Newsweek recognizes CHUM as Canada’s smartest hospital

The Centre Hospitalier de l’Université de Montréal (CHUM) was recognized earlier this year as Canada’s most innovative hospital in a ranking by the U.S-based magazine Newsweek of the world’s top 250 Best Smart Hospitals for 2021.

Twelve Canadian hospitals made the list with CHUM finishing in 56th place, followed by Toronto General, The Ottawa Hospital, Mount Sinai Hospital, North York General and Vancouver General all placing in the top 100. Eighty-nine of the 250 hospitals were in the United States, including the three top ranked hospitals: the Mayo Clinic in Rochester, Minnesota, Johns Hopkins Hospital and the Cleveland Clinic.

The ranking was based on innovations in digital surgery, digital imaging, artificial intelligence (AI), telehealth and electronic medical records.

CHUM finally completed construction of its massive four million square foot downtown campus earlier this year. Built at a cost of $3.6 billion, the hospital boasts 772 individual patient rooms, 39 operating rooms and 65 outpatient clinics. It cares for approximately 500,000 patients annually and employs 17,000 people.

“We were surprised and happy about our ranking, but to be honest, it’s the result of a corporate decision we made five years ago to have an approach to innovation with a view to continuously improve our performance,” said CHUM president and CEO Dr. Fabrice Brunet.

Deploying innovative technologies at CHUM goes hand-in-hand with measurement to confirm a positive impact on efficiency and patient care, not only in the department the technology is intended for, but also in other departments.

“For example, we used an AI tool to improve the flow co-ordination of patients in our OR and had an increase of 15 per cent, but we wanted to know at the same time what the impact would be on the Emergency Department and the medical specialties. This is something that is rarely done. Usually, we just measure the benefit to the department in which the innovation has been implemented, but sometimes you can have deleterious side effects on other activities, and in that case, the global benefit is not the same as we expected.”

CHUM began working to develop the teams and infrastructure for telehealth 10 years ago, so everyone was trained and ready when virtual care and remote monitoring were required to cope with the pressures of the COVID-19 pandemic.

“We dramatically increased our use of telemedicine,” said Dr. Brunet. “We follow patients with cardiac disease, neurological disease, cancer, mental health patients and women with at risk pregnancies. We provide them with IoT connected devices and monitor their status through our co-ordination centre.

“For example, a patient who had cardiac surgery leaves the hospital after five days and goes home. If there is a problem with the wound after seven to 10 days, a picture is taken and sent to our co-ordination centre, where we either reassure the patient that it is nothing to worry about, arrange a consult with a nurse practitioner, or ask the patient to return to the hospital.”

The Ottawa Hospital, which placed 79th in the Newsweek ranking, also used virtual care extensively during the height of the pandemic, noted Dr. Alan Forster, vice-president of information and quality. “Patients who have undergone surgery are being discharged early and receiving post-operative care at home with vital sign monitoring. We have also done that with COVID patients. We send them home, we monitor them from afar and can access escalation of care to a physician or have them come back to the hospital to be readmitted if necessary.”

Virtual care is also offered within the hospital, allowing doctors and nurses to observe and interact with patients using cameras and vital sign monitoring devices. “It doesn’t replace the personal care of a nurse going in, but it does complement it,” said Dr. Forster.

CHUM has concluded that commercially available electronic medical records are deficient in not being able to capture data on the patient’s clinical pathways before and after hospitalization, so it is working with hospitals around the world to develop a personalized patient electronic record that employs AI to correlate different sources of information.

“Most of the EMRs today are very structured, which means there is a lot of data that you cannot insert into the medical record,” explained Dr. Brunet.

“Let’s say you have a patient with diabetes. The patient comes to the hospital and has different investigations and treatments that are recorded in the EMR, but then the patient returns home. Connected devices measure his glycemia and weight, and transmit data to our hub, but it can’t be added to a conventional EMR because it’s not structured for that.

“So, if you want to understand why a patient is worsening or having an episode, you will miss this information. Our hub will collect this information and add it to our data lake, along with the data from our EMR. Then the deep learning machine will make the connection between what happened before, during and after the patient’s hospital stay.”

Dr. Forster, who served as a member of an expert committee advising Newsweek on the criteria for ranking hospitals, credits the Ottawa Hospital’s implementation of an Epic EMR for facilitating its transition to virtual care technologies.

“We were just getting used to it in January when COVID came around and in March [2020] we had to do this major shift. Epic went from being ‘I can’t believe we did this’ to ‘thank God we did this.’ It has been a major benefit to our organization. Having a digital platform with a single EMR allows us to integrate other systems as required.”

In addition to innovations in telehealth and digital records, CHUM is at the forefront of pioneering AI and robotics. AI, for example, is used in imaging to diagnose cancer with the help of data from other sources when the image itself is inconclusive. It’s used to detect seizures, cardiac failure, at risk pregnancy and mental health disorders, including suicide risk.

Robotics are used in surgery, in CHUM’s labs and in the hospital’s pharmacy. Networked bedside terminals are used to interact with patients, provide them with information, connect with family, surf the Internet and watch movies.

While the Ottawa Hospital’s Dr. Forster would like to see Canadian hospitals rank higher, he cautions that “any ranking is open to interpretation, especially when they are based on subjective opinions.”

Innovation, he said, may indeed be more difficult in Canada’s publically funded model of healthcare, but is quick to add, “the Canadian system is quite strong and has benefits that the American system doesn’t have.”

Dr. Brunet, on the other hand, doesn’t think it’s more difficult for hospitals to innovate in Canada because they are publicly funded.

“Whether you’re publically funded or privately funded, you always need to demonstrate that the innovation you want to implement will improve or increase the value of your organization. Sure, we need to keep to a balanced budget, but innovation can help you improve efficiency.”