Health Services Genomics
Research
Pauline Sieverding, JD, PhD
VA Office of Research & Development
Health Services Genomics Program Manager
June 30, 2009
Overview

Describe the VA health system / context

What is Health Services Genomics?

D
Development
l
t off a Health
H lth Services
S
i
Genomics Program
g
Veterans Health Administration
Operates the Nation’s Largest Integrated
Health Care System
•
•
•
•
•
•
•
6 million patients annually
153 hospitals
900 ffreestanding
t di clinics
li i
135 nursing homes
207 readjustment counseling centers
Trained 1/3 of all practicing MDs
$36 billion budget
Electronic Medical Record
• Includes virtually all clinical information
• Provides broad research value in g
genomic medicine
Information Characteristic
Added per Workday
Progress Notes
Orders
Images
Vital Signs
I ptt Meds
In
M d Administered
Ad i i t d
+638k
+955k
+884k
+729k
+607k
607k
Added in 2006
874 M
1.65 B
590 M
1.06 B
850 M
What is Health Services
Genomics?
Health Services Genomics will
establish the mechanics of how genetic
g
information will be used in clinical care.
From Gene Sequencing and
Discovery to Public Health
Action
Gene Sequencing
Gene Discovery
G
Gene
Characterization
Ch
t i ti
Cli i l Utilit
Clinical
Utility
Public Health Utility
From Gene Sequencing and
Discovery to Public Health
Action
Gene Sequencing
Gene Discovery
G
Gene
Characterization
Ch
t i ti
Cli i l Utilit
Clinical
Utility
Public Health Utility
Refined research-implementation
pp
pipeline
Health Behavior/
Promotion Research
Clinical Science
Clinical
Basic
Science
Translational
Pre-Clinical
Research
Health Behavior
Effective
-ness
Studies
Health Services
Basic/Lab Science
Health Services Research
Implementation
Research
Improved
Health
Processes,
Outcomes
Health Services Research &
Development (HSR&D)
( S & )G
Genomics
Research
 HSR
Genomics Evidence Review

Maren Scheuner – RAND - commissioned for
Health Services Genomics Working Group - Sept
07

informed programmatic priorities
VA HSR&D
Vol. 299 No. 11, March 19, 2008
HSR&D Genomics Research
Evidence Review
 Develop evidence regarding health outcomes
• Integrate successful models of genomic medicine delivery into
p
clinical practice
 Workforce
• Prepare health care providers to deliver genomics care /
education
 Consumers / Patients
• Create educational programs for patients
Scheuner M, Sieverding P, Shekelle P. Delivery of Genomic Medicine for
Common Chronic Diseases: A Systematic Review. Journal of the American
Medical Association. 2008; 299:1320-1334.
VA HSR&D Research Program on
Health Services Genomics

Capacity
p
y - Building
g a foundation for research that
examines all aspects of translation of genomics
information into the clinical setting

Informatics - Development of new systems of
information retrieval and knowledge management

Education - Development of genomic educational
interventions that link practice patterns to patient
outcomes data

QUERI - Developing and testing implementation
QUERI program
p g
to implement
p
models under the Q
and disseminate interventions
Development
D
l
t
o
of
Health Services Genomics
Research Capacity
Health Services Genomics
Priority Solicitation
•
To encourage innovative research for
evidence-based planning of veteran health
services in genetics and genomics and to
begin the development of tools and models
for genomic translation within the veterans
integrated health system
FY09
HSR&D Centers
Minneapolis
Iowa City
Seattle
Indianapolis
Ann Arbor
Hines
Bedford
ART
Boston
Portland
Denver
CIDER
San Francisco
HERC
Providence
West Haven
VIReC
Bronx
East Orange
Palo Alto
Pittsburgh
Sepulveda
Durham
West LA
Charleston
Salt Lake City
HSR Centers of Excellence
HSR QUERI Centers
C
HSR REAPS
HSR Resource Centers
HSR QUERI Resource Centers
San Antonio
Gainesville
Little Rock
Houston
Tampa
Birmingham
HSR&D Genomic Center
S
Supplements
l
t
 HSR&D Program Announcement for Center
Supplements to build Health Services Genomics
research capacity within the Centers
 The strongest Center applications showed
collaboration between bio
bio-lab,
lab clinical
clinical, & health
services researchers within the VAMCs
 7 supplements
l
t ffunded
d d ffor FY 08 and
d FY 09
 Supplements submitted full merit review proposals
HSR&D FY 2008-2009
Genomic Center Supplements
Minneapolis
p
pilot
instruments to measure veterans with SPMI & p
providers
knowledge & attitudes about genetic issues
Ann Arbor
establish models to translate clinical genomics to health care
delivery
y systems
y
Durham
evaluate health services genomics in primary care interventions
Palo Alto
develop pharmacogenomic decision support tools
San
Francisco
qualitatively & quantitatively document VA genomics services /
develop a evidence based conceptual framework
San Antonio
understand provider & pt barriers to applying genomic info to
clinical care
Greater LA
develop
pg
genomic medicine delivery
y models that incorporate
p
family history & genetic tests into CPRS
Development
D
l
t
o
of
Genomics
Informatics Capacity
Informatics Initiatives


VINCI - Veterans Informatics, Information, &
Computing Infrastructure

patient data in a high performance computing environment

complex modeling / human computer interfaces - allow for applying
genomics in the clinical setting and to manage the information
CHIR - Consortium for Healthcare Informatics
Research

natural language processing / mining text data within EMR

better characterize phenotypes for large numbers of patients
Development
D
l
t
o
of
Genomic
Educational Interventions
Education Initiatives

Education Solicitation –
 First
of its kind - solicit research linking
educational interventions to actual practice
patterns and patient outcomes
outcomes.
 Essential step toward developing evidencebased (i
(i.e.;
e ; using patient outcomes data)
educational programs for providers of genomic
information in a clinical setting.

Collaborating - NCHPEG developing an
educ module for HNPCC
Utilizing
Utili
i th
the QUERI
p e e tat o Program
og a
Implementation
Quality Enhancement Research
I iti ti (QUERI) P
Initiative
Program



enhance the quality and efficiency of VHA health
care by systematically facilitating the
implementation of research findings into clinical
practice.
integral
g p
part of any
y evidence-based translation of
genomic medicine.
developing and testing models to implement and
disseminate interventions
N t Steps
Next
St
?
Research - Next Steps ?

Evaluate patient knowledge, trust, beliefs, and
behaviors in the actual p
provision of g
genomics
services.

Evaluate provider knowledge and attitudes
attitudes,
organizational barriers, and needs to facilitate
effective delivery of genomic services.

Evaluate models of delivery in terms of: specific
roles and responsibilities of various providers;
development of staff educational tools; and/or
building staff capacity to use emerging knowledge
effectively and appropriately in delivering
personalized health care.
Research - Next Steps ?

Develop genomics services delivery models for the
common multifactorial diseases that are due to complex
interactions between variations in multiple genes and the
environment, such as coronary heart disease, stroke,
diabetes, osteoporosis, and cancer that increasingly drive
health care decisions.
decisions

Develop standards for genetics/genomics content in the
electronic health record,, including
gp
patient family
y history
y
and clinical decision support.

Examine cross-system and international comparative
research and delivery off care to inform
f
evidence-based
planning of health services in genomics and to develop
tools and models for genomic knowledge translation
within the health system.
Refined research-implementation
pp
pipeline
Health Behavior/
Promotion Research
Clinical Science
Clinical
Basic
Science
Translational
Pre-Clinical
Research
Health Behavior
Effective
-ness
Studies
Health Services
Basic/Lab Science
Health Services Research
Implementation
Research
Improved
Health
Processes,
Outcomes
pauline.sieverding@va.gov