2017-2018 Annual Report

The Thunder Bay Regional Health Research Institute is taking advantage of a new Council of Academic Hospitals of Ontario (CAHO) initiative to streamline access to new digital health and other innovative health technologies for testing, ultimately benefiting patients faster. CAHO, which is the Ministry of Health and Long-Term Care’s Innovation Broker, created a system with one point of access for digital health vendors, making it easier for them to connect with the 23 member hospitals.

However, a new challenge arose: how to decide which of the 33 proposals from 29 vendors (and growing) to pursue. For example, our Hospital must weigh the needs of the patient population in Northwestern Ontario as well as other considerations such as alignment with the Hospital’s and Health Research Institute’s strategic plans, and current infrastructure to support the research and potential care programs.

Dr. Abraham (Rami) Rudnick, Chief Scientist at the Health Research Institute and Executive Vice President of Research and Development for the Thunder Bay Regional Health Sciences Centre, developed a specialized algorithm to help make that decision – and it’s an algorithm that CAHO’s Innovation Broker has adapted for other hospitals to use.

“Everyone has a decision-making process for long-term projects such as purchasing a PET scanner, but many hospitals struggled to screen so many applications within, say, four weeks,” said Amarjit Chahal, Manager of Business Development at the Health Research Institute. “CAHO adapted our decision algorithm to make it generic so that all member hospitals could use it.”

Currently, the Health Research Institute and Hospital are in the early stages of partnering with a vendor and a few other hospitals in the province to research a new method for following up with patients after discharge using a digital health technology. (Specific details of the project were not available at the time of this writing as the project was still at the application stage.)

Digital health covers a wide range of options including devices, web-based solutions, and smart phone apps. It is a rapidly emerging field that will revolutionize the way health care is provided – particularly for distance health.

“These innovative digital health technologies have great potential to help residents across Northwestern Ontario overcome various barriers to care including geographical, cultural, and language barriers,” Chahal said. “Above all, these technologies will bring health care closer to home.”

As examples, Chahal mentioned medication reminders that link back to the patient’s physician to help with compliance, in-home sensors that could detect a fall in elderly patients, and a smart phone app that provides access to information vetted by their doctors and other trusted sources customized to their health needs.

“It’s only been a year so far. More proposals are coming in, and now we have a process in place to prioritize and evaluate various digital health solutions, evaluate funding options, and make a decision as to which opportunities to follow.”

Funding is another key consideration. The Health Research Institute and its partners in the above-mentioned project have applied for a Health Technology Fund grant through the Ontario Centres of Excellence.

Dr. Amarjit Chahal, Manager of Business Development at the Health Research Institute, said that innovative digital health technologies have great potential to help residents across Northwestern Ontario overcome various barriers to care.

The Cyclotron Program at the Thunder Bay Regional Health Research Institute took another step towards sustainability in May 2018, forming an alliance with an industry partner to market radioisotopes on the global stage. Not only will this help create new revenue sources, it will provide invaluable insights into which isotopes are needed most on the world markets.

“We hope to produce FDG for the Hospital in the near future, so it raises the question of what else we can do to make the cyclotron self-sustainable,” said Dr. Jesse Walker, Director of Cyclotron Operations. “The cyclotron that we have comes with more capabilities than some models, so we are able to look at producing a variety of isotopes in addition to F-18.”

Examples of such isotopes are radioactive metal isotopes such as Technetium-99m, Zirconium-89, and Indium-111. This class of radioisotope has a variety of uses including diagnostic imaging and therapeutics. Many radiometals have long half-lives which means they have the potential to be transported globally from Thunder Bay.

Although the details about what will be produced and sold are still being determined, the agreement provides several potential options.

“We see this as an opportunity to partner with other experts in the field,” Walker said. “The radioisotope market is more complex than one might think, so developing our own client base would be difficult. This partnership allows us to focus on the production and processing of isotopes.”

“It gives us a clear path forward, knowing what isotopes their customers are looking for so that we can plan isotope development,” Walker said.

That’s important because every isotope may require a different development procedure. Often, the source metal has to be electroplated onto metal plates and irradiated. However, it’s not a “one size fits all” process – preparation, irradiation and processing varies from metal to metal.

“The identity of the metals will dictate the chemistry. It will be similar in some instances, but it will take research to develop a process that works for each particular radiometal.”

Dr. Jesse Walker, Director of Cyclotron Operations at the Thunder Bay Regional Health Research Institute

The Thunder Bay Regional Health Research Institute started the hiring process in 2018 for three new scientists in radiochemistry, biophysics, and smart health technology. The positions, which involve joint appointments at Lakehead University, will continue to build on the Research Institute’s strengths and prepare for a new era of health care, particularly in relation to remote health technology and Indigenous health.

Dr. Abraham (Rami) Rudnick, Chief Scientist at the Health Research Institute and Executive Vice President of Research and Development for the Thunder Bay Regional Health Sciences Centre, said that although they have general goals for the positions based on the Health Research Institute’s and Hospital’s strategic plans, research project details will depend very much on the successful candidates.

“It’s difficult to predetermine what specific areas of study they will follow since each scientist, even within our plans’ scope, may bring particular skills, backgrounds, and interests. But we do have clear goals in mind that we want to accomplish,” Rami said.

In radiochemistry, the goal will be to continue to develop and research new isotopes – and new applications – for the growing cyclotron program.

“Part of that is science and part of that business development. There are lots of opportunities for radioisotope research both for health and other applications,” Rami said.

For the biophysics position, Rami said that they are looking for a scientist who will be able to add to the current strength in imaging research. The ideal candidate will have a strong background in computational skills.

“That’s a highly valued set of skills lately in biophysics – fully understanding the software aspects of working in biophysics.”

The smart health technology position represents an exciting new domain of study for the Health Research Institute. Smart health represents various areas of rapidly expanding interest such as smart phone apps, online solutions, and Artificial Intelligence (AI) – decision support software for clinicians that can quickly analyze many pieces of information.

For Northwestern Ontario, the most immediate advantages will be in the area of distance health and particularly Indigenous health, overcoming barriers to care including geographical and cultural barriers.

“We already have vendors coming our way with software solutions for clinical validation in various health care areas. The smart health scientist will also work with Lakehead’s new digital health lab developing new solutions and hopefully testing them out at our Hospital and across the region,” Rami said.

All three new scientists are expected to start their work at the Research Institute and Lakehead University by late 2018.

Dr. Abraham (Rami) Rudnick, Chief Scientist, Thunder Bay Regional Health Research Institute.

A new reciprocity agreement between the Thunder Bay Regional Health Sciences Centre and Lakehead University has sped up the approval process for research projects. The agreement, signed on April 1st, 2017, reduces the duplication of work for the Research Ethics Boards (REBs) at both institutions. The collaboration illustrates the growing bond between the two institutions, especially pertaining to research.

“We’ve been looking at setting up a reciprocity agreement for a while now,” said Katherine Bell, Manager of Quality and Research Ethics at the Hospital. Bell underlined that all research projects will still undergo rigorous evaluations. However, the agreement reduces unnecessary overlap during that review. “Previously researchers had to go through both boards, which of course lengthens the process. It was a barrier to research.” For example, if a project was approved by one REB but the second REB requested changes, the whole application would have to be resubmitted to the first REB for approval again once the changes were made.

Under the agreement, the two institutions set up a system to decide which board should review each research application based on several criteria. Broadly speaking, the Hospital’s REB will review any research project that involves the review of medical records, Health Canada approval, or is a clinical trial. Lakehead’s REB would review projects that may involve patients but not their medical records. The comprehensive agreement has to account for many different situations including the involvement of students from the Northern Ontario School of Medicine (NOSM), research that involves other institutions, and other considerations.

Bell said that although REBs have merged elsewhere in Ontario, this two-board approach is what was felt to be most appropriate for the Hospital and Lakehead.

Currently, there are two portals for researchers to submit their projects – an electronic one at Lakehead, and a paper-based portal at the Hospital. Research proposals go on to their respective research ethics offices where they are sorted based on agreed upon criteria. Bell said that there may be opportunities in the future to more closely integrate the portals and perhaps include other institutions in the agreement.

So far though, the collaboration is going extremely well.

“The researchers are happy, and we are doing a lot of good work with Lakehead to standardize processes,” Bell said.

Both REBs follow Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS 2) standards while reviewing research project applications.

Dr. Abraham (Rami) Rudnick of the Health Research Institute and Dr. Andrew Dean of Lakehead formally sign the reciprocity agreement on April 17th, 2017, that will help streamline the ethics review process for research projects at both institutions.

What constitutes informed consent when it comes to research ethics? That was the topic of the first workshop hosted jointly by the research ethics offices of the Thunder Bay Regional Health Sciences Centre and Lakehead University. The event, which took place in October 2017, was a successful first step towards shared research ethics training within both institutions.

One of the goals of the reciprocity agreement signed in April 2017 between the two institutions is to foster shared training opportunities in research ethics with consistent messaging. Laurel Knowles, Research Ethics Officer at the Hospital and Sue Wright, Research Ethics and Administration Officer at Lakehead co-facilitated a workshop on participant informed consent shortly as a way to kick off the new partnership and provide timely information about the changes.

“The goal of this workshop was to provide consistent information to researchers from both of the organizations about the core principles of consent,” Knowles said.

The two-and-a-half-hour workshop included information about consent forms as well as an overview of how the new reciprocity agreement will affect researchers. There were about 30 attendees from both institutions including researchers, clinicians, students, and Research Ethics Board members.

“We really found that it was a great opportunity for researchers to become part of the process,” Knowles said.

It also showed an opportunity to delve into other topics, supporting researchers as they navigate questions of ethics.

“There are some opportunities with the Brown Bag sessions that the Health Research Institute hosts to bring forward some conversations around research ethics and hot topics in the research world,” said Katherine Bell, Manager of Quality and Research Ethics at the Hospital. “We would like to create learning sessions for people who are interested in research or who are currently assisting with studies.” There are clear benefits to training staff members of an academic health sciences centre who may come into contact with patients enrolled in research projects.

“We want all staff at the Hospital who may be involved in research to have an understanding of the ethical principles of research,” Knowles said. That may include physicians, nurses, therapists, lab technicians, administrative staff, and others. Providing them with ethics guidelines strengthens the overall clinical research system within the Hospital.

There may also be future opportunities to incorporate research ethics into the orientation program for staff.

“We would like to provide some information about research ethics for everyone when they start here so that staff can have an understanding of the core principles,” Knowles said.

The latest collaboration between Lakehead and the Hospital took place on May 29, 2018 with a presentation to the university’s Kinesiology faculty about the scope of review of both REB, and the Hospital’s research application process. More learning sessions are planned based on feedback the office has received from researchers and REB members.

Katherine Bell (left) and Laurel Knowles hold the Tri-Council Policy Statement (TCPS 2) which guides all ethics reviews at the Hospital and Lakehead University. The first joint workshop on consent, held in October 2017, was a successful step towards shared ethics learning sessions at both institutions.