Informatics Consultation Request Form

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xrjkPAUDeqNgJghiFLsjsoVds5uRV5FLwySozV94wU5DZ2pKMLPdor5RdG2rF836yX8BCRMWZ

You are about to request a consultation with CTSI's Best Practices Integrated Informatics Core (BPIC).

BPIC offers free consultations related to informatics research support, collaborative science and data access and management.

This service is managed in part by the Academic Health Center - Information Exchange (AHC-IE), an initiative aimed at centralizing the handling and distribution of clinical data within the University.

Thank you.

Your request ID is:

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Your role on the project

* must provide value

PI first name:

* must provide value

PI Last name:

* must provide value

PI email address:

* must provide value

Employer of the PI:

* must provide value

PI x.500:

Other

College or School:

* must provide value

Department (if applicable):

Other (please specify)

* must provide value

Medical School Department:

* must provide value

Division within department (if applicable):

We understand that you are not the PI on the project. Please provide your contact information below. Thank you.

Your first name:

* must provide value

Your last name:

* must provide value

Your email address:

* must provide value

Your x.500:

Your phone number:

Purpose of consultation (please pick one):

* must provide value

MCC Request Type

What service are you requesting?
(Can select multiple)

* must provide value

CLHSS Project Folder Creation

Data Analyst Support/Supplemental Data

What service are you requesting?
(Can select multiple)

* must provide value

UMOM Project Folder Creation

Data Analyst Support/Supplemental Data

When to select Data Storage:

The data already exists and you need a secure environment to store and analyze data
You need access to a secured environment to access HIPAA compliant applications (e.g. REDCap, Box, Qualtrics)

When not to select Data Storage:

You need the BPIC team to identify your study cohort and/or provide outcomes data
- For these requests, select "Clinical EHR/Data" as your purpose for consultation
You need informatics assistance with analyzing your data
- For these requests, select "Informatics Faculty Support"

Does your study utilize Fairview EHR data?

* must provide value

Yes

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What resources do you need for your data storage request?

HIPAA Compliant Web Apps (e.g. Box, REDCap, Qualtrics)

Microsoft Office Suite

SQL Datamart

GPU Server

Statistical Applications (e.g. SAS, Python, R, Stata)

Data Visualization Tools (e.g. Tableau)

Is the project already in Portunus (i.e. does it have a folder in the data shelter)?

Yes

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What is the CLHSS project folder name?

What is the UMOMs project folder name?

Please include CLHSS Project Folder Creation in your request.

Please include UMOM Project Folder Creation in your request.

What should the CLHSS folder name be?

What should the UMOM folder name be?

Who should have access to the CLHSS folder?

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Who should have access to the UMOM folder?

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What imaging service are you requesting?

* must provide value

CR3 Project Folder Creation

Nestrasil Project Folder Creation

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Who should have access to the project folder?

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EHR/Clinical Data Source

Primary Project Purpose

* must provide value

Research

Quality/Healthcare Operations

Recruitment

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Output Needs
(Can select multiple)

* must provide value

Patient level data

Feasibility counts

Aggregate data

Recruitment list

Cleaned/formatted/analysis ready data

IRB Status- Does this study currently have IRB approval?

* must provide value

Yes

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What is your IRB submission number?

What is your IRB status?

Full IRB approval

Not Human Subjects Research Determination

Exempt Determination

IRB approval pending

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Consultation- Do you need a BPIC consultation for the IRB HRP-595 abbreviated process?

* must provide value

Yes

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Is your project working with a statistician from CTSI's Biostatistical Design and Analysis Center (BDAC)?

* must provide value

Yes

Not sure, but tell me more

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Name of BDAC statistician you are working with.

Does your project require advanced analytics from faculty in the Institute for Health Informatics (IHI)?

* must provide value

Yes

Not sure, but tell me more

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Name of IHI staff/faculty member you are working with.

Does this request have any hard deadlines?

Yes

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Hard Deadline Date

M-D-Y

Is this project being used to fulfill a student's academic research requirement?

* must provide value

Yes

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You have requested data for feasibility/recruitment purposes. Please choose from among the options below.

I need to know the size of the cohort to determine the feasibility of the study. Please provide me with the count of patients matching my criteria.

I plan to recruit patients based on the data provided to me. If I want to send out recruitment letters to Fairview patients, I'll visit the Fairview recruitment instructions. If you'd like to explore recruitment options, please contact the CTSI recruitment center at ctsi@umn.edu.

I am planning a study and want patient data to determine feasibility. My goal is not patient recruitment at this time.

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If you've already discussed this project with an informatics consultant or other BPIC team member, please indicate their name here.

Title of your project

* must provide value

Please provide a brief description of your research question, project aims and your informatics needs.

* must provide value

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Choose the funding source that will support costs for services

(Updated Oct 2022)

Hourly ISO Rates
BPIC $120/hr
Masonic Cancer Center Members $95/hr

Departmental Support Agreements

School of Dentistry
Center for Pediatric Obesity Medicine
Department of Anesthesiology*
Department of Dermatology
Department of Family Medicine and Community Health
Department of Pediatrics, Emergency Medicine
Department of Pediatrics, Cardiology
Department of Pediatrics, General Medicine*
Department of Surgery*
ATRIA Microbiome
Diabetes, Endocrinology and Metabolism
Department of Otolaryngology
Cystic Fibrosis (CF)*

*Departmental pre-approval may be required

* must provide value

Which departmental contract does this project fall under?

Artificial Intelligence in Cardiology Program (ATRIA)

Center for Pediatric Obesity Medicine

Department of Anesthesiology

Department of Dermatology

Department of Family Medicine and Community Health

Department of Pediatrics, Emergency Medicine

Department of Pediatrics, Cardiology

Department of Pediatrics, General Medicine

Department of Surgery

Diabetes, Endocrinology, and Metabolism

Department of Otolaryngology

School of Dentistry

Cystic Fibrosis (CF)

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What Masonic Cancer Center (MCC) group does this project fall under?

MCC- CTO (Clinical Trials office)

MCC- TTL (Translational Therapy Lab)

MCC- Cancer Research Translational Initiative (CRTI)

MCC- Admin and Researchers

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Upload supporting documents to help us understand your request (e.g., protocol, abstract, inclusion/exclusion criteria, DUA, etc.)

Upload file

Today's date

* must provide value

M-D-Y

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