The Coalition to End Racism in Clinical Algorithms (CERCA) is making strides in investigating and addressing the use of race-based medical algorithms. Initially focusing on clinical algorithms for glomerular filtration rate (eGFR) for kidney function, spirometry/pulmonary function testing (PFT), and vaginal birth after Cesarean section (VBAC), CERCA is now expanding its efforts to include clinical decision support tools used in hypertension management. Health Commissioner Ashwin Vasan, MD, PhD, emphasizes the potential impact of racism in medicine, outlining how it has adversely affected the care of minoritized communities. He asserts that confronting this legacy is crucial for promoting health equity and building trust in public health. With the support of the Doris Duke Foundation, which provided $2.9 million in funding, CERCA’s expansion into hypertension management is a critical move toward developing race-conscious approaches in healthcare. Hypertension, a major cause of disease and mortality in the U.S., particularly affects Black New Yorkers. The use of race-based algorithms in medical care, especially in hypertension management, has been criticized for perpetuating bias and causing harm to patients. For example, race-based adjustments in kidney function algorithms have been shown to overestimate Black patients’ kidney function, potentially delaying necessary care. Nine health systems and organizations have joined CERCA in its mission to eliminate race modifiers in clinical algorithms. Their goals include evaluating the impact of non-race-based algorithms on patient outcomes and health equity, and implementing patient engagement initiatives to support patients affected by these race modifiers.
Michelle Morse, MD, MPH, Chief Medical Officer and Deputy Commissioner of the NYC Health Department, questioned the outdated practice of using race-based algorithms in clinical decision-making. She points out that decades of research have demonstrated that race is not a biological factor, demonstrating the need for a fairer and more equitable healthcare system. The role of race in clinical algorithms has received attention with the increasing use of AI and other clinical decision support tools. Research published in The Lancet Digital Health revealed that AI models could detect self-reported race from medical images, raising concerns about exacerbating health disparities. This finding necessitates further research into the mechanisms AI tools use to identify patient race.
In the past two years, seven health systems have adopted changes in their clinical algorithms to improve racial equity. Some institutions have completely removed the use of race-based algorithms in multiple focus areas. CERCA’s continued efforts, particularly in addressing race-based hypertension prescribing, aim to develop more scientifically sound approaches to healthcare that do not rely on unproven assumptions about race being a biological factor.This initiative is recognized as a large step towards improving population health and health equity. A special issue in the journal Health Equity titled “Race Adjustment in Clinical Algorithms and Other Clinical Decision-making Tools” features articles underscoring the need to end the practice of race adjustment in clinical algorithms.CERCA’s progress and ongoing efforts are supported by partnerships with various foundations and organizations, including the Fund for Public Health NY, Josiah Macy Jr. Foundation, New York Academy of Medicine, and Robert Wood Johnson Foundation. These partnerships are a positive collaborative movement towards correcting biases and transforming healthcare into a more equitable system.
Nichola Davis, MD, MS, Vice President and Chief Population Health Officer at NYC Health + Hospitals, highlights that achieving population health is impossible without health equity. Sam Gill, President and CEO of the Doris Duke Foundation, applauds CERCA’s leadership in forging a just path forward in healthcare. Sara Gardner, CEO of the Fund for Public Health NYC, recognizes the coalition’s role in bringing attention to the improper use of race in clinical algorithms. Holly J. Humphrey, President of the Josiah Macy Jr. Foundation, notes that CERCA’s work is essential for equitable health and healthcare. NYAM President Dr. Ann Kurth lauds the initiative for putting equity at the forefront and addressing biases that have historically led to inaccurate diagnoses and treatment in healthcare. CERCA’s work marks a positive step towards removing racist biases in diagnosing protocols, improving patient care, and creating a new era in medicine that benefits both patients and the future generation of healthcare providers.