How Tech Can Shrink Racial Disparities in Medicine
By Kosali Simon, PhD
March 26, 2021
Kosali Simon is a health economist, professor at Indiana University and member of the 2021 Tradeoffs Research Council. She studies health insurance and health policy.
The pandemic has shined a light on longstanding racial disparities and biases in the U.S. health care system. Technology can be a double-edged sword in trying to address these inequities. On one hand, evidence shows algorithms can perpetuate racial discrimination. But a new paper in Management Science shows that technology also has the potential to correct wrongs.
Researchers Kartik K. Ganju, Hilal Ataso, Jeffrey McCullough, and Brad Greenwood examined how clinical decision support systems (CDSS) impacted the rates of amputations for Black and white diabetics at hospitals in California, Florida and Maryland. CDSS are digital programs that analyze data from an electronic health record to provide physicians and nurses with set protocols and checklists which standardize decision making in hopes of reducing subjective (and therefore possibly biased) assessments. Existing research shows that Black patients are more likely to have limbs amputated than white patients, while white patients are more likely to undergo revascularization procedures that can save their limbs.
In this study, the authors looked at whether those disparities decreased after hospitals adopted CDSS. They found that CDSS adoption reduced amputations for Black patients by 4% while amputation rates remained unchanged for white patients, reducing the amputation disparity by more than half. Through statistical analysis and interviews with physicians, the authors found the decreased rates of amputations in Black patients were likely due to specialists getting involved more often, thanks to the standardized steps laid out in the CDSS. The study argues that standardized protocols of care through CDSS could lead to 550 fewer amputations a year among Black patients, although the authors note that further research is necessary to see if the results in these three states hold for the entire country.
The HITECH Act, passed as part of President Obama’s economic recovery package in 2009, has made use of CDSS almost universal in hospitals, but reducing racial bias was not a stated nor expected result. And we know that technology has more often than not exacerbated racial disparities. But this paper shows that at least in some cases, technological advancements like digitized CDSS can offer the unanticipated benefit of mitigating inequities. Further research and policy should look for other ways we can extract maximal social justice benefits from health information technology.