Quebec hitches a ride on the Infoway

Local company scores a piece of the EHR pie.
Goodbye paper trail?

By Elizabeth Wasserman

For Quebec clinicians tired of being on the wrong side of the digital divide, last month brought good news. The Quebec government has officially joined the drive to transform a chaotic health record system consisting largely of notes scrawled in doctors' longhand into a seamless electronic network.

Quebec is the last province to sign up for the Canada Health Infoway, a government-funded corporation set up in 2001 with a mandate to invest $1.1 billion in the implementation of electronic health records (EHR) in medical facilities across the country. Quebec's Deputy Minister of Health and Social Services, Juan Roberto Iglesias, joined up at the beginning of February. Also in February, Montreal software company Purkinje became the first major beneficiary of Quebec's planned $250 million investment in EHR technology, winning a $2 million contract to provide its Dossier Prescriber software to 52 Family Health Groups (Groupes de mÄdecins de famille).

With this first substantial initiative, Quebec aims to fortify two of the principal weak links in the medical information chain: general practitioner and patient prescription records. Purkinje's Prescriber software, integrates data on patients' medical histories with a drug therapy guide and an electronic prescribing tool. It contains a database of over 23,000 prescribed and over-the-counter medications and natural remedies, and is programmed to alert doctors to potential allergies or dangerous combinations.

CATCH ERRORS TO SAVE $$$

According to a 2002 study sponsored by Western provincial and territorial governments, the reduction of these kinds of errors through the use of electronic prescription systems in Saskatchewan, Manitoba, Alberta and British Columbia would save a combined $184 million per year. Moreover, a study by McGill epidemiologist and EHR researcher Dr Robyn Tamblyn showed that faulty transcription and illegible handwriting account for a 15% error rate in prescriptions, of which 2% have potentially severe consequences.

Dr Tamblyn believes that Quebec has done right to focus first on family practice. "Family physicians provide 80% of healthcare and get too little attention," she says. "They weren't even hooked into the Resource Coordination for Surgical Services for goodness sake! It will benefit them to be organized into more sustainable, larger groups."

According to Dr Fernand Taras, Purkinje's president, increased interest in medical IT solutions can be explained in part by doctors' rising comfort level with the keyboard. "Today physicians are using the computer all the time and computerization is simply not a barrier anymore." The main challenge now, said Dr Taras, is offering health professionals a "value proposition." Put simply, they need to be shown that systems will benefit them personally, and won't just turn them into glorified data-entry clerks.

Recent developments have brought the value of EHR into sharper focus. For one thing, family doctors find themselves increasingly having to keep up with their wired patients. "Patients are using the Internet to get better informed about their own conditions, and doctors who prescribe without knowing much background are starting to look bad," Dr Taras explained. Even more influential is an initiative from the Quebec College of Physicians this year, calling for laws which would require physicians to provide patients and authorized third parties with medical records on demand.

Optimism about EHR in Quebec was reinforced by the results of Laval Regional Health and Social Services Board's February 16 report on its $5.5 million electronic networking project, Système d'information du réseau intégré de Laval (Integrated network information system, or SI-RIL). Launched in October 2001, SI-RIL was designed to facilitate the transfer of information between Laval's 14 family practice and community health clinics and two hospitals. The reported time and cost-saving effects of the system were substantial. At the Cité de la Santé hospital, the proportion of stays exceeding 48 hours fell from 20% in 1995 to 2.7% in 2003. Also 83% of doctors and 82% of patients asked were satisfied with the program.

Infoway's goal is to have half of Canadian healthcare providers using EHR systems by the year 2010, and Quebec's Ministry of Health intends to play a major role in the transformation. In an interview with Le Devoir, Cathy Rouleau, spokesperson for Health Minister Philippe Couillard, expressed hope that the province would get at least a quarter of the $1.1 billion Infoway has at its disposal. How those funds are allocated, however, will be determined less by government officials than by the work of companies like Purkinje. "It's not a question of percentages province by province," Infoway's Corporate Communications Director Cindy Hoffmann emphasized. "That's why we were created as an independent corporation.