DHiC 10 – Knowledge into Action

Dr. Tracie Risling: If we haven’t sorted out how to translate knowledge to action, and by action, I mean the uptake of science and actual evidence based information by the public, we are running out of time to do that.

Katie Bryski: Hello and welcome to Digital Health in Canada, the Digital Health Canada podcast. My name is Katie Bryski, and I am a podcaster turned digital health professional.

Shelagh Maloney: And I’m Shelagh Maloney, a digital health professional turned podcaster.

Katie Bryski: Data drives our health system, and digital health research is a formidable engine for innovation.

In today’s episode, we explore how research turns into impact, knowledge spurs action, And what leaders need to know to support the next generation of digital health professionals. We are very pleased to welcome two leaders to guide us through the world of research and look towards the future of health.

Joining us today in the virtual studio are Dr. Kim McGrail, Professor at UBC School of Population and Public Health. and CEO and Scientific Director of the Health Data Research Network Canada, and Dr. Tracie Risling, Associate Dean of Innovation in the Faculty of Nursing at the University of Calgary, and President Elect of the Canadian Nurses Association.

Thank you both so much for being here.

Dr. Kim McGrail: Thanks for having us.

Dr. Tracie Risling: So great to join you.

Katie Bryski: So regular listeners will know that we love to start by learning more about people’s journeys and how they got to where they are, so I’ll ask you to tell us about yourselves, and the journey you took to your current position.

Tracie, why don’t we start with you?

Dr. Tracie Risling: Sure, absolutely. Well, I’m a journalist turned nurse, turned educator, turned scientist, turned president elect of nurses, I guess. So it’s a bit of an odd journey, and people often wonder how the zigs and zags of that happens, and I don’t always have a good explanation for it.

Other than I was deeply committed to the health of people and communities in the world, and, you know, I tended to do a bit of that in the journalism work anyway, and, uh, I’m forever grateful for that foundation because it certainly has served me well. Thinking about, you know, how we create connections and build community and in my own journey, so, you know, I really have kept it with me, but truly nursing is the heart of my journey now.

And hopefully, uh, will be for many years still to come.

Katie Bryski: And Kim, yourself?

Dr. Kim McGrail: Same itinerant, not expected, um, not a planned journey. I immigrated from the U. S. after getting a Master’s of Public Health and had really been bitten by the research bug. During my master’s training, I ended up in Vancouver and got a job as a research assistant and things just blossomed from there.

I realized eventually that I had my own questions that I want to, wanted to ask and went on to do a PhD, was lucky enough to have a faculty position that I was able to compete for and end up working at the center for health services and policy research at UBC. And really have focused on equity in healthcare services use and healthcare financing and then got more into digital health and data space because so much of my research was dependent on data.

I do a lot of policy evaluation using large, routinely collected data sets, ideally linked and at an individual level. So it’s been an interesting, unexpected journey, but it has taken me to some pretty interesting places.

Shelagh Maloney: It’s sort of interesting because a lot of our guests have had that circuitous route, but there’s lots of things that folks have in common and a deep curiosity and a passion and an awareness that this could really be a whole lot better than it is now.

So you both are academics, you both work with students. And one of the things that we often talk about and people get into this field to say, well, I had a professor or I had a colleague or I had a mentor. I’m curious about, as a mentor and as a mentee, if you can talk about maybe your experiences there.

Kim, maybe why don’t we start with you?

Dr. Kim McGrail: I was clearly inspired to go back and do my PhD from working with really, really wonderful mentors. And there’s too many to name, but they were people who were around UBC at the time and included Morris Baer and Clyde Hertzman and Bob Evans, people who worked in economics and social determinants of health and the real pioneers in the population health kind of area.

And why I was so inspired by them was what you were saying, Shelagh, that just the curiosity but real commitment to using research to make things better and make things better, particularly for people who were not necessarily being served well by health systems or within the broader social determinant space, people who did not have access to the kinds of things that would help them be healthy, which of course is then essential for being able to choose the things that we want to do in life.

So that was my inspiration from them, that maybe I could do something to help make that better. And I’ve tried to take that into my mentoring of now students, really leading with follow your heart, do what you really are passionate about doing, and a lot of the rest of things will get taken care of if you’re leading with your values and your interests.

Dr. Tracie Risling: I love to be in spaces with folks who fell in love with research from day one or were driven along their career path by research, like Kim has indicated. Whereas, you know, I didn’t really plan on becoming a nurse. It was a bit of a surprise detour, but it was shockingly easy to fall in love with nursing.

It took only a few weeks in pediatrics till my heart was forever taken. And then when I went on to teach nursing, again, instant love. I’ll never be happier than I am in the classroom. And then they were like, well, now you have to do research. And I was like, what? No, wait a second, research? No, I don’t, I don’t think I’d be interested in something like that.

And it took the longest amount of time, and it was actually digital health that brought me into any kind of relationship with research. And on that journey, I have to identify Dr. Lynn Nagel, really a global leader in health and nursing informatics as a mentor of mine. And I’ll never forget, it was maybe a lifetime ago, at least in social media years, we’ll say, and I was going to one of my very first conferences as a new academic.

I don’t even think I was done my doctorate yet. But I was off to this Canadian Nursing Informatics Association conference, and I was going to present on social media and nursing. And I had very senior colleagues tell me, you know, what a frivolous topic this was, and what a fad social media was, and like, what was I doing, and so off to this conference I go, and then who is in this room but Dr. Lynn Nagle and Peggy White, and some of Canada’s most foremost leaders in digital health and nursing informatics, and I was terrified. So not only did I present and that went okay, but as I was presenting my phone dings and who is following me on Twitter but Dr. Lynn Nagle and I was honestly paralyzed on social media for three weeks.

I was like, “But what if Dr. Lynn Nagle sees this tweet that I’ve put out?” And so it’s just the funniest start to a relationship Which I have now benefited from for many, many years and been inspired by and supported in. And honestly, I don’t think I can say enough when folks attain that kind of, kind of reputation and do that kind of body of work, but are still so willing to reach out and support and connect with all of those who are fangirling or fan academic ing behind them.

And I’m just forever grateful and I try to keep that same energy now myself.

Katie Bryski: So one of the things that I always find so interesting is that mentoring is often a bidirectional process, right? Like the, the mentee is learning and the mentor is learning too. So I’m curious, what are some of the things that you’ve learned from your students?

Dr. Tracie Risling: That’s my number one rule. Anytime you work with students or folks, I had a brand new assistant professor in our faculty sitting across my desk today for our first conversation together. Learn first. Learn first is the rule. What comes next for me is, clear the path, but don’t put too many markers along the way.

I like to take those barriers down where I can, but you don’t need to shine every light on that path. You don’t need to give all the GPS coordinates.

Create fail space. I know we’re big on safe space and I like that too, but I also like fail space. And then you have to celebrate. You have to celebrate every fail, every swing, because without those, no progress is made.

Especially in digital health. We know that we have cultivated that idea that we fall forward and it’s a bit harder with the health part. The digital part of that is easy, right? You can fail all over the place in the digital tech world. When we added the health in, you know, all of us who carried the profound responsibility of health took a deep breath on that whole fail forward kind of idea.

But especially with students and in the early career, people have to have those opportunities to take risks. And I, I can’t work in innovation without trying to create that. And I think the last thing is just cultivating connectivity, far beyond myself. You know, I’m one person, one opinion, one set of life experiences.

Who can I plug you into that is going to help you as you continue on your journey? And then, snacks. Can I just say, just a hallmark of my relationships. Can we get some ice cream? Can we get some coffee? Let’s just have a snack and you know, everyone will feel better and we’ll be energized to carry on.

Dr. Kim McGrail: Yeah, there’s not really a lot to add to what Tracie has just said. I just want to pick up on a couple of things. So first of all, it is the greatest pleasure of my job to work with students. And it is because of the bi directional learning. I can, they keep you on your toes. There’s no question that you need to stay on top of the field that you’re working in, and they introduce you to new ways of thinking and.

Because we work in such an interdisciplinary space within our School of Population and Public Health, they’re constantly pulling me into new directions. I have students who have backgrounds in anthropology and philosophy and geography, which is excellent because it brings this entirely new way of thinking about problems.

They also, what we used to teach in graduate school is now what students are often learning in high school. And just thinking about some of the social issues and some of the ways of thinking about problems and what Tracie was talking about, connectivity and collaboration. What we had to learn, they come with second nature.

So they’re already in some sense so far ahead of where I would have been at that stage and that it’s always really inspiring. I also really want to pick up on what Tracie said about the fail space. One of the things I talk with students about is if you don’t have some failures along the way, you’re really not trying hard enough because we should never expect that everything we try is going to work or work the way we want it to.

But that’s such a hard, hard thing for people who are self motivated and goal oriented and frankly, have had, by the time they get to graduate school, they’ve had a certain sort of course of successes. So it’s really important to kind of have those conversations and it’s not just about resilience. It’s really about the expecting that you’re pushing boundaries and sometimes you will push in ways that don’t work and recognizing that and then being able to recover from that and carry on.

Shelagh Maloney: It’s interesting because I think, you know, when you’re talking about innovation, innovation inherently is risky. If you are truly innovating, you are taking risks. At the same time, and Tracie, you touched on this, healthcare is healthcare and sometimes lives are at stake. It’s almost a conundrum. You have to take risks to be innovative, but in digital health, we’re quite a risk adverse industry.

And so I’m curious, Kim, you talked about the backgrounds and all the different varied backgrounds that your students have. How do they feel coming into this space? How do they operate within that environment? Is it new to them?

Dr. Kim McGrail: For some students, it’s new, and we’ve gotten better as a school in accepting students into our program who don’t necessarily have a health background.

And some come from bench science, but some come from completely different areas, which I think is a strength because of the interdisciplinary benefits. I would say that students who come into our department in particular are very driven. They’re self motivated for sure. I think that’s true of most graduate students and undergraduates too, but They’ve come for a very particular reason.

There’s a, something that they feel compelled to try to improve, or a population that they feel they want to support or bring some attention to. And so I think part of the challenge is keeping that motivation high when they see how much change is needed and then how difficult that change can be. But it is that they do come with this very sharp view of what, why they’re there and what it is they want to do through an academic training.

Dr. Tracie Risling: I think, for me, I’ve kind of evolved resilience to grit, exactly for the reasons that Kim has just highlighted, and, and for the challenges, the exponential challenges that health care faces. And this is why we need these increasing transdisciplinary solutions and these collaborative ways forward. There is no way that no one discipline Even among the health professions, there’s no one group of folks who is holding on to the solution in digital health and this path forward.

And also just the support, just for the support alone, right? Like, let’s do this as a group and not as a solo effort here and there, because it’s just too difficult to do alone.

Katie Bryski: And this maybe gets into something I’ve been wondering. So to pick up on Kim’s point about people get into this because they want to make things better, right?

They want to make a change, but we know it can be hard to move from Doing that work in an academic space to seeing the impact on policy and practice. I wonder if you can walk us through what that journey looks like, and if there ways to help facilitate and shorten that time to impact.

Dr. Kim McGrail: This is an excellent question and a really, really hard one to answer.

And I think the way I’ve come to on this is that there’s actually two, at least two different paths for how do you have impact. So one is the one we might think of as the evolving one where the way you have impact is by including people who are going to use your research in the research itself, right?

And this absolutely includes members of the public, patients, because they can help you identify the things that really need attention and the outcomes that matter. But then also clinicians and policy makers that people who are going to have to help implement something that’s successful and, and that sort of thing.

So you’ve got this really broad group of interests and views and ideas that come together. You work on a research project together and by the Very effective working together and everybody having an investment in this, then you have a greater chance of something being successful. If it shows that it’s worthwhile, then there’s more of an ability to implement.

It still leaves a challenge of spreading that to other places, because I don’t think what we want is a research system that requires that kind of integrated, deep. Long process for everything that we do, but that’s one way to have influence. The other I think is equally important, but trickier, which is more of the critical research that will come and say,

“Hey, Hey, health system. There’s a really big problem here. And the way that things are organized right now is not going to solve that. And we need to do something different. And here’s some research from other places, or here’s some ideas about what that might want to do.”

So it’s an interesting kind of conundrum in a way, because on the one hand, you’re building partnerships and you’re doing things in an integrated way, and then on the other hand, there’s times when it’s necessary to come from an external view and actually challenge the system and provide a positive challenge, but a challenge to the way that things are organized or thought about at the current moment.

Katie Bryski: Kind of those two different levers, and it makes me think of Tracie’s comment just a moment ago, you can’t do it alone, either way, right? Whether you’re coming with that external perspective from others or you’re working with those internal partnerships.

Dr. Tracie Risling: Yeah, I have to really echo that collaborative co design piece.

I think that in our work, and I have always been an applied health researcher, which is probably makes sense given my reluctant association with research off the top, but even in the years, which I have identified as such, you know, there’s been a huge change in the visibility, the value, the acceptability of applied health research, you know, especially in very traditional academic settings.

That’s really been something that has come about because of this long length of time between research outputs and their uptake. And I think applied health research, one of the really important reasons that it’s advanced is because it is seen as a way to shorten that window a little bit.

I think that co design, I think, you know, things like integrated, uh, knowledge translation, so that IKT piece, and, and the amazing strides in the same amount of period of time that applied health research has come to be, uh, more favorably viewed. I think, you know, we start to see the amazing work done in implementation science, and even this evolution of knowledge, right, from knowledge translation to dissemination to now CIHR is about to launch its new knowledge mobilization framework.

And we see this here in our university where we have a brand new knowledge to impact office. What a fantastic ability and resource. And really just signaling, not just to our academic community, but certainly to partners internal and external, what we are about, you know, we are about as an academic institution, not only, you know, the creation, the facilitation, collaboration of knowledge, but putting it to work immediately for some benefit.

And I think that that’s really. What has helped me fall in love with research and stay engaged in this, especially in the digital health arena.

Katie Bryski: And I’m curious, does that move towards knowledge to impact and demonstrating it right away? Is that specifically your institution or are you seeing it more broadly across not only the Canadian context?

But also international partners.

Dr. Tracie Risling: I hope so. I hope it’s a movement. I was really impressed. I mean, the university of Calgary is known for its entrepreneurial, you know, when, when you have a slogan that starts something right, you’ve got, you’ve kind of got that upstart energy. And so I’m not surprised to see us.

make this move. But I work with the AI for Public Health CIHR funded training platform. I’m a co-director there and we’ve been running some short courses for folks to get engaged about the impact that artificial intelligence is going to have not just on digital health but data for sure and our health systems.

But we were running this knowledge mobilization course and one of the leads of our knowledge to impact office came and has spoken to students and really talked about You know, this evolution and this transition that we’re seeing, and, and I guess what I see is it’s just a huge validation of some of the work that we have done on really meaningful engagement, not just patients included and patient partners.

Really, again, I think that interdisciplinary wide spectrum approach to these are all of the different voices we need around this table, not just to make this success, but to make it useful so that it’s uptake is immediate and sustained and hopefully scaled.

Dr. Kim McGrail: I feel like I just want to follow up on that just, and I hope this doesn’t come across as a wet blanket on this.

But here’s my concern about all of this. I’m an applied health researcher through and through. I agree with everything that Tracie said. What my concern comes about if we go back to thinking about the fail safe kind of idea. One of the things that could happen, and I’ve seen this happen a bit, is if we expect every single project to have knowledge mobilization output that’s truly worthy of knowledge mobilization, then what we’re saying is we’re going to only do safe projects that are very incremental, that only have small benefits.

So somehow we have to marry this idea that some things are going to fail with that commitment to knowledge mobilization, and if it turns out there’s just nothing that we found here that is worthwhile taking forward, that’s still a success. Finding that something will not work is still a success. So I think it’s just really important to keep that balance in there.

Shelagh Maloney:

I really like that answer. One of the things, and, and Kim, I think it was a Digital Health Canada event I saw you speak at, and it was around artificial intelligence, because that’s what a lot of people talk about these days. But, but I remember one of the things that, one of the comments you made is, let’s choose, and you, and you mentioned it even earlier, choose those critical problems to work on.

There’s lots that we could choose, but it’s not only about a fail safe and being innovative and creating those learning environments, but it’s also let’s, Choose where we’re going to put our stake in the ground and let’s try to really tackle those critical issues Are there two or three projects that you’ve been involved with that you really are tremendously pleased with the outcome and the impact that it’s had?

Dr. Tracie Risling: You know, I was thinking about projects versus kind of like this methodological evolution that we’ve just finished chatting about, you know, how we’ve even talked about knowledge or how we even think about it and value it. And I agree with Kim. I mean, and it, it is worthwhile to note that there are some funding calls in particular that are for the risk takers, right? That deliberately, you know, think about that, but I agree. And not, and not just. Only that, I don’t know if we consistently value and give space for the amount of time that co designing actually takes, authentic co designing actually take, and then I don’t know if there’s enough support actually for knowledge mobilization.

So it’ll be interesting to see. Are we just going to call it a different name, or are we actually going to invest money, not just in the research, but in the uptake and use of the research, right? So that we can have those fails in that space. So we can say, okay, well, this is not how you mobilize knowledge at all.

We need to try it a different way. Even in IKT and some of the great work that’s been done there, again, that’s a typically a subset or a focal point of funding. Whereas what I would like to see if we really want to think about projects where knowledge has moved to action, I think we’re going to need to see some kind of funding or mechanism where after the project is done, there’s actually a body of funding and a focus of work where you can continue to try out a few different ways to build that out and to build that through.

Because there is always a time limit. A clock is always running on that project. And the first thing that’s gonna go, right, is the creative knowledge mobilization. Is, you know, the pressures that can be put on that. And so I think we’re missing an opportunity. And then we’re missing opportunity to action results that are already in existence.

Like it would be really interesting to see funding and other opportunities where you take existing research and the whole opportunity is to see can you scale, sustain, action that knowledge in a new way. And I think this is some of the energy that we see. When we’re privileged to run these design sessions or these hacking sessions, right, is we see sometimes those ideas, but sometimes people are holding on to something that they just want to put into practice in a different way.

And I think there’s an energy to that that could really help us to advance digital health research, but more so that uptake of knowledge.

Dr. Kim McGrail: Building on what Tracie said, my biggest success in research projects has probably been less about specific interventions that are scaled because that’s less about what I do, but more the way that people think about problems or the way that they define or design outcomes, the conceptual development of who we’re worried about and how we identify those people.

It’s those kinds of things. And I think part of this relates to the other thing I’ve been thinking about is that it is true in an applied health research setting, you have everything from the identification of the really critical problems that need addressing, building your teams, going and finding new research or doing a systematic review or whatever it is you’re doing.

All the way to knowledge, mobilization and implementation, something new in practice. And somehow we have started thinking that it is needs to be the same researcher who runs the whole thing from that very beginning piece to the end piece. And I actually think that these skills and the knowledge And capacities are so different in this different parts of the knowledge mobilization pathway.

I think it’s actually time to start thinking differently. Like maybe it’s not me who should be implementing my research intervention into practice or to scale. Maybe it’s somebody else who takes my findings and findings from a number of other studies and packages it and as an actual implementation scientist practitioner who does that.

So I think kind of dislodging this notion that as a researcher, you have to follow everything from A to Z, as opposed to you do your part where your expertise really lies and pass it on to another group of people who have a different set of expertise.

Dr. Tracie Risling: All hail science communicators! We are just finishing a research project on social media, misinformation, and science communication to be an engaging science communicator, to be able to stand up against the onslaught of myths and disinformation, and I will tell you, if we haven’t sorted out How to translate knowledge to action and by action I mean the uptake of science and actual evidence based information by the public.

Like we are running out of time to do that because the threat of mis and disinformation is growing exponentially. The Canadian Medical Association just released their annual report on that with some really fascinating results. We know what is happening in the global mis and disinformation landscape, and actually the World Economic Forum identified it for the second year in a row as the number one threat.

It’s the number one threat to our world! Hi, planetary health – which I mean absolutely is coming in there at number two and then in the 10 year reclaims its top spot But I don’t know if as a science community We’re really thinking about that and I I Kim I could not agree more with what you said. We cannot train Every scientist to become a highly effective science communicator in the next 10 years.

Do I think every scientist should have the opportunity to learn more about effective science communication and the use of digital tools, AI, social media to do that? Yeah, I do. I think we all need to be pushed to step that way. But we need to take advantage of the folks who are really excelling in that field if we really want to put our knowledge into action.

Shelagh Maloney: You know, the misinformation, disinformation, it’s real, there’s no question. And I really like that idea of there are those who communicate well, but I also think that it’s a sign of the times that people are, I want sound bites, I don’t want to read the research and so it’s succinct, but also I suspect Canadians are, they know how to use chat GPT and they are interested in these things or they can become an expert and have an opinion.

And both of you have done work on sort of equity and social determinants. And so I’m curious about how you think, as researchers, as a digital health community, we can help Canadians, particularly maybe those from vulnerable or marginalized populations, access the right kind of information or develop critical skills that will help them think about what it is that they’re reading and learning about.

Dr. Kim McGrail: There’s a lot of conversation going on right now in the health data literacy and digital health literacy space and to the extent that the conversation includes how do we create curriculum that goes all the way back into elementary school. I would liken it a bit to all of the, for those who are old enough, the sort of media literacy stuff that happened maybe 15 or 20 years ago.

It’s that kind of thing. And I. The thing is that the young kids will get this and they’ll understand it. And so it is this sort of critical thinking and your individual analytics skills, being able to take in different sources of information and parse through what’s believable and what’s not believable.

Those are all great skills. And I think we underestimate all of the public’s ability to take these on. What’s going to become more challenging probably is actually being able to judge the sources of information as they’re coming, particularly because of AI and because there’s some evidence or at least some discussion around the fact that the more AI we have, the more that it could drift from reality because it sort of starts to feed on itself and pulls away from actual facts of things.

So there’s a huge challenge here. But I don’t think this is about helping marginalized communities, only everybody across the whole system from all ages needs these tools and the accessibility of the learning, as well as the accessibility of the tools.

Dr. Tracie Risling: Back on all platforms, please, everyone. This digital health community, researchers, clinicians, leaders, policymakers, everyone, back into the pool, please, of social media.

It’s like the ocean, you cannot turn your back on this. If for no other reason than to know what’s going on, and believe me, everyone gets, you know, exhausted in that space. But if we’re not there, then we will not know how to combat what is there. But it is about co-design and connectivity. And I was reflecting, it’s been this time to come around again on the latest polls that speak about how, you know, nurses, physicians, and other healthcare professionals are among the most trusted in the world and around the world.

And what I’ve really come to think about this week is that trust is not enough. It’s just not enough. We need to create relationships with people. You know, the fact that I say, well, I’m a nurse, so you trust me now, and here’s the three things I tell you, and now, you know, off you go. It’s exactly what Kim has highlighted.

It’s about building a skill set that goes far beyond trust, that is independent, that you use so you can trust yourself, perhaps, right? Like, I’m happy if you trust me because I’m a nurse, but what I want for you is for you to be able to trust that you have the skill and knowledge – even in a very complex, very tricky, and ever evolving climate of misinformation and AI driven information – to be able to trust that you have what you need to make the best choices for your health.

And digital health, I mean, it was already so critically important, but in this era that we’re in now and moving ahead, it is going to have such a role to play in supporting people in this education, in this learning, in the fact checking. All of the tools that could potentially be created in the digital space to really support this in co-development with the folks who are actually going to use it, I think there’s some really exciting times and opportunities, and I think Canada has an opportunity to be such a leader in this space, and I’m excited for those opportunities ahead.

Katie Bryski: And maybe as we start to wind down, we can look towards the future and explore a little bit more of where you think some of those opportunities may be and where you think those really critical areas might be in the research space.

Dr. Kim McGrail: This maybe takes us in a slightly different direction than things we’ve been talking about, but I’ve been thinking a lot about virtual care, in part because it’s one of those examples of something that changed very quickly when it was convenient for the health system and providers within the health system, rather than it changing when it was convenient the preferred thing of patients and families, which, because I would have meant that we went to more virtual care way earlier than March of 2020 when the pandemic hit.

But I think one of the things that Virtual care, virtual systems can do is really make things more accessible and available to people who don’t have ready access to specialty providers who live in rural and remote areas who can engage in self management and understanding their own health data. If we make that available and then connect with providers when they need to.

It’s like it is. So much that can be done from an equity perspective if we can get some of those services, right? so it’s a combination of what Tracie’s talking about with the relational kinds of care but using the technology to actually fix a really important problem in the health system Which is the accessibility of services to people who don’t happen to live in a highly urbanized environment

Dr. Tracie Risling: I think, you know, virtual care, virtual reality, again, you know, as I just said, the digital health space, the digital tools, the solutions that are coming forward have never been as needed, and we are doing quite a bit of work with artificial intelligence right now and thinking about You know, we talked about that transition from social determinants of health to digital determinants of health, and this literacy piece has to be key among it, but also it gives us an opportunity, you know, AI or generative AI that’s trained on the entirety of the internet is one kind of creature, but generative AI that’s It’s trained on reliable evidence based information, Canadian information, right, that can, in a personalized way, cut through the noise and make it so much easier for a patient to get reliable information exactly on the topic they need.

This could be a game changer, especially, you know, in the language that they want, in the, you know, in the amount of information that they want, in the level, you know, of the, the reading level in which they want. If we use this in a thoughtful way. In a co designed way and really thinking how are people going to best be able to use this information?

There are tools emerging now that are going to make things possible that we maybe only dreamed about when digital determinants of health were social determinants of health, but they also still carry the risks That we make things worse and not better, especially when we’re thinking about equity and access, and that’s something that we just can’t have happen.

So keeping an eye, a real eye on that digital divide and how we include people could never be more important than it is in this moment where I think we’re really on another threshold of a huge technological leap forward.

Shelagh Maloney: I think, Tracie, that sort of echoes the comment you made and I really like supporting people in their learning.

And as you said, there’s so much technology and using those tools to benefit to increase access it to help people learn and be critical in their thinking. Be mindful of what they can do just before we, we wind down last thoughts that if you could only talk to people about health research and academia, what would be your key messages to folks, you know, listening to this podcast are interested in this field.

Dr. Kim McGrail: I mean, it’s a fascinating field that’s evolved tremendously in the even relatively shortish time that I’ve been involved in it, so there’s plenty to do and lots of really interesting things to follow. I think I, what I would maybe add to that is just a reminder that we’re in service of people who live in Canada who need health services and deserve equitable and effective health services.

And I, I think what we don’t want to do is design a system that expects them and requires them to engage with all these digital tools and so on because some people really thrive with that. And some people are not interested at all. And it has to be, if we’re really going to be person centered. That choice still needs to be there to say, look, I’m just not, I’m not interested in these, these things.

So it’s exciting for all of us. And I think that our own excitement and hype can kind of overshadow that not everybody’s going to be on that same page and we need to be mindful of them too.

Dr. Tracie Risling: Yeah, as a nurse, I always have to be about where the people and the technology connect. And, certainly a few years ago with the RNAO and AMS, we had that wonderful opportunity to walk through what the future of AI was going to look like for nursing in particular, and just that absolute focus on compassionate care.

Ultimately, when I think about data and I think about evidence and evidence based, I have to think about that critical difference between evidence based and evidence informed. Evidence informed, the art of applying evidence to a person in front of you, which is always a collaborative, relational moment.

Right? This is the evidence. How do you want this represented in your life? You know, in what ways is this going to be useful to you? But I honestly think it’s also the art of turning knowledge into action. Is understanding that uptake is based on engagement on activation right and sustaining that and I think that you know we really open some of those doors when we thought about patient oriented work and started including all of those different voices.

But I think there’s lots left to learn. And I think you have to be, you know, humble about it and you have to, you know, be willing to admit when your solution as passionate as you were about it wasn’t what people wanted. But that’s what makes it exciting. It’s something new every single day, and so if that’s something that you’re interested in, then welcome, come on in.

But also I think more collaboration, you know, you don’t, this doesn’t need to be your full time gig. This is the beauty of applied health research. If you’re a clinician, a leader, a policymaker, an administrator, and you have a problem that needs solving, then I, I encourage you to find your friendly local applied health researcher and see.

Right? You know what their dockets like and can you do something together? And I think we’re starting to see a lot more of this connectivity because there’s a lot more opportunity to have these kinds of conversations and just invite different people into the space so that we can solve these problems together.

Katie Bryski: What a great way to end. Kim and Tracie, thank you so much for being with us today and it really does feel like we’re, we’re at a watershed moment in digital health and the health system generally, so extra appreciate your taking the time to both lead us through how we got here, what could be ahead, and the ways that we can support each other as we navigate the road ahead.

Thanks again. Thanks so much.

Dr. Kim McGrail: Thank you.

Katie Bryski: Well, Shelagh, what did you think of that conversation?

Shelagh Maloney: Gosh. It was so refreshing to hear from Kim and Tracie. I think the digital health research world is certainly not one that I’m, I know very well. I learned a lot from that conversation. And I really liked this whole notion of applied health research, and especially in the digital health world.

And, you know, the comments about there’s so much change going on in our industry right now. And the pace of change is accelerating exponentially. And so having researchers come in and it’s not like that 17 years from, you know, research project to actually putting into practice. We just, we need to move faster than that.

And Tracie and Kim, I think are, are so aware of that and they really have so many things going on and are involved in so many different things and there’s so many different avenues to contribute to. So that was a real significant finding for me and I was really pleased and really enjoyed the conversation.

Katie Bryski: Yeah, it was a really energized conversation. And for me, one of the things that really stuck out was this focus on interdisciplinarity and the value of having people coming from different backgrounds and contributing to research with their different perspectives and experiences. And it made me reflect that digital health itself, I think, is inherently an interdisciplinary field, right?

We’ve got the tech aspect and the health aspect. I think it really speaks to the value of having a field that’s inclusive and has pathways for people to come into the sector. Yeah.

Shelagh Maloney: And the whole concept of, you know, Tracie’s, I think it was Tracie that said, I might take it this far, but then somebody else will take the implementation side and, and it’s sort of that scope of practice and recognizing what you need.

In fact, I was talking to a hospital CIO about a month or so ago, and it was the same sort of concept. They said, when you’re implemented digital health strategy or change your technology, it’s up to sort of the it folks and the technology folks and the CIO to make the business case. But it’s really an organizational wide thing, and so it’s every department or every user has a say, and so to assign it to one person exclusively from beginning to end, it doesn’t feel quite right.

And so recognizing that not only is it interdisciplinary and everybody plays, but there might be different stages where people will take off and lead and follow, and there’s that nice rhythm to that and recognizing that. You don’t have to own everything from beginning to end.

Katie Bryski: 100 percent and that makes me think of leadership broadly, like you don’t and shouldn’t know and own everything, right?

You’re part of a team and you have a role on that team as the leader, but you don’t have to be the expert on, say, implementation science or IT. It’s having the people around you and supporting them so that they can do their best job at the things that they know best.

Shelagh Maloney: Well, and that was sort of, you know, you said it earlier, it was a very energized conversation.

And we’ve heard this from others as well who work with students, is that you see that the energy that Tracie and Kim get from their students and that learning, and it’s that reciprocal benefit that the students learn and then the professors learn. Sometimes you’re the teacher and sometimes you’re the student.

Sometimes both at the same time. Yes, yeah. You know, one of the things, the other thing that I really, it’s just, it’s so relevant right now and, and it really underscores the need for digital health research and applied research. And it’s that statistic that Tracie mentioned around the World Economic Forum identifying misinformation as one of the number one issues.

Not surprising, necessarily, but scary, nonetheless. And I think really underscores the importance of the type of work that’s being done in this field.

Katie Bryski: Yeah, and I think especially when a lot of decisions right now are being made or have the potential to be made based on ideology, rather than evidence.

Remembering there are many different types of evidence and types of research that can contribute. But yeah, I think it’s extra important now to have that capacity both to do the research, but also to analyze it critically. And then also to have it available and accessible.

Shelagh Maloney: Well, that was a whole thing around digital literacy, right?

And I love that digital determinants of health in addition to, and in conjunction with social determinants of health. Cause that’s a big issue is like people are, don’t have the critical thinking skills potentially to see something and, and recognize that it’s disinformation or misinformation. And recognizing that’s part of the research application, right?

It’s not just publishing the research, but it’s publishing it in accessible ways, and making it clear and understandable to, to everybody.

Katie Bryski: Which kind of comes back to the interdisciplinary and the co design and You know, if you’re having research, maybe that impacts a particular community, making sure that community is involved both in the creation of the research, but also the communication of it.

Look at that. It’s all, it’s all a circle.

Shelagh Maloney: It’s all together. It’s all a cycle and it’s consistent in what we’re hearing across episodes, which is good.

Katie Bryski: I am sure those themes will continue in our next podcast, but I’ll be curious to see how exactly they manifest.

And we will see you next month right here on Digital Health in Canada, the Digital Health Canada podcast. Thank you for listening to today’s episode. Digital Health Canada members can continue the conversation online in the Community Hub. Visit digitalhealthcanada. com to learn more. Be sure to subscribe to the podcast to get new episodes as soon as they’re available.

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