Digital health transformation in Quebec: assessment of interoperability and governance strategies

The rapid expansion of health data has led to unprecedented information availability within healthcare systems. Health information systems (HIS) play a central role in managing this data and enabling improvements in care delivery, system performance, and population health monitoring. Maximizing the value of HIS, however, requires effective information exchange across systems, making interoperability a critical prerequisite. Despite its recognized benefits, interoperability remains a major challenge within Quebec's Health and Social Services Network, largely due to the heterogeneity and fragmentation of HIS across healthcare institutions. This paper assessed how Quebec's Plan sante addressed interoperability challenges, using the dimensions from the Healthcare Information and Management Systems Society (HIMSS): foundational, structural, semantic, and organizational interoperability. This study highlighted initiatives aimed at strengthening infrastructure and information system architecture to support foundational interoperability and showed persistent challenges at the structural and semantic levels, particularly those related to the adoption of standardized data formats and harmonization of clinical terminologies. Finally, significant implementation challenges that require coordinated change management were identified regarding the organizational interoperability. Overall, while the Plan sante demonstrates a clear commitment to technological modernization, it does not fully address the interoperability multidimensional nature. Achieving meaningful interoperability will require sustained efforts across technical, normative, and organizational domains beyond the strategies currently outlined. Recent governance developments, including the creation of Sante Quebec, add complexity to this evolving context and raise further questions regarding the coordination of interoperability governance.