Hi I'm Julie Lynch, and I work for VINCI services
at the VA Salt Lake City Healthcare System,
and Scott DuVall is actually my boss.
Hi I'm Scott DuVall,
I'm the Director of the VA Informatics
and Computing Infrastructure (VINCI) based in Salt Lake City
at the Salt Lake City VA Healthcare System.
Precision medicine is making sure that people's healthcare and treatment
are informed by specific aspects of their genetics
or specific aspects of their disease.
What we're able to do is look at genetic components,
we're able to look at past medical history components,
we're able to incorporate a lot of their family history,
we're able to look at environmental factors,
and really, the hope is that eventually we'll be able
to have the whole picture
so that we can make the very best care decisions,
or at least research what the very best care decisions are.
Clinical translation of precision medicine into the VA
and the veteran population is extremely important.
The VA has a very diverse patient population.
So, many of these advances, particularly in cancer,
are happening in NCI cancer centers,
where the patient population is frequently white men and women.
In the VA we have African-Americans,
we have Hispanics, we have Asians,
and so it's extremely important
that precision medicine advances happen within the VA.
The important distinction of what the VA can do,
from a research genomics standpoint,
is use information in the electronic health records,
so clinically annotate the whole genome sequencing
that's going on, and that's unique.
There've been other research initiatives,
but they don't have the extent of electronic health data
to really inform the genetic analysis.
So, what we're doing at VINIC is collecting the data feeds
from the laboratories that are processing these tests,
and we're making sure they get into the electronic health record.
As our VA providers are treating patients
and are using some of this information
to better decide what treatments to go at,
we'll be able measure that and evaluate that
and make sure the very best practices
can be implemented at other places as well.
The other thing that's very important in VA
is to make sure that accessibility is there.
We want to make sure that all of our veterans
no matter their race or their gender
or their location in the country
has access to some of the very best treatment that's available.
The VA GDX program
is a joint clinical operations and research program.
So the research component of it, is taking all the test orders
and test results and linking them to the electronic health record
and then we're looking at the clinical practice guidelines
and identifying the patient population
that should have undergone specific testing
and seeing whether they did undergo specific testing.
So for example, there is a test,
21-gene risk score.
It identifies veterans with breast cancer
who may be able to avoid chemotherapy.
And so we identified all the breast cancer patients in the VA,
we identified who of them, underwent Oncotype DX
the genomic test that identifies patients
who can avoid chemotherapy.
We determined what percentage of patients were tested
and what percentage of patients weren't tested,
and then we looked at the medical record
to see why they weren't tested and then we took that information
back to the clinical leaders and we said,
"Okay of the total veterans
"that should have been tested, only 27 percent were tested.
"And here's what needs to be done
to make sure we reach 100 percent."
The reason I'm at the VA
is because I'm really appreciative
of the work the veterans have done
to support our country and protect us
and it's really why I'm in the VA,
rather than the NIC Cancer Centers.
I'm grateful to work in the Department of Veterans of Affairs.
There's no place that has bigger data;
that has better data.
And our patient population, our veterans who have served,
they are the kindest, sweetest men and women to talk with,
and it's a pleasure to work here
in the Department of Veterans Affairs.