Hospital for Sick Children Leading Child Health Research

The Medical Technology Blog

Sick Kids takes centre stage in robotics, imaging and simulation technology development

At first glance, a first time visitor to the Hospital for Sick Children, or “SickKids” as it’s more commonly known, could be forgiven for thinking that they were in a plush shopping centre rather than a major specialist paediatric hospital. Indeed, it has all the trappings of coffee bars, food outlets and such forth.  The downtown Toronto-based hospital is a sprawling campus of old and new buildings, colourful furniture and equipment, and boasts one of only three medical centres in the city equipped with a helipad.

Centre for Image Guided Innovation & Therapeutic Innovation

Somehow, the combination seems to works because the hospital has grown rapidly to become Canada’s largest centre for child health research. Supporting this strategy has been the Centre for Image Guided Innovation & Therapeutic Innovation (CIGITI), which was set up at SickKids in 2009 and, as part of a public/private partnership is developing three technologies with paediatric and foetal applications:, namely minimally-invasive endoscopic manipulators, a natural orifice anastomotic device and MR-guided high-intensity focused ultrasound.

In the case of the KidsArm technology development, the public contribution comes in the form of research and clinical expertise (SickKids) and government-based funding, whilst the private sector contribution encompasses contributing robotics (MDA Corporation), imaging (Philips Healthcare) and simulation (L-3 Communications MAPPS) technology.

The ambition for KidsArm can hardly be described as modest. The goal is for the technology to effectively to secure a position as a world leader in robotic surgery and imaging. Billed as the first robotic surgical arm for paediatric imaging, the device allows surgeons to navigate to a specific treatment area without impacting upon structures such as blood vessels. It could also be used to perform procedures such as the suturing of vessels and tissues at a rate of at least ten times faster than a surgeon.

The surgical platform is intended for use across all key surgical specialties, including cardiac, foetal, urosurgery/general surgery and neurosurgical areas. The device also has the benefit of producing virtual reality-based models that can be used in planning and teaching.

As with all high-profile technological breakthroughs, CIGITI has not got a clear field in terms of competitors, which include the likes of Intuitive Surgical, which has emerged in recent times as a leader in robotic technology through its DaVinci system. Still, confidence in the KidsArm’s attributes is strong and in a presentation to analysts, CIGITI isn’t afraid of holding back on a direct head on comparison with Intuitive Surgical.

First up, CIGITI says the KidsArm is markedly smaller and lighter than that from Intuitive, and that its device will be much cheaper and adaptable than its rival. As the KidsArm device is specifically targeted for paediatric use, it can also be used for any procedures that require minimal inversion. In contrast, Intuitive’s technology stands accused of being too large for paediatric use and limited to urological applications. Other technology standouts for KidsArm include built-in telesurgery and imaging guidance initially focused on MRI.

Unlike Intuitive, development of CIGITI’s technology is still at the relatively embryonic stage, although a clinical working model is expected to emerge within two years. Backed by C$10 million in funding awarded by the Canadian government in 2010, Phase I of the programme, which started in 2009, has been focused on the development of technological innovations such as in the areas of advanced complex surgical delivery, mulit-modality fusion and real-time image guidance and creation of surgical simulation models.

Whilst this process is still continuing throughout 2012, Phase II of the programme, which started in 2011 and will last two years, involves a critical analysis of the KidsArm technology. This includes a review of minimally-invasive surgery (MIS) vs robotic surgery, a look at fusion and real-time image-guidance and improving the accuracy of the surgical system and simulation modules. Analysis will also be carried out at high-frequency imaging for foetal intervention procedures. All this work, if it continues to impress, is likely to lead to commercial and clinical opportunities for the technology from 2014 onwards.

So why is a hospital taking such an active role in product development and when it’s primary role is providing healthcare provision? Aside from the revenue earning potential of creating IP assets that can be licensed or used for start-up companies, the collaboration stands to general high-end manufacturing jobs, healthcare and research opportunities and substantially improve education available from school students and rising all the way up to medical staff, both in Canada and the province of Ontario.

For SickKids, such efforts help to improve patient care and the quality of healthcare provided by the institution by introducing novel image-guided tools into the paediatric setting. So far, in just two years, SickKids/CIGITI has created a number of positions across all levels of academia, filed for three patents covering surgical tools (including one for KidsArm), secured C$25.8 million in research funding, signed a licensing agreement with Medical Modeling relating to patient-specific cranial facial models and templates and forged tentative links with venture capitalists.

Article source: Medical Industry Week – supplied by Lawrence Miller, editor.

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GE/UPMC bids to change the face of pathology

The Medical Technology Blog

Welcome back to our Canada Healthcare series from the Medical Technology Blog,

GE Healthcare

GE Healthcare has profiled efforts it is making to change the way in which pathology imaging is conducted across the globe. The opportunities, should its technology gain acceptance, looks set to deliver the final blow to an analogue-based procedure for looking at images that has largely remained unchanged over the past 120 years.

University of Pittsburgh Medical Center

Omnyx is a 50:50 digital pathology joint venture set up in partnership with the University of Pittsburgh Medical Center (UPMC) and GE. The business has chosen Canada as the location for its first Global Pathology Imaging Centre of Excellence (PICOE), located in the MaRS Excite campus in Toronto. The JV is investing C$7.75 million in the health technology programme, which is also backed by a C$2.25 million contribution from the Healthcare Technology Exchange (HTX). It is hoped that further collaborative R&D partnerships in the area will boost the over research figure by an additional C$7.2 million over the next three years.

In some ways, Canada represents ideal territory to test the benefits of digital pathology, mainly due to the sheer scale of the country and low population dispersion. The digitisation of pathology opens up the potential for remote medical centres to send contentious images fast and directly to regional centres and right into the lap of experienced pathologists.

The process would not only increase the number of images processed by pathologists, but it also comes as the healthcare environment suffers from a shortage of pathologists that has limited the capacity to get the most out of the resources available. GE believes that Canada has the level of awareness and political will to do something to fix the problem. The large regionalised healthcare system also lends itself to the Omnyx model, along with the clinical knowhow, and the number of trained clinicians able to support the rapid introduction of such an advanced technology.

Buoyed by an “ideal collaborative framework”, PICOE has government support, institutional backing community, including some of the biggest universities in Canada, as well as potential clinical partners such as the Ontario Institute for Cancer Research and hospitals. PICOE is not just about developing a new technology, but investigating how to take the system and deploy it across a nationwide, regionalised healthcare environment. The company says it benefits from the collaboration as it can apply this technology and methodology to other global healthcare markets.

Whilst PICOE is currently a research-use only tool that GE hopes will convince pathologists to ditch the old, cumbersome method and embrace a new form of working that will meet the challenges of modern pathology. As with all technologies that require a change in working techniques, it’s not a straightforward task that will be adopted overnight. However, the combination of innovative research and the influence of such a large business in GE Healthcare, could give PICOE a toe-hold in an industry that needs to be dragged kicking into the modern age.

The patent-pending Omnyx Integrated Digital Pathology (IDP) system includes whole slide scanners, pathologist and histology workstations and an integrated software platform that aims to deliver the scale and reliability for demanding pathology departments. The combination of a workflow server and digital archive combine to offer benefits such as: real-time image access from anywhere; the ability to automatically retrieve case information for individuals; image storage and retrieval; and, most notably, low entry cost and scalability.

The University Health Network is the first site to participate in the PICOE programme and will conduct both beta and clinical testing for primary diagnostics. It will also help to formulate guidelines and best practices for model pathology.

As of November 2011, UHN had scanned and reviewed over 2,000 slides as part of its testing activities.  This testing process started with five pathologists but within seven weeks had been expanded to 22 pathologists from nine specialty areas. A total of six Omnyx VL4 scanners, forming part of the DIP package, have so been shipped to beta customers worldwide.

At its core, the PICOE approach represents a “holistic” approach to pathology imaging, including scanners, servers, healthcare information systems and workstations, to provide a means of getting information out to the virtual community. GE will act as the exclusive distributor for Omnyx, and provides the implementation, training and support for the Omnyx Integrated Digital Pathology system.

Article provided by Lawrence Miller, editor of Medical Industry Week.

Next in the series….

…..Sick Kids takes centre stage in robotics, imaging and simulation technology development

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Medical Futures & Cipher Pharmaceuticals in Tramadol Deal

The Medical Technology Blog

Medical Futures to gain a slice of Canadian tramadol market through deal with Cipher

Medical Futures, a Canada-based pharma company, has signed a pact for Cipher Pharmaceuticals to distribute Durela in Canada. Patent-protected Durela is a once-a-day formulation of tramadol for the treatment of moderate- to moderately-severe chronic pain in adults. It was approved by Health Canada in August and has immediate- and extended-release properties.

As for the particulars of the distribution deal, Cipher will receive an upfront payment from Medical Futures of C$300,000, and could also be eligible for future payments, dependant on net sales milestones. Also, Cipher will get its hands on a double-digit royalty on new sales. Cipher has further responsibily for product supply and manufacturing, which will be taken care of by its supplier, Galephar Pharmaceutical Research.

Medical Futures’ CEO, Colin Campbell, says he is excited to offer Durela in Canada, believing that the product “strengthens and demonstrates [Cipher’s] commitment to providing top tier solutions to the Canadian market”. It appears Cipher is equally delighted with the deal, as it provides valuable royalty revenue to the company. Cipher also recently shook hands on a US$5.5 million US distribution deal for Durela with Vertical Pharmaceuticals, with the former set to receive a payment of US$1 million on the first commercial sale of the product.

With sales of over US$60 million in 2010, the seemingly robust Canadian tramadol market looks like a sure thing for both parties. Medical Futures plans to launch Durela in the first quarter of 2012.

Thanks to Sophie Bracken for this article, Sophie edits Espicom’s business publication Drug Delivery Insight.

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Canada’s Healthcare Support System – Medical Industy Week Special Report

The Medical Technology Blog

Welcome back to the Medical Technology Blog. After a bit of a hiatus, we have a special report compiled by Lawrence Miller (editor of Medical Industry Week) after a recent trip to Ontario, highlighting Canada’s healthcare system. The report features the agencies that are supporting business, and the companies that are benefiting from it. The first is a long piece so I have split it into two articles, please read on…

How private and public sectors are working together to boost Canada’s healthcare system

The Canadian med-tech sector has evolved rapidly to become a priority for Ontario as part of an overall goal to build innovation capacity in the province and establish the region as an “outstanding place” to develop advanced medical technology. It’s an ambitious goal but, over the four busy days, Medical Industry Week was shown how these initiatives are being put in place and position the country and province for significant growth potential. So why the need for change? To do answer that one has to look at Canada’s position as a relatively small local market that lies right on the doorstep of the world’s largest market for medical devices – the US.  Historically, the pattern of implementing healthcare procurement decisions in Canada, where, as Dr Tom Corr, President and CEO of the Ontario Centres of Excellence (OCE) acknowledged, were overtly focused on  small deals with the result of haemorrhaging investment in Med-Tech innovation – that is converting R&D into products and technology – over the past five to ten years.

Given the recent global economic meltdown, the Ontario Province’s Med-Tech cluster is comparatively healthy.  It’s one of the reasons why Ontario as a province is so keen on the Med-Tech. The sector has high value and boasts recession proof nature, and stats from 1997 to 2006 have shown that the medical devices market performed favourably compared with the likes of pharmaceuticals and other higher-profile industries such as IT. Med-Tech companies also have “very good returns” because of the shorter innovation cycles (third less than pharmaceuticals), lower investment requirements, high margin products, high M&A activity as companies are sold in bite size chunks.

There are 1,100 companies in the Canadian Med-Tech field, of which 700 are manufacturers. Clusters of expertise have evolved around universities and teaching hospitals such as Waterloo, London,  Ottawa, as well as Thunder Bay and Windsor. Southern Ontario is the third largest medical R&D cluster in North America when taking into account the universities, health science centres etc, whilst volumes of trials and treatments range third largest in North America.

Ontario has 13 million inhabitants, C$46 billion public healthcare system and C$20 billion private system. Historically, however, the healthcare system itself hasn’t had a dedicated R&D arm.  So whilst lots of R&D has been made in the products, but not directly by the payer for the payer. Current moves are aimed at changing this process/environment, with a particularly eye on healthcare IT, diagnostics, home healthcare and medical imaging.

Med-Tech is still a challenge, especially in view of a major decline in funding and participation in recent times of venture capital investors. Angel life science investment has also dropped. This has prompted the policy makers  in the province of Ontario to start a C$400 million government backed venture capital funding initiative, and recently unveiled plans for a C$400 million tax credit initiative.

Most seed capital comes from Angel investors, whilst a fraction comes from government agencies and venture capitalists. At this stage of development, most  Med-Tech companies need it to support clinical trials, approvals, reimbursement studies and outcome trials (healthcare assessment). The Ontario government says that although money is provided by countries worldwide in support of R&D it is not always applied in the most effective areas. It’s a viewpoint that not only looks outwards but is also highly critical of its own perceived failings.

Ontario, and Canada as a whole, has kept on churning out new companies but recognises that it may not have helped them financially in comparison to countries such as the US.  Overall R&D spending has mainly been dished out in the form of tax credits. These help going concern companies, but start-up companies are less keen because they have to earn the money to get the money. The push for Ontario going forward is to refocus from pure R&D funding to translation and commercialisation and direct investment.

Government Funding

Funded by the Government of Ontario, the OCE’s mission statement is to create jobs in the province. Employing around 30 business development people, split in three regions – South West Ontario, Greater Toronto and North East Ontario – the OCE has a clear a focus on tapping into ideas that emerge from both universities and companies.

OCE has a clear criteria in awarding its grants. For every C$1 of funding it provides, the applicant must also at least match this funding. The goal is to support research at the very early stage and then pass it on to other organisations such as like HTX and Mars Excite. This “synergistic” approach with HTX aims to ensure the organisation work alongside each other rather than overlapping.

In total, 95 per cent of OCE funding is targeted within four industrial sectors, of which healthcare comprises 25 per cent. All decisions are externally verified and money is given based on milestones over a time period.

In 2011, OCE secured C$30 million from provincial government and C$5 million from the Federal government, along with industry matching contributions of approximately C$40 million. The initiative claims to have secured over 2,000 jobs were created by OCE initiatives in 2010. Encouraging spin-offs from university graduates/students

In practice, industry often approaches government and OCE employees also work with universities, but ensure that the university works with the company on the project. In fact, the commitment of the OCE is a key attribute to its activities. In some cases, the OCE may even help subsidise some of the salary of medical students as they gain a foothold in the industry for the first year or so, which has resulted in around 75 per cent of these students being offered permanent positions with their employers.

OCE also funds colleges and institution’s with Technology transfer grants. Dialogue with professors helps to identify IP and research that may offer significant opportunities within industry either in terms of a potential start-up or for licensing to larger established businesses.  OCE provides funding and as the technology matures within university helps to look at the issues involved in transferring them to additional programmes.

The OCE’s Social Innovation Programme (SIP) provides a valuable link between industry and not-for-profit organisations and helping the two conflicting parties work to together. In these cases, the non-profit company would hold the IP, and the OCE will provide cash in partnership with companies to make the programme a reality….

This article, and the rest of the articles to follow next week in this series, have been kindly provided by Lawrence Miller, editor of Espicom Business Intelligence’s excellent publication Medical Industry Week and medical newsletters teamleader.

Please come back to read the rest of this article tomorrow, and more in this Canada Healthcare System series this week.


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