Health Care Disruptors

OVER THE PAST 125 YEARS, ST. MICHAEL’S HOSPITAL HAS BEEN INVOLVED IN A NUMBER OF MEDICAL BREAKTHROUGHS THAT HAVE UPENDED THE STATUS QUO.

From performing minimally invasive procedures with robots to creating a “black box” to minimize errors in operating rooms, St. Michael’s has been at the forefront of some of the most revolutionary health-care innovations of our time. Urban Angel selected a handful of disruptors who are pushing the boundaries by exploiting gaps in health care to save even more lives.

A Global Early Warning System for Infectious Diseases

What we’re doing at St. Michael’s lies at the crossroads of medicine, engineering, data science, design and business. – Dr. Kamran Khan, Scientist, Li Ka Shing Knowledge Institute

The photos were devastating: babies from Brazil with abnormally small heads and other severe birth defects. People, especially women of childbearing age, were afraid. St. Michael’s infectious disease specialist Dr. Kamran Khan was called on to forecast the potential spread of the Zika virus across the Americas, Europe and then Africa and Asia-Pacific (the carrier mosquito does not live in Canada).

Dr. Khan was there when SARS crippled Toronto in 2003 and saw that public health decision makers needed information fast to deal with dangerous outbreaks. Dr. Khan’s light-bulb moment: a big data platform, BioDiaspora, that models the global spread and impact of infectious diseases using real-time data on airline travel, climate and many other data sources. In 2014 he formed a for-profit social enterprise, BlueDot, and received funding from Li Ka-shing’s Horizons Ventures. The platform has been used to evaluate H1N1, Ebola and Yellow fever at events such as the 2012 Olympics and the Hajj and, most recently, the Zika virus. Thanks to BioDiaspora, we are better prepared to deal with outbreaks.

Big Data for Better Care

We will have the most advanced, comprehensive data warehouse of any hospital in the country at St. Michael’s. – Dr. Muhammad Mamdani, Director of LKS-CHART

Big data is set to disrupt health care, thanks to St. Michael’s new enterprise data warehouse, which will connect 19 existing hospital databases with over 17,000 data elements from half a million patients. A big part of that impact will come from the LKS-CHART (Li Ka Shing Centre for Healthcare Analytics Research and Training), a bold new research initiative led by Dr. Muhammad Mamdani. While Founding Director of the Applied Health Research Centre at St. Michael’s, Dr. Mamdani created a drug policy research program that identified significant overuse of blood glucose testing, helping Ontario save more than $100 million over five years.

Thanks to philanthropist Li Ka-shing, Dr. Mamdani and his research team will work with clinicians and decision makers to use advanced analytics to answer pressing questions and solve real-world challenges – measure a problem, propose a solution, measure results – to generate improvements both big and small. For example, can we identify the most at-risk stroke patients in the Emergency Department? If yes, physicians can manage these patients diff erently and save lives.

Using the Brain to Drive the Respirator

The key is the NAVA module, the software that translates the signals from the brain into information that tells the respirator what to do. – Dr. Christer Sinderby, Scientist, Keenan Research Centre for Biomedical Science, St. Michael’s

Respirators keep critically ill patients alive, but can damage delicate lung tissue. With 26 patents, St. Michael’s Dr. Christer Sinderby and Dr. Jennifer Beck invented the revolutionary Neurally Adjusted Ventilatory Assist (NAVA) device, where the patient’s nerve signals trigger each breath, rather than imposing the rhythm mechanically. Now, the duo is taking NAVA to the next level to manage carbon dioxide buildup. Current solutions include more air, which can cause lung damage and increased mortality, and external filtering of blood, which can cause severe complications.

Their elegant solution? NAVA Through-Flow (TF), with an in and out tube, so the patient breathes less CO2 back in with each breath. They expect to move to human trials this year. Dr. Beck is also working with Neonatal Intensive Care Unit Director Dr. Doug Campbell on LifeVest, a NAVA-equipped negative pressure vest to help premature babies breathe. In 2015, LifeVest won St. Michael’s Angels’ Den research competition. In 2016, NAVA-TF came second, and both went to the Global Healthcare Innovation Academy’s international competition in Calgary last August, where LifeVest won first prize. Drs. Beck and Sinderby, time to catch your breath!

A Prescription for Poverty

In my experience, living with low income has the biggest impact on a person’s health. – Dr. Gary Bloch, Family Physician, St. Michael’s

Dr. Gary Bloch sees the impact of poverty every day: “Poverty is at the root of many of the illnesses I treat.” Known as the “social determinants of health,” it means income, literacy and employment status all impact health. So rather than just prescribe, Dr. Bloch wants to pre-empt.

As Chair of the Social Determinants of Health Committee in the Department of Family and Community Medicine at St. Michael’s, Dr. Bloch and his team have launched projects to address these challenges.

One, likely a Canadian first, was to hire an income-security health promoter who works to improve the income security of patients. Next, Legal Aid Ontario, in partnership with St. Michael’s, funded a lawyer to help patients with employment, housing and other problems. Working with the Toronto Public Library, the team launched Reach Out and Read to improve literacy by providing books to babies and young children during checkups. Appointed to Ontario’s Income Security Reform Working Group in July of 2016, Dr. Bloch comments, “We need to treat poverty as a disease. People with adequate resources would be healthier and happier and not held back by poor health.”