A crisis of care is quietly unfolding in Ontario’s long-term care homes. The stories mostly go unheard, and the people who urgently want to tell them are forgotten andignored.
What truths would those stories reveal? That there aren’t enough nurses and health-care professionals to provide timely and appropriate care to
wages being the main cause. And that corporate long-term careproviders
Solutions are available.Long-term care employers must compensate residents’ needs.The Ontario government must also step up,by regulating long-term care is an essential part of our health-care system.
There is an emerging consensus that Canada’s healthcare system is in crisis.
Stories appear in the media daily describing the horrors Canadians are experiencing trying to access timely and quality healthcare. It is tempting to assume the media is being histrionic, that representatives of healthcare professions, such as myself, are over-stating their case.
I can assure you – the crisis is real. And it may be worse than most people think.
It is equally tempting to think of our failing healthcare system in the same way we think of supply chain issues, inflation and the challenges being faced in the service industry – as remnants of the effects of the pandemic that will get better on their own with time.
Unfortunately, our health system breakdown is not only the result of the pandemic. COVID-19 was simply the straw that broke the camel’s back.
Healthcare in Canada is on the verge of collapse because of decades of willful ignorance and inaction by healthcare decision-makers at all levels of government, and throughout the country. Not only was it all predictable – it was predicted.
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Health policy researchers, healthcare professionals, think tanks and others have been sounding the alarm for years. One of the very first meetings I went to when I started my career in 1998 was about the challenges facing healthcare and what needed to be done to avert catastrophe. Even then, it was not a new conversation.
So, if our current crisis isn’t the result of the pandemic, what exactly is the problem?
Governments have too often ignored the fact that healthcare is people. That is, without healthcare workers, we have nothing but empty healthcare facilities. While this might seem obvious, governments routinely ignore the people who actually deliver healthcare.
Announcements made touting large investments in new hospitals, machines and other infrastructure are often devoid of any mention of the people required to transform these investments into actual increases in healthcare delivery capacity.
When governments do bother to include the people who deliver healthcare in their proposed solutions, they are almost exclusively physicians and nurses. Of course, we need more nurses and doctors.
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Due to the commitment and dedication of the adult Emergency Department (ED) and adult inpatient staff and physicians, over several months, London Health Sciences Centre (LHSC) has reduced the time paramedics have to wait to transfer the care of a patient to Emergency Department staff by almost 70 per cent.
With the support of Ontario’s Ministry of Health, what was previously a two-hour wait for paramedics is now taking less than 40 minutes, which inturn frees up paramedic partners to return to service in our community and respond to new 911 calls for health emergencies.
“Like many hospitals in the province, we have been seeing an increase in patients with more complex health conditions coming to our EDs for quite some time, and we are continually finding new ways to make the best use of our space and staff to safely move patients through our EDs and across our hospitals,” says Dr. Christie MacDonald, Physician Department Head, Emergency Medicine at LHSC. “In an effort to improve that ambulance offload time, in November we used two key strategies that have also proven successful at other Ontario hospitals in terms of AOT. The team created fast and drastic change and we saw immediate improvement here.”
Today, regardless of how patients arrive to our Emergency Department, all patients are triaged and then transitioned to one of three care spaces:
• immediately into a care space for physician assessment and treatment,
• to a stretcher,
• or to a chair.
CHANGES TO HOW PATIENTS MOVE WITHIN HOSPITAL ARE FREEING UP PARAMEDIC PARTNERS TO BE AVAILABLE TO RESPOND TO NEW 911 CALLS IN THE COMMUNITY
Dr. MacDonald says, “A visit to the EDs is going to look a little bit different for patients and families than it did previously, where depending on your condition you could potentially be moved from a paramedic stretcher to a chair in our waiting room, but these are important and safe changes that al-
low us to speed the availability of care to all patients arriving to our EDs.” Part of improving ambulance offload times has also changed how we admit patients from the Emergency Department into the hospital when necessary. Our staff throughout the hospital are now flagging when beds
become available on patient floors more quickly, allowing a patient waiting in the ED to be admitted sooner.
Once an available bed has been assigned to a patient waiting within the ED, units expedite the movement of the patient within 45-minutes. Speeding-up the time to inpatient units following a bed assignment allows us to in-turn free-up a space within the ED for the next patient and helps to better ensure that all members of the community receive the care they need when they need it.
“Our frontline teams are truly remarkable. We are still seeing high volumes of patients in our EDs, but by redesigning care and taking a hospital-wide approach to a solution for something that could easily be viewed as an ED-specific challenge, we are achieving success that wouldn’t be possible otherwise.” adds Dr. MacDonald. “Our team is pleased by what has been accomplished so far and we are focused on ensuring sustainability. We are excited to now consider other processes that streamline ED care for our patients and our families.”
Middlesex-London Paramedic Service Deputy Chief Adam Bennett shares, “We are encouraged by LHSC’s efforts to help improve ambulance offload times.”
It is important to note for our community members that while these improvements do speed up ambulance offload times, patients arriving to our EDs may continue to experience wait times as we see the most critically ill and injured patients first. Our estimated ED wait times for non-urgent and non-emergent concerns are always available on the hospital’s website. ■ H
Physicians in Canada, especially male physicians, are working fewer hours than they did three decades ago, and these long-term trends must be considered in workforce planning, according to new research in CMAJ (Canadian Medical Association Journal).
“Canadian physicians’ work hours, crucial for health care access and planning, have seen a long-term decline, especially among male and married physicians, suggesting a shift towards better work–life balance,” said Dr. Boris Kralj, Department of Economics, Centre for Health Economics & Policy Analysis, McMaster University, Hamilton, Ontario.
Using Statistics Canada’s Labour Force Survey, researchers from McMaster University conducted a study on long-term trends in physician work
“CANADIAN PHYSICIANS’ WORK HOURS, CRUCIAL FOR HEALTH CARE ACCESS AND PLANNING, HAVE SEEN A LONG-TERM DECLINE, ESPECIALLY AMONG MALE AND MARRIED PHYSICIANS.”
hours, with data from 1987 to 2021. They hope that the findings will help governments make smart health care policy decisions, inform physician work force planning, and foster gender equity.
Highlights:
• Compared with the general population, physicians worked more hours per week, about 20 per cent more hours in 2021
• Weekly physician hours decreased 13.5 per cent from 52.7 hours per week in 1987 to 45.6 in 2019
• Average hours worked by male physicians declined markedly beginning around 1997
• No differences in declines in hours among urban versus rural settings, incorporated versus unincorporated physicians, physicians younger or older than 45 years, or those with or without children under age 5 years, were apparent
• Hours worked varied by province, but these differences declined over time
Cognitive behavioural therapy (CBT) delivered remotely, with therapist guidance, appears to be as effective as in-person therapy for a range of mental health problems, according to new research published in CMAJ (Canadian Medical Association Journal)
“The World Health Organization has designated CBT as essential health care, but access remains an important barrier for many people in Canada. Our findings suggest that therapist-guided, remotely delivered CBT can be used to facilitate greater access to evidence-based care,” notes Dr. Jason Busse, McMaster University, Hamilton, Ontario.
CBT is commonly used in psychotherapy to help modify unhelpful thoughts and behavioural patterns, and it is effective for a variety of mental health problems as well as chronic pain. In Canada, CBT is offered mostly by registered psychotherapists, social workers, and psychologists, making it costly because it is not covered by many publicly funded health systems
and is capped by many private benefit plans.
There is evidence for the effectiveness of in-person CBT, but the effectiveness of remote therapist-guided CBT is uncertain.
In this systematic review and meta-analysis, researchers included 54 randomized controlled trials (RCTs) with 5463 patients that looked at CBT treatment of anxiety and related disorders, depression, insomnia, chronic pain, chronic fatigue syndrome, tinnitus, and alcohol use disorder. These RCTs compared in-person and remote CBT.
“Our systematic review found moderate-certainty evidence of little to no difference in effectiveness of CBT delivered either in person or remotely with therapist support,” write the authors. “This finding was unaffected by type of clinical condition, length of follow-up, or whether CBT was provided individually or through group sessions.”
Affordability is a barrier to accessing mental health support. An August
2023 poll by Mental Health Research Canada found that the number of people who were unable to access mental health care because of cost increased from 18 per cent the previous year to 29 per cent.
These findings should interest policy-makers as they underscore the usefulness of remote delivery of CBT, which is also more convenient for many people. The authors urge the provinces and territories to consider funding online therapist-guided CBT to widen access to effective and much-needed mental health care.
“Access to psychotherapy is an important barrier for many people in Canada, particularly those living in remote or rural areas, including military veterans and Indigenous populations, both of which are at higher risk for chronic pain and mental health disorders,” write the authors.
“Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials” was published March 18, 2024. ■ H
The early part of the COVID-19 pandemic was associated with a 15 per cent decline in working hours, with an 11 per cent decline among male physicians and a 20 per cent decline in hours worked by female physicians in the second quarter of 2020. However, by the end of 2020, hours worked reverted to prepandemic levels.
The study’s authors suggest that a desire for better work–life balance may be driving these long-term trends. For a long time, doctors have been expected to work very long hours and be available all the time. This has led to unhealthy workplaces.
“[W]e propose that a shift in male physicians’ preferences toward achieving better work–life balance is an important contributing factor. The question of whether these trends are related to physician burnout is relevant. Characterized by emotional exhaustion, depersonalization, detachment from work, and reduced personal accomplishment, burnout can lead to negative effects on health, lower productivity, reduced work hours, and even exiting medical practice,” write the authors.
They found no evidence that higher payments contributed to physicians working fewer hours. The observed decrease in hours persisted during periods of both rising and stable payment levels.
These trends highlight the need for Canada to have enough doctors to meet its population’s evolving needs. It is important for policy-makers to consider not just how many doctors there are, but also how many hours they work.
“The way forward will likely involve policy-makers increasing the size of the medical workforce – including physicians and other occupations involved in interdisciplinary care – faster than population growth to accommodate historical and potential future hour reductions (and increasing demand from an aging population),” write the authors.
“Long-term trends in the work hours of physicians in Canada” was published March 25, 2024. ■ H
Obesity is a risk factor for stillbirth, and the risk increases as pregnancy advances to term, according to a large study published in CMAJ (Canadian Medical Association Journal).
The overall risk of stillbirth in pregnancy is approximately 0.4% in Canada. “Our findings suggest that an earlier delivery date may help reduce the risk of stillbirth for pregnant people with obesity,” says lead author Dr. Naila Ramji, a high-risk pregnancy specialist in Fredericton, New Brunswick, and assistant professor at Dalhousie University, with coauthors at The Ottawa Hospital and senior author Dr. Laura Gaudet, a high-risk
Most
pregnancy specialist and associate professor at Queen’s University.
Although the link between obesity and stillbirth is well-known, there was little research on the association between obesity and stillbirth risk by gestational age, or on the impact of higher classes of obesity.
To address this gap, the researchers analyzed data from the Better Outcomes Registry and Network on 681 178 singleton births, 1956 of which were stillbirths, in Ontario between 2012 and 2018. After adjusting for other stillbirth risk factors like diabetes and high blood pressure, the researchers found that people with class I obesity (BMI 30-34.9 kg/m2) had double
the risk of stillbirth at 39 weeks’ gestation compared to those with normal BMI (18.5-24.9 kg/m2). For those in obesity classes II and III (BMI 35–39.9 kg/m2 and BMI 40 kg/m2 and higher, respectively), stillbirth risk at 36 weeks was 2 to 2.5 times that of people with normal BMI. This risk further increased with gestational age, with a more than fourfold risk at 40 weeks.
“For other medical conditions that increase the risk of stillbirth, there are guidelines that recommend delivery at 38 or 39 weeks. Interestingly, the risk thresholds for those conditions are lower than the risks we found associated with obesity. We worry that implicit biases against people with obesity may
be causing the medical community to take the risks they face less seriously,” says Dr. Ramji.
The authors also looked at whether stillbirths occurred before or during delivery and found a higher risk of stillbirths occurring before delivery in people with class I and II obesity.
They hope that these findings will improve care for this at-risk population.
“Pregnant people with obesity, especially those with additional risk factors may benefit from timely referral and greater surveillance closer to term, and the presence of additional risk factors may warrant earlier delivery,” says Dr. Ramji. ■ H
of childhood cancer don’t get the tests needed to detect serious long-term adverse effects
Surviving childhood cancer does not always mean a clean bill of health, as the treatments that eradicate those cancers can put adult survivors at risk of new cancers and other serious health problems. Despite the existence of surveillance guidelines that recommend screening for adult cancers and other “late effects” of cancer therapy, childhood cancer survivors (CCS) are rarely up to date for recommended tests, according to a large study published in CMAJ (Canadian Medical Association Journal) led by researchers at The Hospital for Sick Children (SickKids) and Women’s College Hospital.
As many as 80 per cent of childhood cancer survivors will develop a serious or life-threatening effect, such as cardiomyopathy (heart disease) and colorectal and breast cancer, from treatment by age 45 years. The risk of colorectal cancer is 2–3 times higher than for the general population, and the risk of breast cancer in females who underwent chest radiation is similar to that of people with a BRCA mutation.
“Surveillance for late effects in adult survivors of childhood cancer is poor, placing many survivors at risk for preventable harm,” writes Dr. Jennifer Shuldiner,
AS MANY AS 80 PER CENT OF CHILDHOOD CANCER SURVIVORS WILL DEVELOP A SERIOUS OR LIFE-THREATENING EFFECT, SUCH AS CARDIOMYOPATHY (HEART DISEASE) AND COLORECTAL AND BREAST CANCER, FROM TREATMENT BY AGE 45 YEARS.
scientist, Women’s College Hospital, Toronto, Ontario, with coauthors.
In this study, researchers used Ontario provincial data on 3241 CCS who had been diagnosed with cancer between 1984 and 2014. They studied CCS who were at elevated risk of breast, colorectal cancer, or cardiomyopathy because of radiation treatments or specific chemotherapies. Of the total, 2806 (87%) were at risk for at least 1 of these late effects, 345 (11%) were at risk for 2 and 90 (3%) were at risk for three late effects.
The North American Children’s Oncology Group has developed longterm follow up guidelines (there have been 6 versions) to monitor adults who had cancer as children.
However, the number of survivors who were following the screening recommendations was low, with 13
per cent, 6 per cent, and 53 per cent adherent to colorectal cancer, breast cancer, and cardiomyopathy screening recommendations, respectively. Those who were older at diagnosis were more likely to follow the cancer screening guidelines, whereas younger age at diagnosis was associated only with higher likelihood of following screening guidance for cardiomyopathy.
A lack of awareness of the negative long-term effects of cancer treatments may underlie these low rates. Even in the case of survivors who attended specialized cancer survivor clinics, screening adherence rates were low.
“Earlier studies found that a lack of knowledge about late effects risks and surveillance recommendations among survivors, family physicians, and specialists are substantial barriers to adherence,” write the authors.
Screening recommendations need to address barriers to completing screening to ensure that CCS continue to lead healthy lives as adults.
“The challenge of ensuring that CCS receive the risk-adapted health care and surveillance testing they need to maximize their long-term health and quality of life is an area of intense focus,” adds Dr. Paul Nathan, director of the AfterCare Program and oncologist in the Division of Haematology/Oncology at SickKids. “Building on these findings, we will be launching a province-wide study to determine if periodic surveillance reminders for CCS and their family doctors will improve completion of these potentially life-saving tests.”
The findings demonstrate a need to support patients and primary care clinicians to improve adherence to surveillance guidelines among CCS. The authors note this responsibility must be shared between the cancer care systems, particularly the provincial pediatric cancer survivor network, and the patients themselves, through advocacy and other survivor support groups.
“Longitudinal adherence to surveillance for late effects of cancer treatment: a population-based study of adult survivors of childhood cancer” was published March 11, 2024. ■ H
A37-year-old man collapses on a golf course. He’s rushed by ambulance to the nearest hospital and needs to be intubated. He has no vital signs as the EMT continues CPR. The alert reaches the team at Cortellucci Vaughan Hospital’s Magna Emergency through triage, and within minutes, four nurses are in action.
One nurse takes the lead: “Pause compressions. Do we have a pulse? Resume compressions!”
As real as this scenario feels, it isn’t a real patient they’re working on. It’s a drill – a scenario meticulously orchestrated through Mackenzie Health’s Simulation Program.
The Simulation Program at Mackenzie Health has elevated the traditional learning experience. In addition to conducting mock scenarios and drills in the Giovanni and Anna De Gasperis/Eugene and Eva Kohn Learning Centre at Cortellucci Vaughan Hospital, the program also brings the training directly to frontline staff where they are. The team introduced the Sim2You roving cart, a mobile simulation unit, in January 2023 to offer a convenient and immersive learning experience right there, on their clinical units.
With the large numbers of new staff being hired to address health human resource challenges, new ways of teaching outside the traditional classroom setting have become necessary to train clinical staff quickly and efficiently.
“Using the Sim2You roving cart, we’re not only ensuring that training is more accessible for our staff, we’re also enhancing how they can adapt to some of the real-life situations they may encounter in their day-to-day work caring for patients,” said Christina Scerbo, Simulation Program Lead. “Innovations like this along with our continued commitment to staff development are resulting in improved per-
formance and better outcomes for our patients.”
The mobile simulation unit is offered across both Mackenzie Health hospitals, Mackenzie Richmond Hill Hospital and Cortellucci Vaughan Hospital, and at its patient care units at the Reactivation Care Centre. For hospitals without a fully outfitted simulation lab, a mobile simulation unit can be a cost-effective way to incorporate simulation into a training program.
In the scenario with the 37-year-old patient, CPR compressions are done on a manikin attached to an iPad that provides feedback on the technique in real time, offering an opportunity for nurses to make corrections and learn in the moment.
Mackenzie Health’s interdisciplinary team of health care professionals continually refine their skills, from
electronic medical record updates to surgical best practices. Feedback from staff is taken into consideration when selecting the content for each month’s training – staff get to learn and brush up on what’s most topical and relevant to the work they do.
Another recent exercise brought the Sim2You roving cart to units to help staff improve rates of central line associated blood infection (CLABSI). In the exercise, a manikin’s arm is sprinkled with powder before a nurse begins the process of disinfecting the arm and inserting a central line. Once she’s done the job, a blue light is directed at the arm to identify where spots may have been missed and where there’s now a risk of a central line infection.
Having staff regularly brushing up their skills and trained in best practice leads to positive results. Over the span
of three years, Mackenzie Health was able to decrease its CLABSI rates by more than 40 per cent and is now well below the 2020 national benchmark rate of 4.08 per 1000-line days.
In simulation exercises, health care professionals replicate the challenges of real-life situations. As scenarios unfold, nurses are given a complex medical situation, challenging their skills and teamwork. They swiftly assess a simulated manikin and perform life-saving interventions.
In the simulation laboratories at Cortellucci Vaughan Hospital, the hum of medical equipment and urgent discussions creates an atmosphere of intensity and dedication. From cardiac arrest responses to newborn intubations, the labs offer a simulated hospital environment for safe practice. The control room, doubling as an observatory, provides clinicians with hands-on training before applying skills in live hospital settings.
“Positioning learning as our facility’s cornerstone advances life-saving skills and provides a secure environment for staff training,” says Deborah Lefave, Simulation Educator. “Our simulation labs immerse health care professionals in dynamic scenarios, fostering swift and co-ordinated actions. Prioritizing teamwork, communication and protocol adherence equips our teams with the resources and confidence needed for effective responses in real emergencies, elevating patient care and safety.”
As a simulation concludes in the Learning Centre at Cortellucci Vaughan Hospital, the team of dedicated nurses exchange nods of satisfaction. The stable manikin they were working on now represents the successful culmination of their collective efforts. Lefave smiles, noting each participant’s growth. Drills like this one highlight the transformative impact of preparation and innovation, promising a health care future led by expertise and unwavering commitment. ■ H
Christina Cindric and Alysia Burdi work in communications at Mackenzie Health.
Respiratory syncytial virus (RSV) is a common respiratory virus that usually causes mild symptoms (cold-like illness) but can cause severe illness, including bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) that may lead to hospitalization or even death.
While most RSV cases are mild, it is not possible to predict which healthy infants could get seriously ill and end up in hospital. *
In a Canadian first, Dr. George Athwal at St. Joseph’s Health Care London has introduced the revolutionary next step in mixed reality technology that can track surgical instruments in real time and precisely point the way for surgeons. St. Joseph’s is one of two centres in the world to debut the technology.
Mixed reality technology in the operating room just got smarter, and surgeons even more precise. In a Canadian first at St. Joseph’s Health Care London (St. Joseph’s), orthopedic surgeon Dr. George Athwal has introduced the ground-breaking next
Dr. George Athwal at St. Joseph’s Health Care London has introduced the revolutionary next step in mixed reality technology that can track surgical instruments in real time and precisely point the way for surgeons. St. Joseph’s is one of two centres in the world to debut the technology.
step in mixed reality technology that enables 3D imaging, similar to holograms, not only to act as a visual blueprint during shoulder replacement surgery but to track the surgical instruments and guide the surgeon’s hands in real time.
With this evolution of technology, a 3D representation of the patient’s anatomy and shoulder implant is overlaid on the surgical site, giving the surgeon the sci-fi superpower of X-ray vision while operating. Points of light provide vital markers for the surgeon to target. With the position of the instruments monitored by the system, Dr. Athwal has taken visionary surgery to a whole new level – literally and figuratively.
“Put simply, the system allows me to peer into and through the incision to the bones and other anatomical structures below. It knows exactly where my instruments are and can guide me where to make the most intricate adjustments to replicate the pre-surgical plan precisely,” explains Dr. Athwal.
Dr. Athwal, a surgeon with St. Joseph’s renowned Roth McFarlane Hand and Upper Limb Centre, became a global pioneer in developing and using digital 3D imaging technologies as tools in shoulder replacement surgery three years ago when he performed Canada’s first – and the world’s second – shoulder replacement using Stryker’s Blueprint® Digital Platform. The first generation of the futuristic system, which pairs stereotaxic (3D) technology with pre-operative planning software, allows a surgeon, wearing a special headset, to visualize and manipulate a digital rendering of the patient’s anatomy and the shoulder implant to plan the surgery pre-operatively. The surgeon can park this 3D map in space as an interactive reference in the operating room. It appears similar to a floating hologram.
The newest version of the technology is the Stryker Blueprint® MR Guidance solution. Using the same digital headset with specialized instrumenta-
Dr. George Athwal at St. Joseph’s Health Care London prepares to perform the ground-breaking next step in mixed reality technology that enables 3D imaging, similar to holograms, not only to act as a visual blueprint during shoulder replacement surgery but to track the surgical instruments and guide the surgeon’s hands in real time. Dr. Athwal is the first in Canada to use the technology.
tion, Dr. Athwal can now overlay and match the 3D representation onto the patient’s physical anatomy. Through a front-facing camera on the headset, the position and orientation of surgical instrumentation are tracked in the physical environment so imaging and guidance widgets can be displayed on the patient and in the surgeon’s line of sight without disrupting the surgeon’s
normal workflow. The feedback in the heads-up display informs Dr. Athwal of where to position and orient his surgical instruments.
“What’s new and exciting is the giant leap in what we can now do with this technology to advance surgical precision,” says Dr. Athwal. “The 3D representations of the patient’s anatomy can, quite literally, point the way.”
“PUT SIMPLY, THE SYSTEM ALLOWS ME TO PEER INTO AND THROUGH THE INCISION TO THE BONES AND OTHER ANATOMICAL STRUCTURES BELOW. IT KNOWS EXACTLY WHERE MY INSTRUMENTS ARE AND CAN GUIDE ME WHERE TO MAKE THE MOST INTRICATE ADJUSTMENTS TO REPLICATE THE PRE-SURGICAL PLAN PRECISELY.”
The technology, he adds, has been shown to enable surgical plan execution within two millimetres and two degrees of a preoperative plan.
This latest version of the technology recently debuted with a global launch by Stryker that included St. Joseph’s and Mayo Clinic in the United States. The two centres are the first in the world to use it in the operating room.
Dr. Athwal was part of a team that worked with Stryker, a manufacturer of shoulder implants, and Microsoft Corporation, manufacturer of the HoloLens 2 – a holographic headset – to develop the mixed reality shoulder replacement technique. He has since performed numerous surgeries using
the initial version of the technology and is in demand to provide demonstrations worldwide.
Involved in the development of this software and technology for the past 10 years, the London surgeon says “it feels like you’ve been watching your child grow and become increasingly successful at every stage.” He envisions this next generation of the system being particularly instrumental for more complex shoulder replacement patients – those with the greatest amount of bone deformity and disease.
“For the most challenging cases, where implant positioning is critical to successful patient outcome, this technology is a game changer.” ■ H
With the latest evolution in mixed reality technology, orthopedic surgeon Dr. George Athwal at St. Joseph’s Health Care London can overlay a 3D representation (similar to a hologram) of the patient’s anatomy and shoulder implant on the surgical site. This allows him – using a special headset - to peer into and through the incision to the bones and other anatomical structures below. The technology tracks the surgical instruments, which informs the Dr. Athwal where to make the slightest adjustments in positioning and orientation of his surgical instruments. The technology significantly advances surgical precision.
William Osler Health System (Osler) has partnered with McMaster University (McMaster) on a system-level transformation project that helps decrease transfers from long-term care homes to Emergency Departments (ED) – the PoET Southwest Spread Project (PSSP). The first of its kind, this study evaluates the impact of an ethics-based intervention in long-term care and has now been proven to have reduced consent-related errors that can result in long-term residents receiving unwanted and/or non-beneficial treatment, and hospital transfers at end of life.
Long-term care transfers to acute care for aggressive interventions are sometimes unnecessary, can increase health care costs, and result in avoidable hospitalizations with associated complications and even mortality. Conditions like infection, changes in mental health status, injuries due to falls, as well as the false assumption that end-of-life services are available only in an acute care setting, have resulted in avoidable transfers to the ED over the last several decades. The absence of consent from a capable long-term care home resident was also identified as a cause for many transfers to hospital. The Prevention of Error-based Transfers (PoET) Project, an award-winning Ethics Quality Improvement Project developed at Osler, helps staff and physicians of Ontario long-term care homes address these causes for transfer by aligning their policies and practices with the Ontario Health Care Consent Act (HCCA) and with related professional obligations.
The results of the PSSP show that PoET has the potential to both benefit long-term care home residents and have a positive impact on the entire provincial health care system. The findings validate an association between PoET and decreases in patient transfers to the ED and hospital, especially at end-of-life stage:
• Residents in long-term care homes where PoET was executed were sent to an ED at a 27 per cent lower rate than residents in other long-term care homes;
• The rate of transfers from long-term care residents to acute care hospitals at end-of-life was at a 45 per cent lower rate than those in other longterm care homes; and
• Residents in long-term care homes where PoET was implemented experienced palliative care encounters at a 147 per cent greater rate than residents from other long-term care homes.
“We believe that PoET is the first ethics quality improvement project worldwide to demonstrate an association between improvement in an ethics intervention and a decrease in transfers from long-term care homes to Emergency Departments,” said Dr. Paula Chidwick, Director, Ethics & Spiritual Care, Ethics Quality Improvement Lab, William Osler Health System. “PoET has not only proven to enhance the lives of long-term care home residents through more informed decision-making, but it is a collaborative approach to health care system transformation.”
The PSSP implementation is a fourweek process. During the first week, PoET team members observe the processes, decisions and discussions relating to hospital and ED transfers in the long-term care home. Based on these observations, in week two, PoET team members present the long-term care
home with recommendations aligned with HCCA-related goals such as obtaining resident consent whenever they are capable. PoET team members also work with the long-term care home to tailor recommendations to ensure they are actionable and to create accountability for these changes. In weeks three and four, PoET team members mentor and support the longterm care home to implement, test and refine the recommendations to ensure continued sustainability. Researchers from McMaster then work with individual homes and the Institute for Clinical Evaluative Sciences (ICES) to collect data that would allow a comparison of PoET homes to similarly matched control homes in Ontario.
A continuation of the initial PoET Project, PSSP is a collaboration between Osler’s Ethics Quality Improvement Lab and McMaster’s Department of Family Medicine. Through this collaboration, PoET was piloted in 54 long-term care homes in the Hamilton, Niagara, Haldimand, Brant, Mississauga and Halton regions in Ontario. The project and its evaluation ran between 2019 and 2022, through a financial contribution from Health Canada’s Health Care Policy Contribution Program.
“The PSSP project demonstrated that PoET makes a difference to both
residents of Ontario’s long-term care homes, and the entire health care system,” said Dr. Jill Oliver, Ethicist, Ethics Quality Improvement Lab, William Osler Health System. This is a fundamental shift in thinking for long-term care home staff, and we are so proud to make the program available to all long-term care homes in Ontario.”
Dr. Henry Siu, Associate Professor at McMaster University’s Department of Family Medicine and co-lead of the PoET Southwest Spread Project, agrees. “As an academic family physician and a long-term care attending physician, the PoET Project is a game-changer,” said Dr. Siu. “Our work in the PoET Southwest Spread Project has shown that a shift in practice culture that promotes true longterm care resident-centric care can have huge system-level impacts that reduce unnecessary transfers to acute care, while supporting more palliative care in the long-term care home.”
Following these significant findings, the project team aims to develop measurable process and performance indicators to help long-term care homes demonstrate alignment with the Health Care Consent Act, as well as advocate for an accreditation standard that will positively benefit all longterm care home residents and their families. ■ H
Noone should experience untreated pain. Yet, in Canada, two out of three children undergo painful procedures without any pain management, and one in five experience pain that lasts months to years. Health Canada’s 2021 ‘Action Plan for Pain in Canada’ recognized children as a population disproportionately impacted by pain. Poorly managed pain hurts children in the moment and has life-long consequences across all areas of life, including their physical, mental, and social well-being.
Unfortunately, Canada is also in the midst of an opioid crisis, with a particularly detrimental impact on youth, who are the fastest growing age demographic requiring hospitalization from opioid overdose. The undertreatment of pain is a major contributor to the opioid crisis, and pain relief is a primary reason for opioid prescribing, long-term opioid use, non-prescription opioid use, and opioid use disorder amongst youth. Opioids prescribed for pain in youth, and poorly managed pain, can start a cascade of opioid use that persists into adulthood.
At the same time, opioids are recognized as an appropriate and important part of pain management, particularly for moderate to severe short-term pain and when other pain treatments are inadequate. Although opioids should not be considered the first choice for pain relief in children, they are safe and effective when used correctly. However, there is a lack of evidence-based guidelines for opioid prescribing for pain in youth, driving an urgent need to bridge the knowledge gap between treatment practices and evidence-based solutions.
We have learned a lot about how to effectively and safely prescribe opioids to help treat pain. While not necessary in all cases, many youth, including the most vulnerable, need these medications to live normal lives. Explaining to youth and families
why opioids can be helpful and how they can be safely used is critical to delivering high-quality care.
In October 2022, Solutions for Kids in Pain (SKIP), a national knowledge mobilization network promoting evidence-based solutions for children’s pain, launched “Youth in Pain: Solutions for Effective Opioid Use”. This 18-month project funded by Health Canada mobilized solutions for effective, safe, and equitable use of opioids for pain management in youth. SKIP led this work in partnership with a 16 member national advisory group, 86 patient and parent partners or advisors, and 38 organizational partners (including the Canadian Centre for Substance Use and Addiction, the Canadian Dental Association, the Sickle Cell Awareness Group of Ontario, and the Institute for Safe Medication Practices, among others).
The project co-developed over 30 tools, resources, and activities in English and in French with and for youth, families, health professionals, and decisionmakers. These include interactive educational modules, factsheets, conversation guides, an evidence-based toolkit, media articles, information and implementation documents for health professionals, patients, and caregivers, and a narrative change campaign launched during National Pain Awareness Week in November 2023 that reached more than 9 million views (#ItDoesntHaveToHurt #NPAW2023).
The project shares best-available evidence and guidance for the use of opioids for acute and chronic pain for youth, and emphasize a multimodal and de-stigmatized approach to pain management that combines physical, psychosocial, and pharmacological strategies. This aligns with guidance in Canada’s first national health standard for Pediatric Pain Management (CAN/ HSO 13200:2023) published in 2023 by the Health Standards Organization
in partnership with SKIP. The Pediatric Pain Management standard guides organizational leaders and healthcare teams how to deliver quality, equitable acute and chronic pain care for children from birth to 18 years old in all hospital settings.
Health professionals and decisionmakers should work together to create an environment where evidence-based approaches for pain management, including the use of opioids when appropriate, are considered without judgment.
Partly due to the immense burden of the ongoing opioid crisis, there has been growing concern from prescribers, patients, policymakers, and the media about the societal and health risks associated with opioid use, especially amongst youth. In many instances, stigma around the use of opioids co-occurs with widespread stigmatization of pain itself.
“Living with pain means that a lot of my struggle is invisible and can make it hard to understand by others. That lack of recognition only pushed me further to believe that my comfort and wellbeing was not prioritized, instead it was being invalidated,” adds Sabrina Cannella, a youth living with chronic pain. “I was incredibly reluctant to state I had pain in fear of being labelled as ‘drug seeking’, I equally hesitated to describe the benefits I felt from the opioid medications to avoid being labeled with substance use disorder. The conversation would shift from creating a care plan to treat my pain in the best way possible, to a plan that carried the least stigma or the least risks. I no longer felt like pain control was amongst the goals of my care team but instead a plan to cater to the stigma of opioids”.
There is a need for resources that address both pain- and opioid-related stigma in youth with pain. Opioids should never be withheld in situations where they are clinically indicated or warranted, and health professionals need to
remain mindful of biases when deciding whether to prescribe opioids, such as those related to race, gender, and/ or socioeconomic status. To address intersecting stigma and racism, SKIP’s Youth in Pain project prioritized the development of resources for specific populations such as youth with sickle cell disease, for whom access to opioids are an important part of quality pain care.
Invest time to talk to youth and families about their pain. It helps to ensure they feel heard and cared for, reduces stigma around pain and its treatments, and increases the likelihood of engagement in care.
Open communication between youth, families, and health professionals is helpful to understand how pain works and identify the best solutions. As highlighted by Sabrina, “I finally felt on solid ground when my team and I met in the middle. I know that my pain will never be 100per cent resolved with opioids alone, or anything for that matter. Instead we created a tool box that was composed of multiple methods to address the pain cohesively. It no longer felt as though I was doing something wrong by finding relief in high risk medications like opioids.”
Access to effective pain management for all children is more than just a human right; it is critical to address the intersecting public health crises related to pain, opioids, and mental health – especially amongst Canada’s children and youth.
It is clear there is a sustained need for conversations that prioritize quality pain care for youth, and the role of opioids as part of multimodal pain care. SKIP’s Youth in Pain project begins to fill that gap by raising awareness and promoting use of evidence-based solutions. We call on others to also ensure that equitable, comprehensive, and effective pain management is integrated into all relevant child health policies and strategies as essential to support youth, their families, and health professionals in Canada. H
In a world where an implantable electrode can reduce the number and intensity of a patient’s seizures, there’s no question that health care and engineering have become inextricably linked. Nowhere is that clearer than in the KITE Research Institute at University Health Network (UHN), which has been pushing the boundaries of medical innovation and healthcare technology since its inception.
No one is more committed to fostering collaborations between health care and engineering than Dr. Milos R.Popovic, Senior Scientist and Director of KITE. Since his appointment as Director in 2018, the research arm of the Toronto Rehabilitation Institute has seen a surge in funding, published countless research papers and established a number of technology-based research labs, collaborations, and clinics.
Dr. Popovic, who was also appointed Director of the Institute for Biomedical Engineering at the University of Toronto (UofT) in July 2023, is acutely aware of how beneficial it can be when diverse experts from UHN and academia – more specifically, in his case, UofT – come together. Moreover, he knows how challenging it can be to establish these types of alliances.
That conviction has led Dr. Popovic to his latest initiative, a groundbreaking collaboration between KITE at UHN and the Institute of Biomedical Engineering at UofT. The goal of this partnership is to create a barrier-free conduit that allows scientists at both institutions to transform cutting-edge technology research more quickly into practical medical applications.
While some collaborations between the Institute of Biomedical Engineering at UofT and UHN have already happened in recent years, each has come with a high degree of friction, explains Dr. Popovic. Even as someone with one foot firmly planted in each institution, he has found that moving between them requires degrees of complexity that slows every step in the process.
“Hospitals and universities may seem like they’re compatible, but
they’re not,” he adds. “Although scientists pursue research at both types of organizations, each has its own culture, with different modalities of thinking and different approaches to research and intellectual property.”
Although UofT and UHN are connected through the Faculty of Medicine, and the Institute of Biomedical Engineering has partnered previously with UHN on individual projects, this initiative is different. Dr. Bradly Wouters, Executive Vice President of Science and Research at UHN, explains how this collaboration is meant to capitalize on the natural synergy between KITE, which has a large focus on robotics and assistive technology, and the Faculty of Applied Science & Engineering.
“UHN has a very strong relationship with the University of Toronto,” he notes. “But in this case, we’re looking to break down some of the barriers [between institutions] and create opportunities – for people to collaborate,
to meet each other, to bring complementary expertise and to take the talent and ideas that are in the engineering faculty and involve them more in our hospital-based research.”
Traditionally, Dr. Popovic explains, universities and hospitals guard their intellectual property fiercely, because it can be a source of revenue. That means people from other institutions need to jump through hoops to gain access to protected information, even if it’s in the name of advancing medical treatments.
With Dr. Popovic now leading both institutes – KITE Research and Biomedical Engineering – he can serve as a connection between the two, with countless opportunities for scientists, students and clinicians to move freely between the spaces, and use resources as if they belong to their own institutions.
“My hope is to reduce that friction or minimize it so that things like intellectual property are properly divided and assigned to both UofT and UHN and that the people, funds and students can move between two institutions without any headaches.”
Most of the scientific community is familiar with what’s known as the valleys of death. While not life-threatening in the traditional sense, these lulls along the journey between initial scientific discovery and putting that discovery to use in humans represent an existential threat to research, which comes in three stages.
The first is known as a preclinical finding, which happens during basic scientific research when no patients are involved – think, the “aha!” moment a scientist has in their lab. The second is when that discovery is developed, or translated into a practical application and tested, which can be anything from pharmaceutical drug trials to the development and testing of neuromodulating electrodes. The final stage is when the discovery finally reaches market, whether it’s a method now used in hospitals to regrow skin on burn victims or assistive technology available at rehab clinics for people with mobility issues.
In between each of those stages is a “valley of death” in which that discov-
ery can languish due to lack of funding, communication, knowledge or interest to continue to the next phase, to name a few reasons. Dr. Popovic, with his extensive experience in bringing engineering-based medical solutions to market, has a deep understanding of each stage of the process and knows the value of accelerating the translation of ideas from the lab all the way to patient solutions.
“Normally, you do the research, publish the paper and then only later that work moves into the hospital, because somebody tries to implement it,” he explains. “It would be much better if the scientist who is working on an MRI tool immediately gives it to Dr. X, who will immediately implement it and give you feedback.”
Although the partnership is still in its infancy, everyone has high hopes for what the future will bring, as the kinks are ironed out. Dr. Popovic points out the reason it makes sense to try a collaboration like this at UHN and UofT – the two institutions are already deeply connected, making the barrier to entry far lower than at other research hubs in North America.
“I was at Texas A&M University recently, and they have a wonderful biomedical engineering department,” he notes. “But they don’t have a hospital or medical school attached to the university, so everything they do is done in isolation.”
For Christopher Yip, Dean of the Faculty of Applied Science & Engineering, this official partnership is just the tip of the iceberg. His dream is to create a mixing zone where faculty from all areas of engineering can come into KITE or other parts of UHN and gain access to challenges, opportunities to collaborate and more.
“The hospital is an entire ecosystem, of which engineering is actually a huge part,” Dean Yip notes. “I’m excited about what this [partnership] could be because it’s about something bigger than biomedical engineering. It’s looking at what KITE is doing and then looking at how we can introduce similar aspects through engineering in the partnership.”
Dr. Popovic cautions that there’s still some distance to cover before the floodgates can open, but the plan is to officially launch the partnership in the fall of 2024. Then, they can start dreaming big.
“If everything works as planned, in five years, this collaboration between KITE and UofT will have 200-plus scientists attached to it, a ridiculous number of graduate students and an influx of philanthropic cash,” he says, with a note of wistfulness.
“Then you will start seeing some of the technology coming out, going into the marketplace and accelerating discovery and change in the healthcare system.” ■ H
Continued from page 4
Having more of them, however, will not result in meaningful improvements to our system until the number of other healthcare professionals is also addressed.
Our health system delivery is complex and includes a wide range of health workers.
For example, wait times in hospital emergency rooms are often used as a metric for the health of our healthcare system but the bottleneck is not only doctor and nurse care. If you add more doctors and nurses, patients might be triaged more quickly (an important metric), but then they will likely wait just as long – merely at another stage in the process.
In the vast majority of cases, emergency room physicians need diagnostic tests to determine what is going on with a patient. And these tests are done by medical radiation technologists (MRTs) who conduct X-rays, CT scans and MRIs. Ultrasounds are done by sonographers. Bloodwork and other tests are done by medical laboratory technologists and medical laboratory assistants. Diagnostic testing is also central to the healthcare Canadians get in other settings.
Effective healthcare requires teamwork. Any effort to get us out
of the mess we are in will need to reflect this fact and address the staffing needs of many healthcare professions.
And this situation is everywhere, not only in diagnostics. Many of the MRTs in our association work as radiation therapists, treating patients with cancer. The shortages in their ranks over the past months have led to reductions in cancer care services for patients.
The list of what I call ‘invisible healthcare workers’ is long.
We have a shortage of them too –and those who are working are experiencing an unprecedented level of burnout, job dissatisfaction and leaving for early retirement.
We are at a crossroads: governments can continue to do what they have long been doing – they can even do it harder and spend more money. But as the saying goes, the definition of insanity is doing the same thing over and over again and expecting different results.
Our healthcare system is on life support. Coming off of life support only happens for one of two reasons: either the patient is showing signs of improvement or it is determined that there is no hope of recovery.
Irving Gold is the Chief Executive Officer of the Canadian Association of Medical Radiation Technologists.
Right now, the patient is our healthcare system. Its fate will be determined by the willingness of those
who have the capacity to implement change – and to include all healthcare professionals in their strategies. ■ H
Humber River Health (Humber) has identified a core priority of delivering comprehensive, quality care closer to home for members of its community. This commitment is particularly relevant to caring for one of our most vulnerable populations –seniors.
In February 2021, Humber implemented a Long-Term Care (LTC) Remote Monitoring initiative in partnership with seven LTC Homes in Northwestern Toronto, scaled to two more LTCs in January 2022, and continues to grow. This program uses Practical Routine Elder Variants Indicate Early Warning for Emergency Department (PREVIEW-ED©), an observation-based clinical deterioration tool, and LTC+, an integrated team
of healthcare professionals, to detect early signs of health deterioration in LTC residents and facilitate early intervention.
This initiative promotes an integrated, upstream approach to care through an innovative partnership between the hospital and LTC homes, reducing the number of Emergency Department (ED) visits and hospital admissions, which are key priorities for the Northwestern Toronto (NWT) Ontario Health Team (OHT).
On average, approximately 1,000 LTC residents per year visit the ED at Humber, with approximately 50 percent being admitted. By minimizing these occurrences, Humber’s LTC Remote Monitoring initiative is improving resident care, optimizing patient outcomes, reducing healthcare system burden and costs, and boosting staff capacity.
LTC+ aims to re-imagine access to care and is committed to expediting the care of LTC residents close to or in their homes. The program focuses on putting the resident first by streamlining access to community and hospital services that previously would have required transfer to the ED.
LTC+ is operated by nurse navigators who offer general advice and assistance in navigating services at Humber and in the community. Nurse navigators also facilitate urgent virtual consults between LTC physicians and a General Internal Medicine (GIM) Physician or Geriatrician to support timely access to care. To further en-
sure residents receive the care they need when needed, a Nurse Led Outreach Team (NLOT) is involved to provide urgent mobile care.
The program creates efficiencies through pathways that support linkage to common health services needed among LTC residents. Pathways include streamlined access to diagnostic and medical imaging, fracture clinics, and lower limb preservation. This creates a seamless transition to and from the LTC home, supporting equitable access to care and services, helping reduce ED visits, and positively contributing to LTC residents’ quality of life.
The program uses technology to deliver these services and creates stronger integration between LTC homes and the health care system more broadly. An electronic version of the PREVIEW-ED tool can be embedded within Point Click Care and includes
tracking and reports. The tools and digital components ensure appropriate actions are completed in a timely manner at the LTC to avoid ED visits.
Humber has seen significant outcomes and successes with this program. In March 2023, we expanded the program and launched new pathways in diagnostic imaging (DI) and transportation support for LTC residents, both supported by new funding from the Government of Ontario.
As a result of these expansions, between March and August 2023 Humber successfully diverted 139 ED visits from LTC homes and 99 patients were transferred to and from Humber via non-urgent transport. Furthermore, 154 consultations with nurse navigators were performed for DI needs.
LTC Remote Monitoring has also facilitated improved care coordination and increased knowledge and awareness of available resources
among LTC staff. A provider experience survey revealed that 85.7 per cent of LTC staff who interact with the program indicated improved ability to identify early health decline, 85 per cent noted it has fostered their assessment skills, and 85 percent said that it has enhanced team communication related to changes in residents’ health status.
These successes are the result of the collaborative approach among our partners in the LTC sector and our Humber team. The leadership of Beatrise Edelstein in establishing, operating and evaluating this initiative has ensured that it is sustainable and meets the needs of both LTC residents and care providers. Kathleen Kirk, Clinical Manager, has been instrumental in leading and supporting collaboration with LTC homes and physicians, as well as overseeing the program’s execution and evaluation. Humber’s team of knowledgeable nurse navigators help bring the program to life and ensures its ongoing success.
The program is guided by an overarching philosophy of supporting LTC residents in their homes and increasing access to equitable care. Many factors influence patient access to equitable care, and those variables are often compounded and more complex for seniors.
Two common barriers to care for seniors in LTC are cost and transportation. A standardized, free-to-access service is not currently in place to provide non-emergency transportation for LTC residents. In response to this, Humber, alongside our program partners and with the support of the Government of Ontario, are piloting a service that provides free transportation to residents that need to receive care outside of their LTC home.
Downsview LTC Facility is among our partners where the pilot program is active. They share that “residents and family members have been lamenting how difficult and expensive it can be
to get to and from the hospital or doctor’s appointments. The LTC + free transportation services for non-emergency visits piloted by Humber can make a massive difference to the residents at Downsview LTC Facility, who may otherwise find it stressful and tiring to access hospital services when they need them the most.” It is anticipated that feedback like this will help shape and inform similar programs and services across Ontario.
Humber is the only acute hospital in the Greater Toronto Area that has a robust LTC+ hub that integrates a clinical deterioration tool (PREVIEW-ED) with LTC+ and its numerous pathways, and that is supported by NLOT and in-hospital nurse navigators. As we look ahead, our focus is on continuing to expand and build upon the program, delivering care where it matters most – closer to home. We are eager to share our insights with other hospitals and health care providers as we continue to light new ways in healthcare. ■ H
niversal Health Hub (UHH) is the only health care organization in Canada, which is focused on geriatric care, wherever the seniors age whether at home, hospital, reactivation care centre, long term care home or a retirement facility.
Founded in 2019 by Nurse Maya, who is credited with making private senior care affordable in Ontario. Maya is a Registered Practical Nurse (RPN), foot care nurse and nurse educator. Maya has over 10 years of work experience in the Canadian healthcare industry. All UHH nurses are registered, and all Personal Support Workers (PSWs) are certified in Canada. All staff is background check clear with First Aid CPR.
Today, UHH services over 1,000 seniors every month in foot care, personal care and other geriatric care services.
UHH services over 10 Hospitals in Toronto and GTA such as Oak Valley Health, Humber River Hospital, Southlake Regional Health Centre, Mackenzie Health, North York General Hospital, Scarborough General Hospital, Trillium Health Partners and more.
UHH is contracted for providing clinical services to several LTC homes and retirement homes in Toronto and GTA such as Amica, Scarborough Retirement Residence and Sienna Senior Living. UHH also services several not for profit communities such as North York Seniors Centre.
UHH is built on trust from the vulnerable and their families which is evident from the video testimonials from the elderly and several 5 star Google reviews. Universal Health Hub (UHH) has been recognized in Business Excellence of dedicated age-diverse workforce. UHH is certified as a Women Business Enterprise (WBE) and member of several communities such as Ontario Retirement Communities Association and more.
UHH’s personal care starts at $25 per hour and medical foot care starts at $95. For personal care, UHH crafts personalized health care plans for seniors, starting with an in-person assessment to understand family needs. The specialized foot care addresses conditions such as ingrown
toenails, corns, callus and diabetic foot ulcers. UHH is listed on Home and Community Care Support Services CCAC (formerly LHIN) servicing 6 regions: Central, Toronto Central, Central West, Central East, Mississauga Halton and Hamilton Niagara Haldimand Brant. H
Mixed reality is being introduced to patient care at London Health Sciences Centre (LHSC) through an innovative research project. Supported through LHSC’s Academic Realignment Initiative Awards, the technology is currently being tested to improve patient outcomes in interventional radiology procedures.
First introduced in 2022, LHSC recently announced 15 additional research and quality improvement projects that will be supported through the Academic Realignment Initiative Awards with more than $1 million in funding from London Health Sciences Foundation and Children’s Health Foundation.
“These Awards reflect LHSC’s commitment to embedding research and learning throughout our operations,” says Cheryl Litchfield, Senior Director of Research Operations, LHSC. “These new projects will help strengthen patient outcomes by enhancing surgical procedures, optimizing imaging technologies, and elevating treatments for a wide range of conditions. We are seeing incredible results from our first round of awards, including the testing of mixed reality in interventional radiology.”
Jonathan Collier, an interventional radiology technologist at LHSC, was among the first group of recipients and saw an opportunity to optimize the use of innovative imaging technology through a growing partnership with Siemens Healthineers. One focus of his research is the use of mixed reality technology in angiography suites, which are used to provide minimally invasive surgeries. Interventional radiologists diagnose and treat many conditions using minimally invasive procedures, including placing stents to open blocked blood vessels. These procedures typically require a stationary 60-inch monitor, which can be restrictive to the care team.
Collier collaborated with Dr. David Hocking, Diagnostic and Intervention-
Jonathan CollierInterventional Radiologist, LHSC, conducts research using the Microsoft HoloLens.
al Radiologist at LHSC, to pioneer the use of the Microsoft HoloLens in interventional radiology. The HoloLens is a mixed reality headset with see-through holographic lenses that allows users to consult crucial imaging through holograms while remaining aware of their physical surroundings and maintaining closer contact with patients.
“As advancements in angiography introduce more images and data for physicians to make informed decisions, large display monitors occupy
a considerable amount of tableside space, which puts a wall between the health care workers and the patients,” explained Collier. “Mixed reality technology enables health care teams to continue to focus on the patient while maintaining access to the most advanced images.”
The team hopes the technology –which is being paired with software developed by a team led by Collier and Dr. Hocking – will allow patients to feel more connected to their health
care providers while improving patient safety. Studies have shown that physicians needing to turn away from the patient to view a monitor can reduce accuracy. The HoloLens allows the physician to keep the imaging data and patient in the same field of view with the goal of improving patient outcomes.
“This technology has the potential to change the future of interventional radiology,” says Collier. “Through support of LHSC’s Academic Realignment Initiative Awards, we are testing leading-edge innovation that can improve the delivery of care for our community and is already attracting interest from other healthcare organizations.” ■ H
Join us at the Parq Vancouver from May 26 to 28 for
e-Health is the premier event for Canadian digital health professionals working to make a difference in health and healthcare delivery.
Since its inception in 2000, the e-Health Conference and Tradeshow has served as a vital epicentre of Canadian digital health discussion and debate, attracting over 1,000 health professionals annually. e-Health is the optimal spot for networking and knowledge sharing with peers nationally and around the globe.
With in-demand speakers, expert panellists and presenters, and leading-edge exhibitors, e-Health always delivers memorable education and networking opportunities.
e-Health is hosted by Canada Health Infoway, Digital Health Canada, and Canadian Institute for Health Information.
Diamond Sponsor
Oracle Health
Platinum Sponsor
Amazon Web Services (AWS)
Salesforce
Gold Sponsor
Baxter
Calian
EY Canada LLP
LGI Healthcare Solutions
Novartis
Orion Health
Silver Sponsor
Akinox
eHealth Centre of Excellence
Smile Digital Health
WELL Health
Workday
Bronze Sponsor
Accenture
CDW
CGI Inc.
Deetken Insight
Deloitte
H.H. Angus & Associates Ltd.
Meditech
Microsoft Canada
NTT DATA
Philips Canada
PricewaterhouseCoopers LLP
Stryker
Teladoc Health
TELUS Health
Exhibitors
3M Canada
A&D Medical
Aetonix
AlayaCare
Altera
AMPM Mobile Solutions Inc.
Bittium
MPM Inc ttium
CANImmunize Inc.
CareTeam
Civica Solutions
Connexall
DCM
Fresenius Kabi Canada Ltd Harmony
Healthcare IT
Harris Healthcare
Health Workforce Canada
Healthtech Consultants
infologiQ
Intel & Lenovo
Interlinx Systems
Keewaytinook Okimakanak
Lime Health
MEDFAR
Novari Health
OntarioMD
Petal Health
PHSA – Provincial Health Services Authority
PowerSante (PowerHealth)
Pure Storage
QNAP Systems
Quest Diagnostics
RFID Canada
RIcoh Canada
Solutions Protexia Inc (SecurMEDIC)
Spectralink
SS&C Blue Prism
Tangent
Thrive Health
University of Waterloo
Venuiti Healthcare Inc. VeroSource Solutions Inc.
Verto Health
Vitec Raisoft Oy
Zebra Technologies
Zynx Health
Beam Mobile
Cortico Health Technologies Inc.
DataSpeckle Scientific Inc
Dogwood Health Consulting Inc.
ElderPRIME Solutions Inc.
GoAutomate Inc.
HealthEMe
Medimap
Orthodontia Vision
Red Rover Health
Strongest Families Institute
TEEMA Managed Solutions
Vistacan
WaiveTheWait
cross Canada, most hospitals and healthcare authorities recognize the need to modernize their systems. Integrating electronic medical records (EMR) and electronic health records (EHR) to a cloud-based platform is the way of the future as this medium offers more security, better scalability and improved functionality in the overall health ecosystem. Plus, other third-party resources that healthcare organizations rely on – including homecare services, physician offices and other allied health care – are also transitioning to the cloud, which makes the need for integration all the more inevitable.
Further fueling this migration acceleration is the fact that Microsoft’s Biztalk Server mainstream support is expiring in 2024, with extended support ending in 2029. As a result, health organizations need to plan ahead to adopt from on-premise BizTalk to the Azure cloud environment.
For those responsible for cloud integration in large healthcare settings, on-premise migration to the cloud can seem daunting, especially because the size and scope of operations is vast, and the nature of information collected in EHRs and EMRS is highly sensitive. But it doesn’t have to be an arduous journey.
Calian® Corolar™ is an interoperability platform that allows healthcare organizations to connect siloed data systems seamlessly and securely, involving any combination of on-premise and cloud-resident endpoints, and ensuring compliance with PHI regulations and HIPAA privacy standards. This means organizations can stay in their old systems while onboarding new ones without disrupting their operations. The platform allows healthcare centres to maximize their previous investments while continuing to modernize with new ones. Corolar acts as a catalyst, helping clients reach cloud migration using a measured, phase-in and digestible approach.
Drawing on more than 25 years of experience working with healthcare organizations in North America and abroad, the Calian team is also available to support clients every step of the way. With subject matter experts specifically focused on health, the team offers solid advice to show organizations the most effective and seamless way to reach cloud migration. Along the way they’ll also highlight cloud benefits that may not have been initially apparent and simplify the complexities around all the tertiary actions that need to be integrated outside of an organization’s home base. This means hospital staff can focus their time on providing connected care for patients and a connected experience for their providers instead of worrying about the technology.
For existing BizTalk customers, the Calian Corolar platform provides features to maximize reusability of
existing BizTalk artifacts, as well as the introduction of “Corolar Pipeline Framework” to help organizations to accelerate the BizTalk to Azure Cloud Migration.
Calian’s long-lasting relationship with Microsoft is another key advantage with Corolar. Healthcare clients can rely on technology that is not only leading edge, but always supported. As a past Microsoft Partner of the Year (globally No.1) winner and Microsoft Impact award winner in the last five consecutive years, Calian is committed to providing top-notch services to our customers in the Microsoft technology stack.
In working with clients, Calian provides expert guidance on architecture – and can provide staff augmentation, training and code development.
Even after migration is completed, the team is available for ongoing support as needed. This includes helping organizations to connect systems within their own network, as well as contribute data for future research by safely sharing their data with outside government agencies and other data analytic platforms. This kind of comprehensive support has earned Calian healthcare clients throughout Canada, the U.S. and the United Arab Emirates.
With Corolar, healthcare organizations can trust that their journey to the cloud can truly be steady and seamless. To learn more about how Corolar and the Calian team can support your organization’s modernization migration, visit our booth at e-Health or contact healthinfo@calian.com
For more insights and digital health solutions visit calian.com/health/digital-health H
DAY TWO: MONDAY, MAY 27
8:00 AM–9:30 AM
PLACE
MAY 26-28 AT THE PARQ VANCOUVER
DAY ONE:
SUNDAY, MAY 26
12:00 PM/1:00 PM/2:00 PM
Recharge with Outdoor Yoga
Join us for a calming Sunday stretch! Register to attend any one of three outdoor beginner-level yoga classes on the Park Terrace (Level 6). The instructor will begin each 30-minute session on the hour starting at 12:00 PM.
12:30 PM/1:30 PM/2:30 PM
Energize on a Sunday Seawall Walk
Take a Sunday afternoon walk in the park! World-famous for its scenic vistas and lush green backdrop, the seawall loop around Stanley Park is Vancouver’s most popular fresh-air attraction. Register to join us for any one of three scheduled 30-minute walks on Sunday, May 26. Groups will meet at registration (Park Level 4). Be ready to set out on the 2-minute walk from the hotel to the Seawall and to enjoy a guided walk following the Seawall towards Stanley Park for approximately 15 minutes, with another 15 minutes allowed for the return to the hotel. City maps will be provided.
5:30–7:30 PM
Network at the Welcome Reception Sponsored by AWS
The Welcome Reception is the official opening of the e-Health Conference. Drop by the Welcome Reception – the official opening of the e-Health Conference – at the JW Marriott Parq Vancouver (Level 6) for snacks, drinks, and the pleasure of reconnecting with old friends and meeting new delegates.
Healthcare Human Resources: What Physicians, Nurses, and Healthcare Providers Need to Make Their Jobs Easier and Manage Burnout, Technology, the Administrative Burden of Health, and the Impact on Human Resources.
In this session, Dr. Kathleen Ross will share innovative strategies to manage workloads more effectively and discuss insights on addressing and mitigating burnout and its impact on overall healthcare delivery. The session will also explore utilizing innovative technology to streamline healthcare processes and enhance the efficiency of medical professionals proposing solutions to alleviate its impact on physicians, nurses, and human resources.
Avis Favaro has always had one mission – telling stories that help Canadians. Favaro began as a news writer at Global Television and then discovered a passion for health journalism. In 1992, she was recruited by CTV News and reported on a vast array of important health issues in the three decades since. Since 2022, she has worked as a freelance journalist, contributing stories to W5 and CTV News on the rise of Medically Assisted Death in Canada and the crisis in front-
line medicine. She also hosts the “The CHIP” – the English language podcast by the Canadian Institute for Health Information.
She is a proud London, Ontario girl, a graduate of Western University with an honorary PhD from McMaster University, where she served as the first journalist in residence in 2022. She speaks English, Italian, and a bit of French. She is also an enthusiastic grandmother who believes public healthcare is a human right.
Dr. Ross is a family physician; she does clinical work in community primary care and obstetrics and surgical assist work in cardiovascular surgery at Royal Columbian Hospital (RCH). She is a wife and mother of two. She holds a MSc in pathology and a MD from the University of British Columbia and teaches in the UBC Department of Medicine undergraduate and postgraduate programs.
Numerous leadership roles have provided Dr. Ross the opportunity to establish health care policy and lead grassroots improvement in both community and acute care services, including: past president of Doctors of BC; founding member and chair of the Fraser Northwest Division of Family Practice (FNDFP), RCH’s Collaborative Services Council and FNWDFP’s Shared Care Committee; and president of the RCH medical staff.
Dr. Ross is recognized for her interest in advancing technology in front-line clinical care. She has served as a physician lead and chair of the Pathways Patient Referral Association from inception to its current state as an indispensable online clinical and referral tool for physicians in BC and the Yukon.
As a founding member of Doctors of BC’s Diversity and Inclusion Advisory Group in 2018 and physician lead for RCH’s Antiracism and Unconscious Bias Working Group in 2021, Dr. Ross remains committed to fostering learning, awareness, education and ongoing implementation of inclusive, diverse and antiracist practices in health care.
Dr. Ross is a member of the Physician Quality Improvement faculty with the Fraser Health Authority and the Physician Quality Improvement and Spreading Quality Improvement Steering Committee with the Specialist Services Committee and Fraser Health.
She also currently chairs the CMA’s Administrative Burden Working Group and is participating in the McMaster National Health Fellows Program.
Dr. Deborah Cohen is the Chief Operating Officer of Health Workforce Canada, a newly formed organization mandated to work with health system stakeholders to plan, build and support a strong health workforce for the future – one that will enhance quality of care and health outcomes for all. Most recently she was the Director of Health Human Resources Information Systems at CIHI, where she focused on building the pan Canadian HHR data foundation, as well as health workforce analytics and forecasting models to meet critical healthcare planning needs across the country. Throughout her 20-year career, she has worked in a variety of health data sectors including health human resources, pharmaceuticals, mental health, population health, Indigenous health, and equity. Deborah holds a PhD in epidemiology and is an Adjunct Professor with the University of Ottawa, School of Epidemiology and Public Health.
(EP =ePoster, O = Oral, P = Panel, RF = Rapid Fire)
Artificial Intelligence in Healthcare
• EP – Artificial Intelligence-Based Rib Fracture Detection in RealWorld: A Feasibility Assessment
• EP – Clinical Validation and Applications of CNN Models for Chest X-ray
• EP – An Artificial Intelligencebased Chatbot for Pharmacists in HIV Care: Results from a Knowledge-Attitudes-Practices Needs-Assessment Questionnaire
• EP – Clinician attitudes and readiness towards using AI-based interventions in psychiatry
• O – External Validation of AI Model for Breast Cancer Risk Prediction in Canadian Context
• O – An AI-based universal screening framework for early detection of autism spectrum disorder using population-based data
Patient Engagement and Empowerment
• O – Cultivating Patient Empowerment: Evaluating and Enhancing a ProvinceWide Personal Health Records Application
• O – Empowering and Supporting Patients and Family in the Digital and Virtual Care Ecosystems: CoCreated eToolkit
• O – Co-creating digitally-enabled integrated care with patients and caregivers
• O – Embracing Technology and AI in Patient-Centered Healthcare: Insights from the Perspective of Patient Organizations
Digital Technology and Healthcare Human Resources
• EP – The Impact of a Customizable Homepage in an EMR on User Perceptions and Satisfaction.
• EP – Robotics in Nursing: A Scoping Review Protocol
• P – How Integrated Clinical Change Management and Transformation Strategies Accelerates Digital Transformation Adoption
Health Data Management, Security, and Privacy
• O – Safeguarding Patient Care: Building Cyber Resilience in Healthcare
• O – Safeguarding Healthcare: A Prescription for Cybersecurity Resilience
• O – How can primary and community care physicians respond to cybersecurity threats?
• O – Measuring Success of Virtual Health Products : Analytical Strategies & Metrics of Value Digital Health Equity and Access
• RF – On-demand Video Remote Interpreting (VRI) – Provincial Evaluation Results
• O – Digital Navigator: Closing the Gap in Digital Literacy and Virtual Care Access
• O – mHealth-enhanced type 2 diabetes care in regional populations: Results from a randomised controlled teletrial
• O – Implementing Virtual Supports from PICU to Community Providers Caring for Critically Ill Children in BC
Virtual Care, Telemonitoring, and Remote Patient Care; Health Data Management, Security, ad Privacy
• EP – Patient-Physician agreement for wound assessment of Remote Digital Wound Care Service
• EP – Defining User Requirements for Remote Health Monitoring of Elderly Populations
• EP – Pharmacist-led remote hypertension monitoring in a university-affiliated clinic
• EP – Clicks then bricks: a virtualfirst comprehensive primary care model for thousands of unattached patients
• EP – Development and Implementation of a Remote Care Management Framework in Specialized Paediatric Care
• O – “I Consent” – The Patient Perspective on Consent and Digital Health Tools
Connected Care and Interoperability
• EP – Project Hope: Engaging Patients, Family Members and Practitioners in Redeveloping a Suicide Prevention App
• EP – Advancing on a multi-year journey for modernizing panCanadian acute and ambulatory care data
• P – Establishing pan-Canadian Gender, Sex and Sexual Orientation Standards
• O – Building a foundation for interoperability: a deep dive into Canada’s framework for connected care
• O – The Red Fish Virtual/Digital Innovation Hub. The Wearables Project
• O – Foundry Virtual: A Novel Platform for Youth-Centered Digital Mental Health Services
• O – Forensics Legal Solution for Mental Health Care
• O – Enabling Data-Driven Forensic Mental Health Care
11:00 AM–11:30 AM P3
• Bridging the Gap in Rural Health: Technology Integration and Innovation Strategies – Hosted by H.H. Angus and Associates Ltd
• Navigating the Future: Innovations in Smart Hospitals for Enhanced Healthcare – Hosted by CDW Canada
• Innovation adoption in clinical environments: Clinical and IT perspective – Hosted by Philips Canada
• Reducing clinician burnout with speech AI – Hosted by Nuance, a Microsoft Company
• Health’s Digital Sky: Harnessing the Power of the Cloud for Citizen-Centered Excellence in Canadian Healthcare – Hosted by Salesforce
• Breaking Barriers: Advancing Integration of MEDITECH Expanse and AI in Digital Health – Hosted by MEDITECH
• Transition of Care. Getting patient’s the right care, at the right place, at the right time –Hosted by LGI Healthcare Solutions
• Enabling ER Access for Canadians – An exciting partnership that is keeping hospitals open in rural communities – Hosted by Teladoc Health
• Interoperability in Motion: Personalizing the Patient Care Experience – Hosted by Calian
Artificial Intelligence in Healthcare
• P – Transforming Clinical Workflows with Cognitive Computing and Machine Learning
• O – Digital Twin/Digital Front Door: Revolutionizing capacity management and access to clinical pathways
• O – Infection Control Automation in Acute Care Sites
Connected Care and Interoperability
• P – A Provincial Interoperability Journey to Streamline Resident Transitions between Hospital & Long-Term Care
• P – Advancing Connected Care: An update on Pan-Canadian efforts to improve interoperability
• P – New Brunswick’s patient empowerment journey: secure data access enabling individuals’ active participation in their healthcare
• O – Eliminating Unnecessary Emergency Encounters
• O – Modernizing data management and performance reporting for organ donation and transplantation in Canada
Digital Technology and Healthcare Human Resources
• O – Reimagining an innovative, equity-informed, technologyenabled strategy for nurses in Atlantic Canada
Patient Engagement and Empowerment
• O – Best practices for patientprovider communication among Integrated Care patient population
• O – A Digital Front Door to Foster True Patient Engagement and Empowerment
• O – Bolstering Engagement to Reduce Patient Risk Through Automated Omnichannel Communication
Digital Health Equity and Access
• O – Putting the public in digital health: Challenges and opportunities for a provincial public health institution
• O – Leading Change from the Ground Up: A Proven Change Management Approach for Digital Health Solutions
• P – Right care at the right time: Innovative, patient-centric digitally enabled program design, delivery, and scaling
Technology Solutions for Mental Health
• O – The Development of Early Warning Score and Alerting System for Adverse Events in Psychiatry
• O – Digital Innovations to Enable Measurement Based Mental Health Care
• O – Preparing the Next Generation of Nurses for Digital Health and Artificial Intelligence: A Mixed-Method Study
• O – Reducing wait times and improving access for specialist consultation: Triaging Referrals to eConsults
• O – It’s Confirmed – Patients Love eReferral: High Satisfaction, Improved Experience with Electronic Referral
• P – No Name, No Shame: Empowering Indigenous Voices with Anonymous Peer Support Virtual Care, Telemonitoring, and Remote Patient Care
• RF – Using Technologies to Augment Supports for Patients to Live Safely at Home
• O – To Infinity & Beyond: Virtual Urgent Care Supporting Patients When & Where They Need It
• P – Improving Clinical Outcomes with Digital Patient Engagement and Remote Care Monitoring
The future of healthcare is here, and it’s powered by cloud technology
Scan the code to read our e-book and discover how the cloud is helping to enhance the healthcare experience.
IT modernization promises a bright future for Canadian healthcare. By embracing the cloud, organizations can improve care, streamline operations, and fuel innovation. Intentional strategies that account for patient safety, data security, and enterprise growth can help you unlock the power of the cloud for better clinical and operational outcomes, including scaling resources and improving collaboration.
Artificial Intelligence in Healthcare
• RF – Natural Language Processing (NLP) for automated extraction of cancer diagnosis from pathology reports
• RF – Developing a natural language processing method to predict sentiments from patient feedback about virtual care
• RF – Extracting Social Determinants of Health from Electronic Health Records using Natural Language Processing (NLP)
• O – Harnessing the power of AI to strengthen the ‘Data’ foundation
• O – Breakthrough AI technology enables continuous, autonomous monitoring of patients and clinical environment without compromising privacy
• O – Enhancing Patient Engagement through Digital Health Co-Design: Best-Practices for Co-Designing with Patient Partners
• O – Integrating empathetic, data-enhancing screening in a Pediatric ER to enhance care quality, workflow, and outcomes
• P – Co-creation and Implementation of TrustSphere: a Digital Ecosystem for Collaborative Clinical Care & Research
• O – SmartParent: Teaching by Texting
• O – Using a Text Messaging Platform to Support Pediatric Patients and their Families after Cardiac Surgery
• O – Better technology for healthier lifestyle
Ontario hospital CEOs are thinking about these very questions.
While there are differences in experiences across hospital systems stemming from geography, population, community make up, and fundraising capacity, there are also clear similarities across these organizations when it comes to some of the challenges they’re encountering like funding, health human resources, expectations from their communities, and system integration.
StrategyCorp’s Healthcare Communications and Engagement Practice interviewed CEOs from hospitals across Ontario to understand their perspectives on the most pressing issues in healthcare today. You can read the full report on our website by scanning the QR code.
Digital Technology and Healthcare Human Resources
• O – Virtual Waiting Room at Urgent and Primary Care Centres
• O – Driving Advanced Analytics and Innovation at Providence Health Care with BC’s First Care Coordination Centre
• O – Transforming Diagnostic Imaging referral Workflow: From Paper to Automation
Health Data Management, Security, and Privacy
• O – Health Data Access for All: The Remarkable Growth and Reach of the Infoway Insights Website
• O – Unified Identification Protocol (UIP) and Cross-border Telehealth
• P – Data Integration and Visualization as an Enabler of Value-Based Health Care
Technology Solutions for Mental Health
• P – Attitudes Towards Patient Portals in Mental Health Care3:00 PM – 3:30 PM
• O – Implementing a Patient Generated Data Solution in Outpatient Mental Health Settings
• O – Digital Mental Health Stepped Care for a Heart Failure Remote Monitoring Program: Feasibility Study
Connected Care and Interoperability
• O – Patients’ experiences with connected care in the Canadian healthcare system
• O – Virtual Care: Interoperable Technology & Frameworks to Support New Models of Care
• P – Exploring primary care integration in a health information system: An innovative approach
Virtual Care, Telemonitoring, and Remote Patient Care
• O – Developing a Balanced Scorecard to assess Quality in Virtual Care
• O – Supporting the transition-ofcare for Heart Failure patients: TEC4Home Home Health Monitoring Trial Results
• O – Enhancing Remote Patient Monitoring Care Quality through Centralization
• O – Virtual Hospital: BC’s first Virtual Psychiatric Unit (VPU)
9:30 AM-10:00 AM Concurrent Sessions
Artificial Intelligence in Healthcare
• P – Canada’s first Health SystemWide Digital Twin for Decision Making
• P – Revolutionizing Healthcare through AI: Fraser Health’s Transformative Initiatives
Patient Engagement and Empowerment + Technology Solutions for Mental Health
• P – Conceptualizing an Ideal Virtual Caregiving Intervention
• O – Using digital health technology to empower citizens and unlock the power of mRNA vaccination
• O – Participating in Video-Based Group Therapy for Postpartum Depression: Qualitative Experience
Digital Technology and Healthcare Human Resources
• RF – Automating quality assurance testing of an Epic patient-facing tool at Princess Margaret Cancer Centre
• O – Carmi – a virtual assistant connecting primary care and vitality
• P – Modernizing the panCanadian Health Human Resource Data Standard
Patient Engagement and Empowerment + Health Data Management, Security, and Privacy
• O – A digitally empowered patient experience: Exploring technical enhancements to optimize the patient journey
• O – Utilization of a CDM Solution to Improve the Patient’s Surgical Journey Experience and Health Outcomes
• P – A Dashboard on Patient Safety Incidents for Transparency and Accountability in Quality & Safety
Digital Health Equity and Access
• P – Cultivating equity through Indigenous-led pathways to ehealth using an innovative P3 model to partnership
• O – Poppy: Robotic Process Automation (RPA) to Improve Clinical Workflow Efficiency and Population Health Management
• O – Deteriorate while you Wait, No More!
Technology Solutions for Mental Health
• O – E-Mental Health Strategy for Canada, Paving the way for digital mental health solutions and advancements
• O – How implementing a CRM in mental health and addictions services can improve patient management
• P – Digital Front Door Solution Expands Access to Substance Use Health and Mental Health Treatment Services
Connected Care and Interoperability
• O – The Value of Connected Care for Nurses
• O – Electronic Documentation; a compelling vision and what’s in it for you?
• P – Connecting Care across BC with the First-Of-Its-Kind Procurement of a Digital Referrals and Orders Solution
Virtual Care, Telemonitoring, and Remote Patient Care
• O – Starting with the end in mind: Needs-driven innovation through the power of partnership
• O – Enhancing Heart Failure Management: Insights from In-home Medication Trials
• O – Preliminary Findings from Radiation PATH: Investigating a Mobile Health-Based Radiation Oncology Patient Assessment Tool
• Healthcare staff scheduling isn’t just important – it’s vital to patient care – Hosted by LG Healthcare Solutions
Artificial Intelligence in Healthcare
• P – Advancing Healthcare: Intelligent Automation Insights & Outcomes from Alberta Health Services
• P – Evaluating AI Scribe & Automation Technologies in Primary Care: A Perspective on Clinician Burden Reduction
• RF – Improving human memory through volitional control of hippocampal theta oscillations
• O – Accelerating the Adoption of AI in Healthcare Through Mentorship
• P – Empathy in Algorithms: How Conversational AI is Reshaping the Patient Journey
Digital Technology and Healthcare Human Resources
• O – Forecasting the Future: Innovative Strategies to Optimize Staffing and Curtail Overtime Costs in Healthcare
• O – Cancer Command: Data Integration and Insightful Visualizations to Support Decision-Making and Improved Quality of Care
• O – A Data-Driven Approach to Building a Provider Efficiency Program
• O – The Healthcare Experience & Advancement Lab: Co-designing Automated Solutions
• O – Digital referral management: Case study of an ambulatory care hospital
• O – Examining Nurse Practitioner Experiences Delivering Virtual Care during the Covid-19 Pandemic
• P – Co-Designing the Next Generation Electronic Health Record System with Clinicians
Patient Engagement and Empowerment + Virtual Care, Telemonitoring, and Remote Patient Care
• O – Engaging Patients: The Impact of Integrated Bedside Terminals in Hospital Care
• O The Impact of Virtual Training Programs on the Self-Efficacy of Informal Caregivers of Older Adults
• O – Grading of the Digital Health Interventions in a Remote Monitoring Program Technology Solutions for Mental Health
• P – Assessing Mental Health Apps: MHCC Experiences from Developing an Online Library, Repository, and Review Engine
• O – Building the Modern Digital Ecosystem for Mental Health Care
• O – Evidence2Practice –Digitizing Quality & MeasurementBased Care in Anxiety & Major Depression Across Hospitals
Connected Care and Interoperability
• P – What’s Next in Interoperability –or, What Have 20 years of Trials and Tribulations Taught Us?
• P – Enabling Care Continuity: A Provincial Interoperability Initiative Review
Virtual Care, Telemonitoring, and Remote Patient Care
• O – Bridging the Gap in Access to Care Utilizing Nurse Practitioner Virtual Care Solutions
• O – The next evolution of Telehealth and Virtual Health Solutions
• P – The Unclosable Emergency Department: Deploying a virtual ED at provincial scale
Artificial Intelligence in Healthcare
• P – See You Soon! AI-Enabled ED Virtual Patient Intake and Queue Management Application
• O – Enhancing workflow efficiency by automating EMR tasks/ticklers and filing inbound faxes
• O – User Perspectives on Explainable Artificial Intelligence (XAI) in Healthcare: A Rapid Review
• O – Artificial Intelligence, Interoperability, and Data Management in the Evolution of Precision Medicine
• O – Digital Human Teammate to Empower Health Human Resources: An Innovation Collaborative
• O – From Scan to Solution: Harnessing AI to Address Physician Burnout
• O – The use of AI in healthcare: Perspectives from Canadians and Clinicians
Digital Technology and Healthcare Human Resources
• O – Increasing Healthcare Human Resource Capacity through Clinician Interoperability and Patient Access to their Own Information
• O – Preparing the Workforce for Long-Term Sustainment of Health Information Systems
• P – Transforming Pediatric Healthcare: CHEO’s Workday Implementation Journey
Connected Care and Interoperability
• P – Implementing eReferral Across Canada: Transferring Knowledge, Sharing Learnings, & Identifying Opportunities
• P – Empowering Community Healthcare: A Digital Transformation Journey
• O – Overcoming challenges to primary care adoption of digital health technology: A clinicianfocused approach
• O – Reduce medication errors and improve patient safety through PharmaNet/EMR Integration
• O – Benefits Realization Management for a Provincial Data Integration through a BiDirectional Information Exchange
• O – Catalyzing Public Health Excellence: Unleashing Digital Innovations through Transformative Public-Private Partnerships
• O – Prioritizing Equity when Designing Digital Health Services
• O – A geospatial platform to calculate patient-paid healthcare costs and CO2 emissions from e-health services
• O – Digital Health Adoption and Health Equity: Unraveling Disparities Among Racialized Ontarians
• O – Intergenerational digital health learning experiences among South Asian older adults: findings and applications
• P – Transforming HealthLink BC Services: Opportunities, insights, and implications for Virtual Primary Care
• O – Effect of Digital Home Monitoring on Postoperative Outcomes in Patients Undergoing Thoracic Surgery
• O – Partnering on Appropriate Virtual Care – Patient-Informed Safe and Appropriate Care in Hospital at Home (HAH)
• O – Acceptability, feasibility, effectiveness and future directions for synchronous video groups for health interventions: patient perspectives
• O – Island Health Hospital at Home: Increasing Clinical Capacity through Zoom for Healthcare Video Visit iPads
• O – Shifting Post-Operative Care from Hospital to Home
• O – Revolutionizing PatientCentered Care with Hospital at Home: Expanding the EHR into the Patient’s Home
This panel will examine the transformative potential of Artificial Intelligence (AI) in healthcare and explore the ethical and regulatory accountabilities in leveraging AI for public health data and the critical importance of security measures in safeguarding health-related information.
Emcee
• Avis Favaro, Health Journalist
Speakers
• Sue Robins, Bird Comm, Author and Patient Engagement Consultant
• Dr. Khaled El Emam, University of Ottawa, Canada Research Chair in Medical AI and Professor, School of Epidemiology and Public Health, University of Ottawa
• Dr. Kimberlyn McGrail, University of British Columbia + Health Data Research Network Canada, Professor + Scientific Director and CEO
• Dr. Devin Singh, The Hospital for Sick Chidren (SickKids), Emergency Physician & Clinical Lead for AI in Medicine
Moderator
• Dr. Mohamed Alarakhia, eHealth Centre of Excellence, CEO
Sue Robins is a health care activist, speaker and author. Her latest book, Ducks in a Row: Health Care Reimagined, is a scrappy challenge to the established health care world. Her first book, Bird’s Eye View: Stories of a life lived in health care is a poignant memoir of her experience as a caregiver and cancer patient.
Sue has written for The New York Times, Canadian Medical Association Journal and The Globe and Mail. She has spoken at countless national and international health conferences about storytelling, the patient experience and best practice in patient engagement.
Sue’s work experience includes paid family leadership positions with the B.C. Children’s Hospital and the Stollery Children’s Hospital. She is a senior partner with Bird Comm, a health communications company.
She lives with her husband and youngest son on a mountain outside of Vancouver. More about Sue can be found at www.suerobins.com.
Dr. Kimberlyn McGrail is a Professor in the UBC School of Population and Public Health and Centre for Health Services and Policy Research, and Scientific Director of Population Data BC and Health Data Research Network Canada. Her research interests are quantitative policy evaluation and all aspects of population data science. In 2019-2020 she participated as a member of the Canadian Institute for Advanced Research Task Force on AI4Health and from 2020-2022 she was a member of the Expert Working Group for the Pan-Canadian Health Data Strategy. She is currently a Canadian representative to with the Global Partnership for AI as part of the data governance working group, and sits on a number of other data-related advisory committees. She holds a PhD in Health Care and Epidemiology from the University of British Columbia, and a Master’s in Public Health from the University of Michigan.
Dr. Khaled El Emam is the Canada Research Chair (Tier 1) in Medical AI at the University of Ottawa, where he is a Professor in the School of Epidemiology and Public Health. He is also a Senior Scientist at the Children’s Hospital of Eastern Ontario Research Institute and Director of the multi-disciplinary Electronic Health Information Laboratory, conducting research on privacy enhancing technologies to enable the sharing of health data for secondary purposes, including synthetic data generation and de-identification methods.
Khaled has founded or co-founded six product and services companies involved with data management and data analytics, with some having successful exits. Prior to his academic roles, he was a Senior Research Officer at the National Research Council of Canada. He also served as the head of the Quantitative Methods Group at the Fraunhofer Institute in Kaiserslautern, Germany.
He participates in a number of committees, including the European Medicines Agency Technical Anonymization Group, the Panel on Research Ethics advising on the TCPS, the Strategic Advisory Council of the Office of the Information and Privacy Commissioner of Ontario, and also is co-editor-inchief of the JMIR AI journal.
In 2003 and 2004, he was ranked as the top systems and software engineering scholar worldwide by the Journal of Systems and Software based on his research on measurement and quality evaluation and improvement. He held the Canada Research Chair in Electronic Health Information at the University of Ottawa from 2005 to 2015. Khaled has a PhD from the Department of Electrical and Electronics Engineering, King’s College, at the University of London, England.
Dr. Devin Singh is one of Canada’s first physicians to specialize in clinical artificial intelligence. He is an emergency physician at The Hospital for Sick Children (SickKids) and holds a Masters in Computer Science degree from the University of Toronto. He is an Assistant Professor at the University of Toronto in both the Temerty Faculty of Medicine and the Division of Computer Science and is an emerging scholar helping to innovate the regulatory, privacy, and ethical landscape for AI in Canada and beyond. He is also the co-founder and CEO of Hero AI, a healthcare technology company dedicated to empowering patients and providers with AI.
Plenary Panel Moderator Dr. Mohamed Alarakhia is a practicing Family Physician at the Centre for Family Medicine Family Health Team and the CEO of the eHealth Centre of Excellence. He is the Faculty Digital Health and Innovation Lead at McMaster University, Michael G. DeGroote School of Medicine (Waterloo Campus) and an Adjunct Professor at the University of Waterloo.
Dr. Alarakhia was awarded the Digital Health Executive of the Year Award in 2019 and the College of Family Physicians of Canada Award of Excellence in 2018 and 2022. Dr. Alarakhia and the eHealth Centre of Excellence won the Innovation Award in 2022 from the Greater Kitchener Waterloo Chamber of Commerce. The eHealth Centre of Excellence received a Canadian Medical Association Joule Innovation Grant and an AFHTO Team Award in 2020, as well as a Patient Care Innovation Team Award at the 2019 Canadian Health Informatics Awards and a 2019 Ingenious Award from Information Technology Association of Canada. The eHealth Centre of Excellence is recognized as one of the Best Workplaces in Canada.
In a first-of-its-kind study, Vancouver Coastal Health Research Institute researcher Dr. Kathleen Martin Ginis and her team offer concrete data revealing that the experience of participating in physical activities is a greater determinant of well-being among people with disabilities than the amount of time spent doing those activities.
“This study proved that, when thinking about the relationship between physical activity and aspects of mental health, physical activity needs to be thought of not solely in terms of the time spent on the activity, but in terms of the quality of the experience of that activity,” states Martin Ginis.
Martin Ginis and her team’s study –published in the journal Psychology of Sport and Exercise – forms part of a larger body of work through Martin Ginis’s SCI Action Canada Lab and the Canadian Disability Participation Project that is filling in major gaps in the field of physical activity and health disability research.
This data can inform science-based policies and practices in support of the approximately 27 per cent of Canadians aged 15 years and older living with one or more disabilities, adds Martin Ginis. With a growing demographic of older adults, the number of individuals with age-related disabilities may continue to expand. Already, disability rates in Canada rose by five percent between 2017 and 2022.
Martin Ginis’s groundbreaking study included 535 adults with physical disabilities from across Canada. Participants were separated into two groups and completed questionnaires.
In the group of sports participants, 271 individuals of an average of 44 years of age were asked to report the amount of time that they engaged in organized sport programs or training over the course of a week. In the group of exercisers, 264 individuals of
“THE GOAL OF OUR RESEARCH WAS TO DETERMINE WHETHER THE QUALITY OF PEOPLE’S SPORT AND EXERCISE PARTICIPATION EXPERIENCES EXPLAINED VARIANCE IN THEIR SUBJECTIVE WELL-BEING ABOVE AND BEYOND THE TIME THEY SPENT ON SPORT AND EXERCISE IN PEOPLE WITH DISABILITIES.”
around 57 years of age were assessed based on their weekly participation in weight training or aerobic exercise.
All participants also responded to standardized measures of their Subjective Well-Being (SWB), which were separated into: life satisfaction and emotional well-being, as well as physical, psychological and social health satisfaction.
The Measure of Experiential Aspects of Participation (MeEAP) – previously developed by Martin Ginis and colleagues – was employed to assess the quality of participants’ participation in sport or exercise activities.
MeEAP evaluates participants’ experience based on six elements: autonomy, belongingness, challenge, engagement, mastery and meaning.
Martin Ginis and her team first calculated the relationship between participants’ SWB scores and their age, gender and highest level of education. When total weekly minutes spent doing either exercise or sport was factored into the equation, for the most part, time spent on activity was unrelated to participant’s SWB scores. Time was important only within the domain of physical health satisfaction, explaining 1.3
per cent of the variance for the sport participants and 2.6 per cent of the variance for the exercise participants.
However, when researchers incorporated MeEAP scores into their data analysis, the amount of variance explained in the SWB outcomes increased by between five to 21 per cent for both sport and exercise participants. Participants’ perceptions of the quality of their sport or exercise experiences explained significant variance in all of the measures of SWB.
Looking at the specific participation elements measured by the MeEAP, participants who rated their sport and exercise experiences higher in terms of feelings of belongingness and mastery also rated themselves higher in SWB domains. Belongingness here refers to experiencing a sense of belonging to a group and acceptance or respect from others. Mastery refers to experiencing self-efficacy or a sense of achievement, competence or accomplishment “that can build on our sense of autonomy, which can help people feel more confident and able,” says Martin Ginis.
“I have heard too many stories of people with disabilities being turned away from gyms that cannot accommodate them, or whose adaptive equipment, such as a special arm crank used to propel a wheelchair during a spin class, is set up in the corner of the room, away from other class participants,” states Martin Ginis.
She believes that the evidence from this study could support work among policymakers to ensure physical activity programs and initiatives for people with disabilities are adequately resourced to provide quality sport and exercise participation experiences.
In subsequent research, Martin Ginis plans to take a closer look at how in-the-moment physical activity experiences may impact the mental and physical health of people with disabilities over time.
“There is a need for health researchers to include people with disabilities in their studies,” Martin Ginis says. “This work is one way to contribute to a growing and much-needed body of research.” ■ H
Over the past few years, incidents of violence against healthcare workers has increased worldwide. Windsor Regional Hospital has worked closely with its staff leadership, bargaining agents and Occupational Health and Safety Committee on putting into place various layers of protection for its staff as well as its patients and visitors. The number and severity of these incidences of patients attending the hospital with knives and even guns were increasing. However, we knew the issue was worse because “we did not know what we did not know”.
Over the past year, Windsor Regional Hospital embarked on an ambitious journey to enhance the safety and security of our patients, staff, and visitors through the implementation of cutting-edge EVOLV™ detectors. This transformative initiative has not only elevated our security protocols but has also significantly contributed to our ongoing commitment to fostering a safe and welcoming healthcare environment.
The decision to integrate EVOLV™ detectors into our security infrastructure was driven by a proactive approach to addressing the evolving challenges of maintaining a secure healthcare facility in today’s complex world. Recognizing the critical need to efficiently screen for potential threats without compromising the patient experience or operational flow, we turned to EVOLV’s™ state-ofthe-art detection technology. These advanced detectors are designed to seamlessly identify concealed weapons and other items of concern in real-time, all while allowing the natural movement of individuals through our entrances
without the inconvenience of traditional security checkpoints. You do not have to empty your pockets of your cellular device, keys or remove belt/shoes. You can enter via a wheelchair without issue.
A video we produced when we introduced the EVOLV™ technology can be found on youtube, https:// youtu.be/xfnOrNZWnmA?si=wSa4tfHEz7PRWkp-
From the outset, our goal was clear: to implement a solution that not only enhanced security but also aligned with our core values of compassion, respect, and excellence. The journey to achieve this was anything but straightforward. It required meticulous
planning, cross-departmental collaboration, and a deep commitment to our shared vision of a safer hospital. Our teams worked tirelessly to ensure a smooth integration of the EVOLV™ detectors, addressing technical, operational, and ethical considerations with the utmost diligence.
The results have been nothing short of remarkable. Since the installation of the EVOLV™ detectors, we have witnessed a significant improvement in our ability to preemptively identify and mitigate potential security risks. The technology has proven to be incredibly effective, with an impressive accuracy rate that has bolstered our confidence in the system. In just over 5 months we have been able to detect over 2000
“threats” with over 1000 of them being knives. Nothing is 100% full proof but again this is another layer of security for our staff, patients and visitors.
More importantly, the feedback from our community has been overwhelmingly positive. Patients, visitors, and staff have expressed their appreciation for the enhanced sense of security, noting how the discreet and non-intrusive nature of the detectors has minimally impacted their hospital experience. The fact everyone attending the emergency department through the main entrances has to walk through these EVOLV™ detectors is comforting to many.
One of the most notable outcomes of this initiative has been the way it has continue to foster a culture of safety and vigilance across the hospital. The presence of the EVOLV™ detectors serves as a constant reminder of our unwavering commitment to the well-being of everyone who steps foot in our facility. It has encouraged open dialogues about security, safety, and the collective responsibility we all share in creating a secure environment.
WRH will continue to work with its staff and examine other ways it can enhance security for its staff, patients and visitors. ■ H
David Musyj is President & CEO, Windsor Regional Hospital. Some of the items discovered by the technology include knuckles, knives and drug paraphernalia. The EVOLV™ detector at the entrance of the emergency room.The rising number and intensity of wildfires in British Columbia are taking an immense toll on people and communities, prompting calls for further interventions to protect public health. Vancouver Coastal Health Research Institute researcher Dr. Christopher Carlsten and his team applied advanced science in the field of health outcomes to assess the cost-effectiveness of a hypothetical BC government-administered rebate on air filters to reduce smoke-related asthma complications.
Published in the prestigious American Journal of Respiratory and Critical Care Medicine, the model is designed to inform future public health discussions in the province.
“Air filters are backed by research evidence as being highly effective at reducing air pollution in the home, such as from wildfire smoke,” states Carlsten. “The missing, big-picture question is: ‘What is the most economical way to get them into peoples’ hands?’”
Wildfire smoke contains fine particulate matter with a diameter of 2.5 microns (PM2.5) – one millionth of a metre – or smaller. For comparison, a human hair is approximately 50 microns. These microscopic particles can travel deeper into the lungs, negatively impacting tissues. As a result, government health agencies often recommend that anyone with asthma or other health conditions that can worsen from fine particulate matter stay indoors during wildfire smoke events with elevated PM2.5.
Research into the long-term health outcomes of inhaling wildfire smoke is not well-established. However, shortterm health implications for people with asthma, a chronic lung disease, may include increased respiratory symptoms or flare-ups, such as a worsening cough, wheezing, shortness of breath and decreased lung function, as well as other adverse health effects and hospitalizations.
A 2021 Health Canada report classified fine particulate matter as one
of three leading outdoor pollutants collectively responsible for 15,300 premature deaths in Canada annually and a cost of $114 billion to Canada’s economy.
“The existing evidence suggests that traffic-related air pollution has, overall, relatively greater effects on cardiovascular outcomes than lung effects. Conversely, emerging data on wildfire smoke inhalation suggests that the respiratory system may be impacted somewhat greater than the cardiovascular system,” states Carlsten. “It is important that we understand how to protect people from wildfire smoke since the same interventions used to reduce traffic pollution effects may not apply.”
Air filtration devices with high-efficiency particulate air (HEPA) filters can improve indoor air quality by trapping particles, including PM2.5, and reducing their overall concentrations. Tax benefits for the cost of an air filter, cleaner or purifier are currently offered through the Government of Canada, but not a rebate for a portable HEPA air filter, which can cost $150 and up.
Using a health economics approach, Carlsten and his team, including Dr. Kate Johnson as well as statistical research scientist and lead author, PhD student Amin Adibi, created a simulation model that predicted the outcomes of a five-year HEPA filter rebate program with a start and end period of 2018 to 2022.
The research team’s analysis drew from historical data on wildfire smoke and PM2.5, as well as hospitalizations due to wildfire smoke inhalation and HEPA air filter effectiveness at removing particulate matter. Researchers also consulted with patient partners living with asthma, two medical health officers, an environmental health officer and a policy analyst.
“WILDFIRE SMOKE IS A SIGNIFICANT PUBLIC HEALTH PROBLEM THAT IS WORSENING. HOWEVER, MULTIPLE FACTORS CAN MAKE IT CHALLENGING TO GET A PROVEN INTERVENTION TO THE PEOPLE WHO NEED IT.”
The test scenario targeted all BC residents 42 years of age with a diagnosis of asthma and compared them with the same demographic without portable HEPA air filters in their homes. In this scenario, the BC provincial government offered a 100 per cent rebate on portable HEPA air filters to the test demographic.
“We chose conservative estimates of the HEPA air filters’ effectiveness that did not include their ability to remove other indoor sources of air particulate matter, such as cooking particles, wood burning stove smoke and pathogens,” says Adibi.
The team found that the HEPA filters could prevent more than 600 emergency room visits and 400 hospitalizations across the province. Additionally, a full rebate on the cost of a HEPA air filter was cost-effective in the Kootenay Boundary region of BC,
which was also the most wildfire-prone area under analysis within the given time frame.
However, across the province, researchers found that a $100 rebate program on HEPA air filters was mostly cost-effective if each filter was used continuously throughout the year. A $30 rebate was cost-effective in wildfire-prone areas of BC’s interior and northern interior when a HEPA air filter was used only on days when PM2.5 levels exceeded 25 microns per metre squared.
“Geographic differences were a significant factor in the cost-benefit analysis of this broad-based public health intervention,” states Carlsten. “Any intervention that shows great promise at being able to improve patient outcomes should undergo a similar process when evaluating its cost-effectiveness.” ■ H
Unity Health Toronto is one of the first hospitals in Canada to work with Google Cloud to develop a generative artificial intelligence (Gen AI) tool to speed up the process of reviewing complex research contracts. The tool aims to reduce turn-around times for clinical trial contracts, resulting in a faster launch of groundbreaking health research and the development of interventions and treatments aiming to improve patient care.
Every year, Unity Health’s research contracts team receives roughly 1,400 research contracts. Of these, about 250 are clinical trial agreements, which are the most complex.
Before patients can enroll in a clinical trial, there are a number of approvals required, including ensuring that
the clinical trial agreement is negotiated and signed between Unity Health Toronto and the external party. A clinical trial agreement is a legally binding agreement that governs the conduct of a particular study and outlines the obligations of each party. These include complex legal terms, insurance requirements, privacy obligations and study drug warranties to name a few.
The process of reviewing a 40-50 page clinical trial agreement involves
multiple reviews, back-and-forth communication between Unity Health and the other party, as well as consultation with legal counsel. As such, it can take a highly-specialized reviewer up to 1418 hours to complete a first review, says Manager of Research Contracts, Karen Ung.
Right now, the process of reviewing these agreements is all manual, with a team of skilled reviewers relying on their expertise, guidance documents, principles, and policies to revise and redline the agreement, Ung said. Anything redlined is then proposed to the other party for further discussion, negotiation and editing.
“By completing that first step faster, staff can do other things like negotiate with counterparties, which AI is not going to be able to do,” Kang said. “This is a tool that will aid our highly-trained staff to do what they do best. We see this as augmentation, not automation.”
The tool is being built with Google Cloud’s Vertex AI platform and leverages Google’s large language models. Unity’s model will be fine-tuned in a secure and confidential environment using its own administrative data, policies and parameters, said Kang.
There will be a learning period, where Unity Health will supply the developers, Quantiphi, with several hundred data points. The development team will also receive Unity Health’s guidance documents and checklists. This learning period will be followed by a 24-month period, where the tool will be continuously optimized and fine-tuned through daily usage by Unity Health research staff.
At the end of this optimization period, the tool will have evolved from the original foundational model to better match the needs of Unity Health’s research institute, said Ung.
“Clinical trial agreements come with the most amount of complexity but they also provide significant benefits to Unity Health Toronto. Most importantly, they provide access to treatments – sometimes potentially life-saving treatments– that would otherwise be unavailable for patients,” said Ung. “What we’re hoping to do is create a tool that completes the first round of redlines for us, which allows the reviewer to go through the draft, fine tune it, and ensure everything is complete before sending it to the external party. Ideally, we’d like to get to the points of contention with the other party faster, so we can review and mitigate them, sign the contract and get the trial up and running.”
“Some may see this investment in technology as risky, because we’re not buying an off-the-shelf product, and therefore we don’t know exactly what we’re going to get,” Ung said. “But we’re confident that we can develop something that will ultimately help the team save time while ensuring that we are agreeing to the best terms possible for Unity Health and our patients.”
Kang agrees.
By using Google Cloud’s AI to complete the first redlines, the tool will free up valuable time for research contracts staff, so they can do other critical tasks, adds Senior Director of Research Operations Mani Kang.
“There’s definitely a level of excitement around this technology, but this project is grounded in the principles that make our organization tick,” Kang said. “We’re doing this for a reason, and that reason is to get faster access to the latest research and innovation for our patients.” ■ H
TJ, a 45-year-old male with symptoms of a common cold (sore throat, headache, runny and stuffy nose) goes to his local pharmacy, as the Acetaminophen 500 mg tablets that he has been taking at home does not seem to be strong enough to relieve his symptoms. He walks down the cough-and-cold aisle and intends to purchase a [Brand Name] Complete Cold and Flu formulation over-the-counter medication (with active ingredients: Acetaminophen, Diphenhydramine, and Pseudoephedrine) (Figure 1).
Over-the-counter (OTC) medications can be purchased without a prescription. They are usually located outside of the dispensary for self-selection by consumers/patients. Common examples include cough-and-cold medications, pain relievers, antacids, antidiarrheals, allergy medications, etc.
A drug interaction is an interaction between two medications (including supplements like vitamins or natural health products), between a drug and food, or between a drug and a medical condition that may affect how the medication would work in the body, hence leading to potential side effects. This article will focus on the first type of drug interactions: drug-drug interactions (DDIs) with OTC medications.
Commonly purchased OTC products include cough-and-cold and pain relief medications. This was reflected in the above case scenario with TJ. One of the most common DDIs is duplication of therapy, that is, using
two or more of the same kind/class of medications. For example, some patients may be taking OTC Ibuprofen for headache but may also be taking Naproxen (from a prescription) for another medical condition, not realizing that both medications belong to the same drug class called non-steroidal anti-inflammatory drugs (NSAIDs). If taking too much NSAIDS, it will increase the risk of side effects like ulcers, water retention, increased blood pressure, and bleeding, etc. Some OTC pain relievers contain acetylsalicylic acid (ASA) and for patients who are already on ASA or some form of blood thinners like Warfarin, they will be at an increased risk of bleeding if they take an ASA-containing OTC pain relief medication. On the other hand, many OTC products have similar active ingredients like Acetaminophen which may potentially lead to duplication of therapy if the patient is already taking another acetaminophen-containing OTC cough-andcold products. An overdose of Acetaminophen may be associated with liver damage. Similarly, allergy medications like Diphenhydramine are commonly included in OTC cough-and-cold products as it relieves symptoms like runny nose and aids the patient in sleeping. Patients may not be aware of the drowsiness or sleepiness side effect of Diphenhydramine, and this can be of concern for patients who are concurrently taking other medications that can increase drowsiness (e.g., antidepressants/anti-anxiety medications, opioids, anti-seizure medications, etc.). Lastly, Pseudoephedrine is a common decongestant in OTC cough-and-cold products and its use is contraindicated with some
types of antidepressants (e.g., monoamine oxidase inhibitors) due to a significant increase in blood pressure.
Consulting a pharmacist before purchasing OTC medications is the best strategy to prevent DDIs with OTC medications. Referring to our case scenario above, TJ is already taking Ac-
etaminophen 500 mg tablets at home, and he is planning to purchase an OTC cough-and-cold product which also contains Acetaminophen. Using both products would put him at risk of Acetaminophen overdose. TJ should consult a pharmacist who would be asking him about medications that he has been taking, his symptoms, his medical conditions, his allergies, etc., before purchasing the OTC coughand-cold product.
If consulting a healthcare professional is not feasible, then TJ can inspect the list of active ingredients of the OTC product prior to making a purchase. Most OTC products will have their indication(s) listed beside the active ingredients (Figure 1). For example, one may not be aware which active ingredient is a pain reliever when purchasing OTC cough-and-cold medication. However, when inspecting the list of active ingredients, it is mostly likely that you could identify which of them is pain reliever (e.g., Acetaminophen). If a patient is already taking another Acetaminophen-containing medication (e.g., from a prescription or another OTC), then it is best to avoid this potential duplication of therapy from an OTC product. Alternatively, there are online DDI checkers like WebMD Drugs Interaction Checker (https://www.webmd.com/interaction-checker/default.htm) where one can manually look up and check DDIs. However, it is important to note that information retrieved from these selfhelp online tools should not be considered as a replacement or substitute for the advice or consultation from a pharmacist or your primary healthcare professional/provider. The best strategy to prevent DDIs is to speak to your pharmacist and your healthcare provider. ■ H
Uroosa Abbas is a PharmD Student at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto.]
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