As a 3rd-year biomedical engineering student at Polytechnique Montréal, by April 2023, I had already completed my compulsory internship and was looking for an additional, out-of-the-ordinary internship experience. That is when I saw the biomedical engineering internship position at the First Nations of Quebec and Labrador Health and Social Services Commission (FNQLHSSC) and where the adventure began.
From mid-May to mid-August, I had to move to Quebec City for my internship, which took place just outside the city, in Wendake, the chief town of the Huron-Wendat nation and its customary territory, Nionwentsïo. Covering an area of 1.1km2, the Saint-Charles River flows through Wendake, whose name in Wendat is Akiawenrahk, meaning “trout river”.
One of the goals of the FNQLHSSC is to provide tools and guidance to non-treaty First Nations communities in the delivery of their health and social services. These communities, made up of 7 different Nations and 26 communities, are scattered across the entire provincial territory of Québec. Thus, my mandate as a biomedical engineering intern was linked to the deployment of an electronic medical record (EMR). Prior to the EMR, the majority of communities were using paper-based methods for medical record note-taking. The deployment of the EMR in each of the healthcare environments was finalized at the end of 2022, and it was noted that some communities were still not using it optimally.
Immersion at FNQLHSSC
This is where I come in. My main role was to analyze the use of the basic and additional functionalities of the EMR in each environment, and to make recommendations for optimizing the use of the platform. This was to be done in constant collaboration with users, and with due consideration for the specific issues facing each community. Indeed, each community has its own governance and is completely autonomous in its decision-making. Our role at the FNQLHSSC is not to impose methods, but to establish a relationship of trust through the sharing and exchange of knowledge. Each community will decide whether to adopt the use of the EMR platform if the solutions put forward suit them.
An experience that stays with you for life
The various communities all face different realities and challenges. For example, some are more isolated than others, making assistance more difficult; others often experience high staff turnover, making it equally difficult to implement sustainable work processes. Some have only recently been connected to the Internet, making the level of computer literacy quite low, and thus complicating the deployment of an EMR. The final objective of my internship, therefore, was to write a report of recommendations to the FNQLHSSC.
The process: I accompanied my colleagues as they trained various users from First Nations health centers on the EMR and data analysis. The health centers would contact us when they encountered issues in establishing certain processes, and we would act as advisors.
My mission also included participating in the deployment of the social component of the EMR for a community located on the North Shore: Uashat mak Maliotenam. Uashat mak Maliotenam is an Innu community divided in two, 14 km apart, managed by the same band council, hence the term mak, which means “with” in Innu. The Uashat part is located in the heart of Sept-Îles, while Maliotenam is more isolated.
At the heart of decision-making
I had the chance to attend pre-deployment meetings with the company trained in clinical solution. During these meetings, we had to take into account the way in which staff worked with their customers, to ensure that we established work procedures adapted to the platform to optimize their work. In addition, we had to raise any issues (e.g. confidentiality of medical data) that we could foresee concerning the use of a single file combined with health services. I also attended remote staff training sessions to identify people who might need extra support. Finally, during the face-to-face “GO-Live”, I had the chance to go out into the community to support staff during the roll-out. I spent a week in each community, moving between the Uashat and Maliotenam sites, training staff, orienting them, answering their questions and helping them to improve work processes. By the end of the week, my colleagues and I had drawn up a list of recommendations to present to the managers, so that they could better supervise their teams in the coming weeks of adaptation. We had to identify the challenges to be taken into account, suggest solutions for supporting individuals or services, and submit additions to be made to the platform to facilitate the transition.
The staff at Uashat were very welcoming and open to our offer of support. Sharing and listening are key values among community members, and this made the GO-Live much easier. Thanks to this warm welcome and open-mindedness, I never felt like a mere intern, but a real employee of the FNQLHSSC, with ideas and comments that deserve to be heard.
During this week, I really saw the impact of the work carried out during the preliminary meetings’ efforts as well as the time saved by the EMR, andabove all, more significantly the greater impact on the improved quality of treatment that the community center’s clients will receive. I have observed some healthcare providers falling behind on their clinical notes writing, but with the use of the EMR, they were able to quickly catch up while still providing the same quality of care. This was the part of the internship that had the greatest impact on me knowing that work done in a very short amount of time can have such a big impact on the work and therefore, on the quality of life of users of the EMR and their patients.
My internship at the FNQLHSSC was one of the most enriching experiences I could have had, and I’m very grateful to the TransMedTech Institute for funding it. I would also like to thank the FNQLHSSC for the opportunity and the trust placed in me. I was faced with new challenges week after week. I had the chance to learn more about the reality of non-treaty Aboriginal communities, their history and culture. I was able to quickly put my analytical and problem-solving skills to good use, as I was continually confronted with different issues specific to each community. We had to constantly adapt our solutions to different realities. Health centers are required to produce annual reports quantifying the work carried out over the course of the financial year, so I deepened my knowledge of data analysis and statistics, concepts I’d only scratched the surface of at Polytechnique. The internship also gave me the opportunity to learn more about change management, something I hadn’t been taught in school.