2019
DIGITAL HEALTH MODERN MEDICINE
FROM VIRTUAL REALITY TO GENETIC FINE-TUNING, THE FUTURE OF HEALTH CARE HAS ARRIVED
PATIENT DATA DOES BLOCKCHAIN HOLD THE ANSWER?
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FUNDING WHY BUSINESSES ARE INVESTING BIG IN DIGITAL HEALTH
SUPERCLUSTER COLLABORATIONS KEY TO STOKING INNOVATION
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CONTENTS
17
2019
DIGITAL HEALTH MODERN MEDICINE
FROM VIRTUAL REALITY TO GENETIC FINE-TUNING, THE FUTURE OF HEALTH CARE HAS ARRIVED
PATIENT DATA DOES BLOCKCHAIN HOLD THE ANSWER?
COLUMN
Dakers—7
COLUMN
Paish—8
COLUMN
COLUMN
Arazi—11
Ackenhusen—15
COLUMN
Bidu—16
COLUMN
Moreno—23
20
12 FEATURES
4 THE B.C. ADVANTAGE Digital health firms, large and small, debate the advantages of being based on the West Coast
FUNDING WHY BUSINESSES ARE INVESTING BIG IN DIGITAL HEALTH
SUPERCLUSTER COLLABORATIONS KEY TO STOKING INNOVATION
PRESIDENT: Alvin Brouwer EDITOR-IN-CHIEF, BUSINESS IN VANCOUVER; VICE-PRESIDENT, GLACIER MEDIA: Kirk LaPointe EDITOR: Tyler Orton DESIGN: Petra Kaksonen PRODUCTION: Rob Benac CONTRIBUTORS: Nelson Bennett, Chuck Chiang, Glen Korstrom, Tyler Orton, Albert Van Santvoort COLUMNISTS: Mary Ackenhusen, Ohad Arazi, Michael Bidu, Natalie Dakers, Sylvain Moreno, Sue Paish PROOFREADER: Meg Yamamoto DIRECTOR, SALES AND MARKETING : Pia Huynh SALES MANAGER: Laura Torrance ADVERTISING SALES: Betty Jin, Blair Johnston, Carl Rudnik, Corinne Tkachuk, Chris Wilson ADMINISTRATOR: Katherine Butler Digital Health is published by BIV Magazines, a division of BIV Media Group, 303 Fifth Avenue West, Vancouver, B.C. V5Y 1J6, 604-688-2398, fax 604-688-1963, biv.com. Copyright 2019 Business in Vancouver Magazines. All rights reserved. No part of this book may be reproduced in any form or incorporated into any information retrieval system without permission of BIV Magazines. The publishers are not responsible in whole or in part for any errors or omissions in this publication. ISSN 1205-5662 Publications Mail Agreement No.: 40069240. Registration No.: 8876. Return undeliverable Canadian addresses to Circulation Department: 303 Fifth Avenue West, Vancouver, B.C. V5Y 1J6 Email: subscribe@biv.com Cover photo: Shutterstock
9 PATIENT DATA Barriers to accessing medical and health data for research are no longer technical ones 12 PHILANTHROPIC FUEL How foundations are working to drive innovation in health care 17 ROBUST RETURNS Institutional and retail investors are doing well by doing good, investing in improved health care
PRODUCED BY
20 HEALING THE VULNERABLE Breakthroughs in technology are treating some of B.C.’s most vulnerable patients in ways previously impossible
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Charting a new course for healthcare. We are leveraging innovative technologies to enhance health experiences for Canadians and their care teams. Discover our digital health solutions at telushealth.com
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THE B.C.
ADVANTAGE Digital health firms, large and small, debate the advantages of being based on the West Coast
T
TYLER ORTON
he play ends instantly after a big hit against a BC Lion. The Lion’s helmet took the brunt of it and the CFL player is rattled – that’s when HeadCheck Health’s technology kicks in.
FOR THE FIRST TIME WE’RE GIVING LEAGUES THE ABILITY TO LIFT UP THE HOOD AND TAKE A LOOK AT WHO’S COMPLIANT AND ARE THERE POSSIBLY WAYS WE CAN MAKE THE GAME SAFER j Harrison Brown CEO, HeadCheck Health
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As the team’s medical staff tests for concussion symptoms, the league’s concussion protocol is being managed through the Vancouver-based company’s platform. Gone are the days of a patchwork system used by different teams across the league, instead replaced by a unified digital platform that relays back to the league play types, areas of the field and game times at which the concussion occurred. “For the first time we’re giving leagues the ability to lift up the hood and take a look at who’s compliant and are there possibly ways we can make the game safer,” says HeadCheck Health CEO Harrison Brown. For the past few years Brown and his digital health firm have been building up partnerships with smaller leagues and organizations before landing their first pro league, the CFL, earlier this year. “Operating and starting a business is very
easy to do here in B.C. and I don’t know if the same thing would have happened in the United States,” he says. “Our privacy laws and our health-data laws are very positive for customers and also for businesses. In the U.S., you’ve got things like the Patriot Act and stuff like that that is not great for privacy. Being positioned in Canada with the talent we have and the laws that we have … is certainly an advantage.” That privacy question is also one factor propelling Telus Corp. into the health-care sector, according to group president and chief corporate officer Josh Blair. For 11 years the Vancouver-based telecom giant has been pursuing everything from facilitating electronic medical prescriptions to video consultations with doctors. “We just thought that all of our core abilities to transfer data in a safe, secure way to people who needed to make decisions with that data, and
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Tyler Wish, CEO of NACBio, says Canada’s health-care system must do more to fully embrace digital health technologies • CHUNG CHOW
deliver better outcomes as a result of those decisions, made a ton of sense,” Blair says. “It was really transferring what we’ve been good at over a century now and putting the health-care lens on it.” Critical to the company’s strategy has been recognizing that the e-health space has been fairly siloed up until now. Telus has been developing a broad range of digital health products, has been acquiring medical clinics and was one of the founding partners of Canada’s Digital Technology Supercluster. The B.C.-based supercluster, which received $153 million in funding commitments from Ottawa last year, requires that participants make investments in collaborative projects pitched to the program. Each project must include a minimum of three organizations – at least one of which must be a smallto-medium-sized enterprise – in a bid to stoke partnerships within the business community.
HOW’S YOUR BRAIN DOING TODAY?
HEALTHTECHCONNEX.COM
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THE B.C. ADVANTAGE
Josh Blair, group president and chief corporare officer, Telus •SUBMITTED
RIGHT:
HeadCheck Health
CEO Harrison Brown says B.C.’s privacy and health-data laws provide companies like his a competitive advantage in the realm of digital health •ROB KRUYT
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“Typically you’re going after something that’s much newer and requires collaboration across a large number of constituents,” says Blair, pointing to pharmacogenomics as as a prime example. Pharmacogenomics entails studying genes to determine how an individual will respond to different drugs. The B.C. pharmacogenomics project was among the first to secure funding from the supercluster and the private players collaborating on it. “You’re talking about needing to involve doctors, pharmacies, researchers … government, in terms of overseeing it. So that’s the sort of project that makes a lot of sense for the supercluster to take on because it’s a fundamental change in the way we do medicine,” says Blair. “B.C. is an exciting place to be in terms of digital health in Canada.” And, he adds, because it’s the only province that reimburses doctors “significantly” for virtual care visits, it’s having the effect of drawing other tech companies to B.C. to pursue digital health. “If we harness that as the government, as the private industry all working together, we can really carve out a long-term leadership position,” Blair says. But challenges persist in the bid to make digital health as ubiquitous on Canada’s West Coast as it is in other jurisdictions, according to Dr. Tyler Wish.
“Canada’s a difficult place for digital health. In the U.S., just in the way in which the healthcare system is structured, it’s much more conducive to building, commercializing and monetizing digital health solutions,” says Wish, CEO of cannabis data intelligence company NACBio. Wish’s own background is in biotechnology, having previously launched another company leading Newfoundland’s genome sequencing initiative aimed at breakthroughs in pharmaceuticals. NACBio has designs on developing deep profiles – including use of genetic information – by studying as many as 100,000 Canadians to offer evidence-based recommendations for products best suited for users’ needs. “Canadians and the Canadian health-care system still have a long way to go to accepting these technologies. I think one of the most specific challenges related to that is procurement by Canada’s health-care system at the provincial level,” Wish says. “It’s just been a major issue for Canada for a period of decades, and until the Canadian health-care system is more ambitious and more willing to engage with Canadian-developed digital health solutions, it’s rather difficult for Canadian companies to get the traction and commercialize these innovations.” É
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NEW FRONTIER How digital therapeutics serve as doctor-prescribed software
NATALIE DAKERS
In recent years, adding “tech” to you r i ndu st r y h as become a l l the rage. Fi ntech. Cle a ntech. A g r itech. A nd g uess what? T he ma rriage of technology and medicine (a.k.a. digital therapeutics) is coming to a doctor’s office near you. Technology is disrupting almost every sector, and medicine is next in line. This revolution is taking the world by storm with billions of dollars – to the tune of $14 billion-plus – invested in digital health, including digital therapeutics. Whereas digital health describes all technologies for health and wellness (like your fitness tracking watch), what sets digital therapeutics apart is that it is evidence-based and goes down a regulatory pathway. It can best be described as software – prescribed by a doctor – that prevents, manages and treats medical disorders or diseases. For example, algorithms that activate different neurological regions in the brain to treat dementia or depression. Digital programs to prevent the onset of diabetes. Video games utilizing adaptive sensory stimulus software to treat ADHD. When you think about the many chronic conditions and diseases currently lacking effective treatments, the opportunities for digital therapeutics to change medicine and patient care are endless. Alzheimer’s, Parkinson’s, diabetes, obesity, you name it. In the near future, digital therapeutics may well become a gold standard for treating patients. That said, where is Canada on this front? Health and biosciences are one of the six priority areas that Canada has decided to focus its innovation efforts to support the well-being of our people and bring greater prosperity to our country. In fact, in fall 2018 Canada created a vision to double the size of the health and biosciences sector – both in exports and companies – by 2025. This means we’d have to create 150 companies per year to
feed that kind of growth in the next six years. Think about the capital and people required to make that work. Unfortunately, we are slow to saddle up and take part in the innovation race, as there is not enough capital and talent to go around. Pioneering companies in other parts of the world are leading the way in health and biosciences. We had best take note to embrace this new frontier in digital therapeutics or risk being left behind on that front, too. The good news? We can heed the lessons learned from those who have already ventured into this space. And use these lessons as a springboard to catch up. Here are a few things for Canadian entrepreneurs to think about if they want to create a digital therapeutic: ■Your ticket to success is making sure that your clinical trials provide compelling evidence of your impact claims. And, fortunately, these trials are shorter and cheaper than for traditional therapeutics or pharmaceuticals. ■Your business model is just as important as your software. Figure out how to go to market, who’s willing to pay and what outcomes you expect. ■Attract both tech and life science investors to strengthen the success of your venture. ■Your team of medical scientists and software developers must understand each other’s needs and work well together. ■Be thoughtful about protecting your intellectual property. In summary, the convergence of medicine and technology is coming fast and furious, and these therapies are being embraced by regulatory agencies like the U.S. Food and Drug Administration. There are many opportunities we could take better advantage of, and niches we could get into, that could be globally competitive. And we are well poised to move into this area given our strong digital capabilities and strong drug development – the two just need to come together. Canada, it’s time to embrace the future of medicine because it is already here. É Natalie Dakers is president and CEO of Accel-Rx.
IN THE NEAR FUTURE, DIGITAL THERAPEUTICS MAY WELL BECOME A GOLD STANDARD FOR TREATING PATIENTS
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MEANINGFUL COLLABORATION Why Canada’s Digital Technology Supercluster mandates partnerships from companies large and small
SUE PAISH
These are exciting times for Canadian digital health technologies. On one hand, we have the potential to improve both health outcomes and the sustainability of health systems around the globe. On the other, Canadian-based technologies are providing the foundation for Canadian companies to scale and expand into new markets with new customers. We have the opportunity to lead the world in a field that touches citizens across the globe. To realize this opportunity we must change our mindset and adjust our perspectives around the “health-sector table” to fully appreciate the valuable contributions that organizations of various sizes and backgrounds make to health technology, digital innovations and health-care delivery. There is a kind of magic that comes from interaction, partnerships and collaboration. Harnessing the power of collaboration is what Canada’s Digital Technology Supercluster is all about. By bringing small entrepreneurial organizations together with multinationals, researchers, health authorities, hospitals and universities, the positive impact of innovative ideas is multiplied. To realize the benefit of working collaboratively in the health space we need to move beyond historical constructs that put players in separate spheres of isolation: private sector in one box, public sector in another, research and academia in a third, and so on. We are seeing the impressive benefits of multi-party engagement and partnerships through some of our inaugural supercluster projects in precision health. These projects present prime examples of the positive power of industry-led collaboration and consortia-based innovation. One such project is the Dermatology Point-of-Care Intelligent Network. By using artificial intelligence to augment MetaOptima Technology Inc.’s tele-dermatology technology and Change Healthcare’s tele-pathology imaging technology, the diagnosis of potential skin cancer cases is expedited through e-referrals and e-triage and the application of algorithms for clinical
decision support. One in six Canadians will develop skin cancer in his or her lifetime. Patient survival declines from approximately 85 per cent to 15 per cent in about six months. It can take six months or more to see a dermatologist in Canada due to a severe shortage of these specialists. You can do the math on survival with those data points. The technology being refined and scaled through this project can reduce diagnosis time from many months to less than two weeks, dramatically changing patient survival outcomes while delivering meaningful savings to our health-care system. Then there’s Tailored Health – Pharmacogenetics. Led by Telus Health in partnership with GenXys, LifeLabs and Genome BC, this project is creating a pharmacogenetics ecosystem by digitally connecting testing labs and medication decision support software with primary care and pharmacy management systems. We know that the efficacy of medications is influenced by our genetics. This project takes us closer to getting “the right drug to the right person at the right time” through a simple cheek swab. This is hugely beneficial, as adverse reactions to medications account for up to 12 per cent of emergency department visits and five per cent of hospital admissions, and are estimated to claim between 10,000 and 22,000 lives per year in Canada alone. After being tested at scale through the supercluster project, the software will be available for deployment across the country and beyond. When this happens, the health care system could save billions of dollars, while the lives of hundreds of thousands of patients will be improved and in many cases saved. I understand the long history of isolation and separation between private and public organizations in the health sector. The industry-led collaborative consortia model in the Supercluster is showing early signs of the important benefits to be realized when we leave that old model behind. We are on the cusp of realizing the oft-stated, but not often realized, objectives of better patient care and a more sustainable health-care system. We are only just beginning to see the impressive potential of working together. The best, I am sure, is yet to come. É Sue Paish is CEO of Canada’s Digital Technology Supercluster.
THERE IS A KIND OF MAGIC THAT COMES FROM INTERACTION, PARTNERSHIPS AND COLLABORATION
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PATIENT DATA
Barriers to accessing medical and health data for research are no longer technical ones NELSON BENNETT
A
private biotech researching a new diabetes drug would like your permission to access your personal medical history.
Public health data is still largely off limits to private biotechs, says LifeSciences BC CEO Wendy Hurlburt •ROB KRUYT
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Would you click “yes” to that request? Would you feel more secure if you knew you could share that data using a blockchain wallet that would give you full control over who can access your records? These are some of the questions that tech companies, medical researchers, privacy commissioners and government curators continue to wrestle with: how to provide researchers with better access to medical and health-care data to advance medical science and improve the public health-care system. Advances in supercomputing and data science have removed some of the technology barriers. The main barriers now are legislative and social. One advantage of a public health-care system like Canada’s is that it generates a huge amount of patient and public health data that is archived and curated by government agencies like Population Data BC – data that can be valuable for medical and pharmaceutical research. It’s been a long-standing lament of the local life sciences community that this cornucopia of information can be difficult to access. While things have improved for university and hospital researchers, it can be next to impossible for private biotechs to gain access to public health data, unless they are collaborating with academic institutions or hospital researchers. “There are a whole host of issues that make accessing the data very difficult,” says Wendy Hurlburt, the new CEO for LifeSciences BC. “From my understanding, it’s almost virtually impossible for them to get it if you are a private biotech company.” Not only would improved access help facilitate medical and pharmaceutical research, but also it could improve the public healthcare system, Hurlburt says. But there are reasons why health insurance companies and public curators like
Population Data BC keep a tight grip on things like patient outcomes, lab tests and drug prescriptions. Citizens are uneasy with the prospect of their personal health records ending up being shared or even sold without their knowledge or permission. Even though data can be scrubbed of personal identifiers before being shared with researchers, anonymization and de-identification isn’t foolproof. When Phemi Systems was developing its big data management platform for health care, it put a lot of effort into privacy and security. Hospitals and clinics contain huge amounts of data – from MRI results to blood tests – that can be of enormous value to researchers, if they can get their hands on it. “When you go in to get a blood test or something like that, that’s hugely valuable information which may tell a few things about you as one person but, combined with other data, has enormous value to humanity if we can ask the right questions of it,” says Phemi chief technology officer Scott Morrison. “That’s what Phemi is about – creating a platform so that researchers can ask those right questions and come to new insights and better outcomes in the end.” Phemi’s platform uses supercomputing for managing and analyzing sensitive big data. The problem with health-care data is twofold, Morrison says. “One is just how you integrate that data and pull it together, and then the next one is how you protect it, because it’s enormously sensitive,” Morrison says. Victoria Lemieux, an associate professor of archival studies at the University of British Columbia (UBC), thinks blockchain technology holds great promise in addressing some of the concerns around what she calls “sovereignty” of personal health information. “We’re seeing blockchain as a possible solution here because of the potential that
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PATIENT DATA
blockchain provides to give individuals what they’re calling, in the blockchain world, self-sovereignty over their data,” says Lemieux, who is the lead for the university’s blockchain supercluster: Blockchain@UBC. Her group has been working with a company called Molecular You, which provides personalized preventive health assessments, on a blockchain approach. Clients can have Molecular You run genetic or bionomics health risk assessments, which means they have to agree to provide things like blood tests. Blockchain is being explored as a secure way for clients to share their personal health data with companies like Molecular You. “There is a potential to open up that data for types of research to advance personalized and precision medicine,” Lemieux says. Using blockchain “wallets,” people could agree to share their private health-care data with researchers for the sake of science and would be in full control over who they share it with. Morrison thinks blockchain could become yet another tool in the tool belt of data scientists in the area of medical research. “It isn’t all hype,” he says. “There is a lot of incredibly valuable stuff there.” Others aren’t so sure. One concern with the storage of personal health data is that, if it is all concentrated in one place in the cloud, and if there is a breach, that data could be used for nefarious purposes – political character assassination, for example. Blockchain uses a distributed system that places data in multiple ledgers, with multiple permissions required to access or alter information, making it more difficult for anyone without
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permissions to access it. But even blockchain can be hacked. “That issue doesn’t go away with blockchain,” says B.C. Information and Privacy Commissioner Michael McEvoy. “When you think about it, now that record is not just going to be in one central location – that record could be in multiple locations and multiple nodes.” Kimberlyn McGrail, a professor of population and public health at UBC and scientific director for Population Data BC, says health-care data is already securely stored and shared. “I do not envisage blockchain as being a place to put data,” McGrail says. “You generally want to use blockchain for storing data only in a situation where there isn’t a trusted entity that could house the data securely in a different way.” B.C. has a particularly rich archive of public health data, in part because of B.C.’s PharmeNet system, McGrail says. But other provinces also have good health records. It can be a headache for researchers to try to navigate multiple jurisdictions with different protocols, however. Coming up with a better system to co-ordinate the sharing of health-care data with researchers right across Canada is the aim of an $81 million project that McGrail is now leading: the Strategy for Patient-Oriented Research (SPOR) Canadian Data Platform. The idea is to create a single portal for researchers to conduct multi-jurisdictional research using harmonized data. “We have completely not taken advantage of the fact that we have this incredible natural laboratory in Canada,” McGrail says. “So our project is about being able to enable multi-jurisdictional research.” É
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CRITICAL MASS Reconciling the hard truths about innovation in Canadian health care
OHAD ARAZI
In 2016 the Harvard Business Review published an article on innovation in health care with a fantastic quote, saying, “This internet thing … is going to be big.” That was a funny thing to say when the internet was already in full swing, but all of those who know health care understand that it’s not a laughing matter. An $8 trillion global industry on which all of our lives depend still relies on clipboards and antiquated solutions like fax machines and legacy software buried in hospital basements. Critically, in Canada, where we are lauded for our universal health-care system, more than five million Canadians still don’t have a family doctor and, daily, roughly 15 per cent of patients in primary-care hospitals are waiting for a bed. The adoption of technology is often cited as the way forward, but there are four hard truths about innovation in health care in Canada that we face despite organizational and societal pressures for transformation: 1. Canadians are not treated as health-care consumers. Most industries are heavily influenced by consumers – they decide what product or service to buy and use. In Canada, most health care is funded by government or insurance companies, so before a consumer can benefit from anything innovative it first needs to be approved by these public and private payers. 2. The “fee for service” model does not foster innovation.Simply put, there is no incentive to avoid cost or to invest in prevention when doctors are principally compensated by how many sick people walk into their clinics. Essentially – and this is a paradox – the sicker the population, the more the system pays out. 3. The health-care landscape is fragmented. We don’t have one health-care system in this country – we have 13. When innovations occur, their reach can be greatly inhibited by regulatory hurdles across provincial boundaries. Moreover, while we have automation in pockets of the health-care system, few of these data
points talk to each other, which creates data silos. 4. Health care is historically resistant to change. Health care is a serious business and we must always be mindful of patient safety, privacy and security. But consider other sensitive industries like the financial sector that have faced similar hurdles. Today, you can conduct essentially any banking transaction on a smartphone from almost anywhere in the world. By comparison, health care has a long way to go. Despite these challenges, there are real signs that Canadian health care is verging on critical mass. I define critical mass as the point when innovation achieves a rate of adoption that makes it self-sustaining. To tip the balance, we need to: 1. Put patients at the centre of the health-care experience and treat them like consumers. Patients should have choice over how, where and when to consume health-care services, even if they are not paying for the service themselves. 2. Develop a strong network effect, where the value of goods and services on the network increases exponentially the more connections you have. We can learn from similar models that have transformed industries like hospitality (Airbnb Inc.) and transportation (Uber Technologies Inc.). A great example of a collaborative health network is the Telus Health Exchange (THX). Established through Telus’ investments in health for more than a decade, the THX leverages numerous point-of-care connections to deliver digital services such as electronic prescribing, appointment booking and claims adjudication and makes them accessible to any physician, pharmacist or allied health-care professional that is connected. Accelerating the concept of an innovation ecosystem in Canada has its hurdles, but with the infrastructure required to quickly volumize and accelerate the adoption of any given idea, we will create a network effect – of consumers and suppliers – to achieve critical mass in health-care innovation so we all live longer, happier and healthier lives. É Ohad Arazi is chief strategy officer and vice-president at Telus Health.
IN CANADA, WHERE WE ARE LAUDED FOR OUR UNIVERSAL HEALTH-CARE SYSTEM, MORE THAN FIVE MILLION CANADIANS STILL DON’T HAVE A FAMILY DOCTOR
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PHILANTHROPIC
FUEL
How foundations are working to drive innovation in health care
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Albert Van Santvoort
P
hilanthropic foundations have been integral to Canada’s health-care system for some time.
The Heart and Stroke Foundation of Canada was founded in 1952, a decade and a half before the country would begin its public health-care system. Fast-forward 70 years and the health-care industry is embracing significant transformation as technology becomes increasingly ingrained in the way health care is delivered, from health data analytics to robotic surgery rooms. But in a 21st century world of innovation and continuous change, how are philanthropic institutions and non-profit organizations that are older than the health-care system itself staying relevant? The Vancouver General Hospital & University of British Columbia Hospital Foundation (VGH & UBC Hospital Foundation) has been working to place itself at the heart of health-care innovation. VGH & UBC Hospital Foundation partners with donors to fund improvements in specialized health care and research for British Columbians. Board member Dr. Kendall Ho, a professor in the department of emergency medicine and lead of digital emergency medicine at UBC, started the Innovators’ Challenge to do just that. It’s a Dragons’ Den-style business-pitch competition with innovators in the health-care sector competing for philanthropic money in the form of seed funding. “What we’re trying to do is create a culture of innovation in health care,” says Angela Chapman, chief development officer for VGH & UBC Hospital Foundation. Philanthropic foundations have a unique place in the province’s health-care system that allows innovation to flourish. Hospitals and care providers are limited to a pre-set budget needed to fund hospital operations. While some of the budget is slated for capital investments, those budget dollars are allocated judiciously and spent almost exclusively on products and procedures that have been tested and guarantee good results, according to Chapman. “One of the challenges in trying anything new is there’s risk [aversion] and there’s a lack of capital,” says Chapman. That’s where philanthropy steps in. By co-ordinating private donors and donor groups, foundations are able to provide the initial seed funding for new health-care innovations. This provides innovators with the money needed to develop their product. Working with hospital foundations, innovators can pilot a project and prove its viability, giving health-care providers the confidence they need to invest large sums of money and hospital resources to implement the product. Foundations play a particularly critical role when it comes to early-stage ideas. “You come up with a great idea, fantastic,” says Ho. “But trying to prove it in the clinical case, that’s where many of the innovations stop because they can’t get health professional groups to adopt or they can’t get it tested on patients.” This year alone, the VGH & UBC Hospital Foundation raised $450,000 and awarded two-thirds of it to Dr. Peter Skarsgard,
Let’s Pick Up The Pace Our size and expertise enable cutting-edge technology—and faster clinical advancements. Change Healthcare is leading the effort to deliver a solution that uses artificial intelligence paired with rapid, cloudbased visualizations of dermatology and pathology images. This enterprise-wise Intelligent Imaging Network will help more patients receive rapid assessment and care in their own communities. In addition to allowing early diagnosis of skin diseases, the solution will serve as a model for similar end-to-end processes in other image-intensive areas. Our Richmond office is a technology powerhouse engaged in exciting, meaningful work. Come join us.
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PHILANTHROPIC FUEL
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The VGH & UBC
Hospital Foundation is trying to build a new culture of innovation, according to chief development officer Angela Chapman • ROB KRUYT
ABOVE:
VGH & UBC
Hospital Foundation board member Dr. Kendall Ho says potential innovations often get stymied if companies can’t get health professional groups to adopt technology • SUBMITTED
cardiovascular surgeon at VGH and president and cofounder of Vesalius Cardiovascular. Skarsgard created a medical implant device that can repair a heart valve without having to perform openheart surgery. By injecting the device into the patient’s bloodstream and guiding it to the heart, Skarsgard was able to significantly reduce the risk and cost associated with openheart surgery. Through this philanthropic funding and the Innovators’ Challenge, Skarsgard will be able to continue to develop his product to the point where it can have widespread use throughout the province and could even become a standard practice globally. However, actual health-care product and process development isn’t the only innovation being addressed by the philanthropic sector. One foundation is even working to innovate its own funding model and develop a social enterprise arm to its support services. In response to radically changing market dynamics, the Heart and Stroke Foundation revamped its support and funding strategies with a renewed focus on innovation and technology, according to board member Alison Twiner.
“As focused on outcomes as we are, the pressure we put on ourselves really should be no different than the pressure for a for-profit that’s trying to innovate,” says Doug Roth, chief financial officer at the Heart and Stroke Foundation. While donations still make up a majority of the Heart and Stroke Foundation’s funding, it is continually looking for other ways to earn revenue and bolster its fundraising efforts. Heart and Stroke has embodied this business mentality by launching money-raising programs that extend beyond asking for money from the traditional sources. The foundation offers its CPR training courses to people across the country through a franchise model. For a fee, the Heart and Stroke Foundation accredits trainers and provides them with training material. This works to address heart health issues from two directions. Not only is the organization able to increase the awareness and CPR capability of Canadians but also it is able to reinvest the program fees back into heart health research and support. The Heart and Stroke Foundation also helped develop Canada’s first social impact bond in health care. It signed a “pay for success” agreement with the government in which donor money would help fund and secure other private investment to test a community hypertension prevention initiative. If the program proves successful, government funds will be invested in the project in an amount dependent on what pre-set targets the program meets. The health-care industry is unique in the way philanthropic foundations, public service providers and private investors all work together towards the same goal. The synergy that is created from this hodgepodge of different actors working towards the same goal means that philanthropy has been able to play a significant role in health-care innovation and has in fact helped to fuel its progress. É
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SUCCESS AND FAILURE How health authorities are bringing health care into the 21st century
MARY ACKENHUSEN
W hen people’s lives are at stake, “failure” is not a word most people want to associate with health care. Yet as Vancouver Coastal Health (VCH) strives for better results for patients and looks to sustain itself into the future, it is critical that we embrace it. As our population has grown and aged, costs have soared and technology has radically altered every aspect of our lives, yet health care has lagged behind. As a result, our health-care system produces only average outcomes while eating up about 40 per cent of the provincial budget. That’s not acceptable for the people we serve and it’s certainly not acceptable to me. To bring our system to the 21st century, a change is underway at VCH. Data-enabled care, personalized medicine, flexible diagnostics, advanced virtual health, artificial intelligence and electronic record-keeping are at the heart of the digital revolution that’s transforming health care. Patients, armed with unprecedented access to health information and technology through their smartphones, are taking more control over their care and expect more access, input and accountability. This technology-driven democratization of health care, coupled with a shift to providing services in the community through improved primary-care networks and urgent-care centres, is paving the road toward health care that produces better results, transforms access for patients and puts the system on a more stable footing going forward. The only way this revolution happens is by shedding the traditionally risk-averse culture within health care. To be clear, when I talk about risk and failure, I’m not talking about sacrificing the care people expect and deserve to receive. In order to innovate, Vancouver Coastal Health needs to be willing to embrace technology and ideas, fearlessly implementing them where we might expect to see advances, piloting them in real-world settings and committing to scaling them up when they demonstrate success.
That means being open to ideas. It also means being open to failure. Failure and innovation have always been inextricably linked, especially when it comes to technology. Thomas Watson, the founder of IBM, said, “The way to succeed is to double your failure rate.” At VCH, we have a virtual health division responsible for connecting care teams and patients through technology, improving access to health-care services and enabling a seamless experience regardless of distance, location or time. They implement, pilot and scale up programs in three areas: virtual encounters (using technology to facilitate interactions between care teams and patients), remote monitoring (point-of-care technologies to monitor a patient’s physiological status and health conditions in real time) and virtual engagement (empowering people to take action to improve their health and make informed decisions). There have been some great successes, like Just-inTime interpreter service, which through instantaneous video interpretation connects patients that don’t speak English to an interpreter in their language of choice. There’s also Kelty’s Key, an online platform that offers therapist-assisted internet-based cognitive behavioural therapy to people with mild to moderate mental health conditions. There have also been failures, like trialling Skype for Business for virtual visits in numerous clinical settings. That solution wasn’t quite as seamless and simple as we would have liked to support our clinical needs. But what’s important was that the virtual health team was able to, without negatively affecting patient care, take an idea, run with it, see it wasn’t working and allow it to fail fast. That’s OK. There wouldn’t be a Kelty’s Key if we were too afraid to try it. Our team is looking at other technologies, like Apple Inc.’s FaceTime, that might work better for virtual visits, and they’re not afraid to try and try again until we find something that works. Ideas may sometimes fail but our commitment to innovation and quality health care to the people we serve never will. É Mary Ackenhusen is president and CEO of Vancouver Coastal Health.
THE ONLY WAY THIS REVOLUTION HAPPENS IS BY SHEDDING THE TRADITIONALLY RISK-AVERSE CULTURE WITHIN HEALTH CARE
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WHY DIGITAL HEALTH? A perfect storm is sweeping a new kind of medicine into our daily lives
MICHAEL BIDU
Consider this: you go to your doctor for a mild but annoying cough. Your doctor sends you to a specialist who orders X-rays and a computerized tomography (CT) scan. A specialist examines the scans and, finding nothing, suggests the cough may be caused by your blood pressure medication. You can live with that. But now, a year later, new scans definitely show lung cancer. Chemotherapy begins and you are scared as hell because lung cancer at this stage is hard to treat effectively. Let’s go back a year: you get CT scans of your lungs because of the cough and the scans are examined in seconds by a special artificial intelligence (AI) program. It easily spots the lung cancer at a stage when it can be treated with a much better chance of success. It takes a radiologist three to four seconds to interpret an image. Even working eight-hour days for 252 days straight, a radiologist could not process more than 1.8 million images in a year. The average salary of a radiologist in Canada is $390,000. It will take 140 radiologists, $54.6 million and 252 working days to process 250 million scans. But with AI, according to Dr. Eric Topol in his bestselling book Deep Medicine, “machine processing can be remarkably fast and cheap. For medical imaging processing, it was estimated that more than 250 million scans could be read in 24 hours at the cost of $1,000.” And Google claims its AI deep learning model can spot lung cancer in CT scans a year before doctors can. That is the digital health difference: faster, better diagnosis, fewer errors and less expensive treatment. Digital health saves time, money and lives. WHY NOW?
More than 2,000 years ago the Greek physician Hippocrates – often called “the father of medicine” – started a revolution and created the medical profession. His
new thinking was that diseases are caused by natural factors, including diet and lifestyle, and not by superstition or gods. Hippocrates had upended the medical status quo of his day, and you can imagine how unsettling his approach must have been to those who preferred to leave everything in the hands of the gods. This new way of looking at medicine led him to a central belief that is mentioned in Deep Medicine: “It is more important to know what sort of person has [a] disease than to know what sort of disease a person has.” Fast-forward to 2009-19, when a new revolution in medicine begins: digital health. The main promise of digital health is to put the person, not the system, at the centre of health care. Digital health is happening now because of what has been called a perfect storm of population growth, patient demand, the super-convergence of digital technologies, the reduced costs of computing and storing data, and new social, environmental and economic conditions around the globe. WHAT CAN DIGITAL HEALTH DO FOR B.C.?
Our province will spend $21 billion in health care in 2019-20 for a population of 4.9 million. The current government’s priorities include mental health, the opioid crisis, primary care, pharmacare and support for life sciences organizations. The previous government promised “a doctor for everyone” and couldn’t deliver on that promise. The current government promises to hire 200 new family doctors, 200 nurse practitioners and 50 pharmacists to deliver better health. Today we have about 13,000 registered physicians in B.C. So even if the government hires 450 new people, do you think that will give us “a doctor for everyone”? Not likely. “A doctor for everyone” seems like a crazy idea but when you think about it differently you can actually make it happen. Just imagine empowering every British Columbian with the digital health tools and services to start focusing on self-care and prevention. É Michael Bidu is CEO of Interface Health.
THE MAIN PROMISE OF DIGITAL HEALTH IS TO PUT THE PERSON NOT THE SYSTEM AT THE CENTRE OF HEALTH CARE
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GenXys co-founder and chief scientific officer Martin Dawes (right) and CEO Karl Pringle are working to fix the global problem of inappropriate drug
ROBUST RETURNS Institutional and retail investors are doing well by doing good, investing in improved health care
prescribing  • ROB KRUYT
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ROBUST RETURNS
GLEN KORSTROM
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nvestor passion for the digital health sector has started to pay off, prompting renewed investments, ambitious expectations and, for some, a sense that they are putting their money in a niche that is beneficial to humanity. Unlike providing capital to a defence company that is perfecting bomb technology that would take lives, investing in digital health comes with the satisfaction of doing well by doing good. Mercom Capital Group calculates that there has been about US$37 billion in disclosed venture capital funding in digital health since 2010. About US$2.2 billion of that venture capital funding came in the first quarter of 2019, making it clear that the sector is attracting attention. For some investors the rationale is to capitalize on the demographics of an aging population, while others look at the technological advances, proven management teams and momentum stocks. Speaking of doing well, take a look at Vancouver’s Well Health Technologies Corp. – one of the hottest stocks on the Toronto Stock Exchange so far this year. Shares of the company that owns 19 family-doctor clinics in B.C., and an increasing electronic medical records (EMR) business, started the year at $0.45 and more than quadrupled to $1.87 before settling back a bit. Giddiness about the company from institutional and retail investors has come in part because some big investors have a strong track record of success. Hong Kong billionaire Li Ka-shing owns slightly less than
11 per cent of the company while his venture capital firm Horizon Ventures owns approximately 7 per cent. Well’s founder and CEO, Hamed Shahbazi, who owns about 18 per cent of the company, is likely best known for founding Tio Networks Corp. before selling it to PayPal Holdings Inc. for $304 million in 2017. Well Health has big ambitions in the Canadian EMR space, where it is currently a small player compared with Shoppers Drug Mart owner Loblaw Cos. Ltd. and
Telus Ventures managing partner Rich Osborn oversees an investment arm of Telus that has about a dozen digital health investments • SUBMITTED
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the largest player in the space, a branch of Vancouver-based Telus Corp. known as Telus Ventures. Telus Ventures managing partner Rich Osborn explains to Digital Health magazine that investing in digital health makes sense for a telecommunications company such as Telus because of the synergies. “We think that health care is one of the great social challenges of our time,” he says. “So when you think about our core competency as a telco, which is storing, transporting and securing data – and by the way those are the same challenges at the heart of digital health – it’s only natural that we would apply the skills and the infrastructure and the learnings from our telecommunications business into an industry like health.” Telus Ventures has made about 70 investments since 2001 and about 30 of those are still active. About a dozen of its active investments are in digital health, and all of those range in value between about $500,000 and $15 million. The other investments are in technology niches such as the Internet of Things, the connected consumer and digital security. Osborn would not reveal which Telus Ventures investments were in the $15 million range. Examples of its digital health investments, however, include capital pumped into Medisys, which owns the Vancouver-founded Copeman Healthcare Centres; Beacon, which operates in the virtual-care niche; and GenXys, an upstart Vancouver company that aims to take the guesswork out of doctors’ prescriptions. “You know the story,” says GenXys CEO Karl Pringle. “You go to your doctor and the doc says, ‘Karl, sorry to tell you that you suffer from migraines. I’m going to give you a prescription for drugs. Try this. If it doesn’t work or if your hair falls out, come back and we’ll try something else.’” GenXys’ software takes the trial and error out of that kind of prescribing by connecting with a vast database in Canada called DrugBank. Its patients pay close to $500 for a medical kit that includes a swab and a plastic tube. They swab their mouths to provide a DNA sample, and GenXys’ software uses an algorithm to alert them to which drugs will have the most beneficial effects. A crosstown rival to Telus Ventures is Vancouver’s PenderFund Capital Management, where private equity and portfolio managers have been investing in digital health for many years, even though it is a small slice of the company’s $1.6 billion under management. One win for PenderFund came when it invested millions of dollars in the pioneering Kelowna-based EMR company QHR Technologies Inc. and cashed out its 15.8 per cent stake in the company for many times that amount when Loblaw bought QHR in 2016 for $170 million. PenderFund in April invested a “significant” amount in North Vancouver-based Jane Software Inc., which makes clinic management software for paramedical offices, says PenderFund’s senior
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vice-president and private equity and portfolio manager, Maria Pacella. It also invested about $3 million in Burnaby’s Clarius Mobile Health in May 2018. That company makes portable ultrasound scanners that are now being sold only to practitioners because it takes an expert to be able to take the scans and interpret the images, she says. Pacella expects in the future that the scanners could be sold to individuals such as pregnant women who want to be able to monitor their fetuses. More machine learning would be necessary in order for those expectant mothers to be able to interpret the scans, she says. By then, the cost may also come down from the current price of nearly $10,000. With Clarius being only five years old, Pacella says that an exit from that venture could be years away as there is much evolution to go before it could go public. And while she is excited about its future, she is content for now being an investor in a space where the capital at work is helping to benefit humankind. “It is pretty gratifying to be able to, through technology, solve very personal challenges,” Pacella says. “We do look to invest in companies that are making, ideally, much more than just an economic impact, and this sector certainly qualifies for that.” É
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HEALING THE VULNERABLE
Breakthroughs in technology are treating some of B.C.’s most vulnerable patients in ways previously impossible CHUCK CHIANG
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hile there remain significant challenges when it comes to digital health technology’s capability to serve B.C.’s vulnerable population – infants/children, the elderly, those with disabilities or those living far away from care facilities – the situation is rapidly improving.
WE ARE NOT TALKING ABOUT A BIG COMPUTER THAT YOU HAVE TO PUSH EVERYWHERE j Dr. Ran Goldman Head of B.C. Children’s Hospital’s Goldman’s Innovative VR Pain Lab
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That is the assessment of medical and academic officials involved in the adoption of digital health throughout the province, who adds that technologies like augmented/ virtual reality (AR/VR), artificial intelligence (AI) and advanced robotics have already made a visible dent in B.C.’s health-care sector. Dr. Ran Goldman is directly involved in one example of digital tech revolutionizing care for the vulnerable in B.C. Goldman, a researcher who has worked on pain management issues for more than two decades, now heads BC Children’s Hospital’s Goldman’s Innovative VR Pain Lab. The lab has been conducting clinical trials in the last two years on the effects of virtual reality and its ability to distract young patients from painful procedures – which in turn improves their healing prognosis. “We are looking at discoveries that are quite surprising,” Goldman says of the research. “The fact that you can take these children to a digital world, a different place, has been so successful that it’s becoming hard to offer another option when we are doing studies.… Now, children and their doctors are requesting virtual reality, and we are seeing much less anxiety and pain in children.” The application of VR in children’s pain management – which has shown to both improve healing time and lower patients’ reluctance to undergo necessary but painful procedures – has been so promising that, Goldman says, the BC Children’s Hospital has taken steps in the past few months to make itself Canada’s first completely
“VR-friendly” medical facility. That means patients and care professionals can access VR for a full variety of treatments throughout the entire facility, which helps further with adoption. “We are not talking about a big computer that you have to push everywhere,” Goldman says, adding that efforts are also underway to train other pediatric health-care professionals to utilize these tools. “That was the problem 10 years ago when the technology was first developed. It was a massive operation. Nowadays, with portable devices, it’s very easy to bring to the bedside.” Beyond VR treatments themselves, digital tech is also changing the way B.C. trains its conventional-care practitioners. At the British Columbia Institute of Technology’s (BCIT) specialty nursing department, the school runs 40 fully functional robots simulating patients from a wide variety of age groups, demographics and ethnic backgrounds – a program that aims to have nurses hit the ground running when they move from the school into an actual hospital environment. “When we send students out into clinical situations, we used to call it ‘practice,’” says BCIT’s Rob Kruger, who leads the department’s simulation/innovation work. “Well, we don’t want people to practise anymore; we actually want people who are able to do. The patients being admitted into B.C. hospitals today are much sicker than they were even 10 years ago; they can’t afford to
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HEALING THE VUNERABLE
have nurses who can’t recognize their change in condition or have the potential to make errors. There’s a lot less room for less-than-optimal care; the patients are so acute that mistakes will end in a bad place.” The program’s robot simulation began in 2004 with a single robot. Given that the robots’ prices range from $28,000 for a simulated newborn infant to $200,000 for a fully grown adult, the fact that the province is investing so much into the machines shows the benefits officials have seen in the quality of nurses graduating from the program, Kruger says. He adds that because the robot manufacturers in the United States have limited their offerings to represent largely Caucasian patients, BCIT researchers have taken up custom programming to simulate patients from different cultural backgrounds in order for the students to learn how to understand and care for the diverse patient base in B.C. “When you focus on one gender or ethnicity, you can foster an implicit bias in students,” Kruger says. “We want students to be aware of the diversity of the patients they care for.… For example, people from different cultures and genders are presented with symptoms of cardiac arrest differently. So if a woman of East Asian descent comes in and complains about being tired and short of breath, in the early ’90s it may be interpreted as hyperthyroidism. Nowadays, I want my students to be able to recognize that woman may be having a heart attack.” Robots currently have a limit of simulating patients up to age 60, but Kruger says that VR programs have helped them simulate treatment for the elderly, as well. The next big step, both Kruger and Goldman agree, is artificial intelligence linked up with the digitization of patients’ health data. Hospitals are increasingly taking clinical and systems transformation programs to convert records into digital formats, allowing doctors and patients to access personal records (via computer or mobile device), access treatment history and formulate direction of future care. There are challenges to that end. First, Kruger notes that current data and AI have not been developed extensively enough to simulate patients with mental illness, but he adds that innovations are quickly taking shape on those fronts. Meanwhile, Goldman says, B.C.’s own
adoption of AI and big data – from both vulnerable patients themselves and medical professionals – has not reached a point where it can achieve its full potential of presumptively anticipating and treating conditions that may arise. “I think we are not there yet,” Goldman says. “Medicine is still very complex, especially in pediatrics. Children in the preschool age don’t tell you what’s going on with them; many times, they are non-verbal or can’t describe their symptoms clearly to the point where we can feed the computer with data. So we need to figure out how to assess previous data, and need to increase the ability of digital devices to identify salient signs or symptoms in the patients.... So there’s work to be done, but I think within five to 10 years, we will definitely use AI as part of our tools – together with the stethoscope and the otoscope.” É
A simulation robot at BCIT’s specialty nursing program allows students to literally get under the skin of a potential patient • SUBMITTED
— THE RIGHT TRAINING MAKES ALL THE DIFFERENCE. HEALTH SCIENCES EDUCATION FOR A COMPLEX WORLD. BCIT is a leading provider of health professionals in British Columbia. Students are taught by industry leaders in modern learning spaces that replicate real-world clinical and laboratory settings. From simulation to augmented reality, students receive hands-on technology training to ensure they’re job-ready as soon as they graduate. Learn more at bcit.ca/health
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A REVOLUTION IN HEALTH How rising health-care costs and greater expectations for quality of life are changing the system
DR. SYLVAIN MORENO
Imagine being a parent of a nine-month-old baby born with a heart defect. Doctors predict that your child has less than a 20 per cent chance of surviving to their first birthday. Although your baby needs surgery, the small size of his or her heart and the complexity of the operation make the operation complicated, lengthy and risky. Now imagine that with the help of 3D modelling the medical team decided to build a full-sized model of your baby’s heart using a 3D printer to preplan the complicated surgery. This digital health technology allowed them to understand precisely where and how to cut, and even map details such as how big the incision should be to reduce scarring. This is a real story. It recently happened in China, and the medical team reported that digital health was a key factor in saving the life of this baby. This is just one example of how digital health technologies are revolutionizing medicine and improving patient outcomes. We’ve all heard incredible stories showing the undeniable potential for digital health in our current society. Digital technologies can offer limitless possibilities to improve health: from personal fitness to building stronger health systems for entire countries. Why do we see such interest and excitement? Do our lives need digital health technologies? The answer is clearly “Yes.” Digital health is a critical tool as costs rise and families expect an increasing quality of life. In recent decades, governments have struggled and have been unsuccessful at containing the cost of health systems. We desperately need innovations to maintain public health and the quality of care people deserve. From the World Health Organization and UNICEF to cities and companies, people are working to create solutions to important health challenges.
According to a new research report by Global Market Insights Inc., the digital health market will reach $500 billion by 2025, showing immense possibility for innovators and the public. Moreover, major corporations are enthusiastically investing in digital health innovations. Recently, Apple showed a clear strategy towards digital health by releasing Apple Health Records and Apple Watch with a single-lead electrocardiogram device. A new report by Morgan Stanley projected Apple health-care revenue reaching over $300 billion by 2027. Another indicator of this digital health push is the investment by large companies in digital health, including over $500 million investment by Google and associate (i.e., Alphabet Inc.) in Oscar Health, or the $100 million investment by GE Ventures in Iora Health. For Canadians to benefit from these new solutions and to grow the role of the Canadian industry in this sector, the federal government is supporting two British Columbia initiatives. The first is Canada’s Digital Technology Supercluster, which connects “a range of digital technology market participants, from start-ups and innovative SMEs to postsecondary institutions, to large multinational corporations,” according to its website. The supercluster’s goal is to be “the link between technology developers and adopters in the B.C., Canadian and global economy.” The second is a major investment by the federal government in support of the B.C.-based Digital Health Circle. Circle supports small and medium-sized companies in developing digital health products using an innovative co-creation model. This model brings together patients, researchers, public health authorities and business to solve health problems with and for Canadians. By listening to each other and working together we can transform health and improve people’s lives with digital technology. A digital health revolution is underway and you can help make it successful by getting involved. Don’t wait; the revolution is starting. É Sylvain Moreno is the CEO of Digital Health Circle and an associate professor at Simon Fraser University.
DIGITAL HEALTH IS A CRITICAL TOOL AS COSTS RISE AND FAMILIES EXPECT AN INCREASING QUALITY OF LIFE
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The Centre for Aging + Brain Health Innovation (CABHI) is a solution accelerator focused on driving innovation in the aging and brain health sector.
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