2021 SHIEC Annual Conference Speaker Proposal Form

Important:

  • Please contact info@strategichie.com if you have any questions.
  • Form cannot be saved prior to completion, so please submit when all information can be provided in one sitting.
  • Deadline to submit a proposal has been extended to April 30, 2021

The Role of Health Information Exchange: Innovation in Public Health, Partnerships, and Pandemic Response


     

    Presentation Topics & Tracks

    Please select one of the Tracks below and choose the best sub-topic within the drop down menu that closely matches your presentation proposal.


    Please Select Only One Track/Subcategory

    Track #1 - Public Health and HIE

    Using health information exchange to support public health and pandemic response.


     

    Track #2 - Innovations in HIE

    Using health information exchange to advance clinical care, operations and community value.


     

    Track #3 - Government and Policy

    Government and public policy related to health IT and health information exchange.


     

    Track #4 - Technology and Data Management

    Technology and data management to address gaps in health care data, and associated impacts.


     

    Track #5 - Privacy and Security

    Technology, policies, and practices regarding the privacy and security of patient data.


     

    Type of Presentation and Time

    Please check one or more of the following presentation types below that the speaker(s) plan to provide.

    PanelLectureOther (Describe)

    Audience Size Preference:

    Presentation Details

    Answer questions below for presentation details.


    Presentation Title*

    Please limit this to 12-15 words.

    Presentation Summary*

    Please provide a 100-150 word summary of your presentation topic.

    Presentation Audience*

    What audience do you intend to target and how will this presentation specifically provide opportunity or education to SHIEC Members and conference attendees?

    Presentation Objectives*

    Please include 2-3 learning objectives for your presentation.

    Presentation Needs

    Presentation Needs - The SHIEC Annual Conference provides a laptop computer and LCD projector for all in-person presentations and will load all presentations in advance. A podium, microphone, and/or wireless lavalier will also be provided for all presenters. Please provide any additional needs for your presentation.

    Speakers Information:

    Please complete the information below for the Primary speaker and co-presenter(s).

    Main Speaker Information


    Select type of your presentation:

    First Name*

    Last Name*

    Title*

    Organization*

    Email*

    Mobile Phone*

    Office Phone*

    Speaker #1 Headshot

    Upload a high-resolution headshot of the speaker.

    Biography of Professional Background*

    (2000 characters max, including spaces). Please do not provide a resume.

    Public Speaking Experience*

    (2500 characters max, including spaces): List the most recent three presentations made at regional and national meetings. Identify speaking organization, date, program and name of presentation.

    Speaker Introduction*

    (1000 characters max, including spaces): Should this proposal be accepted, please provide a written introduction for the Co-Presenter. Please write in 3rd person, present tense, and in a business-like tone.

    If the Primary Speaker would like to present in collaboration with a colleague(s), please include their contact information below:

    Co-Speaker #1 Information


    Select type of your presentation:

    First Name

    Last Name

    Title

    Organization

    Email

    Mobile Phone

    Office Phone

    Co-Speaker #1 Headshot

    Upload a high-resolution headshot of the speaker.

    Biography of Professional Background

    (2000 characters max, including spaces). Please do not provide a resume.

    Public Speaking Experience

    (2500 characters max, including spaces): List the most recent three presentations the Co-Presenter made at regional and national meetings. Identify speaking organization, date, program and name of presentation.

    Speaker Introduction

    (1000 characters max, including spaces): Should this proposal be accepted, please provide a written introduction for the Co-Presenter. Please write in 3rd person, present tense, and in a business-like tone.

    Co-Speaker #2 Information


    Select type of your presentation:

    First Name

    Last Name

    Title

    Organization

    Email

    Mobile Phone

    Office Phone

    Co-Speaker #2 Headshot

    Upload a high-resolution headshot of the speaker.

    Biography of Professional Background

    Limit responses to 250 words. Please do not provide a resume.

    Public Speaking Experience

    List the most recent three presentations the speaker has made at regional and national meetings. Identify speaking organization, date, program and name of presentations.

    Speaker Introduction

    Limit responses to 150 words. Should this proposal be accepted, please provide a written introduction for the speaker in 3rd person, present tense and in a business-appropriate tone. This will be used for the speaker introduction.

    Co-Speaker #3 Information


    Select type of your presentation:

    First Name

    Last Name

    Title

    Organization

    Email

    Mobile Phone

    Office Phone

    Co-Speaker #3 Headshot

    Upload a high-resolution headshot of the speaker.

    Biography of Professional Background

    Limit responses to 250 words. Please do not provide a resume.

    Public Speaking Experience

    List the most recent three presentations the speaker has made at regional and national meetings. Identify speaking organization, date, program and name of presentations.

    Speaker Introduction

    Limit responses to 150 words. Should this proposal be accepted, please provide a written introduction for the speaker in 3rd person, present tense and in a business-appropriate tone. This will be used for the speaker introduction.

    Co-Speaker #4 Information


    Select type of your presentation:

    First Name

    Last Name

    Title

    Organization

    Email

    Mobile Phone

    Office Phone

    Co-Speaker #4 Headshot

    Upload a high-resolution headshot of the speaker.

    Biography of Professional Background

    Limit responses to 250 words. Please do not provide a resume.

    Public Speaking Experience

    List the most recent three presentations the speaker has made at regional and national meetings. Identify speaking organization, date, program and name of presentations.

    Speaker Introduction

    Limit responses to 150 words. Should this proposal be accepted, please provide a written introduction for the speaker in 3rd person, present tense and in a business-appropriate tone. This will be used for the speaker introduction.

    Speaker Proposal Submission

    Please provide the name and contact information below for the person who is submitting the Speaker Proposal.


    First Name*

    Last Name*

    Title*

    Organization*

    Email*

    Mobile Phone*

    Office Phone*