Supporting a major digital transformation initiative in healthcare

A multidisciplinary action research team with members hailing from 7 academic institutions in Québec is actively involved in the rollout of Dossier santé numérique (DSN), the most important digital transformation initiative ever undertaken in any industry in Québec.

A Large-Scale Provincial Project

Fifteen investigators, including 6 from HEC Montréal, have been mandated by the Québec Ministry of Health and Social Services (MSSS) to support decision-makers and managers in understanding and solving problem situations and complex issues related to the DSN (digital health record).

The DSN aims to provide the entire healthcare network with an integrated platform for managing clinical and administrative information with a view to improve employee workflows and the quality of public services. To that end, 2 integrated health and social services centres (CIUSSS) have been selected as showcase regions for the project: CIUSSS de la Mauricie-et-du-Centre-du-Québec and CIUSSS du Nord-de-l’Île-de-Montréal. A province-wide rollout will be considered subsequently.

An Outstanding Action Research

From the outset, ministerial authorities have expressed their wish for an action research approach. Fostering real-time learning, evidence-based practice adjustments, and co-construction of solutions tailored to organizational context; this method involves close cooperation between research and practice communities.

The research team is working on 2 broad objectives:

• Contribute to ongoing reflections by sharing insights gained from literature review, theoretical frameworks, research models, and evidence-based data with the showcase project owners.
• Together with stakeholders on the ground, generate new scientifically certifiable knowledge that could eventually be transferable to comparable contexts.

Four main axes of research were established, based on the needs of partners:

1. Review of international scientific literature
   Leverage insights from scientific literature to inform the research team and project owners about the issues, challenges, potential solutions, and recommendations relating to large-scale rollouts of electronic medical records.
2. Stewardship of the DSN showcase project
   Analyze and assess governance practices at 3 different levels: province-wide, showcase institutions, and the 150 working groups and committees responsible for structuring the DSN’s 51 modules.
3. Change management
   Periodically generate dashboards summarizing change management issues and priorities for all parties involved.
4. DSN impact assessment
   Analyze the impact of the DSN on 4 priority markers: medication circuit, hospital fluidity, first-line mental health services, and home care.

The benefits observed to date in all 4 axes illustrate the active role the team is playing in highlighting areas of tension, co-building steering tools, mobilizing knowledge, and assessing the project’s impact—all while providing direct support to decision-makers and managers of the health and social services network. So far, the research has led to 2 publications in scientific journals: Journal of the American Medical Informatics Association* and Health Informatics Journal.**

The Power of Multidisciplinarity