Jenny Basran

The silver tsunami is coming

Saskatchewan, like much of the industrialized world, is poised to get hit with a silver tsunami that threatens to engulf government health budgets, but also offers exciting opportunities, according to Dr. Jenny Basran.

"The baby boomers just started turning 65," said Basran, Saskatchewan's only geriatri­cian. "So everything we see in the hospitals, all the concerns in long-term care, all these home-care demands, are not the baby boomers. This is just the smaller group before."

Basran explained that in addition to there being more older adults, people are living longer, which is already straining health systems to their limits. And the pressure is set to increase considerably.

"If we can't handle it now, what will happen when the baby boomers start needing this level of care?" asked Basran, who was named 2015's Physician of the Year by the Saskatchewan Medical Association.

What is needed is a new model, and here is where she sees opportunity.

Basran explained the current system is based on short-term, in-and-out care. Someone comes to the hospital with a problem, the problem is fixed and they are sent home. Until now, it's been a tremendous success, bolstered by advanced technologies from elec­tronics to medications and proce­dures.

"You look at mortality rates and they are coming down, which is a great success story of medicine," said Basran, originally from the small town of Cabri, Sask. near the Great Sand Hills.

The flip side is people are now living longer and many develop not only one, but many chronic conditions such as congestive heart failure, arthritis and dementia, and "our system is not built for that."

Some of the consequences are not immediately obvious. For example, Basran and her colleagues took a look at long wait times in emergency rooms. It turned out the problem was far upstream: patients are occupying beds in emergency because there is no room in the acute care wards, because those beds are filled with people waiting for long-term care, subacute care or community services that may or may not exist.

"We're looking at a new normal, and this new normal is we have people with multiple chronic diseases who need a continuum of care," she explained. "It's not episodic. It needs to be continuous as they move from the hospital to the community and vice-versa. We have to figure out a system that responds to that."

Saskatchewan and the University of Saskatchewan are well positioned to design just such a system, Basran explained. The province's Health Quality Council has both the rich data sets and expertise to use them, while the Saskatoon Health Region has access to the university's academic research community with expertise in a broad range of disciplines.

For example, Basran is collaborating with Nathaniel Osgood, an associate professor and public health informatics expert in the Depart­ment of Computer Science, and modeler Yuan Tian at the Health Quality Council.

"We built a hybrid dynamic model of the health-care system, starting with Saskatoon and Regina health regions," Basran said. "It allows us to ask the ‘what if' questions when making decisions about how to make changes to the system. We are really leading the way in this area and it has generated a lot of excitement."

The computer model allows health researchers to take the findings from the evidence and their pilot studies—of which there are many—and see how they would look if applied to the whole system.

"We can find out, ‘oh, that would cause a backup over here,' or ‘you would need this many teams,' or ‘I would do it in this order versus that order,' or conversely, ‘it doesn't do anything for patient flow,'" she explained.

It is a development that is catching international attention.

"I was recently in New Zealand and met with the group that is developing their national seniors' strategy and they were just amazed at what we were able to do," she said.

Both the technology and expertise are exportable and bound to be in high demand as other jurisdictions in Canada and around the world struggle with the health-care demands of their aging population, Basran continued.

She also sees potential to harness the creativity of researchers and students by connecting them directly with health-care professionals and the business community.

Small steps have been taken with events such as Hacking Health, which puts technology creators in the same room with health professionals over a weekend to identify problems and create solutions. Basran herself is an alumna of the first Hacking Health in Montreal, which produced iCaregiver, an app designed to help people manage and monitor their loved ones even when they are not able to be there in person.

"It's great, but it's just a weekend," she said. "Where to take it from there? I don't know how to write a business case, don't know how to further develop the app; I can't leave my day job."

Such short-term initiatives, as well as some research projects, can result in orphan technolo­gies. For example, Basran was involved in a project aimed at creating a wearable device to address the problems of falls among seniors—events which often abruptly rob them of their ability to live independently. Armed with a $500,000 grant from the Natural Sciences and Engineering Research Council of Canada, the team came up with an early prototype device.

"After three years the research funding ran out and we just had such difficulty knowing where to go next," she explained. "We hadn't quite got the prototype to work as the tech­nology wasn't quite there yet and it just got shelved."

"This was almost 12 years ago, and I laugh because there was actually a wrist band. We wanted (seniors) wearing a bunch of sensors that had accelerome­ters, gyroscopes, the whole thing. So, kind of like an early FitBit."

Basran envisions creating an environment of learning and innovation that combines the strengths of the research community, front-line health professionals and business to create real-world solutions. One example is the "capstone" project fourth-year engineering students must complete for their under­graduate studies.

"What if we said, this univer­sity is going to take a lead in this," she says. "We're going to bring in health science students, match them with fourth-year engi­neering students and computer science students. Then we bring in students from the Edwards School of Business, who work out, ‘is there a business model for this?' ‘what's the market?'— all the things you really need to bring innovation to market."

From the clinician side, supervising doctors and other health professionals would help identify problems and recruit patients and families to test and refine the new ideas. Finally, the students would present their finished products and services to prospective business partners at an event for that purpose, such as the 2020 Health Visions Conference organized by the Saskatoon and District Chamber of Commerce that took place October 19 and 20.

"Maybe we need to figure out among all the deans a way to do that, partner with the (health) regions and Health Quality Council and come up with an ecosystem that can support, incubate and evaluate ideas and innovation in healthcare," Basran said.

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