Table 1.

Mechanisms by which bias in medical technologies is introduced and perpetuated

Mechanism	Pulse oximetry	Algorithms to estimate healthcare needs	Pulmonary function testing
Physical aspects of technology design	Melanin may cause light scatter leading to performance differences based on skin pigment	Not applicable	Not applicable
Use of data that do not reflect important patient subgroups	Calibration of modulation ratio with saturation may be biased if data lack sufficient diversity	Not applicable	Not applicable
Conflation of biological and social determinants of health	Not applicable	Use of a biased outcome: healthcare costs as proxy for healthcare needs	Assumption that population-based differences in lung function represent biological differences
Evaluation and regulatory standards	Lack of robust standards to ensure equal performance in relevant subgroups	Varying standards for regulating software algorithms	Delayed appreciation of findings described in peer-reviewed medical literature