Quebec hospitals to standardize on Cristal-Net EHR

The computerized system is already used extensively by the CHU de Québec-Université Laval, which in early 2000 co-developed Cristal-Net in conjunction with the CHU de Grenoble in France. In October 2015, the CHU de Québec-Université Laval obtained the complete rights to the system and is now the sole owner and developer.

Health Minister Gaetan Barrette, who has publicly voiced his frustration with the inability of the patchwork of electronic records used in Quebec hospitals and clinics to inter-connect, announced the plan to standardize on Cristal-Net last December.

It came as a shock to many in the e-health industry, who assumed the move would displace the commercial systems being used in many of Quebec’s hospitals – including some very new solutions with state-of-the-art software.

However, far from ripping-and-replacing the clinical solutions that are already installed, the plan is to keep what’s working well, but to use Cristal-Net as a powerful integration tool to view and complete the clinical data for the patient. It will tie together existing systems that previously couldn’t communicate.

As well, “many of the hospitals still don’t have an electronic medical record, and Cristal-Net will be used as the EMR in those facilities,” said Louis-Jacques Lalonde, Assistant-Director of Information Technology at the CHU de Québec-Université Laval.

He explained that Cristal-Net has numerous modules, including lab, pharmacy, Kardex, integration with the QHR (Quebec Health Record), oncology, and the ability to integrate with PACS and RIS.

“It has a lot of capabilities,” said Mr. Lalonde. It’s also user-friendly: “To create Cristal-Net, we worked closely with the clinicians, with doctors, pharmacists and nurses, to make the system useful to them.”

He pointed out, however, that it doesn’t have each and every capability – for example, hospitals will still need to acquire imaging systems from outside suppliers. Other features that are add-ons include order sets and closed-loop medication management.

“We’re leaving that to outside vendors,” said Mr. Lalonde.

However, he noted that alerts and flags from these systems will be integrated with Cristal-Net, so that all clinicians will be able to see important patient information. “The idea is that you should never have to leave Cristal-Net to do your work if you don’t need an access to a specific clinical system.”

A team at the CHU de Québec-Université Laval is in charge of implementing Cristal-Net in hospitals across the province. It’s currently a group of 26, which will soon nearly double to 50. “Our team of 26 was serving the CHUQ hospitals, but the game has changed now. We need more people to give quality services to the new users of Cristal-Net,” said Mr. Lalonde.

The new staff members will include not just programmers and designers, but content experts like nursing and pharmacy experts. This way, they will be better able to converse with clinicians, to explain the system to them and, conversely, to carry back their ideas and needs to the development team.

While the plan is to have Cristal-Net up-and-running in all Quebec hospitals by 2019, there is a good deal of preliminary work that first must be done. Mr. Lalonde said that his team is creating a check-list for all hospitals, to determine what their current capabilities and needs are when it comes to electronic records.

Organizations will need governance committees and groups to establish the best workflows and standards. As an example, to promote interoperability within hospitals, regions and across the province, common terminologies are needed – for medications, tests, diagnoses and treatments.

As well, training will occur, to get the users ready for Cristal-Net. “We’re going to train the trainers,” said Mr. Lalonde. “They in turn will train their clinicians.”

While the team in Quebec City will be training and supporting the users of Cristal-Net across the province, local hospitals and healthcare organizations will maintain their own IT departments and will stay in control of their systems.

Some hospitals are, of course, ahead of others, and installations of Cristal-Net will begin this year. “Everyone has already started, and some have more to do than others,” said Mr. Lalonde. “But by 2019, everyone will be using it.

“It is going to happen very fast.”

The agenda for implementation is being created by a committee that reports to the Minister of Health. The task has been made easier by the sweeping healthcare reform that took place in Quebec in April 2015, when 182 health organizations were consolidated into 34. “It makes it easier to communicate,” said Pascale St-Pierre, a Communications Manager at CHU de Québec-Université Laval.

Each of these provincial organizations will be able to grant permissions to clinicians to use Cristal-Net, and will be able to control how much of the patient record various care-givers can see. They will also be able to provide access to community physicians and clinicians, if they wish.

Mr. Lalonde, a software engineer by background, joined the Cristal-Net team in 2010. He has helped bring commercial software development techniques, like fast, agile production, into the organization.

The team now creates one major upgrade of Cristal-Net each year, with a smaller update each month. “That way, the changes are gradual, and the users have less trouble adapting,” said Mr. Lalonde. The continual updates, moreover, help ensure the system is staying current with state-of-the-art technologies.

It also goes through rigorous testing. “In the last two years, we added more than 8,000 automated tests that are running each day to make sure Cristal-Net is bug-free” he said.

He said the system has all of the latest technological features – it is fully web-enabled, and authorized individuals can use it remotely, from anywhere when it’s required in their job.

It also has innovative abilities when it comes to integrating a wide variety of clinical information systems, and presenting the relevant data to clinicians.

Mr. Lalonde said that many commercial, clinical systems are not “open”, and it has proven difficult for hospitals to connect them together using their own resources. But Cristal-Net, he said, has powerful tools for integrating to existing systems.

The plan is to use Cristal-Net first to connect systems and departments within hospitals and to make the data easily viewable and usable to clinicians.

Next, Cristal-Net will be used to connect hospitals and health organizations across the province, so that clinicians in Chicoutimi, for example, can see what happened when their patients were treated in Montreal or Quebec City.

Cristal-Net can do this, said Mr. Lalonde, without the need for centralized repositories that collect and house data. Instead, the system pulls what it needs from existing repositories. “We don’t want to duplicate information,” said Mr. Lalonde. “We’re able to use the information that’s already stored.”

Other provinces that have had trouble connecting their own clinical systems will be watching Quebec closely, no doubt, to see what can be learned.