The pioneer in the Electronic Health Record is the U.S. Department of Veterans Administration, with the development of the the Veterans Health Information Systems and Technology Architecture (VistA). They are again on the forefront of the design and development of a new VistA Electronic Health Record (EHR), using an eclectic open source model involving academia, the corporate sector and federal Healthcare IT.
They have much to be proud of – the use of VistA has enabled the VA to reach a pharmacy prescription accuracy rate of almost 100%, 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. The goal is to create a usable, next generation EHR that can anticipate and be flexible enough to accommodate where clinical informatics will be headed over the next decade, and the big target is genomic data from the VA’s own Million Veterans Program (MVP).
The ambitious MVP is an ongoing initiative, according to Veterans Affairs Eric K. Shinseki, “It is my honor to join with so many fellow Veterans in keeping VA at the leading edge of genomics research. This innovative research program will support VA’s mission to provide Veterans and their families with the care they have earned.” The Million Veteran Program is a trailblazing VA effort to consolidate genetic, military exposure, health, and lifestyle information together in one single database. The database will be used only by authorized researchers with VA, other federal health agencies, and academic institutions within the U.S.—in a secure manner—to conduct health and wellness studies to determine which genetic variations are associated with particular health issues. By identifying gene-health connections, the program could consequentially advance disease screening, diagnosis, and prognosis and point the way toward more effective, personalized therapies.
In a recent workshop held at the prestigious Institute of Medicine, called “Integrating Large-Scale Genomic Information into Clinical Practice”, several key scientists and clinicians from Genome Centers described the evolution of clinical genetic diagnostics – from gene test panels to whole exome sequencing to whole genome sequencing. With the precipitous drop in the cost of human genome sequencing, the strong recommendation from participants at the workshop was, although we have interim genome-based diagnostic tests, within 2-3 years everyone will be performing whole genome sequencing and analysis because it reveals so much more information about the correlation between genetic variation and disease phenotype1,2. This mantra is now resounding within the VA’s clinical MVP program, which is evolving with the technology:
1 Ley at al (2008) DNA sequencing of a cytogenetically normal acute myeloid leukaemia genome. Nature 456, 66-72 (6 November 2008) | doi:10.1038/nature07485.
2 Welch et al (2011) Use of Whole-Genome Sequencing to Diagnose a Cryptic Fusion Oncogene. JAMA, April 20, 2011. 305 (15): 1577-1584
