The media coverage afforded Quebec’s “digital transformation” is astonishing in both its breadth and breathlessness.
“C’est un go!” exclaimed a Radio-Canada headline published just after 3:40 a.m. on May 9, when a couple of hospitals started cautiously using a new electronic health record system.
“It’s almost like magic,” the Montreal Gazette reported in a front-page story noting that electronic health records are more efficient than paper files and fax machines.
Quebec first announced plans to digitize patients’ health records back in 2001. After more than a decade and some $1.6-billion in spending, the project was deemed a disaster and put on ice.
Then, in late 2023, the government of François Legault decided to finally make a bold leap into the, um, 20th century and create a centralized data system that would gather patient health records, lab test records, radiology images and prescription data.
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The $1.5-billion, 15-year contract was awarded to Epic Systems Corp., a giant U.S. software provider.
Normally, the installation of new computer software and hardware, even on a large scale, doesn’t generate much media or public interest. After all, EHRs have been around since the 1960s.
Every other provincial health system has already undertaken a digital transformation of varying degrees. Ontario, for example, has a similar Epic platform which has been rolling out since 2017.
But in Quebec, a massive political scandal related to the digital transformation of Quebec’s auto insurance board changed the optics.
The insurer’s online platform, SAAQclic, not only dramatically increased waits for services like drivers’ licenses, but it was a financial debacle. SAAQclic was supposed to cost $458-million, but the final bill will come in over $1.1-billion.
There are fears that the DSN (dossier santé numérique) project will suffer from similar cost overruns, and more political headaches.
For that reason, the new Premier, Christine Fréchette, and the brain trust of Santé Québec, the agency that oversees the province’s health system, have been vigorously promoting the DSN project as a game changer.
So far, only a modest pilot project is up and running. But the kickoff was staged like the launch of the Artemis rocket, complete with a countdown, cheers, and tears when the system went live.
But the rah-rah approach can’t hide some concerning realities.
The first phase of the electronic health record rollout, a two-year pilot project in two regions of the province, has already cost $402-million, up significantly from its $265-million budget.
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There has been a lot of pushback from health workers, who complain that the system is not intuitive, and that the 12 hours of training offered has been inadequate.
There are concerns too about data sovereignty. Epic, as a U.S.-based company, is subject to the CLOUD (Clarifying Lawful Overseas Use of Data) Act, which allows any U.S. government entity to demand the release of “all electronic communication.”
Gilles Bélanger, Quebec’s former minister of cybersecurity and digital technology, was quite critical of the DSN project for that reason. In Quebec, the word “sovereignty” packs a punch. Soon after, he lost his job in a cabinet shuffle.
Despite the challenges, there is no doubt a digital health record could greatly improve efficiency and safety of care. No more faxes. No searching for paper records. No more manual entry. All of a patient’s information in one place.
But an effective electronic health record is not just about software. Ideally, equipment should be upgraded so, for example, vital-sign information can be transmitted electronically. Quebec didn’t budget for that, so things like blood pressure are still written down on paper, then entered into the system manually.
Not exactly the model of hi-tech efficiency.
Operating a large data system is costly too, about $100-million a year. It’s estimated that Epic’s contract will ultimately cost the province close to $3-billion.
And that’s just one part of Quebec’s digital transformation. The province is also planning to modernize its health information systems for procurement, human resources and laboratory services – known respectively by their French acronyms SIFA, SIRH and SIL-P – all at great expense.
The SIFA procurement system has already cost $430-million, up from a budget of $202-million. SIRH, the HR system, is on hold, haunted by Ottawa’s Phoenix system debacle. The SIL-P plan is to replace 119 different software programs being used in labs with a single one, with a budget of $72-million.
All these investments in software platforms and systems come at a time when AI is about to change, well, everything. Data will matter more than ever.
And who knows how much that will cost health systems, in Quebec and elsewhere?