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>> So the B.B. structure the event today is each of our speakers they're going to take two hours to give us some remarks and then they will come up to the stage and you will have a Q. and A station so these Make sure to prepare your your questions for our speakers so I would like to invite Dr Ross.

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To the state. To give her too much. Good afternoon can you hear me. Because unfortunately I have nothing I can attach this to today so I'm going to leave it up here and hope that you can hear me and it seems like that's going to work out quite well Well good afternoon it's my pleasure to be here and I'm going to tell you a little bit about the Center for quality growth and regional development and let me start by saying we are very fortunate because we get to play in everybody's backyard in fact we were established that way in one thousand nine hundred seven group of intellectuals.

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And entrepreneurs were sitting around and they said they were even mad to think that Atlanta would be the place where we would create a think tank of sorts one that would study the ills challenges plagues opportunities there really lie in front of not only American cities but cities globally and all that came of commitment on the part of Georgia Tech to establish a center for quality growth and regional development and very benevolent fund agreed to fund a chair they had three West professorship and I've had the delight of.

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Holding that chair and operating as the director of the center I left from one nine hundred ninety nine to two thousand and three so I would be from two thousand and three to right now so I lay claim to having the opportunity to have spit many great years working with a number of other folks across campus departments around the topic there really is very multi-disciplinary.

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There we go let me talk a bit about our the vision that they had. Georgia Tech of course create a lot of new knowledge on Fortunately I would suggest a great deal of it stays here so the idea with the Center for quality growth the development of that was that we would take that knowledge and actually put it out there in the real world implement it share it inform practice and so you'll notice as I go along that most of the work that we do has a practical bit to it we certainly have a now talk about Want to two of those a number of theoretical concepts that are resonating globally of which I'm very proud but no doubt a lot of what we do is really focused on transferring technology transfer and new concepts transferring new techniques into the world of practices so if you look at our vision and mission statement they really reflect that bias or I should say preference rather than by.

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So. What we care about I'm going to identify these areas you can look at them and then let me suggest that what we really care about is the integration of those five and so obviously we're in a College of Design no surprise there to community development design would would be at the forefront healthy places is a is a call for our sales through looking at the lack of any consideration for health impacts where decisions are made by those who make decisions some of which have very negative consequences for the environment in which we live in so we've called the place for us sales relative to healthy places transportation infrastructure in my bio I really do a lot of transportation planning that's my my preparation and so that infrastructure and as you know excuse me.

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We have we have lots of challenges around the infrastructure question I give you the roads I twenty I eighty five and I had a. Phone call from Fortune magazine this morning to talk about Atlanta's transportation ales so you can be looking for a not so great article in Fortune magazine that will talk about the the challenges of infrastructure in the city of Atlanta I tried to talk him down I don't know how much look ahead on it but I did put a positive spin on it so so I what we really worry about and think about is how little things get connected What are the opportunities for practice for theory and that regard and how do we tap those resources as we go along to really make contributions in those areas that we're really to really submit new linkages between and among them.

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So what we do what I hope to be able to do in the short time I have is really to talk to just give you a snippet about what we can what we do the real challenges because we are in everybody's backyard I'll talk about a variety of topics some of which will surprise you others effect may not so if we talk about sort of transportation solutions I have a joint appointment a civil and environmental engineer and I do a lot of work with that group and transportation solutions across the spectrum are in our purview I look at our staffing and I think it kind of tells the story we have engineers landscape architects and planners in a number of very brilliant doctoral students who really do as you all know a lot of the work in that regard so we have a very diversified staff as well the mega region concept I'll talk about I think we own that globally I'm very proud of the fact that emanated from Georgia Tech and of course we are a Georgia Institute of Technology so emerging technology is one of those arenas in which we we actually play quite a bit so that we do how we do a lot of different things let me talk a bit about assistance and influence and I've just picked up a couple of resource some a while ago continuing over the last nine or ten years.

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To look at housing You might for example in your family if you might think that well the point. Is in the city it's really not it's in the suburbs you'd be surprised the quality of materials we're using to construct suburbs in this regard the Georgia coast I'll just talk very briefly about those so you get some of the takeaways of the big ideas what is the magic number Well why do I care because federal funds get tight at what my population is going to be and let me tell you the numbers that they got when they ran growth for the next twenty five or thirty years and the numbers that we get the very different course were used by the Environment Protection Division to limit water uptake out of the Chattahoochee to talk about the funding of federal programs this so again really important work but again pointing to the practical implication which is really in my mind what I hope I can communicate and then what you know the various sensitive landscapes ecology ecological systems that they have we done a lot of work with them.

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Just so my own personal contributions the least less focused health impact in the United States A.J. was an opportunity that I think is before all of us to make sure that we can really talk about the integration of health in all policy systems very widely of clickable methodology and it really gives us a chance to say to decision makers that these are in fact what you're not considering these are in fact the impacts that are likely to occur with your decision your recommendation where there's a policy a program or project and of course the mega regions book where we're now working on the second book in that regard really good use that this is one of the tools concepts and applications that works on the global economy most of us do not in fact work we're pretty good people mostly in our financial systems financial calculations techniques methods geographic footprint doesn't resonate with global markets and so this idea of a new geography a new concept new strategies gay.

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Right so the mega region which really came out of again very smart people who take classes here at Georgia Institute of Technology and then the inner city really talks about ongoing challenges in that regard. One of the things that we're equally proud of is about thirteen years ago we started something that we called the healthy places research group it meets once a month we invite everyone we have people from the community physicians elected officials.

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Agency heads not government organizations the private sector you'd be surprised what people do for a bagel and a cup of coffee in the morning about seven thirty they've become for about twelve or thirteen years now we have a wonderful exchange typically it's one or two presentations if you will and then we do a round robin update on relevant topics conferences research opportunities and a number of very important research activities have to have were developed out of that I laugh to myself we we have bagel couple pastries and coffee and one time the community of Southwest Atlanta largely minority decided to host the healthy places research group and we were a bit embarrassed when they came in with their you know pastries and bagels.

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They get they had their coffee but the point was they made us look pretty bad on the healthy food issue and we we were the whole for a long time and they said Let us tell you how you really do it and they actually did quite an outstanding job but we're really proud of this this this has been replicated around the country a number of universities have healthy places Research Group is a great forum for really getting down to the basics and what communities struggle with how they think about their own health challenges what kind of services they receive and they're very willing to partner with us so this is something that happens every month I would love to have all of you attend this.

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Is very unlikely for those of us who live in the ivory towers so to speak I really like having the community involvement in in that. Rebar. So many courageous as I say it is a concept that I think we all locally and we have been working and funded by the Federal Highway Administration for about ten years now so we develop the concept the methodology to D.I.Y. Griffy the connectivity most of the whole platform for what mega regions means in the U.S. It's not just us if you look at China here the European Union of course the famous northeast corridor that in one nine hundred forty S. really gave rise to this concept of connected cities with the megalopolis concept in a way mega region builds on that about nine years ago it was call super city school go figure that one out it was slower migrated back now but it but it really talks about the kind of connectivity we're seeing globally that begins to link the economic course of different geographies together in a way they create a new huge economic engine and so we were involved about I guess not ten years ago the Rockefeller Foundation indicted thirty people from around the country fifteen from the U.S. fifteen from Europe to talk about this these these this great connecting these globules of population that we're going to gather and we had George to take decided we were something we should be interested in I really was struck by the fact that I was in the room I did my work at Cornell there's a little northeast and snobbery going on I hope I don't step on any toes I certainly was a part of that when we get in but I'm always a little bit why is this something is going on here and of course it was what was going on is that in Atlanta was the fastest growing of these new geographies and so without having us in the room we would've been not is fruitful a conversation nonetheless it's given rise to a real area of interest continuing research for us funding a number of our students as I've suggested for the last nine or ten years these are basically the mega regions and as we see them we say they drive eighty eighty five percent of the U.S. economy we don't think like that we think about fifty states one fifth.

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That is one fifty that the global economy ignores that they talk about regions and the support they can get in regions for what their investments might be what the kinds of industries they might attract look like and what is your capacity to respond to that and so you see the automobile industry being attractive back to the south right not necessarily to the north would obviously was House tour for many many years and with a new footprint that talks about the connectivity of Charlotte the land of Birmingham and rally and what that means in the global context so all of this really funny these names I'm proud of but my quest to name these and some where we started would not have been something I could have put on the screen so I'm really happy that we will eventually ended up defining these and it's really nice to get a call from around the world they say Come tell us about the Cascadia mega region and I think about where it started Georgia Tech we actually got quite good in that regard in that the Atlantic Station project the big project we're all things to use they came out of the College of the zine the school city and regional planning many many years ago and as you know now they are billion dollar investments and so we're proud of their track record in that regard and I'll try to hurry along so I don't take too much time here.

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Again another map of these mega regions we stayed with this even when we were the lone voice because we know other countries are doing this this is the competition and we need to get on our own single footprints in terms of thinking about our global competitiveness but I would argue are not only our global competitiveness but our national competitiveness and so I suggest that we've been quite fortunate for the last ten years the Federal Highway Administration is has basically funneled.

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Put lots of resources let me suggest they help us to really give this a very critical look and I think they are now building up on there to talk about how we should change requirements for our metropolitan areas so again that is a. A reflection so you might as well why are they important why do we care about it.

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And I'll just go with this very quickly I've talked about it quite a bit it is the idea that if you look at the non mega regions than a mega regions twenty five percent is all they consume in terms of geography of the non-major region areas about seventy five percent but if you look at well look at who's come from the new ideas innovation ninety percent emanate from one of those ten areas that I told you about driving innovation to a large extent in our country if you look at where Fortune five countries five companies Fortune five hundred companies are located at the you find them there of course we also have the biggest part of the missions no surprise there and I and so it goals and so we think these geographies resonate in a global context in a way that is very important for us to embrace to begin to bring to our own planning frameworks although we tend to as you know play it on a very short term basis but this thing is something.

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That we are resonates in in a very different way. Now to talk just a little bit about some of our work I've talked about that but I'll drill down on just on a couple of projects we were completing to have complete over the last couple of years one is as you know much concerned about the Panama Canal and what might this mean well we know it means greater capacity greater commodities being moved but we know right now if you talk internationally exchange you have Savannah in China you have Charleston in Europe and so what does this mean about shifting these Panamax ships now they can go through the Panama Canal from the West Coast to the east coast who's going to benefit so we conducted a study.

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Commodity forecast of twenty thirty and then twenty forty four three major ports on the East Coast the savannah Norfolk and knew all ins and then began to try to figure out what it would mean for those with this expanding capacity how competitive it would be the Panama Canal is going to.

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New winners and new losers and of course you know the whole the whole economic picture is important right now port pricing days down so there's plenty of supply but the we know it will stay that way and a question becomes how then do we in GA Do we record representing the port of Savannah we may compare it if we found a lot of things that we put G.P.S. tracking systems on trucks so that for the first time we really know where trucks really go where you think they go not where they're supposed to go now where the company tells them to go but where they really go and we found out a number of new things one of the things that we found out was here's where you need to be making investment because here's where they're going and guess what there's no infrastructure to support just stop being there to support truck facilities there to support parking there so here's an idea for you G. deal T. and others to think about relative to new investment we found out where there was ample parking space and not along all three of the ports we found out where commodities flow how much is so was really quite an interesting study and this was funded by as we do lots of work for the Georgia department of transportation issue might well imagine one of things that we're really proud of in this instance when you go to the Georgia legislature to say give me money and they do so the point they realize this importance I guess less than the average citizen so one of the things that we have been working on is this idea that not only do you need to know how much of a commodity is flowing through on your arterials on your freight network you need to know what those are and so the other thing that we did was to take the freight analysis framework which basically talks about an ace is called a commodity falls and we took that to the Panama Canal results and actually began to say OK under scenario one which is the middle map you're going to give this person a broken down to say that I have the Georgia counties who's going to benefit the most so now I can say to a legislature or here's a particular industry you're going to experience this much growth in twenty thirty and boy should you start planning now so.

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Really I mean it's have to take international global investment or U.S. investment in terms of the improvements to Savannah link to this global investment the expansion of the Panama Canal and drilling down to the very local level so we go from global to let Bill saying how much is going to happen in Fulton County What is that and how much are you likely to benefit so we could talk about employment for example we could talk about a number of jobs and that sparked everybody's interest and I'm going to hurry up right now.

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Almost and I'll go very quickly. A little bit about half the places I talked about the healthy places received were things that we decided is that everywhere you are there's an opportunity to consider health we have adopted the help in all policies in our research it doesn't matter what the topic is it doesn't matter who's funding it we ask the question is there an opportunity to talk about health is there an opportunity to improve health and so help in our policies sometimes the answer is no more often than not the answer is yes and we've embraced it kind of independently of whatever else we might do one of the big areas of focus has been the negligence that we think smaller world towns actually suffer from because not much attention gets placed there we have in the last a year and a half put a lot of attention on net looking at emissions from traffic that passes through stops in their land in other places so they missed as a cause the new smaller urban places the been a physicians of somewhere else and many a system we start to track that to basically raise a lot of focus on the question of what is the exposure who is getting exposed you won't be surprised when I tell you the answer to that how much is it and how is that likely to change between now and twenty forty and it actually changes Kreiss of Stan Chile.

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The project we just finished was looking at a city wide study and we have this chorus and the question becomes should we have what was around them so we say. Sort of condoms only that should happen certain kinds of buildings that shouldn't be constructed so kind of services schools etc that are not to be very closely aligned with a freight corridor and so the idea of creating But first which is what you see on the right this is the and this is the idea as freight quarters on a right where they really occur right now is on the left in the yellow an idea about protecting and thinking about how freight operates in our cities we think there are issues that should be zoning it talks about specifically loading and unloading it happens everywhere now you know that you get behind a truck they do it everywhere maybe there's a better way to do this so lots of work in that regard to your mother and I have one more the last thing you'll see that big.

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Black square in the middle a look at our N.P.R. saying to them make health policies your strategy we suggested they create a health Coordinating Committee we set it on par with the other major committees in the Metropolitan Planning Organization for us which is the Atlanta Regional Commission and gave it there for the ability to talk about health the route a R.C.S. operations.

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The last thing is this is a web based tool we just finished again it looks at rural Georgia we paid a lot of money to the Georgia Department of Public Health to get health data we're able to desegregate that there for now we could talk specifically about not only what will happen is frightening creases but what is the status of health right now what is the litter tell us about what happens in terms of the kinds of diseases health challenges that occur as a result of this so twenty forty we can tell you that environmental justice communities low income communities they're proportional for exposure to PM two point five and zero two is going to increase exponentially so I have taken more time than I should I apologize but thank you very much for your attention.

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Very much Dr Ross we will keep. To the end so our next speaker is Margaret walking her dog. Well good afternoon and I have to say now I'm really glad I'm following because much of what I'm going to talk about is sort of the drill down aspects of health that are.

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And. They really are going to enable more of the research that goes on as we just heard so so I'm going to talk about health analytics and really a very specific issue which is the case for interoperability. OK. I'm not sure. OK Thank you. So. I think. No you originally agreed to have this session I was with the enterprise innovation institute but my life changed and I am now with the Office of the industry collaboration and and in that context to work very very closely with the enterprise innovation institute and you'll see why because as we also just heard health is also a really significant economic development opportunities so and I want to put this in context so the work that we do at Georgia Tech in the College of computing science and also within the G T R I and certainly with I a swine cross a lot of sectors of campus and we really are looking at the issue of health and the right to be healthy it also has responsibilities and so when we look at what where healthcare reform has come from it actually started with Nixon it's like why do we make this so hard that we had started with Nixon and really the conversation was about is health care a social responsibility or is it a big business and in this country we're pretty schizophrenia about that so what we're really good at is acute emergency care we really are probably the best in the world if you have a heart attack you want to be here and but weren't allowed at prevention and were lousy it creating a culture of health thank you and.

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But here's the deal two hundred thousand deaths per year we actually think that number is higher but it's two hundred thousand deaths per year from just going to the hospital so that's like a Boeing seven forty seven crashing every day and you know if that was happening if people knew that in heard about then I think we probably see health care reform happening a little faster and because it's unacceptable so analytics as we see it and the technology that some.

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Torques analytics really has a very significant mission in how health is evolving whether it's precision medicine whether it's population health whatever but the fact is high performance computing and how we treat data in an analytic context is really really key to this so we say analytics can impact behavior and this is really important because actually you can have all the data in the world but if you can't move the needle on behavior it's really a problem so the Hondo reference is a very special reference in the hospital world so when we say impact behavior even Honda's what we're talking about are hypertensive obese non-compliant diabetic alcoholics.

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Just saying. And when we talk about the electronic health record which started back in the G.W. Bush era two thousand and four when it was really mandated federally that everybody would have to adopt electronic health records as a way to improve health care and really I think what's important in this conversation is that the where where we're going with innovation is far beyond the electronic health record on the other hand if you don't have the H.R. you're not getting there so I also want to talk about what is referred to as a national tax on the N R N Julie heard this a million times but we use it in health care all the time and this was derived from the Institute for Health Care Improvement and Don Berwick this is just a seminal character in this and actually was part of that original conversation with Nixon and that he developed this taxonomy and it really is the three buckets that we use when we talk about improving health care so improves the patient experience improve the health of populations and reduce the per capita cost and the real challenges we have to do all of that at the same.

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Time. So when we drill down a bit into E.H.R. adoption and has the if you like the foundation for how we're going to look at analytics and this is where we are seventy six percent of hospitals have now adopted a basic E.H.R. and when I talk about basic what I base it what I mean is it's an electronic records that keeps track of obviously patient name gender ethnicity and what the issue is what the basic.

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Lab report might be and what the appointment structure is so it's pretty pretty basic in terms of providers and by that we mean physician practices and it's much less it's a Brits running about fifty percent so you can see we've still got a long ways to go. But I want to talk about why this is the home port because going back to that issue of the seven forty seven in the health care world in the provider world we talk about transitions of care and this is actually were about eighty percent of those medical errors that can happen in a hospital happen and it involves because of miscommunication.

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And it's between the caregivers the responsibility for the patients and what is referred to as the handoff and one in five Medicare beneficiaries when they're discharged from the hospital are readmitted within thirty days and this is become kind of a national benchmark for how well a hospital is doing not with just the particular episodic treatment but with how well they're providing the the continuum of care what's going to happen to that patient once they're discharged but this area is is a significant area and of course the electronic health record and how we treat all of that information that data is really key so in the population health context it's more.

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OK good but it's so important so the challenge here is how do you aggregate analyze this data it's there in a meaningful way and it's usually coming from a lot of disparate sources and so what we will talk about is not semantically consistent and what that can mean and so what provider might refer to an echocardiogram.

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But another provider might just call it a chest X. ray and so when you don't have those kind of consistent terms it gets hard to measure data. So in a public health context we need these opportunities. To leverage clinical care data in these new way and so I have this time around basically just showing in public health this is what we think about this is what we worry about you look at the socioeconomic factors and that context is changing constantly to make individual decisions.

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The long lasting protective interventions clinical interventions and of course counseling and education and so if we have this world where we're able to harness all of this patient data from across a lot of different contexts this is going to really inform public health and ultimately policy so of course we all talk about on learning health system and this is predicated on what ultimately will be a lot of machine learning but of course you have to have your adoption of your E.H.R. the interoperability piece which I will talk about and then the analytics piece so what do we mean when we talk about Iraq ability and then again to impune are probably sick of me talking about this is sort of the that my my passion because it is such a germ main problem that just can we just fix this make it stop and but the interoperability issue is so if you think about all the different software all the.

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Different data that comes from these particular areas in the health care continuum and imagine. None of it can easily connect and relate to each other and yet between the primary care the hospital the specialists the long term care the public health context the pharmacies the labs all of this needs to be able to communicate and it doesn't the vendors in the hospital world are probably the three biggest offenders would be Cerner at the MET a tech in the provider the physicians provider world there are probably about a thousand providers and everybody has their vendors and they all have their own system.

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So this is the vendor reaction to interoperability. Just could you not. And in fact what it used to be when you talk to a hospital C.I.A.O. five years ago three years ago their answer to inner operability is just by Apple or just by CERN or just by the one system and you're good well now as we and the other party want to get across here that makes this very exciting to be a Georgia Tech is this is an area of innovation that is going so fast and I'll give you an example of that and then.

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So what this means here is and this is really where we're at with finally conquering this issue of inner operability and I'm very proud of Georgia Tech because when we were involved with H L seven which is the international standards community that has been talking about how do we make interoperability interoperability really workable You know they've really talked about this since one thousand nine hundred seven and got very far and part of it is there are a lot of computer geeks in the room and they have the sense of perfection it's almost like the Apple Microsoft story.

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And the apple part of it being just going for the ninety eight percent per head perfection and Microsoft's saying eighty percent is good enough and the problem is because of this perfection issue it was really hard to use it works beautifully but it was really hard to use so this amazing guy Graeme grief from Australia about three years ago five years ago actually decided we're just going to get more practical about this and he developed with with other developers a really straightforward way of doing this and it's referred to as the fast health interoperability resources and it's based on the same technology that Amazon uses all those search engine technologies that are able to very quickly synthesize what you're searching for and then push you all that magic stuff so the health care version of that is much more encrypted it's much it's much more secure but it's using the same principles so it gets referred to as fire and Georgia Tech embraced fire before anybody else did in the academic situation so and we were the first to academic institution to Bill have fire servers and the training our students how to use fire so that's been a big deal.

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And this is more technical stuff about but the main elements of fire but the point being is it's really easy for users to embrace and quickly adopt and that's that's for C.T.O. to C I O's they've been really skeptical about this because OK it's. Great easy for developers but what's that going to mean in terms of the standards community Well actually if you get this far enough along in embedded enough and people start to see it working and their data being liberated as we say and.

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And and it is able to be secure. It's working and so our surprise frankly has been when fire was first talked about five years ago. We didn't think it would go that quickly because in health care things do not innovate very quickly we're about twenty years behind Fin Tech and and aerospace So this caught on really quickly so I'm here to say three years later everybody is paying attention to this and I'll give you some examples but fire being implemented in this very general context in the care provision medication immunization diagnostics going back to that circle all of these things are beginning to finally connect up.

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So here's an example of major enterprise information systems Cerner is one of the the top three vendors they have to absolutely embrace using fire they've opened up their sandbox if you like and so this is an example where they have set up the first apps store for service so it means anybody in the hospital world or the start of a company world or in the industry world who wants to go in and start playing with this stuff and see if they can come up with relevant apps they can get into this and actually acquire.

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So. It is referred to this app thing I'm talking about is the architecture for that it's referred to as smart of fire Believe me you get all kinds of you know we have tech on fire so that smart on Fire is this is an example of Duke University's medical system and they use the other vendor ethic but they were able to use murder and fire to go ahead and set up a really interesting way for patients to track their medications and so this is called the do pill box and you can see it gives all of the information as to what the patient needs to take.

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But it has a picture of what the pill looks like and what time they're supposed to take and this is something that is when we say app the expectation is it's on your phone or wherever. So community based care so what we're saying is this extending more into a community challenge childhood obesity and this is just showing where the physician through this fire app is able to connect is able to provide data analytics and reporting that can go to a care coordinator who's really looking at what what we can do to educate the patient and the family and you can see it's sort of.

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A circle that everybody is informing each other. So U.S. government projects and tech has been These are all examples of tech projects and we've done a very significant project with the Veterans Administration we've built their first prototype of what's referred to as a gentle health platform and so the idea is for our vets when they are in the military and getting ready to be discharged to retire whatever part of the effectiveness of this is whatever it is they're they're Navy Army it doesn't matter their health records were automatically go to the V.A. and it will be already there for them when when they're ready to do whatever they need to do health wise and this has been a huge huge issue with the A and Ted So we're looking forward to that but but what's interesting about this is that the V.A. is embracing this idea of using fire apps using A.P.I. gateways doing all of this stuff to rest on top of their existing legacy health information system which is called Vista there what we're staying away from is the rip and replace with a lot of these systems because it's.

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Doesn't work you just trade one set of problems for another so the idea is if you've got your legacy system that you can put this stuff on top of it it will eventually migrate to this digital platform that is very in our operable and this is the public health context what is fire based interoperability look like for public health and so you can see the top of this is by having these these fire unable to apps that can collect data from wearables whether it's your remote monitoring device or your or whatever port that back into a data analytics engine that's going to inform a lot of partners and and again ultimately affect public health and policy.

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And this is just examples of what's in it for public health and I think where we're moving certainly with some of our projects with the C.D.C. is that this is catching on very quickly because again and magine interoperability across the different states that all have their own state health departments that collect data their way how does that how can we enable that to be reported in a very straightforward way to C.D.C. and to make these large scale observations.

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So here's an example of our online Master of Science in computer computer science has been and had been deeply deeply involved in embracing fire and doing some very specific applications and so this is the childhood obesity one that I talked about but these all fall within this arena of what we see going back to the AAA and the things that are going to improve the experience for patients so whether it's using clinical decision support for a physician to be fully informed about what what the best medication is for that patient.

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Whether it's population health. And works looking at these different health surveys interoperability among existing systems so that we can collect all of this stuff and make make observations public health surveillance healthy communities. So these are just some quick examples of projects we've done so and clinical decision support tool to help prevent Group B. streptococcus infection in newborns this is actually something that happens a lot more than people realize and it's usually because the woman is infected and it is passed along through the birth canal as the child was born and so this was an app that was designed again to help assess the the level of infection of the woman and then to enable the treatment before the birth.

[00:44:36]
Opioid epidemic this is something we've been working on with C.D.C. It's my my my last example here but one of the really interesting projects we've had students work on is what how deaf gets reported in this country because when somebody dies there has to be a death certificate and depending on what the nature of the cause of death that sets off a whole chain reaction of and where does that information go and if it's a specific if it's a HIV something like that it has to be reported federally so you can imagine all these different states and honest to God there are some medical examiners in rural parts of the country that tests are typically it's are in boxes in the back of their cars and there are other cities where big cities where it's much more streamlined aligned but because of the systems they used to harmonize with their state it doesn't necessarily mean that it's easy to extract that data and get it to C.D.C. So this is an example of where we helped develop an interface for you to.

[00:45:49]
To look at controlled substances in Marietta with their prescription history and death certificates to again be able to look at the patterns of. Drug abuse and then also to track who is issuing the per script sions Where are they from and this is of course the stories that you hear in the press about the.

[00:46:10]
The you know the drug store that it's got a population of ten thousand people but for some reason has issued two million Oxycontin pills so. That is where a lot of this technology is being applied. So in terms that and tax role in this we've been a very early evangelist to fire we've been a very early evangelist of the need for interoperability but here's the deal here's where it's shifting.

[00:46:38]
We used to talk about it purely from a place of connectivity how different data disparate data sets are connecting that's going to happen this this is the big change it's on the way it's still going to take another five years but it's happening right now what we're really interested in is looking at the interoperability and data how interoperable is that data because the data and now and in any academic institution but this one in particular with our faculty you can't give them enough data if they just want as much data and they don't care how complicated it is or where it comes from but the bottom line is if we're going to try and build this.

[00:47:22]
Culture of health it's got to be based on a lot of observations about our population and to understand our population needs to build that culture of health that also will help inform where the bike trails need to be and the walk to school program and all of those things and you know we need people to be able to look at aggregate data from all different sources and to be able to do it in a way.

[00:47:48]
That they can use high performance computing to come up with these observations pretty quickly because the landscape is changing so quickly so I think that tech there are AM And so what I have to say is there between the college of computing I ask why you there are many many places that are engaged in this kind of work across campus I tend to be more engaged with hospitals and industry and also working to help teaching R.I. and built a very applied data analytics program but the interesting thing is teaching or I this many of us know has money and they are building a very strong bridge back to campus and that's through our our newly recruited.

[00:48:37]
Clinician Dr John do and he is ALSO have time in the College of. Computing departments so I think tech is doing some things that are unusual and are being recognized nationally and one of the reasons is because we don't have a medical school where you have a medical school and you are very much confined by the legacy of that school their curriculum how they train their docs what the expectation is and how that academic medical center has functioned and by not being tied to that we actually are viewed as engineers who are going to probably have a much more innovative freer thinking kind of approach to these ideas I also think that it is known that we have people that have a lot of experience and in tech but also in aerospace and you know the I will tell you in healthcare there is a constant reference to the airline business because well what we've seen recently is they maybe could do a little better on the manners front but they are.

[00:49:48]
Certainly a lot safer than being in a hospital and so I think there are some really interesting analogies and expertise that health care and the industry is beginning to come in poll from different and this goes back to the interdisciplinary so. I think that it. Thank. You in a much milder to be appreciated great very interesting presentation so our final speaker is Dr Laura and we'll take a minute to.

[00:50:42]
So she can. Give us her marks as a recording. It's pretty good all right. Thank you all for being here. And thank you to the organizers for their patience and my. Schedule I just flew from San Diego and landed about forty five minutes ago. So. I'm going to talk for Coit So I'm back.

[00:52:18]
Any suggestions on fixing the feedback. I could. OK it's better to be slightly better maybe I also just talk quite so. It's very hard not to talk loud large and larger. So I'm not a member in the school computer science and I've been a Georgia Tech for a pretty long time almost twenty five years and I'm going to tell you and I want to tell you a couple stories about some projects that I've been involved in and then I want to tie together the different I don't like this phrase so maybe you have a better one for me but I'm going to call it a news for which this work has gotten done so the first story has to do with West African country of Liberia.

[00:53:35]
And but here is a country that has a special relationship to the United States it was formed as a return location for. American slaves. That's why it has a name that sounds like like liberty so the U.S. has had a long close relationship with Liberia my dear is also had a difficult.

[00:53:58]
History. Is really bad. The hand. OK this time. It's definitely much better I agree I'll use this. To try to do that and so so the U.S. has had a long relationship with Liberia the country of Liberia in Liberia itself has had a troubled history especially in the last twenty twenty five years with the civil war that was off and on but mostly on over a period of time and that.

[00:54:41]
And that that civil war. Led to a lot of. Damage in the country and one particular area that. The. Won't surprise you but I think has gotten relatively little attention in the developing world and that is the issue of mental health care so many people were very negatively impacted by the war it was not it was not fought on a kind of front line it was very chaotic so it couldn't be behind it wasn't as if people behind the front lines were relatively protected from the war that we're serving everywhere and so so the Carter Center had already been doing some work in Liberia and and realized there was this large mental health need that was not being addressed and so they.

[00:55:33]
So they decided that they would do a pilot program in Liberia you may know Rosalyn Carter one of her causes has been mental health care so they not done something like this before they decide to do it as a pilot I was able to travel there in two thousand and ten fall two thousand and ten and I took these photos there are these are women waiting outside an outpatient clinic.

[00:55:56]
This is this is what the pharmacy looks like so it's a box with a lock on it though if you really were determined you wouldn't have any trouble getting into this box made out of wood some light like colored wood. And. Speaking of records and record keeping this is their patient visit records and.

[00:56:23]
They're there they're filed in an order that order is not is. Served five digit number and and that probably is connected as well to this which is a patient reminder So this is somebody holding a reminder that he has an appointment at G.W. Harley hospital in October either the eight there or the ninth of two thousand and eight or two thousand and nine depending on what our touring is being used for that zero eight zero nine.

[00:56:53]
And there's a number there and you can see kind of in the background this sheet and these numbers are being crossed off that's to make sure they don't reuse the same number five digit number so this is the sort of this is really the general setting with respect to the health care system and their and their record keeping system as well as just a small view into some of the need for mental health care in the country so as I said the Carter Center.

[00:57:23]
Decided to undertake a pilot program and fortunately. Somebody who was. In a lead leadership position in the Carter Center about this for this program had a connection to the college of computing her husband was the lead it was in the communications office in the College of computing and we were looking for projects for students to work on in a project based course we've called computing for good computing for social good and he said Mike said Well Shelley might be interested in talking to you and so we started chatting and what came about was a partnership that included as its most significant technical development working on this patient encounter software so this was software that clinicians would use to record not the medical records but to make a record of the encounter they'd had with a patient so they'd see a patient and then they would fill out this demographic information diagnosis information some follow up information and then the next time they saw a patient they do the same sort of thing so we so again as I said in two thousand and ten two thousand and eleven time period were first getting involved and so with students we developed the software and I went over to Liberia eight times to do training in the use of the software so software was built by teams of undergraduate master's level students that were taking this project based course.

[00:58:53]
We went through a couple of different versions of the one that. Is the stable one that's been in use since June of two thousand and twelve is this version two point zero and that was an app based version version one point zero was was web based there are some technical interesting technical issues I guess if you're a computer science geek that had to do with wanting to preserve patient confidentiality.

[00:59:19]
And yet be able to link one encounter to the next so that they could measure outcomes like are the patients getting better and be able to evaluate how well the program was working that's much more challenging in the kind of technical setting. This program was operating in where there was frequently no power no internet access so you're not you know you're not interact and that client server and I don't are acting with a server you have to keep many many things local and you have to deal with this intermittent Internet connectivity so.

[00:59:57]
Some challenges in that in that in that way in addition to building the software which was the part that the students were really quite instrumental in. We also advised the Carter Center on purchasing low cost laptops that could be used by the clinicians so of course it wasn't there wasn't as if there was laptop or computer infrastructure spread around the country that could be used that the software could be put on to so so I worked at the Carter Center on purchasing at that time what made sense was to purchase these kind of five hundred dollar net books there'd be a lot more opportunity more options available at this point in time and at that price point and also training training the clinicians This is why I went twice a year I didn't the software development didn't require twice a year being there but the training of the clinicians to use the software and frankly training within inches and how to use a laptop.

[01:00:53]
Both of those were an integral part of what Georgia Tech did within the program so software development training and consulting essentially on laptop purchases and configuration. So and and I leave it to this challenge of of the environment the overall. Technical and frankly social and working environment on the difficulty in completing the software workflow which in and US space setting would be relatively trivial but here there are many steps a clinician had to go through for there to be sort of a success from the standpoint of using this technology they had to see a mental health patient there was a lot of stigma associated with mental mental illness and so even and there had been so little in the way of capacity to treat mental illness that it wasn't as if there were a bunch of patients lining up to get mental health care they had to spread the word there and Carson had a number of programs to reduce stigma to help people understand what kinds of symptoms they might see in a loved one or a neighbor that would be appropriate for mental health care so the question first had to see a patient they had to they had to take some notes about the encounter.

[01:02:13]
They had to have the law top and it had the power it had to be free of viruses viruses are a huge issue so everything Dr in the whole country carried a virus it sounds like they I sometimes I exaggerate and I don't this is actually not an exaggeration all thumb drives are essentially infected.

[01:02:34]
You know they had to they had to fill out the software and then at some point they had to get access to the Internet and they had to successfully upload the form so they were meant every spot along this workflow had the potential to be leaky and to lead to non you know not resulting in you know.

[01:02:53]
Eventually getting this this uploaded. Form so we were actually quite interested in this process from. So you know it's one thing I said one thing to write the software so the piece here that involved writing the software basically you know that they were using the form well there's a little bit more that had to do with being able to store it locally on the laptop and then upload it but there's an awful lot of pieces here that are really human issue not a technical issue or a mixture of human and technical issue so we were very interested in what was how that process was working and in particular what was what were the motivations of the clinicians had when they were able to successfully complete so that So the participation rate was pretty impressive given all those stages where it was possible not to participate now of course these issues of motivation to participate also show up in US based settings clinicians you know anybody's asked to do something that feels to the side of their job you know there are challenges with motivation challenges with completion so we did it we did a study where we and we looked into the barriers to participate and the reason supports a spate and we used some theory that has to do with.

[01:04:15]
Persistence why people persist and the role of pride in persisting and what we found was that these clinicians were very aware. That what they were doing was going to be visible to others outside the country outside of Liberia at the Carter Center which they viewed as a very prestigious and.

[01:04:39]
Prestigious place that that was visible also visible outside so Clinton said things like this that you know they were proud of their practice and they wanted to be able to share information about it you know that they wanted to let the Carter Center know. They were working you know that they were doing things that had been you know that they knew they'd been trained and they wanted to demonstrate back again that they had made use of their training and they were in the field work.

[01:05:05]
And so in addition to you know the software development over several offerings of this course and we conducted this study which we then published in a conference called I.C.T. information communication technologies and development about how to sustain this kind of practice I'm not going to talk for too much longer about the story but I wanted to talk about this and with one something about student impact so this is this is Greg your e and you'll see here this is a this is a screenshot from his Linked In profile.

[01:05:38]
I probably took the screen shot about three or three years ago it's more or less still the same and he's still a senior software engineer at Google so he started working in that fall two thousand and twelve class and then he kept working on it I must be Fall two thousand and eleven continued in spring two thousand and twelve and then it went to Google and when we had problems with the software I emailed him.

[01:06:04]
And he answers and he fixes the software so why why is he doing that. So I asked him that and he said he said this it feels good to use my talents to help other people it lets me stay in touch with George attack it's nice to know something I helped create continue to serve a useful purpose and I like maintaining and improving it so that it can continue to serve its purpose purpose so you know this is this is a very powerful.

[01:06:32]
Statement from the standpoint of an academic institution that is a long is remains connected to the university and not not you know in addition to a kind of the development people call him up and ask him to give money all the time you know and that tangible way and a way which is really.

[01:06:53]
Actually quite active remain active connection that remains and so. I've let me I'm a month Skip I have like three stories but I want to tell three stories in fact I think maybe I'm here to tell you like one I just tell you what the spaces of the other two stories so one of this the second story has to do with free and fair elections in countries where that is not guaranteed and has to do with building software and processes that allow lection monitoring that doesn't fall in this formal monitoring category which is the kind of thing that the Carter Center and other international organizations do where there's training and there's checklists and they deploy people to particular locations and polls and but instead tends more towards the left hand side where you're making use of the fact that the crowd is producing information and trying to tap into that as a way of looking for irregularities in polling locations all the way up to violence occurring as a result of elections so that's a second project and and in that project.

[01:08:07]
Which we worked on in the structure of a vertically integrated project a V.I.P. team these are two students computer science and electrical engineering undergraduate students who went with me and a graduate student to Argentina to monitor the Argentina runoff presidential election using crowd sourced monitoring via an app of what was happening in polling places so we partnered with a small startup in Argentina to do that work.

[01:08:42]
And there's a great story here as well where Paul Wilson one of those two students said that this introduced him to the idea of computing for good and it shaped his interests. Into desiring to program and develop systems to tackle problems that interest me rather than programming just to make money so the second example and the third one has to do with again working in Liberia on education and sending three different students one each for three different summers to teach programming and physical programming and online education how to navigate online education resources in this i Lab in Liberia where there's essentially no no tertiary computer at computer science education in the whole country in fact at one point I asked one of the founders of AI lab who is Georgia Tech was it Richard tech Masterson how many people he thought in the country could write a program computer program and he said he thought was less than ten if you think about what this means for a country's future in this century if you know that it's really literally almost a handful of people who can can write a computer program so there's no there's no kapan and there's no capacity to build that capacity actually as.

[01:10:01]
Strong similarities to the mental health situation there was very little capacity to build mental health capacity here very little capacity to build computer skill capacity so we had these students go over one each summer for three summers and offer classes these are the three students Alan went first and then Zane and then Michael and All three of them are now in Ph D. programs none of them are Ph D. programs at the time all three of them are now in Ph D. programs Allan's at Michigan and the I school Zane is here at Georgia Tech and Michael is at CMU.

[01:10:35]
So now let me jump to something here so. I wanted to kind of draw this pathway from this initial course this computing for good we try now not to call it that although I have a very hard time not calling it that. When you try mostly to instead of saying good to say social good and instead of saying for to say and.

[01:11:02]
If that none of that mean just trust me really hot issue all right computing and social good. That course as a direct line to a School of Computer Science retreat those of you have been on retreats with your academic units are like those are awful nothing ever comes out of them.

[01:11:23]
That actually this didn't come out of that retreat. So I suppose that makes them all worthwhile I'm not sure that's quite quite true but and then that course led to. This participation that I mentioned in this vertically integrated project that worked on the election software that's a that's so the Course has the problem that it only lasts for a semester and is very challenging match between that and the kinds of projects that I've been talking about they just actually frankly almost all projects you know the real world doesn't operate on a start in the middle of August in and in the beginning of December and then take exams and go home and sleep for three weeks kind of schedule so so that's a problem with the course and this vertically integrated projects are really fantastic because they're long lived projects and students can come in and out and work on them on a semester on semester boundaries but you build up a team that's big enough that the project the fact you've transitioned over semester boundaries the project can can absorb that without like without a major.

[01:12:33]
Change in the in how work is being done so that that led to this very clear great projects it also led in led to a summer internship program called data science for social good the way that got going is that the University of Chicago had gotten a nice gift from Eric and Wendy Schmidt foundation to started.

[01:12:53]
A science for social good internship program and a guy who was had a Ph D. in computer science from Rice was working in Atlanta heard about it and said that program sounds really cool Georgia Tech should do something like that and so I kind of walking around Georgia Tech and knocking on doors calling people on the phone looking for interest and when I heard about it I said well that's a whole lot like competing for a good seat for G.E. just in the summer and the students work full time rather than taking three other classes at the same time and you pay them and you run an application process so I said I we don't want to do that you know we understand that model so we started this summer internship program and it's run for three summers and for this summer in the fourth summer it's now a National Science Foundation Research experience for undergraduates site thank God because the raising of the money every year for one summer off at a time was a real pain you guys may have even given us money at some point I'm sure I asked you I might have asked you I asked everybody on campus to give us these little amounts of money so so that's a very nice sort of progression story to this funded N.S.F. are you site and then the other thing that is actually a fairly direct line is from the Course to the ten year campus initiative called serve learn sustain so serve long sustain is.

[01:14:16]
Is in the second year and it is intended to provide curricular and co-curricular activities plus the integration of the four students around building sustainable communities so. Community Engagement service learning around the notion of sustainable communities and communing Gage meant service learning parts were something that I brought to the table as we were talking about what to do for this what Georgia Tech was going to do for this ten year effort and there's a come directly from working in the C. for G. course and then Beryl who some of you probably.

[01:14:53]
You know brought the sustainability part to truth be told I knew nothing about sustainability and I would say she knew nothing about service learning community engagement we got asked to put these together and to create a try to create a coherent plan and now we have somebody who knew a lot about both Jenny Hershey who's directing that center for surveillance sustain and that center was part of the basis for an institutional transformation and S.F. award that I have now with Jason Borenstein in public policy column Potts as a vice provost and Wendy Newstead are to look at how community engagement in courses impacts students concern for public welfare so there's a.

[01:15:41]
Famous infamous study showing that engineering students their concern for the public public welfare declines as they go through an undergraduate program so they arrive as these fresh faced you know eighteen year olds and they and they feel pretty strongly about the importance of. Attending to public good. And then apparently we beat it out of them and when they graduate they have much they have a low and this is a study that is fairly robust over a collection of universities so it wasn't just like that happened at MIT it was it was a public university a mass Amhurst it was a small that a small engineering college experimental all one and all women's college Smith So you can't just say Well at some places they figured that out it varied but it was it was the result was consistent across those so and I sat as a program to basically say all right apparently whatever is being done isn't working so what else might work in terms of students ethical to see the cease.

[01:16:53]
STEM is cultivating cultures for ethical stem so we have this hypothesis that community engagement can play a role here and we are actually looking at Georgia Tech over a longitudinal four year basis to see how Gage Mint impacts these kinds of measures and that that also has its path tracing back so.

[01:17:15]
I think I'll probably stop here. But I did want to illustrate these variety of ways that I've been involved in having students work and other colleagues work on projects that are in the. Health humanitarian area. Almost always with software always I guess with software as a piece but also essentially always with some surrounding elements because these are such.

[01:17:51]
Socio technical problems and. Much of the technical piece then you know you have to you have to think about the whole both in development and certainly in use of the technical piece so stop here thank you. For this. So. Yes we have don't we're not looking at it.

[01:18:23]
Yet. Meghan can you make that other screen planes. There function. So we're going to open it up for of the questions in discussion from the audience I also have a list of questions but I want to. First allow some of you to go and put your hand up and we'll see if we can get yes great we have some already and while you're doing that my name is Julie Swan And the other co-director of the center.

[01:18:53]
We thank you for coming today and we thank all of our speakers this is just a taste of the many people around Georgia tag who are working in this health and humanitarian space but you can see that the stories are so fascinating and the topics are so interesting OK so let's see if we will take your question tell us who you are in what you're affiliated with at Georgia Tech please before you give us your question.

[01:19:19]
And I am going to be changing my major to I and I have a global development minor and so I had two questions and so my first question was about the effect of connecting all of these medical information in terms of just how is it going to affect insurance market because with more information.

[01:19:49]
It was really. And so I was wondering what you think is going to happen as a result because it's going to give a lot of companies more basis to reject people or raise premiums and then my other question was for you Professor Ross and it was about we have a large we're seeing increased urban to well rural to urban migration so we can build these cities in such a way and we can improve transportation networks especially with autonomy vehicles but it is a question should really keep improving these cities to where we can house more people or should we be trying to make it so there's this big argument that we have an ideal city size where you see this drop in efficiency of cities do you think we should be instead trying to improve other locations where people don't currently want to live and make it more spread out.

[01:20:54]
And it's a great question and I think there there are two pieces to it I think what you're hitting on is absolutely what we're facing in this country right now in terms of health care reform as. In as we know it's complicated. And what I would say is that in terms of what's going to happen with insurance and all of that it is.

[01:21:23]
Americans have said no matter what what we want to do about the way there are some things that we want to hang on to so no preexisting condition issue. And we want to be able to keep our kids on at the up to the age of twenty six the other part of it that is going to be a huge bone of contention over the next However if if if there if we are going to tackle health care reform is going to be the issue of essential benefits and what's so important about the essential benefits his that it makes it very clear and no matter who you are what age you are where you're from there are certain things that you must have in terms of your insurance whether it's under Medicaid whether it's under Blue Cross Blue Shield Kaiser doesn't matter and and I think that reality will I think that's going to stick so to answer your question about premium increase you know I think the reality is.

[01:22:28]
We're going to have to deal with insurance reform like we did the last time and so it's in increments at the data actually I would take a different tack I think actually. Obviously personal health information has to stay very secure very very private on the other hand the more data we have to show.

[01:22:53]
Show better outcomes it is a fact that better outcomes usually means less money. And so I think if anything what we're going to see are health care systems and you see this all over the country where systems are merging with each other and well star is now the biggest health care system in the state of Georgia but what you will see as these systems become more sophisticated with how they're using data to determine the best outcomes there will be spending control as well so.

[01:23:29]
You know we really we don't know yet and it's going to go back to that question social responsibility versus big business many of my colleagues in health care governance keep raising the question what if you just cut out the middleman look at all of the employees that are necessary just to process a claim we've got you know third party administrators through the whole system what if you just got rid of a whole layer of complexity there what would that do to cost so I don't think there's a clear answer yet but it's going to be real interesting.

[01:24:07]
Thank you and thanks for the question I don't hold out much hope for an idealised city size let me give you two examples one of my hopes relative to this argument that I've been making for a long time now that this mega region is a global geography an economic system except for a there resonates in a way that we don't typically think about it in our country the idea is you have economic coal ores and that they have areas of influence some of which are immediately proximate to them and proximity but others are pretty far flung and so this idea of having to be in the city or of a certain size or even in calls proximity to have access to basic goods and services.

[01:24:54]
Where really the rubber hits the road and so I there's a big argument globally about this I am of the opinion that we use the kind of economic activity glamour to the effect that occur when we talk about these connected metropolitan areas that really function is one from a global perspective even though they are in different states that we talk about what kind of affinity industries what kind of services what kind of spin offs can we develop ancillary supportive related to as a result of other places that are not as dense maybe not in the core part of this connected core So this idea of idealised city.

[01:25:35]
You know I know there are these movies long time ago the corporate giant has pots and pots are just sizes every six people on a pod and. I think we all live in places that we like and that's OK and that we have a responsibility to provide services wherever you find the holes now are there certain things that benefit economically makes sense if they are proximate in the sort of location absolutely they will do that because it didn't own best interest to do that that's not a requirement everywhere and so it seems to me is an artificial argument to say that there's an idealised city size.

[01:26:15]
Thank you very much to we have another question from the audience here she already has Mike Yes good afternoon I must a student is going to take the entries are planning this question I guess I would like everyone to answer I was wondering what your thoughts are about communication and calm as a language and culture because I know you said that in Liberia I was just wondering if you could talk about was that an issue with language and also in this country there are so many more people who do not speak English who can't communicate and I feel like that's probably a huge issue.

[01:26:53]
When in trouble with the. Public and with being able to you know communicate across groups so just anything that you would say to that. Also a great question so. In Liberia. Official language is English although. There there's Liberian English and there's. Call book anguish so we speak book English.

[01:27:30]
A story when one point when I was there I went to a graduation ceremony for the clinicians who were being trained and they had a theater chirrup that as part of their effort to educate people about mental illness and when you should go to a doctor for example they had theatre groups that would go around from village to village and put on a performance and people would come to the central part of the village watch the performance of this is of course they were going to hand out pamphlets that you read because the literacy rate in the country is very low so they had these troops to perform this these performances to educate people about when you should go to a doctor so they put on one of these performances at the graduation ceremony.

[01:28:14]
I could not understand a single word I knew that they were using humor well people were laughing and it was actually clear from the body language and all that that it was that there was something funny happening but I actually only when I could understand was the person that played the doctor he spoke book English because that was he was a doctor and I couldn't understand a single word of any of us so.

[01:28:38]
You know that's to say of course there's there's the official and then there's the practice. Certainly that was a huge. It made the work hugely easier from the standpoint of. Software development but also training and and if I'm being honest I think. Sort of the ability to feel a personal connection and sort of reward to the work I did some other work and bond.

[01:29:08]
And we had you know we had translators there for all of that and that that step removed makes a difference. From a culture so language I think I think we're getting your software systems are getting better at what's sometimes called DOS what's the word. There's a word for essentially regionalizing.

[01:29:34]
Systems so that you substitute you know you have a configuration configuration information that does essentially the translation for you you build the software once and then you and then you have this there's a word for it that I'm not remembering but it's like regionalization but it's not that so that part I think on the technical side is in reasonably good shape and there's some very nice work done using actually audio audio recordings and audio playback for a low literacy culture is another thing right that is not that's that's because culture has so many more subtleties to it you know it's not a matter of translation.

[01:30:18]
I. There was some cryptography Well there was some hashing functions one my functions that used in the software the idea of a one way function is that. You put in some endpoints you get out an output and you can easily reverse it so you can't from the output see what the input is and that was used to provide patient confidentiality Well I guess I had to try to explain to the clinicians like what is this about and so I first I had this analogy about making.

[01:30:48]
Soup or something or rice like you take the ingredients and then you make it in Utah. Aced it and you know I got this fantastic but you couldn't be certain exactly what got put in and then they told me well you shouldn't use that food as I mean I thought this was a very proud of myself what an awesome analogy and they're like what we don't actually make soup like that in life but instead you could use rice so you know something like that you're just never going to never going to get it and less and less you're deeply involved with local people so.

[01:31:19]
I guess I'm not it's sort of I think a portion of the language part of your question as more tractable and more solvable by kind of a common common technique that can cut across but the culture piece completely different. Well I would say in the States a same issue and certainly in healthcare systems and one of the things that at a governance level that is talked a lot of a great deal is about diversity of even health of the boards of hospitals because they're not very diverse at the moment and yet that's the reality is the communities that we're so engaged with are tremendously diverse so there's a big movement about looking at that I think also one of the sectors of healthcare that that people rely on a lot for this is nursing because if you look at who becomes nurses in terms of gender and ethnicity it is very diverse and so that's a that's a good thing and I also think they're one of the concerns I have to say even though I've been espousing the electronic health record and collecting data and all that and the next iteration of that really has to be looking at making these systems much more and ubiquitous because what patients and everybody complains that doctors hate these systems they just hate them because they're not really designed for a clinical so.

[01:32:53]
And so patients everybody says you know my doctor doesn't talk to me anymore he's looking at a screen and I think in terms of so I think the next wave of technology will address a lot of that but the other point and there are. Certainly on the West Coast there's a great bit of attention being paid to bringing back the art of.

[01:33:19]
The healing touch and that of course is a very culturally sensitive thing but but to train our medical students again to know to be observant to be self aware to walk into a place and know that that patient is is. You are in a position of power and you need to meet that patient where the patient is at and so that I contact and that touch knowing culturally what what you can touch and is it is I think something that people are paying much more attention to.

[01:33:57]
Saw time not repeat the great comments that have gone before but a couple of observations and i would are I was suggest to you that my own communication and culture broke down when I started work with physicians from C.D.C.. And it wasn't a language barrier in terms of both of us thought we were speaking English it was rather the doctors No offense to anyone in a room are very different.

[01:34:21]
That the scientific method that's what's in the foreplay of things so it took us we did a joint project funded by the Robert Wood Johnson Foundation the first three months I thought what have you ever gotten yourself into because we had all of those issues on one side were trying to come up with health indicators that we would then go out and measure Boy it took I what Honestly it took understanding what they would say and what they meant and what we would say what we would mean to come to a common definition so we could advance the research itself.

[01:34:53]
Three months honestly so I start with something that's simple at home to talk about communication and the importance of that and I'll talk about it from the conducting research side and another project we have with children on the beltline Well you know kids are kids and we are not you really have to learn there's a silly commercial on television if you see what these were working for Google is done by talking this case is really scary disgusting talking kids voices and you go but my point is to really think about who and what the in the Is and to do whatever it is whether it's communication whatever artifacts or whatever you have to do to communicate to bridge that is so important terms of the quality of the research and what you can do there's nothing I think so and this is where you all can have this experience you go to a foreign country where you can speak a word and you just have some sense of what this feels like when people who are diverse come into these hospitals come into this research environment and there's no one like them there's nobody who understands what they're saying and then you say you don't understand why we have as much difficulty as we encounter with regard to actually getting really qualitative and reducing error with regard to the research and the work that we do so I've been in situations where I learn such respect for culture and diversity I cannot tell you I think that's a great place to be can.

[01:36:21]
I see another hand in the back we'll take your question please Yeah my name is Paul will go. By and question goes to someone who may be coming could also comment. About I was wondering. Do you work within government is Jesus. And also. Against you shows Nigeria to be.

[01:36:49]
In terms of building local capacities yet another question is. Are they building that I mean coming up with. The population about the elections down to play and resistance I mean being Think of instructions because what I know about I've been to a building that democracy is. Where you from.

[01:37:17]
Ghana. So OK so. Part of both of your questions had to do with working with the government. So in the case of the. Mental health project you know we benefited tremendously from really working under the Carter Center and its relationship with Liberian government so the Carter Center will not go into a country without being invited that's the way that.

[01:37:55]
They operate so. They and they are very. Careful to plan their programs so that. They are looking to have the sustaining elements of the program be in country so you know they are there for a period of time but even from the start there's a plan to transfer you know to have local the local government and Ministry of Health.

[01:38:24]
And local people to be able to take on the work and carry it forward so in that case I personally Well I went to some meetings. Mostly as an observer. Of that in the included Ministry of Health and other folks so I watched from a safe distance some of the negotiations and discussions which were.

[01:38:55]
You know not simple kinds of discussions and processes. So in that case there was some I was you know sort of shielded a bit in this way. I have worked closely with the I T director who is a librarian actually there now on the third one so. But the mental health program has an I.T. director and there's been three three folks in that position and I've had a relationship with each of them.

[01:39:25]
That has involved talking about you know do we have a new version of the software you know do we need to get some data out so so I think that's been a kind of capacity building. To help local help the local i t person be able to extend his his experiences beyond you know installing some of the more basic kinds installing software and using using productivity tools but to issues of data and data analysis and for instance they they want to track which clinicians are responding to the survey so so that's a that's an example in the election monitoring case.

[01:40:10]
That work has been done also with in country partners in each of the I didn't go through this election software that aggregates from social media this is a little bit different than the crowd sort of Argentina work but the basic initial system called agie has been used in.

[01:40:30]
Probably about seven or eight elections starting in Nigeria Actually most recently in Nigeria again. And that work is done in conjunction with with relationships with the police and government and election officials because. If there is an issue. That is discovered during monitoring they want to be able to connect to someone in the field who could respond and that so.

[01:41:03]
You know on the more but nine in some sense kind of issues of things like the ballot that polling place didn't open or didn't open on time that's one thing but there's also been instances in the use of that software of uncovering reports of violence and then contacting officials who could go and check that out and respond if necessary so we can't do the you know these kinds of.

[01:41:32]
Many of these projects just can't be done without a partnership with local with local government and I haven't been in the position to navigate that myself but instead through partners have had that happen. Thank you I'm going to ask one last question now ask and to all of our panel speakers.

[01:41:56]
And ask for a short answer so that we can get to the food out in the hallway and I'm asking something that I think is probably relevant core a number of people here and those watching the video. Offline in that's for people who are looking to move into this space who haven't been working at it before do you have any comments about what advice you might have for them.

[01:42:21]
Be persistent It is really important I think be open to partnerships that my not be top of mine there are opportunities in many places I imagine that a lot of the work that I've had the opportunity to be involved with really came because I had a conversation with someone even about research in the way as a result of having an exchange we continued to have a dialogue that led to questions that we both had that eventually led to an activity we could both become associate.

[01:42:53]
With that's really I think you have to be very very open it's really exciting because there's so many issues and challenges out there that we we can really bring some light to it and help improve the quality of life that we have so for me I think it opened my interesting goal of the spaces you don't usually occupy go to spaces that are your own and be comfortable in trying to understand what they are about and open to suggestions that might come as a result of those interactions.

[01:43:26]
And I would just add I think in the healthcare context at the end of the day health is all personal We all have our personal stories in our personal passions about it and I think if you get excited and have a commitment to that and you can certainly through many of us on campus find your way into where some of these really interesting projects are or if you have your own personal passion about it believe me we are always looking for people like that and we're always looking for and themes subjects to build projects around so I think it is as you were saying it in a way you just have to be OK with jumping in.

[01:44:12]
So I think if you're a student thing that's exciting is that there's now many more opportunities to get involved and there once more and so there are classes that can get you kind of connected into some of these sorts of projects there are V.I.P. teams that there's that span all kinds of different areas so that from a student standpoint there are some really great opportunities and just to put in a brief plug for Serve learn sustain if you go to their website they have a list of all the courses that are affiliated with us all us for the fall semester including I'm teaching one on technology and sustainable community.

[01:44:53]
Development it's going to be a three thousand level class. So there's many more opportunities for students if you're not a student so I got into this because teaching the class was a really good way to start kind of a foot a toe in the water and then as you can see some of the things that got started in the class grew legs and you know and lasted over long periods of time and turned into research and turned into publications a kind of things that we traditionally look for as academics as impact so.

[01:45:28]
So there's opportunities to do things start with something small and see how it grows. It is very much about about relationships though that's a thing you know both Catherine M. are going to mention this. You know these projects of the ones that succeed. Are based on long term relationships and being in space over a long period time because you just can't there's just a lot a lot to learn and to keep learning as you as you work in these kinds of areas.

[01:46:03]
Please join me in giving a sense here thank you to our speakers today. Thank you. I'd like to thank to other groups that Georgia Tech library videotaping and recording to make it available to others and also to our academic department the School of Industrial and systems engineering which helps support to boot that is right outside the room and now we'll all go and continue the discussion a little bit longer Thank you very much.