 Thank you very much, Larry. I'm going to make a few remarks because we're talking today about implementation in particular, and I'm going to talk about how the VA Office of Research and Development has supported the clinical implementation of genomic services in the VA. So several things about the Office of Research and Development. We fund over 90 projects that have something to do with genomics and ranging from basic to clinical to even rehabilitation and now health services research and development. We also have a number of high-profile initiatives such as the Million Veteran Program. I'm going to be talking today primarily about our T3 and T4 efforts to explore and examine how implementation is of genomic services is happening in the VA. And one way that we've connected with the clinical services is through a new process that we describe as partnered research. So as we were developing projects in health services research examining the implementation of genomic medicine in VA, we were simultaneously working very closely with Larry on his clinical efforts and Larry attended many of our meetings, gave us feedback on our priorities, our research focus and direction. This new process of partnered research pairs up health services researchers with key clinical and operations decision makers in VA. So it allows the research to more closely inform the VA clinical implementation effort. And so there are three, although health services research has funded over, I think, 15 research projects. There are three in particular that I think link with some of Larry's efforts most closely. One is led by Maaren Schuner at Greater LA. And that project really seeks to examine and test methods of implementing Lynch syndrome screening in the VA. Another project at San Francisco and at the Durham VA originally led by me, now led by Don Provenzali at Durham, seeks to examine how genomic services for Lynch syndrome are incorporated into routine clinical care for veterans diagnosed with colon cancer. And that project really examines the pathways of care and coordination in care in an established integrated healthcare system that's been integrated for quite some time now. And how do we introduce new types of clinical services into the system? So that project addresses those issues. And then finally, one of our projects at Ann Arbor VA led by Angela Fegerlin examines how we should be communicating probabilistic information that we often need to communicate when we're talking about genetic testing and genomic services. Working with veterans, many of whom are cared for in the VA have lower health literacy, lower numeracy. And so how do you communicate that complex probabilistic information to veterans to support their decision making? There are a number of different opportunities, I think, that the VA brings. And Larry mentioned some of them, and I'm good to just go into a little bit of detail about them. One is the VA actually gives us a great opportunity to look at equity, because many of the veterans enrolled in care in the VA are of lower income, lower socioeconomic status, and lower health literacy, lower numeracy. So it really gives us an opportunity to examine health equity in genomics. Another reason why research and clinical linkages in integrating genomics into VA is important is that we have a number of models of integration of specialty care and generalist care that allow us to examine different pathways of care and also help us look at how health professions should be educated about genomic medicine. And then finally, our electronic medical record system and our decision support systems within that electronic medical record system give us great opportunity to understand the best methods of decision support. And then related to that, one of the things in the projects I mentioned, we're looking at ways of studying the electronic medical record that can tell us more about how genomics is integrated into care by using natural language processing. So when new services are integrated into a healthcare system, they are not often common events. So we start with uncommon events, uncommon services that are built up over time, and using natural language processing provides a very rigorous way of examining the medical record beyond medical record abstraction, which is the gold standard that we often think of. And so I'll close there to allow a chance for questions. Thank you very much. Great. Thank you very much. So questions for our VA colleagues? I'm interested in hearing a little more about how you're using more advanced informatics to extract information out of the VA medical record. So just expand a little bit on the very last comment that you made. Yes. So in several of our studies, we are building data sets using VA administrative data as well as clinical data. And so the most comprehensive data sets includes all inpatient records, outpatient records, fee basis, which allows us to examine care at the other medical centers that we use usually at our university affiliates to VA. And we have full text data on the records of our entire population of veterans diagnosed with colorectal cancer. And so at this point in time, we are starting to develop the ontologies that we need to develop to understand a number of things. One is how family history is documented in the VA medical record. Another is to look at the molecular analysis of tumor tissue, genetic testing in VA, and in addition, referral to consultations with geneticists and genetic counselors. And so because some of these events in the VA are going to be rare in the beginning, using NLP, we believe is going to allow us a much better way of examining the integration. Hi. Could you illuminate a little bit what is driving the genetic workload that you showed, the increasing, is that all Lynch syndrome or do you have other projects like Lynch syndrome that you're putting through implementation and outcomes research? So it's really all over the map. That's just clinical. So in building out a clinical service, we're clearly coordinating with research. And I'm a researcher at heart. But I expected way over half of that to be Lynch syndrome. We are instituting universal Lynch syndrome screening once we get into every VA. And getting the lab handled for that and the information flow is ongoing. But I would say it represents probably less than a third Lynch syndrome, probably a third BRCA1, especially after Angelina Jolie's announcement last week. We saw a huge bump, something like the Betty Ford bump. I expected to go down, but right now we're swamped with consults. We see a fair amount from neurology. We do a fair amount of perinatal. Right now, the population of the VA is 6% women. But a lot of those women are younger and are childbearing age. So I'm really surprised at the amount of perinatal genetics that we're doing. And then there's cardiology, pharmacogenetics all over the map. It seems like that's really informative to help maybe guide where some of the additional HSR types of projects might go is where the demand is from some of the users. I have one of the questions in the spirit of connecting the dots. If we wanted to get a catalog, if you will, of all of the genomic medicine research that the VA is currently undertaking, is there an obvious place to go? If we wanted to look for synergies between what NHGRI is doing and what the Air Force and other programs are doing, maybe there's some collective learnings there. Would there be an obvious place where we could understand where that information resides? Yeah, so I have some knowledge of the ORD things. I think Ron Przadski back there is probably the best person to answer. My understanding is that it's probably 120 or 130 individual awards. I think we have 91 currently funded. Yes. Well, I mean, yeah, 91, but think of it this way. If you're looking at 90,000 schizophrenic, 90,000 bipolar and a 20,000 reference cohort, that's one study. So you have to put that in that perspective as well. But if you need any of that information, just contact me. Yeah, and there is a good genomics page on ORD. I had to add a comment about the VA medical record system and the consortium. You know, doing phenotyping for research through natural language processing, I think it's excellent. But I'm not sure it's adequate for doing CDS at the point of care. And so I think we do need more structured information. You know, you can milk stuff out of family history for a research study. But if you're trying to actually recommend whether a referral or a test is appropriate, I don't think that's the best way to go in the long term. So we really need to move towards more structured information as we can. I'm not sure if this is a question for Larry or Susan. I know that for some veterans served by VA, they're also getting care. And yes, and elsewhere. Do any of your projects capture that? Yes, the San Francisco Durham Project does capture dual care. So they were getting the testing elsewhere? Yes. Just maybe one last question. Larry, could you describe a little bit more the telemedicine model that you're using? This is for genomic counseling for returning results, for consent, for all of the above, or how does that work? Sort of for all of the above. We only get testing in, I think, a little less than half of all of our consults. A lot of it is just, a lot of them are e-consults to the provider. There's a lot of times we'll contact the veteran and determine that the testing is not appropriate. And so it's all over the map. If we are consulted, and if a test is ordered, we do pre-test counseling and follow-up, post-test counseling. One of the things that I'm fairly manic about is ownership and stewardship of the results and data. And so that we close the loop and inform the patient, make sure the patient knows how to inform their family and all of that. Document it appropriately. Communicate with the entire provider's team locally. So do you have a manual for doing that, or a set of standard operations that you might be interested in sharing with other groups that are trying to do something similar? I think it's fair to say that SOPs are in preparation. This is very much designed to play while you're flying. Oh, absolutely. And there are others designing similar planes. And Golly, wouldn't it be nice to build off the efforts that you all are doing? So if there's some way we should talk later about that, that'd be great. It's sort of like the magnificent men in their flying machines. That's what we're kind of looking like right now, I think, all of us. Thanks, Mark. It was similar. OK. Super. We're running a little behind, but we're allowing time for discussion. And discussion is, in many ways, the most important part of the meeting. So we don't want to inhibit that. So any other comments? If not, why don't we go ahead with Dr. Sessions from the Air Force, who will talk about PC-2Z.