When the message arrived in his inbox in early 2018, Dr. Brett Belchetz’s company was a fledgling, but rapidly growing, virtual health provider. Maple offered fee-for-service telemedicine, such as prescriptions and doctor’s notes, but had no experience in the public health care system.
Paul Young, from Western Hospital in Alberton, PEI, was about to change that. As the administrator for the 27-bed facility, he was facing huge challenges. A full complement of 10 doctors doing rounds had dwindled to two, and the provincial government had given an ultimatum: come up with a stable plan for in-patient care by Aug. 6, 2018, or close your doors for good.
Desperate, he turned to Maple.
Dr. Belchetz remembers opening the email.
“He asked us if we could provide virtual staffing at the hospital during the night. My gut reaction was, who is this Paul Young guy and should we take this seriously?”
None of Maple’s existing platforms were designed for a hospital setting. They would need to start from scratch to build the type of tele-rounding platform the hospital needed.
Here is what the teams learned about working under pressure, in a public–private partnership:
Have buy-in from all parties
Given the limited timelines, Paul Young made sure senior leaders from the hospital and Health PEI, the regional health authority, were involved right from the first planning meeting.
The solution he and Maple were proposing to hospital officials was unique. Tele-rounding would mean that often there would be no physicians physically on the wards and that rounds would be completed virtually, by physicians across the country.
Having those key decision-makers in the same room was critical for Dr. Belchetz.
“There was very little bureaucracy and very little friction for what needed to happen in PEI, which was the recognition that this was a really good match and a really good idea,” he recalls. “Because the health care needs were so pressing, they were willing to give us the benefit of the doubt and allow us to build that solution.”
Get the necessary regulatory approvals
The provincial government needed to approve the six-month pilot project and change the regulations to allow the “virtual” doctors to be paid to work in PEI.
“Tele-rounding was met with a lot of caution,” recalls Dr. Wassim Salamoun, the medical director for hospitals in western PEI. “We had to provide a lot of data and proof that virtual care was feasible.”
Dr. Salamoun provided examples of hospitals in the United States that were currently using telemedicine successfully.
It also helped that Maple waived its fees for the project, so there would be no cost to the taxpayer.
Three months later, in May 2018, the government gave the green light for what was a first in the province.
Be agile and hire the right staff
Once the approvals came through, Maple had just three months to design, build and test the technology.
“It was an unbelievably tight sprint,” says Dr. Belchetz. “We had to build an entire platform for in-patient virtual care, one that really didn’t exist at that point in time.”
Dr. Belchetz knew he had the technical staff to pull it off but needed a project manager to meet the August deadline. He hired a new team member, strategy consultant Shelly-Ann Rampersad, who had experience implementing system-wide health programs for governments around the world. She added the missing element: she met with hospital staff in PEI, mapped existing workflows and adapted them, and recruited the doctors who would work on the platform to ensure they were licensed in PEI in time for the launch.
She also managed the implementation of the technology, upgrading the wi-fi networks and figuring out what a telemedicine cart would look like.
“Without her, we wouldn’t have been able to pull this off,” says Dr. Belchetz.
Things may go wrong, but don’t despair
On Aug. 7, 2018, the first day without any physicians scheduled on the patient floor, the tele-rounding project went live. There was one hiccup.
“We started our tele-rounding on day one and the cart died about 45 seconds later,” laughs Dr. Belchetz.
Maple had underestimated the battery needs of the telemedicine cart. It has since upgraded the power supply with heavy-duty batteries than can last through an entire set of rounds.
“These are some of the trials and tribulations you face.”
Measure your impact
The goal of the tele-rounding project was to develop a sustainable system at Western Hospital that could deliver a level of patient care similar to that provided by onsite doctors.
Over the six-month period, the hospital consulted with 72% of the 166 patients discharged. A survey indicated that 91% were satisfied with the quality of care they received via tele-rounding and 75% said the experience was equal to or better than seeing a doctor in person.
On the basis of those outcomes, Western Hospital entered into a contract with Maple for its ongoing tele-rounding services until it can recruit more physicians.
As a result of the strong partnership they developed during this project, Maple has helped the hospital and Health PEI develop two other groundbreaking virtual care programs, each completed in less than 90 days.
This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule. Feel passionate about this topic? Please connect with us at firstname.lastname@example.org.