Province signs deal to bring electronic health records to Nova Scotia

The Nova Scotia government has signed a $365-million contract to bring electronic health-care records to the province, a move officials said Wednesday represents a game changer in the way patient care is managed.

Health Minister Michelle Thompson said the system would begin a staged rollout within two years, with an initial computer portal ready in 10 months.

The change strikes at the heart of long-standing complaints from health-care providers about dealing with inefficient record-keeping systems and outdated technology, and from patients frustrated about having to repeatedly recount their medical history each time they go to the hospital or meet a new provider, said Thompson.

"They're both right," she told reporters at a news conference in Halifax.

Nova Scotia's system still uses "20th century methods," including the phone, fax machine and paper to record and share patient information, along with a range of computer systems that cannot communicate with each other. It's one of the few provinces still using a paper-based system, officials said Wednesday.

"We need to get out of working on paper," Dr. Christy Bussey,  medical executive director of the health authority's central zone, told reporters.

"We need to get into a digital way of delivering care."

The new system known as one patient one record, or OPOR, is a "web of communication" that will lead to better, more timely decisions for patients, said Thompson. It should increase capacity to see patients, cut down on surgery wait times and improve efficiencies in using acute care beds because the system will track what is happening in real time across the province's regional hospitals, the QEII Health Sciences Centre and the IWK Health Centre.

Getting to this point has been years in the making. A tender was first issued in 2015 under the previous Liberal government. Officials said Wednesday that four companies responded to a call for bids in 2017 before the field was narrowed to two in 2020. The process was paused during the COVID-19 pandemic.

Oracle Cerner Canada, a division of U.S.-based tech giant Oracle Corp., learned in recent days that it was the winner of the contract and a 10-year deal to design, build and maintain the system.

Brian Sandager,  vice-president of Oracle Cerner Canada, said the company would begin with a model tailored to this country's health-care system and then adapt it based on the needs of practitioners. Nova Scotia is the ninth province to sign a contract with Oracle.

Operating costs are not included in the contract with Oracle and government officials would only say on Wednesday that those costs would fluctuate and be updated each year through the annual budgeting process. Thompson said the province is hoping for financial support from the federal government.

Wednesday's news conference was focused squarely on what OPOR could do for Nova Scotia's buckling health-care system.

In the most basic sense, OPOR allows providers in any part of the province to see what's happening with a patient in real time when they enter the acute care system. That means paramedics, emergency department doctors, nurses and specialists will all have access to the same information about a patient as it is being updated.

Lab tests and other diagnostic results will be uploaded to the system immediately and it can also communicate with paramedics, continuing care staff and mental health services, including the SchoolsPlus program.

"It's not very often I'm in a room with this many happy doctors," joked Thompson, who worked as a registered nurse and long-term care administrator before entering politics.

One of those happy physicians was Dr. Leisha Hawker.

The president of Doctors Nova Scotia said it's been more than a decade since she first heard discussions about a single electronic file for each patient and she expects it to be far more efficient than the current situation. 

"I'm either paging the resident ... on call, talking to the charge nurse who's usually trying to hunt down the nurse that's taking care of that patient or I'm calling the patient's room directly and trying to find out what's going on with them and help with the discharge planning," Hawker told reporters.

Dr. Steve Lownie trained and worked as a neurosurgeon in Ontario for 37 years before returning home to work in Nova Scotia in 2020.

Lownie said he left a hospital system in London, Ont., with OPOR, only to find one in Halifax using technology more than a decade older than his previous workplace.

"I felt like I was going back in time," he told reporters.

Like other doctors who spoke Wednesday, Lownie hailed the efficiencies OPOR creates so that physicians and other practitioners can spend more time treating patients and less time waiting for paperwork to be filed or people to return phone calls and faxes.

OPOR cuts down on medication errors and removes concerns about the legibility of orders and records because they will be entered into a computerized system that is consistent across the province.

"This is the biggest thing since MRI," said Lownie. "This is a game changer and it's really going to be great for the people of Nova Scotia."

Future work

Bussey said primary care providers will be able to view OPOR and make digital requests for specialist referrals, consultations and tests through the new system, but they will not be able to do their own charting or add progress notes.

Many primary care providers have their own medical record systems which people using OPOR will be able to view. Bussey said future work will look for ways that OPOR could connect further with primary care providers' existing electronic medical record systems, or roll everything into one entity.

Opposition politicians welcomed the news of the contract, but they said it would be important for the government to be upfront with the public about operations costs of the system as that information becomes available.

Bussey and Thompson were part of a team from Nova Scotia that toured the Vancouver General Hospital as OPOR was rolling out there. Both were stuck by how smoothly the transition went following extensive preparation and how it improved practitioners' workflow.

"They loved it," said Thompson.

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