Eservices: https://sumc.service-nw.cm/ 1. FOR NEWLY HIRED EMPLOYEES: Use On-barding Services & On-Barding Guide Frm Please Nte the fields required fr Research IHIS access are the same as thse utlined in the General Accunts and Access detailed belw but is included with ther n barding requests fr new emplyees that d nt have an existing medical center user ID. This frm shuld NOT be used fr Mnitr access 2. ACCOUNT MODIFICATION REQUESTS: USE ACCOUNTS & ACCESS REQUESTS: General Accunts and Access Frm This frm shuld be used fr emplyees with existing User IDs that need new r mdified access and fr mnitrs with existing User IDs that need new r extended research access 3. INITIAL STUDY MONITOR REQUESTS: Use Nn Hspital Identity and Accunt Request Frm then Cmplete the General Accunts and Access Frm nce yu receive the mnitr User ID via email This is a tw step prcess and shuld be fllwed fr initial mnitr requests 4. MONITOR EXTENSION REQUESTS: Use General Accunts and Access This frm shuld be used fr mnitrs that already have IHIS Access but need access extended It is the respnsibility f the direct Supervisr t cnfirm that all f the infrmatin entered in the request is accurate and valid. The Supervisr is required t maintain adequate dcumentatin which shuld be available fr review upn request. The cmpliance requirements shuld be fulfilled prir t requesting IHIS access fr research. The Supervisr will be required t apprve all eservices requests. Fr questins regarding cmpliance requirements: Medical Center Privacy Office at 293-4477 Fr questins regarding IHIS Research Training Classes and CBLs: IHIS Training Center 366-4777 ihisresearchtraining@sumc.edu Fr questins regarding Emplyee Health Assessments: Cntact yur Human Resurces Prfessinal and Emplyee Health 293-8146 Versin 1.0 1/23/2015 Page 1
Submit a Request Services Access and Accunts Request General Accunts and Access ACCOUNT MODIFICATION REQUESTS Requester/Request fr Infrmatin This Request is fr ME r Anther Persn Defaults t ME and must be changed t Anther Persn if requesting access fr anther emplyee. Cmplete the Requester infrmatin Lgn ID, Full Name, Phne Number, Email Address Cmplete the Request Fr infrmatin Lgn ID, Full Name, Phne Number, Email Address Supervisr/Manager Cmplete the Supervisr infrmatin Lgn ID, Full Name, Phne Number Please nte the Direct Supervisr will be ntified via email f any request and must apprve the request electrnically Cst Center/Fund Infrmatin Cmplete Cst Center and general department Fund Infrmatin Desired Delivery r Start Date Please nte that delivery r start date fr the individual may nt be guaranteed. Accunt Expiratin Date Extensin Please nte this ptin will nly appear when yu select the request is fr Anther Persn in questin 1. This ptin will be used t extend an access date. Are yu requesting an extensin t this accunt s expiratin date? (Yes r N) If NO: yu will be required t cmplete the remainder f the frm If YES: yu will nly be required t enter the new desired expiratin date, cnfirm that HIPAA CBLs have been cmpleted and prvide a business justificatin fr the request. General System Access Mdel general Access after this Medical Center Lgin ID: Please nte that Research access is reviewed fr minimum necessary t perfrm research jb duties. Mdel like requests may nt be guaranteed. Has the individuals cmpleted HIPAA CBLs? (Yes r N) Supervisr is respnsible fr cnfirming the date the individual has cmpleted the HIPAA and Research HIPAA CBLs and maintain cpies dcumentatin. These shuld be cmpleted prir t requesting IHIS access fr research. Netwrk/Email Access (Check Bxes as Applicable) Individual Wrk Flder (P Drive) Email Accunt Versin 1.0 1/23/2015 Page 2
IHIS Research Access Request Guidelines Business Applicatins (Check Bxes as Applicable) Clinical Applicatins (Check Bxes as Applicable) Check Bx fr IHIS if requesting access t the electrnic medical recrd fr research purpses. Additinal questins will appear n the frm that must be cmpleted. Mdel IHIS-Specific Access after this Medical Center Lgin ID: Please nte that Research access is reviewed fr minimum necessary t perfrm research jb duties. Mdel like requests may nt be guaranteed. Will this individual need t be scheduled with patients in Cadence? (Yes r N) If the individual will be scheduling clinic visits r ther prcedures please select YES. Specific training will need t be cmpleted fr scheduling access. Practice Areas fr IHIS Access (Check Bxes as Applicable) Staffing Rles fr IHIS Access (Check Research Staff and any ther Bx as Applicable) Please nte that yu must check at least ne bx. Research Access (Yes r N) Select Yes fr IHIS research access. Additinal questin will appear n the frm that must be cmpleted. Is this user a Research Mnitr? (Yes r N) If request is fr a mnitr please select Yes additinal instructins fr mnitr access are utlined in the Clinical Research Mnitr Access sectin f this dcument. If the request is NOT fr a mnitr please select NO Additinal questins will appear n the frm that must be cmpleted. The infrmatin shuld be available and/r cmpleted prir t submitting a request fr access t the electrnic medical recrd fr research purpses. Failure t prvide any f the fllwing infrmatin may lead t a delay in apprving access requests. Has the individual cmpleted a backgrund check? (Yes r N) Prvide the date f Backgrund Check Cmpletin If N is Selected Cntact yur HR Prfessinal t arrange a backgrund check with ID Prcessing. Please nte that requests fr access will nt be prcessed until the backgrund check is cmpleted. Has the individual cmpleted a Drug Screen? (Yes r N) Prvide the date f Drug Screen Cmpletin If N is Selected Cntact yur HR Prfessinal t arrange an appintment with Emplyee Health/University Health Services. Please nte that requests fr access will nt be prcessed until the drug screen date has been prvided. Please nte that a drug screen is required f all individuals requesting IHIS access. Versin 1.0 1/23/2015 Page 3
Has the individual cmpleted vaccinatins? (Yes r N) Prvide the date f Vaccinatin Cmpletin If N is Selected Cntact yur HR Prfessinal t arrange an appintment with Emplyee Health/University Health Services. Please nte that requests fr access will nt be prcessed until the vaccinatins date has been prvided. Please nte that vaccinatins are required f all individuals requesting IHIS access wh will be in direct cntact with patients r bispecimens, r wh may enter any f the hspital r ambulatry facilities. Prvide IRB Apprval Number(s): Please click n Fr example fr additinal guidance Is the individual listed as Key Persnnel r as a Sub-Investigatr? (Yes r N) If N is Selected Submit an expedited amendment t the IRB t list the individuals as key persnnel. Please nte that requests fr access will nt be prcessed until the individual has apprpriate IRB apprval. Use the Paperclip icn at the tp right f the frm t attach a cpy f IRB apprvals r ther relevant dcumentatin. Will a signed Prtcl-Specific HIPAA Authrizatin Frm be btained prir t accessing individual patient infrmatin? (Yes r N) Is a partial r full waiver f HIPAA Authrizatin required? (Yes r N) if the individual will be screening patient infrmatin prir t btaining written HIPAA authrizatin frm patients that d nt have a clinical relatinship with the PI, apprved sub-investigatrs r Key Persnnel, r if the study was apprved with a Full Waiver f HIPAA Authrizatin and written authrizatin will nt be btained. Use the Paperclip icn at the tp right f the frm t attach a scanned cpy f the waiver. Select N if the individual will nly access recrds that have a clinical relatinship with the PI, apprved sub-investigatrs r Key Persnnel fr screening purpses prir t btaining patient written HIPAA Authrizatin. Versin 1.0 1/23/2015 Page 4
IHIS Research Access Request Guidelines IHIS Functinality Needed (Check all that apply): View and/r Print Recrds Dcuments in Recrds Assciate Patients t Studies fr Research Billing In-Basket Access Only Cmplete Research Billing Wrk Queues Schedule Research Subjects Describe Data Strage & Security Plan: Please click n Fr example fr additinal guidance Patient Phtgraphy Applicatin Request Is Access t the Patient Pht Applicatin Needed? (Yes r N) Please prvide a general business justificatin fr this request: Describe why access t the medical recrd is necessary fr research Add Request t the Shpping Cart & Prceed t Checkut INITIAL CLINICAL RESEARCH MONITOR USER ID REQUEST Submit a Request Services Access and Accunts Request Nn Hspital Identity and Accunt Request This frm must be cmpleted first t btain a User ID fr the study mnitr. Once the frm is cmpleted yu will prmptly receive an email ntificatin with their User ID. Yu will then need t cmplete the General Accunts and Access Frm and fllw the instructins belw. Requester/Request fr Infrmatin Cmplete the Requester infrmatin Lgn ID, Full Name, Phne Number, Email Address Supervisr/Manager Cmplete the Supervisr infrmatin Lgn ID and Full Name Please nte the Direct Supervisr will be ntified via email f any request and must apprve the request electrnically Cst Center/Fund Infrmatin Cmplete Cst Center and department general Fund Infrmatin Request fr Infrmatin Cmplete the fllwing required infrmatin fr initial mnitr requests: Legal First Name, Legal Last Name, Date f Birth, Last fur digits f their Scial Security Number, External Email Address, Expiratin Date (will nt exceed 12 mnths after accunt creatin date), Title, Vendr/Temp/Cnsultatin Cmpany Name. Is an @sumce.edu email address required fr this individual? Select N Versin 1.0 1/23/2015 Page 5
Primary Spnsr Name.#: List the emplyee OSU.# respnsible fr ppulating recrds fr the Inbasket fr this mnitr. Secndary Spnsr Name.#: List the emplyee OSU.# wh is the Supervisr f the Primary Spnsr entered r the PI f the study the mnitr is reviewing. Please nte nce yu Add t Cart and Prceed t Checkut, yu will prmptly receive an email with the study mnitrs user ID. Yu will then need t cmplete the General Accunts and Access frm as utlined belw t request IHIS access fr the study mnitr. CLINICAL RESEARCH MONITOR IHIS ACCESS REQUESTS Submit a Request Services Access and Accunts Request General Accunts and Access Requester/Request fr Infrmatin This Request is fr ME r Anther Persn Defaults t ME and must be changed t Anther Persn if requesting access fr a study mnitr. Cmplete the Requester infrmatin Lgn ID, Full Name, Phne Number, Email Address Cmplete the Request Fr infrmatin Lgn ID, Full Name, Phne Number, Email Address Supervisr/Manager Cmplete the Supervisr infrmatin Lgn ID, Full Name, Phne Number Please nte the Direct Supervisr will be ntified via email f any request and must apprve the request electrnically Cst Center/Fund Infrmatin Cmplete Cst Center and general department Fund Infrmatin Desired Delivery r Start Date Please nte that delivery r start date fr the individual may nt be guaranteed. Accunt Expiratin Date Extensin Please nte this ptin will nly appear when yu select the request is fr Anther Persn in questin 1. This ptin will be used t EXTEND a study mnitr s access date. Are yu requesting an extensin t this accunt s expiratin date? (Yes r N) If NO: yu will be required t cmplete the remainder f the frm If YES: yu will nly be required t enter the new desired expiratin date, cnfirm that HIPAA CBLs have been cmpleted and prvide a business justificatin fr the request. Versin 1.0 1/23/2015 Page 6
IHIS Research Access Request Guidelines Please nte that study mnitrs are nt required t cmplete HIPAA CBLs and yu can mark this respnse as NO Add t Cart and Prceed t Check Out t submit the Mnitr extensin request General System Access Mdel general Access after this Medical Center Lgin ID: Please nte that Research access is reviewed fr minimum necessary t perfrm research jb duties. Mdel like requests may nt be guaranteed. Has the individuals cmpleted HIPAA CBLs? (Yes r N) Please nte that study mnitrs are nt required t cmplete HIPAA CBLs and yu can mark this respnse as NO Netwrk/Email Access (Mnitrs d nt need P Drive r Email Access) Individual Wrk Flder (P Drive) Email Accunt Business Applicatins (Check Bxes as Applicable) Clinical Applicatins (Check Bxes as Applicable) Check Bx fr IHIS if requesting access t the electrnic medical recrd fr research purpses. Additinal questins will appear n the frm that must be cmpleted. Mdel IHIS-Specific Access after this Medical Center Lgin ID: Please nte that Research access is reviewed fr minimum necessary t perfrm research jb duties. Mdel like requests may nt be guaranteed. Will this individual need t be scheduled with patients in Cadence? (Yes r N) Select N Mnitrs will nt need access t schedule patients Practice Areas fr IHIS Access (Check Bxes as Applicable) Staffing Rles fr IHIS Access (Check Research Staff and any ther Bx as Applicable) Please nte that yu must check at least ne bx. Fr mnitrs check the bx fr Research Staff Research Access (Yes r N) Select Yes fr IHIS research access. Additinal questin will appear n the frm that must be cmpleted. Is this user a Research Mnitr? (Yes r N) If request is fr a mnitr please select Yes What is the mnitr s emplyer name? Prvide IRB Apprval Number Please click n Fr example fr additinal guidance Patient Phtgraphy Applicatin Request Is Access t the Patient Pht Applicatin Needed? (Yes r N) Please prvide a general business justificatin fr this request: Describe why access t the medical recrd is necessary fr research Add Request t the Shpping Cart & Prceed t Checkut Versin 1.0 1/23/2015 Page 7