 Thank you. Luckily Aaron and I are about the same height so we get the microphone at the same level so I'm going to be talking about the Spark toolbox and specifically the implementation guides for the ignite network. Let me see if I Advance this if that will go forward. So I don't see that it is I'm going to let the experts handle that Okay So it this the discussion this morning was very interesting because we had the opportunity with an ignite Which is a many of you know and many of you are part of Multi-site network focused on implementation of genomic medicine to create Implementation tools kind of within this world of implementation science and so it was a great discussion this morning because That was we kind of based this tool creation and this website on On this whole process and so when everybody was kind of thinking about well, how do we apply this and how do we make it? You know kind of applicable and usable in the colon in the clinical space That was really what we thought of and thought through when we were putting together this tool And so I was very excited to kind of think through some of those things And I wrote a lot of notes down to refer back to some morning presentations and so There's actually two pieces that I'm going to talk about and I'll be able to show you those in one second the first We did thing we developed was a toolbox and so similar to other NIH networks We have a website that houses information about the different sites and and how they Kind of interact with their research projects are in addition to that within the ignite website if you'd like to go there It's ignite hyphen genomics org and that will be up here in just a minute, but in addition to To that information we also wanted to have on the site some tools because implementation is really so Clinician focused and in such an important need and we were really actively discovering things within the ignite network as we were Implementing in different environments We really wanted a quick way to be able to turn that around and be able to get that out to people to let them know How to use these tools in practice, so we started out by creating a toolbox So it's the spark toolbox and it's supporting practice through application research and knowledge and it really was I just kept going So so we'll be talking about this we talked about the ignite network This is our home page of our website now You can see the address there and as I mentioned we started out at that yellow arrow Really is pointing to the toolbox area of our website that houses these different tools And it's really divided up into clinicians and researchers and our thought was really there's there's two different needs here There's an implementation science research need So we're developing surveys and all the work that Laurie's group did with seafoor and kind of that framework within ignite But we're also developing clinician resources and so we wanted a place for both of those and so the first thing We did was build this database to house those things and this it's a really robust There's lots of great information on here I've just done two clips here just to show you on the clinician side We broke it down by what's a target implementation again trying to think of what's important for that clinician to know And how are they going to search and use that website? Probably by what they're trying to do and then you can see here We point to different resources that are either housed it developed by ignite a lot of people have contributed to this website It's been a great place to kind of keep things in a centrally central location And then we point into the specific things that people might need on the research side We've tried to make all of our tools public that we can so surveys for example that Laurie's use that we've used at the University of Florida That the network has used and Carolyn All of those things we tried to really make this publicly available so that anybody can look at those and say Hey, well, maybe this isn't exactly what I'm going to do But this might help me think about how to conduct implementation science research in the space So we put those up there and we're really excited about it and the feedback that we got was that's all great It's really good. But what if I don't know what to look for like what if I don't know to ask that question to get to the right place? I thought well, that's a really good point And so we set out to make kind of it's really called a guided interactivity model And so the website because I really had to kind of think through this It's it walks people through creating a how-to guide for how to implement a specific genomic medicine implementation Within their within their site and it's it's really kind of technically referred to as guided interactivity from a website development process The first thing we did and you can see it here. That's on the top of our home page now So we talked about the toolbox is on the bottom up there at the top Our first guy that we did was with clopidogrel and sub 2c 19 And I'll go back we started there because we had been working with the pharmacogenetics interest group and with a lot of those a Lot of the affiliate and core ignite sites to pull together Experiences and resources already within sub 2c 19 clopidogrel in that post PCI environment So it made sense We had already pulled together a lot of things that we would need to build an implementation guide and that pharmacogenetics Working group within ignite already really had a collective a critical mass of those implementers of people who had done this successfully So we started there and said let's develop a pilot and then we'll know how to do it and then we can move forward from there So starting with that one the first thing that we really did and I have framework up here And I thought about like I don't think I'm not sure if that's the right term now that we know Kind of have had framework and model defined But the first thing that we did actually was kind of what you know, and my background is clinical I'm not really by training a researcher. My background is not in genetics It's in primary care and so when I'm thinking through these things I'm really thinking more of a primary care clinician And so I had to kind of think well We have all this stuff on our website and there's all these frameworks And so how do we gonna put the stuff in the right bucket so that people will know how to use it? And so kind of approaching that I went through this process that a lot of us I think I've gone through of looking at the different implementation models and we actually settled on The implementation research network stages of implementation It was funny because kind of went through that process this morning personally I'm a knowledge translation girl. That's really my favorite implementation model But more probably more because of an educator perspective But I think that we chose this one because I kind of thought and asked myself Why did we end up here when we looked at all these and I think part of the reason why is this was a practice focused Implementation model so it a lot of the other models include research aims And we really wanted this tool to be focused for clinicians And so this is a very kind of simple practical straightforward model and it fit it encompassed all of the steps that we had seen We also thought though. Well, it's not just about the model as we thought it through people aren't necessarily gonna come to the website and say I want to be in the exploration phase. You know, what should I do? And so we thought it's really about the steps and where do they fit? And so we did a literature analysis and looked at the number of steps that had been cited within different publications of a Genomic medicine implementations over the the years and I think at this point We'll probably redo this when the process of putting this together this process together There's a manuscript and so we'll we'll redo this literature search But at the time there are about 28 publications that we found that had descriptions of genomic medicine implementations that listed steps that they took and so And so we listed all those steps and then we said well Who how many times were they listed to try to kind of categorize the relative importance of them? And then where do they fit into our overall model and our overall framework and we said okay now Now what's our tool going to look like? We had a group and really you know thought through where are we gonna build this and and the first thing that When we first started this process We really thought we were building it from the perspective of this kind of phased approach that people might be able to go on and say Oh, I'm in the exploration phase and that's good for me to know and this is the thing I but the more we talk to people the more we realize that Probably most of our frontline clinicians weren't really going to be thinking about what phase they were in at all any more So then you know we think about that when we learn something new they just need to meet that immediate need And so we really started looking at well What's the kind of best practice for guided interactivity websites and one of the ones that really kind of Had received a number of awards. It was the Virgin Airlines website, which unfortunately I pulled up to see it's no longer exist but But I had actually a picture I forgot to include it on my slide. I know I'm sorry It was not the business. I was not anything else It was just what they did and what they had at their home page on their website was three questions and it said who Like where from and where to so basically said who who's gonna go somewhere? Where are they going from where they going to and so it kind of distilled down the process of buying an airline ticket Into the questions that people really were trying to ask and so we tried to really think about this and say, okay How do we put this information in the context of the questions that people are trying to ask and so from this 19? Individual steps we actually tried to kind of combine those down into what are the actual Steps that somebody's going to come to me and say I need to Develop a testing process. I need to integrate this into my electronic health record Versus kind of the flip side so on the back end of our website It's really based on this implementation model and this framework and kind of the systematic step-through analysis But on the front end of the website the clinician will never know that really and I think that's okay Because we wanted to make sure that we had put it within that structure But at the same time they don't necessarily, you know need need to have that level I guess of a Not sure white of structure, maybe they really really just want to answer their questions And so for to build an implementation guide It starts to go and this is just for again for clippenegrole and septuC 19 now We distilled those those at 19 points down to kind of six questions That we still kind of tweak every now and then and then we categorized our resources Based on those questions and so once someone selects answers to each one of these Steps then it will give them each of the steps with resources listed and it lists usually the first four or five Resources and then you can see more so in this one you can see this is step one gathering institutional support We defined what that meant because it probably means different things to different people And then we put up the different resources that we had gathered Some of the top ones and if you hit expand there you can include more tools So it's very simple list all of the steps the potential resources Users just put a checkbox where they want to include a specific resource and then it automatically builds them That's this guide and the guide is available in two different ways. It's available as a An online guide and so if you bookmark the page that you create You can always go back to that page and there will be an HTML version of that guide And so that looks like really just goes through the steps and then provides you with links to the resources and we're always adding in links We're always adding in new resources you can also request a PDF copy of that and And so that they tend to be long because some of these resources are very you know They're kind of patient education brochures from different institutions But but I think that's very helpful for some people that PDF then is built in a way to make it kind of Here's how you cite this guide. We wanted to make sure that this is something that is somebody can use and it has a You know a structure to it within their institution and then each page Each sex step starts with a new page and an explanation of what that step means And then it automatically pulls in the resources that that individual checked Checkboxed so that they can kind of least have a little bit of customization within what's going to work for their site And I think this builds on a lot of things that people were saying this morning Which is that it's not necessarily a completely different process It is an end of one we've done with at the University of Florida a number of implementations They're all very different, but we have identified common threads And I think that's a key here is kind of trying to see what those common threads are So before I finish that is my last slide But I had I wanted wanted to tell you is we're in the process now So we did we launched our sub 2c 19 Clopidogrel guide in May. I tried to see if I could pull some data We've had I think I don't have yet data on how many guides have been downloaded or created I've got some people working on that there have been 250 Visits unique visits to the site. So I don't know if that's led to the creation of 250 implementation guides My guess is probably not that Probably not that many but we have had Utilization of the of the guides when we do monitor that in an ongoing way our next Kind of our next process that we wanted to look at to say how do we then expand on this concept has been to build a guide for Sip 2d6 And I think it initially started out as opioids and then it's we've expanded it to include antidepressants because of the presence of CPIC guidelines and so we're in the process that that is currently Getting ready to launch and we really use the same stepwise process that we used for Sip 2c 19 and Clopidogrel But just as with implementations it's been very different And I think the process the thing that I've seen and I've learned from I guess a clinical perspective is how different even just Asking people what it is that they did at each one of these steps for Sip 2d6 testing versus Sip 2c 19 testing and And so I just wanted to point some of those out. So there were a lot fewer resources with Sip 2d6 Implementation, it's not as a wasn't kind of as why I think we had 21 sites contribute resources for For the first Sip 2c 19 where we had about 10 to 14 maybe about 12 sites or so Contribute resources there just weren't enough people who had weren't as many people who had actually implemented that So I think that's something we have to keep in mind is that building these you know Pragmatic practice-based tools depends on also the actual progress that we've made in that area Sip 2d6 is a very complex gene So there's a lot of variability among the sites And I know a lot of this is being addressed on a more of a national level for our interpretation and testing and how that's done There's drug gene interactions drug drug interaction. That's much more complex Some places had to consider de-implementation So if you were taking coding off of the formulary because of a suit because of the FDA warning That's really a de-implementation And so do we provide resources for practical things that you have to do to use Sip 2d6 testing within your environment? And it was really a much more diverse patient population And so it wasn't really this very narrow cardiac population But I think it has really to me it really shows kind of what we're going to come up against every time that we really try to Kind of equip someone to implement within a health system is that they are all going to be different I think our challenge is identifying those common threads and And really helping people to be able to use that and apply it kind of seamlessly to their practice without really even you know Kind of realizing they're fitting into this model or that model But really just saying this this is oh, that's the resource. I need thanks so much And let's go do that and then they have fit themselves into that step really without even realizing it They move through that they progress through that model Naturally, but I think for me at least it's been Very enlightening to see the different complexities and the different types of implementations And we've really just we're just within pharmacogenomics. We really haven't even our next guide will be in probably in family health history in conjunction with Duke, but you know And there'll be a totally different, you know completely different animal, but I think that's what we need That's kind of what that's a good thing to learn and so we've learned a lot from this process Definitely think that having this guided interactivity is very helpful and if there's some way that we can kind of Help equip and empower all of these things for our frontline clinicians And that's a great step that we can take in this direction