How Health Informatics Influences Public Health Policy: An Interview with Arpita Saxena

An Interview with Arpita Saxena

Arpita Saxena is a public health researcher specializing in public health technologies. Her career focuses on the equitable distribution of advanced technology in healthcare, from the comprehensive perspectives of policy, accessibility, user experience workforce training, and health equity. 

In this interview, Arpita discusses the interaction between new technologies and public health, and describes how her research has contributed to designing better user experiences in public health technologies for diverse populations. 

After earning Bachelor’s and Master’s degrees in Dental Surgery, you earned a Masters in Health Informatics from the University of Michigan, Ann Arbor. What is health informatics, and what inspired you to pivot to this field?

Growing up in India, I experienced life in many semi-urban and rural communities as my family moved with my father, who was a senior government official working for the Indian Forest Services. Living in these different places gave me the opportunity to see diverse ways of life. Sometimes these places were very remote, and the nearest city would be over 100 kilometers away, which would take many hours of travel to get to because of poor infrastructure. One common theme shared by these various communities was scarce healthcare facilities, and an extreme lack of public health awareness. Looking at the public health situation from the position of relative privilege was disturbing, and it left a lasting impression on me. I was then determined to do something to improve this situation.

After finishing high school, I chose to pursue dentistry. Throughout my studies, I visited several small villages and remote communities to participate in numerous health camps and provide medical help to people in need. I observed that in these remote locations, public health awareness was dismally low. Even patients who came to the hospital at our college lacked basic health education. All signs pointed to a desperate and largely neglected public health system. By the time I finished my undergraduate degree, I had decided to work in public health and join the specialized Master’s program (MDS) in Public Health Dentistry, which focused on epidemiology, biostatistics, and dental and public health, and enhanced my practical knowledge.  

While conducting research for my graduate degree, I realized the importance of technology and statistical analysis in the healthcare sector. From basic data gathering, storage, and manipulation, to complex statistical analysis through Statistical Package for the Social Sciences (SPSS) or MATLAB software programs, I have used technology comprehensively. It is very clear that the future of public health aligns with the rapid proliferation of technology and digital support systems in this field.

I thus enrolled in a second Master’s degree program in Health Informatics at the University of Michigan, Ann Arbor, to gain the necessary technical underpinning to achieve my professional goals. Health Informatics is built on a foundation of three pillars—healthcare, information technology (IT), and data science—to improve the quality, efficiency, and accessibility of healthcare services. It is supported by the power of usable data, Artificial Intelligence (AI), and advanced statistical tools and techniques. This education gives me unique insight into the growing importance of electronic health records (EHR), telehealth/telemedicine, health analytics, and other digital health solutions. My goal is to make a difference in improving public health systems, and to contribute to advancing the public health  field.

Your career has focused on enhancing and protecting the user experience as it relates to innovative tools. What is the role of a public health researcher in the intersecting fields of healthcare and technology?

My projects have always been about enhancing and protecting the user experience (UX). In this regard, I focus on the presence or absence of certain technologies, which I believe is pivotal in safeguarding UX. 

For example, in one of my projects, “Soothing Anxious Minds of Dental Patients by Relaxing their Olfactory-Auditory Senses: An Adjunctive Clinical Trial,” I employed randomized, controlled clinical trial design to incorporate a diverse sample of dental patients. I provided patients with calming music and aromatherapy during their dental treatment to ease their anxiety. Quantitative measures such as anxiety scale, heart rate, and blood pressure were monitored during each treatment to strengthen the analysis and result. My focus was to transform patients’ dental experience, and thus create an environment to better motivate them to care for their dental health. 

As a public health researcher, I visualized the intersection of healthcare and technology in this research project by incorporating digital analysis tools like SPSS and MATLAB to facilitate the processing and interpretation of the vast amount of data collected during the clinical trial (the presence of technology).  Advanced analytics techniques, such as machine learning algorithms, can give a deeper insight into the efficacy of music and aromatherapy in reducing patients’ anxiety.

In this study, I also chose not to use tools that could have intensified the project (absence of technology), such as wearable devices that are equipped with sensors to continuously monitor the patients’ physiological parameters (i.e. anxiety scale, heart rate, and blood pressure), or using Virtual Reality and/or Augmented Reality to create immersive environments, or mobile applications that could be specifically tailored to the research project with guided relaxation exercises, or personalized playlists. My rationale was that these technologies would distract patients and prevent their induced relaxation during the trial. 

As a public health researcher, I am also committed to community well-being. In 2018, I ran a “Tobacco Intervention Initiative” in a slum area of India. My hands-on approach involved counselling more than 100 individuals, coupled with regular follow-up consultations over a three month-period. The result was transformative, with 20 individuals reporting that they successfully gave up their cancer-causing addiction. In this initiative, I used innovative tools and platforms to support individuals in their efforts. These included a text messaging strategy to deliver supportive messages, and reminders sent directly to users’ mobile devices, to keep them motivated and on track during the process of quitting tobacco. I also used mobile apps that  provides resources, such as tracking smoking habits, setting goals, and peer support.

In one of your early research experiences in public health, you worked on a project funded by the National Science Foundation in which you provided design recommendations for collaborative health technologies, to help parents of children with Type 1 diabetes better manage their illness. Can you tell us about this innovative approach? 

I was very honored to learn that the  National Science Foundation (NSF) was funding the projects that I was working on. An NSF grant is very prestigious and supports outstanding graduate students pursuing STEM education. I was further honored to present my research in two consecutive years at the CHI Conference on Human Factors in Computing Systems, in 2022 and 2023, respectively. These projects were “Transitioning Toward Independence: Enhancing Collaborative Self-Management of Children with Type 1 Diabetes” and “It’s Like an Educated Guessing Game: Parents’ Strategies for Collaborative Diabetes Management with Their Children.” 

In these collaborative health technology projects, the goal was to develop innovative ideas that not only facilitated collaborative care, but also empowered children with Type 1 diabetes to transition to autonomously managing their illness. My role within the team involved actively engaging with children and their parents, and recruiting them through multiple communication channels. We also conducted insightful virtual interviews to understand their outlook on data tracking, and identify their pain points in managing Type 1 diabetes. We carefully applied these insights to design child-friendly questionnaires, to motivate children to take charge of tracking their own data. Overall, the project had a holistic approach, recognizing the technological aspects, as well as the emotional and psychological needs of both children and parents.

In the second research project, the aim was to empower parents through innovative tools and platforms. We focused on facilitating open communication channels between parents, enabling them to freely share their concerns, insights, and strategies with each other, for effectively mitigating risks during management of Type 1 diabetes in their children. Both projects leveraged technology (including customizable tracking tools and gamification) to encourage children with Type 1 diabetes and their parents to better manage this chronic, life-threatening disease. 

Technological advancements over the last decade are reshaping healthcare and extending longevity. What are the implications for the public health sector? What is most promising in terms of population health? Where are the greatest pitfalls? 

The brisk pace of technological advancements has provided a new era of possibilities and challenges in the public health sector. One of the most notable impacts is the extension of longevity and improvements in overall population health. Innovations have enabled hospitals and pharmaceutical companies to actively engage in health management, leading to the early detection and intervention of diseases. Additionally, the integration of big data analytics and AI has dramatically transformed disease surveillance, outbreak prediction, epidemiological research, chronic care management, genomic medicine, and more in developing tailored treatments and preventive strategies. 

However, these technological advancements in healthcare also pose some potential challenges. First and foremost, health inequalities persist when the delivery of advanced treatments and technologies are limited by socioeconomic factors. Moreover, an over-reliance on technology and/or algorithm bias may also contribute to existing health disparities for certain populations, based on race, ethnicity, gender, and demographic data. Secondly, the concern for securing sensitive health data increases as hospitals and private and public clinics are adopting EHR. Frequent news about data breaches prevents some patients from sharing their full health information with their physicians, because they do not want their data to get leaked in public.

As a public health specialist, you have researched telehealth applications and their privacy policies? What did you discover in your research? What types of changes do you recommend for these technologies? 

I received an internship grant from the University of Michigan School of Information (UMSI)) to pursue research for my master’s thesis, in which I assessed the implications of telehealth apps’ user privacy policies and terms of use. My findings revealed the inconsistency of information throughout the documents. Users may find it misleading and confusing, if they are unable to comprehend the purpose of the telehealth apps they are utilizing. I found that some statements in telehealth apps’ privacy policies mention that they do not even verify the qualifications of healthcare practitioners on their platforms, which was one of the most disturbing findings. Additionally, several telehealth apps’ have inadequate security protocols that subject users to data privacy violations. 

To resolve all these consequential issues, my research proposed suggestions for how policymakers and regulators could make the patients’ experience smoother and comfortable on the telehealth platforms, such as implementing a “Consumer Privacy Framework for Health Data” to ensure the privacy of a user’s health data outside HIPAA protection. Some of the main points of this framework are centered around limiting the amount of health information collection and disclosure, and restricting the sharing of information with third parties. Re-designing the privacy policy and terms of service documents is essential, because users—as the beneficiaries of the telehealth services—should receive a comprehensive understanding of these services, and how their information will be collected, shared, and disclosed by the platform involving third parties.

What do you think is the greatest threat to public health in terms of new technologies? 

Determining which new technologies pose the greatest threat to public health depends on various factors. Foremost in my mind is data security. With the increased use of EHR and the collection of large chunks of sensitive PHI (personal health information) without proper security protocols, the fear of identity threat, financial fraud, and other negative implications is escalating. 

How can public health leaders and data engineers collaborate to utilize technological innovation for advancing public health? Is it important for academia and the IT industry to collaborate? 

Public health leaders and data engineers must collaborate to ensure that the technology satisfies end users’ guidelines and complies with legal and ethical requirements. While data engineers can use their experience in technology development to crate tailored solutions as needed, public health leaders can offer insights into the context and complexities of public health challenges. It is critical that both academia and the IT industry participate jointly in future trends, so that they positively impact public health.

How can public policy shape the future of technology in healthcare? 

Public policy plays an important role in advancing public health. Because policies help in safeguarding and promoting population health, these public policies need to address issues such as data privacy, security, interoperability, ethical considerations, and more, to ensure that upcoming technologies are benefitting patients, as well as their healthcare providers. Public policies have the capacity to shape the future of technology in healthcare because of their ability to adapt to required regulations, determine allocation of resources, and define health priorities. These are important issues for providing health equity, sustainability, and accessibility in healthcare systems.

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