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Digital Health

To enable equitable access to high-quality heart failure care, we co-create precise, predictive digital health solutions with patients and caregivers.

Dr. Heather Ross holding sensor
Medly app screen

The Centre focuses on technology that enables people to receive individualized heart failure care anywhere – no matter their distance to hospital. Continuous monitoring and proactive, remote support helps clinicians and patients take action before symptoms worsen.

Underpinning this effort is Medly – a unique remote heart failure management program. Patients enter their symptoms, receive real-time feedback on self-care, and their medications are adjusted remotely in their Medly app. The clinical team uses the Medly dashboard to monitor patients and receives alerts when specialists must follow up on urgent issues.

Areas of Impact

Reducing hospitalizations for heart failure

At UHN, our Medly program reduced rehospitalizations by 50% and all-cause admissions by 24% for people with heart failure – while improving their self-care and quality of life. This is published in a 2020 study.

In 2020, Medly became the first telemonitoring system to be designated a Class II medical device by Health Canada. That year a pandemic struck: during COVID, our teams onboarded 500 new patients to Medly, helping keep vulnerable patients out of hospital.

Unique technology that keeps people safe at home

Through Medly, we keep patients stable by flagging deteriorations and worsening symptoms early. Its sophisticated algorithm feeds an expert triage system by which one nurse can remotely monitor 350 patients at once.

For clinicians, Medly’s intuitive design enables them to seamlessly adopt the technology into their existing workflow while collecting meaningful patient data. For patients, it is easy to use and becomes a routine part of their daily life. Medly keeps patients safe at home, guarded by specialized care for which they’d otherwise need to visit clinics.

Supporting guideline-directed care

Medly is proven to safely titrate medications to achieve guideline-directed medical therapy faster than typical care. We are able to get patients to target doses of medications with fewer visits – further evidence of its potential as a cost-effective solution to keep heart failure patients safe at home. The team is devising an expert rules system to allow automatic titration of guideline directed care, which will be a world first.

Collaborations with other centres and industry partners

The Medly program first transformed the model of care at UHN, and is now being deployed in specialty cardiac centres and primary care clinics across Ontario.

Meanwhile, our digital health innovations caught the attention of Apple, which partnered with our team to test how Apple Watches and iPhones can improve remote heart failure monitoring. Exciting studies include TRUE-HF, keying in on whether biometric data from an Apple Watch can estimate someone’s cardiorespiratory fitness – vital to determining prognosis in heart failure.

New app proves invaluable during pandemic

As COVID-19 devastated the population and tested hospital capacity, we leveraged deep data science efforts to create a new app. “RCOVID” automatically pulls together patient’s health-care data, including bloodwork and COVID tests, and prepopulated fields for physicians to quickly view.

As a virtual visit is complete, physicians can create a traditional clinic note that is stored in the EMR and accessible by all doctors in that patient’s circle of care. Through this app, clinicians efficiently delivered accessible virtual care and tracked and triaged at-risk patients. Over the first two years of the COVID pandemic, nearly 100,000 patients were managed with RCOVID, leading to a steep decline in ED admissions.

Wearable and remote diagnostic sensor technology

A wearable sensor for patients with heart failure is a health monitoring device that easily fits into someone’s everyday life, helping keep them safe at home. For example, sensors can be embedded in clothing to monitor key vital signs. These sensors communicate a patient’s status in real-time to their healthcare team.

Wearables and remote diagnostic sensors can come in a variety of forms, such as:

  • “Smart textiles” (sensors built into fabric, such as socks, patches, or vests) that monitor heart rate, blood pressure, and fluid buildup
  • Mobile apps that use a probe or camera to measure blood flow below the skin
  • “Lab-on-a-chip” devices that enable lab-quality at-home testing of biomarkers and deliver diagnostics to healthcare providers
  • Technology that syncs with popular consumer devices, such as a Fitbit or Apple Watch

Our team, led by TRANSFORM HF, designs biosensors that reflect the needs of all people living in Canada and explores how to integrate them into models of care.