Hitting the Sweet Spot with Predictive Analytics (David Shulkin)
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Transcript of Hitting the Sweet Spot with Predictive Analytics (David Shulkin)
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U.S.NewsBestHospitalsHealthcareofTomorrowDavidShulkin,M.D.UnderSecretaryforHealthDepartmentofVeteransAffairs
November3,2016
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VETERANSHEALTHADMINISTRATION
Predictive Analytics in Issues That Are Critical to Veterans
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• Oncology
• PTSD• TBI• Suicide
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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
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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
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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
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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
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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
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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.
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VETERANSHEALTHADMINISTRATION
Exploring Use of Analytics and Social Media
• ResearchsuicidebehavioralindicatorsandonlinecontenttoadvanceunderstandingofVeteransathigh-riskforcommiengsuicide
• PotenHallydevelopanautomatedandreal-HmealgorithmwhichcaneffecHvelypredictVeteransatriskforsuicide
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VETERANSHEALTHADMINISTRATION
Center for Compassionate Innovation
Mission:ToenhanceVeterans’healthandwell-beingbyofferingemergingtherapiesthataresafeandethical,parHcularlyafertradiHonaltreatmentshavebeenunsuccessful
• Evaluateproposalsthatlackrigoroussciencebuttheevidenceiscompelling
• Considerproposalswhereclinicalbenefitsoutweightherisks
• IncorporateVeteran’svoiceinemergingtherapies
• LeverageinnovaHontoaddresstheuniqueneedsoftheVeteranpopulaHon
• MaintainfundamentalprincipletoDoNoHarm19