L-R: Dr. Sacha Bhatia, Dr. Danielle Martin
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Bridging the gap between technology and healthcare
By: Camilla Cornell
Cardiologist Dr. Sacha Bhatia sees patients who travel all the way from Thunder Bay to Toronto for a short appointment to get their life-saving pacemaker examined. Yet the technology exists for those patients to be able to connect with him remotely through a laptop, saving them the trip to the hospital.
“I can check their device, their heart rate and their blood pressure to determine if we need to make adjustments,” says Dr. Bhatia. “Unless something is wrong, there is no need for them to come into the hospital.”
It’s that type of innovation that Dr. Bhatia aims to harness as director of the Women’s College Hospital Institute for Health Systems Solutions and Virtual Care (WIHV). While other healthcare organizations hone in on finding cures for diseases, Dr. Bhatia points out, WIHV seeks to find cures for what’s ailing the healthcare system as a whole.
It asks questions like: How can we help people manage chronic diseases better? Why don’t 50 per cent of Ontarians have same-day access to a doctor? And how can we help keep people out of the hospital by improving home care service?
The answer, Dr. Bhatia believes, lies in unlocking the power of innovation and digital technology to make healthcare more accessible, more effective, and more sustainable as the population ages.
AT THE FOREFRONT OF DIGITAL TRANSFORMATION
“Digital technology has transformed so many industries – from banking to travel to music,” says Dr. Bhatia. “But healthcare still uses faxes and pagers and other old-school technology. What we’ve started to do is figure out ways these new types of technology – like apps and wearables – can make healthcare better.”
WIHV currently has more than 20 digital healthcare projects on the go, aimed at helping patients recover from surgery at home and manage a range of chronic conditions.
Among the innovations being tested are an online platform that connects patients with mental illness to care and peer support; a diabetes care app that offers diet and lifestyle tips and checks blood sugar levels; and a project that provides high-risk cardiac patients with a series of educational reminders by phone or email, aimed at reminding them to take daily medications or attend rehabilitation appointments.
The hospital’s goal is not simply to transform healthcare within the walls of Women’s College itself, but to scale up successful models, “from Windsor to Wawa and beyond,” says Dr. Bhatia, reaching smaller communities with limited access to doctors and specialists.
To that end, WIHV is set to lead a Provincial Centre of Excellence in Digital Health putting it at the centre of a partnership of more than 30 organizations, including a number of hospitals and three universities.
WHY WOMEN’S COLLEGE?
As an ambulatory care hospital, Women’s College is well positioned to lead the digital revolution.
“We are a hospital without the hotel,” explains Dr. Danielle Martin, co-founder of WIHV, family physician and vice president of medical affairs and health system solutions at Women’s College Hospital. Although Women’s College provides diagnostic tests, surgery and clinical treatments, says Martin, “we don’t have any inpatient beds and we don’t have an emergency room.”
That “liberation from the dependence on traditional hospital models,” makes Women’s College an excellent place to research innovative approaches to care, Dr. Martin contends.
“We’re free to focus on where most healthcare is happening currently and where it will happen in future; helping people manage chronic diseases, such as diabetes and cardiovascular conditions, in the community.”
Our healthcare system tends to focus on acute illnesses like heart attacks, car accidents and broken hips, adds Dr. Bhatia, but people with chronic illnesses are the least well-served. “If we can support them effectively through new models of care, we hope they will be less likely to have a heart attack or stroke, for example,” he says.
In order for Women’s College to achieve that goal, says Dr. Martin, it is moving increasingly toward a “virtual hospital” model, where doctors care for patients at a distance. In a virtual hospital, patients can interact with healthcare providers through virtual means – by phone, email, electronic messaging or face-to-face interaction through a virtual portal.
“It may mean anything from being able to book your own appointment online to messaging electronically with your healthcare provider through a secure private platform to get questions answered,” says Dr. Martin. “By properly integrating digital tools in our healthcare system, we hope to solve some of the access problems, reducing wait times for outpatient care and increasing convenience, all while saving the system money.”
TAKING A HOLISTIC APPROACH TO DEVELOPMENT AND TESTING
In order to develop tools with the potential to remake the healthcare system, Women’s College relies on the ingenuity of private sector engineers and researchers.
“We’re not building these solutions,” explains Dr. Bhatia. “We work at the intersection of four elements: patients, physicians, researchers and private companies.” What generally happens, he says, is that digital tech companies approach the hospital at an early stage of their invention and say, for example: ‘We have this technology that we think might have value in monitoring patients after surgery so they can recuperate at home rather than spending five or six days in hospital.’”
WIHV’s scientists and doctors then work with the company to try to determine the benefits of the solution, as well as to pinpoint the challenges. Finally, “we go out into the field and test it using scientific methods to determine if it is altering outcomes and providing value for money,” says Dr. Bhatia. “After all, you can’t just assume they work.”
He points to the popular activity trackers as an example. “The assumption is if you keep track of your steps and get your 10,000 steps in every day, it will help you lose weight,” he says. “But when they actually tested that assumption they found people who use these trackers didn’t lose any more weight than people who didn’t. How does that make sense?”
The answer isn’t clear, he says. But perhaps some people give themselves permission to take that extra scoop of ice cream as a reward for upping their activity level. In that case, “it’s possible trackers might actually help people lose weight if they are provided with a support system,” says Dr. Bhatia. “Maybe they need to be connected with a nutritionist, for example.”
Or maybe you’d have better outcomes with a different type of patient. “The patient must be motivated to make the change,” says Dr. Bhatia. “Just as all drugs don’t act the same way on every patient, neither will other interventions. Patient fit is very important.” In order to get the most out of technological innovation, he says, “we try to figure out for whom and how will these products work best. Then we try to create a system where products will work best.”
THE REAL-WORLD LITMUS TEST
The primary benefit of conducting research and assessment at a working hospital, says Dr. Bhatia, is that potential innovations get tested in real scenarios. “That’s really important,” he says. “Sometimes research can be dismissive of actual care of patients. But at Women’s College, we do research and then we go two floors down and we’re in clinic with patients who are actually living with healthcare challenges day-to-day.”
In addition, says Dr. Martin, Women’s College has always had a “deep commitment to equity.” That has led researchers to really think about “how new models of care can close health gaps and offer improved access for people who are marginalized – that includes women, as well as trans people, Indigenous people and other groups who have traditionally experienced barriers to healthcare.”
Rather than tweaking mainstream interventions for a group that is experiencing poorer health outcomes, she says, “we begin by co-designing the innovation in partnership with those groups. We design something that is made for them.”