Third in a four-part series called Code Now, a comprehensive look at how the Waterloo Region tech ecosystem can assist the local medical community during COVID-19 – and longer-term. In today’s segment, we hear from front-line doctors who are coping with patients infected with COVID-19 and are preparing to face more cases in the coming days and weeks. Editor’s note: Companies that believe they can provide a solution to any of the problems listed below should contact Communitech’s Medtech Startup Advisor, Armin Eichhorn, at armin.eichhorn@communitech.ca.
Bob Wickett
Emergency room physician, Grand River Hospital
THE PROBLEM: “We’re trying to pool our resources [but] we’re having a challenge co-ordinating everything,” says Wickett. “We have multiple doctors doing different things. All those [doctors] have nurses doing different things. We have senior administration and fire and police and [emergency medical services],” all involved.
“We need to make sure there’s no redundancy going on. Obviously some good headway has been happening over the last couple weeks. But we still have multiple people all trying to do their own little projects.”
So. Efficiency. Delegation. Project management. Staying on top of the status of projects. All are issues in need of a solution.
THE ASK: Software, perhaps in the form of a dashboard, that shows the tasks assigned to each agency and each health-care worker, with the aim of eliminating redundancy and ensuring maximum co-ordination and efficiency.
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THE PROBLEM: Front-line medical staff are being continuously exposed to patients potentially carrying the COVID-19 virus. Many are becoming infected. In other cases, patients who are not positive are risking infection from medical staff. To reduce exposure for both, Wickett says emergency room staff have considered placing new patients in a room equipped with video equipment and having a doctor evaluate them remotely from an adjoining room. The evaluation then triggers either a further physical exam, or a determination that the patient needs no further intervention.
“So, that way, every 10th patient we might actually physically see,” says Wickett. “Just reducing that interaction with the healthcare people would be worthwhile. So, a video conferencing [system] that’s easily transportable between physical sites, or even virtually, that can be quite useful.”
THE ASK: A video system that would allow patients to be screened virtually, thereby reducing exposure to the virus for front-line medical staff and patients.
Mary Jackson
Respirologist, St. Mary’s Hospital and Medical Director, Regional Thoracic/Chest Program
THE PROBLEM: The local medical system is a complex web of several institutions and organizations: Acute-care hospitals, clinical-care facilities, long-term care facilities, family clinics, retirement homes and home care. Managing communication among them, and having visibility into the projects or actions of each, is unwieldy and piecemeal. “The benefit of a smaller community is we all know one another and it’s always possible to pick up the phone and call somebody,” says Jackson. “But that communication is sometimes very inefficient. Effort is sometimes duplicated.”
THE ASK: A system that allows each facility to see at a glance what the others are doing, and who the appropriate contacts are on projects or initiatives.
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THE PROBLEM: Physicians, says Jackson, are being overwhelmed by information, both of a scientific and medical nature, and policy directives. “We have information coming from the CDC, from the WHO, from Health Canada, from Public Health Ontario, from our professional organizations.”
Trying to stay abreast of all that information while treating patients is, as she puts it, “challenging. There’s been a lot of use of WhatsApp,” but that, she says, isn’t really adequate for the purpose.
What would help, Jackson says, is some kind of “executive summary,” one that would collate, rank and sort what is crucial to know now versus what can wait.
THE ASK: A platform that distils virus-related information and can immediately push out to doctors and healthcare providers must-know material in a brief summary, and allow workers to access less critical information at a later date.
Paul Hosek
Emergency physician, ICU physician and medical director of the ICU at Grand River Hospital
THE PROBLEM: A worldwide effort is under way to produce more ventilators for intubated patients – Canadian Prime Minister Justin Trudeau recently announced 30,000 new ventilators are on order from Canadian companies – but Hosek says not enough thought has been given to converting physical space where those ventilators can be used.
“We run up against real physical limitations in terms of where we can safely mechanically ventilate patients,” Hosek says. “The space has to have a cardiac monitor, it’s got to have a line for air, a line for oxygen, suction. It’s got to have, obviously, enough electrical outlets to support and monitor the ventilator. And it’s got to be easily accessible to a central point where one person could monitor multiple patients on a mechanical ventilator.
“Even if they delivered 100 ventilators to our doorstep tomorrow, we couldn’t use them because we don’t have a place [to use them].”
THE ASK: Solutions to create usable space for critical-care patients, including efficient expansion of the hospital’s existing internal plumbing – air lines, oxygen lines, electrical outlets – to support more ventilators.
Alex Trussler
Palliative Care and Internal Medicine specialist, Grand River Hospital
THE PROBLEM: Palliative care patients, particularly those in their 70s, 80s and 90s, require frequent return visits to the hospital where they’re in greater danger of contracting COVID-19. “We need to get people out of the way of the flood that’s coming,” says Trussler. “The main thing that I would want from a technology company would be a way to keep people at home who are prone to coming back to hospital,” and yet still get them the care they need.
Trussler says people with palliative diagnoses – cancers, end-stage organ failure, congestive heart failure and other chronic illnesses – ”are the ones that bounce back rapidly to hospital.”
He wonders if a nurse, equipped with software and a laptop, could go to a home and conduct rapid follow-ups in order to “tweak people’s meds, control their pain, their shortness of breath, and just do everything possible to keep them at home.” Or, if a nurse isn’t able to visit, equip a patient so they can contact the hospital virtually.
“Typically what happens with my palliative patients is one of their symptoms gets out of control.” He wonders if software could allow a patient to press a button and open up a dialogue box with a nurse.
“You could just leave a message for a palliative nurse and say, ‘Look, my pain is getting harder to control. I think I need something done. Could we schedule an assessment?’ And then either do a teleconference visit or you bring them into a limited clinic setting. That would be ideal because then we save the trip to Emergency. And that’s what we need to prevent.”
THE ASK: A tech-enabled way to assess palliative-care patients without them making a visit to the hospital.
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THE PROBLEM: Different levels of protective equipment are required to be worn by health staff depending on the person being treated and their type of illness. “Right now, we’re just using a sign or a card on the door of the patient’s room,” says Trussler. The signs alert someone entering the room to the level of protective equipment they should wear. “But sometimes the cards fall off the door or get misplaced,” meaning the health professional then needs to err on the side of caution and don full protective gear. This potentially wastes personal protective gear, all of which is in short supply, and slows treatment, as the healthcare provider suits up.
“It would be nice if we had a modern system where there was a computer screen or something on everyone’s door saying what type of protective equipment is needed, because right now we’re just using signs and cards.”
THE ASK: A quick, inexpensive, way to identify the level and type of protection required to enter a patient’s room, something that can be easily changed once a new patient takes over a room.
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THE PROBLEM: “One of the barriers to getting people sent home from hospital is that we’re sometimes waiting a day or two for the correct staffing pieces to be allocated and put into place [so the person gets proper home care]. A lot of phone calls go into that,” says Trussler. “If we had some kind of AI or machine-learning process that is more quick on the draw to get resources queued, it would really help.
“And you can extend that to prescribing medicine. What we do now is fax off a prescription, then the pharmacy puts it all together and sends it out to the house within a day or two.
THE ASK: Software that would trigger a personnel and pharmaceutical response once a patient is nearing release from hospital, speeding their release in order to free up beds.
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Tomorrow in Part IV, the final instalment of Code Now:
Meeting of the minds: The medical and technology communities are working toward a forum to bridge ideas for ongoing mutual benefit. This bridge, ideally, becomes a partnership that outlives the current crisis and provides a forum for innovation and efficiencies within the medical community and, simultaneously, a source of opportunity for entrepreneurs.
