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tv   Medical Technology for Veterans  CSPAN  June 12, 2018 8:03am-10:00am EDT

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captions copyright national cable satellite corp. 2008 captioning performed by vitac again, i think what we're lacking is once the sensors are included once we use the mapping between the data that's being derived from real world use and when that owe essentially means and how we should direct that to how the devices either interact with the patients, healthy user, learn from the user, and improve, i think there's still dwaps in the basic research in the sense that once the data is available, how do you effectively use it, and i think we need to make certain that
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research is being directed in the way to answer some of those questions to fill those gaps. again, the sensor technology has improved dramatically and it's rapidly advancing. they are getting smaller and small, and our ability to include them in devices such as peretzes and orthoses so i don't think that's much of an issue. others include on-board battery power and battery power and miniaturizing that technology will help in this case. research needs to be directed to answer the those questions on how to use the data effectively and how we can use that and collect the data and how clinicians can use the data and at the same time also protecting the privacy of the patient, right, becau once youave a the data streaming in, one of the important things is to make sure that patient privacy is being considered in that case. >> are we training the -- are we adequately training next generation of scientists to do
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this work that is needed? it's reached across a lot of different areas. do you think we're doing an adequate job that have? do we need to do more and focus -- well, do we need too more e? >>ea i'd be hesitant to speak more broadly, but in my experience i think we are. i think we -- one of the benefits of this type of research that it is interdisciplinary, and we need to make sure that it continues to be so, right? because, again, it is this combination of engineeringnd medicine, but we need to start, of course, integrating other disciplines as well. whether that's materiel science, robotics, psychology, whatever that might be, but we need to make sure we're still promoting the integrative and interdiscipline research to make sure we're staying competitive andcing the progress of this particular science. i think we're doing an excellent job. of course we had can always do better and as long as we continue on this track this particular research will remain competitive and we'll need to continue to take the steps we
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need to to elevate this type of technology. >> moving on. it's great to see, mr. wordin, the work that you're doing there with hero tracking, and we still, veteran suicide data is inclusive, so still trying to understand this. what does your -- you know, what does herorack really provide in that direction and what else more can you -- do you think can be done to leverage commercial technologies in order to -- to do this? >> well, this report that's about to come out is pretty clear on what the root causes and diagnosis of suicide are, and when you get into depression, anxiety, hopelessness, you know, those are all factors, and what w
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found in our - i ourh so far in our testing of the hero tra is that veterans feel like they have a support system with them 24/7 right on their wrist because it can connect to a loved one, a clinician, miember a peer so that if they have an episode, they are able to get help immediately, and it's something thathey direct, so they are in control, and so the feedback that we've been getting from our focus groups has been really remarkable in the acceptance of being able to wear basically a technology monitoring device thaterstdshat'oi on with youentally and physically, and so that power help alleviate that hopelessness, so if are eling depressed, you know, hey, if i have an episode, you know, it automatically will text message my buddy from iraq or my wife or my girlfriend or my father orhatever, you know, you particularly program in,
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and -- and that -- that abili really creates that sliver of hope that's the difference between suicide and not suicide. >> all right. thank youer muc myime is up. a lot of things to talk about here, but i thank all of you for the work that you're doing. >> and i now recognize mr. web. >> thank you, chairwoman. dr. kuznetsov you talked about how the national labs with a history in the research llaboration and ability to confront short and long-term complex science challenges. hold that thought in mind for one second. miss maccallum, you said you talked to a vet who felt a stigma when tryingteract with? >> in going out, in socializing, in being in a wheelchair and trying to get around people and feeling that he was, quote, in the way. >> perfect.
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>> mr. recordiwordin, you listef the calls of suicide, and do you have that list of suicide where we can get that later, anxiety, depression, depression. was stigma once of the reasons? >> no, but that's why he don't receive services. doctor, back to you. i think quite frankly earlier, mr. wordin, that they have difficult working with outside groups. the department of energy does not and they produce great work. i've got a point here. how do they benefit for benefits on behalf of the va. and mail it all back together? >> thank you. that's the right question for us. for us the dat with its unique
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complexity and comes with subject matter experts that is curated by experts brings with it a team of specialists that allows us to attack the artificial intelligence and technology challenge with our experts, and so the meeting -- the intersection happensthat place where we look at the priority questions at t veterans administration has surfaced. we bring together the technology specialist, the hardware, the software, the engineers and ask how do we answer those questions. >> many times those are outside industry and groups. keep going. >> yes. so the -- the nexus is the two agencies coming together. we draw from the breadth of the laboratories. we engage the private sector and acemia as needed. we bring in as many people as we can bece recognize it's going to be tan all of the above type of activity to answer these
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priority areas that the veterans administration has defined. >> actually, that's a perfect marriage, if you will, and we have that ability and we're able to do that and thereby do awayw the non-ability to not work with outside groupso make this as seamless as possible. i'm still going to come back to you for one more. these research partnerships have the potential to accelerate scientific breakthroughs and health care delivery systems in bio sciences. should the department replicate that model in other fields of research, and what steps can we as congress take to facilitate that? >> so i think the answer is y in terms of replication. our focal point right now has been on the veterans health data and on the precision medicine data set because of its unique complexities, because it -- it comes with -- with annotations, with handwritten notes, with data streams and imagery and the
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collections of multi-modal data that talks to a situation in unique ws that was going to test how we develop predictive technologies, artificially intelligent-based computing. when we start to get our head around what those hardware and software technologies are. these are ones we want to apply to other areas, but we find that the highest leverage opportunity for us is around this data set because it dra in so many other partners who want to come, who want to participate, and it's a force multiplier for activities. >> well, that brings me up to another question then. do you see any problems with the d o'and t d.o.e. and v.a. working together? >> no, not taggett. secretary perry in the beginning of april did sign a new moa to work together that we have started to implement now.
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it identifies more data that we already have resident and plan to aggregate so we have a very nice path forward. >> what process would you use to report back to congress? in other words, to say this is working, we' ming huge steps in the right direction. how do we get that from you? >> i think at your discretion coming to you with the v.a. side by side would be an effective means to do in a. >> okay. thank you, madam chair. i'm going to deed back. >> thank you. i now recognize m veasey for five minutes. >> thank you, mr. chair. i wanted to ask a couplef questions on data privacy and cyber security. >> dr. kuznetsnesoff the data iy sensitive information. almost 600,000 veterans have
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voluntarily given dna and other samples that is can be used and what i want to know is how is the da and v.a. working together to implement federal requirements for cyber security? >> thank you very much. i would add to your list of the veterans who have signed up, the secretary of energy, secretary perry also joined personally in may of 2017 donating his dna and medical records to the set so security, of course, is important. the personal health information enclave or the initial one that we launched at oak ridge national laboratory is what's considered a moderate with enhanced controls under the fips 199 standards that meets the hipaa and high tech acts requirements. so we've set up an enclave isn't with the protection standards, but in addition through our cio office and through our cyber
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security specialists and privacy specialists we do external reviews of the enclaim. we also have engaged the v.a. counterparts in the information security offices for their assessment of how we protect the data. in addition, we were very sensitive to appropriate house. housing the data is one thing, but who gains access is done through training programs. we identify labonratory people who will be engaged but we run that through the v.averages. we've created teams, v.a. and d.o.e. laboratory science who are attacking key problems that the d.o.e. has surfaced. the members of the teams that are allowed to access the data is controlled by the v.a. once we go through the training requirements. so just housing the data don't give anyone access to the data. we worry about the control. we worry about the use of the data for the purpose, and we monitor that through irb
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processes as well, so, you know, we've set up certainly an enterprise sensitive to the use and protection of the data for the very reason you remarked. >> you know, with you putting in all those parameters to protect the information, are there any challenges to accessing the complete medical records of veterans whe neen be? i guess i would want to know is it easily accessible, quickly accessible in situations where it needs to be? >> so there are two parts to your question. technically it is easy to access now. in terms of the tools, the the infrastructure that we've set up, hardware and software, the learning environment. what is still a bit of a challenge is the irb process. youkn, what we've been doing here is new. every step we take is new for everybody in terms of how we access data, and i think as we
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try and create the irb structure for accessing veterans data, we're sensitive to the fact that machine learning and artificial intelligence will kind of invert the world that people are used to. normally when youave a researcher looking at data, they will pull the specific data they want to address a particular problem. if you're trying to learn from more than 22 million veterans health records that span decades from genomic daysa and so on how you develop patterns of use is very different than how others look at the data so walking through the irb and setting up the right protocols to allow access is a positiones that we're still working through, so we've done some. we can technically access the data. we have accesses and controls in place, but the policy side we
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are still working through how we get everyone to think about where the future is in terms of learning from ta. yeah. thank you. >> madam chair, i yield back. >> thank you, and i now rec mize mr. rohrabacher. >> thank you very much and thank you to our witnesses today. let me just -- this is not directly on technology, but it's dealing with the v.a. issues. some of the things that you're describing that have motivated you to focus on trying to find technological solutions like depression, sense of hopelessness, et cetera, a lot that have can be traced, some of us believe, to the use of op opiates by the v.a. some of us believe that the v.a. has taken the easy way out simply by prescribing opiates to somebody with a problem which
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wh you supply that kind of a prle you're going to end up with someone with serious problems. now, do - this question. should the v.a. be permitted to use cannabis? should they have that as an option rather than just opiates, and just -- i guess some of the questions that go directly to technology, but could i have your opinions on that, just a yes or no or something like that? >> all right. i'll jump in. >> okay. >> should cannabis be an option for v.a. in terms of treatment of our folks rather than just opiates, not just opiates? >> i understand your question. >> okay. got it. >> well, i've been doing this for ten years. >> yes. >> and i've had over 30,000 veterans come through my program, and i will tell you unequivocally that many of the veterans in our program use cannabis, and they use it as an
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alternative to opioids. >> is that good? >> it seems to be wking because they are all still alive. >> all right. does anybody else have an opinion on that? >> okay. i won't force you to coming pubically on that. okay. yes, there are controversial issues. i would suggest that it is sinful that we do not permit our veterans that option. the veterans and doctors that i know -- i know countless, not countless but i know a number of veterans who the doctors have had to goaside and go to them in an off-campus, you know, situation where they could then recommend marijuana, and it's ridiculous that we have to put doctors in a situation like that where they can't even recommend what they think is the right treatment. mr. meek, i should say, you mentioned that it is difficult
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for medical devices to get approval, and maybe you could give us some -- and we find that sa true with commercial items as well, like the fda and others, and as well as our regulatory things. could you give us a little more detail on that. >> sure. and you talked about the fda specifically, and i'll reference the exo suit which is the primary device that we fund. you know, certainly to go through many phases of the clinical trials. then you have to go through different phases for fda approval, and that takes years, i mean, literally years. >> people are suffering during those years. >> exactly. >> and do you have an example of a device that was left behind or delayed so much that people were left to suffer. >> again, just not to beat a dead horse, the exo suit. this has proven to -- one specific veteran from iowa was
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told he would never walk again and going through six months of rehab with a device we donated he was able to walk his daughter down the aisle. so it does work. >> i had serious troubles with my arms and i know a lot of veterans get this as well. i actually -- all the cartilage was gone, i'm a surfer and ended up surfing all the cartilage away in my arms. i know how painful that was, and what's really helped is i have had a shoulder replacements that were i believe developed to help our veterans and now they have helped all of us. do we have a situation where veterans are having to wait because i know how painful that was. are our veterans having to wait to use the technology that we've developed? >> i think the question is whether they are actually getting the tech have i via the v.a. or through private facilities so private rehabilitation facilities will get it much more quickly and much more accessible than going through the v.a. process of them
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going through the fda approvals, whether to get the funding or not because it doesn't come from v.a. here in washington. each individual v.a. has their budget and it's up to them to deem what they consider appropriate or necessary for their care and that's where we step in. >> new technologies and medicines are really elongated in the process for us to use them, and when you mention batteries about -- how new batteries will probably help in many of the challenges that we face or for helping the disabled, let mow just note that there are new batteries on the way, and the inventor of the lithium battery has had a major breakthrough that should have an incredible impact on the things that we're talking about, but then, again, we have to make sure that the fda approves the use of these batteries and everybody else approves the innovation all the way down, so i'm very pleased that you
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alerted us to the bureaucratic problems that have to be overcome in utilizing new technologies for oureteran thank you very much. >> thank you. and i now recognize miss esty for five minutes. >> thank you, madam chairwoman. i want to thank the chairwoman and ranking member lipinski and chairman weber and ranking member veasey for joining us here today. as a member of both the science-based and technology committee and the veterans committee i want to thank all of you for your real important work and give a shout-out to mr. meek and soldier strong based in connecticut, and we're really grateful for the work that you've done. all of us in connecticut know people who died in the twin tors, a that's a searing memory and your cmitmen to that. my niece was one of those who answer that had call a answered that call and served in afghanistan and i know how important the work you all are doing. i think it was you, mr. meek, no
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darpa for the v.a., and dr. major, you've also talked about the -- the v.a. does not -- has aging facilities doing research, so i have a couple of questions here so i'm going to ask all of you to say whether you think there ought to be a darpa for the v.a. or rather whether we should be using darpa as it exists but task them with v.a., v.a.-specific goals because that's what happened around exo skeletons. the early work was through darpa. they have now dropped it and it's been left for v.a. to pursue. so opine on that. >> i'll begin. yeah, essentially in terms of funding mechanisms, i'm obviously all for additional funding. the typical way that the mechanisms run in the v.averages and there are certain priorities that research is directed towards. i mean, for instance, on the protsic needs of women mainly
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because of the growing population of women veterans and they are fit into existing mechanisms, and i would actually look frd to something where theris may more targeted mechanisms, targeted funding mechanisms speaking certainly towards different priorities. darpa may be a different way to do it or different formation or implementation effective to that which could be effective. maybe not darpa in and of itself but something that could work effectively in the v.a. that would allow individuals to target certain priorities. i think essentially that would help with the technology, the development and advance president and implementation in the v.a. specifically which i think is something that is essentially badly needed. so, thank you. >> mr. wordin, i know thattin actually under dr. shulkin his only clinical priority was on suicide priority. you've talked about a lot of feedback information. a question i have for you, is you're collecting a huge amount
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of important information hand much of it tracks what we we know anecdotally as well as the research needing to be done about feedback. do we have an ability to share or how will we go about sharing that important information that basically you're developing with the privacy concerns and that's proprietary to you, and here's part of challenge. we have innovative work being done on the private sector in order to push it through all of the v.a. and then we have questions about access. who has access to the data and how do we safeguard it and then share that information that you're developing that would help us develop better programs for veterans. >> okay. well that's a - i'll tackle that in pieces. first off, under secretary shulkin and under president trump suicide and prevention in mental health is a number one priority yet they don't -- there's no visible funding for technology this addresses those issues, not a single dime. so that's one area of concern that we have.
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the testing that we're doing right now, we're not collecting -- we're collecting inal idividuormation but we're not iifying tindihe duals, so it's a blind study, so there's no privacy concerns with that. with our program in general, we partner with the v.a. and we track particularly mental health status and suicide ideation of every participation in our program, and we have done that on a longitudinal basis for some time, and that information is contained or housed in their v.a. medical records so we're able to deal with the privacy in that regard, so as long as the v.a. medical records are private and they have security, then the information that we're gaining will have that same security. >> i want to follow up with you afterwards because i've got some interesting testimony over in the senate on gun violence issues and work that l.a. is doing through text to deal with students who have suicidal ideation and other issues, so i think there may be alternatives that we can look at that have
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been developed elsewhere that could help marry the technology that you're developing to connect to say the v.a. hotline, you know. how can we have an ability to connect because that's one of pele even kno about the v.a. do hotline, make sure that you've got staff. i don't know if you've looked at that at all. >> actually, when we do our focus groups and as the device has been developed, it has four options when you have a ptsd episode, whether it's self-resiliency or it's contacted a family member or a peer or whether it's contacting the v.a. hotline or 911, and what we find is that most veterans, i would say over 80% of veterans would rather connect with a peer or a family member rather than a stranger on the v.a. crisis hotline. >> that tracks with all the other research we have that they would rather have peer, so, again, i'm over time but i really want to thank all of you for your important work on these initiatives and urge you to continue to bring your ideas forward so we can do a better job to serve those who have
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served this country. thanks very much. >> thank you. and i now recnize mr. hultgren for five minutes. >> thank you, chairwoman. thank you all so much. this is really important. there's nothing more important than what we can be doing than caring for our veterans, letting them have every opportunity for a full lives that are fulfilling and to be amazing and productive so thank you for your work. doctor, if i could first address a couple of questions to you. you said that the d.o.e. partnership is the oak ridge national lab will be able to host v.a. data, the only institution outside the v.a. to be able to do so. what steps is d.o.e. doing to protect the individual information of our veterans and should d.o.e. be allowed to host information from other sources such as private industry? >> so, thank you very much for that question. the data security piece is very important to us.
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certainly compliance with hipaa and high tech are important. we have a process that we put in place to secure the data in the enclave. it includes an annual external review from a third party that reports back to the feds, and then we provide the authority to operate the enclave. we engage our cyber security and privacy experts and the v.a. to oversee all of this so we're very careful about data use and protection for this enclave. >> do you think there's opportunities to host other secure data from other sources? >> these are things we already do across d.o.e. for many different reasons, from other agencies, for many different reasons, so, yes. the simple answer is yes. >> great. d.o.e. houses four of the top ten fastest supercomputers in the world and is the principal federal agency for leadership in
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computing facilities. how will providing d.o.e. with access to the v.a. benefit specifically healthcare for veterans? >> i think what we've found in applying the basic tools in artificial intelligence is they break very easily at the data set. the complexities, the size, the amount of informaon contanld already exceed what the standard tool sets are allowed to -- you know, can accommodate. d.o.e. is very interested in pushing the limits of technology in supercomputing and ai and these kinds of stresses are very interesting to us in terms of where the next generation of more cognitive tools will come from, so we're going to be pushing this data -- the data itself is the mechanism in which we set up this next frontier of
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ai-inspired simulation. >> great. dr. major, thank you for being here. grateful for your work. so proud of northwesternnd incredible accomplishments that come out of your work and other work there at northwestern so thanks for being with us. getting older brings with it many challenges, including the danger of falls. does your research provide any quantitative data and how much more of a danger this is to veterans in need of prosthesis or orthosis compared to veterans who don't require such devices? >> thank you for the question. yeah. i'm not particularly aware of any research that is targeted specifically to veterans of that nature and what that distinction is between those, again, who do use prosthetic devices and the those who may not. in terms of fall and fall risk. that type of research i think is certainly needed. i think anything in terms of looking at specifically different types of veterans, the
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area which they come from and the combats which they maybe perhaps serves, i think that that particular research would certainly be helpful in trying to target certain reputation technology, whether it's prosthetic and oratic devices or other types of rehabilitation technology in order to target that specifically to individual cohorts. i think it's something that can be done. speaking again to some of the issues that were brought up again today, the veteran statistics, the type of data that we have, because it's such an integrated healthcare system, it's ripe for the type of research. it cannot be conducted necessarily on a wider scale. i think the resources we have available to us through the vha, this is a perfect opportunity to do that type of work. it is currently -- some of it is currently being done but, again, i think we could take bert opportunity that have. >> great. quickly, dr. major, if i can follow up. clearly our goal is to continue to improve the quality of life of veterans but also for all people. i wonder with your research and work in prosthetics, how is it making its way to companies that
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develop such devices that could benefit from your findings and in turn provide better technologies to veterans and to all people? >> yea sone of the benefits that we have is oftentimes the partnerships that we developed through a lot o these research efforts, so just to use an example. my research in particular, even though it's directed through v.a. funding, it also includes partnerships with academe yeah, for instance, northwestern university. in addition to that even in industry partners as well and much of the technology that is developed and the patents then developed through those efforts are jointly owned, right, so it would be owned by the v.a. as well as industry partners or academia as well and so that is a way, a method in which the technology that is developed by funding support through the v.a. that can be brought out and benefit civilians so we do a lot of that in fact and i think it's a great mechanism. i will say that, you know, in terms of technology transfer, i think if certain mechanisms could be developed within the v.a. to help that -- to help
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advance that process it would certainly be beneficial because there is a lot of great technology developed in the v.a. and these efforts and the funding through the v.a. does support that and i think trying to get that out to the civilian population would certainly be of great benefit. >> love to see that. my time has expired. thanks so much for your time. i yield back. >> thank you, and i now recognize mr. mcinerney for five minutes. >> i thank the chair and committee for having this hearing. i got excited listening to your tim but i'll start with d dr.kusnez. a federal sentist wking for thea. v.ade more than $400 million when he sold the company for $11 billion to this pharmaceutical giant gilad in 2012. the drug was then discovered -- the drug was discovered with federal resources and tended to treat veterans with hepatitis "c," but, unfortunately, once the drug was sold to the private company, it was out of reach for veterans and the v.a. both.
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so does the v.a. and d.o.e. work together with the private sector, how do we also ensure that the data and technology resulting from taxpayer resources and labs is not exploited by startups in the private sectorentity solely for the commercial gain for a few individuals? >> thank you. that's a great question. in our partnerships there are some fundamental tenets we have. one is open source for the tools we create, for the very reason you mentioned. we done have some partnersps with pharma, for example, with glaxosmithkline right now, an effort called adam which is also related to all of this activity. what we do in the space with pharma and the technology companies is pretty competitive so it's by definition open to other entities to join and
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openly available and accessible for that reason, so we're sensitive to the question you're asking, and we have to manage thedl ia suita way s that it does draw in the right kind of risk mitigation from the private sector which adds value to this but does not do this at the expense of others, and so we are keeping an eye on it. again, open source and pre-competitive are foundatnal here. >> okay. we've seen this happen in other cases here so it's a very difficult situation when veterans can't have access to medicines that were developed with federal money. we need to work on strengthening those protections. s if mr. word-innin, i was pretty excited about your ptsd
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alarm and you're using data, and the graphs you show saw a spike in the heart rate and then additional sort of physical indicators after that. were you able to identify in thoseases phesical event or the emotional event that triggered those reactions? >> we aren't able to do that, but we ask the participants in our study right now to keep a journal, and they were able to document what the environment was. we try to look at both immediately before, a few minutes before and maybe half an hour before, and it's -- it's -- it's great empowerment to an individual veteran to understand at caused ptsd episode for them, because it's different for each veteran. >> absolutely. and if -- i mean, if you could understand what's triggering, then that leads to all kinds of opportunities for treatment and mitigation of those sorts of tryingers. >> absolutely, and the great
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thing about the device it will measure that and see if what you're doing to mitigate is actually working or whether you see whether the prescription drug or the therapy options that the v.a. on your healthcare provider has -- has given to you, you can objectively understand how it's working, what is working, if it's working, and so it's -- i mean, that's the great thing about the device it's completely objective. it is what it is. >> and do you see similar sort of characteristics, you know, data characteristics from different individuals with regard to pt triggers? >> yeah, i mean, when you look at the spike, if that's what you're referring to, yes. >> yes. >> that's a common theme if someone is having a ptsd episode. that's how the device detects the ptsd episode is through the spike in heart rate or heart rate variation. >> we saw a spike and saw a little bit of a quiet period and saw additional. >> that was -- the graph that you're referring to, that showed
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physical activity because i wanted to differentiate -- one of the questions i always get is how does it know whether it's ysctivity or whether it's a ptsd episode, and the device is able to detect because the steepness of the curve when you're having a ptsd episode versus say when you're riding your bike, there's a difference in how your heart rate elevates and how fast it elevates. >> thank you. i yield back. >> thank you. and i now recognize, let's see, mr. webster. >> thank you, madam chair. thank you all for appearing. this is great work you're doing, and we really appreciate it. mr. meek, you talked about, i don't know your exact words, but you talked about the fact that technology was ahead of the -- of the v.a.'s practice in a sense and you get these technological advances that are not a part of the normal v.a. treatment.
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i would assume, i don't know assumpon, that advances in e technology usually cost more and that if it does more, it probably costs more, but my question would be how do we balance that. how do we mold together availability and advancement so that -- i mean, you could have this scenario where you make an advancement, and i you spend all your money making advancements then you could come up with something that -- that helps a veteran ten times better than current practice. however, you could only afford one out of ten where under of the old technology you can afford ten out of ten. is there a balance there? do you see what we might be able to do to certainly make advancements but we also want to be able to pay for it.
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>> sure. i think back to the other question about that darpa should be a model to transfer to the d.a. i think it should be. we put the most advanced technology we can in our war fighters and once it's done meeting darpa specs spore the battlefield, darpa stops. there's nothing to commercialize that for the private sector back home. you look at a lot of the devices, i mentioned the average cost that we fund is 10000 with a couple of them almost 200,000. think about the original cell phone, the size of a small suitcase, you know, and cost $1,000. well, today it's the size of a calculator and it fits in your pocket and it' supercomputer so having that continued research and development on a specific device, whatever it may be for advancement, you know, where that funding comes from, there are certain i think separate pools that we can look at, but you have to keep that funding going because over time it will bring costs down. devices are so advanced that they cost a lot right now but 10 and 20 years from now, some of the work that dr. major is do,
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they are hard wiring devices into individual brains. you've seen a person who lost his arm in vietnam and through the sensors he touched a doo knob and cried because it was the first time in 25 years. this will eventually reduce costs and improve healthcare for the patients. >> i saw your video and was totally astound that had someone could actually go from a sitting position and rise with no help at all, not even necessarily using their arms. they could just get up. so i would want everybody to have that. it's just the idea of making it available is an expensive and sometimes that would come at the expense of any more technological advances. i had another question. mr. wordin, this doesn't have
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anything to do that with particular issue, it those do with self-directed mental health care which i have -- you said something about that, i don't know exactly what you said, but it struck a note, that that's what you were talking abo in that theersonould help in the direction of what they would be choosing for their mental health care. i have seen that work in the private sector. do you think that ought to be more uniformly alied in the v.a.? >> well, i don't know if i would use the word uniformly, but i think it needs to be available because every veteran that suffers from ptsd is different. if you've seen one veteran with ptsd you've seen one veteran with ptsd, and i think what they found as their support system individually is the most important path, and -- and the great thing about the hero track device is it gives them feedback individually so then they can make decisions for themselves based on how their quality of life is that they want or that
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they have right now, and so if you go to the v.a. and you see your mental health kline chan and he goes, how are you sleeping? i'm not sleeping so good. well, we've give you some ambien. how do you know whether that actually does any good for you? >> well, with the device you're able to monitor and look at sleep patterns and look at ptsd episodes during sleep and being able to decide whether or not that's something because every prescription drug that you take has a side effect or it has some kind of addictive quality and that affects your quality of life as well. i mean,eteran in our program that literally have suitcases full of prescription drugs that the v.a. sends them on a regular basis, and then when they get io our program, they -- they get off of those prescription drugs and yet the v.a. continues to send them the prcripti drugs, and when you talk about costs for technology, technology is way cheaper tn prescription drugs. >> yes. that's not shocking.
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and that's awesome. thank you all for appearing, every one of you. it's been very encouraging, each of you, and your work. i yield back. >> thank you, and i just want to take a liteprerogative, too. on that particular point. if you can send us some ohose examples, you know, with whatever way that protects the patient's privacy, that would just be really helpful in us making this case, because i think that this is great disruptive technology that is going to save money, and the more we can highlight examples like that, i think as we move forward, so i now recognize mr. dunn for five minutes. >> thank you, madam chair. i love these joint committee meetings. we're all gathered and sort of underscores our interconnectiveness. we're sitting here with the energy secretary, the research subcommittee and talking about quantum computing from our national labs, and it's being applied to translationaleal
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genomics and all of this on veterans health. dr. kusne sew oy, i'm a urologist and prostate cancer is very near and dear to my heart. i know you're working on ways to determine bio markers that lethality of prostate cancers and how it can b treated more effectively. >> i can talk more to the technology side to the side that you might be more familiar with. >> i want to know the bio mark. i do appreciate what you're doing, and i think that that's key. mr. meek, you've partnered with v.a. hospitals and also i suppose military hospitals like walter reed. >> not walter reed. >> thee completely separate from you. so you partner with the v.a. hospitals. how do you select which ones? >> so we work with the device manufacturer, depending on what the device is, so if it's for an
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individual, sometimes they fall through the v.a. cracks and the device manufactureler find somebody that maybe the v.a. won't fund it or the v.a. will fund the device and not the flitting, so they will reach out tos to fill that void. in terms of the exo skeleton devices, again, we work with the manufacturer. there are 24 spinal cord medical facilities within the v.a. center and we start with those that have the largest population that they serve with the goal of hitting all of those with one device that they begin with and go back and circle back again. richmond, virginia, serves the largest with 5,000 spinal cord veterans and they have one device. they could use 25. pa alto has 3,000 to 4,000 veterans they could serve and they could use a few devices as well. one doesn't cut i it's a rehabilitative device where someone goes in like going to the gym with a personal trainer and you set your 45-minute time and do laps around the v.a. >> all right. do you also -- when you do provide one of these exo skeleton whatever type suits to the veterans, do you also provide continued support, a minute nerngs upgrades? >> we do.
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when we purchase it it comes with a four-year warranty as well as training for the entire staff at the v.a. >> you mentioned that the regulatory burdens, i just want you to know that we have been tasked by no less than the esidento streamline the regulatory burdens, so if you have regulations that you think are bad regulations bring them to us. we'd love to get rid of regulations, especially bad ones. miss maccallum, you're sort of a people strategist and you deal with a lot of people in different strata. you in your opinion have you seen the v.a.s and the veterans themselves, are they receptive to some of the new technologies? >> absolutely. you know, but i think about the fact that -- that just demonstrating with sergeant rose on the set --n our set we were able to raise enough money to buy an exo suit for a veterans hospital in one day, so i just think that the awareness that
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people need to have, and also i think that the partnership between public and private entities is so important, and i think about the new v.a. bill that is moving its way through congress andhe the gaps exist and the v.a. can't provide that stan theare allowed to turn to a privatentity in order to fill that gap, and i think we need to look for more ways to do that so that private enterprise and the v.a. can work most efficiently together, and then i think you'll see a scaling up of this technology in private facilities d veterans facilities, and i think that the will of the people in terms of what we've seen is certainly behind it, and i also think that when you look at the cost benefit analysis in terms of taking care of veterans long term and you just heard what mr. wordin said about the incredible expense of armauticals, this psychological benefit and life benefit of these devices hopefully will make some of
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those pharmaceuticals unnecessary. >> well, i -- i share your optimism and i thank you for the gratuitous plug for the mission act, the v.a. bill that we're carrying across the finish line right now. it's near and dear to my heart. i sit on that committee as well. i'm looking at 20 second left on the clock and it's not fair to bring up the question, mr. wordin, that you brought up, so cogently in your report the stigma that we attach to ptsd and tbi, not just in our veterans but in our active duty troops, and that this is -- this is a major, major problem that we've just been whistling past the graveyard on. you know, if we could treat it perfectly, we stl aren't allowed to diagnose our active duty troops or lest we ruin their careers. we don't have time to comment on that, and i'm glad you brought it up. >> if i could, i would like to say one thing about -- >> with the chairman's
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permission. >> one of the things we found in testing, one of the things that was brought up to -- by us by the v.a. is vets just for them wearing a device, but because it is an apple tch, it makes them cool. so the stigma is removed. therefore, they are getting help they wouldn't ordinarily get. we are aware of stigma in the vets we service. you have to find creative ways to get around it. >> thank you very much. you bet. >> thank you. it is gathering general information that's good for health and well-being along the way, too, right? so excellent. i now recognize mr. palmer for five minutes. >> i thank the chairwoman. i'll be fairly brief. i have to preside over the house in a few minutes. but looking at your involvement in this, i really appreciate how this started with soldier strong providing things to the soldiers
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in the field. some good friends of mine son's sister started that program and sending everything from sporting magazines to staples, essential things and it got to the point where her broth would get things and the other guys would say could you share that and it turned into a program support our soldiers. unfortunately he was killed on april 28th, 2010. an ied, but the program continues and has expanded and we're having a banquet next thursday night. these programs are incredible important for morale but also for the families that a lot of these guys don't get letters from home. they don't get things from home. thank you for what you are doing. mr. warden you mentioned the project heroes reduced participants use of prescription drugs and opoids.
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and mr. dunn brought this up as well. i think the process of dealing with these soldiers begins before they get home. and the whole thing about pstd, all that begins before they get home. and one of my concerns -- we got 22 veterans per day that commit suicide. and i just have to wonder how much of that is related to reactions to drug use. and what you are trying to do to reduce the dependance on drugs, i think mr. warden, could you comment on that, how you think that might help us reduce what i think is an unbelievable tragedy that's occurring every d with veterans. >> sure. when you look at the report that's going to come out, the risk factors that they looked at worsening of health status and decline in physical ability, those can be directly related to
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prescription drug use, particularly when you overprescribing of prescription drug use. and it's not working. and therefore you start losing hope. and then it starts depression. and then you're on the downhill spiral. and then eventually that's what leads to suicide. so that's where i think the prescription drug use comes into ay is because for doctorshe easiest solution is here's a pill. this is going to make you all better. whe whereas, that's not necessarily what's in the best interest of that individual. you are going to be able to figure out what's in the best interest of the individual and be able to prescribe for that person a health care path that is actually going to make a difference for him. >> thank you. i told mr. normal, if you would yield to me, i would hold three minutes. i think i came pretty close to that, mr. norman. and with that, madam chairman, i
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yield back. >> okay. we'll now recognize mr. norman. >> thank each of you for taking the time to testify. it is valuable. i'll emphasize what dr. dunn said. as you move forward, if you see regulations that are impeding what you do, let us know because we have a body here that is strong and will take your case to get needles regulations out of the way. it is a goal of the president. it is a goal of this body, of this house. you got an interesting role, as i describedn people business as an anchor and on the advisory board. what is your opinion on this and what has been your experience on the specific technology for veterans that is effective with raising money and raising the is it one or t that you can point to? >> you know, i think when people hear the stories of these veterans and the impact it has on their lives, you know, here is one veteran, jason gieger who
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was a soldier strong beneficiary, he said you cannot put a price on walking. you can't put a pce on someone's ability to be six feet tall gen and stand up and kiss your wife. you can't put a price on th. we talk a lot about money because we have to, because it is part of bringing this technology to our veterans, but i think there is a will in america to provide for this. i think people are very much aware. you talk about regular eurasians of the waste that exists in the federal government in its good efforts in many ways to solve some of these problems. but i think eaveryone sitting here is working towards efficiency in improving the lives of our veterans. through technology and awareness, a lot of these ideas can help us cut some of the waste in these programs and to produce more benefit. >> we don't know what we don't know. and as i'm glad you brought up
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waste because every agency, particularly now, can give us a road map as to where they have waste specifics on how we can address it. i hope y'all will do that as you move forward because every dollar saved through waste goes back, would go back, into potential good use. mr. meeks, how did we decide on the soldier strong decide which v.a. hospitals will receive the soldier suits? >> so again we with orkede device manufacturer. and within the v.a. medical there are 24 facilities. we also worked with those that have a traumatic unit as well. and, so, the spinal cord injury unit will focus more on traumatic. we'll take the recommendation from the device manufacturer with the goal of getting those that serve the largest population a device first and
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then going from there. >> okay, perfect. thank y'all. i think we're at about 12:00. we approaeciate yr testimony. i yield back. >> i thank the witnesses for their testimony today and the members for their questions. without objection, chairman weber and ranking member opening statements which were not available to make when we started the hearing are made a part of the record. i really so appreciate the great testimony here today. i think we're really seeing discorrudi disru disruptive, positive innovative technology and there is no question that we need to reallocate resources, get new resources and make sure we're providing this choice because a lot of the things we're talking about in our veterans what we're trying to improve is more veterans choice and what you are offering is more choice and more positive outcomes. i think it is a lot of win-win
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solutions that you have here. so we look forward to working with you on how we can redirect and reprioritize this so we actually end up with better outcomes that will ultimately, most importantly save lives, but also save money. so this is real exciting and i think this is the beginning of what i hope will b a continued discussion on we're already discussing to be some legislation and efforts we can work with on our members. thank you forinspire rational work. the record will begin open for two weeks. and this hearing is now adjourned.
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we are live on capitol hill this morning as alex azar will be testifying on president trump's prescription drug pricing plan before the senate health committee. limiting the growth of medicare payments for drugs administered in the doctor's office to consumer inflation. the administration unveiled its plan late last month and since then several drug companies have raised their drug prices. this hearing should start in a moment. you see mr. azar right there on the right.
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