8 Canadian startups on the frontlines of remote medicine

The Canadian healthcare system has some of the longest wait times in the developed world. It isn’t uncommon for patients to wait hours for emergency care, and months, if not years, for elective surgery. The country has only 2.7 doctors per thousand citizens, compared to Australia, with 3.5, and Germany, with 4.1. In many Canadian urban centres, hospitals are routinely packed beyond capacity, sometimes at 140 percent.

Canada’s healthcare workers are under tremendous strain, but don’t expect the stressors to disappear anytime soon, not with the boomer generation lumbering into old age. A report from the Fraser Institute estimates that by 2031, Canadian healthcare spending could be up 118.5 percent from where it was in 2016.

And with the COVID-19 pandemic, fear of system collapse has never been stronger, among everyday Canadians and government officials alike. The coronavirus has unloaded thousands of unexpected patients onto the country’s hospitals and clinics. Masks, goggles, and breathing machines are suddenly in short supply. And cities like Toronto have already begun leasing hotels to house homeless people and displaced hospital patients.

To survive the coming deluge, our system needs to innovate. Canada’s entrepreneurs must find ways to make medical services faster, cheaper and more reliable. The last decade saw tremendous technological upheaval, affecting everything from the way we find dates to the way we order souvlaki. The coming decade requires similar disruption, albeit in industries that are far more essential to human wellbeing: diagnostics, mental health and surgery. And the transformation has already begun. Here are Canadian startups that are building apps, robots and even fashion accessories to make healthcare more accessible than ever before.

A doctor in your pocket

In 2011, Samuel Duboc, a Toronto entrepreneur and co-creator of the Air Miles Reward Program, forced himself to face a difficult truth: he was suffering from depression. “My brother had recently died,” he recalls. “Suddenly, I could barely get out of bed. I’m from Indiana, where people don’t talk openly about mental illness. By the time I admitted I had a problem, I was well into it.”

By acknowledging the issue, Duboc had overcome what should have been the only barrier to getting treatment. In reality, though, he’d just passed the first hurdle. To get an appointment with a psychiatrist, he needed a referral from his GP. Then, he spent three months on a wait-list. “I thought, if it’s hard for me to get help,” Duboc says, “it must be really hard for someone who doesn’t have my advantages.”

Duboc is currently the chair and CEO of the MindBeacon Group, which, in 2017, released a digital platform that offers accessible care for people with depression, anxiety, panic disorder, PTSD and insomnia. Prospective patients simply download the Beacon app and answer a battery of questions about their condition. Within 48 hours, they are connected to a therapist who guides them — step by step — through a customized treatment regimen. The client and therapist typically communicate asynchronously, via messaging. If the client wants a real-time phone consultation, they can get one, but few avail themselves of this option.

Beacon specializes in cognitive behavioural therapy, which, unlike talk therapy, is all about independent work. The therapist assigns tasks, which the patient completes. The goal is to build up cognitive skills that improve mental wellbeing. For patients with mild-to-moderate conditions, the app is highly effective; in more severe cases, Beacon therapists can recommend external resources for the patient to seek out. Most people who get workplace health coverage through one of the major Canadian providers — Manulife, say, or Green Shield — can get a refund for Beacon expenses, which are a fraction of the price of other mental-health services. “Roughly 80 percent of our clients have a reduction in symptoms,” says Duboc. “Those outcomes are equal to or better than in-person care.”

Duboc is addressing a growing problem in Canada, where demand for mental health services is wildly outstripping supply. It’s not uncommon today for people to wait a year before seeing a psychiatrist. When it comes to physical health, the picture is similarly bleak: hospital emergency rooms are overburdened with patients seeking non-emergency care. This situation won’t improve, Duboc believes, unless some of that demand moves into the digital realm.

Today, with individuals facing weeks — or even months — of self-isolation, the need for cognitive behavioural therapy has never been greater. For that reason, MindBeacon Group recently launched its COVID-19 support service to help Canadians manage the stressful times ahead.

Beacon isn’t the only company trying to facilitate this shift. Dialogue, founded in Montreal, offers digital healthcare packages that employers can include in their benefits programs. Using the Dialogue platform, sick employees can video conference or chat with clinicians, who are able to give diagnoses, referrals or prescriptions. Similarly, Toronto company Maple has an app that CEO Brett Belchetz jokingly calls “Uber for doctors.” Like the ubiquitous ride-sharing company, Maple matches excess demand to excess supply. In their off-hours, doctors with time to spare can log on to the platform and see a patient or two without having to travel to a clinic or work a full shift. Both experts in the digital realm, the startups have taken novel, real-world approaches to tackling the coronavirus: Dialogue’s free tool aggregates the latest data from federal, provincial and territorial health authorities; while Maple, in partnership with Shoppers Drug Mart, is launching a virtual care service to relieve burdened clinics and emergency rooms.

Of course, virtual medicine cannot satisfy every person’s needs. Some bodily ailments necessitate physical examinations, just as some mental conditions require talk therapy in a face-to-face setting. But the point of these apps isn’t to make in-person care obsolete; rather, it’s to take pressure off the system, thereby freeing up resources for where they’re needed most. “It would take 40 years’ worth of Canadian university graduates to supply the current demand for mental healthcare,” says Duboc. “The problem isn’t solvable without digital innovation.”

Diagnosis at a distance

One of the most dangerous health conditions is lack of awareness about your health. Between 2006 and 2012, more than 44,000 Canadians had a lower-limb amputation, many due to diabetic infections that could’ve been treated via less-extreme measures had they been caught in time. Chronic obstructive pulmonary disease is the fourth leading cause of death in the country, a figure that is greatly exacerbated by failures of early detection. Heart disease, meanwhile, is the second leading cause of death, and yet, among Canadian women, early signs of a heart attack are missed 78 percent of the time. COVID-19, for its part, has spread so quickly because the vast majority of carriers don’t even know they have it and aren’t getting tested.

Clearly, we’re overlooking things we should be seeing. This fact hardly seems surprising when you consider that, according to 2017 data from Statistics Canada, 15.8 percent of us don’t have access to a regular healthcare provider. Even among people who do have a GP, getting timely treatment is difficult. In 2017, a survey from the Canadian Institute for Health Information revealed that 57 percent of us were unable to get same-day — or even next-day — care the last time we needed it. If we can’t easily get to a doctor, should we somehow diagnose ourselves?

Karen Cross, the co-founder of Toronto startup Mimosa Diagnostics, believes that technology can help us do just that. Mimosa has developed a tool — a kind of camera, currently in prototype — for people with diabetes, a disease that can turn minor cuts and scrapes into wounds that refuse to heal, particularly in hard-to-monitor regions of the body, like the soles of our feet. Every morning, diabetic patients can take out their Mimosa device and train the lens on their feet. The camera uses proprietary near-infrared technology to examine the tissue and blood vessels for telltale signs of a wound or infection, and it alerts the patient of developments that require medical attention.

Innovations such as this belong to the field of “remote diagnostics,” an industry specializing in portable devices that help people keep tabs on themselves. Beginning in April, Myant, a Toronto startup, will release its first line of intelligent fabrics — underwear, bras, and tank tops equipped with fibrous electrodes that monitor your pulse for possible signs of atrial fibrillation, a coronary disease that, if left untreated, can lead to blood clots, heart attacks and strokes. Myant also plans to release a polo shirt and a baby onesie later this year. In time, the company hopes their garments will be able to detect falls, keep track of ovulation and monitor people for signs of driver fatigue.

Similarly, Tech4Life Enterprises, an international company headquartered in Milton, Ont., has produced a variety of affordable, lightweight diagnostic tools, including a digital stethoscope that connects, via Bluetooth, to an iPhone or tablet. The tool — intended for nurses in remote areas — produces heart and lung recordings that can be emailed to a doctor elsewhere for analysis. Other Tech4Life products include the Sojro Classic, a kind of backpack containing a vital-signs monitor, a dermatology camera, an ENT camera, a digital stethoscope and a tablet loaded with the necessary software to run these applications. You can think of the Sojro Classic as an all-in-one health kit, like a Swiss Army Knife for frontline caregivers. Tech4Life products have been used not only in rural Canada and the U.S., but also in Kenya, Pakistan, India, Saudi Arabia, Nigeria and Afghanistan.

The goal of remote diagnostics is to empower people, wherever they live, to catch potentially critical problems long before they become acute. Cross, for instance, believes that Mimosa technology will radically reduce the need for amputations among diabetic Canadians. “Our device,” she says, “will be like having a doctor’s eyes in your home.”

The robot will see you now

From 2004 to 2014, Justin Allport was an engineer for the space-tech company MacDonald, Dettwiler and Associates, where he worked on the Rosalind Franklin rover, which will be sent to Mars this July. To survive on Mars, the vehicle must be able to guide itself. “It has to find its own path without a person steering it in real-time,” says Allport. To this end, he and his fellow technicians outfitted a prototype version of the rover with an array of cameras, which create a 3D rendering of the landscape, enabling the vehicle to plot the safest course.

The project got Allport thinking: could this technology have medical applications? “Planetary terrain is comparable to the human body, just at a different scale,” he says. “If you zoom in close on a human, you’ll see lots of similarities in structure and topography.” Like the surface of Mars, our bodies are a landscape of undulations, bumps and fissures.

It’s the latter that are of interest to Allport. In 2014, with colleagues from the University of Toronto, Allport co-founded Swift Medical, a startup that has built a smartphone app to monitor wounds. When treating a patient with an abrasion, doctors or nurses can open the Swift app and wave their phone over the injured area. The app, meanwhile, takes a suite of photographs from a variety of angles.

What separates the Swift tool from other diagnostic devices is its use of machine learning. An AI algorithm analyzes the wound images, figuring out the size and depth of the abrasion and the composition of the tissue. If the caregiver takes another set of pictures the next week, the app will determine — with a greater degree of accuracy than the human eye — whether the wound is healing, refusing to heal or becoming infected. This information can ensure better treatment for injuries, surgical lesions and more routine ailments like bed sores, a problem that is easy to manage, so long as caregivers don’t miss the relevant symptoms.

Allport believes that robotics — that is, automated technologies, some powered by AI — will transform healthcare, helping doctors do their work with a higher degree of efficiency and precision. Similarly, Synaptive Medical, a global company headquartered in Toronto, is seeking to bring sophisticated software and robots into the contemporary operating room. In 2017, the company launched the Modus V, a robotic digital microscope that follows a neurosurgeon’s instrument as it moves through the brain, like a spotlight trained on a dancer. This tool saves surgeons from having to constantly refocus their microscope, thereby reducing costly operating-room hours and enabling patients to spend less time anaesthetized. More recently, the company launched the Modus Plan, a software program that analyzes a patient’s MRI data to produce a colour-coded image representing white matter in the brain — vulnerable regions that surgeons should seek to avoid.

At first blush, the very notion of “medical robotics” born from space might have an ominous ring to it, but robots won’t be replacing healthcare workers anytime soon. Rather, they will enable doctors to better visualize and navigate the human body, assess sick patients from a healthy distance, and discover new treatments and vaccines for world-changing viruses. Technologies once thought of as outlandish — even other-worldly — are now being applied quickly and affordably right here on Earth.