Ibukun Abejirinde, Payal Agarwal, Jeanette Smith, Myrtede Alfred, Michele Strom, Quynh Pham

Monitoring programs often take a disease centered approach, tailored to a specific clinical pathway – this inadvertently shifts focus from the individual to the disease. Additionally, remote patient monitoring is not immune to the existing inequities in heart failure care along the axes of gender, socioeconomic status, and ethnicity/culture. In an era of increasing multimorbidity, an integrated approach to health and wellbeing for chronically ill patients is imperative.

Dr. Abejirinde’s team has already identified common features of remote patient monitoring programs under four domains: 1) Technology, 2) Integration, 3) Patient-centricity/Equity, and 4) Touch. The TRANSFORM HF Collaboration Starter Grant will help to further advance this research and ultimately support the design and implementation of patient-centered service models.

The outputs of this work will inform a CIHR catalyst grant application to create an equitable service model that factors individual, institutional, and resource needs and can be piloted in real world settings.

Megh Rathod, Dan Franklin, Heather Ross, Elizabeth Igaga, Sahr Wali

Pulse oximeters are recognized by the World Health Organization as essential tools that improve patient safety. However, the issue of increased oximeter inaccuracies in highly melanated skin has been flagged. With current studies only available from populations in North America and an inadequate supply of pulse oximeters in low-resource countries, it is impossible to know just how far-reaching this problem is.

The lack of appropriate medical devices to meet the needs of low-and middle-income countries has long been a global health concern. Technology that does exist in developing countries is often imported from outside nations and does not consider local factors. This may lead to a disproportionately high percentage of imported medical devices in low-resource settings becoming non-functional in contrast to only 1% in high-income countries. The true extent of biased pulse oximetry may be unknown due to lack of access, but this also provides a fruitful opportunity for the technology to be adjusted to the realities of low-resource settings.

Valuable strategies can be realized in low-income countries by strengthening local capacity, supporting innovation, and encouraging inclusion. Megh Rathod plans to carry out this work via environmental scans, co-creation with local communities, development of educational material, and knowledge dissemination.

Shumit Saha, Joseph Cafazzo, Yan Fossat, Ian Connell, Jouhyun Jeon

Prolonged exposure to abnormal blood glucose levels can cause diabetes mellitus, a leading cause of global mortality. In patients with heart failure, the prevalence of diabetes mellitus can reach up to 31%, highlighting the importance of controlling blood glucose levels to manage heart failure.

As blood glucose levels directly influence the neurologic, vascular, and muscular systems – all of which are essential components of voice function – Dr. Saha believes that changes in the level of blood glucose may influence aspects of voice. Building on primary evidence gathered by their partners at Kick Inc., Dr. Saha and his team plan to launch a pilot study to better understand the relationship between voice features and glucose levels.

Through this research, Dr. Saha will lead a new line of development for an improved, accessible blood glucose monitoring method.

Sahr Wali, Aamir Jeewa, Joseph Cafazzo, Navreet Gill, Stella Kozuszko

Advancements in care have seen more than 85% of children born with heart failure surviving into adulthood. However, care continuity has become a growing challenge with improvements in life expectancy, with many adolescent patients experiencing lapses of care during the transition to adult services. Prolonged gaps of care are especially common amongst ethnic minorities and patients of lower socioeconomic status due to systemic inequities.

Dr. Wali’s project aims to optimize the pediatric care journey by developing an integrative transition pathway between the Hospital for Sick Children and Toronto General Hospital. By leveraging the Medly-Peds and Medly digital therapeutic programs, her team will streamline the transfer of care and safeguard the patient care experience. Dr. Wali plans to use user-centered design principles and amplify patient voices to co-develop Medly “Bridge” – a module that enables the creation of individualized transition plans alongside their Medly care journey.

Shumit Saha, Scientific Associate, Centre for Global eHealth Innovation

This project seeks to optimize an already developed rules-based auto-titration algorithm for Guideline Directed Medical Therapy (GDMT) through patient and clinician interviews. These interviews will help identify potential barriers to implementing the auto-titration model and shape the model’s user interface.

This will be the first study to explore the potential implementation process of automated titration of GDMT. Next steps include the inception of an automated heart failure therapy delivery model.

Emily Seto, Associate Professor, Institute of Health Policy, Management and Evaluation; Affiliated Faculty, Techna Institute; Affiliated Researcher, Centre for Global eHealth Innovation

This project will support the creation of an international network of researchers, patients, clinicians, industry partners, and other stakeholders in Canada, the United Kingdom, and Australia for the development of a grant application. Aimed at advancing care models of heart failure (and other chronic diseases) that are facilitated by technologies, the application’s ultimate intent is to enable equitable and high-quality virtual care.

Jay Shaw, Assistant Professor, Department of Physical Therapy; Research Director, Artificial Intelligence, Ethics & Health, Joint Centre for Bioethics; Scientist, Women’s College Hospital Institute for Health System Solutions and Virtual Care

Through interviews and workshops, this project will 1) investigate how strategies to promote engagement with virtual care technologies among structurally marginalized communities fit within existing Canadian policy frameworks and 2) seek to understand the perceived need among policy stakeholders for policies that enhance access to virtual care for structurally marginalized communities in Canada. The research team will prepare a tri-council grant submission as a final step of the project.

Quynh Pham (Scientist at University Health Network and Associate Director of the Centre for Global eHealth Innovation), Noor El-Dassouki, Raima Lohani

Research will engage Medly knowledge users in co-creating enhancements to the remote monitoring application so that caregivers are better integrated and can help address gaps in access, especially for the elderly, those from ethnocultural minority communities, or those with limited English proficiency. The goal is to create a shared virtual care experience and define enhancements to build out new Medly Caretown features and functionality. (Medly is a remote patient management system designed to keep Canadians with heart failure safe at home.)

Valeria Rac (Scientist and Health Technology Assessment Lead, Ted Rogers Centre for Heart Research and Toronto General Hospital Research Institute), Aleksandra Stanimirovic

This project, with both TRANSFORM HF members and international collaborators, will create a Canadian framework to assess AI-powered technologies as such methods gain prominence and shape models and care solutions.

Robert Amelard, Postdoctoral Fellow, KITE-Toronto Rehabilitation Institute, University Health Network

A diverse group of TRANSFORM HF collaborators will conduct a series of user engagement studies with patient partners to optimize remote monitoring technology adherence, propose guidelines for technology design with patients, and build relationships for future funding competitions.