDept. Contact Email
Department Information Vendor Information Other Information
Technology EvaluationReturn to Requestor Form
Technology Name
Technology Description
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