A pioneer in clinical informatics with the development of the the Veterans Health Information Systems and Technology Architecture (VistA), the U.S. Department of Veterans Administration is again on the forefront of the design and development of a new VistA Electronic Health Record (EHR). Using innovation as the major theme involving academia, the commercial sector and the federal government, an open source program is being put together with a top notch team of individuals with experience in Healthcare IT, including some former venture capitalists. The goal is to craft a usable, next generation EHR that can anticipate and be flexible enough to accommodate where clinical informatics will be headed over the next decade.
They have much to be proud of – the use of VistA has enabled the VA to reach a pharmacy prescription accuracy rate of 99.997%, and the VA outperforms most public sector hospitals on a variety of criteria, enabled by the implementation of VistA. VA hospitals using VistA are one of the few hospital systems that have achieved the qualifications for HIMSS Stage 7, the highest level of EHR integration. And with about 20 million Veterans in the U.S., this is providing a great service for those that provided excellent service to their country.
One of the goals of the new EHR design is to integrate data from the Million Veterans Program, another ongoing effort of the VA to provide enhanced clinical IT support for its patients. According to the VA, “The MVP will establish one of the largest databases of genetic and health information to be used for future studies that may lead to new ways of preventing and treating illnesses in Veterans and all Americans.” This all-volunteer program is evolving to whole genome analysis of patients, given the tremendous drop in the cost of human genome sequencing.
Thus, according to several pundits from NIH-funded Genome Centers, like Dr. Richard Wilson of Washington University, “In 2005, with some of these next-generation sequencing technologies coming out, we decided that the right way to look at cancer genetics was not just to make a list of our favorite genes and focus on those, but to sequence the whole genome, using both tumor and normal tissue from individual patients, and find all of the mutations.”
The Washington University researchers published findings from the first cancer genome to be sequenced in 2008, that of a patient with Acute Myeloid Leukemia (AML). Follow-up from that study revealed that one of the new mutations discovered (in a gene called DNMT3A) helped identify patients with AML who are at high risk of recurrence.
The recommendations from many clinicians and researchers suggest that the new VistA EHR be configured to access a patient’s whole genome, annotated with genes and variants associated with higher risk of disease, or who may have alleles that render them more likely to have an adverse event to a given drug or therapeutic intervention. Again, the VA is a pioneer – this time, in the integration of patient genomics and the EHR.