The gradual deployment of the Electronic Health Record (EHR) in Trois-Rivières

The CHRTR, now a part of the CISSS-MCQ, was formed in 1997 through the amalgamation of the Hôpital St-Joseph and the Hôpital Ste-Marie in Trois-Rivières. Following this consolidation, the majority of operations were gradually transferred to the site of the Hôpital Ste-Marie (of more recent construction). At the time, the CHRTR provided services with 470 short-term care beds, 177 doctors and nearly 1500 nurses and other professionals.


The medical archives, then in the form of paper files, were distributed between the two sites a few kilometers apart. Access to medical records was becoming a major logistical problem whether at one site or the other. When a patient came, some archival records had to be sent by courier, causing significant delays and considerable potential for loss or misfiling upon return. Although some of these logistics could be managed proactively for patients whose arrival was known in advance, all the unforeseen and more urgent situations forced clinicians to work without having (timely) access to part of their patients’ history. Even within the same site, moving records and routing them to the care units posed an obvious logistical problem in itself.


In 2004, the CHRTR signed a contract with Purkinje to implement a digital solution for medical records based on complete EHR software. This solution would make medical records available in the form of electronic documents that could be consulted instantly at all points of service. All the challenges with moving paper files around would be eliminated. The solution aligned with the Integrated Clinical Information Management Network project that was underway at that time.


The transition from consulting paper files to using a computer and consulting on screen was a fundamental operational change. The CHRTR’s strategy aimed to provide maximum benefits to clinicians (speed of access, availability at all points of service, convenient file structure, etc.) while minimizing the time and effort required by stakeholders to obtain them. The approach was to move from paper to electronic first for the archives, and then extend to the solution’s other data and functions. The CHRTR would therefore progress from a digitized archive file to a complete Electronic Patient Record (EPR) covering all data sources.


The starting point for the solution’s deployment was the implementation of digital chains that automated the process of converting paper files into their electronic form. The enormous volume of paper in the archives and the experience of other similar clients led the CHRTR to innovate by introducing the concept of “practical digitalization.” This is a set of processes that helps to identify records that could soon be in use and should therefore be digitized as a priority. This, as opposed to a systematic digitization process of all medical records that would have been carried out before start-up.

Following the initial launch in 2008, the EHR content was gradually enriched by integrating data from other electronic sources such as reports and tables of laboratory results, imaging, dictation, reports, hospital summaries, etc. The solution’s flexibility made it possible to integrate all forms of electronic data available. In 2013, the practice management was established to ensure that each medical record is unique.


As predicted by Denis Lefebvre, Deputy Director of Medical Services, the EHR eventually became the “official” central patient file in the establishment. It is complete and accessible instantly and simultaneously by all authorized parties. Its use is integrated into the organization’s processes and culture. During a pandemic and forced isolation, the EHR has ensured service continuity while minimizing the risks of contamination related to the handling of paper files. The CISSS-MCQ is preparing to continue its EHR’s evolution by expanding it and opening access beyond the CHRTR’s borders.