From artificial intelligence to Walmart telehealth stations, the agency spent 2019 focused on how tech can augment its health services.
The Veterans Affairs Department, often hammered for over budget, timeline-busting modernization projects, spent much of 2019 harnessing innovative and cutting-edge technology.
In a recent conversation with Nextgov, Veteran’s Health Administration Innovation Ecosystem Executive Director Dr. Ryan Vega reflected on the fruits of VA’s mission- and digitally-driven innovation that blossomed this year across several domains—and shed light on the agency’s plans to implement new applications of emerging technology in 2020.
“The vision in terms of the ecosystem is really focused on two main concepts: to build the organizational capability and to build the organizational infrastructure,” Vega said. “What I mean by that is the organizational capability to truly be a forward-leaning, progressive, innovative organization requires a workforce that has a skillset to be able to embrace and to guide true change agents, that understands what it means to embrace new disruption and new ideas.”
With insights and experience working at VA medical centers and across the agency, Vega looked back on the agency’s milestones and investments in several areas this year.
Innovation Driven By Artificial Intelligence
Recognizing the need to harness the power of artificial intelligence—especially as VA houses one of the most robust data collections and one of the largest integrated medical records systems in the world—the agency appointed its first-ever director of AI in July. Dr. Gil Alterovitz, a Harvard Medical School professor and member of the Computational Health Informatics Program at Boston Children’s Hospital, was tapped to spearhead VA’s efforts to improve veteran care through AI-enabled solutions. Early in his time in the new role, Alterovitz told Nextgov that his ultimate aim is to leverage the emerging technology and its cornucopia of data to proactively tackle problems afflicting veterans like never before.
“The importance of [hiring Alterovitz] and what having a director means is that it’s the recognition that the organization is going to embrace this—and not run away from it,” Vega said.
The agency also appointed Kshemendra Paul as its new chief data officer in September. With more than a decade of experience already leading data modernization efforts across various federal agencies at the time of his appointment, Paul will develop and accelerate the agency’s approaches to data collection, management and security. Strong data is the foundation for robust AI innovation, so he streamlined data pipeline will be crucial to implementing new applications.
VA rolled out a variety of AI-focused efforts this year. For example, the agency released a paper in Nature, a biomedical science journal, on a study that demonstrates how the agency and technology company DeepMind Health developed an AI system that can forecast a life-threatening kidney disease before it appears. And with tech-giant IBM, the agency also launched an AI-powered mobile application that was implicitly designed to help veterans spend less time navigating the web to access VA’s resources.
And in December, VA established a National Artificial Intelligence Institute to coordinate and advance strategic vet-focused research and development efforts to harness the budding technology. It will be led by Alterovitz. Vega noted that AI has a tendency to either get federal insiders either overly excited to a point where they overestimate what the potential might be, or overly fearful about the technology’s possibilities.
“But I think the thing you don’t do is to shy away from it—you have to say this is going to become part of who we are as a society, and as a federal agency we are going to embrace the playbooks that are coming out, the guidance coming out from the government. We are going to hire someone who is an expert in this realm to really drive research and we are going to be a leader in this realm—we are not going to shy away from it,” he said. “I think that's the important takeaway is that you see the agency embracing this and not saying ‘we are going to sit on the sidelines and see how this plays out.’”
Harnessing Emerging Technologies to Boost Veteran Care
The agency’s internal personnel and medical professionals also are leveraging emerging and digital technology to transform the experiences and care of VA patients. They are pioneering new ways to use 3D-printing to plan surgeries, assist amputees and, eventually, build bones and organs from scratch.
“We’re really trying to spark creativity at the frontline,” Beth Ripley, a VHA radiologist who leads the agency’s 3D-Printing Advisory Committee told Nextgov in April.
And the agency is also exploring innovations in precision medicine to boost the treatment it provides. In October, Marc Wine, senior adviser at the VA also reflected on how the agency hopes that the impending speed of 5G connectivity will soon allow for precision surgery that’s down to the microsecond and augmented by holographic imaging, as well as accelerated and expanded health care training from the use of connected devices that enable virtual participative medical education.
He said he recently observed the use of augmented reality through which one physician in the United States was wearing “will be 5G-enabled” AR goggles and communicating live with a physician on the ground in the Middle East who was treating a wounded service member. “They were working together in real time,” Wine said. “I became acutely aware of how virtual reality ... and other health information technology solutions enabled by 5G broadband in health care will advance, enhance, and innovate the tools and solutions that will help our consumers take charge of their own health care and wellness in advanced ways that will be seamless, less costly and more rapidly innovative, and in particularly, secure and trustworthy.”
The agency has also been working to hardwire customer service into all the new digital resources its developing for veterans. For instance, in August the department’s National Cemetery Administration developed and launched an online memorial platform—Veterans Legacy Memorial—to honor millions of veterans interred in national cemeteries across America. For insights on how to build a site that customers would use, the site’s development team met with veterans across many generations and a variety of other stakeholders for feedback and inspiration during the development process. And in after introducing Microsoft’s adaptive video game controllers to clinics across America this summer, VA unveiled in October plans to launch an outpatient program in Washington D.C. to connect, support and rehabilitate veterans with limited mobility through esports and gaming.
In November, the agency together with Apple announced that the company’s iPhone Health app was integrated with Veterans Affairs’ patient data API, giving veterans access to their medical information on their phones. Also in November, the agency announced that a year after re-launching VA.gov, more veterans access to agency-offered digital resources is booming.
“Far too often emerging tech and solutions are designed in a laboratory—they are experimented on, but they are never co-developed with subject matter experts in the real-world setting,” Vega said. “So what we are doing is we are looking at a number of sites across the country that can't just be incubators, but they can also be co-developers with industry and some of the leading academic institutions across the country to help catalyze the development of these emerging technologies.”
Fruits of Innovative Collaborations
In 2019, VA insiders and America’s health care community also saw the fruits of unique approaches the agency is taking to spur innovation through partnerships and hackathons and piloting to spearhead new ideas.
“I think what’s really important about innovation is that it’s a team sport and what hackathons do is bring people together with a common purpose to solve a problem,” Vega said. “What we generally see is networks of like-minded people who have unique skill sets and different professional and life experiences, form [meaningful relationships], and we see those relationships grow thereafter and we see those individuals coming back together—and the best example of this is Podimetrics.”
More than 1 million people are diagnosed with diabetic foot ulcers each year, forcing them to face potentially debilitating medical treatments—including amputations—and costs. The condition is notoriously difficult to detect early on and has particularly devastating impacts on the veteran population, which faces an increased risk of developing it. But this year a cutting-edge ulcer-detecting device for the company Podimetrics—which came together after the devices were originally thought up at a hackathon promoting public-private partnerships in 2011—is now making its way to VA centers across the nation.
“These hackathons are really a mechanism for bringing that community together and its really about the diversity of experience and knowledge and the networks and relationships that form and that drive the potential,” Vega said.
Through a new project called Atlas, or “Accessing Telehealth through Local Area Stations,” recently launched a telehealth initiative to stand up remote, virtual exam stations in some of the nation’s most rural communities, where millions of veterans face serious challenges accessing the health care that they need. The innovation was made possible through collaboration with Veterans of Foreign Wars, the American Legion, retail giant Walmart and the electronics corporation Philips, among others. Through the Atlas project, veterans will be able to participate in telehealth appointments either in private virtual exam rooms at participating Walmarts via the stores’ existing space and tech, or at American Legion or VFW locations inside uniquely prototyped telehealth exam pods that Philips custom-designed.
According to Vega, the agency recognizes “that we are not going to solve any of these challenges alone. Take telehealth for example, you have rural veterans that are maybe hours away from a VA medical center,” Vega said. “How is the VA going to solve a broadband or connectivity issue? I mean we can buy iPads and iPhones, but we are not a telehealth communications corporation so how are we going to be able to solve the fundamental reality of being able to provide care for those individuals? We partner with folks.”
Ambitious Hopes for 2020
Next year, Vega said the agency will hone in on accelerating advancements across various emerging technologies. He said given the agency’s infrastructure, “bioprinting is going to be one area that we have to take charge.”
He also added that the utilization of 5G-enabled tech will also offer up the ability to use things like augmented reality in an operating suite, where doctors can look at patients anatomy through a hololens layered onto the patient. “I am basically just looking at their CT scans, but I am taking that data and making it a physical object,” Vega said. “This fundamentally changes the way that we engage with data and all of this technology that’s sort of coming together.”
He added that in the new year, the innovation will continue to be wholeheartedly mission-driven.
“There’s not a single individual who is driving this work who doesn’t pass a hospital that’s easier to work for or with. But everyone comes united by the same mission—this idea that through innovation I can change the life of a veteran and maybe even save their life,” Vega said. “That is so incredibly powerful and I think it‘s something that organizations can look to VA as a leader and see that if you really want to do this at scale, you really need to find your ‘why.’”