Good Tech, Compassionate Healthcare

Thank you for joining us for this special episode of Good Tech Compassionate Healthcare. In May of 2024, AMS Healthcare was thrilled to convene 170 healthcare stakeholders from across Ontario to delve into the timely and ethical scaling of AI in our healthcare sector. The insights we gained were invaluable. The conference revealed a consensus that there is an urgent need to deploy AI solutions in the most capacity-challenged areas of our healthcare system, particularly in primary care. This move is crucial to reducing workforce burnout and improving workflows. Many of the leaders that we spoke to at our conference were asked a series of questions about AI in healthcare, and we will be sharing their insightful responses in these special episodes. The leaders featured in Part Two are: Jennifer Gibson - Director of the University of Toronto Joint Centre for Bioethics Suresh Balu - Director for Duke Institute for Health Innovations Nicole Woods - Director of The Institute of Education Research at the University Health Network Carla Velastegui - Caregiver Advocate in the Digital Healthcare Sector Dr Amol Verma - Physician and Scientist at St. Michael's Hospital Unity Health Anna Foat - Patient Partner and Advocate Laura Desveaux - Science Lead and Learning Health System Program Lead at Trillium Health Partners amshealthcare.ca

In this conversation, Kieran Quinn, a general internist and palliative care clinician-scientist at Sinai Health in the Department of Medicine and at the Institute of Health Policy, Management, and Evaluation at the University of Toronto, and James Downer, a critical care and palliative care physician in Ottawa, discuss virtual end-of-life care during the COVID-19 pandemic. https://pcpcrc.ca/ - The Pan-Canadian Palliative Care Research Collaborative is a national network of researchers, healthcare providers, community stakeholders, and patient and caregiver partners who are passionate about palliative care research. Dr. Kieran Quinn is a General Internist and Palliative Care Clinician-Scientist at Sinai Health in the Department of Medicine and Institute of Health Policy, Management, and Evaluation at the University of Toronto and an Adjunct Scientist at the Institute for Clinical Evaluative Sciences (ICES). His research focuses on using advanced analytic methods and large administrative datasets to improve access and delivery of high-quality end-of-life care for patients with terminal noncancer illness, such as heart failure and dementia, and improving the recognition and care of people with post COVID-19 condition (long COVID). Dr. Quinn was awarded the Governor General's Gold Medal for Academic Excellence and the John Charles Polanyi Prize in Physiology and Medicine. He is co-lead of Canada's national research network on post COVID-19 condition and co-chair for the development of clinical practice guidelines for the treatment of post COVID-19 condition. He served as the Assistant Director of the Ontario COVID-19 Science Advisory Table, the Ontario Public Health Emergencies Science Advisory Committee, and as an Expert Member of the Chief Science Advisor's National Task Force on the Post COVID-19 Condition. His early research success includes over $28 million in competitive grant funding and 7 CIHR grants as the nominated principal applicant. He has mentored 12 trainees who have published and won several awards for their work together. He has 103 peer-reviewed publications, including 52 as first author or senior author in high-impact journals such as JAMA, JAMA Internal Medicine, and BMJ. Dr. James Downar is a Critical Care and Palliative Care physician in Ottawa. He graduated from McGill Medical School and completed residency training in Internal Medicine, Critical Care, and Palliative Care at the University of Toronto. He has a Master's degree in Bioethics from the Joint Centre for Bioethics at the University of Toronto. He is currently the Head of the Division of Palliative Care at the University of Ottawa and a Professor in the Department of Medicine. He is the chair of Palliative and End-of-Life Care at the University of Ottawa, the co-chair of the Pan-Canadian Palliative Care Research Collaborative, the chair of the Ethical Affairs committee of the Canadian Critical Care Society, and the co-chair of the Ontario Palliative Care Network's Provincial Education Steering Committee. He has authored more than 100 peer-reviewed publications, has been principal investigator on more than 20 peer-reviewed grants, and is a former Associated Medical Services Phoenix Fellow. Dr. Downar also led several provincial and national efforts to respond to the COVID-19 pandemic. He was involved in planning for medication shortages for both critical care and palliative care and led the development of a critical care triage system for the event of major surge in critically ill patients His research interests include communication and decision-making for seriously ill patients and their families; Palliative Care for the Critically Ill; and Palliative Care for Noncancer Illnesses. http://amshealthcare.ca/

In this conversation, Laura Sikstrom, a Medical Anthropologist and Project Scientist at The Krembil Center for Neuroinformatics at the Center for Addiction and Mental Health, and an AMS Healthcare fellow in Compassion and AI, speaks with Sean Hill, the Director of The Krembil Center for Neuroinformatics, Senior Scientist at the Center for Addiction and Mental Health, and Professor at the University of Toronto. They discuss the meaning of fairness in mental health and the concepts used to support. Dr. Laura Sikstrom is also an assistant professor (status-only) in the Department of Anthropology at the University of Toronto. Dr. Sikstrom also co-leads the Predictive Care Team at CAMH, which focuses on the intricate intersection of artificial intelligence (AI) and mental health care. By integrating computational techniques with ethnographic insights, this team investigates the potential and challenges of incorporating AI into mental health practice, with a focus on compassionate and equitable care. Dr. Sikstrom received funding from AMS Healthcare, Google, SSHRC and CIHR and is also a nominee for the prestigious Governor General's Gold Award. Dr. Sean Hill is also a computational neuroscientist with experience in building large-scale computational models of brain circuitry. The Centre collaborates with clinicians and researchers, employing neuroinformatics, artificial intelligence, and multi-scale modeling, to develop data-driven definitions of brain disorders, predict patient trajectories, and transform mental health care. Dr. Hill applies large-scale data integration, neuroinformatics, multiscale brain modeling and machine learning to improve our understanding and treatment of mental health disorders. The Centre's mandate is to accelerate global collaborations in brain science using the power of big data and brain modeling to fundamentally change how mental illness is understood. Resources: Sikstrom, Laura, Marta M. Maslej, Zoe Findlay, Gillian Strudwick, Katrina Hui, Juveria Zaheer, Sean L. Hill, and Daniel Z. Buchman. 2023. "Predictive Care: A Protocol for a Computational Ethnographic Approach to Building Fair Models of Inpatient Violence in Emergency Psychiatry." Sikstrom, Laura, Marta M. Maslej, Katrina Hui, Zoe Findlay, Daniel Z. Buchman, and Sean L. Hill. 2022. "Conceptualising Fairness: Three Pillars for Medical Algorithms and Health Equity." What is 'AI' and what is it doing in psychiatry? A webinar presented at the RBC Patient & Family Learning Space, CAMH, November 2, 2022. https://www.youtube.com/watch?v=qVUs-BnGIOU What happens to our brains when we get depressed? The Walrus, 2021, by Simon Lewsen. https://thewalrus.ca/what-happens-to-our-brains-when-we-get-depressed/

In this conversation, Ibukun Abejirinde, a scientist at the Institute for Health System Solutions at Women's College Hospital, and Assistant Professor at the Dalla Lana School of Public Health at the University of Toronto, and an AMS Healthcare Fellow in Compassion and AI chats with Terence Tang, a General Internal Medicine Physician at Trillium Health Partners, a Clinician Scientist at the Institute for Better Health and an AMS Healthcare Fellow in Compassion and AI. They discuss social determinants of health, health inequities, and digitally enabled models of care. Ibukun Abejirinde is an Implementation and Evaluation Scientist who works with policymakers, patients, community organizations, and researchers to find practical solutions to persistent and emergent problems in healthcare. Her research focus on innovative models of care that use digital technology. Specifically, how they impact health equity and health service delivery. Ultimately, her goal is to improve access to high-quality care for everyone, irrespective of where they live or where they are from. Dr. Abejirinde is currently a Scientist at the Institute for Health System Solutions, Women's College Hospital where her work informs the implementation, sustainability, and expansion of virtual care programs within and beyond Ontario. She is also an Assistant Professor (Status) at the Dalla Lana School of Public Health, University of Toronto. As a 2022 AMS Healthcare Fellow in Compassion and AI, her study is being conducted in partnership with three community partners, with the aim of understanding how immigrants and refugees to Canada experience virtual care and digital health compassion. AMS Research Team Members - Ibukun Abejirinde (Scientist/Principal Investigator) - Emily Ha (Research Associate and PhD candidate, UoT) - Marlena Dang Nguyen (Equity Specialist and Research Coordinator) - Kyla Gaeul Lee (PhD student, UoT) - Isabelle Choon-Kon-Yune (Research Assistant) - Mohaddesa Khawari (Peer Researcher) AMS Study Research Partners 1. FCJ Refugee Centre Website 2. Crossroads Clinic, Women's College Hospital Website 3. Access Alliance Multicultural Health and Community Services Website AMS Research Advisory Team Members 1. Dr. Vanessa Redditt 2. Denise Zarn 3. Dr. Onil Bhattacharyya 4. Dr. Jay Shaw Readings and Resources 1. Abejirinde IO, Ha E, Nguyen MD, Kaur D, Redditt V. Beyond technology: Digital Health Compassion for Canadian Immigrants and Refugees. January 2023. Volume 19, Number 4. Canadian Diversity (pg. 10-12). https://km4s.ca/2023/04/beyond-technology-digital-health- compassion-for-canadian-immigrants-and-refugees/ 2. Panel Discussion. Digital Health Imperative - Equity and System Transformation. Access Alliance Multicultural Health and Community Services, Canada. All Staff Professional Development Day. November 2022. Summaries- blog and video clip 3. Hankivsky, O., Grace, D., Hunting, G. et al. An intersectionality-based policy analysis framework: critical reflections on a methodology for advancing equity. Int J Equity Health 13, 119 (2014). https://doi.org/10.1186/s12939-014-0119-x 4. Hodges BD, Paech G, Bennett J. Without Compassion, There Is No Healthcare: Compassionate Care in a Technological World. Edited by Brian D. Hodges, Gail Paech, and Jocelyn Bennett. McGill-Queen's University Press; 2020. 5. Crenshaw K. Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory, and Antiracist Politics [1989]. In: 1st ed. Routledge; 1991:57-80. doi:10.4324/9780429500480-5 6. Singh P, King-Shier K, Sinclair S. The colours and contours of compassion: A systematic review of the perspectives of compassion among ethnically diverse patients and healthcare providers. Van Bogaert P, ed. PLoS ONE. 2018;13(5):e0197261. doi:10.1371/journal.pone.0197261 Want to connect? Are you attending the Metropolis Social Determinants of Health Conference in Gatineau Québec (October 2-3 2023)? Join our roundtable dialogue 11:00am - 12:15pm on October 2 nd titled "Reimagining Compassionate Healthcare for Immigrants: Lessons learned from Virtual Care" Contact: Ibukun.abejirinde@wchospital.ca Terence Tang is a General Internal Medicine physician at Trillium Health Partners located in Mississauga, Ontario, and a Clinician Scientist at the Institute for Better Health. He has training in informatics and has a passion of using digital technology to improve care delivery and population health. Links: Institute for Better Health (https://www.instituteforbetterhealth.com/) A tool to capture social determinants of health by Upstream Lab (https://upstreamlab.org/project/spark/)

Biographies Gillian Strudwick Bio Venkat Bhat If you wish to participate in the study: https://www.honeybeetrials.com/researcher/018850/a-paid-digital-health-study-for- nurses Program: Interventional Neuropsychiatry Program Study Funder Department of Defense, Canada (IDeAS Program): https://www.canada.ca/en/department-national-defence/programs/defence-ideas/element/competitive-projects/challenges/moral-trauma-frontline-see-prevent-treat.html UHT-St. Michael's link to the Phase 1 of the current project (Phase 2): https://unityhealth.to/2021/08/vr-moral-distress-pandemic/ Useful Resources: https://covid19-sciencetable.ca/sciencebrief/burnout-in-hospital-based-healthcare- workers-during-covid-19/ https://pubmed.ncbi.nlm.nih.gov/35614505/ https://theconversation.com/high-rates-of-covid-19-burnout-could-lead-to-shortage-of- health-care-workers-166476 https://www.researchprotocols.org/2022/2/e32240/ Pertinent Publication Links: https://pubmed.ncbi.nlm.nih.gov/34871178/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9731177/ https://ieeexplore.ieee.org/stamp/stamp.jsp?arnumber=10095849 https://pubmed.ncbi.nlm.nih.gov/36310921/

Jen Recknagel Director, Innovation and Design, NORC Innovation Centre Jen combines a background in human-centered design to address challenges at the intersection of health and its social determinants. Experienced with executing a variety of service design projects, she is currently the Senior Design Lead at UHN OpenLab, and Director of Innovation and Design at the NORC Innovation Centre. Her work is focused on engaging a diverse set of stakeholders, and using participatory-led approaches to developing solutions to complex organizational and health system challenges, a national award-winning magazine focused on urban health in Toronto. Isabel Mannion RN, BN, M Sc,(A) , CHE Member of the Seniors Advisory Committee and The NORC Innovation Centre Advisory Committee Isabel Mannion has baccalaureate and master's degrees in nursing with a particular interest and experience in gerontology, the study of aging. A retired senior, she enjoyed a long career working in, consulting, accrediting, speaking, and writing about the care of elders and others in long term, chronic and acute care, UHN's NORC Innovation Centre, and serves on two of its committees. NIC Vision The NORC Innovation Centre at UHN (NIC) is a first-of-its-kind centre advancing new models of social connection and accessible care for older adults living in the community. Our mission is to support a new model of integrated health and social care in naturally-occurring retirement communities (NORC), and to develop health, social, and technology solutions that support healthy aging. Resources NORC Innovation Centre at UHN Stay Updated: Twitter | LinkedIn | Sign Up For Our Emails Policy Paper created in conjunction with the National Institute for Aging "It's Time to Unleash the Power of Naturally Occurring Retirement Communities in Canada" https://norcinnovationcentre.ca/wp-content/uploads/NORC-Report-FINAL.pdf Toronto Star article Women's College Hospital Women's College Hospital and NIC have secured a 3 million research grant funding to study NORCs in Toronto. The objective of the research is to identify new solutions by successfully implementing community-driven NORCs enhanced with on-site access to health services and social supports (referred to as 'enhanced NORCs') that leverage and build on existing community resources. Women's Age lab website Definition: 'Elder orphans,' without kids or spouses, face old age alone. An overlooked segment of the population.

In this episode, Sarah Munce, Scientist at the KITE Research Institute at the University Health Network, and Assistant Professor in the department of Occupational Science and Occupational Therapy at the University of Toronto, and Jennifer Stinson, Nurse and Clinician Scientist in the Child Health Evaluative Science Programs within the Research Institute at the Hospital for Sick Children, discuss virtual peer navigation as an avenue for the delivery of compassionate care for youth, and a smartphone based app that has been developed to help young people cope with pain. Pediatric Patient Engagement Online Training Material https://porcch.ca/

In this episode we have two brilliant scientists, both AMS Fellows in AI and Compassion, discussing how important compassion is in the co-design of digital care allowing for buy- in, ownership and engagement for patient, provider and community alike. Carolyn Steele-Gray, PhD Scientist, Toronto's Bridgepoint Laboratory for Research and Innovation, Sinai Health Assistant Professor, Institute for Health Management Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto Tier Two Canada Research C hair in Implementing Health Innovation 2020 AMS Healthcare Fellow in Compassion and Technology Mike Lovas, BEng, MASc, BDes Director of Design and Innovation at Cancer Digital Intelligence, Princess Margaret Cancer Centre at UHN. 2021 AMS Healthcare Fellow in Compassion and Technology

In this conversation Nicole Letourneau RN, BN, MN, PhD, Monica Oxford PhD, and Linda Duffet-Leger PhD, MN, BN discuss their study on mothers with depression and how they are developing a technology to improve the serve and return relationship between caregivers and their children. If you would like more information on Nicole, Monica, and Linda and the important work they are doing here are some links to get you started: Nicole Letourneau RN, BN, MN, PhD: Professor and Research Chair in Parent and Child Mental Health at the University of Calgary Monica Oxford PhD: Professor at the University of Washington school of Nursing and Executive Director for the Barnard center for Infant and Early Childhood Mental Health Linda Duffet-Leger: PhD, MN, BN: Associate Professor in the Faculty of Nursing at the University of Calgary Team members: - Shane Sinclair: Associate Professor in the Faculty of Nursing and Adjunct Professor in the Department of Oncology, Cumming School of Medicine at the University of Calgary. Founder and Director of the Compassion Research Lab. - Cindy Lee Dennis: Professor at the Lawrence S. Bloomberg Faculty of Nursing and the Faculty of Medicine, Department of Psychiatry at the University of Toronto. - Penny Tryphonopoulos: Assistant Professor at the Arthur Labatt Family School of Nursing, Western University - Mohammad Moshirpour: Meng Software Program Director Schulich School of Engineering, Senior Instructor Department of Electrical and Software Engineering at the University of Calgary. Parent child interaction teaching scale (PCI): used to be known as the nursing child assessment teaching scale Serve and Return: parental sensitivity and responsiveness to infants and young children in relationships EQIP: enabling quality interaction with parents Links to resources on infant and child mental health: https://www.sickkids.ca/en/learning/our-programs/infant-and-early-mental-health-promotion/ https://www.zerotothree.org/ https://www.youtube.com/watch?v=TzMxrMJBZdQ https://developingchild.harvard.edu/science/key-concepts/serve-and-return/ https://developingchild.harvard.edu/resources/serve-return-interaction-shapes-brain-circuitry/ https://barnardcenter.nursing.uw.edu/ https://www.pcrprograms.org/

In this conversation Dorothy Kessler PhD, Assistant Professor at Queen's University, Affiliate Scientist at the Bruyère Research Institute, and a 2020 AMS Compassion and AI Fellow and Babak Taati PhD, PEng, Scientist at the KITE Research institute UHN, Assistant Professor at UofT in the Department of Computer Science and the institute of Biomedical Engineering, and 2020 AMS Compassion and AI Fellow discuss the work they are doing in technology to improve the quality of life for aging populations in long term care facilities and at home. If you would like more information on Dorothy and Babak and the important work they are doing here are some links to get you started. Dorothy Kessler, PhD, Assistant Professor in the School of Rehabilitation Therapy at Queen's University and an Affiliate Scientist at the Bruyère Research Institute Ottawa https://www.ams-inc.on.ca/project/developing-tools-to-assist-people-with-cognitive-decline-benefit-from-home-monitoring-technologies/ https://healthsci.queensu.ca/stories/feature/queens-research-improving-digital-home-care-dementia-patients Collaborators: Dr. Frank Knoefel, Bruyère Research Institute https://agewell-nce.ca/frank-knoefel Dr. Neil Thomas, Bruyère Research Institute https://carleton.ca/sam3/people/dr-neil-thomas/ Dr. Marica Finlayson, Queen's University https://rehab.queensu.ca/marcia-finlayson Dr. Jeff Kaye, Oregon Health and Science University https://www.ohsu.edu/oregon-center-for-aging-and-technology/our-team Babak Taati, PhD, PEng Scientist at the KITE Research Institute, UHN Assistant professor at UofT in the Department of Computer Science and the institute of Biomedical Engineering. https://www.ams-inc.on.ca/project/using-artificial-intelligence-to-reduce-falls-in-ltc/ Collaborators: Dr. Andrea Laboni Geriatric psychiatrist and clinical researcher based at the Toronto Rehabilitation Institute, UHN, Medical lead of the specialized dementia unit https://www.uhnresearch.ca/researcher/andrea-iaboni Dr. Thomas Hadjistavropoulos: Professor; Research Chair in Aging and Health, University of Regina and Registered Doctoral Psychologist https://www2.uregina.ca/hpl Dr. Yana Yunusova Professor, Department of Speech-language Pathology, Faculty of Medicine, University of Toronto Senior Scientist, KITE Research Institute – UHN https://slp.utoronto.ca/faculty/yana-yunusova/

In this conversation Gerrilynn Manitowabi, Associate Director at Wikwemikong Health Centre on Manitoulin Island in Northern Ontario and Nancy Young, Senior Scientist at the Children's Hospital of Eastern Ontario Research Institute in Ottawa discuss The ACHWM Research Project- A culturally relevant tech-enabled tool that measures and supports the health and wellness of the children in First Nations, Inuit, and Métis communities in Canada. If you would like more information on key people and items mentioned in this conversation here are some links to get you started. Stephen Richie, Linkedin: Stephen-ritchie-08aa113 Mary Jo Wabano, @MJWabano ACHWM- https://achwm.ca/ CHEO- https://www.cheo.on.ca/en/index.aspx. Wikwemikong Health Centre- https://www.wikyhealth.ca/ Medicine Wheels- https://www.edcan.ca/articles/teaching-by-the-medicine-wheel/

This conversation focuses on exploring technologies and their impact on compassionate healthcare and features Laura Desveaux @lauradesveaux, a behavioural scientist at Trillium Health Partners and physician and scientist Amol Verma @AmolAVerma from St Michael's Hospital. If you would like to learn more about the resources, people and articles mentioned in this podcast here are a few links to get you started. Both Laura Desveaux and Amol Verma are 2020 AMS Healthcare Fellows. If you would like to learn more about their Fellowship work, you can read about their projects here: Understanding the emerging intersection between digitally-enabled and compassionate care. Evaluating AI prediction tools in enhancing compassionate care in hospital You can find information on The GEMINI study here: https://www.geminimedicine.ca/about

In this conversation, Nursing Professor Claire Mallette, Medical Educator Tina Martimianakis @martimianakis, psychiatric resident Erene Stergiopoulos @fullerenes and nursing student Ola Thomas Obewu @olatommi reflect on the challenges of teaching, and learning, compassion in this digital age. If you would like to learn more about the resources, people and articles mentioned in this podcast here are a few links to get you started. Jean Watson Caring Theory The Royal Alexandra Foundation Video, The difference Between Care and Caring