NWT electronic medical records system reaches end of life

The NWT’s electronic medical records system needs replacing, just a few years after it was finally implemented in all of the territory’s communities.

In the legislature, health minister Lesa Semmler said a request for proposals is expected to go out this September for the first phase of the work.

The estimated cost to replace the system is $20 million to $30 million according to Range Lake MLA Kieron Testart.

Testart is personally familiar with the system’s flaws. He’s been trying to figure out a lung infection and, at his most recent appointment, the system was down and the terminal in the exam room wasn’t working.

“The technology infrastructure really is in desperate need of replacement,” Testart said.

Electronic medical records, often referred to as EMR, is one of a number of different information systems in the territory.

The records are electronic versions of a paper chart that carries a patient’s medical history and primary care information, said Michele Herriot, the Department of Health and Social Services’ chief information officer.

The idea is that EMR keeps all of your medical records in one place so, if you access healthcare in a different community, any provider can look at your information – including past appointments, charting, test results and more.

“If you start off in Inuvik and then you end up in Yellowknife or Hay River, any one of our communities, they’re all charting in the same system,” Herriot said.

Dr Ewan Affleck, a past chief medical information officer for the NWT’s health authority, has lived and worked in northern Canada for 30 years. Affleck was instrumental in bringing the EMR system to the NWT, receiving the Order of Canada in 2013 for his work improving healthcare in remote areas through the use of electronic medical records.

While the NWT started rolling out EMR in 2001, Affleck said, it wasn’t fully implemented in all of the territory’s communities until 2018.

As to why it took 17 years to implement, “it’s just a very slow deployment,” Affleck said. “It was a complex endeavour with a small staff.”

‘The technology needs to change’

Now, the EMR software is at the end of its life.

“Some of these systems we purchased 20 years ago, 15 years ago, so it’s just a natural life cycle of technology,” said Herriot.

“Our electronic medical record system as well as a bunch of our systems are ageing, and we need to replace them.”

Herriot notes it’s not just the age of the systems that’s the problem, but also that these systems are not necessarily meeting current clinical needs.

“As programs and services advance, and change in how the care delivery model looks and functions, the technology needs to change alongside that,” Herriot said.

“In some cases, the technology is old and doesn’t support those new care delivery models. And so we need to replace them for that reason as well.”

Though primary care providers are charting in the same digitized system, different care systems remain compartmentalized. Hospitals, for example, have digitized lab results and appointments, but charting is still done on paper.

“Even though it seems like when you walk in the front doors of a hospital, it looks like they’re checking you in on a computer… if somebody is laying in a bed in the hospital, like as an inpatient, that charting is still all done on paper,” Herriot said.

More modern systems would be able to exchange information between care teams so that it’s less compartmentalized, while maintaining security and respecting privacy rules.

Implementing electronic health records is a pan-Canadian priority, Herriot said. “This is something that across Canada, everybody is moving towards, being able to exchange that information so it’s available to the right practitioner at the right time to support care delivery for clients.”

In a 2022 report, the Expert Advisory Group – an advisory body to the Public Health Agency of Canada, of which Affleck was a member – addressed the topic of EMRs.

“While calls for a single, consolidated, pan-Canadian EMR are appealing in their simplicity, the EAG does not favour this approach,” the report stated.

Instead, the EAG suggested that provinces and territories should adopt common integrated data standards and a person-centred health data architecture to support a pan-Canadian health data network.

This would enable provinces and territories to share patients’ information more easily. That could be especially useful for NWT residents who travel to Alberta for specialized care that’s not available in the North, or for residents displaced by circumstances outside their control, like wildfires.

Currently, Herriot said, “each province and territory is at a different stage of this… in some areas, we’re ahead of some provinces and territories, and in some areas, we’re behind.”

Obviously, implementing new systems takes money and resources – including skilled labour. “A big challenge that we have is technical staff are really difficult to recruit and retrain,” Herriot said. “Because everybody’s doing this across the country, there’s a high demand for the technical staff.”

Mitigating risk

In the meantime, there’s a risk that the technology could stop working altogether.

“If we don’t replace them soon enough, then the technology could fail,” Herriot said. “And then where we have digitized, we could end up having to go back to paper.”

It’s also important to keep in mind the need to mitigate risk of privacy breaches, said Great Slave MLA Kate Reid.

“Over the years, there’s been a lot of privacy breaches in the health system due to things being moved around by accident,” she said.

Implementing a new system can be costly, Reid said, “but you have to balance that with the idea of making sure that we’re mitigating risk.”

The longer we wait to modernize, not just in the NWT but across Canada, the longer that information doesn’t get exchanged, Herriot said. “So if people end up in different care settings, whether that’s across the NWT or across the country, their right information won’t be available, and you could have adverse outcomes then for clients and their care.”

Not being able to share EMRs between provinces was a recent factor in blood cancer patients being told they had to fly to Edmonton every week or every two weeks to receive care.

In May, Semmler told Cabin Radio that oncology staff in Alberta had previously delivered a lot of treatment virtually, but the program would have to stop because the way it was running virtually wasn’t up to Alberta’s standards.

One problem was that the process of transferring bloodwork and records to Alberta involved systems that “do not speak to our system,” Semmler said.

Replacing the EMR needs to move forward, Testart said, so that people don’t end up in situations where they can’t access services or have to be flown out.

“It just adds cost to the system,” he said.

“It puts incredible stress on patients who are often very vulnerable because of their conditions, and it’s going to encourage people to leave the Northwest Territories.

“People deserve a healthcare system in their community.”  

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