Yale New Haven Health and The Generations Partnership

April 30, 2021

ID6547

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00:00It's my pleasure to now introduce our next
00:03speaker who is Doctor Keith Churchwell.
00:06He graduated from Harvard
00:09University and earned his.
00:11Medical degree from the Washington
00:13University School of Medicine.
00:15He then completed his internship,
00:17residency, and chief residency at the
00:19Emory University School of Medicine where
00:22he also did a fellowship in cardiology.
00:25An additional fellowship
00:26in nuclear cardiology,
00:27he became the president of the Yale
00:31New Haven Hospital in October of 2020.
00:34As an Assistant associate Clinical
00:36Professor of Medicine at the
00:38Yale School of Medicine,
00:39and with that I'll turn it
00:41over to Doctor Churchwell
00:44Thank you Sam. Appreciate the time.
00:46I know I I feel that my introduction
00:48maybe longer than my presentation,
00:50so will try to keep it short
00:52and brief and keep us on track.
00:54It's been a great pleasure to
00:56work with Mike and with others,
00:58and in developing our generations
00:59project what came out of that though,
01:01as our next steps has been incredibly
01:03important in thinking about the development
01:05of genomic health that we use of clinical.
01:08This clinical information across
01:09not only for Yale Hospital bill,
01:11New Haven Hospital,
01:12but really across our health system.
01:14As we think about the idea and the
01:17opportunity around personalized
01:18medicine and precision medicine.
01:21I'm gonna share, I guess if we go for right.
01:24So very few flights I want
01:28actually want to go forward and.
01:32And sort of give a bit of
01:35a background in regards
01:37to how we got to where we are from
01:40the from the health system standpoint as
01:43we work collaboratively with the school.
01:45This particular project actually had
01:47its beginnings with Rick Tukwila and
01:50aren't Indian alperin back in 2017
01:52with an announcement and initiative
01:54at our senior leadership Group.
01:56At that time, about the development
01:58of genomic genomic health,
02:00platform and program, the idea was to.
02:03Have available for anyone who wanted to
02:05participate from a patient perspective
02:08to have their genetic information
02:10evaluated within our Group 4 at
02:13this at that time and at this point
02:15free an for us to actually have a
02:18longitudinal pathway in a basis for
02:21that evaluation and and and and.
02:23Information back to those individuals,
02:25whether there was an abnormality or not,
02:28as we gained additional information,
02:30the opportunity to actually develop a
02:31a rich and deep database for genetic
02:34information that we can use clinically
02:36and also from Reese perspective,
02:38was the was the reasons behind this
02:42and beginnings of it.
02:43What has been remarkably,
02:45I think helpful,
02:46and we're thankful love has been the
02:48significant an great collaboration with
02:50with the school and with the hospital
02:52with the development of our executive board,
02:55which actually has Antonio and Brian Smith,
02:57Moroccan Elan Hotel and
02:58others from the school,
03:00along with our number of senior
03:02leadership from the hospital who
03:04are actually involved with those
03:05particular service lines we have,
03:07we thought through the development of
03:09the generations project and also the
03:11opportunities that generations would give us.
03:14In helping us develop the platform
03:16to think about the day-to-day
03:18opportunity around genomic health.
03:20When you think about it from a institution
03:23standpoint from a health system standpoint,
03:26we touch greater than 1,000,000
03:28individual lives per year.
03:30I think about that not only just
03:32said he'll New Haven hospital,
03:34but across our health system,
03:36the opportunity to actually have a database
03:40that is Accra Markably rich to speak to a.
03:44In individuals and populations
03:45that really mirror the population
03:47of the United States to give back
03:49information that actually pertinent
03:50and be helpful in terms of the
03:53development plans and processes around
03:55care and Anna rare rich database.
03:57Ultimately they could be for use
03:59for research purposes, I think
04:00has been one of the charging
04:02factors for us to include this
04:04continued overall development.
04:06One of the big issues
04:08that actually has helped us and and
04:10this overall development that we
04:12needed to actually invest in has
04:14been the computational data Lake that
04:16Wade Shields will talk about their
04:18greater extent with the next talk.
04:20The health system has actually
04:21made a point of a significant
04:23investment in putting this together.
04:26The importance of it, I think,
04:28cannot be under emphasized.
04:29Its need for the generations
04:31project and in the development
04:32of our clinical pathways to make
04:34health is obviously important.
04:36But it is actually our obviously been
04:38extremely important for us in terms
04:40of data acquisition and evaluation
04:41and treatment plans and processes,
04:43and understanding how we have
04:44developed these plans in in the
04:46midst of this pandemic.
04:47Without it,
04:48I think we've actually had been a bit
04:50blind in regards to how we wanted
04:52to look towards the development of
04:54plans and processes around kovid and
04:56actually sort of came in an important time.
04:58We continue that investment.
05:00That investment will actually go
05:01over the next two to three years so
05:03that we can actually interdigitate
05:05and bring together all of the.
05:07Important databases across our health system,
05:09both the Epic database our
05:11genomic database are a dead
05:12databases around the financial
05:14aspects and also the demographic
05:16aspects for our patients so that we
05:18actually have a full and rich
05:20picture that we can actually have.
05:22We have invested in for us to be able
05:25to answer important questions. As
05:29part of the work of generations,
05:31what came from that as we think
05:33about the development of the clinical
05:35pathways for genomic health,
05:37we we did something I thought was
05:39actually very important to us.
05:41We put together a what we described
05:43his office hours that Mike Murray
05:45and the rich lisitano and I had with
05:48actually many of chairs and Chiefs,
05:50and actually clinicians and clinical
05:52researchers across the spectrum of Yale
05:54Medicine and across our health system,
05:56and asked that actually a very
05:58simple question. How can we help?
06:00What are actually the things that you
06:02are doing actually within your lab?
06:04Or actually I in your clinical
06:05research or their day-to-day work
06:07that generations may be helpful to
06:09and helpful and helping develop as
06:10a pathway for us to actually have
06:12to have additional information,
06:13but also have an impact in terms
06:15of overall health.
06:16This wheel,
06:17which is actually for me a very popular
06:19slide and it was a very popular side I think.
06:22With Dean Alford has been developed
06:24over the past few years and with each
06:26one of these arrows representing
06:27those particular groups that have
06:29come to us and talked and thought.
06:31And and talk to us about the projects
06:33they had ongoing there and also projects
06:35they actually wanted to put forward.
06:37And they needed additional help with
06:39and how we can actually move forward
06:41and have an impact on overall health
06:43of all the individuals that we touch,
06:45right?
06:46Look at this wheel and there's a couple
06:48of fan taxes examples of where we've
06:50been able to actually move forward
06:52with additional initiatives that are
06:54actually a part of generations but
06:56actually expanded generations might
06:57talked about our renal transplant program
06:58and the building of actually having
07:00an epic order for this evaluation.
07:02For those patients with undifferentiated
07:04reasons for actually for chronic
07:06renal disease,
07:06where you actually have also
07:08developed a farmer Koja genomics
07:10pathway for their patient population,
07:11hexxeh's head transplantation
07:12and B&A test for those people for
07:15the individual tracks,
07:16they have a sensitivity to
07:18immunosuppressive drugs.
07:18Man,
07:19that may lead to adverse reactions
07:21which will allow us to actually avoid
07:23those drugs and have the patient
07:25take another set of medications to
07:27to to to ensure that we are not
07:30leading to significant adverse
07:31reaction to those patients.
07:33We look on the wheel for cardiovascular
07:35health and there are multiple actionable
07:37mutations that lead to you know
07:40pathology within cardiovascular
07:41disease that as we if we can identify
07:43and I put patients in the right
07:45bucket for that overall assessment,
07:47we can actually bring forward
07:49therapies that actually are truly life,
07:51saving those patients.
07:52Those are patients with hypertrophic disease,
07:54cardiomyopathy,
07:54disease and also arhythmic disease.
07:56Then when identified,
07:57we actually have plans and
07:59processes that we have in
08:01place to treat those patients.
08:03We've
08:03uncovered other parts of the of our
08:06health system that are actually actively
08:08doing clinical research and actually
08:11think about clinical opportunities
08:13for care using genetic information,
08:15especially in our GI disease
08:18portfolio of undifferentiated.
08:20Non identified a liver disease and
08:22also chronic pancreatic cracker.
08:24A tick disease that we have worked towards
08:26helping to develop a better pathway
08:28for us to be able to evaluate patients.
08:31Keep the data within our own database and
08:34move forward to expand our overall horizons.
08:36About our overall using genomic health
08:38data and allow them to actually be
08:41able to treat their paces effectively.
08:43And also think about new and even
08:45more exciting research opportunities
08:46across the board.
08:47And as you can see,
08:49this particular will actually started
08:51with about four or five different.
08:54Programs we have added as we've
08:56got started and had more and more
08:58additional and talks with others
09:00across our health system.
09:01You can see the arrows have actually
09:04multiplied significantly and we
09:05have an expectation as the arrows
09:07will continue to increase.
09:09Now we've we've had to have a bit of
09:11a pause because of covid in terms
09:13of the overall expansion of our
09:16generations project and the clinical
09:18application of genomic health.
09:19We are working towards re constituting
09:21our executive board and also
09:23reinvigorated reinvigorating our
09:25overall opportunity as we look
09:26towards not only what is happening
09:28here on our campuses in New Haven,
09:30but the impact that it actually should
09:32have truly across our whole health
09:34system as we develop the collaborations
09:37with the school and the opportunities
09:39for identific identifying disease
09:40states that have genetic basis.
09:42And thinking towards plans and our pathways
09:44for care for care for those who are affected.
09:47But also how do we follow those families that
09:50actually may be affected in the long term?
09:52So I'll stop there and allow us
09:54to really go forward and have you
09:56and then wait to have some time
09:58to really think about the exciting
10:00opportunities that the computational
10:02platform is brought to us.