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