VA Can Be a Leader in Healthcare AI, Lawmakers Say
The Department of Veterans Affairs (VA) must balance innovation with careful implementation of emerging artificial intelligence (AI) technology, lawmakers and witnesses said during a House hearing on Thursday.
“The VA is not an island. AI efforts within the federal government are proceeding in parallel, while private industry is significantly ahead of the public sector. Even within the [VA], this subcommittee has heard that efforts to use AI are fragmented,” chair Mariannette Miller-Meeks, MD (R-Iowa), said during the House Committee on Veterans’ Affairs Subcommittee on Health’s oversight hearing. “A priority of ours is to ensure VA moves forward with a cohesive strategy.”
Subcommittee ranking member Rep. Julia Brownley (D-Calif.) echoed that this is a critical moment for the VA to develop policies and protocols for developing, testing, and using AI tools in clinical care.
“VA is the largest healthcare provider in the country,” Brownley said. “Its implementation of AI technology can be a model for other healthcare systems, which makes it all the more important that we ensure VA and other AI users establish best practices, procedures, and guardrails early on in the implementation.”
“Careful implementation will allow VA to establish trust in the technology and encourage veterans and providers to see AI as a tool to solve problems, rather than a murky technology with potential risks,” she added.
Charles Worthington, chief technology officer and chief AI officer for the VA, testified that the department has adopted proper controls for oversight and security of AI implementation.
Worthington outlined the VA’s six principles for ensuring a measured approach to AI, including that any new AI tools are purposeful, effective, private, equitable, transparent, and accountable. Worthington also emphasized the department’s history with technology in healthcare.
“VA has long been a leader in healthcare research and at the forefront of technology,” he said. “We’ve led the way in various innovations like the development of the first electronic medical record, early adoption of telehealth, 3D printing, and more.”
David Newman-Toker, MD, PhD, director of the Armstrong Institute Center for Diagnostic Excellence at Johns Hopkins University School of Medicine in Baltimore, testified that the VA also has an advantage when it comes to data used for training AI models.
“The VA healthcare data environment is better suited than most to deliver high-quality data that might train AI systems,” he said. That includes “a large national network of providers [and] patients, a unified health record” and “independence from financial reimbursement-driven problems,” he added.
Miller-Meeks raised concerns that the VA’s ongoing efforts to transition to a new electronic health record system could hinder its AI efforts, challenging Worthington on recent “hiccups that the VA has had in implementing its electronic health record.”
Worthington acknowledged the ongoing transition, but said the VA had more than 40 use cases where AI was already effectively being implemented, ranging from speech recognition for clinical dictation to AI-based visual-assistance with endoscopies.
“I think you’re raising a really critical point, which is that many of these AI solutions, to really be truly effective, need to be carefully integrated into the existing workflows so that they actually reduce burden and reduce the number of clicks and not add yet another thing that the providers need to check,” he said.
“By investing in these projects, VA aims to learn how AI technologies could assist VA clinical staff in delivering better healthcare with less clerical work, enabling more meaningful interactions between clinicians and veterans,” Worthington added.
Miller-Meeks said lawmakers should continue to closely watch the implementation of new AI tools and address any failures to meet the standards discussed during the hearing.
“AI is a powerful technology with great promise,” she concluded. “From automating tedious tasks and saving time for clinicians and administrative staff to aiding in diagnosis of disease and tailoring treatment, AI will alter the delivery of healthcare. As we’ve heard, there are concerns that must be addressed. These concerns, of course, have to be addressed in how the VA uses AI and in how the VA acquires and implements AI.”
