A spotlight series on British Columbia
Saving Lives from the “Other Crisis” During the COVID-19 Pandemic at Lifeguard Digital Health
Guest Post by Dr Chandana Unnithan, CIO/CTO at Lifeguard Digital Health
Published in partnership by the Information and Communications Council (ICTC) & the Vancouver Economic Commission
The field of digital health is growing exponentially in the post-COVID world. As physical distancing becomes a necessity to sustain lives and governments lock down countries into quarantines, convergence of digital technologies has enabled health care services online. Services that are often cited include telemedicine, mobile applications, wearable devices, remote monitoring sensors, and even the use simple text messages via mobile phones that sends alerts to public.
From a technology perspective, the focus of digital health is on the development of interconnected health systems that leverage smart devices (e.g., smart phones, tablets, wearable fitness devices), internet, big data, advanced computational analysis methods, and wireless communications. The involvement of multiple disciplines and stakeholders, including clinicians, allied health workers, scientists, researchers, experts, and citizens with expertise ranging from health, engineering, public health, social sciences, health economics, and data science makes this discipline unique, yet complex and dynamic.
As a digital health professional, my passion and expertise originated in Australia with some notable examples in pioneering Internet of Things (IoT) in public hospitals, telehealth services, national e-health records, and developing mobile applications for smart healthy cities. As an expert in the field with WHO and UN, I have also seen the merit of sharing the knowledge across contexts and countries. This multifaceted discipline offers great potential for the post-COVID era, when governments wrestle with protecting the lives of citizens from a “previously unknown” virus, using existing policy frameworks while negotiating evolving technologies and creating new guidelines in a time-compressed manner.
Digital health integrates technologies and people. However, digitization in health also makes the world apprehensive about security and privacy. Will my personal medical data be available publicly? Will it compromise my security? Will my data be used for “other” purposes? The questions relate to the collection, aggregation, and use of data amongst communities and across regions. Inevitably, all questions are regarding civil liberties that should not be compromised. The key to unlocking the digital transformation productively in the health domain is to incorporate privacy-preserving approaches in the design and implementation of technologies while also keeping the public informed about “how” this is being accomplished.
Until a decade ago, health data was controlled entirely by health professionals. Today, as the result of digital transformation, big data is generated by average citizens, as well as health professionals, scientists, policy makers, and others. The need is therefore in designing technology, whether it is for transmission of data or for synthesis, with added security to preserve privacy.
The use of blockchain for secure data transmission is one of many facets of digital health that has been successfully trialled in many countries. The same method is designed for use in other sectors such as digital banking, e-transfers, or points of sale (PoS) using contactless cards. Blockchain technology allows users to assign access rules for their medical data, for instance, permitting authorised researchers to access parts of their data for a fixed period of time. In another example, an additional security layer can be enabled to protect the data being transmitted while using a mobile app.
How can data be securely shared and used to inform public health strategy in the future? In the COVID-19 pandemic context, public health authorities and emergency response centres retain data for statistical purposes and for informing preventive strategies. This data can be used for training predictive models or using artificial intelligence methods such as deep learning in time to combat another epidemic or pandemic. Globally, this could make it possible for humanity to be one step ahead of any future pandemic.
Permissioned blockchain is one solution that adds an access control layer to allow certain action to be performed only by preauthorized participants. Big data aggregated via smart devices can be synthesized, cleansed, and combined with health information retained by public health authorities to become a “real-time” enabler for prevention strategies, if another epidemic unfolds.
The “Other” Epidemic: Opioid Crisis
The quarantine and lockdowns due to COVID-19 have a significant impact on the health workforce as well as the mental health of average citizens. While front-line workers have been highly impacted, the average citizen is negotiating a “new normal” in work and personal life. Often, the unwarranted outcomes of a pandemic are sufficient to cause other crises.
In the context of British Columbia, the 170 illicit drug toxicity deaths reported in May 2020 mark the highest monthly total ever in British Columbia, which represents a 93% increase over the number of deaths in May 2019 (88) and more deaths than the entire first wave of COVID-19. Canada also has the second-largest per capita consumption of prescribed opioids in the world, which often has the unintended consequence of leading to addiction.
While emergency workers and paramedics are grappling with harm reduction techniques, including safe-injection sites, the pandemic has rendered it difficult to maintain levels of care. As a result of people being locked down and isolated in their homes, the already high rates of overdosing alone have been exacerbated in this “other” crisis in BC.
Lifeguard Digital Health — Saving Lives!
As BC sought technology as the next mile for “contactless” and yet efficient solutions to address this additional crisis, Lifeguard Digital Health emerged as the lifesaver. The Lifeguard App is a user-centred and privacy-protected way of interrupting an overdose in progress by sending a prioritized alert directly to ambulance services.
The pioneering “Lifeguard App” was conceived as a brainchild of Jeff Hardy (CEO), a successful serial entrepreneur based in British Columbia and an alumnus of BCIT.
Clinical trials were underway in Vancouver’s notorious Downtown Eastside from 2017 where the team worked in collaboration with BC Emergency Health Services, a world leader in emergency response. It has been extensively tested with real people using opioids in their own environments. It works in an inimitable manner as it connects directly with emergency first responders.
How does it work? The Lifeguard App has to be downloaded by the user, who is empowered to activate it when required, through a simple one-time registration process. The person taking a drug can simply activate the app. When a user location is confirmed (by activating the app), a one-minute timer automatically starts to count down while the individual consumes the drugs. If the user has not stopped the timer before its expiry (indicating the user is or may be in distress) the app sends a text message which is converted to voice and reaches emergency (9–1–1). It is prioritized in the queue, and a procedural call is made to filter false alarms. If there is no response, Emergency Health Service will dispatch paramedics.
Simply put, the app offers a lifeline, especially when users are alone. Once enabled, the app automatically connects users with emergency responders in the event that they become unconscious or unable to function. Importantly, Lifeguard’s app arms the emergency responders with information: where the user is located; what drug he/she has used; what time the drug was taken — crucial information for the success of any emergency intervention. Emergency response within the first 10 minutes of use is critical to the survival of people whose drugs have been contaminated with fentanyl.
Lifeguard App protects user privacy as it does not retain any data collected during or after the call. Specifically, the app connects directly to emergency services (9–1–1). Once the call is connected, all information is transferred to the first responders (similar to any other emergency call). All the information on the call is then automatically erased. The app uses geofencing capabilities to identify location and allows for emergency responders to be directed appropriately. For remote communities, the app is configured to alert community-based first responders and volunteers, who can administer remedies to preserve a life.
Efficient use of digital health techniques is apparent in the Lifeguard App, which not only enables privacy protection but also ensures security during data transmission. The information of the caller, with relevant details required to save the person’s life, are encrypted in a text message and transmitted direct to reach relevant emergency services on time. Using text-to-voice conversion, the message then is taken by Emergency paramedics (similar to all other emergency services).
Immediately after the call is attended by the emergency responders, all data relating to the call and information is automatically deleted from the app. The app is thus preserving the privacy of the individual by not retaining any data related to the emergency call, and the potential of this data being misused is eliminated.
In late May through mid June 2020, the Lifeguard App was successfully rolled out in BC across all health authorities, led by BC Emergency Health Services (BCEHS) and Provincial Health Services Authority (PHSA), enabled by the BC Ministry of Mental Health and Addictions. It has begun saving lives with two successful end-to-end episodes reported in May and June (i.e. successfully saving lives). The app has been endorsed by the Honourable Judy Darcy (Minister for BC Mental Health and Addictions), Dr Theresa Tam (Chief Public Health Officer, Canada) and Dr Bonnie Henry (Chief Public Health Officer, BC) as a powerful tool to save lives from the opioid crisis.
The Journey Continues @ Lifeguard Digital Health
As Lifeguard App begins to save lives in a simple yet efficient manner in BC, the use of novel technologies to create harm-reduction tools continues to be the central theme at Lifeguard Digital Health. The team is working with BCEHS, BC Ministry of Mental Health and Addictions, BC Centre for Substance Use, and BC Centre for Disease Control (BCCD) to create a mental health platform that utilizes permissioned blockchain. This platform is initially for creating an informational dashboard for the provincial government.
All information shared on this platform and protected with permissioned blockchain security will be synthesized and used for training predictive models using AI deep learning techniques to inform future public health prevention strategies in real time. We expect to get ahead of the crisis and save lives along the way.
Where do we go from here? The journey continues at Lifeguard Digital Health with further developments with senior care solutions post-Covid, integrating mobile solutions with IoT, and geospatial techniques. As a pioneer in digital health integrated services and smart applications, the company looks ahead to extending the reach of its life-saving products, globally.
This article was published as part of a spotlight series on the province of British Columbia (BC) through a partnership between the Information and Communications Technology Council (ICTC) and the Vancouver Economic Commission. Our contributing partner for this post was Lifeguard Digital Health.
