Student Health Center - Purdue University

Start Date September 20, 2006
Finish Date
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Student Health Center
Electronic Health Record
Project Charter
Introduction
An Electronic Health Record (EHR) is a medical record or any other information relating to the past, present, or future
physical and mental health, or condition of a patient which in an electronic data format that is captured, transmitted, received,
stored, retrieved, or linked for the primary purpose of providing health care and health-related services.
The PUSH EHR Project encompasses much more, though, that the EHR module in PyraMED. This project will include
several phases. These phases introduce different pieces of the EHR module to the daily processes of the Student Health
Center and ancillary sub-systems (i.e. – CR/PACS and RxWriter). As a whole, these phases will complete a fully operational
EHR system.
The Purdue University Student Health Center has been given a unique opportunity: the vendor of its current health
information system, PyraMED, is offering their version of the EHR free of charge. PUSH is also in a position to take
advantage of this offering in terms of provider interest, available resources, and parallel projects (Laboratory Information
System) that will benefit both endeavors.
Objectives
The objective of this project will be to:
1. Have installed a working version of the EHR in both the PyraMED Production and Test environments.
2. Complete each phase of the project outlined in attachment A where possible (limitations exist where Media Highway may
or may not have certain modules available for implementation).
3. Interface with existing LIS.
4. Install and interface with a CR/PACS.
5. Create a sub-department of the Medical Records department that coordinates the scanning and indexing of paper
documents into electronic health records stored in PyraMED.
6. Interface with Purdue University's Pharmacy system.
7. The building and implementation of Forms in the PyraMED EHR for use by the Providers.
8. Training of Pilot Group and "Go Live" of Pilot Group for each phase.
9. Feedback sessions with Pilot Group for each phase.
10. Training of Clinic and "Go Live" of Clinic for each phase.
Scope
1. The Student Health Center will be responsible to manage the information between campus departments that are needed
to accomplish this project. PUSH will supply the other campus departments a schedule and timeline. PUSH will verify 1)
that all objectives are met in the project, and 2) that all software installed functions as needed.
2. Student Service Technology Assessment will provide advice and direction to the Student Health Center during the project
and help prioritize departmental task lists to include deliverables within the project to meet scheduled deadlines.
3. Student Services Workstation and Technology will provide resources and manpower to implement workstation-side
software and hardware components that are required by the EHR module to function properly. SSWT and PUSH will
work together to test and verify software and hardware builds and installs.
4. The Infrastructure of Information Technology at Purdue will consult with PUSH on a minimal number of phases during
the project. In phases associated with PyraMED, ITaP will work with PUSH to help determine storage growth of the
PyraMED database due to the EHR and Document Imaging. ITaP resources will also be requested during Phase Three,
Computerized Radiology as ITaP will be asked to house the Picture Archive Communication System (PACS) for power
backup options and possibly data backup solutions. Most other phases of the project will not require ITaP resources as
the several phases of the project incorporate features that already exist in PyraMED.
5. Information Technology Security and Privacy and Internal Audit will verify the security and privacy of the EHR module
and other sub-systems included in the project.

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EHR Project Charter
6. Media Highway, vendor and supplier of the EHR module, will fill the roles as provider of software and documentation,
support center, installer (server-side) and trainer.
7. Radiation Services of Indiana, vendor and supplier of the CR/PACS component of the system, will fill the roles as
provider of software and documentation, support center, installer (server-side) and trainer and it relates to CR/PACS.
Deliverables
1. Staff Requirements
a. Identify Executive Sponsor
b. Identify Steering Committee
c. Identify Core Team
2. Timeline
3. Phases outlined in attachment A.
4. Milestone
5. Implementation
6. Developed agreed upon schedule
7. Long-term structure
Staffing
1. Executive Steering Committee - Its primary purpose is to provide high-level focus, oversight, and strategic guidance
and vision to the Program. Providing high-level direction on business impacts and technical approach and ensuring proper
and complete resources are engaged. Ensuring all University policies are engaged to properly manage risk.
a. Lee Gordon...................................................Assistant Vice President, Student Services Technology and Assessment
b. Steve Baker....................................................Student Services Technology Director
c. James Westman ............................................Director, Student Health Center
d. Susan Prieto-Welch......................................Director, Counseling and Psychological Services
e. Mike Rubesch ...............................................ITaP
f. Peggy Fish .....................................................Internal Audit
2. Steering Committee - Its primary purpose is to make major decisions in the best interests of the EHR project and to
ensure that the project adheres to its fundamental principles found in the project's objectives, scope, and deliverables.
Ensuring all Purdue University policies are being properly followed to manage risk. This group will help to spread the
strategic input and buy-in through-out PUSH and the rest of the university community, and this group will meet
periodically to evaluate the progress and success of the implementation of the EHR technology solution.
a. Susan Clark....................................................Co-Project Manager (Processes)
b. Janet Moore ..................................................IT Consultant, SSTA
c. Greg Sabens..................................................Co-Project Manager (Technical)
d. Sarah Sayger ..................................................Medical Clinic, PUSH
e. Bob Wallace ..................................................Manager of Business Office, PUSH
f. Joan Vaughan ...............................................Director, HIPAA
g. Jim Slopsema ................................................ITaP
h. Diana McKinney..........................................ITaP ITI
i. Greg Hedrick................................................ITaP Security and Privacy
3. Project Team
a. Patti Emshousen ..........................................Computer Services, PUSH
b. Tamara Hazbun............................................Medical Clinic, PUSH
c. Luke Pickett ..................................................Computer Services, PUSH
d. Joyce Roosz...................................................Business Office, PUSH
e. Sarah Sayger ..................................................Medical Clinic, PUSH
f. Ernest Stalnaker ...........................................DBA, ITAP Infrastructure
g. Peggy Fish designee.....................................Internal Audit
h. PUSH Key Players

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EHR Project Charter
Assumptions
1. Information Technology at Purdue will continue to support the PyraMED database on the Oracle servers. A new SLA to
be drawn up for phase 3, Computerized Radiology and the Picture Archiving Communications System (CR/PACS).
2. Media Highway, the vendor, will continue to support and help maintain PyraMED, along with the new EHR, within their
abilities to access the system. Their level of access will remain constant.
3. Student Services Workstation Technology will continue to provide workstation support to the point that the PyraMED
client installed on Student Health Center workstations will run without issue that result in negligible loss of system
effectiveness and functionality.
4. The Computer Services department of the Student Health Center will continue to support the PyraMED Health
Information System as system administrators and work as liaisons between the aforementioned departments to help
during software upgrades, running maintenance, determining resolutions to issues, and other activities that ensure the
continue availability of the system.
Schedule
For project timelines and dates, see Attachment A. Listed below are descriptions for each phase, resources required and
required steps to be completed for each phase of the project.
Phase 1 – Planning
Description: The creation of the timeline, engagement of key players, and installation of the EHR module.
Resources: Medical Staff, Media Highway Training, Application of the EHR module to the PyraMED Core System, PUSH
Computer Services
Phase 2 – EHR –Move to EHR Coding
Description: In this phase, we move the providers from coding in the old, PyraMED Coding screen to the new EHR
Coding screens. Other than a change in the environment, the process is the same for providers. This will give them
the chance to become familiar with the new EHR screens but require nothing new from them.
Resources: Medical Staff, PUSH Computer Services
Phase 3 – Computerized Radiology
Description: Installation and configuration of the PACS and CR systems as well as the interface with the existing
PyraMED Core systems.
Resources: Radiation Services, ITaP server and support group, SSTA, SSWT, Radiology Staff, Dr. Miller (et. al.), PUSH
Computer Services, Media Highway Interfacing
Phase 4 – Notifications
Description: This is an intra-system messaging module at patient level that allows sign off and other communications
between staff. This already exists in the core PyraMED system but is currently inactivated.
Resources: Medical Staff, Nursing, Lab and Radiology, PUSH Computer Services
Phase 5 – Referrals
Description: This PyraMED Core module will allow providers and staff to create referrals to community physicians and
specialties. We are also going to be using this to refer patients internally to other PUSH departments.
Resources: Physical Therapy, Medical Staff, Nursing, PUSH business office, CAPS, PUSH Computer Services
Phase 6 – Document Indexing
Description: This module allows multimedia images to be associated with patient records. This includes the scanning of
external documents and historical paper records as well as the importation of anatomical graphics and digital photos.
Resources: Medical Records Group, SSTA, SSWT, PUSH Computer Services, Media Highway Support Team, ITaP
servers group
Phase 7 – EHR- RxWriter and Pharmacy interface
Description: The RxWriter module provides the ability to automatically check ordered prescriptions for interactions and
allergies. This module also allows printing and electronic sending of prescriptions. The Pharmacy interface would be
the other part needed for the sending of electronic prescriptions to the existing QS1 pharmacy system at the School of
Pharmacy. This bridge from PyraMED to QS1 will also allow additional information for the providers regarding the
prescriptions.
Resources: Pharmacy, SSTA, SSWT, PUSH Computer Services, Media Highway Interface Team, QS1 Interface Team,
Medical Staff

EHR Project Charter
Phase 8 – Transcription
Description: There are currently 2 possibilities being developed by Media Highway. The first would allow direct recording
into the chart and transcription of this recording either by means of software such as Dragon Speak or by a
transcriptionist. The second and less preferable method would allow import of external transcription using a ridged
format structure. This second method requires we maintain the external transcription system.
Resources: Medical Records Group, PUSH Computer Services, Medical Staff, Nursing, Media Highway, SSWT
Phase 9 – EHR – Forms and Electronic SOAP Notes
Description: This phase truly moves PUSH into the electronic health record era. Having completed the previous phases,
we will be in a position to use the EHR module to its fullest capacity. In this phase, we will begin the use of
electronic forms in order for providers to document their encounters electronically by limiting the necessity of
transcribed notes on the chart. The forms allow standardization of documentation on encounters.
Resources: Medical Records Group, PUSH Computer Services, Medical Staff, Nursing
Dependant Phases: 10, 11, 13
Phase 10 – Recalls
Description: The recall module extends patient care by providing the Providers with a way to create reminder notifications
for follow-up care.
Resources: Medical Records Group, PUSH Computer Services, Medical Staff, Nursing
Phase 11 – Electronic Signature
Description: Media Highway is developing an interface so that electronic signature pads can be connected to the
PyraMED system. This will allow patients and staff to electronically attach their signature to encounters.
Resources: Medical Records Group, PUSH Computer Services, Medical Staff, Nursing, Media Highway, SSWT
Phase 12 – EKG
Description: Media Highway is developing an interface to allow for real-time communication between an EKG machine
and PyraMED. We will be dependent upon Media Highway’s development of this module and the EKG machines
interface structure.
Resources: Medical Records Group, PUSH Computer Services, Medical Staff, Nursing, Media Highway, SSWT
Phase 13 – Complete – Review and sign-off of the completed project.
Costs by Phase
2. EHR Coding - non-recurring; $0, recurring; none, training; $7000
a. EHR Module is provided to us at no cost ($30,000). No additional hardware requirements.
b. Training for staff occurred April at Media Highway.
3. CR/PACS - non-recurring; $175000, recurring; $~$1,000
a. The purchase price of the 2CR/PACS is $170,000. We have secured a $40,000 discount from the vendor.
b. We are currently defining the contract with the vendor for the annual licensure fee that includes support.
c. Costs from ITaP to house the server are currently unknown. SLA to define this to be finalized by end of year.
d. Media Highway costs to setup interface to costs $5,000. Approximately $1,000 added to annual licensure fee.
e. ITaP backup costs are approximately $3/GB of backed up data.
4. Notification - non-recurring; $0, recurring; $0
5. Referrals - non-recurring; $0, recurring; $0
6. Document Indexing - non-recurring; $3270 + Scanners, recurring; ~$1,000, cost for increased data storage needs.
a. We were given a 20% discount on the purchase price of the Document Indexing software.
b. There will be a cost involved to purchase acceptable scanners.
c. Increase in the annual licensure fee to Media Highway will be approximately $1,000.
d. Costs for increased data storage due to EHR Form (phase 9) will be calculated during this time. Projected
growth of data storage due to EHR is 10% above normal growth experienced to this point.
7. RxWriter - non-recurring; $7940 + $7500 + printer purchases, recurring; $4140 annual cost for FirstDataBank
a. We have received a 47% discount on the purchase of the RxWriter software.
b. An interface will be required between Purdue Pharmacy’s QS-1 system and PyraMED. Typical PyraMED
interfaces cost $7500.
c. We are considering additional printers for prescription printing. Costs for this to be approximately $2000.
d. There will be an annual cost for use of the FirstDataBank information. This allows the RxWriter to remain
current to drug and allergy interactions.
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EHR Project Charter
8. Transcribing - non-recurring; unknown, recurring; unknown
a. Media Highway is working on a transcription system. They have not release details.
9. EHR Forms - non-recurring; $0, recurring; $0.
10. Recalls - non-recurring; $0, recurring; $0
11. E-Signature – non-recurring; unknown, recurring; unknown
a. Media Highway is considering creating software to work with electronic signature pads. Signature pads retail
for ~$300 and more. We do not know if there will be a cost involved with the software from Media Highway.
12. EKG Interface - non-recurring; ~$7500 but unknown, recurring; unknown
a. Media Highway is working on an interface to EKG machines. It is unknown if there will be charges for the
software.
b. If an interface is required, the current cost for PyraMED interfaces is $7500.
c. We do not yet know if we would be required to purchase a different EKG machine in order to interface with
PyraMED.
Summary of costs
Phase Non-recurring Recurring Savings Unknowns
2 $7,000 $30,000
3 $175,000 $1,000 $40,000 ITaP Support Charges
6 $3,270 $1,000 $654 Scanner Hardware, ITaP Charges for Storage
7 $17,000 $4,140 $3,730
8 Media Highway Transcription System cost
11 E-sig Pads, Media Highway Software
12 $7,500 Media Highway Software, new EKG machine
Totals $204,770 $6,140 $74,384
Risks
Currently, the Student Health Center uses a pneumatic tube system to convey paper medical charts throughout the building.
This 40 year old system is in constant repair and all those repairs are done in-house as there is no longer any support from the
original vendor.
Benefits
1. Immediate and universal access to the patient record through predetermined levels of security, thus ensuring HIPAA
compliance.
2. Easier and quicker navigation through the patient record.
3. The elimination of misdirected physical paper charts.
4. The standardization of visit documentation among providers within the organization.
5. Clinical data formatted so to easily read and analyze.
6. The reduction of paperwork, documentation errors, and filing activities and the associated costs.
7. Greater efficiency in completed visit documentation.
8. The invaluable ability to create alerts for medication errors, drug interactions, and patient allergies.
9. The possibility to electronically transmit information to other providers (history, treatments, prescriptions, etc.).
10. The availability of clinical data for use in quality, risk, utilization, auditing, and return on investment analyses.
11. Eliminating the need for the antiquated physical tubing system and various costs associated with the upkeep of it.
Estimated yearly costs of parts is $3500, and labor and maintenance $8000.
12. The elimination of chart folders, stickers, labels, forms, outguides, and other paper products will approximately reduce
Medical Records costs by a surprising $17,000 per year. Another $3,000 per year will be saved in printing costs.
13. Spending on Student worker positions can be reduced over time saving ~$60,000 per year to the Student Health Center.
14. We will realize an average, annual savings of approximately $16,000 in the Radiology department with the elimination of
paper used for orders and reports, fixer and developer, processor service contract, film, jackets and labels, reprints,
departmental losses due to uncharged copies, etc. In addition to this, over all, the student population will see a savings of
over $3000 saved for copies that are charged by the department.
15. A decrease in spending in subsequent years by no longer purging and destroying paper documents (after 7 year retention
period phase out), more than $500 per year currently (Ten cents per pound. 4,336 pounds disposed of on last trip).

Signatures
_________________________________________________________ ______________
Lee Gordon Date
_________________________________________________________ ______________
Steve Baker Date
_________________________________________________________ ______________
James Westman Date
_________________________________________________________ ______________
Susan Prieto-Welch Date
_________________________________________________________ ______________
Mike Rubesch Date
_________________________________________________________ ______________
Peggy Fish Date
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EHR Project Charter