 All right, I think we can do this reasonably expeditiously. So Northwestern will be hosting the GM5 meeting in Bethesda. Please make note of the dates. It'll be the 28th and 29th. So unfortunately, that means travel on Memorial Day for people that observe Memorial Day weekend. As Terry alluded to, and as you just sort of saw a preview of, initially, the plan had been to think about using this to explore international genomic medicine implementation projects. But just due to the closeness of Memorial Day weekend to now and the fact that none of the international groups had actually been contacted at this point, we decided it actually probably made more sense to delay that for GM6 because there's probably a little more lead time when international groups are involved and really focus on wrapping up what's really been a two-year process. So this meeting will be happening very close to two years after the original GM, I guess we're calling it GM colloquium, not GM1 since we heard about that earlier. So what we want to really do is see if we can summarize the four meetings that have been held since that initial or the four, including the initial colloquium. And try to come together and review what it is that we've learned from engaging this wide variety of stakeholders. We've effectively talked about many of the places that are doing implementation projects. We've talked about integrating with payers, and you've heard a lot about the payer meeting and some of the work that was done on that. You've heard a lot about the funding opportunities that NHGRI has put out based on the discussions in this group. I think we'll have some clarity by that meeting of who some of those awardees are likely to be. And we've had this meeting where we've really had, I thought, a really good discussion about what the role of societies were and how do we think about education for the various stakeholders, whether they're patients or whether they're physicians or other health care providers. And so what we want to do is use this meeting as a chance to sort of revisit that and refocus our energies going forward on what makes sense to do. One of the other things I think that's very clear that came out of this meeting was that there is probably additional discussion to be had with the societies around the idea of clinical practice guidelines, best practice guidelines, and other levels of maybe non-randomized controlled trial based or evidentiary based approaches since we're very early in the game. And so I think we still want to use this meeting as an opportunity to maybe have a discussion about some of those issues in the context of how do we move forward in terms of filling the pipeline to get us to the place where we're actually able to have some clinical implementations that are maybe even able to be funded by payers and to be more broadly assessed for their outcomes. Since the meeting will be held in the Washington, DC area, one of the other things we thought was a great opportunity for this meeting was to engage the key federal partners. We have had several of the federal partners have people in attendance at these meetings, but we'd really like to think about what are the opportunities with things like ARC, I guess that's just not showing up. CDC, CMS, FDA, DOD, we've had good participation from the Air Force at a number of our meetings. VA is another one that wasn't on this list where we've had some good participation. We'd like to reengage, they have big plans. And then obviously as we think about outcomes, PCORI seems like a very important partner in terms of thinking about what should genomic medicine look like going forward. And I'm sure there are others and would welcome suggestions from you in a minute about what those others might look like. And then in addition to those groups outside of NIH, there's a variety of groups inside of NIH that we'd like to reach out to and see if we can engage at this meeting, including NCATs. One of the partners that's always made a lot of sense I think for us as we think about genomic medicine is the network of CTSA awardees and what they may be able to bring to the table. I know that in eMERGE most of the eMERGE consortium members are also affiliated with CTSAs and so we think that trying to leverage that and what NCATs goals are going forward makes a lot of sense. We heard quite a bit today about cancer and so engaging with NCI in a more formal way seems like it makes a lot of sense as well as heart, lung and blood. Those are some of the key stakeholders where genomic medicine seems like an early and initial good source for interactions. And then even though it's really focused on more fundamental studies, NIGMS is also funds a lot of genomics work and so it would make sense for us to engage them to the extent that they're ready, they're in the process of changing leadership and so hopefully that'll be maybe a little clarified by then. And then to invite anybody else from NIH that makes a lot of sense. So this is sort of the outline of what we're thinking about for this May meeting and so maybe I'll stop there and see if that resonates with people, see if people have suggestions for other stakeholders that should be involved or for people that we've missed that aren't on these lists. So we have Jean here first I think. Child Health is particularly interested in this. That should be on the list for sure. So we have Joan and then Chris and Alan. I was just going to suggest that HRSA may play a role in being here. Great suggestion. Yeah, I just want to say that for the Air Force side of the DOD component we've had a lot of interest from the Navy in kind of picking up our current study and probably by that May timeframe we should know what that implementation is going to look like and what their level of involvement will be. So they might be another good partner. Well that would actually be I think a really nice extension. So they're actually effectively talking with the Navy. That's fantastic. Yeah, it's pretty unbelievable. Well they want all things joint right now so it's kind of working in our favor. Excellent. Great. Alan? Chris maybe you mentioned this already but I think re-engaging the EHR vendors would be a good idea for this meeting since we've heard that's a real bottleneck for many of us. Obviously Rex gave a very abbreviated summary of this. I'm not absolutely certain that that would be the right venue for this particular meeting given that in some ways some of the output of this is going to be looking forward to the international meeting that we're going to hear about which may have less to do with some of the on the ground EHR but I think it is something that's important for us to consider as a planning group to say you know at what point do we need to bring that up as a prioritized topic? Yeah, it may be for example as Josh mentioned Emerge is engaged with the EHR vendors and had them at a meeting really around that general topic. It may be that a second round of meeting with them through Emerge and then eventually and obviously through Emerge and its growing collaboration with PGRN might make sense for a place to have that discussion and then a report back in the future. So we have I think Pearl then Jonas then John. I'm a little hesitant to offer these but just because we refer to them commonly I was just wondering about Office of Civil Rights for HIPAA. Should they just know what we're talking about and maybe even more tangentially with the Office of Human Research Protections. But I think you know not as a speaker but. Yeah it's a it's a it's a it's yeah you know and it's an interesting time for them because you know as you know with the advanced notice of proposed rulemaking and with I think increasing uncertainty about where that advanced notice is heading although maybe somebody else in this room knows more. Last I heard there was increasing uncertainty about the timeframe for the implementation of that. I don't know if that's actually a good time or an awkward time to engage them so I think it's an interesting point for discussion yeah. I mean one thing with the context of the Secretary's Advisory Committee of Genetic Health and Society when we invited them to come about the specific issues about lack of clarity around family history data they actually took that back and created a statement about the family history data which is actually much more liberal than any of us would have ever imagined that they would have come up with so I think if there are targeted issues that we've identified that fall into their purview where we could you know explain the problem to them and say if you can provide any clarification or assistance they might well act on that. Yeah there was in conjunction with recent or well I guess a year ago a merge meeting there was also a data sharing, return of results discussion and they actually did send representatives who participated very actively in both of those in those discussions and so there's certainly willingness on their part and I just the question is whether this is the right time or not and but that should be the planning group will certainly discuss that and reach out to them and see if that makes sense. Jonas? Since there are some non-trivial big data governance issues in this sort of framework it will be interesting to bring the NSF big data and data sciences people. Is that just a suggestion? Many of us would be interested in the financing of trying to get genomic medicine implementation to work and so I'd like to learn more about the third party payers and how people solve that problem around the country and what works and what doesn't and I don't see that on your list. Sounds like we need a 14 day meeting. Well I think to some degree John we tried to address that at GM3 but more at the payers meeting and so we would have some review and status from one to four maybe not I mean that's a topic unto itself that could take several days and so maybe we can touch on it I'm not sure that we can do it in May. We may want to think about having some kind of a separate effort or some subsequent effort for that but maybe we can work with you on kind of identifying what are the key issues that could be addressed in sort of a sub-segment in May. Well and I think a related piece is that there's still quite a few as you heard from Derek earlier there's still quite a few outstanding issues from the payers meeting and so it may be that at this meeting we'll be able to report on what some of those outstanding issues from the payers meeting are and that'll set the stage who knows for genomic medicine seven or eight. Hers is a key education partner so I don't know if you thought about inviting them or having some discussions with them. Well keep in mind before Marin and Jeff maybe you could head up to the podium. Keep in mind that where we're trying to go at least what was proposed was to unify our efforts in the U.S. genomic medicine implementation so that then we could present more of a united effort in September or whenever we meet with the foreign folks. So yes, right, so HRSA would be one of those but it sounded like you were trying to take us further than that, just HRSA. I would say from the VA I know you've invited the folks that are responsible for a million veterans program and the Biolab side of the Office of Research and Development but you might want to consider inviting David Atkins who's the lead for the Health Services Research and Development part and that's where I get my funding from VA to do implementation research and so forth and he also used to be the director of AHRQ as you may know so he's kind of pretty savvy guy and Seth Eisen who just left that position I think he's been charged with trying to look at the million veterans program and how it might relate to kind of assessing outcomes, et cetera. So especially with our EHR and all that so Seth Eisen might be somebody as well. Great, thanks. Any other comments? Wonderful, thank you Rex. You milked that one slide for all it's worth. Great and then last but not least by far Jeff.