Quebec to invest nearly $1 billion in health IT

QUEBEC CITY – The Québec government has announced a plan to invest $951 million over three years to modernize the technological infrastructure of its hospitals. The goal is to improve communication among healthcare professionals through better electronic health records, enhanced security systems and more effective networks.

For some time, Québec health minister Christian Dubé has complained about the lack of interoperability of records in the healthcare system. He has also targeted the antiquated use of fax machines to transmit records and cited the need of patients to repeat their histories to providers wherever they go.

The new investment is designed to overhaul and update the technological architecture to minimize these problems.

“This technological modernization plan for the health and social services system is a decisive step in our efforts to truly change our network in depth and improve the healthcare experience of Québecers in a lasting way,” said Dubé in a news release.

At the end of 2022, an integrated system for sharing electronic records will be tested for a period of two years at two sites: the CIUSSS du Nord-de-l’Île-de-Montréal and the CIUSSS de la Mauricie-et-du-Centre-du-Québec.

As the systems are tested and fine-tuned, they will be rolled out to other regions across the province.

The government said the initial sites were chosen because of their expertise in electronic solutions.

The ultimate goal of the system is to allow healthcare professionals and patients to access all patient information in one place, with no more hunting for files from one repository to another. As well, it aims to reduce the use of paper in the healthcare system, especially the reliance on faxing.

According to an article in Le Journal de Québec, a government source said Québec wants to deploy its electronic health record gradually, in order “to avoid slippages”.

Of course, Québec has attempted to computerize its hospitals and healthcare system since the late 1990s. Observers estimate that it has invested some $2 billion in the effort, much of which has come to naught. Many of the solutions have either performed poorly or have been rendered obsolete by technological innovations.

Some ambitious rollouts of technology have simply been abandoned.

In the latest modernization strategy, the $951 million investment includes $292.5 million for improving the telecommunications network of healthcare establishments. As part of building links among providers, the goal will be to strengthen computer security, consolidate data processing centres and shift to cloud computing.

Another $238 million will be set aside for projects aimed at getting rid of the faxes, paper folders and other paperwork that clutters hospital counters and complicates the work of administrators and clinicians.

The outdated nature of the information systems in hospitals and health centres came into full view at the start of the pandemic, in 2020, when Québec found itself unable to obtain an overview of the needs on the ground.

“The anachronistic use of faxes in hospitals has become a sad symbol of a delay in the development of information technologies. A major digital modernization project is necessary,” Dubé said earlier this year.

A previous government made its own attempt to modernize with the announcement of the Dossier santé Québec (DSQ), the Digital Health Record.

However, this project has been criticized as taking too long to implement.

The task facing the government now is what to do with the DSQ. One solution is to connect hundreds of existing systems, no matter whether they are obsolete or leading-edge, to the DSQ.

This will potentially create an integrated system that provides healthcare professionals and patients with access to previously siloed records.

The Journal de Québec reports that “the project deployment strategy is still to be finalized,” according to the director of communications for the office of the Minister of Health, Marjaurie Côté-Boileau. She added that, as of now, the DSQ has not been shelved.

The current government has also been working to improve the legal underpinnings needed to share medical information. Bill 19, which was tabled last December, is designed to facilitate the sharing of data with doctors, managers and patients.

As in other provinces, the COVID-19 pandemic exposed flaws in the healthcare information system. For its part, Québec could not find out how many workers were on duty or track early vaccinations.

The combination of investments in interoperable health records and changes to the legal structure governing the sharing of health information are designed to improve access to data.

When he announced Bill 19 late last year, Dubé said: “Yes, it’s a colossal job, but a necessary one. The pandemic shed light on the weak points of our health system. Data problems were part of the equation. We don’t want to re-live this. We want to ensure a fluid movement of information.”

Québec now has 9,000 data platforms operating in 34 regional health and social service authorities scattered in 17 regions, Dubé said. The system is essentially hospital-focused, and in many instances, data is still stored in file folders.

When it comes to patient information, hospitals are reluctant to share it for privacy reasons, which Dubé said can make it hard even to get test results passed along the chain to medical personnel involved in a person’s care.

Another example of the troubled system cited by the minister: While there are 8 million Québecers, there are 30 million hospital cards in circulation, with patients holding multiple cards for different hospitals.

The same patient may have records in multiple hospitals, but those records are stored in different formats that aren’t interoperable. The new system, incorporating enhanced connectivity and cloud technology, will be designed to connect all the records.

For the past few years, a partnership between French-based Enovacom and Purkinje, of Montréal, has been working to connect the record systems used in Québec’s hospitals.

Enovacom’s country manager in Canada, Alain Larochelle, said that many centres have implemented interfaces or are in pre-production. Larochelle is confident that the Enovacom Integration Engine will continue to be a building block that’s leveraged by the Québec government’s new strategy.

However, Larochelle asserted that much more than hospital-generated data should be collected and linked. “Data can be generated by information systems, medical devices, and wearables that go beyond the hospital. First-line providers and community clinics also generate data, and the patient partner will be part of the ecosystem – not only as a consumer but also as a producer of data.”

Larochelle noted that the new data will need to be hosted. For its part, Enovacom is proposing the Enovacom Data Repository, an FHIR compliant data repository that can meet the need of clinical operations.