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and pay for the treatments already in place, there is little capacity—or appetite—to fund and implement something new. Heilbron is undeterred. He's a serial innovator (he was instrumental in introduc- ing the use of CT scans in cardiology), and while he explains this by saying, "I'm old, so I have time on my hands," the comment is hard to take seriously. Even at 63 (not as old as it used to be), Heilbron gets up early three days a week to ride his bicycle 50 kilometres. After that, he gets to work, seeing patients, managing as co-director of the Advanced Cardiac Imaging Program at St. Paul's Hospital in Vancouver, or teach- ing as a clinical associate professor for UBC. In his spare time, he's also vice-president and head of cardiac testing at LifeLabs, Canada's largest private-sector medical laboratory, so he knows both the public and private systems. Still, the challenge of overcoming the inertia of B.C.'s medi- cal system would be an impossible uphill climb without, he says, the path-clearing assistance of Vikram Devdas. Devdas is director of medical technolo- gies at Providence Health Care Ventures. PHC Ventures uses what Devdas describes as "a small fund," including, for example, the $1 million that St. Paul's makes on its parking lot every year, to leverage the out- put of the many researchers and clinicians in the Providence system. As an innovation hub and business accelerator, PHC Ventures works to help health professionals develop new drugs, devices, AI-driven tools and other innovations to improve health care directly and/or to make money to augment the income that Providence gets from the provincial government. "We help incubate companies," says Devdas. "We connect the dots. We get the right team together and raise the funding." It's work for which he is well trained. Devdas is one of those people who reminds you why it's a good idea to welcome bril- liant students into the Canadian post- secondary system. He came from India in 1989, at age 17, and graduated from UBC five years later with a degree in computer engi- neering, joining what was then a 30-person high-tech startup called Sierra Systems. In five more years, by which time Devdas had also completed a master's degree in electri- cal and electronics engineering at UBC, PMC Sierra was the second-largest semi-conduc- tor company in the world, behind Intel—a run-up that had made Devdas so wealthy that he decided to retire. But not for long. He has since spent his career enriching his education (at Harvard, Stanford and Cornell), starting four companies and act- ing as an angel investor, specializing in life sciences and bioscience. So when PHC Ven- tures recruited him in November last year, he says, it seemed like the perfect opportu- nity to give something back. Devdas also notes that the ECG AI algo- rithm offers an excellent project for PHC Ventures. Although a U.S. company called Anumana has commercialized Nosewor- thy's innovation and won FDA approval for its first application—identifying a heart complication called a low ejection frac- tion (LEF)—the AI still has to be proved in Canada. So, with PHC Ventures' support, Heilbron and his colleagues are setting up a pilot project: a small study to prove the concept and generate the data neces- sary to win Health Canada's approval for a complete rollout. The results could be transformative, Devdas says. LEF describes a kind of heart failure in which the left ventricle fails to pump out enough oxygenated blood. A normal ECG can give a hint that it's happen- ing, but then a patient will require a refer- ral for an echocardiogram to confirm the diagnosis, sometimes waiting a year to 18 months. If, instead, someone at St. Paul's could pop the ECG image into the cloud for a $5 review by Anumana's ECG-AI LEF algo- rithm, Devdas says, "you get a diagnosis in hours instead of months, and you haven't wasted tens of thousands of dollars. You also leave echocardiogram machines and staff available for people who really need them. You use resources more efficiently." There are also a host of other potential ECG AI applications, including one that has already been developed by a UBC cardiol- ogy resident named River Jiang, whom his UBC supervisor, Heilbron, describes as "a superstar." Jiang is something of an AI hobbyist. He says that even in high school in Kitchener, Ontario, he enjoyed programming and web development: "It was a toss-up whether I would study comp sci or biology in univer- sity." Biology won, but through his under- grad, his MD and his residencies in internal medicine and cardiology, he's watched the development of AI, shadowing post-docs in the UBC electrical and computer engi- neer lab and teaching himself enough cod- ing that he could create and validate an AI model. ("There's so much information available online," he says.) Hearing about Jiang's expanding exper- tise, Andrew Krahn, a professor and head of cardiology at UBC, challenged Jiang to do something with long QT syndrome, a hereditary condition that causes tachycar- dia—accelerated and uneven ventricular contractions. It often strikes people in their 30s and, under normal circumstances, the first presenting symptom can be sudden death. So Jiang wrote a new ECG algorithm on his laptop, accessing a dataset through the cloud to train his model. It's now being validated with information from clinics across the country associated with the Hearts in Rhythm Organization ( HIRO), which Krahn founded in 2016 and which specializes in hereditary conditions. The bottom line, says Heilbron, is that AI is "so powerful." Using it to review ECGs alone, "it will promote early identification, better diagnoses, better access to therapy, less inappropriate testing, less waiting and frustration," he maintains. And across the system in general, Heilbron adds, "AI will change everything in medicine, in a good way." 24 B C B U S I N E S S . C A S E P T E M B E R 2 0 24 "YOU GET A DIAGNOSIS IN HOURS INSTEAD OF MONTHS, AND YOU HAVEN'T WASTED TENS OF THOUSANDS OF DOLLARS."—Vikram Devdas, director of medical technologies at PHC Ventures S C I E N C E

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