California AG Asks Hospital CEOs for More Information on Their SDOH Technology

Attorney General Rob Bonta has sent a letter to the CEOs of 30 California hospitals asking for details on how they use data mining software to address racial and ethnic disparities in care delivery, saying those algorithms may be contributing to the problem rather than solving it.

California Attorney General Rob Bonta is investigating whether data mining software used by healthcare providers is hindering underserved populations in accessing healthcare.

Bonta has sent a letter to the CEOs of 30 California hospitals asking for information on how their clinical software is addressing racial and ethnic disparities in care delivery – and whether those algorithms may be discriminating against minorities.

“Our health affects nearly every aspect of our lives – from work to our relationships," Bonta said in a press release. "That’s why it’s so important that everyone has equal access to quality healthcare."

"We know that historic biases contribute to the racial health disparities we continue to see today," he continued. "It’s critical that we work together to address these disparities and bring equity to our healthcare system. That’s why we’re launching an inquiry into healthcare algorithms and asking hospitals across the state to share information about how they work to address racial and ethnic disparities when using software products to help make decisions about patient care or hospital administration."

Healthcare organizations across the country are tackling social determinants of health by identifying and addressing the barriers to healthcare access, such as home and family concerns, employment, food insecurity and digital literacy. But some are questioning whether the technology they're using to identify and take on those issues are instead causing more problems.

"While there are many factors that contribute to current disparities in healthcare access, quality, and outcomes, research suggests that algorithmic bias is likely a contributor," Bonta's office says in the press release. "For example, data used to construct a commercial algorithmic tool may not accurately represent the patient population for which the tool is used. Or the tools may be trained to predict outcomes that do not match the corresponding healthcare objectives. For example, researchers found one widely used algorithm that referred white patients for enhanced services more often than Black patients with similar medical needs. The problem was that the algorithm made predictions based on patients’ past record of healthcare services, despite widespread racial gaps in access to care. Whatever the cause, these types of tools perpetuate unfair bias if they systematically afford increased access for white patients relative to patients who are Black, Latino, or members of other historically disadvantaged groups."

In his letter to hospital CEOs, Bonta is asking for:

1. A list of all commercially available or purchased decision-making tools, products, software systems, or algorithmic methodologies currently in use that assist or contribute to the performance of any of the following functions: 

• clinical decision support, including clinical risk prediction, screening, diagnosis, prioritization, and triage;
• population health management, care management, and utilization management;
• operational optimization, e.g., office or operating room scheduling; or
• payment management, including risk assessment and classification, billing and coding practices, prior authorization, and approvals. 

2. The purposes for which these tools are currently used, how these tools inform decisions, and any policies, procedures, training, or protocols that apply to use of these tools; and
3. The name or contact information of the person(s) responsible for evaluating the purpose and use of these tools and ensuring that they do not have a disparate impact based on race or other protected characteristics. 

"As healthcare technology continues to advance, we must ensure that all Californians can access the care they need to lead long and healthy lives,” he said.