Dr. Michael Cary's Quest for Health Equity in AI and Algorithms

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At a time when health equity and social justice have never been more critical, Duke University School of Nursing (DUSON) stands firmly at the forefront of the movement.

Michael Cary PhD, RN, FAAN, the Elizabeth C. Clipp Term Chair and Associate Professor at DUSON is emblematic of the school's dedication to forging a path toward a more equitable healthcare delivery system. As a driving force in healthcare and technology, Dr. Cary exemplifies DUSON's commitment to advancing health equity.

A Champion for Health Equity

Dr. Cary's journey into the intersection of healthcare and technology was ignited by a powerful vision– a future health system revolutionized by AI and advanced technology to provide ethical and equitable care for all. His unwavering commitment to leveling the healthcare playing field, particularly for marginalized communities, has been instrumental in shaping his pioneering work.

In his role as the Duke AI Health Equity Scholar, Dr. Cary leads initiatives aimed at safeguarding patients and ensuring that AI-enabled technologies in healthcare do not perpetuate disparities, but rather become powerful catalysts for fairness.

Eliminating Bias in Healthcare Algorithms

Dr. Cary's mission to eliminate biased algorithms spans various dimensions:

• Research: Advancing the development of AI and machine learning models that are less prone to bias. Dr. Cary and collaborators are at the forefront of developing algorithms guided by the 'health equity by design' framework, an innovative and comprehensive approach that places a central focus on eliminating unfair, avoidable, or remediable differences among groups of people. 
• Education and Training: Designing curriculum and training programs, ensuring that AI tools are used in a manner that enhances equitable patient care and safety.
• Health System: Dr. Cary recognizes the critical role that healthcare systems play in implementing AI solutions. To address bias within these systems, Dr. Cary works closely with healthcare professionals, administrators, and data scientists to ensure that AI is deployed thoughtfully and responsibly. 

Recent Breakthrough: Health Affairs Paper

Dr. Cary's recent groundbreaking work, published in Health Affairs, addresses a pressing issue in healthcare. In July 2022, the Department of Health and Human Services proposed a rule prohibiting discrimination by healthcare providers and health plans when using clinical algorithms. However, it offered no specific guidance on achieving this vital goal. Dr. Cary and his team responded with the most comprehensive review to date, encompassing 109 articles, and providing actionable recommendations to mitigate bias in clinical algorithms.

These recommendations serve as a call to action for researchers, developers, healthcare organizations, and policymakers. They offer a roadmap for achieving health equity in healthcare by involving diverse patients and communities, integrating health equity considerations, fostering diverse, well-trained teams, expanding empirical evidence, and promoting transparency and accountability. "Embracing these recommendations is not merely a matter of compliance but a commitment to creating a healthcare system where bias has no place, discrimination is eradicated, and every patient receives ethical and equitable care," said Cary. 

A Comprehensive Approach to Health Equity

What sets Dr. Cary apart is his approach to health equity. Acknowledging that health disparities are deeply rooted in issues such as structural racism, unequal access to resources, and socio-economic conditions, he goes beyond eliminating biased algorithms. Dr. Cary actively shapes policies and practices to address systemic factors that contribute to healthcare disparities.

Moreover, his involvement in hosting the Duke CTSI READI - Community STEAM event for young adults on October 21st underscores his commitment to education and community engagement. This event serves as a testament to DUSON's mission of nurturing young talent in science, technology, engineering, art, and mathematics.

On December 1, Dr. Cary is set to deliver a presentation to Epic’s Equitable Brain Trust. This initiative exemplifies DUSON's commitment to partnership and leadership in the quest for a more equitable healthcare system. It challenges the status quo and centers efforts on saving lives among the most vulnerable and structurally oppressed.

On January 8, 2023, the  FAIR HEALTH (Fostering AI Research for Health Equity and Learning Transformation) ™ Workshop will take place at Kirby Hall at Duke Gardens This workshop will bring together experts from various disciplines, including health professionals (nurses, physicians, therapists, etc.), data scientists, and others, to address the critical issue of algorithmic bias. Dr. Cary and his team have created a curriculum designed to train health professionals how to identify and mitigate bias within clinical algorithms. The goal is to 1) showcase the curriculum as part of the workshop, 2) apply mitigation strategies to case studies, and 3) measure awareness and knowledge gained via pre- and post-surveys.

Additionally, a Research Symposium is scheduled for March 13-14, 2024 at DUSON. Using the recommendations for mitigating racial and ethnic bias in clinical algorithms in the recently published Health Affairs paper, this research symposium will further the discussions on algorithmic bias. The symposium will include keynote presentations, breakout sessions, and a panel discussion. The goal is to create a list of key priorities to be published as part of a research-setting agenda for the field.

As a tireless advocate for health equity, Dr. Michael Cary's contributions serve as a testament to DUSON's leadership role. His dedication serves as a beacon for our mission—to lead the charge in advancing health equity, advocating for social justice, and blazing a trail toward a brighter, more equitable future in healthcare. At DUSON, we firmly believe that progress toward health equity begins with individuals like Dr. Cary, whose unwavering commitment to this cause inspires us all.