Meharry Health Equity Moonshot Summit

This episode of Straight Outta Health IT is brought to you by WellLink, your trusted partner connecting healthcare organizations, data, and innovation for a healthier community. WellLink helps healthcare providers navigate complex challenges, from analytics and AI to workforce solutions and community health impact. Because at WellLink, we believe when healthcare is connected, everyone thrives. Learn more at WellLinkCommunity.com. [Music] Hello everyone, welcome back to another episode of Straight Outta Health IT. Well we have an unfiltered dialogue about all things affecting health delivery, public policy, and health equity. I am your host, Christopher Cunningh, and I have the distinct pleasure of being in Nashville, Tennessee today at the Mejari School of Global Health, and I am participating in our Innovation Moon Shot Summit. And I want to first of all, before we get started, I want to thank Dr. Gaws and Dr. Khan for their leadership and vision of initiating this moonshot program. I think it's going to be transformational for healthcare, and I just it's just such a pleasure to be a part of this initiative as well. So let's get this party started. I've been in healthcare for over 25 years, and I've sat in more board rooms, more vendor demos, more conference sessions, and more strategic planning retrieved than I can count. And at all that time, all across those conversations, I have never been convinced that the decisions we're making in the next three to five years will determine whether artificial intelligence will be the greatest equalizer in history of American medicine, or its most sophisticated instrument in inequality. This is not hyperbole. This is the actual choice in front of us. AI is already inside of every clinical decision support tool your providers are using. It's already inside insurance algorithms determining patient coverage. It's already inside risk stratification models determining which patients get more resources in which ones get fewer. And the community's most likely to be harmed by those systems when they fail, when the algorithms are biased, and when the training data is incomplete, and the governance is insufficient, all those communities that are sitting in very front of Mejari's mission. I have the privilege of just finishing my first book, it's called Diagnosing Distrust, why people of color don't trust the US healthcare system, and how the technology can be its cure. And what I have found that we are at a very important inflection point. It is about trust. It is about accountability, and it's about our participation and engagement in it. So we're here today because trust cannot be assumed, it cannot be marketed, and it cannot be automated. It has to be built intentionally, accountability, and it's genuine partnership with communities whose lives depend on heating this right. And that is our conversation today. So I have the profound pleasure of introducing three amazing superstars, change makers and disruptors in this space today. And we're going to have an unfiltered conversation about responsible AI, civil rights, and community trust. I want to like let's each of them give their origin stories, and I'm going to start first of all with Tanisha. I wasn't expecting to go first. Yeah, absolutely. You're right next to me. We're about to do this. We're going to make this thing happen. Okay. Thank you so much for the invitation to be here with you all today. I'm a hairy. It is wonderful to be in Nashville by way of Boston, Massachusetts, where we are celebrating in Massachusetts really 20 years of the mass health connector, which was really one of the kind of origin policies that led to what we now know as the Affordable Care Act in the United States that was birthed out of Massachusetts. And I share that because I come from a place where health equity, health access, health for all is just part of our cultural DNA in Massachusetts. We're not there yet, but it is an ecosystem that is consistently striving toward that goal. I want to thank Dean Dawes and Dr. Conn also for the invitation and how fabulous it is to be on a podcast today with you. So I'm Tanisha Sullivan. I am the head of external engagement in health equity strategy at Santa Fe. Santa Fe is a global biopharmaceutical company headquartered in Paris, France. My work within Santa Fe really focuses on how we partner across health care systems, community, and with policy makers to improve access, trust, and most importantly, patient health outcomes. I come into this work by way of the legal profession. I am a practicing attorney have spent more years than we're going to talk about today practicing primarily in the corporate health law space and have also had a career within public service having served as a chief equity officer in a public school system. And so my work really for my entire career has been about how we improve access and how we disrupt in equity. Wonderful pleasure to have you on the show. Chris. I guess I'm up next. Yes you are. So first I want to start with three words. Some of you know because you've already spoken to me, but I'm a preacher. So you're going to hear that come through when I speak. I got three words in my spirit. Gratitude, glory, and grit. Gratitude to be in this moment with all of you. Gratitude to Dean Dawes, Dr. Khan, gratitude to my brother and my sisters here on this panel and gratitude to all of you because we need you to be a part of the doing and the solution building right now. Glory, let us rebel in the moment because when we focus so much on deficits and gaps and what is wrong and what is not working right, we might lose sight of the power and the strength that's in this room. I used to tell my students back when I was where my professor had may art thoughts collide up against one another and produce something beautiful and then grit. It's going to take us grit at a time where public health is under attack. Health equity is under attack. Black folks are under attack in a nation that is still seeking to find itself. As we dawned 250 years, we're still seeking to find ourselves. My origin story begins in eastern New Jersey. I am the daughter of two parents who lived through the Jim Crow South and who were a part of that great migratory pattern to go north for hope to flee tyranny. I had a father that started at the famous Bell Labs cutting grass and within six months was inside of a lab never having gone to college. I know personally the power of black ingenuity to help solve, right? Instonisha has heard me say this before and to work alongside those who would ultimately create caller ID, three way calling and easy pass. That was birthed in black ingenuity at Bell Labs and so that is the man who raised me so can't was never in my vocabulary. I was scared to bring home a B y'all and you know and a mother that had a Ph.D. in love. There you go. Neither my parents went to college but they cultivated within me a love of humanity, a love of community and faith and so I started thinking I would be the next bin Carson and I found out being the first doctor Chris is perfectly fine. Yes I did. But literally I fashioned a lot of my young black life. I was in the sixth grade when I came up with this idea that I was going to be as a neurosurgeon in my black public school in East Orange New Jersey. A lot of my life was how do I become that thing? I didn't become a brain surgeon. I am a public health and preventive medicine physician. Yes, yes. And I had to go through adversity and I had to learn that success and life is not linear and my career has taken me through several iterations as a public health and preventive medicine physician whether in the labor management space with 1199 SCIU so understanding the role of labor and equity in justice whether as a C-suite health systems leader working at a safety net hospital during the pandemic where I developed radicalization to stand up to the the president. of the United States and to say your policies are killing people or killing my people or killing my family members and then landing at the NAACP as the director of their Center for Health Equity. So that's all the well that I draw from and hopefully now I draw from this well too as we build and we solve. Thank you and I think everyone in this room can appreciate your journey as well. I'm sure all of us in this room can cite one of many people in our families and our communities that have inspired us to be where we are today and so to your point we all stand on the shoulders of those folks who came long before us who sacrificed, who encouraged, who prayed for us to be where we are today. So thank you for sharing your story. And last but certainly not least, Kimberly. Thank you. We had a conversation last night where I was warned that this was not going to be your grandfathers podcast. I believe it was what you said to me. You can listen though. And I came back with, well, I didn't have any grandfathers growing up, but I was raised by one tenacious grandmother prepared me for it to get on this stage today with you and very thankful for that opportunity. My origin, I am local to Nashville now, but come by way of Pennsylvania, very central Pennsylvania where that same tenacious grandmother was ignored for many years over a decade suffering from silent heart attacks that ended up taking over 70% of her viable heart muscle. And by the time someone listened to her, we were in emergency transport an hour away to the closest hospital or a six open heart bypass surgery. And as a 12 year old girl, I stood by her bedside and stayed at the hospital for weeks taking care of her and watching the story and the importance of adequacy, which fueled then my journey into health care. I started out in behavioral health, found my way here at Vanderbilt in Nashville. I am a hospital C suite by core as well, lived through the pandemic as a hospital CO, a local CEO here, but now I sit in a position focused on women's health and women's services for middle Tennessee and being in that seat now, learning the tenacity for my grandmother, the patient advocacy. And now to have a space of creative autonomy in our community is what drives the conversation today. Thank you for sharing. I want to share personal stories as well, and then we can jump into the conversation today and why I'm actually here and why I wrote the book and why I'm so passionate about health equity. My mom was, I grew up in a small southern town in Georgia, two traffic lights. We had our local one primary care physician that pretty much saw everyone in the community. My mom would go on an annual basis to get her annual checkup. And during those visits, she would tell our local physician that, you know, I notice some blood in my urine. Is that okay? And he said to my mom, her name was Maddie. Maddie, yes. That's fine. Nothing to worry about. This year, same thing. This went over for almost ten years. My mom going to her physician, telling her, telling him, she sees something that doesn't seem quite right. Long story short, it got so pervasive that it finally had to have tests. She had finally had to have tests and if they've discovered she had kidney cancer. And by the time they found it, it had metastasized. And a year and a half, maybe she was gone. We have to fix that. That is, I don't know if that's malpractice. I don't know if that's racism. I don't know if that's all of the above. I want to suspect, in my heart, it's probably all of the above, but we have to fix that. No one else should go through a situation like your grandmother, like my mom, or anyone else who has those stories, and we all have stories about family members who have experienced poor service and health care, poor delivery of care. And this issue around trust is permeated on generations of folks who have experienced medical atrocities that have gotten us to a point where, as a coping mechanism, we just decide not to go and seek care, right? We say that's better than going and getting mistreated. So I want to talk about now we're in the age of AI, this possibility of how it can transform health care, right? And it's a double-edged sword, right? It can miraculously change what we do or can perpetuate the biases that exist. So share with me Chris, I'll start with you, share with me one key idea or concern, innovation or approach about responsible AI that is really shaping your vision, your passion, what you're focused on today. Yeah, so I'm going to start in the sea suite of a hospital where I had agency and I had some power and we're in the pandemic and we're talking about how we use a new software to help identify who's eligible for clinical trials. And on the face of it, that sounds like a phenomenal idea. But what was lacking was transparency, what was lacking was how would we explain to our patients and the community the benefits of such a tool that it would be used and why it was important for a safety net hospital to have access, right, to the power of technology to help solve problems. And we had a very unfiltered conversation that day and a conversation that then led to some changes on behalf of, you know, the hospital's decision-making. And I start there because you heard me talk about the power of innovation. We live on two sides of a coin because we live in several different versions of America. Many things in life have both a benefit and a risk for harm. I can't define one right now that does not. In healthcare, in public health, in health equity, we are seeking to maximize benefit while minimizing harm. So when we think about AI or when we think about technology, we in the NAACP, we realize that the only way we're going to save Black Lives is to get in where innovation is happening and to get in in a way that forces conversation to one that is ethically centered and has equity at its core. And so I'm not one of those people that says we should have no AI, right, because I've met some people to say, you know, we should just re-invent how we solve problems without the use of things like AI. I've been a part of those conversations and then on the other side, people saying, "Oh, AI is going to be the panacea." We recognize that we cannot allow digital device to be perpetuated because our communities will be harmed further. So we started in a partnership with Tunisia Sullivan and Santa Fe to think about how can we begin to solve health AI and we have a public health initiative called ACE Your Health. At some point during this conversation today, I'll take you all to the webpage and ask you all to join up and to start to use the tools and the resources. But this is for framing, right, to think about what is possible, but in thinking about what is possible to understand specifically the needs of communities that have been historically marginalized and/or harmed or abused by medicine, healthcare, and science. With that lens in that frame, we are still going to be aggressive, right? We are going to be aggressive to ensure that opportunity is afforded to our communities. And so we embarked on a white paper using the best minds and the best thoughts, but to say, what is an approach for AI that takes into consideration the safety net institution? What is an approach for AI that takes into consideration, the federally qualified health center? What is an approach to AI that takes into consideration the Black grandmother whose position continues to tell her there is nothing wrong though there is a blood in her urine? What is approach to AI that takes into consideration someone who is living in a rural space, right? It does not have consistent access or usual source of care. And with that, if we don't have that level of supreme responsibility in how we design, fund, innovate, and create, we know that we are going to continue to lose. And nobody here is interested in losing. Exactly. We lost it. Right. And so I think that is the frame with which we all need to step into this AI conversation. And then, you know, where does you walk in it, right? Live that life and live that possibility. Tanisha is shopping at the bit. So, well, I want to jump in here because, well, for a couple of reasons, but one, just picking up on what Chris shared. One of the things that I really want to lift up in this moment, it was referenced on the last, um, during a previous conversation we had, um, this work when we talk about health equity. We talk about AI and the intersection of the two is not philanthropic. It is not philanthropic. And what do you mean by that? And what I mean by that is this work, if we are truly going to realize the potential for AI as a tool to help advance health equity and address health disparities, there has to be shared ownership and cooperation by between and among government, the private sector, philanthropy, yes, nonprofit community. It is across ecosystems. There's a difference between how this work has historically been addressed and where we need to be historically in this space for a relationship between an organization like the NAACP, an institution, excuse me, like the NAACP and an organization like Santa Fe has historically been philanthropic. We were very intentional in saying this will not be that. There's shared ownership. There's shared accountability for realizing its potential. The other thing I want to share goes back to something you made reference to relative to your mom. When I think about where we are in this moment, relative to all of us, being able to live healthy, thriving lives, and where we can be, I am incredibly hopeful about how AI as a tool, and you'll hear me as a tool, AI is not the thing, it's the tool, how AI as a tool can help us get there because what I consistently hear is for many of us, personally and for our families in our community, is that we are so reliant historically on healthcare providers to be the experts, to tell us what to do and what not to do, that we are often misdiagnosed or late-diagnosed. One of the really pieces of gold and the power that's in these tools is that they can be empowering. No, right, no longer do we have to rely on the expert by education to tell us what could or what should be. We actually may have in the palms of our hands the information to help guide and inform the conversations we have. And I think that's a powerful comment because I think what happened with my mom was a generational thing, that it was the white coat syndrome. Yes. It's what happened. She trusted and believed the man and the white coat had her best interest in heart. That's right. And the other challenge we have, and I do want you to jump in in just a second, and the other challenge I think we've had historically in our communities, we don't talk about our health. That's right. I didn't know that was going on with my mom until years later, when she finally told us, you know, what was going on with her. I said, "Mom, you wouldn't take your car to a mechanic, and you had a flat tire to keep telling you you needed an old change. Why do you keep going to the same doctor?" Right. And you know, whenever you see blood, that's not a good thing. It's just as a human being. I mean, it's someone with relative decent intelligence. Why would you keep trusting someone that keeps telling you that something is not right with your body when you know it's not right? So I want him to jump in because you work for a major health system that touches probably almost every state, close to it anyway. Close to it. Yeah. Yeah. Yeah. Jump in this thing and tell us what, you know, you're perspective and what your organization is doing to get this arm around this issue. Yeah. So I think several things were said as one of the largest nonprofit health systems in the country and the nonprofit health system here in Tennessee at Ascension St. Thomas, we get approached often with the tool. Right. It's going to solve this. It's going to do this for us. And one of the first questions we ask is, "Who is it serving?" Because we serve all. Is it nonprofit health system? Is it designed to read and absorb the bias? Or is it designed to change that? And when we look across our ecosystem, I have maternal units that are maybe 40% Medicaid, 90% Medicaid. And when we look at our data, we separate that. It is not aggregated to hit the green mark or the gold star. We use it to drive and change clinical outcomes. Specifically, hypertension is a huge focus. If any of you know Dr. Connie Graves, she's the director of our Paranetal Services, first in St. Thomas, a force to be reckoned with. If you can find her, she's traveling all over the country all the time to speak on our behalf. But how many have been labeled hysterical, non-compliant, aggressive patient, and where we see that impacted OB patient, shows up to the emergency room, high blood pressure, have the labels sent home. Instead, we took a look at that and said, those protocols don't work. Those are built for a male body. Women are not small men. And work to change those protocols. In our ERs, to know it needs to be flagged sooner. She's not going home. Number one. The other thing we have been pushing over the last few years, care for every woman at every stage of life. Maternal health is incredibly important. We have a lot of work to do here in Tennessee. That responsibility is not lost in us on a health system. I can assure you. But we are more than our uteruses. And we are here to connect that conversation. Absolutely. And to be a trusted, authentic partner in that conversation. And we have created a space called Her Health 360. We're on year two this year. And the intention is just that. However, we tell our providers where the white coat. We want them at this free community event here in Nashville to sit down with you. You, as a patient, we encourage to say, you don't have a G1. You want a new primary care doctor? Come to the event. You get to do a 50 minute interview of a primary care doctor. You don't like them. Schedule with the next table. Because that's what we're there for. And so just continuing to push that conversation. The two topics we really focus on. One, it's a free event. Free access. We do not want financial barriers to be another resource that limits anyone accessing that information in the system. Do not assume for women that symptoms that we think are normal, blood in the urine decades ago, bladder leaks. We think they're common. We have those conversations. They're not normal. Speak up. Advocate. Push back. And the secondary piece to that is the intergenerational medical history. It's a huge component of our education. The medical information or lack thereof can significantly change the screenings you need to be thinking about. Considering. Noting for your children. I think about my daughter. I think the hard history of my grandmother significantly changes how I need to look. And for years, I've spent a defense coping mechanism, even though working in a health system. Ignoring the doctor's office. And it's taken a community around me to push me to go. To get past that fear that was ingrained in me. And to change the conversation. To make sure that I have access. My daughter has access. And to take away the shaman silence around that medical history. Absolutely. Chris, can I just lean into something politically? Based off of what my two sisters just said. Look, AI is either. An equalizer or multiplier or it's a magnifier. Exactly. Right. And let's break down what the difference between that is. If AI, the way it is developed and designed and even funded, is not done through an inclusive process. We know that if the training data sets are not representative of all, it will perpetuate bias. We know that if we use synthetic data, that is not representative and conclusive of all, it will perpetuate bias. We know that AI in these large language models in particular, they're going to hallucinate at a certain percentage. They're just going to make stuff up. Right. And so with knowing that, there has to be a control. Because otherwise, it is just going to magnify, put a magnifying glass on top of all of the bias, the harms and the potential that is already swimming around. But what you heard, my two co-panelists say, unless we get involved in the tool, right, we won't have the opportunity to use it as the equalizer or the multiplier. And especially in communities where there is, I like to say broken trust, right? Because there wasn't an accountability of systems, institutions and organizations to develop the trust with community. So yes, for once, I had a mother who did listen to her doctors than her daughter was a doctor. She listened to her doctors. Well, the doctor didn't say that. That's not true. And Dr. Oz, if he didn't say it, it wasn't true. Right? As opposed to a father who was like, no, I'm going to follow the data. But we need to have a way that for once a person who has had a history of abuse or an assistant or a person that has had a history of abuse. You know, I'm not sure how to deal with this can say hey, I have an idea that I can bring and we finally can have shared decision making finally shared decision making we finally can have patient centered care because the last thing that I'll say so I have pots and I was diagnosed with pots over 20 years ago. And so we knew very little about pots. We know more about pots because COVID really has been a mass to save them. Postural orthostatic tachycardia syndrome. And so I go into my cardiology appointment at UCLA. I'm going to name it right. I'm an intern my first year surgery and I get very sick and I don't know what's happening. I just get back from New Jersey and I can't breathe. I can't round my patients and I go in and I say hey, you know, something's going on. Are you stressed out? Are you nervous? Are you anxious? Right. And I'm like, no, I just was on a month's vacation. I can't breathe. And then ultimately I pass out. Then ultimately I found that I have injection fraction that's 35% because I've been sick for so long and people have been telling me that there's nothing wrong with me. And then one day I remember my father said, you know, we're talking at the lab. There's another physician, a woman. And she says, call her if you need her the next time you go into your appointment. I said, no, I got it. I figured out what was wrong with me. I had to take a journal article in some of my cardiology appointment to say, this is what's wrong with me. And if we don't treat it, I'm going to hurt myself. Imagine the power of AI. Exactly. That's what we're talking about. The promise of it, absolutely. And thank you for sharing your story as well too. AI is transforming healthcare, but modern care depends on infrastructure that cannot fail. Cisco's AI ready unified edge securely unifies operations, the resilient infrastructure that modern healthcare demands. What's exciting and also a little scary about AI today, truth be told is, we're building a plane and flying it at the same time right now every day, something changes with AI. And everyone's talking about, you know, efficacy and, you know, accountability, how do we ensure it does no more harmed and good. But the reality of it, this thing is changing every day. That's right. So how do we put guard reals in place, you know, to prevent the discriminatory outcomes that it might exist, you know, in AI from both a civil rights perspective, from an industry perspective. What policies, what government governance mechanism is okay to say, hell, I don't know. We've got to figure it out. But if you got answers, we'd love to hear them because that at the end of the day is what's going to determine. Well, we actually can make this moonshot reality, right? I'm going to just put it out there, let me any one of you jump in that one. So what I'll say is we have to do both fly and work on work to ensure accountability. That's critically important. And I say that because this to your point, I would argue it's every day, it's literally every second, the thing is moving, right? And so if we spend too much time in the lab, trying to figure it out and what should we do and kind of pontificating and debating, we are widening the gap. We cannot do that. So it's flying. So it is continuing to use, continuing to bolster our individual and collective AI fluency, learning how to interact with these tools, again, individually and ensuring that we're working in community to do that. But while also working in partnership to build frameworks and Chris, I'll let Chris talk about Dr. Chris talk about the frameworks that we've built together, building frameworks for ethical use of AI. That is inclusive, that is responsive to community and that most importantly, centers patient health outcomes. That's critical. Before you jump in, I'm going to ask him, though, again, large health system, you guys are rolling out AI every day. You're into these meetings, probably have an AI governance committee or something. Everything has a committee. Absolutely. Yeah, management by committee. Talk to me about what guard rails you guys are putting in place. Yeah, I think that's incredibly important, but at the same time can't slow us down. Right. And influence the conversation at the design level. I think a lot of health systems can be deterred by wanting the final product and at the end, and I would say less than a policy and a committee, assumptions taking a stance that the guard rails were engaging early as a part of that design to break that. And I would also say, yes, the plane is in the air and we're flying it at the same time. Multiple planes, some injects, some helicopter, some of some planes are still on the ground. And as a health system, I would say too, you know, I mentioned we actively look at, you know, the bias. Does it read or absorb it? And is it designed to remove it? And you think about the words I said hysterical, aggressive, noncompliant. The accountability is still on the ground with the health system, though, that equity and education training is still on the health system and our nursing schools and our med schools. And even post five years, 10 years that 20 year nurse that those charts are being reviewed that education is on us because those words shouldn't even be in the health chart for AI to remove. So I think that's the other piece that as a health system that accountability and responsibility is not lost on us that we are still needing to fix the systemic issues on the inputs into the AI that's on the plane. And so to combine with what both of you said, so I talked about ACE your health earlier, right? You can go to any search engine and if you put an NAACP ACE your health, it's going to take you to a landing page. This is this large public health initiative that we partnered on and one of the main deliverables of that partnership has been a health AI white paper, you know, building and bridging a healthier future. And something that the white paper calls for in addition to what we've already discussed is a framework and the framework that it calls for has three layers and it's what you said Kim is right. So it has this ethical framework that says that one, we have to make public and transparent the tools and the resources that institutions and organizations are using. So that that scenario that I described to you in my suite, sees we does not happen right so whether that is through a public dashboard, whether that is through relationships in community to develop fluency. That is something that is a part of that ethical layer right taking information out of the closet and putting it in the domain of the public. Okay, and so in addition to that, it has to be organizational that's where actual governance committees have to come into being and there must be power within those governance committees to answer those questions that I said before, who's training data. Right, are we using synthetic data, how was the data created, it has to say what is the rate of this thing lying or hallucinating it has to say where is their bias and how are we removing it, but the house system also has to say who created this thing were, were they inclusive and representative of all of humanity and we have to begin to use the power and the agency and the weight of the particular institution that we live within to drive accountability. And then finally operational evaluation has to be built into any tool or resource that you're doing and also the evaluation has to be built into any governance framework. We got to evaluate ourselves, are we achieving the outcomes, is it having the impact that we have and we have to ensure this is where the NAACP as that cultural institution and the word that Tunisia used in fluency, going in community and ensuring that you have equal understanding right or equitable understanding so that you can drive accountability and then the last thing that I would say is that where does community have power. Right, where is community leveraging its power in this process are we a part of those governance committees right are we holding not just institutions but elected officials responsible and accountable and this is where the issue around data centers right comes into play. We can have a conversation about AI and it being ethical or equitable about talking about the potential harmful environmental impacts that are happening that as I heard on this stage yesterday, you know, the digital red lining that's happening and we in the NAACP are very hyperbolic right in that lane. My partner at the NAACP, a break on our leads are center for environmental and climate justice and the NAACP has released a community's front line framework to say how our communities stopping where AI is being used in a harmful way meaning data center. aren't using the latest or safest technology, right? They're who built this data center, right? So sometimes they're operating. You don't know that they're operating. Or they're expanding, you don't know that they're expanding. And the last thing is what tools are we using in the NAACP? We understand center equity. We understand the power of research. And we also understand the power of litigation, right? And so recently there was a lawsuit against Elon Musk, right? And they're XAI and Memphis. So there is a way to do this. And then there is a way to demand that it's done properly. Thank you. Thank you. There, please. [APPLAUSE] I'm going to ask an provocative question. If I haven't already. There's more. Yeah, there's more. What's an acceptable error rate for AI? People make errors all the time. Look. Now, AI is going to make errors. We see hallucinations all the time. What's acceptable? What's acceptable? So what's acceptable is striving for a tool that does not have errors, right? Like that's what's acceptable, the standard should be it's accurate 100% of the time. Recognizing-- Can we demand out of it people? I think what we demand is excellence out of people. This is a tool. And so again, I would submit that our expectation is that that tool is correct 100% of the time, recognizing that it will fall short. And that's where having the guard rails and the frameworks in place can help ensure accountability for when they do inevitably fall short of that, whether it's-- It was held accountable. Held accountable for-- When it fall short. I think that's part of the work. And it depends on where the failure is. It depends on where the failure is. And so as a physician, I don't have to tell you all. You all know this because you've lived it. We have an unacceptable rate of medical errors. When I even talk about AI, let's close the computer now. I'm not even talking about AI. I'm talking about surgery on the wrong side of the body. I'm talking about writing a prescription right there on rounds. And the decimal point is in the wrong place, right? I'm talking about me sitting in an ER with a young man who's having an allergic reaction and a health care provider rushing in and about to give a cardiac dose of epinephrine. And they realize that at the last minute, it runs out. Because they have traumatized themselves because they were about to kill a young kid who came in to stop an allergic reaction. So if we're going to have a very provocative conversation, we have to have a conversation about errors writ large, right? Then if we want to focus it on AI, we have to have the frame that we talk about in quality and safety of never events. Like Tanisha said, there is a goal of never making an error. But we know in actuality, it happens. You should never go into the hospital and come out with an hospital acquired infection. But it happens, right? And there are rigorous systems that have been set in place to minimize and lessen the chance that it happens. We have to have that same type of rigor. I'ma back us up around racism, right? Rigger around medical racism, racism in care, bias in care. Don't have the fallacy that suddenly discrimination has been introduced into the equation because of AI. That's right. Discrimination has always been in the equation. So we have to take that tenacity into AI to say, where are the accountabilities? There are individual accountabilities. But then the more power is the organizational accountability. And how can we have AI hold us accountable? Exactly. Looking at work on that, asking a quick question for you. And racism is expected to say, why did you treat that patient differently than the other person? Yes. Ms. Wealth, what is up in there? I'm going over here. It's getting out over here. But this is the right conversation. And these are the right questions that we have to wrestle with now, not later. That's right. Before we put it in place, and it's too late, and we cause harm. That's right. We cause more distrust. We cause more gaps in here. And then I want to ask one final question, and we'll open it up for the audience as well, too. How do we get past Tuskegee and Henrietta Lab in trust? And now that we have AI, I know, right? I'm looking down the other hand. I'm going to let you all start. Do you want me to go? Yeah, jump on it. OK, first of all, we get past it by not calling it Tuskegee. OK. OK, let's start there. Because it was the United States Public Health Service study. Well, it's important in framing, right? Yes. Because that too has caused harm. Absolutely. It has caused harm. And again, I'll start with a personal story, right? And so I told you about my father. My father lost his life in the pandemic. He died of COVID, April 13, 2020. And my father lived with chronic HIV/AIDS, right? And his infectious disease doctors always say, Tim, it's not the AIDS that's gone kill you. It's not even the HIV infection that we now have caused to be undetectable. It's the smoking, right? And so we would laugh and we would talk about it. But basically, the smoking was a setup. His lungs were destroyed. And then he got COVID and he died. But I say that to say, my father was in the hospital right before COVID struck. November, 2019. Copa was already there. But we weren't talking about it openly. He's in the hospital. He goes in with a rupture aneurysm in his lung. So he's coughing up copious amounts of blood. They stabilize him. But then things go south. And he has to be forwarded. He has to be moved to a acute care floor. He's being rushed down the hall about two or three in the morning. And the doctor says, watch out. Here comes HIV. In 2019. You're kidding me. Watch out. Here comes HIV. I don't have the name Tuskegee. I don't even have the name here. We have the blacks. We have to be able to talk about those experiences that are happening on a daily basis, multiple times a day that are allowed to exist within health care, allowed to exist. Nobody in that moment held that peer accountable, OK? The way the accountability happened in that situation, my father pancing barely able to breathe days later would be intubated. Caught my brother the bishop and said, you have to come here right now, because these people may very well kill me tonight. Right. And then they didn't even tell me that night. They told me the next day. Does they know how I am? I'm going to show up. Right, right. But I knew how to get to that CEO. And I said, you have to fix this. You have to fix this for the person who doesn't have a doctor, Chris, in their family. That's correct. And so that's what we have to begin to drive, right? And I'm going to say to Gengal, yes, we should be talking about both the potentials and the harms of AI. But we got to deal with the larger, systemic issues that AI is existing within, right? And when we begin to have the guts, the bravery, and the courage to deal with that, then we can customize it for this particular as Tunisia keeps saying, and rightfully so, tool. Yes. Yep. Yeah, I second that in terms of AI is a tool. We're still on the ground fixing part of the solution. And in not even seven years, tomorrow, I don't want to see words like hysterical, non-compiant, aggressive, and a women's chart. Not anywhere in my hospital, in my health system. And that responsibility, that accountability, holding everyone accountable from the ground, from that ground level, before even reaches the plane, is the story that I focus on. The story that needs to be brought in partnership. The many sectors, organizations that we partner with every day, it's the uncomfortable conversation. It's the provocative question. We have to have them. We have to have it. And we have to be honest. As a health system, we say zero harm. That's right. It doesn't happen. Yeah. It doesn't happen. And the transparency in that is key. Absolutely. We can only learn from the transparency. That's right. Something real quick, and I know we got a call. That's true. OK, so I'm sitting in my office in another C-suite executive sitting across from me. And he tells me to my face, Christi, the only reason I'm doing these things that you're now trying to impose in the hospital, is because I think this part of it is easy to perform. But otherwise, I don't believe in equity. Someone told me that in my office, I am the chief strategic integration and health equity officer. He tells me, I don't believe in equity. And unless the CEO makes me do it, I'm not going to do it. Right? That is the problem that we're talking about, right? And so then hospitals go through these processes to do culturally responsive care. And that's where partnerships like this have power right because they begin to say how can you have now We're beyond having courageous conversations How can you begin to drive accountability in actions and solutions and what does sharing power look like and when we Fell to share power gaps disparities and inequities remain when we learn to share power Ethically and equitably that's when we begin to erase narrow in subtract. Thank you Questions Yes, we have a lot of questions Okay, come on up. This is fantastic. I'm Kim Smith. I didn't introduce myself earlier Second-year PhD student the global health equity program stuff a question kind of linking it back to Connecting maternal health and AI and predictive medicine, but I want to give a context In South Carolina my husband's paternal grandmother was pregnant 18 years in a row and gave birth every time With the midwife in her home That same county today is a maternal care desert I happen to be in that county 14 years ago on the verge of a maternal health crisis and didn't know it Made it back home. Thank God. Unfortunately was diagnosed with help syndrome lost my daughter Lauren Kelly Which is a severe version of a life-threatening hypertensive disorder pregnancy I can't get out of my head what my mother-in-law said thank God can made it back to Richland County Thank God she made it back to maybe a physician on call someone who knew what they were doing the same county that can produce healthy babies 18 in a row Is a desert and people are afraid to even stay there. So my question is One of responsibility around what a powerful tool like AI can do to address its disparity knowing that maternal health is a looking glass to future cardiovascular disease What are our hospitals doing those that have had to or chosen to pull out of those rural communities that still serve those members On how to use AI to predict disease Engage with them in a way this innovator beyond just telemedicine beyond saying we have digital health But in a way that is strategic that shows these are breadcrumbs that can lead to xyz What are hospitals doing today not in the lab? But in the communities today With a sense of urgency because people are dying and they're making life-threatening decisions Based on how they feel because they got a drive 45 minutes to get to care. Absolutely. I'm gonna let you out of that We can I would say specifically I can talk about our system here in Tennessee We have three centers in the state that deliver babies And in the 45 county stretch one of those currently is delivering point eight babies a month Okay, that unit still has to be staff 24/7 The provider still has to be staffed 24/7. That is not a financial financially viable Business decision. I can tell you that if someone was looking straight at the P&L that they would not keep that open But we have committed investing in the last two years significantly in the last 12 months We are not gonna become another OB desert here in Tennessee 60% of Tennessee is deemed an OB desert in our in our system in our market We will not become another one if we close the next closest hospital women have to have two hours To reach the closest We can't invent doctors overnight. We can't invent OB's overnight. I can't change Medicaid reimbursement or policy overnight Well, we're still having those conversations. We're investing with other partners FQHCs have an incredible space Here in maternal health and we have an FQHC who has midwifery as a secondary service They will be opening up three clinics in that region uppercumberland here If those in Tennessee, McMinnville, Tennessee, so not only that one center where the hospital is they're expanding with us to create a new Hub and spoke model. It's also not financially viable for them But we know that pregnancy is the window to future women's health care We care about the women her whole stage of life We also know this FQHC one of the questions we ask was it's all encompassing so wraparound services primary care Mom and baby specifically as we know the influence on zero to eight years and what that has for an economy So we're looking outside of ourselves and saying who's that right partner? Who's willing to take on and tackle something that maybe doesn't make sense when you look at the PNL But it makes sense for community health And just it's for time. I want to let everyone's okay. I love it Thank you I'm Tracy Coleman a second year PhD student at Health Law Policy and Management Thank you all for your time today. Chris. Thank you for leading the discussion. I really I had like three questions I'm going to choose one I'm seeing as though we just you can add some after decisions. I know I said okay Which one is the most important but this one I think it's really resonating with me So we talked about Henrietta Lacks and the US public health service experiment at Tuskegee Thank you for grounding us with that We've seen what happens when innovation moves faster than ethical safeguards as I work In AI governance every day with development teams. I have Mentioned on a few occasions and raised for our AI governance for the notion of treating as we were developed a test in the systems How can we hold AI developers and employers accountable similar to how we do it here as a research institution as we all take city training and have to know about How we have to come forward to institutional review boards and understand how our research, you know, may impact communities I really feel like there's a void among AI developers and really understanding some of the things that you guys raised today About how these systems can cause harm. So just what are how do you think we could Explore something like that or do something like that because it's really you're building a tool and you're not even considering Some of the practices that were raised today. I was just gonna quickly comment on that. That's what we're doing today That's why we're here. We have to build a pipeline of the next generation of black and brown Health care technologist professionals and pharmacists clinicians who are all part of this equation I want my you know non-bellinated folks to to be a part of this journey with me and we're what we want them to See value in who we are as human beings But we also know that we're tribal in nature. We trust people wouldn't look like us You know, and those people are gonna have our viewer perception hopefully most of the time as well So I applaud institutions like Bayhary who's developing these next generation of Leaders in this space because that's what's going to be to me to catalyst for change And I'll just give you this last comment as well too in 2006 I was vying for a CIO position at a large very respected institution and I went to the retiring CIO and and asked him what his succession plan was and He didn't have one. I said, well, hey, I'm interested You know, what do you think the opportunity is and he looked me in the eyes of Chris from be very honest with you This institution has never had a person of color in the C-suite and I don't think they're planning to do it any time So he said you're better off going somewhere else and And getting and finding your way into the C-suite in another institution long story short I'm going to tell you after the fact. I became CIO at that organization despite the obstacles But this was 2006 and we still have these biases at all levels in organizations So all of you are in these programs. I applaud you for taking a leap and sticking to it Because we need you to be the voice to face the advocates to change makers to disruptors in this space as well too Otherwise, people will still have that view like he had You know, I'm just resting 20 years ago Thanks Hi, my name is Brittany little sin and I am a second-year PhD student in the Health Wall Policy program here at Mahari and I am also a native nationalian so can my question is for you because I am a maternal health advocate and that is my interest We talk about AI being a useful tool But when it comes to the current governance especially federal level governance of Data, how can we use AI to combat that when data is currently being restricted, especially around reproductive health For a health system like ourselves, we start with our own data We're not going to allow the the controls and limits to be on our own data We serve thousands of lives every day and that goes back to my point of the intentionality with our provider Leadership saying we're not going to aggregate this. We're going to take the hard look at our own stories by population and not just take the gold star or the CMS rating And take take control look internally and influence from that from that level up We can't allow those barriers just slow us down Hi, I'm Courtney Christian. I'm a second-year PhD student here in the Health Wall Policy Management program My question is a little bit different. I work in the bio pharmaceutical industry and so a lot of our member companies I work for the trade association and starting to use AI in medicine development. So my question is more about how do we ensure that bias is not baked into innovation? - Yeah, so I'll jump on that one. So yes, all across industry now, AI is being used and we are experimenting with AI tools on the research and development side of the house. And I think part of the answer goes back to what Chris said earlier around AI governance frameworks. I think it's critically important in the absence of federal state or local oversight by way of policy and/or regulations that institutions individually and collectively have robust AI governance, internal AI governance frameworks committed by way of committees or other aspects of infrastructure to support oversight within those organizations. That's one. The second is I do think there is a role for trade associations to play in helping to hold our collective organizations accountable, okay? The last piece I'll say, 'cause it's probably the last time I'm gonna get the microphone. So I do need to say this. When we think about using AI as a tool and I bring this into the conversation from my legal background, I think about this. Like all of the things that go into determining what a system might look like, how a tool may be used, how we address care gaps. And I think about all of the legal work that needs to happen, right? All of the due diligence that needs to happen, all the research that needs to happen, AI has the potential not only to help fill care gaps directly, but it also has huge potential to radically impact the amount of time it takes to get to a decision to go or not go. Let's not lose sight of that. It's not just at the bedside, it's also all of the things that oftentimes can take months, if not years, to have in place before a decision can be made. We can radically reduce that time, which can thereby have an indirect impact on care delivery. - So we're gonna have to leave it there, drop the mics. This conversation will be continued. Thank you everyone. Thank my amazing guests for joining me on the podcast. We'll be posting this soon. So look for straight out of health IT. You can find it on all the major podcast channels. If you like what you heard today, please like, share it with your friends, colleagues, even people you don't care too much about. Because everybody can benefit from these amazing women and start leadership and conversation. So thank you, Mayhary, for allowing us to have this. Thank you everyone. (upbeat music) (upbeat music)