West Montreal health region devises its own EHR

When the senior leadership teams at most Canadian hospitals are in the market for a new Electronic Health Record (EHR), they almost invariably opt for one of the mainstream solutions. But that wasn’t the case at CIUSSS West-Central Montreal, which includes the Jewish General Hospital (JGH). Instead, the CIUSSS and the JGH partnered with Harris Healthcare to develop a solution from scratch.

“Several years ago, when we started looking at the EHR options out there, we had a couple concerns with what was available,” said Dr. Justin Cross, the hospital’s chief digital health officer.

Foremost was the ability of an EHR system to fully support the way Quebec’s healthcare system is organized into integrated health and social service networks.

The JGH is part of the Integrated Health and Social Services University Network for West-Central Montreal (also known as CIUSSS West-Central Montreal), and serves as the network’s acute-care site. The integrated network also includes long-term care centres and rehab hospitals, community care, public health community centres, family medicine clinics, mental health services, and other social services.

“Many EHRs on the market are very hospital-focused, and we wanted to build something for the continuum of care across our health network because a lot of our patients transit from one service or facility to another. It’s very important for the different members of the care team to be able to see what’s going on,” said Dr. Cross.

There were other reasons that steered the JGH toward developing a new EHR. Citing an article published by the Annals of Family Medicine in 2016, Dr. Cross highlighted the findings that for every hour of direct patient care, doctors are spending two hours in their EHR.

“Coming out of the pandemic, we have seen a lot of burnout that has resulted in both doctors and nurses taking early retirement. We’re dealing with a workforce that’s tired. We have an aging population that requires more from our care teams, so we didn’t want to put in a software system that would add to their burden.

“We wanted to develop something that’s easier to use because a lot of the mainstream solutions have been out there for decades. They’ve been upgraded over the years, but the way the screens are set up and how clinicians interact with them hasn’t really changed. There are still a lot of tabs, a lot of clicking, and a lot of hunting for information. We shared our vision with Harris Healthcare and discovered that they too were interested in reimagining the EHR, so we entered into a partnership in January 2022. The teams here at CIUSSS West-Central Montreal serve as the clinical and strategic experts, and the Harris Healthcare team provides the software development expertise.”

JGH doctors, nurses and administrative staff have had numerous meetings with the Harris teams at which they describe what they need clinically “because we don’t want to end up with software that doesn’t work for us. We want the software to support the clinical reality,” said Dr. Cross.

The end goal of this innovative project is a modern enterprise EHR called Harris Arc, which will be used not only at the Jewish General, but across the CIUSSS network to fully incorporate the clinical information architecture across the care and social services continuum.

Another goal for Harris Arc is improved data accessibility. Years ago, explained Dr. Cross, provincial government budgets were based on volume alone. Today, they also take into consideration the quality of care delivered, which means there’s financial risk associated with hospital readmissions and failure to follow standards-based care.

“So, we wanted to make sure that we have access to the data necessary for all of our quality improvement initiatives,” said Dr. Cross. “Historically, there have been challenges accessing data from EHRs that are in a proprietary format and difficult to get to. This often resulted in extra charges for a health system to access its own data. We are making sure to follow a more modern standards-based design approach to ensure that data is available and accessible for necessary purposes.”

Dr. Cross, a primary care physician with a sub-specialty in clinical informatics, is originally from the U.S. where he worked in the U.S. Department of Health and Human Services’ Office of the National Co-ordinator of Health Information Technology. As a medical officer and Medical Director for Systems Safety at ONC, he worked on a wide range of issues – from interoperability and safety to best practices around implementation of electronic health records and reduction of burden associated with health IT. Dr. Cross joined the Jewish General in February 2019.

The JGH-Harris partnership celebrated their first milestone in November 2023 with the release of the EHR’s first module, the Patient Timeline.

“It’s a chronological viewer of all of a patient’s information across our healthcare network that allows a clinician to zoom in and out and pan back and forth on one screen,” said Dr. Cross. The Timeline module has incorporated and normalized many disparate data sources from the CIUSSS current software ecosystem into a standard patient data model. The Timeline is serving to unlock previously siloed data and will also serve as a historical data load for the eventual future full EHR launch.

Clinicians can see when the patient was in the ER, the hospital, in long-term care, in rehab, and can see other community encounters along the care continuum. By clicking on the various encounters, they can pull up notes, lab reports, diagnostic imaging, and other documentation.

“This is the first time in our health network that we have had a unified clinical view of a patient’s trajectory. We released it to all our clinicians in November 2023, so it’s live now and includes five years of historical data.

“We have nurses working in long-term care who are now able to see what’s happening with their patients who are in acute care and can start planning for their return. We even have home care workers out in the community who can now optimize their home visit routes and save an hour of driving if they see their patient is currently in hospital.”

The Patient Timeline module and the EHR as a whole use Microsoft Azure’s cloud environment with its full security suite. It’s compliant with Quebec’s certification process for health software.

The system is also language-agnostic; it is built to support both French and English at the individual user’s configuration settings level.

Simon Beck, vice president of Sales for Harris Healthcare, commented that the Harris development team is using FHIR-based technologies to promote interoperability and aims to link all major systems to its new Patient Timeline. “It will take feeds from all of the major systems,” said Beck.

He observed that interoperability and the ability to include data from different parts of the patient journey are critical to producing the best outcomes. “Healthcare isn’t just given in the hospital now, it’s out in the community and in the home, too,” said Beck. “Clinicians need to see those records. Otherwise, they’ve got an incomplete record.”

Dr. Cross thinks the Harris Arc Patient Timeline could appeal to healthcare systems across Canada and elsewhere that also want a view of a patient’s trajectory of care across a network of health services along with improved usability and data accessibility, especially for jurisdictions that contain multiple clinical data source systems. Quebec’s Ministry of Health has classified the Jewish General initiative as an innovation project.

The JGH and its software development partner are targeting the launch of Harris Arc for the end of 2025. The EHR will initially be launched at the hospital itself and the medical clinics associated with it, to be followed by the long-term care facilities and rehabilitation hospitals in a second phase and the community care centres in phase three.

“We keep reminding ourselves that we have to keep the clinicians at the center of the design process, because we know that when we take care of our teams, we can ultimately deliver better care to patients, which is why we’re all here. We are proud of what we’ve accomplished so far, and we are very focused on getting this done. We think that others will find value in it as well.”

Dr. Lawrence Rosenberg, president and CEO of CIUSSS West-Central Montreal, said that Arc is a perfect complement to “Care Everywhere”, the CIUSSS’s broad approach to patient-centred care. Its goal is to achieve the right outcomes by delivering the right care at the right time in the location that is most appropriate, safest and most convenient for healthcare users.