Exclusive: Last-minute changes made to Quebec Digital Health Record less than 24 hours before launch

Last-minute changes have been made to the rollout of Quebec’s Digital Health Record less than 24 hours before the province’s long-awaited pilot project goes live Saturday.

Santé Québec has revised internal guidance given to health-care workers about how to speak to patients during the transition and has also changed how part of the rollout will be deployed in certain facilities, according to two documents obtained by CityNews.

The new system, known in French as the Dossier santé numérique (DSN), is set to launch May 9 in the Mauricie-et-du-Centre-du-Québec CIUSSS and the Nord-de-l’Île-de-Montréal CIUSSS.

The ambitious digitization effort aims to centralize some 400 different computer systems within the health-care network and allow health-care workers to view and update a patient’s medical files with all relevant data regardless of where they work.

Hospitals will reduce non-urgent care to 50 to 75 per cent in the two weeks after the Saturday go-live as staff adjust from Quebec’s paper-heavy system to the new one. Health professionals have already been undergoing training in the weeks before May 9 with the aim of hitting the ground running.

Sanitation, biomedical waste management staff in 5 hospitals to undergo 2-phase rollout

Biomedical waste and sanitation staff in five hospitals under the CIUSSS du Nord-de-l’Île-de-Montréal were informed the rollout would now happen in two phases after a missive was circulated on May 8.

Initially, the rollout of the DSN was intended to be done all at once across the board.

The first phase beginning May 9 will only apply to five hospitals:

• Hôpital du Sacré-Cœur-de-Montréal
• Hôpital Jean-Talon
• Hôpital Fleury
• Hôpital en santé mentale Rivière-des-Prairies
• Hôpital en santé mentale Albert-Prévost

The second phase — which includes all other facilities in the CIUSSS du Nord-de-l’Île-de-Montréal network, including CHSLDs and CLSCs — will happen at a later date that has yet to be determined, the document reads.

Until then, staff were instructed to continue using current procedures for sanitation and biomedical waste management requests at those facilities.

Union leaders from Quebec’s Alliance of Professional and Technical Staff in Health and Social Services (APTS) are hailing the move as a red flag.

“A call like this less than 24 hours before deployment raises questions as to the readiness for this platform to be deployed,” said Teresa Muccari, union representative for workers at the CIUSSS du Nord-de-l’Île-de-Montréal.

But the update may be a blessing in disguise for many workers, Muccari said. According to APTS surveys, only 13 per cent of union members said they were ready to make the leap on Saturday despite 80 per cent of them having undergone DSN onboarding.

“For sure, they’re breathing a sigh of relief,” she said.

Santé Québec told CityNews in a statement that the hygiene and sanitation department have “prioritized our inpatient units, as well as critical and priority clinical areas, to ensure the smooth delivery and safety of care and services.”

“The other facilities mentioned are those where the rollout has less impact on service delivery. The timelines are less restrictive, and there are no repercussions for patients,” the rest of the statement reads. “The only other facility that will have a later rollout is the Angélica CHSLD, which was recently acquired 5 weeks ago by the CIUSSS du Nord-de-l’Île-de-Montréal.”

Controversial user guide instructions to health-care workers withdrawn

If you can’t say something nice, don’t say it all.

Santé Québec has updated instructions given to health-care workers on how to communicate with patients during the rollout after initially telling them not to criticize the system.

In a guide dated April 27 obtained by CityNews, support staff and health-care professionals were told not to say phrases including:

• “The system is down”
• “We are having technical problems”
• “It’s going to be okay”
• “Don’t worry”

The document also had recommendations for staff responding to patients experiencing delays or asking questions about the transition to the DSN system.

One script in a crib sheet-style FAQ section tells employees how to respond when patients ask if there is a problem with the system.

One sample response instructed workers to tell patients: “No. We are implementing a new IT system, and our teams are taking the time to get used to it. But the quality and security of our services remain our top priority.”

However, in an updated version of the guide dated May 7, the entire “Do not say” section had been removed.

Santé Québec did not directly answer questions about why the section was removed, but said in a statement that: “Sections containing words to avoid are always accompanied by clearer suggestions, which facilitates understanding.”

“It offers adapted wording to help volunteers or other employees who do not all have the same level of familiarity with the DSN to assist our users,” the statement also reads. “This is the same type of document found in other workplaces.”

The guide also provides general information about what digital health records and best practices for support staff and professionals to use for email and telephone interactions, including sample scripts.

Quebec health-care professionals have welcomed the digitization arguing it would streamline their tasks and improve the user experience. However, interventional cardiologist at Sacré-Cœur Hospital Dr. Raja Hatem said that, regardless of the long-term benefits of the digital transformation, the launch is sure to be imperfect.

In this situation, he said, it’s important for health professionals to be transparent with patients.

“We don’t have specific sentences to tell them: ‘oh, no, everything is pink and rosy and everything will be fine,'” he said. “We’re going to be honest and transparent with the patients.”

Hatem also said that there is no “100 per cent guarantee” that patient care will be negatively affected amid the temporary service slowdown.

“Anybody that tells you 100 per cent guarantee, no impact, is lying, right? It’s common sense,” he said. “But the preparation was done.”

But despite concerns linked to the DSN’s rollout, health professionals and patient advocates alike agree that a centralized, digital health file system will be a huge step for users.

Patients will be able to interact with their own health files and access their own test results with the new system, according to Hatem.

“They won’t have to re-explain time and time again their health history, their medication list, all that,” he said. “With the new digital platform, I’ll just be able to click, and electronically the prescription will be digitized and sent directly to the patient’s pharmacy.”

The pilot project also has the potential of trimming down patient wait lists as health professionals become more efficient with the new system, according to patient advocate Paul Brunet.

“There’s no reason why there shouldn’t be a positive impact on the waiting lists,” he said.

The spectre of SAAQclic: Cost concerns continue

Even as Santé Québec was making changes just days and hours before the launch of the DSN, questions surrounding the cost of the project was in the spotlight again.

Santé Québec confirmed that the cost of rollout to the first two CIUSSSs networks was $402 million, 50 per cent more than initially expected. The overall project is expected to cost the taxpayers $1.5 to $3 billion initially and then $100 million annually for maintenance.

On Friday, Health Minister Sonia Bélanger defended the high price tag of the project.

“When you implement an information system—whether in healthcare, administration, or the economy—there are always operating costs after the system is implemented, because once the system is up and running, you have to keep it updated, and there will always be training needs since new staff are constantly joining the healthcare system,” Bélanger said.

Amid the controversy, Santé Québec also released a statement Friday afternoon calling the installation and maintenance costs “planned and necessary.”

“This is a far-reaching transformation aimed at replacing a fragmented environment with an integrated, modern, and secure clinical platform,” the statement read.

The health agency echoed the health minister’s projections that the DSN would save the government expenses replacing a big part of aboout 10,500 systems currently in use by various health departments in the province.

“The gradual phase-out of currently used systems and licences, with more than 50 per cent of existing systems being phased out,” the agency said.

Santé Québec estimates that DSN would result in $120 million per year through licenses, reduction in paper records and other productivity costs.

For her part, Christine Fréchette said she only learned about the costs after taking over as premier.

“I met with Santé Québec shortly after taking on my new role, and I was informed of these operating costs, which, as Minister Bélanger said, are entirely normal and routine,” she said.