Innovator Spotlight: Giovanni Ferrara

Concerned with information gaps and wait times with the traditional doctor-patient follow-up model, Giovanni Ferrara, professor of medicine and director of the division of pulmonary medicine at the U of A, is harnessing digital tools and integrating wearable technology to improve how patients are monitored and cared for. This week, hear more from Giovanni on his plans to move this work forward.

How do you describe your work to people who don’t work in your field?

The intersection of clinical practice and medical research presents a unique opportunity for physicians to improve patient outcomes, particularly in fields such as respiratory medicine, where chronic and progressive diseases pose significant challenges to patients first, but also to their caregivers and healthcare providers. 

As a physician, my primary duty is to work closely with patients, guiding them through their disease journey, a process often fraught with difficulties due to poor prognoses. The central question that drives my professional endeavors is: How can we improve the quality of life for patients and mitigate the burdens they face due to their illnesses? 

This inquiry not only shapes my daily clinical practice, but it is also the core question for my research. In medical research, the aim is, in essence, to ameliorate the patient journey by innovating treatment options and improving disease management strategies for those with severe and often incurable conditions.

My early career was marked by a profound interest in understanding and addressing the unmet needs within the realm of medical research. My interest was sparked during my initial work with tuberculosis. The challenges presented by tuberculosis (such as the tolerability of treatment regimens and the need for faster diagnostic tools) highlighted the importance of research in developing new solutions that are both effective and safe for patients. 

The crux of medical research is to validate new strategies and interventions and ensuring those strategies and interventions confer more benefits than risks to patients. This fundamental principle guides my work as I strive to directly address patient care issues through rigorous research methodologies.

What’s one big problem you want to solve through your work?

A significant dilemma in medical practice is the limited time available for patient interaction, which often leaves physicians with an incomplete picture of the patient’s health trajectory between clinical visits. This concern was particularly pronounced for me, given my propensity for anxiety regarding the potential adverse effects of my interventions. Medicine inherently involves some level of risk, and the goal is to achieve a high benefit-to-risk ratio. Yet, the persistent uncertainty about patient outcomes during the intervals between consultations prompted me to seek innovative solutions. The traditional model of periodic/planned patient visits seemed inadequate in capturing the dynamic nature of my patients’ journey, which, especially when I was an early-career doctor, would cause high anxiety for me.

The advent of wearable technology, such as the Apple Watch in 2013, catalyzed my exploration of continuous patient monitoring as a potential solution to this gap in medical practice. I envisioned the utility of wearable devices in collecting real-time data on patient activity, including their heart rate and other health parameters, thereby providing a more comprehensive view of the patient’s condition over time. The ongoing digital revolution, with new big-data analytics and high computational power, offered the opportunity to make continuous patient monitoring more than an idea. New technologies could be instrumental in identifying digital endpoints, such as identifying markers that could predict disease trajectories and inform clinical decision-making before the next scheduled patient visit. My most recent research has been driven by the hypothesis that such technology could revolutionize patient monitoring, offering a proactive approach to disease management.

To date, my research endeavors have included conducting two clinical trials aimed at evaluating the feasibility of integrating wearable technology into patient follow up. These trials have provided valuable insights into the potential of digital health tools to transform patient monitoring and improve clinical outcomes. While the journey of integrating such innovations into everyday practice is ongoing, the preliminary findings are promising and suggest a potential paradigm shift in how we approach patient care in chronic disease management. 

What does the word “innovation” mean to you?

Well, that's a very good question because we live in a time where people are enthusiastic for change, and there is a strong push towards digital innovation. In our rapidly changing world, digital innovation is at the forefront, fundamentally altering our lives, as seen with the shift to remote work during the pandemic. However, innovation in medicine requires more caution. It's crucial to ensure that new approaches are both effective and safe for patients — especially as history has shown instances where unvalidated medical interventions have caused harm. Therefore, while innovation is essential, and it is the main goal in research, it must be methodically implemented only after thorough validation. Bill Gates says that innovation has to be introduced discreetly, almost behind the scenes. Unlike digital platforms, where innovation can enter our lives gradually and be improved over time, medical advancements must be carefully and systematically assessed to prevent harm.

What’s been your biggest a-ha moment — in life or work — so far? 

Professionally, my "aha" moment came during my first year of residency when I realized much of our medical practice was experience-based rather than evidence-based. This realization coincided with the global spread of evidence-based medicine and the work of Cochrane in the late 1990s and early 2000s. 

Working with exceptional mentors taught me the importance of rigor in medical decision making and how to discover and address relevant questions in research. One of my mentors once said to me, “it takes the same time to do crappy work or to do wonderful work. It's just up to you to decide what you want to do.” 

Personally, there have been many “a-ha” moments, of course. I think it's part of growing up and developing as a person. This could sound like a clichè but meeting my wife and the birth of my two children profoundly reshaped my perspective on life, my career and my responsibilities. 

How do you or your team come up with your best ideas?

My research is rooted in medical practice and patient observation, but our best ideas emerge from collaborative brainstorming sessions with a multidisciplinary team. I am lucky to work with people with different skill sets, including computing scientists, big data analysts, allied professionals and physicians at different stages of their careers, from trainees to senior faculty. Each team member contributes their unique perspective, enriching our collective understanding and enhancing our research projects.

What’s your favourite thing about working at the U of A? 

While I jest about the weather, I truly appreciate the supportive and collaborative environment at the University of Alberta and in Canada. Colleagues and people working at the U of A are in general very friendly, supportive and collaborative, so it's easy to establish professional collaborations and develop projects together. The university offers excellent facilities and abundant opportunities for professional development and research. Edmonton itself is a welcoming, family-friendly city that combines the qualities of a large metropolitan area with ease of living. And I became a great fan of the Oilers!

Do you have a role model at the U of A? How have they influenced you?

I spent much of my career in Italy and Sweden, and I was always lucky to benefit from great mentors who valued and taught me that honesty, excellence in clinical practice and rigor in research are the main pillars of our profession. I moved to the University of Alberta almost six years ago to take on a leadership role with my division, and I continue to benefit from mentors with similar qualities. Dean Befus has been a kind advisor and a valued friend, and in research, Lawrence Richer and Evangelos Michelakis have significantly influenced my work, especially in digital health and, more recently, climate change.

In Shape: The University Strategic Plan 2023-33, the University of Alberta commits to having a positive impact on our students and staff, our communities, and the communities we serve here in Alberta and around the world. How does the work you do create impact?

During the challenging years of the COVID-19 pandemic, my primary focus has been on ensuring the well-being of both university and clinical staff. The transition to normalcy post-pandemic has required significant adaptation, particularly for professionals with high workloads, such as physicians. In my leadership position, I have prioritized providing support and securing the well-being of my staff to the best of my ability.

Additionally, I have endeavored to support and guide students, residents and junior faculty who have recently embarked on their careers, helping them navigate their early professional development.

What’s next for you? Do you have any new projects on the horizon?

In research, especially in fields like medicine, it's important to tackle new challenges and make a positive impact on people's lives. This is especially true for our patients who rely on us for their health and well-being. In my field (respiratory medicine), climate change has become a significant issue. Climate change affects the air quality we breathe. Air pollution (linked to climate change) is now recognized as the fourth leading risk factor for death globally. It comes right after high blood pressure, uncontrolled diabetes and high body mass index. In the past couple of years, we've experienced many days with poor air quality due to wildfire smoke, which posed a high risk to patients with respiratory disease. At the same time, our population is getting older, which means more people are vulnerable to these health risks and may face new problems and challenges. I would like to harness digital tools to better monitor patients and understand their journeys, integrating environmental data to assess climate change and pollution impacts and develop adaptive strategies.

Innovator Spotlight is a series that introduces you to a faculty or staff member whose discoveries, knowledge and ideas are driving innovation.

Do you know someone at the U of A who is transforming ideas into remarkable realities? Maybe it’s you! We are interested in hearing from people who are helping shape the future, improving quality of life, driving economic growth and diversification and serving the public. We feature people working across all disciplines, whether they are accelerating solutions in energy, shaping the evolving landscape of artificial intelligence or forging new paths in health and Indigenous leadership.

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