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Director's Letter

Partnering to Address Emerging Priorities

Melissa Braganza, MPH

The emergence of novel technologies such as artificial intelligence (AI) and virtual reality has become an area of national importance. These technologies have the potential to reduce provider burden and help make health services more efficient, but there are also many unknowns and questions that remain regarding implementation and regulatory challenges, provider and patient acceptance, and the possibility of these technologies exacerbating health inequities. Pilot testing these technologies is critical to overcome these challenges, and VA is partnering with industry, academic institutions, and nonprofit organizations to design and pilot interventions using AI-powered solutions (e.g., ambient dictation for clinical encounter notes, community care document processing to compile key point summaries for VA providers) to help improve patient care transitions and avoid provider burnout.

The use of virtual reality and AI-enabled solutions in VA is a key priority that was discussed during last month’s Health Systems Research (HSR)/Quality Enhancement Research Initiative (QUERI) annual strategy meeting, which brought VA national, regional, and facility leaders together to discuss their top priorities. The discussion highlighted the need to understand Veteran and provider perspectives of these technologies and evaluate the implementation and impact of these technologies on provider burnout, Veteran experience of care, and cost.

HSR/QUERI investigators are working closely with VA leaders to help answer some of these questions. Last year, Rani Elwy, PhD, and her team partnered with VA leaders to examine Veteran perspectives on the use of AI in their medical care. Results from two surveys showed that Veteran attitudes toward AI vary with the type of care provided (e.g., survey respondents appeared to be more open to AI involvement in skin cancer screening than they were to chatbot use for mental health support). This work also highlighted the importance of:

• Using clear and consistent AI messaging throughout VA by sharing best practices via learning networks or collaboratives.
• Treating Veterans as partners in their care with honest, transparent, and frequent conversations with Veterans about AI.
• Providing opportunities (e.g., town halls, education sessions) for Veterans to learn more about AI use in healthcare.

More currently, QUERI investigators have been working with multilevel partners to evaluate Veteran and provider perspectives regarding ambient dictation and the virtual reality platform RelieVRx for at-home chronic low back pain management. As VA continues to pilot virtual reality platforms, AI-enabled solutions, and other technologies, we hope to continue to expand HSR/QUERI evaluation work in these areas to help ensure these technology-based interventions work for both Veterans and providers.

As a national, integrated health system with an embedded research program and a strong commitment to training healthcare professionals, scaling best practices, and driving the use of innovations to transform care for Veterans, VA is in a unique position to conduct rapid, iterative evaluations and develop tools to support the uptake of effective technologies across the system. Rigorous evaluation of these technologies in VA settings will be essential to ensure sites and providers have the support, tools, and training they need to leverage these technologies to enhance health services and reduce administrative burden while ensuring equity.

Melissa Braganza, MPH
Acting Director, Quality Enhancement Research Initiative