If one were to ask the average citizen where cutting-edge technology is developed, the most probable answer would be “private industry”; think Apple, Tesla, Uber. This lies in the belief that the U.S. government is slow, risk-averse and cumbersome when it comes to innovation efforts. But taking a deep dive into the recent history of innovation in the U.S. would yield a different perception.
For example, consider the Defense Advanced Research Projects Agency, known as DARPA. Born out of the realization that the U.S. had fallen behind the Union of Soviet Socialist Republics (USSR) in the Space Race, DARPA was created in 1958 to catch up to Russia and ensure that the U.S. would never lag behind technologically in matters of national security.
A few years later, DARPA expanded its mission. A partnership was formed between the military (Air Force) and academia (Douglas Engelbart and the Stanford Research Institute) to create the framework for modern computers (the oN-Line System). This model of an academia and private-sector partnership would be used repeatedly to innovate, eventually leading to the invention of the internet.
In the 1960s, the Lockheed Corporation developed Eclipsys, allowing physicians to place orders electronically. In 1977, the federal government laid the groundwork for an electronic health record (EHR) system with the Computer Assisted System Staff (CASS). CASS was developed at the Veterans Affairs (VA) Medical Center at Massachusetts General Hospital and became the precursor of today’s Veterans Administration’s EHR platform, Veterans Health Information System and Technology Architecture (VistA). In short order, the VA allowed unrestricted access to this EHR technology, providing the private sector the opportunity to expand its use. Two decades later, the VA developed and implemented the Computerized Patient Records System (CPRS), the first clinically usable EHR in the world.
Patient care has also benefited from government innovation. In 1978, a joint venture between the U.S. Navy and DARPA led to the technology of Excimer lasers, used for laser eye surgery and arterial atherectomies. In 2006, a joint venture—LUKE—between the VA, DARPA and the private sector (DEKA Research and Development Corporation) led to the development of an electromechanical prosthetic upper arm with near-natural control. These examples are just the tip of the iceberg.
In 2020, the Veterans Health Administration (VHA) launched two new programs: VA Ventures and the Office of Healthcare Innovation and Learning (OHIL). VA Ventures’ mission is to promote collaboration between the VHA, academia, start-up companies and industry to drive healthcare innovations towards sustainable, high-impact solutions and to ensure that innovations are delivered initially to military veterans.
Direct patient care technologies include: 3D bioprinting, artificial intelligence (AI) and machine learning imaging, robotics, and augmented and virtual reality. One project directly applicable to the surgical community that highlights the VA’s push for innovation is Project Convergence. The VA is leveraging a public-private partnership between the VA, Verizon, Medivis, Azure and Microsoft to develop a 5G medical campus. The goal is to convert 2D imaging to 3D-holographic imaging, leading to better preparation and planning for surgery.
Thus, it is shown that the U.S. government, and, by extension, the VHA, has recognized that to stand still is to be left behind. The VA has been at the forefront of developing new ways to deliver healthcare to veterans and the general population. Through public-private partnerships, the VA will continue to innovate and look for new, better and more effective ways to provide progressive patient care.
Frederick Beavers, MD, is a member of the SVS VA Vascular Surgeons Committee. George Akingba, MD, is a vascular surgeon at the VA Medical Center in Washington, D.C.