Disaster Awaits Quebec's "Digital Health Record"
The "Digital Health Record" (Dossier santé numérique -- DSN), launched by the Coalition Avenir Québec government in 2023, will finally be rolled out as a pilot project on May 9, after a delay of more than two years. Initially, it will be used in two "showcase" institutions, the Integrated University Health and Social Services (CIUSSS) of Nord-de-l'Ile-de-Montréal and Mauricie-et-du-Centre-du-Québec. If the trial proves successful, the DSN will become the gateway to the health care network across Quebec. Once fully rolled out, the DSN is supposed to provide every user and resident in Quebec, as well as their health care professionals, with online access to their medical and clinical history and handle appointment bookings and follow-ups, electronic prescriptions, etc.
The system is designed, installed and operated by the U.S. health
care digitalization monopoly Epic Systems. It is not yet
operational but already it has run up cost overruns of nearly $135
million, on an initial total estimated cost of $1.5
billion over 15 years. Some estimate that the cost could in fact
double before the program's full deployment. The former minister
responsible for access to information, Éric Caire, admitted as
much during public hearings on the SAAQclic fiasco, which
involved the digitalization of driver licences and vehicle
registration across Quebec. Radio-Canada reports that an
internal memo by Santé Québec forbids anyone involved in the
project to speak to the media.
Despite the Legault government's mea culpa regarding the
massive cost overruns of the SAAQclic project, and corroborating
the Gallant Commission's conclusions that "there is no obvious
solution" to this corruption, it is clear that the practice of
handing over decision-making and the management of
government services to private interests remains the agenda. These
private interests then use their monopoly position to impose their
dictate and get what they want through blackmail, including
cost overruns, but also control over government decision-making
on matters of health care policies.
Delays and postponements in implementing the DSN are, among other things, linked to a lack of interoperability between the system designed for the "paying user" model in the U.S. and the historical realities of Quebec's public health care system. As a private entity contracted by the U.S. government, Epic Systems manages the medical records of the 340 million residents across all 50 U.S. states and is the largest provider of software for managing critical care, patient monitoring and more in intensive care units in the country's hospitals. It also manages Alberta's health care records system called "Connect Care" and part of Ontario's, and it controls the health records of some fifteen other countries to a greater or lesser extent, including Finland and Denmark where its implementation was viewed as "severely problematic."
To justify the decision to select the U.S. monopoly Epic Systems, Christian Dubé, then Minister of Health, said that "this company is one of the world leaders in the market for digital solutions in the health care sector." However, many observers in Quebec, notably the Union of Quebec Government Professionals (SPGQ), criticized Dubé for failing to draw on Quebec expertise that is already deeply rooted in the historical development of the Quebec health care system. The SPGQ wonders what has become of the CAQ government's "economic nationalism" (as in the "Blue Basket" appeal to Quebeckers to buy local products and the "modern nationalism" promoted by leadership candidate, now Premier, Christine Fréchette) when it comes to choosing partners for "crucial government projects." The SPGQ points out that "protecting and strengthening Quebec expertise should be at the heart of the government's concerns."
It is not merely a matter of cost overruns and delays, which are by no means insignificant. It is above all a matter of what goal and what needs are being served. When he announced the project, Dubé said that the DSN "will improve the patient experience by making it smoother and more transparent" and that "the new technological solution will undoubtedly make the work of health care workers easier by reducing paperwork and the bureaucratic burden." And "by lightening the workload," it "will also help make our health care network an employer of choice" (this is a reference to the exodus of health care professionals and workers due to the untenable working conditions in Quebec's health care system.)
In reality, the party benefiting most from this project is Epic Systems, to the detriment of Quebec's health care needs. In the IT sector, and especially for artificial intelligence companies, public data has become the "new black gold." AI monopolies and oligopolies are scrambling for the massive amounts of data held by public authorities to make their algorithms more efficient and thus more competitive. It is well known that public health systems offer some of the largest databases in the world today.
This data is part of the nation's collective wealth, yet it is appropriated by private interests that not only pay nothing, but are in fact paid to take it over. These private interests are paid from public funds to integrate public data into their for-profit databanks, thus establishing monopoly control and then arrogantly declaring a cost overrun. The resulting expertise belongs not to the government, but to the private company. Such is the logic of the "economic nationalism" of the CAQ government.
By first monopolizing the medical records of certain states, and then of all the states in the U.S., Epic Systems has been able to rise to the rank of the sector's dominant monopoly in the entire world. And then Minister Dubé says the reason for choosing it is that "this company is one of the world leaders in the market for digital solutions in the health care sector"!
Myriam Lavoie-Moore, an assistant professor at Saint Paul University in Ottawa, has conducted an in-depth study on the role of very large private interests in diverting the goals of artificial intelligence in health care and other public or national functions. Her study corroborates in the greatest detail that "technologies no longer respond to the needs identified by stakeholders; rather, it is the market that determines and sets the agenda for health and social care technologies," she said in an interview on the I.A. Café podcast.
She has also written specifically about Epic Systems: "Apart from the fact that its implementation in the public health care systems of Finland and Denmark was such a resounding failure that it became a case study in medical informatics, the company is also known for its resistance to interoperability. This means that integrating other software into its own is difficult, if not impossible. Local innovations in AI could therefore be difficult to add to the system." The same can be said about integrating local expertise, which is seen as a competitor rather than the precious contributor it is, with the government of Quebec saying "let's go with the best" and forget small local potatoes.
The sheer scale of the development of productive forces, combined with private appropriation, has the effect, among others, of exposing the destructive impact of this phenomenon. At the same time, it provides a glimpse of the incalculable benefits that could be gained by harnessing the productive forces for the benefit of the people. Take for example the fact that all of this is currently being directed towards what is known as curative care, as opposed to preventive care. Another conclusion reached by researchers in health AI is that all venture capital is directed towards curative care, because selling a pill or a machine to "cure" is more profitable than putting technological developments in the service of prevention. Just imagine the benefits of applying AI to preventive care in these times!
Governments such as those of Quebec and the provinces and federal government are past masters in running schemes to pay the rich while claiming they are "builders" and "champions of responsible development." They are corrupt and too inept to govern. Health care professionals and workers from all sectors need to assert themselves as decision-makers.
This article was published in
Volume 56 Number 23 - April 24, 2026
Article Link:
https://cpcml.ca/TML2026/Articles/T560235.HTM
Website: www.cpcml.ca Email: editor@cpcml.ca