For years of racism required blacks and other people of color in the United States to use the back door to enter restaurants, movie theaters, and other public places. While this practice is done away with, digital loopholes could make them and others second-class citizens again when it comes to health.

Digital loopholes are technological processes and tools used in healthcare, such as racially biased algorithms, infrastructure restrictions, and dirty data. They unwittingly exacerbate existing health inequitieswhich the World Health Organization defines as “systematic differences in the health status of different population groups.”

How are digital backdoors created?


Their root cause is related to human activities due to the development and application of technology by some health information technology (Health IT) developers and clinicians who do not fully or explicitly consider health equity.

Today, almost everyone must navigate a wide range of health and care information interactions that are mediated by computers, mobile apps, wearables, telemedicine, and telemedicine—collectively known as digital health. Companies that use technology to deliver healthcare services and products are committed to helping people on this journey by developing digital entrance doors.


Here’s how Mutaz Shegevi, director of research at Intersystems, a provider of data solutions for healthcare systems and other organizations, describes these portals: “The digital front door is driving healthcare towards a more consumer-friendly, patient-centered paradigm” and “supported by digital touchpoints that enable better access, interaction and experience across the entire continuum of services.”

Digital front doors are expanding healthcare beyond conventional buildings, using technology that people have already incorporated into their lives.

What worries me about the digital front door concept is that it requires healthcare consumerism approach to designing experiences for patients. Instead of treating healthcare as a right, the digital front door approaches it more as a commodity.

Despite the seemingly democratizing appeal of digital healthcare front doors, many people of color interact with health through digital back doors. How racist etiquette of the physical back door in existence for most of the 20th century, the digital back door creates an uneven path to healthcare.

In the tech industry, the term “back door” usually refers to alternative, often hidden and nefarious access to computer systems that bypasses security mechanisms. In healthcare, the digital back door also avoids the improved health and well-being outcomes that medical technology often promises.

Thanks to my work as director COVID blackan organization that uses data and technology to advocate for health equity, I have identified three key components of the digital health backdoor that are leading communities of color down the path of health inequity: Internet access, artificial intelligence, and the electronic health record. compatibility.

Telemedicine and Internet access

Necessary and fast transition to telemedicine During the pandemic, to replace most in-person doctor visits, it has become clear to healthcare providers what activists and social reformers have long known: not all Americans have broadband Internet access, or access at all. This disparity is partly due to digital redline, which the National Digitization Alliance defines as “discrimination by ISPs in deploying, maintaining or upgrading infrastructure or providing services.” Poor Internet access is also associated with constant digital divide, the gap between people with free access to computers and the Internet in the United States. This gap is partly due to the cost of broadband and lack of digital skills, and the fact that people use and interact effectively with digital technologies.

Pew Research Center as well as other reported that people of color tend to have less access than whites to broadband services, a home computer, and Internet-enabled devices, limiting their access to telemedicine. BUT interview conducted by the Office of the Assistant Secretary of State for Planning and Evaluation, which is part of the Department of Health and Human Services, shows that while people of color are more likely to use telemedicine than white people, they are less likely to use video. telemedicine services than audio recordings during the pandemic.

Video-assisted appointments offer opportunities for partial physical exams, non-verbal communication assessments, and give clinicians the ability to evaluate a patient’s home environment from a safety perspective. Researchers suspect that disparities in access to broadband, along with other factors such as digital ownership and access to a mobile device or camera-equipped computers, may manifest in low levels of video-assisted health care visits among communities of color and function as a digital back door. to reduced medical services.

Artificial intelligence

Artificial intelligence is becoming increasingly important in healthcare, facilitating diagnosis and treatment recommendations; improving the organization, storage and transmission of medical information; and patient engagement and monitoring with machine learning that predicts no-shows and canceled appointments, and sends patient reminders to take essential medications.

However, algorithmic bias in AI, the malicious misrepresentation of predictions based on a sequence of well-defined instructions commonly used to perform calculations on health data is also driving communities of color through the digital back door to healthcare.

Health IT developers create and train algorithms using datasets to predict and solve healthcare problems. If this data lacks variety, is biased, or is erroneous, the algorithm can make predictions that misdiagnose patients or service white patients for additional medical care compared to black patients.

Because most medical IT is developed in black boxin which the intricacies of the inner workings are opaque, it is often difficult to determine the exact source, apart from problems with training data, algorithmic oppressionor discrimination based on computer code. What is known is that racial bias in AI is also a design issue. For example, the widely cited study highlighted how an algorithm designed to assign risk scores to individuals based on total health care costs accumulated in a year resulted in black people, who were more sick than whites, less likely to be identified for individual care. In this case, healthcare IT developers lacked an understanding of how structural racism creates a system in which black patients can generally pay less for health care, even though they may have poorer health outcomes. Bad data and flawed AI design function as a digital back door that endangers the health of patients of color.

Interoperability of electronic health records

Technology has changed medical records, giving clinicians more ways to document patient encounters. Electronic health records turned out to be efficient containers medical information, but they also reveal racial bias in some clinicians’ perceptions of their patients.

Researchers at the University of Chicago used machine learning tools to demonstrate that black patients are more than twice as likely as white patients to have at least one negative descriptor in their electronic health record. While negative descriptors are not automatically racially stigmatizing, they can have an adverse effect by accompanying black patients to other health care settings and influencing the care they receive from other physicians.

Electronic health information exchange called compatibility of electronic medical records, facilitates the exchange of patient information between different EHR systems and healthcare providers. In most cases, EHR interoperability simplifies the delivery of care to physicians. However, clinician bias, reflected in the disproportionately high number of negative descriptions of black patients, can turn EHR interoperability into a digital back door that exacerbates and creates new health inequalities.

If medical technology is truly committed to accessible digital healthcare, it must first acknowledge the presence of digital backdoors, manifested in digital redlines, algorithmic bias, stigmatizing language in electronic health records, and other forms of racism made possible by how medical IT developers and clinicians use and apply digital technologies in healthcare. Putting the health of patients of color at risk, digital backdoors are a sign of health inequality.

The health industry’s promise of innovative end-to-end digital health platforms must begin by closing digital black doors and creating peer-to-peer digital entry doors to truly make a difference in the nation’s health.

Kim Gallon is the director of COVID Black and a Just Tech Fellow at the Social Science Research Council.

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