That model is one in which not only you interact with veterans at the time that they initially agree to become a part of the study; they also agree to allow us to take information developed over time, from their electronic health records, and relate it back to information about their genome.

The NIH has also proposed a million-person cohort for its database and is really building on the concept that we’ve shown can be achieved – getting information from electronic health records from a broader group of Americans and moving forward. That initiative and ours have a lot of places where there is complementarity. I think we have a clear commitment to be able to exchange data for those veterans that wish to participate in their cohort and for us to be able to learn from veterans that may be participating in the NIH cohort but aren’t receiving care within VA.

I think there’s also a developing likelihood that we’ll be helping the Department of Defense to create a framework for looking at precision medicine in the care of soldiers, sailors, airmen, and Marines. As I said, we’re serving the same people at different points in their lives. We also recognize there are things the NIH Precision Medicine cohort can do that we can’t, and vice versa. The NIH Precision Medicine cohort will have a much larger faction of women. We are only enrolling from our health care system, so to enroll 500,000 women in the Million Veteran Program would be an unrealistic expectation. But for a broad population cohort in the United States, enrolling 500,000 women is quite feasible. So there are questions they’ll be able to ask about women’s health that we won’t be as able to ask.

At the same time, we and the Department of Defense are interested in understanding what predisposes bad outcomes from traumatic brain injury or what predisposes combat-associated PTSD. We’ll be able to answer that question through the Million Veteran Program; that question will have a sufficiently large population of people exposed to military hazards to answer many of the questions we have. Our efforts, I think, are beautifully complementary. We’re currently involved in the planning activities for the NIH Precision Medicine cohort, deeply involved with the White House staff trying to implement the president’s vision.

So what kind of innovations or advances do you think VA Research will be celebrating 90 years from now?

We have three really major thrusts or strategic directions we’re pursuing now. One of them is this movement toward genomics and precision medicine, and the Million Veteran Program is an important part of that. The movement from pure research into the clinical applications of genomics will be an important thrust going forward. At this point, we’re in the discovery phase, and one of our strategic directions is obviously to move from discovery to practical implementation.

Both for genomics and for other health care divisions, the use of informatics in high-performance data mining, hypothesis testing, and communications capabilities is a really, ^really important topic. We have a health care system, but like health care in the United States in general, we implemented electronic health records in the field some time ago in a way that was neither consistent nor homogeneous. The result is that it takes some effort for VA researchers gathering health data from different parts of the health care system to make sure they’re looking at exactly the same thing. Researchers involved in our VINCI [VA Informatics and Computing Infrastructure] program are working to create a platform that basically cleans up the data, so that whether it comes from Palo Alto or it comes from Boston, it means exactly the same thing.

The final strategic thrust is mainly in the area of interagency collaboration and cooperation. When I say we have a tight interaction with the Department of Defense, I mean we communicate multiple times a day. As the Precision Medicine Initiative develops, I think we’ll develop the same kind of tight interaction with our colleagues at Health and Human Services. We all have data and information we can use to help each other. …

So VA researchers are discovering efficient and robust ways of pulling in information from the 150 medical centers, and nearly a thousand outpatient clinics and vet centers in VA. Those lessons will extend beyond VA to the nation. At the same time, they also use tools which make it possible to feed the genomics program with information about health care and health care outcomes for people participating in the Million Veteran Program and allow health services researchers to get a much better handle on what is going on across VA.

The final strategic thrust is mainly in the area of interagency collaboration and cooperation. When I say we have a tight interaction with the Department of Defense, I mean we communicate multiple times a day. As the Precision Medicine Initiative develops, I think we’ll develop the same kind of tight interaction with our colleagues at Health and Human Services. We all have data and information we can use to help each other. Talent is sometimes uniquely available in one place or another. So we need to work more effectively as a government to solve these problems we face together – which doesn’t take away from our mission of serving veterans. Indeed I think it enhances it – and at the same time enhances the efforts of our colleagues in the Department of Defense to serve the active-duty and dependent and retiree population, and HHS’ efforts to serve the broader American population.

¹Edward Freis’ 1964 VA Cooperative Study on Antihypertensive Agents, a five-year study launched in 1964, earned Dr. Freis the 1971 Albert Lasker Clinical Medical Research Award, “For his demonstration of the life-saving effectiveness of drugs in the treatment of modern hypertension.”

²The COURAGE Trial results were reported in the April 12, 2007 issue of the New England Journal of Medicine.

This interview first appeared in The Year in Veterans Affairs & Military Medicine.