Kaeli Yuen, MD
WASHINGTON — It was working at VA that, for Kaeli Yuen, MD, sparked a passion for finding new ways that health information technology can ease the burden on overworked, schedule-packed clinicians. Her first job out of college was with the VA Palo Alto, CA, Healthcare System, working as part of a research group developing clinical decision-making support tools for VA’s electronic healthcare record.
“I loved that work,” Yuen said. “It was a great way to combine my interest in healthcare and technology. I was providing tools for doctors to make better decisions on a large scale.”
That job eventually informed her decision to go to medical school and pursue extracurricular health information technology activities that would prepare her for the role of physician informaticist.
Today, she is a Presidential Innovation Fellow with the Government Service Administration, a program that brings outside experts into the federal government to help accelerate modernization. Appropriately, Yuen has been detailed to VA’s Office of the Chief Technology Officer.
“Our goal is to bring digital tools to VA and help modernize the experience of veterans and their caregivers. I’m happy to say that I’m working on almost exactly the same thing I was doing in Palo Alto,” she said.
That included helping create a hypertension management tool for VA clinicians. The program takes in patients’ healthcare data such as demographics, medications and illnesses, runs that data through a computerized version of the VA’s hypertension guidelines and produces patient-specific recommendations.
“It helps offload some cognitive burden for clinicians,” Yuen explained.
Yuen began her fellowship at VA in October 2019—just in time to get settled and get the hypertension project under her belt before the world changed. The COVID-19 pandemic forced healthcare systems across the country to make sudden, drastic changes, including embracing information technology applications faster and more broadly than ever before.
VA’s technology office began receiving a flurry of requests from administrators asking for any digital tools that could help facilities cope.
“The first thing I was tasked with was helping to solve the problem of the huge influx of calls that were coming in to clinical centers at VA,” Yuen said. “Veterans were calling asking what to do if they had an appointment or how to get tested or how is this affecting my benefits, as well as a lot of questions in general about COVID.”
Consequently, call centers were slammed, with veterans being left on hold for up to three hours. Yuen led a team building a coronavirus chat bot that would answer basic questions in an automated way, freeing up VA staff for other work.
Aware that chat bots do not necessarily have the best reputation, Yuen and her team did several rounds of user testing before and after development. The response was overwhelmingly positive.
Chat Bots
“They were skeptical of chat bots. People don’t always have a favorable impression of those,” Yuen said. “But when they realized they could get their answers quickly, they embraced it.”
With the chat bot up and running, Yuen joined the team working on a COVID screening tool for VA facilities.
When VA first mandated that all visitors and patients be screened for COVID risk factors, it initially resulted in long lines outside VA facilities. Visitors were required to fill out a paper form, then pass it off to VA staff, have their temperature taken and only then were allowed into the building. Tents were sometimes set up outside hospitals to handle the overflow crowd.
“Our team digitized this process so you could answer the questions on your phone,” Yuen explained.
The medical center screener was completed in record time—going from start to stand-up in just 12 days. But because one of GSA’s mandates is to promote cross-agency innovation, the project did not stop with VA.
Yuen’s role with the team has been taking that VA screener and developing it so it could be used at other federal facilities.
“There was an urgent need,” she explained. “People were coming back to the workforce over the summer. Everyone was urgently trying to put into place multiple layers of safety measures.”
The governmentwide screener took longer than 12 days, due to the significant amount of cross-agency coordination that was required but was eventually launched and is now in place at several federal agencies.
With the screener up and running, Yuen has moved back to clinical decision support, this time working to create a COVID patient manager.
“This is a physician-facing tool for emergency medicine physicians helping them make disposition decisions for patients with COVID,” Yuen explained. “Because COVID is such a new condition, physicians aren’t yet attuned to how to deal with it, and the guidelines are so new.”
Yuen is targeting patient disposition because that’s where a bulk of the decision-making currently exists for physicians.
“There aren’t a lot of treatments for COVID. Physicians are mostly dealing with the consequences of the virus, and those are things that physicians are already familiar with,” she said. “Right now, the main decision is where do patients receive care—at home, the ICU or admit them as an inpatient. That’s what led me to emergency medicine physicians as first users.”
Yuen is partnering with emergency physicians at several VA facilities to test out the program and hopes to launch the pilot in early-to-mid 2021.
“Those emergency medicine physician partners will promote the program to their colleagues, as well as help explain it.”
However, Yuen noted, if she and her colleagues do their job, the program won’t need much explaining at all.