Quebec may not standardize on Epic province-wide

MONTREAL – The Quebec government has already abandoned the idea of partnering with U.S.-based Epic Systems for the deployment of digital health records across the whole province, due to fears of mounting costs and privacy concerns, Montreal’s Gazette newspaper reported.

On May 9, Epic Systems and Santé Québec will roll out two pilot projects involving what is known as the Dossier santé numérique (DSN). The price tag for those projects has soared from the original figure of $265.4 million to at least $402 million, and sources warn the final tally may well exceed $600 million.

Santé Québec, however, disputes the latter figure and insists the projects are proceeding under the budget of $402 million.

On Monday morning, premier Christine Fréchette (pictured) released a video on social media giving Santé Québec the green light to proceed with the pilot projects after insisting last week that she first needed guarantees on the protection of Quebecers’ private medical files.

“I know this shift is causing concern… That’s normal,” Fréchette tells viewers. “The digital health record isn’t just an IT project. It’s a profound transformation of our ways of doing things.”

In her video post, Fréchette did not comment on the prospect of partnering with Epic Systems for a provincewide deployment.

Former cybersecurity minister Gilles Bélanger has raised concerns about a lack of safeguards for the privacy of Quebecers’ sensitive medical files, given that Epic Systems is subject to the U.S. CLOUD Act, which empowers law enforcement south of the border — in the event of an investigation — to access data held by American companies on their foreign computer servers.

Although Santé Québec has officially downplayed the possibility of such breaches — as the data will be stored on Epic Systems’ Montreal and Toronto servers — The Gazette has learned that leadership at the state corporation internally acknowledged such digital sovereignty concerns long before Bélanger went public with his criticism.

The Quebec government’s unease with Epic Systems stems as well from the company’s experience in Alberta, which had announced in 2016 a five-year project to deploy digital health records across that province. The project was only completed by the end of 2024, costing taxpayers at least $1.6 billion.

“The decision has already been taken, although they haven’t announced it yet,” a high-ranking source said of the Quebec government, referring to dropping Epic Systems for the whole province.

“I know they’re already looking at alternatives, but money aside, you need two other things. One, you need a mature IT infrastructure, which most health institutions in Quebec don’t have because the government never invested in it, and secondly, you need an IT manpower force to implement it and to support it, and that also doesn’t exist across the province.”

The source, who agreed to be interviewed on condition that their name and position not be published, estimated that deploying the DSN with Epic Systems for the whole province would cost at least $3 billion — and that’s not including the added expense of upgrading IT infrastructure and hiring IT staff.

“Most places in Quebec cannot support Epic software because they just don’t have the infrastructure to do it,” the source explained.

Indeed, many hospitals across Quebec still rely on fax machines and antiquated computers. What’s more, the two DSN pilot projects appear to be hobbled from the start, as there were not sufficient funds to purchase enough vital signs monitors to upload information to the computer network.

Vital signs monitors with that capability will be restricted only to hospital intensive-care units in the CIUSSS du Nord-de-l’Île-de-Montréal and the CIUSSS de la Mauricie-et-du-Centre-du-Québec.

Thus, nurses who work outside of ICUs in those two regional health authorities taking part in the pilot projects will still have to write patients’ vital signs down on paper — defeating in large measure the purpose of digital health records.

Santé Québec leadership has also expressed concern that additional funds that will likely be necessary for the success of the pilot projects may not be forthcoming, a second source told The Gazette on condition of anonymity because they were not authorized to speak to the media.

“There are other additional costs that may come and they’re not getting the support they need,” the second source said of Santé Québec. “They’re worried about the Conseil du trésor (the provincial Treasury Board) and blockages at the ministry level.”

Catherine Barbeau, a spokesperson for Health Minister Sonia Bélanger, declined to respond to The Gazette’s queries about the government’s decision not to proceed with Epic Systems for the whole province. She referred all questions to Santé Québec.

In a statement on Friday, a Santé Québec spokesperson cautioned it’s premature to suggest Epic Systems will be excluded for any provincewide rollout.

“The provincial expansion strategy is currently being developed,” the spokesperson said in an email.

“The lessons learned from the two pilot projects will be crucial in guiding the subsequent deployment. Over the coming months, the organization will analyze the results obtained, particularly in terms of clinical, organizational and user benefits.

“This information will inform future directions, using a rigorous, progressive and value-driven approach for the network and the population, and will allow us to confirm the strategy for the provincial expansion of the DSN,” the spokesperson added. “At this stage, it is premature to comment on the deployment schedule in other establishments.”

After publication online of this article Monday, Santé Québec released a second statement to The Gazette challenging several points in its story.

“It is not the government that will make this decision. It is Santé Québec,” the state corporation clarified, alluding to whether to stick with Epic Systems in a provincewide rollout.

In fact, it was the Quebec government and not Santé Québec that first signed a contract with Epic Systems, and it will be the Treasury Board — and not Santé Québec — that will authorize any funding for a provincewide deployment.

Santé Québec also challenged the figure of $3 billion for the whole province — a number that La Presse also reported on Monday and which The Gazette cited based on information from two senior sources.

Santé Québec eyes other projects
Santé Québec has previously confirmed it’s closely monitoring the rollout of another pilot project on digital health records that is being spearheaded by the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, which oversees the Jewish General Hospital. That project is entirely made in Quebec and is being financed 100 percent through donations raised by the Jewish General’s foundation.

In the meantime, Santé Québec’s partnership with Epic Systems has turned into a political football for the Coalition Avenir Québec government, with the opposition parties on the attack almost daily and premier Fréchette on the defensive. With a provincial election set for October and the CAQ government trailing in the polls, the future direction of the DSN will likely ultimately be decided by the political party voters choose in five months’ time.