TM

Professor Jadad, Alejandro

University Health Network

11800

42300

Centre for Global eHealth Innovation

Program in eHealth Innovation 416 340-4800

416 340-3595 ajadad@uhnres.utoronto.ca

eHealth, Internet, Technology, Knowledge-management, Usability, Simulation, Experiments,

Society, Globalization, Evidence-based Decision-making

497 163 1 556 440 186 667

Date:

Signature Date

Innovation Fund

2 240 270

4.9

8.7

30/08/2001

Description of Infrastructure Project and Assessment Against CFI Criteria

Page 1 of 20

Canada

Foundation

for Innovation

Descriptive title of infrastructure project (no more than 200 characters):

Funding program applied to: Language of application:

English French

Institution/lead institution (See next page for multi-institution applications)

Total cost of infrastructure project and amount requested from the CFI

Year 1 Year 2 Year 3 Year 4 4-year TOTAL

Designated Project Leader

Name: Title:

Department Telephone:

E-mail Fax:

Key words: Provide a maximum of ten (10) words that describe the infrastructure project. Use commas to separate each

key word.

Research discipline/field code: Area of application code:

Primary: Primary:

Secondary: Secondary:

Signature: It is agreed that the general conditions governing the matching provisions and the use of CFI funds as outlined in the

Institutional Agreement and the CFI Policy and Program Guide apply to the infrastructure project outlined in this application and are

hereby accepted by the institution.

CEO or President of the Institution (or authorized representative)

Name

Project number 4805

Costs

Total project

CFI request

1 242 907 3 891 099 466 667 5 600 673

Ext.: 6823

Partner

contributions 745 744 2 334 659 280 000 3 360 403

Note that for each year the CFI request should not exceed 40% of the cumulative cost to that year.

University Health Network

Centre for Global eHealth Innovation

Our intention is to create the 'Centre for Global eHealth Innovation' (the Centre). By

'eHealth Innovation', we mean the conceptualization, design, development, application and

evaluation of new ways of using existing or emerging Information and Communication

Technologies (ICTs) in the health sector. This concept goes beyond pure technological

considerations, including an analysis of the effects of ICTs on access to information,

services, the culture of health and healthcare, society in general, and technologies

themselves.

The development of the Centre represents a major research priority for the University

Health Network (UHN), as reflected by its strategic plan and the commitment to completing

and making available 15,024 sq. ft. of contiguous space in a prime location, on the fourth

floor of the new Toronto General Hospital's 'R. Fraser Elliott Building'. By centralizing

and equipping the key facilities to support eHealth Innovation research activities, the

Centre will create an integrated set of resources that will optimize research potential

and efficiency, promoting collaborative links amongst the researchers associated with the

UHN and the University of Toronto (U of T), as well as amongst innovators across

provincial, national and international boundaries.

The Centre will include three main components, easily upgradable over time.

(a) The 'eHealth Innovation Collaboratory' ('collaboration - laboratory'): This will be an

area of 8,252 sq. ft. designed as dry laboratory space and including three sub-components:

(a.1) A network of 60 fully equipped workstations serving a team of 10 senior scientists,

5 senior research associates, and 45 research and technical staff, post-doctoral fellows

and graduate students. The research team will work on three major thematic areas: society,

health knowledge management, and technology.

(a.2) Collaborative research spaces include multimedia resource / archive rooms and

interaction / meeting spaces (e.g., for group-to-group interaction tools)

(a.3) 16 dual processor Graphic Workstations with server capabilities.

(b) The 'Health Usability Laboratory': The first facility of its kind in Canada. This lab

will include a total area of 952 sq. ft. dedicated to supporting pre-testing and

refinement of computer interfaces and applications, implementing research projects on

human-machine interaction, and developing new methods to study eHealth innovations. This

laboratory will comprise the following research structures:

(b.1) A Testing Room of 464 sq. ft. within which research subjects will interact with

eHealth innovations on an individual basis. The room will contain high-resolution video

cameras and microphones to capture data on task analysis, user-technology interaction

(e.g., eyeball tracking), relevance and preference (e.g., speak-aloud navigation).

(b.2) An Observation Room of 281 sq. ft. will include 3 workstations to support

researchers' activities. This room will be connected to the testing room physically and

electronically. A removable one-way mirror will allow researchers to observe humantechnology

interactions. Using the workstations and cameras, researchers will be able to

monitor and analyze data captured in the testing room and to modify in 'real time' the

Institution and Title of Infrastructure Project (from p. 1 of this module):

Description of the infrastructure: Briefly describe the infrastructure that will be acquired or developed and indicate

where the infrastructure will be located. Use language appropriate for a multidisciplinary committee.

Use this page and up to one additional page.

Project number 4805

Page 3A of 20 Canada Foundation for Innovation

University Health Network

Centre for Global eHealth Innovation

eHealth innovations being tested.

(b.3) A Research Collaborators' Observation Room of 207 sq. ft. This structure will allow

simultaneous observation of both research subjects in the Testing Room and researchers in

the Observation Room. It will enable research on usability testing - a field on which

there is limited knowledge in health - and allow for training of researchers in the use of

this type of facilities.

hinder the development of research on eHealth innovation. First, innovators have limited

access to the environments where health-related decisions and information exchange happen.

Second, innovations cannot usually be tested in the real world without serious disruptions

of daily activities. This multi-tasking environment will be the first simulation

laboratory in the world exclusively dedicated to health. It will be used to assess group

use of eHealth innovations, in controlled conditions, in an area that simulates real-world

health settings. By manipulating the context where eHealth innovations can be used and

allowing for group interactions to be observed, innovators will have the ability to

develop and evaluate such innovations thoroughly and efficiently. Following testing and

refinement of eHealth innovations in this environment, innovators can take newly developed

technologies to the real world with maximum likelihood of uptake and minimum disruption.

The simulation environment will cover a total area of 5,820 sq. ft. and will include the

following structures:

(c.1) A Testing Room of 4,240 sq. ft. with a central area that can be transformed, through

the use of movie set techniques, into health related environments such as, among others: a

hospital waiting room, a consulting room, a nursing station, an intensive care unit, an

emergency room, an operating room, a classroom or a home environment. Equipped with data

capture and transmission equipment, the central area will have the capacity to simulate

more than one setting at a time, either to conduct simultaneous, independent experiments

or to analyze complex interactions between two related environments. The maximum number of

research subjects involved in the simulations would be 40. Around the central area there

will be a corridor to let technical staff and researchers move and work without disrupting

the ongoing experiment and 220 sq. ft. of user-interaction space.

(c.2) Two Research Observation Rooms with a total of 509 sq. ft. to accommodate up to 12

researchers. The room configuration will be flexible to adapt to the needs of the specific

simulation under way. For example, experiments on the use of eHealth innovations across

settings will host groups of participants, such as physicians at a hospital and patients

at home, contributing to a telehealth project, with observation from separate rooms to

minimize the potential for contamination and bias. The equipment for the Observation Rooms

will be similar to that described for those in the Usability Lab.

(c.3) A Research Collaborators' Observation Room of 292 sq. ft. with functions similar to

those described for the Usability Laboratory.

(c.4) A Modular Environments Repository of 559 sq. ft. will be used to store the used to

recreate the simulation environments in the testing room.

Institution and Title of Infrastructure Project (from p. 1 of this module):

Description of the infrastructure: Briefly describe the infrastructure that will be acquired or developed and indicate

where the infrastructure will be located. Use language appropriate for a multidisciplinary committee.

Use this page and up to one additional page.

Project number 4805

Page 3B of 20

University Health Network

Centre for Global eHealth Innovation

Imagine a world in which people, regardless of who they are or where they live, use stateof-

the-art information and communications technologies (ICTs) with enthusiasm, proficiency

and confidence, to achieve the highest possible levels of health and to help health

systems make the most efficient use of available resources. This has been an elusive goal

for Canada and the rest of the world, for a number of reasons.

Ironically, many of the barriers preventing us from achieving this goal stem from the

accelerating pace with which technology and knowledge are developing. This has generated

what Thomas Barlow has described as "technological angst, an ambivalence to change, and an

escalating feeling that advances in science have begun to outpace human ability for making

judgments about their application" (Financial Times Weekend, page II, London, May 12 - 13,

2001). In addition, innovations are usually developed in a business environment, driven by

the need to rapidly enter the marketplace and not by health sector priorities. As a

result, such innovations are often introduced into the health system with incomplete

evaluation, in conditions that do not meet the needs of their intended users. For testing,

innovations are brought to busy clinical settings - often through disjointed, slow and

awkward efforts, disrupting routine activities, producing scant evidence of their

usefulness and potential risks, and creating frustration among patients, providers and

administrators. This, in turn, leads to further delays in the introduction of technology

into the health system. Finally, the current health system was designed for the pre-

Internet era, without the flexibility or incentives to adapt to rapidly changing

conditions.

Solutions for the creation of an accessible, effective, efficient, and equitable health

system in the 'Information Age' will only emerge through the close and dynamic

collaboration of innovators from a variety of disciplines, including information

technology, the social sciences, and health knowledge management; through creative

partnership among the government, academic institutions and the industry, with meaningful

public participation; and through political will. One of the most important factors for

this endeavour to succeed is the creation of a strong research infrastructure.

Canada is uniquely positioned to accept and meet the challenges. The infrastructure

proposed will be a perfect example of a strategic investment for shared benefits based on

Institution and Title of Infrastructure Project (from p. 1 of this module):

A1 - The Research

Choose the statement that best represents the research

Self-assessment

(a) produce a modest but useful advance;

(b) meet national standards, or be the best in an underdeveloped field, AND contains some innovative aspects;

(d) be exceptional by international standards, have a major impact, AND be highly innovative.

Project number: 4805

The proposed infrastructure will be used for research that has the potential to:

Page 4A of 20 Canada Foundation for Innovation

Provide information to explain and justify the choice of statement, using the space below and up to 5

additional pages.

Outline the major research programs to be enabled by the infrastructure.

Situate the research in the larger international context and highlight the innovative aspects of the research.

Describe the anticipated impact on the research programs of the major users (those with CVs attached).

University Health Network

Centre for Global eHealth Innovation

the principles of economies of scale. The paramount goal of the Centre for Global eHealth

Innovation (referred to as the Centre hereafter) is to provide scientists with access to

unique physical and virtual research facilities and testing environments with the

flexibility for accelerating the conceptualization, design, development and evaluation of

new ways to use existing and emerging ICTs related to health. The Centre will build on the

diversity of Canada (the country is home to people from over 150 countries) and complement

its strong service infrastructure, to help create a 'mini-model of the world' to study

eHealth innovations in ways that are not possible anywhere else in the world.

Although the infrastructure will be generic and will support a wide-ranging scope of

innovation, many of the projects in the first 3 years will focus on cancer, to ensure a

coherent program of research that can lead to substantial results within a reasonable

timeframe. Cancer provides ideal conditions to develop and test eHealth Innovations. It is

one of the leading causes of death for Canadians of all ages; is a disease associated with

high morbidity, stress and costs; there is a strong clinical infrastructure in Canada

devoted to its management; it has a spectrum of concerns that span from prevention through

treatment to palliative care and bereavement; it concerns a large segment of the

population; and is experiencing a disorderly explosion of information on the Internet.

Work on cancer will not only maximize the impact of the research on society from the

outset, but it will help speed up the integration and cooperative capacity of groups

working in different regions of the country. The Centre will also be available to

researchers from other areas with great societal impact such as arthritis/musculo-skeletal

conditions and rehabilitation, cardiovascular disorders and neurosciences. The projects in

these areas will be increased in number and complexity gradually. The possibilities of the

Centre for research and innovation are so numerous, and the pace of development of

technology and knowledge is so fast, that we anticipate that there will be many uses for

the infrastructure that we cannot now imagine.

Three key research themes have been identified to provide the framework for organizing

projects and setting priorities for investigation. The themes have been structured in a

way that will promote transdisciplinary research across groups. These themes, and their

leaders, are as follows:

== Theme 1: Society (Leaders: Coyte, De Kerckhove, Streiner). This will examine the

human, organizational and social elements related to the introduction of eHealth

innovations for the improvement of the health system and the health of the population.

== Theme 2: Health Knowledge Management (Leaders: Goel, Jadad, Reznick, Straus). This will

contribute to the exploration of innovative ways to synthesize, 'package', integrate and

deliver different types of information (e.g., clinical, anecdotal, heuristic), to

different groups of decision-makers operating in different settings.

== Theme 3: Technology (Leaders: Gallie, Mann, Vicente). This will contribute to the

evaluation of the impact of existing and emerging ICTs to help decision-makers access

information and communicate efficiently, and to enhance the interconnectivity of different

components of the health system in different settings.

Institution and Title of Infrastructure Project (from p. 1 of this module): Project number: 4805

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University Health Network

Centre for Global eHealth Innovation

The Centre will support programs of research that will benefit from its infrastructure and

that will incorporate elements of the 3 themes. The first generation of programs will be

as follows.

++ Virtual knowledge management centres. This program will lead to the creation of virtual

tools, spaces and resources to help decision-makers access, understand and use high

quality information to guide health-related decisions.

One of the first projects within this program will be the design and evaluation of a

'Virtual Pain Control Centre' (Jadad, Reznick, Vicente). Pain relief will be used as the

initial model, because it is the most prevalent and distressing symptom in patients with

most types of cancer and other pathologies, it involves physical and emotional components,

it remains inadequately managed despite the availability of effective treatments, and

because its adequate treatment is hindered by significant communication problems and

myths.

The Virtual Pain Control Centre will be the first of its kind in the world. It will

include virtual agents and virtual knowledge resources. These components will be

conceptualized, designed, tested and refined making use of the Collaboratory, the

Usability Laboratory and the Multi-tasking Simulation Environment. In the Collaboratory, a

multidisciplinary group of researchers, with input from pain specialists, patients and

significant others, will develop the computer-generated agents that will 'manage' a set of

high-quality Internet-based resources on the management of cancer pain. These agents and

resources will be pre-tested through multiple iterations in the Usability Laboratory,

where researchers will obtain input from potential users of different demographic, socioeconomic,

ethnic, linguistic and educational backgrounds. Special emphasis will be placed

on meeting the needs of people with low literacy or socio-economic levels, recent

immigrants with non-dominant cultural backgrounds, and members of indigenous communities.

Research participants will help evaluate different formats, media, interfaces and devices

for each of the components of the virtual centre. These components will be subsequently

tested in the Multi-tasking Simulation Environment. For example, in a simulated living

room, patients and their family members will use the virtual centre to prepare for the

encounter with physicians and nurses, will learn about different treatment modalities and

will prepare a set of questions to discuss during the clinical consultation. In a

simulated consulting room, physicians and nurses will receive information from patients

and respond to them, evaluating the impact of the interactions on the clinical encounter.

After this, the refined virtual centre will be further evaluated in real-world clinical

settings at Princess Margaret Hospital.

++ Wearable computing (Mann, Jadad, Straus): The wearable computer was invented in Canada,

20 years ago, by one of the lead investigators in this proposal (Mann). This field is

undergoing major transformation thanks to the progressive miniaturization of computers.

This program will support projects in which members of the public (healthy and ill) and

health professionals will use wearable computers to create a 'community of online

cyborgs'. The Usability Laboratory will be used to refine existing tools and interfaces,

adapt them for use in the health system, and to help the project participants to become

familiar with the equipment for their use as part of research efforts. Subsequently,

research will be conducted in the Simulation Environment by allowing the group of

participants to wear the computers and interact with others in different settings. The

ultimate goals of this program are to create 'ecologically' valid experiments in real,

Institution and Title of Infrastructure Project (from p. 1 of this module): Project number: 4805

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University Health Network

Centre for Global eHealth Innovation

actual settings with participation of people from any background, and to study the

implications for the patient-provider relationship of the availability of uninterrupted

communication between the public and the health system.

++ Hand-held computing (Straus, Reznick, Mann): This program will look at the role of

hand-held computers to provide easy, consistent and inexpensive access to health resources

(people, information and services), in real-time, irrespective of the physical location of

the user. The program will support projects that share a common goal: studying the role of

hand-held devices to create an effective, real-time, bi-directional connection between

'knowledge' and 'practice'. In one of the projects, the Usability Laboratory and the

Simulation Environment will be used to test and refine the interfaces, databases and

network infrastructures required to make clinically relevant and valid research evidence

available, immediately, at the point of care. In another project, the infrastructure will

be used to explore the opposite direction, looking at ways of capturing clinical

information at the point of care, and integrating it into the existing pool of knowledge,

to support future decisions.

++ Telehealth (Coyte, Goel, Jadad): This program will facilitate the transition from the

current institutional- physician-centric approach to telehealth, into a new model that

involves home-based applications, relies more on the Internet and gives members of the

public more control over the decisions related to their health. One project will use the

simulation environment and the living laboratories at UHN hospitals and homes, to study

different configurations of clinical settings and home-based knowledge centres and the

impact of e-mail and Web-based communication between health professionals and patients,

using supportive cancer care and palliative medicine as the model. Another project will

utilize the simulation environment to develop and evaluate measures for assessing the

impact of telehealth. Presently, there are very few rigourously validated tools for this

purpose, resulting in limited research in this field. Within the simulation environment

it will be possible to study health interactions with and without the use of

communications technology. For example, telehealth is increasingly used in dermatology

for diagnosis of difficult cases. In the simulation environment, two rooms will be set up

for an experiment. In one space, a typical dermatology consultation room will be set up

and the clinician will be presented with potential melanoma cases. In the other space,

the consultation will be done over a simulated telemedicine connection. In this

controlled scenario, we will develop and refine outcomes to assess the quality of the

clinical encounter, physical and through virtual means, and the impact of ICTs on the

patient-provider relationship. Another example of the many uses of the simulation

environment to study other innovative applications of telehealth technology will be

through a project with Cancer Care Ontario, in which the Centre's infrastructure will be

used to support a virtual surgical oncology tumour board to study how ICTs could bring the

expertise of academic specialists in tertiary centres to community based practitioners.

Projects like this will make considerable contributions to our understanding of how groupto-

group collaboration can be implemented successfully in the health system.

++ Integration of clinical information systems (Gallie, Goel, Mann, Streiner): This

program will focus on the integration in the electronic health record of new biomedical

devices, decision-support tools, evidence-based resources and systems, data generated by

Institution and Title of Infrastructure Project (from p. 1 of this module): Project number: 4805

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University Health Network

Centre for Global eHealth Innovation

new bio-optics tools and wireless devices, and data collected in bio-informatics

databases. The first projects will lead to the design of new interfaces and Semantic Webbased

applications to facilitate the use of electronic health records by different groups

of decision-makers at tertiary level institutions. A key simulation will be that of a

population based health information system. A major challenge to developing new tools for

health information management is that they must be tested in real world environments. In

particular, it is currently impossible to examine issues of interoperability between

systems within the health system. Within the Collaboratory, a population of 1 million

people will be simulated. A complete medical record for each individual will be developed

and stored in the formats of the leading medical records software vendors. This data set,

the first of its kind in the world, will enable research on the exchange of data between

different standards and across institutional boundaries. More importantly, it will be

possible to examine the interaction between new tools, such as evidence-based guideline

reminders that are triggered by laboratory results, and these different systems. In the

Usability lab, interfaces for accessing these systems will be evaluated with different

types of health providers. In the Simulation Environment, typical settings for accessing

such systems will be set up, such as offices, nursing stations and homes, and the

interaction between groups of providers and these systems will be studied.

++ Innovation in eLearning (Reznick, Goel, Jadad, Straus, Vicente): The rapid development

of knowledge and ICTs are putting increasing pressure on educators, academic institutions

and professional organizations to develop and implement effective and efficient

educational strategies. For more than a decade, it has been clear that most traditional

programs and tools do not meet basic educational principles [http://jama.amaassn.

org/issues/v282n9/abs/jrv90027.html]. With the advent of the Internet and the

increase in power of ICTs, there is increasing optimism about the ability of technology to

lead to effective learning with efficient use of the limited resources available to

education and training activities [http://www.aahe.org/technology/ehrmann.htm]. To date,

however, most efforts to use technology to promote learning (eLearning) have failed to

meet this promise

[http://tamino.catchword.com/vl=55822587/cl=8/nw=1/rpsv/catchword/tandf/0142159x/v23n2/s1/

p117].

This program will support research projects on eLearning strategies to help learners

achieve high levels of competence, optimal performance and decisions that lead to

improvement in health outcomes. For instance, the Usability Laboratory will be used to

help developers of clinical practice guidelines on the prevention and treatment of cancer

to assess whether their eLearning tools are flexible enough to meet the range of

preferences and learning styles of family physicians, residents and undergraduate medical

students. In the Simulation Environment, researchers will simulate different settings

(consulting room, classroom) to evaluate the ability of the applications to promote

contact between learners and tutors, reciprocity and cooperation among learners, active

learning techniques, sufficient time on task, effective delivery of feedback, and meeting

high expectations. In particular, the Simulation Environment will be used to assess the

effectiveness of learning in on-line forums versus small group sessions.

The program will also support research on computer-intense virtual reality applications,

to help learners (e.g., surgeons) acquire the complex skills needed for surgical care of

patients with cancer.

Institution and Title of Infrastructure Project (from p. 1 of this module): Project number: 4805

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University Health Network

Centre for Global eHealth Innovation

++ International and cross-cultural aspects of eHealth innovation (De Kerckhove, Gallie,

Jadad): This program will seek to expand the Network beyond Canada, through the

development of international collaborative efforts between innovators in Canada and

colleagues in other countries who are facing a similar constellation of challenges. One of

the main thrusts of this program will be the evaluation of the extent to which research

done in Canada could be extrapolated to other countries, and the development of innovative

tools to promote international collaborative research projects. By using the diverse

multi-cultural population of Toronto as a 'mini-model' of the world, innovators supported

by the Centre will explore the extent to which the results of research on eHealth

innovations involving immigrant communities in Canada compare across other communities

(e.g., comparison of the results of an experiment on the Virtual Pain Control Centre

involving Chinese and Western European participants) or can be extrapolated to their

countries of origin.

++ Meta-research on methods for the evaluation of eHealth innovations (Gallie, Jadad,

Streiner, Vicente): This program will lead to improvement of existing methods or the

creation of new methods to handle and understand the complex and dynamic nature of the

interactions among humans, communications technology, multimedia and knowledge. Emphasis

will be placed on methods to evaluate the impact of information technology on healthrelated

outcomes in 'real enough time'.

Once the infrastructure is developed, the Centre will catalyze the formation of a Global

eHealth Innovation Network. The Network will be composed of scientists from Canada and

around the world, who will be using the infrastructure of the Centre and the products of

the research fuelled by the Centre to invent new hardware, software, processes of care,

and methodologies that will be rapidly introduced into the health system through currently

networked areas, which will act as living laboratories. The research supported by the

Centre and the Network will accelerate the transformation of the health system to be more

effective, accessible and efficient. The unique contribution of the rigorous, systematic

and trans-disciplinary approach proposed will ensure that we avoid self-deception and a

recurrence of the 'irrational exuberance' witnessed in the last decade.

Institution and Title of Infrastructure Project (from p. 1 of this module): Project number: 4805

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