The Digital Health Record (DSN) from the American company Epic Systems will be tested in the coming months by the Quebec Ministry of Health and Social Services (MSSS) in two establishments in the province, which could signal the imminent arrival of artificial intelligence (AI) applications in Quebec public health.
The MSSS announced in mid-January the signing of an agreement with Epic Systems for the deployment of its solution called EHR (for “Electronic Health Record”, the English equivalent of “Digital Health Record”) in the Center integrated university health and social services (CIUSSS) of the North Island of Montreal and in the CIUSSS of Mauricie-et-du-Centre-du-Québec. Quebec will spend $533 million over 12 years for these two establishments, which will test the technology. If everything works as planned, the contract will be extended to all of Quebec and the bill will rise to 1.5 billion for a period of 15 years.
The ministry requires that data collected in Quebec be hosted by Epic in the province. “We confirm that data hosting will be done in Quebec. We confirm that Epic will have the necessary facilities in Quebec to host the servers as well as the data,” said a spokesperson for the ministry in response to questions from the Duty.
Epic Systems, whose digital health record solution is already used in Alberta and Ontario, has increased partnership announcements over the past year to further integrate AI into its own technology. Health data managed by Epic elsewhere in the country is stored on Azure servers of the American giant Microsoft, with whom Epic also has an agreement to use its generative AI based on GPT, the language model of the Californian company OpenAI. OpenAI, creator of the ChatGPT application, is a close partner of Microsoft.
Epic is one of the two largest computer service providers in the United States, where it has for several years relied on Microsoft and Amazon servers to host its service. Microsoft also has data centers in Quebec. The American giant has also announced at the end of 2023 the construction of four additional centers around Quebec City.
Microsoft hopes, with these new centers, to host data from government services. “This is an opportunity for the provincial and federal governments to use our technology and harmonize public services,” said the president of Microsoft Canada, Chris Barry, at the end of November.
AI for doctors
Epic and Microsoft are fond of digital data because it powers artificial intelligence solutions that they then sell to third parties. Epic says it has information from the health records of 226 million patients spread across the 50 American states. In total, 9.8 billion consultations with their doctors by these patients are used by Epic to develop an AI that it plans to offer to North American doctors later in 2024.
“Right now, about 10% of decisions made by doctors are based on evidence, 90% being anecdotal or based on their previous experiences,” explained the CEO of Epic Systems, Judy Faulkner. “Now we’ll be able to say, ‘Here are 28,572 patients like yours and here’s what worked well for them, which treatments worked faster, which ones maybe took longer but were more successful.’ This information will be shown to the clinician, who can then make the best choice for their patient. »
We do not know if this information, obtained from the analysis of electronic files of American patients from Epic, will be enhanced to include data from Quebec patients. The Department of Health and Social Services promises that “under no circumstances may the supplier access or use data for purposes other than those provided for in the current contract. Access to production data by third parties is prohibited by the contract.”
In its call for tenders won by Epic, the ministry still opens the door to the “automation of certain tasks”, which may imply that AI applications will be used as part of the Digital Health Record from Quebec.
Epic declined to comment following questions from Duty about the use it planned to make of its AI and data management within the framework of the Quebec DSN.
Stimulate Quebec expertise
In the Quebec technology community, we hope that Quebec will not entrust all of the tasks related to the Digital Health Record to foreign companies. There is room, we believe, for solutions created in the province.
“The government can still make room for Quebec companies,” assures the president of Micro Logic, Stéphane Garneau. Based in Quebec, Micro Logic has developed a cloud service used by local developers of AI applications. “Quebec must position itself to be something other than a simple client of a foreign giant,” adds Mr. Garneau. With everything coming in cloud computing and AI, this is enormous potential that should not be missed. »
Same story from assistant professor of digital health and big data analysis at the University of Montreal Jean Noel Nikiema. “We have the best universities in the world in terms of AI. How can we not put all of this together and develop local expertise? » asks the Montreal expert.
“There, we deal with American experts and we risk losing this expertise. Subsequently, it could become even more difficult to change solutions,” he says.