PORT HAWKESBURY, N.S. -- The inability of doctors to access health records was the focus Friday of an inquiry investigating why former soldier Lionel Desmond killed three family members and himself four years ago in Nova Scotia.  

In the four months before the killings, the Afghanistan war veteran repeatedly asked provincial health-care professionals to help him cope with severe post-traumatic stress disorder and major depression

But those doctors and nurses didn't have full access to Desmond's medical records, including files from the Canadian Armed Forces, Veterans Affairs and even some records at the provincial level.

An expert in electronic patient records told the inquiry that the systems Nova Scotia uses to keep track of medical records remain "antiquated."

"Many of the systems across the province are old and in need of an upgrade," said Alyson Lamb, a clinical nursing informatics officer with Nova Scotia Health.

The inquiry has heard Desmond, who served in Afghanistan in 2007, was diagnosed with PTSD in 2011 while still in the military in New Brunswick. He then returned home to Nova Scotia as a veteran in August 2016.

Several health-care professionals have told the inquiry they had difficulty accessing Desmond's medical records after he moved to Nova Scotia, where he sought help for his worsening symptoms.

Lamb told the inquiry that Nova Scotia currently uses a number of patient information systems, some of which date back to the 1980s. She said most of these systems are not electronically linked, which she says makes it difficult for health-care practitioners in different regions to share patient files.

"If you were to draw it (on paper), it often looks like spaghetti on plate," Lamb said. "There's so many systems with feeds going everywhere."

She said digitization of paper records started in Nova Scotia's central region before being extended to the rest of the province beginning in 2017.

Linda Plummer, Nova Scotia Health's director of health information services, told the inquiry that the province's various systems are not connected to any federal systems. As a result, if veterans want their federal medical records included in the provincial electronic files, they have the option of submitting them for inclusion.

Plummer said it was rare for the health authority to receive that kind of request.

The provincial official suggested that kind of record-sharing should be the responsibility of Veterans Affairs Canada, which often appoints case managers to veterans who need additional help. Desmond's case manager has yet to appear before the inquiry.

The inquiry has heard that staff at Veterans Affairs were in the process of securing mental-health services for Desmond when he killed his 31-year-old wife, Shanna, their 10-year-old daughter, Aaliyah, and his 52-year-old mother, Brenda, in their home in Upper Big Tracadie, N.S., on Jan. 3, 2017.

Desmond had started talking to a community psychotherapist in Antigonish, N.S., in December 2016 -- but that therapist told the inquiry she never received any medical records from Veterans Affairs, and she had yet to start providing any real therapy.

She also said that if she had known the extent of Desmond's mental challenges, she would have declined to offer him therapy.

Meanwhile, Lamb told the inquiry that Nova Scotia is in the process of procuring an informatics system that will allow for full integration of all electronic patient records. But the project has been in the works for several years and is still years away from full implementation.

The new internet-based system will allow patients to gain access to their own health records through their smartphones, she said. This patient portal would also allow people to share their health records with health-care providers in other jurisdictions.

Lamb said there were no plans to automatically integrate any federal health records.

The inquiry does not sit next week and will resume hearings on March 23.

This report by The Canadian Press was first published March 12, 2021.