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Join Juan Carlos Gonzalez, Jr., health equity researcher and advocate, as we explore the transformative power of technology in health care. This podcast episode discusses the potential of health information technology, telehealth, and data-driven solutions to improve patient access and enhance care. We delve into the challenges of equitable implementation, the digital divide, and the role of clinical and technical teams in creating inclusive practices. Discover how technology can bridge gaps in health care and drive positive patient outcomes.

Juan Carlos Gonzalez, Jr. is a health equity researcher and advocate.

He discusses his KevinMD article, “How data and technology influence health in ways that doctors don’t.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and you can get CME for this episode by clicking on the CME link in the show notes. Today we welcome JC Gonzalez. He is a health equity researcher and advocate. His KevinMD article is titled “How data and technology influence health in ways that doctors don’t.” JC, welcome to the show.

Juan Carlos Gonzalez: Thank you so much for having me.

Kevin Pho: We’ll get into your article in a little bit. First off, briefly share your story and journey to where you are today.

Juan Carlos Gonzalez: Well, my name is JC Gonzalez. I’m a health equity researcher, as you said. I’ve been focused on understanding the development and expansion of data and technology that address health inequities. I have over 15 years of experience in health care, first as a clinical systems designer and project manager, and more recently working in strategic planning for the Institute of Global Health Equity at Meharry Medical College. My research has focused on understanding how technology and data contribute to our strategies and interventions that deepen our understanding of the root drivers.

Kevin Pho: All right, so you talk more about that in your KevinMD article, and we’ll dive deeper, “How data and technology influence health in ways that doctors don’t.” So how did this article come together?

Juan Carlos Gonzalez: Well, with this article, I wanted to address the impact of health technology and integrated applications on patient care and highlight the potential gaps and biases that can arise from that. Through research and drawing from real-world examples, I aim to shed light on the importance of equitable decision-making and the importance of representative data collection, and really explore the collaboration between clinical and technical teams during technical development.

Kevin Pho: All right, so go more into that.

Juan Carlos Gonzalez: Well, what we’ve seen, really in the last three years or so, is an industry that has not historically been deep on technical innovation, and by that I mean health care, and the industry’s been thrust into a widespread adoption of technologies that simply didn’t exist a few short years ago. So I wanted to explore the rapid pace of this innovation and what that means for the growing role of technologists.

What we’ve seen, you know, early in the pandemic and over the last few years, is really the expanded role that technologists have in the clinical and patient care experience. We’re really starting to see where those decisions are made and who’s making them.

Kevin Pho: So when you talk about technology and innovation, what specifically are you talking about from the patient’s perspective?

Juan Carlos Gonzalez: So, drawing from my own experience and what we’ve worked on, it’s the design of something as simple as the telehealth app that a lot of people use on their phones. There are really a lot of technical decisions that are made on how that should function, the workflow and data flow. And when you think of it, there are really two perspectives. There’s how you wish the technology to work, but then there’s also the patient experience: How does that promote engagement for the patient, to lessen the burden and barriers so they can adopt that technology effectively? And ultimately, I think most people involved in technology have the goal of having the technology disappear, so the doctors and care providers can interact with the patient and not be struggling.

Kevin Pho: So one of your specialties is that intersection between equity and technology. Specific to these telehealth platforms, what are some disparities that arise from the implementation of this?

Juan Carlos Gonzalez: That’s a great question, and it’s an important one. I think of my mom a lot, as someone who struggles with technology. And we see in the literature now that the growing digital divide is a term that you see more often now. It’s just thinking about this rapid pace of invention, really, and how these things are developed and put out there.

There are some people that just don’t know how to use it. Maybe they don’t have the digital literacy for it. Maybe they have mistrust; they don’t understand how their data is collected and will be used. Or there’s just a training component on the clinical side of things. So it’s really thinking about not only getting these solutions out there, which is important, but also thinking about the training aspect of it and the adoption aspect, and addressing those kinds of disparities and why some people use them effectively and others don’t. We want to make sure that no one’s left behind.

Kevin Pho: So tell us your ideal world. If you were in charge, how would you implement this to reduce some of these disparities?

Juan Carlos Gonzalez: Well, the important part really is thinking about the importance of collaboration and interdisciplinary teamwork. I mentioned earlier non-clinical teams, and we’re talking about technical designers and data scientists. They’re really emerging into the patient care experience in a way that we haven’t seen before.

So I would caution clinicians, especially physicians and other providers, to be thoughtful of who the decision-makers are during development, and ensure that we follow those technical considerations downstream into the patient care experience. We want to leverage, you know, the unique experience of everyone, including non-clinicians, but ensure that ultimately the patient care experience is followed all the way through.

Kevin Pho: So you mentioned telehealth as one platform that patients often interact with from a technological standpoint. What are other examples? What are some other ways that technology influences a patient’s health experience?

Juan Carlos Gonzalez: It’s huge, and the big area of focus that I’ve had is really representation and data. We know today that health systems, insurers, and different stakeholders, not just direct care providers, are generating huge amounts of data. We’ve seen the rise of AI, and machine learning leverages data.

So when you think about the way that data influences our health care, when policy decisions are made and resource allocation decisions are made, you want to make sure that we have a very good, strong understanding of how that data is collected and who’s represented in that data, and that it ultimately is leading to data-driven decision-making from all aspects and all stakeholders. So it’s a big and growing field, just because of the volume of data that’s generated every day, but there are the core representation and transparency concerns around that data.

Kevin Pho: Give us a story or a case study of how you feel this data is being, you know, misrepresented or not being used to the best of its capability.

Juan Carlos Gonzalez: I have a great example, and I don’t want to name names. In my previous role as a product manager for the Health Equity Tracker, which is a data platform we developed to really think about lessening the barriers to data, so that ultimately more people could use the data, whether it’s for a personal decision or maybe it’s an organization, one example that I really loved to use in the past is a data set we used for COVID case counts, hospitalizations, and deaths. It comes from the CDC, and one core challenge we found was the way race and ethnicity is encoded in the data set.

So very briefly, and I’m oversimplifying for the sake of time, if I was in the data set and I recorded myself as white Hispanic, white is my race and Hispanic is my ethnicity. Due to the way the data structure was encoded, it was only able to capture Hispanic, so in the data set I would be represented as Hispanic only. And the opposite is true as well. Some people identified as, maybe, Black Hispanic, and maybe they lost the demographic detail of their race being Black.

So what that does at a broader scale is it adjusts our perceived impacts to populations. You’re either overcounting or undercounting impact, and we know, especially for some of these marginalized groups, the impact is huge. If you’re not really representing the data in an accurate, representative way, decisions are made understating those impacts. So I hope that answered your question, but that’s a very simple example of how data could maybe not be as representative as we strive for.

Kevin Pho: So when you say some of these decisions are being made based on data that isn’t being coded correctly, what would be an example of such a decision?

Juan Carlos Gonzalez: So that was completely a technical constraint, and the decision at the time was to capture one or the other. Later on, I was happy to see that they were able to fix it, and what they did was break it out into separate categories. So now you get the fidelity of race and ethnicity, not one or the other. So it’s a good example of not a clinical decision, not a patient-driven decision. It was purely a technical design decision that grew downstream, and you could see and follow that down to see how that is represented.

Kevin Pho: So to my clinician audience, and I’m a primary care internal medicine physician, what are some things that we can do to kind of help this data disparity, this health inequity as it relates to the data? Anything that individual clinicians can do?

Juan Carlos Gonzalez: Absolutely. I would say, and I think I spoke to this earlier, it’s being partners with these new kinds of technology-focused roles, understanding that it’s our responsibility to advocate for inclusive design. When we think about data collection, advocate for representative data. Expand your understanding and advocacy for your own training and knowledge, to understand how data is collected and what kind of definitions are included in a data set, and that could expand to technology as well, so understanding how a system is designed and how it functions.

And really, I think it’s the role of the clinician to advocate for the patient care experience, to ensure that whatever is developed, that is not an afterthought, and to make sure that the patient engagement and design decisions that could expand on inclusivity, promote engagement, and promote representation are discussed frequently and often and early in development.

Kevin Pho: We’re talking to JC Gonzalez. He is a health equity researcher and advocate. His KevinMD article is titled “How data and technology influence health in ways that doctors don’t.” JC, you mentioned the influence of artificial intelligence as it relates to health technology innovation. That’s certainly a big topic now. How do you see the role of AI now and going forward?

Juan Carlos Gonzalez: There’s tremendous interest in thinking about AI and language models and how that could be used in health care. We’ve seen, you know, the tremendous pace of innovation. We really don’t know where that’s headed. The potential is exciting.

From my role as a health equity researcher, we want to just make sure that these systems are programmed in a way that discourages bias, that they are not proliferating bad data, and that we really train these programs and models in a kind of thoughtful, inclusive way that doesn’t spread the lack of understanding of how it works and how it’s trained. From my background in technology, you know, we typically don’t get a lot of access to the training of these kinds of artificial intelligence and language models, so advocating for transparency in how these things are programmed could be an important thing to consider.

Kevin Pho: And my final question: Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Juan Carlos Gonzalez: I hope the take-home message, again, is that we all have a role in this rapid pace of development and the exciting times that we are experiencing in health care. Like I said, I think we haven’t seen anything like this in health care innovation, and so it’s about being a partner with these different roles that are emerging and advocating for the values that we know lead to good health care, the things that patients value.

And I’ll speak on my own behalf as a patient: It’s technology that encourages engagement with providers, that makes me feel represented and accurate to my own experience. And that doesn’t happen by accident. That takes an active kind of decision point from someone, whether it’s a technology decision, a business decision, or a clinical decision. So it’s really about advocating and partnering with these teams, looking for the strengths of each role. It really is an exciting time for health care, especially when you think about where this technology is headed, and I think we all have a role to ensure that its decisions and adoption are equitable.

Kevin Pho: JC, thank you so much for sharing your time and insight. Thanks again for being on the show.

Juan Carlos Gonzalez: Thank you so much.