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Electronic health records

Quebec’s EHR late and over budget, AG says

MONTREAL – Quebec’s auditor-general has called the province’s electronic health record program – known as the Dossier de santé du Québec (DSQ) – a failure, citing serious delays and management problems.

Auditor-General Renaud Lachance (pictured) concluded that: “The initial parameters of the project, costs, scope and schedule, will not be respected. Given these changes, we consider that the project in its originally defined structure no longer exists and, in this sense, is a failure.”

Lachance asserted that the DSQ was budgeted in 2006 at $563 million and was to be in full operation by 2010. The program had the backing of Canada Health Infoway.

Now, the government is committed to spending $900 million more to computerize patient health records, bringing the cost beyond $1.4 billion when the DSQ becomes operational in 2016.

Lachance would not venture a guess at the final cost of the DSQ.

What’s more, the strategy for the architecture of the system has changed. Instead of a new province-wide system for all regions and health providers, the strategy is to make use of regional solutions and to tie them all together.

François Bonnardel, of the Action démocratique du Québec, called the DSQ “the biggest flop in Quebec’s information technology history,” and asked why Quebec did not follow the same strategy as other provinces.

The Auditor-General cited a lack of continuity in managing the DSQ, noting that six managers of the program have come and gone. Lachance criticized Quebec’s reliance on outsourcing of information technology in developing the DSQ and other applications.

“Due to the lack of in-house expertise, strategic positions are entrusted to these resources,” he noted. “Moreover, experienced individuals leave the public service and return as consultants at higher costs.”

Of the original $563-million budget, Quebec was to put up $260 million and Ottawa $303 million. But because Quebec has not respected the timetable outlined under the Canada Health Infoway, the province has lost $52 million in federal money.

According to the Auditor-General’s office: “The completion of all of the sub-projects making up the DSQ is behind schedule. The delays for the sub-projects vary from 2 to 4 years at the very least. As for the pilot project under way in the Capitale-Nationale region, no date has been set by the MSSS (ministry of health) for its completion.”

“The initial scope of the sub-projects of the DSQ has been revised. Several sub-projects have seen their scope reduced. The Viewer, which was supposed to be the tool for viewing and accessing the electronic health record, will only be used for a limited or temporary clientele. Similarly, the solution advocated for the support and security of all information exchanges no longer holds any more. Several platforms associated with the electronic patient record will be used to provide regional, then provincial, interoperability with the end result that the initial solution which was supposed to be the sole platform will no longer be used as initially planned.”

One Quebec expert told the Montreal Gazette the plan to computerize all health records was doomed to fail from the start because physicians and pharmacists were not given any incentives to take part in it.

“In theory, this was a great plan because it meant that the medical information would be accessible no matter where you were,” said Robyn Tamblyn, of McGill's clinical and health informatics research group.

“But what got us bogged down is that we didn’t invest in the users at the front lines – meaning the private clinics, the CLSC clinics, the hospital emergency rooms – so that these people could connect to the software.”

Health Minister Yves Bolduc has noted that 3,300 family doctors have access to the medical-record software. But Tamblyn estimated that at most, 8 percent of physicians actually use it.

Many observers have said that simply creating electronic networks will not produce results. Physicians and others must be enticed to use the solutions. In Europe, for example, front-line physicians are actually compensated by the government for using electronic systems.

Posted May 19, 2011