EHRs in Quebec need a lot of work: health minister

QUEBEC CITY – Quebec’s Health Minister, Gaétan Barrette (pictured), says the province’s $1.6 billion investment in electronic health records has been a major disappointment. Far from the interoperable and seamless system that was envisioned, the province is left with numerous databases and repositories that can’t communicate.

“It’s disheartening,” Barrette said of the Dossier Santé Québec during an interview with the Montreal Gazette in November. He admitted that the current e-health system is a “disaster” and “not what it should be,” adding that it should be thrown out and revamped from scratch.

But to do so would add another “billion dollars” to the cost, Barrette said, money he does not have.

Electronic health records, in theory, are supposed to be shared among health professionals – primary care physicians, clinicians in hospitals, pharmacists, and professionals working in labs and clinics.

“But things are not as they should be. At least I admit it,” said Barrette, adding he was involved as an adviser from the beginning, when Canada Health Infoway, the federally funded agency responsible for rolling out e-health in Canada, was created in 2001. The exception is medical imaging, Barrette said – the area where he was personally involved.

“Decisions were not coordinated. It was not designed properly and the result is what we have today,” Barrette said, calling the systems that are installed a patchwork of digitized services that do not communicate with one another.

“I need to find a way to patch things together, so that we have a common ground that will be workable both in the field, outside the hospital, in hospital and between hospitals. As we speak today, that does not exist,” he said. “If I were to invest money to have the proper result, I would scrap what has already been done and start from scratch again and it would cost a billion dollars. And I don’t have the money to do that.”

Barrette blamed the architecture of the computer software. “The way the code was written was not coordinated between applications. They are all stand-alones and there is not much common ground. I know that for a fact, because I was there,” Barrette said.

Doctors can choose from nine different electronic medical records technology systems and some regions have hired consultants to help them find the best one, said Dr. Serge Dulude, director of planning at the Fédération des médecins omnipraticiens du Québec.

The province missed its target of signing up clinicians to its new electronic health records project, Dulude said, but there have been significant gains. Of 6,000 of the province’s 8,000 family physicians who provide front-line medical care, more than 3,000 have gone digital. Another 1,500 (for a total of 4,500) should be signed up by April.

Some areas, including Gatineau and Chaudière-Appalaches, are better connected than others to the DSQ pipeline – doctors to laboratories and medical imaging results and prescriptions to pharmacies. However, Montreal is “not a winner,” Dulude said.

Connecting doctors to hospitals and clinics is another story, Dulude said. “The idea of interoperability is extraordinary. It’s a challenge. Was it well handled? There was a lot of money thrown at it and teams changed often … in 2008, I thought, ‘it will never work.’

“But actually, now, well it’s not Nirvana, it’s not paradise, really it isn’t. But it’s having an interesting denouement,” he said, pointing to the DSQ site and the growing trend of clinics, hospital and pharmacists that have signed on.

Doctors are already using tablets and other mobile devices when it comes to treating patients.

In the future, the province is expected to add missing patient information on vaccination and allergies.

But what’s frustrating doctors most, Dulude said, is that the DSQ does not provide summaries of hospitalized patients who return for follow-up care to their physicians.

“The teaser for doctors was that they could be connected to the hospitals, and that’s not happening in Montreal,” Dulude said. If they can’t get hospital laboratory and imaging results and hospitalization records straight to their email, they say they might as well continue using paper records, said Dulude. His organization provided members with a 25-page guide on how to move from paper to e-health.

“When it’s well done, the process takes between six-months to a year,” he said.

Doctors are already using tablets and other mobile devices when it comes to treating patients. The annual physician survey by Canadian Medical Association to be made public this month is expected to show digital records use is a growing trend with the most advanced use of e-health over paper charts in Alberta, Ontario and Saskatchewan.