U.S. News Best Hospitals Healthcare of Tomorrow David Shulkin, M.D. Under Secretary for Health Department of Veterans Affairs November 3, 2016
U.S.NewsBestHospitalsHealthcareofTomorrowDavidShulkin,M.D.UnderSecretaryforHealthDepartmentofVeteransAffairs
November3,2016
VETERANSHEALTHADMINISTRATION
Predictive Analytics in Issues That Are Critical to Veterans
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• Oncology
• PTSD• TBI• Suicide
VETERANSHEALTHADMINISTRATION
Cancer Moonshot
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VETERANSHEALTHADMINISTRATION
VA National Precision Oncology Program Federal Agencies-NCI, FDA, NIH, DOE, DOD
• VAMolecularOncology:80geneHccounselorssupporHngcliniciansfromSLC
• NCISPORE(SpecializedProgramsofResearchExcellence)predicHvemodelsforprostatecancer
• VA-DOEcollaboraHon-VAEHRandgenomics
• FDA-INFORMED”iniHaHve-IntegrateEHRdatawithdataonapproveddrugs
• VHAandDoD-medicalandadministraHveoutcomesresearch
• NIH-InteragencyagreementonprecisionmedicineiniHaHve 4
VETERANSHEALTHADMINISTRATION
Genomics Data- 520,000 Enrolled
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VETERANSHEALTHADMINISTRATION
MVP and PMI Summary Objectives
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State-of-the-artcomputaJonalenvironment
MVPparJcipaJonavailabletoall
VeteransandDoD
DataaccessleadingtoscienJficdiscoveriesandpublicaJons
MVPParJcipants
Veterans
DoDGenomicData
VAInvesJgators
Non-VAInvesJgators
MedicalRecords
SurveyResponses
• Currentenrollment520,000Veterans• Enrollatleast1Millionby2020• ExpandsecurecomputaHonalcapacitytoservemorethan1,000simultaneousVAandnon-VA
researchersby2020• Safe/secure,CLIA-compliantbiorepositorywithback-up• Establishmechanismstoreturnresultsresponsiblytoproviders,EHR,andparHcipants
VETERANSHEALTHADMINISTRATION
Partnership with DOE
• LeverageDOE’scompuHngcapabiliHesandVA’sgenomicexperHsetounlockanddevelopbeXerwaysofprevenHng,detecHng,treaHng,andcuringdisease
• VAandDOEsigninteragencyagreementtoestablishgovernancethroughoutthe5-yearrelaHonship
• PilottobelaunchedonJune1,2017
• JointprogramnamedMVPChampion
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VETERANSHEALTHADMINISTRATION
VA and IBM’s Watson
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VETERANSHEALTHADMINISTRATION
Precision Mental Health (PMH)
BasedontheMillionVeteranProgram(MVP),VA’sPrecisionMedicineplaUorm,andQUERIEvidenceSynthesisrecommendaJons,anaJonalstudyinvolvingmorethan2,000Veteransintendedto:
• Understandthegenomicsandpharmacogenomicsofdepression
• TesttheeffecHvenessofindividualizedtreatmentfordepressionbasedontheiruniquegeneHcinformaHon
• EmpowercliniciansandpaHentswithgeneHcdata,therebyensuringtherightdrug,attherightdose,givenattherightHme
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VETERANSHEALTHADMINISTRATION
VA Clinical Care for TBI
• InFY2015,VAprovidedcarefor98,426uniqueVeteranswithTBI
• VAhasscreenedmorethan1millionVeteranssince2007
• UsingMVPdataandEMRbigdataanalyHcstounderstandbeXerwaysofprevenHngandtreaHngTBI
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VETERANSHEALTHADMINISTRATION
Chronic Effects of Neurotrauma Consortium Research into TBI and PTSD
• $62.175millionVAandDoDfunding
• 130acHvePTSDStudiesand10TBIstudiesacrossmorethan30parHcipaHnginsHtuHons*
*asofAUG2016
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To establish the association (onset,
prevalence, and severity) of the chronic effects of
mild TBI (mTBI) and common comorbidities*
Determine whether there is a causative effect of
chronic mTBI/concussion on neurodegenerative disease and other
comorbidities*
Identify diagnostic and prognostic indicators of
neurodegenerative disease and other
comorbidities associated with mTBI/concussion
Develop and advance methods to treat and rehabilitate chronic neurodegenerative
disease and comorbid effects of mTBI/concussion
Consortium Objectives
VETERANSHEALTHADMINISTRATION
Suicide in America
In2014,therewere41,425suicides
Ofthose,7,403(17.9%)wereVeterans• 20perday
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VETERANSHEALTHADMINISTRATION
Predictive Analytics REACH VET
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• RolloutnaHonally• UsesdatatoidenHfyVeteransathighriskforsuicide
• NoHfiesVAprovidersoftheriskassessment
VETERANSHEALTHADMINISTRATION
Background: The Predictive Model • DevelopedbyVA,NIMH,anduniversity-basedresearchers• IncludesclinicalandadministraHvedataforeachVeteranusing
VAhealthcareservices
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Outcome Top.1%TopRisk
Suicide(onemonth) 33x
Suicide(oneyear) 15x
SuicideaXempt(oneyear) 81x
CalculatedRisk
*As compared to overall VHA population
VETERANSHEALTHADMINISTRATION
Identified At-Risk Veterans Provide Opportunities for Enhanced Care
Ofthoseinthetop.1%,only30%wereidenHfiedashighriskforsuicidebasedonclinicalsignsandsymptoms
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VETERANSHEALTHADMINISTRATION
REACH VET Roles and Responsibilities
REACHVETCoordinators
• EnsurethatnoHficaHonsregardingidenHfiedpaHentsreachtheappropriateproviders
MentalHealthandPrimaryCareProviders
• AcknowledgenoHficaHonofidenHfiedat-riskpaHents• ContactpaHentsandassessthem• Re-evaluatediagnosesandtreatmentplans
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VETERANSHEALTHADMINISTRATION
Mental Health and Social Media
– Monitor VA social media to identify troubling/concerning posts – Veterans Crisis Line locates the individual to provide information, intervention,
life saving services.
– Since 2011, VA has posted 16,343 responses via Facebook and YouTube (average of 318 per month). Concerning posts have been escalated to VCL 217 times throughout the campaign’s lifetime.
VETERANSHEALTHADMINISTRATION
Exploring Use of Analytics and Social Media
• ResearchsuicidebehavioralindicatorsandonlinecontenttoadvanceunderstandingofVeteransathigh-riskforcommiengsuicide
• PotenHallydevelopanautomatedandreal-HmealgorithmwhichcaneffecHvelypredictVeteransatriskforsuicide
VETERANSHEALTHADMINISTRATION
Center for Compassionate Innovation
Mission:ToenhanceVeterans’healthandwell-beingbyofferingemergingtherapiesthataresafeandethical,parHcularlyafertradiHonaltreatmentshavebeenunsuccessful
• Evaluateproposalsthatlackrigoroussciencebuttheevidenceiscompelling
• Considerproposalswhereclinicalbenefitsoutweightherisks
• IncorporateVeteran’svoiceinemergingtherapies
• LeverageinnovaHontoaddresstheuniqueneedsoftheVeteranpopulaHon
• MaintainfundamentalprincipletoDoNoHarm19