Amrika Ramjewan is brisk and to the point. For the senior health systems engineer and instructor of healthcare systems engineering at the Mayo Clinic, the top ranked hospital in the United States, that’s the only way to keep on track, as she extracts meaning from data to tackle some of healthcare’s most pressing problems. The lives of more than a million of the hospital’s patients a year are at stake, not to mention the millions more indirectly influenced by the clinic’s research and practices.
Tell us about your early interest in healthcare.
I’m originally from Sangre Grande. I grew up in a rural area. I went to school in St Joseph’s Convent in St Joseph.
My grandmother had diabetes when I was growing up. I grew up seeing her take a whole bunch of medications; I remember as a child helping her sort through all her medication. She actually passed away very early in life. From that time, I was always interested in preventative care.
From the beginning, growing up in TT, you learn to live in an environment where you have to do things with limited resources. Being here in the US where we have so much resources, it was interesting to hear everyone still facing a huge amount of problems.
In TT we don’t talk about wellness or health maintenance.
I was very athletic when I was growing up. I played tennis and I play cricket. Even now I’m passionate about sport.
After school, you went to the UK, to Manchester.
It was challenging, especially the cultural differences. I didn’t know many people, it was difficult making friends. Getting into a routine was tough. I think it was difficult being away from your family, being away from your parents.
I then lived in Rochester, Minnesota and they have four-to-six-month-long winters! I’ve been in the US now for four years. Prior to that I worked in Trinidad. Some of my time was spent in healthcare there.
(After completing a master's in analytics in the UK, Ramjewan returned to TT, and in 2017 joined the Mayo Clinic in the US.)
In the UK did you devote yourself more to your work?
When I went to the the UK I looked at the NHS (National Health Service). My thesis was on comparing top-down redesign of a whole health system with gradual improvements and determining which would yield better outcomes.
With design-led approaches you have an opportunity to do meaningful change. With respect to public-sector change there has to be top-level leadership driving change. They need to believe in the change.
Here at Mayo Clinic we have this really amazing culture. We have this one core value: we say the needs of the patient come first. Everyone really believes that and constantly quote it.
You don’t have that in every organisation. Our employees connect with that culture. People understand the culture. (Culture is) something that you have to shape and be deliberate about. When we’re hiring, we want people that can relate to the culture.
In TT, they often neglect how important that is.
What are some of the problems in healthcare that you’ve seen in TT?
There’s tremendous lag. (In the US) we have the infrastructure, we have the access.
In developing countries we lack the infrastructure. We need infrastructure and delivery mechanisms.
There’s also a huge communication gap between patients and doctors.
What the big problem you’re trying to solve right now?
We’re looking at launching the Mayo Clinic platform to full integrate technology into practice. We’re working on delivering hospital level care to patients at home. We co-ordinate with the team to do that. We have access now to devices enabled by internet of things, remote monitoring and sensors. This is the future of outpatient care.
Will that degree of personalised care be more expensive?
I’m working at comparing that right now!
How has covid19 affected your work?
I would say it has accelerated plans. We have this really bold strategic vision that started before covid19, so we were already well on our way. We have a mission of connected care. Now, a new level of remote monitoring is enabling that – what allowed us to do this quickly and change the environment.
There have been more than a billion telehealth visits last year alone, but adoption has been slow in TT.
How do people access care right now? They go to physicians that they know?
In telehealth, you often have physicians who they don’t know. Why would they switch to someone that they don’t know? How do we maintain relationships with technology? Patients don’t know what kind of procedures work with technology.
Seventy to 80 per cent of a diagnosis is derived from a patient’s history. Do we have opportunity to do better data capture?
I don’t see this something that should be a barrier but it is. Many times in TT you request records to be transferred, and it is very difficult. There are so many barriers to access digital health records.
Where would you start?
Electronic data capture. We really need to start developing those.
We don’t have to adopt what other countries are doing. There’s a growing realisation that EMRs (electronic medical records) are designed for payers and insurers, and not doctors. Giving that we’re starting from pretty much nothing, we have an opportunity to really change.
Something as simple as scheduling: the systems are designed poorly. There are so many angles we can tackle!
There is definitely less access to data in developing countries. We don’t have the level of participation in clinical trials. What are the barriers? Is it consent, is it fear, is it access to care? It’s inequitable.
This is where we might have some of that data in paper records but we need to digitise. Is this an opportunity?
People pay a lot of money for this type of data. It’s something we can monetise with this type of data.
Have you ever considered starting your own organisation?
At some point. I do plan to return to TT in the long term.
Health and wellness are very important to me. There are huge deficiencies. We focus on curing and we don’t focus on prevention. Helping people to do that.
What does that mean? Behaviour change. It’s being able to eat properly, movement. How can we get them to shift so that we get?
When I was in TT I was able to do some work that had some small impact. We were able to make small inroads, but it wasn’t sustainable.
How would you reform the system?
Being really passionate about something and not being able to convince someone of something was very frustrating when I was back home.
In TT, we have this national IT plan. We fail on implementation. We never follow through on full-scale implementation and delivery. We’re collecting data, but are people willing to improve based on what they learn? Is there hope for the introduction of some form of performance-based system in the public health sector?
I think there are several barriers that need to be reduced: barriers of access to opportunities, to do the things you want to do, to community support or even to the support of colleagues.
How can we engage successful people from the diaspora like yourselves to help?
Would people act on it? I would be less likely to agree to work with an organisation or government if my advice was just information sessions.
Earlier on we started a grassroots organisation called Caribbean DataFam and we were willing to do this at no charge. I would like to repurpose it into more educational form. I would love to have more folks. St Kitts and St Vincent and Grenadines. It actually just started with a Linked In post and 40 people attended that initial phone call. I still have the Slack group active.
What is your advice for a young girl growing up in Sangre Grande right now?
As a tennis player, when you play sports and you’re on the wrong side of the point – every point counts. I would tell myself: just one foot in front of the other.
Keep on dreaming and know that what you want to achieve is possible.
Kiran Mathur Mohammed is an economist and co-founder of the social enterprise medl. He is a former banker, and a graduate of the University of Edinburgh