2018-2019 Annual Report

Standard patient records, whether they are paper or electronic, are large and often fragmented collections of information. But what if you could bring all that information into a design environment and create a “blueprint of care”? This would allow care providers to literally visualize the treatment plan and instantly see the big picture. That’s exactly what Dr. Arnold Kim, a Hospitalist at the Thunder Bay Regional Health Sciences Centre, set out to do 10 years ago.

When you go to see the doctor, he or she records your symptoms in your chart, analyzes what you’ve said, and then starts treatment planning. Your doctor may order tests, prescribe medications, and plan a follow-up visit. But these entries are disconnected bits of information that will need to be read again in the future, forcing the care provider to reconstruct the patient story or “narrative” from scratch every time.

“That’s a weak point in the medical system,” Dr. Kim said. “Narrative works well when you are giving simple directions, like to the store from your house. But when we rely upon narrative to describe very intricate relationships like those in health care, it breaks down. There are many more directions, perhaps several destinations, and even different steps happening at the same time.”

Now imagine that when doctors enter information into your electronic medical record (EMR), the system automatically suggests a blueprint of care. Instantly, any health care professional helping you can visualize your care plan, where you are, and what the next step is.

Aurora Constellations is that software. Dr. Kim calls it a patient care design tool – and there is nothing quite like it anywhere. The name comes from the fact that when we see constellations rather than a mass of disconnected stars, we are better able to navigate. Aurora Constellations represents the next generation of EMR technology, adding decision support for treatment planning, automating test ordering, direct prescription ordering, integration of the latest research, and more.

“It’s a powerful way to accurately implement evidence-based medicine, standardized care procedures, and hospital policies inside the patient’s blueprint of care,” Dr. Kim said.

Although patent pending, Aurora Constellations software is still in the development stage, he said. A number of collaborators came together including our Hospital, students from the Computer Science Department at Lakehead University including James McCormack and Lisa Ewen, and the Northern Ontario Medical School (NOSM). Clinical trials involving NOSM students are scheduled to begin at our Hospital in the fall of 2019.

“Students tend to be more tech savvy, so I believe that they will be more able to help undertake this huge shift towards design-based patient care.”

(L-R) James McCormick, Lisa Ewen, Connor Little, and Dr. Arnold Kim

Research is vital in Northwestern Ontario, helping us find solutions to our unique health care challenges. Despite our barriers to care, Thunder Bay Regional Health Sciences Centre programs consistently rank among the best in Ontario, and we are a Leading Practice in several areas including orthopaedics, Telemedicine, and Patient and Family Centred Care (PFCC). The Thunder Bay Regional Health Sciences Foundation continues to support health research thanks to the generosity of donors throughout the region.

Mike and Dawn Wrenshall are incredible examples of how local residents can make a big difference to research. Their contribution was a direct result of the care Mike received. He was diagnosed with bladder cancer in 2018 and referred to urologist Dr. Hazem Elmansy.

“When you find out you have cancer, your world shifts – majorly,” Mike said. “I had surgery in less than a week. It was such a relief to get it out of me... You feel violated that something like that would be in your body.”

Mike and Dawn credit Dr. Elmansy for helping Mike survive his cancer. “We’re extremely lucky to have him here in Thunder Bay,” Mike said. “I don’t actually think our community recognizes just how talented and caring he is.

The story doesn’t end there. What you may not know is that research is of particular interest to Dr. Elmansy. Many clinicians choose to practice in Thunder Bay specifically because of the research opportunities available to them. It’s big enough to offer a wide range of possibilities, yet small enough that it’s easy to work with other clinicians and scientists at the Thunder Bay Regional Health Research Institute.

The couple decided to support Dr. Elmansy’s ongoing urological research, donating $10,000 to the Health Sciences Foundation. “I am proud to donate in honour of him,” Mike said. “I thought that if there was anything I could do to recognize his work and allow him to continue to offer incredible care, then I’d do it. It’s our way to show support for the work he’s doing now and the work we hope he will continue to do in the future.”

Many people in Northwestern Ontario like the Wrenshalls understand the importance of local research to find local solutions. Donations through the Foundation’s Health Discovery Fund help support scientists and clinician researchers meet those goals with funding that wouldn’t otherwise exist.

Mike and Dawn Wrenshall

“Smart health” is one of the most promising areas of health care advancement today. Smart health encompasses a wide range of technology that will help health care providers connect more easily with their patients, receive more information about their patients’ health faster, and ultimately improve patient care.

Dr. Zubair Fadlullah is the Thunder Bay Regional Health Research Institute’s newest scientist, joining in January 2019. He becomes the first Lakehead University-Health Research Institute Research Chair in Smart Health Technology. Dr. Fadlullah’s goal is to develop a smart health program that meets the needs of both institutions: a viable academic program focusing on smart health technology development at Lakehead, and clinical research initiatives at the Thunder Bay Regional Health Sciences Centre to help improve health care for patients across the region.

“Smart health is about health care access for patients, no matter where they live in Northwestern Ontario,” Dr. Fadlullah said. “Geographic barriers to care have always had a huge impact on health care here. Smart health can help us overcome these and other barriers to patient care.”

The lessons learned here could be applied to remote areas around the world that rely upon distance health programs. Dr. Fadlullah plans to focus on three specific areas: Sensors, Connectivity, and Analysis.

• Sensors includes all data collection from remote monitoring of vital signs (for example, heart rhythms in a patient with cardiovascular disease) to simple questionnaires.
• Connectivity is the ability to send that data from the patient to the health care provider – in this case, our Hospital – via existing and new infrastructure.
• Analysis will involve some level of artificial intelligence (AI) to help quickly interpret the data and provide decision support for health care providers.

“Smart health has the potential to positively affect every area of health care at our Hospital,” Dr. Fadlullah said.

The first step is to decide what smart health technologies would be most effective in Northwestern Ontario. Over the next year, Dr. Fadlullah will conduct a patient needs assessment across the region, develop project plans to meet those needs, hire students and post-docs for research at Lakehead, and start building pathways to future clinical trials. “We need to find the areas we can start working on now, and create a plan for what we will do in the long term.”

Thunder Bay is a leader in the world in terms of working directly on smart health technology as a tool to overcome geographic barriers. It is a natural progression from our leadership in distance health research and program development.

Dr. Zubair Fadlullah