Will Technology Leave Some Communities Behind?
Fit watches. Patient portals. Teledoc appointments. Automated menus.
These are all things that prove the future is now, and as technology advances, so does its use in health care. On the surface that can be very positive news for both patients and health care providers. But is technological advancement hurting some communities while empowering others?
Yes, says Dr. Edmondo Robinson, Moffitt Cancer Center’s chief digital innovation officer.
“Technology has long been a part of retail, delivery services and restaurants, especially in this pandemic,” said Robinson said. “Health care has been slow to embrace some of these things but now seem to be accelerating toward a digital future. The question is, who do we leave behind as this happens? The fact is there is a disproportionate effect on some communities versus others.”
Robinson highlighted this disparity during a “My Heath Virtual Series” event in partnership with the University of South Florida. The discussion focused mostly on the Black and African American community.
“Health disparities in our community are front and center, especially if you think about COVID,” Robinson said. “Accessing your doctor and health care has seen major advancements in the digital world, but we have to ask who we’re leaving behind. It’s the Black community.”
Dr. Brandon Blue, assistant member in Moffitt’s Department of Malignant Hematology, also has concerns about how the lack of access to technology or a lack of knowledge with digital interfaces can impact minority communities. He enjoys technological advancements, but he also sees how members of his own family struggle with it.
“Not only am I a practitioner, I’m a father and a son,” Blue said. “My parents are elderly. When the pandemic hit, my son had to do virtual learning and we had the opportunities available to us to let him do that. But not everyone is so fortunate. Not everyone has internet, an iPad or even a computer.”
Dr. Brandon Blue
The elderly population is especially vulnerable to disparities in technology, Blue said, citing his own parents as an example.
“They are older and set in their ways,” he said. “Now they have to do televisits with their doctors. And even if they have the money to do it, they sometimes have trouble finding the on button, not to mention navigating an app. It all came on so suddenly and not everyone was prepared. The pandemic sped up the inevitable with technology.”
Robinson likened the recent boom in technology in health care to the appearance of ATMs in the banking industry. Many people, including his grandmother, were not ready to use the machine to extract cash. Even for small bills, many from previous generations were just more comfortable waiting in line and speaking with a teller.
“The bottom line is that digital innovation is a tool, but if used inappropriately it can exacerbate disparities,” Robinson said. “If we use it well, we can eliminate disparities.”
In order for technology to work, it has to be designed for everyone, not just those who are technologically able. Making digital technology easy and intuitive is important, but not the only important way in which all of society can benefit.
“There are underlying social and economic infrastructures in the United States that can limit the functionality of these machines,” Robinson said. “Do you have Wi-Fi? Can you get it where you are? Digital technology should be considered along with other social development factors like transportation, education, income and housing.”
So how do we ensure that rapidly advancing technology doesn’t increase disparities? Robinson said it’s important to first understand where technology in health care is heading.
“My theory is that artificial intelligence is going to be pervasive throughout all of your life, and certainly in health care,” he said. “It’ll be how hospitals and clinics are run and it will be how you interact with doctors and nurses. It’s everywhere.”
The challenge with that, however, is to program an AI interface to react to everyone, which needs a lot of data. That means it needs data from diverse populations.
“AI algorithms need to learn, and we give them a ton of data so they know how to predict the next thing,” Robinson said. “But we’ve learned that data isn’t coming from our communities. An example of this is when you’re programming AI to read a heart rate through a particular type of skin, or using facial recognition to predict the outcome of a heart attack. Not enough data representing people of color is present.”
The bottom line, according to Robinson: AI can certainly predict human needs, but there isn’t enough information coming from the Black and African American community to make it as useful to the entire population as it should be.
Technology available now is marketed as “ready to go.” But when a person of color tries to use some of these devices, it doesn’t work properly and Robinson said minorities too often just accept that and move on.
“That has a lot of consequences,” he said. “I’m interested in building bias like this into these types of technologies. As I’ve said, digital tools can be used to address and exacerbate disparities. In this case I’m very concerned about these tools. If this is done well, it can really give us some opportunities.”
According to Blue, patients and health care providers must have conversations about getting people of color involved in studies, whether they are ones involving AI or cancer treatment.
“We have to talk about these things to each other and to our doctors,” Blue said. “If you want to be involved — in a clinical trial or in something involving AI — you have to ask and it’s highly likely your doctor will find you something.”
