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Quebec’s provincewide effort to digitize health records officially begins Saturday, and the cost is going to be at least a billion dollars more than expected.
Initially estimated at $1.5 billion, the cost to deploy the system across all of Quebec is now evaluated at $2.5 billion.
However, some experts warn that even these figures may be conservative. Samer Faraj, of McGill University’s department of social studies of medicine, suggests the final tally could be much higher.
“You’re looking at $5 billion of total cost, possibly more, rising quickly and at least a billion dollars of additional costs yearly,” says Faraj.
The Digital Health Record (DHR) rollout begins as a pilot project within two regional health authorities: the CIUSSS du Nord-de-l’Île-de-Montréal and the CIUSSS de la Mauricie-et-du-Centre-du-Québec.
The Cadillac of e-health records
The high price tag is partly attributed to the platform the province has selected. Widely regarded as the Cadillac of electronic health records, the Epic system is known for its functionality and its premium price point.
In a statement, Santé Québec defends the choice, noting the technology is already a global standard, currently used by over 500,000 doctors in 16 countries. Officials describe the system as a “robust” and “proven” solution despite the high cost.
Beyond the initial setup, Santé Québec has revealed that operating the system in just the first two health authorities will cost $100 million per year, an amount that notably includes salaries for IT support staff, hosting and licensing costs. The public health agency announced the costs on its website Thursday.
With 23 regional health authorities in total, the ultimate annual operating cost for the entire province remains unknown.
The government is moving forward under the shadow of past IT bungles, such as the Dossier Santé Québec which was declared a failure by the Auditor General in 2011.
Premier Christine Fréchette has been adamant that this project will not mirror the more recent auto insurance board transformation chaos.
“There might be bugs, but I assure you, we will not relive another SAAQclic,” Fréchette stated recently.
Digital health records needed, government says
The government maintains that the investment in DHR is non-negotiable for a modern health-care system.
“It’s a profound transformation of our way of doing things and above all, an improvement for patients and all the network’s personnel,” the premier said.
According to the government’s official rollout plan, the primary benefit for patients is the end of information fragmentation. Once the system is fully operational, users will no longer need to repeat their medical history at every appointment, as clinical data will follow the patient automatically between different facilities.
The government argues that the move will ultimately save money by eliminating paper-based inefficiencies and redundant systems, though for now, the focus remains on the massive upfront and recurring costs of the transition.
Santé Québec issued a statement Thursday, claiming the DHR will generate at least $120 million in annual savings, mainly by eliminating several legacy systems and current licenses, as well as reducing costs related to archiving and managing paper files.
“In Quebec, within the health and social services network, there are currently more than 400 different systems and over 4,000 different applications,” argued Health Minister Sonia Bélanger. “As we integrate what we are doing, we will also divest ourselves of existing contracts, which will give us some breathing room.”
WATCH | Some concerned about digital rollout:
Santé Québec to digitize health records in 2 regions, but it’ll come with service reductions
The pilot project will roll out in the CIUSSS de la Mauricie-et-du-Centre-du-Québec and the CIUSSS du Nord-de-l’Île-de-Montréal on May 9. It will centralize patient information on one platform, but several unions and provincial ministers have raised concerns about whether it’ll be ready on time — and how safe patients’ data will be.
Health-care workers have expressed concerns about the launch, which takes place Saturday at 4:00 a.m., and a Radio-Canada investigation revealed that cybersecurity measures will only be implemented after deployment.
In a statement, Santé Québec leadership emphasized that teams, including hundreds of IT workers, are “ready and mobilized on the ground” with the agility to make rapid adjustments as bugs emerge.
Bélanger admitted on Friday that she had been informed of the operating costs for a long time. Fréchette was also notified after taking office.
Guillaume Cliche-Rivard of Québec Solidaire questioned the lack of transparency.
“It is unacceptable from the minister for a project of this scale,” he said.
Liberal health critic Monsef Derraji said the situation “smells like a scandal.” He asked: “How much will the operating costs be if the government decides to go provincewide?”