IMAGE BY JASON SMITH/ORNL, U.S. DEPT. OF ENERGY
V E TE R AN S AFFAI R S & M I LITARY M E D I CI N E O UTLO O K
with DOE’s high-performance computing and artificial intelligence capabilities to explore questions about the COVID-19 pandemic. VA’s Office of Research and Development, the FDA, HHS, and DOE, recognizing the enormous potential of this data to study and perhaps solve some of the mysteries of COVID-19, began discussing a partnership in March 2020, when U.S. cases numbered in the hundreds. The speed with which the new partnership was launched is due in part to the fact that VA electronic health record data was already mirrored on servers at Oak Ridge: Four years ago, the two agencies launched an initiative, MVP-CHAMPION, to apply DOE’s supercomputing, artificial intelligence, and data analytics to VA’s unparalleled health care data and genomic data compiled by the VA’s Million Veteran Program (MVP). Since 2017, computing and clinical experts have been working to gain insights into three topics important to veteran health: cardiovascular disease, cancer, and suicide. The outcomes of these ongoing projects will provide better predictors of disease and improved clinical decision support for VA care providers and patients. As Justice pointed out, moving VA data onto DOE servers required a lot of work to get all the permissions and privacy protections in place. “All of that happened before COVID-19 hit,” she said. “If it hadn’t, none of this would have happened.” Justice compared the unexpected benefit of the MVP-CHAMPION initiative to NASA’s Apollo program, which ushered in a sequence of unforeseen technological innovations. “When COVID-19 hit,” she said, “all of a sudden there was an immediate use for that data that no one could have anticipated when we first started the collaboration.” According to Molly Klote, MD, who directs the VA’s Office of Research Protections, Policy, and Education, MVPCHAMPION was formed for the benefit of both agencies: “The Department of Energy needed to practice modeling with the use of their supercomputers, and they needed an enormous data set,” she said. Genomic data from the MVP
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A normal blood vessel, shown at top, is compared with a blood vessel affected by excess bradykinin. A hyperactive bradykinin system permits fluid, shown in yellow, to leak out and allows immune cells, shown in purple, to squeeze their way out of blood vessels.
– obtained so far from about 500,000 of the 830,000 veterans participating in the program – comprises the largest such database in the United States. It’s been Klote’s job to navigate a new set of regulatory and privacy concerns, to unlock this data trove for analysis of COVID-19. “The enclave at the Department of Energy where all the VA data sits is a VA enclave that meets all of VA’s standards for privacy and security,” she said. Disclosure of a veteran patient’s data requires a series of permissions, usually including the signature of the veteran, but because the COVID-19 pandemic is a public health emergency, the Partnership has received permission under HHS Public Health Authority to pool health record data from the VA and
the Centers for Medicare and Medicaid Services (CMS). Because the RAS-bradykinin computational study was formulated while Klote and her office were securing this public health authority, veteran data was not used to develop the mechanistic model developed at Oak Ridge – but as Jacobson pointed out, the COVID-19 Insights Partnership is about more than sharing data; it’s also about sharing expertise. “The partnership with Amy [Justice], and getting her perspectives on the mechanism, was extremely helpful,” he said. “This was a good outcome of the Insights collaboration, and it’s leading to a lot of what we hope will be very productive interactions with the VA.”
NEXT STEPS Studies are underway both within and outside of the COVID-19 Insights Partnership. Three studies of existing drugs, each targeting a different part of the RAS-bradykinin pathway – icatibant;
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