Can AI Make Homeless Californians Healthier?

from Marissa KendallCalMatters

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As AI expands into every aspect of society, a California company is testing whether the technology can help improve the health of people living on the streets.

Akido Labs, a Los Angeles-based health technology company that operates clinics and street medicine teams in California, plans to begin using its AI model on homeless and insecure patients in the Bay Area next month. The program generates questions for outreach workers to ask patients and then suggests diagnoses, medical tests and even medications, which the human doctor then signs remotely. The idea is to save doctors time and allow them to see more patients.

The new model, the so-called AI rangedeals with a very real problem: there are not nearly enough doctors visiting camps and shelters. At the same time, homeless Californians are outnumbered worse health and die earlier than the general population.

“There are people who haven’t seen a doctor in years. There are people who have never seen a dentist,” said Steve Good, president and CEO of Five Keys, which is partnering with Akido to roll out AI technology at its San Francisco homeless shelters. “There just aren’t enough resources to go out there and understand the needs that these people have.”

Experts who research AI told CalMatters that if done right, the technology has the power to increase access to care for homeless and other marginalized communities. But while many healthcare providers are already using AI for administrative duties, such as transcribing patient visits, using it to help diagnose people is still a relatively new field. It raises concerns about data privacy, bias, and patient outcomes that are especially pressing when the technology is used on homeless patients and other vulnerable populations.

“We still don’t have perfect solutions to many of these challenges,” said Angel Hsing-Chi Huang, an assistant professor at USC who studies human-AI interaction.

How Scope uses AI to diagnose homeless patients

Scope AI essentially allows non-medically trained outreach workers to begin the intake and diagnosis process before a patient sees a doctor.

A field worker goes out into the field with Scope on their tablet or laptop. When they start interviewing a patient, Scope suggests questions for the outreach worker to ask. Scope listens, records, and transcribes the interview, and as the interaction progresses, suggests new questions based on what the patient says.

When enough information is available, Scope offers diagnoses, prescriptions and follow-up tests. This information is then sent to a human doctor who reviews it (usually the same day) and either signs the prescriptions, makes changes or, if the case is more complex, arranges an appointment with the patient to obtain additional information. Medical care is paid for by Medi-Cal through its own CalAIM expanding into social services.

In demonstrating the technology to CalMatters, using an imaginary 56-year-old female patient complaining of breathing problems, Scope asked several follow-up questions to understand her symptoms. He then made suggestions that included: a diagnosis of COPD or chronic bronchitis, a chest x-ray and a spirometric breath test, and a prescription for an albuterol inhaler.

Scope AI technology is already being used in several target areas. Akido street medicine teams began using it in homeless camps in Los Angeles County in 2023, where more than 5,000 patients have since been seen. Akido also uses AI at camps in Kern County, clinics in California and Rhode Island, and for treatment carpool workers in New York.

“Overall, I would say it’s not going to work for this population.”

Brett Feldman, Director, USC Street Medicine

According to Akido Scope, it reaches the correct diagnoses in its top three suggestions 99% of the time.

Other studies question the reliability of diagnoses made by artificial intelligence. A 2024 surveyfor example, found that AI was significantly more likely to misdiagnose breast cancer in black women than in white women.

The penetration of AI into homeless services has drawn concern from some critics who argue that homeless patients, because of their increased vulnerability, need a human health care provider.

“We should not be experimenting on unhoused or low-income patients to implement AI,” Leah Goodridge, a tenants’ rights attorney and housing policy expert, and Dr. Oni Blackstock, a physician and executive director of Health Justice, wrote in a recent opinion piece for the Guardian.

Brett Feldman, director of USC Street Medicine, agrees. When someone is homeless, a lot of their health depends on the environment they live in, he told CalMatters. For example, he recently treated a patient with scabies. Normally, he would prescribe a shampoo or body wash, but this patient didn’t have access to a shower — a key detail the AI ​​might not know to ask.

Instead, he prescribed an oral medication. The patient needs one dose immediately and another dose in a week. He had to decide whether to give the patient the second dose now and trust that it would not be lost or stolen, ask the patient to go to a pharmacy to pick up the second dose, or try to find the patient again in a week to deliver the dose. AI can’t do this complex calculation, and neither can a doctor who hasn’t met the patient and seen their life situation, Feldman said.

And any missteps the AI ​​makes can have huge consequences when the patient is homeless, Feldman said. If a patient has a problem with a prescribed medication, they probably don’t have an easy way to contact the doctor or make a follow-up appointment.

“Overall, I would say it’s not going to work for this population,” Feldman said.

Aikido argues that the benefit of AI is clear: better efficiency and improved access to healthcare.

Before AI was introduced, each of Akido’s street medicine doctors in Los Angeles and Kern counties could carry a caseload of about 200 homeless patients at a time, said Karthik Murali, head of safety net programs for the company. Now it’s closer to 350 patients per doctor, he said, because doctors spend less time asking routine questions and filling out paperwork.

That means more patients get faster access to care and medicine, Murali said.

Nearly a quarter of homeless Californians surveyed from the UCSF Benioff Homelessness and Housing Initiative reported needing medical care that they could not get in the six months prior to the survey. Only 39% said they had a primary care provider. Nearly half of the homeless Californians surveyed reported their health was poor or fair — a rate about four times higher than that of the general U.S. population.

Good, of Five Keys, hopes the technology will allow clinicians to build trust and deeper relationships with their clients. A field worker using Scope will have time to bond with the patient and better respond to their individual needs, unlike a doctor rushing through the visit to get to the next patient, he said.

His organization hopes to introduce the technology to some of its homeless shelters in San Francisco next month.

Partnerships and access

Aikido also plans to work with Reimagine Freedom and the Center for Young Women’s Freedom to use AI technology at four centers — in San Francisco, Oakland, Richmond and San Jose — that serve women and girls who are or have been incarcerated. The clients they serve often had poor access to health care while incarcerated or had their medical issues ignored, said Reimagine Freedom President Jessica Nowlan. Many do not trust the medical system.

The centers currently offer health education. This new AI technology will allow them to provide actual medical care, Nowlan said.

“Our guess is that we’re going to see a huge increase in women accessing health and self-care,” she said.

Reimagine Freedom began testing Scope AI at its Los Angeles clinic in November. So far, “it’s going really well,” Nowlan said.

Akido plans to partner with additional homeless service providers that can help it deploy its AI technology to more locations in the Bay Area.

If providers who serve vulnerable patients are left out of the AI ​​race, all the benefits of the technology will instead go to wealthy communities — further widening the gap between the haves and have-nots, said Stella Tran, who researches AI companies for the California Health Care Foundation Investment Fund. That’s why social service providers need to be involved in testing this technology and developing the ground rules and safety checks, she said.

But that doesn’t mean Tran doesn’t have concerns. For example, AI works differently in different communities. An algorithm that produces accurate diagnoses for patients in Los Angeles may not work as well in the Bay Area, she said. And while AI has the potential to be less racially biased than human doctors, it all depends on how the algorithm is built.

“I think there’s potential to increase access if we do it right,” Tran said, “with the right set of guardrails and careful attention to safety, patient transparency, consent and all of that.”

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.