hitting the sweet spot with predictive analytics (david shulkin)

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