Leveraging Mobile Technology to Improve Outcomes with Patricia Mechael, Co-founder and Policy Lead at HealthEnabled

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: Welcome back to the outcomes rocket podcast. Today, I have an amazing guest. Her name is Dr. Patty Mechael. She is the co-founder and policy lead at HealthEnabled with many years of health care experience. Her focus is in global health and digital health and all that it takes to be successful in medicine. And so I want to open up the microphone to Patty to fill in the gaps in the introduction. Tell us a little bit more about herself and what is it that they do at HealthEnabled. So Dr. Mechael thank you so much for being with us today. Welcome to the podcast.

: Thanks Saul. I’m really pleased to be here. So not sure where to begin except to say that a lot of my work has been in global health. I have spent probably in the last more than 25 years primarily working in Africa, Asia and Latin America. And my background really is in public health so really looking at how do we prevent diseases that we can prevent and strengthen health systems to address conditions and help people in ways that they need to be helped if and when they do get sick. And for about the last 20 years almost, I have been looking primarily at the use of mobile technologies to improve access to health and health information in a broad range of different settings and was the idiot savant that did a Ph.D. looking at mobile phones and health when the penetration rates were about two and three percent in this country. So even before the telecommunications companies anticipated that we would have more mobile phones than people on the planet.

: That’s amazing. What got you interested in that particular topic. Did you see where it was going. Or was it luck? What are your thoughts there?

: I didn’t see where it was going. I had taken a bit of a break from my work in global health and I was working for a dotcom in New York. And when one of my mentors approached me to apply to Ph.D. programs which I had never really planned to do and so I was like sure I’ll apply to a Ph.D. programs. And at that time everyone was looking at and I wanted to look at technology and health but everyone was looking at the Internet and I had spent time working in places like South Sudan during the Civil War and Somalia and Uganda and Kenya where there is just no basic infrastructure so there is no running water, there’s no electricity. There wasn’t going to be the Internet for at least 10, 20, 15, 30 years but, we were starting to see mobile phones appearing particularly in the urban centers in different developing countries. And so it’s just like well what about cell phones like what if people had access to cell phones, could use those cell phones to access emergency transportation like consults with a doctor. Like how could we leverage this emerging technology in a way that could really help improve health outcomes. So I applied to a couple of programs. I was really fortunate because the London School of Hygiene and Tropical Medicine had a science and technology studies sociologists on faculty. When he saw my application which is like you have to come to school here you have to do your Ph.D. here. And he was so enthusiastic about it. So I sort of began my journey not really knowing kind of what to expect. It was more around the like well what if people did have cellphones. And what if they could use those phones to do interesting things related to health. And then quickly it sort of really started to pick up even in my Ph.D. research which was an ethnographic study because nobody had ever researched it before people we’re already very informally starting to use mobile phones to access health services and health information and organize themselves and do disease surveillance. So even just a natural progression in the use of technology was very very interesting from very very early, early early days.

: Well it’s become very practical Patty and I think it’s really neat that you decided to get on this track why medicine to begin with?

: So I’m a first generation immigrant to the United States. My parents emigrated from Egypt in the 1960s and so of course as is typical of immigrant families if you have kids that are good at math and science then you’re going to be the family medical doctor and so it was one of those and I was always very passionate about helping people and so I I kind of had that that then. And when I was in high school I was an EMT and brewed .. in my town in New Jersey. It was very keen to kind of get into that field and I was I was incredibly fortunate to have done my undergraduate degree at at Johns Hopkins because at the time I was an international relations premed student so. So I wanted to work. So I had this like dream of being like a flying doctor in Africa. And so I wanted to do medicine and health in underserved countries and populations. And I didn’t quite know exactly what I wanted to do and how I would go about doing that and why in my first year at Hopkins the School of Public Health offered a course in the winter session called careers in international health. So I took this course and I was amazed that all of these people who had worked with WHO and with UNICEF as well as ministries of health from around the world. And this more sort of population-based approach to health which is sort of like instead of going to one by one and diagnosing and treating individuals. How do we start to look at, you know entire populations? And that got me really really excited. And so I sort of felt passionately in love with the concept of public health and then started reading everything that I could in this space including the World Development Report from 1993 which was focused on health published by the World Bank which I think is the same document that got Bill Gates excited about global health which I learned like 20 years later and I was like that’s awesome so I’m like, “you, too” so then you know I decided to pursue a Masters in International Health and really spend time living and working primarily in East Africa working on sort of a broad range of public health related initiatives.

: That’s pretty cool. And you know it’s fun to hear your story about how one thing led to another and you just got involved with this group over there. Hopkins that was doing more population based things and it just sort of fell in love with it and as we fast forward today the reality whether it be global or domestic, the importance of managing populations and health population health management is a very key topic. What would you say is a key topic that needs to be on every medical leaders agenda today?

: Yeah I think we’re getting to a place where the personalization of health I think is becoming more and more possible and really helping people to integrate health into sort of their everyday everyday lives and existence and so oftentimes our intersection with the health care system is around a disease or around like a particular health condition. But as human beings we’re more than our disease conditions and we live in the real world and we have things that are really passionate about and things that get us excited. And we have families and we have. And so I think it’s really important to contextualize health with sort of the person and to really start to think about how do we move towards a more personalized approach to health which I think ultimately will lead to better community health and better population health. And I think that right now we have a highly burdened health care systems that can’t afford to deliver services to their populations, don’t have the workforce to meet the demand. Don’t have the right distribution of healthcare providers in rural areas that can serve different types of populations and that sort of thing. And so it’s becoming more and more important to engage individuals in their own health care and in their own health. Ultimately like nobody wants to be sick. So there is like OK let me go out there and fall sick so you know if we can keep healthy people healthy for as long as possible and engage them in fun and new and interesting ways in their healthand provide them with you know insights into what’s going on in their bodies either through wearables or different types of technologies. I think that’s certainly a really important push but then also for those that do fall sick to provide services and engage them in ways that really acknowledged that each of us is very different and has a very different set of needs interests approaches etc. and that health is a very personal personal issue and should be treated as such.

: Yeah I think that’s a really great thought there. Dr. Mechael you know when we take a look at a patient just as a sick person a disease, their particular disease it doesn’t doesn’t help with thinking about it more broadly is going to help us come up with better solutions. I’m curious so the work that you guys are doing at HealthEnabled, maybe you could walk us through some examples of how you guys have created results or improved outcomes in these rural populations by doing things differently?

: Sure to a lot of our work at health and able for the past few years has really focused on nationally scaled and integrated digital health systems so we spend a lot of time working with governments to develop supportive policies that can help sort of these emerging technologies be scaled to the entire population of of their countries. And so, for example we’ve worked in South Africa with the National Department of Health on a platform called MomConect, which a few years ago set out to register every pregnant woman in South Africa and provide stage and age based messaging throughout her pregnancy as well as for the first year of a child’s life and was largely designed using a lot of ethnographic work and research with voices and text messages that are acceptable to the population. And it was incredible. The Ministry of Health and the Department of Health of South Africa took an incredible leadership role and it was one of the first sort of stale implementations where they’re currently reaching over a million pregnant women and they have about a million I year of pregnant women and so it’s basically like they’re reaching practically every pregnant woman in South Africa with these messages and the data and the research on these types of mobile messaging programs is now starting to catch up with the innovations. And it’s really showing that there are improvements maternal health practices that we’re starting to see improved outcomes among children and newborns. And it’s a really exciting time particularly for these types of for these types of programs. We’ve seen similar results in India and other countries as well have had started to implement these types of programs including Nigeria and China. I mean the United States has our own version text4baby which is largely built on the same set of core, set of messages and approaches.

: That’s pretty great. And the nice thing is that once you once you build it you could customize it to the particular country for acceptable messaging and maybe like fill in the gaps in cultural traditions. And then it’s just sort of like an out-of-the-box tool that could be customized for each country right?

: Yes and no I mean..

: It’s never that easy.

: It’s not that easy.

: I have a colleague at UNICEF and we joke with each other that we should write a book called And Health Is Hard and because its actually it’s a sophisticated kind of epic undertaking.

: That’s too funny.

: What you think should take a few months could take a year. But yes there are some aspects of these types of programs and it’s mostly like the approaches that can be replicated from one setting to another setting. A lot of times that basic health and key health outcomes that we’re really striving for can be standardized across different settings. But one country might have to prioritize certain health outcomes another may have to prioritize other health outcomes. For example in a country like South Africa where you still have relatively high HIV rates things like prevention of mother to child transmission of HIV in the messaging becomes really critical during the pregnancy and you know or you know in a country like India where anemia is quite high and you do have eclampsia pre-eclampsia and those sorts of conditions they’re making sure that the women are able to identify the risk signs as well as like take preventive measures to prevent those conditions and maintain a healthy pregnancy. But then if and when they do start to notice things during their pregnancy is that they can take action at the appropriate time.

: Yeah that’s really interesting. So snd health is hard.

: It is.

: So Patty through your journey I’m sure you’ve had mistakes, setbacks that you’ve learned a lot from. Is there one in particular that you want to take us to and sort of share and what you take out of that?

: Sure. So early on in my career so I was really fortunate when I finished my Ph.D. and it has been about 2006-2007. I moved back to the U.S. and I decided that I wanted to live in Manhattan. So I started contacting different colleagues and networking and I got a call from Jeffrey Sachs at the Earth Institute and a totally random. And he invited me to brunch the next day at his house and was like..

: Just randomly like that.

: I mean something that sent him my CV and gay guy and they were about to launch a partnership with Ericsson to look at mobile technologies across ten countries in subsaharan Africa and they had prioritized health is what are the first areas that they want to look at. And they were like you just finished your Ph.D. looking at mobile phones and health, like would you be interested in helping us figure out how we look at mobile phones and health. And one of the early projects that we designed and implemented as part of this program was using text messaging to register pregnant women and then track their pregnancies and then register children and then track their make sure that they got their immunizations and those sorts of things. And we did this in 10 countries. And I think what we did as a spread ourselves too thin and I don’t think we did a very thorough job of like really explaining kind of what this was, etc. And so some of the countries picked it up really well knocked it out of the park. We’re starting to show like improved health outcomes, et cetera. But we had one country where when we bend like a year later went back and did an evaluation like discovered that they had a whole pool of pregnant men in this community in Africa and I went to a country but, it’s one of these things early, what in the world is going on. It was interest agates and people were the health workers were using the system but they weren’t actually looking at the data that was coming out of the system or using the data that was coming out of the system. And it was one of my first one of my early experiences really around data use. And we find this all the time is that you know health workers are really overburdened. They were sent having to collect data if they’re not getting value out of that and taking the next step towards like encouraging a culture of data use is an epic undertaking it is. It is a very difficult to change sort of workflow and add value and help people to really see the value of data if they’re not used to having data in their day to day engagement or work. So since that, I spent a lot of time looking and working on data use and I think the other thing I think that’s really important to me is that I’ve learned over time is to just because you build it doesn’t mean they’re going to use it. So really making sure things are done in a participatory design approach that’s whatever it is that you are doing is like actionable that something can be you know if you’re collecting some information that you can actually do something about it that you’re feeding that information back to people in a way that they can really use it and glean meaning from it. So I think some of those lessons came out of that. But I but I like looking at the data, it’s coming out of this country and I say, pregnant men? This is weird?

: And so what a great learning there Patty. Let’s make sure we build the solutions in conjunction with the end user and let’s socialize that data use aspects of the programs that we put forward. I think some things that that are very easy to take for granted that I think you call about Patty very important to highlight in the projects we take on. How about something that you’re super proud of in your experience. What would you say that is one of those moments that you’re like wow this is why I got into this?

: So a few years ago maybe more than a year and so I think with 2014, 2013 so I had done a lot of work in Nigeria around health systems strengthening, around health information systems as well as around mobile health and I developed a very good relationship with the Minister of State for Health at the time and he was really keen to see Nigeria become a leader in the digital health field. So he asked me if I would help facilitate the development of a national health I.T. framework for Nigeria and Nigeria is a very complicated country it’s a federated system similar to the United States, India etc. So the states have a lot of autonomy and then you have a federal government or a central government so it’s always a bit of like who has the authority,.

: Right.

: Kind of a question. And we got some funding from the government of Norway to do this to do this initiative. And we took a very participatory approach to the design of a national strategy and as we were developing it, it was co-chaired by the Minister of Health as well as the minister of ICT information innovation technology and we had over 150 stakeholders over the course of a two year period that were really actively engaged in the design of the strategy as well as the implementation alongside the design so as we were developing the strategy and working through the strategy development process, bits and pieces that were already being implemented which was really really exciting and then it got officially adopted by the parliament of Nigeria. So for me that was probably one of the projects that I have been involved and that I have like the most proud of.

: That’s pretty awesome.

: Mostly because it’s so needed like countries really need to have a road map because otherwise with technology, it’s really easy to get distracted and to kind of go in a million different directions and not necessarily be able to have an impact or are really be able to systematically improve health outcomes or strengthen the health system. So I am a huge, like advocate and firm believer that you know the enablers and the enabling environment and the sort of policy is related to be in place to support technology and innovation because the technologies are going to keep changing and new innovations are going to keep coming. But if you have the right sort of supportive policy environments, then that can really help guide you both short term investments as well as the longer term investments. You need to have in place for these technologies to have an impact.

: That’s excellent. And Dr. Mechael, have you had a chance to visit back with that health minister to see how they’ve been doing since the adoption of this roadmap.

: So the minister changed midway through our process and actually it still ended up being successful and which was actually like probably one of the biggest successes that we have.

: Staying with it despite the change, right?

: Absolutely. And I think you know he was an excellent minister and I think he he set it up in such a way that it could succeed without him. Knowing that ministers in some countries only last a year or two years or three years. So that was also like part of the success of it that was that even after he had laughed the process continued on and there was so much buy in and such a commitment to see this thing through and that we were able to get it through him. And yes I have and have gone back to Nigeria and have a lot of colleagues that I still engage with over there. And you’re doing great. It’s incredible. To see it’s the the national strategy is being socialized at the state level and it’s really providing the framework that they needed to have to make sense of technology.

: Congratulations that’s a wonderful accomplishment.

: Yeah, thanks.

: Can you share an exciting project that you’re working on today?

: Sure sir. And we’re about to launch in a few weeks at the World Health Assembly in Geneva which is a global digital health index. So while HealthEnabled as an organization, our focus tends to be to go deep in a handful of countries as well. So they work very closely with large scale health implementing organizations. We want to have one activity that could kind of help raise the bar on the field. And and so we’ve kind of debated different things and you know like national prize or different types of awards and then you and a colleague at our at our incubator, the global development incubator suggested an index like potentially is the field of digital health ready for an index. And So we spent a bit of time to benchmarking looking at different indices, looking at different areas and really assessing the digital field to see if it was a time for an index and really consulting with the digital health community around this. And so the aim of the index is to really help countries at a national level measure and track their progress and maturity in digital health. And so essentially it’s a national digital health maturity model that has been designed and developed using the World Health Organization, International Telecommunications Union e-health strategy toolkit and in consultation with everyone from the government of New Zealand and Denmark to Peru and India. So we had 13 countries work with us on the prototype earlier this year and now we will be launching at the World Health Assembly alongside a digital health resolution that’s being put forward by the governments of India and Australia as a tool to help kind of countries really advance their work in this space and have some visibility into kind of what, where they are and where they need to start moving towards.

: That’s pretty exciting and I think it will be a pretty useful tool for for the folks focused on countries outside of the ones you guys are focused on.

: Absolutely. Absolutely. I mean we can’t be everywhere and our goal is ultimately to work our way out of a job. So it’s like OK how do we get everybody start to do these things. Yeah it’s an exciting time.

: That’s awesome. Congratulations on that tool. I’m sure it’s going to be pretty exciting. Folks if you want to learn more about what Dr. Michelle and her team are up to, just go to healthenabled.org and you’ll be able to learn more about their purpose, their mission, their five-year roadmap, their team. They’re doing some pretty cool things for health across the globe. So definitely be sure to check them out. healthenabled.org. Getting close to the end here, Patty let’s pretend you and I are building a medical leadership course on what it takes to be successful in medicine. It’s the 101 or ABCs of Dr. Patty Mechael. And so we’ve got a syllabus here for the listeners. It’s going to be a lightning round. So I’ve got four questions for you followed by your all time favorite book. You ready?

: Got it.

: All right. What’s the best way to improve health care outcomes?

: Measure them. measure them. That which is measured gets done. Oftentimes we don’t measure them and we don’t plan to measure them and we don’t prioritize them. We just implement programs, hoping for the best health outcomes don’t improve that way.

: What’s the biggest mistake or pitfall to avoid?

: Implementing programs without having a primary health outcome in mind. So designing in the absence of a specific health target.

: How do you stay relevant despite all the change?

: It’s hard to stay on top of it on top of everything. I remember there is a moment where I realized that I couldn’t wrap my arms around the entire field of health anymore because it was too much happening and too many new players and too many new technologies. I think the idea is to really state focus on what you’re trying to accomplish in health and then as you are able to sort of identify some of the new innovations and tools, really think through how they can be applied to improve this health outcomes in strategic ways.

: And what’s one area of focus that should drive everything in a company?

: Well-being if we’re all about health and the health that we should be all about is the health of our people. As an organization and I’m not going to cut to the chase on your next question around the book that we actually at HealthEnabled, when we created that organization and we wanted to create an organization that we would want to work for. So we we make everybody read the book Thrive by Arianna Huffington, which really looks prioritization of well-being, you know including things like sleep and stress management and all these different areas that really do have an impact on productivity as well as quality of life. So if we’re not able to sort of put the oxygen masks on ourselves as healthcare providers or advocates, et cetera, then it becomes a lot harder to try to extend that to the communities that we serve. And I think it’s a really important aspect and often underlooked aspects of the workplace and one that can lead can add years to and healthy years to people’s lives. When you look at the sleep research and you look at the stress research and the physical activity studies, etc. There is so much to be gained from mindfulness meditation, from enjoying your time with your family and disconnecting from work. And so you know like people are not allowed to e-mail when they’re on vacation. Like you just know. like I’m on vacation.

: Yeah I think this is so great. Patty you know and listeners. One thing that you should take away from this recommendation, Thrive by Arianna Huffington. One book that I haven’t read Patty but I definitely I actually as we were chatting here just downloaded it from an audio book. It’s so important for health leaders to take care of yourself because if you are running on fumes there’s no way you’re going to be able to take care of the people and the populations that you’re responsible for. So I think this is a wonderful recommendation. Patti thank you so much for that. Yeah you’re welcome. And listeners don’t worry about writing any of this down. You can go to outcomesrocket.health/enabled as in Healthenabled to find to find all the things that we’ve discussed, the transcript, shows notes, as well as links to healthenabled.org and also links to the book that Dr. Mechael shared with us right now. Patty would love if you could just leave us with some closing thoughts. And then the best place for the listeners could get a hold of you or follow you.

: Sure. So, final thought innovates, we need innovations and health. We need new ways of doing things and thinking about things that are really going to improve people’s health. We’ll just do it in a way that is grounded and respectful of people and really people-focused and also consider the enablers that need to accompany those innovations that are coming into the health care and public health setting. And if you want to, can you can find me on LinkedIn as well as on Twitter @PattyMechael and through Healthenabled.

: Outstanding Patty this has been so much fun. Really appreciate you sharing your experiences and and your stories with us. Really look forward to staying in touch with you.

: Sounds good. Thanks Saul.

Thanks for tuning in to the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don’t forget to check out the amazing healthcare Thinkathon where we can get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is “implementation is innovation”. Just go to outcomesrocket.health/conference that’s outcomesrocket.health/conference. Be one of the 200 that will participate. Looking forward to seeing you there.

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