What started as a passion project to create a safe space for youth to share sensitive information has led to an incredible journey for former ER physician and specialist in adolescent medicine Dr. Sandy Whitehouse. Now, nine years after launching her Vancouver-based startup – Tickit Health Ltd. – to advance the idea of using digital empathy to collect personal data, she’s on a mission to take the technology mainstream.
“Collecting information is often at the front door of any organization,” said Dr. Whitehouse, Tickit Health founder and chief medical officer. “What I would like to see is that people feel safe and comfortable interacting with organizations because their digital front door is welcoming.”
The idea was born from Dr. Whitehouse’s clinical experience. Often working in chaotic scenarios where decisions were made quickly based on the information at hand, she realized she was missing out on critical, sensitive data that had a direct impact on care.
What sets Tickit Health’s data collection platform apart from other online assessment or survey tools is its ability to recognize and overcome communication barriers related to literacy or cultural and socio-economic differences.
Four pillars of empathy – engagement, trust, confidence and empowerment – are embedded in every solution the company builds, regardless of the population being surveyed.
The goal is to close critical communication gaps in healthcare, particularly when it comes to questions about gender, racial inequality, social determinants of health and mental health.
Gaining truthful answers about delicate issues – such as drug use, sexuality, poverty and other concerns can sometimes be difficult to achieve. For its part, Tickit Health has found ways to do this, by gaining the trust of patients.
“It’s important to think of people’s contextual environment, either the way you’re asking the questions, why you’re asking them or how you’re going to be using the information,” she explained, noting that the company’s digital empathy framework can be applied wherever healthcare intersects with community care, including social services and schools.
“People are sharing this personal information with you, and you need to think about what you can give back to them for the privilege of receiving it,” she added. The greatest benefit, of course, is that clinicians can discreetly help solve the patient’s problems, once they discover if there are emotional or physical issues that are troubling a person.
Tickit Health prides itself on a system that is more efficient in collecting information than general survey solutions and has demonstrated far better results in collecting critical data – outperforming others both in terms of quantity and quality of the information obtained.
The platform is built to gold standard encryption and security protocols and complies with leading privacy standards, including SOC2, HIPAA in the U.S. and PIPEDA in Canada. It also includes application programming interfaces (APIs) so that any data collected can be exported to other systems, such as electronic medical records, customer relationship management systems or learning management systems. At-a-glance analytics are provided through a dashboard interface.
The company’s early success working with Boston Children’s Hospital and Seattle Children’s Hospital to develop youth risk assessment tools has led to steady growth.
Today, Tickit Health has 15 full-time employees and is partnering with more than 500 organizations in Ontario, B.C., the U.S. and Australia, helping them to improve workflow and data collection efficiency, increase response rates, improve data accuracy and reduce the risk of missing critical data.
King County, Washington, partnered with Tickit Health and Seattle Children’s Research Institute in 2018 to launch a universal digital screening program in 50 middle schools. Referred to as the School-Based Screening, Brief Intervention and Referral To Services (SBIRT) program, it not only uses validated tools to detect symptoms of at-risk behaviours, but also includes carefully crafted indicators such as, “At school there is an adult who really cares about me,” or “Others have said that I am good at …” to gather information about more protective factors such as strength and resiliency.
Other systems didn’t have the same level of sensitivity or specificity as Tickit Health. “We looked at all of the validated screening tools, and they all looked for problems. Our kids are not just a set of problems and symptoms,” said King County school-based SBIRT program manager Margaret Soukup, noting that Tickit Health enables the screening “to have a deeper reach.”
The screening is presented as a health and wellness initiative and it’s up to each school to select at which grade to administer it, ranging from grade 6 to grade 8. More than 8,000 students participated in the program in its second year and the county is on track to reach 5,000 students this year, despite the fact that most schools transitioned to online learning during the pandemic.
Using Tickit’s dashboard, school counsellors monitor student responses in real time. A green flag means no intervention is required, a yellow flag indicates the need for a brief intervention of a non-urgent nature, and a red flag alerts to concerns that must be addressed immediately or within 24 hours. According to data from the 2019-20 school year, nearly half of participating students received brief intervention, and 15 percent were referred to services.
“This is the beautiful part of Tickit,” said Soukup. “The students are taking the screener and in real time, the counsellors see the results in the backend… so they can triage and be really efficient.”
Since introducing the program, counsellors have uncovered a vulnerable group who would normally be extremely difficult to identify: internalizers, those students who appear to be doing great on the surface but are actually harbouring unsafe thoughts.
“Counsellors are just unbelievably grateful for the screener because for whatever reason, some of these students will really say what’s going on,” said Soukup.
Bayshore Specialty Rx of Mississauga, Ont., is another Tickit Health user getting to know its customer base better. As the preferred pharmacy for the Manulife Specialty Drug Care Program, Bayshore needed a more efficient way to identify and monitor the health concerns and progress towards health goals of its patients.
Prior to implementing Tickit Health, information was primarily gathered over the phone as part of a regular check-in by nurses, and even though the intent was to revisit patients at six months, follow-up surveys were easily missed.
“It was very difficult for me to demonstrate that we actually did have an impact on health outcomes,” said Vincent Ng, director of the Manulife Specialty Drug Care Program at Bayshore.
Working with Tickit Health, Bayshore created a digital health assessment survey that is sent to patients prior to their first phone call with a nurse, prompting them to answer questions about their condition and overall wellbeing.
“This enables our nurses to have a more productive conversation with the patient,” said Ng. “Instead of spending 15 minutes going through the mechanics of filling out a survey, they spend that time talking about the implications of responses to the survey. It’s a better use of their time.”
Online responses are integrated directly into Bayshore’s customer relationship management system, and follow-up surveys are automatically triggered six months later.
When he noticed that patients were dropping off at one point during the survey, Ng worked with the Tickit Health team to tweak the look and feel of the online survey so that it would encourage them to finish. The end result is better data, which in turn enables Ng and his team of data analysts to run detailed reports on patient outcomes.
“We’re a team of nurses, pharmacists and clinical people, so being able to make a difference is meaningful to us,” said Ng. “To have a tool that helps us to provide hard numbers – these are the facts, we are making a difference – really helps us as a team in terms of morale and being energetic about work.”
Though she didn’t imagine her idea would carry her this far, Dr. Whitehouse continues to be inspired by how people are choosing to apply the digital empathy framework, including the company’s recent work with indigenous groups.
“Over the past 10 years our world thinking about historically under-served populations is evolving and changing, particularly around gender, inequities with BIPOC populations, with social determinants of health and also the huge recognition of the impact of mental health,” she said. “The concept and issues around stigma, and discomfort around sharing sensitive information has been a real issue, and people are starting to realize how important it is to uncover it.”
– Diane Daniel, Canadian Healthcare Technology