One of the biggest challenges in healthcare today is ensuring that all patients receive quality care, despite their skin color, race, gender, or sexual orientation. There are plenty of factors that play into health equity, both biological and structural. Unfortunately, cognitive bias plays a role as well, leading providers to use presuppositions and flawed judgements to make a bad call regarding a diagnosis. These kinds of things happen all the time, contributing to this chasm of health equity amongst differing patient demographics.
One area that is improving in regard to health equity is pulse oximetry. Pulse oximeters are non-invasive devices that use sensors to shine a light through the patient’s finger to determine how well oxygen is being delivered through the body. This has come to be known as the fifth vital sign, along with heart rate, blood pressure, temperature, and respiration, acting as an excellent, non-invasive way to monitor patients. But even while it’s improving health equity, it certainly isn’t perfect.
Health equity through pulse oximetry
Pulse oximeters play an invaluable role in healthcare, especially during the height of COVID-19, as a way to manage care for patients based on their blood oxygen levels. But when those numbers are inaccurate, it can create a dangerous environment for treating patients.
The FDA released new draft guidance in January 2025 on pulse oximeters after evidence showed that these devices can have so-called “blind spots” for patients with darker skin pigmentation. Because melanin absorbs the red and infrared light from the oximeter, it can cause the device to provide inaccurate oxygen saturation levels in people with darker skin tones. This can lead to higher rates of occult hypoxemia, a condition where a person’s blood oxygen level is dangerously low, though it won’t be picked up by pulse oximeters.
A study published by PubMed documented the racial disparity in oxygen saturation measurements by pulse oximetry, saying, “Overestimation of oxygen saturation in patients with dark skin tones has serious clinical implications, as these patients may receive insufficiently rigorous medical when pulse oximeter measurements suggest that their oxygen saturation is higher than the true value.”
Another study published by JAMA Internal Medicine found that in a group of patients with COVID-19, the oxygen saturation levels in Asian, black, and Hispanic patients were overestimated by pulse oximeters compared to white patients. According to the results of this study, the inaccurate oxygen saturation levels in those groups contributed to either “unrecognized or delayed recognition of eligibility to receive COVID-19 therapies.”
When oxygen saturation levels are inaccurate, it can seriously compromise patient safety – without the total picture of the patient’s health, how can providers accurately give a diagnosis? Even beyond the immediate ways to address those concerns, like supplying oxygen, it can result in dangerous conditions slipping through the cracks.
Bridging the gap
Understanding how pulse oximetry limitations can impact patient care is crucial for helping providers to make clinical and diagnostic decisions, especially in the fast-paced environment of an ambulatory surgery center. As ASCs continue to handle a growing volume of outpatient procedures involving anesthesia and sedation, ensuring patient safety through continuous and accurate monitoring has never been more important.
Pulse oximeters like Nellcor from Medtronic are designed to help bridge the health equity gap. While there are plenty of pulse oximeters on the market, Medtronic has taken a unique approach to integrating modern technology that simplifies a technology that’s already accessible. The pulse is identified through artificial intelligence – by focusing on the pulse as the foundation, the oximeter allows providers to track and monitor the patient during their time at the ASC.
Once the pulse has been identified, the signal is scrubbed to clean up any noise or interference, due to motion or low perfusion. OxiMax technology, a digital memory chip designed to enable higher accuracy and improved performance, is used to calibrate the signal. From there, the entirety of the Nellcor OxiMax system is used to deliver accurate, moment-to-moment readings that are generated from arterial signals.
Jason Case, VP of R&D for Acute Care & Monitoring at Medtronic, told Modern Healthcare, “Think of it like trying to find a signal in a fog. Our AI is trained to recognize even faint pulses, no matter how thick the ‘fog’—whether it’s caused by pigmentation, low perfusion or a weak signal. It tells us exactly when to take a measurement, improving accuracy when patients need it most.”
For a fast-paced setting like an ASC, tools like this greatly improve efficiency and quality of care for the whole facility. By bridging that health equity gap, providers can ensure that all of the patients are receiving the care that they need, based on accurate monitoring results.
“We want to design technologies with all patients in mind from day one, not retrofit them later,” Case said to Modern Healthcare. “That’s why we’re investing early in diverse patient cohorts, including collaborations around the world, like in India, to ensure we’re capturing a wide range of physiologic characteristics. Innovation is not just about advancing technology. It’s about making sure that innovation reaches everyone – and works for everyone.”