Duke University, in collaboration with the Veterans Health Administration (VA), has received one of six awards from a new $27 million initiative from the National Institutes of Health to establish a genomics-enabled Learning Health System (G-LHS) network. This innovative project aims to improve the implementation of genomic medicine across the country, with a focus on underserved populations and enhancing patient care outcomes through cutting-edge genetic testing and personalized medicine. Dr. Orlando is one of four PIs on the award; the other PIs are Deepak Voora, MD (Duke, Division of Cardiology and Durham VA), Jason Vassey, MD, MPH (Harvard), and Maren Scheuner, MD, MPH (UCSF).
Dr. Orlando will oversee coordination of all VA G-LHS implementation evaluation activities across projects conducted, including qualitative and quantitative data collection and analysis. Dr. Voora will serve as the project implementation lead for the proposed pharmacogenomics testing program to optimize pharmacotherapy, championing the project to the network and leading it across participating VA sites.
The NIH award will support the VA in bringing its national infrastructure and expertise in genomic medicine to the new LHS network. As part of this initiative, the VA will share its successful strategies for implementing genomic medicine across diverse healthcare systems, including in resource-limited settings. The VA, which serves over 9 million veterans annually, is uniquely positioned as the largest and most diverse learning health system in the U.S. With patients spanning every state and U.S. territory, many veterans live in rural areas classified as Health Professional Shortage Areas (HPSAs), where access to healthcare is limited. The VA also manages a higher prevalence of physical and mental health issues compared to the general population, making it a critical partner in this genomic medicine initiative. Despite these challenges, the VA has consistently delivered high-quality care through its focus on performance measurement and continuous quality improvement (CQI). One of the cornerstones of this success is its robust use of electronic health records (EHRs) and its integration of patient-centered care practices. The VA’s pioneering efforts in implementation science—applying research findings to real-world healthcare settings—have enabled it to create a dynamic system where data is continuously used to improve patient outcomes.
The VA has been a national leader in several areas of clinical genomic medicine, including pharmacogenomics (tailoring drug therapy based on genetic profiles), telegenetics (remote genetic counseling), and precision oncology (using genetic information to guide cancer treatment). Through the VA’s LHS model, genomic innovations are continually evaluated, refined, and shared at both local and national levels, ensuring that successful strategies are scaled to improve care across the entire system.
This collaboration will focus on three key areas:
- Pharmacogenomic Testing: The VA will lead efforts to optimize pharmacotherapy by conducting pharmacogenomic testing to tailor medications based on genetic profiles, reducing adverse drug reactions and improving treatment outcomes.
- Germline Testing for Cancer: The VA will expand the use of germline genetic testing, which identifies inherited mutations that can inform cancer treatment strategies, leading to more personalized and effective care.
- Monogenic Disease Detection: The VA will enhance the use of EHRs to identify patients who may have undiagnosed monogenic diseases (conditions caused by a mutation in a single gene) and provide germline testing to confirm diagnoses and guide treatment.
Another critical component of the project is the recruitment of under-served populations, including veterans living in rural or under-resourced areas. By focusing on these communities, the VA and its partners in the LHS network aim to ensure that genomic medicine becomes more equitable, reaching those who historically may have had limited access to advanced healthcare technologies.
The VA’s involvement in this groundbreaking genomics initiative will have far-reaching effects, both within the veteran community and across the broader U.S. healthcare landscape. As the VA shares its expertise with other clinical sites in the network, it will also gain valuable insights from the collaborative effort. The goal is to continually refine and improve genomic healthcare delivery for veterans, their families, and their communities.
“We are thrilled to be a part of this exciting initiative,” remarked Dr. Orlando. “This initiative underscores the critical role of genomic medicine in the future of healthcare, particularly in improving patient outcomes through data-driven, personalized care strategies.”