12 If the need arises to obtain speciﬁc health outcome information, a separate health information consent form will be provided for the informed consent process to occur. The cons ent process complies with the Health Information Privacy & Accountability Act (HIPAA), which protects the privacy of individually identiﬁable health information, and the conﬁdentiality provisions of the Patient Safety Rule, which protect identiﬁable information being used to analyze patient safety events and improve patient safety. Your participation in this research is strictly voluntary. You are free to refuse to take part in the study at any time. You may refuse to answer any questions and may stop taking part in the study at any time. Whether or not you choose to take part in this research will have no bearing on your status at UCSF and your aﬃliated institution. If you have any questions about the research, you may contact me Ken Russell Coelho, directly at (415) 206-8539 or by e-mail: ken.coelho@ucsf.edu and/or my faculty advisor Dr. Hal Yee, at (415) 206-4808 or by email: hyee@medsfgh.ucsf.edu. If you agree to take part in the research, please sign the form below. Please keep the other copy of this agreement for your future reference. If you have any question regarding your treatment or rights as a participant in this research project, please contact the University of California, San Francisco, Oﬃce of the Committee on Human Research at (415) 476-1814, or by email: chr@ucsf.edu. I have read this consent form and I agree to take part in this research Date . . . . . . Date . . . . . . Participant’s Signature for Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Person Obtaining Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . C. Interview Guide for Key Informant Interviews Thank you for joining me today and agreeing to participate in this Key Informant Interview. My name is Ken Russell Coelho and I am currently working with Dr. Hal Yee, Chief Medical Oﬃcer of San Francisco General Hospital and Director of the Center for Specialty Care Access and Quality at the University of California, San Francisco. I am a graduate student researcher in Global Health Sciences at UCSF and this research study is being conducted as part of my Masters of Science graduate thesis. We are interested in learning more about your experience as part of the San Francisco Safety-net. As you are aware, safety-net settings across the country have grappled with providing adequate access to specialty care services, and San Francisco has also had to grapple with the same issue. With the advent of the Healthy International Journal of Telemedicine and Applications San Francisco, this challenge of access to specialty care services at San Francisco General Hospital has presented even greater strain, with an anticipated potential increase in the inﬂux of the volume of patients. Interestingly, the California Policy environment took a new turn with the passing of Proposition 1D. This educational facilities bond will provide funds for capital improvements to expand and enhance medical education programs in the state, with a focus on telemedicine. In essence, with this proposition and additional funds, SFGH will be able to connect UCSF and SFGH with outpatient clinics using telemedicine. As a result, we are particularly interested in your ideas on how to improve the delivery of specialty care to uninsured and Medicaid patients in the San Francisco public health system, with the use of telemedicine. We hope that during this conversation you will be able provide us with information on your current practice and to learn from you about your experience in your practice and ways we can improve the types of services and programs oﬀered. The length of this interview will be 30 minutes and we will tape record the session and then we will use the tape to make a written copy of the comments. We will not use your name or identifying information when we make the copy. However, responses from this interview may be shared with the leadership team at San Francisco General Hospital with the ultimate goal of improving care and services oﬀered. Care will be taken to eliminate your name from the transcripts; although worthy comments which require prompt follow up will be identiﬁed to the SFGH leadership team. You may refuse to answer any questions and may stop taking part in the study at any time. Whether or not you choose to answer any question or participate, this will have no bearing on your status at UCSF and your aﬃliated institution. Do you have any questions for me? (Address any questions that may be asked or refer them to PI if needed.) Begin recording. Questions/Points of conversations. Let’s start with: Introduction (General Questions about their clinic, Niceties). Now, I would like to start with a general scenario which you may or may not ﬁnd typical presenting at your clinic (INSERT CASE SCENARIO—varied based on PCP or specialist OF PATIENT IN PRIMARY CARE/SPECIALTY CARE SETTING PRESENTING WITH SYMPTOMS NECES- SITATING NEED FOR SPECIALTY CARE SERVICE REFER- RALS/CARE AT SFGH). (1) Does this scenario sound familiar to your Clinic/ practice? Please feel free to elaborate. (2) From your experience, what is the current process for this patient? Could you walk me through some of the steps encountered? (3) What do you like about the current process? (4) What do you NOT like about the current process?