Digital Health Record: Quebec government doesn’t rule out picking other solutions

The Fréchette government is not ruling out the possibility of ultimately choosing a solution other than the Digital Health Record (DSN), which is currently being tested in a $400 million pilot project in two CIUSSSs in the Mauricie region and in Montreal.

During a parliamentary committee hearing on Wednesday, Treasury Board President France-Élaine Duranceau suggested that the government would evaluate all options and examine technologies that might be less expensive, but that it would first await recommendations from Santé Québec.

On Tuesday, it was reported that the system proposed by the American firm Epic might not be implemented across the entire network and that there could be exceptions, but on Wednesday, Duranceau mentioned other technologies that might be suitable.

“Is this the technology we should roll out across all of Quebec, or only in university hospitals? Could other, less expensive technologies do the job?” or “Could multiple solutions be selected?” she asked, in response to a question from Liberal MNA Michelle Setlakwe.

However, “we’re putting the cart before the horse a bit,” added the president of the Treasury Board, noting that the rollout of the pilot projects had gone smoothly and that we needed to give it some time.

“We need to move to digital records, but within our means,” she emphasized.

Duranceau noted in particular that she had “heard good things” about another solution already deployed at the Jewish General Hospital in Montreal.

One thing is certain: she wants to wait for Santé Québec’s recommendations before making a decision.

An audit of the pilot projects is already underway, said Stéphane Le Buyonnec, chief information officer (CIO) of the Ministry of Cybersecurity and Digital Affairs, standing alongside the minister.

Currently, Santé Québec is relying on Epic’s solution to eventually carry out the long-awaited major digital transformation across the network.

The total cost of implementing Epic’s DSN across the entire network is estimated to be between $1.5 billion and $3 billion.

The system aims to merge no fewer than 400 different IT systems and gradually replace a significant portion of the approximately 10,500 systems currently in use, many of which are aging and costly to maintain, according to Santé Québec.

The “Quebec Government Information Resources Project Dashboard” describes the DSN as “a major break with traditional systems.”

The system “replaces faxes, paper forms, and manual scanning with a smart, seamless, and interoperable digital platform.”

It is a daily work tool that “enables clinicians to receive real-time alerts, avoid duplicate tests, better coordinate care, and improve patient safety. It transforms clinical, support, and administrative practices, while empowering citizens.”

Managers will also have “real-time access to DSN information, allowing them to monitor operations and effectively support teams.”

It should be noted that the Public Procurement Authority (AMP) has launched an investigation into the process of awarding the contract to Epic.

The first call for tenders in 2022 was canceled, and a senior official had a vested interest in Epic winning the second call for tenders in 2023, the Liberal opposition suggested.

But Health Minister Sonia Bélanger has already stated that the contract was awarded in accordance with “best practices.”

Medical professionals currently undergoing the pilot rollout, like Dr. Raja Hatem, say that the biggest risk from a move like this is the loss of a centralized record of medical files.

“It would be complete nonsense, and it would be an insult to everybody who worked so hard implementing this platform,” he told CityNews.

Hatem – also insisting the government stick with the system they chose in the initial launch. 

He says backing away now — or splitting hospitals across different digital systems — simply isn’t an option.

“We’ve spent so much money, energy, dedication to make this project work and it’s working,” he said. “If you choose different platforms, the patient information won’t be shared very smoothly.”

Those concerns, also echoed by patients rights advocate Paul Brunet.

“If you’re telling me that there’s gonna be options and other systems that would not be able to talk to one another, the objective is not net,” he said.

CityNews did not hear back from Minister Duranceau’s office in time for broadcast. 

But on Wednesday she said she would wait for Santé Québec’s recommendation before making any decisions. 

In a statement to CityNews, Santé Québec wouldn’t confirm whether it still planned on using firmware provider Epic for the provincial expansion of the DSN, adding: 

“The provincial expansion strategy for the DSN is currently being developed (…) ongoing analyses aim to identify the most appropriate scenarios to support the long-term needs of the network and citizens.”

Hatem says the pilot rollout at Sacre Coeur has gone smoothly so far. 

The DSN has been especially useful for referred patients with a complex medical history he previously wouldn’t have access to, he said.

“Everything is on one single platform, and all the information is easily accessible,” he explained.

While the system is still in its early stages, Hatem says its full potential will only be realized once hospitals across Quebec are connected through a single platform.

 “The real power of this tool,” he said. “Will be really showcased once the platform launches nationwide.”

—With files from The Canadian Press, first published in French and translated by CityNews