Alan Roga, MD, FACEP, is a healthcare technology entrepreneur and emergency medicine physician. He has over 25 years of experience in healthcare, including his current role as Founder and CEO of TruLite Health, a healthcare organization that developed Truity.

As the first comprehensive health equity platform, Truity is designed to improve health outcomes for diverse populations. By combining patient data with clinical expertise, healthcare organizations can provide interventions to address the needs of their patient populations.

We’re talking with Dr. Roga about the importance of health equity, how Truity uses innovation to address health inequities, and advice for aspiring healthcare innovators.

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Check out these resources to help your health solution or organization learn more about using technology to advance equitable health innovation.

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In Full Health (IFH): In your time working at the intersection of health equity and innovation, what progress have you seen, and what opportunities do you see remaining?

Dr. Alan Roga: I think, as unfortunate as it was to see George Floyd’s murder and for COVID to descend upon the world, it really accelerated our knowledge and understanding of how inequitable and disparate care is in the United States. Dr. Martin Luther King, Jr. has a great quote, which is, “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane,” and it’s actually written on the wall of our office. But what upsets me about it, is that this quote is almost 60 years old. I do think we’re seeing substantial tailwinds.

We surveyed over 100 hospital executives and found that health equity is a top five priority for almost every health system in the United States. As of July, the Joint Commission has made health equity a national patient safety goal with six requirements that need to be met. We align very well to those requirements for health systems.

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We’re finally talking about [health equity] to the degree it needs to be. We’ve enlightened and brought the conversation upward and to each other, not isolated and segregated in communities that have been marginalized.

Alan Roga, MD, FACEP
Founder and CEO, TrueLite Health

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We’ve also seen CMS come up with the ACO REACH program, which puts payment differentials around improving clinical outcomes, and the FDA is requiring late-stage clinical trials to have diversity. So, you are seeing health equity pop up in lots of places. We are very proud that, as an early-stage company, we have found we can meet with almost every health system and have a discussion around health equity in a non-threatening way, non-political way.

We’re about remediating clinical bias, and this is the science, right? The science is flawed in certain spots. We need to do better. We need to evolve and let us enlighten where our blind spots are and what interventions we should be doing to provide the best care and outcomes for our patients.

So, the good part is that these conversations and changes are occurring. Large trade organizations like yourselves at the AMA and the AHA are taking massive leadership roles around health equity. The flip side is the challenges. It’s not going fast enough, right? We are still having poor outcomes. In fact, they are getting worse. So, as an impatient New Yorker, I would like to see more action and less analysis.

IFH: Can you shed some light on Truity and how your software works?

Dr. Alan Roga: Absolutely. What the software does is it is a clinically integrated workflow tool, so it directly integrates into the Epics, Cerners, Allscripts, Meditechs, Athenas, the EHRs (Electronic Health Records) of the world, and it will grab data in the background. So, when a patient registers for an account, makes a visit, sees the provider — or if a provider orders a med or closes the record — we’re always grabbing their data in real-time. We run it against our knowledge base to find where care is being impacted inappropriately because of race, gender, orientation, zip code, and then we action it in a multidimensional way — clinical, social, and behavioral.

We are providing clinical insights in three forms: facts, actions, and articles that we write around everything you want to know about this disparity. For instance, a fact can be, “This patient is three to five times more likely to end up in the ER.” An action we take is, removing the race correction component from this formula, this article, or this calculation, and our articles are provided to not just the physicians (because we can’t keep adding more to the doctor’s plates), but to nurses, care coordinators, and social workers. Everyone is getting broad-based organizational education at scale on health equity. Because it’s applied to a patient, it allows us to be stickier and to take specific actions and measures.

We also provide the same information to the patient, and it is available immediately in their patient portal at a middle-school reading level, in English and Spanish. We then follow it up with social interventions, which in our world is health equity coaching.

What we’ve done is created the market’s first health equity-certified coaching role, and we’ve done this in partnership with the Morehouse School of Medicine. Our coaches will be dually certified by Morehouse School of Medicine and TruLite Health. This creates patient advocacy and engagement because we know the studies show that communities of color have a lot of distrust in, and are disengaged from, the healthcare system right now.

So, coaching is best practice. Our health equity coaches help to reduce hemoglobin A1C levels, reduce readmission rates, and improve compliance. They are reinforcing the clinical needs of the patient, and are also highlighting health-related social needs that a health system may have invested in. For example, discounted meds, or transportation programs. And it’s all virtual.

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IFH: Is there a specific example you can give us of Truity’s software working optimally?

Dr. Alan Roga: Let’s take asthma. One disease, right? So, let’s say a Black patient presents with Asthma to the ER, PCP, or Urgent Care center, and they’re wheezing a bit. Most likely, they will get a prescription for albuterol and be sent home.

But this is a massive, missed opportunity. As we know, the lung function/pulmonary function test race corrects. It actually says that this patient’s lungs are 10-20% weaker than a white person’s lungs. This misses early disease, misses necessary interventions. Albuterol doesn’t appear to work as well with diverse populations. This patient also may need a second medication, and we can get social information from our datasets that will reveal their quality index in their area. Are they near a PCP? Can they afford their meds? So, a health equity coach can reinforce the treatment needs, can show where there are health-related social needs in the community, and assist with overall adherence to the plan.

Statistically speaking, absent Truity, that patient is three to five times more likely to end up in the ER and to be hospitalized. So just for that one disease, there are examples of where we can intervene and make somebody’s care better.

IFH: There is an AI aspect being used — can you speak more to that?

Dr. Alan Roga: This is an important point. We use deductive AI, which means we can explain why somebody matches on the information. AI, while it has great promise, has also been shown to increase disparities in some areas. As an example, the AI algorithms inside of electronic records or sepsis protocols have been proven to widen disparities.

So, we are not using AI to generate. We are using deductive AI to find a match. Call deductive AI “matching” for simplicity.

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We have got to provide tools for the chief health equity officers and clinical leaders to measure outcomes and impact. Using our tool, these leaders can see how the patient is doing, who is engaging, who is not engaging, who needs more information and help, and who needs more coaching.

Alan Roga, MD, FACEP
Founder and CEO, TrueLite Health

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IFH: What advice would you give to underrepresented entrepreneurs who are just beginning their search for capital?

Dr. Alan Roga: You know, it’s the same advice I would give to any aspiring entrepreneur, which is: If you knew you couldn’t fail, what would you do? That matters. And if your project is important enough, impactful enough, then go do it and do your best. Show up every single day and then you release the rest to a higher power of the universe, God, whatever you believe in. So, show up, do your best, release the rest to a higher power and authority. For diverse entrepreneurs, there is certainly a desire in the market to fund and support diverse entrepreneurs, so timing is very good.

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