Quebec’s Digital Health Record Faces Delays, Cost Overruns & Translation Issues

The rollout of Quebec’s ambitious digital health record system, the Dossier santé numérique (DSN), is already facing significant headwinds even before its pilot projects launch in May. Reports indicate a confluence of issues – translation errors, cost overruns, and a platform ill-suited to the province’s healthcare structure – are raising concerns among healthcare workers and casting a shadow over the $402 million project.

A System Designed for a Different Model

At the heart of the problem lies the choice of Epic Systems, an American company, to build and deploy the DSN. While Epic is a dominant player in the US healthcare IT market, its software is fundamentally designed for a highly different system than Quebec’s. As Myriam Lavoie-Moore, a researcher at the Institut de recherche et d’informations socio-économiques (IRIS), explained, the US system is heavily hospital-centric, largely excluding preventative care and social services. “Here, we have a more autonomous, more flexible structure,” she noted. Radio-Canada’s reporting highlights that Epic’s software readily recognizes hospitals but struggles to identify Quebec’s network of long-term care facilities (CHSLDs), community health centers (CLSCs), and other specialized care providers.

This mismatch requires significant customization, a process that is proving both costly and time-consuming. According to sources within the Quebec healthcare system who spoke to Radio-Canada on condition of anonymity, “everything is being created” from scratch to adapt the software to the provincial context. This has led to unexpected budgetary pressures, with cost overruns already totaling $136 million, as reported in 2023.

Translation Troubles and Workflow Disruptions

Beyond structural issues, the translation of Epic’s software from English to French is proving problematic. Sources cite inaccuracies, Anglicisms, and inconsistent medical terminology. Examples include using the term “ordonnance” (prescription) to schedule home visits for novel mothers and “prescription” to refer to interprofessional consultations. Even seemingly minor errors, like using “brancard” for “stretcher,” are raising concerns about potential confusion and medical errors. Santé Québec acknowledges the translation is ongoing and that “very few elements” remain to be completed in the user interfaces.

These translation issues compound workflow disruptions stemming from the DSN’s attempt to digitize all processes. The system relies heavily on standardized online forms, requiring healthcare workers to answer a series of pre-defined questions for each patient interaction. Isabelle Roy, president of the Nord-de-l’Île de Montréal healthcare professionals union, estimates that administering medication in a long-term care facility could grab 20-30 minutes per patient under the new system, a significant increase from the current 5-10 minutes. This increased administrative burden is fueling fears of burnout and potential impacts on patient care.

The Expanding Price Tag and Limited Interoperability

While the current budget for the DSN is $402 million, the total cost could reach $1.5 billion over 15 years if the system is fully implemented across the province. This escalating price tag is raising questions about the long-term financial sustainability of the project. Reports suggest that the DSN may not achieve its goal of consolidating all patient data in one place. Sources indicate that some existing systems and data sources will continue to operate outside the DSN, requiring healthcare workers to navigate multiple platforms.

For example, medication profiles will reportedly remain unavailable within the DSN, requiring staff to scan paper copies into the system. Similarly, Sainte-Justine Hospital reportedly did not approve the integration of its own specialized forms into the DSN. This fragmented approach undermines the core promise of a unified digital health record.

A Culture of Silence and Limited Transparency

Adding to the concerns is a lack of transparency surrounding the DSN’s development. Santé Québec has reportedly prohibited employees working on the project from speaking to the media, creating a climate of silence and hindering public scrutiny. This restriction, as reported by Isabelle Roy, prevents healthcare workers from voicing concerns about the system’s shortcomings. Epic Systems directed inquiries to Santé Québec, which declined to provide interviews regarding the DSN.

Alternative Approaches and What’s Next

Some experts suggest Quebec could have explored alternative approaches to digital health record modernization. Frédéric Cuppens, director of the Institute for Cybersecurity and Cyber Resilience at Polytechnique Montréal, points to France’s federated system as a potential model. Instead of building a centralized platform from scratch, France opted to integrate existing healthcare IT systems through standardized interfaces. This approach is less ambitious but potentially more efficient and less disruptive.

The DSN is currently in the pilot phase, with deployments planned for the Mauricie-et-du-Centre-du-Québec and Nord-de-l’Île de Montréal regions. The initial rollout was delayed from November 2025 to May 2026. The next several months will be critical in assessing the system’s functionality, usability, and impact on healthcare delivery. Key areas to watch include the resolution of translation errors, the streamlining of workflows, and the successful integration of existing data sources. The project’s ultimate success hinges on addressing these challenges and ensuring that the DSN truly improves patient care without adding undue burden to already strained healthcare professionals. The Quebec government’s project dashboard indicates the project is currently 84% complete, with an estimated completion date of December 31, 2027.