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Quebec moves to a single, province-wide EHR

Gaetan BarretteQUEBEC CITY – Health Minister Gaétan Barrette (pictured) announced that Quebec will move toward the use of a single electronic health record system in hospitals across the province. The solution decided upon by the province is called Cristal-Net, and it has been in use at the Centre hospitalier universitaire de Québec – Université Laval since 2003.

“The decision to deploy a single solution for Electronic Medical Record is part of our efforts to standardize practices within our health and social services, clinically and financially and administratively,” said Barrette. “This will benefit clinicians and all users.”

The Cristal-Net solution will be implemented in all 34 hospital institutions in Quebec, starting with those who do not have an electronic record system.

Institutions using another solution will have to establish a transition strategy in order to comply with the directive, taking into account the end dates of contracts with current suppliers.

This process will be overseen by a governance structure composed of CEOs of the network and health and social services deputy ministers who will have to set development priorities, approve deployment strategies and endorse the clinical and administrative practices that result.

According to an article in Le Soleil, Barrette called the decision a “master stroke” for Quebec economically and functionally.

“You end up with a product developed here, which is provincially owned and for which we do not have to pay huge licencing fees,” said Dr. Barrette, noting that the costs of IT products are generally quite high.

Cristal-Net was co-developed by CHUQ, in Quebec City, with the CHU de Grenoble, in France. The director of information technology University of Quebec-Laval University Hospital, Jean Boulanger, has led the development team in Quebec since 2000, when they signed a co-development agreement with the centre in France.

Boulanger said Cristal-Net is useful and effective: “Doctors find it easy to use, the software is very user friendly.”

Institutions using another solution – five different software solutions are currently used in Quebec hospitals – will be required to establish a transition strategy in order to comply with the new directive, taking into account the end-of-contract dates with current suppliers.

For the Minister of Health, the money invested in other electronic health records systems is not considered to be wasted. “The work that has been done is useful work,” said Dr. Barrette. He observed that existing EHRs have enabled hospitals to collect patient information, which will be transferred to the new Cristal-Net system.

“This is just the container, the destination of the data that changes. And it will be a complete vehicle, analyzable and searchable, something we do not have at this time,” said Dr. Barrette.

Deployment of Cristal-Net across Quebec will lead to the completion of the 2019 Quebec Health Record (EHR), a database that will allow physicians and other healthcare professionals to access the results of examinations and laboratory tests, prescription drugs, vaccines received in Quebec, a summary of hospitalization and information on allergies.

Barrette believes that the government will have spent around $ 2 billion to complete the integrated, provincial electronic health record.

Le Journal de Montreal reported that the government announced the expansion of Cristal-Net in late December, when MPs and ministers had already left the National Assembly for their constituencies and the holiday season.

Before the announcement, Quebec hospitals could select their own software solutions from a list of approved products.

In Montreal, the chosen solution was Oacis (now owned by Telus) and its development began in 2004. The system is not fully implemented and will be completed in 2019 at an estimated cost of $130 million, the Journal de Montreal said.

After the completion of the Oacis contract in 2019, however, the Montreal hospitals will be required to shutter the system and start over again by implementing Cristal-Net.

The Journal de Montreal asked the minister, “Will the hundreds of millions spent on systems other than Cristal-Net be put in the garbage?”

The minister’s office answered that “It is not true that everything that has been done will be wasted. There will be database transfers. And ultimately, there will be less money wasted.”

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6 Comment responses

  1. Avatar
    January 07, 2016

    This is the smart decision for Quebec. It is the only way in a publicly managed system can provide information technology to hospitals both effectively and efficiently to meet the demands for complete and integrated health records. Only Ontario remains an outsider now and it needs to get moving. It will be difficult but is the only viable long-term solution.

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  2. Avatar
    January 13, 2016

    I am wondering what are the real reasons behind crystal-net selection. I don’t understand what are the government advantages of becoming dependant on Crystal-net for running their health care operations. EMR are central to a connected healthcare system. Obviously a decision taken by people who don’t really understand technology.

    What the industry need is a standard group like in the telecom world. Where any vendor meeting the agreed standard can be used. Creating isolated digital medical getto is creating another barrier for outsourcing medical services and lower cost tax payer cost.

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  3. Avatar
    January 22, 2016

    There will be a negative impact on jobs as well as current players are pushed out. The Quebec healthcare IT niche has a storied and incestuous past (MediSolution (Lawson, Infor), Logibec, Telus, Artefac, etc., etc., etc). Almost seems as though the Healthcare IT cycle (on the patient info systems side) has come full circle returning back to the days of Partagec! IMHO, logical move? yes for all the political and somewhat questionable financial reasons. Odds of success? As with any gov’t driven IT initiative, will take too long and will most likely get siderailed by lack of concensus amongst hospitals. What is old is new , , , , merde alors! Seulement au Québec.

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  4. Avatar

    Gaetan Barrette has decided to choose Québec city over the Sherbrooke and Montréal regions that are far more advanced in the EHR than the Québec capital — and for more then 20 years. Presently in Montréal, clinicians at the MUHC can order labs, radiology, consultation, diet and pharmacy, even the ambulatory sector has a functional adapted tool. Patient care orders and cardiology were ready for pilot. Order set such as heparin protocol and insulin were ready for production. Allergy, Clinical Measurement, Vital signs, were in production.
    To choose a solution that will bring back clinicians to the paper world and provide a new “health care solution” going back 10 years in the past is not only a proof that M. Barrette’s friends were unable to advise him properly, but to choose to limit the development of the so called solution only in Québec is a step back and a waste of knowledge. If it’s open source (not really the case) RUIS should be able to improve the software to fit their need and ensure there won’t be a paper gap. Hospitals have cut back on administrative clerks, and professionals are not interest in going back to fax and paper list.

    By also pushing an agenda for all the ancillary system to be the same this creates chaos that really show how little the Minister understands about the complexity of health care. Changing a pharmacy system takes year, the same for a lab or a radiology system. Wishful thinking is dangerous when someone is in charge of 50% of all Québec healthcare expenses and plays the totalitarian approach — shutting down all dissident voice with an unrealistic target. On a macro perspective, this means more years of delay in achieving the Canada Infoway target. Please note the cristal-net solution will probably be in French and this for Montreal region and McGill associated facilities will impact the attractiveness of Montréal for fellowship and international students. Destroying the teams that have been leaders for years and to replace them with teams that believe standardization is the key, and expecting healthcare facilities just to adapt to the tools provided, some of us know how life is not that simple.

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  5. Avatar
    June 30, 2016

    Is the decision of adopting ‘Cristal-net’, and as Dan said “pushing out other Software developper players such as: MediSolution (Lawson, Infor), Logibec, Telus, Artefac, etc., etc., etc)” even complies with the Competition Act in our legislation?

    Will clinics be obliged to use Cristal-Net or will they be free to choose among other products and still be able to operate ?

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    • Avatar
      January 21, 2017

      I am not crying for the software developers, they suck all the subvention the physicians have received, they charge outrageous licencing fee, provide minimal support, and don’t care about our input for improvement to the EMR. MSSS is very interested in the little doctor user in the trench, they hired me to be on the consulting implementation team ! I’m delighted they care, and that I have the opportunity to participate in an important positive change for our healthcare system.

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