Author: Katharina Stock

Professor Wendy Chapman is the Director of the Centre for Digital Transformation of Health at the University of Melbourne. The Centre focuses on the translation of digital health innovations into clinical practice, envisioning healthcare as a connected system. Recently, I had the opportunity to sit down with Wendy to discuss how she found her way into medical informatics, challenges people — especially women — face when pursuing a career in the field, and what motivates her to continue pushing for the digital transformation of healthcare despite its complex challenges.

Professor Wendy Chapman currently serves as an Associate Editor for Frontiers in Digital Health.

Photo credit: Francesco Vicenzi/Casamento Photography

Your career in medical informatics started in a somewhat unexpected place. Can you talk a little bit about your passion for language and how this led to a career in natural language processing and medical informatics? 

“I started out at university with a major in elementary education and as part of that major we had to take a linguistics class, which was my favorite class. I went to Hong Kong for a year and a half and while I was there I learned to speak Cantonese. I had never spoken or taken a foreign language before and I discovered I really loved learning the language. When I came back from Hong Kong, I switched my major to linguistics with a minor in Chinese. I was later admitted to a PhD program in Chinese literature, but I wasn’t a literature fan as I’m not very good at analyzing it. It was the language itself that I loved.

“In the meantime, while I was waiting to get my fellowship, which I didn’t get, my husband switched his career trajectory from physics and electrical engineering to medical applications and enrolled in the program at the University of Utah. There he met someone who did natural language processing. Natural language processing seemed like a really useful way to turn my love for language into something practical, so I convinced them to let me into the program. I was let in on probation at first because my background was in the humanities and I had never taken science classes.”

You first became aware of natural language processing through your husband, was there anyone else in the field who inspired and encouraged you to take this path?

“Not at first. I knew nothing about natural language processing until I entered the field. Once I did, my advisor Peter Haug was really supportive. He was very passionate about natural language processing. He said ‘I see a day when an older woman can ask her computer “Remind me of the day I went to lunch with my daughter,” and the computer will tell her the story.’ He felt that natural language processing will be really important in our future for many different purposes.

“He was a great mentor. I had a one-year old when I started university and I gave birth to my daughter while I was a PhD student. He let me work from home for months so that I could be with her while she was young. Later on, I would sometimes bring her to work or nurse her in our group meetings. He was always very supportive.”

I wanted to talk a little more about challenges you might have encountered, specifically as a woman in the field. You already had a child when you started at university and gave birth to your daughter during your PhD, what was that like?

“It was hectic, especially being on a graduate stipend and not being able to afford a nice daycare. Luckily, we lived in the same city as our family. My in-laws would watch our kids once or twice a week and my sister ran a daycare, so we would send them to her house. It was a lot to organize though. The fact that my husband and I were getting our PhDs together in the same field was an advantage because we were able to go on drives and study together while the kids were in the backseat of the car.

“I also had this attitude that I had flexibility and I was going to use it. I would go home early when I needed to. I didn’t give in to that graduate student attitude that I feel leads to a lot of depression and anxiety, where you feel like you have to do this as quickly as possible and give up your whole life. Perhaps because I was new to it all, I didn’t know that might have been what was expected. When I think about academics now, the expectation seems to be that it becomes your whole life. I took a lot longer to graduate with my PhD because I took the time to spend with my kids. And now, who cares that it took me two years longer than most people?”

Do you think this has changed since you were a graduate student? Is the field more or less welcoming to women now? 

“I think that earlier on in the field they were less picky about who they admitted. I don’t think I would ever get admitted now. I had no vision for the field. Programs want people who know exactly what they want to do for their research and who have all the ‘right’ background. When I think of my cover letter discussing reasons why they should admit me, I wrote something like, ‘I use hyperlinks and email and I’m interested in healthcare.’ So they took a risk on me and I don’t think people take those risks now. When I became chair of the same department later on, I saw that people would brush off candidates that I thought had potential because they didn’t have the background and know exactly what they wanted to do. Applicants coming from the humanities, as opposed to STEM fields, are less likely to get admitted because people don’t see the importance of that expertise.

“Another point is that everyone is so focused on your productivity. I do think nowadays there is more consideration given to going slower and taking time off, however it can vary. For example, we admitted a student who had taken time off to take care of their mom who had cancer and everyone was very supportive of that, but there was much less support for someone who had taken time off to care for their children. So there are still these biases. Programs want people that are all in and have complete devotion.”

Considering your own background, do you think there is something academic institutions should do to change this?

“I think we need to be willing to take more risks and go with our gut when we feel someone could succeed. We should acknowledge that these different types of skills are something we need in digital health and informatics, which is such a multidisciplinary field. For example, we could offer classes to support people coming from other fields. Most programs won’t do that. They just require that you already know how to program and have taken statistics. Of course, nowadays there are online options, but we need to support those who don’t have those skills so we aren’t just admitting people who have gone down the same path. It narrows our perspective. The idea that everyone has to come into the field ready to hit the ground running and know exactly what they want to do is really limiting.

“Additionally, expecting early morning meetings or meetings after hours really penalizes people. They end up sacrificing other parts of their lives; they don’t get to exercise, they don’t walk their pets, they don’t drop their kids off at school. This attitude that you owe everything to your career is outdated and harmful. It impacts everyone, but especially women who are often in caregiving roles.”

Why do you think it’s important for women to have representation in medical informatics?

“I think it’s part of diversity as a whole because the field is very multidisciplinary. It requires a lot of different perspectives so we need to have representation of different thoughts and experiences, as well as diversity of skills. Everyone knows that the technical component is an important part of medical informatics, but it’s the social component that determines whether it works or not.

“Another mentor of mine, Reed Gardner, said that informatics is 20% technical and 80% social. Almost all failures in digital health and informatics have been social failures. The problems were with the workflow, usability, or the lack of value added. They were not a result of the technology working incorrectly. So we need different kinds of people and disciplines to join us. Psychology, implementation science, economics — it’s all really important for what we do.”

Nowadays you focus a lot on the digital transformation of health. What motivates you to work on this? 

“What motivates me is the vision for our center, which is ‘connected health’. When patients encounter the healthcare system, we want them to have a connected journey. We envision a future where the data that they’re generating on themselves and their knowledge of their own experiences and symptoms are brought to the table and are part of the discussion. A future where they know who to see when and that the information generated from each visit is available to the different members of the care team. One that doesn’t feel so fragmented and frustrating for patients and where they are more likely to get the right care. We want patients to become participants and activated partners in healthcare.”

With your knowledge of healthcare as it is, what do you think are the key challenges for the digital transformation of the system?

“The existing fragmentation in healthcare is the biggest challenge. It’s different in different countries, but there’s fragmentation everywhere. When I moved from the US to Australia, I thought that perhaps since Australia has a government-led healthcare system, it was going to be less fragmented, but in reality it’s more fragmented than what I experienced in the US.

“The second challenge is the funding models of healthcare. This is a huge challenge because it drives every decision in healthcare and it almost never aligns with what is best for patients. Of course, clinicians care about what’s best for the patient, but the system is not built for that. It’s driven by finances so you have to figure out ways to fit the new innovations that will benefit patients into the existing financial models, which is not always possible.

“The third challenge is lack of capacity. There just aren’t enough people that understand the issues to be able to work on them together.”

Do you think that these challenges have changed since you first entered the field? And looking ahead, do you think we are any closer to solving some of these issues?

“There are more opportunities now, more advancement in attitudes, beliefs, and technology. However, these three challenges still remain.

“We are still far removed from where we want to be. I believe many people see the issues, but because it’s a systematic problem, it’s not clear how to solve it. Powerful groups and the need to make money are still what drive everything. When you bring the government into it, it becomes political, which makes things even more complex. For example, in Australia, the general practitioner system is completely fragmented and so disconnected from all other aspects of healthcare delivery. The government knows this, but they won’t change it anytime soon. Imagine thousands of small business owners running these clinics. How are you going to change that? There would be an uproar.

“But I do see that as hospitals become more crowded and healthcare has too many people knocking on their doors and they can’t help them all, it’s become a little more aligned. Before they would focus on bringing people into the hospitals because they would lose out on money if they didn’t. Now they won’t lose money. They have plenty of patients to fill those beds. This gives them the opportunity to think more about making sure that the patients that come to them are the ones who really need them.”

These problems are really complex. I imagine it’s not easy, specifically with regard to policy making, to convey these issues to the general public. Do you think that health communication plays a role here too? 

“Absolutely. It’s true for many issues in healthcare. For example, data sharing. Many people fear having their data shared or breached, but they don’t realize the cost and the harm that comes from not allowing your data to be shared for healthcare purposes. So communication around healthcare is definitely important.”

So what are you working on now? Is there anything that you’d like to share, something you are passionate about? 

“Yes! We are building something called the Digital Health Validitron. It’s a platform that helps bridge the gap between great innovation and implementation into healthcare. There are hundreds and thousands of useful apps, decision support systems, and artificial intelligence tools that never make it into practice. It’s very difficult to go from developing technology to embedding it in healthcare. We are trying to better enable this. Part of this is asking questions about how it’s going to be financed in the future and understanding what the decision makers with the funds want measured, so that you can actually answer those questions and get the necessary funding. Working with patients and clinicians to co-design and validate things in a simulated setting before you put them into a real-life setting is an important element of this. So we made a digital sandbox where you can replicate the environment that you’re trying to enter, allowing you to do that research.

“It’s not that people don’t know ‘the path’. It’s that there isn’t one. There are so many unanswered questions about the best way to develop these new models of care, how to fit them into the workflow, and how to make them usable. We don’t have the answers to these questions, so applied research is really needed to help optimize the workflows together with digital enablement.”

Finally, what do you think can or needs to be done to encourage more women to pursue a career in medical informatics? 

“Well, we have to start with the younger ages so that they even know it’s an option. Often people stumble across it later in life. There are efforts to create programs that help high school students do internships in informatics, but I think we need to start even earlier by going into elementary and primary schools to host activities. People need to understand that data and data analysis are not just for those interested in math and computers. Having more data analysis in your English or history classes and seeing data science as relevant to everyone is one way of overcoming this.

“People still think it’s a very technical field, but it’s part of life and there are many aspects to it.”

Frontiers is a signatory of the United Nations Publishers COMPACT. This interview has been published in support of United Nations Sustainable Goal 5: Achieve gender equality and empower all women and girls.