Augusta Lipscombe

Weeneebayko Area Health Authority works to transform health care with support of UHN

Christopher.Sorensen — Thu, 11 Jan 2024 16:21:57 +0000

Weeneebayko Area Health Authority works to transform health care with support of UHN

Christopher.Sorensen Thu, 01/11/2024 - 11:21

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The Weeneebayko Area Health Authority operates the Weeneebayko General Hospital in Moose Factory, Ont., the large, multi-winged building in the foreground (photo by Anne Simard)

Augusta Lipscombe

Topic

Our Community

Institutional Strategic Initiatives

Temerty Faculty of Medicine

Transform HF

Ted Rogers Centre for Heart Research

University Health Network

Subheadline

Transform HF, a �Թϱ�� institutional strategic initiative focused on digital innovation for heart failure care, is also supporting efforts to bring health care closer to home for the region's communities

Gloria Stoney waited five days in October to be medevaced to Toronto from her home in Peawanuck, Ont. – a Cree community near the shore of Hudson Bay – after she began experiencing serious cardiac symptoms.

“I didn’t feel so comfortable, but my family was there to take care of me and make sure I wasn’t alone,” she says.

Upon arriving at Toronto General Hospital, she was admitted immediately for further work-up and was able to return home to Peawanuck while she was monitored remotely. A short time later, she was flown out to Kingston, Ont., for more testing and returned home at the end of November.

Gloria’s experience criss-crossing the province could soon become less common for local residents thanks to efforts by the Weeneebayko Area Health Authority (WAHA) that are being supported by physicians at the Peter Munk Cardiac Centre, University Health Network (UHN).

With limited access to specialized cardiac care in the region, patients such as Gloria Stoney must travel more than 1,300 kilometres south by a combination of boat, train, plane and car (supplied image)

Building on an existing 2017 partnership, WAHA and UHN have signed a five-year memorandum of understanding that would support the cardiovascular needs of James Bay and Hudson Bay communities with a focus on direct care and remote management. That includes building local capacity and making use of remote technologies and other digital tools to bring diagnostics and treatment closer to where patients live.

“Signing the MOU emphasizes WAHA and UHN’s joint dedication to enhancing cardiac care in the James and Hudson Bay region," says Lynne Innes, WAHA's president and CEO. “Together, we’re working to improve cardiac care delivery, making it more accessible while enhancing quality of life.

“This partnership is a significant example of how health equity can be advanced in Indigenous communities.”

Using both Indigenous and western strategies, WAHA provides health care to six communities throughout the James Bay and Hudson Bay region, including Peawanuck.

Moose River (photo by Anne Simard)

Innes notes there is currently limited access to specialized cardiac care in the region, requiring patients such as Gloria to use a combination of boat, train, plane and car to travel more than 1,300 kilometres to the south.

“Leaving home for medical care is tough,” she says. “It requires the co-ordination of many people and organizations, and for our clients, it can mean a lot of anxiety from having to navigate a different city and hospital, all while missing the comfort of home. It’s a journey of healing mixed with the struggle of being far away from what’s familiar.”

Under the arrangement, co-ordinated clinical care would involve regular in-person visits by UHN staff to WAHA’s six communities and use of the Medly Program – a remote patient monitoring system for heart failure management that already counts more than 30 WAHA community members, including Gloria, as users.

There would also be opportunities for researchers and trainees to engage with WAHA and community members through Transform HF, a �Թϱ�� institutional strategic initiative focused on digital innovation for heart failure care that brings together the university and the Ted Rogers Centre for Heart Research – itself a partnership between the University of Toronto, UHN and the Hospital for Sick Children.

Left to right: Samuel Petrie, Stella Kozuszko, Erica Groenewoud, Mena Gewarges, Tanis Ross, Heather Ross, Elaine Innes, Sandra Kioke, Anne Simard and Sahr Wali (supplied photo)

Heather Ross, head of the cardiology division at the Peter Munk Cardiac Centre at UHN and a professor in �Թϱ��’s Temerty Faculty of Medicine, says improving access to culturally safe cardiovascular care in WAHA’s communities could drastically improve patient care and outcomes in the region.

“Digital innovation is the key,” says Ross, who is also co-lead of Transform HF. “It can provide access to health-care services not historically offered in the region and that require clients to travel out of community.”

A recent community-based study in Moosonee, Ont., found that community members are receptive to digital health tools, though they must be designed in a way that reflects their values and integrates western and Indigenous approaches.

Gloria, for one, says digital tools such as Medly have made a difference in her life.

“Medly has been helpful,” she says. “It saves me running to the clinic every time something happens. You get a response right away, and someone reaches out to you when something is up.”

Gloria says she also appreciates that her results are available through the app, so when she needs to receive care outside of her community, there’s no need to re-explain her symptoms and management.

“I’m not the only one in Peawanuck with a heart issue,” Gloria says. “Medly benefits a lot of people here.”

The partners are also initiating a screening program for earlier detection and primary prevention of heart failure.

Additionally, the partnership will support ongoing community-based qualitative and quantitative research with a focus on field testing digital devices, point-of-care testing and other innovations in community and on the land.

WAHA and UHN will also work together to build capacity in the community. Mentorship programs will facilitate exposure to clinical and research environments for the next generation of WAHA-based health-care providers, and opportunities will be created for Toronto cardiology residents and fellows to participate in this collaboration through observerships.

“Working in community, with community, is so important – this MOU supports that,” Ross says. “When you add in the layer of digital health and remote monitoring, I think we can support WAHA in keeping their community members healthy at home.”

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Transform HF

Earbuds to monitor blood pressure? Researcher says they could outperform smartwatches

Christopher.Sorensen — Thu, 16 Mar 2023 17:44:30 +0000

Earbuds to monitor blood pressure? Researcher says they could outperform smartwatches

Christopher.Sorensen Thu, 03/16/2023 - 13:44

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Ken Christofferson, a doctoral trainee under �Թϱ�� Assistant Professor Alex Mariakakis's co-supervision, collects physiological data from earbuds for blood pressure monitoring (photo courtesy of TRANSFORM HF)

Augusta Lipscombe

Topic

Our Community

Institutional Strategic Initiative

Computer Science

Faculty of Arts & Science

Ted Rogers Centre for Heart Research

When it comes to blood pressure monitoring, Alex Mariakakis and his team are all ears.

Alex Mariakakis

Mariakakis, an assistant professor in the University of Toronto’s department of computer science in the Faculty of Arts & Science, has been awarded a seed grant by TRANSFORM HF – a �Թϱ�� institutional strategic initiative that develops point-of-care diagnostics, wearables and AI technologies to monitor and proactively treat people with heart failure – for his project “Accessible Blood Pressure Estimation with Earbuds.”

As a ubiquitous computing researcher, Mariakakis’s work leverages pervasive technologies (smartphones, wearables, even Wi-Fi) for use in human-centred applications.

We sat down with Mariakakis to learn more about how earbuds could be used to monitor blood pressure and how he is revolutionizing digital health for heart failure care.

Can you describe your earbuds project?

At our core, we’re interested in trying to make blood pressure assessment more accessible to everyone.

Blood pressure cuffs are the gold standard for blood pressure assessment, but they can only be used on occasion: Someone has to sit down, put the cuff on their arm, and remain still to complete the measurement. This process can be cumbersome and people might not wear the cuff properly or follow the official protocol for measurement. And, of course, people must own blood pressure cuffs for self-monitoring at home.

We’re interested in leveraging existing technology – earbuds – to remove the cost of a blood pressure cuff and increase the ease of at-home blood pressure measurement. Our moonshot is to facilitate regular assessment of blood pressure and support self-management of heart failure.

Many earbuds have noise-cancelling technology, which relies on having an outer microphone and an in-ear microphone. The outer microphone listens for ambient sound while the in-ear microphone listens to what’s happening inside the ear. It turns out that the in-ear microphone is able to pick up on some very interesting sounds inside the body, including heart sounds. Research has shown that you can use the audio recorded from inside the body to measure heart rate, but you’re really able to get the same sounds you would hear from a stethoscope. We’re hoping that we can analyze these heart sounds using different signal processing techniques to infer someone’s blood pressure.

An earbud prototype that has been wired for data collection (photo courtesy of TRANSFORM HF)

How would a person with heart failure use this technology?

The nice thing about using earbuds for blood pressure monitoring is that people wouldn’t need to do anything differently. The idea is that you would just wear the earbuds and the in-ear microphone would collect audio and transmit it to your smartphone using Bluetooth – and the phone would analyze the heart sounds to determine your blood pressure. That information could be shown to you or it could be delivered to your care team.

Any earbud that has an in-ear microphone will be able to utilize this technology. So as long as patients already have active noise-cancelling earbuds, the technology will work!

Because earbuds can be used in noisy places and heart sounds can be very subtle, a quiet environment is going to be key for effective use. So, the most practical use case for this technology would be a telehealth consultation when people are often seated inside their homes.

How do earbuds differ from other sensing technologies?

More and more, we see smartwatches coming out with the ability to provide health metrics like heart rate, blood oxygenation, sleep scores and stress metrics. Why not earbuds? I think earbuds can do a lot of the same things – and in some cases better.

For example, a lot of the smartwatch-based systems for estimating blood pressure rely on looking at blood flow at a single site. The advantage of earbuds is that you get two locations – the left ear and the right ear — which can give us twice the amount of information. Some researchers have also found that we can measure blood pressure based on how long it takes for a heart pulse to go from one location of the body to the other. You can do this kind of estimation with a smartwatch, but the distance between points does not give a lot of room for error. With earbuds, you get a much larger distance. That’s one of the exciting opportunities where we think that we can actually outperform smartwatches.

Through this project, TRANSFORM HF is welcoming a new partner into its network: Tsinghua University. What role they will it play?

I’ve known Yuntao Wang (assistant professor, Tsinghua University and project coinvestigator) for a few years. When I was in Seattle, he was a visiting researcher and we collaborated on multiple projects. He’s a really great guy and it just so happens that he has also been doing research with earbuds. For example, in one project, he created a lightweight algorithm for detecting coughs from the audio recorded by earbuds.

Beyond bringing his technical expertise, Yuntao will also help us to generate a more diverse data set. We are hoping to do some data collection in China, which will be really helpful for ensuring that we have a diverse cohort. It will allow us to check that our algorithms apply to different populations, making us more confident in whatever we develop.

What are the next steps after this seed grant?

We’re very interested in monitoring blood pressure through any ubiquitous sensing mechanism. One study we’re hoping to do alongside this project, or maybe a little later, would be to compare and contrast all the different technologies being considered for blood pressure monitoring – earbuds, smartwatches, smartphones – to see what works best. Can we get better performance with earbuds versus a smartwatch? Can we combine a smartwatch and earbuds to get an even more accurate measurement?

Eventually, we want to deploy this in clinic. This will help us to answer all sorts of questions related to how we would integrate this kind of technology into health care: What benefits are there to measuring blood pressure multiple times a day for patients and clinicians? Is showing the data enough, or do we need to help people put that data into context? We also want to deploy our technology to those who are underserved. I am hoping that the TRANSFORM HF seed grant will help us initiate engagement with different groups, including Indigenous communities.