New Az-developed software tool takes on institutionalized racism in health care

An expecting mother goes for her first ultrasound with a new doctor.
During the appointment, the doctor’s attention is drawn to an alert on
her computer about the maternal mortality rate for Black women, like her
new patient, being 2.6 times higher than that for non-Hispanic white
women in the United States. The doctor adjusts her patient’s care plan,
making personalized clinical decisions.

With the integration of Truity, a comprehensive health equity
software platform developed by TruLite Health, this hypothetical
situation may soon become real for patients of Mayo Clinic Arizona.

“If you are not white, male, educated, living in an urban ZIP code,
have some money and straight, your outcomes are likely worse in some
capacity, and that’s the disparity,” Dr. Alan Roga, co-founder and CEO
of TruLite Health, said. “How’s that possible in the wealthiest country
in the world?”

The Truity software tool is designed to identify and remedy the kinds
of disparities named by Roga, for instance the “institutionalized racism
and bias in medicine” researchers have highlighted as reasons behind
the disparate Black maternal mortality rates.

TruLite Health, a software systems developer based in Tempe, set out
to tackle clinical bias that leads to health inequities. The company
studied health care tools, practitioners and research and found that
disparities are getting worse. To repair clinical bias, Truity processes
patient data and health equity knowledge in order to provide clinical,
social and behavioral interventions to improve health care outcomes with
diverse populations.

Truity can alert providers to known disparities and suggest
patient-specific interventions such as early screenings, adjusting
medication dosages and delivering educational resources to patients
through a portal. Patients are encouraged to ask questions and be
proactive regarding their health care plan.

TruLite was founded in 2021 to address the health inequities that
cost the U.S. health care system nearly $320 billion, according to
Deloitte, an international auditing and consulting company. Roga and the
TruLite team found that disparate care exists across the globe and is
widening, for reasons that go beyond socioeconomics, like a lack of
diversity in clinical trials. They set out to remediate clinical bias by
integrating the Truity software into daily workflows through health
systems’ electronic records systems.

Deloitte’s 2022 study estimates that in less than 20 years, the cost
of health disparities could reach $1 trillion. According to its
actuarial team, reaching that cost is not sustainable and would further
impact affordability, quality and access to care.

“This is a significant issue, not only a financial issue and an
economic problem, it’s a moral problem that we have to face and
address,”Dr. Nathan Delafield, associate chair of equity, inclusion and
diversity for the department of medicine at Mayo Clinic Arizona, said.
“It’s a public health emergency that we have to address in order to
improve health care outcomes, because at the end of the day inequity
leads and lends itself to delayed diagnosis, poor communication,
terrible patient care and patient experience.”

Health disparities are differences in the burden of diseases, injury,
violence or opportunities that are experienced by socially
disadvantaged populations. These populations may differ in race,
ethnicity, geographic location, disability status, education, income or
gender and are disproportionately affected in health care outcomes.

“We’re seeking to better understand why these differences exist
because our understanding of biology and science suggests that we are
far more alike than we are different,” Delafield said. “So these
differences are likely the result of other factors that are contributing
to poor health outcomes for some.”

On Jan. 9, TruLite Health announced
an agreement with Mayo Clinic Arizona to use and enhance Truity
software in clinical practice. According to Delafield, the hospital will
focus on feedback, workflow enhancements and evaluating platform
features. He didn’t give a date for when Truity will be officially
launched.

Truity is also partnering with Morehouse School of Medicine, in
Atlanta, to develop virtual health equity coaching for patients, aimed
at improving self-advocacy.

Health coaching helps patients identify goals, implement new routines
and navigate their care plans. Increased discussions on conditions,
management strategies, community resources and advocacy techniques can
streamline appointments and discussions with medical professionals.

“Coaching has shown to reduce diabetes, hemoglobin A1c measure (a
blood test measuring a patient’s average blood sugar levels), it is
shown to reduce blood pressure control and it is shown to reduce
readmissions,” Roga said. “What we have done is taken coaching and now
evolved it to health-equity coaching, with Morehouse, in using their
tools around cultural competency and humility.”

At Mayo Clinic Arizona, Truity will intervene and provide real-time
education to clinicians as well as feedback on how to narrow disparities
and offer resources to patients. Previously, Mayo Clinic Arizona
acknowledged disparities after the fact, through a review of patient
outcomes, now Mayo Clinic Arizona hopes to prevent problems before they
impact patient care.

“Whether it be when the patient is being roomed, and their
medications are being reconciled or when the clinician is seeing them
and prescribing a new medicine, there will be health equity insights
based on the patient’s chart regarding who they are, where they’re from,
what diseases they are diagnosed with and provide information related
to health equity,” Delafield said.

Delafield sees the platform helping Mayo Clinic Arizona address
disproportionate levels of disease and access to care in Arizona’s large
Native American and Hispanic populations, and mitigate health
disparities for many other marginalized populations as well.

“I think as we better understand various health care disparities, it
will motivate us that much more to ensure we are appropriately including
diverse patients at all stages of clinical research and care, in a way
that ensures the outcomes are better for all people, no matter their
race, ethnicity, gender, age, etc.,” said Delafield.