On April 1, the House Committee on Veterans Affairs held a hearing, "Harnessing Biomedical Innovation: Modernizing VA Healthcare for the Future." Dr. Sairam Parthasarathy, director of the Center for Sleep, Circadian and Neuroscience Research at the University of Arizona Health Sciences and professor and chief of the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at the U of A College of Medicine – Tucson, was one of four people invited to testify.

For more than a decade, Parthasarathy served as a physician and associate chief of staff for research at two VA hospitals: Edward J. Hines VA Hospital in Hines, Illinois, and the Southern Arizona VA Healthcare System. Today, in addition to his duties at the U of A Health Sciences, he serves on the board of directors for the Biomedical Research and Education Foundation of Southern Arizona, a nonprofit that facilitates and supports the medical research and education mission of the Southern Arizona VA Healthcare System.

The U of A Health Sciences Office of Communications talked to Parthasarathy after his testimony, which can be viewed on YouTube.

Q: Why is this the perfect time to talk about modernizing health care and biomedical research?

A: A wealth of scientific knowledge is being generated by biomedical research that has cross-cutting benefits to veterans’ health, especially in the nascent area of sleep and circadian science. But just because there is a research innovation doesn’t mean it is automatically going to become a standard of care. It is not an organic process. The problem is it diffuses slowly before it reaches the clinic and the hospital. The general saying is that it takes 17 years for 15% of research innovations to make a difference in the lives of the people who should be benefiting from it, and that's kind of tragic. There is a dire need to disseminate and implement – or simply put, "harness" – these research findings into day-to-day clinical practice for us to realize the return on investment for such scientific knowledge and to improve the health of the veterans and the nation. 

Q: Is there a way to bridge the gap between biomedical innovations and clinical application?

A: Part of the problem with harnessing new innovations is not knowing the touch points, barriers, facilitators and solutions to be able to integrate a new way of doing something. The approach of implementation science entails harnessing new biomedical innovations to the bedside and clinics to benefit patients everywhere, including veterans. Implementation science is figuring out a smart way of doing something new. Implementation science considers the health care provider's work-related burden in a busy clinic or hospital and the validity and applicability of the scientific findings to that context. But just because something is there doesn't mean we know when to use it or how to use it. That's why we need artificial intelligence and machine learning. Enabling AI and machine learning approaches will assist with dissemination and implementation science while shifting the task from the busy health care providers to machines that can work hand in hand with them.

Q: Can you give us an example of implementation science in action?

A: I'll use sleep as an example, but this is applicable to anything – management of high blood pressure, heart failure and any chronic medical condition for that matter. We refined a machine learning algorithm developed by researchers at the Massachusetts Institute of Technology and embedded it into our electronic medical records system here at Banner – University Medical Center Tucson. The algorithm can identify individuals with high likelihood of sleep apnea, alert the health care provider to that fact, and enable them to place an order for a diagnostic test or sleep study. If the patient is already diagnosed with sleep apnea, it will ask if the person is using a CPAP machine. By clicking a button, the heath care provider can trigger an approach to promote CPAP adherence through peer-to-peer support via the phone.

Q: Are you working on any new biomedical innovations that could benefit veterans?

A: Sleep apnea is very common in veterans and is characterized by repetitive obstruction of the throat, snoring and temporary cessation of breathing associated with low oxygen counts during sleep. Sleep apnea has been associated with heart attacks, strokes, high blood pressure, traffic accidents, poor outcomes in individuals with traumatic brain injury or PTSD, depression or suicidality, and even death. There are an estimated 40 million people with sleep apnea in this country alone and an estimated 7 million people who are on CPAP therapy. Treatment of sleep apnea with a CPAP machine that delivers pressurized air to keep the throat open has been associated with reduction of motor vehicle accidents, improvements in blood pressure, reduction of cardiovascular mortality, however, only two-thirds of patients with sleep apnea are CPAP adherent. There are not enough sleep specialists to support the millions of patients in need of CPAP adherence promotion programs. You need an artificial intelligence, machine learning-based tool that can help promote CPAP adherence and benefit people. This unmet need is being addressed at the University of Arizona Health Sciences, where we are in the process of developing an AI/machine learning approach for algorithms to help veterans and civilians be adherent to CPAP therapy. There are similar machine-based approaches available through Apps that can deliver cognitive behavioral therapy for insomnia – another common sleep disorder – with huge implications to mental health.

Q: Your testimony was in front of the House Committee on Veterans' Affairs. Do you see broader implications for harnessing biomedical innovations?

A: The burden and severity of sleep problems are very high at the VA, so it's a good place for us to start talking about it. The time is now to harness the biomedical advances to benefit the health of veterans using AI and machine learning, and targeting sleep would enable us to touch every organ system, address chronic medical conditions such as heart disease, dementia, diabetes, respiratory diseases such as COPD, and thereby improve overall physical and even mental health. Veterans are veterans, but they are also U.S. citizens, and they are part of our communities. There will only be downstream benefits – society at large will benefit from addressing sleep problems in veterans and thoughtfully harnessing and implementing these innovations into the real-world.

A version of this article originally appeared on the University of Arizona Health Sciences website.