Healthcare systems globally are straining under the weight of increasing cost, explosive service demand, and aging infrastructure and equipment. As governments wrestle with these challenges in Canadian provinces such as Ontario, healthcare providers are also under pressure to achieve new standards in patient-centric care and to support a shift towards more complex continuity of care models, all the while providing greater transparency on spending in reporting to the provincial ministry, the basis for forward funding. The consumer experience of healthcare is also changing; health risks associated with practitioner shortages in many communities are increasingly exacerbated by longer wait times for specialist care, hospital and other health services. Research organizations focused on a variety of healthcare metrics have returned mixed reviews for Canada’s healthcare system: in a study authored by the GBD 2016 Healthcare Access and Quality Collaborators, out of 195 countries, Canada holds 14th rank on the Healthcare Access and Quality Index, and in a study of healthcare performance in 11 developed countries based on data provided by key global healthcare agencies, Canada placed third from the bottom.
Fortunately, this gloom and doom scenario represents only one side of the coin. Healthcare innovators are discovering new treatment methods, administrators are streamlining processes, and practitioners are collaborating on the best ways to deliver patient-centric care. In these efforts, information technology has an important role to play, acting as an enabler across systems and process designed to improve diagnostics, treatment and disease prevention, as well as the management and delivery of healthcare services. But what exactly does this innovation look like? At a series of events in Toronto, Microsoft Canada recently highlighted new solutions that may help healthcare providers and practitioners develop new approaches to healthcare delivery that will serve consumers into the future. As Peter Jones, health industry lead for Microsoft Canada, noted at the Next in Health Summit: “We’re at an inflection point in healthcare. It’s really going to open up. We have enough references and use cases so that very soon it’s just going to take off.”
One of the more inspiring use cases, which easily captures the imagination of researchers, healthcare providers and consumers alike, was outlined at Microsoft Canada’s Future Now conference in Toronto last month. In a dialogue with Microsoft Canada VP Public Sector Jason Hermitage, Dr. Benjamin Haibe-Kains, senior scientist, Princess Margaret Cancer Centre, University Health Network, described his team’s use of cloud powered AI in research designed to identify the best approaches to cancer care targeted at specific patient needs. According to Dr. Haibe-Kains, advanced analytics are used to sequence the DNA in a tumour, and this gene map is used to understand cancer biology, as a step towards mapping biology to a program of therapy for individual patients. The research method – epigenovix – involves the use of mass amounts of data, he explained; there are approximately 2.7 billion potential associations generated by bio-makers, and the research depends to a great extent on trial and error methodologies – of the 10 connections the team tries to make, 0.1 actually work. For this kind of variable, compute intensive workload, the rapid spin up of cloud infrastructure was critical: Dr. Haibe-Kains estimates that half a million cores for a half hour would be needed just to establish that a particular path should be pursued. Hardware costs – in terms of both finance and set up time – have dictated a cloud foundation for the Princess Margaret team’s research program. Dr. Haibe-Kains believes that adoption of the Azure platform has saved 90% of cost of building traditional infrastructure. But even more important from a research perspective has been productivity boosts associated with the cloud adoption model: with fewer resources dedicated to building compute capability, the team has been able to engage in new research efforts. Dr. Haibe-Kains attributes the launch of three new projects to the decision to go with Azure.
Another future forward application of IT in the healthcare world is mixed reality. At the Future Now event, Microsoft demoed the HoloLens 2, an immersive technology solution which creates holographic images that can be moved in visual space, resized, that respond to gesture and voice, and that allow the viewer to control a text scroll with eye movements. In healthcare, the ability to overlay virtual objects onto physical space offers huge potential to advance medical procedures. For example, along with Royal Philips Microsoft has developed a unique mixed reality concept for the operating room of the future. The project combines Philips’ Azurion image-guided therapy platform with Microsoft’s HoloLens 2 holographic computing platform to deliver an augmented reality application for minimally invasive therapies. The goal is improved patient outcomes at reduced cost. The tool also offers unique benefits in educational settings; a HoloLens training program at Case Western Reserve University, for example, allows students to skip the cadaver, but see human anatomy in new contexts and in more detailed ways, speeding the learning process and encouraging greater confidence in students.
Emerging tech in Ontario hospitals
But cutting-edge research and technical marvels are only one side of potential ICT opportunity in the healthcare. As Ottawa Hospital IT lead Jean Claude Lemonde noted in a panel discussion at the Future Now event noted, “technology is now an actor in healthcare” that helps administrators in their quest “to do more with less.” Ottawa hospital is using cloud – has implemented Office 365 – and is building an EHR system that will take advantage of advanced IT. Lemonde envisions unique potential in the deployment of new communication technologies to improve workflow and has replaced email with SharePoint for the management of information on alternative level of care patients. At SickKids Hospital in Toronto, similar focus has been placed on some of the more prosaic challenges in IT operations management. Noting that to now a good deal of effort has been devoted to “keeping the lights on,” Sarah Muttitt, VP, Information Management and Technology & CIO, SickKids, stressed that the organization is now assessing where technologies such as cloud might be used to replace on-site IT infrastructure. And with much of its “plumbing work” (information management) in place, the hospital is now looking for new initiatives. Specifically, SickKids is beginning to work with AI and ML – a new chair for bioinformatics and AI has been established – and is looking to further optimize operational processes. According to Muttitt, SickKids has introduced standardized tools around ITIL to support information sharing across two hospital properties; it has created dashboards for many hospital processes with an eye to “finding the value stream”; and it looks forward to leveraging Power BI to shift towards a more Agile, dynamic workplace.
For Mark Rajak, director of innovation, Niagara Health Systems, the goal is not to “jam technology” into workflow in existing environments, but rather to begin with a problem statement and align technology around that. The Niagara Health System (NHS) mobility strategy, for example, was intended to extend communications beyond its four hospital sites to address the need for continuity in patient care: “from an innovation perspective,” Rajak added, “I’m not looking within the four walls of the hospital, but within our community in Niagara. So how could we engage with partners like EMS (ambulance services)?” To bring together silos of information on the patient journey residing in different agencies, NHS is developing the means to integrate data from various organizations, with an overarching goal of creating a seamless health experience for the patient. A key piece in this effort has been establishment of “the basics,” which Rajak described as security and privacy – through the creation of digital identities. Built to support collaboration between hospitals within the Niagara system and across various stakeholder entities such as Emergency Services, Public Health, long-term care homes, etc., the NHS identity access and management system is also designed to enable remote virtual care in which the patient controls sharing of health information with family and other practitioners. While secure communications for even thousands of employees within an organization can be managed using solutions like Active Directory, scaling out to the community represents an additional challenge that Rajak believes will itself require collaboration. In executing on technology projects like this, Rajak is led by the notion that where good off the shelf solutions exist, partner expertise should be leveraged, allowing the hospital innovation team to tackle local issues such as the improvement of process flow. Rajak added, “I don’t think innovation is something that Niagara Health has to put on show and run with. It’s something we need to work on together as a whole and not in silos. There is our community and amazing vendor partners such as Microsoft.”
Stated another way, innovation does not necessarily have to be the ‘big idea’, it can emerge in the way that technology or process improvement is applied to address gaps or business challenges in the healthcare sector. According to Lydia Lee, national CIO advisory and digital health lead, KPMG Canada, healthcare innovation is “really about how do you change the way care is delivered through enabling technology. We always apply it [the term innovation] to how it is impacting the way people deliver care or the way the healthcare system is organized, which we believe can be greatly enabled by technology.” So while pure research (as takes place in KPMG’s data science Lighthouse group) is vital in healthcare, applied technology in pilots, PoCs, and tests and their scale into production are a key aspect of healthcare innovation. As example, Lee also pointed to virtual care, where patient apps or telehealth may be used to extend care into the home or other care facilities outside the hospital – or even the linkage of Skype for Business to personal Skype accounts to facilitate communication as in the case of a pilot in a remote area in Nova Scotia. In another example, Lee described the use of augmented reality in hospital planning to improve the utility of the actual workspace, and the use of AI to optimize design aimed at minimizing “foot traffic.” In contrast to this ‘hospital of the future’ are older buildings with older infrastructure; but even these may benefit from digital overlay achieved through sensor technologies, such as the use of simple armbands with RFID to track where equipment, doctors, nursing staff and visitors are within physical space, as well as patient flow within the facility. As Lee noted, while monitoring to improve the patient journey can reduce wait times for individuals and clinicians, thereby improving the individual experience and potentially the care outcome, “if you multiply that by hundreds, or thousands or even millions of cases over the course of years, or across multiple hospitals, you can pull information that will really allow you to think about the optimization of care delivery.”
For organizations looking to innovate, technology investment can be a hurdle, particularly in public health environments such as Ontario’s where a revamped its funding model has led to more heavy reliance on performance-based metrics. According to Lee, investment strategies in hospitals will also require rethinking. Pay as you go cloud-based infrastructure, for example, will demand a shift from CAPEX to OPEX financing, an accounting issue that can be addressed relatively easily. Going forward, however, Lee anticipates more pressure on healthcare facilities as they wrestle with provincial financial reporting requirements and with standards designed to incent more productive, performance-driven behaviours. On this score, though, technology can help: “reporting is a requirement and so hospitals are finding a way to do it. And they are finding that it’s a lot easier to use tools that can help, rather than pull together data from all sorts of disparate sources.” It is also possible to use tools to build the business case needed to justify investment; but Lee added “you can’t do all this – planning, forecasting and predicting [performance outcomes] of care teams without really robust AI and analytics capabilities.”
Aligning solutions with healthcare needs
Drawn from existing or planned technology projects, the use cases described above provide a good sense of the dizzying array of new opportunities to optimize healthcare delivery that are now available. To introduce some order, Microsoft has advanced solution categories that cross the range of software and even hardware platforms in its portfolio. Peter Jones described these categories as three pillars aimed at the evolution of health systems: care coordination/care collaboration; patient engagement, and operational optimization/excellence. The first pillar consists of legacy Microsoft products, such as Office 365, and a newer offshoot, Teams persistent unified communications, which are designed to help healthcare practitioners collaborate more effectively. “I’m very intrigued by Teams,” Jones noted “as it’s a platform for bringing everyone together via instant messaging, chat, voice, video, and document sharing, which also meets the healthcare compliance and regulatory requirements around data privacy and security. I believe Teams will have an impact on healthcare because if you look at how care is delivered, you coordinate care within the hospital, but care is moving into the home. So we need to manage patients within the home environment and in community-based care. Teams allows you to communicate with the care provider in the hospital, the primary care doctor, the home nurse, a home care provider, family members and the patient.” In Jones’ view, Teams is well aligned with healthcare remodelling in Ontario around care teams.
Beyond these productivity tools for healthcare workers is a second pillar – patient engagement that is delivered through provider portals. Microsoft partner Novari Health, for example, engages patients through specialist referrals, reducing wait times for expert consultations. Novari also delivers a telehealth solution, built on Azure, that is now used by Ontario Telemedicine Network. For its part, Cloud DX has developed sensor and AI technologies that monitor various patient vitals to support remote management of chronic diseases. In this solution category, Microsoft serves as a provider of scalable, cost-effective cloud resources that meet regulatory requirements, which partners build on to develop advanced healthcare applications. According to Jones, “We have hundreds of ISVs in Ontario that are specific to healthcare who are using Azure to build healthcare solutions.”
The third pillar focuses on the use of data to help drive excellence in the delivery of business operations. In a healthcare context, this would include use of data to gain better insight into patient care, or to improve management of hospital operations. As example, Jones pointed to a bed management solution built on Azure by partner Oculus Health, which provides info on what beds are available, while monitoring how quickly these can be turned over in order to admit new patients, as well as a hospital command centre which tracks patient flow within the hospital.
In thinking about the most promising opportunities in healthcare, Jones believes data is the key. In the near term, data will produce ‘quick wins’ through operational improvements, which are needed to establish the business case for ongoing technology investments. Projects that deliver insights that can enable new operational efficiencies, he argued, represent early adoption scenarios that can demonstrate productivity increases. Ultimately, however, the best longer-term prospects lie in use of personal data – with the right governance in place – that can affect care. “Data is the most powerful tool we can use in healthcare to achieve better outcomes for patients,” Jones observed. “This will involve use of data on the patient and consolidating patient records. On the research side, genomic data will provide a perspective on how we can begin to understand certain diseases or how a patient is affected by a certain medication. If you can track data in pharmacogenetics to understand the genomic makeup of an individual and how they might react to certain drug therapies, we can begin to develop common approaches to how we treat cancer patients.”
As the healthcare industry lead for Microsoft in Canada, Jones’ goal is to “drive an industry perspective on how Microsoft technology can impact healthcare.” While this mandate requires the education of healthcare leadership on what technologies are available and emerging, it also involves collaboration to better assess healthcare needs and the potential sources of innovation to better align product and solution development with everyday realities for Canadian healthcare providers. Jones seeks to fulfill these tasks through work with C-level executives in the healthcare space in Digital Health Canada’s CHIEF, the Canadian Health Informatics Executive Forum, which meets twice a year to discuss common industry challenges, and to elaborate how transformation needs to occur. So far, the CHIEF has not adopted Teams for dialogue on the key healthcare issues that Canada is facing, but in educational outreach like the healthcare events mounted in Toronto this month, Microsoft is working to bring the healthcare future closer.