Saskatchewan pioneers new telehealth technologies

SASKATOON – In late April, Prime Minister Trudeau made a quick visit to Saskatchewan during which he highlighted the $21 million designated for the Saskatchewan Indian Institute of Technologies (SIIT) Virtual Health Hub which will be deployed from Whitecap Dakota First Nation.

Whitecap Dakota First Nation Chief Darcy Bear, president and CEO of SIIT Riel Bellegarde, and Dr. Ivar Mendez (pictured), professor of Neurosurgery and director of the Virtual Care and Remote Presence Robotics Programs, along with other dignitaries were present at Wanuskewin for the media event. The development of the Virtual Health Hub has been ongoing for several years.

Research conducted by Dr. Mendez and his team in the Virtual Care and Remote Presence Robotics Program at the University of Saskatchewan showed that pregnant women living in rural and remote communities were 30 percent less likely to receive an obstetrical ultrasound than their urban counterparts. This disparity increased for Indigenous women who, research showed, were 50 percent less likely to have an obstetrical ultrasound than non-Indigenous women.

Dr. Mendez’s research included a study to determine the feasibility of using telerobotic ultrasound as a service delivery model to remotely provide ultrasound access to rural and remote communities distributed over a large geographic region.

Telerobotic ultrasound clinics were established in three northern, remote, Indigenous communities, namely Stony Rapids, La Loche, and Pelican Narrows, between March 2018 and February 2021, with the purpose of the study being to investigate the clinical practice management particulars of implementing telerobotic ultrasound in a real-world setting.

At the end of the study, participants expressed appreciation for having access to ultrasounds without having to travel away from their community and not having long waits for the scan.

Chief Bear, who sits as the chair of the Board of Governance for SIIT, shared that he is proud that the virtual care project is being led by Indigenous people, and that the Virtual Health Hub will help make healthcare more efficient and effective for everyone. He referenced the Park Ridge Care Home Centre in Saskatoon which has a virtual health pilot project and where how previously they would have sent 56 people to the emergency room, but because of the technology, they only needed to send eight.

Chief Bear and Riel Bellegarde, have been instrumental in the development of the VHH. Highly trained staff are essential to the extension of the VHH services which makes SIIT a crucial partner in the initiative.

With trained staff operating from a central location (the Hub), the robotic arm is controlled to remotely perform an ultrasound without requiring the patient to travel long distances for essential services. “We’re especially interested in providing remote care to populations that are underserved, and the most underserved populations are Indigenous populations, so we want to train Indigenous students to use these technologies of the future,” said Dr. Mendez. “This is how we change the narrative of Indigenous youth contributing to the country.”

The Saskatchewan Indian Institute of Technology prides itself as a world leader in the delivery of robotic prenatal sonography, having performed more than 500 ultrasounds using another telerobotic ultrasound solution from AdEchoTech, a medical device manufacturer in France, which featured in Mendez’s initial study into telerobotic sonography from 2018-2021.

Dr. Mendez describes AdEchoTech’s Melody device as a first-generation telerobotic ultrasound solution, as it requires the presence of an onsite support person in the remote community to position the robotic arm on the patient. The Melody device consisted of a control box and a 3-degrees-of-freedom (3-DOF) robotic arm to which an ultrasound probe which was connected to a standard ultrasound, was attached. The more advanced Cobionix robotic arm can be operated without the need for an assistant at the patient’s location.

Last October, the Saskatchewan Indian Institute of Technologies (SIIT) showcased the Seven Degrees of Freedom Ultrasound Robotic Arm purchased for this purpose. Dr. Mendez said, “Robotic platforms combined with artificial intelligence will have an important role in health care delivery in the future.”

‘Codi’ is an AI-enabled, ultrasound robotic arm developed by Cobionix. Founded in 2021 at the University of Waterloo’s Velocity incubator, Cobionix raised $2.8 million a year ago in seed funding to commercialize Codi. Codi is designed to undertake all parts of the ultrasound procedure, facilitating the delivery of diagnostic imaging to underserved communities and eliminating the need for travel to distant health centres. The acquisition of the device by the Saskatchewan Indian Institute of Technology provides Indigenous students with the training required to operate these transformational technologies.

Codi is equipped with speakers, microphones, and cameras, and it can look at a patient and talk with them in the same way someone would talk to Alexa or Siri. It is capable of delivering instructions to patients to lie on the bed and lift their shirt before it deposits gel on their abdomen and performs the procedure. It is also equipped with natural language processing capability for communication and reasoning, position estimation smarts, and object detection capabilities. Codi can also communicate with patients in several different languages.

Ultrasound is one of the most common imaging diagnostic tools for many health concerns. Mendez noted that algorithms will be developed so the robotic arm can also perform gall bladder, kidney, and other ultrasounds. The deployment of telerobotic ultrasound technology to remote, underserved communities by the University of Saskatchewan’s Virtual Health Hub and the Saskatchewan Indian Institute of Technology, Mendez stated, can serve as a model for the rest of Canada. “We are at a pivotal time in the development of technology with artificial intelligence, 5G telecommunications, and robotics enabling virtual care,” said Mendez. “These technologies will transform the way we deliver healthcare in the future. The problem is that we are not prepared for it.”

Newborn mortality in Indigenous communities is ten times higher than in the rest of Canada, Dr. Mendez said in an article published in Canadian Healthcare Technology in January, and one of the reasons for the high mortality rate is the lack of good pre-natal care and readily available pre-natal ultrasounds. “There is a high rate of pregnancies among young girls in Indigenous communities and they are often high-risk pregnancies. There is no availability of ultrasound in many of these communities, so if you are a pregnant young person, you need to be sent to a city for diagnostic imaging. You are away from your family and put up in a hotel.”

“As a national leader in Indigenous healthcare training, the partnership with the VHH is a natural extension of SIIT’s strategic goals to serve our communities many of which are rural, remote, and northern,” explains Bellegarde. “SIIT is committed to being leaders of change in the implementation of the TRC Calls to Actions related to healthcare (18-24, 55) and UNDRIP to ensure parity in healthcare outcomes for Indigenous Canadians.”

Chief Bear sees the VHH as a game changer for public healthcare. The innovations being utilized will make public, not private, healthcare “more efficient and effective for all Canadians.” Chief Bear also thanked the provincial government for their contribution of $12 million to the project and their support right from the start. “We are going to change how healthcare is delivered right across, not just Canada, but right across the globe. We are not only going to change the healthcare outcome for Indigenous communities, but for non-Indigenous communities as well, and we are doing it together.”

SOURCE: Carol Baldwin, Local Journalism Initiative Reporter, Wakaw Recorder