VITAL connects data for research and development across Canada

TORONTO – The VITAL project, devised and led by two physicians at St. Michael’s Hospital, is now backed by $210 million in government and institutional funding. Moreover, VITAL is already building new and impressive applications to fulfil its mission of improving the health of patients across Canada through deeper use of data, including artificial intelligence.

“We’re just now picking our first use cases,” said Dr. Amol Verma, one of the co-founders of VITAL, along with fellow St. Michael’s physician Dr. Fahad Razak. “One of them is to examine the appropriateness of medication prescribing in hospitals.

“We’re looking at the prescribing of four different classes of medications across 115 hospitals in Ontario and Alberta, as a starting point. We found really wide variations in the way hospitals are using things like sleep medications, opioids, antipsychotics and antibiotics, highlighting important opportunities to standardize and improve care.”

Dr. Verma explained that very good medication data is available about outpatients. However, not so much is known system-wide about medication usage for hospital inpatients.

“We don’t know which patients are being prescribed different medications, when they’re being used, or how frequently they’re being used,” he commented. “Electronic medical records coming online at scale now across the country gives us an opportunity to look, for the first time, inside the black box of hospital medication prescribing. It gives us the opportunity to improve.”

“It’s an exciting new opportunity, and that’s why it was our first use case,” Dr. Verma said.

St. Michael’s Hospital gained national attention in June when the federal Minister of AI and Digital Innovation, Evan Solomon visited the facility and officially announced Ottawa’s investment of $100 million in VITAL.

The funding was in addition to $110 million previously raised by the project, which intends to create a system of linked, patient data repositories across Canada. Massive quantities of anonymized data will be made available to researchers across the country to produce AI-driven applications.

Those apps could dramatically improve patient outcomes, and at the same time, through commercialization, could spur Canada’s economic development and competitiveness.

Solomon noted at the St. Mike’s announcement that in the last 15 years, the number of clinical trials for the drug industry have dropped by 50 percent in Canada – due to a lack of advanced infrastructure. The network being developed by VITAL aims to bring those trials back to Canada.

“Trials are happening elsewhere because there’s better data infrastructure elsewhere,” said Solomon. “Others are getting innovation first. Why should Canadians wait?”

The thinking behind the project is that Canada’s hospitals produce large amounts of data about patients, problems, visits and outcomes. If the information could be better analyzed and used to create new, computerized solutions, patient care could be dramatically enhanced, and Canada might very well become an AI-powerhouse in the healthcare sector.

Additionally, more clinical trials are expected to take place, providing Canadians with leading-edge therapies. Interestingly, even the patients receiving placebos during clinical trials are found to receive a higher level of care, as they’re more closely monitored by nurses and allied professionals.

In June, Dr. Razak and Dr. Verma explained their vision to some 250 healthcare and political luminaries, including Unity Health Toronto CEO Altaf Stationwala and fellow hospital CEOs from the Greater Toronto Area like Sunnybrook’s Dr. Andy Smith, UHN’s Dr. Kevin Smith and Trillium Health Partners’ Karli Farrow.

It’s well-known that to create effective AI applications, huge quantities of data are needed. But the data must also be high-quality and reflect the variations found in the population. By collecting data from hospitals across the country, and with such an ethnically mixed population as Canada’s, the VITAL repositories promise to become an excellent laboratory for data scientists to work with.

The project began a few years ago in Ontario and was called GEMINI. It linked 45 provincial hospitals, with data from 3 million patient visits – that alone made it the largest repository of hospital research data in the country.

Dr. Razak commented at the June meeting that GEMINI established the framework for data networking and collaboration. It showed how improvement in patient care – and cost reductions – could be made by interpreting data from a wide range of hospital partners.

“By taking the data out of silos and providing analysis back to physicians and hospital executives, we’ve reduced hospital stays by about one day on average at hospitals with the longest length of stay,” said Dr. Razak. “That’s one extra day with their families instead of waiting in the ER on a stretcher. Over a one-year period, this has saved the province more than 40,000 days, with a cost of about $50 million.”

Dr. Razak noted, “That’s just through simple use of data when you’re connected across the system. Now, AI is bringing an exciting new frontier to these kinds of opportunities.” He expects that artificial intelligence will greatly amplify the gains to be made.

“But these are new technologies, and we need to make sure they’re safe and effective, that they work well for everyone, and that they don’t propagate biases.”

For that reason, VITAL aims to develop infrastructure that rigorously tests and carefully develops new tools.

Dr. Razak has frequently spoken about the need to ensure that AI-powered solutions are not only used in urban centres with large, research hospitals. For the sake of equity, they must also benefit patients in rural and remote areas.

In June, he said, “I often tell the story of my parents … in Windsor. It’s not a small town, but very little of this kind of innovation reaches them. We need to make sure it gets to all Canadians.”

Importantly, Alberta and Quebec recently joined the VITAL network, boosting the number of partner hospitals to 160, and now, with its new moniker of VITAL and the latest federal government investment, the project is expanding across the country.

“The specific funding announcement says that five additional provinces and territories will join,” said Dr. Verma, who asserted that eventually, he hopes all Canadian jurisdictions will participate.

The latest investment of $100 million will be used for infrastructure, to set up secure repositories in the partner provinces that will collect, link and safeguard the de-identified data.

Governance is also high on the agenda, with policies to make data sets readily available to researchers so they’re not required to spend an inordinate amount of time on permissions.

Strong governance will also ensure that the provincial partners feel their data sets are secure and remain within their control; in this way, they will be eager to participate, Dr. Verma said.

Interoperability of data has always been a challenge for healthcare IT, and this project will depend on linking hospital information – in near real-time – to provincial repositories, and to enable researchers to access the data sets through a portal.

Luckily, there have been advances in connecting research data, and VITAL is using a system called OMOP, a common data model that aligns different data standards in healthcare, harmonizing them so they can be linked.

Importantly, VITAL is going to start linking to diagnostic imaging repositories, greatly expanding the size and scope of the data available to researchers. High on the priority list is connecting to OCInet, Ontario’s province-wide repositories of diagnostic images. OCInet is currently the world’s largest DI repository, with some 200 million images relating to more than 10 million patients.