With health care increasingly moving online, DePaul has emerged as a leader in cutting-edge digital technology leveraged for the greater good. From harnessing design as a vehicle for social change to creating an app to help close racial inequity gaps in care, 21st-century advances with an eye toward Vincentian values are unfolding every day at DePaul thanks to the inventiveness and ingenuity of its faculty, staff and students.
Health EquityIn the spring of 2020, as COVID-19 began to extend its grip, Fernando De Maio received a call from the Chicago Department of Public Health.
“They were seeing the first wave of COVID deaths come in for Chicago, and they saw very clearly that race and ethnicity were missing in about half of the records,” says De Maio, professor of sociology and an expert in the field of health equity research.
The missing data were a clear indication of an underlying structural problem. Although thousands of people were tested for COVID-19 each day, key data documenting race and ethnicity were not being recorded—an error intensified by the fact that the virus was hitting minoritized and marginalized communities the hardest. While Black people make up only 30% of Chicago’s population, they accounted for nearly 70% of deaths from the virus at the beginning of the pandemic, according to De Maio.
“These initial death and testing records indicated significant health inequity, an injustice that fell along racial and ethnic grounds,” says De Maio, a founding co-director of the joint DePaul and Rush University Center for Community Health Equity. But to fully understand the problem, and to better evaluate efforts to address the burden of COVID-19 among Chicago residents, the missing data problem had to be solved.
The city requested help developing a statistical model to predict race and ethnicity in COVID-19 testing data. Since this particular technique was not only specialized but uncharted territory, De Maio put out a call for help.Daniela Stan Raicu answered the call.
A professor in the College of Computing and Digital Media (CDM), for the past two decades she has been researching biomedical informatics via machine learning, artificial intelligence and computer vision algorithms to solve problems in the areas of biology and medicine.
But she had never worked in public health before. Working closely with graduate
students Hao Wu and Ian Wang from DePaul’s Center for Data Science, which she directs, as well as Ilyas Ustun, a professional lecturer at CDM, they developed a probabilistic algorithm to predict patients’ unreported racial information based on their surname and place of residence. They brought together information from the city’s COVID-19 test dataset with data from the U.S. Census Bureau’s surname dataset, which can be used to predict the probability of an individual being in a given racial/ethnic group by surname, and the American Community Survey, which can be used to study the racial/ethnic composition of any given neighborhood. The team’s algorithm leverages these probabilities.
The team vetted the model with the Chicago Department of Public Health and presented the work to the commissioner. The model was also discussed at the data workgroup of the Chicago Racial Equity Rapid Response Team, which brings together researchers from all of the major research institutions in the city. Raicu’s team also worked closely with researcher C. Scott Smith of DePaul’s Chaddick Institute for Metropolitan Development, who, along with De Maio and other members of the Center for Community Health Equity, has been an active member of the Chicago Racial Equity Rapid Response Team data workgroup.
“To be sure, the model isn’t perfect. There were certain names we were not able to predict. Since we do not want to contribute to the further marginalization of any group, particularly those who have been rendered invisible in other venues and data systems, it was especially important that we vet this with the Chicago Racial Equity Rapid Response Team,” says De Maio.
In the end, the team’s statistical model successfully reduced the rate of missing data in Chicago’s COVID-19 tests from 47% to just 11%. This significantly improves the evidence-based research informing the city’s efforts, and it also enables a much stronger evaluation of the racial/ethnic patterning of the pandemic’s impact on Chicago communities. The team developed an application that makes it easy for public health officials to use the model as new data come into the system—a practical tool with real-world benefits for Chicago residents.
Yet much remains to be done.
“I’m immensely proud that DePaul stepped into this role because we knew that it was the right thing to do,” says De Maio. “But this should have been something that the government ought to have been able to do in-house. The reason they turned to us is because we, as a society, haven’t invested in the public health infrastructure in the way we should.”
“Our efforts should be geared towards fixing the system in the first place,” continues De Maio. “We need to do a better job of funding critical public health infrastructure. We also need to do more to explain to everyone, inside and outside of the health care system, why measuring racial/ethnic inequities is important. And we need to do more to make sure that equity-focused data analysis is always a priority or we will misdiagnose the problems and render injustice invisible. COVID-19 is a clear reminder that public health and social justice are inextricably intertwined.”
Social ChangeChristina Harrington teaches her students that design can be a force for good.
“We consider design as a catalyst for social change,” says the assistant professor in CDM’s School of Design. “Design could be a way of thinking. It can be a process. It can also be a tool that you can put in someone’s hands to actually change social conditions within particular communities, neighborhoods or environments.”
Trained in electrical engineering and industrial design, including working as an engineer and UX designer for Apple before turning to academia, Harrington founded and directs DePaul’s Equity and Health Innovations Design Research Lab (EHI Lab).
Launched in 2019, the lab evaluates and designs technologies in the areas of health and racial equity. Harrington directs a team of undergraduate and graduate students who carry out the research. “Today, many major design companies have accessibility divisions or departments within their design or development teams. So inclusivity kind of becomes this other thing that’s more about the human resources or corporate logistics outside of the company,” says Harrington.
What Harrington is working toward is not only a more holistic integration of inclusion and accessibility in design, but also a commitment to equity within the movement itself. “Today’s definition does not consider social class, different backgrounds of races and ethnicities and its implications for design,” she says.
Which is precisely why she launched the EHI Lab. “I started the EHI Lab to say that all of these things are part of the ways that we think about tools and systems and infrastructure and environment,” she says. “We can’t go in and say I designed this for a person with differing abilities, but [in reality, it will only impact] those who live in an affluent neighborhood, have access to resources and have money for sustaining certain solutions.”
Ultimately, the EHI Lab is putting technology not only to good use—but to use for the greater good. “Our lab is working to use technology to better the lives of marginalized groups, which means really focusing on their needs and wants rather than [making assumptions] and saying, ‘Let us fix that for you,’” says Harrington.
For one of the lab’s major studies, “Health Information Seeking Practices Among Black Elders,” older Black participants from the South Side of Chicago and in the greater Detroit area were studied to help uncover the barriers to in-home information communication technologies. “What is the best way to engage with this population to keep them safe, meet their needs and not take advantage of them in terms of research harm?” says Harrington.
Through triangulation, which involves engaging in data collection in three different ways, Harrington and her team assessed needs and taught hands-on digital tools, from Google to Zoom. “You can use your phone to program your medication reminders or to program different numbers that might serve as emergency contacts. This is also an opportunity for our team to engage with the community and not just collect data from them. This is a way to actually educate people in digital health literacy to hopefully, somewhere down the line, improve outcomes,” says Harrington.
What makes this study so crucial is how it works to bridge the widening digital divide between those with access to technology and those without. “Part of the problem in terms of health disparities is you’ll start to see folks who have access to technology as an intervention for chronic illnesses and diseases and how their health outcomes look versus those who don’t have access and how their health outcomes look.”
In this way, the EHI Lab is fostering health equity. “Equity literally means giving things to folks to be where the ‘majority status’ already is. We already know the folks who don’t have access to Google devices tend to be poor or Black and brown folks who are already disproportionately impacted by many of these health disparities. Unlike those with access to resources, the folks without access to money also don’t have access to resources [and] as a result have a shorter life expectancy,” says Harrington.
Harrington credits much of the lab’s success to its student workers. Representing a range of majors, these undergraduates and graduate students are integral researchers on all of the projects.
“The EHI lab spoke to what I wanted to do with my career and with my desire to research,” says junior Julianne Sorek, a research assistant who is majoring in psychology with a concentration in cognitive neuroscience and a minor in designing for physical technologies. “Being able to help people through technology is what motivated it. I definitely see it as an incredible opportunity, and I think it has taught me some very valuable skills that will carry on into the future.”
Harrington is counting on students like Sorek to make the world more equitable. “We want more designers in industry or researchers in academia to start off approaching projects from a way of true inclusion. Students working in my lab start off with this mentality. They’ll go into the workspace approaching design with equity being the standard. I think that in itself will help lift the industry,” she says.
AutomationWhen Enid Montague was in graduate school pursuing MS and PhD degrees in industrial and systems engineering, she came across a report that changed the direction of her research.
“The report revealed the alarming rate of medical errors in the health care system,” says Montague, associate professor in CDM.
“The report revealed the alarming rate of medical errors in the health care system,” says Montague, associate professor in CDM.
The report attributed 250,000 deaths per year in the United States due to medical errors—a staggering figure that surpasses the 150,000 deaths per year from respiratory disease (pre-COVID-19), which was ranked as the third leading cause of death by the Centers for Disease Control and Prevention.
The report called for more engineers and computer scientists to devote their research to health care. “When I read this report, I felt really inspired,” says Montague. “Here was something that I could do to be of service. It was something that felt really meaningful, like it was my calling.”
She soon accepted a research fellowship on improving human health and well-being. “Most people don’t talk about their graduate fellowships once they are [advanced in their career], but I am really proud of the fact that I was able to use my engineering expertise to improve human health and well-being,” says Montague.
Since joining DePaul in 2015, she has continued her quest to improve health care through the tools of her trade: engineering. “My goal is to make health care safer, more efficient and more effective,” she says.
Montague, director of the Wellness and Health Enhancement Engineering Lab (WHEEL Lab) at DePaul,and her team of students conduct exploratory, experimental and field research involving human interaction with computers, technologies and systems. Projects run the gamut from developing tools for people suffering from chronic pain to making mental health care more accessible through automation. A survivor of the 2007 Virginia Tech shooting, Montague has made mental health accessibility a particular calling. (Watch her TEDxDePaulUniversity talk, “How to Improve a Community’s Well-Being After Tragedy.”)
While the foundation for her work rests on engineering—thinking about design solutions by building prototypes, evaluating them and working closely with patients, practitioners and other collaborators with the goal of ultimately developing an application or website—Montague never loses sight of the human beings who stand to gain from these new technologies.
“How do we build systems that leverage technology in the right way while relying on humans for the parts that they really need to be a part of? That is what I’ve been doing at DePaul for some time in the areas of health care and medicine,” she says. “I understand that not everything can be automated. Robot doctors aren’t going to work for everyone and everything. People are still really important, but if it is done right, automation can be used as a way to improve human efficiency.”
A case in point is Montague’s research into ways to enhance primary care providers’ capabilities. “Primary care [research] is becoming a lot more relevant now,” she says, citing a shortage in primary care providers, a growing number of people without access to primary
care, and other factors such as an aging population with chronic conditions and a young generation suffering from an increase Enid Montague in chronic conditions.
“Primary care is where a lot of important health care work occurs. Your primary care doctor is supposed to be the first person who notices signs of everything from cancer to diabetes and who is there to help you manage all your medication and your transition to different phases in your life,” says Montague.
When utilized smartly, automation can help mitigate the primary care crisis. But like everything else when it comes to science, improvements often move at a snail’s pace.
“I’ve been working on primary care [automation] for the past 10 years,” says Montague. “I would love to solve it, but it’s a mixture of understanding the current system, envisioning what a new system could look like and then also being given support.”
By further incorporating digital technologies, our health care system will enable more people to access the care they need, which could be the difference between life and death.
“What we want is a functional health care system. What we don’t want are people who aren’t getting diagnosed for chronic conditions at the right time, because that makes it harder to treat them. We don’t want people to suffer because they’re not taking the right medications, which can also lead to other problems down the line. A functional health care system will benefit everyone, and by weaving in automation when appropriate, it will also increase access to health care and make it more affordable,” says Montague.