 Hi, thanks very much, and there's a lot of interplay between what I'm going to talk about and what's already been talked about. And Kristen gave a great example of implementation, and this is a bit higher level than that, so just keep that in mind. So the Inter-Society Coordinating Committee, or ISCC, is something that is run out of my branch in the Genomic Healthcare Branch in the Division of Policy Communications and Education at NHGRI. And it's not specifically about pharmacogenomics, but what I'm going to try to do is give you some background on the organization and talk about current activities that are pertinent to pharmacogenomics and also highlight some opportunities where pharmacogenomics would really fit in quite easily into ISCC activities. So in the beginning, so ISCC came out of a sort of pathway of steps that led to its engendering. First National Advisory Council for Human Genome Research, and then the NHGRI's Genomic Medicine Working Group, which is a working group of our advisory council. And this meeting, number four, about physician education and genomics, and a recommendation came out to leverage the medical societies who are doing most of the CME training in advances in medicine in general to try to promote genomics education and to make it easier for societies that aren't necessarily used to genomics to move forward. So the charge is to improve genomic literacy of physicians and other practitioners to enhance the practice of genomic medicine through sharing of educational approaches and joint identification of educational needs. And the sort of methods are to facilitate interactions among professional societies. The initial focus was on physicians and dentists, and it's expanded to pharmacist, nurses, and genetic counselors and others. So the goals, and this is basically off of the original documents, to gather and facilitate dissemination of best practices and resources in genomic education and clinical care, identify advances in genomic science that will require new educational initiatives, identify needs of societies and clinicians in filling gaps in evidence and knowledge and providing effective educational efforts, identify foundational educational needs common across professional professions and specialties. So a lot of these are sort of horizon scanning gap analysis, seeking the optimal educational balance between competencies and basic knowledge, and I'll talk a little bit more about the competencies in a minute, to design short, medium, and long-term work plans with initial focus on producing tangible outcomes within the first year, and to assist societies in jointly and separately publishing papers of common interest. So the society now has more than 80 members, and they're made up of professional societies, so American Academy of Ophthalmology, American Academy of Family Practice, et cetera, et cetera, and it ranges from family practice to specialties and subspecialties, including genetics, and as well as dentistry, pharmacy, genetic counseling, and educators of those as well, so organizations that educate. NIH institutes and centers are also represented on the ISCC, as well as federal agencies such as CDC, HRSA, the VA, and so forth. Hospitals and health systems, so there are some places like Geisinger and University of Florida that are really active in the field who are participants outside of their own professional society, and universities as well. Other education organizations like the Association of Professors of Human Medical Genetics, Jackson Laboratory efforts, things that grew out of the old Nichepeg, for example, are also part of that. Crediting organizations, ACC, ME, and ACGME, especially board organizations, including the ABMS, who are all on the roster, and we added actually in the last sort of year, a year and a half, a number of international education programs to take advantage of some of the things that are going on in countries with national health services, including Canada, Australia, and England, or the UK. And then some infrastructure providers, people who are actually interested in participating in these efforts and providing dissemination pathways, other kinds of infrastructure and patient advocates and even insurers. So the pharmacogenomics related members, I just kind of went down the list of things that are really focused on that are the ACCP, University of Florida College of Pharmacy, Vanderbilt is an institutional member, and if I miss some, I'm sorry, but there are a number of things there. So the operations, how does IACC work? It is run out of our offices, and we basically provide administrative support. I'm the NIH Co-Chair, the non-NIH Co-Chair is Ann Cardi from AAFP, that's transitioning now to Rich Haspel, who's a pathologist at Harvard, at Deaconess, and so that rotates on an as-needed basis, administrative support through our branch, there are no dues or membership costs. Basically, if you have a group that is interested in participating, we'll send you some information to take to your governing board so that they'll know what the cost structure is, how much commitment they're making for this, which is really very little, and then you come to us with their short interest letter in why they think it's important that they be part of this organization, and, you know, generally it's a slam dunk, there's no problem. So we have one to two in-person meetings per year, the last one was in January, the next one is February 1st, 2018, if you want to mark down that date. We have monthly plenary Webex calls, where we have presentations and also reports from people who are doing things, as well as disseminating announcements of activities, resources, things like that. That call is actually today at one o'clock, so at one o'clock I have to step out, and I may miss some of the discussion as a result of that in order to chair that call. The working groups are, there are a number of working groups I'll go over, and they occur by natural aggregation, so if there's a few people that say we really want to do this, we think this is important, they can form a working group and get an NIH chair and a non-NH chair, and they're off to go. Okay, so this is the website for the Inter-Society Coordinating Committee, or ISCC. It's very simple, there's a pointer here, www.genome.gov. Slash ISCC, to get there we have the overview members, memberless working groups are meetings and activities, including links to all the agendas and slides at the meetings, resources and contact information. So the working groups, there are two, the first four are active working groups right now, the last four are groups that are on vacation or have retired because they've completed their charges, and the innovative approaches working group, and I'm going to go through these, so I just don't want to belabor this anymore on this particular slide. So the case studies working group was created to create a template for sort of formalized case studies to make it easier for the specialty societies to create case studies that can be used in educational materials, and there were two case studies that were generated that actually are pharmacogenomics. So there are a couple of case studies there, in addition to the template and an example of its use there. So those are free and available on the ISCC website under the case studies working group page. The competencies working group was created to create, for, to generate competencies or IP, let's see, I remember the other term for competencies basically say we don't want to treat just facts, we want to teach just facts, we want to teach toward ability to complete something, to be competent in something in the clinic. And so the competencies working group worked on competencies not just for physicians, but now for other specialties as well, and I jumped through the competencies to find these that had to do with pharmacogenomics from the competencies output. So there are a number of competencies that are potential targets, and the competencies are really to be used by the educators to build programs, build curricula, and help them avoid gaps in their curricula. The educational products working group collects existing educational products, identifies resources and initiatives that could assist genomic as education efforts and works with cases group to identify areas of emphasis for educational products. The educational products working group has recently been morphed as with an addition of the international members to the global educational products group working group, so we have the input of those parties as well. And that working group meeting is recorded and sent out to the people who are in different time zones that can't join live with the working group meetings. And there's this competency-based education report from Kristen and colleagues who developed that. So this is a website called G2C2 or genomicseducation.net, Genomics Genetics and Genomics Competency Center, and this was actually developed in its initial forms before ISCC, but the things that sort of come out of the educational products working group make their way to the editorial board of this resource, which is basically a clearinghouse of peer-approved genetics and genomics education resources. And individuals can go there to get, you know, find resources themselves, but it's probably most of the use for educators. And it's based, anybody can submit something, have it go through the editorial board, be approved. The editorial board has a process, which Donna Messersmith has streamlined to help create the metadata around this and make it really useful. And I'll take just a moment to, if I can make this work, to launch that and you're not seeing that. So do I need to share that? How do I make that seeable? You know what, you need to spend a lot of time on it. I'll talk. So basically, you enter here, you can enter a search phrase like pharmacogenomics in the search field. So this is the website. So it's a web browser. You can't do that. OK. All right. So never mind. We'll get back to you. And so you can enter the search terms. And I was just going to give a short demo that you can narrow it down by something that's relevant for nurses. There's kind of a navigation bar along the left side on the results thing, just like you do when you go to Home Depot and you're trying to find something in black as opposed to something or a certain price range. So you can do it by competency. You can do it by nurse versus pharmacist or so forth. So it makes it actually really, really slick to get into it. There's a browse topics thing up in the upper right hand corner, which gets you to other areas quite quickly. And then you can go to the competencies as well. And this is what you get when you go to the competencies thing. And you can click right into the competencies maps there on these panels here and get into the details of those competency maps and then move from a competency to the resources that actually are earmarked for those competencies as well. So a lot of this work was done by Gene Jenkins initially. Gene Jenkins and her colleagues initially. And then Donna Messersmith has really improved the functionality and accessibility of all of that. So ISCC also has an innovative approaches working group. And it was created to develop novel ways to teach genomics, built on the highly successful training residents in genomics or trig approach developed through the American site of clinical pathology. So it's an approach using a flip classroom and a small group work, a hands-on work on using, accessing real databases. And it has been then generalized to apply to other specialties. So for example down here, American Society Academy of Neurology, Jeff Vance has translated the same approach for neurologists in clinical chemistry and also Kieran Musenuru has done this from AHA, has done this for cardiology as well. So this is a really good example of a way to take something that's targeted towards a specific group and then use those methodologies and translate them to other specialties. The insurer staff education working group, as I was going to say about that, that particular curriculum, as far as I know, doesn't include pharmacogenomics, although the cardiology one may have included that. I'm not sure what the curriculum is. So that's an opportunity to work something in there. The insurer staff education working group set out in collaboration with Blue Cross Blue Shield Association to create a webinar series. Now there's 14 webinars, 13 of which were presented to the Blue Cross Blue Shield Association staff members about understanding genetic testing and all the issues around that. And those are now posted for anybody to look at on the genome.gov channel on YouTube. And I'll point out that at the request of one of the people in the room here, we recently added a pharmacogenomics webinar as well. So that actually went live yesterday. So that's there with Vicky Pratt from Indiana University having given that webinar. OK. ISCC engagement of specialty boards working group had the intent to engage the specialty boards and try to increase the frequency with which genomics is integrated into board requirements for training as well as for the board exams. And that's an opportunity for pharmacogenomics as well. The newest working group is something called Building Bridges. And this came out of our last in-person meeting with the recognition that we had a lot of people who were generating really useful resources. And other people who needed those resources were needed some kind of connection to make sure that the people who had certain skill sets or resources were matched up with those who needed them. And so this working group was built. So that's the bridge across the Columbia River near the mouth of the Columbia River in Oregon and Washington at Astoria. This is not part of ISCC, but I wanted to mention it. This is another opportunity. The global genetics and genomics community is a set of unfolding case studies for genetics and genomics health education. So these are actually video snippets that are tied together and the pathway changes depending on what choices you make through it. And it's really cool. And we're planning to do a pharmacogenomics case for that as well. This is something that one of the things that I've learned as a result of being involved with this organization is that there's sort of this anatomy of usable knowledge. And one of the biggest difficulties is engaging those providers who are out there in practice. And what we've learned from people who have done this in a number of specialties like cancer, who are already doing this in depth, is that you can't go to them and say, we're going to come and we're going to teach you about genomics because they won't come. You need to engage at their level, what's relevant for them in their practices. So there is this core knowledge and you have these multiple specialty groups, multiple disciplines around at medicine, dentistry, nursing, et cetera. Those are little triangles. And then within one of them, you have a number of specialties, each one sort of focusing on a different patient area. And that really makes it challenging. And so what we say is that this is where providers engage at their specialty level. And that's where you need to be able to teach them. But you need to back translate to get them the core knowledge indirectly, so to speak. So practitioner motivations, relevance to their practice, effectiveness compared with their current methods, time-neutral or better in their work flows. And that includes insurance coverage, counseling a streamlined data collection, streamlined in the time that they take to learn this as well. So is there an opportunity to find ways to teach them in very small increments of time, which also brings us to the point of care, education, things that Geisinger is doing, patient satisfaction as they perceive it and cost-neutral or better as their system perceives it. So this is something that actually came up fairly recently as a result of another initiative that I don't have time to talk about, but with respect to provider engagement. And we came up with the concept that disease group focus may be sort of the way to do it, as opposed to saying let's talk about a specific test or let's talk about a specific technology. Let's talk instead about a disease group focus. And our example is about heart disease. So heart disease encompasses familial hyperchloroemia, familial cardiomyopathies, dysrhythmias, and pharmacogenomics. And of course, it's not just the clopridic, you guys know what I'm saying, but also the statins and so forth that we heard about this morning. So there's a lot of opportunity here for pharmacogenomics to be fit into the education about genomic impacts on these particular areas. And the second reason for looking is that the outcome measures in heart disease are pretty well defined. And that's useful. And then the third reason is that multiple specialties actually deal with heart disease, cardiology, primary care, and concluding pediatrics, emergency medicine, sports medicine, pharmacy, and you can go on down the list. So that's kind of a different way of thinking about how we approach the provider groups in an efficient and effective manner to get to something that's relevant to them. So I'm going to stop there and answer questions. Yes, Mark. So Bob, we've heard about the importance of engaging with end users as we begin to roll things out. Had the really interesting presentation from Steve and I think the other examples of how this has been important with the nomenclature reconciliation efforts. One of the challenges, and you know this from my recurrent emails to you, is ISCC is being an opportunity to engage with those end users around specific resources that are being created, things like the ClinGen website. And I think we could imagine some of the other, the Ignite site that's being set up. Because rather than showing it around to those of us that are familiar with this, we really want to get that in front of people that we think are the intended audience. And so I have two questions for you three. One is, do you see that as a role for ISCC? Do you think that the members of ISCC actually are representative? And do you think that there's any opportunity for ISCC membership to get it out to their broader membership to be able to get a broader source of feedback? And how might we utilize ISCC in that role if you think that that's an appropriate role? Yeah, I think that it could be viewed as a way to engage the societies and the educators in those societies who are the ones that are developing their CME materials and so forth. And I think that's an excellent concept. We have run into the barrier that most of the societies are unwilling to take something that we want distributed and put that on their email list. Because they're really trying to limit the email stream to their members to things that they think are really relevant or our society business. So if it's done, it has to be created through a different pathway. And so that's a challenge. And then the middle question was? So except in the fact that we can't just blast emails out, and I understand the sensitivity there, are the members of the ISCC themselves representative enough that even if we got those folks to interact with the materials, do you think that that would be sufficient? Or are these people more too much like us? Yeah. So they are not all like us. The people who are the most active are the ones that are like us. And that's a problem. So getting, and that's one of the reasons we created this sort of Building Bridges Working Group to try to bring those groups that are either inactive or at least not telling us what they're doing or not telling us what they're not doing to the table and be able to partner to make that work. And the other part of that is bringing together those different parts of expertise. So we recognize that having someone who's really an adult education expert who knows how to do adult education in different populations, who knows how to do the evaluations of that education and the behavioral changes we're trying to make as part of it, as well as having somebody with genetics expertise and somebody from the specialty who really knows that specialty and what people are going to sink their teeth into, we really have to create those teams. And not all those groups have that team available. So we have to kind of go across specialties in order to create those things. So getting the educators in those specialty areas engaged is a challenge, and we continue to work on that. So I think it would be interesting to get the other speaker's perspectives on this question. But I think let's move to the last talk in the session and we can revisit this question. So the final speaker in the training session is Howard McLeod from Moffitt Cancer Center. And Howard is going to talk to us about multidisciplinary approaches and training pharmacogenomics practitioners at Moffitt.