What hard lessons did the US Department of Veterans Affairs (VA) learn in 3 decades of EHR development, and what can it teach us about building better AI in medicine? Stephen Fihn, MD, MPH, of the University of Washington, and formerly a leader in the VA’s EHR efforts, joins JAMA+ AI Editor in Chief Roy H. Perlis, MD, MSc, to discuss his experience at the VA building decision support tools and other technology. Related Content: The VA Was an Early Adopter of Artificial Intelligence to Improve Care—Here’s What They Learned Hello, World—Introducing JAMA+ AI