Despite challenges that remain to be addressed in the implementation of the Digital Health Record (DSN), the digital transformation project in the healthcare system is on track, according to Dr. Christian Carrier, a hematologist-oncologist and head of the hematology and medical oncology departments at Santé Québec Mauricie-et-Centre-du-Québec – Universitaire (formerly CIUSSS).
More than 26,000 users have logged into the DSN out of a total of 30,000 users, it was revealed Wednesday during a virtual press conference held by Santé Québec to present the DSN’s progress report, one month after its rollout in facilities across the Mauricie-Centre-du-Québec and Nord-de-l’Île-de-Montréal regions.
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This represents nearly 90 per cent of all logins to date. Erika Bially, vice president of information technology at Santé Québec, stated that this figure is “very close to the maximum number of users who will log in to the DSN,” as reaching 100 per cent is difficult due to professionals being on leave.
“We’re on the right track, and this project will be beneficial in the medium term for our regions—and, I hope, for the entire province,” Carrier said during the conference.
Bially stated that the government-owned corporation was in the process of developing “the provincial expansion strategy.” She confirmed that the DSN will be rolled out to other facilities, but Santé Québec has not yet decided whether this will be done province-wide. It is also unclear whether the U.S. company Epic Systems will be behind future implementations of the DSN. “We’re talking about the provincial expansion of a digital health record system, which may or may not involve Epic,” she said.
Figures from Santé Québec show that from May 9 to June 15, just over 30,000 system tickets were received; 85 per cent were resolved, and none are pending resolution. Among the tickets considered high priority, 98 per cent were resolved. Another highlight is that records for 687 births were entered into the DSN.
“It’s still very demanding for doctors and the medical team, but we’re making progress,” said Carrier.
He admits that there are still several issues for doctors. “There are process-related challenges. We’ve discussed medication reconciliation, […] the list of consultations, how to ensure there are no omissions or delays on that front, and how to make triage easier. We’re working on it,” he said.
The admission and discharge processes are also challenging. “This is important because it’s what will make the processes run smoothly and speed them up. There are human-machine interaction issues that we’re discovering as we go along,” continues the hematologist-oncologist.
He believes that the challenges for patients who have never interacted with the DSN during a visit will remain “for quite some time.” For these patients, staff must enter all sorts of information, such as weight, height, allergies, medication history, and their full medical history. “It’s clear that right now, for a patient who is already known to us but is coming in for their first visit in the DSN, it’s going to take much longer,” emphasizes Carrier.
There is good news, however, regarding surgeries that had to be postponed: the backlog is being cleared. “In surgery, we were able to resume our usual volume ahead of the target date,” said Adélaïde de Melo, president and CEO of Santé Québec Nord-de-l’Île-de-Montréal, adding that the plan to resume operations was being followed for virtually all activities.
For outpatient clinics, there has been a slowdown in scheduling patient appointments in the two regions where the DSN is serving as a showcase project. “Currently, our focus is on outpatient clinics because the electronic conversion of data may not have been as smooth as we would have liked,” said de Melo.
She did not provide a specific target for restoring appointment volumes to pre-DSN levels, but she hopes to reach 100 per cent capacity as early as next week.
It is incorrect to say that things have almost returned to normal, according to the Alliance of Professional and Technical Staff in Health and Social Services (APTS), which represents about 100 different job types within the network, such as social workers, medical imaging technicians, occupational therapists, physical therapists, and others.
“The main message, honestly, is the employer’s lack of realism,” protests Véronique Neth, APTS national representative for Mauricie and Centre-du-Québec. “We understand that they want to strike a positive tone regarding the DSN, […] but no one I’ve spoken to has told me, ‘I’m able to get back to the pace I had before the DSN was implemented.’ So this gap between what the employer says and what’s actually happening on the ground is still quite significant.”
According to what employees have told Neth, filling out paperwork in the new computer system is time-consuming, not intuitive, and staff often get stuck. For example, filling out a home support assessment form used to take about 45 minutes, whereas it now takes around four hours.
Teresa Muccari, APTS national representative for North Island of Montreal, points out that frequent changes to the system make it difficult to get the hang of the tool.
“Santé Québec’s statement trivializes the experiences of people who use [the DSN]. Our members tell us that it’s a huge mess and that there’s a great deal of distress. It trivializes all of that and also trivializes the impact it has on users—users who haven’t received meal assistance services, for example,” explains Muccari. She notes that in North Island of Montreal, some professionals are considering working in another region where the DSN has not yet been implemented.
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