Joni:

Hi, this is Dr. Joni Watson. Welcome to The Handoff, the podcast for nurse leaders brought to you by Works. I'm thrilled to introduce our episode guest today. We're exploring the realm of artificial intelligence and healthcare and how it shapes our future and influences health equity. Joining me is the distinguished Dr. Michael P. Cary Jr. 

Dr. Cary is a renowned scholar whose groundbreaking work bridges the fields of nursing health services, research, and artificial intelligence. As the Elizabeth C. Clipp Term Chair of Nursing at the Duke University School of Nursing, Dr. Cary's expertise lies in leveraging AI to advance health equity and enhance care delivery for vulnerable populations, particularly older adults in post-acute rehabilitation and skilled nursing facilities. With over 50 published manuscripts and book chapters, Dr. Cary's research has garnered support from prestigious institutions such as the National Library of Medicine, the National Institute of Nursing Research, and the Duke Clinical and Translational Sciences Institute.

His exceptional contributions to improving healthcare were recognized with his induction as a fellow of the American Academy of Nursing in 2022. Dr. Cary's impact doesn't stop there. He was handpicked by Duke AI Health to serve as the inaugural equity scholar, leading an interdisciplinary team dedicated to identifying and addressing bias in clinical algorithms that perpetuate racial and ethnic health disparities. His leadership underscores Duke Health's commitment to upholding ethical standards and healthcare technology, ensuring that AI serves as a tool for equity rather than exacerbating existing inequalities. 

Join us as we delve into the innovative work of Dr. Michael P. Cary Jr., exploring how AI is reshaping the landscape of healthcare and paving the way for a more equitable future. Dr. Cary, thanks so much for being here today. Some people really look up to rock stars and movie stars, but I have been anxiously awaiting this podcast because give me a nursing scientist any day of the week and I will fan girl out. So thank you for being here.

Michael: 

It is my pleasure to be with you, Joni. Thank you for the invitation.

Joni:

Absolutely. So it seems like, and maybe this is just my bias, I'm not sure, I welcome your thoughts, but it seems like everywhere I look in healthcare, AI is just everywhere. I mean, I can't turn my head without seeing some mention of AI. It's definitely in a hype cycle right now too. It feels like it's the answer to all of our world's problems at this point. And as I'm talking with other nurse leaders, I'm finding that a lot of nurse leaders, it really feels like unfamiliar territory to us. And I really just want to get your thoughts and jump right into it. You're an expert in this intersection of healthcare and AI and equity, which is also having its great moment right now in healthcare. What do you see as the biggest challenges in integrating AI into nursing and healthcare, and how can these be addressed?

Michael: 

Yeah, it's a great question. I think to address that question, let me backup for a second and say that human beings have been using AI for a very, very long time. I think often people just don't realize it, that it's literally in the palms of their hands and they're using it every day. If you're using Siri or Alexa, you're using AI to collect information and inform your thinking. If you're going shopping at Kohl's or at Footlocker, AI systems are being used to market and entice you to buy their products. And even if you're just sitting at home and watching Netflix, there are a number of movies that are recommended to you that are based on patterns and preferences and the types of movies you've watched in the past. So I think in healthcare, especially while there are a number of AI technologies being used every day, we have, I would say we've been slow adopters relative to other industries.

I think integrating AI and nursing and healthcare has several challenges. And as a researcher in a member of the AI Governance Oversight Committee at Duke, I think a lot about ethical considerations. There are a number of ethical considerations surrounding AI's use in healthcare that have to be addressed so that patients remain safe. And AI technology doesn't discriminate against certain particular groups resulting in any kind of harm, and that is used responsibly. So given that these decisions that clinicians are making each day impacts human lives, these are the types of safety and ethical concerns that are really significant challenges in integrating AI into healthcare

Joni: 

And how do we address those?

Michael: 

So I think there are a number of ways. One of the issues that I've been thinking more about more recently is preparing the next generation of nurses to deliver safe care and ethical care to patients in this AI era. And as someone who spends a lot of time teaching and educating nurses on the use of data and technology to kind of guide care, I think there's a significant gap in our education that exists among not just nurses but all healthcare professions and overcoming that is going to require this really concentrated effort in education and workforce training so that these healthcare professionals and nurses are comfortable with using technology and they understand more importantly how these tools work and how the use of these tools within the clinical pathway can actually enhance or augment their work rather than replace it.

Joni: 

Yeah, that's so great. So thinking about, I mentioned as I talk with nurse leaders that AI often seems very novel to nurse leaders and many nurse leaders, they feel kind of like a fish out of water when we start to step into this technology space. But it's so important as nurse leaders to be able to talk intelligently. You don't have to know everything. You don't have to be an expert in AI, but in order to drive strategy, and I guess to not get left behind in the way that care is moving forward, you have to be able to understand and know pieces about artificial intelligence. And so from your perspective, Michael, what qualities do you think nurse leaders need to possess to effectively guide their teams through the AI integration process to ensure a smooth transition? Because like you said, whether we realize it or not, there's AI happening all around us, even in healthcare, right? I mean, if we use things like risk predictive models that has components of machine learning and AI in it.

Michael: 

I think nurse leaders play a critical role in AI integration. Ideally, leaders would have a basic understanding of AI capabilities as well as their limitations, but this is unlikely in many health systems and academic institutions because really what we're talking about is a specialty area such as nursing informatics, which is a relatively small group across the entire U.S., which is why I think all academic institutions need to consider how we can expand course offerings and training opportunities in this space. But for current leaders, I would say that I think they need to be open to learning more about AI and how it can support nurses but not necessarily get swept away in the hype. I think that they should be curious and seek out opportunities to better understand AI and how it can improve patient care and operational efficiency alongside some of the more practical understanding of AI's limitations and challenges.

I also think that this technology, without a doubt, is disruptive and nursing leaders need to have strong skills and change management so that they can guide their teams through this transition and address any kind of apprehension or resistance. And those who have some emotional intelligence about them are very helpful in empathizing with teams that have concerns in creating environments that foster support and innovation. So creating forums where nurses can openly have opportunities to discuss AI's potential impact on patients and their role and responsibilities. And enhancing care is not only helpful for nurses, but it's also helpful for leaders and informing them on how to best support them through training and professional development.

Joni:

That's great. Michael, I think you mentioned because this is a specialty that we need to be mindful of our informational technology, our nursing analytics and informaticists colleagues who really are experts in this area, and as nurse leaders, if we're not close to those colleagues, it's really important to kind of pull those colleagues close right now because you mentioned the limitations of AI, which I feel like it's sometimes a decision trap for nurse leaders because AI looks really shiny right now. It can fix everything, but you're so right. There are definite limitations to AI that we have to know as leaders. So I'm curious, Michael, nursing is such a collegial and interprofessional discipline. I mean nursing, we're BFFs with everyone in the healthcare system. Can you tell me your thoughts on the importance of interdisciplinary collaboration in advancing AI applications in nursing, particularly with groups that I don't feel like nursing has largely been BFFs with our technologists, our data scientists and other IT and tech professionals?

Michael: 

Yes, that's a great question. So the importance of interdisciplinary collaboration and advancing AI in nursing cannot be overstated. Engineers, computer scientists, statisticians, these are people with really deep technical expertise and they'll tell you that they cannot build AI systems alone without the expertise of health professionals such as nurses. This technology is complex and health AI is an area that is rapidly growing. But where I think nurses are so unique is our proximity to patients. So while all clinical disciplines are important and spend time with patients in order to conduct their assessments and inform their care planning, it's our knowledge of patient care and equally important, our proximity to patients that make us unique. And so nurses, we oftentimes bridge the gap between patients and docs, but we can also begin to bridge the gap between patients and technology experts and ensure that these tools are designed with real world healthcare needs in mind. 

Joni:

That is beautiful. 

Michael:

We are uniquely suited to be that liaison between these groups because of our training and the proximity to patients.

Joni:

Yeah, that's so true. When I think about the times that I've worked with data science groups and applied AI teams, I have been blown away. First, it's a challenge sometimes because we do speak totally different languages. So I feel like there's a little bit of a learning curve for both groups because we haven't historically worked a lot together, and so we have to build that relationship just like we do with anybody else. But I have been blown away listening to applied AI team members or data science team members about how they talk about patient care. They are, and I dunno why I've had this bias in my head, Michael, but they are so passionate and driven to do what they do to improve patient care, but they need a clinician to partner with them and they are hungry for it. It's pretty incredible.

Michael:

And I think we need to think about the cohesiveness and the comprehension of these teams and their unique lens that they bring to patient care. I really do see data scientists now as a part of the care delivery process. They are no longer a group that works aside of or in addition to, they are part of the healthcare delivery team and in a very important one, and certainly that will be the case as we advance AI and nursing and in healthcare more broadly.

Joni:

Yeah, that is a great point, Michael. I totally agree with you there. So you've talked about how you're thinking about how we prepare our nursing workforce and our pipeline with these technologies. I'd love for you to expound on that a little bit. How can we practically ensure that our nursing workforce feels number one, empowered and number two, equipped to work with AI technologies in their daily practices?

Michael:

I think there are a number of ways in which we can empower the nursing workforce to work with AI technologies. It definitely will involve a multifaceted approach, but I think it starts with a few things. I think one, I think it starts with holding open forums and opportunities for nurses to express how they feel and think about the use of AI. What are their concerns, where are their doubts? And so that's an opportunity for them to share with nursing leadership where those concerns and doubts are. And also that's an opportunity for nursing leadership to identify where there's potential for training opportunities. I also think from an academic standpoint, we need to begin integrating these AI concepts into nursing curricula and begin to provide some hands-on experience with AI tools through simulations, through the creation of sandboxes. These are like secured virtual environments where nurses can use different types of technologies to experiment with them and learn how to work with these technologies.

I also think it's important for us to build educational opportunities to keep pace with these technological advancements and these educational opportunities cannot solely be a two year master's program. We have to be flexible in the delivery of our content. There are lots and lots of practicing nurses out there that really want to learn how to use these AI technologies but are not necessarily interested in engaging in a two-year program. They don't have the time and their lives are busy with other personal commitments. So we really need to think about are there ways of delivering content that's more flexible, such as online on demand training modules, and enticing them to participate in these types of modules by giving them some type of digital badge or some kind of continuing education credit.

Joni:

Those are great perspectives too when we take the time as nurse leaders to not only have those open forums or open dialogues to identify how our nurses are feeling about AI and what are their doubts, which certainly gives us insight into how we can train. I think too, Michael, what it does for me as a nurse leader, it also helps me identify the bright spots where I probably have nurse leaders all throughout my hospital or my healthcare system who want to learn this, who are eager and hungry. They are the ones that are probably going to speak up. And if I just give them just a little bit of education, man, the amount of use cases that those leaders distributed throughout my organization could bring back. It's pretty phenomenal what happens when we give nurses just a little bit more education. I mean, I know I'm totally biased, but we are brilliant professionals.

Michael:

Absolutely. Without a doubt.

Joni:

Totally. I love the thought too of building sandbox environments, protected environments where, because I mean, make no mistake, nurses care deeply for protecting patients, and this kind of dovetails into your intersection of health equity. None of us go to work wanting to hurt a patient overtly or covertly, explicitly or implicitly. So there's been a lot of talk about bias in AI, and again, I feel like everywhere I turn I see that and rightly so. So nurses need to understand how this technology works because I know nurses are thinking, I just don't want to hurt somebody with what I'm doing, how I'm taking care of someone. So the thought of doing something in a sandbox in a protected environment for me as a nurse gives me a sense of safety and protection for the patients that I'm serving.

Michael:

Absolutely.

Joni:

Yeah. So you've talked about nursing education and making sure that it's flexible. I love the idea of it being online and on demand. The flexibility. You're right. I mean, I ended up taking a postgraduate certificate program on AI and healthcare just because I felt like I was being left behind. I have to upskill and refresh my own skills, but I didn't want to do a two year degree. I don't want to be a nursing informaticist. That's not my passion or my calling because I have colleagues who are experts. They did get master's degrees and doctoral degrees in that field. So as you think about, and you have already touched on this a little bit, but if you could expand a little bit more, what changes do you envision for nursing education to prepare future nurses for an AI enhanced healthcare environment? And that could either be formal or informal. It could even back up all the way up to health prep academies because the way that my children use technology is really totally different from the way I use technology. So what are your thoughts on not just education now, but education in the future as well for this technology? It does seem to be advancing at a mind boggling pace. For me at least.

Michael:

I think that as nurse educators, we have no choice but to evolve along with the technology. That's how we close the educational gap that I was speaking of before. As I mentioned, I believe that health systems around the country are developing these very important partnerships with big technology companies, and the idea is to improve patient care through the use of AI and other types of advanced technologies. And so that is going to bring about the need for nurses to kind of upskill and be prepared to use these technologies. So I think that nursing education is going to evolve to meet that need and to close that educational gap. I think that what that looks like is there will be some formal opportunities for nurses at every level be that of graduate or undergraduate programs where we're really focusing on integrating AI and informatics concepts into the curriculum, and more importantly, these ethical considerations of AI into nursing education. I also think that there's going to be an opportunity for advancing a lot of simulation and virtual based learning experiences. We mentioned the sandbox before where these are secure environments allowing nurses to learn and engage with different types of technologies such as generative ai so that they are used to working with these technologies. So when they get into practice, the learning curve isn't as steep.

Joni:

Yeah, that's a great thought.

Michael:

I also think what needs to be done in the meantime is the field is really starting to leap forward. And I think that nursing schools and programs need to begin to develop and offer opportunities to help nurses in practice as well as nurses who are seeking formal education to provide different examples of education. For example, we recently offered a four-hour workshop at Duke back in January, and the idea was to really kind of just bring about awareness of AI in its use, its potential harms, that bias that AI can bring about to patient care. And that went very well, and that was only four hours. And we actually engaged in some case study and use case examples as well where we had the opportunity to discuss some of the strategies that one might consider in identifying but also mitigating bias in these rhythms. We also, just last week, held a research conference at Duke and the idea was to bring together professionals across different disciplines to better understand what they see as the problems within their disciplines and how we can create interdisciplinary solutions. So we're really in the process of writing up those findings. We hope that it's going to be a research setting agenda that we can publish, but also more importantly, figure out how to create collaborations across Duke and beyond in tackling some of these research gaps that exist.

Joni:

That's so great. Michael, you mentioned two things that I think are really key right now, academic practice partnerships, which can help close that gap faster. I kind of see these almost like how DNP and PhD nurses work together just symbiotically to help ensure that we have the evidence that it gets implemented. But with academic practice partnerships, we can really help set our future workforce up for success by feeding back to our academic partners, “Hey, this is what's happening in practice” and being nimble between one another. I love that thought. And then you mentioned something that I think is super important that I often see as an issue as I'm talking with healthcare systems across the United States. You mentioned bringing professionals together to ask what their problems are to see what the solutions could be. And I think this is particularly where we get into problems with AI because there seems to be so many AI solutions these days that we pick the solutions and then we retrofit it to our problem or we create our problem to try and get to that technology. It's like a shiny object or something that we have to have, but when we start with the problem first, we end up getting better solutions. And so that's really cool that you just asked for the problems first.

Michael:

Well, the interesting thing is we have developed what we call an initiative, and we're calling it FAIR Health. FAIR Health is an acronym that stands for Fostering AI Research for Health Equity and Learning Transformation Hub. And that hub is designed to bring together multiple disciplines to collaborate and problem solve and to educate one another. It's also designed to build partnerships across the health system and academia. But we take that a step further. It's designed to build partnerships between academia and industry. We have several colleagues that are engaged in industry that are really doing some amazing work, but they don't always have access to the latest evidence. And oftentimes that evidence may be inaccessible if you don't have PubMed access. And healthcare professionals and scientists are generally publishing on PubMed. And so we are trying to create a bridge where there is bi-directional communication in these partnerships and where the work that we do is directly feeding into these industry partners so that they have, because they have the resources and the means to integrate these strategies and solutions relatively quickly as opposed to academia who are oftentimes relegated to developing grants that may or may not get funded, which slows the science down.

And so we're really trying to figure out ways of accelerating our findings through these meaningful partnerships.

Joni:

Wow, Michael, that sounds really cool. And in a truly complex system like healthcare, you mentioned the right word bridge. I mean, if we can bridge between all of the disciplines, that's really where transformation lives is in the middle of all of those bridges. So kudos to you all for doing that. That sounds like a great practice. And so I'll be anxiously awaiting as y'all start to publish and release findings on your work together. Michael, again, I'm totally biased because I'm fangirling out. I've used your work as I've taught nurse executives and healthcare leaders, and so this time for me is just like magic and gold. And so I'm curious, I ask this to every single guest, but I'm curious, what are you reading and what are you learning about to sharpen your skills? I'm always curious how leaders are kind of formed and crafted. What do you feed your mind and your soul these days?

Michael: 

So I certainly spend a lot of time reading the most recent publications. There are certain individuals that I follow more closely because I see them as leaders in this space, and those individuals might include Eric Topol or Ziad Obermeyer. And then there's a couple from Duke that I work closely with that I really appreciate their leadership in the field such as Michael Pencina or Christina Silcox. But there's one book that I recently purchased that I'm finding really interesting, it's called Unmasking AI: My Mission to Protect What Is Human in a World of Machines. And it's written by Joy Buolamwini, and I'm really just getting into it, but I find it very interesting and I'm looking forward to finishing it.

Joni:

That is awesome. I feverishly took notes as you were talking. I'm totally going to look up some of those people because some of them are totally new to me and I'm absolutely going to get that book. So thank you for those recommendations.

Michael: 

Sure.

Joni:

Michael, we've talked about so many interesting things today. I'm curious, what are you working on right now? Is there any way that you can give us some inside scoop onto what's coming down the pipeline for you? What are you focusing on? Maybe there are things that might interest some of our listeners.

Michael: 

Yeah, I'm happy to share. There are two initiatives that I'm currently involved in and I'm really excited about. One is under our FAIR Health initiative at the Duke University School of Nursing, we will be developing and offering a two-day summer institute for individuals who are interested in learning more about AI and its use and how to identify bias and other ethical concerns within AI. The other thing that I'm particularly excited about is a new special call for AI in nursing through Nursing Outlook, and I will be serving as a guest editor along with Kay Lytle, who is Chief Nursing Information Officer at Duke Health and Ian Wolfe.

Joni:

Powerhouses.

Michael: 

And so I'm excited to work with those two amazing individuals as well as work with Nursing Outlook. I think it's going to be particularly groundbreaking because unlike the other special calls that have been in AI and nursing, we're really looking to develop a roadmap for nursing leaders. So we hope that this accumulation or special group of papers will provide that roadmap for nursing leaders as they move forward in this AI era.

Joni: 

So what kind of papers, Michael, because I'm certainly interested, but when calls come out sometimes it's a short timeframe. I know how long it takes for me to write a paper. What kind of papers are you guys looking for?

Michael: 

There are several papers that we're looking for. We're looking for papers on nurses’ role in AI policy advocacy. We're looking for papers on evaluating AI's impact on health equity. We're looking for papers focused on strategic leadership in AI integration. So it is really about advancing the policy agenda and the leadership agenda in AI as opposed to research, which is certainly important, but we're really trying to provide that roadmap for nursing leaders.

Joni: 

That's great. Do you have any idea on when that call might go out or when you might need papers back? Sorry to get so practical so quickly.

Michael: 

So I'm working with Dr. Sean Clark, who is the editor of Nursing Outlook now, and we are aiming for the call to be released sometime within this summer. Those things haven't been finalized yet, but we're hoping to get that call published and available for folks to take a look at and think about sometime this summer.

Joni: 

That's incredible. So certainly, as I'm connected with you on LinkedIn, as I start to see both the dates for the summer institute at Duke, which sounds incredible and like a great resource, as I see those dates posted, and as I see the call for the Nursing Outlook papers, you have my commitment that I'll repost those and share those to my network. So if you're listening now, nurse leaders at all levels, if you are working on AI components in your healthcare systems, I would encourage you to start brainstorming and thinking about submitting a paper for the call to Nursing Outlook. I mean, this a great opportunity, and I think like you said, Dr. Cary, this is a little bit different because it's really about true implementation efforts, which you're right, will create a stellar roadmap for nurse leaders, and I can't wait for that because I will use that in one of my courses for sure. That whole issue. Beautiful. Thank you for sharing that, Dr. Cary.

Michael: 

My pleasure. Thank you so much.

Joni: 

This has been absolutely fabulous. You've talked about several different pieces here. Overall, what would you like to handoff to nurse leaders at all levels and in every setting on this topic?

Michael: 

I guess I would say that the integration of AI and healthcare is inevitable, and I think that it presents a unique opportunity to enhance patient care. So I would encourage them to be open to learning and embracing change.

Joni: 

That's great. Thank you so much. Michael. Where can people follow or connect with you to find more of your work? Because I know people will want to do that after this episode.

Michael: 

Oh, sure. I'm active on LinkedIn and I often share insights and articles there about AI and healthcare, so feel free to connect with me. In addition, all of my projects and publications can be found on the Duke AI Health Equity Scholars page. Duke AI Health is not only excellent about sharing my work, but certainly the other amazing scientists and clinicians and administrators who are part of that team. And lastly, I am working with a web design company now to create my own webpage, and hopefully we'll stand that up sometime by mid April. So by keep checking back on that Duke AI Health website for any kind of recent developments.

Joni: 

That's incredible, Michael. So everyone, be sure to find Dr. Michael P. Cary Jr. on LinkedIn to continue conversations. Absolutely find his work on the Duke AI Health Equity Scholars page. I'm sure once your website is live, we'll see that on LinkedIn as well. I'll be your first subscriber for sure. I love the way that your leadership and your expertise and your passions bridge fields to improve patient care. Dr. Cary, thank you for handing off your challenging and sharpening leadership expertise with us today.

‍Michael: 

Thank Joni for the opportunity. This was a blast. I appreciate it.