Artificial intelligence has empowered humanity with the ability to transform the world for the better if used responsibly—and as healthcare startup Acclinate understands, solving major systemic issues with AI relies on the communities they work with to co-create a solution for the greater good.

Cofounders Del Smith, PhD and Tiffany Whitlow know that machine learning is only as good as the datasets it is built on; to correct legacy problems such as inequity in healthcare, builders also have to fix the tech that perpetuates it. So when the Acclinate team set out to make clinical trials more equitable for communities of color, the company was faced with another mission: correcting algorithmic bias in AI.

Del and Tiffany knew from the outset that it was a two-for-one challenge. “The US population is about 42% racial and ethnic minorities and growing. But if we look at clinical trial participation—the process that we use to get much-needed drugs to market—only about 5% of clinical trial participants are identified as African-American or Black, about 1% as Latinx, and that percentage is even lower for Native American and other Indigenous populations,” Del explains. Such systemic bias is too easily replicated in the technology that determines the accessibility of healthcare—Del continues, “As we set out to train our models, the data [reflected] the people that are currently in trials—and if we use that data, we're going to create the same problem.”

It’s a mission informed by lived experience: both founders have been personally impacted by a lack of access to the right healthcare as a result of flawed data and inadequate outreach to marginalized communities. Tiffany, who as an adoptee didn’t have access to her health history, experienced the consequences of biased clinical research as a young mother when her asthmatic son was prescribed a common asthma medication; she discovered later that the medication, albuterol, is 47% less effective in African Americans and 67% less effective in Puerto Ricans. They were not offered options: “I didn't even know what a clinical trial was. I had never been offered an opportunity,” she says.

As a result of this experience, she became a founder because her calling found her: “It was an ‘aha’ moment that we need to start educating and engaging the minority community so that people can make a real healthcare decision with better information.” Del’s family was tragically impacted by inequity in clinical trials: they learned of a clinical trial that may have saved his mother’s life from tuberculosis only after she passed. Del stopped waiting for someone else to solve the problem: “You're saying this problem still exists and you're wondering, who's gonna solve it? And you look around and you realize that you're probably the one most suited to address it. So that's what we did.”

Because Del and Tiffany represented their target audience, they knew that the first challenge Acclinate had to address was mistrust. Del says, “Our communities have been historically forgotten about by healthcare. We have an issue of trust in terms of their ability to trust that healthcare is going to produce an outcome that's beneficial to them, or mobilize them to be able to take actions for the betterment of their health.” Engaging these marginalized communities was critical to collecting the data that would allow Acclinate to build better and more inclusive technology, and underscores the importance of keeping humans involved in the development of AI.

Acclinate lives at the intersection of advanced artificial intelligence and grassroots community engagement. In their technology, AI does not replace humans; rather, it relies on them. They created an online network, #NOWINCLUDED, as an engagement platform: “It is a central trusted place where our communities of color go to get information tailored to their specific needs,” explains Tiffany. #NOWINCLUDED enables members to share and learn information about diseases and chronic conditions that disproportionately impact people of color due to lack of access to appropriate levels of care. Acclinate empowers communities with information about their health as well as access to resources and research; their goal is that Black people can exercise agency over their healthcare and ultimately participate in the research that has excluded them to date.

Throughout their work, Acclinate’s North Star is a commitment to how the company can serve communities of color. Tiffany clarifies their order of priorities: “It is really about trying to overcome the issue of trust, and then about utilizing the data.” The company leads with the knowledge that communities excluded from clinical research need extra outreach; these in-person insights are critical not only to developing its own technology, but to advancing the medical industry. Tiffany says, “Once we're in community with someone, we might find out that they're never going to trust technology. We can share those insights with pharmaceutical companies so that they understand how to set up their trials. Through the grassroots work, we learn a lot about the communities and how to better serve them.”

This means protecting the data they collect. Acclinate knows the value of its data, which “is the new currency,” says Del. The company toes a fine line between using this data to advance clinical research and upholding its role in the community. “Trust is at the heart of everything we do,” says Del. “And sometimes we're dealing with an industry that says, ‘You guys are the trusted source to this entity that we don't have access to. Give us the data.’ And we won’t. That's not the way we operate. We're a trusted intermediary.” Acclinate cooperates with the industry insofar as sharing insights generated from aggregated data that will help other institutions reach and better serve marginalized groups who are being excluded from equitable healthcare. In a piece Del and Tiffany wrote for Google Cloud, they explained how they share their data: “For healthcare-related organizations, we offer the opportunity to better understand the attitudes, aspirations, and unmet needs of underrepresented minority communities. Data from #NOWINCLUDED feeds our HIPAA-compliant SaaS platform, e-DICT™ (Enhanced Diversity in Clinical Trials), which uses predictive analytics and machine learning to identify individuals matching the requirements and most likely to be receptive to participation in a particular clinical trial.”

Their ethical responsibility permeates Acclinate’s AI, its partnerships, and also its financing: the founders have turned down funding from investors who were not aligned with Acclinate’s values. Del tells us, “After several meetings, I didn't hear the word mission and purpose one time. At this stage, it's so important that we ensure that even our investors are leaning into this idea that sometimes they're going to make decisions that aren't the most economical.” Del explains that the trust they have earned is their “competitive advantage—and if we lose that, then essentially we've lost the value of our company.”

Acclinate’s proprietary technology, a participation probability index, is patent-pending; it ingests data and combines social determinants of health data with the individuals’ engagement data to generate an index of prospective trial participants. Acclinate’s primary source is #NOWINCLUDED, its own platform, but it also collects data from Instagram, Google, ads, and YouTube. The latter is a potentially rich source the company wants to explore further “to figure out where people are leaning into their issues of concern, and how active and how engaged they are around particular issues,” Del tells us. Del and Tiffany are excited about what the future of AI holds for more equitable healthcare—specifically, evolving its technology from predictive to generative. AI has allowed Acclinate to understand previously underserved communities, and looks forward to further empowering them in a way that is “less manual and resource-intensive, from a personnel standpoint,” Del explains. He continues, “what that allows us to do is greater scale, greater reach, more timeliness, and even more relevant information about the concern and the thoughts of our community.”

Acclinate has built its AI using Google Cloud Tools. Del tells us, “We are happy to be aligned with Google Cloud to have powerful cloud infrastructure that will scale with us, as well as high-caliber champions united in partnership.”

The collaboration is extensive: On the front end, Google Tag Manager and Google Analytics ensure that #NOWINCLUDED reaches and engages the target communities that provide invaluable data. Google Cloud services such as Vertex AI store the datasets on which Acclinate develop AI that can identify clinical trial participants, while AutoML provides an intuitive interface that can be used to train and compare models that learn and iterate upon interaction with the community. Google Cloud Platform’s serverless technology keeps infrastructure management costs down, and they integrate BigQuery with CloudSQL for real-time insights with Cloud’s built-in security, governance, and reliability controls.

Other Cloud products used include Virtual Private Cloud (VPC), for scalable and flexible networking, Identity and Access Management (IAM) for improved oversight of Google Cloud resources, API Gateway and Cloud Functions for reliable developer access to Acclinate’s services, and Memorystore to reduce platform latency. Del says, “All of this comes together to provide an outstanding experience for our platform’s users and contributors.”

Google and Acclinate’s co-creation goes beyond tech. Participating in the Google for Startups Accelerator: Black Founders and the Google for Startups Black Founders Fund helped them build and gain a greater, more credible foothold in healthcare. “People use Google every day, so whether we're trying to engage in conversations with industry experts or with somebody in a rural community, it is helpful to have the buy-in of a globally-recognized brand as we take on a historically difficult, systemic issue with challenges around trust,” Del and Tiffany tell us. The program’s $100K in non-dilutive funding and Google Cloud credits and in-person expertise enabled the company to migrate to Cloud and develop AI that can handle large datasets and run predictive analytics. Critically, Del says, Google collaborated with Acclinate to avoid replicating bias in its AI. Del explains, “When we had the conversations with Google about exacerbating these issues, they were very receptive. They said, ‘Let's figure out how we can look at these models and make sure that we're not creating more problems than we have currently today.”

The program also gave the team access to critical resources and best practices including AdWords, which helped Acclinate improve their community outreach, and funding from within Google’s network. Acclinate is built on the power of community, and the program allowed the company’s founders to benefit from a entrepreneurial community. “It was an opportunity to be around individuals who are trying to make a social impact change, utilizing technology. The resources provided, both in terms of expertise and talent and technical credits, as well as money, was very helpful to where we are today.” Acclinate was also chosen to take part in a face-to-face web conference with Google CEO Sundar Pichai, who reiterated Google’s commitment to health equity. “Ultimately,” Del and Tiffany say, “it's not just about the funding we get, but we are also gratified to receive support from an entity that truly believes in addressing this issue. We know Google is aligned with our mission of health and racial equity.”

As well as shared values on health equity, Acclinate is aligned on its vision of AI. “AI can be used for good and for not so good: people are paying more attention to that, and Google understands that,” says Del.

Del attributes systemic change, and the power of institutions to enact that change, to intentionality. “There's a lot of big data players right now in this space [who have asked to partner with us]. As a young company, we have to ask if we want to shut doors that could mean opportunities. We come back to our mission and ask, ‘Who's really talking the talk and walking the walk’? And it's what Google is doing. I think [investing in equity] is going to come back dividends in terms of where we're going as a world.”