 So, today we'll be talking about the network of genomic enabled learning health systems. Before we get started, I would like to recognize the team here that has been working on this to bring the SnowFo to publication and wanted to thank them. This team will be working on the application with the applicants and also be working through the applicant process and review process. So, to get started, I just want to go through a quick overview of the overall talk so you know where we're going with this. As first, we'll actually talk about the purpose of the genomic learning health system, SnowFo. We'll go through some definitions. We'll also go through an overview of the funding announcement. We'll provide a little bit of specific information about NCI's Institute's specific interest. We'll go through the eligibility criteria. We'll talk about some important dates. And then we'll get into questions and answers. So, the purpose of this funding announcement is something that NHGRI recognized was a key gap in genomic medicine, which is that key gap is actually taking the transition into clinical practice, a lot of the evidence that has been generated in genomics. So, this purpose of this SnowFo is to form a network of genomic enabled learning health systems to work together to improve the approaches for integration of genomic information. And the important point is a virtuous learning health system cycle of implementation, evaluation, refinement and implementation. So we want to, we know that many of you on this call are actually familiar with what a learning health system is, but we thought it would be for this funding announcement to go through the definition of how we're seeing it for this SnowFo. We recognize that a fundamental hallmark of a learning health system lies in the capacity to seamlessly incorporate evidence-based interventions into clinical practice. The important part is that this integration entails a continuous collection of data from the health care providers and patient, which essentially allows us to pivot and process adjustments aimed at enhancing medical care through the wider adoption of evidence practices. We do recognize that a key feature of this is a close monitoring of outcomes to facilitate real-time adjustments and ensuring that the achievement of the anticipated results. This approach will revolve around a virtuous cycle of consistently implementing enhancements and then rigorously assessing their impact on patient outcomes. We recognize that there's many examples of learning health systems that are used to adopt a wide range of health care needs that we just used a few examples here, whether it's palliative care and end stage liver disease or testing and de-labeling patients that are reported with a penicillinology. Another one is balanced crystalloids versus to reduce adverse kidney events in critically ill patients. So I want to go through a few definitions that are included in the SnowFo, but to go through the ones that are relevant to this discussion. One is a genomic medicine intervention. And again, this pertains to evidence-based clinical care initiatives. And I think the important part is there's evidence, there are evidence-based initiatives that leverage genomics to enhance patient outcomes. And these projects will be selected for implementation due to their proven effectiveness. And we included a few examples here that could be as broad as incorporating or using electronic health records to identify individuals that carry a pathogenic variant, to also genome sequencing for critically ill infants. And we recognize that there are many more. The other definition here is genomic medicine implementation strategy. We refer this to how an intervention will be implemented and scaled to multiple health care environments. One of the key things of this SnowFo is to advance the adoption of genomic learning health system. So this could include things such as educational models or modules. EHR provided clinical decision support checklist or formulary. And we recognize there's many others. We defined a virtuous learning health system cycle is that iterative process to encompassing implementation, evaluation, refinement, and then re-implementation. And the idea of this is a framework that health care stakeholders deliver evidence-based interventions while concurrently learning to enhance care delivery throughout that continuous feedback loop that we talk about in learning health systems. So this slide is to kind of give you an idea in terms of where the focus of this is. As you can see here on red, this is on the subway chart in red here is really studies that actually we've supported that actually look at efficacy. And then here in yellow is some studies that we look in terms of effectiveness. This SnowFo was intended as highlighted in the green here to establish a network to develop and refine genomic learning health system approaches using an implementation science framework. Really with the goal to help with the adoption of genomics into clinical care using by doing qualitative and quantitative research and measure the impact. I think the one thing that's important we recognize with this SnowFo is that we do need to make it possible to essentially have near automated low resource ways of measuring outcomes to be successful. So what are the gaps addressed by this initiative? We recognize that there's been a slow uptake of several evidence-based genomic medicine interventions. Many of these people on this call will be familiar that there are multiple conditions, whether it's actual conditions for hereditary breast, no variant cancer, Lynch syndrome. There's also time sensitive genome sequencing and critically ill infants and pharmacogenomic testing again are just some examples of things that have been slow to uptake. And really this is intended to take those areas where there's effective evidence that they should be more broadly adopted. And we also recognize that there's a limited incorporation of genomics into learning health systems. We've actually looked at what NIH does support, which is plenty of learning health systems, but there really is a posity of genomics incorporated into those learning health system models. We recognize there's a need for improved exchange of genomic information across the health systems. We see in some of our studies that in order to include people in studies that one of the challenges is that as we know patients get their health care in multiple settings and it's important for that information to be able to track with them. And this last part is we recognize there's really no resources out there for genomic learning health system approaches, tools and resources. And so one of the key products of this effort is really to actually make these more broadly available so other institutions can adopt a genomic learning health system. So the objective here is to establish a network of institutions with the track record of using genomic learning health system approaches in their health system. We do expect including in resource limited communities the ideas that they'll refine and develop these practices into implementation resources. You will notice that we identified two to four network-wide implementation projects and the idea of that is really to check the robustness of the genomic learning health system, but and to use those to kind of understand these tools and resources to make them more broadly available for other sites to handle. So just to talk very briefly about Institute specific interests as you will recognize on this bullet list here, many of these are we've already talked about. But I think the one thing that is unique that NCI has brought up is tumor sequencing as one. So really the program structure, the plan is to fund this over five years. We have issued two U01 NOFOs with a single coordinating center and then four to six clinical sites. Again, the project plan in year one is the network is to share their learning health system implementation practices and identify really those that are suitable for cross network implementation in years two through four. The idea is the network will actually select and implement two to four genomic medicine intervention projects and then year five will really define develop these and refine these the genomic learning health system strategies as resources that can be used to broadly adopt for other institutions to adopt genomics into their health system, including in low resource settings. The funding is five point three million over five years for a total of twenty six point two million. So eligibility criteria, I think this is very straightforward. I think the most important point is that is not eligible. We're not allowing non domestic, non US entities to apply. And then just really to provide some important dates, the open date for the earliest submission of an application is October 6th of this year. The letter of a tent is also due, but notice this is optional. It does help us when you do submit this to kind of help us plan for review and planning how many applications we have to manage. The application due date is November 7th of two thousand twenty three at five p.m. Your local time of your applicant organization. We do anticipate funding this in August of twenty twenty four. I'm going to move on to some questions and answers. I think one of the question that we've heard consistently is why does this meet NIH definition of clinical trial? Well, one important point to recognize is NIH expanded its definition in twenty fifteen of what a clinical trial is. Just going through what the criteria are, it does involve human participants. It prospectively assigns these participants to an intervention. It evaluates the effect of the intervention and monitors biomedical or behavioral outcome. I think that it's very important to make the point, though, the primary focus of this endeavor is quality improvement. We do recognize that some interventions may meet the NIH definition of clinical trials and the application should thus meet the clinical trial application requirements. I have put these in the slide here in terms of what is the significance of being a clinical trial? I think the first thing is the application evaluated is based on is based. The application is evaluated based on specific clinical trial criteria, which is linked out here. And then some other things is the the the network will have to register anything that is deemed a clinical trial with clinical trials dot gov. This is usually done by the Coordinating Center. The grantees must you must ensure that you have good clinical practice training for all the clinical investigators that are involved with this. The next point is a principal investor must set a human subjects and clinical trials information form. It's important to note that we are anticipating this not to be to be a delayed onset human subject research. And the reason is is we will not have we're not expecting a protocol at the time of submission, but we will need to get we will need to have this. The protocol submitted to us for review and approval before we start. The principal investigator must also update using the human subjects system. And the principal investigator will also have to post the clinical trial informed consent. Again, this is usually done by the Coordinating Center if it's a network wide protocol. And the lastly, the network will need to submit a single IRB if we are doing the same study across multiple sites. So now I'm going to just step through a few of the questions that we've received. What are the key aspects of a learning health system that need to be in place for this NOFO really that you should just demonstrate that your organization has adopted a learning health system approach that is committed to the real time collection of data from patient encounters. And it's really related to that intervention and then really the ability to rapidly adjust or make changes based on those findings. And we really do are hoping to a nearly automated means for doing this, just recognizing that it's very difficult to capture data manually. The next one was what level of detail of statistical analysis should applicants provide for the proposed pilot projects where we are really thinking of two areas, there's two aspects of this will require measurement. There's one, the adoption of genomic intervention, and there's also the varying effectiveness of different interventions when they are adopted. And we're just anticipating that you will define what will constitute a meaningful impact for that you're the proposed intervention and outlawing your analytical strategy for assessing both adoption and effectiveness. You should also include the power of your proposed design to detect meaningful outcomes. Does my research strategy need to adhere to the 12 page limit? The short answer is yes. How conceptually distinct to the proposed implementation interventions need to be. We are encouraging you to offer a diverse array of implementation interventions that are substantiated by the most robust existing evidence, really with the imperative to suggest that the evidence should have broader adoption within the health systems to enhance patient care. We're really leaving it up to you as the applicants to discern and describe distinctions among the proposed projects and justify why more than one conceptually related project is needed. Do applicants need to have a learning health system in place to apply? The answer is yes. We recognize there's a significant amount of effort and time that it takes to establish a learning health system. And so given the funding announcement and the funding period, we recognize that this will be important to be established at the time of award. But does your institution have to have genomics? We reckon already incorporated into your learning health system. No, we do expect you to demonstrate that you have the capacity and expertise to implement genomics into your existing learning health system. And then will sites be able to work implementation interventions that are not selected by the steering committee? The focus will be on these implementation interventions that are selected by the network with recognizing that the funding is limited and is provided for the snowfall for these sites wide implementation projects. You are welcome to implement and share site specific interventions and products using your own resources, but these must be a secondary priority to the network wide implementation. What is meant by having an active partner in the investigative team? We think this is a very important point. We recognize that not all health systems actually have learning health systems. But the intention here is actually to have investigators that are in your community and preferably from underserved communities that don't have a learning health system in place. And the idea is they can work from the beginning as a co-investigator to work with us as we select different things that should be implemented to help us adjust what we're implementing, but also the intent is at the end that these individuals could go back to their institution and probably share the genomic learning health system approach. And that's all the questions I have. Again, just a reminder that this is recorded and it will be available for viewing on the website again, give us a week to get that to you. If you do have any questions, you can email me at this email here. And the FAQs, we will continually or consistently and regularly update those, but there will be no announcements in terms of when that's done. We have provided the link to the two NOFOs that have been published here at the bottom for the clinical sites and the coordinating center. And that's all I have and we can take any questions. Hi, Rob. So there are a couple of questions in the chat. The first question we got are our health economics based outcomes mandatory. Their health economics outcomes are not mandatory. No. The next question we have are is does the genomic data sharing policy apply to all applicants, even if we're not collecting new genomic information from participants as part of the project? Yes, you will have to submit as part of the new data management sharing policy. You will need to submit a data sharing policy plan or your plan, and that will have to be reviewed. Another question we got is how should CS applicants budget for years two to five, given that it is not known which projects will be chosen? Yes. So with that question, you know, we've outlined in terms of what that budget will be for the network and everyone will have the same constraints or the same budget to work within. Once all these projects are provided by the network and the steering committee is going to have to consider the financial parts of that and whether it's feasible to implement at all the sites. I think that answers the next question as well as should clinical site applications budget for two to three pilots or one pilot project? And then the next question we have is how many examples should we have of both of tools and resources we are prepared to share with the network? Well, I think there's a couple of things with that. In terms of tools and resources, the expectation is that you should use some examples of what tools and resources you would develop in terms of specifically saying that you have certain tools to share at the time. The idea is, I guess, if you could use an example, if we used hereditary breast and ovarian cancer, you might have some tools to be able to do that. And you could say that that's why you're choosing this project because this is one of the projects is because you have these tools and resources available for implementation as as opposed to being very specific about how many you have. Before I go on, I believe Catherine Nathanson has her hand raised. Catherine, are you able to ask your question? I am. I have actually a few questions. Can you hear me? Yes, we can hear you. So one of our questions has been how do we manage the investigators on the project? So, for example, I'm getting hypothetical. We propose a pharmacogenetics project. We have a pharmacogenetics person in funded and has effort on the grant. No pharmacogenetics project is selected by the by the consortium. And so now do we like we have someone who's like I just am unsure about how. But for example, we can pull in a neurologist. We didn't propose a neurology project. We don't have a neurology person with effort, but we could pull them in and give them effort like I just am unsure about how we propose other than sort of the PIs, the investigators who would be the clinical champions for the various implementation science projects, because we don't know what will be selected by the group. Yeah, so we've done this in the past, too, is where we have sites actually propose what they think is the best. Of course, this will go to the steering committee. The steering committee will make a final decision on what those are. As a result of that, you're right. There might be some individuals that don't necessarily meet the criteria are needed, as you used an example, pharmacogenomics and maybe you do need a neurologist to kind of help. The idea would be is you could you could reallocate your budget to support the people that you would think to need to adopt that certain intervention. And so that's something you can do once it starts. And Terry, I see that you came on. Do you want to? I did. Yeah, thanks for that question and that answer. I agree, Rob. I think also in your application, you may want to consider budgeting based on what you're proposing as your two to three projects and have it make the most sense for your proposal, recognizing that that may not be a proposal that goes forward. So if if you're thinking of something that's that might be a little bit extreme in one direction or another, that that might be a constraint on you to to try to describe and then to re-budget in the future. But we will allow re-budgeting. Obviously, we want to talk about it, especially if they're like an MPI or something like that. So so I think we can we can allow flexibility, but do propose what what you include in your application for your budget they should match. OK, thanks. I had a second question on which is how do we deal with the fact that different institutions are at different levels of implementation of genomic medicine and I'll give an example. So, for example, at our institution, we have really all our pancreatic cancer patients are getting genetic testing routinely, but that may not be true at many other institutions. And so how are you guys thinking about when you have really differential implementation of genomic medicine and projects are proposed where one institution like already has something in place and they're already doing it, but multiple other institutions don't. I'm just sort of thinking out loud about how do you think about that particular issue? I think there's two parts I would say with that. Number one is if you come in with that is one of your proposed projects. You're kind of going to be the condition lead expert in terms of that and probably further along. So I mean, I think that's helpful. I think the idea would be is hopefully by bringing these other institutions, you can improve your process, but at the same time help the others move along. That being said, there's two other if we select three, there's two other projects that you might not be an expert in. So hopefully they balance out and those will have to be things that we consider when we actually select when the steering committee selects those conditions. Thank you. It looks like there's several more questions in the Q&A. I believe that this these few questions answered one of the previous questions about asking if some of the sites may not be able to implement some projects. For example, a children's hospital may not be able to implement a project involving adults. So is there anything more you'd like to say on that? Yeah, I think I would go back to I mean, the steering committee is going to depending on who's funded and what resources are available, that's going to have to be part of the calculus in terms of whether we choose a different one of these network wide implementation projects. And Rob, if I could just add, I think the goal here really is to do genomic medicine writ large or broadly. And and during negotiations and discussing with potential awardees, we need to understand what are the limits on your capacity or what kind of constraints are you working with? And if you're working with, we can only do 12 to 18 year olds. That may be a major consideration and as it probably would be in review as well as to the value of that compared to others. So so we would encourage you to be as flexible as possible and have multiple sites in the in the group that you're trying to remember. This is a it's a health system. It's not just a single single institution. So really trying to to get be as broad as you can. The next question is, can grant funding be directed to pay for genetic testing expenses? Yeah, so there's there's two parts. It has to be very limited and the justification would have to be clear. The intention really with this announcement is not to fund genetic testing since we are. I mean, the idea is to implement things that have evidence and we know that insurance doesn't always cover those. But I think you'd have to make a strong argument for why you would want genetic testing done. OK, thank you. And the next question is, given the requirement for community stakeholders to be external to the applying institution, do you anticipate using a subcontract to add those stakeholders as investigators? The short answer is yes. We really do want to incorporate them as early as possible so that they can be part of the team and really help define what requirements are for development, but also be part of the process so they adopt the approach. Yeah, Robin, and given that, whether it's a subcontract or some other kind of arrangements that you make, that's up to you as to how you do it. But but the goal, as Rob said, is to have them involved from the beginning and throughout. Yeah, go ahead, Jonathan. Sorry. So I think one of the attendees said that they think that there are potentially funds available for sequencing. And could you elaborate on that a little bit? In terms of funds for sequencing, I mean, I think what you'd have to do is I mean, here's an example. If you recommended a whole genome sequencing, as you know, that's probably a significant cost that would not be amenable based on our current budget. But again, if if if it has evidence to support its implementation, we hope that the insurance covers this as part of part of care. It's just the idea that it hasn't been more broadly adopted is really what we're focused on with this is really to develop the genomic learning health systems to adopt, you know, the approach. But if there is need for it, I think you just have to include that in your application and explain why you think that needs to be covered as part of your application. In recognizing that that's going to be a significant drain on the resources of other sites that may not be be doing that. So again, that might go into both selection of initial awardees and selection of projects. But sequencing can be applied to a single gene as well. So it doesn't have to be able to genome. Thank you. The next question is what are the expectations for the coordinating center specific to this opportunity? In terms, I guess I'm not real clear in terms of that question other than just answer, I mean, the coordinating center really is responsible for coordinating the meetings during we have work group meetings that are weekly. Well, also there's a process that is probably unfamiliar to many, but a process of actually identifying what tools and resources and what intervention projects are each site has, compiling that and helping the network kind of think through that to come up with those projects. Once the projects are implemented, I mean, there's things if it is decided that as a clinical trial, they'd be responsible for submitting the single IRB, they would be responsible for also, you know, ensuring that we're reaching our milestones as a network whole. Each site is responsible for their own effort, but really coordinating that effort. And then there's this the end is really kind of at the the project is really sharing the resources and really we'd expect the coordinating center to come up with a strategy in terms of how they plan to do that and coordinating the meetings with those individuals or those groups that they think that could help broadly share the information. And Rob, you did this very well from memory. So I would refer to the question or the responsibilities really are very clearly outlined in the RFA and and far be it from us to try to remember them all. But there are seven of them that are listed just above the research approach they have to do with, as Rob said, you know, collecting, contributing to harmonizing the shared strategies, etc. Assuring and ensuring assessing and ensuring quality of data. I mean, there are several of them there. So I'm not sure we can do much better on this call than what's in our face. But, you know, John, I think you skipped one on is human subjects protocol required? Oh, my apologies. Yes, as a human subjects protocol required is one of the questions. It is just a background on that. As you understand that sites interpret whether this is a quality improvement versus clinical trial, there will be human subjects involved. We know that for sure. So it is human subjects research, whether it's a clinical trial is the other question that we don't necessarily know from the outset. So that's why we are having people follow the clinical trial application guidelines that are outlined in that slide. Thank you. The next question is, do you believe the data sharing plan will be a concern for health systems? I don't know the answer to that. I mean, it probably knowing working with attorneys in terms of working through that, I think there will always be some questions whether it's an issue, a big issue is yet to be determined. And I think in fairness, where there are legitimate concerns, we may be able to work with them, but the data sharing policy is really pretty firm, institutions are learning to live with them. And if your institution can't, this may not be the best RFA for you. Thank you. The next question is, is this no focus on adult onset diseases? If pediatric sites can apply, how would they be integrated with adult sites, given the diseases are different? Yeah, so they would really this is the idea is the network would actually select those two to four different intervention projects. We're expecting that it could go the lifespan, but we'd leave that up to the sites to decide if your focus is only on pediatrics, I think it would be very difficult without some other partner that could help you implement in adult sites. And I think in fairness, but vice versa, we're really talking about health systems treat humans. And so so one that's that's specialized in a given area, again, this may not be the best RFA for them. Thank you. The next question is, how will this network complement other existing consortium such as Emerge or Ignite? Yeah, so that's a great question. That subway chart intention was really to kind of address this a little bit. So I would suggest if you look at that. NHGRI has supported a lot of efforts to generate evidence about genomics and also has developed a lot of tools. The gap that we really see with this is that taking those tools and also that evidence and putting it into practice, the idea is to take that next step in terms of the spectrum of research to actually do the implementation science to get these things into clinical practice, as opposed to those are really focused a lot of the time looking at effectiveness or whether something's effective. So it's really at the end of that spectrum of research. Thank you. The next question is a clarification. The attendees asking if the investigators in each application should include a network of four to six GLHS is that correct? That is correct. So I think there are a couple of interpretations to that, Rob. Yeah, so it sounds like this person is asking, should each application come in with four to six GLHSs so that we end up with 30 GLHSs? No, yeah, yeah, no, it's the entire network will be four to six clinical sites and one coordinating center. Right. And each clinical site could be a single, you know, large comprehensive health system or it could be multiple that have gained together to address some of the constraints that might be on a single hospital or a single health system. But I hope that answers that person's question. Thank you. The next question is, will NCI fund one single cancer only site or will it fund a project or projects that might be implemented across the consortium? We haven't finalized that, but the the initial plan is that what this is one network and the idea is that we'll have two to three projects and one of those will have, I mean, the ones that they would support would be focused on cancer. So it'd be incorporated. It wouldn't be a separate effort. Right. And maybe I could just just elaborate a little bit. So so if a cancer project is selected, everybody would do it. That's the the ideal. How NCI's money might get allocated may be that they will just fund one center because that's the easiest way for them to get money to the program. But that wouldn't mean that that there would be one site doing only cancer and nothing else and none of the other sites to cancer. Right. So it's just a way of spreading of using that money to offset the costs of the program. But as Rob said, the goal is for all of the sites to do all of the interventions that have been implementations that have been agreed upon by the network, including if one has chosen a cancer project. Thank you. The next question is, should we demonstrate collaborative links with other LHCSs who are applying for this funding opportunity? I'm going to make an assumption that it's learning health systems. The C is, yeah, yeah, just so with that in mind, I think it's always helpful to show that you've actually worked with other learning health systems. Again, one of the key kind of large strategic goal with this is to advance that the number of sites that actually have genomic learning health systems. So I wouldn't suggest you don't, but I don't think it's a requirement. Thank you. The next question is the budget for the NCI and NHGRI are different. How are you suggesting that we manage that issue? I guess I would say this is I would just it's one application and then how those are funded in the end will actually NHGRI and NCI will work on that. So I don't I don't think that should change your application. Right. No, I agree. And really, you know, please try to focus on the funding for each site, which I believe we may have said I'm looking forward in the RFA. But but yeah. So we don't really say that it's just support four to six sites and then five years to support the clinical site. So I think you can estimate that the six fifty total per year total costs that's estimated for one clinical site is is probably about the budget that you should be aiming for and don't worry about whether it's cancer or not or who the money comes from or anything like that. This is going to be one program. Hope that helps, Kate. Thank you. The next question is is it possible for the coordinating center applicants to be considered as a clinical site if they're not selected as a coordinating center? The short answer to that is you couldn't like repurpose the application. You could but a site could actually have an application come in as a clinical site and could come in as a coordinating center. It would have to be different investigators. And but you couldn't repurpose. I mean, you couldn't expect to have a coordinating center application be considered as a clinical site if it's not awarded. Thank you. And I think along similar lines, the next question is, do you allow more than one application from a large institution? Knowing the size of some health systems, I would say, yes, you could come in. I think it would probably be wise to actually talk with them and strategize why they would need to come in a separate person. Also, because of the need, you know, this is a big country and a small program. It would be highly unlikely for NHGRI and CI to award two sites to a single or make two awards to a single institution for the, you know, for essentially the same work in the clinical sites. So so think about that carefully as well. I mean, anybody can apply, but do give that some consideration. Thank you. The next question is from someone who has not previously participated in a U01 grant. They're asking, does each application include a group of four to six GLHSs that investigators have assembled, given that you are looking to fund five applications? Does that mean each application that includes four to six sites will receive 5.3 over five is about 1.06 million divided between them? The only thing with the math is you have five divided by the total budget. And you got to remember the 5.3 also includes the Coordinating Center. And also keep in mind, it's not each application has to include four to six sites. It could include 10 sites or two or one, as long as it can cover the waterfront. So hopefully that's not confusion from the previous question. And how you divide up the budget is up to you. Thank you. And then the next question is. How should we understand the fact that NCI's budget is different? 650 K versus 450 K since NCI funded sites are full and equal members and expected to participate in all projects. That's something we do on a regular basis just to explain. I mean, how NCI comes in to support this? I guess one simple way to look at it is there's a pool of funds that we will distribute among the sites and how much each institute contributes. But that will have to be worked out later. Yeah, I think actually the questioner is confused between total and direct costs. So so there's 650 per year total costs, 450 per year direct costs. Does that help? Yeah. Thanks, Sarah. I couldn't see that. No, that's fine. Thank you. The next question is, can you speak to the expectation for sharing patient level genomic data outside our health system for other health systems and providers to be able to use or should we focus on sharing within our health system alone? The answer is both. What our hope is that that within your system, you improve the sharing of your genomic data, but also the intention is to actually come up with ways that it can be shared between different health systems, too. Right. So not just focusing on sharing within your own system, hoping to to move forward with the health health information exchange idea of that has been very effective regionally in making electronic medical records transportable and care more efficient across different sites. So so that's the expectation here is that we would move to that. Obviously, there are obstacles to that that we would want the network to to address. Thank you. And I think this is the last question is returning to a prior question. They said that Terry mentioned anticipating a budget of six fifty k. But according to the NHG, I notice awards are limited to four fifty k. per year direct. If the budget limits for NHG or an NCR different, it seems we'll have to direct our proposals to one funder or the other. Is that correct or would you like to expand on that? Right. So six fifties total for fifties direct. Hopefully that that clarifies it. Thank you. And I believe that's all the questions we have in the Q&A, although attendees are free to add questions or to raise their hands if they would like to ask something. And while people are thinking that, I would just mention that these are our estimates on the direct versus the total because every institution has a different indirect rate, et cetera. So so you know, you can pick which one you want to go with, depending on what your indirect rate is. But those are the ballparks that we're in. Well, if we don't have any more questions, I just wanted to thank everyone for attending again, please go to the website that has our FAQs. We will update those as we get new questions that come in and look forward to seeing your application. And Rob, you're you're always welcome or you're always open to two questions directly to you, correct? Absolutely. And then those when when we answer those, we'll make those answers available to everyone. Thank you, everyone. All right. Thanks.