Pilot project at JGH to advance telemedicine in Quebec

MONTREAL – Amid rising COVID-19 admissions, the Jewish General Hospital has launched a pilot project to establish a “virtual ward” for as many as 50 patients to receive their care at home while their vital signs are monitored remotely.

So far, there have been three individuals “admitted”, who would otherwise have been hospitalized but are able to stay home instead, with the Jewish General loaning them medical equipment that can include portable oxygen tanks.

The pilot project – part of a strategy dubbed “Care Everywhere” – is one of the first of its kind in Canada, although similar initiatives have been set up in the United States and Europe. (Island Health and Northern Health, in British Columbia, launched a Hospital at Home project in 2021.) The goals of the new project are to advance telemedicine in Quebec to the next level, improve home care and reduce hospitalizations in an overburdened health network.

Although the project is innovative, it is somewhat experimental, and it’s for that reason that the Jewish General is using extensive “exclusion criteria” to ensure that truly at-risk patients are not admitted to the virtual ward. Premier François Legault has been briefed about the project and is said to be “ecstatic” about its potential.

“We’ve been involved with this digital transformation for quite a while now. It preceded the pandemic, but it got put on the front burner because of the pandemic,” explained Dr. Lawrence Rosenberg, executive director of Montreal’s centre-west health authority, responsible for the Jewish General.

“One of the things we really wanted to do for a while is introduce a virtual care program. Because of the need to free up hospital beds urgently, in a safe way – not just to throw people out, to look after them safely – we accelerated our virtual care program. So we introduced (Tuesday) quietly a virtual care ward where we can care for people at home, monitor their vital signs remotely.

“The main reason people get admitted with COVID is because they need oxygen,” Rosenberg added. “So we came up with a way of delivering them oxygen at home, monitoring their use and monitoring their O2 sat and everything else that needs to be monitored.”

Back at the Jewish General, a command centre with a dedicated team of clinicians receives the vital-signs signals from the virtual patients every five minutes. At home, the patients are hooked up to “special wearables that monitor in real time a variety of vital signs,” Rosenberg said.

But what would the command centre do in the event that a virtual patient’s health deteriorates suddenly?

“We’ve spoken with Urgences-santé, and if somebody needs to come back, they’ll bring them back to our emergency room,” Rosenberg responded. “These patients are being monitored around the clock. They’re probably getting more monitoring than if they were sitting in the hospital.

“We’ve developed very strict exclusion criteria as to who can be included and not included,” he continued. “Our criteria was so strict to start with that they couldn’t find a patient initially.”

The first virtual patient, a woman, is “absolutely thrilled” to be at home rather than in crowded hospital with the Omicron variant circulating and she’s doing well, Rosenberg said.

The Jewish General, affiliated with McGill University’s medical school, is considered one of the best hospitals not only in Quebec but across Canada. It was initially designated a COVID treatment centre, in part, because its K Pavilion was designed with a potential pandemic in mind.

And throughout the COVID pandemic, the Jewish General has tested new technologies, some more successfully than others. For example, the hospital relied on a sophisticated AI program by Israeli software engineers to project COVID-19 admissions during the first wave in 2020. That initiative was deemed a success.

However, another pilot project involving a smartphone app using facial-recognition technology produced mixed results and never took off.

Last week, COVID hospitalizations rose by 117 to 2,994 across Quebec. At the Jewish General, 138 patients were being hospitalized for COVID, 17 of whom were in the ICU, according to the Health Ministry. That compares with a record of 178 during the first wave.

Source: Montreal Gazette