Sluggish navigation forcing the user to make several mouse clicks to achieve his goals. Too slow opening of requests. Lack of preparatory employee training. The implementation of a new laboratory information system throughout Quebec has experienced several hiccups since the fall, including delays threatening patient safety, say stakeholders.
After being launched in a chaotic fashion in the fall of 2022 in Laval, in Estrie, at the CHUM and at the Suroît hospital1, the new Provincial Laboratory Information System (SIL-P) was deployed on March 7 at the Charles-Le Moyne Hospital.
And again, it’s not going very well.
“Sometimes there are multiple patient names on the same page. It’s a risk of error not to choose the right one […] When you have a lot of analyzes to request at the same time on several patients, it can become dangerous to make a mistake, “says a professional from Charles Hospital -Le Moyne, who prefers to remain anonymous.
The health network says it is doing “agile development” in this file, while the 165 million contract awarded in 2019 to the company Médisolution indicated that the government wanted a “turnkey” solution. Over the past few weeks, eight stakeholders working in both IT and healthcare have independently contacted La Presse and confided that the SIL-P project is not a “turnkey” project. And that the dangers caused by system failures are real.
Some of them draw the parallel between the tedious implementation of SIL-P throughout Quebec and the mess seen at the Société de l’assurance automobile du Québec (SAAQ) during the launch of its new SAAQclic platform earlier this month- this.
Others worry about the significant problems with this IT transition as an even bigger one brews in the coming months: the digital health record.
With its SIL-P, the government wants the province’s 120 hospital labs, grouped into 11 “clusters” under the Optilab project, to be able to communicate with each other using a single vendor’s system (there are had five before).
In September 2019, Médisolution won the call for tenders to implement this unique system throughout Quebec. The company forwarded questions from La Presse to the Ministry of Health and Social Services (MSSS).
On the day of the launch of the SIL-P at Charles-Le Moyne Hospital, a major breakdown occurred. “We fell into manual mode” which caused significant delays, explains Mélanie Leblanc, president of the executive of the Alliance of professional and technical personnel in health and social services (APTS) at the CISSS de la Montérégie -Center. Some doctors took a second sample from their patient because they thought the first one had been lost. “Emergency doctors came to the lab directly because they wanted results from a patient who was in the shock room,” says Ms. Leblanc. A similar failure also occurred the following day.
At the MSSS, it is specified that the failures observed “were not related to the SIL-P”, but rather to “the middleware of certain laboratory analysis instruments”.
But for Mélanie Favreau, director of the APTS union office at the CISSS de la Montérégie-Centre, the training offered to workers before launching the SIL-P was too fast. Only four small video trainings were offered. “Making an IT change is not easy. But there should be full training before,” adds Natacha Pelchat, national representative of the APTS.
The wait times caused by the IT transition are an additional burden in laboratories that are already under pressure and overwhelmed, according to Ms. Leblanc. Radio-Canada, for example, reported last week that the MUHC laboratories have 20,000 analyzes overdue.
Also at the CHUM, the laboratory fridges are overflowing with overdue samples, according to photos obtained by La Presse. In February, the two medical federations of Quebec wrote an open letter denouncing the “failed deployment” of the SIL-P and asking for an emergency intervention from the Minister of Health, Christian Dubé. “Behind every sample that accumulates in coolers and waits to be analyzed, there is a human,” recalls Ms. Leblanc.
Among the other glitches observed at Charles-Le Moyne Hospital, we note that navigation in the SIL-P is not very instinctive and inefficient.
Delays of 15 to 20 seconds are observed in the display of certain results. “It may not seem like much, but if you have to open hundreds in your day, it adds up,” Ms. Favreau says. In Laval too, we deplore the slowness of the SIL-P, even if the situation is a little better than in the fall. “We are afraid that it will be slower and slower when the other regions are added,” notes Pierre-Luc Carrier, president of the APTS at the CISSS de Laval. Currently, SIL-P is present in nine of the 120 laboratories in Quebec. But the deployment will continue until 2025.
“We paid for something that is not good. And much worse: which is clinically dangerous,” adds a second source, independent of the first, who also works at Charles-Le Moyne Hospital.
To these setbacks was added Wednesday a provincial breakdown of the SIL-P, as reported by La Presse.
In December, faced with problems in the implementation of SIL-P, the Ministry of Health indicated that adjustments were being applied and that it was “agile development”. However, in the specifications of the call for tenders for the SIL-P project, consulted by La Presse, it is indicated that the government was looking for a “turnkey” product.
Assistant professor at the National School of Public Administration, Justin Lawarée indicates that the concept of “turnkey” is normally used for “ready-made” software, especially “in accounting, human resources management or administration”. “It works well for basic functions […] But it can be problematic when applied to a set of organizations for which the processes are not the same,” he says.
At the MSSS, we assure that “the technological solution itself works properly, despite some performance and interface issues […] quickly corrected by the supplier (or in the process of being corrected)”. The MSSS affirms that “banks of hours are provided for in the contract to carry out this work” deemed “minor”, that the anomalies observed “did not concern elements that could endanger patient safety” and that, sometimes, issues locals explain the delays. “Remember that currently there are more than 70 versions of systems that do not communicate with each other (in the laboratories of the health network). It is normal for a project of this magnitude to require adjustments,” says the MSSS.
President of the APTS at the CHUM, Nathalie Moreau notes that “there are always corrections” with the SIL-P, launched in October in her establishment.
Ms. Moreau does not understand the rush to roll out SIL-P to other institutions when there are still many problems and changes. “We haven’t had enough help and we still don’t have enough help to correct the mistakes and be able to get out of it […] We keep going all wrong,” she said.
In a newsletter sent on March 1 to hospitals and obtained by La Presse, the MSSS says it is “aware of the challenges encountered”. “Deploying the SIL-P across the province by December 2025 will not be an easy task,” acknowledges the MSSS, which says it has “implemented several actions,” including “forums” to “establish a more fluid dialogue with clinicians”. A “new version of SIL-P” is also promised in 2023.
Mr. Lawarée recalls that “the objective of a digital transformation is economy, efficiency and effectiveness”. “If, by implementing digital software, you lose a few seconds during each operation, that raises questions in terms of efficiency and, ultimately, it calls into question the relevance of the tool. »
With its 1338 criteria to be met, the call for tenders for the Provincial Laboratory Information System (SIL-P) project launched in 2017 was very ambitious. Only two companies out of the five that already offered their services in this environment in Quebec submitted compliant bids. And the government picked a winner who is being accused today of not having had all the required licenses at the time, La Presse has learned.
In the “Good Practice Guide for Information Technology Contracts” published in 2016, the Treasury Board Secretariat wrote that it is important “that the requirements and selection criteria” of a call for tenders bids “are not excessive in order to promote competition”. With 1338 criteria, was this recommendation met in the SIL-P tender? “More than 1300 criteria seems like a lot to me. I don’t have an average to compare […] But the more criteria you have, the more complex it is,” says Justin Lawaré, assistant professor at the National School of Public Administration (ENAP).
Professor of public law at ENAP, Nicholas Jobidon says he has “no doubt that the public body, which is forced to comply with rigorous and demanding regulations”, has “done its possible”.
While five suppliers shared the laboratory information systems market in Quebec, within three years, the Médisolution system must be implemented everywhere. A report by the Conference Board of Canada and HEC Montreal dated March 2017 states that “if it restricts market access to a single supplier, the government becomes dependent on that supplier”, which risks increase prices in the medium term.
Wouldn’t it have been easier to force the five existing providers to talk to each other than to impose a single system? According to Mr. Laware, it can be interesting to bet on the “interoperability” of computer software. But this solution can also have its share of complexity, particularly in terms of intellectual property and the sharing of algorithms. “In principle it’s a good idea, but in practice it’s more complex. It takes political will,” he said. Mr. Jobidon recalls that it all comes down to a question of “risk management”.
Medisolution did not have all the necessary accreditations when the government awarded it the $165 million contract to implement SIL-P, according to a competing company that filed a lawsuit in Superior Court. Omnitech Labs of Saint-Jean-sur-Richelieu believes that the government should never have awarded the contract and is now demanding $ 75.4 million in compensation from the government, La Presse learned.
In the SIL-P tender, launched in December 2017, it was stated that the tenderer must have “the necessary permits, licenses […] and certifications”.
In order to distribute a medical device in Canada, a company must hold a Medical Device Establishment License (MDEL). This license provides assurance that medical devices “meet safety and efficacy requirements,” says Health Canada.
Gold Médisolution did not hold a valid license when obtaining the contract in September 2019, denounces Omnitech Labs. In an introductory application, the company indicates that “Médisolution does not meet the eligibility conditions of the call for tenders and that its bid must be rejected”.
In its motion, Omnitech Labs says it filed a complaint in May 2019 with Health Canada on this subject and alerted GACEQ (now the Center d’acquisition governmental du Québec) at the time, which had awarded the contract for the SIL- p.
President of Omnitech Labs, André St-Jean says he finds it “disappointing that GACEQ did not wait for the end of the Health Canada investigation to move forward with this contract and did not act accordingly as they had said”. Médisolution and the Government Acquisitions Center did not want to comment on the case since it is before the courts.
A laboratory information system (LIS) is essentially software that acquires data from laboratory robots, analyzes that data, and provides results to healthcare professionals to guide patient care. This software allows, for example, to tell a patient who has had a blood test if he is indeed suffering from diabetes, jaundice or other diseases.
When entering a new patient into the system, healthcare workers must fill in the “species” field. This field has only one choice: “human”. Stakeholders doubt the relevance of this single-option box.
In the patient’s “address” field, healthcare workers should list the apartment first and the street name without an accent thereafter. An “apartment” field also exists, but should be left blank. Which is sometimes confusing.
In a newsletter sent to hospitals, the MSSS provides three pages of “tips and tricks” to better use the SIL-P. It is specified that users must “choose their clinic carefully”, because an error can “result in delays in processing the user”.
In this newsletter, it is indicated that certain search engines in SIL-P modules have distinct characteristics. In one of them, you should know that a parenthesis “is part” of the word. “For example: ‘(DR’ will not be found by specifying ‘DR’.”
