The launch of the first-line access window (GAP) in several regions of Quebec is compromised by glitches experienced in the deployment of another major IT project: the HUB, an “orchestrator” which is described by Quebec as a “Trivago” of frontline medical appointment scheduling.
“The deployment of the HUB was done in a rush. We are told that time slots remain unfilled. […] It is certain that the success of the GAP is based on a HUB that works,” notes the president of the Federation of General Practitioners of Quebec (FMOQ), Dr. Marc-André Amyot.
“If the HUB is not optimized, I am not super optimistic for the application of the GAP,” says Dr. Michel Tran, who practices in a family medicine group (GMF) in Ahuntsic–Montréal-Nord.
On June 1, Quebec healthcare institutions must have deployed the first phase of their GAP. This counter aims to offer non-emergency consultations with health professionals to patients without a family doctor (see box). Patients who need to see a doctor will be assessed by nurses who can give them an appointment at a FMG in their area. For the system to be effective, nurses will need real-time access to doctors’ availability slots. To do this, they will use the HUB.
Also called the “orchestrator”, the HUB is a platform that brings together data from electronic medical records (EMR) and appointment booking platforms, such as Bonjour-santé or Rendez-vous santé Québec (RVSQ). Rolled out gradually over the past few months, the HUB aims to make it easier to book appointments on the front line.
The general practitioner speaks in particular of duplicates in appointments and patients. “It looks like the HUB was forced on us before it was functional,” she says.
Dr. Tran also notes “a lot of problems with the installation logistics” of the HUB established in his offices for a month, including appointments booked by two different patients. “It brings a lot of frustration because there are more delays when you have double the number of patients in the clinic,” he notes. Dr. Christian Leduc says that 15% to 20% of patients at his GMF in Vaudreuil-Dorion do not show up for their appointments since the HUB was implemented. A situation attributable, according to him, to the fact that the HUB does not limit the number of appointments that can be made by the same person. Another problem, according to Dr. Leduc: since there are no geographical limitations in the HUB, patients from as far away as the Laurentians can make an appointment in Vaudreuil. “It’s really not optimal for tracking,” he says.
Dr. Claude Rivard, from Sainte-Julie, for his part, deplores that with the HUB, his clinic receives patients from “Laval, Pierrefonds, Salaberry-de-Valleyfield, Granby, L’Assomption and even Saint-Lin”. “This has had a direct impact on our accessibility to local primary care, as our outreach patients do not have access to our services. But the most disconcerting thing is that because patients coming from far away get stuck in traffic, you see 30% fewer patients,” he says.
To circumvent the HUB’s shortcomings, some establishments that want to deploy their GAP are currently assigning their appointments “to the mitt”. Head of the local table of the Regional Department of General Medicine of Montreal (DRMG) for Verdun, Ville-Émard, Côte-Saint-Paul, Saint-Henri, and responsible for the GAP file in Montreal, Dr. Ariane Murray recognizes that this way cannot be used when GAPs are fully functional with thousands of appointment slots to manage.
“The HUB’s lack of functionality is pulling us in the foot a bit at the moment. But there is hope […] that these problems will be solved,” she said. At the Ministry of Health and Social Services (MSSS), it is stated that “the IT teams continue day after day to solve the problems that arise” with the HUB. It is considered that with a project of this magnitude, it is “normal that there are technical hiccups”. However, we have mechanisms allowing clinics to send us requests for corrections, which are made as soon as possible. The situation is therefore being closely monitored,” says the MSSS.
The GAP will consist of a single telephone number per region, where patients without a family doctor can call for a non-emergency consultation with a health professional. Administrative agents will filter some of the calls, explains Sébastien Blin, director of the Regional Directorate for Access to Frontline Medical Services at the Montreal DRMG. More complex calls will be triaged by a team of nurses. The launch of GAP was originally scheduled for February 1 in Quebec, but was pushed back. Some establishments have already launched their first phase of the project. Initially, only people aged 60 and over will be able to use the GAP. Other clienteles will be added over the summer so that the counter will be fully functional on September 1.
At the Ministry of Health and Social Services, the HUB is described as “a technological solution that facilitates the making of appointments in FMGs”. The HUB integrates a total of 28 different systems, including appointment scheduling systems. Emergency workers can also use the HUB, developed by PetalMD, to redirect certain non-emergency patients (called P4-P5) to clinics. Currently, 580 of the 601 FMGs in Quebec are connected to the HUB. This proportion must reach 100% by June 30.