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Perspective from HSR HQ

With its unparalleled data and data infrastructure, VA is uniquely positioned to advance the state of the science in developing and leveraging Artificial Intelligence (AI) to improve health and health care. VA is the largest fully integrated healthcare system in the nation, with an enterprise-wide comprehensive electronic health record (EHR) system that has captured longitudinal data spanning over three decades from more than 23 million unique Veterans. VA EHR data are multi-modal, inclusive of structured and unstructured data, garnered via traditional clinical encounters (e.g., patient vital signs, clinical notes, medications, medical images) as well as specialized modalities (e.g., implantable biosensors, wearable devices). VA also has sizable repositories of genomics data, gathered in the course of clinical care as well as through research investments, such as VA’s Office of Research and Development (ORD) Million Veteran Program. Leveraging the unmatched vastness of these data enables VA to develop advanced AI tools aimed at improving diagnosis, treatment planning, and operational efficiency, thereby enhancing the quality of care for Veterans.

It is important for VA to invest in developing and tailoring AI tools to fit with the VA healthcare system as well as the needs that are specific to or highly prevalent in Veterans, including suicide prevention, post-traumatic stress disorders, traumatic brain injury, military environmental exposures, chronic pain, substance use disorders, housing and economic insecurity, among others. AI tools are hardly ever one-size-fits-all and hence, due to the distinctive needs and characteristics of Veterans and the VA healthcare system, AI tools should be developed with the right audience in mind to ensure that they optimally enhance care delivery. This goal can be achieved by embracing methodologies such as Veteran-centered care, user-centered design, and engagement and implementation science when developing AI tools and integrating them into clinical practice. As a multi-site national healthcare system, VA is well-positioned to scale AI tools and best practices across its facilities, maximizing the impact of these technologies.

Achieving this ambitious goal requires the right expertise. Due to its vibrant community of researchers — with multidisciplinary expertise spanning data science, computer science, systems engineering, statistics, organizational anthropology, and implementation science, among others — who are strategically embedded in the VA healthcare system and directly interact with clinicians (or are clinicians themselves), VA is uniquely positioned to advance AI science and develop solutions that work for Veterans. Indeed, VA’s cross-disciplinary teams are distinctively suited to identify and address novel, use-inspired, and application-driven AI research questions that would otherwise remain unexplored. Supporting these teams and expediting the translation of research through the translational pipeline – from development through full adoption, with Veterans receiving direct benefits from VA’s research investments – is indeed at the heart of ORD’s recent reorganization.

As VA approaches a century of medical research excellence, building upon our technological breakthroughs such as the development of cardiac pacemakers and CAT scans, as well as foundational contributions to chronic disease management, it is time to chart the course for the next 100 years. AI stands as a transformative tool to propel the health and healthcare of Veterans toward a brighter future. Aligned with VA’s mission to “serve Veterans, their families, caregivers, and survivors,” it is our commitment to invest in research, empowering our workforce, and providing the necessary resources to continue our legacy of discovery and service. This commitment ensures that, as in the past century, VA innovations will not only serve our Veterans but also have a lasting positive impact on society as a whole.

Anahita Khojandi, PhD
AAAS Science & Technology Policy Fellow, Health Systems Research, VHA Office of Research & Development

Kristina M. Cordasco, MD, MPH, MSHS
Acting Director, Health Systems Research, VHA Office of Research & Development