Notes from “Driving the Future of Digital Health”

Mark Casselman, Digital Health Canada CEO, welcomed over 120 attendees to Driving the Future of Digital Health at the Beanfield Centre at Toronto’s Exhibition Place on October 30. Driving the

Driving the Future of Digital Health

Future of Digital Health is a new one-day digital health industry conference with an interactive format and engaging (slide-free) individual presentations, panel-wide discussions, and audience questions.

With the acknowledgement that the common constant in the digital health industry is change, Mark set the tone for the day with the question: what roles and partnerships will be needed in the future? Three expert panels and an “out of this world” keynote group offered some answers.

Take-away points

  • The empowered user, either consumer, patient, or practitioner, is a common thread in the digital health application story
  • Fragmented economy requires an open partnership mindset – there are no single solutions
  • Less focus on the new widget and more focus on the model that will allow people to share information freely
  • Change the way we work in response to a rapidly changing digital world: more than just figuring out what the next technology will be, reframe the problem set or else we are just going to buy stuff and disappoint people.
  • Before deploying any new technology, first filter out old processes
  • We need better data governance
  • Whoever collects data feels a sense of ownership, which presents challenges around data governance
  • Some data is worth more than others
  • Data should allow us to switch the focus from the provider perspective to the patient perspective by offering more choice to the patient based on data acquired

Keynote Panel
Digital Health: A Launchpad to the Moon + Mars

Dr. Robert Thirsk, Chancellor, University of Calgary and former astronaut, Canadian Space Agency; Isabelle Tremblay, Director, Astronauts, Life Science and Space Medicine, Canadian Space Agency; and Dr. Sonny Kohli, Physician in Internal Medicine & Critical Car, Founder, CloudDX, and finalist of the Qualcomm Tricorder XPRIZE. Moderated by Ivan Semeniuk, The Globe and Mail.

This panel explores what is on the horizon over the next 10-20 years for human travel in space and providing on-orbit medical care, and the potential points of alignment between space-to-earth and earth-to-space digital health knowledge transfer.

Dr. Thirsk noted that an anniversary approached, as November 2 was the first date humans inhabited the International Space Station (ISS), and that people have been in space uninterrupted since 2000.

The unique health challenges of space travel
The health challenges faced by the people aboard the ISS are unique, and include the effects of a new and harsher environment, where everything works against the body. Cardiovascular health is of prime importance, as the walls of the heart thin and the muscle itself becomes deconditioned with prolonged periods in space. Second to cardiovascular health is bone condition, as the absence of gravity causes bones to demineralize. Ocular and mental health are also affected, and landed astronauts require regular post-mission monitoring.

Dr. Thirsk spent six months aboard the ISS in 2009 and, as a family doctor, performed regular medical exams on his fellow ISS staff members. Regular monitoring is crucial, and counter-measures to the adverse health effects of space travel include diet, extensive preflight training, and exercise – as much as two hours daily to maintain normal health and counteract the effects of zero gravity and increased radiation.

The challenge is how to care for someone in space: What are the technical limitations? If we will be leaving lower earth orbit in the future, the human health challenges are huge. A trip to Mars, with travel times exceeding two years, will require complete medical independence.

“When you push the frontier you encounter new problems”

 

Isabelle Tremblay noted that humans are the most important challenge we have in space travel, and there is a renewed focus in the industry on human health research. The astronaut corps use ISS as an operations centre to perform experiments in space, and the Canadian Space Agency (CSA) works with international partners to understand the effects of space travel on humans. Ambitious research projects are underway, with plans to go further and stay longer in space.

International community plans exist for deep-space transport for Mars, on which Canada has played an important role and will continue to contribute. Traditional robotics health and bio-medical systems are very important, as is engaging the broader health and biomedical communities.

“Technology has the ability to set good habits by providing short-term rewards”

 

“Technology has the ability to set good habits by providing short-term rewards,” said Ms. Tremblay. “It is becoming increasingly important that we study and learn how to keep people healthy in space for longer periods of time. CAS has four studies currently on the go: bone and bone marrow, cardiovascular health, and culture — how space station residents develop a unique culture while aboard.”

The extended black bag
After treating attendees to a brief show-and-tell of the “Bold Epic Innovator” prize-winning tricorder, a hand-held health monitoring system, Dr. Kohli addressed the rapid rate of change in the digital health industry, and the potential application of devices like the tricorder to astronaut health: “Look at Star Trek. The technology used to seem futuristic, but now the tricorder exists. The communication devices exist. The 3D printers exist. We have to look ten years into the future just to keep us relevant.” A device like the tricorder could function as an “extended black bag” for a doctor on board a lengthy space mission, giving residents the medical autonomy they need on a long-term mission.

“We have lots of capability in Canada. I would like to see a maple leaf on a medical kit in space”

 

Earth implications of space health research include enabling patients to take care of themselves – keeping the healthy, healthy rather than treating the sick – and using technology to extend medical autonomy to vulnerable segments of the population (seniors, mobility-challenged, and remote communities).

Testing on the ground is important, and isolated communities in Canada’s north could prove ideal for testing. Supporting medical professionals in remote communities is an ongoing challenge, and technologies developed to provide medical autonomy in space could help doctors working alone in remote communities. CSA is jointly developing space and terrestrial applications, with space researchers contributing specialized training, expertise, and experience with integration and partnerships.

On artificial intelligence and bio-monitoring sensors
Training in artificial intelligence (AI) is important, and further study may be required before we know if AI, which is already complementing the work of physicians, could actually replace them in space. The digital health industry in Canada helps by bringing AI and user interface experts together to work toward finding a solution.

Earth-to-space communication delays mean there is a limited ability to monitor astronauts in real-time, and subsequently bio-monitor sensors are valuable and worthy of further research. Currently Canada is actively working on bio-monitoring and analysis on the space station with the goal of providing medical autonomy to crew on longer missions. Implanted monitoring devices are great from a quantum perspective – they contribute hugely to data gathering – but potential issues include infections. Future research may need to focus on non-invasive sensors, like skin surface measuring, to avoid potential negative side-effects of implantable devices.

Panel One

Panel One
Consumer-directed Health Management

Jamie Bruce, Senior Vice President, Healthcare Strategy & Innovation, Shoppers Drug Mart; Dr. Sacha Bhatia, Director of the Institute for Health System Solutions and Virtual Care (WIHV), Women’s College Hospital; Azi Boloorchi, Director of Innovation and Strategic Partnerships, Revera. Moderated by Hadi Salah, Industry Lead at the Office of the Chief Health Innovation Strategist of Ontario.

Today, Canadian citizens are gaining access to health services and information through a growing number of channels – including physical and virtual access points via traditional providers and new entrants. This panel explores intersection points between consumer-driven access, retail health, virtual care, and innovative extensions of traditional care models.

Omni-channel business consumers need to be in on the plan. We need to reorient business to partner across all jurisdictions, and include the consumer in the conversation. Shoppers Drug Mart is talking to patients and digital health providers, and partnering with the doctor and other providers to arrive at solutions that work for everyone involved.

“The consumer wants to know how to make future-focused healthcare”

 

“The consumer wants to know how to make future-focused healthcare,” said Mr. Bruce. “We are redefining the health and welfare experience with better stores.”

Both new models of care and new models of community are required to reach the goal of supporting the patient to achieve independent living in the community. The entire business model of healthcare needs to change to be sustainable – the digital solution comes later. The Institute for Health System Solutions and Virtual Care (WIHV) needed to work on the ground level to figure out how to take tools and get them into the hands of the consumer to help them with their health.

When talking about digital health innovations, we need to replace the term “research” with “program evaluation” – research simply takes too long. We can’t support 4-5 year randomized trials on apps and wearables; that methodology is no longer applicable in a world where the technology is moving and changing so quickly.

“People get invested in a hot project but we need to stay open to all projects”

 

“People get invested in a hot project but we need to stay open to all projects,” says Dr. Bhatia. “Rapid evaluation – Will it work? Will it improve in value? – is required to get useful technology in the hands of the user, and we need to quickly move on from non-starters.”

Useful studies are not just about the technology, but how to implement it into clinical practice. Actually getting people to use the devices, and how to engage all stakeholders, is what matters.

We don’t yet know what the model for digital health is, and we don’t know what types of digital health are coming. The fast pace of innovation makes it difficult to know what will be the thing that works next. First, focus on answering the question of how to make it work – apps and technology only work if the patient understands and cares about their condition.

The challenge of implementing digital technology across multiple sites and jurisdictions becomes a problem of scale and adaptability. At Revera, with 50,000 residents and 40,000 employees working in a highly regulated industry, there was little room for adapting technology that might not work.

“The solution lies in working together with all providers”

 

“We started with the employees,” said Azi Boloorchi. “What can be automated for a Personal Support Worker (PSW)? Does it work, do they want it, and how can we make it work? The solution lies in working together with all providers.”

Patient-focused innovations
Shoppers Drug Mart will be digitizing in-store blood pressure readings, moving from paper readouts that end up in the trash to a smart phone app where consumers can track their readings and share them with their care providers. Digital tools at Revera include sensor-enabled incontinence products that help both the resident and the employee: if the PSW doesn’t have to wake the patient to check on their status, the resident has a better chance of an uninterrupted sleep.

Other innovations include a program that can detect and monitor dementia through a speech sample (less intimidating for the resident than the standard test) and a “fall score” system that enables independence by assessing an individual’s risk of falls and encouraging engagement in physiotherapy.

Government/public partnerships

If our cherished public healthcare system is bursting at the seams, how can we partner with private sector stakeholders to make the most of all available financial resources? Transformative changes available through cost-effective technologies can uncover efficiencies and reduce costs, but government moves slowly and is by necessity risk-averse. There is veritable tsunami of change coming to a $250B industry. Questions we need to answer:

  • Is there a way where we implement new technologies in a reasonably rapid and responsible way?
  • What should we be paying for and what should be privately funded?
  • Could we use a pharmaceutical model around prescription of apps?
  • How to keep people safe but not stifle innovation? How to stay nimble?

Virtual vs. connected care
The idea of virtual care is great, but connected care is what people want. Will my doctor get this info? Will my daughter? Is anyone watching? We aren’t facing a technology problem so much as a workflow, change management, and information issue. We need less focus on the new widget and more focus on the model that will allow people to share information freely.

One of biggest hurdles is the fragmented nature of our health system. Single-payer doesn’t mean fully integrated, and cross-jurisdictional privacy policy conflicts are stalling implementation. We can protect privacy while ensuring fragmentation is limited – more work needs to be done on sharing of personal health information.

Customers can use their power to push for integration and adoption, and Ontario is a great place for this to happen – the government understands how important it is. With advocacy, innovation will happen.

Panel Two

Panel Two
Personal Health Information Meets Personalized Medicine

Angela Copeland, Director, Data & Analytics Strategic Initiatives & Governance Cancer Care Ontario; Sarah Richard, Chief Marketing Officer at Carrot Insights; and Dr. David Jaffray, Senior Scientist, Princess Margaret Cancer Centre. Moderated by Lydia Lee, Partner and National Digital Health Lead, KPMG Canada.

Health data is growing at an unprecedented rate and provides a rich resource for enhancing health service delivery, empowering consumers, and improving health outcomes. Leaders are developing partnerships to leverage decentralized data from many sources to improve decision-support, empower behaviour change and population health, support patient self-management, and deliver precision medicine. This panel examines the opportunities and challenges for driving connected health and enabling new models for consumer engagement and data-driven health care delivery.

The importance of data and meta-data
Analysis is a core capability, and everyone should have strategic data sourcing. But we need to broaden our focus beyond simply collecting data and move toward solving specific problems. We need to change our focus and expand how we work to look at data holistically, as an enterprise asset in the organization. Also, turn our focus to data quality and meta-data; data about the data. How the data is collected impacts the analysis.

Define what our business outcomes should be, and how the data will support them. The digital team doesn’t have a specific value, but exists to digitally enable the work of the organization.

“How can we enable what the organization needs to do?”

 

Data needs to flow. At UHN, a Patient Portal launched at scale in January. As soon as data is available it goes right out to the patients. Informed patients actually help with doctor-patient conversations. The only exceptions to complete data transparency are clinical trial participants, who shouldn’t see results that might influence study outcomes.

Data contains so many valuable details on population health. Imagine population health data in a cloud-based EMR supporting thousands of doctors and millions of lives; EMR becomes a public health platform, like the one that revealed the presence of Zika in certain zip codes.

Who controls the data assets? Imagine inheriting three or four generations of health data – it’s very valuable. The paradigm around who owns the data becomes very valuable.

It’s all about trust. It’s not just a hospital conversation, it’s a government conversation about data and ownership. It’s a latent expiring asset, and we need to get processes in place to work that asset. Government and organizational partnership needs to add consumer into the mix to move us forward. Opportunity exists at a national level, but national data standards are required to facilitate interoperability. Major changes needed to happen.

No separate IT in the future
We are in the first phase of tech connections and digital health. There is no separate IT in the future; we will live in a world where technology connects everything, and all data is streaming into the data lake. Digital will be the background piece running everything, like electricity.

Precision medicine equals personalized medicine. Now that we can measure, we can design treatments and achieve greater precision in deciding on optimal treatments for individuals

The ease at which we can reach scale is incredible. Consumer trends enable us to do so much more than we could before. Consumer health use to be focused on the super-healthy, but we want to focus on people who need it.

There is no real economic incentive to implement new technology to enable population health paradigms. Population health is collecting information and building up a time course, and structuring the incentive around the customer. We can only measure impact by measuring outcomes, but outcome collection is not funded, and incentives are not funded. It doesn’t exist across the board. Patient-reported outcome should happen naturally.

We need Social Impact Bonds and a “deliverology” focus on impacts that deliver results. If you deliver, you get funding. You are held to a result. This is a great model for public-private partnerships. If we don’t offer opportunities to innovate the brains will leave. Broader Public Sector procurement and co-development need to be clearly separated.

“It’s cool to see different industry players all interested in the same thing.”

 

The challenge is figuring out the way we engage with organizations. It’s not about digitizing a process, but about questioning if the process should be there in the first place. And we need more than incubators for new start-ups, we need support for businesses beyond “step two”. Stop building incubators and reallocate funds to post-implementation survival focus.

Follow the money. Innovation comes from the consumer, and the motivation for implementation will come from the consumer side. We are digital natives now; just look at the consumer space and you will see how things are going to go. Change is not going to be driven by the provider sector, but by the client sector.

Dr. Jennifer Zelmer

Panel Three
Health and Care Moves Everywhere

Mary Lou Ackerman, Vice President of Innovation, Saint Elizabeth Health Care; Joe Blomeley, Vice President, Public Sector, Morneau Shepell; and Jennifer Flexman, Director, Product and Service Innovation, LifeLabs. Moderated by Dr. Jennifer Zelmer, President, Azimuth Health Group.

This panel explores innovative partnerships that are moving care and information from hospital to community to work and home.

A great example of partnership comes from the Government of Alberta. When facing lawsuits form jurors with PTSD, the government partnered with Morneau Shepell to developed a juror assistance project to deliver mental health solutions, a tool that is now available to all Albertans. Government partnership pushed that initiative.

Choosing Wisely Canada partnered with LifeLabs on an initiative called “Give the test a rest”, in which LifeLabs worked with primary care doctors to assess suitability of testing rates. The initiative comes from a desire to create value by ensuring end-users are spending money on the right things.

Ideal digital health partners help with understanding available data and improving health literacy. The goal is to deliver not just more data and information, but better quality information that’s taken in context.

Digital health partners might direct a vendor into an area where they should be playing. For instance, insurers sit on huge amounts of data with in-house capacity around data analysis. A good partner will help them figure out what to do with it.

Public sector players are looking for partners who want to collaborate to solve a problem, and who can help with scale and share risk and value.


See pictures from Driving the Future of Digital Health here. 

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