 So, as some of you have learned that as of February 1st at midnight, Group Health Cooperative became Kaiser Permanente of Washington, and GHRI now has an even more complicated name of Kaiser Permanente Washington Health Research Institute, so henceforth we will be known as that. So I'm going to talk about a project about building a family network. I'm a clinician at Group Health Cooperative, and I see the patients that are identified and emerge, and how Group Health has many intact families within its system, and how we can use these intact families to distribute information about genetic risk. So when I think about building a family network, I think about why we do this, and that is to provide information to family members who have risk for their own health care. People share in families for different reasons, but one of the big reasons is to get support. If you get diagnosed with a genetic condition, if you get diagnosed with breast cancer in a woman, you typically the first person you talk to is your sister, and the correlation of how you share genetic information is based sometimes on the severity of the disease. There are certainly barriers of sharing information, genetic information, including family dynamics, and then we have regulatory information, including HIPAA versus our duty to warn. So we published a little paper about our experience with three families from Emerge II who had incidental findings. Two of them turned out to be VUSs. One, the LDHR patient. We vetted this change, and because it was consistent with disease, we were concerned that it was part of what was going on with the patient. But in each of the families, you can see the pro-band is identified by the arrow and who we were able to test additionally in our cooperative because they were group health members and what impact that had on their health. The first family is an SCN 5A family, and while the pro-band and her two children did not have a significant phenotype, the grandson had had seizures when he was given medications for ADHD as a child, and as an adult when he was put on antidepressants, also got a seizure disorder and almost died when falling in the shower. He ultimately was found to have a significant cardiac rhythm abnormality and he's being considered for an implantable device. I don't know if his seizures were because of the arrhythmia. There are some literature that SCN 5A also is associated with seizures as some of the other SCN genes are, but those are the three families that kind of prompted this work. So we put in for a supplement, and we were awarded a supplement that has been entitled the family network approach to assessing the trickle-down effect of genetic testing. My group will no longer let me use trickle-down effect. They make me call it the family network. And it's being led by Nora Henriksen, who is a PhD at Group Health Research Institute now that long Kaiser Permanente name. And the specific aim of this project has been to explore the feasibility of health systems led identification and a communication with family members of the emerged participants. The patients that we're including in this study are only members of Group Health, Kaiser Permanente Washington, who are enrolled and emerge. These will be at Group Health, we're returning pathogenic, likely pathogenic, variants of uncertain, significant for colorectal genes, and negative results to the participants. So all of our participants who have consented will get some kind of result from us. And Group Health and Kaiser are integrated health care systems, whereas both insurers and health care providers, we want to try to identify people at risk so that we can appropriately monitor them and provide medical care. So to explore social, ethical, and legal feasibility, we are going to be conducting semi-structured interviews with approximately 20 e-merge participants before their results have been returned. We're going to cover topics like what they consider is the definition of their family. We want to ask them if they have a preferred role, if any, for Group Health Cooperative, for actionable, for sharing actionable results with likely affected family members who are also Group Health Kaiser Permanente members. We are asking them, do they want Group Health Kaiser Permanente providers to contact relatives directly with the pro bands consent and how they would feel about the electronic medical record being used to share information predominantly between providers. We're also asking them questions, you know, specific to pediatric cases. If you have, if you're identified to have a significant gene in adulthood, how would you like that information to be stored and how would you like that information to be provided for children who are at risk? We're using a couple hypothetical scenarios. We're using vignettes, one's a colorectal cancer vignette because the focus of our e-merge project, we have about 1,000 of our e-merge participants have colorectal cancer or polyposis. And we also wanted another condition that was an actionable gene that would span lifetime and so we picked Marfan syndrome. We will also collect contact information for relatives identified by each participant. We will attempt to identify relatives based on first name, last name, and date of birth provided by the e-merge participant. We will not access, we will not access relatives records, but we're just trying to see if we can build a family network based on the information a pro band has provided us. We're looking at the legal ramifications of this work. We're in contact with our legal consults within our own institution. We have talked to Bob Wilden about his process at NHGRI where he developed a family history tool. And Malia Fullerton who is here is assembling a team of legal experts from the e-merge sites to address issues including duty to warn versus HIPAA across the e-merge sites. Our other ongoing work is a family talk trial where we are trying to prove communication with patients who have a risk for colorectal cancer that's being headed by Deb Bowen. That's part of our e-merge three project. We are developing dot phrases so that when we see all of our e-merge patients in clinic, we're able to consistently draw on the information regarding family network and who else could be at risk and whether they are in group health. We're looking at what family networks have looked like for some of our other populations that we have been following consistently in genetic services. And there's a development of an e-merge-wide family network project being led by Janet Williams in the return of results group. So this is our e-merge group at University of Washington and Kaiser Washington and the group that's right involved in the supplement which is Nora, Gail, Malia, myself, and Erin Skrull. Thank you.