The Hospital Information System Project (HISP) is a province-wide initiative designed to improve access to patient information through a central electronic information system, an electronic patient record (EPR). HISP’s goal is to streamline patient information flow and its accessibility for doctors and other health care providers. These changes in service will improve patient care quality and patient safety over time. The first site for the introduction of the EPR in Winnipeg is St. Boniface General Hospital (SBGH).

System Components
There are five key components or “modules” in the system.

1. Registration
   The system captures and records patient demographics and visits at the point-of-care. Registration data will be displayed consistently and automatically on screens in the clinical system.
2. Order Entry and Results Reporting
   All clinical orders will be listed with indications of what has been completed and what is pending. Electronic alerts will appear for orders duplication and errors and provide information to assist clinical decision-making. All test results in the patient’s electronic chart will be filed with alerts for abnormal results.
3. Clinical Documentation
   This module provides on-line documentation of clinical encounters such as flowcharts and structured notes. Eventually this information will be shared across health care facilities within Manitoba.
4. Scheduling
   Patient scheduling schedules patients for appointments with clinicians or for tests and procedures.
5. Patient Billing
   All billable health services will be accessible and processed in this system. Examples: private rooms, out-of-country coverage. The vendors selected to provide the software is Eclipsys. The Eclipsys suite of clinical software is known as Sunrise Clinical Manager (SCM), Sunrise Access Manager (SM). MediAR is the software for the billing system.

Who Benefits
Physicians

• Introduces Computerized Provider Order Entry (CPOE)
• Improves accuracy & legibility of, and access to, the required patient medications
• Improves clinicians’ efficiency & effectiveness through provision of key patient information (e.g., allergies) at time of ordering, plus conflict checking, order checking and online access to best practice information
• Improves care through the logging of all orders
• Reduces medication error rates

Nurses

• Will allow immediate access to orders and results
• Will provide immediate access to patient demographics, medication and test results
• Will provide improved access to information on line (ie: suggested medications or drug alerts)
• Will decrease the need for paper, decrease errors and increase patient safety

Allied Health Professionals

• Will allow immediate access to orders and results
• Will provide immediate access to patient demographics, medication and test results
• Will provide improved access to information on line (ie: suggested medications or drug alerts)
• Will decrease the need for paper, decrease errors and increase patient safety

Ward and Registration Clerks

• Will provide a single point of contact for patient registration information and reduce duplication of effort

Clinical Benefits

• Provide a common source of information about a person’s health history
• Enhance the ability of health care professionals to coordinate care by providing a person’s health information and visit history at the place and time that it is needed
• Link information from diagnostic information systems such as X-ray and laboratory into the EPR
• Strengthen internal and external communication among health care providers
• Eventually be accessible for use in all of Manitoba’s academic and community hospitals, as well as long term care facilities
• Allow care providers access to the patient’s health history and results between facilities
• Will provide improved access to information on line (ie: suggested medications or drug alerts)
• Will decrease the need for paper, decrease errors and increase patient safety

Administrative Benefits

• Will provide improved access to information on line (i.e. suggested medications or drug alerts)
• Will decrease the need for paper, decrease errors and increase patient safety
• Strengthen internal and external communication among health care providers
• Will decrease the need for re-registrations of patients across multiple sites

Major Milestones / Schedule

• Phase I - Went live April, 2007 at St. Boniface General Hospital (SBGH), which included Registration Electronic Patient Record (EPR), Billing and Results Viewing.
• Phase IIa - SBGH is now officially live with Computerized Provider Order Entry (CPOE) and Medication Worklist. The completion of electronic order entry occurred in mid-February, 2009.
• Phase IIb - Clinical Documentation (Implementation schedule under review)

Glossary
Computer Provider Order Entry (CPOE) - Systems perform checks in the background when providers write orders. These checks include whether the patient is allergic to the drug, whether there are interactions with other drugs the patient is taking, whether the dosage ceiling for the drug is being exceeded, and so forth. When orders are entered that are contraindicated for the patient, alerts and reminders pop up. These give the provider options to change the order or document a reason for overriding the alert.