AN RN'S dream

Registered nurse Irene Manning calls it a "nurse's dream," but its real name is the Regional Shared Health Information Program, or RSHIP. RSHIP is a collaboration between seven of Alberta's nine regional health authorities (RHAs) Aspen, Chinook, East Central, David Thompson, Northern Lights, Palliser and Peace Country. Together they are working to create a single, integrated, enterprise medical record encompassing all aspects of health service for patients within their regions. RSHIP replaces multitudes of separate, non-integrated clinical information systems such as pharmacy tracking, laboratory test results, diagnostic imaging and transcribed results. And, it also replaces a number of financial and administrative systems.

"In 2003, the seven regions went into partnership to see how they could improve health care for Albertans. They wanted to adopt a collaborative vision and implement an integrated health information system," said Irene Manning, project manager, Northern Lights Health Region.

The timing of the collaboration coincided with a number of the health regions needing to replace outdated information systems. At the same time, Alberta Health and Wellness was encouraging RHAs to find opportunities for collaboration and was developing a strategy to create electronic health records for all Albertans.

In response, the RSHIP partners decided they would pool their resources and build - in two phases - a shared health information system from the ground up. Phase one would involve the implementation of core administration and clinical modules, and the development of enterprise medical records (containing a client's demographic, allergy, lab and medication information and diagnostic imaging test results) for clients.

In the spring of 2004, all seven partner regions dedicated multidisciplinary teams to the task of setting standards for the core administration and clinical modules.

"Developing a shared health information system has involved an extraordinary amount of time, commitment and collaboration. It is a huge accomplishment and the RSHIP partners should be proud of what they have achieved. It has involved getting all seven health regions to speak in the same "medical" language and use the same standards," said Irene Manning. "Before the regions set standards, one region may have called something 'spiritual care' while another called it 'pastoral care'; and yet, we all meant the same thing."

Standardization and all the other work that has gone into creating RSHIP will have a big pay-off this summer. By the end of July, the phase one core modules will be implemented, and every client will have an enterprise medical record.

Building on this foundation, phase two of the RSHIP implementation will begin to move forward this fall. Phase two, the Advanced Clinical Systems (ACS) will focus on reducing medical errors, improving documentation of client care, enhancing patient care, and assisting health-care professionals in the management of their workload. The RSHIP ACS will consist of the following integrated modules:

* Emergency Department Management

* Operating Room Management

* Patient Care System

* Bedside Medication Verification

* Physician Care Manager

* Continuing Care (home care)

* Continuing Care (facility)

* Public Health: Immunization and Adverse Events

* Mental Health

For example, in acute and continuing care facilities, nurses will use the Patient Care System (PCS) and the bedside medication verification modules. PCS features electronic assessments and charting, automatic alerts, notifications when patients require their medications, graphing and trending of vital signs, a status board or work list, care plans with interventions and outcomes documentation, patient notes and much more.

The Bedside Medication Verification module can be used with a mobile computer and a scanner. Before administering medication, nurses will scan bar codes on medication containers and patient wrist bands to ensure the right patient is getting the right medication at the right time.

"Real time documentation at my fingertips will allow me increased time to assist my clients and their families," shared Irene Manning. "As well, it will improve the ability of nurses to assist each other and/or the other health-care providers they work with on a regular basis. It really is a win-win situation for the client and our health-care team."

The RSHIP regions recognize that standardizing the way health care is provided and documented is a huge challenge; however, this vision has enabled the regions to collaboratively and successfully develop an integrated health information system.

"The fact we are doing this is exciting. To be part of a project on the leading edge of technology in health care is a privilege," said Irene Manning. "We know that implementing change will be challenging, but that's okay. Just because we have been doing something for 20 years doesn't mean there isn't a better or more efficient way. RSHIP will be a better way, and the dream will become reality. It will be a more efficient way and, in the future, it will allow us to create health-care standards and bench marks."