Jennifer Goldsack (she/her) is the CEO of the Digital Medicine Society (DiMe), a global non-profit and professional home for those working in the digital medicine community. DiMe’s mission is to advance the ethical, effective, equitable, and safe use of digital medicine to redefine health care and improve lives.

Ryan Vega (he/his) is the Chief Officer of Healthcare Innovation and Learning at the U.S. Department of Veterans Affairs (VA). Prior to this position, Ryan also served as the Executive Director for the Veterans Health Administration (VHA) Innovation Ecosystem.

Here, Jennifer and Ryan share how health solutions developers can more intentionally create solutions for and with veterans.

In Full Health (IFH): How did you become interested in Veterans Affairs — were there any particular personal experiences or “aha” moments that brought you to the place you are today?

Ryan Vega: I was really fortunate to have the opportunity to serve as a chief resident for quality and safety in the VA. I was also a chief medical resident at the time, and sort of served in this dual role. That was really my foray into veteran’s affairs and I just fell in love with the mission and with the idea of being able to give back to service members and to veterans and their families.

Jennifer Goldsack: When I think about our mission at the Digital Medicine Society to advance the ethical, effective, equitable, and safe use of digital technologies to really redefine health care and improve lives, the VA is absolutely the best partner that we could think about in order to do this at scale.

IFH: What are some unique health or health care challenges veterans face?

Ryan Vega: I was not a service member myself, and I can’t pretend to understand what combat is like. Some of the challenges include visible, physical injuries of war — for example, if you want to live an active life, and have had double bilateral amputations. But there are also invisible injuries and challenges, like toxic exposure and PTSD. I can’t see in the lungs or in the mind that something is developing or someone is struggling. This is where screening becomes incredibly important to helping veterans live and reintegrate into civilian life.

IFH: DiMe and VHA recently released The Playbook: Digital Healthcare Edition — what are some key takeaways from this research and how can it be applied both to veterans’ health and the health of all Americans?

Jennifer Goldsack: In The Playbook, we dive into eight different digital health solutions that we believe are ready for prime time, that we believe are ready to be embedded into routine health care now in a way that improves access, improves effectiveness, improves efficiency, and improves equity. That actually allows us to improve the lives and experiences, not just of veterans, but of the clinicians who care for them. Solutions that are actually yielding system-level benefits as well as individual patient benefits.

The Playbook gives readers some tangible examples of how those digital tools can solve the problem in your health care system today — whether that’s a clinician shortage crisis, patient dissatisfaction, or unaffordable costs and supply chain issues. We try to define these solutions and provide tips, tricks, and then tangible examples of success to really guide people to success at scale.

Expressing Gratitude

I want to take a moment to recognize our VA colleagues as being extraordinary partners. By trusting us (even as a younger organization), to be the most thoughtful leaders in the digitization of health care and allowing us to be true thought partners in their strategy, implementation, and evaluation, we are not just improving the lives of veterans, but we are creating that blueprint for what good looks like.

Jennifer Goldsack
CEO, Digital Medicine Society

IFH: The VA and the FDA recently announced that they will be working together to accelerate medical device innovation and advance care — why is this partnership so important, and what do you hope to see come out of it?

Ryan Vega: A lot of it stemmed from the work that VA and FDA did during the pandemic, particularly around point-of-care manufacturing or additive manufacturing, more commonly known as 3D printing. There was such an overwhelming response from the community to help and assist with the design and development of novel 3D-printed personal protective equipment or diagnostic testing swabs when there was a significant shortage. The VA and FDA sort of rose to the challenge to figure out new methodologies and modalities of testing solutions that had never existed before.

Innovation is not just the ideation and the creation, but getting these things into the consumer’s hands so that they’re creating value. That’s the essence of innovation, is that value creation. To do that — and to do it safely and effectively —  we need new relationships and new partnerships. We need faster ways of developing real-world evidence and data. For all of those reasons, the partnership between the FDA and VA has been crucial.

Community Connections

Carolyn Clancy

I would love to shout out my mentor, Dr. Carolyn Clancy — she is the brainchild of bringing together the Office of Academic Affiliations, the Office of Research and Development, and the Office of Innovation under one umbrella within the VHA. She has a unique tenacity about her where you don’t even recognize that she’s pushing you. She is almost like a rip current. You don’t recognize you’re moving forward until you look up.

Ryan Vega
Chief Officer of Healthcare Innovation and Learning, U.S. Dept. of Veterans Affairs

IFH: What are two to three key things health solution developers should keep in mind when designing health solutions and technologies that will be utilized by veterans?

Jennifer Goldsack: Veterans Affairs is the largest integrated health care system in the U.S. If you can make your product work for the VA, that is a large buyer.

So, what should developers be looking for? The VA absolutely insists that you take a human-centered design approach — and I might even go further and say a sort of a human-centered and equity-by-design approach. If you can’t demonstrate those things, if you can’t point at how you thought about the full scope of users — including diverse veteran patients as well as clinicians in the system itself — you don’t have a path forward there.

Because it’s taxpayer money, I think the other piece the VA insists on, is that you are able to actually demonstrate the value that is going to be returned to veterans and the VHA. It doesn’t have to be in the first 6 months. They’re much more patient than many other health care systems because they have different incentives. But you have to be able to demonstrate real, tangible value to veterans and to the system.

Ryan Vega: Be obsessed with the problem, not the solution. This is something that great inventors, great innovators, and great companies — whether they’re in health care or not — do well. They’re obsessed with the problem, understanding the problem, and understanding the customer’s perspective of the problem. They don’t just ask, “How can we fix this?” They ask, “Why does the problem exist?”

The second thing to consider is, I think we often take for granted the complexity of medicine and the complexity of health care. There are so many interconnected and inter-reliable parts that must come together and work almost symbiotically — it’s no wonder the systems are so fragmented and no wonder that patients fall through the cracks and no wonder that people have terrible experiences.

Creating a watch that can detect atrial fibrillation and alert the patient, that’s great. It’s a really unique and cool piece of technology. But how does that individual then get access to care or a physician that can determine that this atrial fibrillation warrants further intervention or needs medication? I call this the “So what?” To people that are developing solutions, you have to find the “So what?” And that means that your solution is integrated into the care continuum.