practicum

Student Advances Digital Health Equity with Guidelines for Inclusive AI

MacKenzie Hilton, a recent MPH graduate, reflects on her practicum last summer at Boston Children’s Hospital, where she helped to outline guiding principles for the equitable development and application of artificial intelligence in healthcare.

Technologies once confined to the realm of science fiction have rapidly become a part of present-day reality. Where confirming a person’s identity used to require a trip to the police station to submit fingerprints, today cameras on the streets can rapidly identify individuals and track their whereabouts without their knowledge. Artificial intelligence (AI), such as facial recognition software, and other digital innovations are changing the way industries operate, from national security to healthcare. Whether these developments help or hurt patients is not something MacKenzie Hilton plans to leave up to chance.

As a practicum student with the Innovation, Digital Health, and Accelerator (IDHA) at Boston Children’s Hospital last summer, Hilton (SPH’24) served as the right-hand of Katrina Cook, the team’s equity and inclusion specialist. Together, Hilton, Cook, and the IDHA team worked to lay a foundation for future digital health equity, both at Boston Children’s and across the industry.

A major highlight of the experience, Hilton says, was the opportunity to contribute to the creation of guiding principles for integrating health equity into the development and application of AI tools at the hospital. Boston Children’s leadership, including Chief Innovation Officer John Brownstein, later brought ideas based on these principles to the White House, where they collaborated with other industry partners to define a set of voluntary commitments for the responsible use of AI in healthcare settings across the country. So far, 28 healthcare providers have signed on, agreeing to abide by the “FAVES” principles that any AI they use be Fair, Appropriate, Valid, Effective, and Safe.

“A lot of times when we think of AI, we think it is going to be harmful, and it will be harmful if we do not make regulations around it,” says Hilton. She points out that facial recognition algorithms were primarily built using databases of White faces, so the software often does a poor job of distinguishing Black features. This can lead to mistaken identity and, worst-case scenario, land innocent people behind bars. It is important to build in equity from the beginning, she says.

Hilton says she first learned about the promises and pitfalls of emerging digital technologies such as AI in the course PM804 Digital Disruption in Health: The Effects of Health Information Technologies on Polices, Delivery, Patient Engagement, And Health Outcomes. Taught by instructor Michelle Sasso, the course introduced Hilton to the ways digital tools can enhance quality of care and expand access; however, she also learned to be wary of the ways these tools can magnify human biases and exacerbate inequities.

In addition to her work on AI, Hilton also supported an initiative to expand the reach of telehealth at Boston Children’s. By analyzing hospital data using skills she gained in the course GH854 From Data to Dashboards: Building Excel Skills to Support Health Program Decisions, Hilton discovered a disparity in the attendance of telehealth appointments between English-speaking patients and families and those who required interpreters. The findings presented an opportunity for the hospital to improve its services to better meet the needs of its diverse patient population.

Hilton, who moved from a small town in Virginia to attend SPH, credits the core course PH720 Individual, Community, and Population Health, with teaching her how to identify health disparities and familiarizing her with the types of disparities commonly found in her new city. The recent healthcare management graduate says she hopes to find a job at a startup, tech company, or hospital in the area where she can continue promoting digital health equity.

“MacKenzie very skillfully used her opportunity at Boston Children’s Hospital to learn something new, think critically about an important national issue, and make recommendations that guided her hospital leadership in their interactions with the federal government. This is a home run in terms of what a practicum outcome can be,” says Chris Louis, clinical associate professor and associate chair of Department of Health Law, Policy and Management, of his former student. “MacKenzie’s professionalism, creativity, and hard work really paid off in this situation. I know personally that this is just the first accomplishment at the beginning of an amazing career.”