Designing the Digital Future of Health Care: Ravi Patel

Ravi:  We've had to change our subjects, we’ve had to change our settings. How can we work together to make sure that we're still recruiting? I'm happy to say we're able to restart that project albeit in a different methodology which, as a researcher like myself, sometimes change is challenging, but that's great because we can investigate, what is the difference in the data that we gathered when were in the homes of patients compared to when we are talking to them online like we are doing now. 

Mike: From CTSI, this is the Products of Pittsburgh. A show about the people in Pittsburgh – innovators, scientists, community leaders – and the remarkable stories behind how they came to be and the work they’ve produced. I’m Mike Flock. On the show today, we catch up with Dr. Ravi Patel, Lead Innovation Advisor for the University of Pittsburgh’s School of Pharmacy

Mike: Ravi is a teacher, a researcher, and an innovator. He has a lot of interests and a lot of questions. Like how do different people interact and experience health care? What can we learn from those experiences? And how might we inform and design a better health care experience? It all started in the suburbs of Chicago, where Ravi grew up with parents who had a variety of jobs. His father worked in different factory settings, as well as the federal postal service. And his mother was an educator, working with pre-school aged children. When Ravi was a teenager though, the family moved to central Pennsylvania and his parents became small business owners, running a fast-food franchise for more than a decade. Needless to say, Ravi had exposure to a range of different careers and experiences growing up. And before pursuing a career in the health sciences, he had a particular job in mind…  

Mike: When you were a kid was there anything particular that you wanted to be when you grew up? Was there any particular career path let's say when you were in elementary school or middle school, for example?

Ravi: I knew that I was going to be a race car driver. I think the allure of having a driver’s license and going really fast in a circle definitely stood out. I’m sure Mario Kart played a heavy role in that experience as well. As I started progressing my education probably middle school and early high school I remember just generically thinking science was definitely an area I wanted to be in. I use the term scientist very loosely because I didn't know what it meant back then and today I don't know if I know any one definition of it, which makes me all the more interested and happy that ended up in that field where I can constantly ask questions and play the five whys to myself to say, well, why do we know this about medicine or why do we know this about what we’re trying to discover?

Mike: Why pharmacy? Why was that the particular area that you landed in? 

Ravi: I still use that answer that when I grow up I still think I'll be a pharmacist in health care in some way. In the way that I approached the opportunities in different fields in health care, I remember thinking that there was so much opportunity within just this one profession and I think that's true of all the professions, but truly when I had a chance to, as an undergrad, I actually I started sneaking into the School of Pharmacy and going to student organization meetings. I don’t know if that meant I took initiative or I was in a place I wasn’t supposed to be. I’ll lean towards the fact that I took initiative but I remember the supportive nature of the community when I raised my hand and said, I’m not actually part of this school but I’m hoping to. It was an incredible group of people around me who said, oh that’s great, around me who jumped in with their support. The reason I originally went there was because this was a group that looked at global and public health and I spent as much time in the School of Public Health here on campus and I remember thinking, I wish I had this component alongside my clinical education. And then going to the School of Information Sciences back then to say, oh well this is cool I wish I knew how data fit into health care. And I wish I knew how the psychology and behavior we experience in everyday life. I had a lot of different questions and pharmacy really offered this great zone where you can pull them all together, you can help solve problems whether it be in an in-patient setting, whether it be a community setting, government and policy in large pharmaceutical companies, in small start-ups that are changing the way that all of us experience health care. There is such a vast number of opportunities which brought me to this profession. I like to say I took a bit of a gamble and it paid off if in spades and dividends. I try to make that available to my students, my patients, and all the folks I work with as well.

Mike: In 2008, Ravi came to the University of Pittsburgh as an undecided major. Not everyone has their path figured out and Ravi decided to explore options across the health sciences and sit in on various events. It was during his sophomore year that he decided to apply for the competitive doctor of pharmacy program where he was accepted and would go on to receive his PharmD in 2014. Unlike many graduates though, Ravi didn’t leave. He became a research fellow in the School of Pharmacy and eventually the Lead Innovation Advisor, transitioning rather quickly from student to teacher.  

Ravi: The day you go from sitting in the seat of a student to turning around in the lectern where you get to stand behind, it's for sure exciting. I remember the first time I was sitting in a debrief session with students and we got a thumbs-up from our of incredible staff  that we get a chance work with at our school of pharmacy to say, do you have all the papers you need, the schedule that we have, I'll be back in an hour or 45 minutes and then they close the door and then there was a moment that I had to stop and say, oh no, I’m the one in charge here. This is something that I've had different experiences in here and there even in volunteering in the past where I was put in charge of a small staff that helped interact with high school students during a summer program and every time that somebody starts to look towards you for an answer, for guidance, it’s a really challenging, exciting, nervous but overall rewarding experience and I think that comes through in knowing that my teaching approach and reflecting my experiences as a learner. Everyone says they want to have something hands on but being hands on is very scary and I know that the experience of being lectured at the history of lecturing professing truth to be a professor didn’t sit as well just to say, I know this and I want to speak to you about it, but rather than being a leader of an entire conversation, someone who facilitated the conversation definitely is a role that I’ve worked towards.

Mike: It seems like the sort of tenets of humans centered design is evident throughout all your work. Is that something that you had learned about as a student or something that you had sought out training afterwards - how has that become kind of part of your efforts here at the University of Pittsburgh?

Ravi: I appreciate that question, Mike, because I think a lot of what we do in how we practice, whether it's at a job, whether it’s at a hobby, it really reflects very universal experiences, what I mean by that, in education having to learn how to do something, when we were very young we learn what the alphabet is then we'd learn how to read. Now we learn how to speak at impromptu debates and whatever the case may be it really forms a little bit of everything we do in the world and my transition to health care was something very similar where I had to figure out waking up, eating exercising, all of these really informed components of health, even if I thought about it or didn’t think about it. So many of our colleagues in the world of health care come in with significant experiences in the world of health care, their own experiences, broken collarbone to pull from my own world, a family member who had asthma growing up, somebody who had to help, siblings who might have had type 1 diabetics when they were growing up. These kinds of experiences help shape how we manage our own health, as well as what a lot of our clinicians today and the people who are involved in health care because so much of health care is possible not only from the clinical practice but all the people who make it possible. It really pulls from all these different kinds of experiences. If we consider just on this podcast, you and I, I’m sure you can speak to a couple of those points from your own life and your own family as it became a family. Everyone goes through health care in different forms. Whether it’s learning, whether it’s health care, I think design is another example to say it's problem solving and something we do every single day but we don’t necessarily term it as such.

Ravi: I love human centered design because it's so much of what we do both in health care and the world even if we call it patient centered design or problem-oriented thinking, they all help reconcile what someone is trying to accomplish. A user and a task is typically how I break that down for my students. While I had minimal training in user centered design, originally when I was first interested, my first dip of toe into the water not necessarily as a clinician but when I was learning about the health care system was quality improvement, QI. The Institute for Healthcare Innovation, IHI, actually offered certification and as I was…I don't want to say suffering, I'll say struggling through, balancing our community service experiences, which helps teach how we talk to our patients, the rigors of anatomy and physiology, and the first top 200 medications that you learn about , how to counsel, how do they work, how do they watch for interaction, I was really excited to dip my toe into that water and practice but I felt like I lost sight of the forest for the trees to say, well this all happening in a human's life and someone's experience. And through this program held by IHI, I've been lucky to build on through fellowships at the Jewish Healthcare Foundation in Pittsburgh, through my internship at the Veterans Administration Hospital, to what I do today in interviewing patients for my research in digital health. It all came down to making sure you can contextualize what someone is trying to accomplish, who's your user, what’s their task they’re trying to accomplish, and how do you make that easier?

Ravi: Sometimes it’s really hard to quantify some of those experiences, the same way it’s hard to quantify what’s it like getting a diagnosis for the outcome you don't know. I have allergies I’ve developed just this year, some of the worst I’ve ever experienced, and my own body is almost rejecting the world around it. It's a little concerning at times that I can't do anything to fix it but I can mitigate some of those symptoms. In my interest in leveraging data to understand the design of behavior and health care, there is this great series of the questions that you can ask to say, well what happened to my previous experiences regarding allergies? What are my connections to the emotions that I feel? Do I feel helpless if I have to blow my nose constantly and what kind of outcomes am I looking for from my pharmacotherapy? Are my more recent agents in the world of over-the-counter antihistamine something that's going to help solve the problem that I’m looking to solve? And the data that’s tied around that, whether it be qualitative, how I feel, what I experience, what can someone observe about me or the actual quantitative, how many of those over the counter antihistamine pills and tablets that I’ve taken in the past 3 months and does that compare to different populations similar to my age, my demographics, and what makes me similar and different from them? So that's the broad focus and how I approach a lot of what I get to do and it's really exciting and fun because there is no end of opportunity. I used to say there's no end of problems that we can solve in health care but in re-framing what we can do, there is no end of opportunity.

Mike: Engaging stakeholders and end users as active participants can help researchers ask better study questions, obtain new insights, and ultimately help develop more useful and effective medical innovations. Integrating human-centered design principles into research protocols may also help ensure that any advances in health care aren’t limited to a select few but rather distributed to more communities. And there will always be challenges. Conditions change. And even Ravi, an expert in digital health, is having to adapt his teaching and research approach to a new environment. 

Ravi: The unique element of the experience of my work, my practice, my daily life under these circumstances in COVID has really magnified a lot of the highest highs and lowest lows or way that I approach something. For some people, it changes things significantly, for example I'm not on campus, I'm not going to patient homes for the research studies that I helped lead and participate with but rather it changes how we do it and we have to be very conscious of what kind of changes we make. So, some of the easiest ones to speak to, and I say easiest only because there was some direct protocols that in these times of very open-ended outcomes are either really helpful or potentially can present a barrier. When it came to teaching on campus I'm very, very thankful that we were proactive to be able to say, we're transitioning to a completely off campus approach. Our patients were not typically coming into the hospital unless absolutely required, especially those early days when hospital resources and even now we are still very conscious of what kind of resources we need to support our health for those who are both healthy and potentially sick. Having the educational protocol in place and to say that here’s how we're going to come out on the other side to know that these are the outcome we’re shooting for goes back to a unique artifact in the world of teaching and it’s the syllabus. It’s a joke that a professor will say, make sure you read your syllabus to know about the dates, the time, etc., and there is an incredibly important component of the syllabus that sets out expectations. I always thought of it as a living, breathing document.

Ravi: Mike, however you approach the world of what I would say experiences in pharmacy might be very different from what my student experiences from their role in pharmacy and different from the student next to them and that one different from the one next to them. So it's very unique in how everyone learns. So, when we had to move to a completely online approach towards education, originally I had planned for in-person presentations. It really highlighted the idea that sometimes there's discomfort whenever you have to present and there’s growth associated with discomfort, if we get practice, if we give guidance and support. When we moved online it was a very unique opportunity to ask for students, after 14 weeks, rather then presenting for five minutes and getting questions for five minutes can you give me a 2-3 minute presentation on that which you’ve learned and applied to a concept, and submit it to PInCh to then go on and do amazing things, etc., but in the skill set these students develop, you have a chance to really magnify, well this is what I learned, these are the strengths that I can leverage in this process I’m presenting, and here's a different opportunity now that I've created this video, I can share that at a scale hundreds of times larger than what I originally would be able to if I just gave a verbal presentation, so there's a lot of open-ended opportunity that comes with our teaching and that’s just an example for my course that we teach to introduce concepts of innovation, new and useful ideas in pharmacy. Other courses, like our data course that we use Python to teach folks in, actually had a chance to leverage the idea that so much of coding and programming is really supported by a community of online forums and really stack overflow. I know you learned a lot of lessons from the world of programming and not being face-to-face sometimes that was very limiting, having to say, I can't see if you're confused right now so let's see if we can get on a call and see if we can step-by-step walk-through this problem compared to students having this opportunity and really awesome experience that it's such of privilege of mine to work with students who are so smart, they are probably able to get to the level of knowledge that I have so much faster, by the end of the semester they know parts of the curriculum to a greater extent because they were able to use that autonomous experience when we weren't face-to-face.

Ravi: I want to take a page and highlight the high highs that the circumstances brought out, for example the Pitt+Me registry. Some of the research that we were doing beforehand in this project that in my world and interest in digital health, how does technology not necessarily present a solution, but better identify problems and support solutions. To understand in this case, medication adherence, potentially a trillion dollar problem, with a T, and one of those questions that I was very fortunate to be on this campus to ask from a pharmacist perspective like myself, alongside information and computer scientists who are asking the same questions, how do we know if patients are taking their medications? Sometimes the record show X sometimes the patients report Y. We really wanted to dig into it and we used the Pitt+Me registry to find a unique set of patients that helped inform a more specific version of that question to say, well what can we learn about daily routines and what’s your acceptance of technology? But when the circumstances of COVID took place we had to transition from in-patient interviews we were going all across Pittsburgh, to an online platform to not only recruit patients but also to understand if they had the technological capabilities and I want to tie that back to say the flexibility of what CTSI has been able to create at the University of Pittsburgh and a large organization to do research, hundreds of thousands of patients to create this platform that we could still go to and say, that we've had to change our subjects, we’ve had to change our setting, how can we work together to make sure that we're still recruiting? I'm happy to say we're able to restart that project, albeit in a different methodology which, as a researcher like myself, sometimes change is challenging but that's great because we can investigate what is the difference in the data that we gathered when were in the homes of patients compared to how we are talking to them online like we are doing now.

Mike: Colleges and universities across the world are having to rethink the future of higher education. Ravi, like many professors, are having to adapt not only their approach to teaching but also their approach to conducting research. Some clinical studies are having to move towards a remote design and assessment strategy, which really highlights the importance of digital tools, communication, and information technology. Whether these adjustments are long term obviously depends on the environment, as well as the teacher, researcher, and institution. But one thing is for certain - the act of teaching, learning, and conducting research will continue to evolve in the months and years ahead. As Ravi moves forward in this digital world, he is making sure to save some personal time for another interest – running.    

Mike: Any hobbies or interests outside of the work that you do at the University of Pittsburgh?

Ravi: It's been quite some time since I’ve had a chance to say I am a runner; that's such an open-ended answer. I think it's how I approach life, there are a lot of fun gray zones. I can say I'm a scientist and there are amazing scientists who are at the top of their fields who I can look to and say yes, absolutely. Albert Einstein was an amazing scientist. But if I had think to myself well if I'm looking at an Olympic Marathoner, yes, that's a runner, I might ask myself, well wait a second does that make me a runner? I share all of this, Mike, because I love how you started at the beginning because even when I was young middle school, high school, I was in the track program and cross country program and I can't tell you, in the first year if there was ever a race that I did not finish last and that took a lot of persistence to overcome, and by the end of my career I still wasn't good but it was something that I learned to enjoy and carrying that on through life, it was an amazing experience to come to Pittsburgh and really get a chance to see what a city has to offer. I remember volunteering at the Great Race when I was an undergrad and to see, I believe it's a 5 and 10K race with thousands and thousands of participants that stream through campus just outside of the Litchfield Towers on the main campus of the University of Pittsburgh. It was this opportunity that as volunteer I had just a small chance to contribute back to the amazing city that I have a chance to be part of and that extends out to what I do now. Even if I’m not training at two a days or doing repeats on the tracks like I used to, I still get a chance to lace up a pair of shoes and maybe with a friend go out to Schenley Park or Frick Park extending that into swimming or the amazing bike trails that we have in Pittsburgh. Someday soon I hope to make it on the trip on the bike trail from Pittsburgh to DC just by bike and stopping by either B&B's or camping out along the way so definitely a chance to reconnect with nature. I often joke that REI is my go-to place when it comes to finding a way to spend a good afternoon to say, oh I can do that or I wish I had that gear, hopefully extending that into a camping trip or an exploration of national parks. I think that all really reflects I started with running, it gives me a chance to connect to the outdoors and I hope I still get a chance to connect to the outdoors. And even in our current times what better way to distance yourself from others then at a great campsite with a campfire and the stars above you. 

Mike: If you could select one word to describe yourself what would that one word be?

Ravi: Concise is not going to be the answer, for sure. I would say interested.

Mike: That I can definitely see.

Ravi: The reason I say that is when I started using the title and the term of “innovation,” it meant a lot to me when I first started because there was both academic and immediate practice-oriented context to it, new and useful, very simple but very powerful. I think a theme in the things I mentioned so far but being able to extend beyond just that. If somebody else referred to the work that I was doing or referred to the way that I approach something as innovative, that felt very important to me or at least validating in context of what I thought I was trying to do. And it goes to establishing personal brand, the way you share your story, whether it be your own personal self, your practice in health care, your research to the world, how other people describe it really mention how you put forward the thing that you're trying to do and to hear your very kind comment to say that “interested” reflects my interaction in my work really means a lot to me and the reason I chose it is because I think I often say I am a struggling academic and a worse anything else. I don't necessarily fit, hopefully, a traditional academic mold because I'm so interested in so many different things and still want to be able to build a focus that I can but so much of what we do, the phrase I commonly think I use, and others can tell me if I do or not, is that there is infinite complexity or infinite number of variables that we look at in the world and even if it’s not answering what are all those variables, I’m interested in learning more about whether it's a person, whether it’s a circumstance or situation, or whether it's probably for my own safety, security, interest, and, probably, fun to say, ah, now I understand it. If I knew that Mike woke up every morning because he’s the biggest fan of pancakes in the world, I would be so excited to learn about what that was and what that drives him towards and Mike I know that’s probably not true…

Mike. I do like pancakes. I have to admit. I'm the person who puts peanut butter on pancakes. 

Ravi: I’m so interested, when does that start? Did you ever try the jelly combination?

Mike: Maybe, in fact, it’s something I remember watching my grandpa do and so that's how I picked it up.

Ravi: Oh that’s wonderful, Mike, thank you for sharing.

Mike: Yea, so, surprisingly yes. Pancakes are something I would enjoy.

Ravi: I think there's a really fun practice that accounts for why I enjoy so much of what I do and how I do it. It gets to ask the question of what if? Two simple but powerful words that we can leverage to really understand what we do now and why we do it, as well as what we can do and the way this is manifested has been, in my world, what if we were able to scale the impact of having a one-on-one conversation between a patient and a provider to improve their health care? What if we could do that a hundreds time better? How we do that comes from the technology but it really started with the what if? Likewise, I'm very privileged to participate and help host alongside an amazing team of colleagues and, really, our student leaders, a hackathon each year for which I'm very thankful that our CTSI also co-sponsors to be able to ask our students, what if we wanted to solve this problem? Anything from medication adherence, to remembering to floss everyday, to addressing public health at both a local and global level. We get to start with what if and the students just take it and run in 48 hours, less than that, 36 hours, to come up with amazing ideas and being able to come together with people they might not have known before. That started with being able to ask what if? Likewise, our approach towards innovation, our approach towards what we can do at Pitt, as a product of Pittsburgh, we can say, what if we're able to take all that we do in Pittsburgh and help change the world? And for that I'm grateful to have had this conversation, Mike, and I hope I can help ask other people, whoever might be listening to this today, to ask yourself, what if, whether it be in your own life, your practice, your family, what you're doing in your hobby, ask yourself what if? I’d love to hear what you come up with. But reach out whenever. Share your what if?

Mike: Ravi Patel, PharmD, Lead Innovation Advisor for the University of Pittsburgh’s School of Pharmacy.

That’s our show. Thank you for listening to the Products of Pittsburgh. Be sure to check out our website at http://www.ctsi.pitt.edu/podcast to hear more episodes as well as learn about CTSI programs and services. I’m Mike Flock along with Zach Ferguson, until next time on the Products of Pittsburgh.