By Dian Cohen
Local Journalism Initiative
While there’s not much we can do to fix the overall healthcare system, there are ways to use the system we have to our best advantage. One way is to know what our health professionals are saying about the state of our health so that we can be part of the team trying to improve it and the quality of our lives. We can do that by accessing our personal health information and medical records – we’ve had the legal right to do so since 2004.
There are two streams of information in Quebec. One is Quebec’s Health Booklet. It’s an online service that lists the medications you get from the pharmacy, your lab test results, medical imaging reports, medical services you’ve received that are paid on a fee-for-service basis, health workers who’ve consulted your health information. It also allows you to make an appointment in family medicine online using the Québec Medical Appointment Scheduler or register with the Québec Family Doctor Finder (GAMF). It’s all in one place and it’s free.
The second stream is your health professionals’ notes. Your always-curious reporter has had experience requesting health records in Ontario, and like most Canadians, has found the process both frustrating and confusing. You’re given paper photocopies of documents in the file. They’re difficult to understand as they’re written in medical jargon and barely intelligible shorthand.
A quick review of Statistics Canada findings on the subject shows that just over 50 per cent of Canadians reported accessing electronic health information in 2023; 27 per cent were unaware of the existence of such records, and the rest were uninterested or uncomfortable and so never asked.
On Sept. 22, 2024, Quebec added a new phase to its Law 25, that says, among other things, that, at the applicant’s request, computerized personal information must be communicated in the form of a written and intelligible transcript. Your reporter has been running late following up in Quebec; this provided a perfect opportunity to evaluate the provincial system.
To register for your Québec Health Booklet, the only eligibility criteria are having a health insurance (RAMQ) card and being 14 years of age or over.
The first step is to be computer-literate – this is an online service. Next, you have to prove that you’re you — the Government Authentication Service. This is a new service “that will gradually replace clicSÉQUR for authentication to online government services,” according to the website. Opening an account and verifying who you are gives you access to everything you may have to do officially with the government — SAAQclic – Société de l’assurance automobile du Québec online service; Québec certification service for early childhood educators; registration for Public Prescription Drug Insurance Plan; replacement of a RAMQ card if it is damaged, lost or stolen; making your consent to organ and tissue donation official; issuing your directives in case of incapacity; and of course the Québec Health Booklet.
There are more eligibility criteria to authenticate yourself to the government. To open an account you must be over 14, have a social insurance number (SIN), a RAMQ card and ensure that your Quebec-issued identity cards (RAMQ card and driver’s licence) show the same first and last names. Your reporter immediately ran into trouble — driver’s licence has the married surname but the RAMQ card has the maiden name. This situation arises because Quebec’s digital platforms don’t talk to one another. If they did, they would know from other identity markers that the person holding both cards was one and the same. Until this is corrected by your disgruntled reporter going in person to a Service Outlet with other identifiers like a passport, birth certificate, marriage certificate, she is locked out of the system. A big red flag for newcomers to Quebec – make sure the names on your driver’s licence and your health insurance card are the same! And understand that as of 1981, RAMQ for your health insurance card insists on the maiden name, but SAAQ for your driver’s licence doesn’t.
Fortunately a friend became a surrogate – he opened an account without a snag and was able to access his Québec Health Booklet. He reviewed the prescription drugs he takes and the lab tests he’s had and thought the Booklet was complete. A couple of things to add: When you go into the Québec Family Doctor Finder, the first thing you see is that as of April 2024, you will be registering for a nurse-practitioner. The site tells you that it’s not possible to say how long you’ll be on the waiting list.
Bludgeoned but unbowed, your reporter moved on to accessing her files from her local healthcare provider. This doesn’t seem to be difficult. You ask. They print out your file, charge you a small amount for the paper and you’re on your way. Asked why the doctor’s/nurse’s notes can’t be emailed, the answer is concern about security. This is but one of many local healthcare providers. All of them operate in more or less the same manner. The difference between them and other aspects of our lives is striking: we live in the age of email, e-banking and e-commerce. We can not only access, but also manage our private banking, insurance, purchasing and investing online from anywhere. Securely. Why isn’t access to our health information as convenient and secure as it is in banking or buying? Because no one has put in the effort – they’re so far back in the dark ages that the digital systems can’t even speak to each other.
Patient access to information is valuable. It helps us manage our own health. It saves the system money! Our money! Almost half the people surveyed by Canada Health Infoway said that having their health information saved them from having to see a doctor at least once. “The return on investment is significant when we can avoid wasted patient and physician time when a visit isn’t necessary,” says Canada Health Infoway.
What we have is way better than nothing. But we need to keep pushing to ensure that different platforms can talk to each other and then to us. In confidence. We should be able to access to our health information whenever we want and from wherever we connect.
Cohendian560@gmail.com