EP67 Designing Digital Health Solutions with Avanthi Hulugalle

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I AM GPH EP67 Designing Digital Health Solutions with Avanthi Hulugalle
EP67 Designing Digital Health Solutions with Avanthi Hulugalle

Alexandra Arriaga:    Hello, everyone, and welcome back to another episode of I am GPH. My name is Alexandra Arriaga, and today we are going to talk to NYU MPH alum Avanthi Hulugalle. She currently works as director of product strategy and client success at Open Doctor, where she works to optimize patient utilization of engagement technology and partner with healthcare organizations to create tactical solutions, improving patient experience of care. She is passionate about healthcare access and a strong believer that technology will bridge gaps between quality care and patient empowerment. If you would like to learn more about her trajectory and the intersection between public health and technology, please stay tuned.

Alexandra Arriaga:    Hello, Avanthi. How are you doing today?

Avanthi Hulugalle:    Hi, I'm good.

Alexandra Arriaga:    Thank you for coming and joining us.

Avanthi Hulugalle:    I'm excited to be here.

Alexandra Arriaga:    We're excited to have you. So, you graduated with your MPH from NYU, and when you look back at your time here, do you have any favorite classes or professors that stood out that you feel prepared you well for the work that you're doing today?

Avanthi Hulugalle:    I think maybe an unpopular opinion, I loved my first bio stats class. It was with Professor Goodman, Melody Goodman, and I just loved the teaching style. I finally got to dive into data and felt really empowered to figure out my own insights from a really gross Excel sheet. It's really served me well today. I think that's a really useful skill that I can bring to teams that don't normally have a statistical background. Just having that base knowledge has been so useful in my career so far. I think besides that though, I worked in a lab during my time at NYU. The Reproductive Health and Health Systems Lab, which I don't think is actually part of the college anymore unfortunately, but during my time here it was starting. My co-director and I, Allison, really had to figure out a start-up, how to find funding, how to build priorities for our graduate assistants, how to work with an investor board or our professor, Dr. Laurie Zephryin, who didn't have a ton of time, and we needed to figure out how to prioritize time with her and work to figure out projects and present to other people. It was totally a new thing for me to have to learn how to build something from the ground up, but now I work in start-ups, and that's all I do all day. I think that area to play around with what building is and how to create anything from human resource documents was so vital to what I do today.

Alexandra Arriaga:    Well, you sound very confident about it, so that's great.

Avanthi Hulugalle:    I'm glad I sound confident.

Alexandra Arriaga:    I mean, sounds like you got a handle of it. Yeah, you sound really confident. That's excellent. So, when you say that you are working in start-ups, what exactly are you doing?

Avanthi Hulugalle:    Yeah, that's a great question. I think most of my team would also like to know what I'm doing for my company. My title is a little confusing and long. It's the director of product strategy and client success. I think a lot of terms that are thrown out today for Millennials is product management. You hear of product manager roles all the time in tech spaces. Really, I have a two part role. One of it is designing the product, so trying to figure out ... We have this healthcare tech platform. We know that we need patients to use it, which are our users. But we also know it needs to be really useful for our healthcare providers and healthcare staff, so I kind of bridge the gap with what's going to be utilized on the data end but what's going to look pretty for the patient and what's going to make them use it. That's the design and fun part of my day.

Avanthi Hulugalle:    The less fun part is the client success portion, which is where I actually have to work with operations management of healthcare practices and explain to them that technology is so important and that they need to have and give their patients access to being able to schedule their appointments online, to understand how to read their results, to understand what they're going to be doing prior to their healthcare exam. It's a lot of teaching healthcare practices that are so set in their ways. It's surprising because nowadays you can book an airline ticket, you can do hotel reservations, anything really online, and healthcare is still hesitant to give patients any ability to empower themselves to do their own tasks.

Avanthi Hulugalle:    And patients are there. Consumers and patients, they're ready. "I never want to call for a healthcare appointment." And so, we're really trying, as a client success person, trying to hold everybody's hand and say it's okay and that we're going to get through this transition.

Alexandra Arriaga:    I feel like Langone is actually doing really well. They have that app that is actually really good. I had my first experience with it kind of recently, and you can actually set up your appointments, talk to your provider on a little chat, send secure messages. I like that. I like that direction for healthcare.

Avanthi Hulugalle:    Right. And we live busy lives. You don't want to have to be confined to making an appointment or talking to your healthcare provider within the 9 to 5. It's just not useful. And you bring up a really good point about Langone. Langone and bigger health systems are paving the way in creating these abilities, but what we're finding is that other communities and people that actually have less access also have less access to technology and this ability to be able to schedule their appointments online. Those are probably people who need it the most because they might not speak English very well or might be really scared or intimidated by talking to staff, and so having that tech filter and screen would be really useful. We're trying to figure out ways to kind of bridge those gaps as well in healthcare disparities.

Alexandra Arriaga:    We'll have to bring you back when you have figured it out, so you can tell us how it went.

Avanthi Hulugalle:    Yeah.

Alexandra Arriaga:    Obviously what you're doing is related to public health. I can definitely see some of the applications, but I'm wondering about your intellectual trajectory. So, how did you find your way to the kind of work you're doing now, and were you always interested in technology?

Avanthi Hulugalle:    I guess the short answer is no. I really wanted to work on ... I think I started my career in research doing pregnancy research, and it was basic information to understand how medications end pregnancy and the effects of it because a lot of things can't be tested in the lab, so pregnant women are just warned, "It's not tested, but if you really need to take these meds, go ahead and take them. We'll see what happens." What I was finding by doing these studies is that pregnant women just didn't have access to information. It seemed to really baffle me that there is all these huge holes and not a lot of tactical solutions to figure out how to get information out to people. It was such an obvious ... We have social media. There's so many things that we could be doing to pump out information, and we just aren't effectively doing anything about it.

Avanthi Hulugalle:    Within technology, I think I kept finding ways of wanting public health and public knowledge to be out there, and I wanted to almost redesign the ways that we were communicating to populations. I didn't really know how to do that at the time or what I was really doing when I first came to NYU, but I think being in the Reproductive Health and Health Systems Lab, I really honed in and researched digital health. I was trying to look up apps and trying to figure out differences. What really frustrated me was that a lot of apps and the things that I was specifically looking at, which were menstrual apps, were all the same. People were just reinventing the wheel and reinventing the wheel, and it was kind of like why aren't we trying different things? Being innovative isn't necessarily being high tech. It isn't finding machine learning and artificial intelligence. Yes, that's amazing technology, but what we need to do is create better design for technology and actually be able to be effective to patients.

Alexandra Arriaga:    Fully agree. And may I rant very shortly?

Avanthi Hulugalle:    Please do.

Alexandra Arriaga:    Menstrual apps suck. I have yet to find one that I like. They're ridiculous. Even though these signs are so childish sometimes and I'm like ... I don't know. It's just weird.

Avanthi Hulugalle:    Yeah. It's dumbing down things sometimes makes you not want to use it because I can do that anyway. I do it actually.

Alexandra Arriaga:    Exactly.

Avanthi Hulugalle:    Help me do something I can't do.

Alexandra Arriaga:    Yeah. So, speaking of technology, you are very involved with other projects, and I'm excited to hear more about some of these projects you're managing, especially the hack-a-thons. So, can you tell us about what you're working on?

Avanthi Hulugalle:    Yeah. I think after graduating from NYU and being so focused on public health and doing so many things for social justice issues and human rights, I went into a very private field. I started working in radiology and working with technology that helps radiology patients. I think it's so useful and so necessary, but I really miss the social justice and advocacy part of myself and really getting in there and working with community organization because now I just work with really rich, health guys. I think my co-founder of these, LYLAS Labs, and she started LYLAS, which is the main group that we work under. We were really trying to figure out ways to use our public backgrounds. She graduated from Wagner, actually. She did public policy. I did public health at GPH, and so we wanted to figure out ways that we could utilize our public health skills while also seeing how amazing the tech community can be and how we're building things for private companies and building things to make people richer almost. We're leaving some of our community organizations behind with easy applications. A lot of people want to work on social justice issues. I know myself, I'm so sick of going to panels and rallies and thinking, "Yeah, women don't get paid enough," or, "Yeah, climate change sucks," and just being angry about it. But what these hack-a-thons are facilitating is a space for people to actually come and innovate with other people that they normally wouldn't get to. I think the hack-a-thon mentality is really used to have a day where you can really work out issues and think about how to build solutions around them that you don't normally get to do in your day-to-day.

Avanthi Hulugalle:    I think hack-a-thons historically have been a very intimidating environment. Not a lot of people I know before I really joined the tech community didn't want to go to a hack-a-thon. I thought I couldn't possibly be involved in anything like that. What I was also finding was that at these hack-a-thons it was all men. It was just men designing things. We were talking about the menstrual apps. Could a man really build a good menstrual app? Probably not.

Alexandra Arriaga:    Not really. I mean, they could.

Avanthi Hulugalle:    Right. And they have tried based on what's out there. So, we wanted to get women more involved in tech, and women who probably don't normally get to go to hack-a-thons because maybe they're more in the marketing side or more in the business side. They're on the public health side. But everybody has so much knowledge that could make the design of a solution that you build out that day at a hack-a-thon ... Because everybody's past experiences or important careers actually have a lot of value to the design methodology of a hack-a-thon.

Avanthi Hulugalle:    So, we're building these hack-a-thons to be cross industry, which means that we'll have engineers there. Obviously, at a hack-a-thon you want to build out a tech solution, but technologists and engineers aren't the only ones who should be in the room when this happens. Making it more inclusive is a really big deal for us, and we're working on social justice issues, so we're not using hack-a-thons to build start-ups that are so focused on money. We're using community organizations around New York that don't have tech teams, they don't have a software development team that works on them 24/7.

Avanthi Hulugalle:    Giving them a day of coming in, saying, "It would be really nice to have a basic database that could help us talk to other community organizations." Okay, let's think about ways to build that. So, we spend the day really hacking the issue and talking it out and, I think, getting to know more New York City community organizations that are doing amazing things and just having the day to spend with them and be like, "I think we can re-design this or re-jigger this a little bit." And getting to meet other advocates that ... We're just sick of listening to problems. We want to fix something.

Alexandra Arriaga:    I love that. I love the mentality of let's get into action to find solutions, and I also like what you said about just keeping an open mind, even if it's something you've never done before or something that you never imagined yourself doing, try it.

Avanthi Hulugalle:    Try it.

Alexandra Arriaga:    You might find that you're actually really good at it.

Avanthi Hulugalle:    And everybody has something to offer. I've never talked about ... I know climate change is the problem. I don't know how to fix it, but it was a cool ... I bring my reproductive health knowledge and go, "Well, this is this population's issue." The other person talking about environmental health all day didn't think about that population, so I think we all have strongholds that we could talk about and discuss.
Alexandra Arriaga:    Mm-hmm (affirmative). Yeah. Absolutely. Something to contribute. So, you're working with a lot of great projects by the sounds of it that live at the intersection of health and technology. Where are the gaps in the public health field that this work is filling, and what would you say are the greatest opportunities for health and technology to make a difference?

Avanthi Hulugalle:    Loaded question.

Alexandra Arriaga:    Loaded. So, let's focus maybe on the first part first. So, what are the gaps that you think this work is filling?

Avanthi Hulugalle:    Yeah, so I think the gaps ... I think we all understand that technology equals access, so having telehealth visits now being part of insurance plans, so not having to go to the doctor's or go actually to the physical doctor, being able to talk to them online is starting to be an understood and okay thing. We're starting to understand that this gives people access. I think what we're still really struggling to figure out how to do is to work with patient data and to build solutions. That's a huge term that's used and thrown around today, which just means that we don't know how to communicate from health organization to health organization. I think as public health people we understand that. I'm not just a woman who only has OB/GYN concerns. I also have the mental health capacity or how my community is around me and housing, and trying to figure out how to use someone's data across sectors is something that we as a public health community is really struggling to figure out how to bridge.

Alexandra Arriaga:    Yeah. I think that also a really big problem is just the lack of uniformity in terms of the way that medical records are stored and things like that. We're dealing with information that is protected health information. You can't just email a patient about their condition, so you have to jump through so many hoops.

Avanthi Hulugalle:    Yeah. And that sometimes really is a detriment to the patient because if I'm a caregiver and I'm maybe a caregiver not to my child but to my parent, it's really hard for me to get information or to help them.

Alexandra Arriaga:    Yeah.

Avanthi Hulugalle:    These protections are there for a reason, but we need to figure out better solutions.

Alexandra Arriaga:    Agreed. Fully agree. Well, I guess you're working on it.

Avanthi Hulugalle:    I am, right?

Alexandra Arriaga:    Going back to the second part of the question, where do you think are the greatest opportunities for health and technology to make a difference?

Avanthi Hulugalle:    I think especially talking to a public health community, I think that we ... I'm sorry to keep using the word design, but I really think that that is our strong suite. I think as public health people, we look at a whole person and their whole life and quality of life. That is something that a health community only really looks at their subspecialty. They might be just looking at internal medicine or just looking at, "Do they have the flu? Okay, no. You're healthy." Maybe that's not the case. Whereas the tech community is always looking for business case opportunities. "Where are we going to make the most money? Are the most users using this? How are we going to make this marketable?" For public health people, we're somewhere in the middle. We want more people to use it and that's patient health and population health. And we're also on the health side where we want to make everybody really healthy as a whole being. I think it's sad, but I also see that a lot more public health people are coming into digital health and saying, "We kind of understand how to bridge these sort of two worlds, and I think we have a good opportunity to make a difference here."

Alexandra Arriaga:    Yeah. I think so too. Hopefully, we'll seamlessly get to a point where it's possible.

Avanthi Hulugalle:    Yeah. I think so.

Alexandra Arriaga:    So, something interesting is that I'm getting the impression that your work is very solution-oriented. Correct me if I'm wrong. But can you talk about how you balance creating and building a tool with observing and understanding the main points of a population? I talked a lot about this recently in Aspen where, I think, what we're having trouble with right now as being solution-based is that we think that we understand people. As a product designer, I have to believe that I understand people, but I don't always understand the populations I'm serving. A huge problem in product design and how we're building technical solutions is we're not actually talking to the populations. I think that's, again, something amazing that public health is is we go out in the communities, and we do these survey, and we do these community interviews, and that is something that we need to do when we're designing products. If I'm designing something for a low-income community, I need to be in that community understanding how they receive information. Is this screen really intimidating? Are there too many words on it? Do you understand how to maneuver it? If we're not testing with those populations and just assuming that we know it by just doing journey mapping or just kind of assuming that we understand them, I think that's what we're really missing right now.

Alexandra Arriaga:    Yeah, so incorporating that social context of the people, not just their actual health, but literacy level or all these things.

Avanthi Hulugalle:    Yeah. And having them really touch and feel the product. I think we always just do basic surveys like, "Is this word better than this word?" Or it's this A-B testing, and having people in the room or really part of it I think makes for the best product.

Alexandra Arriaga:    Yeah. Is walking around and thinking of solutions something that just comes natural to you?

Avanthi Hulugalle:    I don't think so, but now I'm pretty obsessive. Now I'm constantly thinking, "That person walked that way. I wonder why she did that." I'm becoming a way more curious person, which I think is why I love doing what I do. I'm constantly, even when I'm on apps now going, "I wonder why they did it that way?" Or, "I wonder why someone asked me that question?" Now I'm just being annoying because now I'm constantly questioning, but I think that means that I'm enjoying what I'm doing, and I'm learning a lot more about my surroundings and the people around me.

Alexandra Arriaga:    Absolutely. And I feel like the curiosity kind of fuels new ideas. Yeah.

Avanthi Hulugalle:    Absolutely.

Alexandra Arriaga:    You need to keep that up. So, it's possible that there are graduate students in the technology side of things who are interested in this line of work, but might feel like they're lacking the health background. The same could be said for public health students who might be thinking, "Oh, no. I don't know how to code." What advice would you have for graduate students who want to pursue a career in a hybrid type of field as health and technology?

Avanthi Hulugalle:    Yeah. I had the same concerns. I'll be really honest. I always felt incompetent, and I didn't know that I knew enough technology. I think what we have to really inherit, especially going out into applying for jobs, is that you have to understand and really know your value as a public health professional because we just look at the world so differently than other people. In knowing that value and being able to portray that value to your future employers is going to make you a stronger employee, but also make people understand the value of public health and that health in tech isn't going to succeed without understanding population needs and how well that we've done in CGPH and being able to not just do one focus. I know my classes were never just on one health feed. I learned a lot about different types of health sectors. I think not a lot of other graduate studies can say that they do the same. You really focus on what you're focusing on in that particular program, and you don't really get to think about the world differently. It starts with understanding your own worth and understanding your own value and being a curious person, and then being able to, I think, portray that to future employers being like, I know I'm ... " Maybe don't say this, but you know that you're not going to be the coder, but you're going to be the person that inspires the coder to build better code because of how you question things and how you've learned to really dig deeper.

Alexandra Arriaga:    Yeah. Seeing yourself as a very important part or a very important piece of that puzzle, and just knowing that there will be a space for your abilities.

Avanthi Hulugalle:    Yeah. There's so much space for public health. It's not going to always be in a public health office. That isn't your only option. It's a great option, but I think we are going to only be able to scale up higher if we expand to other communities and other corporations, and we can do that.

Alexandra Arriaga:    I like that. I like seeing people like you that are just doing things that are not the usual path because, yeah, there's so much territory to explore, and people should get out there.

Avanthi Hulugalle:    Yeah. New York is a good place to do it too.

Alexandra Arriaga:    Exactly. We're in the perfect place. Finally, I'm wondering where does motivation come from to put in the hours and do all the work that you do?

Avanthi Hulugalle:    I will say the one thing about technology is that it's a lot of hours, and I work with global teams, so that means I'm pretty much working probably 20 hours a day easily. I'm never tired, which I know I'm in the right space because I'm constantly motivated by my teams coming up with new ideas. I think also I have my 9 to 5 job. I'm with Open Doctor, but I do things outside of it, and I think that's super important going into your career, especially after grad school when you get to do so many different things.

Avanthi Hulugalle:    You get to do your internship, you got to go to class, you got to have your friends. Being that person in your career is also going to be really important, so having the hack-a-thons on the side makes me inspired to go to work every day because I know after work I'm going to put in a few hours and really help with these social justice issues I care about, and then come to work and be inspired to make population health better, even though it might not be in a social justice lens. So, I think constantly having different dimensions of your day is what fuels me.
Alexandra Arriaga:    Amazing. Yeah. And I think that's great advice for everyone that you should always just pursue the different projects that help you feel whole as a public health practitioner. And I think New York people just love keeping busy, so we're in good company if we do that.

Alexandra Arriaga:    That is true. That is very true. I don't think I've ever seen a New Yorker just truly chilling. Everyone always has something. Even if they're chilling for five minutes, they have somewhere else to go.

Avanthi Hulugalle:    Oh, totally. Even in the park, you can't just relax and sit. You're tight roping or you're playing some sport, spikeball. No one can relax here.

Alexandra Arriaga:    It's like reading a book but listening to a podcast.

Avanthi Hulugalle:    Yeah.

Alexandra Arriaga:    Oh, my God. I know. I can relate. That's so bad. Well, thank you so much for coming today.

Avanthi Hulugalle:    Thank you.

Alexandra Arriaga:    And we cannot wait to see what happens with the hack-a-thons and what you're up to next.

Avanthi Hulugalle:    Appreciate it. Thank you so much.