Center for Learning Health System Sciences (CLHSS) Service Request

Center for Learning Health System Sciences (CLHSS) Service Request

Completion of this form is the first step of the CLHSS services request process. The request review process takes approximately 2-4 weeks. Requests for more information will follow the initial review. Questions? Email clhss@umn.edu.

Service Request/Project Title*

First Name*

Last Name*

Personal Pronouns

Email Address*

Job Title*

Affiliation*

Select

Is your home dept part of the Medical School?*

Select

Please provide the name of your home dept/division*

Please provide DeptID for your home dept/division.*

Please provide your home college and dept/division*

Describe "Other" Affiliation.*

Project Details

Please provide the name and email address of the principal investigator for this project, if different from the person submitting this request.

Research Question*

Please provide the research question and/or what clinical care delivery problem you are trying to solve.

Deliverables*

What are the anticipated key deliverables for this request?

Outcomes/Metrics*

What are the key outcomes or metrics that will be needed to know if you answer your research question or improve clinical or care delivery?

Project Deadlines*

Are there any project deadlines (i.e. grant, manuscript, etc.) that we should be award of?

Collaborators

List other project collaborators that should be included on any project communication. Provide first and last name(s) and email address(es)):

Supporting Material

Please attach any additional material that helps define the request, e.g. order sets, protocols, algorithms, etc.

Drag and drop files here or

Service Request

Please select the CLHSS service(s) that you need for your project below. Please note that we are an internal service organization and there maybe a fee associated with the service(s) you request.

Structured Data

Image Data

Data/Statistical Analysis

AI Tool Design/Development

AI Tool Validation/Implementation

Digital Health Technology Design/Development

Digital Health Techn Validation/Implementation

Review of Biomedical Literature

Pragmatic Trial Support/Coordination

Qualitative Research Methods

Other/General Research Support

*Where did you hear about CLHSS?

Select

Please describe "Other" source.*

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