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Strategic Framework

Work Group Report

Final

Aug 10, 2016

VUMC Strategy Framework – Design Report I. Scope

Across the lifespan provide all persons with human‐centered, precision care through an open and intentional approach to healthcare innovation.

II. Goals Molecular Goal To better connect the research infrastructure to the larger clinical laboratory in a way that allows rapid translation and application of new discoveries that improve the delivery of care in the clinical environment, and that helps guide for the direction of future research efforts. Individual Goal To build the connections across the entire institution in order to enable our significant discovery efforts and patient care experiences that inform our efforts in designing improved human‐centered individual health and community health management initiatives. Population Goal To build robust and interlinked connections between basic discoveries and applied practices, and between researchers and clinicians with a goal of advancing learning and of improving the quality of our interventions in service of the health for individuals and populations connecting.

III. SWOT (appendix) IV. Key links to other Nodes (Work Groups)

V. Synthesis (2 page maximum to answer all the following questions) What is your work groups’ definition of design node in the strategy framework?

- Our definition of the design node is that it is an intentional, iterative, research‐based, and human‐centered process that makes it possible for VUMC to realize value in the discovery, development, and transfer of knowledge between the research lab, individual, and community. We see it as a mechanism that will enable us to develop and achieve safe, reliable and scalable improvements in individual and population health, enhanced research, and in community care.

Where do we need to be and in what time framework

- The resources and infrastructure required to implement our goals are significant. The development would take the form of three interdependent initiatives addressing the goals of the molecular, individual and population levels of analysis. We propose that a new design‐based approach to these initiatives can feed an ongoing learning‐doing cycle. Ultimately, our goal is the development of a process model for reliably identifying meaningful hypotheses, for testing them in a learning environment, and for guiding the safe and reliable implementation of the insights derived from these inquiry and discovery efforts.

- We also believe that the work of defining and developing the model should be started immediately, specifically by specifying the tri‐directional linkages across the three levels. Over the course of the next six months, investment in the other elements of this approach could already begin to bear fruit. The molecular‐level effort could be launched within 3 months (after defining the swimlanes and resources) with a challenge goal of full implementation within a year of launch. This is achievable because of VUMC’s significant research infrastructure, our research core capabilities, and because of the translational enterprise, VICTR. The integration of the individual goal would follow a similar time line.

- VUMC has had past failures in work synchrony; this has left prior important efforts incomplete and has reduced adversely affected the impact of those efforts. Our group feels strongly that the VUMC strategic plan efforts will need to be fully connected to the VHAN initiatives, and that the planning of the interaction mechanism start immediately. Strong and continuous communication and feedback between VUMC’s PICORi efforts, VHAN, VICTR, VICC, other outreach efforts, and the new PMI initiative are foundational to the goals we have set. Only in this way will we address the weaknesses and threats identified in our SWOT analysis.

Where are we now? - VUMC is situated to move towards the health design goals we have outlined, and as such could

lead the nation in providing true personalized medicine through our efforts at all three levels. The strength we identified in our SWOT analysis suggests that we already have an emerging framework and inventory of skills that can help us achieve these important goals.

- While there are significant weaknesses in organization and resources that will need to be addressed in order to reach our goal (e.g., large gaps exist in the design, build and implementation of medicine 3.0, personalized medicine, pop health), we still believe that VUMC has people, resources, and the social capital through our patient‐base leadership and geography that can be focused (or refocused) towards the development of an inquiry and design process that ensures our ability to be the premier institution driving efforts at personalized medicine at scale for the region and beyond. Given VUMC’s history of health leadership, this is not an unreasonable expectation.

Why invest time, energy and resources now?

- Completion of our larger goal is absolutely critical to the future of VUMC as a health care system and for the health of our region. If the time, energy and resources are not invested now, it will be too late. We do not want to be chasing the innovation of others. Pursuit of these goals will realize the true image and greatness of VUMC. Through this process, we have the VUMC people's’ attention‐ they are waiting to act‐ to move forward into the new phase of existence.

- The threat of competition is greatest by “new entrants”, not legacy healthcare. Look at what Google and Amazon do with “big data” in understanding and predicting consumer behavior. We need to apply this in healthcare.

- Perception is that VUMC in some ways is resting on past successes. But what are we planting as our future successes? It’s time to re‐engage more widely our innovative selves.

- The population is rapidly growing and changing in our city/in our region.

- The best time to plant a tree is 20 years ago… What unmet needs or important gaps in knowledge, practice or health do these goals address?

- We do not know/understand molecular signatures of each individual. We need to get there. Although we are recognized as a leader in precision medicine in the country, we do a very limited job in practice of molecularly characterizing our patient population. We are just taking baby steps at integrating information across VUMC patients and the VHAN network, even those groups that are most closely aligned. We need the resources and personnel to focus on these efforts to make it happen.

- We do little to understand social determinants at a population and individual level as these interact with the molecular to determine impact in population health.

- We need to make good on our promises of precision medicine. There is a least a perceived gap between the promise and the delivery of care.

- When we talk precision medicine, what do we really mean? What do patients, doctors, administrators, payers really want?

- We need to understand the population in our region. - We do not understand our patients’ needs and their barriers to care (transportation status,

housing status, and financial status) as this relates to cost and hospital utilization and ultimately individual and population health.

How do we get there?

- We need to focus and not get distracted by the new shiny object. - Through the development and deployment of organized team(s) of committed VUMC leaders

that are given the time, resources and effort to focus on these goals. We need to engage at all levels and give a voice to every member of VUMC. We need executive leadership commitment to help remove obstacles and provide or reallocate key resources for infrastructure support, lab equipment, expanded IT, and individuals with expertise in education.

- We need outstanding project managers and engineers to assist in designing the strategy, the swim lanes, and the interactive work process that connects with individuals throughout VUMC and the community.

- We need a “platform” for risk managed experimentation and a way to connect efforts across the organization to reduce unnecessary work and enhance productive value

- Understand the growing Nashville population to ensure we are designing systems to meet their growing needs.

How do we enable progress?

- Progress requires a set of tools and infrastructure that supports a cultural change and incorporates a “design process” that includes basic discovery of knowledge and translation to improving health into the “DNA of VUMC”. Our organization should embrace design centric or even design tolerant behavior that support our strategic priorities as an institution.

- We need to create the infrastructure to ensure that VUMC culture is not a barrier to creating and implementing change. There are existing silos within the organization that need to be torn down in order to create a true collaborative effort between operations and research. We need to identify and evaluate our current channels for receiving feedback (from researchers,

patients, and the community) and see if we are really “listening”. We should ensure that “research” has feedback in population needs (i.e. not “pie in the sky” but quantitative research)

What does success look like?

- VUMC is the regional leader in innovative health care beginning with the laboratory and discovery, translation of that discovery into patient care and education, and a healthier population.

- We will have defined ways to measure health outcomes and discovery related advances so we can continually improve and grow from our accomplishments. Our infrastructure will contain a “virtuous cycle” of relating deep insights to the common good.

Strengths

• Previous work (DMT, BioVU, Predict, etc.)

• NIH grant

• VHAN

• ‘Uber’ for nurses (new apps)

• Research/Bioinformatics

• Collaborative environment

• Resident training/education

• Core infrastructure

• Shared/Common footprint with VU

Weakness

• Internal blockers for innovation (Sheryl’s dilemma)

• VUMC Culture and willingness to change – change takes time and diligent focus

• Willingness to take risks

• Discovery v. business operations

• We are not nimble and lack start‐up mindset

• Core infrastructure connectivity and logistics

• Lack of $$$

• Pushing people to do too much in a constrained environment

• Venues for exchanging expertise/knowledge/ideas

• Partnerships‐ We are not good with truly partnering

Opportunities

• EPIC as ‘transactional system’ – more bodies to innovate

• Optimal wellness for all patients – not by socio‐economic status

• Epic network

• VHAN

• Design thinking process‐ “Bringing up design literacy”

• Partnering/ VC infusions

• Information exchanges

• Venues for exchanging expertise/knowledge/ideas

• “Day of Thinking”

• Stronger tie to Center of Global Health

Threats

• Continuum of care

• Payer models

• Outside competitors‐ Google, Walgreens and other niche, non‐legacy based centers that use “Big Data”

• Lack of time in demanding work world

• Technology processes not developing fast enough

From birth to end of life- provide all patients with human-centered, precision, care that allows for an open, innovative healthcare system.

VUMC Strategy Framework – Diversity & Inclusion Report

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I. Scope VUMC embraces the concept of Diversity as an ever‐expanding tent, filled with new members added to expand our cognitive diversity, i.e., broad ideological and intellectual points of view generated by the presence of patients, families, faculty, staff, patients (and their families), and trainees (medical students, nursing students, residents, fellows, etc) of all ages [across the life span], races, ethnic groups, religions, genders, gender identities, sexual orientations, socioeconomic status, veteran status, disabilities, national origin, immigration status, and insurance status & payer. Having citizens of VUMC that represent the spectrum of Diversity is necessary, but not sufficient to deliver on our mission. We must be equally committed to Inclusion to insure person of our varied community has an opportunity to engage VUMC in their appropriate loci such that their combined identities, experiences, education, health literacy, sense of common community, perspectives, and the neuro‐biological basis of learning styles will help us deliver better health care, research, and new forms of treatment to the city, region, country, and world. From this process, Diversity and Inclusion will become an organic central part of our ethos and ALL PEOPLE will feel valued, be part of a nurturing VUMC family, and recognize that we are a better place when we learn from each other and are committed to each other. [When we write ALL PEOPLE we mean the VUMC community (faculty, staff, trainees, and volunteers – clinical and non‐clinical) and all people VUMC touches (e.g. patients, families, etc.).]


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II. Goals Molecular Goal Use our knowledge of molecular diversity to promote the health and understanding of ALL people.

Aspirational examples:

VUMC determines specific susceptibility genes to guide development of effective treatments and better risk identification within ALL people, especially those underrepresented.

VUMC leads on the ethical standards, education, and practice for use of molecular data on diverse populations, with a focus on making intentions clear and overt. (e.g. breaking through fears and low trust from history of eugenics and the Tuskegee Syphilis Study for example)

VUMC discovers complex interactions between genetics & environment across communities (e.g. people from Appalachia are at higher risk for cancer. What part of this is genetics, if any? What part of this is environmental, if any?)

Individual Goal VUMC community values, understands diversity & inclusion, and creates an inclusive patient experience by understanding each patient’s diversity, and personalizing their approach to each encounter. Thus, eliminating health disparities and advancing health equity


All VUMC faculty, staff, and trainees understand patient health literacy diversity,

and apply methods to meet each patient’s health literacy needs. (e.g. ongoing,

sustainable education and tools)

All VUMC faculty, staff, and trainees value diversity and inclusion, understand

cultural competency & diversity, methods for inclusion, and apply methods to serve

each patient based on their unique identity. (e.g. organizational values; ongoing,

sustainable education and tools)

VUMC provides a 24/7 complex care team for patients where the intersection of

their complex conditions and their diversity need a unique, competent team to

facilitate the education, health system navigation, and care coordination. (e.g. 20‐

day new immigrant, speaks no English, just diagnosed with cancer and heart failure

in 2 days)


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Population Goal ALL people serving ALL people well regardless of their personal identity groups, and according to their needs.


The diversity of the VUMC community = the diversity of Nashville’s community.

VUMC is insurance status and payer agnostic.

VUMC accurately and comprehensively collects data to inform discovery and care of

diverse populations.

VUMC eliminates health disparities through interprofessional collaboration,

community collaboration, and advocacy for socio‐political change – thus giving back

to the people we serve.

III. SWOT (appendix)

See appendix IV. Key links to other Nodes (Work Groups)

See key links to other nodes attachment.

Key links to work outside of the Strategic Framework nodes

1. LGBT office of research 2. PMI diversity application

(Consuelo Wilkins) 3. Meharry‐Vanderbilt Alliance. 4. VU/VUMC. Connect to law, ethics, policy 5. Music industry. Bridge to public to get message out regarding research 6. Creation of a Health Disparities Institute 7. New U54 Center for Excellence in Precision Medicine & Population Health (Consuelo

Wilkins)


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Synthesis (2 page maximum to answer all the following questions)

1. What is your work group’s definition of D&I node in the strategy framework?

The D&I node is a key node in that it intersects many, if not all, the other nodes. We know from the

work of Scott Page and other researchers on the value of imbedding and hardwiring D&I into

institutional culture. It is clear that it will bring new ideas to the table such that we will ideate and

innovate better, leading to new approaches to solving problems across all departments and

demographics.

Lastly, by engaging all members of the VUMC Community—family, patients, staff, faculty and

trainees—on the problem creation and definition side, it will bring new synergies and institutional

momentum to carry us to our goals.

2. Where do we need to be and in what time frame?

We need to be at a place where:

a. We are collecting demographic data, including sexual orientation and gender identity on all

patients, which will assist us in addressing health disparities for our URG patients. Time Frame:

Months

b. We need to have formed multidisciplinary teams to address specific health disparities for URG

groups and have a plan on how to address them for all URG patient populations. Time Frame:

Months to a Year

c. In the words of John Rock: "We are training physicians who understand...that your ZIP code is a

better predictor of your health than your genetic code." John A. Rock, M.D. is Dean and Senior

Vice President for Health Affairs at FIU Herbert Wertheim College of Medicine

d. Develop true Community Partnerships and engagement process to build trust and reveal our

commitment to their unique medical and policy needs. Time Frame: 1‐2 Years

e. A fully‐funded, supported Program for LGBTI Health that will allow it to develop it current

programs and new ones to address the striking health disparities in this population by creating

a value‐based population management strategy. Time Frame: Days to Months

3. Where are we now?

We are at the same point as some institutions and behind others. With the announcement of the

new Chief Diversity Officer and this new strategic process, we can build on some of the current

successes, e.g. GME diversity, The Program for LGBTI Health out of the Office for Diversity Affairs,

etc. From these program, we have: 1) Begun to slowly populate our faculty from the talent of our

housestaff; 2) Developed a minority housestaff program that creates a sense of positive climate for

these trainees, such that they assist in recruiting new housestaff and support our URM students; 3)

Developed a national name in our work in diversity with regard to the number of URMs in our

medical school class (from 1:4 to 1:5 in the entering classes). These numbers put us squarely in the

top rank of our peer U.S. News and World Report Top 20 Schools; 4) Our Program for LGBTI Health,


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which has been a national leader in promoting best practices in curriculum development on LGBT

subjects and has served multiple VUMC nursing, staff and clinical departments in the education of

LGBT health.

Finally, with these successes and the and the momentum that will occur after our Strategic

Diversity and Inclusion Plan is enacted, we expect further success and advancement of D&I

throughout VUMC.

4. Why invest time, energy and resources now?

It is clear from the corporate world and other examples that the institutions who will thrive in this

century are those that will embrace D&I early. These are elemental and essential components to

advance an institution like VUMC. With our national and global reach, we need the vision,

perspectives, ideology and energy that diverse groups bring. This is made even more important by

the rapid growth of Nashville and its positioning to become the next International City, after

Atlanta, Georgia.

Furthermore, it is essential that VUMC connect with its surrounding communities. We cannot be

successful without us know the health needs of our growing diverse patient base. In engaging

them, it will inform our research and strategic growth as a medical center.

5. What unmet needs or important gaps in knowledge, practice or health do these goals address?

These goals address unmet needs in the area of (1) patient engagement, (2) provider education,

and (3) clinical services for underrepresented patients.

6. How do we get there?

We must continue our efforts to engage communities, underrepresented and otherwise, in this

work. We must invest in infrastructure to support these programs. We must ensure we have a

culture that embraces diversity and inclusion. This must include visible action from the VUMC

executive leadership team, department chair people, and other institutional leaders.

7. How do we enable progress?

We must remove institutional barriers to inclusion that exist today in the research arena, patient

care arena, and academic arena. We must require demonstrated basic cultural competency for all

VUMC faculty, staff, employees and trainees on an ongoing basis.

8. What does success look like?

VUMC is seen as THE place to go for care in the community. ALL patients, including

underrepresented patients, seek us out. Referring doctors from the community who care for

underrepresented patients seek our consultations and refer to us. Our URG faculty, staff, and

trainees no longer express feelings of isolation. Vanderbilt is recognized as a national leader in

demonstrating continued commitment to diversity and inclusion.


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APPENDIX:

Diversity & Inclusion SWOT Analysis

Diversity & Inclusion Persona (15 y.o./AA)

Diversity & Inclusion Linkages

Diversity & Inclusion Info Diagram


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SWOT ANALYSIS MOLECULAR GOAL

STRENGTHS WEAKNESSES

1. Infrastructure 2. Faculty 3. Reputation

1. No structured link between knowledge of health disparities and research enterprise

2. Work in this field is often dis‐incentivized (money, promotion, publication, etc.)

OPPORTUNITIES THREATS

1. Funding in interdisciplinary work with community partners

2. Educate people on the benefits & history of this work.

3. Internal commitment to lead in health disparities research regardless of external funding availability. For example: Development of population (gender) appropriate scales for interpreting lab measurements.

1. External perceptions & mistrust of research.

2. Lack of supported effort (e.g. NIH funding).


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INDIVIDUAL GOAL


1. Diverse pediatric population 2. Education and training – piloted &

implemented 3. LGBT program & health disparity models 4. Strong clinical department & institutional

respect 5. Networking with peer institutions and

community provider support

1. LGBT Program structure 2. Don’t have a diverse staff 3. No disparities health literacy assessment

Education 4. Financial support 5. No mandatory diversity education

(e.g. unconscious bias & cultural competency training)

6. GME coordination – residency programs are very much siloed.

7. Mentality that this may be an add‐on. 8. Time to train is limited – there is a real

and opportunity cost to training, and it needs to be prioritized.

9. Recruitment of faculty and trainees with disabilities needs to be addressed.


1. Collaborative staff efforts a. Patient‐provider partnerships b. Peer networking

2. Embed cultural competency throughout with emphasis on external regulatory pressures: CMS, Joint Commission.

3. Multidisciplinary work groups to address health disparities.

4. Staff awards and incentives champions

1. Financial fears for uninsured or underinsured

2. Private vs. exclusive perception 3. Time limitations across settings 4. Passing the buck & lack of interest. 5. Majority – Minority exposure 6. Recruit & retention of URM faculty 5. Harsh immigration policies 6. Fear of judgment

a. Stereotype threat b. Who judges and makes decisions.


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POPULATION GOAL


1. Epic implementation brings increased ability for data collection (demographics, social determinate data, etc.)

2. TransBuddy program (navigators) 3. Institutional reputation 4. Community Needs Assessment

implementation plan/structure 5. VHAN (building infrastructure to care for

large population) 6. Some community links already

established

1. Lack of existing knowledge of established work/programs/opportunities

2. Lack of community engagement 3. Need of accurate data banks ‐ Lack

central clearing house 4. Behavioral health

a. Disconnect with behavioral health

b. Lack of resources c. Lack of education at every level

outside of behavioral health 5. Lack of financial support 6. Lack of continuity of care in transitioning

between pediatrics to adult. 7. Navigator for chronic care patients 8. Legal/medical Services for certain

underserved populations with major legal needs.


1. Increase community engagement (health fairs, faith & health)

2. Growing population 3. Education on cultural competency &

unconscious bias (VUMC & VHAN) 4. Develop goals for health disparities by

population groups 5. Closer alliances with clinics involved with

immigrant care

1. Increased demands of growing population

2. Financial pressures 3. Changing political atmosphere 4. Apathy


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VUMC Strategy Framework – Efficacy, Effectiveness & Reliability Report I. Scope

To harness and consistently apply data (big data, genomic and molecular data, patient preferences, clinical data, etc.) to create a novel, exceptional learning/innovation health community that consistently improves every patient’s well‐being and does not miss improvement opportunities. We define a “learning and innovation health community” as a learning system that emphasizes a collaborative approach that builds upon the typical concepts of a “learning health system.” The proposed system emphasizes both learning from existing data and evidence gaps, but also support the importance of novel research and innovation to drive system improvement. The proposed system generates, identifies, and shares data and insights to drive better, more efficient clinical practice and patient care. The system also expands beyond the concept of a typical learning health system, by more robustly engaging and addressing the needs of the local community. This interconnected system in turn can be supported by new methods of clinical research and data analysis and would rely on modern information technology and informatics to manage and communicate data that would help guide the decisions made by health systems, care providers, and patients and their families. There is no consensus around a single definition of well‐being, but we define well‐being as the presence of positive emotions and moods, the absence of negative emotions, satisfaction with life, fulfillment and positive functioning. This includes: physical well‐being, economic well‐being, social well‐being, development and activity, emotional well‐being, psychological well‐being, and life satisfaction.

II. Goals Molecular Goal Expand focus on molecular research, including genetic research that is integrated into the health system and the community. This includes expanding our capture and use of genomic and other molecular information for research and clinical care including genetic research that examines how molecular data leads to well‐being, and Identifies high impact molecular targets to improve well‐being across populations. Individual Goal

Expand the collaboration between research, health system, and the community to perform efficacy studies,

comparative effectiveness research, and pragmatic clinical trials to expand our knowledge about optimal

approaches to care to improve patient, family, and community well‐being, and incorporates systems to assure

these approaches are consistently applied.

Population Goal

Expand the collaboration between research, health system, and the community to perform implementation and

dissemination research, and to disseminate and reliably implement optimal approaches to care that promote

well‐being at the patient, family and community level.

III. SWOT

• Strengths • We like this stuff! Expanding in this area will align with our passions. • We are building on our strengths (infrastructure, genomics, informatics, health services research, etc.)

• We have a collaborative atmosphere and unified leadership between the medical school and the medical center

• We are national leaders in these spaces • Our culture appreciates innovation • We are the major academic medical center in the mid‐South region • The scope of VHAN brings tremendous breadth and opportunity to achieving our goals.

• Weaknesses • Expense/Finances of supporting new goals. • Workforce capacity/resources required to support new goals. • Threats to patient privacy as we expand the use of health data. • Engagement of patients that are not tech‐savvy, low literacy, or less engaged may be challenging. • We need to better integrate research and clinical operations

• Opportunities • To further integrate research and clinical enterprise • To expand engagement with the community • To build more clinical decision support at the point of care • To build more tools for patient reported data, self‐management support and patient communication • We can use this new goal as part of our brand. This can help to support the clinical enterprise, and to

support recruitment of patients, students, trainees, faculty (everyone). • Can lead to the creation of a novel medical technology and analytics center • Can support goals to expand internationally to improve care • Can potentially create a private company that can share tools developed in health analytics/information

technology to promote financial sustainability. • We can expand our training programs in how to optimize the collection and use of health data.

• Threats • We will have competition from other health systems, innovators (ex. Geisinger) in this space. • This is an innovative space that is constantly upgrading. It can be hard for an academic center to keep up

– particularly with industry competitors. • Our expenses may exceed the benefits – particular in the start‐up phase. • Our Faculty/Staff could be recruited away by industry or other Centers as other groups see the value

that our Faculty/Staff have in this space. IV. Key links to other Nodes (Work Groups)

Our group shares key links to the Translation and Learning work groups. Both the Translation and EER work groups strive to capitalize and expand upon the robust information network VUMC has created to further scientific discovery. Both of our groups aim to develop an infrastructure to facilitate new discoveries in both the clinical care and research spaces. We both aim to improve translation by creating systems to assure it is more effective and reliable. Additionally our work group shares a vision with the Learning work group. We both agree that VUMC is a source of learning for the faculty, staff, students, patients, and the community. Our vision is to create bidirectional systems at VUMC that enable faculty and trainees to access our resources will further our mission in clinical care, education, and research.

Synthesis (2 page maximum to answer all the following questions)

What is your work groups’ definition of Efficacy, Effectiveness & Reliability node in the strategy framework? We define efficacy as how an intervention works in the ideal setting. We defined effectiveness as how the intervention works in the “real world” setting. We defined reliability as the consistency over repeated measures or interventions. Although we can currently evaluate efficacy and effectiveness in a lab or in the clinical trial environment, there is a significant gap in the implementation of scientific evidence into health care operations and delivery. Our work group’s definition of efficacy, effectiveness, and reliability focuses on how to use basic and clinical research, implementation science, and innovation to lessen the gap between clinical care, clinical evidence, and patient/community health. In addition to shortening time from discovery to implementation, we seek complete implementation (reliability). Our definition fits in the strategic framework by focusing on systems at VUMC to create bidirectional scientific discovery between research and patient‐well being at the molecular, individual, and population levels.

Where do we need to be and in what time frame? We need to be a place that has fully integrated scientific discovery and evidenced based practices into our care delivery system. We are already creating the tools and infrastructure to be a more robust learning and innovation community. Ideally, over the next 5 years we can create a fully integrated system that can monitor performance and deliberately close gaps. The short time‐frame for this goal is needed in order to develop a health system that can be competitive in the current value‐based reimbursement system that is rapidly evolving.

Where are we now? VUMC is a national leader in education, research and scientific discovery. We have successfully invested in our research enterprise, and those investments have translated to scientific innovation to improve human health. VUMC’s investment in our clinical research infrastructure has created numerous novel research resources. We have created BioVU to allow investigators to access genomic data through BioVU. We have incorporate genetic data with clinically useful guidance into the VUMC Electronic Medical Record through PREDICT. We have created the Research Derivative, a tool for researching identifiable data, and a de‐identified mirror of the Synthetic Derivative to enable investigators to investigators to conduct large scale research projects. We have developed connectivity between health data sources across VHAN, the TN Department of Health, TNcare and other sources. We have conducted pragmatic clinical trials that leverage the strength of our informatics system, and the collaboration between our health system and our research enterprise. We also have significant expertise in clinical and research informatics, genetics, translational research, and health services and implementation research. Additionally we have expanded our shared core facilities enabling investigators to access these resources easily. Although we have made great improvements to our research enterprises, these improvements have, for the most part, occurred outside of clinical operations. There remain significant opportunities to strengthen the connections between the novel methods used for scientific discovery and the consistent, pervasive translation of those discoveries into patient care and community/population health. Why invest time, energy and resources now? It is important to invest time, energy and resources into creating a learning and innovating health care system to continue to improve patient and population health. We need to continue to develop and support the research enterprise while creating systems to integrate our research enterprise into the clinical enterprise. We have the unique opportunity to set a national standard for not only the development of novel scientific discovery but for their translation and embedding into the clinic space – with a particular opportunity to examine how to best leverage genetic and other molecular information to improve patient and population health. This will assure that VUMC remains competitive amongst other institutions with strong research enterprises including industry. Creating this new learning/innovation health system will also be essential for competing in the new health care marketplace that is now focused on value‐based care. Through the MACRA legislation, CMS is placing significant emphasis on the development of Accountable Care Organizations, and merit‐based reimbursement systems that reward systems that can more efficiently and effectively provide evidence‐based preventative and clinical care to improve patient and population health. Private insurance companies, are also developing pay‐for‐

performance and other strategies that transfer more financial risk/benefit to health systems. It is imperative that Vanderbilt and VHAN develop infrastructure and resources that can build a network that can develop high quality care and low cost and deliver a consistent product/process for every patient, every opportunity.

What unmet needs or important gaps in knowledge, practice or health do these goals address? Our work group identified unmet needs and important gaps in knowledge and practice that are addressed through the framework of a learning and innovating health system. We discussed the need to improve the ability for scientific discovery to translate to improved patient care and wellness. We discussed the deficiencies in the quantity, quality and application of evidenced based practices. We discussed the need to use technology at the bed‐side to inform practices at point‐of‐care and to track patient data to ensure continuity of care. We discussed the need to collect more data from patients, including genomic/molecular data, patient reported data (social determinants), and physiologic data that could be used to drive research and clinical care. We also discussed the need to have monitoring, reporting and notification systems in place to track and manage the effectiveness of practices. Finally we need to create a method to disseminate and share results amongst members of VUMC and the community at large.

How do we get there? To create a novel learning and innovation health community we need to engage stakeholders in the clinical, research, and education enterprises and create novel informatics tools to integrate research into clinical care. First we need to engage key stakeholders. Stakeholders include faculty and staff in clinic care that are interested in improving care delivery at VUMC for patients. It also includes investigators interested in furthering scientific discovery. Additionally we need to engage health systems leaders and decision making who support creating a system to improve patient care through learning and discovery. Finally we need to engage patients to learn about their needs and perspectives as patient, family member and caregivers. We need active collaboration between these four groups to create a culture of teamwork that is committed to continuously support learning and adapting as a key aim. Second we need to improve our biomedical informatics infrastructure to support technologies that incorporate evidence based practices into clinical and administrative decision making support at the point of care. We need to create a technology system capable of tracking and reporting project metrics and costs for evaluation purposes. We need to create a system for disseminating findings to our Vanderbilt community and beyond, and ultimately to both assure adoption and to learn from instances where application is incorrect. Third, we need to recruit the right faculty and staff to help support this mission. This includes additional personnel with training in informatics, molecular and genomic sciences, pragmatic clinical research, comparative effectiveness research, data analytics, social and behavioral health, health services research, implementation research, and community and public health. How do we enable progress? Enabling progress will require: 1) cultural commitment from leadership (Executive Faculty, Clinical Operations, etc.) to support a shared vision of creating a more synergistic learning/innovation health system to improve patient‐wellness, 2) expansion of infrastructure to support informatics and other technologies as noted above, 3) financial support to recruit additional faculty and staff as noted above, 4) financial support to build infrastructure and perform initial innovation research and implementation studies that lead to improved health care delivery and outcomes.

What does success look like? The successful implementation of the learning and innovation health community will create systems that make practitioners enthusiastically leverage scientific knowledge to evaluate their decision at the point‐of‐care. The system will promote bidirectional discovery that results in practitioners’ ability to adapt their practice on the basis of scientifically valid evidence. It will include a system to collect data and analyze results to evaluate current and proposed practices and initiatives. It will include a mechanism to disseminate results to providers across the institution and the community to improve care and health for everyone.

Design

Design care and evaluation base on evidence generated here and elsewhere. Include engagement

from the community.

Implement

Apply the plan in pilot and control settings. Perform pilot

research (efficacy)

Evaluate

Perform research and implementation studies. Collect data and analyze results to show what does and does not work in broader settings (effectiveness)

Adjust

Use evidence to influence continual improvement

Monitor

Monitor project adherence and performance (reliability)

Scale

Disseminate and embed across the network and community (reliability)

Learning and Innovation Health Community

Improved Well‐Being

Well‐Being

Population

Individual

Molecule

VUMC Strategy Framework – Engagement Report I. Scope

Establish actionable goals that will help Vanderbilt engage internal and external

parties to help better the lives of patients, colleagues and the community.

II. Goals

Molecular Aspiration

Vanderbilt employees and patients passionately serve as ambassadors for health*,

actively improving their health & the health of their communities**.

Definition Expansion:

* Envisioning “health” broad enough to cover topics such as: research, research trials

** Networks/communities in their broadest sense, including everything from friends and social

circles to professional organizations and colleagues (like investigators and scientists)

Individual Aspiration

Vanderbilt enables patients and healthcare professionals to easily find and connect

with the appropriate level of care and the right healthcare professionals at any point

in a person’s health and life.

Population Aspiration

Vanderbilt is the nation’s model system for engaging patients, families and

caregivers in decision making and in supportive and/or preventative care (ex:

activities of daily living) across the continuum of life. III. SWOT (appendix)

Please see our “Engagement team aspirations FINAL” PowerPoint slides IV. Key links to other Nodes (Work Groups)

Feedback from the Patient Family Advisory Council meeting on Tuesday 7/12 that

relates to our Engagement aspirations:

PATIENT EXPERIENCE TEAM

Committee member (CM): what about transition of care? From adult hospital to

home? This relates to our Population Goal

CM: good experience is when someone educates the patient and makes them the

driver of their care This relates to our Population Goal

CM: integration within the system: a lot of patients don’t know “I can go here at

Vanderbilt, or I can go here at Vanderbilt” This relates to our Population Goal and

Individual Goal

LEARNING TEAM

CM: needs to be age appropriate

CM: needs to be learning-style appropriate, everyone learns differently

CM: never assume someone knows something. Sometimes they’re afraid to ask

These comments relate to our Population Goal

V. Synthesis (2 page maximum to answer all the following questions)

What is your work groups’ definition of [work group name] node in the strategy framework?

Engagement is an interaction for mutual benefit that involves commitment, loyalty,

passion and/or emotional connection that is friendly, collegial and respectful. It can

also include a collaboration between diverse groups to work together to achieve a

common goal.

Where do we need to be and in what time frame?

Within a year, we should figure out the resources needed for prototyping all areas in

play. Near the end of the year, we should be actively prototyping and reiterating

the ideas. By year 2, we should be scaling ideas across our networks and outside of

VUMC. By year 4, we should be scaling ideas across the nation.

Where are we now?

This is addressed in our Strengths and Weaknesses on our PowerPoint slides.


We have confirmation from nine groups that these are important places for

Vanderbilt to move into. Key themes from our feedback surveys (over 70

respondents) and the Patient, Children’s and Psych Councils (50-60 attendants) were

incorporated into further revision of our goals. We had passionate feedback. Please

see our supporting documents for details.

What unmet needs or important gaps in knowledge, practice or health do these goals address?

This is addressed in our Opportunities and Threats on our PowerPoint slides.


1. Is more discovery and research needed?

2. What current programs can we leverage as proof of concept?

3. Expand these proofs and/or prototypes to test groups or the next level.

4. Scale it across the network.

5. Scale it across the country.


Align priorities and incentives with organizational parts that are needed to support

specific aspects of the work. Then implement a good feedback loop on progress on

specific goals.


Success is having established an atmosphere and supporting processes/platforms

that inspire people to want to work, learn, receive care and/or health knowledge,

and participate in discovery across Vanderbilt and all its related entities.

Engagement

• Scope of Work: establish actionable goals that will help Vanderbilt engage internal and external parties to help better the lives of patients, colleagues and the community.

• Definition: engagement is an interaction for mutual benefit that involves commitment, loyalty, passion and/or emotional connection that is friendly, collegial and respectful. It can also include a collaboration between diverse groups to work together to achieve a common goal.

• Overarching aspiration: create an atmosphere and supporting processes/platforms that inspire people to want to work, learn, receive care and/or health knowledge, and participate in discovery across Vanderbilt and all its related entities.


Vanderbilt is the nation’s model system for engaging patients, families and caregivers in decision making and in supportive and/or preventative care across the continuum of life.

STRENGTHS

• Biomedical Informatics

• Precision Medicine Grant

• MHAV provides on-demand, 2-way communication

• Marketing staff/team

• Patient-Family Advisory Council

• Pockets of care coordinators linking across services

WEAKNESSES

• Patients can’t understand what we’re talking about or don’t know how to prioritize the decisions to be made

• Patients may be afraid to ask Qs or not know how to ask doctors Qs

• Physicians don’t always give an ansewr that is informative, respectful or satisfying to the patient

• Time and insurance keeps staff from “educating” that patient/family

• Residents are an important part of the MD/PhD decision making. Many are not adequately supported across specialties



OPPORTUNITIES

• DECISION MAKING• Create written patient-facing information on common/priority conditions to: raise knowledge among patients & families, engage patients in

thinking about care & treatment options, instill & motivate patients to act on their own behalf

• Methods: On-brand internet toools/monographs. Social media outreach. Link with community events.

• Challenge: Who wants this? Also, each of these products takes time, expertise to develop & keep updated

• Add human coordinator? Another option: avatar coordinator

• Natural trends towards greater shared decision making

• Used qualified patient advocates to help patients understand what Qs they should ask

• PRECISION MEDICINE • Use Precision Medicine for payor negotiations

• Getting the right care quicker through Precision Medicine

• Intersection of personalized medicine with shared decision making

• VHAN can ensure “voices” heard broadly



THREATS

• Infrastructure cost

• Are others already doing this?

• Fear of using a patient advocate to talk to another patient

• Start ups/apps can help me make better health decisions without going to the doctor (ex: Omada Health for pre-diabetes, One Drop for diabetes)




Vanderbilt employees and patients passionately serve as ambassadors for health*, actively improving their health and the health of their communities**.

Definition Expansion:

* Envisioning “health” broad enough to cover topics such as: research, research trials** Networks/communities in their broadest sense, including everything from friends and social circles to professional organizations and colleagues (like investigators and scientists)

STRENGTHS

• SOCIAL MEDIA• My Southern Health = shareable “viral” health-related content

• Have robust social platforms/knowledge

• CULTURE• Collegial atmosphere = tradition of working across cultures

• Everybody has same shared mission & can articulate it

• Huge diverse workforce with multiple communities

• Employees take pride in being part of a great organization

WEAKNESSES

• Diversity & Inclusion Office only covers Children’s Hospital

• Hard work gets more hard work – pay levels are not based on C = C model

• Internal politics sometimes demotivates people/staff

• Unprofessional interactions reinforce silos

• Decreasing “protected time” for participation in non-billable activities such as national committee service (see “Engage & incentivize” faculty & staff to participate)



OPPORTUNITIES part I

• COMMUNITY• People are more influenced by friends/people they know than by orgs

• People have more ways to connect with their networks bc of technology

• Connect all aspects of mission to a common thread – new linkages

• SCIENCE & INNOVATION• Opportunity to have great basic science researchers to feel “at home” in

new home

• Increase diversity of population new ways of thinking

• Connections with healthcare business community

• Capitalize on existing & growing networks of multi-site research collaborations: CDRNs-DCORI, trial innovation network/center, CMS clinical transformation, personalized medicine collaborations

• Encourage & incentivize more faculty to participate in high level committees/processes shaping medicine: IOM committes, NIH study sections, Moonshot for Cancer, business partnerships: ex, partnering w VHVAN to study the effects of incentives to making shared money savings across a network

OPPORTUNITIES part II

Sub-goals of this aspiration include:

• Every employee knows the overall mission & sees their role in the bigger picture. Are able to recite the 3 main priority goals of the medical center

• Employees become the ”go to” source for regular engagement with the business community for research in science and in health business practices. Includes communities such as scientists

• Non-direct patient care staff turnover rates are the lowest in the southeast



THREATS

• Growing diversity of US populations – forces us out of our “mold”

• Other competitors reaching out to our target audience

• Breadth of Nashville healthcare, some with own agenda




Vanderbilt enables patients and healthcare professionals to easily find and connect with the appropriate level of care and the right healthcare professionals at any point in a person’s health and life.

STRENGTHS

• EDUCATION & PROGRAMS• We have excellent individual

physicians & programs

• We have the power to teach “best practices”

• NETWORK• Vanderbilt sometimes gives me

options of who to see if my doctor is busy

• We have built VHAN

WEAKNESSES

• ACCESS• Access points are not coordinated as should be. Individual staff doesn’t know how to navigate

• People start out in the highest level of care vs the right level of care

• MHAV is slightly more convenient than the call center, but both are slow. Online appointment booking is best option so far, but still requires follow up calls/emails. Get something like StyleSeat?

• Current systems seem clunky

• CARE COORDINATION & DIRECTION• We don’t know what specialties we want people to go to outside of Vanderbilt

• ER becomes a referral center = bad medicine!

• Admins can’t book appointments in openings because software reserves that opening for specific types of appointments

• There is little effort to coordinate care between departments/divisions. Patients are left to navigate on their own

• Vanderbilt is so large, I often get sent in circles as an employee and a patient



OPPORTUNITIES part I

• Physicians want/desire to have complex patients taken care of at VUMC

• CRM tools

• Opportunity dovetails with suggestion to create patient-facing engagement tools (from #1): in this case, the target is a layer audience of patients & providers in large referral networks like VHAN, MAN, etc

• Right patient in the right place saves appointments saves payors money

OPPORTUNITIES part II

Sub-goals include:

• Build easy (inviting) transparent systems for patient referralsand for patient entry into the Vanderbilt system.

• Regional PCPs become VUMC/network advocates

• Patient referral system provides easy access and complete follow up

• It’s clear at the network level what to send out and to who

• CMEs: alumni have access to virtual ground rounds (real-time and archived). This lifelong learning opportunity familiarizes alumni with our specialists



THREATS

• Complex referral patients may be $$ losers for the system

• Patients who are able to pay for care have many options, including leaving state for MD Anderson, MSKCC, etc

• Others will do this if we don’t

• “Networks” are closing fast with ACA



1

VUMC Strategy Framework – Entrepreneurship Report I. Scope

The scope of the committee is to apply entrepreneurial principles to support and advance opportunities utilizing our core competencies to create new revenue and brand recognition opportunities for the medical center. This can be achieved in three ways – reinforcing a culture of entrepreneurship in which employees have the ability to pioneer truly innovative product; devising new business models in healthcare; and exploring and adopting novel disruptive solutions developed in the community. II. Goals

Create a culture and climate in which those few, who do wish to pursue entrepreneurial initiatives/activities, are encouraged by institutional policy and incentives to do so, with bureaucratic restraints removed to the maximum degree possible. III. SWOT (appendix) IV. Key links to other Nodes (Work Groups)

o Design o Fundamental Discovery o Translation


What is your work groups’ definition of [work group name] node in the strategy framework?

Reciting Harvard Business School’s definition, “the pursuit of novel opportunity beyond resources controlled.” Many profit improvement opportunities are not novel, and therefore not entrepreneurial. Entrepreneurship is synonymous with risk taking, but the risk is a considered risk, not an uncalculated risk. Further, entrepreneurs have a sense of urgency that is uncommon in established companies – time is money to an entrepreneur.

Where do we need to be and in what time frame? The following are some high level milestone steps that could be accomplished within the next 12 months. These are basic milestones to which a lot of detail could be added:

o Identify and consult with other organizations as to what has made them successful in creating a pro‐entrepreneurial environment o Take those learnings to a group of leaders / advisors within VUMC with the specific goals of determining how to operationalize within VUMC culture o Assign an executive leader who will be responsible / accountable for leading the development of policies and culture development. Enable the leader to create a development skunkworks so that it is not hindered by legacy institutional thinking and processes o Promote an environment where it is safe if an idea fails – this is often the biggest barrier to people coming forward with ideas o Create a panel of specific industry experts who can be paired with entrepreneurs based on the type of potential business / offering / invention

2

o Set aside designated funds to support entrepreneurs in the development of ideas into potential business models o Enable internal entrepreneurs to partner with external experts in order to refine the specific business / offering / invention o Align incentives for students, staff and faculty

o Identify one or two ideas to use as pilots of the new process o Test, monitor and refine based on results

Where are we now? o Bureaucratically stilted

Why invest time, energy and resources now? o Creates new business/revenue opportunities o Would allow growth and depth for institutional goals o Would increase employee satisfaction, retention, and recruitment

What unmet needs or important gaps in knowledge, practice or health do these goals address? o Lack of connectivity to local entrepreneurs and TN healthcare startups. o People do not know the rules, policies, expectations, or what is permissible

How do we get there? o Coordination o Education o Investment o Cultural change o Barrier reduction

How do we enable progress? o Expand resources, local partnerships, investors, entrepreneurs, and capital o Make policies transparent and entrepreneur‐friendly o Incentives

What does success look like? o TN external medical impact committee (external advisory committee) o VUMC dedicated new entity/skunkworks with mission to coordinate and leverage all pockets of

assets throughout VUMC and VU o Revised policy book o Entrepreneur of the year award/celebration (perhaps along with innovator of the year) o Being recognized nationally as a center that encourages and allows for entrepreneurial risk taking

(i.e. UPMC, Stanford, etc.) o VUMC creates an annual contest where people come forward with ideas and inventions o Judges could be both internal Vanderbilt experts as well as a panel of industry experts and venture

capitalists

3

o Winners in various categories (technology, services, etc.) are funded and paired with their respective industry experts to develop the idea / product into a true business

o Once commercialized, VUMC, the entrepreneur and the provider of the investment capital share in the ownership rights

o By making it an annual competition you can promote the idea, get industry leaders engaged (which leads to all kinds of other opportunities for VUMC) and you create a spirit of competition that has its own innovative culture

WorkGroup:Entrepreneurship

Date:07/22/2016

Positive Negative

Strengths Weaknesses1.Historyofmoleculardiscovery:VICB,Proteonomics,Drugs

1.Culturenotentrepreneurial

2.Topratedbasicsciencedepartment:Pharmacology,Cancer,Biophysics

2.Servicesbycontract

3.IntegratedcampusinProximity 3.Poorcommunicationbetweennodes4.PREDICT 4.Lackofawareness5.Biobanking 5.Incentivesnotalignedwithentrepreneurialspirit6.Brandrecognition 6.Lowrisktolerance7.CTTC/VHS/Verticals/CTSA 7.Promotionbarriers8.SharedCoreinfrastructure/uniqueportfolio 8.MinimalVCrelations

9.Differentiatingskillsets9.Cultural&practicalbarrierstocollaboratingwithindustry

10.Significantregionalinfluence 10.Inadequatephilanthropyfocustobeentrepreneurial

11.No/lowcompetitioninregion 11.Lackofexpertiseinpophealthtranslation

12.Enablenovelusers

13.Public‐privatepartnershipsventurebroad

Opportunities Threats1.Expertise 1.VUMCis"bestinallthings"mindset2.IPandentrepreneurshiprich 2.Highcapitalinvestmentcost3.Increasephilanthropy(Local/national) 3.Non‐traditionalcompetition‐Googleventures4.VHAN 4.VU‐VUMCseparation5.Skunkworks 5.Inertia

6.Maintainingsalarywhileseekingentrepreneurialideasoutsidethecompany.

7.Workingwithsmallbusinesseslocally8.Partnershipswithlocalentrepreneurs,localinvestors,andInnovationCenter9.Developaproofofconceptfund

Goal Types: Molecule, Individual, Populations

SWOTAnalysis

Goal:Createacultureandclimateinwhichthosefewwhodowishtopursueentrepreneurialinitiatives/activities,areencouragedbyinstitutionalpolicyandincentivestodoso,withbureaucraticrestraintsremovedtothemaximumdegreepossible.

Entrepreneurship 1

GOAL:

Create a culture and climate in which those few, who do wish to pursue entrepreneurial initiatives/activities, are encouraged by institutional policy and

incentives to do so, with bureaucratic restraints removed to the maximum degree possible.

Strategy: Populations

Expand resources, local partnerships, investors, entrepreneurs, and capital

Strategy: Molecule

Make policies transparent and entrepreneur-friendly

Strategy: Individual

Incentives

Tactic

TN External medical impact committee (external advisory

committee)

Tactic

VUMC Dedicated new skunkworks with

mission to coordinate all pockets of assets

throughout VU and VUMC

Tactic

Revise policy regarding

entrepreneurship

Tactic

Entrepreneurship and Innovator of the year

awards

Tactic

Create CTSA-like platform for

Entrepreneurs

Tactic

Change Promotion Criteria

Tactic

Change Compensation Model

VUMC Strategy Framework – Fundamental Discovery Report I. Scope The process of understanding the basis of biology and human health at the molecular, individual and population levels – how things work. VUMC should be a model for enabling basic science in a medical center environment. Threats include:

Basic scientists may leave VUMC. We may not be able to retain and recruit faculty basic scientists in VUMC departments

Converting faculty evaluation to solely money vs. impact.

Devaluing contribution to basic science education Demo projects:

Establish a unified basic science academic entity, with no distinction regarding basic science investigators and trainees at VUMC vs. VU

Creation of VUMC basic scientist pilot project program

II. Goals

Molecular Goal Scope: Discovering the molecular basis of biological function. How molecules work. Goal: Understanding and targeting the components and dynamics of cellular machines.

Individual Goal Scope: To provide the conceptual framework for understanding an individual as a system, which implies the ability to practice precision medicine. How bodies work. Goal: Using Vanderbilt’s strengths in precision medicine for fundamental discovery. Connecting knowledge of molecules and cells to their roles in individual humans.

Population Goal Scope: To provide the conceptual framework for understanding groups of individuals that form a system. How populations work. Precision therapeutics ‐ Immunomodulation idea ‐ Precision immunology Goal: Developing the computational and analytical infrastructure to enable quantifying the effect of environmental influences on heterogeneity of biological response. Why populations differ.


Transfer target discovery to Translation

IP and technology transfer to Entrepreneurship

Patient Care & Experience Gap: Can fundamental discovery provide information to patients? How do patients learn about the molecular basis of their disease, or contribute to fundamental discovery?

o Identifying highly motivated research subjects who want to engage in fundamental discovery efforts.

Patient Care & Experience: outreach to patients, understanding the contributions they are making to fundamental discovery.

Partner with Diversity & Inclusion to develop communications, outreach and understanding across patient populations that are a resource for clinical research.

Learning: trainees at all levels of cutting edge approaches to biomedicine o Grad students in basic sciences benefit greatly from time spent in clinics, clinical labs

Precision Medicine & Computational Biology heavily driven by Technology – rapid rate of change.

Coordinate with Translation group to establish integrated tissue resource.

V. Synthesis (2 page maximum to answer all the following questions) What is your work group’s definition of Fundamental Discovery node in the strategy framework? Fundamental discovery is the study of how things work. This type of activity is not compelled to achieve translation; but it does set up the entire medical center to translate new knowledge into actionable processes. Not limited to laboratory based, molecular studies, also encompasses population, behavioral, implementation and other sciences. However, there is a subset of fundamental discovery scientists who are laboratory‐based whose work forms a foundation for understanding mechanistic basis of many areas of biomedical endeavor. Where do we need to be and in what time frame? Within a year, FD should be integrated into VUMC as a highest priority. This will be what distinguishes us from other regional or national healthcare powerhouses that are focused only on clinical care delivery. We aspire to be an internationally unique leading institution in discovering how things work, a model for a medical center that supports basic scientists and translates our own discoveries to improved health and healthcare globally. Where are we now? We are a top tier academic medical center, with a substantial base of fundamental discovery. There are tremendous opportunities for VUMC to lead fundamental discovery in the context of translational medicine. However, we are in this state of flux. Numerous domino effects of the separation have the potential to negatively impacting the logistics of implementing fundamental discovery research at VUMC.

Administrative leadership of the broad area of fundamental discovery at VUMC needs to be better defined, and information propagated as soon as possible. The central role of fundamental discovery in the overall medical center mission needs to be fully affirmed or otherwise clarified. Why invest time, energy and resources now? E2E restructuring and expansion of the Vanderbilt footprint across VHAN enhances financial sustainability and allows access to extremely large patient populations that could enhance our research mission. Against this backdrop, the separation of VUMC from VU has left us at a critical juncture academically. Stability and forward vision that recognizes the long term value of fundamental discovery and its integral importance to VUMC must be prioritized. What unmet needs or important gaps in knowledge, practice or health do these goals address? Discovering the molecular basis of biological function. How molecules work. To provide the conceptual framework for understanding an individual as a system, which implies the ability to practice precision medicine. How bodies work. To provide the conceptual framework for understanding groups of individuals that form a system. How populations work. Precision medicine is obviously a major part of fundamental discovery present and future, but the full return on our investment in personalized medicine to date is still unrealized. We have the foundation and infrastructure, but have not yet harvested the connections that are needed in fundamental discovery to create improvements in health and healthcare, and have only about a 2‐3 year window to do so. A large opportunity is to use fundamental discovery specifically for development of new approaches to precision therapeutics. For example, nearly half of the drugs in the pharmaceutical pipeline are biologics, especially monoclonal antibodies, which will revolutionize treatment in the cancer, autoimmunity and infectious diseases fields. The potential impact of enhancing the fundamental discovery environment for coherent collaborative areas in therapeutics such as precision immunology is enormous. Such efforts also enhance and require support from other strategic areas, like the VUMC entrepreneurship milieu. The threat of basic scientists leaving VUMC because of confusion or lack of clarity about whether the medical center brands itself more as a care provider than academic discovery unit is a critical and immediate concern. Leading scientists don’t think of themselves as a natural part of a “hospital”, they want to thrive in a discovery institution. Implementing integrated plans to achieve discovery goals will be central to preventing loss of key faculty members in the basic sciences. How do we get there? Re‐establish the School of Medicine as a unified research and education entity, with integrated administrative, science, educational processes that do not distinguish between VU and VUMC basic scientists and trainees. This may require a collaborative new entity (Institute or Foundation) as part of the VU and VUMC organization chart. How do we enable progress?

Retention and recruitment of basic scientists and trainees. Basic scientists in VU and VUMC have the same metrics, resources, and are treated the same. No advantage for being in one or other institution. Integration of fundamental discovery objectives into every aspect of the medical center and VHAN. What does success look like? Major new fundamental discoveries of international impact are made each year, and some of those are translated into actionable processes to improve health and healthcare delivery. Targets of Opportunity

Design of an integrated tissue banking resource for fundamental scientists at VUMC o BioBanking ‐ live human tissue, blood, CSF, etc. (cross reference Translation wkgrp) o Leveraged by: CHTN, BioVU DNA, TPSR o Need: Universal consent, core facility

Convenient interface and resource the concierge service for BioVU, a dashboard. Everybody should be able to access – metric would be breadth of projects.

Enhance EM‐based structural biology Microbiome studies

Become the model for medical centers that support basic scientists. o Create a tenure track basic scientist track, with potential for uniform expectations of

support, and with evaluations that are performed by peers across the university campus (other basic scientists), in which metrics are based primarily on scientific impact and training/teaching successes.

Existing Demo Projects Molecule

Single cell molecular biology, using molecular, cellular and systems imaging. Examples include: o Nikon Center of Excellence o Flow Cytometry Core o VANTAGE o TIPs – Crowe, Meiler, Spiller and Ohi: Hybrid methods for structural biology (next

generation vaccines) Individual

Discovery of individual molecular biomarkers. o Proteome, metabolome, epigenome o Caprioli DARPA project: Identifying molecular fingerprints of compounds that would be

reporters across population. o Aligns with analytical infrastructure goal.

Population

Nancy Cox – Mega/BioVU project

Work Group: Fundamental Discovery

Goal: Molecule

Date: 7/22/16

Overall: Areas of excellence: Resources and technologies: Overall: Areas of excellence: Resources and technologies:

Immuno‐biology

Microbiology and Infectious Disea

Cancer

Metabolism HTS at many levels

Cell Biology Centers: VICC, DRTC, etc

Neuroscience,

Neurodegeneration, Brain

disorders

Chemical Biology

Drug Discovery

Structural Biology


VU‐VUMC transition Epigenetics VU‐VUMC transition

Antibiotic resistance

Cancer $$ Basic scientistis may leave

VUMC. We may not be able to

retain and recruit faculty basic

scientists in VUMC departments

Neurodegenerative Disease Converting faculty evaluation to

solely money vs. impact.

Need to enhance EM‐based

structural biology

DARPA funding

Devaluing contrubition to basic

science education

Support for entrepreneurial

culture

Private money resources

interested in shifting from care

to biotechnology (visionary

philanthropists)

Demo project would enable

short timeframe success to

attract resources, longer term

investment

Emerging structural biology EM

and hybrid techniques

STRENGTHS

OPPORTUNITIES

Positive Negative

WEAKNESSES

THREATS

Flexible responsive organization,

considering size and scope

Molecular probes: broader than

pharmacology; disease

molecules vs. normal

dysregulated e.g. proto‐

oncogenes

Core systems aging and

expensive, big science overall

weak (a few experts, but not

many users)Lack of concierge type services,

need to lower activation energy

(enable novice users)

Bringing institutional thought

resources

Supporting emerging science

leaders (mid‐career)


Goal: Individual

Date: 7/22/16


Culture that accepts research

and clinic being closely aligned ‐

highly integrated and collegial

interface between basic sci and

Cancer Deep Phenotyping

Access to large pateint populations

across VHAN

HTS of patient samples

Cellular Signaling

Developmental Individuation PDXs


Microbiology & Immunology Google, Venter, Broad, Other

resources at a scale that could

trump our efforts

Microbiome VU‐VUMC split

Integration of patient care and

research activities is an

unrealized dream

Epigenomics

Antibiotic Resistance, e.g. CARB

Cancer $$

Individual access to

fundamental, molecular

knowledge

Optimal integration of BioVU into

FunD – unrealized dream

Reinvestment in cores, model for

lowering costs and barriers to

usingLack of centralized tissue

biobanking

Metabolism (Obesity and

Diabetes)

Model Systems and Systems

Physiology

Lack of precise, rigorous clinical

deep phenotyping

Positive Negative



Lack facilities for microbiome

research


Goal: Population

Date: 7/22/16


Huge patient network and global

cohort access; ages, geography,

socio‐economic

Impressive amount of core

infrastructure available to apply

to the problem

Global Health

Pre‐term birth


Trans‐generational effects Nashville racial diversity is

different than national trends,

demographics

Fetal origins of adult disease

Messaging to diverse subject

populations regarding

opportunities to participate in

research

Population behavior

Create new forum for

translational researchers and

fundamental discovery scientists

Every patient is a research

subject, with opportunity to

access knowledge derived from

their data

Addition of phenotyping data,

could be BioVU, or incubators to

develop tools.

Segregation of fundamental

discovery researchers from

translational research and

clinical care delivery, resulting in

gaps in communication and lack

of idea exchange

Subject populations not yet as

diverse as they should be

Expand the diversity of use of

subject populatoins, not just

local/regional, but global

Exposing patients to their

contributions to BioVU

Quantifying the effect of

environmental influences on

disease

Positive Negative



Not just epidemiology, but also

mouse models

Heterogeneity of mechanisms

(gender/aging/race)

Cancer, gene X environment

interactions

Physics

Chemistry

Biology

Engineering BiomedicalEngineering

Molecular &Cell Biology

MicrobialBiology

Biochemistry

Biophysics

Medical Biology and Physiology

Biology of Health & Pathogenesis of disease

Biomedical targets for intervention

Development of drugs, devices & interventions

ClinicalResearch

ClinicalPractice

Public Policy

Fundamental Discovery

Neuroscience

Environment or behavior Molecular effectsImmunology

Genetics

VUMC Strategy Framework – Learning Work Group Report I. Scope

VUMC will create an ecosystem of learning that is rich for discovery and exploration, invites exchange of thoughts and ideas, is multi‐dimensional and multidirectional, leverages the ways in which we all interact and strengthens our value in learning. Learning is a complex dynamic process of acquiring the knowledge, skills, attitudes, habits and behaviors that result in improved performance within many cognitive, procedural, interpersonal and systems‐level domains. It is a social and collaborative process undertaken by individuals, teams and organizations and often happens organically in the context of the workplace. The ultimate goal of learning in health care should be constant improvement of health, alleviation of illness and mitigation of suffering of the individuals and communities that we serve.

II. Goals Molecular Goal To elucidate the interactions between the basic science of learning and the environmental, behavioral, health and social factors, and to leverage this knowledge in order to enhance our learning environment and effectiveness of our programs. Individual Goal Every individual who works, learns, collaborates or receives care at VUMC and its network will have the opportunity and individualized resources to optimize health, learning and livelihood across the lifespan. Population Goal VUMC will create an engaging and collaborative ecosystem for learning about health and disease for diverse populations, including providers, community members, patients and caregivers, so that the communities we serve will thrive.


While learning links to everything we do as an institution, and serves as the glue that binds all parts of the institution together, we feel that there are important links to other work groups as depicted in the diagram. We must recruit and nurture a diverse group of learners and create a learning environment that is welcoming and inclusive for all. Realization of our aspirations will require that all stakeholders are engaged. Becoming a learning health system will require a rich technology infrastructure as well as the capabilities described by the EER work group. Finally, our molecular goal will require collaboration with the basic discover group.


What is your work groups’ definition of [work group name] node in the strategy framework? Similar to a physiological nodal reaction, the learning node in the strategy framework is the fundamental intersection of knowledge and people that accelerates propagation of change in behavior and performance.

Learning is a complex and dynamic process of acquiring the knowledge, skills, attitudes, habits and behaviors that result in improved performance within many cognitive, procedural, interpersonal and systems‐level domains. It is a social and collaborative process undertaken by individuals, teams and organizations and often happens organically in the context of the workplace. The ultimate goal of learning in health care should be constant improvement of health, alleviation of illness and mitigation of suffering of the individuals and communities that we serve.

Where do we need to be and in what time frame? Within three years, VUMC should be a hub of multi‐directional and collaborative learning for all of its stakeholders and for the growing region that it serves. It should be able to track educational discovery, delivery, uptake and impact at the molecule, population, and individual level.

Where are we now?

VUMC currently has many strengths when it comes to resources for learning, although there is much opportunity for strategic growth and improvement. For example, VUMC has many strengths in learning at the molecular level, with a strong foundation existing through the Brain Institute, the Educational Neurosciences Program, and other programs at the Kennedy Center and Peabody. At the individual level, VU and VUMC have strong medical and nursing education programs, although this learning is more focused on disease than on health and well‐being. We have a strong foundation for patient learning through the efforts of Terrell Smith and Lane Styles, and also through My Health at Vanderbilt. At the population level, VU/VUMC has a strong reputation for excellence in learning and service, although we would benefit from strong community partnerships and in some corners a lingering mistrust about motives and intentions persists.

Why invest time, energy and resources now? It is important to invest time, energy and resources now because the engagement of all learners could make VUMC an exemplar of continuously improving value‐based care that is patient centered and precise. If we unable to constantly learn from what we are doing and from our patients, we cannot improve. We cannot attain the IHI Triple Aim of improving patient experience of care, the health of populations and a reduction in the per capita cost of health care without robust and coordinated learning programs and without a system‐level capacity to learn.

What unmet needs or important gaps in knowledge, practice or health do these goals address? The aspirations created for the Learning Work Group address many unmet needs in practice and learning at the molecular, individual and population levels. The SWOT analysis process allowed the work groups to identify gaps. Examples of gaps include: time and monetary investment, lack of focus on learning about health (currently there is more focus on learning about disease), lack of trust from patients and communities (i.e.: “What is the motive?), and the need for development of a culture that supports value‐based education and values lifelong learning and personal development.

How do we get there? One idea discussed by our group is the creation of a model similar the Crowdsourcing Innovation Model used by GE (http://www.ge.com/about‐us/openinnovation). A micro‐grant program aimed at developing solutions to existing learning challenges could be offered to staff of VUMC and community members. Micro‐grants could even offer time to staff rather than money. For example, rather than being awarded a dollar amount to develop an idea, a nurse could be “funded” with a set amount of hours per week to work on an idea. In order to ensure progress, a rapid‐cycle process could be set‐up. The individual would submit deliverables on a weekly basis, until the end of the funding period. By using a Crowdsourcing model, the micro‐grant program could utilize the ecosystem to produce best in class results. This and other processes that engage and empower individuals and groups toward the development of a learning ecosystem could become a cornerstone of our culture.

Another idea is the creation of a real and/or virtual VUMC Institute for Continuous Lifelong Professional Development. Any individual, team or organization that interfaces with VU/VUMC would have coaching opportunities that help them identify gaps in competencies as well as aspirational next steps. The VUMC Institute would provide a variety of learning resources that would enable individuals, teams and organizations to reach their goals.

How do we enable progress? In order to enable progress for these learning initiatives, it is imperative to engage and empower learners, educators and researchers with resources and incentives at all three levels. It is also fundamentally important to ensure that learning is an indispensable component of our culture, and this is evident among all individuals and at all levels across the system.

What does success look like? Success in learning is achieving the aspirations at the molecule, individual, and population levels. Success is understanding the complex biological, behavioral and social interactions that facilitate or impeded learning, and applying that knowledge in improving all of our learning initiatives. Success is creating in a culture where learning is an essential component of our brand. Success is in our ability to create and sustain a collaborative ecosystem of learning that is rich for discovery and exploration, invites exchange of thoughts and ideas, is multi‐dimensional and multidirectional, leverages the ways in which we all interact and strengthens our value in learning. Success is becoming a learning health system.

Strengths Weaknesses

•Kennedy Center

•Peabody School •Lack of translational science in this area

•VU Educational Neuroscience Program

Opportunities Threats

•This could become a philanthropic focus

•Build on the foundation of the Educational

Neurosciences program and expand the

focus

•Other funding and resource opportunities

Learning Work Group: Molecular SWOT Analysis

•Expertise in the science of related topics

(genetics, learning/memory, stress)

•Foundational Neurosciences strengths ‐

the Brain Institute

•Research into the basic science of learning

is not as well developed as other research

areas

•We have a stronger focus on disease states

than on health and well being


•My Health at Vandy platform


•Lack of time

•Apathy/burnout

•Change fatigue

•Genuinely valuing learning

•Lack of trust

•"Embracing technology vs. embracing the

question"

Learning Work Group: Individual SWOT Analysis

•Patient and Family Councils: actively share

learning experiences

•Outstanding quality of VU and VUMC

educational programs

•Quality of our learners: VUSN, VUSM

students and post‐graduate trainees

•Foundation of individualized learning in

Curriculum 2.0

•Cutting edge learning technologies in the

form of VSTAR and CELA

•Individual focus as opposed to team focus

may be too strong

•Translation (i.e.: implementing optimal

learning approaches for a variety of

individual learning styles)

•The working‐learning environment does

not always support or allow time for

individual or team learning

•Fragmented and uncoordinated learning

programs

•Lack of adequate teaching and learning

space, both in terms of quality and quantity

•Further enhance our use of educational

technology

•Lack of investment: time and monetary

investment

•Individualize resources that are responsive

to customer (learning) needs (vs. provider

needs)

•Increase and improve bi‐directional

communications related to health learning

•Increased focus on learning about well‐

being

•Create "value‐based education" that

demonstrates improved outcomes in

learning or patient health

•Create an ecosystem of collaborative

learning that attracts students, patients,

community members and employees

•Develop expert educators and educational

designers who employ effective educational

innovations


•Reputation of VU/VUMC

•The developing network (VHAN)


•VHAN outreach opportunities

•Build, expand and develop new

community partnerships

Learning Work Group: Population SWOT Analysis

•Emerging leaders within population health,

research and education

•Great strength across multiple disciplines

in the university related to social, economic

and behavioral determinants of health

•Referring providers' perception of VUMC as

elitist, arrogant or self‐serving

•Lack of robust community partnerships to

disseminate and learn from

•Priorities (i.e.: residents serving superiors vs.

patients, families and communities

•Expand reach of learning communities

regardless of affiliation with VUMC to

elevate health across the region

•Competition with other academic and non‐

academic health systems

•Competing messages about health and health

practices (e.g.: vaccinations and the internet)

•Credibility of VUMC as being self‐serving vs.

genuinely concerned about communities

•Lack of trust ‐ groups may not trust the center

or programs (i.e.: "What's the motive?")

•Lack of respect (i.e.: referring physician might

perceive "attitude" from attending and may

not feel like part of the VUMC group

•VUMC physicians increasingly serve and

engage with community physicians

•Development of learning ecosystem (as in

individual SWOT)

•Opportunity to become a super‐regional

center for learning about health and illness

•Increase communication, transparency

and involvement of stakeholders

•Potential to undertake multi‐disciplinary

studies of the healthy, ideal society

VUMC Strategy Framework – Patient Care and Experience Report I. Scope

VUMC will improve the health and well‐being of our patients and their families, now and into the future, across the continuum from preventive to end‐of‐life care, and through this, influence the health of our region, and beyond. Thoughts: We conceptually considered the ‘patient’ from the vantage point of a ‘zoom microscope.’ That is to say our patients are not just the patients we currently have in our panels but need to reflect a greater population (defined narrowly as current referral base to more broadly as statewide to even more broadly SE regional to national to international). In addition we started with the premise that we are not just considering the patients of today but looking toward future patients and different expectations of delivery of healthcare. We agreed as a working premise that ‘care’ applied to ALL aspects of a person’s care: not just what we deliver in the moment but across a continuum, not just a single disease but overall health and well‐being, and not just of the individual but the support team of that individual inclusive of community partners. We agreed as a working premise that ‘experience’ referred to all aspects of a person as they engage with VUMC—communication, attention to medical, cultural and spiritual needs of the person as they engage with us and that we needed to also consider patients as learners, research participants.

II. Goals Molecular Goal To broaden and deepen the impact of discovery programs and to improve care across the region, we need to expand biomarker development, broaden biomarker testing, and link biomarkers to prevention and disease management, as well as enhance our expertise in neuro‐degenerative diseases, immunology, tissue engineering, and regenerative medicine. Individual Goal VUMC is committed to providing integrated and compassionate care to each patient and family, in a timely and efficient manner, sensitive to individual physical and environmental characteristics. Population Goal Leverage VUMC and VHAN resources ‐‐discovery, training, information sharing, and extensive partnerships‐‐to understand, prioritize, and improve the health of our community and region.


IV. Key links to other Nodes (Work Groups) (see added notes on diagram in attachment)


What is your work groups’ definition of Patient Care & Experience node in the strategy framework? We believe we are central yet in a dynamic partnership with all other nodes, with some nodes directly facilitating success in our goals and others informing and catalyzing direction and improvements in health care delivery.

Where do we need to be and in what time frame? In 3‐5 years, be able to have broader access through expanded availability of our resources—thinking of this as going beyond ‘patients come to us’ and transitioning to ‘Vanderbilt comes to you.’ This is both a ‘physical’ and ‘philosophical’ approach. Potential tactics to facilitate this include but are not limited to enhanced access to the education portfolio, research protocols, clinical pathways, employment of trainees regionally and shared access to the latest technology.

Where are we now? While attracting volume due to our brand, expertise, and access to state of the art treatments, there are significant challenges in access to care, coordination of care, preventative care and improvement of community health and well‐being. We have proven success in our ability to collaborate on campus, but have not transferred that knowledge externally.

Why invest time, energy and resources now? We believe we are missing opportunities now to enhance the health and well‐being of our patients. We believe there is significant local, regional, and national competition in this space –

for patient care and funding‐‐yet we also believe we have the right building blocks to do something great in this space. While a bit cliché, here were some of our comments to this question:

If not now, then when?

‘Because tomorrow. now will be yesterday’

‘If you’re standing still, you’re moving backwards’

What unmet needs or important gaps in knowledge, practice or health do these goals address? They address all the needs and gaps mentioned in the goals (ex: biomarkers, access, information sharing).

How do we get there? We cannot approach these goals by doing more of the same. While VUMC success is substantive, we need to start thinking differently and making profound decisions about our priorities and how we effectively use our resources including partnerships external to VUMC/VHAN to change the way we deliver care.

How do we enable progress? We believe progress in this area will require greater leveraging of the ‘secret sauce’ of Vanderbilt culture: collaboration internally and with existing partners but also the development of collaborative relationships and partnerships external to the organization.

What does success look like? For people to want VUMC to come to them. Providing access to VUMC –being able to reach people, get an answer, and have problems solved. To become frictionless (ex: Amazon purchasing and returns process) Always deliver on every patient, every time. Improved health score card locally, statewide, regionally

WorkGroup:PatientCare&Experience

Date:06/27/2016

Positive Negative

Strengths Weaknesses1.BioVu(250,000DNA) 1.Limitedbiomarkerexpertise

2.Syntheticderivatives(over3million) 2.Lackofexpertiseinpopulationhealth

3.PREDICT 3.Lackofevidenceandimplementationinbiomarkerandprevention

4.Humangeneticsversushumangenomics 4.Cost(people,resources,space)

5.Coreinproteomics 5.Lackofreimbursement

6.MyCancerGenome‐compendiumofgeneticmarkersforcancer 6.Limitedongoingactivity

7.Expertiseinearlycancerdetection 7.Limitedongoingbasicandclinicalstemcellresearch

8.Abilitytolinkgenomicstobesttherapiesandclinicaltrials

9.Cancerandheartepidemiologygroups

10.PrecisionMedicineInitiativeCohortProgram

11.Meharry‐TSUMinorityInstituteCancerCenterPartnership

12.Pharmacogenetics

13.VUSchoolofEngineering/NewDean

14.KennedyCenterandBrainInstitute

Opportunities Threats1.VHAN/Meharry 1.Epic‐limitedcapabilitiesaschallengeto#8strength

2.Epic‐toconnectwithotheruserstoinfluencehealthofregion/beyond

2.Potentialformisuse(compromiseemployabilityandinsurability)

3.ExpandeduseofBioVUandsyntheticderivative 3.Developmentandtestingaretimeconsuming

4.Reducehospitalization,LOS,drugcomplications/rightdrugforrightdiseaseforrightpatient

4.Expensiveandfundinguncertainty

5.Precisionmedicine 5.Repealofaffordablecareact

6.Reducedcostwithpreventativecare 6.peerinstitutions:VUMCbehind(e.g.Upennintissue,HopkinsandHarvardinneuroscience)

7.Maintainleadershipinprecisionmedicine 7.CompetingscientificprioritieswithinVUMC

8.UseMeharry‐TSU‐VUMCpartnershiptoaddressminoritydisparities9.OpportunitytoenhancecollaborationwithVUSchoolofEngineering


SWOTAnalysis

Goal(Type*andDescription):Molecule:1.Tobroadenanddeepentheimpactofdiscoveryprogramsandtoimprovecareacrosstheregion,weneedtoexpandbiomarkerdevelopment,broadenbiomarkertesting,andlinkbiomarkerstopreventionanddiseasemanagement,andtoenhanceourexpertiseinneuro‐degenerativediseases,immunology,tissueengineering,andregenerativemedicine.


Date:07/05/2016

Positive Negative

Strengths Weaknesses1.Clinicalexcellence 1.Deficientinprimarycare

2.Breadthofexpertise 2.Inadequateandaginginfrastructurethatcannothandledemand

3.Infrastructuretoidentifypersonalmolecularcharacteristics 3.Lackofbehavioralhealthservices

4.Oneintegratedpractice 4.MultipleinsuranceplanswhichVUMCisnotinnetwork

5.Onemedicalrecord 5.Poorreferralinfrastructure(internalandexternal)

6.PatientandFamilyAdvisoryCouncilforeachentity 6.Lackofaneasywaytoseehowpatientflowsthroughoursystem(norealtimefeaturesofpatientcareacrossproviders)

7.Patientportal 7.Lackoftimeandmoney

8.Demandforservices 8.Lackofstaffeducationonshareddecisionmakingandcompassionatecare

9.Residencyprogramfornurses 9.Lackofrecognitionofandfocusonnon‐revenuegeneratingservices

10.Employedphysicians 10.Turnoverofnurses

11.OvercrowdedERandhospital

12.Largemedicalcenter‐donotknowcolleagues

Opportunities Threats1.Socialmediapresence 1.Capital

2.CarecoordinationwithinVUMCandexternalnetwork 2.Conventionalcompetitionandalternativesourcesofcaretakingpatientsandworkforce

3.Focusonprevention 3.ShortageofRNs,CPs,LPNs

4.Epic(reportingstructureandpersonalcharacteristicstoguidecare)

4.Millennialprovidersaremorewillingtoswitchjobs

5.Poorhealthofregion

6.UseofexistingdatabasestolinkEMRwithindividualcharacteristics7.Nursingschooltotrainnurses

8.Partnershipwithnetworktotrainrecentgrads

9.Nurseretention

10.Havinga"captainoftheship"tocoordinatecare

11.Patientengagementandcommunicationwithnursesforpatienteducation


SWOTAnalysis

Goal(Type*andDescription):Individual:VUMCiscommittedtoprovidingintegratedandcompassionatecaretoeachpatientandfamily,inatimelyandefficientmanner,sensitivetoindividualphysicalandenvironmentalcharacteristics.


Date:07/14/2016

Positive Negative

Strengths Weaknesses1.NetworkofVanderbiltrelationships 1.Poorhealthofregion

2.Learningsfromcommunityhealthneedsassessment 2.Lackofintegrationofhealthinformationsystems

3.Ourbrand(andregionalpresence) 3.Lackofaccesstocare

4.Cancerepidemiologyprogram 4.Lackofplanofcommunityintegration(partnershipsarenotcoordinatedorexplicit)

5.Meharry/VanderbiltAlliance 5.Affiliationwithpartnershipsisnotalwaysatruepartnership

6.MinorityInstitution/CancerCenterPartnership

7.InstituteofGlobalHealth

8.VUMCSchoolofNursing(largeNPprogram)

Opportunities Threats1.Betterinformpatientsandcommunityaboutgenomicmedicine 1.Alternativemodesofcare(retailmedicine,virtualvisits)

2.Betterinformpatientsandcommunityofbenefitsofhealthylifestyle

2.Politicalenvironmentisnotconducivetochannelingresourcestounderserved

3.LeveragelearningsfromVanderbilthealthplanacrossregion 3.LackofMedicaidexpansion

4.Epidemiologyandpreventativehealth 4.Competingprioritiesandabilitytofocus

5.Leveragealternativeproviders(NPs)forprimarycare

6.Alternativemodesofcare(retailmedicine,virtualvisits)

7.DevelopadultequivalentofCumberlandPediatricFoundationtohelpaddresseducationandprioritieswithcommunity‐basedproviders


SWOTAnalysis

Goal(Type*andDescription):Population:LeverageVUMCandVHANresources‐‐discovery,training,informationsharing,andextensivepartnerships‐‐tounderstand,prioritize,andimprovethehealthofourcommunityandregion.

The Patient Care and Experience Workgroup believes that the output from our group connects with all other workgroups in a bidirectional manner, with some groups being more of a catalyst enabling/enhancing all other interconnections (such as Technology and Design), with some groups forming a loop of interchange to drive progress forward (the interfaces between Fundamental Discovery, Translation and Patient Care/Experience) and remaining groups optimizing overall care delivery across the healthcare system as it relates to individuals and populations. From the vantage of an academic medical center/healthcare system, all of these groups are foundationally supported by and inform learning across all domains.

1

Appendix: Patient Narrative CHIEF COMPLAINT: SUDDEN ONSET OF A PROLONGED RAPID HEART RHYTHM CURRENT NARRATIVE OF CARE A: Patient calls MD’s Office for an appointment (which occurs after the symptoms are gone). An ECG is done, biomarkers are assessed, and a 30 day Event Monitor is ordered. If the monitor is diagnostic, therapy is initiated based on both the identified arrhythmia and the relevance of the patient’s biomarkers. If the monitor is non‐diagnostic and the symptoms recur, a Tilt Table study is done, an EP study is done and /or an implantable loop recorder is inserted. B: Patient goes to ED or ambulatory walk‐in setting while symptoms are present. An ECG is done and biomarkers are assessed. If the ECG is diagnostic, therapy is initiated based on both the identified arrhythmia and the relevance of the patient’s biomarkers. If the ECG is non‐diagnostic, an appointment with a specialist may be scheduled. FUTURE NARRATRIVE OF CARE Patient uses his/her smartphone or tablet app to record the heart rhythm then consults a provider via telemedicine access. If the recording is diagnostic, therapy is initiated based on the identified arrhythmia and the patient is referred to a local ambulatory site for biomarker assessment and fulfillment of prescription medication. A live follow‐up visit is schedule at the convenience of the patient with subsequent tele‐visits as needed. If the recording is non‐diagnostic, the patient is scheduled for a live visit with a specialist MD at the patient’s convenience.

VUMC Strategy Framework – Technology Report I. Scope

To develop and implement state‐of‐the‐art technologies to enhance discovery and improve health of individuals and populations.

II. Goals

Molecular Goal VUMC will develop and implement state‐of‐the‐art technologies to accelerate the discovery of disease mechanisms and novel diagnostics and therapies. Rationale: Clinical diseases reflect biological changes that have molecular origins. Our understanding of fundamental biological processes, their detection and assessment, and their subsequent manipulation by different therapeutic approaches have relied ever‐increasingly on the development and introduction of new technologies, themselves catalyzed by progress in diverse fields such as molecular biology, materials science and computing. Clinical medicine and medical research rely on advanced tools for molecular recognition, the analysis of molecular structure, the detection of molecular transformations and the design of molecular agents whether they are drugs to treat or probes to detect. These determine our abilities, for example, to diagnose diseases from human samples, to identify genes, to design and target drugs and to measure therapeutic response. At VUMC we currently operate state‐of‐the‐art facilities, often housed within Core Resources, that enable relatively easy access to current technologies. One specific goal should be to ensure this level of investment in hardware and personnel is maintained in order to ensure continued success in molecular medicine. But a further goal is to aspire to bring along the next generation of technologies that will push the limits further ‐ bringing greater sensitivity and precision to molecular diagnostics, enabling more widespread and less expensive testing e.g. of genotype, and to provide the technological basis for new discoveries in how diseases originate, evolve and may be treated. This should involve a greater emphasis on being at the vanguard of technological development rather than just an early consumer, necessitating a change in culture from user to inventor and requiring investment in applied science and engineering, early stage adoption and entrepreneurial development of new inventions. Furthermore, we need to ensure our healthcare system embraces fully the opportunities afforded by convergence of biomedicine with the physical and engineering sciences.

Individual Goal VUMC will develop and support the use of state‐of‐the‐art technologies to empower individuals and caregivers to achieve improved wellness and personalized care.

Rationale: Healthcare should embrace more than treating diseases and sick patients and must move towards preventive and pre‐emptive medicine to maintain health and reduce risk of illness. Further, visits to hospitals or care facilities should not be the first interactions of individuals with care providers. Cost effectiveness can be increased with the use of new technologies to monitor, advise, and deliver care to individuals at a distance. There should be an emphasis on technological innovations to facilitate these goals, including telemedicine, mobile technologies and point of care diagnostics. Patients will require counseling and education to accept a revised model of caregiver‐patient interactions but will be empowered to take greater participation in their health maintenance. The information provided and medical decisions made for the individual may be based on population‐derived knowledge, modified by the specific phenotypic and genotypic data from the given individual. Moreover, once a significant illness arises, outcomes can be improved using advanced technologies capable of more accurate and specific diagnoses (for instance, via the use of molecular biomarkers and advanced imaging) and better targeted therapies. Population Goal VUMC will implement the widespread use of technologies for patient monitoring, point‐of‐care delivery and patient‐provider interactions that improve health and provide population‐based information.

Rationale: VUMC should develop and implement technologies to facilitate the delivery of care to the broad populations that it serves. The goals of this care include better health in the community, enhanced quality of life, and improved distribution of care, with a particular focus on reaching under‐served populations. From a technological perspective, VUMC has a particular opportunity to improve population health with its existing strengths in bioinformatics, health IT, and health services innovation. These strengths can serve as a foundation for expanded and more effective use of remote monitoring, point‐of‐care testing, and telemedicine, to name a few examples. To achieve these goals, VUMC must overcome barriers posed by fiscal constraints on large‐scale technological investment, challenging geography, and traditional payment models. On the other hand, successful attainment of these objectives will allow VUMC to solidify and expand its reputation as a national leader in population medicine.


See Appendix A

IV. Key links to other Nodes (Work Groups)

Entrepreneurship Translation Diversity and Inclusion

Learning


What is your work groups’ definition of Technology node in the strategy framework? The dictionary defines technology as the use of science to invent useful things or solve problems and includes the application of scientific knowledge for practical purposes. We adopt this broad definition as it pertains to healthcare, the adoption of healthy lifestyles, and the diagnosis and management of patients.

Where do we need to be and in what time frame? We currently operate state‐of‐the‐art facilities, often housed within Core Resources, that enable relatively easy access to current technologies. One specific near‐term goal should be to ensure that this level of investment in hardware and personnel is maintained in order to ensure continued success. This will require significant resources over the next 2‐5 years. A longer term goal (5‐10 years) is to bring along the next generation of technologies that will push the limits further ‐ bringing greater sensitivity and precision to molecular diagnostics, enabling more widespread and less expensive testing e.g. of genotype, and to provide the technological basis for new discoveries in how diseases originate, evolve and may be treated. This should involve a greater emphasis on being at the vanguard of technological development rather than just an early consumer, necessitating a change in culture from user to inventor and requiring investment in applied science and engineering, early stage adoption and entrepreneurial development of new inventions. Furthermore, we need to ensure that our healthcare system embraces fully the opportunities afforded by convergence of biomedicine with the physical and engineering sciences. Cost effectiveness of healthcare can be increased with the use of new technologies to monitor, advise, and deliver care to individuals at a distance. The relevant technologies are rapidly developing, and we see their potential impact within 2‐5 years. There should be an emphasis on technological innovations to facilitate these goals, including telemedicine, mobile technologies and point of care diagnostics. The information provided and medical decisions made for the individual may be based on population‐derived knowledge, modified by the specific phenotypic and genotypic data from the given individual. Moreover, once a significant illness arises, outcomes can be improved using advanced technologies capable of more accurate and specific diagnoses (for instance, via the use of molecular biomarkers and advanced imaging) and better targeted therapies. From a technological perspective, VUMC has a particular opportunity to improve population health with its existing strengths in bioinformatics, health IT, and health services innovation. Moreover, these opportunities will expand as VHAN grows, and with the commercialization of

patient‐based informatics developed at Vanderbilt. We see this as having significant impact in the next 5‐10 years.

Where are we now? At VUMC, we currently operate state‐of‐the‐art facilities, often housed within Core Resources, that enable relatively easy access to current technologies. VUMC has a strong tradition and basis for pioneering advanced diagnostics, treatments, and personalized medicine. VUMC also has existing strengths in bioinformatics, health IT, and health services innovation. These are further expanded in our SWOT analyses.

Why invest time, energy and resources now? The current pace of technological developments coupled with the changing nature of healthcare delivery demand that VUMC devotes substantial investment of time, energy and resources to stay at the forefront of biomedicine.

What unmet needs or important gaps in knowledge, practice or health do these goals address? Our molecular goals address challenges to fundamental discovery that would enable new knowledge to answer questions such as the “12 Provocative Questions” posed by the director of the NCI. Our individual goal addresses current limitations in the use and availability of technology to advance wellness and precision care. Our population goal would integrate technology and data to enable the synthesis of new information that can be broadly applied to improve the health of populations.

How do we get there? / How do we enable progress? We need a greater emphasis on being at the vanguard of technological development rather than just an early consumer, necessitating a change in culture from user to inventor and requiring investment in applied science and engineering, early stage adoption and entrepreneurial development of new inventions. Furthermore, we need to ensure our healthcare system embraces fully the opportunities afforded by convergence of biomedicine with the physical and engineering sciences. We need to deploy new technologies to monitor, advise, and deliver care to individuals at a distance. There should be an emphasis on technological innovations to facilitate these goals, including telemedicine, mobile technologies and point of care diagnostics. Patients will require counseling and education to accept a revised model of caregiver‐patient interactions but will be empowered to take greater participation in their health maintenance.

VUMC must overcome barriers posed by fiscal constraints on large‐scale technological investment, challenging geography, and traditional payment models.

What does success look like? Technology will have facilitated achievement of each of the goals of the other nine working groups and will have impacted all aspects of the VUMC strategic plan. VUMC will be recognized as an international leader in the deployment of advanced biomedical technologies. Patients will have greater access and connectivity to VUMC with improvement in measurable health outcomes. Major industry leaders, the government, and foundations will want to partner with VUMC in the further implementation of advanced technologies.

APPENDIX A: SWOT Analysis of Goals Molecular Goal: VUMC will develop and implement state‐of‐the‐art technologies to accelerate the discovery of disease mechanisms and novel diagnostics and therapies. Strengths: 1. History of successful investment in molecular discovery, e.g. VICB, Drug Discovery, Structural Biology, Proteomics 2. Top rated basic science departments at a medical center – pharmacology, cancer biology, molecular physiology and biophysics 3. Integrated campus with proximity to professional schools (e.g., Owen School of Business) Weaknesses: 1. Lack of proximity and/or close relationships to industry 2. Cultural and practical barriers to collaborating with industry (e.g., risk averse legal culture) 3. Decreasing efforts at VUMC in supporting fundamental technological developments: little effort in e.g. VUSE; little activity in applied biomarker development, etc. 4. Inability to attract top‐tier technological innovators 5. Inadequate philanthropy and lack of access to investment 6. Traditional academic model might not align with developing new technologies Opportunities: 1. Greater leverage of basic science discoveries to enable rapid translation to clinical applications 2. NIH funding disease‐based focus 3. Expand intellectual property and entrepreneurship 4. Expand programs in fundamental technological discovery 5. Unify efforts in diagnostic biomarkers at molecular level – who talks to each other? (Center for biomarker discovery?) 6. Increase philanthropy and investment opportunities (local and national) Threats: 1. Overall declining NIH funding over time and increasingly conservative awards 2. Upfront cost plus major capital investments age quickly as technology progresses; high capital investment costs, need for continuous investment 3. Industry has ability to scale up quickly. Industrial efforts move more quickly? Driven by intellectual property considerations 4. Competitive technologies

Individual Goal: VUMC will develop and support the use of state‐of‐the‐art technologies to empower individuals and caregivers to achieve improved wellness and personalized care. Strengths: 1. Reputation for delivering personalized care. 2. Access to and ability to mine large amounts of patient data (Bioinformatics, BioVU, EMR) 3. High patient volume 4. Experience with implementing advanced Health IT 5. Vanderbilt Institute for Global Health 6. Experience with clinical trials for drugs Weaknesses 1. Culture of treating patients when ill rather than culture of wellness. 2. Unwelcoming atmosphere – access to providers, unfriendly staff 3. High patient volume 4. Lack of people and support for developing and/or considering mobile/wearable technology 5. Lack of outreach 6. Slow pace of implementation (legal barriers, bureaucracy, conflict of interest policies) 7. Conservative mindset 8. Little experience with clinical trials for technology 9. Siloed environment (technology requires inter‐disciplinary teams) Opportunities 1. NIH Precision Medicine Initiative Cohort Program 2. Vanderbilt alumni are developing technologies 3. New sources of funding (federal, non‐federal) 4. New EMR 5. VHAN 6. Prevalence of certain diseases lend themselves to intervention Threats 1. New EMR (Third‐party application) 2. Current reimbursement model and payment reform (push to cost containment reduces certainty of optimal outcomes) 3. Competition (healthcare institutions, private companies) 4. Reliance on technology could result in inferior healthcare (reduce patient‐doctor relationship) 5. Access to internet and/or cellular networks in rural areas

Population Goal: VUMC will implement the widespread use of technologies for patient monitoring, point‐of‐care delivery and patient‐provider interactions that improve health and provide population‐based information.

Strengths: 1. Informatics department and health IT 2. Reputation for excellent care enables dissemination and leverage 3. Institute for Medicine and Public Health 4. Potential to scale from pilot to full network (VHAN) Weaknesses: 1. Financial constraints on large‐scale investment in technology 2. Underdeveloped telemedicine 3. Silos 4. Geography and population density Opportunities: 1. Industry 2. Telemedicine 3. Enable mobile technologies 4. Other funding sources (e.g., CMS, PCORI) 5. Potential for new reimbursement models 6. Successfully serve rural communities (VHAN, telemedicine) Threats: 1. Focus on this could reduce other clinical revenues 2. Local competition (e.g., HCA, Sarah Cannon) 3. Current reimbursement models

Infographic

Zoom in on “Individual” sphere from Comprehensive Infographic above

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VUMC Strategy Framework – Translation Report

I. Scope

To provide a framework for enhancing and prioritizing development of a robust culture and infrastructure for translating novel molecular discoveries to populations in a way that optimizes health for individuals. This may encompass:

● Enhance and operationalize informatics expertise

● Enhance systems for EHR data mining, linked to biobanking

● Facilitate acquisition and redistribution of viable human cells and tissues linked to human phenotypes for research purposes

● Enhance interactions between basic and clinical sciences

● Enhance training of translationalists

● Translate discovery to new therapies

● Make translational research as seamless as possible between basic scientists, clinicians, and interested participants (cases and controls)

● Enhance bi-directional flow of information among Molecule, Individual, and Population making data available to investigators, clinicians, and patients

II. Goals

Molecular Goal

Discover molecular basis for variation in disease susceptibility, disease progression, and drug response and translate discoveries to novel therapies.

● Develop a robust, integrated information network

o Facilitate access to reagents (clinical data, DNA/cell/tissue banks, model animals)

o Enhance productivity (connecting people and interpreting experimental output)--”pushing” information to individuals, not solely relying on individuals knowing where to go for information

o In a way that reduces healthcare disparities to improve the health of the entire population (increasing diversity in populations studied facilitates discovery)

● Translate molecule/basic discovery to cellular, whole organ and whole organism levels to improve current therapies and develop new ones

● Facilitate acquisition and redistribution of human samples for research purposes

o Systematic collection and storage of viable human tissues and cellular samples (normal and disease-associated) from multiple organs that can be used for discovery, such as:

● Enhanced stem cell capabilities: e.g. PBMCs in large numbers of consented subjects with EHRs

● Optimize storage methods for recovery of viable tissues tied to robust phenotyping of the donor

● Organoid development

o Enhanced GCRC capabilities: Maintain basic support; Consider not only a physical space for research protocols but also capabilities in sample collection/study conduct in difficult environments


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● Enhance systems/tools for EHR data mining, linked to biobanking

● Develop a reward structure to incentivize clinicians to collect data.

Individual Goal

Link individuals to information and resources that promote wellness, enable early identification of disease, and foster personalized interventions.

● Expand biobanking to diversify patient populations and sample types, and that foster longitudinal sampling of individual patients

● Link and integrate existing Big Data repositories, and develop tools to make data mining easy to non-informaticians (e.g. clinicians etc.)

● Develop tools for matching basic scientists with clinicians and/or patients (exceptional or poor responders) - Matchmaker

● Make myhealth@vanderbilt more interactive, empowering patients to use their own data to identify resources and information to improve their own health, and thus helping patients feel like “partners” rather than “subjects” in research.

Population Goal

Acquire and integrate multiple data types across populations to drive discovery and translate those discoveries to promote individual health.


● Develop a platform that would integrate “omic” data with PubMed to rapidly drive collaborations locally/nationally/internationally to validate new data sets and drive discovery.

o Matchmaker to formally search for and suggest potential basic-clinical partnerships

● Translate unusual patient phenotypes (e.g. extraordinary/elite drug responders; serious adverse effects; extreme longevity) into fundamental mechanisms of disease

o Develop a community research advisory council (with representation across the healthcare network) to suggest, prioritize and recommend research agendas.

o Engage patient/disease advocacy groups.


IV. Key links to other Nodes (Work Groups)

● Design: data mining systems, informatics in the service of discovery

● Diversity & Inclusion: Increasing diversity in populations studied is the right thing to do, but it also facilitates discovery. For example, in model organisms variants severe in one genetic background can be benign in another, and that applies to humans as well. Interesting rare variants may occur only in some populations.

● Efficacy, Effectiveness, & Reliability: needed as discovery is translated to implementation

● Engagement: Patients, patient advocates, philanthropists as partners

● Entrepreneurship: Deploying new therapies; Commercialization of discovery.

● Fundamental Discovery: A key partner (the key partner) in propelling discovery from population resources.

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● Learning: critical need for developing and deploying training curricula for translation: Big Data management/analysis, issues in EHR research, contemporary issues in genomic discovery and implementation, ethics, etc

● Patient Care & Experience: Enhancing the patient experience encourages patients as research partners

● Technology: data mining systems, informatics in the service of discovery, deploying new technologies in the service of translational discovery

V. Synthesis

What is your work groups’ definition of Translation node in the strategy framework?

The Translation node seeks to facilitate generating discoveries and moving them efficiently from novel therapeutic applications to pre-clinical validation through clinical trials, to engage patients at multiple steps and ultimately improve the health of the population. As such, it is fed by the Fundamental Discovery node and enabled by Technology and Entrepreneur nodes, and ultimately will hand off new therapies to the Patient Care & Engagement node.

Where do we need to be and in what time frame?

Building on current strengths and our perception of needs for the basic, translational, and clinical communities, the priority investments in the next 5 years include

1. Modify the legal and operational structure to enable full patient engagement and acquisition of multiple sample types

2. Need for data mining and analysis tools, including access, analysis, and training

3. Executing the “Patients like this one” project

4. Need for deep phenotyping capabilities including expanded/redefined GCRC capabilities

5. Developing workable solutions to the problem of integrating Big Data sets

Where are we now?

We are leaders in a number of areas (e.g. precision medicine, bioinformatics, and translational medicine) but don’t have sufficient depth and resources to enable them to spawn the kind of dominance in healthcare that is desired, nor to do so in a sustainable way. Need to identify critical areas for investment and develop critical mass and thus leadership in those areas.


Basic research and the ability to use large datasets for discovery are evolving at an incredible pace. There is an obvious gap between discovery and application to humans, which is likely to increase in the next several years. This represents an unprecedented opportunity for us to fill. We want to be proactive and ahead of other institutions who think and act similar to us.

Investment in the information systems and data/sample resources described will enable us to attract research participants beyond our region (nationally, internationally), accelerating new therapies through implementation, and enhancing our reputation for discovery.

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What unmet needs or important gaps in knowledge, practice or health do these goals address?

The goals set forward by Translation group address 1) the need for expertise in organizing and managing large data, 2) the importance of creating a platform where multiple stakeholders can obtain and share reagents and knowledge, and 3) the desire to enhance our ability to detect unusual phenotypes and translate them into basic mechanisms of disease

A vital unmet need that will require further thought and engagement of Technology, Design and Diversity work groups is the need to incorporate mechanisms for engaging patients/participants across the full range of socioeconomic strata. This is critical not only to enhance diversity of the data/sample sets that drive translation, but also to ensure that the fruits of research are translated to benefit underserved populations.


Expansion of workforce in selected areas (recruit and grow), appropriately incentivizing all involved parties, tackling HR issues, increasing philanthropy and partnerships with venture capital for the institution, continuous cycle of re-evaluation of investments, strategic needs and priorities. Always be looking at the next new thing, and not rest on a leadership position in a specific area. Critical for all work groups, but especially critical for translation where new advances may require nimble investment that was simply not envisioned 2-3-5 years ago: a strategic compass and not a strategic plan.


See above


See Patient Scenario, A VHAN Translation Story (appendix).

Vanderbilt as leader in specific areas, locally, regionally and in national efforts and networks.

Translation SWOT

STRENGTHS

COMMON

● Elements of existing information networks and translational research groups on campus that can be used as models: BioVU, mycancergene, Vaccine Center

● Existing Big Data repositories: BioVU, CTSA, EHR, PDW (peri-operative data warehouse), EDW, mycancergenome, Vanderbilt Cancer Registry (VCR), DBMI, SCCS, Shanghai

● Expertise in Basic, Translational and Clinical science to support connections that feed the arc from discovery to therapy

● Leaders or key participants and current activities in national networks to identify unique or extreme phenotypes (Undiagnosed Disease Network, eMERGE, Pharmacogenomics Research Network, Precision Medicine Initiative) and provide new molecules of interest

● Expertise in Pharmacogenomics and Chemistry. Vanderbilt is part of Chemical Biology Consortium (CBC), and only one of seven dedicated centers as part of NCI Experimental Therapeutics (NExT) Program to accelerate drug discovery and development to clinical trials.

● Existing expertise in developing EHR and informatics tools

● Academic Informatics with focus on developing new tools

● Existing and expanding biorepository – BioVU

● One of the longstanding and robust EHR systems in the country

● VHAN – an expanding health system adding new patients

● Existence of physician-scientist degree programs e.g. MSCI, Masters of Bioinformatics, MPH

● Leaders in Health Literacy – Center for Effective Health Communication

MOLECULE INDIVIDUAL POPULATION

● Expertise in Pharmacology and Chemistry enable new discoveries to translate to new drugs

● Expertise in Basic, Translational and Clinical science and existence of collaborative environment to facilitate bench to bedside and back again to research

● CTSA

o GCRC

o Deep (human) phenotyping

o Physician-Scientist development

● Proteomics initiative

2

Translation SWOT

WEAKNESSES

COMMON

● Narrow focus of MyHealth@Vanderbilt does not engage individuals fully

● HR obstacles to achieving world class IT/informatics workforce--non-competitive salary structure; inflexibility toward non-traditional job descriptions; slow process

● Pockets of expertise that are poorly integrated

● Insufficient instruction in informatics, and reliance on classroom based, traditional educational system limits availability to individuals (investigators, clinicians, even participants) with busy work schedules

● Academic informatician’s focus on informatics discovery does not serve implementation and sustainability needs for the larger enterprise

● Lack of informatics tools to efficiently and effectively perform data mining

● Biostatistics - Applied

o Lack of clinical trials infrastructure across institution

o Limited access to biostatistics resources for individual researchers

● Insufficient numbers of “connectors”--those who can mediate connectivity between stakeholders

● Lack of incentives all across domains, financial and intellectual (clinicians, scientists, and maybe patients)

● Despite a collaborative culture, individuals working in their own silos (largely because of lack of awareness amongst investigators and clinicians that they are working on the same diseases/problems)

● Limited talk between basic and clinical translational researchers

● Expansion of cores across all domains

● Limited biobanking: BioVu is limited to genomic DNA only (no collection of proteins or RNA or other tissue samples etc.) and mostly collected at one time point. Need to expand to multiple tissue types across multiple time points.

● Lack of “linked” big data repositories: even though Vanderbilt has big data repositories, they are not linked to each other which are a major obstacle in performing translational research. e.g. EHR, PDW, EDW and VCR are not linked to each despite having large subset of overlapping patient populations

● Lack of a well-developed, easily accessible commercialization stream to assist in moving discovery from molecule to preclinical investigation to clinical trial

● Dismantling of GCRC


● Secure storage sufficient to support data/sample acquisition

● Lack of system to identify unique or unusual phenotypes e.g. exceptional or non-responders

● Lack of engagement with diverse populations

● Epidemiology

● Translational research training across all disciplines and stakeholders

● Genomic research

● Training individuals

● Gaps

o Genomics

o Metabolomics

o Biostatistics

o Data Coordinating Center structure

3

Translation SWOT

OPPORTUNITIES

COMMON

● Operationalize the GCRC into a mechanism for recruiting participants and acquire/archive data and samples, to centralize these processes, reduce cost, and alleviate the burden on investigators and clinicians

● Grow, integrate, and facilitate use of existing areas of strength that support the goal: BioVU/SD/PathLink

● Develop E-tools that engage investigators, clinicians, and patients in the discovery pipeline

○ Investigators like me (Molecule)

○ Research like mine (Molecule)

○ Patients like me (Individual)

○ Patients like this one (clinician/Population)

● Develop a common IT language to enable integration of multiple platforms for information exchange and sample archiving

● Develop a non-academic IT/informatics service line dedicated to implementation of new tools, education of users, and sustainability of the tools in a growing health system

● Develop a common IT/informatics core to develop multi-purpose E-tools such as:

o Integrate and link repositories including but not limited to EHR, PDW, EDW, VCR, BioVU, SD, Pathlink etc.

o Expand myhealth@vanderbilt for patients to be engaged at various levels such as support groups (patients like me or disease like mine) and research (patient like me) so that patients feel like “partners” rather than “subjects”. Make myhealth@vanderbilt more interactive to empower patients with data and information to improve their own health

● Develop a centralized service that facilitates rapid and continuous education/awareness about resources that support the arc from discovery to new therapy.

○ Matchmakers

○ Connectors

● Utilize telecommunications to augment informatics networking by providing video links with individuals (patients, clinicians, investigators) within/across the healthcare system to promote and support the arc from discovery to therapy

● Recent split of HR between VU and VUMC is an opportunity to restructure HR to optimize hiring of a workforce that will drive discovery

● Streamline the process of recruiting participants, acquiring data and samples in an effort to facilitate research by centralizing these processes to reduce cost and alleviate the burden on investigators and clinicians – need to better utilize GCRC

● Expansion of Biobank to blood and tissue

● Areas where we can be national and international leaders:

○ Research ■ Aging and Frailty ■ Health Literacy ■ Obesity ■ Pragmatic trials (for quick translation from bench to bedside) ■ Mobile health tools

○ Precision Medicine ○ Informatics ○ Genomic Research ○ Matchmaker for patients and researchers ○ Global Health ○ Telehealth ○ Innovation Center ○ Epidemiology and Biostatistics

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Opportunities continued


● Develop a commercialization stream that supports nascent project development, provides project coaching to maximize return on investment, integrates entrepreneurship into the academic ladder, and promotes engagement of venture capital to encourage swift commercialization of deliverables

● Expand biobanking - across nucleic acids, body fluids, tissue types at longitudinal timeline. Also develop patient-derived (reproducible) cell-lines, organoids (normal and disease) and xenografts

● Expand VHAN to improve diversity, underserved and underrepresented populations. Also to engage VHAN in research: patients and providers

● Improve training opportunities

o Develop certificate courses (abbreviated focused training) within or outside MSCI, M in Bioinformatics, MPH

o Clinical training for PhDs including training grants (e.g.T32s)

● Clearing House for Regional Patient and Population EHR

● Regional and National Referral Center for Orphan Diseases

● Easy access to multiple diverse large patient cohorts

● Collaboration with other Biobanks

● Collaboration with Biopharma for VUMC centered research initiatives

o Phase I-IV studies/clinical trials

● Leader in Pragmatic Trials

● SCOPE

o Regional

o National

o Global

o Across peer institutions

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Translation SWOT

THREATS

COMMON

● Incentives are not aligned to facilitate busy clinicians participating in the process of sample collection or busy investigators doing fundamental discovery in the process of participating in translational projects

● IT integration: proprietary software, individual user interfaces, new hospitals/clinics that have their own IT systems

● Non-competitive compensation: BIG IT companies (especially in the healthcare space) and other large academic enterprises can hire away our workforce; we train, they drain.

● Current HR obstacle to hire and/or keep individuals

● Lack of incentives for individuals – clinicians to participate in collection of bio-specimens, investigators to collaborate with clinicians to translate their research and patients treated as subjects rather than “partners”

● Others currently doing it with potential to grow: Broad Institute, Craig Venter, Dishpande Institute at MIT, Scripps, Wash. U.

● Areas where we are behind peers

o Genomic research o Microbiome research o Metabolomics o Epidemiology o Telecommunications

● Lack of collaboration with Industry/Pharma/Venture capitalist

● Within VUMC

o HR o Manpower with specific infrastructure expertise o Dismantling of GCRC o Limited access to large cohorts o VUMC_Meharry Alliance o Limited data and biological sample resources

● Outside of VUMC

o Peer institution competition o Steady or decreasing federal funding o Fast paced discovery by others (need to catch up)

DATA MANAGEMENT

& ANALYSIS

INVESTIGATORCLINICIAN

MOLECULE

INDIVIDUAL

POPULATION

Open Source Network

Linking Health Care Information,

Tissue, Cell, & OmicResources

Phyllis• 70‐year‐old, recently moved after the death of her husband to live with her daughter in Williamson County. • She had been in good health until his death. • Over the last 3 months, she has experienced listlessness, forgetfulness, and loss of appetite. • A recent minor fall resulted in a Colles’ fracture.

Technology, Engagement

Phyllis’ daughter engages VHAN

Completes simple survey at MyVUMC portal

Technology, Engagement, Design, Learning

VHAN provides Phyllis‐specific information to her

PCP


VHAN provides resources and contacts to Phyllis and her

daughter

Fundamental Discovery, Engagement, Entrepreneurship, Diversity & Inclusion, Efficacy, Effectiveness & Reliability,

Patient Care & Experience

Phyllis participates in a DNA & cell‐based study that

develops a new bone drug


VHAN provides resources and contacts to Phyllis and her daughter

• A new day program at Williamson Hospital for elder care• Two research studies, one a collaborative project in Geriatrics

and Psychiatry on depression in the elderly, and the other a collaborative project in Endocrine and Cell Biology on bone mineralization.

• A list of available Geriatricians at VUMC and VHAN Hospitals• A link to an iPad/iPhone App to help organize medications,

link them to Calendar and Alarm Apps, and record when they were taken

• A brief video about a recent Vanderbilt study published in JAMA about the benefits of a new medication for osteoporosis developed at Vanderbilt.

• A description of the new biobank, BioVU‐ID


VHAN provides Phyllis‐specific information to her PCP

The survey and results trigger an email to Phyllis’s primary care provider with the following resources:

• A list of other common diagnoses and medications being used in his female patients over age 65 with osteoporosis and depression, and in all VHAN patients.

• A link to an evidence‐based protocol for osteoporosis– A pop‐up demonstrating what percentage of his women patients over 65 have had Dexa scanning, with an

additional option to flag the EMR of those without for discussion at their next visit

• A link to an evidence‐based clinical pathway for depression in elderly patients– A pop‐up of a 5 question screening tool that can be deployed to his patients over 65 prior to their appointment, or

in the waiting room prior to their next appointment

• A link to the Geriatrics Consultation Service at Vanderbilt– A pop‐up demonstrating how his patients over 65 compare to network patients for 5 clinical indicators, with

additional links to evidence‐based discussions of management of each clinical indicator, with the ability to choose a management and add flag each patient’s EHR for discussion at their next visit.

• A list of research studies on depression, osteoporosis, frailty that would be available for Phyllis, and the contact information for the Research Coordinator at the Center for Innovative Research to facilitate sample acquisition and enrollment

Fundamental Discovery; Engagement; Entrepreneurship; Diversity & Inclusion; Efficacy, Effectiveness & Reliability; Pt Care & Experience

Phyllis participates in a DNA & cell‐based study that develops a new bone drug

• At the suggestion of her PCP, Phyllis agrees to participate in a depression study, and on enrollment consents to have a tube of blood collected for DNA and stem cell preservation.

• Later: Endocrinology and Cell Biology investigators find a mutation in her DNA that confers an age‐dependent reduction in strength of bone generated by bone cells made from Phyllis’s stem cells.

• Her bone cells are then used in a high throughput screen of small molecules that identifies a drug to restore bone strength.

• BioVU‐ID identifies 100 other individuals with the same mutation, and some of these have agreed to be recontacted. These subjects, including Phyllis, enroll in a clinical trial to assess the efficacy of the new drug on bone density.

• The trial is a success and the drug is leased to Merck‐Pfizer‐Roche, with the provision that the Vanderbilt network and its patients are entitled to the drug at reduced cost for the duration of the initial patent.

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