COVID-19 response: Digital health and analytics

 

Identifying and detecting potential outbreaks of infectious disease around the world remains our best defence against these threats in Canada. Today, as the world adapts to living with COVID‑19, finding the virus and tracking it in our communities is an important way to contain its spread and protect Canadians.

Increased collaboration in the fight against the COVID‑19 pandemic

The National Research Council of Canada (NRC) is proud to support Government of Canada efforts to fight the COVID‑19 pandemic‑increasing collaboration with industry to build domestic capabilities to fight future pandemics.

On October 30, 2020, the Minister of Innovation, Science and Industry announced  Innovative Solutions Canada (ISC) Phase 1 funding for 4 project proposals under the COVID‑19 Challenge: An intelligent digital clearing house – funded by the NRC in collaboration with Public Services and Procurement Canada (PSPC).

The objective of the challenge is to deliver a digital platform for Canadian industry and global communities of researchers, health providers and funders to exchange, share and procure expertise and materials in response to COVID‑19. A one‑stop shop for use by public, private, and non‑profit organizations across multiple sectors to share information and expertise in response to COVID‑19 and adaptable for future global crises.

Four proposals by Canadian companies made it through the evaluation process and were successful in receiving funding to prove the feasibility of their proposed solution:

  • 11983393 Canada Inc. is receiving $300,000 for a platform that enables government subject‑matter experts to efficiently share key knowledge
  • Bulky Inc. is receiving $221,933 for a rapid‑response platform that will deliver a digital solution to enable Canadian industry and global communities of researchers, health providers and funders to exchange, share and procure expertise and materials in response to COVID‑19
  • Cole Webber Productions Inc. is receiving $285,750 for a platform that matches resources and capacities with need by compiling information on available sessions, facilities and resources
  • Optima Analytics Inc. is receiving $293,000 for its intelligent clearing house, a scalable web application accessible from anywhere using a computer, tablet or mobile phone

This investment is important to find a solution that could help researchers from a broad range of disciplines and industry come together to strengthen Canada's ability to respond to the pandemic and future health threats.

Digital connectivity in isolation provides hope (CAMH)

What do gaming and mental health have in common? A new Canadian‑made technology platform uses gaming technology to make remote mental health support as real as possible. Intelligent digital characters that interact with patients, fun exercises to build good mental health habits, and rewards for making progress will all be part of it.

Now under development, this new software is the brainchild of technology and mental health experts at the National Research Council of Canada (NRC) and the Centre for Addiction and Mental Health (CAMH). It is designed to meet escalating mental health needs arising from the COVID‑19 pandemic that have depleted existing health‑care resources. With in‑person therapy becoming increasingly scarce, time‑consuming exercises eating into schedules and frontline workers stretched beyond their limits, the mobile app–available 24/7–is a promising option.

A recent CAMH study reports that the pandemic is leading to more loneliness, depression and substance use, especially alcohol. Nearly a quarter of Canadians have significant mental health problems and about 30% of the population appears to be drinking excessively. With unprecedented uncertainty continuing as the world restructures into the "new normal," the mental health pandemic will likely persist long after the physical crisis is over.

Catherine Proulx, Researcher, Simulation and Digital Health Group at our Medical Devices Research Centre, is confident that the software platform will help with its engaging content, and also be accessible to all Canadians through their networked devices.

The strength in play

"We are harnessing video‑game tools for learning and therapy," says Proulx, explaining that from an early age, humans learn and benefit from playing. "We design our exercises like those in a computer game–fun and interactive. And because it's interesting, users are more motivated to develop good mental health habits such as practising mindfulness or reframing disruptive thoughts."

The platform will be integrated into CAMH's mental health portal, which includes moderated discussion boards, video conferencing and other digital resources. According to Dr. Peter Selby, Senior Medical Consultant at CAMH, a community discussion board moderated by mental health professionals during the 2003 SARS outbreak proved to be a credible and popular information source.

"This time, we had the website up and running in mid‑March when Canada had only 700 cases of COVID‑19," he says. Since then, the site has seen more than 300,000 visits and 22,000 downloads of the coping resources. "As new needs arise and feedback comes in, we keep adding features, so we expect that this new tool could have significant positive impacts both during the pandemic and in the aftermath." He added that the challenge is to test new ways to help while the pandemic evolves, and through innovation and evaluation bring credible resources to Canadians.

Credibility is particularly important in the age of rampant social media where information is often suspect. He mentions that by providing reliable information along with clinically validated tools, CAMH's suite of mental health resources will give users a network of tools to help maintain stability in an era where staying home is encouraged. "With increasing isolation affecting Canadians' lives, we are creating content to help them tap into their inner strengths and be motivated to take action with those strengths."

Designs for virtual living

The multidisciplinary NRC‑CAMH research teams hope to launch a prototype in early 2021 that will have the online features in place, and connect to the cloud. At this point, real users will have a chance to test‑drive it and provide feedback.

The development process is a collaborative one that includes getting clinician and public input into the design, and adjusting software on the fly. It must also ensure that the technology is inclusive and serves the needs of vulnerable populations.

"The technology that comes out of the NRC's labs holds the highest‑quality industry standards," says Selby. "While the process of working with a range of engineers, clinicians, researchers and users takes time, it ensures that the science is right and works over the long haul."

The COVID‑19 pandemic has clearly shifted the mindset of the world toward faster adoption of virtual living. In a world that is more confusing than ever, well‑crafted technology enables people to tap into a new reality with confidence. And that goes a long way toward lifting their spirits.

Virtual healthcare guidelines redefine house calls (with OCAD University)

If your eyesight is weak, you can change the contrast on your computer or phone screen–or adjust font size and colour. You can add glossaries to words you find difficult. Have your system speak to you.

Customizable features such as these started out as modifications for those who had physical difficulties accessing parts of their devices. Decades later, that capability/inclusivity is commonplace and often taken for granted. But new barriers to accessibility are mounting as the COVID‑19 pandemic drives communications, health care, entertainment and other human activities farther into virtual territory. For example, nearly two‑thirds of Canadian organizations now have at least 60% of their workforce working remotely.

This is particularly relevant to the overburdened health‑care field. To meet the increasing health needs of Canadians during the pandemic, health care is moving online. Virtual health care takes the familiar concept of telehealth‑which is online visits with doctors‑into new frontiers. It uses digital tools that connect patients in real time to a network of health‑care professionals, labs, pharmacies and medical records. It also incorporates features such as translation and dictionaries. While it is an amazing resource for bringing health care into the home, virtual care can be a daunting proposition for some.

A 2018 survey by the Ontario Telemedicine Network found that more than 4 in 10 respondents would try virtual care if they could. But it does require some tech‑savvy, proper connectivity and trust in the technology.

"Our role is to facilitate adoption of this approach by demonstrating to Canadians that it will give everyone better access to health care," says Denis Laroche, Team Lead, Bio‑mechatronics at the National Research Council of Canada's (NRC) Medical Devices Research Centre. "We have launched a major initiative to set inclusivity guidelines for developers of virtual care platforms and applications." Software and hardware must be easy to use and take into account the needs of vulnerable populations with disabilities as well as language and literacy issues.

"As we've learned from the pandemic, a healthy society depends on how well we take care of people who are the most vulnerable," he says. "And this project approaches virtual health from that perspective."

The process

According to Laroche, inclusivity guidelines are used around the world by many organizations, including the Government of Canada. For example, departmental websites must follow standards for font sizes, navigation and terminology that help people with disabilities and special needs. But virtual health care is a whole new realm that calls for innovative approaches to guideline preparation.

"To establish the right guidelines for virtual health‑care developers, we need to identify existing standards from around the world that work in this context," he says. "As we collect these, we will prepare software to test on users with accessibility issues, and adjust or create new standards as required."

A key collaborator on this project is Toronto‑based OCAD University, home to the Inclusive Design Research Centre (IDRC), the largest facility of its kind in the world. IDRC Founder and Director Jutta Treviranus says that the centre's goal is to ensure that everyone can participate in shaping and using the technological systems and networks that are transforming and connecting our society.

"Individuals who use virtual health‑care systems have a diverse range of needs and capabilities, and the farther their needs diverge from the average, the more important it is to personalize their experience," said Professor Treviranus. "We want to create a range of options that match those needs: how the interface is controlled, how the information is presented and what feedback prompts are given." These all help to determine the success of patient interactions.

Treviranus adds that virtual health‑care systems allow users to set up and save their personal needs and preferences on desktops, mobile phones or tablets‑and take them anywhere. A patient might also establish a network that includes a family physician, a nutritionist for diet advice, a lab for tests, a pharmacist for prescriptions‑and language translation software. To reduce confusion and lighten the learning load, each person's preferences must therefore operate across many systems.

"Health interactions can be stressful, and tend to become more so as they become more urgent," she says. "We don't want the interface to add another layer of stress."

One research challenge is recruiting individuals who struggle with technology and the current health system to help design and test the virtual care guidelines. "This is a different approach that we expect will lead to innovative features and more flexibility to benefit all users," she says. "And the NRC has been quite open to trying this unique methodology."

Beyond the pandemic

While this collaborative project is part of the NRC's COVID‑19 Pandemic Response Challenge program, developing guidelines and technology is an iterative approach that will continue beyond this pandemic, and Laroche foresees the first test scenarios taking place in early 2021. He also expects that, with the boom in virtual health care, Canadian companies will be lining up to supply software, hardware and related services to the health‑care system.

"The guidelines will clearly indicate how inclusivity should be handled in the development process," he says. "They will also help purchasing authorities verify that products meet those established standards." And that's a healthy approach to caring for a community.

New contactless technology shifts health monitoring between hospital and home (with UBC)

Online banking subscribers can check their financial health at any time from anywhere. New technology for medical patients allows them to check their physical health remotely by using contactless sensors.

Like going into a busy bank and lining up for service, visiting a medical facility to get your vital signs checked can be time‑consuming. Wires, adhesives and Velcro normally connect monitors to equipment that checks your heart rate, temperature, blood pressure and oxygen level. It restricts body movement and limits the number of tests that can be performed at a time. During a pandemic, going for face‑to‑face examinations by professionals may not even be possible.

But this will soon be a thing of the past. The COVID‑19 epidemic has quickly transformed the health system from traditional in‑person diagnosis and treatment to technology‑based alternatives that do much of the work virtually. As part of the National Research Council of Canada's (NRC) Pandemic Response Challenge program, innovative digital care solutions will promote safety and convenience for patients and health‑care providers.

Among these solutions is contactless sensing software that will be integrated into virtual care systems. It will enable both patients and clinicians to track vital signs‑such as heart rate, oxygen saturation, respiratory rate and temperature‑remotely and securely from any device.

"Health‑care professionals are already using computers and cameras for virtual care and patient management, but they need objective data on hand to help them confirm diagnoses and prescribe treatments online," says Di Jiang, Team Lead, Medical Devices Research Centre, NRC. "Innovative contactless sensing technology, using built‑in cameras in laptops, cellphones and other portable devices, will allow clinicians get near real‑time readings of vital signs."

Jiang points out that, while some contactless sensors exist, their reliability, accuracy and robustness need to be confirmed through additional research and validation. "Here at the NRC, we use digital augmentation employing machine learning, computer vision and skin optics to not only enhance the robustness and precision of existing contactless sensing algorithms, but also create new models." The NRC's contactless sensing software will enter a preliminary clinical testing phase in October 2020, when it will go to the University of British Columbia's (UBC) Department of Emergency Medicine for validation and analysis.

Collaboration brings success

"While our lab tests in simulated conditions are important in the development phase, UBC will validate the technology in the emergency room (ER) with actual patients," adds Jiang. For example, to gather data for the oxygen saturation (hypoxia) component of the tool, the NRC examined subjects in a commercial hypoxic training tent filled with reduced‑oxygen air. These tents help athletes such as mountain‑climbers calculate what adjustments their bodies require to perform in high altitudes. "That's how we created essential data without using real patients."

Testing the software on actual patients is the task of Dr. Kendall Ho, Lead, Digital Emergency Medicine Unit, UBC Faculty of Medicine. "One well‑known phenomenon is that patients infected with COVID‑19 could have a dangerously low blood oxygen level without feeling it," he says. "They may report being slightly short of breath but unless we have critical numbers about their oxygen saturation, we cannot confidently advise them whether to stay home or go to the hospital."

Ho explains that in a case such as this, the test scenario is to ask patients in the ER waiting room if they agree to participate in the study. A clinician then puts the computer with the special camera in front of them to detect and record the status of vital signs. To confirm the accuracy of the software, the numbers are compared to standard hospital equipment data.

"Our clinically based analysis of hypoxia and other vital signs will reveal how the system can be integrated into virtual care generally," adds Ho. "We will also determine how it can be applied in different situations such as community care, emergency medicine, contact tracing and patient follow‑up."

The collaboration between the NRC and UBC blends the medical side of technology usage with the technological side of medical device development. "None of us can do this by ourselves, but working together gives us the ability to successfully carry out this digital transformation," says Ho, who is not only a health researcher and academic, but also a practising emergency doctor. "I feel privileged to work with the NRC because they have excellent expertise, especially engineering, computer science and tool design. They can also find technology collaborators to extend the reach of the tool."

Beyond the hospital

The benefits of the vital‑sign assessment software could go far beyond clinics. For example, by using cameras built into any mobile device, Canadians can track their health status by keeping an eye on their vital signs so they know when to contact their doctors. The tool will also be made available to industrial clients for integration into telehealth platforms, and it can help the Public Health Agency of Canada identify disease patterns and severity. And it is an ideal screening device at international borders and airports, since it checks vital signs on the spot while allowing social distancing.

The UBC hospital validation phase is likely to run until July 2021, when patients will be provided access to the NRC's vital‑sign assessment software from their own devices. Clinical trials in various ER departments across Canada will hopefully begin in late 2022. If the testing yields solid data, the NRC will facilitate mechanisms for deployment.

"The COVID‑19 crisis has spurred us to better understand where our health gaps are, and where technology can help redefine our health system," says Ho. "This tool contributes to that system, which not only helps us now, but may well have a lasting legacy to transform the way that health professionals partner with patients to support their wellness at home."

You can bank on that.

The Global Public Health Intelligence Network System

The Global Public Health Intelligence Network (GPHIN), headquartered at the Public Health Agency of Canada (PHAC), is an early warning system used to identify potential public health threats worldwide, including outbreaks such as avian influenza and SARS (Severe Acute Respiratory Syndrome).

Originally developed by the Government of Canada in collaboration with the World Health Organization (WHO), the GPHIN system was recognized by the WHO as the organization's "single most important reporting source for identifying potential (international infectious disease) outbreaks."

Between 2016 and 2018, PHAC commissioned the National Research Council of Canada (NRC) to build the replacement multilingual text analytics software application for GPHIN. The NRC used its research expertise in natural language processing, artificial intelligence and text analytics to build the new software application.

On December 31, 2019, the GPHIN software application detected the emergence of an unusual respiratory phenomenon in Wuhan, China; this viral outbreak was subsequently termed COVID‑19.

The GPHIN software application is meant primarily for PHAC's human analyst team to maintain curated global awareness of emerging public health hazards. PHAC analysts use GPHIN to monitor media sources worldwide and provide organized, relevant information to respond to potential health threats in a timely manner. Other users include non‑governmental agencies and organizations, as well as international and foreign government authorities who conduct public health surveillance, including the WHO.

As an open source text analytics platform, the GPHIN software application augments formal public health reporting by harvesting 5,000 to 9,000 articles per day from around the world in 10 languages. Based on PHAC categories, the GPHIN software application applies state‑of‑the‑art machine translation and natural language processing techniques to extract and display information for PHAC analysts to use.

The GPHIN software application is an example of how artificial intelligence tools can be deployed to inform public policy. The NRC monitors the GPHIN software application as part of ongoing technical service but does not play a role in decisions made regarding public health threats.