 So, thank you, Terry. Good morning, everyone. Let me add my own personal welcome to all of you for joining us for this important genomic medicine meeting, and really stress how valuable these types of meetings are for NHGRI. But I also think that in some ways this meeting, as you heard it described with the objectives were by Rex, really points to the idea that it's a bit of a taking stock and then looking forward kind of a set of objectives. And this is happening in a broader context for something that's very important to NHGRI, and that is a strategic planning process that we recently kicked off. And so while this meeting is not formally part of that strategic planning process, we are going to gather input both from what the meeting does and also during a focused session tomorrow where this will be explicitly discussed. And so I thought it would be important to set that context by giving you a background about the strategic planning process. Recognizing some of you in the audience have seen this, and I won't at all care if you want to just check email because you've already seen these slides in other venues as we've been starting to march along with the strategic planning process in terms of events to help get us the kind of input that we want. We kicked off this new round of strategic planning at a meeting of our advisory council in February of this year, so we're only a handful of months in. And we certainly have a long way to go. If you really want to get more details about sort of the background for what we are trying to accomplish and the reason we've done this in the past and the reason we are doing this now, I would send you to this video, which is the longer presentation I made at our advisory council meeting back in February. In brief, one of the main points I made, which is worth thinking about, is just how much the world of genomics has changed. The discipline has only been around for about 31 years since genomics was named as a discipline. Our institute has now existed for 29 years, about to hit our 30th anniversary as an institute or as an organization. More than 28 years ago since the Human Genome Project began, and we're now 15 years out from having the Human Genome Project completed. One of the things we as an institute did over the past couple of years is really to think a little bit about, well, what is our role? In the last 15 years since the Genome Project ended, we've seen genomics spread across the NIH campus. We are no longer the only funder of genomics research at the NIH. In fact, an aggregate, we're by far the minority funder of genomics research at NIH, because everybody's doing genomics. And that's great. That's part of what we wanted to have happen. But in thinking about where we want to go towards the future, we spent a couple of years sort of thinking about our identity, thinking about what our priorities are and thinking about where we want to be in the future. And we sort of came up with a phrase or a mantra, if you will, or a slogan that sort of embodies what we see in our key role in this ecosystem. And that really is at the forefront of genomics. We're not all of genomics by any means at NHGRI, but what we can do is lead, and we could be at the forefront. And so with this in mind, as we think about our identity going forward, we recognize that it was probably time to also start doing something we've done routinely since the beginning of the institute. And that is to have a fresh strategic plan provide a guide for what we should be trying to accomplish. The historic origins of strategic planning date back to the Genome Project where there were basically three strategic plans that we and others created that help guide the efforts of the Human Genome Project. And that successful process was really viewed to be very important, which is why we as an institute alone forged a strategic planning process and then published a new strategic plan the day the Genome Project ended, which lasted until about 2010, but by 2011 we recognized it was time for a new strategic plan. And so we published that, and that corresponded shortly after I became director of the institute. I would point out that the strategic plan published in 2011 in many ways provided the origins for many of the things we're going to be talking about today because in that title you'll note we made an overt mention of genomic medicine in the title and the centerpiece figure from that strategic plan, which is now, keep in mind, seven years old sort of embodied this notion that what the genome institute really needed to do was expand aggressively beyond fundamental knowledge of genomes and how they operate and how they play a role in human disease, but also think about advancing medicine and eventually improving health care. And in fact, so much of what these meetings have done has helped to define the fourth and the fifth domain from a left to right progression on the far right to sort of bring heat, if you will. In other words, some of that red area within these density plots to aggressively try to move us more and more towards those areas to be able to realize improvements in medicine using genomic information. So we like this strategic plan. In some ways it's holding up quite well and in many ways almost everything we are doing at the institute and even the things we'll talk about here for the next day and a half, very much a capture of the strategic plan. But I would just sort of point out that this plan was written in 2010. It came out of a lot of discussions in 2009 and 2010, obviously published in 2011, and yet we all know genomics is moving fast and furious. And so we simply came to the conclusion that it just was hard to claim or believe that a 2011 strategic plan written in 2010 represented a suitable blueprint for genomics as we entered the new decade. And so that's why we kicked off a new round of strategic planning because we felt we really wanted something new and fresh to bring us into 2020 and beyond. So in thinking about that, we sort of have practical constraints how we're gonna put together a strategic plan, engage the community appropriately and feel we could put a product out that will serve us well as the previous plans have done, and we planned a little bit about this in 2017 and then kicked it off as I said back in February. We know from experience this takes at least two years to do this well. And so we knew we were gonna publish sign in 2020 and that's what we wanted to do. We looked around 2020 and we felt if we waited until October, we could publish it at the 30th anniversary of the launch of the Human Genome Project. That just seemed like too good of an odometer moment to miss, so that's what we're gonna do. And then you just simply back things up. We'll submit a manuscript in July or so. We'll have a finale meeting of some sort in the spring. And then we just basically have all these various ways of engaging the community, collecting input and taking advantage of the expertise that we hope to get from lots of people to be able to put together a strategic vision as we've done in the past. What are those elements? Well, we'll just sort of use tools we've used before and we'll add new ones along the way listed here, the kinds of things, everything from workshops to town halls to gatherings at existing meetings. That's what this is. Obviously a lot of electronic presence. We'll use social media in ways we didn't use before because it wasn't as much of a thing and certainly we have a hashtag associated with this, which in Homics 2020, I don't really know what you do with the hashtag but I know we needed one, so we got one. We're obviously engaging advisory groups at all different levels and then we're certain we'll have some sort of a finale meeting when we actually bring a draft. And so we'll use all these things and then we're receptive to even other ideas along the way as well. We've had a number of gatherings and a number of town halls and a number of workshops so forth already but we're still pretty early. And in fact, just so you know that we, where are we, where we're about there. And so while we have some things in our rear view mirror, we certainly have a long way to go and we're excited about a number of things we already have on the calendar and things that we plan to add and we're always receptive to other ideas of how to capture the kind of information that we want. One thing I thought it was worth mentioning so that you can appreciate how challenging this kind of a process is and it also helps sort of define a little bit how we're gonna sort of tackle this round of strategic planning compared to previous rounds is to just sort of hit on an overarching, a very difficult issue that we always grapple with and I think we're certainly gonna grapple with this time. And that issue is, you know, this strategic planning process about all of genomics as a field or is it just gonna be about what our institute is gonna support. And there is an important distinction and we've done it different ways in previous rounds but I think now is a little different and so we are gonna, we sort of have an idea of how we're trying to pursue this. And let me just briefly explain it. I think it probably is not as hard to deal with with genomic medicine implementation because I think almost all aspects of genomic medicine implementation are at the forefront of genomics. It's still quite early. It's still so much more to do. I'm sure we will play a major leadership role in implementing genomic medicine but that's not true of all areas of genomics and so this slide might be helpful in thinking about what we're trying to accomplish. I like to think about if we're at the forefront, it's sort of like we're about leading a fleet of other ships and that's what we've been doing for a long time but our, the fleet is growing and growing which is great because more and more people are doing genomics. Some of the things are within our wake and some of the things are probably have moved outside our wake and by that I mean some things we will continue to try to lead and some things we're just gonna see to others because that's appropriate and because others will do better with this than us. Some of these areas shown in red outside our wake are areas like cancer genomics, like microbial genomics and microbiome research. These are areas we had major footprints in less than 10 years ago, in fact less than six and five years ago but we think it's time probably to let others lead. It needs its own strategic planning. These are rich, incredibly important areas and we sort of feel like these are probably out of scope for what NHRI is gonna be doing going forward and there's probably other areas we will identify in a similar way that sort of are out of scope. When you get to what's in scope for us, there's sort of areas that we will do alone because no one else is yet there and then the other areas will be sharing leadership and having major partnerships. I think about rare and common diseases. Clearly we and many other institutes and other funders are working in that space. I think we wanna strategically plan but we will certainly engage others and we'll partner with others in pursuing that research. Similarly, computational genomics, much bigger than us. We need to play a major role in it but there'll be others as well. I think there's sort of the mainstream areas where all eyes will be on us for the most part to help lead in this. Maybe not the exclusive funders but we will be sort of, it'll be our mainstream areas. I list some prototype mainstream areas here and there you will see genomic medicine implementation and I think that's why I made my comment that I think this scope definition is probably not as critical for what we're gonna be discussing over the next day and a half because almost everything we're gonna discuss is gonna be a mainstream area for NHGRI at least in terms of leadership. So that's sort of the way we're thinking about how to answer the question what exactly are we gonna be pursuing in this round of strategic planning and the answer just is in another phraseology of the genomics 2020 strategic planning will focus on the forefront of genomics as it pertains to human health and disease and we hope that will help bound the discussion because we can't be strategic planning across all areas of genomics but the important ones are the ones that we're gonna focus on that we regard to be at the forefront. So in summary what we hope will come out of the strategic planning process will be provide a driving force for much of genomics at NIH and around the world. We hope that coming out of this will be a clear and yes we are being tongue in cheek at 2020 vision for using genomics to advance human health. Obviously as all previous strategic plans will guide the Institute's scientific priorities and shape our research portfolio and importantly it'll foster partnerships with research healthcare education policy and various general public communities. I think in ways that simply what wasn't the case in the previous strategic plans I think these sets of communities are growing and growing making it very difficult but also making our role in leadership increasingly important. And I think also that the strategic plan will really help us better shape and define our position at the forefront of genomics. So as I said it's very early in the process we hope you will become engaged in this process in various ways you will help us tomorrow at 1.30 when Anastasia Wise and Terry and I will sort of help collect input from you and Anastasia's gonna nicely frame the kind of input that we want at that time. But also please follow along on the website we're making everything we do very transparent and putting lots of things up on the website for people to look at. Obviously you can email us anytime and you can follow us on social media with the hashtag indicated there. So that's what I wanted to tell you and it looks like there's maybe even a couple minutes if people have any questions. So thanks for your attention. Thanks very much Eric. Questions for Eric. Comments. So one comment I might make is that the meeting that Rex was referring to that we held in Chicago was actually the direct outgrowth of our last strategic planning process when we sort of moved to the bedside to Benchin and base pairs to bedside I think was the rubric and we would expect that our upcoming strategic planning process will also really help guide us in how we do implementation. So we're really hoping that at this meeting you'll keep in mind the fact that we're trying to plan our directions for the next five to 10 years and where we go in genomic medicine and inflammation. Do we just let it happen? It's probably gonna happen driven by other forces than us or do we take a role in that and what role should it be? So I think that's a great point here. I mean I can't stress enough how you really can connect these dots between what is written in these strategic plans and then what happens. I mean if you think back at the 2003 strategic plan when we wrote that sentence where we talked about the $1,000 genome that came out that we the audacious claim come up with a $1,000 genome and out of that immediately came planning for a technology development program the institute has implemented and has run ever since. Similarly when the 2011 strategic plan came out we had all this wonderful prose about implementing genomic medicine and then we all looked at each other and said well how exactly are we gonna do all of this and coming out of that was a working group of council and immediately the first of what is now 11 meetings and you could point to many if not all of those meetings coming out things either they're funding announcements or new initiatives or other kinds of efforts. You really can't connect the dots so I can't stress enough that at least in the case of NHRI our strategic plans really do provide a foundation from which things absolutely grow out directly from what is written. Robert? Eric that's a wonderful presentation. One of the fundamental questions. Dr. Green could you please push the button please. Thank you. Test, test. I think he's good. One of the fundamental questions that I'm hoping we confront in the next two days is when is there when is enough evidence enough to for implementation in any given specific or generalizable state and I noticed your last slide there had a bunch of partnerships which I was pleased to see but it was up briefly but I'm not sure I saw partnerships with regulatory agencies or with reimbursement which may be very fundamental to that question of when is enough enough data and I wondered if you might say more about that. So looking at that I think I have the word healthcare communities and so I think it encompassed within that and remind me I don't know if it's a Laura question or a Terry question. One of the genomic medicine meetings early on deal with regulatory and payers. We actually had two so we had a sort of a stakeholders meeting was the third one that we held and then a fifth one had to do with federal partnerships. Both of those have yielded less than we would have hoped in terms of getting people to the table but I think it's improving. We do have several people around this table who are from communities outside of the typical sort of academic research communities and we very much value their input in terms of how do we make this happen in a way that meets everybody's needs and doesn't break the bank in terms of American healthcare. And Robert in the spirit of your question no we're not letting up on the accelerator of recognizing the importance of that part of this complicated ecosystem. Yeah because I think if there was some way that NSGRI could help convene consensus on some sort of thresholds in that arena such that people would say when we reach this point we feel we have justified implementation. I think that could help a lot. That's a very tall order though. Yeah. Mark. Yeah I just wanted to riff on what Bob had, Robert had talked about. First of all I think the NSGRI has tried to serve the convening function. I think that the issue is that for those of us that have lived particularly the reimbursement world for 20 years there is no such thing as consensus in reimbursement. Each of the payers is their own entity and without something that comes down from the federal system that says everybody will cover this which seems highly unlikely given the political environment. That's probably unrealistic but that being said trying to get input in terms of what type of evidence is necessary is a crucial role of that convening function. The other thing that I wanted to mention that is more tangible relates to another NSGRI funded project which is ClinGen where the ClinGen process has actually been actively engaged with FDA and the FDA is providing guidance in terms of how the ClinGen process could be used as part of the FDA's regulatory process for approval of genetic testing. So I think that's a very tangible example of how the work that NSGRI is doing starting this convening function is actually resulting in what looks to be a policy win I think for Genomic Medicine. I think we had one last question or comment Steven. Thank you. Again just riffing off Robert's really excellent question. An implication of implementation science is a fairly radical basic change in sort of the party who you are as an institute thinking of as your target audience that hitherto the measure of success, if you say we work essentially ultimately for taxpayers, the measure of success has been peer reviewed publications. And NSGRI has clearly been incredibly successful in that regard. When it comes to implementation science and asking when is enough enough, intrinsically there's a change in direction where it's no longer, the ultimate product is no longer peer reviewed publications. Instead it is a focus back on the taxpayer but the taxpayer is gonna measure success in terms of government agencies within DHSS such as CMS actually approving reimbursement within the health service of the products that NHGRI is implementing. And that to me seems a very fundamental change in direction. Those of us who've been part of insight have had our noses pushed against this for the last five years and are very aware of it. And I just think that's such a deep construct that it's something that really requires some careful thought about willingness to go that direction. Those are all great points. I think we need to move on. I'll just to this last point make a note that one of the things that's I think a little different about this genomic medicine meeting is we've got pretty strong representation from some corporate entities that are working in this space as well. And so obviously this question of reimbursement is gonna be very probably of interest to them as well. So I think that suggests that there's a strong evolution to the point of how do we think about the final point of implementation science. I think this will be a theme that we should be talking about throughout the course of this meeting because it's a critical theme. It's a critical element of success for genomic medicine implementation. So Bruce, you came in a little late. Why don't you reduce yourself? Yeah, Bruce Cork from University of Alabama. Birmingham Chief Genomics Officer there. Sorry, I was late. I had a board meeting of the ACMG Foundation. Anybody wants to donate, by the way, please. All right, so then thank you very much, Eric. I'm gonna introduce Jeff Ginsberg who will moderate our first session.