Disrupting traditional models of health care

A smartphone app that can help prevent suicide in remote areas. A virtual reality solution to preventing age-related falls. A credit card-sized heart sensor that could allow patients with chest pain to be assessed at home.

These are some of the disruptive innovations to medical care being explored by University of Waterloo researchers to reduce rising health costs and improve people’s lives. They are building technology that gets better information to doctors more quickly and using our online world to educate and connect people.

One such example is Agii Badrakh, who struggled with anxiety while growing up in Mongolia where there were no counsellors in her community. Today, she’s developing a smartphone app to reach young people in a country where one in five teens seriously considers suicide.

Badrakh, who works as a counsellor at the National Psychology Center in Ulaanbaatar, came up with the idea to use machine learning to psychologically assess teens after meeting Plinio Morita, a University of Waterloo health informatics professor, at a UNICEF event in Mongolia.

An app that assesses suicide risk

“If the smartphone user is low on social engagement and high on anxiety, for example, that teen is likely to be more at risk for suicide behaviours,” she says. “The app might suggest calling three friends to go to a movie.”

Badrakh and software engineer Erka Tseyenkhorol, are coming to the University of Waterloo to work with Morita as PhD grad students in the fall of 2018. The app, called CASCA, will conduct simple conversations and provide psychological assessments through a chatbot. “Teenagers spend many hours using Google Chat and Facebook Chat,” says Badrakh. “If we can create a chatbot that talks like a real person, teenagers will use it.”

She says a major goal for her PhD studies will be to field test and market a version of CASCA to be used in Mongolia and around the world. “In traditional universities, you can often only do academic research. At Waterloo, it’s very different and we’re excited about that.”

For Morita, Badrakh’s approach dovetails with the research he leads in the Ubiquitous Health Technology Lab (UbiLab) in the Faculty of Applied Health Sciences. Morita, an assistant professor in the School of Public Health and Health Systems, is at the forefront of developing health technologies such as wearable sensors and mobile health apps, which can be used by patients at home.

The smart-psych tool that Badrakh and Tseyenkhorol are developing also aligns with the Faculty’s multidisciplinary approach to health. The Faculty, which celebrates its 50th anniversary this year, was founded at a time when the traditional medical model — that merely treated, rather than prevented, illness — prevailed. It disrupted that approach with applied research that focused on health promotion, disease prevention and quality of life.

Fewer unnecessary visits to hospitals and clinics

Morita, the J.W. Graham Information Technology Emerging Leader Chair in Applied Health Informatics, is leveraging machine learning to improve predictive models. He’s researching ways to enhance technologies so the large amounts of data collected remotely from patients through sensors and apps like CASCA can be integrated and presented to clinicians in meaningful ways, such as graphs, charts and scores. That means doctors can diagnose or monitor patients and prescribe a course of action without unnecessary visits to a hospital or clinic.

The app will also store and track each user’s text-based social media interactions. Interactive infographics and engaging articles on a website in the Mongolian language will help educate parents and the public.

Working with Mongolian adolescents and their families as a counsellor, Badrakh now sees anxiety and depression as very common problems that are exacerbated because teens often can’t talk comfortably or openly with their parents. The CASCA app is a psych-smart tool that can help bridge this gap by educating youth and parents about mental health issues, while also empowering tech-savvy teens to help themselves in a system with limited traditional mental health resources.

(From left to right) Agii Badrakh (AHS grad student building mental health app), Helen Chen (AHS researcher developing mobile ECG) and Plinio Morita (Professor leading the Ubiquitous Health Technology Lab)

Virtual reality to prevent falls in older adults

Like Morita and Badrakh, Michael Barnett-Cowan, an assistant professor of neuroscience in the Faculty’s Department of Kinesiology, is looking at using technology to prevent health crises. He uses virtual reality (VR) to help prevent falls in older adults — a health-care issue that costs Canada $3 billion every year. In his Multisensory Brain and Cognition Lab, Barnett-Cowan uses VR technology to better understand how the human central nervous system integrates multisensory information to perceive, make decisions and move in the world.

“Traditionally, scientists studied the various senses in isolation and became good at treating conditions that involved single senses, like vision. We want to understand how the central nervous system synthesizes information across the senses in the normal and aging brain, as well as people with damage and neurological diseases,” explains Barnett-Cowan.

As the brain of an older adult changes, its central processing of multiple sensory stimuli starts to change. “We’re finding that fall perception is nearly twice as slow for older adults. They perceive the beginning of a fall more slowly and these age-related differences may contribute in an important way to the higher fall rates for older people,” he says.

Barnett-Cowan is collaborating with clinicians at the Toronto Rehabilitation Institute and Grand River Hospital in Kitchener. “We hope this research may help to identify effective methods of reducing falls and monitoring the progress of rehabilitation not only in older adults, but also those who suffer from balance impairments at any age,” he says.

 Michael Barnett-Cowan — a professor using virtual reality to prevent falls.

People with chest pain assessed at home

Another researcher in the Faculty of Applied Health Sciences, Helen Chen, is developing a smart, mobile electrocardiogram (ECG) the size of a credit card, which means people with chest pain can be assessed at home rather than the emergency room.

Chen is the software lead for a University of Waterloo team collaborating with Dynacare, a large national health-care lab services provider. They are working to launch a device that works with smartphones and tablets, which cardiologists can use to diagnose conditions such as arrhythmia or heart attack.

Currently, health professionals who visit retirement homes to give residents ECGs use expensive, bulky, stand-alone equipment that produces a paper tracing of the raw test data. Couriering paper copies back and forth between health professionals for interpretation and diagnosis typically takes two weeks.

“A doctor seeing people at a retirement home could use the device to get a result right away and decide whether to adjust a patient’s medication during that visit,” says Chen, an assistant professor in the School of Public Health and Health Systems.

The global ECG equipment market is valued at more than $5 billion. Working with the Waterloo Commercialization Office (WatCo), Chen’s research team is seeking additional partners to help commercialize the mobile ECG device. Chen has been to China several times and has identified a potential hardware manufacturer to produce it.

“China has the speed and capacity to manufacture the device and the Chinese government sees this type of product as the future for their health care,” she says.

Artificial intelligence that brings your health data together

Chen and Morita are also developing a platform that could radically transform how doctors prescribe drugs by using artificial intelligence to mine everything from your social media messages to lab reports and doctors’ clinical notes.

“Artificial intelligence allows you to make the best use of the large amount of scattered health data available to get its true value. This precision medicine could make it possible to give a new drug only to people for whom it’s effective and spare the others that it won’t help,” says Chen.

Diana Parry, a professor in the Department of Recreation and Leisure Studies, has shown in her research how women are turning to online social networking sites like Momstown.ca for peer support and friendship they used to find in neighbourhoods. By simply logging into a social networking site, women across Canada are being empowered by technology to find a virtual neighbourhood at their fingertips and benefit from a 24-hour support system that can counteract the social isolation and anxiety often experienced by mothers raising young children.

The distinctive ease, convenience, and speed of online connectivity, combined with the respectfulness cultivated within this specific online community, gives moms the opportunity to connect with peers who not only have children of the same age, but share similar leisure interests and values. Parry’s research challenges the medicalization of women’s health and maternal health. Her studies shift attention to important quality of life issues, and demonstrate the transformative possibilities of cyber-feminism in promoting women’s health.

“People want to have health services delivered where they live, either at home or in the case of many older adults, in a long-term care home. Mobile devices improve the quality of care by getting data to doctors faster for diagnosis while reducing data errors.”

Helen Chen

Whether it’s alerting doctors to older adults at risk for falls, getting better and more timely information about patients with heart disease, or connecting with depressed teens through smartphones, it’s ultimately about improving health care.

Agii Badrakh knows her smartphone app won’t solve adolescent mental health problems in Mongolia, but it is another tool to educate teens and parents. “The reality is there aren’t many counsellors in Mongolia and youth need more help,” she says. “For some kids, especially those in remote areas, CASCA will act as a counsellor.”

Chen says: “In Canada and worldwide, people want to have health services delivered where they live, either at home or in the case of many older adults, in a long-term care home. Mobile devices improve the quality of care by getting data to doctors faster for diagnosis while reducing data errors.”

Morita adds, “We want to keep patients in Mongolia and in Canada out of hospital by using technology to connect more directly with the user. We’re focused on technology solutions for community and home-based care to help people of all ages live healthier, more independent lives.”

Looking back: The Faculty of Applied Health Sciences beginnings