Analysis: Santé Québec’s digital health plans are a PR disaster
No pilot project in health care has sparked so many negative headlines in so short a period as has Santé Québec’s plans to launch digital medical records on May 9.
Consider just a couple of news reports from the past few days:
- “Digital health records: ‘The way this is being done is ridiculous!’ ” read the headline over a Radio-Canada story published Saturday, which quoted a surgeon at Sacré-Coeur Hospital.
- “Fourteen internists are sounding the alarm about digital health records,” declared Le Devoir in an article on Monday, reporting the concerns of a group of Drummondville doctors that the two pilot projects — known in French as the Dossier santé numérique (DSN) — may result in care that is “less safe.”
No wonder, then, that Health Minister Sonia Bélanger went out of her way Tuesday to point out she reserves the right to halt the pilot projects if necessary, adding she’s following the dossier closely every day and holding weekly meetings with Santé Québec.
“I’ll be able to give the green light or the red light before the launch on May 9,” Bélanger told a Presse Canadienne reporter.
Longtime patient-rights advocate Paul Brunet suggested the two projects are far from ready. Santé Québec is launching them in the CIUSSS du Nord-de-l’Île-de-Montréal, which oversees 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.
“It’s frightening,” Brunet said. “We know the government hasn’t been very good at implementing digital platforms.”
Brunet was alluding to the ill-fated launch of the SAAQclic website for vehicle permits, which blew its budget by $500 million and led to massive lineups at SAAQ outlets across the province. Some managers responsible for the SAAQ project are assisting Santé Québec with its DSN deployment.
In what is already being viewed by observers as an ominous sign, the DSN has cost overruns of nearly $135 million and has faced delays of more than two years. Despite those setbacks, nurses will still have to take down patients’ vital signs on paper rather having the information uploaded into the computer system outside intensive-care units, The Gazette reported in January.
In contrast, the Jewish General Hospital in Côte-des-Neiges has kicked off its own pilot project involving digital health records. Under that project, patients’ vital signs will be uploaded digitally across the hospital system. The Jewish General Foundation is financing the project, which has already attracted a $500,000 donation from Shopify president Harley Finkelstein.
Fears over ‘digital sovereignty’ intrusions
Much of the unease with Santé Québec’s projects arises from the fact that the Health Ministry had decided to partner with an American software giant, Epic Systems of Wisconsin.
The prospect of an American firm handling Quebecers’ sensitive medical information prompted the Coalition Avenir Québec’s own cybersecurity minister to take the unprecedented step earlier in April of publicly criticizing the U.S. partnership.
“Is our health data safe right now? I don’t think so. Not at all,” Gilles Bélanger said.
In an apparent rebuke for his public comments, Quebec Premier Christine Fréchette did not name Bélanger to her new cabinet on Tuesday.
For its part, Santé Québec has released a stream of statements on the X social media platform in response to every news report as it defends its handling of the projects. The state corporation managing health care is to hold a technical briefing with reporters Wednesday in the hope of turning public opinion in favour of the DSN.
In a statement, Santé Québec spokesperson Lisa Fiset insisted that Quebecers should not have to worry that their personal medical information might be inadvertently mishandled by a foreign corporation.
“Rest assured, digital health record DSN data will be hosted in Canada, specifically in Montreal and Toronto, in data centres operated by Epic Systems that meet very high security standards,” Fiset said in response to queries by The Gazette.
“These standards are designed to protect the confidentiality, integrity and availability of information through rigorous risk‑management practices. Digital health record data remains the property of Santé Québec. The vendor, Epic Systems, has no control over this data, regardless of the hosting environment.”
Ramping down clinical activities
Concerns about digital sovereignty aside, a number of physicians have complained that Santé Québec will be purposely ramping down clinical activities to ensure that the DSN deployment runs glitch-free. Sacré-Coeur Hospital, for example, will reduce its volume of surgeries to 50 per cent of its capacity in the first week of the deployment and to 75 per cent in the week afterward.
Liberal opposition health critic Monsef Derraji revealed Saturday what he viewed as a host of problems with the deployment at Sacré-Coeur, based on interviews he conducted with staff. Those revelations include labs and the blood bank struggling to integrate with the new system; “superusers” who are supposed to help staff still relying on cheat sheets to navigate the system; and more than 80 per cent of doctors and nurses acknowledging they have not been trained adequately.
Derraji urged Quebec’s professional orders for doctors and nurses to intervene as quickly as possible.
“I request that the Collège des médecins du Québec and the Ordre des infirmières et infirmiers du Québec be officially notified of this situation so that they may promptly assess the actual impact of the DSN rollout on the quality of care, the continuity of services and patient safety,” Derraji said on X.
“The modernization of the network cannot occur without transparency, without listening to those in the field and without absolute priority given to patient safety.”
Meanwhile, Santé Québec will reduce the number of of hospital beds by 104 in the Mauricie and Centre-du-Québec regions, also to accommodate the DSN deployment.
Fiset, of Santé Québec, contends such measures are necessary and anyone with an urgent medical problem will be treated.
“To allow teams to become familiar with the system, some activities will be temporarily slowed down,” Fiset explained. “These measures are intended to support the transition, ensure safety, maintain the quality of care and protect critical areas of our organization.”
“We would like to reiterate that anyone with an urgent health issue will be cared for, across all sectors,” she added. “Service modulations therefore apply only to situations that do not require urgent intervention.”
Santé Quebec’s ‘top-down’ approach
Former health minister Christian Dubé created Santé Québec to run the province’s public medical system more efficiently. But since Dominique Biron took over the reins of the state corporation in 2024, critics have charged that Santé Québec has over-centralized health care in the province, relying on a top-down management style. Until 2021, Biron had served as CEO of the private, for-profit Biron Health Group.
Brunet, of the Conseil pour la protection des malades, blamed Santé Québec’s centralizing approach for many of the DSN’s problems.
“What they need to do is consult the professional medical organizations that will be involved in these projects so that everybody agrees,” Brunet said. “Unfortunately, most of the time it’s been top-down and then (Santé Québec and the government) ask, ‘Why is everyone being so critical?'”
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