The document discusses the Veterans Health Administration's use of predictive analytics and precision medicine to address critical health issues for Veterans. It summarizes several key initiatives: 1) The Million Veteran Program has enrolled over 520,000 Veterans and aims to enroll 1 million by 2020 to study conditions like cancer, PTSD, TBI, and suicide through genomic data and electronic health records. 2) Precision mental health studies aim to understand depression genetics to enable individualized treatment, while TBI research uses data to prevent and treat traumatic brain injury. 3) The REACH VET program uses predictive models to identify Veterans at high risk for suicide who may not otherwise be flagged, allowing for enhanced care intervention.

1. U.S. News Best Hospitals
Healthcare of Tomorrow
David Shulkin, M.D.
Under Secretary for Health
Department of Veterans Affairs
November 3, 2016

2. VETERANS HEALTH ADMINISTRATION
Predictive Analytics in Issues
That Are Critical to Veterans
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• Oncology
• PTSD
• TBI
• Suicide

3. VETERANS HEALTH ADMINISTRATION
Cancer Moonshot
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4. VETERANS HEALTH ADMINISTRATION
VA National Precision Oncology Program
Federal Agencies-NCI, FDA, NIH, DOE, DOD
• VA Molecular Oncology: 80 geneHc counselors supporHng clinicians from SLC
• NCI SPORE (Specialized Programs of Research Excellence) predicHve models for
prostate cancer
• VA-DOE collaboraHon- VA EHR and genomics
• FDA- INFORMED” iniHaHve -Integrate EHR data with data on approved drugs
• VHA and DoD-medical and administraHve outcomes research
• NIH- Interagency agreement on precision medicine iniHaHve
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5. VETERANS HEALTH ADMINISTRATION
Genomics Data- 520,000 Enrolled
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6. VETERANS HEALTH ADMINISTRATION
MVP and PMI Summary Objectives
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State-of-the-art computaJonal
environment
MVP parJcipaJon
available to all
Veterans and DoD
Data access leading to
scienJfic discoveries
and publicaJons
MVP
ParJcipants
Veterans
DoD
Genomic
Data
VA
InvesJgators
Non-VA
InvesJgators
Medical
Records
Survey
Responses
• Current enrollment 520,000 Veterans
• Enroll at least 1 Million by 2020
• Expand secure computaHonal capacity to serve more than 1,000 simultaneous VA and non-VA
researchers by 2020
• Safe/secure, CLIA-compliant biorepository with back-up
• Establish mechanisms to return results responsibly to providers, EHR, and parHcipants

7. VETERANS HEALTH ADMINISTRATION
Partnership with DOE
• Leverage DOE’s compuHng capabiliHes and VA’s genomic experHse
to unlock and develop beXer ways of prevenHng, detecHng,
treaHng, and curing disease
• VA and DOE sign interagency agreement to establish governance
throughout the 5-year relaHonship
• Pilot to be launched on June 1, 2017
• Joint program named MVP Champion
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8. VETERANS HEALTH ADMINISTRATION
VA and IBM’s Watson
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9. VETERANS HEALTH ADMINISTRATION
Precision Mental Health (PMH)
Based on the Million Veteran Program (MVP), VA’s Precision
Medicine plaUorm, and QUERI Evidence Synthesis recommendaJons,
a naJonal study involving more than 2,000 Veterans intended to:
• Understand the genomics and pharmacogenomics of depression
• Test the effecHveness of individualized treatment for depression
based on their unique geneHc informaHon
• Empower clinicians and paHents with geneHc data, thereby
ensuring the right drug, at the right dose, given at the right Hme
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10. VETERANS HEALTH ADMINISTRATION
VA Clinical Care for TBI
• In FY 2015, VA provided care for 98,426 unique Veterans with TBI
• VA has screened more than 1 million Veterans since 2007
• Using MVP data and EMR big data analyHcs to understand beXer ways of
prevenHng and treaHng TBI
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11. VETERANS HEALTH ADMINISTRATION
Chronic Effects of Neurotrauma Consortium
Research into TBI and PTSD
• $62.175 million VA and DoD funding
• 130 acHve PTSD Studies and 10 TBI studies
across more than 30 parHcipaHng insHtuHons*
* as of AUG 2016
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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

12. VETERANS HEALTH ADMINISTRATION
Suicide in America
In 2014, there were 41,425 suicides
Of those, 7,403 (17.9%) were Veterans
• 20 per day
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13. VETERANS HEALTH ADMINISTRATION
Predictive Analytics
REACH VET
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• Rollout naHonally
• Uses data to idenHfy
Veterans at high risk
for suicide
• NoHfies VA providers
of the risk assessment

14. VETERANS HEALTH ADMINISTRATION
Background: The Predictive Model
• Developed by VA, NIMH, and university-based researchers
• Includes clinical and administraHve data for each Veteran using
VA health care services
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Outcome Top .1%
Top Risk
Suicide (one month) 33 x
Suicide (one year) 15 x
Suicide aXempt (one year) 81 x
Calculated Risk
*As compared to overall VHA population

15. VETERANS HEALTH ADMINISTRATION
Identified At-Risk Veterans Provide
Opportunities for Enhanced Care
Of those in the top .1%, only 30% were
idenHfied as high risk for suicide based on
clinical signs and symptoms
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16. VETERANS HEALTH ADMINISTRATION
REACH VET Roles and Responsibilities
REACH VET Coordinators
• Ensure that noHficaHons regarding idenHfied paHents reach the appropriate providers
Mental Health and Primary Care Providers
• Acknowledge noHficaHon of idenHfied at-risk paHents
• Contact paHents and assess them
• Re-evaluate diagnoses and treatment plans
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17. VETERANS HEALTH ADMINISTRATION
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.

18. VETERANS HEALTH ADMINISTRATION
Exploring Use of Analytics and Social Media
• Research suicide behavioral indicators and online content to
advance understanding of Veterans at high-risk for commieng
suicide
• PotenHally develop an automated and real-Hme algorithm
which can effecHvely predict Veterans at risk for suicide

19. VETERANS HEALTH ADMINISTRATION
Center for Compassionate Innovation
Mission: To enhance Veterans’ health and well-being by offering
emerging therapies that are safe and ethical, parHcularly afer
tradiHonal treatments have been unsuccessful
• Evaluate proposals that lack rigorous science but the evidence
is compelling
• Consider proposals where clinical benefits outweigh the risks
• Incorporate Veteran’s voice in emerging therapies
• Leverage innovaHon to address the unique needs of the
Veteran populaHon
• Maintain fundamental principle to Do No Harm
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