Report by Tiffany Oei, Rotman School of Management, University of Toronto and Kirti Minocha, Nova Scotia Health

November 10, 2021 – Digital Health Canada’s Driving the Future of Digital Health Virtual Conference took place on Tuesday, November 2. The conference welcomed over 100 attendees for an afternoon of learning, an opportunity to connect with others, and a burst of Olympic-sized inspiration starting at 12PM Eastern Time with A Story of Innovation: How CHUM Became Recognized as Canada’s Most Innovative Hospital followed by Opportunities for Accessing Care in 2021 and Beyond (12:50); Hot Topic: Innovation by Necessity vs. Innovation by Strategy (1:30) Digital Therapeutics (2:00) A Future Where Care Follows the Person, Not the Place (2:35) Workplace Wellness and Mental Health: The Pandemic Effect (3:20) Hot Topic: Advancing Health in a Digital World (4:00) and closing with Canadian Gold Medal Olympian Damian Warner!

A Story of Innovation: How CHUM Became Recognized as Canada’s Most Innovative Hospital
Kathy Malas, Associate to the President & chief executive officer; Pole of Innovation and AI, University of Montreal Health Centre (CHUM) and Luc Sirois, Chief Innovation Officer, Ministry of the Economy and Innovation, Quebec. Moderated by Mark Casselman, CEO, Digital Health Canada.

At CHUM, innovation is deeply integrated throughout the organization, from the CEO ‘demanding’ innovation to frontline staff given dedicated time to solve complex problems one piece at a time. All of this is accomplished by having a small dedicated cross-cutting team that provides structure, tools, processes, and support for innovation. The key is giving the gift of time to work out tough issues by those who are in it every day. This takes a lot of coordination among managers and backing by all C-suite executives and  the board of directors to create feasible schedules for staff. It does not stop there: solutions that come out of these innovation workshops are then piloted for at least 6 months and then learnings are shared widely. Whether it is a success or failure, both are deemed valuable and support the continual ‘keep trying’ attitude to make things better. Digital technology is seen as a valuable tool to achieve innovation. CHUM seeks out partnership with other companies to help create, inform, and confirm results to ensure value creation. Final important steps: knowledge sharing and KPI’s to measure innovation and strategy value. Why this all works is because, at the heart, people want to help people, enabled by Kathy Malas and her team sparking and fanning the flames of innovation.

The post-session question period saw strong support from conference participants for the ‘learning from failure’ model to drive innovation and a virtual three-way ‘finger bump’ in place of a physical handshake!

Opportunities for Accessing Care in 2021 and Beyond
Mark Attila Opauszky, CEO, Sparrow BioAcoustics; Dr. Galia Barkai, Director, Sheba BEYOND (Tel Aviv); Zain Ismail, Director, Center for Healthcare Consumerism, AVIA (Chicago). Moderated by Angela Lianos, Director, Digital Health Data & Services, Ontario Health.

Mark Attila kicked off the panel discussion sharing the power of a virtual chest audio detector for diagnosis of cardiovascular disorder (CVD). Virtually, through smart phones acting as a stethoscope, a patient could record their heartbeat for a care provider team. At Sparrow BioAcoustics, a team of engineers, doctors, and product people have turned the smart phone into a stethoscope. Sounds from the heart, vessels, and lungs can be sufficiently measured to make an accurate diagnosis and conduct informative clinical monitoring. This saves a lot of money and more importantly time, by measuring symptoms as they happen rather than waiting for weeks or even months to see a cardiac specialist. CEO Mark Attila shared his personal health story: he avoided going to the hospital, not really thinking his early symptoms were serious enough to seek treatment. Upon recovery, he reflected that likely many other like him think the same way or for a variety of other reasons avoid going to hospitals. Sparrow is focused on providing instant assessment to reduce risk and save lives by really breaking down barriers leading to more equitable, streamlined services for treating cardiovascular disease.

Creating Sheba BEYOND, Israel’s first virtual hospital, began in the early days of the coronavirus pandemic. Sheba Medical Center had three days to prepare an isolation ward to treat citizens from a Japanese cruise ship with a COVID-19 outbreak. This enormous feat was made possible by bringing together companies that specialised in telemedicine technology (some were competitors) to create a contactless solution. Patients were helped with the technology and physicians were trained in telemedicine use with an emphasis on soft skills such as clear communication. Telemedicine was successful in monitoring and treating COVID-19 patients while containing any spread and reducing contact with hospital personnel. Since Sheba BEYOND opened, telemedicine has evolved and spread into other virtual services with rehabilitation, chronic care management and acute care. Maintaining the closeness of traditional in-person treatment means finding the right balance between virtual and physical care depending on the type of disease and capacity of physicians. Dr. Galia Barkai passionately believes telemedicine empowers patients and allows for better quality, efficacy, and accessibility to healthcare. It is about learning from mistakes to make things work better and collaboration to break down silos. Sheba Medical Center is recognized as one of the top 10 hospitals worldwide by Newsweek.

Advisory based organization AVIA, an early adopter of telemedicine, and saw an explosion of virtual care use among patients and providers during the COVID-19 pandemic – presenter Zain Ismail noted how telemedicine increased from about 400 to upwards of 1100 virtual visits per week. Solutions went beyond synchronous video calls and included chat and instant messaging on a variety of platforms. This all really focused on adopting a journey-based approach by creating patient personas diving into consumer identity, platform preferences, and leveraging digital tools (i.e., Salesforce) to improve patient experience. Zain Ismail’s experience working in both the USA and Canada led to an interesting observation: U.S. hospitals are more willing to try new things and implement at a larger scale, while in Canada, hospitals have a more community-based approach and linking with other services within the healthcare system. There could be cross-learnings between these two approaches in the future.

Participants in the post-session question period highlighted the importance of creating a care method that is personal to the patients i.e. would they prefer receiving text v.s. email or phone call vs. video call?

Hot Topics in Digital Health Part 1: Innovation by Necessity vs. Innovation by Strategy
Moderated by Mark Casselman, Digital Health Canada

A highly-engaged group of participants discussed the following topics:

• Four innovation pillars defined: Demonstrate. Evaluate. Scale. Sustain
• Innovation supports the needs of patients, clients, and customers – it goes where the customer goes
• The importance of the ‘test, fail, redo’ cycle
• What hospital administrative functions can be improved through innovation?
• The importance of setting up innovation by strategy within a governance structure

The group agreed that these ideas for innovation through technology need to be captured, adopted, and followed through; Digital Health Canada will lead a deeper discussion.

Digital Therapeutics (DTx)
Presenters: Andy Molnar, CEO, Digital Therapeutic Alliance (Boston); Dr. Joseph Cafazzo, Executive Director, Wolfond Chair in Digital Health, University Health Network, Centre for Global eHealth Innovation. Moderated by Rina Carlini, President and CEO, Optimal Innovation Group.

What are Digital Therapeutics (DTx)? Evidence-based, clinically evaluated software to treat, manage, and prevent a broad spectrum of diseases and disorders. They are scalable, cost effective, accessible anywhere, and integrate seamlessly. This promotes a holistic care for patients and allow providers and payers to have data to support decision making (ensuring value).

One of the big issues for consumers is there are many apps on the market. It is difficult to tell apart the clinically validated ones from others based on little to no evidence, which may not work or could be even harmful. At eHealth Innovation at the University Health Network, the dynamic team has developed several clinically validated apps to treat and/or help manage several distinct types of diseases:

• bant – aims to show how personal lifestyle impacts blood glucose control.
• Ned – short for “No Evident Disease”, links prostate cancer survivors with their health care team
• iCanCope – comprehensive pain self-management platform for youth living with persistent pain
• Breathe for Asthma and COPD – enables patients to manage their exacerbations with breathing
• Medly for Heart Failure – provided self-care guidance and access to health care team

Barriers to implementing digital therapeutics adoption is high among consumers but low for providers. There is scepticism on efficacy among payers for software working outside the clinical setting. Digital health is primarily seen as a layer of current care rather than a different model of care. Health organizations could then tend to seek out only certain types of technology and not try new things or on the flip try something without evidence backing. Strategies to overcome these barriers focus on developing the evidence base of effectiveness and regulatory approval; these are the largest hurdles for digital therapeutics.

• Clinical trial strategies (know the randomized control trial (RCT) guidelines; demonstrate effectiveness in small trials first and work your way up to larger trials; partner with academic institutions and/or health organizations (e.g., hospitals) for piloting)
• Continually evaluate
• Understand market and business channels (make sure there is a demand)
• Get approval before going to market

The Digital Therapeutics Alliance mission is to broaden the understanding, adoption, and integration of clinically evaluated digital therapeutics with patients, clinicians, payers, and policymakers.

A Future Where Care Follows the Person, Not the Place—It’s Here Already
Suneil Aggarwal Vice President, Hospitals & Health Systems, Teladoc Health (Canada); Zayna Khayat VP Business Development & Strategy, Teladoc Health (Canada)

Teladoc Health is a global leader in whole-person virtual care. They offer fully integrated virtually care that seamlessly works within the existing health care practice. Their solutions enable delivery of whole-person care at any entry point or stage in a person’s health care journey. The emphasis is transforming health care services towards a consumer-like experience with seamless connection that can be done at scale. Teledoc has an extensive global health network and works in these five key areas: acute conditions, pre/post-acute transitions, chronic care management, remote monitoring and wellness, primary care, and triage. A person could be in contact with a doctor halfway around the world and receive timely medical advice right when they need it most.

Suneil Aggarwal and Zayna Khayat are both excited to bring Teladoc into Canada and are deeply committed to making a difference in the health care system. Understanding that digitization is expensive and one of the largest barriers to make the switch, their team works with each client on an individual bases and payment can be made when the results promised are delivered.

Workplace Wellness and Mental Health: The Pandemic Effect
Presenters: Dr. Sanjeev Sockalingam Vice President, Education & Clinician Scientist, CAMH; Dr. Sheri Price Professor, School of Nursing, Dalhousie University; Julie Thurlow Executive Director, Health Services, Workplace Safety and Insurance Board (WSIB). Moderated by Dr. Gurprit K. Randhawa Director, eHealth & Virtual Care Innovation, First Nations Health Authority.

Project ECHO Ontario Mental Health is a virtual training and capacity-building model that conduct needs assessment, curated knowledge, and sharing of challenges, learnings, and opportunities, which builds a community of practice for mental health treatment. Dr. Sanjeev Sockalingam shared his experience during the COVID-19 pandemic and how to cope during this challenging time. The group continually reflects on how to improve the integration of mental health and addictions care in the health care system, lower the barriers to access, adapt based on data and needs, increase partnership, create programs to better support providers, and evaluate impact and engagement among participants.

Dr. Sheri Price shared preliminary findings from eight case studies started just before the COVID-19 pandemic. Among interviewed participants, there was common feedback of burn-out, exhaustion, high workplace demand, and lack of self-care coping strategies. There is still a great amount of stigma surrounding mental health. Dr. Sheri noted that the research survey acted as a self-awareness for respondents who did not even realize they were struggling. There needs to be improvements in having a culture of checking in and asking questions. Having programs that are responsive to learnings that really listen and are then implemented; making sure we are not reinventing the wheel; adopting solutions that are based on research. Also understanding that returning to work is different for mental health—a person could be going back to the same issues in the workplace. We should be building workplaces that contribute to health and wellness, particularly when it comes to mental health.

Julie Thurlow shared work done at the Workplace Safety and Insurance Board (WSIB) for mental health, including passing legislation that acknowledges post-traumatic stress disorder (PTSD) can be cause by the workplace (they have seen an increase for nurses). Her team also developed a Community Mental Health Program with the Ontario Psychological Association to improve access to psychologists for workers who have filed a WSIB claim because of a psychological reaction. Also increase contracts with hospitals to improve triage and timelier services. Challenges still exist, such as difficulties delivering virtual care in rural areas and improvements needed in prevention—it is often too late by the time it comes to filing a claim at the WSIB. What is needed moving forward is a customer-centric navigation system that guides workers to getting the right care sooner. This could be done by setting up a table for establishing a community of practice, leverage system partners, and continual evaluation that WSIB could fully support.

Hot Topics in Digital Health Part 2: Advancing Health in a Digital World
Moderated by Cassie Frazer, Canada Health Infoway

Key Discussion topics:

• Does digital health simplify care?
• Digital health umbrella is large and its important to understand each patient’s individual needs so that care is focused on the patient for the best outcomes
• Having virtual option for remote access is important but also navigation is important. A huge problem in health system today, is that patients often get navigated to the wrong care program. This is where technology can step in, to provide decision support capabilities for navigating the patient through the health care system
• Do digital advancements lead to a healthier population? A survey resulted in patients indicating that they would not have sought care if the virtual option didn’t exist.

Where do we go next? The digital health ecosystem is flooded with tools. We need to step into a place where we integrate them into the health system and make adoption more manageable for the consumer.

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