 So I have no slides. I want to report on the family history working groups activities. We had a good group since no one chose to follow Mark. And we got fairly tactical, so we didn't really change from the themes I told you about last night. The first topic was about EPIC and electronic medical record integration of family history, which I think we were a little bit concerned and maybe somewhat discouraged to hear that in the room there were different versions of family history with EPIC users, which I'm not personally familiar with this electronic medical record, but the fact that one would think that this would be standardized and yet it's not. So we talked about really the need for the EMR to be designed for data capture and collection methods of family history that might encourage patient input and also to capture data from relatives to construct the family tree, understanding the data flow, as well as importing potentially other clinical information for the purposes of developing more global risk calculators. And we also talked about how the family history might be represented in the electronic medical record. You know, does it sort of really stand and be fully integrated, which some of our committee members felt were absolutely essential for fulfilling the meaningful use criteria or could it be just a representation that's imported from another standalone platform. So the bottom line is that as we discussed yesterday, we really need to have a TED with EPIC and maybe CERNR and the other developers of electronic medical records to have them share and understand and hopefully collectively solve some of these problems. We don't have an action item point person on this yet, but I will go back to the committee and try to garner some representatives who have a strong inclination to do this. The second... If I can just add, I think I mentioned yesterday in both the Northwestern group and the Mount Sinai group have been very actively engaged with EPIC about their genomic medicine and their genomics piece in the EHR, and I wonder if maybe actually that might be a good place to focus that direction. Right. If we could dovetail on to an ongoing conversation, that would be very useful. And Erwin mentioned that although he could not attend our meeting yesterday, he certainly is interested in this for the Mount Sinai group, and I know that Maureen was also expressing interest on your behalf, so later we'll figure out how to make that work. The second topic that we spent some time on, which was a very IT jargon intensive discussion, which I don't want to repeat for you, was about the use of what we used to call social media for capturing family history data, but now we'll just call it expanded data capture to maybe alleviate some of the fears that have been discussed earlier. But the idea is to use something called Web 3.0, which I wasn't familiar with until yesterday, and I'm not sure I am even today, but to create data structures and architectures that will allow families as a whole to collect information, to deliver them to either electronic medical records or to some standalone platform for assembling family history information. And Jonas Almeida is really taking the lead on this as he has been all along. And his proposal was really to describe the data architecture and structure and the governance features and publish that, which in the field seems to be an important first step to get these types of things implemented, and then take the next step and figure out how do we actually take that architecture and link it to some of the standalone platforms that already exist, such as the Mitri platform or the Intermountain Healthcare family history tool as well, and so that's something that we're going to pursue. And then the third topic, which was really the one for which we had the most discussion, is related to the demonstration project. And here we felt that the major goal was to deliver an instruction book or a recipe book or something that could inform any practice environment of how to take up a family history tool and import it, integrate it, and effectively use it in their environment. And that would be sort of the overarching goal of the demonstration project. We would select multiple naive sites, naive sites being ones that don't currently have family history tools active in their environments, which is just about everyone, and choose sites that either had or had not used electronic medical records so we can look at the pluses and minuses of that variable. Our goal was to create a toolbox of tools. So knowing that there are many now tools for particularly data collection, Surgeon General's tool, the ones that we described yesterday and several others that we didn't have time to talk about yesterday, to allow the users to select tools that would be best fitting for the environments that they wanted to deploy them in, and that would be a first step. And then we would also have a chance to compare and contrast the different platforms across these different venues. But critical is the fact that we would have a centralized server that would host the algorithms and the clinical decision support tools to which the data would be imported and then subsequently the results exported to the individual provider. So all of that part would be standardized. And I think people rallied around that and there was a lot of, again, fairly intensive IT related discussions about how all that data would flow and what would be some of the requirements for that. So essentially a project might look something like figuring out what are the best data capture methods in the community and exploring multiple collection methods, understanding whether the information is indeed accurate, which is a question that's come up several times about the validity of patient-entered family history information. Does the provider, when they, do they actually, do they get the information, do they use it, how do they use it, and is it useful? And do this in some sort of iterative optimization process? As I mentioned, how should it be represented in the electronic medical record if one exists? And then to test the hypothesis that having this information actually has a change in physician actions and patient behaviors. So the outcome measures would be along the lines of whether docs would recommend certain screening tests or referrals to genetic counselors, whether patients would actually change their behaviors in a broad way, but also specifically to adhere to physician advice and actually go on to get screened or see a genetic counselor, and those types of outcome measures would probably be very tractable in the short term, in addition to some other process measures. We also talked about the diversity of environments that this could be deployed in, and particularly to address the disparities question which came up is to seek the opportunity to create a Spanish version of many of the tools that we're using so that we could look at Spanish-speaking populations which are probably underrepresented in most of the work that we do. We also talked about the military as another interesting group to work with in this regard. So I think that's more or less where we are right now, and in our next series of meetings we're trying to refine this, particularly this last item, and target for a submission to the NHGRI's RFA. Mark? Going back to the toolbox of tools, which I think is a great idea, I know that one of the things that both Mitri and our family health had done for the working group was to make guest accounts available for logins so that individuals from the work group could go in and actually interact with the tools. I think for those two tools and other tools that might be available it would be nice to see if there would be the opportunity under this umbrella to have more guest accounts available so that people that are thinking about participating could actually go in and interact with the tools. So I would just put that on the table as something to discuss with those people that actually have the tools. Sir, I think in whatever we would call it a pre-implementation phase for anybody to decide which tool was going to be relevant to their needs and environment to have a chance to play around with them and all as many of them as possible would be very useful, so we'll take that up. Pearl? Pearl. Yeah, you may also want to touch base with, I think it was Vence Bonham who did the genetic literacy meeting in which I was amazed at the folks who were there, the different concept of what family is, and when they talked about doing family charts such as this, it's like the concept of parent is very different in different cultures, so particularly getting off in disparities, I think he might be able to populate that with fact rather than my poor memory. We did have some discussion, not very detailed about that, but that's a great suggestion, thank you. Yeah, and I think that just to add on to that, some of the resources that are available that I know are being used at both Duke and at Intermountain are ones that were developed out of a project that Genetic Alliance had run relating to community centered family history that took into account those types of things that resources could be customized that would explain what it is that we're trying to do, so I think some of that is in place already, but we can probably do a better job. Okay, other discussion? Let me just make one other point. I would just say if we took the study design which I anticipate we will eventually come up with and then take out the word family history, but put in pharmacogenetics or put in genome sequence data, I would hope that we could use the same type of paradigm with some modifications to deliver the message that this is clinically useful and does result in changes in clinical decision making and outcomes. Okay, Murray, Murray is going to sit where he is. Right, we didn't have, most of the people in the work group are not here at this meeting, and so we really didn't have anything, any changes from yesterday's presentation. I was given a number of other suggestions, so of course we want to go ahead with the demonstration project with pharmacogenetics for dental patients, but other suggestions, for example, John Harley suggested looking at periodontal microbiome and rheumatoid arthritis is of interest. And we also had a suggestion about chemotherapeutic agents that affect bone loss and such. So there are other areas of this where this could go. And right now, as I mentioned before, we're working to come up with a network of institutions, and I would just ask all of you here that if your institution sees dental patients or is interested in microbiome research to please get in touch with those folks or get those folks to be in touch with me, and we'll include them in the working group going forward. Again, our goal here is to come up with sort of best practices of collecting data and to allow sharing across a network. So that's pretty much it. Other comments? I think if we don't have comments, Murray, just keep on keeping on. It'll happen. I'm getting convinced.