After having unsuccessfully swallowed up more than two billion $ over 20 years to eliminate paper and computerize the health network, Quebec is starting over from zero by betting everything on a colossal project that could cost up to $ 3 billion.
Within a few years, the government promises that Quebecers will have access to their complete medical records, in real time, regardless of location in the health care network.
All records as well as health data will be in one place, accessible with a single click.
Called Digital Health File (DSN), it is the largest IT project in the history of the Ministry of Health. It is part of the CAQ government’s digital transformation plan. No more paper, faxes and the 700 different computer systems connected everywhere in the multiple establishments of the health network, says the ministry.
This dream, however, does not date from yesterday. Since the end of the 1990s, the ministry has been promising this technological revolution. He has also tried to achieve it for more than 20 years by injecting nearly two billion in a computer brothel.
For this reason, the classic “paper files” are still present, sometimes digitized, sometimes not. The fax to communicate is therefore still necessary, regrets the ministry.
The technology was not the right one, admits in an interview the associate deputy minister of the Information technologies branch, Luc Bouchard.
“What went wrong? A lack of a common vision, ”he says. “It’s a bit due to the technologies that existed at the time. Ten years ago, we were not in the cloud. ”
Since then, the network has also grown from 927 to 34 establishments without ever adapting the IT systems according to the mergers. “They are still systems that we try to make work together,” says Bouchard.
Quebec ensures this time that the technology is mature and that everything must be bet on the Digital Health File. “There, we want to find a heart, a machine, to which we will be able to connect fewer systems, but which will all talk to each other,” he says.
This program was initiated during the pandemic. “We are there. With the technology, the thinking, the ways of doing things internationally, ”he said, refusing to specify the possible costs due to future calls for tenders. A working document obtained by our Bureau of Investigation estimates it between $ 1.5 billion and $ 3 billion.
Listen to Félix Séguin’s column at Richard Martineau’s microphone on QUB radio:
The ministry has already put all IT projects on the network on hold. The unique Computerized Clinical Record (DCI) project of the former liberal minister Gaétan Barrette is shelved. The technologist chosen was obsolete.
No investment to improve it will be approved. Only upgrades to protect it from vulnerabilities can be performed.
“The Quebec system has voluntarily put itself on hiatus to get off to a better start,” said the deputy minister. “Ultimately, there are a lot of systems that will disappear and that will no longer be needed.”
For 20 years, health network stakeholders have used several incompatible IT tools across the territory, which is far from optimal. Quebec has, however, injected a little over $ 2 billion into these projects, most of which have already reached the end of their useful life. However, many are still not fully deployed in the networks. Here are the main ones:
Quebec health file (DSQ)
Start: 2006 and still incomplete
Cost until 2021: $ 1.8 billion
What the MSSS says: The information in the DSQ is incomplete and it should be considered only as a complementary reference to medical information. As a result, in an institution, it is not currently possible to access consolidated patient information.
Clinical record computerized (DCI)
Start: 2012 (still incomplete and suspended)
Cost at December 31, 2019: $ 238 million
What the MSSS says: 24 out of 34 establishments have DCI components. However, the level of functionality is uneven and more often quite low. The chosen provincial solution, Cristal-Net, is not ideal and secure. This solution is not a tool to achieve the goals of digital transformation.
Medical file electronic (EMR)
Cost for Quebec: $ 60 million
It is used in private practices and for their matching with the Quebec Health Record (DSQ). There are several others, depending on family medicine groups.
* Computer systems for young people and those with loss of autonomy have also been failures that have cost tens of millions over the past 20 years. Others, such as the Carnet santé Québec and the online appointment system, have elements that work well. “These are not lost investments,” pleads Deputy Minister Luc Bouchard.
Thanks to the new Digital Health File, Quebec will create a gigantic lake of data accessible to the entire network and to researchers in order to help science.
The Ministry of Health wishes to enhance the data that will be in the Digital Health File.
All university hospital centers as well as public and parapublic organizations that carry out research will be able to use this data.
However, forget the sale of this data, assures Deputy Minister Luc Bouchard. Unlike the Minister of the Economy Pierre Fitzgibbon who wishes to sell the medical data of Quebecers such as those of the Régie de l’assurance maladie to pharmaceuticals, the ministry argues that it is not in question. “We do not want to sell the data,” promises Mr. Bouchard.
The Access to Information Act will have to be radically changed for the project to work. Meetings with Minister of Health Christian Dubé have already taken place and proposals are already on the table.
“Yes, we want to bring the law to a modern stage, which gives access to information in a structured, protected and secure manner,” the deputy minister said. “We make sure to secure it, this is our first concern. ”
Major investments will also be allocated to cybersecurity.
The ministry also assures us that companies that win the Digital Health File contracts will not be able to use Quebecers’ data.