 Okay. And for our final formal presentation, Ingrid Holm will be talking about the work that she's been doing on providers. So all you need to do is just hit the answer. Oh, right. All right. It's all set up. All right. So I'm here to talk about the healthcare provider survey process and just a little bit of background on this. I mean, as you know, there's very little kind of systematic knowledge right now that we know concerning the views of healthcare providers regarding getting genomic information back of the type that we're returning and emerge. But as it turns out, most of the emerge sites, and so there's non-clinical sites, did not have a specific aim to study the impact of return of results on healthcare providers. Yet the ROR-LC, so the work group, really one of the missions of the work group is to study the L-C, to kind of L-C of both patients and outcomes on institutions returning results, but also on healthcare providers. And so this group really felt that it was really important to assess the impact of return of results on healthcare providers as part of their mission. So we're kind of faced with, we think it's really important to do, but we didn't have a way to do that. And so what happened is that the work group applied for an administrative supplement through Merge through the NHGRI L-C to develop a survey to study healthcare providers. So we kind of, all these are the parts of what we did to develop that survey. And then we applied for an ROR-1, which I should say one of the kind of issues we talk about timing later on is that we didn't get the ROR-1 initially, we had to resubmit it, so between the time that we submitted or decided to do this and actually got funding for it was like a year or a year and a half, but we did get it. And this is ROR-1 was to survey healthcare providers within kind of a month of receiving results back about a patient they were following in Merge. And then to do qualitative interviews six months later at kind of four of the sites to really get some more kind of in-depth information about the impact on healthcare providers. And then to put this all together to kind of identify approaches to returning these genomic sequencing results to kind of overcome the barriers that healthcare providers saw. So it's all kind of very kind of logical, straightforward. We had kind of nine sites doing this all together, but we discovered as you can imagine that there are a lot of challenges and kind of some lessons learned. So the first is just every site had a different return to results process. So this is, you're not supposed to, the idea is not to read this, but to just kind of realize that it's really complicated. So this was a study that, so Georgia Wiesner and Kathy Lepig together kind of developed this group, they interviewed people, they went through to really categorize what the differences are. And there's a ton of differences in how results are being returned. And this is kind of a summary of them. So different cohorts, different methods of returns, study staff returning results, people getting choices. There's all sorts of differences across the sites on the return process, yet we're trying to study this in some kind of a logical way. So and I'm going to go through kind of some of what these differences are and how this impacted us trying to send out surveys and get information back from healthcare providers. So the first question is who returns the results to the participants? So in some case it was a primary care provider, genetic counselor, geneticist, other subspecialties. So it kind of comes down to when it comes to return results, who to send the survey to. So we're not going to survey and emerge geneticists who's returning the results to their, to a participant, I mean that's not the point of this, we know what we think, the point is what other people think. So yet there are some places sites where an actual healthcare provider either subspecialty or primary care providers returning it, we are interested with them. So kind of figuring out who the people are. And then as I showed in the other slide there's like differences in the timing of returning results to provider and patient. So trying to figure out when does a patient have the information and the provider have the information so that we can send a survey because we said we were going to send it within kind of a month. Sometimes these results actually they're all going to medical record but there's also timings with that. Is it in the medical record before it's returned to the patient or is it returned to the patient and then goes to medical record and where does a healthcare provider come into that. So that became kind of complicated. And then once results return to a patient by somebody, who else did these results go to? Because these are the people we were kind of also really interested in surveying. So if a geneticist returned the results, when does it go to their healthcare provider, is it going to a subspecialtyist who's also seeing the patient that might want to follow up on it? And we're interested in getting these views of all these people but it was kind of figuring out who all these people are. And then we had issues with, you know, how are the results returned to a provider? Have they sent a letter? Does it go through the EHR? How do we know that a provider's actually kind of seen the results? And then, and this all kind of gets to this issue of timing of the survey. So we wanted to do this within a month of getting results but we don't really know if they've gotten it yet, have they read it. So there's a lot of kind of complicated kind of issues there. So then there was also other issues. So, you know, things like the surveys are being sent from Boston Children's through a red cap survey but with some issues with technology. There's some issues going through a firewall, issues with knowing that actually the provider received the invitation to participate in the survey. And then, you know, not everybody had email addresses. No, I'm sure everybody, all the health providers had an email address but they may not have an email address associated with their work. I mean, they have their own Gmail account. And so for a number of sites, for the primary care providers that are in community, we couldn't email them. So then we have to send them a fax or send them a letter and if anybody, you know, it becomes much more complicated when you have a survey that's an online survey where you have to send them a letter to get that. And so that made it all kind of added complications. And then we've always had issues with enrollment, you know. So it's like not a surprise. We are providing an incentive but it's not like we're giving them $250 to fill out the survey, which would be probably a real incentive. But, you know, we're giving them some incentive but these people are busy or they're, you know, kind of read this and don't even really know what it is or they're saying I'm just not interested in participating. The email goes to spam. I mean, it's all sorts of kind of issues with kind of engaging participants. And then we had some issues with the survey itself in that we're sending a healthcare provider a survey about a patient but we can't put the name or anything that's identifying about the patient in the email about the survey yet we have to get them to know who it is. So that became quite complicated. I'm trying to say, you know, so we end up saying you're patient who's, you know, X years old who had this disease and things we put in to try to make it so the healthcare provider understood it but that was certainly kind of another complication of sending these surveys out. And then there are, you know, some of the sites for a healthcare provider may have gotten results back on more than one patient. So how do they know which patient you're talking about? So this also became kind of very complicated. And then we had kind of some sites as a specific issue. So I should just say this, we had a reliance agreement. So Boston Children's was the kind of central IRB and we did have this reliance agreement which made it somewhat easier because any changes kind of go through one place. It really did work. But there's still issues at sites for kind of rules or about what is allowed when it comes to things like non-responders. So we're trying to figure out, so if we send three, you know, the survey and then reminders, those are non-responders. Can you call them? Can you kind of contact them in some other way? And certain sites have kind of specific rules about that. And we actually also had other studies, a site that might kind of interfere with the study. And for example, Vanderboot has done or has done qualitative interviews on some of their healthcare providers. And so we don't want to interfere with that kind of process. Then there was a whole thing with timing. And that's really been a big kind of issue for us. And as I said, it took a while to get the grants. So by the time we got it and got going, a lot, a number of the sites had already turned a significant number of their results and were kind of out of this window where any healthcare provider is going to really necessarily remember what we're talking about. And so that has kind of been an issue for us. So at the same time, so we had a lot of kind of issues, but we do see some of these as providing some opportunities. And I think the big one is really kind of leveraging the difference between the return results process of each site. So this allows us to think about, to kind of look at all these issues, responsibility for results, conversations, workflow, management of patient results, benefits, concerns in the context of how results are being turned, how they receive them, and being able to look at does the way you get results and the really impact on what difference it makes on the impact of healthcare providers. So I think the real kind of lesson learned is that taking advantage of all the differences that we have between the sites to really kind of do this experiment of nature and see what maybe kind of works best and eventually come up with recommendations. And so I'll stop there and turn it back to Mark. Great. Thank you. Great. Okay. Okay.