Create Request - Health System IT Project Request

Please fill out all the * required fields to the best of your ability and work with your IT owner where needed prior to submitting Project Request form.
If you do not know who your IT owner is please email at uhealthitgovernance@miami.edu


COVID19- UPDATE: We are focusing our efforts on providing support to the Health System with emerging COVID-19 needs. Our team will continue to review requests through the IT Governance 4-Step process. However, the review timeline may be extended due to the over capacity/allocation of IT resources. Thank you! IT Governance Leadership
*Project Request Name
*
Description

Describe solution in 1-2 sentences (who, what, where, when and why)

Additional details, if known:

•New solution (Application, Software, Hardware, other Technology Solution)

•Is this part of wider project (for example: facilities renovation/move,
acquisitions or divestures, joint venture/operating agreement, or affects
another Enterprise IT solution. Your IT owner can assist.

•Is there a regulatory or compliance need?

•Is this patient/visitor safety-related?

•Is this part of government or grant funding?
Type 1. Health System Project
*
Planned Start

For start and finish leave the default dates as is, if you are unsure of the
timing of the project. This will indicate to IT to work with you on establishing
the timeline.

 m/d/yyyy 
*
Planned Finish

For start and finish leave the default dates as is, if you are unsure of the
timing of the project. This will indicate to IT to work with you on establishing
the timeline.

 m/d/yyyy 
Value Analysis
The Value Analysis Committee (VAC) requires that each request be presented to the respective Value Analysis chairperson with physician chairperson approval. We are looking for any and all qualitative and quantitative
information on supplies, equipment, and/or services to support the request.
Type of Contract Procedure Description
Disposable Items Required Requires Disposables?
Physician Name Requesting Product
Additional Information
*
Business Sponsor

VP/Executive level who the business owner reports up to
and who typically has financial and executive oversight of the project.
*Business Owner*Business Sponsor same as Business Owner?
*Requestor Name*Requestor Phone Number
*Requestor E-mail Address*Requesting Department
*Requester same as Business Owner?
IT Sr. Manager
*
Business Need/Justification/Requirements

• What are the operational issues/challenges today?

• What are the negative impacts to the operation/organization/brand?

• How will this application eliminate the problem?

• List the positive tangible and intangible benefits associated with this
application to operations?

• If your IT owner or vendor(s) have an approximate financial benefit,
estimate in $ here.

*
Existing Solution/Process

• Describe current workflow process. Upload a workflow diagram, if
available in the 'Upload Documents' section at the bottom left of the form.

• Provide Standard Operating Procedures and Policies.

• How do you do things now? (Current State)

• If you have floor plans, please include.
Name of Vendor/Third Party/IT In-House TeamVendor Contact Information
Is this a new vendor?
*Budget Approved *
Budget ($)

Enter rough estimate if known, or work with your vendor and/or IT owner
to enter an approximate estimate or leave as $0.

Budget Requirements
*
Budget Detail

Please also upload a budget document showing dollar values for each of
the Budget Requirements.

• If you have an approved capital budget, include the IT portion to satisfy
this requirement.
• Please summarize the funding history i.e., one or more departments
collecting the funds, etc.
• Split operating vs. capital costs. Any important capital fees year 1, 2, etc.
and any maintenance costs. Describe here.
*Funding SourceTechnical Requirements
*Documentation submitted/in process?
*
Service Location

Provide specific information i.e., clinical department(s), building, location,
unit, floor, etc.

Service Location DetailType of Mandate/Requirement
*Strategic Alignment
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