Dr. Vimla L. Patel — Cognitive Science, Biomedical Informatics and Clinical Medicine.

Introduction

This week, I spoke with Dr. Vimla L. Patel, senior Research Scientist and Director of Cognitive Studies in Medicine and Public Health at the New York Academy of Medicine. She is also an adjunct professor of biomedical informatics at Columbia University and in the College of Health Solutions at Arizona State University.

Currently, her research deals with the application of technology to enhance human cognition in the clinical environment. She studies how technologies can make healthcare more effective and safe. Her scholarly publications total over 350 — spanning books and journals in biomedical informatics, clinical medicine, cognitive science and education. Details can be found on her website.

Conversation

What are your current research interests? How have they evolved over time?

I trained at McGill University in Montreal, and my background is in cognitive psychology and cognitive science, but my research is always contextualized in healthcare. After graduating, I became the director of McGill Cognitive Science Center, focusing on cognitive science research in medicine and health care. At that time, I didn’t know much about Biomedical informatics. In 2000, I was recruited by Columbia University in New York as a professor in the Department of Biomedical Informatics and the New York Psychiatric Institute. The idea was to complement my research on how doctors think, reason, and make decisions, with technological systems that interact with doctors and other healthcare providers. So, my research evolved to medical reasoning and decision-making to decision-making during Human-computer interaction.

After 7 years at Columbia University, I left there to take the first chair of Biomedical Informatics at Arizona State University in Phoenix. Here, I collaborate with computer scientists and engineers to develop and use tools to collect data in intensive care units (ICUs). I also used simple Avatars to train doctors in the emergency room (ER) to be sensitive to ethnic diversity and different gender in patient population to reduce biases.

I moved from understanding doctors in how they make decisions about their patients to how intelligent systems should be designed to support doctors so that they can do their tasks better.

Now in my current position as a senior research scientist and the director of r Cognitive Studies in Medicine and Public Health at the New York Academy of Medicine, with adjunct professorial appointments at Columbia, Weil Cornell, and Arizona State Universities, I have continued the same line of research, but also work with international collaboration in lower-to middle-income countries (LMICs) to help reduce illness burden, using my expertise in theory-driven experimental design and data analyses. Strong team work with multiple expertise is necessary.

What keeps you motivated and excited to research in a constantly evolving field like cognitive informatics?

To start with, you must have a “fire in the belly” so to speak, about research or want to be more inquisitive about explaining why and how something happens, which I always had. I completed the Pre-med path in college and 18 months of medical school, but medical science interested me more than medicine. So, I branched into biochemistry and microbiology. What motivated me to move to another field of cognitive and educational psychology was my desire to change medical education through scientific-driven research to inform better curricular designs. In other words, I was more interested in the science behind education.

Although healthcare platforms keep changing with more sophisticated technologies, basic science remains the same. The methods of data collection and analysis may be constantly updated. Still, the thrill of discovering and contributing to a new body of knowledge and the process by which such knowledge is generated does not change.

Finally, most of the time, my students and fellows keep me excited by coming up with new ideas — no matter how silly they may sound sometimes, they still open up new avenues to think about.

You mentioned your work with lower-to middle-income countries (LMICs). How exactly are you applying your research in these less developed nations?

I have worked in several LMICs, including Colombia, Kenya, India, Ethiopia, and the Pacific Islands, addressing different problems in each country, some without any technological intervention and some with. For example, in Colombia, I worked with school children who were infected with parasites and showed cognitive decline. Showing where and which functions show decline; this can assist pharmaceutical companies to intervene and provide the correct anti-parasitic drug. In Fiji Islands, we leveraged smart mobile phone to identify people with high risk of depression and suicide, such that correct intervention could be used for disorder management. Understanding various socio-cultural constraints are important for these studies.

The international research helps us to generate knowledge that will improve the lives of people living with specific disorders, such as mental illnesses, in LMICs. Focusing on these countries is important because we can include diverse populations, communities, geographical regions, and technologies across the globe, which can accelerate and enrich scientific advancements while helping to address global and domestic challenges, such as impact of Climate change. It can also enhance the potential for multidirectional knowledge exchange.

All these studies are published since I am a stickler for publishing! If you do any research, no matter how small, and if done carefully, it should be available for others to critique it and learn from it.

Considering your background on psychology and cognitive science, and your interdisciplinary research in the domain of medical decision making, what connections are there between psychological research and health information technology? Can you share any insight about how technology can influence healthcare decisions?

As a discipline, cognitive science encompasses cognitive psychology, philosophy, computer science, cognitive anthropology, language, and neuroscience, which will define the brain mechanisms that generate human cognition. Each of these disciplines has its advantages and disadvantages. Thus you can select various theories and methods from multiple discipline to study one problem, such as medical decision making can be studies using ideas from Psychology, computer science and language.

I align my work more closely to the discipline of cognitive science, that plays a significant role in addressing some of the challenges by considering what we know about doctors’ cognitive processes (such as memory, thought, and reasoning) as they interact with intelligent systems and how such systems can influence their thinking processes, positively and negatively. Therefore, designing good technological system in the first place is very important.

Given your interest in health information systems, especially intelligent systems, what challenges come with implementing information systems in clinical, and especially in critical care environments (ICU and ER)?

I worked with the hospitals associated with academic institutions to study their critical care environments (including ICU and ER), which is considered a complex environment. Most evaluation approaches for evaluating technology or people in ICUs are based on linear workflow. The clinical workflow (or how doctors work) is complicated due to interruptions and the need for attention to multiple simultaneous tasks, including the time pressure. In these environments, events are rapidly changing in a non-linear way, and the cognitive demands on the clinicians are very high. It has been suggested that reducing this complexity would be useful. Still, we found that the whole notion of reducing complexity is not always possible because sometimes complexity saves lives, particularly in emergency rooms, when clinicians have to multitask between serving severe and less severe patients.

Research in the complex ICU to better understand the clinical workflow, and the impact of technology, can be facilitated by using theories and methods in cognitive science. This field is usually called, cognitive informatics.

We often focus on health behavior outcomes in these studies but not the processes that lead to such behaviors. By understanding the process (and outcome), we can get a better feel about what aspect of the process contributed to bad behaviors so that we have a better feel for how to correct them. E.g smoking behavior

Have there been obstacles using scientific processes to investigate healthcare systems and medical decision making?

Early in my career, it took a lot of effort to convince people that understanding the details of the process by which specific healthcare outcomes are generated is critical. Looking at outcomes or the end product without understanding how we got there does not make sense, especially if we want to improve things.

My research requires detailed qualitative investigations of a few subjects or participants to capture their thought processes as they do their usual clinical tasks. Then, analyzing these data using formal research methods based on cognitive theories and models of reasoning and decision-making. These are labor-intensive tasks; investigators need to have patience to conduct such research. Furthermore, delivering research results, no matter how exciting, was sometimes challenging at that time, given that I was a young professor, and I am a petite, soft-spoken woman of color. However, I overcame these challenges by being the best at what I do, and I believed and trusted in my work, which allowed me to push forward to cross new boundaries of research.

We all face challenges in one form or another, but we have to find ways to circumvent them.

You’ve experienced many areas of research and medicine, could you share one of your most memorable achievements? Perhaps with a student or research partner?

Research or a state of inquiry is a part of my life, where I do not consider it work, separate from other activities. It is a seamless thought process, even as a part of your family life. My mentees, colleagues and I discuss ideas sitting in a bar , over a glass of wine, over lunch or discuss ideas as we pass each other on he corridor. It is not restricted to the office or the research lab — when most interesting ideas get generated. On memorable event, I remember which defines what research means to me is when my colleague, who happened to be my professor when I was a student and later became my colleague, late Guy Groen, called me at home at 7am to say that he is just out if the shower and had a great idea about how to interpret our complex results, but I should write it down quickly otherwise he will forget it!! That thought eventually ended up being used on our one of the most-cited paper in cognitive science.

Finally, if you could deliver a message to the next generation of researchers — something they would really think about — what would it be?

Don’t always travel the same road as others but take a risk and do something different even though it may conflict with current thinking. It may be a difficult road in the short run, but it will be intellectually rewarding and may even be highly productive in the long run.

Conclusion

Cognitive informatics and intelligent systems allow researchers and clinical professionals to better understand the benefits and drawbacks of technology. Specifically, cognitive informatics relates the properties of human cognition to computer applications. It’s also important to understand how healthcare professionals process information in complex environments like the ER and ICU.

Early in my career, it took a lot of effort to convince people that understanding the details of the process by which specific healthcare outcomes are generated is critical.

As Dr. Patel explained, some ignore the importance of scientific studies on complex environments. There are several factors that influence success of scientific studies (participation, purpose, importance, etc.) but above all, time. Detailed qualitative studies can take a long time, which often makes them impractical for complex environments.

Dr. Patel’s work extends beyond the boundaries of high-income nations, impacting global healthcare through her research in lower-to-middle-income countries. This facet of her career underscores the universal applicability and necessity of her research, especially in diverse socio-cultural contexts. Her insistence on the importance of publication, to share and critique research, speaks to her dedication to the scientific community and its continuous growth. Finally, Dr. Patel’s advice to upcoming researchers — to forge unique paths and embrace intellectual challenges — is a testament to her visionary approach. Her career serves not only as a model of academic and professional excellence but also as a beacon of inspiration for those venturing into the ever-evolving field of cognitive informatics in healthcare.