Disseminating research outputs on actions to modernize gender, sex, and sexual orientation documentation in Canadian electronic health records

Co-lead: 

  • Jody Jollimore
    Community-Based Research Centre for Gay Men's Health

Team members:

  • Roz Queen
    UVIC
  • Marcy Antonio
    UVIC
  • Kelly Davison
    Canada Health Infoway
  • Karen Courtney
    UVIC
  • Aaron Devor
    UVIC

In this REACH project, we will share our prior research and engage stakeholders to discuss A) how our prior research output can address the needs of sexual and gender minorities (SGM) through improved gender, sex and sexual orientation (GSSO) documentation in electronic health records (EHRs), and B) how the prior output and action plan may be transformed into setting-specific knowledge tools.  

Our research team worked with Canadian stakeholders to improve the definition, collection and use of GSSO data in EHRs and generated the following outputs:

  1. An environment scan of how GSSO data are defined in EHRs
  2. Literature reviews of GSSO documentation — current approaches, gaps, needs and improvement efforts
  3. GSSO terms people commonly use to identify themselves
  4. An action plan with a set of broad, equity-oriented clinician-focused interventions to improve GSSO documentation in EHRs

In partnership with the Community-Based Research Centre, we will translate these findings into appropriate media and forms for dissemination to our diverse stakeholder groups. The expected outcomes of this project are enhanced dissemination to stakeholders and SGM-tailored knowledge translation tools in different healthcare contexts in BC.

Building bespoke artificial cells and tissues on a chip for drug discovery

Human cells are fascinating and complex: they reproduce, break down food to create energy and communicate with each other. The ‘skin’ of the cell, the cell membrane, plays a crucial role in choreographing interactions between a cell and the outside environment, for example by allowing or prohibiting the access of drugs from the cell exterior to the cell interior.

I design and build lab-on-a-chip devices, which are plastic chips the size of a postage stamp inside of which I can manipulate tiny amounts of liquids. I use these lab-on-a-chip devices to create artificial cells to be able to study how the cell membrane regulates access to the cell interior. Human cell membranes have lots of different components that are used to transport drugs into and out of the cell.

Since the cell membrane is complex, we do not always know exactly which component is interacting with the drug molecule, and what effect it has. The cost of developing a new drug is around 2.6 billion USD and a significant proportion of drug candidates fail because we cannot predict how they interact with cells.

My research will help design drugs that can interact with cells more efficiently, so that they can get inside the cell in order to work properly.

Managing the Risks of Future BC COVID-19 Outbreaks Using Mathematical and Statistical Modelling.

Cases of COVID-19 have gone undetected, likely causing future waves. The aim of our research is to develop mathematical and statistical tools for the early detection of future BC COVID-19 waves, and to evaluate control strategies for a future wave. A key component is the estimation of unreported cases and the probability of transmission in high-risk subgroups (such as the elderly and homeless). Our mathematical model will determine disease spread and testing policies interactions. We will then identify early detection strategies for future waves. To track the patterns of individual behaviours and evaluate intervention strategies, we will develop a computer simulation model. With other provinces facing the same problems, our tools can be applied to the national pandemic.


End of Award Update: June 2022

Most exciting outputs

The most exciting development from this project is a model to estimate hidden (e.g. asymptomatic or untested and unconfirmed) COVID-19 cases based on public case, recovery, death count data. We applied this model to the Northern Health Region for the first 30 weeks of the pandemic and found that:

  1. Actual cases were 2.5 to 6.25 times higher than the number of detected cases.
  2. Detection rate depends on the number of tests (confirming the intuition that more testing helps find the positive cases).
  3. Community spread rate changes with every BC recovery plan phase (increased control measures reduces community spread, increased travel/reducing restrictions increases spread).

A second development is our theoretical investigation into the effect of contact tracing through a novel mathematical model. The reproduction number (the average number of new infections coming from a single COVID-19 positive case) decreases as contact tracing efforts increase. This is because cases that are found through contact tracing will often isolate. However, when there is a large transmission rate, contact tracing alone may not control the infection. Thus, additional public health measures to decrease transmission are required for contact tracing to be effective. Further, increased testing rate increases the effectiveness of contact tracing.

The Island Health team has made great strides studying outcomes of control measures through agent-based mathematical models to simulate real world scenarios. The team has also been working on profiling contact events between COVID-19 cases and other patients or healthcare workers while accessing or providing service. This provided another method of contact tracing within Island Health service locations.

Impact so far

Our methods and tools are in place for the next pandemic (including open source R code available online). Dr. Cowen was interviewed by the CBC in November 2021, making the public aware of the issue of hidden case counts in the Northern Health Authority region of B.C. This interview came just as case counts began to increase in the region with the Delta wave.

Potential influence

The work done to estimate hidden populations can be done with new variants, different regions, and across the country. The tools that have been developed for Island Health specifically in relation to pandemic response, can and have been adapted to provide actionable insights into other public health crises (i.e. opioid) and pressing operational challenges (e.g. pressure on emergency departments).

Next steps

Our research is part of an ongoing program to improve population models, and we are continuing to apply our methods to a broad range of problems. We have continued our research on developing statistical models for count data and have drafted a manuscript for a Canada-wide model of COVID-19. Similarly, we are just finishing up drafting an article on the mathematical models that consider contact tracing. These include:

  • Parker, MRP, J Cao, LLE Cowen, LT Elliot, J Ma. Multi-site disease analytics with applications to estimating the extent of COVID-19 in Canada.
  • Bednarski, S, LLE Cowen, J Ma, T Philippsen, P van den Driessche, M Wang. A Network SIR Contact Tracing Model for Randomly Mixed Populations.

PhD student Matthew Parker has plans to present the Canada-wide modelling work at several conferences this summer and Dr. Cowen has been invited to present the work at the International Chinese Statistical Association Canadian Chapter in Banff.

MSc student Viet Dao is developing a statistical model based on Island Health lab testing data to provide another method of estimating hidden cases. Dr. Cowen is in the process of hiring a post-doc funded by NSERC EIDM and a UVic Aspirations 2030 Fellowship to continue this work, deploying it to all of BC. Dr. Cowen has hired a second post-doc funded by the Canadian Statistical Sciences Institute to develop models using Island Health’s data to estimate the homeless population and study the number of COVID-19 cases within this population.

Useful links

3D bioprinting personalized neural tissues for drug screening

Bioprinting can produce living human tissues on demand, opening up huge possibilities for medical breakthroughs in both drug screening and developing replacement tissues. The Willerth lab was the first group in the world to use the cutting edge RX1 bioprinter from Aspect Biosystems to bioprint neural tissues similar to those found in the brain using stem cells derived from healthy patients. Similar tissues can be printed using stem cells derived from patients suffering from Parkinson’s disease, recapitulating the disease phenotype in a dish. These highly customized, physiologically-relevant 3D human tissue models can screen potential drug candidates as an alternative to expensive pre-clinical animal models.

This project will bioprint both healthy and diseased neural tissues using our novel bioink in combination with Aspect Biosystems’ novel trademarked Lab-on-a-Printer system and evaluate their function. We will then validate these tissue models as tools for drug screening by exposing them to compounds with known toxicity to brain tissues.

Dr. Willerth has over 16 years of experience in the area of biomaterials and tissue engineering, making her the ideal choice to lead this project. This project will lead to better health outcomes for patients suffering from neurological diseases and disorders, which account for 6.7% of the healthcare burden in Canada and improve the quality of life for B.C. residents suffering from such diseases.

Alongside this Innovation to Commercialization award, Dr. Willerth has also received Mitacs Accelerate funding for this project, expedited through a partnership between Health Research BC and Mitacs. 

A smart multifunctional wound dressing for continuous monitoring and treatment of chronic injuries

Wound management is a major global challenge and poses a significant financial burden to the healthcare system due to the rapid growth of chronic diseases such as diabetes, obesity, and aging population. The ability to detect pathogenic infections and release drug at the wound site is of the utmost importance to expedient patient care. We recently developed an advanced multifunctional dressing (GelDerm) capable of colorimetric measurement of bacterial infection and release of antibiotic agents at the wound site. We demonstrated the ability of GelDerm to detect bacterial infections using in vitro, ex vivo, and small animal tests with accuracies comparable to the commercially available systems.

Wireless interfaces to digital image capture hardware such as smartphones were used as a means for quantitation and enable the patient to record the wound condition at home and relay the information to the healthcare personnel for following treatment strategies. Additionally, we showed the ability of GelDerm to eradicate bacteria by the sustained release of antibiotics.

In this I2C application, we propose to support the commercialization of GelDerm through

  1. developing a multi-nozzle automated dispensing system as a scale-up manufacturing methodology for producing high volumes of GelDerm,
  2. developing a sterile packaging strategy for long-term storage of GelDerm and
  3. performing preclinical safety and performance studies in porcine model.
     

New strategies for unclogging microcirculatory obstructions in the healthy and diabetic brain

Recent work from our laboratory has shown that the brain capillaries routinely get 'stuck,' clogged by cells and debris even under healthy conditions. Most of these clogged capillaries clear within seconds to minutes, however, some can remain stuck for much longer. We also reported that about one third of these clogged capillaries were eliminated from the blood vessel network and never get replaced. Importantly, there are certain conditions which can increase the risk of clogged blood vessels in the brain such as diabetes. However, we still do not have a good mechanistic understanding of how these capillary obstructions can be cleared, or even what impact they have on brain function.

In this study, we will characterize capillary obstruction and pruning rates in healthy and diabetic mice brain. Next, we will focus on devising new strategies to enhance the clearance of capillary obstructions. At various time points, the mouse brain will be imaged to assess obstruction clearance and capillary elimination rates. These aims will provide new insights into microcirculatory changes that occur in healthy and diabetic brains, as well as a mechanistic understanding of how capillary obstructions can be cleared.

Developing long-, short-, and near-term dynamic models of risk and resilience for intentional self-harm in BC youth

My research aims to answer two questions: when and under what circumstances do some young people intentionally physically harm themselves, and how can we improve our clinical tools to reduce these behaviours? Intentional self-harm is alarmingly prevalent in young British Columbians: around 5-7% of BC youth have attempted to end their own lives, 10-15% have experienced serious suicidal thoughts, and 15-18% have engaged in non-suicidal self-injury. These behaviours can have devastating impacts on youth, their families, and their communities. Providing care for suicidal youth is among the most stressful tasks that mental health professionals face, due in part to the difficulty of accurately predicting risk.

To address this important health problem, we need to improve knowledge of:

  1. signs of imminent, near-term risk of intentional self-harm, and
  2. dynamic processes of accumulating risk or resilience in vulnerable youth. My research uses linked provincial health records, prospective cohort studies, and smartphone and wearable technologies to study how risk and resilience for intentional self-harm evolve over hours, days, weeks, months, and years. The research will be used to create and improve decision-making and self-monitoring tools that youth, caregivers, and clinicians can use to reduce and prevent self-harm.

Embedding Health Care Technologies in Real-World Contexts: Developing the Scale-up, Spread and Sustainability of Assistive Technologies in Homes, Communities and Health Systems

Co-leads:

Executive sponsor:

  • Heather Davidson
    BC Ministry of Health

Too often, promising technological innovations are not adopted, are abandoned or face other serious challenges to their uptake, spread and sustainability in real-world contexts (including in people’s homes, community settings, or health systems more broadly). This project aims to apply a new framework for theorizing and evaluating this phenomenon to several innovative assistive technologies (ATs) currently being developed in British Columbia for older adults.

By using a community-based participatory research methodology, the team will bring researchers, key health system decision-makers, technology developers, caregivers and older adults together into an inquiry team, focused on overcoming challenges to embedding ATs in end-users’ real-world contexts and identifying positive factors that support their uptake, spread and sustainability.

This project will directly address two BC health system priorities. Focusing on patients with complex medical conditions as well as the commitment to keeping seniors in their homes as long as safely possible (aging in place), the ATs are focused on improving the health and quality of life of older adults living with complex care needs and multiple chronic health conditions, as well as the onset of frailty.

The research will also contribute to enhancing access to effective primary health care. ATs are a crucial medium for enhancing access to primary health care, as many of the innovations are aimed at making communication and interventions between older adults and their primary health-care practitioners, including physicians, nurses and home support workers more effective.

The project’s objectives are to:

  • Contribute to the body of knowledge concerning effective implementation science approaches to the uptake, spread and sustainability of assistive technologies in home and community care settings.
  • Provide the provincial health system with a more effective framework for innovative technology assessment and evaluation and to give BC Ministry of Health and provincial health authority staff training opportunities in using the framework.
  • Directly improve the uptake, spread and sustainability of promising ATs in British Columbia.
  • Develop and sustain effective partnerships between the research community, the BC Ministry of Health, CanAssist and other relevant organizations.

HIV pre-exposure prophylaxis implementation to key priority populations across British Columbia: Towards HIV elimination

Co-leads:

Executive sponsor:

  • Mark Gilbert
    BCCDC

What are the barriers and facilitators to optimizing HIV Pre-Exposure Prophylaxis (PrEP) implementation in different geographies and priority populations across BC?

HIV PrEP is now universally covered in BC for those deemed at high risk for HIV; however, there is still sub-optimal uptake and adherence of PrEP for a wide range of reasons, including a lack of understanding of PrEP effectiveness, low perception of HIV risk, lack of awareness, and social stigma.

This project will synthesize available surveillance, administrative, and survey data to provide quarterly reports for different regions to provide crucial information on uptake of PrEP at initiation of program/intervention, changes over time, and trend analyses. For example, data from the BC Centre for Excellence in HIV/AIDS (BCCfE) DTPPrEP database on PrEP program users could be linked to inform PrEP referral and uptake based on risk indicators.

This research could also link to qualitative interviews and focus groups with providers and patients regarding health care, social and other barriers. Social community mapping activities could also be used within different communities/regions to better understand the health care networks and community members’ experience trying to navigate these to access PrEP.

Key outcomes from this project will be supporting health authorities, community groups, health care providers, and patients to use PrEP; and contributing towards HIV elimination.

Embedding health care technologies in real-world contexts: Developing the scale-up, spread and sustainability of assistive technologies in homes, communities and health systems

Co-leads:

Executive sponsor:

  • Heather Davidson
    BC Ministry of Health

Too often, promising technological innovations are not adopted, are abandoned, or face other serious challenges to their uptake, spread and sustainability in real-world contexts, including in people’s homes, community settings, or health systems more broadly.

This project aims to apply a new framework for theorizing and evaluating this phenomenon. The non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework will be app/node/5126lied to several innovative assistive technologies (ATs) currently being developed in British Columbia for older adults.

By using a community-based participatory research methodology, this work will bring researchers, key health system decision-makers, technology developers, care-givers and older adults together into an inquiry team, focused on overcoming challenges to embedding ATs in end users’ real-world contexts and identifying positive factors that support their uptake, spread and sustainability.

This project will directly address the health system priority of services for seniors with complex medical conditions and the commitment to keeping seniors in their homes as long as safely possible (aging in place). The ATs in this project will be focused on improving the health and quality of life of older adults living with complex care needs, and multiple, chronic health conditions as well as the onset of frailty.

This research will also contribute to enhancing access to effective primary health care. ATs are a crucial medium for accomplishing this, as many of the innovations are aimed at making communication and interventions between older adults and their primary health care practitioners, including physicians, nurses and home support workers more effective.

This project will work towards directly improving the uptake, spread and sustainability of promising ATs in British Columbia, and will develop and sustain effective partnerships between the research community, the BC Ministry of Health, CanAssist and other relevant organizations.