Québec’s EHR doesn’t automate vital signs

MONTREAL – Santé Québec’s push toward establishing digital medical records for all Quebecers – to date over budget by $135 million from initial projections – has already been scaled down, as nurses will still have to take down patients’ vital signs on paper rather having the information uploaded into the computer system automatically.

According to a report in the Montreal Gazette, the pilot projects do not have the budgets to acquire vital-signs monitors that have the capability of uploading patient data — with the exception of those in intensive-care units.

“You want to do away with all the paper, right?” a senior government source told The Gazette. “That’s why you’re bringing in electronic healthcare records. But they didn’t have the budget to buy the monitoring equipment to electronically transmit vital signs information from patients. So, nurses are still going to have to walk around with paper recording people’s vital signs, and then manually put them into the system.”

In August 2023, in what was then hailed as a “major milestone,” former Health Minister Christian Dubé (pictured) announced that the government had awarded a contract to Epic Systems, based in Wisconsin, to deploy a system of digital health records in two pilot projects.

The goal was that within two years, Epic Systems would successfully deploy electronic records in the CIUSSS du Nord-de-l’Île-de-Montréal, overseeing Sacré-Coeur, Jean-Talon and Fleury hospitals; and in the CIUSSS de la Mauricie-et-du-Centre-du-Québec, also in charge of several hospitals.

More than two years later, however, Santé Québec has postponed the start-up date of the pilot projects until May 9, four months from now. What’s more, the price tag has soared from the original figure of $268 million in 2022 to $402 million today. Of that sum, nearly $280 million has already been spent, according to the latest government tally on its information resources project dashboard.

“It’s completely stupid,” added the source, who agreed to being interviewed on condition of anonymity to discuss the issue candidly. “So that’s just one example of downscoping,” the term used in the information technology industry for projects that are scaled down to cut expenses.

Establishing province-wide digital health records had bedevilled the Quebec government long before Dubé made his announcement in 2023. More than a decade ago, in November 2014, former Liberal health minister Gaétan Barrette acknowledged that setting up digital health records was “a disaster” even then, with the provincial and federal governments having spent $1.6 billion on the initiative in Quebec since 2001.

In October, Barrette suggested that Santé Québec had no choice but to delay the two pilot projects because it had not yet tested how various laboratory equipment would interact with Epic’s software.

In a statement, Santé Québec defended the decision to exclude vital signs monitors from the pilot projects, known in French as Dossier santé numérique (DSN).

“The connectivity of medical equipment to the DSN was the subject of a structured analysis,” Santé Québec explained.

“All biomedical equipment that could be connected was evaluated and then prioritized according to its actual clinical relevance for the implementation of the DSN, in line with the recommendations of the solution provider.

“This prioritization was carried out by a clinical committee, in close collaboration with the biomedical engineering teams at the two pilot project sites and the Ministry of Health and Social Services in order to ensure a balance between clinical value, technological feasibility, and responsible use of public funds.”

Santé Québec confirmed that nurses will still have to enter patient information manually from vital signs monitors.

“When automatic transmission is not enabled for certain equipment, data can be entered manually by clinical staff, as is already done in several current clinical settings. This method does not prevent the use of the DSN or the achievement of the pilot project objectives.

“In addition, critical equipment, such as intensive care monitors, will be interfaced and will transmit data automatically.”

At present, Quebec’s hospitals and other facilities rely on a patchwork of different computer systems for digital health records, making the eventual harmonization of such data – from test results to prescriptions for medications, among a dizzying array of indicators – a truly daunting and expensive undertaking across the entire health network. The Gazette interviewed two doctors and a nurse at three Montreal area hospitals, and each said medical staff use paper charts to enter vital signs data into their computer systems by keyboard.

There are some Quebec hospitals, however, where vital signs data is uploaded automatically to their computer systems.

In announcing the pilot projects, Dubé touted digital health records as a “new technological solution that will undoubtedly facilitate the work of staff by reducing paperwork and bureaucratic burdens. By lightening the workload of healthcare professionals, it will also help make our healthcare network an employer of choice.”