“When Health Gets High Tech” Transcript

MICHELLE ROGERS
We still have structures that were not set up to help people in the ways that we think technology can.

MAURICE BAYNARD
Welcome to Drexel’s 10,000 Hours Podcast. Our goal is to mine the stories behind our region’s innovators, inventors, and thought creators. We’ll be talking to experts in subjects from fashion to neuroscience to find out what lies behind the passion for their work, the inspiration for their ideas, and the motivation for their creativity. I’m your host, Maurice Baynard.

Michelle Rogers is an Associate Professor at Drexel University’s College of Computing and Informatics. Her research focuses on how people interact with and use information technology in complex settings. Her most recent work focuses on information technology and user experience within the health care system.

MAURICE
Hey, Michelle.

MICHELLE
How are you today?

MAURICE
I’m doing really good. Welcome to my Zoom room.

MICHELLE
Thank you.

MAURICE
It’s great to have you. It’s great to record with you in the middle of the pandemic.

MICHELLE
Yes.

MAURICE
I’m super interested to know where you grew up and if that had any impact on how you thought about the world and what you decided to do in it?

MICHELLE
I guess it did. I grew up in Brooklyn, New York– and as I tell people– before Brooklyn was cool. It was more when Brooklyn was “Brooklyn,” you know, where It was more the Brooklyn of a more rougher time. Let me just say it that way. I graduated from public schools in Brooklyn, had a great experience.

MAURICE
You went to a really fancy magnet high school, right? Right?

MICHELLE
Well, it wasn’t really fancy. At the time, there was a test that you take for the science high schools in New York. And actually, my school was the lowest of the three. So there were like three–

MAURICE
OK so wait, you weren’t at Bronx Science.

MICHELLE
I was not at Bronx Science. I was not at Stuyvesant.

MAURICE
You were not at Stuyvesant. You were at the other one.

MICHELLE
I was at Brooklyn Tech, yes.

MAURICE
There we go. OK. There it is.

MICHELLE
I guess the thing that is interesting is that Brooklyn Tech had been all boys until 1977. It was before I went. So I can say that. I’m not quite that old.

But there were not that many females that went there. So at the time, I did not want to go. Because everybody knew that it was one, not a lot of girls there. And two, they were known to be very nerdy.

So I think that while there, I did experience being the only one. And so I guess that kind of helped me when I went to college in doing science and technology because it wasn’t odd for me to be the only or one of few in a classroom.

MAURICE
That’s super interesting. What did you major in when you went to college?

MICHELLE
Well, when I went to college, I was dual-degree engineering, actually. I was an electrical engineering major. And actually at Brooklyn Tech, you have to pick a major.

MAURICE
Oh, wow.

MICHELLE
I did not pick engineering, though, because there were very few girls in that major. And at the time, I didn’t want to totally be surrounded by dudes at all times. So I chose graphic communications, which is really interesting now that I do human computer interaction because it does draw back on a little bit of what we initially learned back then. But I do think it’s interesting that even then, it was not a lot of women in my classes at that point.

MAURICE
So you’ve been thinking about women in technology and their role in technology in male-dominated fields for a very long time, at least–

MICHELLE
A very long time.

MAURICE
–since you were a teenager, which is why you chose an all-women’s college to go?

MICHELLE
[LAUGHS] exactly. No, actually I did not want to go there. I did not want to go to Spelman when I was looking at colleges. I ended up going there primarily– my dad recommended I go there. And up until April, I was going to North Carolina A&T. That’s where I thought I wanted to go. I thought that’s where I was going.

And then I got into Spelman and something said, aww, this might be really interesting. And when we got there after my freshman year, I just knew it was the best place ever. Right? I just knew it was the place to be. So I was really glad I made that decision.

But then when I did dual degree– so part of dual degree is you go for your three years at Spelman. Then you do two years at an engineering school. But those three years were really difficult because of the physics and the math. That took a lot of people out. Really a lot of women who– in high school, they had been top of class. When they got that first D in calculus, it was a shocker. And so a lot of people started out dual degree and not many of us finished.

MAURICE
So we live in a world that is full of machines, maybe moreso now than 20 years ago even. Everything is mediated, including the conversation that we’re having right now, which could not have happened 20 years ago. I mean, we’re in the midst of a pandemic, and the world goes on because we’ve already built an infrastructure where we can all just plug in machines.

I just wonder, as you walk through the world, and you bump into all of these people and see them interacting, are you generally, from your lens, frustrated like, oh, it could be so much better? Or are you encouraged like, wow, look at us. We are really rocking on our human-machine interaction?

MICHELLE
So on the most optimistic days, I am excited about what we can now do. Like I just got an iPad literally a couple of months ago for a research project. So my first time FaceTiming was a couple days ago. So I think that is fantastic so my mom can talk to her grandkids. And we can FaceTime and that’s wonderful.

But at the same time, I also am seeing the limitations of everything that we do. Like it’s really, really frustrating that these machines don’t talk to each other. That we’re so focused on keeping the profit margin of our little company that I can’t make an interface for you to talk to this other company.

So even though we’re having all these wonderful things with being able to have first responders take care of people, ultimately, they’re doing that outside of any information system. Because if they tried to do it where they want to try and get your record from your hospital, they could not do it just because, well, I can’t share that information because it’s at Penn versus it’s at Hahnemann, when it was still open.
You know, like just– we just can’t connect them. And that, to me, is very frustrating.

MAURICE
So you mentioned this, and I’d love to talk to you about your work with clinical information systems. So specifically, the way in which information flows throughout the health care system.

MICHELLE
So originally– as you were saying, we couldn’t do this 20 years ago. So when I first got my dissertation, my dissertation work was on how the implementation of electronic health records was changing the work of people in clinics. So at the time, it was when EHRs first came out. They had clerks entering information because they were trying to get the paper into the computer.

And these clerks, this was outside of the realm of what they had been trained to do. They don’t exactly know all the meanings of everything. They are not clinically trained. So it was a lot– a lot of push-back, primarily because it was just outside of their work. So part of my dissertation was just trying to understand how it changed their work and then, how are we going to maintain that?

And so, you know, over the last 20 years, we’ve had several presidential administrations, several things, from top down, trying to push people toward work making information available, wherever it is. And so most of the work that I did was looking at, OK, how can we design this interface so that doctors, and nurses, and everybody else that looks at that information gets it when they need it, where they need it? That it’s accurate, and that it’s not telling a story or hiding a story?

And so what we’ve found, in some of the work that I’ve done over the years, is that one, that there are ways that, because programmers– for the most part, the computer science folks that are designing these systems work in the IT side of the house. They don’t work in the medical side of the house. So some decisions they make are based on either financial decisions, or things that they like, or they design interfaces that they like, or what they think would work.

And so part of what we– one of the biggest things, actually, we did at the Department of Veterans Affairs was just getting the computer science folks to understand that you need to let somebody clinical look at this, and let them tell you whether or not this supports what they do. Or are you making their job more difficult, and thus you’re getting bad information into this system? So that was one of the things we looked at.

And then as we move forward, since I’ve been at Drexel, one of the projects we looked at was really interesting, is they had a group, a family group that would meet, of expecting mothers and fathers, that would meet at a clinic over in North Philly. And part of that group was helping the women understand what to expect while they were pregnant.

And so the group would meet every week. And there’s a group of statewide public health departments that would send emails– it was called Text for Baby. And it still exists today, and you could sign up for Text for Baby. So based on the gestational age of your child, you would get a text about, oh, now you should be feeling this. And it went to like one, or two, three, years.

And we actually tested whether or not that was effective, and how did it support the women that would come? And how did it not support the women? And did they ignore the messages? Did it help if you had a link that would take them to another page? Maybe the links could take you to a website that would say, OK, you’re at seven weeks. The baby should be kicking. The baby should be doing such-and-such, to kind of give women comfort.

And so, especially for women who maybe got two prenatal visits, or only just went once or twice, this would allow them to be supported in a different way.

MAURICE
So, I’m super interested. So one, was Text for Baby efficacious? And two, did they really debate the name? Because Text for Baby sounds like an app that you go on, and then, like, Amazon shows up with a toddler at your door.
[LAUGHTER]
Like, it just is a bad name. But did it work?

MICHELLE
It is. It did work. It did work. The moms did report they liked getting the reminders, especially after they were born. So one of the biggest challenges is– and especially at a clinic– is you might not see the mom until they gave birth. And because of the way Philly is set up, and where babies are born, you could get your prenatal care one place and then deliver somewhere else.

And then you might not ever go back to that clinic. So they might never know what happened after the baby was there. You might not still be getting the support. But at least, if you signed up with Text for Baby, that– because I think it went to one or two years old– it would still give you reminders, oh, this should be happening now. If this is not happening now, you know, maybe you should go see someone.

It allowed for the information to move beyond just coming to the clinic, which is an older model. And for this new generation of moms, they might not come to the clinic every month, like they should. But if they got a text message, maybe they would. Or maybe it would remind them that this is something they should do.

But it wasn’t as wonderful as everybody thought it was because one of the biggest problems is, especially in low income communities, people use phones– the phones that people have, their numbers change a lot. Because if you don’t pay the bill, they’ve got to get a new phone.

MAURICE
Right. Right.

MICHELLE
And so the challenge would be, while the mom might have this phone number for two months–

MAURICE
Yeah. By the time the kid was a year old, she had a different phone.

MICHELLE
Yeah. They got a new number. And so having to remind them to– so how do you deal with that? How do you deal with, OK, they got a new number. Does it follow the mom? What happens? You know, and all of that. So, yeah. So that’s where the technology works to a certain extent. But after a certain point, We’ve still got to rely on people, right? We still have to make sure they work together.

And so that’s a challenge that we’re still struggling with, especially with lower income families that are working on that model.

MAURICE
There’s so much in that example that you just gave that’s there to unpack.

MICHELLE
Yeah.

MAURICE
That the system seems to have been designed by people who made an assumption, which is, if you have a cell phone and cell phone number, you’re going to have it for 20 years.

MICHELLE
Yes, exactly.

MAURICE
Who changes their cell phone number? And, but they were trying to serve a whole group of people who change their cell phone numbers often. And you wouldn’t have guessed that while you put this–
[INTERPOSING VOICES]

MICHELLE
Exactly. Exactly. You would have never thought.

MAURICE
The other thing–

MICHELLE
if you weren’t in that community, you wouldn’t have guessed that.

MAURICE
Right. The other thing, it seems like it was a one-way communication. And I totally get it. Like hey, have you remembered to do x, because your baby is y old?

MICHELLE
Yeah.

MAURICE
But it wasn’t a system that allowed a parent to go, hey, this is what my baby’s doing– are we on track?

MICHELLE
Yeah. Yeah.

MAURICE
You couldn’t query it. You couldn’t ask questions.

MICHELLE
Yeah. Yeah. So now there are much more advanced systems there. Especially out of Columbia University kind of was at the forefront of this work, and they’ve been doing a lot more, where now they do allow a call back. But once again, you have to be connected to that health system.

So still, we’re stuck in this structure of, what health care system are you with? It is still– we still have structures that were not set up to help people in the ways that we think technology can.

MAURICE
So I think it would be a tragedy to ignore the elephant in the room and not ask you, are you is that we don’t have a more robust system, connected system, with regard to like logistics, and equipment that connect local hospitals, to local health authorities, to the national stockpile?

MICHELLE
Right.

MAURICE
It seems like we’re in a health information crisis, and logistical crisis, as much as we are a biologic crises. And are you surprised that those systems don’t exist? And do you think the current situation will spurn us to allow these things to talk to one another?

MICHELLE
Unfortunately, probably not. Because, so we saw something similar after Hurricane Katrina. So most of the hospitals in Louisiana– in Southern Louisiana– were totally, totally, decimated and offline. The only thing that saved the VA’s facilities was that some of their– because they have an internet, they have a national system, they could recover some people’s records.

But we still haven’t totally digested what happened and then been able to think forward. So there is an Office of the National Coordinator for Health Information Technology. And so they are active in this space, in terms of trying to get systems connected. But what ends up happening, is you get bogged down in, should we be regulating electronic health records? Should we be demanding that the companies that are in this space already tell us about their errors that are going on? Should we require usability standards?

So we’re so bogged down in the details that we still have yet to look at the overall picture. And I think what we’re seeing, big time, is that there are states and regions that are way above other states and other regions. A small state like Delaware, pretty much everybody is in– gets their care from one system. So they are kind of, sort of, like the model.

But when you get to a big state like Pennsylvania, that’s so long, and has rural areas, and city areas, and then suburban areas– and so you have some states that have a lot of that stuff and are doing really well, and they’re more organized. And now you see, there are states that can make their manufacturing turn on a dime, and they have strong Governors that can do that.

But because there was a weak response nationally, it kind of let– it’s kind of like the chips fall where they may. And if you were in a state with a strong– if you have strong infrastructure, then you were able to move forward. But if you were in a place with a weak one, it feels bad for you. You know, it’s just unfortunate.

But the push towards a national health care system right now seems to be stalled. And I don’t think that it’s really going to matter who gets elected, we’re probably not going to get one. That’s probably a pessimistic view, but it’s probably more true.

But the best thing that will come out will be, probably, the logistics. It’ll probably be a better way to get masks, and equipment, and things like that.

MAURICE
So what are you working on now?

MICHELLE
So right now, actually–

MAURICE
So what is your big research question?

MICHELLE
So right now, our big research question is, OK, so now we’re in this place where more people have broadband, more people have some way to get access to a smartphone, or at least have a plan that allows them to have access to data. And so, working with a former graduate student who’s the CIO, the Chief Information Officer at CHOP is looking at, now what is the role of personal health records?
And so now there is this face where most likely, your health record, at your hospital, has a patient portal that you can access. And so now what we’re studying is, OK, so now that we have these patient portals that are now patient-facing, it’s connected to the hospital, and they can get access to– right now, pretty much the only thing you can do is get access to your records. I mean access to your appointments.
You can’t really access your records, but you could maybe send them a note. Or you could get your kids’– you could get a copy of your kids’ record. A copy of your kids’ sports review that they have to turn in at the beginning of the year.

MAURICE
Right.

MICHELLE
Right now, you could usually get that, but that’s kind of like the limit of it. And so now we’re trying to understand, so, yes, now we’re in this sweet spot, where everybody thought. In the 2010s, everybody was like, oh, once people can get patient portals we’ll be in heaven. Because you can look on your phone, and you can look at what you’re taking care of.

We’re there. You might be able to get that value. But we’re still not at that point where your doctor will say, I’m going to send you this on the patient portal, you can look it up. And any questions you have, it could be answered right there. Or if you message the nurse, she’ll answer you.

MAURICE
Yeah. What did–
[INTERPOSING VOICES]
–yeah. Like what’s the problem there? Is it that people aren’t included as we design the systems, and so there tends to be this disjunction once you roll it out? Or is it just education of everybody about why this is a better way to approach the problem? Like what’s the issue?

MICHELLE
Well, one thing we know, is that the literature from way back in the ’80s told us that just giving people information is not enough to make them act. So just because you know you shouldn’t eat chips, chips are good, so you’re going to eat chips.
[LAUGHTER]

MAURICE
I’m sorry, are you– is my video on right now? I apologize.
[LAUGHTER]

MICHELLE
So we know that that’s the case. So we know education is not just it. And so one of the things we do know, though, is if the doctor tells you it, more than likely, you’ll do it if the doctor tells you. So we know it’s some combo of– we have to get the doctors to buy in more, which means it needs to be more a part of what the doctor does on a regular basis for the doctor to see value in it, and then for it to go to the patient.

But then, also, we need to understand, what does the patient view their phone for? What we found, especially in underserved communities, is that their phone is their phone. They go on Facebook. They go on Instagram. They go on TikTok. They do not go on their phone and get health care.
[LAUGHTER]

MAURICE
Right.

MICHELLE
So there is a jump that has to be made. Now that, though, is not necessarily true with young people. What they have found is that teens and early 20s will ask questions that they are embarrassed to ask in the doctor’s office, they will ask on an app. What they haven’t been able–

MAURICE
I’m so afraid that teens are getting health information on TikTok. That just upsets me.

MICHELLE
Exactly. And that is a problem. Exactly– that’s a problem. But the thing is, they have found, though, that they can get at teens that way.
[LAUGHTER]

MAURICE
Right.

MICHELLE
So you have this disconnect, though. So teens will ask, but they ask the questions they are ashamed about. Their parents, though, just don’t do anything. Their parents are just like, oh, I’m going to go to the doctor. I’m not going to ask it on my phone, because that’s not what I do with my phone.
[LAUGHTER]

And so we’re at this point where we have to understand the culture, and the technology, and try to understand how we can help the culture more understand how the technology is useful.

MAURICE
So two questions about the future.

MICHELLE
We’re at that point. Yeah.

MAURICE
Two questions about the future. How far away are we from being able to just go into a physician’s office in any state, hand him our phone, and upload our entire medical history, including every x-ray that we’ve ever had taken, and all our CAT scans, and it’s right there for him, right?

MICHELLE
Right. Exactly.

MAURICE
Are we five years, 10 years, 50 years?

MICHELLE
One would hope not 50 years, but definitely more than five, unfortunately.

MAURICE
Wow.

MICHELLE
Now, I would say there are certain states that you might be able to do that. Within a health system, you might be able to do it in a couple of years. So if you’re in Blue Cross Blue Shield, whatever the name of it is, whatever state you’re in, there might be– in a couple of years, you might at least be able to see what’s been digitized forward.

So if you’re over– probably, if you’re over 45, you won’t be able to get that old, old, old, stuff, like from when you were a kid or anything like that.

MAURICE
Right.

MICHELLE
But you probably would be able to get as much information as, since when you joined that health care system, forward. That is probably more reasonable, and you could probably get that.

But the issue is usually just in between systems, that’s the problem. We will have regional. I think the first step will be regional– probably regional systems. So just like we have E-Z Pass in this Northeast, mid-Atlantic area, eventually– I think probably, in maybe 10 years– we’ll probably have that capability in this area. Just because there’s so much movement, mid-Atlantic, Eastern, and you’ll probably have the same thing in a state big as California.

But across the nation, it will take a big shift in politics. And really, that’s all it is, is politics. For politicians to get beyond trying to have companies be able to own their data, and own your data, I should say. So until we get over that hump, it’s going to be a while.
[MUSIC PLAYING]

MAURICE
Dr. Michelle Rogers, thank you for being on the 10,000 Hours.

MICHELLE
Thank you so much for having me. This was great.

MAURICE
Drexel’s 10,000 Hours podcast is hosted by me, Maurice Baynard. Our producers are Shaun Fitzpatrick and Nathan Barrick.

MICHELLE
Drexel’s 10,000 Hours podcast is powered by Drexel University Online.