How the Connected Health Record helps ensure the right care at the right time in the right location

Part 2 of a Q&A conversation with Dr. Justin Cross

In the first part of his Q&A conversation about the Connected Health Record (CHR), Dr. Justin Cross, the CIUSSS’s Chief Digital Health Officer, presented an overview of the multi‑year mega‑project that will have a major impact on the quality of care for users of health care and social services.

As a catalyst for significant improvement, the CHR will enable staff to obtain updated information about each user quickly and easily on a single digital platform at all sites in CIUSSS West-Central Montreal.

In this second installment, Dr. Cross explains what makes this endeavour so complicated and why custom-designing a new system is preferable to installing all‑purpose, ready-to-use software.

Our CIUSSS will be implementing a connected health record (a CHR), rather than an electronic health record (an EHR). What’s the difference?

An EHR and our CHR are both digital healthcare records. However, in Canada, the term “EHR” refers to a tool that’s typically focused on an acute-care hospital.

We’re calling our system the Connected Health Record (the CHR) to emphasize that it will be developed from the ground up, and it will support all of our CIUSSS’s sites—not just the in-patient hospital environment—no matter where someone is sent for care.

Does the CHR fit into the CIUSSS’s pioneering approach of providing the right care at the right time at the right location?

Very much so. Our CIUSSS’s transformative plan is to provide healthcare users with the right care at the right time in whichever setting is most appropriate, safest, most convenient and most comfortable for them.

Once the CHR is up and running, a team that participates in any of these initiatives will be able to log into the system at any location and get the latest information about any patient or healthcare user.

For example, in the Hospital@Home program, certain hospitalized patients complete their recovery by being transferred from the JGH to their home, where they’re remotely monitored by the Hospital@Home care team.

In planning a patient’s smooth transition to the home environment, the team’s members need to know what kind of treatment the patient has been receiving in the hospital. This information will be readily available in the CHR.

Clearly, this is a complicated endeavour, but why is it being described as the most difficult project the CIUSSS has ever undertaken?

Because an enormous number of methodical steps need to be taken on the technical side and the people side.

On the technical side, the IT team has to do a great deal of work to ensure that every site—especially a major hospital like the JGH—can make the switch seamlessly. IT needs to build new interfaces, decommission antiquated systems and extract useful data from old systems before they’re retired.

For any complementary computer systems that remain in place, IT has to build new interfaces to the CHR. In the transition from the old environment to the new one, the timing of the sequence of events is extremely complex. 

On the people side, since change of this magnitude is quite challenging, we’re committed to providing our staff with the support they’ll need to succeed. CIUSSS employees in numerous clinical departments will have a new tool that streamlines their workflow. I’m referring to things like the way patients are checked in or admitted, how documentation is written, how orders are handled, how care plans are prepared, and so on.

This means we’ll have to examine workflows at every site and consult closely with staff, so that the software truly supports the clinical workflow. What we want to avoid is the reverse situation—where we try to modify the clinical workflow to fit a particular piece of software.

And don’t forget that we’ll be doing all of this while maintaining normal operations at the JGH and at other sites across the CIUSSS.

Is our CIUSSS working with an external partner to develop the CHR?

Yes, we’re collaborating with a Canadian firm called Harris Healthcare, which is a division of Constellation Software. Constellation is headquartered in Toronto and is one of the country’s biggest software companies.

Instead of going to the trouble of building the CHR from scratch, wouldn’t it be simpler to buy off-the-shelf software?

We considered buying off-the-shelf software, but determined that the eventual outcome wouldn’t meet our needs as a CIUSSS. Early in our planning process, we looked at a lot of EHRs in North America, Europe and Israel, but none of them met all of our requirements.

A significant reason is that most EHRs focus on activities at a single hospital, so they wouldn’t be suitable for our CIUSSS, where services are delivered at numerous sites.

Another reason is that a great deal of off-the-shelf software comes from the United States, where there’s no public healthcare system. As a result, a major focus of the American products is on features like revenue cycles, private insurance and related financial complexities. That’s not our reality here in Quebec.

Then there’s the fact that off-the-shelf products often make it difficult to access health-related data for purposes other than treating patients.

For instance, at some point in the future, we might want to examine patient data as part of a new quality improvement project or a new research project. Or we might want to introduce a new initiative that requires access to our health-related data.

Some of the companies that develop off-the-shelf products have made it very difficult for this kind of information to be used for those kinds of projects. In fact, some companies actually charge hospitals for access to the information, which is crazy because it’s data about the hospital’s own patients. By building our own CHR, we ensure that we can use our data as we choose.

We also discovered that none of the off-the-shelf systems is dynamically bilingual; the language of the user interface has to be set to all-French or all-English. With our own CHR, we can give each staff member the flexibility to select the language they feel most comfortable working in.

Without question, building your own system can be risky, but there’s also a significant degree of risk in using an off-the-shelf product.

For instance, as was recently noted in the news media, the United States Veterans’ Administration hospital system, which is a huge healthcare delivery system, has run into numerous problems in the course of implementing one of the market’s leading off-the-shelf EHRs. Off-the-shelf doesn’t necessarily mean risk-free.