This week marks a crucial stage in the next digital health record. However, a few days ago, researchers from the International Observatory on the Societal Impacts of Artificial Intelligence and Digital Technology offered expert findings which raised serious concerns about its performance. Economic and political issues also concern us. Yet, with a few exceptions, public attention directed toward the implementation of the Digital Health Record (DSN) by Epic Systems is almost non-existent.
If the digitalization of the health and social services network seems essential, we cannot resign ourselves to it happening at all costs, at the cost of tying our hands.
The neglected costs of implementation
In the coming days, the two regions hosting the pilot project will “configure” what will soon form the nervous system of the health and social services network. This step demonstrates beyond any doubt that the total costs associated with the implementation of Epic Systems were underestimated.
International firms like Epic tout the ease of implementing their product as if it were turnkey. However, the resources of time and money do not stop at the fees paid to the company that won the contract. The computerization of a work environment as complex as our health system requires the participation of a very large number of actors.
Already, at least eight direct contracts have been awarded to companies to support the transition. At the CIUSSS de la Mauricie-et-du-Centre-du-Québec alone, no less than 1,300 employees must make time to participate in the implementation. This is without counting the numerous researchers who closely follow the procedures and who work hard to ensure its success.
Epic Systems is an American company with a long history of failures all over the world. Denmark, the United States, Norway: examples of deployments that have resulted in minimal improvements or harmful consequences, at enormous cost, are piling up. Although the company recognizes that an adaptation period of a few weeks is essential, data indicates that it takes more than two years before returning to initial performance levels.
After huge investments, it is possible that this system will prove to be a failure. Will we preserve some legacies of this collective experience? Nothing is less sure.
Masters of our data
Quebec acts as if it were investing to improve its own computer network. However, deconstructing the received idea of a turnkey system highlights the problem of sovereignty over the system. Indeed, the efforts made do not serve to develop our DSN. If we bought it we would have a modicum of control, but we would just pay for a license. So, we borrow it from a foreign company that strongly protects its intellectual property. By refusing to be sovereign over an essential health information infrastructure, two problems must be considered.
First, Quebec deprives itself of great flexibility to personalize its computer system in the future. Epic Systems is known for resisting the integration of outside technologies. In artificial intelligence, Epic Systems already has partnerships with major players, such as Microsoft. Thus, the risk is to end up with a digital system that is ill-suited to the needs of the network. We are completely depriving stakeholders of having local initiatives, even if this has proven to be highly beneficial during the pandemic.
Then, limiting the integration of local innovations into the system will completely cut the government off from a sector to support its own economic strategy of digital development. Last January, the Ministry of Economy and Innovation itself reiterated the importance of developing our national expertise and taking control of our digital resources. The Department of Health and Human Services is doing the complete opposite.
As a result, Quebecers will never be the owners of the most important computerization project in the history of the health and social services network: we will be content to pay, year after year, to use our own data, as we pay for a Spotify subscription to listen to our music.
However, other options exist. Renting solutions from dominant US companies will cost more than expected, financially and politically. We must ensure our digital sovereignty in health.