Grand Challenges Call for Collaborative Solutions

TRANSFORM HF is celebrating its 5th anniversary this year – marking half a decade of advancing digital innovation for equitable heart failure care.

We sat down with Dr. Craig Simmons, TRANSFORM HF Co-Lead and Distinguished Professor at the University of Toronto, to reflect on TRANSFORM HF’s growth over the years, the engineering landscape, and what’s next for the initiative.

TRANSFORM HF Co-Leads, Drs. Craig Simmons and Heather Ross

Since 2015, Dr. Heather Ross and I had been part of the Ted Rogers Centre for Heart Research. I was leading the University of Toronto’s Translational Biology & Engineering Program, which works to improve heart health through discovery science and regenerative medicine. I was really intrigued by her work in the digital health space – particularly the UHN-developed remote monitoring app, Medly, and how powerful that could be. I recognized that engineers and scientists at the University of Toronto also had technologies and innovations that could be applied to heart failure care, but they weren’t connected with clinicians or people with lived experience (PWLE).

We had an idea to bring these communities together and build on the remarkable foundation that Heather’s work had laid. Heather and I wanted to push for more cross and inter-disciplinary innovation. We were awarded an Institutional Strategic Initiative award for this vision: TRANSFORM HF, funded by the University of Toronto and the Ted Rogers Centre for Heart Research in 2020.

I think it’s becoming more interdisciplinary, particularly in terms of health-focused work. Engineering no longer only falls under the typical categories of mechanical engineering or chemical engineering – biomedical engineering now draws on a diversity of fields, including basic sciences, biology, and medicine.

I believe this evolution is necessary to tackle these big problems, which require multiple perspectives. As a result, engineers have had to adapt to this new way of working and learn how to communicate with collaborators and stakeholders outside of their siloes.

There’s a huge opportunity for digital health to improve personalized care, which is particularly beneficial for heart failure because it is such a heterogeneous disease. In terms of TRANSFORM HF, the big thing is being able to provide that level of care to people who normally wouldn’t have access. The concept of remote, hospital-in-a-home type of care is super exciting and will impact how medicine is practiced – and how effective it can be.

With CaRDM Eq, we’re instilling in the next generation of digital health engineers and implementation scientists the notion that technologies must be developed with the end user in mind – and the best way to do that is to develop it alongside them. Integrating ideas of co-creation, early collaboration, user-centered design, accessibility, and appreciation for cultural safety is hugely important – and these are concepts that fall outside of traditional engineering education. What’s really encouraging is we’re starting to see these approaches work – students are completely engaged and bought into that way of thinking. They’re appreciative of opportunities to sit down with PWLE whose new perspectives are informing their research.

We also see it on the other side – patients are recognizing how valuable their opinions are and are completely engaged as well. We now have this whole new resource that’s helping to advance our mission. Through TRANSFORM HF’s patient engagement work, we’re now able to do it in a much more impactful and effective way.

Dr. Craig Simmons and graduate students in his lab (Doris Adao, Kevin Da, and Jade Huang) observing microscopic images of heart cells.

These challenges clearly need an approach that incorporates different skill sets, knowledge, and perspectives – and it must be done collaboratively with a common goal. That’s what TRANSFORM HF is doing – connecting really diverse teams to give us new ways to look at and solve problems. Even with our grant review panels, we have representation from engineers, clinicians, trainees, and PWLE, so we can ensure we’re funding research that meets all these perspectives.

The community we’ve built. That was our first goal because we started from scratch and needed to build a network that would be able to tackle grand challenges. And we’ve done that – we’ve got an incredibly diverse, highly-engaged group at all levels. I think we’ve accomplished what we wanted to do locally, and now we’re expanding beyond Toronto.

Then there’s also the social engineering part of it – shifting our thinking and the way we approach research and other activities. CaRDM Eq is a good example of successful adoption among trainees, but I’m also noticing some of my older colleagues in engineering starting to think more like that – myself included.

Dr. Craig Simmons participating in On-the-Land, TRANSFORM HF’s Indigenous Education program led by Dr. Angela Mashford-Pringle.

Next is to leverage what we’ve built, which includes reinforcing our existing relationships and continuing to build new relationships.

From an engineering perspective, we’re going to see the technologies that have been developed during the first few years now start to move out of the labs and be tested with our community and clinical partners – and beyond. We’ve also provided a pathway for the translation and commercialization to occur through the infrastructure we’ve built, like the Digital Hub and ECHO Discovery.

Additionally, I hope to see how our network can impact the way medicine is practiced at a health systems level, in terms of policy and standards of practice. That’s a little longer term, but clearly where our work is headed.

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