Empowering Patients and Providers Through Tech

It’s empowering for individuals and communities to have access to their own health data. At HealthNext, Apple’s Vice President of Health Dr. Sumbul Desai reflected on the formative experience of caring for her mother after a stroke, which inspired her to go into medicine and explore ways to help patients and caregivers better manage their health.

“[At Apple], we don’t want to provide data for data’s sake,” said Dr. Desai. “We want that information to encourage individuals to be empowered, to be able to take an action based on that insight.”

But the potential for technology to empower healthcare providers remains an open question. AI tools could automate administrative tasks and lighten workloads, but Chief Global Information Officer of  Curtis Cole voiced skepticism that these efficiencies will actually improve the lives of doctors.

“I thought EHR was going to create more time and efficiency for me to see patients,” said Cole. “Boy, was I wrong. It made me more efficient at billing. It made me more efficient at doing a whole bunch of things that my employer benefits from, that the insurance company benefits from, that society benefits from, and guess what I have to do? I have to see more patients.”

Protecting Privacy in a Digital Age

While AI and other technologies can empower people to take control of their health, concerns about privacy in the digital age remain top of mind. Board Member of Keystone Strategies Virginia McFerran explained that attackers are getting more and more successful at stealing companies’ data, and AI only makes it easier for them

to “screen scrape” websites like LinkedIn to create convincing scams.

“It’s a war out there,” McFerran said, urging tech companies to know what their policy is ahead of time so that they can act quickly in the event of a data breach. “That means encrypting your data, it means keeping logs granular, it means being responsive.”

At the same time, data sharing and interoperability will be integral to research and healthcare delivery. Micky Tripathi, PhD, MPP, the National Coordinator for Health Information Technology for the US Department of Health & Human Services, discussed the challenge of data sharing in the private sector, given that competition between companies may result in information blocking. The policy response to this challenge, Tripathi explained, is that unless information is confidential, institutions are required by law to share data with one another to improve patient care.

Exploring the Nuances of Consent and Confidentiality

The role of consent in healthcare is critical yet complex. Information Science Professor Helen Nissenbaum described her theory of contextual integrity, which notes that given the complexity of health data, the lay population may not fully understand what they are giving consent for in a medical context. Healthcare inequities exacerbate this issue; NYU Bioethics Professor Art Caplan noted that access to the latest health technology varies widely even in a wealthy, technologically sophisticated country like the US.

“You don’t have opportunity to maximize your aptitudes and skills and abilities… if you don’t have health,” said Caplan. “So to me it’s a right, not a privilege… That means that you’ve got to build in equity concerns at the research side.”

Investing in a Better Future

HealthNext explored the dynamics of investment in AI innovations. Deputy Director of ARPA-H

Susan Monarez offered a government perspective, explaining her department’s “high-impact” investment s

trategy, funding some of the most challenging health problems of our time. “The bottom line is…we would like to allow people to explore a [high] risk space in their academic settings,” giving them the freedom to explore transformative solutions on a longer time scale. 

Vice Chair of the Clinton Foundation Chelsea Clinton, DPhil, MPH urged the audience of founders, researchers, and innovators to consider public service as part of their career trajectory.

“Optimism is a moral choice, and it’s a moral choice how we use what we’re afraid of and build better for tomorrow,” said Clinton. “Whatever brought you here, you fundamentally care about what happens tomorrow… So think about what you want to invest in and what you want to build, and think about whether or not you want to run for office.”

Applying AI in Healthcare

Many health tech startups are already successfully exploring applications of AI technologies in healthcare. Biotia, a startup launched out of Cornell Tech’s Runway Startups Program, uses AI to fight against infectious diseases, addressing a problem that kills 14 million people annually. Another startup, Abstractive Health, is working to lighten physicians’ workloads by automating administrative tasks like note taking. These are just two examples of the revolutionary new approaches coming out of the startup world.

Pessimism or Optimism?

Throughout the Summit, conversations returned to the question of pessimism versus optimism. Concerns about data privacy and bias in machine learning models, for example, must be weighed against the potential benefits to operational efficiency and reducing administrative burden on clinicians. The emergence of AI in healthcare could also be an opportunity for us all to rethink and reshape our healthcare systems for the better by finally including those who have been historically excluded from conversations and research.

HealthNext 2024 convened thinkers and doers of different backgrounds and skill sets, and attendees witnessed the transformative power a diverse group of people can have in improving the future of healthcare.

The HealthNext Summit is an initiative of the Health Tech Hub at Cornell Tech’s Jacobs Institute. To learn more and get updates about next year’s Summit, visit the website and sign up for the newsletter.

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“How can AI solutions improve the quality and outcomes in healthcare? How do you make sure AI systems are fair and unbiased? How can it reinforce patient-provider trust? Can AI reduce existing inefficiencies in healthcare? These are questions that affect everyone,” said Tanzeem Choudhury, Roger and Joelle Burnell Professor in Integrated Health and Technology at Cornell Tech, and organizer of the upcoming HealthNext Summit (March 4 to 5 on the Roosevelt Island Campus), which is presented by the Jacobs Technion-Cornell Institute housed at Cornell Tech

With a broad, interdisciplinary mission, the second annual HealthNext Summit will bring together leading AI thinkers from across Health Tech, healthcare, and public health to envision a future where AI creates a medical system that is at once more effective and more equitable. Welcoming such experts as Micky Tripathi, PhD, MPP, National Coordinator for Health Information Technology, US Department of Health & Human Services; Susan Monarez, Deputy Director, ARPA-H; James Landay, co-founder of the Stanford Institute for Human-centered Artificial Intelligence; the Clinton Global Initiative’s Chelsea Clinton; and Apple’s Vice President of Health Dr. Sumbul Desai, the conference also draws on Cornell Tech’s deep bench of expertise across the Doctoral, Master’s, and Runway Startup programs in Health Tech.

“This event will highlight cutting edge research, innovative science-backed products from big-tech and startups, and the perspectives of how these solutions can transform healthcare for clinical leaders,” said Choudhury, who researches how technology can create personalized and proactive healthcare systems that support health and wellbeing. “In recent years, we have seen amazing development at the intersection of AI and health that can meet the significant needs in healthcare. But Health Tech conversations are too often siloed. With HealthNext, we’re bringing together technology researchers, clinical practitioners, and businesses creating innovative solutions and facilitating deep conversations that could lead to transformative, scalable, and financially viable solutions in healthcare.”

The inaugural Summit last year, which focused on behavioral health, brought together more than 200 clinical practitioners, researchers, entrepreneurs, care delivery organizations, and payers. Patrick J. Kennedy, former U.S. Representative and founder of The Kennedy Forum, and New York City Health Commissioner Dr. Ashwin Vasan gave keynote speeches.

Translating research into real-world impact characterizes the philosophy of Cornell Tech’s Health Tech Hub. One-third of the 100+ runway start-ups to emerge from the campus since its founding have been health focused, including Nanit (a Wirecutter-approved baby sleep tracking software), Biotia (a pioneering pathogen detection company), and Otari (a smart exercise mat that was acquired by Peloton).

The conference will explore health and AI from diverse perspectives, with an emphasis on ensuring that AI is being used to solve real problems for real people. From ethical considerations to clinical applications, HealthNext 2024 will explore the real issues at stake and give innovators and thought leaders the knowledge, connections, and insight to advance a more responsible, effective, and authentic future for healthcare.

Learn more about the Summit here and register here.

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The Google Inclusion Research Award acknowledges individuals who research computing and technology and are dedicated to addressing the needs of marginalized groups and creating a more inclusive and equitable tech ecosystem. This award will allow Taylor to further her research and continue to work on providing safer healthcare practices.

“We must continue to bridge the gap between cutting-edge research, technology, and patient care to create a healthcare system that serves everyone. I am excited to continue this research with the support of Google and receive the Google Award for Inclusion Research,” says Taylor.

In an ever-changing healthcare landscape, Taylor’s research has pushed her students and healthcare professionals to explore original and unexpected solutions. Receiving the Google Inclusion Research Award recognizes her outstanding contributions and advocates her vision of making healthcare more efficient and patient-centered.

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By Liana Began, Cornell Tech

On March 6-7, 2023, the Heath Tech Hub of the Jacobs Technion–Cornell Institute at Cornell Tech broke down the silos across the healthcare sectors and disciplines and brought together clinical practitioners, researchers, health tech entrepreneurs, care delivery organizations, and payers for a two-day Behavioral Health Next Summit at the Verizon Executive Education Center on Cornell Tech’s Roosevelt Island campus. The Summit was led by Dr. Tanzeem Choudhury, Roger and Joelle Burnell Professor in Integrated Health and Technology at Cornell Tech and Director of Health Tech, Danish Munir, Founding Partner at GreyMatter Capital, Ian Chiang, Partner at Flare Capital Partners, and sponsored by Optum and The Carson Family Charitable Trust.

Improving healthcare outcomes and delivery have always been important issues in the industry, but the increasing incorporation of digital technology in healthcare is creating more discussions on how and when these tools are used. Across the tech and healthcare industries, there is hope that by partnering early on through the diagnosis and prevention stages, patient care and treatment can be improved significantly. The COVID-19 pandemic signaled a clear shift in doctor/patient interactions. Doctors have adopted technology to conduct patient meetings virtually through Zoom and created new dashboard apps that allow patients to access their health records or review past visits. One thing is for sure — these shifts are happening and that digital connection is here to stay. However, while the benefits of blending technology with traditional healthcare are clear, what does the impact of this partnership mean for mental healthcare?

The Behavioral Health Next Summit brought together a diverse community of medical and tech professionals who shared thoughts and ideas on the state of the industry, and, more importantly, what actions can be taken within the tech space both now and in the future regarding mental healthcare. There were 35 speakers representing over 50 different organizations from startups to clinicians, providers, and academics. Keynote speaker Patrick J. Kennedy, former U.S. Representative and founder of The Kennedy Forum, kicked off the Summit by speaking on the importance of personal health data and shared his own personal struggles with mental health and addiction throughout his political career with a clear call to action for a modern-day advocacy group in the behavioral health space.

New York City Health Commissioner Dr. Ashwin Vasan led the second day’s discussion focusing on what problems the industry is solving and how that aligns with what patients need. Dr. Vasan also spoke on the importance of data and why it is crucial for the private and public sectors to work together to better the overall system. Dr. Vasan closed his talk by discussing how mental health struggles vastly differ from physical diseases and called for the immediate need to examine how mental health is addressed and treated: “We are in a mental health crisis, COVID has just put gasoline on the fire.”

Throughout the Summit, over 200 attendees from the community were brought together and experienced first-hand demonstrations from companies such as Cornell Tech startups MyLÚA Health and BreathePulse as well as from Cornell Tech PhD candidates. Dr. Jim Yong Kim, Vice Chairman and President of Global Infrastructure Partners and former President of World Bank Group, closed the Summit by speaking on his experiences working on HIV treatments and tackling existing behavioral health barriers. He talked about how what we need in mental health right now is movement and finding all the different ways to move on to get to where we need to be so outcomes are transformed and the stigma on mental illness is changed.

Cornell Tech’s Behavioral Health Next Summit was an inspiring and productive convening of the healthcare and technology industries, which also shone a necessary and vital light on the work being accomplished together by integrating tech and behavioral health.

Liana Began is Marketing Manager at Cornell Tech.

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Hospitals have begun using “decision support tools” powered by artificial intelligence that can diagnose disease, suggest treatment or predict a surgery’s outcome. But no algorithm is correct all the time, so how do doctors know when to trust the AI’s recommendation?

A new study led by Qian Yang, assistant professor of information science in the Cornell Ann S. Bowers College of Computing and Information Science, suggests that if AI tools can counsel the doctor like a colleague – pointing out relevant biomedical research that supports the decision – then doctors can better weigh the merits of the recommendation.

The researchers will present the new study, “Harnessing Biomedical Literature to Calibrate Clinicians’ Trust in AI Decision Support Systems,” in April at the Association for Computing Machinery CHI Conference on Human Factors in Computing Systems.

Previously, most AI researchers have tried to help doctors evaluate suggestions from decision support tools by explaining how the underlying algorithm works, or what data was used to train the AI. But an education in how AI makes its predictions wasn’t sufficient, Yang said. Many doctors wanted to know if the tool had been validated in clinical trials, which typically does not happen with these tools.

“A doctor’s primary job is not to learn how AI works,” Yang said. “If we can build systems that help validate AI suggestions based on clinical trial results and journal articles, which are trustworthy information for doctors, then we can help them understand whether the AI is likely to be right or wrong for each specific case.”

To develop this system, the researchers first interviewed nine doctors across a range of specialties, and three clinical librarians. They discovered that when doctors disagree on the right course of action, they track down results from relevant biomedical research and case studies, taking into account the quality of each study and how closely it applies to the case at hand.

Yang and her colleagues built a prototype of their clinical decision tool that mimics this process by presenting biomedical evidence alongside the AI’s recommendation. They used GPT-3 to find and summarize relevant research. (ChatGPT is the better-known offshoot of GPT-3, which is tailored for human dialogue.)

“We built a system that basically tries to recreate the interpersonal communication that we observed when the doctors give suggestions to each other, and fetches the same kind of evidence from clinical literature to support the AI’s suggestion,” Yang said.

The interface for the decision support tool lists patient information, medical history and lab test results on one side, with the AI’s personalized diagnosis or treatment suggestion on the other, followed by relevant biomedical studies. In response to doctor feedback, the researchers added a short summary for each study, highlighting details of the patient population, the medical intervention and the patient outcomes, so doctors can quickly absorb the most important information.

The research team developed prototype decision support tools for three specialities – neurology, psychiatry and palliative care – and asked three doctors from each speciality to test out the prototype by evaluating sample cases.

In interviews, doctors said they appreciated the clinical evidence, finding it intuitive and easy to understand, and preferred it to an explanation of the AI’s inner workings.

“It’s a highly generalizable method,” Yang said. This type of approach could work for all medical specialties and other applications where scientific evidence is needed, such as Q&A platforms to answer patient questions or even automated fact checking of health-related news stories. “I would hope to see it embedded in different kinds of AI systems that are being developed, so we can make them useful for clinical practice.”

Co-authors on the study include doctoral students Yiran Zhao and Stephen Yang in the field of information science, and Yuexing Hao in the field of human behavior design. Volodymyr Kuleshov, assistant professor at the Jacobs Technion-Cornell Institute at Cornell Tech and in computer science in Cornell Bowers CIS, Fei Wang, associate professor of population health sciences at Weill Cornell Medicine, and Kexin Quan of the University of California, San Diego also contributed to the study.

The researchers received support from the AI2050 Early Career Fellowship and the Cornell and Weill Cornell Medicine’s Multi-Investigator Seed Grants.

Patricia Waldron is a writer for the Cornell Ann S. Bowers College of Computing and Information Science.

This story originally appeared in the Cornell Chronicle.

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Asthma is personal for Tyler Bershad.

“Like 26 million Americans, I have asthma,” said Bershad, Johnson Cornell Tech MBA candidate, during the 2023 Health Hackathon in February. “Asthma is the most prevalent chronic respiratory disease in humans and, unfortunately, those who are most vulnerable are children.”

Bershad knows first-hand the reality that many pediatric asthma patients don’t always know how to communicate their symptoms to their parents or providers. This problem led him and his Hackathon team — named “Mixed Bag” — to create an innovative solution in the form of AiroCare, a smart monitoring device for asthmatic symptoms. It attaches directly to a nebulizer, collecting data on lung performance in real-time before sending it to an app that a physician can easily access. Mixed Bag presented AiroCare to a panel of judges during the Hackathon, winning the $2,000 grand prize.

The annual Health Hackathon, held in person Feb. 17-19 and organized by Weill Cornell Medicine’s Clinical and Translational Science Center (CTSC), brought together 136 student participants and 37 mentors from the Cornell ecosystem — including Weill Cornell Medicine, Cornell Tech, and the Ithaca campus — as well as the wider New York metropolitan area, such as Hospital for Special Surgery, Memorial Sloan Kettering Cancer Center, and others. Mentors from Johnson & Johnson and biotechnology companies were available to coach the teams throughout the weekend. Even local high school student innovators participated.

“The Clinical and Translational Science Center has been involved in these activities for years with Cornell’s Ithaca campus,” said Dr. Julianne Imperato-McGinley, the CTSC’s Founding Director. “This multidisciplinary team activity is unique in that it sparks creativity,  innovation, and disruption. We want participants to collaborate and to think outside the box.”

Over the course of three days, medical, business, engineering, and design students convened in spaces spread throughout two floors of NextJump’s interdisciplinary workspace in New York’s Chelsea neighborhood to create solutions to some of today’s most pressing needs in human health and wellness.

On Feb. 17, they formed teams and hashed out ideas, then met with mentors the following day, receiving intensive feedback and guidance.

By Feb. 19, the event culminated in a day-long project showcase to an audience of peers, mentors, and sponsors. As the participants hurtled through the fast-paced, whirlwind of a weekend, there was time to connect with and learn from people whose points of view might not be like their own. There were times set aside for restorative yoga, fitness, and making new friends.

To hone the technical skills that would be needed for many of the projects, the participants learned rapid ideation, prototyping, and 3D printing by way of a pop-up MakerSpace.

Event coordinator My Linh H. Nguyen-Novotny, Assistant Director of Programmatic Development at the CTSC, said the event is unlike any other.

“At Friday evening’s kick-off, my advice to the participants was to meet someone new,” she said. “What’s special about the Hackathons are the people. Without the people, this is just a room with four walls. Later on, many of the participants confided how much they appreciated that the Health Hackathon is the rare opportunity where individuals from across Cornell’s campuses, who have diverse backgrounds, have to interact in an intentional and engaging way.”

Nguyen-Novotny added that the event was particularly meaningful given that it was the first Health Hackathon post-pandemic that the CTSC has been part of since February 2020.

“It demonstrates remarkable entrepreneurial drive; the creativity of our community coming together to find innovative, cross-disciplinary, inclusive solutions to improve the health outcomes for vulnerable populations,” she added.

The teams presented projects that included helping asthmatic children, devising solutions for teenagers with vaping addiction, seniors who feel isolated, women post-mastectomy, and uninsured individuals. Each project addressed what are some of the most enduring health challenges in society that have often been under-addressed.

Nguyen-Novotny said the participants revealed the great potential of “emerging technologies” — think machine learning, artificial intelligence, augmented reality, virtual reality, miRNA, 3D printing, and on-demand digital fabrication — to solve these problems.

Beyond Mixed Bag, the winning teams were:

• 1st Place for Evidence-Based Solution ($1,500): S-cubed
• Most Inclusive Solution ($1,000): AuthenZ
• Best Research-Backed Impact ($500): Big Red Cures
• Honorable Mention for Addressing a Public Health Need: Connected Dot
• Honorable Mention for Tackling Youth Epidemic: Lagged
• Honorable Mention for Best Pivots: Yes, And

The big challenge for all of these teams was to distill their solutions to very complex problems in just four minutes. That’s how long they had to pitch their projects, followed by a four-minute Q&A session from the judges’ panel. On the final day of the competition, all teams presented during a morning session, before the finalists who received the judges’ highest scores presented their work for the final demonstrations.

Ami Stuart, Tech Events Manager at Entrepreneurship at Cornell who organizes hackathons across Cornell, said it really spoke to the “caliber and reputation” of the event that students from not just Columbia, Parsons, and NYU participated, but those from as far as Philadelphia, Boston, and Hartford traveled to New York City to be a part of the weekend.

When reflecting on the hackathon, Mariia Dobko, one of the members of Mixed Bag and a Jacobs Technion-Cornell Dual MS Degree — Health Tech Concentration student, said that winning the grand prize “was a truly unforgettable experience.” She said the sleepless hours of hard work and dedication were successful due to the fact their team came from such “different backgrounds and diverse skills.”

“Although I have participated in hackathons before, I have never tried to combine so many different parts,” she said. “It was amazing to see how it came together at the end.”

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NewYork-Presbyterian, with physicians from its affiliated medical schools Weill Cornell Medicine and Columbia University Vagelos College of Physicians and Surgeons (Columbia University VP&S), are collaborating with Cornell Tech and the Cornell Ann S. Bowers College of Computing and Information Science (Cornell Bowers CIS) to transform cardiovascular health and heart disease prediction and prevention using artificial intelligence (AI) and machine learning.

NewYork-Presbyterian will support Cornell with $15 million over three years to fund the initiative aimed to improve heart failure treatment, as well as predict and prevent heart failure. Researchers from Cornell Tech and Cornell Bowers CIS will collaborate with physicians from Columbia University VP&S and Weill Cornell Medicine to use AI and machine learning to examine multi-modal data and detect patterns that will help predict who will develop heart failure, inform care decisions and tailor treatments for their patients. The initiative brings together NewYork-Presbyterian, Columbia University VP&S and Weill Cornell Medicine’s technical, clinical and research expertise in cardiovascular medicine with Cornell Tech and Cornell Bowers CIS’s leadership in advanced machine learning and AI.

“NewYork-Presbyterian is thrilled to be joining forces with Cornell Tech and Cornell Bowers CIS to harness advanced technology and develop insights into the prediction and prevention of heart disease to benefit our patients,” said Dr. Steven J. Corwin, president and chief executive officer of NewYork-Presbyterian. “Together with our world-class physicians from Weill Cornell Medicine and Columbia, we can transform the way health care is delivered.”

“Artificial intelligence and technology are changing our society and the way we practice medicine,” said Dr. Nir Uriel, director of advanced heart failure and cardiac transplantation at NewYork-Presbyterian. “We look forward to building a bridge into the future of medicine and using advanced technology to provide tools to enhance care for our heart failure patients,” said Dr. Uriel, who is also a professor of medicine in the Division of Cardiology at Columbia University Vagelos College of Physicians and Surgeons and an adjunct professor of medicine in the Greenberg Division of Cardiology at Weill Cornell Medicine.

Researchers and clinicians anticipate the data from a diverse patient population will answer questions around heart failure prediction, diagnosis, prognosis, risk and treatment, and guide physicians as they make decisions around heart transplants and LVADs (pumps for patients who have reached end-stage heart failure). Future research will tackle the task of heart failure and disease prediction to intervene earlier with those most likely to experience heart failure and preempt progression of cardiac conditions and damaging cardiac events.

“Major algorithmic advances are needed to derive precise and reliable clinical insights from complex medical data,” said Deborah Estrin, associate dean for impact at Cornell Tech and a professor of population health sciences at Weill Cornell Medicine. “We are excited about the opportunity to partner with leading cardiologists at NewYork-Presbyterian to advance the state-of-the-art in caring for heart failure and other challenging cardiovascular conditions.”

“AI is poised to fundamentally transform outcomes in cardiovascular health care by providing doctors with better models for diagnosis and risk prediction in heart disease,” said Kavita Bala, professor of computer science and dean of Cornell Bowers CIS. “This unique collaboration between Cornell’s world-leading experts in machine learning and AI and outstanding cardiologists and clinicians from NewYork-Presbyterian, Weill Cornell Medicine and Columbia will drive this next wave of innovation for long-lasting impact on cardiovascular health care.”

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By Susan Kelley

“Stop it, stop it!” Yanick Pierre-Louis, 68, slapped her knees, frustrated they wouldn’t stop trembling. Again, her body refused to do what she wanted.

She had just spent an excruciating 25 minutes walking, grimacing with each step, from her recliner in her Brooklyn home to her front door and back, leaning on her walker. Marie Dorvilne, her home care worker since 2017, walked behind Yanick and circled her arms around her torso. She used her knee to help Yanick bend her own.

Besides rheumatoid arthritis in her knees and shoulders, Yanick struggles with gout, diabetes, coronary artery disease, memory issues, headaches, and incontinence. She is a breast cancer survivor.

When they made it back inside, Marie eased Yanick down to the recliner. “I don’t turn my back until I know she is on the chair – sitting, not standing,” says Marie, a certified nursing assistant with 18 years of experience in the profession. “I don’t trust her to stand for one minute.” She elevated Yanick’s feet in a recliner and rubbed Yanick’s knees with swift, gentle strokes, her light blue nails making a circular blur. “You’ll be all right, you’ll be OK,” she says. In a few minutes, Yanick’s knees stopped trembling.

Between 8 a.m. and 2 p.m., Marie is Yanick’s bather, dresser, cook, companion, cheerleader and health care manager. She monitors Yanick’s blood pressure, gives her medications three times a day, times her meals to keep her diabetes in check, schedules and takes her to medical appointments, and alerts doctors and Yanick’s daughter to changes in her health. That’s after an eight-hour night shift, taking care of 12 patients at a nursing home. She has one Saturday off every other week.

“Some people have time to relax, but I don’t have time to relax,” Marie says. “But in a way, I feel like I’m not working. I feel like I’m helping her. I look at it like she’s my mother.”

The research illuminates how the COVID-19 pandemic has increased the value of these workers – mostly middle-aged immigrant women of color – while the demand for their services is at a historic high. Yet here in New York state, they are paid on average $15 per hour – about $19,000 per year – and their work is chronically overlooked and undervalued by care teams.

The technology available to them is often out of date and rudimentary – designed mainly to track the workers rather than provide them with tools and support. And though they usually have the most-detailed knowledge of their patients’ conditions, they have almost no interaction with or feedback from their patients’ doctors or specialists.

“Most patients, like Yanick, actually want to be at home, they want to be aging in place,” Sterling says. “It’s a shift that we need to make, to start paying attention to home health providers, who are providing essential day-to-day care to patients to help manage their chronic diseases, and really integrate them into the medical arena.”

Unseen contributions

For Yanick’s first appointment with Sterling, Marie came along.

“Marie slipped into the room, carrying both of their jackets, a bag of medications, hospital discharge papers and a notepad,” Sterling and colleagues wrote in a paper guiding clinicians on how to involve home care workers in their patients’ care. “She hurriedly took out a pen and asked, ‘What did I miss?’”

“What struck me the most was how involved and passionate she was about delivering high-quality care to my patient,” Sterling says. “It was really through interactions in the office where I saw just how much she was observing in the home.”

Marie cooks Yanick three healthful meals per day, makes sure she has eaten before taking her daily 20 pills, and does Yanick’s physical therapy with her.

“She knew when symptoms changed. She also knew when medications were not helping, or when it was time to go seek care,” Sterling says.

That prompted the Cornell team to launch a series of studies defining the unseen contributions of home care workers, establishing evidence of their value and revealing the lack of equity this workforce experiences, Sterling says.

One of their recent studies, which they conducted through Cornell’s Survey Research Institute, suggests home care workers assist with a far wider scope of care than previously documented. Nearly 74% of New Yorkers surveyed said their caregivers provide medical care and/or emotional support. Those patients were twice as likely to view their caregivers as “very important” compared with those who received only personal care.

When Marie sees Yanick become introverted and sad, she takes action. Yanick frequently get depressed by her physical limitations; until about 10 years ago, she lived an active life. She worked in Brooklyn hospitals as a health care worker and raised three children after emigrating from Haiti at age 16.

“I tell her, ‘We don’t have time for depressed. Let’s take a walk outside,’” Marie says. Sometimes she has Yanick sit on the walker and rolls her outside as if she’s in a wheelchair – that always makes Yanick laugh. “That’s what I want to see,” says Marie, 45, who was also born in Haiti and emigrated to the U.S. at age 23.

“She really loves me,” Yanick says. “She’ll say, ‘Come on, smile!’ I feel content with the care. She’s beautiful. She really touched my heart.”

That kind of emotional support has become even more important during the pandemic, when so many vulnerable older people are isolated at home – but it comes at a cost to home care workers. The Cornell team conducted the first study on home care workers’ experiences during the pandemic in the U.S. – and found New York City home care workers faced a higher risk for COVID-19, because many relied on public transportation and frequently lacked protection like masks and gloves. They also faced higher risks to their mental and financial well-being and felt inadequately supported and generally invisible.

The pandemic also exacerbated many of the baseline challenges that home care workers face: low pay, isolation from doctors and other health care providers, physically demanding work, medically challenging patients, unpaid travel time, and frequently changing workplaces that may include unsafe working conditions. “You never know what you’re going to come across. Are you going into a home where there’s hoarding, where there are bedbugs or rodents or crime, broken elevators?” says Faith Wiggins, director of the Home Care Industry Education Fund of the 1199SEIU, the largest health care worker union in the United States, where Marie is a member.

“We really think it’s important to use research to demonstrate the value of the care,” Wiggins says. “With home care, you can’t remote in. You can’t use AI to replace someone assisting you to transfer from your bed into a wheelchair. There will not be a workforce if the wages remain at the bottom, which right now is where they are: minimum wage.”

These challenges contribute to a severe shortage of home care workers, while demand from a population that wants to age in place is growing exponentially, says Ariel Avgar, Ph.D. ’08, professor of labor relations, law and history in the ILR School, and an expert in health care labor relations.

“There’s a tendency in the health care industry to view the workforce as a cost – a cost that needs to be minimized,” Avgar says. “In our research we try to demonstrate how this workforce is not just a cost but a central way in which organizations can deliver high-quality care.”

The authors suggest several policies to support home care workers, such as designating them “essential” workers across the U.S., as they are in New York state; legislation to ensure they have masks and gloves; and assigning them to patients on a geographic basis to minimize their need to use public transportation.

“How do we make sure that the knowledge that they have, the insights that they have, make their way into the system in a more robust way?” Avgar says. “It’s happening in some places. But we’re far from where we need to be.”

Real-time assistance

When Marie needs guidance or has a question about Yanick’s care, she’ll try to reach out to various doctors or her home care agency. “Sometimes you call three, four, five times – you get nobody,” she says.

One of the biggest challenges home care workers face is a lack of information about how to handle their patients’ chronic conditions and exacerbated symptoms. The Cornell team is exploring how to use education and technology to address it.

Because the caregivers work in patients’ homes – isolated from doctors, nurses and other home care workers – they can’t learn from others or ask even questions, says Deborah Estrin, the Robert V. Tishman ’37 Professor and associate dean for impact at Cornell Tech, and professor of population health sciences at Weill Cornell Medicine.

“You don’t have as much chance to see what your colleagues are doing as we do in an office setting or in a hospital setting,” Estrin says.

When home care workers get a new client, they often have no idea what medical conditions they will face. “They often lack the ability to access educational resources on a specific disease that they go into the home with,” Sterling says.

And home care workers want that education.

For example, the team’s research found that when home care workers received training in heart failure – a chronic condition for which they frequently provide care – they had significantly higher job satisfaction compared to those who lacked training.

In June, and as part of Sterling’s Career Development Award from the National Institutes of Health, the team began the first clinical trial, in partnership with VNS Health, to test whether training home health aides and integrating them into care teams can improve their experience and patient outcomes. Over the next year, 100 home health aides will take a virtual heart failure training course. Half will be able to message their nurse supervisor at their home care agencies via an app when they have questions. The team believes training and communication will improve patient outcomes, such as avoiding 911 calls and trips to the hospital.

Tech support

When Marie arrives at 8 a.m. each morning, she uses Yanick’s phone to check in with the agency that employs her. “The minute I clock in, they know that I’m here,” she says.

Technology for home care workers is rudimentary; community health workers in Kenya and India use far more sophisticated tech in their work, says Nicola Dell, associate professor of information science at the Jacobs Technion-Cornell Institute at Cornell Tech and in the Cornell Ann S. Bowers College of Computing and Information Science. In the U.S., technology for home care workers is designed primarily to track them, she says. “That certainly has connotations of surveillance and indicates a lack of trust in the workforce, rather than what we would like to see and what we propose: tools that will actually support the delivery of care and support their existing tasks and workflows.”

Dell is principal investigator on a three year, $1.5 million grant from the National Science Foundation aimed at doing just that. One solution they’ve developed: interactive voice assistants – similar to an “Alexa” or “Siri” device. They presented their findings in early May at the prestigious ACM Conference on Human Factors in Computing Systems.

When a home care worker asks an interactive voice assistant a question, the device answers aloud, so patients and family members know the aide is asking about a medical issue. “It’s providing that information they currently either don’t have or are randomly searching for on the internet, and not necessarily knowing the quality of the information that they’re finding,” Dell says. The device can track completed tasks for the incoming aide, document vital signs, provide information on techniques such as how to assess swelling in a patient’s legs, and suggest when a doctor is necessary.

However, the team’s research also shows the technology comes with complex issues of privacy, power and ethics. “Who gets to turn the device on? Who gets to turn it off, and when? “And whose needs and opinions get prioritized in the process?” Dell says. “That’s why we think it’s important to do the research that we’re doing now and explore these issues before these technologies get deployed at scale and cause all kinds of problems.”

Another idea in the works: replacing telehealth visits with “extended reality.”

“One of the things that we began thinking about is, how can we do even better than just that two-dimensional Zoom-like connection between that remote clinical expert and that local caregiver?” Estrin says. The technology could help with crucial tasks from checking an incision after surgery to helping a patient correctly do rehab after a stroke.

Estrin and her students are experimenting with a headset for home care workers that transmits a real-time video of the patient from different angles to a remote doctor who is also wearing a headset. The doctor sees the video of the patient, while the home care worker sees the clinician’s gestures and directions. “The doctor might say, ‘Place the bandage a little broader’ or ‘Try to support their shoulder differently,’” Estrin says. “That helps the caregiver in the moment.”

She and her team simulate those interactions in their Cornell Tech lab – using a mannequin they named “Dave” after one of the lead graduate students on the project – to create demonstration technologies, get feedback from clinicians and home care workers, and improve the design. The technology could be available in three to four years. “That’s exactly the sort of material that Cornell Tech researchers do so well,” she says. “It’s a wonderful back and forth between the present and the future and back again.”

As a land-grant research university, Cornell plays an important role in developing these experimental systems, Estrin says. The commercial marketplace hasn’t done it, because the complexities of U.S. health care make the business model unclear.

Although technology can play a major role in supporting patients and the people who care for them, it will never replace the human touch, Estrin says.

“We want the last meter of health to be human. I think most of us, that’s what we would choose,” she says. “That’s what excites me about this technology, because it is about bringing superpowers to those caregivers who are touching, listening to and helping patients and really increasing their horizons for the work that they can do.”

What excites Marie is seeing Yanick open a water bottle on her own, or take a step without assistance.

She knows Yanick is happy too when Yanick wants to dance to Haitian compas music – her favorite. “But you know, to stand longer than two minutes, she can’t,” Marie says. “I say, ‘OK, you want to dance? OK, I’m right behind you.’ Just in case.”

This story and video were developed and produced by Noël Heaney and Susan Kelley, with additional support from Matt Fondeur, Sreang Hok, Wendy Kenigsberg, Eduardo Merchán, Marijke van Niekerk and Charles Amyx. It was edited by Lindsay France and Melanie Lefkowitz.

This story originally appeared in the Cornell Chronicle.

The post Overlooked, Undervalued: Cornell Research Seeks to Elevate Home Care Workers appeared first on Cornell Tech.

Deborah Estrin, associate dean and the Robert V. Tishman ’37 Professor at Cornell Tech, has been named the 2022 recipient of the prestigious Institute of Electrical and Electronics Engineers (IEEE) John von Neumann Medal.

The award honors recipients “for outstanding achievements in computer-related science and technology.”

Estrin was specifically cited for “her leadership in mobile and wireless sensing systems technologies and applications, including personal health management.” Her current research activities include technologies for caregiving, immersive health, small data, participatory sensing and public interest technology.

Before coming to Cornell Tech, Estrin was the founding director of the University of California, Los Angeles, National Science Foundation Center for Embedded Networked Sensing (CENS), where she pioneered the development of mobile and wireless systems to collect and analyze real-time data about the physical world. Additionally, she co-founded the nonprofit startup, Open mHealth, and has served on several scientific advisory boards for early stage mobile health startups.

She will receive the award at a special IEEE awards presentation in May 2022.

The award was named for John von Neumann, the Hungarian-American mathematician who made major contributions to physics, economics and computing, including linear programming and game theory. Éva Tardos, the Jacob Gould Schurman Professor of Computer Science in the Cornell Ann S. Bowers College of Computing and Information Science, was a von Neumann award recipient in 2019.

Adam Conner-Simons is director of communications and Jess Campitiello is digital communications assistant at Cornell Tech.

This story originally appeared in the Cornell Chronicle.

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Auggi, which stands for “augmented gastroenterology,” is a personalized digital assistant for gut health that guides patients through a scientific journey towards a symptom-free life. Patients can take photos of their stool and document other key symptoms on their phones, then computer-vision algorithms and deep-learning techniques are deployed to extract clinical insights from this data. This information becomes the enabler of an improved patient-provider experience.

The company was founded in 2019 during Startup Studio by David Hachuel, Jacobs Technion-Cornell Dual Master of Science Degrees with a Concentration in Health Tech ’19, alongside business partners Alfonso Martinez and Cherry Gao. Auggi was one of four winners of Cornell Tech’s 2019 Startup Awards.

“We are excited that Seed Health will carry our vision forward, stewarding new applications of our technology to empower people with greater insights about their digestive health,” said Hachuel in a release by Seed Health. “We look forward to seeing our technologies enrich clinical research and improve human quality of life, which is so significantly impacted by gastrointestinal health.”

Learn more about Auggi’s story here.

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