Over 2,000 issues during Quebec Digital Health Record launch weekend

Santé Québec is preparing for the first large-scale test of the digital health records (DSN) following a launch weekend in the two CIUSSS—Mauricie-Centre-du-Québec and Nord-de-l’île-de-Montréal—which are serving as pilot sites for the implementation of this major transformation of health-care practices.

Those responsible for the rollout received around 2000 support “tickets” per day over the weekend—that is, reports of all kinds of issues—but the overwhelming majority of these were requests for support and information related to the new system.

The most significant problem encountered—and one that remains to be resolved—is latency, meaning when the system becomes overloaded and stops functioning for certain operations. This issue led officials to increase bandwidth capacity from 2 gigabits to 10 gigabits, but the problem was still occurring intermittently as of Monday morning.

“This is our top priority today,” said Erika Bially, vice-president of information technology at Santé Québec, during a technical briefing Monday morning. “We really need to make sure the latency goes away.”

Monday marked the first weekday of the rollout and what officials described as the first real stress test for the new digital system, as hospitals resumed normal weekday operations and significantly more staff logged in simultaneously.

But accounts differ over the severity of the Monday morning disruption.

Monday morning service interruption

Santé Québec described the issue as intermittent service interruptions rather than a full shutdown. However, medical staff and Quebec’s association of radiologists told CityNews the outage effectively prevented staff from using the system for close to an hour.

“For a whole 60 minutes, people were unable to log in in all of the hospital services,” said Dr. Grégoire Bernèche, president of the Quebec Association of Radiologists. “No patients were seen adequately with the digital health record for an hour.”

Bernèche said some staff resorted to writing notes on paper towels due to the lack of a fully restored paper backup workflow after the transition to the DSN system.

“To be clear, I have no understanding that any patient suffered from that,” he added. “But it did cause worry.”

Two health-care workers at Sacré-Cœur Hospital who spoke to CityNews anonymously described a more mixed experience.

One employee said the system went “on and off” between roughly 8 and 9 a.m., while another estimated the complete shutdown lasted closer to 20 minutes.

“It was on and off during the hour, but for the last maybe 20 minutes it was completely shut down,” one said, adding that staff had to manually enter patient information and relay results directly to physicians.

Another health-care worker said the outage didn’t significantly affect patient care in their department because staff were still able to communicate directly with nurses and care teams.

They added that prior onboarding also helped navigating the morning shutdown.

“When we want to chart patients’ interventions,” they said, “we had already pre-prepared documents to make our lives much easier and to make everything go smoothly.

Major outage in Mauricie

However, the entire system was paralyzed for about two hours on Monday morning at the CIUSSS Mauricie-Centre-du-Québec due to “an issue with network equipment,” Santé Québec explained in a statement to La Presse Canadienne. “Since 9:25 a.m., no new incidents have been reported regarding this issue, and connections have now been restored,” the statement noted. “A thorough analysis is currently underway to identify the exact cause and implement appropriate corrective measures.”

However, the CEOs of both CIUSSs report that their operations ran smoothly over the weekend; Nathalie Petitclerc, from Mauricie-Centre-du-Québec, even noted a 29 per cent increase in the number of ambulances arriving at the emergency room compared to usual, without this causing any problems.

Santé Québec also said despite higher volume of ER visits on the day of the deployment, the teams in Mauricie “have maintained care and services while appropriating the new tools.”

By Monday afternoon, Santé Québec said the latency issue had been resolved.

Health Minister Sonia Bélanger said technical hiccups were expected during a transition of this scale.

“When we implement a system of this size, it really is normal to have these types of anomalies,” she said Monday. “The issues that occurred with bandwidth also happened this weekend. They were able to restore service quickly. This morning, it happened for about two hours; I’m told it’s been fixed.”

Number of support tickets lower than expected: Santé Québec

Santé Québec also said support ticket volumes were running below projections from software provider Epic Systems, who had estimated a rate of 6,000 tickets per day.

Officials said roughly five per cent of Sunday’s 2,168 tickets were tied to actual bugs.

According to Santé Québec, 72 per cent of tickets were resolved locally, while the remaining cases were escalated to central command centres.

More than 4,000 support personnel were deployed Monday to assist staff with the transition.

The agency also said 67 per cent of physicians working over the weekend successfully used electronic prescribing though the new system.

Efficiency gains

Among the reported benefits was rapid and comprehensive access to the medical record of a person struggling with mental health issues who was in crisis. “What this means is that the responders were better positioned to manage the risk, knowing the person’s history, and were thus able to better tailor their interventions to that patient’s needs,” said Petitclerc.

Her counterpart from Montreal North, Adélaïde De Melo, reported some difficulties regarding access to the DSN, specifically how to log in. “That remains one of the issues, though it’s being resolved fairly quickly.” She also said she expects a very busy Monday. “Today, there are other new factors, such as the entire outpatient component and the start of elective procedures for the week.”

Santé Québec said that its home care workers on the go also reported improvements in productivity.

“The (mobile-based tool) provides easy access to file notes, which is perfect for teams on the road meeting with users. Visits are therefore faster thanks to this new tool,” the agency said.

–This report by La Presse Canadienne was translated by CityNews