>> GOOD AFTERNOON, EVERYONE. I'M PATTY BRENNAN, DIRECTOR OF THE NATIONAL LIE BREAB OF MEDICINE. IT'S MY PLEASURE TO WELCOME YOU TO THE 2018 LEITER LECTURE, A COLLABORATION. I'D LIKE TO ACKNOWLEDGE WE HAVE TWO MEMBERS OF THE BOARD WITH US TODAY. COULD I ASK YOU TO STAND FOR A MINUTE AND BE ACKNOWLEDGED? THANK YOU VERY MUCH. [APPLAUSE] KEITH IS A COLLEAGUE, DIRECTS THE LIBRARY OF THE NATIONAL INSTITUTES OF HEALTH SO WE HAVE MANY COLLABORATIONS AND SANDRA, I'M GOING TO HAVE TO ASK YOU TO STAND UP AGAIN BECAUSE NOW I'D LIKE TO ACKNOWLEDGE THE BOARD OF REGENTS FOR THE NATIONAL LIBRARY OF MEDICINE, IF YOU WOULD PLEASE STAND TO BE ACKNOWLEDGED. THANK YOU FOR BEING HERE FOR YOUR SUPPORT AND FOR THE OPPORTUNITY TO HAVE THE NATIONAL LIBRARY OF MEDICINE PARTICIPATE. I ALSO NEED TO ASK SANDRA WILLIS TO STAND, SENIOR CATALOGING SPECIALIST, THE ORGANIZER OF THIS PARTICULAR LECTURE. THANK YOU SO MUCH FOR ALL THAT YOU'VE DONE FROM THE TECHNICAL SERVICES DIVISION. I'D ALSO LIKE TO ACKNOWLEDGE MY COLLEAGUES DR. GLEN CAMPBELL AND DR. BARBARA REDMAN, IF YOU'D STAND, PLEASE. THE FRIENDS OF THE NATIONAL LIBRARY OF MEDICINE IS AN IMPORTANT PARTNER THAT BRINGS FORWARD AND SUPPORTS MANY OF THE INITIATIVES OF THE NATIONAL LIBRARY. IT IS A VOLUNTARY PUBLIC ORGANIZATION. AND NOW I HAVE MY VERY SPECIAL OPPORTUNITY TO WELCOME HOME BETSY. BETSY HUMPHREYS HAS JOINED US. [APPLAUSE] NOW TODAY I'M GOING TO BE INTRODUCING ERIC DISHMAN. ERIC HAS A PUBLIC PERSONA THAT MANY OF YOU HAVE ALREADY SEEN, BUT I'VE KNOWN ERIC FOR 20 YEARS YEARS. AND I'VE KNOWN ASPECTS OF ERIC WHICH I WON'T BE COMPLETELY SHARING TODAY, BUT I WANT TO TELL YOU THAT ERIC ONCE WAS A MEMBER OF THE BOARD OF REGENTS IN THE NATIONAL LIBRARY OF MEDICINE AND AS I WAS BEING RECRUITED TO TAKE THIS POSITION, I CALLED ERIC AS A COLLEAGUE AND A FRIEND AND A WISE FRIEND AND I SAID, ERIC, I'M THINKING ABOUT THIS JOB. ALL THE WHILE ERIC IS THINKING, I'M THINKING ABOUT A JOB THERE TOO. SO HE WAS VERY HELPFUL, HIS COUNSEL WAS GREAT AS IT'S BEEN OVER THE 20 YEARS, I COME FOR MY INTERVIEW, I'M WALKING INTO THE INTERVIEW AND ERIC IS WALKING OUT OF THE SAME ROOM AND I THOUGHT, ARE WE INTERVIEWING FOR THE SAME JOB? HE MUST HAVE -- BUT NO, THE BEST THING THAT HAPPENED THE WHOLE -- THERE WAS A CONFLUENCE OF TWO STRONG PATIENT TECHNOLOGY ADVOCATES, ERIC DISHMAN, PATTY BRENNAN, HITTING THE NIH AT THE SAME TIME, AND THEY DON'T REALIZE WHAT IS COMING TO THEM. WHAT HAD CAME FROM ERIC'S PERSPECTIVE, THOUGH, IS BRINGING HIS 25 YEARS OF HISTORY IN SILICON VALLEY AS INTEL'S MANAGER OF HEALTH STRATEGY, THE STARTUP TO FIGURE OUT WHERE TECHNOLOGY WAS GOING TO BE IN HEALTH, NOW COMES IN THE SERVICE OF OUR SOCIETY. THROUGH HIS WORK, ERIC HAS BEEN A PASSIONATE ADVOCATE, POLICY INNOVATIONS, PRODUCT INNOVATION, TO MAKE SURE THAT WE ARE ABLE TO FIND TOOLS THAT HELP PEOPLE LIVE WELL AT HOME. HE WAS A MEMBER OF THE PRECISION MEDICINE WORKING GROUP HERE AT NIH AND THEN CAME TO JOIN WHAT WAS ORIGINALLY REFERRED TO AS THE PRECISION MEDICINE INITIATIVE, NOW KNOWN AS THE ALL-OF-US, AND I MODEL MY ALL-OF-US NOT FEDERALLY PAID FOR NECKLACE. ERIC BRINGS AN ENERGY TO THE CONVERSATION THAT NO ONE IN THE WORLD COULD POSSIBLY BRING, AND HE BRINGS THIS BECAUSE OF HIS LONG-STANDING SKILLS AS AN ANTHROPOLOGIST, AS A SCHOLAR OF HOW PEOPLE LIVE IN THE UNIVERSITY AS A PATIENT HIMSELF, BECAUSE OF HIS OWN PASSION TO TIRELESSLY SEARCH, HE WAS ABLE TO REVERSE A 20 YEAR PROCESS OF KIDNEY CANCER TO MAKE SURE THAT WE HAD HIS TALENTS TO ENSURE HEALTH FOR ALL. ERIC BELIEVES HE WAS ALIVE TO DO THIS VERY PROCESS, THIS VERY APPROACH TO ASSURING THAT THE HEALTH OF THE PUBLIC WILL BE DRIVEN BY KNOWLEDGE OF THE PUBLIC. I THINK YOU'LL ENJOY HIS COMMENTS. I HAVE NEVER, EVER HEARD ERIC SPEAK THAT I HAVEN'T COME AWAY TRANSFORMED AND FRANKLY WITH A LITTLE MORE WORK TO DO. ERIC, WELCOME AND THANK YOU SO MUCH FOR BEING HERE. [APPLAUSE] >> I JUST WANTING HER TO KEEP GOING ON AND ON AND ON. PATTY HAS BEEN A GREAT FRIEND, SCHOLAR AND TEACHER. I THINK WE BEGAN OUR WORK TOGETHER THINKING ALMOST 20 YEARS AGO THAT WE COULD MAKE PERSONAL HEALTH RECORDS WIDELY AVAILABLE, AND I HAVE THREE FAILED STARTUPS ON THAT TOPIC, I CAN TALK TO YOU ABOUT WHY THEY FAILED BUT WE ARE STILL ON THIS JOURNEY TO GIVE PEOPLE INFORMATION THAT THEY CHOOSE TO HAVE ABOUT THEMSELVES AND BE ABLE TO SORT OF MOVE FORWARD WITH THEIR HEALTH IN PROACTIVE WAYS. SO BEFORE I GO ANY FURTHER, I JUST WANT TO SAY THANK YOU, AT THE NLM AND THE NNLM HAVE BEEN WONDERFUL IN HELPING TO GET THE WORD OUT ON OUR NATIONAL LAUNCH OF THE ALL-OF-US RESEARCH PROGRAM WHICH WAS LESS THAN 72 HOURS AGO, THANK YOU, AND WE HAD MEMBERS -- NLM STAFF AND NNLM FOLKS AND LOCAL LIE BRAIR LIBRARIANS AT ALL OF THE SITES, THEY JOINED US FOR CELEBRATION AFTERWARDS. I'M SORT OF LOST IN TIME AND SPACE, 22 MONTHS OF HOLDING YOUR BREATH FOR THIS NATIONAL LAUNCH AND I'M STILL NOT QUITE SURE BUT BEFORE WE GO ANY FURTHER, I JUST WANT TO DO THAT THANKS AND I'LL TALK MORE ABOUT THE LAUNCH IN A FEW MINUTES. I COMPLETELY CHANGED THIS AROUND. PATTY WAS ASKING, DID YOU AGREE TO DO THIS KNOWING THAT WAS THE LAUNCH DATE? I SAID YEAH, I DID, I'M NOT SURE WHY I DID, BUT I KNOW WHY I DID, IT'S BECAUSE LIBRARIES AND LIBRARIANS HAVE A SPECIAL PLACE IN MY HEART AND QUITE FRANKLY THEY HAVE BEEN KEY TO MY SURVIVAL FROM A VERY EARLY AGE, SO I ADDED SOME SLIDES LAST NIGHT THAT -- I WANT TO SHARE SOME OF THOSE STORIES WITH YOU. PEOPLE TEND TO THINK -- THEY SORT OF FAST FORWARD TO THE END OF MY 23 23 YEAR CANCER JOURNEY AND THEY SAY IT WAS WHOLE GENOME SEQUENCING THAT SAVED YOUR LIFE. IF I GO BACK IN TIME, WELL BEFORE I HAD CANCER, IN FACT, WHEN I WAS BORN, THE ROLE OF LIBRARIES AND LIBRARIANS WAS A KEY PART OF EVEN GETTING TO THE POINT IN LIFE WHERE I GOT CANCER. THAT'S A PICTURE OF ME, WITH WHAT I SWEAR IS THE LARGEST BABY FOREHEAD IN THE WORLD. [LAUGHTER] >> >> YOU COULD RENT SIGNAGE SPACE ON MY FOREHEAD. THE REST OF ME, I WAS VERY PREMATURE. I WAS BORN WITHOUT MY HIP SOCKETS BEING COMPLETELY FORMED. THE DOCTORS INITIALLY TOLD MY PARENTS HE'S NEVER GOING TO BE ABLE TO WALK, HE'LL BE IN A WHEELCHAIR HIS WHOLE LIFE,, AND THEY REFUSED TO TAKE ONE DOCTOR'S VIEW ON IT. YOU DIDN'T JUST ACCEPT WHAT THE PERSON IN THE WHITE COAT SAID TO YOU. THEY STARTED GOING TO LIBRARIES, REACHING OUT TO OTHER CLINICIANS, AND THEY THROUGH A LIBRARIAN AND CLINICIAN FOUND EXAMPLES OF A STUDY THAT HAD JUST BEEN DONE ON A PROCEDURE THAT HELPS THE HIP SOCKETS TO FORM THE REST OF THE WAY. I WAS A CROSS COUNTRY RUNNER IN SCHOOL, I MEET OTHER PEOPLE IN MY AGE WHO ARE WHEELCHAIR BOUND BECAUSE THEY IT NOT HAVE THE INFORMATION AND THEY DID NOT HAVE THE PEOPLE THAT WERE ACTING ON THEIR BEHAVE TO CURATE THAT INFORMATION AND GET IT TO THEM IN ORDER TO ACTUALLY IMPACKET THEIR IMPACT THEIR LIVES. SO BEFORE I EVEN SORT OF HAVE LANGUAGE, THE NARRATIVE IN MY HOUSEHOLD WAS DON'T BE A PASSIVE PATIENT, OR DON'T BE A PASSIVE PARENT. AND IT WAS THE POWER OF INFORMATION THAT CAN REALLY LEAD TO ABILITY OR DISABILITY, AND THE NOTION OF A SECOND AND THIRD AND FOURTH, I MEAN, I'VE USED LIBRARIES FOR MY SECOND TO MY 150 SECOND OPINION TO SORT OF TRIANGULATE BETWEEN LOTS OF DIFFERENT SOURCES AND IT WAS BOTH THE SPACE AND THE PLACE, BUT THE PEOPLE WHO WORKED THERE WERE KEY TO THAT SURVIVAL. THE OTHER REASON THIS IS SO DEAR TO MY HEART IS, THAT'S MY MOM, THIS WAS TAKEN A FEW WEEKS AGO, SHE'S PLAYING QUIDLER, SHE'LL KICK YOUR BUTT. SHE WAS A SCHOOL LIBRARIAN IN A VERY POOR SCHOOL IN KINDERGARTEN THROUGH THIRD GRADE IN CHARLOTTE, NORTH CAROLINA. WHEN I WOULD GO WITH HER TO THAT SCHOOL, TO WORK, AND I WOULD SEE, SHE ALWAYS HAD THE ABILITY TO FIND THE RIGHT BOOK FOR THE RIGHT CHILD AT THE RIGHT MOMENT IN TIME. I MEAN, IT WAS UNCANNY. I'VE DONE A LOT OF FIELD WORK STUDYING HOME CARE NURSES AND HOME CARE DOCTORS WHO, IN THE ENVIRONMENT OF THE HOME, SEE THE FULL COMPLEXITY, THE FULL PICTURE OF A PATIENT'S LIFE AND CAN PRESCRIBE A SET OF ACTIONS WITH MORE CONTEXT THAN WHAT WE ARE ALLOWED TO DO IN THE KIND OF 15 MINUTE SORE THE FACTORY LINE FRISKING THAT SO MUCH HEALTHCARE HAS BEEN FORCED TO BECOME BECAUSE OF THE WAY THAT WE PAY FOR IT. AT THAT POINT, I WAS LIKE, MOM, HOW CAN YOU KNOW? SHE WAS LIKE, WELL, I KNOW THESE KIDS' LIVES, I KNOW WHAT'S GOING ON IN IT, I CAN SORT OF READ THEIR MOODS. SHE CAN SORT OF UNCANNILY GO, TAKE ALL THOSE VARIABLES AND 50 FIND A BOOK FROM HER HEAD, SHE KNEW EVERY BOOK IN THAT LIBRARY, AND HAND IT TO THAT CHILD AND IT WAS EXACTLY WHAT THEY NEEDED IN THAT MOMENT IN TIME. AND SHE DID THIS FOR ME AS HER SON, GROWING UP IN LIFE. IF I FAST FORWARD A LITTLE BIT, THIS PICTURE HERE AT THE TOP, AND I SAVED LAWN KNOWING MONEY AND SOFTWARE PROGRAMMING MONEY FOR THAT SOFA BECAUSE I THOUGHT IT LOOKED REALLY ATTRACTIVE FOR THAT FRESHMAN YEAR IN COLLEGE. I WAS DIAGNOSED MY SOPHOMORE YEAR IN COLLEGE WITH A RARE FORM OF KIDNEY CAN SE TOLD THAT I WOULD HAVE NINE MONTHS TO LIVE IF I WAS LUCKY, WENT FOO A DEEP DEPRESSION, AND IF IT WEREN'T FOR ANOTHER PATIENT AT THE DUPE DUKE MEDICAL LIBRARY, THIS PATIENT WHO I MET IN A WAITING ROOM, I WAS WAITING TO HAVE ENDOSCOPY DONE, SHE WAS AN ACTUARY, AND BOY, I GOT THROUGH MY STATISTICS CLASSES IN GRADUATE SCHOOL BUT I'M A QUALITATIVE RESEARCHER BECAUSE I WAS STRUGGLING WITH THOSE, BUT SHE KNEW STATISTICS REALLY WELL. THERE WE WERE WITH ALL THESE JOURNALS, SHE'S LOOKING THROUGH THEM AND SHE'S LIKE -- AFTER A COUPLE OF HOURS SHE'S LIKE, ERIC, THEY DON'T KNOW ANYTHING ABOUT YOU. I WAS LIKE WHY DO YOU SAY THAT? SHE'S LIKE, THERE'S BEEN 2 1/2 STUDIES ABOUT THE RARE CANCER THAT YOU SUPPOSEDLY HAVE AND BOTH OF THEM WERE WITH PEOPLE OVER 65 OR 75. THEY'VE NEVER SEEN A 19-YEAR-OLD AND THEY'RE TRYING TO EXTRAPOLATE FROM THE AVERAGE OF THE FEW STUDIES THEY HAD TO YOU IN GIVING YOU THIS DEATH SENTENCE AND YOU'RE LIVING OUT THAT DEATH SENTENCE. AND I CAN TELL YOU IN THE NOW MORE THAN 2,000 CANCER PATIENTS I HAVE PERSONALLY ADVOCATED FOR AAND I KEEP ALL THEIR STORIES IN MY JOURNAL, IN GENERAL THE ONES WHO ACCEPT AND BELIEVE THE NUMBERS DIE ON TIME AND THOSE WHO GET OUT OF THAT MODE, START LOOKING FOR SOLUTIONS AND DON'T JUST ACCEPT THAT PSYCHOLOGICALLY TEND TO LIVE LONGER. AND THE PROBLEM IS, THIS IS WHEN I REALLY UNDERSTOOD, NONE OF US ARE AVERAGE PATIENTS. AND THERE CAN BE HUGE EVIDENCE GAPS BUT NO ONE TELLS YOU THAT WHEN THEY'RE HANDING YOU THIS DEATH SENTENCE OR THIS PROCLAMATION AT THAT MOMENT IN TIME. SO THIS -- VERNA WAS HER NAME, SHE WAS HELPING ME SORT OF GET OUT OF THAT DEATH SENTENCE AND SHE ALSO TAUGHT ME TO BE A PROACTIVE PATIENT. EVEN THOUGH IT HAD BEEN IN MY NARRATIVE OF MY FAMILY, WHEN I GOT THE C WORD DIAGNOSIS, I JUST SHUT COUNCIL. MY FACULTIES -- I MEAN, I HAVE HELPED DO CANCER ADVOCACY FOR SOME VERY FAMOUS SILICON VALLEY EXECUTIVES THAT YOU WOULD KNOW. THESE ARE POWERFUL PEOPLE WHO HAVE JUST INCREDIBLE DRIVE, STRENGTH AND ARE DATA-DRIVEN BUT THE MOMENT THEY GOT THE C WORD, IT SHUT DOWN ALL THOSE FAK FACULTIES AND I HAVE TO TEACH THEM THE SAME THINGS MY MOM DAD AND VERNA TOLD ME. THIS IS A PICTURE OF THE UNIVERSITY OF UTAH LIBRARY, SO I WOULD HAVE MY TREATMENT UP THERE BUT ALSO BEFORE I WOULD DO TREATMENT, I WAS IN THERE LOOKING AT DIFFERENT JOURNALS, GETTING THE LIBRARIANS TO HELP ME FIND OUT INFORMATION. AND I DISCOVERED OVER TIME THAT I HAVE SUPERPOWERS IN SNOW. IT'S NOT THAT I LIKE SNOW, IT'S LIKE, I HAVE A DEEP SPIRITUAL CONNECTION AND NEED FOR SNOW. AND IF I DON'T GET SOME OF IT EACH YEAR, I THINK I WOULD HAVE BEEN DEAD A LONG TIME AGO. SO AS I WAS PROGRESSING IN THE ILLNESS AND THE RISK OF DEATH WAS BECOMING GREATER, I KEPT SAYING, I WANT YOU TO OPTIMIZE MY -- THE SIDE EFFECTS FROM THE DRUGS YOU'RE GOING TO GIVE ME FOR MY ABILITY TO CONTINUE TO HIKE IN SNOW. I DON'T CARE ABOUT LONGEVITY. THAT'S NOT WHAT I'M OPTIMIZING FOR. THIS WAS A HUGE FIGHT. AND I ACTUALLY HAD TO GO IN TO THE EARLY DAYS OF ELECTRONIC HEALTH RECORDS AND SHOW THEM -- THIS IS AN ANIMATION BECAUSE I CAN'T FIND THE IMAGES FROM BACK THEN, AND I WOULD SAY, IN THE NEIGHBORING NAME FIELD, FIRST OF ALL I GO BY ERIC, MY MIDDLE NAME, CALL ME MY DAMN NAME WHEN I WALK INTO THIS ENVIRONMENT, AND THE SECOND THING IS, ALL THE CHOICES THAT YOU PRESENT TO ME NEED TO BE OPTIMIZED FOR MY PATIENT GOAL THAT SAYS I WANT SNOW TIME, NOT LONGEVITY. IT WAS A FIGHT THAT TOOK YEARS AND YEARS TO DO. WE PROBABLY DON'T HAVE THE SEARCH ALGORITHMS AND INFORMATICS IN PLACE TO REALLY OPTIMIZE AROUND GOALS AND IN MOST ELECTRONIC HEALTH RECORDS, THERE IS STILL NOT A PLACE FOR THE EXISTENCE OF PATIENT GOALS. SO THIS IS WHAT TAUGHT MEMOS OF THE SYSTEM I WAS IN AND ALL OF THE SIDE EVENT DATABASES THAT WERE USED WERE DRIVEN MORE BY RELIABILITY MORE THAN LIVABILITY, BECAUSE TO REALLY GET IN THERE AND FIGURE OUT WHAT DRUGS I SHOULD TAKE BASED ON SNOW TIME WAS A VERY DIFFICULT SEARCH OPPORTUNITY AS WE WENT THROUGH THAT. THEN MORE RECENTLY, LIBRARIES ARE THE PLACES WHERE I OFTEN MEET THE CANCER PATIENTS THAT I ADVOCATE FOR. IT'S NOT NECESSARILY THAT WE COULDN'T GET THE SAME INFORMATION HOME BUT THERE'S SOMETHING ABOUT THE PHYSICAL SAFETY OF THOSE PLACES, THERE ARE PEOPLE IN THERE CURATING AND HELPING US FIND AND MAKE SENSE OF THIS OVERWHELMING DATA. THROUGH THE YEARS, INITIALLY THE INTERNET WAS GREAT FOR ME, BUT IT BECAME OVERWHELMING FOR ME AND I WAS A TECHNOLOGY EXECUTIVE IN SILICON VALLEY, WELL VERSED IN THE TOOLS AND SPEAK ENGLISH AND HAVE MONEY AND MEANS, AND I WOULD HAVE TO -- I MEAN, THE STANFORD MEDICAL OR HEALTH LIBRARY THAT WAS IN THE MALL RIGHT NEXT TO WHERE I COULD GET MY CHEMO WAS KEY, AND TWO DIFFERENT LIBRARIANS IN THERE, TO HELP ME CURATE THE OVERWHELM OF ALL THE STUFF THAT WAS IN THE INTERNET AND NOW JUST THE FREQUENCY WITH WHICH JOURNALS CAME. IN THE EARLY DAYS, I PAID FOR AND BOUGHT MY OWN NEPHROLOGY JOURNALS BUT AT GREAT EXPENSE WHEN I WAS A VERY BROKE GRADUATE STUDENT. BUT TO THIS DAY I NEEDED THAT HELP TO THE TUNE OF THE SEARCH OF THE OVERWHELM INFORMATION. IT'S BEEN ALL THESE PLACES, THE COMPASSIONATE CURATORS, SURROUNDED BY RICH RESOURCES THAT MADE THE DIFFERENCE BETWEEN CHOICES AND LIFE AND DEATH FOR ME ALL ALONG THE WAY. SO IT'S TRUE THAT EVENTUALLY WHOLE GENOME SEQUENCING AND HAVING MY EHR TOGETHER HELPED MY DOCTORS LOOK AT ME AND SAY EVERYTHING WE'VE DONE FOR YOU WAS DESTINED NOW TO WORK BUT WE THINK WE NOW UNDERSTAND THE MECHANISM OF YOUR KIDNEY CAN SE WE WANT TO PUT YOU ON A PANCREATIC CANCER DRUG AND SUDDENLY I WAS CANCER-FREE AFTER TWO MONTHS OF CHEMOTHERAPY AT THE VERY LAST HOUR BEFORE WE WALKED IN HERE, AND I'M HEALTHIER NOW AT 50 THAN I WAS AT 19, WHEN THIS WHOLE ADVENTURE BEGAN. BUT THE ROLE OF LIBRARIES, THE ROLE OF INFORMATION, THE ROLE OF EMPOWERMENT AND THE ROLE OF CURATORS WAS ABSOLUTELY KEY. SO I'M KIND OF LEFT WITH SOME QUESTIONS. I WONDER A LOT ABOUT THE FUTURE. WHAT WILL A LIBRARY BECOME IN ORDER TO CONTINUE TO BE RESPONSIVE AND LIFE SAVING FOR PEOPLE IN A WORLD OF PATIENT-DRIVEN PERSONALIZED CARE BUT FLOODED WITH INFORMATION THAT'S ALMOST TOO MUCH TO HANDLE HANDLE? WHAT'S GOING TO BE THE INFORMATICS THAT ALLOW US TO NOT ONLY LISTEN TO, HAVE A SPACE FOR IN THE RECORD, HEED AND MEET THE UNIQUE GOALS OF AN INDIVIDUAL? HOW ARE WE GOING TO CURATE THIS INCREASINGLY COMPLEX INFORMATION INTO PRECISE N EQUALS ONE ACTION PLANS? WE WOULD COME UP WITH AN ACTION PLAN FOR ME BASED ON WHAT WE BELIEVED WAS THE RIGHT THING TO DO. WHAT'S IT GOING TO TAKE NOW TO STEP BACK AND SAY WITH ALL THIS INFORMATION AND THESE NEW DATA TYPES, HOW ARE WE GOING TO CUSTOMIZE CARE TO THE UNIQUE NEEDS OF AN INDIVIDUAL WITHIN VERY COMPLEX CHANGING WORLDS OF BEHAVIOR AND EMOTION AND BIOLOGY AND SOCIOECONOMICS? AND THEN HOW ARE WE GOING TO CHANGE OUR RESEARCH ASSUMPTIONS AND PRACTICES IN ORDER TO DELIVER MEDICAL BREAKTHROUGHS THAT CAN BE INDIVIDUALIZED? THE ALL-OF-US RESEARCH PROGRAM IS NOT LIKE A PANACEA THAT'S GOING TO ANSWER ALL OF THESE, BUT I THINK WE'RE GOING TO DISCOVER THINGS BECAUSE WE HAVE THE NEED AND THE OPPORTUNITY AND A PLATFORM TO HELP US LEARN SOME OF THESE ANSWERS AS WE SORT OF MOVE TOWARDS THIS JOURNEY. SO WHAT IS IT? I'LL GIVE YOU AN OVERVIEW AND THEN SHARE WITH YOU OUR CHALLENGES AND STRUGGLES FOR DOING WHAT WE CALL PRECISION COMMUNICATIONS, WHICH IS WHAT I THINK EXACTLY JENNY DISHMAN MY MOTHER WAS DOING WHEN SHE CHOSE THE RIGHT BOOK WITH A NUMBER OF CONTEXTUAL FACTORS, WHICH IS WHAT WE WERE DOING WITH THOSE LIBRARIANS COMING IN TRYING TO CUSTOMIZE INFORMATION TO ME AND COMMUNICATIONS TO ME THAT WERE GOING TO EMPOWER ME. IF YOU STEP BACK, AND THIS WAS TRUE IN MY INTEL CAREER AND COMING HERE, RIGHT WHEN I LEFT INTEL, THEY'D GONE OUT AND STUDIED RESEARCHERS AND PRACTITIONERS, PROVIDERS WHO WERE ON THE FRONT EDGE OF DOING PRECISION MEDICINE CARE. NOT JUST CANCER BUT CERTAINLY CANCER WAS ONE OF THE PIONEERING AREAS. OUT OH OF THAT, IT BECAME REALLY CLEAR ON A NUMBER OF FRONTS. FIRST FROM THE PERSPECTIVE OF PATIENTS AND PEOPLE, THE VAST MAJORITY OF EVEN CANCER PATIENTS LET ALONE PEOPLE WITH OTHER CONDITIONS ARE NOT GETTING PRECISION-BASED CARE. WE SIMPLY DON'T HAVE THE SCIENCE AND THE EVIDENCE BEHIND SO MANY OF THOSE PLACES TO DO THAT YES. AND EVEN IN THE PLACES THAT WERE CUTTING EDGE IN 20 COUNTRIES THAT WE LOOKED AT AROUND THE WORLD, YOU WOULD SEE AN ONCOLOGIST OR A PHYSICIAN WHO WAS KNOWLEDGEABLE OF THIS AND HAD TACKLED THE DIFFICULT LEARNINGS FROM IT, IN AN OFFICE RIGHT NEXT TO ONE AND THE SAME DEPARTMENT AND ONE OF THEM WAS OFFERING YOU LIFE SAVING TREATMENTS AND THE OARGS DIDN'T OTHERS DID N'T KNOW THEY EXISTED AND WERE SORT OF POO POOING THE GENETICS, BEHAVE ARE YO, LIFESTYLE WOULD MAKE ANY DIFFERENCE IN WHAT THEY WERE DOING. SO THE SIMPLE REASON WHY WE NEED THIS IS FROM A PATIENT PERSPECTIVE, WE ARE STILL IN A PRIMARILY -- YOU KNOW, AVERAGE OF WHO HAPPENED TO BE STUDIED, TRIAL AND ERROR KIND OF PARADIGM, ESPECIALLY IF YOUR ILLNESS IS VERY COMPLEX AT ALL. BUT FROM THE PERSPECTIVE OF THE PROVIDERS, IT'S NOT BECAUSE THEY'RE DOING BAD JOBS, IT'S BECAUSE THEY'RE NOT EQUIPPED WITH THE SCIENCE OR THE TOOLS OR THE TIME IN THE ENVIRONMENT IN WHICH THEY LIVE TO BE ABLE TO DO THAT KIND OF CUSTOMIZATION OF CARE. I MENTIONED THAT I USED TO STUDY HOME CARE DOCTORS IN GREAT DETAIL AN AN ANETH NOTHING RAFER, AND THEY WERE -- IF YOU THINK ABOUT IT, PULL THE CAMERA BACK FROM THE UNDERSTANDING OF THE PATIENT THROUGH THE LENS OF A CHART, AND SEE THAT, OH OH, MY GOSH, THEY'RE IN AN ABUSIVE SITUATION, OR SEE, THEY HAVE NO AIR CONDITIONING AND LIVE IN ATLANTA, GEORGIA, AND SEE THESE OTHER CONTEXTUAL FACTORS THAT WERE FUNDAMENTAL TO HEALTH, BUT OUR SYSTEM TODAY DOES NOT WANT CONTEXT, IT WANTS FAST PROCESSING AND MOVING ON TO THE NEXT PERSON. SO I DON'T BLAME PROVIDERS, I THINK THEY DO MIRACULOUS THINGS WITH LIMITED TOOLS AND DATA TO DO AS MUCH CUSTOMIZED PRECISION CARE TO THE INDIVIDUAL AS THEY POSSIBLY CAN. WHEN WE LOOKED AT BIOMEDICAL RESEARCH RS IN ALL OF THESE DOMAINS, THEY WERE NEVER GETTING TO THE SCIENCE BECAUSE TO START TO COLLECT THESE NEW TYPES OF DATA TYPES WAS REALLY DIFFICULT, THEY'D GET A THREE OR FIVE YEAR AWARD FROM US AT INTEL, ALSO A UNIVERSITY GRANT THEY HAD WON THROUGH NIH OR SOMEWHERE ELSE, AND THEY'D SPEND YEARS OF THAT GRANT JUST TRYING TO RECRUIT THEIR COHORT OF PEOPLE THEY WERE GOING TO STUDY, ALMOST NEVER WERE THOSE COHORTS VERY DIVERSE IN TERMS OF WHO THEY WERE TRYING TO GET, AND THEN THEY WOULD SPEND ANOTHER YEAR TRYING TO GET THE I.T. SYSTEMS IN PLACE TO DEAL WITH BIG DATA. SO WE WERE WATCHING THEM NEVER GET TO THE SCIENCE AND THEY WERE EEGHT UP ALL OF THE PARTS OF THEIR AWARDS THAT DIDN'T HAVE ADEQUATE FUNDING TO BUILD ALL OF THAT INFRASTRUCTURE AND THEY JUST WEREN'T GETTING TO THE SCIENCE. SO A LOT OF OUR QUESTIONS BECAME HOW CAN WE PROVIDE A PUBLIC RESOURCE TO ADDRESS THESE KINDS OF USER NEEDS. THIS IS VERY MUCH WHAT I THINK ABOUT THE ALL-OF-US RESEARCH PROGRAM BEING. I'LL TELL YOU WE GET SOME CRITIQUES FROM OTHER PRIVATE COHORTS THAT ARE OUT THERE AND I'M LIKE, LOOK, I WILL BE THE FIRST TO SAY WE SHOULD STOP THIS STUDY IF SOMEONE ELSE IS GOING TO RECRUIT A MILLION PEOPLE, CLEAN AND CURATE THAT DATA, MAKE IT AVAILABLE FOR FREE TO ALL RESEARCH ARES AT THE SAME TIME. IF THEY'RE GOING TO DO THAT, I'LL BE THE FIRST ONE TO SAY LET'S STOP SPENDING THE MONEY ON THIS, BUT THEY'RE NOT DOING THAT AND THAT'S WHY WE'RE BUILDING THE PUBLIC RESOURCE THAT WE ARE. SO OUR MISSION IS REALLY ACCELERATION, HOW DO WE ACCELERATE HEALTH RESEARCH IN MEDICAL BREAK THROUGHS THAT ARELY I GOING TO ENABLE INDIVIDUALIZED PREVENTION, TREATMENT AND CARE FOR ALL OF US, NOT JUST THE PEOPLE WHO HAPPEN TO HAVE BEEN STUDIED IN OUR MEDICAL PAST. I SEE THIS AS THREE STRATEGIC OBJECTIVES THAT WE TRY TO ALIGN OUR ORGANIZATIONS AROUND. FIRST WE HAVE TO NURTURE RELATIONSHIPS WITH A MILLION OR OH MORE PEOPLE FROM ALL WALKS OF LIFE FOR DECADES. THESE ARE PARTICIPANT PARTNERS. IF IT IS NOT A TWO-WAY STREET, WE ARE NOT GOING TO RE-CREATE THE SORT OF LOOK AND FEEL OF A LOCAL TOWN LIKE FRAMINGHAM, MASSACHUSETTS ACROSS THE ENTIRE COUNTRY. WE'VE GOT TO BUILD WAYS WE'RE PROVIDING THOSE TRUSTED RELATIONSHIPS OR THE REST OF THE PROGRAM IS DEAD. IF WE DO THAT WELL, WE BELIEVE WE WILL DELIVER ONE OF THE LARGEST BIOMEDICAL DATASETS EVER, AND WE'RE TRYING TO MAKE THAT AS EASY, FREE AND SAFE AS WE CAN FOR PEOPLE TO ACCESS. THEY'LL CERTAINLY BE ABLE TO ACCESS IT, AT SOME POINT, IMENDING ON, THEY'RE GOING TO HAVE TO HELP PAY FOR SOME OF THE ARE WORKING HARD TO MAKE THIS AS EASY, SAFE AND FREE FOR RESEARCHERS OF ALL STRIPES, CITIZEN SCIENTISTS TO THE TOP CORPORATE AND UNIVERSITY LABS THAT YOU WOULD KNOW ABOUT TO USE IT. BUT EVEN IF WE BUILD THAT, WILL THEY COME? OUR THIRD STRATEGIC OBJECTIVE IS, HOW DO WE CATALYZE A ROBUST ECOSYSTEM OF RESEARCHERS AND FUNDERS TO USE THIS PUBLIC RESOURCE? WE DO NOT HAVE THE FUNDING TO FUND THE SCIENCE. IT IS GOING TO BE THE OTHER 27 INSTITUTES AND CENTERS AND OUTSIDE FUNDERS THAT NEED TO LEVERAGE THIS FREE RESOURCE TO GET THE SCIENCE DONE. BUT IF WE PARTNER WITH THEM TO HELP INVENT WHAT GOES INTO IT, WHICH WE ARE, THERE'S A BETTER CHANCE WE'RE GOING TO USE IT AND WE'LL BE ABLE TO GET TO OUTCOMES FASTER. THINK ABOUT IT AS A RESEARCHER. YOU HAVE A LARGER COHORT THAN I COULD EVER CREATE MYSELF, IT'S MORE DIVERSE, I CAN POP INTO A FREE BROWSER TO CHARACTERIZE IT AND NOW I'VE GOT FUNDING FROM THIS PLACE TO COME DO AN ANCILLARY STUDY WITH A GROUP OF PEOPLE I COULD NEVER BRING TOGETHER FOR MYSELF AND YOU'VE ALREADY DONE 90% OF THE WORK AND BROUGHT IN THE BUNCH OF THE TOOLS TO USE. THAT'S THE PARADIGM. THIS SHOULD GENERATE THOUSANDS AND THOUSANDS OF STUDIES IF AND WHEN WE MAKE THIS SUCCESS UL SUCCESSFUL. SOMEBODY NEEDS TO YELL AT ME FIVE MINUTES BEFORE YOU WANT ME TO STOP AND WHEREVER I AM, I'LL DO IT. SO THE VERSION 1 PROTOCOL, I'M TRYING TO GET EVERYBODY INTO THE MINDSET OF LIKE THIS IS ANY OTHER PRODUCT LIKE SILICON VALLEY OR PHARMA OR ANYBODY ELSE WOULD CREATE. USER CENTERED DESIGN PROCESSES, YOU'RE GOING TO START WITH A MINIMUM VIABLE PRODUCT AND YOU'RE GOING TO MAKE CHANGES OVER TIME BASED ON WHAT YOUR USERS, THE PARTICIPANTS AND THE RESEARCHERS TELL US. THE VERSION ONE PROTOCOL THAT WE LAUNCHED NATIONALLY ON SUNDAY, AND WE HAD DONE A YEAR BETA PHASE WITH ABOUT 47,000 PEOPLE SIGNING UP AND THEY'RE SOMEWHERE IN THE PROCESS OF THIS, AND ABOUT 27,000 OF THEM BEFORE WE HAD LAUNCHED ON SUNDAY HAD FINISHED THIS ENTIRE FIRST PROTOCOL. SO IT'S BAYICALLY YOU ENROLL, CONSENT AND AUTHORIZE TO SHARE YOUR ELECTRONIC HEALTHCARE DATA. RIGHT NOW WE'RE RECRUITING 18 AND ABOVE, WE'RE PLANNING CHILDREN, A LITTLE MORE LOGISTICICALLY AND ETHICALLY DIFFICULT TO MAKE SURE WE'RE DOING THAT. THE ONLY FOLKS WE CAN'T INCLUDE RIGHT NOW ARE THOSE WHO ARE INCARCERATED AND THOSE WHO CANNOT COGNITIVELY CONSENT FOR THEMSELVES, AND WE'RE WORKING ON PLANS TO DEAL WITH THAT. YOU CAN IMAGINE IN THE INCARCERATED SITUATION, IT'S A NIGHTMARE WITH 50 STATES WITH ALMOST VERY DIFFERENT RULES ABOUT THE LAWS AND RULES FOR PEOPLE TO PARTICIPATE IN RESEARCH. THEN THE SECOND PIECE OF THIS IS THERE'S THREE INITIAL SURVEYS, KIND OF THE BASICS, OVERALL HEALTH AND PERSONAL HABITS, THERE'S A FOURTH SURVEY THAT IF PEOPLE HAVE BEEN IN FOR 90 DAYS, THEY'LL GET HEALTHCARE ACCESS UTILIZATION, AND THEN WE'LL DO ADDITIONAL SURVEYS OVER TIME, AND THERE'S A BUNCH OF THEM IN WORK. THOSE SURVEYS TYPICALLY ARE TAKEN FROM OTHER PLACES, WE'RE NOT INVENTING INSTRUMENTS OURSELVES, BUT IN ALMOST EVERY CASE, WE'VE HAD TO WORK TO TAKE THOSE INSTRUMENTS AND WORK TO GET THE LANGUAGE DOWN TO FIFTH GRADE READING LEVEL, WHICH HAS BEEN OUR CURRENT GOAL. SO WE'VE GOT TO REWRITE THEM, TEST THEM, MAKE SURE THEY'RE STILL EFFICACIOUS, TRANSLATE THEM TO SPANISH, GET THE IRB TO APPROVE THEM AND PUT THEM IN. SOME PEOPLE WILL BE INVITED BASED ON OUR SCIENTIFIC GOALS, AND THAT IS, DEMOGRAPHIC, MEDICAL AND GEOGRAPHIC DIVERSITY. IF 10 MILLION PEOPLE SIGN UP AND WANT TO DO ALL OF THOSE PARTS I'VE JUST DESCRIBED, THAT WOULD BE FANTASTIC, BUT WE'LL SAMPLE FROM THOSE FOR SAMPLING TARGETS TO ACHIEVE, ESPECIALLY THOSE WHO HAVE BEEN UNDERREPRESENTED IN BIOMEDICAL RESEARCH. WE WILL SEE A WHITE PAPER ON THIS COMING SOON. THERE'S NINE CATEGORIES, WE HAD TO OH DO A TON OF RESEARCH WITH PARTNERS ACROSS NIH TO ACTUALLY COME UP WITH THE KEF ANYTHING'S OF DEFINITION OF TRULY WHO HAS BEEN UNDERREP HE A RESENTED. CERTAINLY RACE AND ETHNICITY IS A BIG FOCUS, AND -- BUT IF YOU'RE INVITED TO COME IN AND GIVE SIMPLE PHYSICAL MEASUREMENTS, IT'S NOT A LIST, IT'S NOT AN EXAM, YOU LEAVE YOUR CLOTHES ON. SOME FOLKS WERE LIKE I DON'T KNOW IF I WANT TO TAKE MY CLOTHES OFF IN FRONT OF YOUR ADMINISTRATORS. YOU DON'T NEED TO DO THAT UNLESS YOU ACTUALLY NEED TO HAVE YOUR HEIGHT AND WEIGHT CON, AND BLOOD STORED IN THE BIOBANK AT THE MAYO CLINIC. COMING SOON IN A MATTER OF WEEKS, WE'LL START A ROUND THAT WILL PROBABLY LAST A COUPLE OF YEARS FOR WHAT WE CALL BYOD, BRING YOUR OWN DEVICE. WE'RE STARTING WITH FITBIT, YOU WANT TO SHARE THAT DATA WITH RESEARCHERS MAKING IT VERY EASY TO DO THAT. MY GUESS IS, AND THIS IS AN AREA OF RESEARCH THAT I FUNDED A LOT OF OUT OF INTEL AND DID A LOT MYSELF, IS THAT AT SOME POINT WE MIGHT HAVE TO CREATE A CONSISTENT DEVICE FOR ALL MILLION PEOPLE OR HAVE THE MARKET DO THAT FOR US, WE DON'T HAVE THE MONEY TO DO IT RIGHT NOW AS WE GET GOING WITH WHOLE GENOME SEQUENCING. EVERYTHING WE DO IS TIMES A MILLION, SO EVERYBODY COMES WITH ME LIKE, HEY, JUST ADD THIS AND JUST ADD THIS. IT'S LIKE, TIMES A MILLION. THEN PEOPLE STACK BACK AND GO, OH, THAT'S PRETTY HARD TO SCALE UP. SO THIS IS WHERE WE ARE, BUT WE'VE GOT PILOTS LOOKING TO GET RICHER ELECTRONIC HEALTHCARE RECORD, PILOTS WITH THE HEALTH APPS, FITNESS WEARABLES, THEN STARTING LATE THIS YEAR, WE WILL START DOING BOTH GENOTYPING AND WHOLE GENOME SEQUENCING ON THOSE WHO PROVIDED SAMPLES AND DO A RESPONSIBLE RETURN OF INFORMATION PILOT WITH 20,000 OF OUR PARTICIPANTS CHOSEN FOR THOSE DIVERSE PARAMETERS FROM THOSE WHO IS JOINED ALREADY TO REALLY UNDERSTAND HOW DO WE PROPERLY DO THIS. PEOPLE KEEP ASKING ME, WHY HAVEN'T YOU STARTED SEQUENCING, IT'S A GENETIC STUDY. I'M LIKE, IT'S NOT A GENETIC STUDY, IT IS A COMPLEXITY OF LIFE STUDY OVER A SPAN, GENETICS IS THE ONE EVERYBODY HAPPENS TO THINK IS SEXY AND VERY EXPENSIVE RIGHT NOW. WE WILL START THAT PROCESS. THERE'S NOT ENOUGH SEQUENCING CAPACITY. WE WILL MAKE ONE OF THE LARGEST ORDERS IN HISTORY IF NOT THE LARGEST ORDER IN HISTORY FOR WHOLE GENOME SEQUENCING AND IT'S NOT THE SAME THING AT 23 AND ME. EVEN THE SORT OF BIOTECH PRESS IS GETTING THIS WRONG. THEY'RE LIKE, WELL, JUST GO TO 23 AND ME. I'M LIKE, THAT'S NOT A WHOLE GENOME SEQUENCE. WE MIGHT PARTNER WITH THEM BECAUSE THEY'VE GOT SOME GREAT VISUALIZATION TOOLS OR ANY OF THE OTHER COMMERCIAL PLACES BUT& THERE'S A BIG DIFFERENCE. BUT THE OTHER GAP IS, BACK TO CURATION AND CONTEXT, THERE'S NOT ENOUGH GENETIC COUNSELING CAPACITY FOR WHAT WE ACTUALLY NEED TO DO. EVEN OUR TOP TIER HEALTH PROVIDER ORGANIZATIONS WHO WE'RE RECRUITING FROM THEIR PATIENTS, WE DON'T HAVE THE CAPACITY TO ADD NOW DOING OUR PATIENTS WHO NEED IT FOR CLINICAL REAPS AS WELL AS FOR REASONS AS WELL AS FOR RESEARCH REASONS SO WE'RE TRYING TO FIGURE OUT HOW DO WE SCALE UP THIS COUNSELING CAPACITY BECAUSE WE HAVE TO DO THIS IN A RESPONSIBLE WAY. YOU COULD FILL OUT THIS CHART A MILLION TIMES OVER BUT IF YOU THINK ABOUT THE KINDS OF QUESTIONS THAT THIS RESOURCE COULD ANSWER, LET'S THINK ABOUT THE EP AT THE MIBG OF EPIDEMIC OF CHRONIC PAIN OR JUST TAKE LOWER BACK PAIN. WE HAVE SOME UNDERSTANDING OF IT BUT WE DO NOT HAVE A LONGITUDINAL STUDY WITH RICH DATASETS LOOKING AT THE INTERSECTIONALITY OF THESE DATA TO PERHAPS SEGMENT CHRONIC PAIN INTO MUCH MORE -- CATEGORIES THAT WE CAN DO TARGETED STRATEGIES FOR. I DID A TON OF WORK FOR YEARS WITH THE ALZHEIMER'S SOASHES. WE'RE COMING TO UNDERSTAND THAT ALL THESE THINGS WE LUMPED UNDER THE CATEGORY OF ALZHEIMER'S HAS MANY DIFFERENT KINDS OF DEMENTIA. CAN WE START TO LOOK AT THE INTERSECTION OF BEHAVIORAL AND OTHER DAY TAS OR CAN WE HELP DEVELOP BETTER PAIN MEDS THAT AREN'T ADDICTIVE? THINK ABOUT DIABETES. SAME KIND OF PROBLEM, RIGHT? YOU THINK ABOUT -- I MEAN, YOU CAN SEE IT IN THE PHENOTYPIC DATA THAT COMES IN THROUGH ELECTRONIC HEALTH RECORDS. THE VARIABILITY OF SYMPTOMATIC RESPONSES FOR ABOUT 10% OF THE POPULATION THAT HAS DIABETES IS HUGE. AND WE DON'T REALLY HAVE GREAT WAYS OF SORT OF SAYING -- I'M MAKING THIS UP, RIGHT, BUT DIABETES RESEARCHERS TELL ME, MAYBE WE'LL DISCOVER THAT THERE'S 25 DIFFERENT PATHS TO THIS AND WE'RE GOING TO TREAT AND DEAL WITH THOSE IN VERY DIFFERENT WAYS. OR MORE CANCERS, AND PARTICULARLY A BIG FOCUS ON DISPARITIES INTERVENTIONS THAT CAN WORK. WE KNOW ABOUT DISPARITIES. THERE'S GREAT RESEARCH THAT SHOW THEM, BUT WE DO NOT KNOW VERY WELL HOW TO ACTUALLY GO DEAL WITH THEM AND WE DON'T HAVE AN ENVIRONMENT WHERE WE CAN TEST THEM IN COMPARATIVE WAYS. YOU COULD LEVERAGE THIS PLATFORM IN THIS GROUP OF PEOPLE TO REALLY MAKE SOME PROGRESS THERE. THESE ARE JUST A FEW EXAMPLES. THE BASIC BUILDING BLOCKS OF THE PROGRAM, ON THE BOTTOM ARE WHAT WE CALL OUR THREE NETWORKS. SO WE HAVE A PARTICIPANT CENTER NETWORK, A HEALTH PROVIDER ORGANIZATION NETWORK, HPOs, THEN A COMMUNICATIONS AND COMMUNITY NETWORK PARTNERS. BETWEEN THESE THREE NETWORKS, THE DIRECT VOLUNTEER ARE FOLKS LIKE WALGREENS, FOLKS LIKE -- I GET LAB WORK THERE ALL OF THE TIME, ONE OF THE MOST COMMON LABS IN THE COUNTRY. QUEST. THANK YOU. CHEMO BRAIN IS A REAL THING. AND I'LL TALK MORE ABOUT THEM IN A MINUTE, BUT THEY HAVE THE ABILITY TO DO POP-UP CAPACITY IN PLACES WHERE JUST -- WE DON'T NORMALLY REACH PEOPLE. THE HEALTH PROVIDER ORGANIZATIONS RANGE IN SIZE FROM FEDERALLY QUALIFIED HEALTH CENTERS WHO ARE REALLY KEY TO OUR DIVERSITY STRATEGY TO LARGE PLAYERS LIKE THE V.A. AND ALL POINTS IN BETWEEN. THERE'S 125 OF THOSE LOCATIONS CURRENTLY OPEN RECRUITING FROM THEIR OWN PATIENT POOLS. SOON WE'LL GET THE IRB PROTOCOL UPDATED THAT THEY CAN RECRUIT FAMILY MEMBERS AND OTHERS WHO MAY NOT BE PART OF YOUR HEALTH PLAN OR ASSOCIATED WITH THEIR PARTICULAR CLINIC. AND THEN A NETWORK OF COMMUNITY PARTNERS WHO AT THE END OF THE DAY ARE OFTEN THE FACE OF THE PROGRAM LOCALLY, THESE ARE NATIONAL PARTNERS OF A LOCAL PRESENCE. IN ADDITION TO THESE 34, WELL, I'LL SHOW IT TO YOU IN A MINUTE. IN ADDITION TO THESE 34, EVERY PARTNER HAS TO HAVE A COMMUNITY -- OR A PARTICIPANT ADVISORY BOARD, AND EVERY ONE OF THOSE HPO PARTNERS ALSO HAS LOCAL COMMUNITY PARTNERS. SO IF YOU ADDED IT ALL UP, IT'S PROBABLY ABOUT 250 OR 300 300 ORGANIZATIONS THAT ARE JUST HELPING US TO LOCALIZE OUR MESSAGES TO FOLKS WHO ARE IN THESE DIFFERENT COMMUNITIES. WHICH IS THE TOPIC THAT I'LL END WITH. BUT THESE ARE PICTURES FROM THE LAUNCH. YOU CAN GO TO JOINALLOFUS.ORG. WE CHOSE SEVEN SITES AROUND THE COUNTRY. I WAS IN DETROIT THERE ON THE FOOTBALL FIELD. THIS IS A BAPTIST CHURCH IN HARLEM. WE'VE GOT FOLKS IN KANSAS CITY, FOLKS IN P ASCA, WASHINGTON, SO A REAL MIX OF COMMUNITIES, GRASS ROOTS EVENTS, HEALTH FARES AND THOSE KINDS OF THINGS TO REALLY BOTH BE AND BE PURR RECEIVED THAT WE ARE FOCUSING ON DIVERSE GROUPS AROUND COULDN'T TRI AND CHOSE DIVERSE SITES TO ACTUALLY DO THESE LAUNCHES AND GET THAT OFF AND IT WAS VERY SUCCESSFUL IN THAT REGARD. OUR GOAL, BY THE WAY, FOR UNDERREP RESENTED BIOMEDICAL RESEARCH IS THAT 70 TO 75% OF THE MILLION PEOPLE WILL BE UNDERREPRESENTED IN BIOMEDICAL RESEARCH BY THOSE NINE CATEGORIES, AND I'LL GO INTO MORE DETAIL ON THIS -- THAT'S A TWO HOUR TALK JUST TO EXPLAIN THE HELL WE WENT THREUP TO TRY TO FIGURE OUT WHAT ARE REALLY THE CATEGORIES UNDERREPRESENTED IN BIOMEDICAL RESEARCH? SO THE LAUNCH AND DESIGN APPROACH TO THE EVENT IS SORT OF EXACTLY KIND OF THE DESIGN PRINCIPLES THAT WE HAVE AS A WHOLE ORGANIZATION. SO THERE'S THREE DESIGN PRINCIPLES I WANT TO TALK ABOUT HERE BECAUSE THEY SHOW THE CHALLENGE OF HOW ARE YOU GOING TO DO RESEARCH DIFFERENTLY. AND THE FIRST IS THAT ALL HEALTHCARE IS LOCAL, SO MAYBE ALL HEALTH RESEARCH SHOULD BE LOCAL AS WELL. RIGHT? SO WE'RE TRYING TO FIGURE OUT, HOW DO WE BUILD LOCAL CAPACITY CONVENIENT TO WHERE PEOPLE LIVE, WORK AND PLAY, SO THEY DON'T HAVE TO BE NEAR OR ASSOCIATED WITH A LARGE ACADEMIC MEDICAL CENTER TO PARTICIPATE IN RESEARCH. NOW, MANY OF OUR PARTNERS ARE LARGE ACADEMIC MEDICAL CENTERS, BUT THEIR HEALTH PLANS HAVE A REACH IN MUCH GREATER RURAL AND OTHER KINDS OF COMMUNITIES THAN JUST THE MAIN URBAN CENTER HOSPITAL DOES. THE SECOND IS MEET PEOPLE WHERE THEY ARE, SO HOW DO WE ORIENT TO THEIR CULTURAL, SOCIAL LITERACY TIRCHESES THAT MAKE A DIFFERENCE, AND THE THIRD IS ONE THAT FROM LONG AGO AT MY INTEL DAYS I'VE ALWAYS CALLED DOUBLE VALUE. IF WE'RE GOING TO DO RESEARCH, WE WANT TO COLLECT DATA THAT'S RESEARCHERS BUT WE WANT TO SEARCH AS MUCH AS POSSIBLE TO GIVE VALUE BACK TO THE PEOPLE PROVIDING THE RESEARCH. SO WE'RE TRYING TO CHOOSE SCIENCE AND DATA AND ASSAYS, AND WE HAVE PARTICIPANTS INVOLVED IN OUR GOVERNANCE, IN OUR SCIENCE COMMITTEES, THEY WERE INVOLVED IN OUR REQUIREMENTS GATHERING WORKSHOPS FOR WHAT SCIENCE AND WHAT MEASURES SHOULD WE TRY TO CAPTURE TO REALLY TRY TO FIGURE OUT WHENEVER POSSIBLE HOW DO WE DELIVER DOUBLE VALUE FOR WHAT WE'RE GOING TO TAKE THE TIME TO COLLECT. NOW, I'VE GIVEN THIS TALK AT AMEA A NUMBER OF TIMES, NOT THIS TALK BUT I'VE USED THIS FRAMEWORK CALLED SHIFT LEFT FOR NOW PROBABLY 24 YEARS OF MY 27 YEAR SILICON VALLEY CAREER, ANYWAY, AND I FOCUSED ON INDEPENDENT LIVING FOR SENIORS IN MY OWN RESEARCH IN GERIATRIC CARE AND WAS DESPERATE, LIKE IF MY TOMBSTONE SAYS ONE THING, I HOPE IT SAYS HERE LIES ERIC DISHMAN, HE HELPED TO END HOSPITALS AND NURSING HOMES AS WE KNOW IT. MY GOAL WAS ALWAYS TO SHIFT HOME CARE TO THE COMMUNITY AS MUCH AS POSSIBLE. THIS WAS WHAT GUIDED A LOT OF THE STARTUPS I DID ON TELEHEALTH AND INDEPENDENT LIVING TECHNOLOGIES FOR SENIORS AND THE RESEARCH THAT WE DID. SO IF YOU THINK ABOUT ACTUAL HEALTHCARE, COST OF CARE PER DAY, THE AMOUNT OF EXPERTISE NEEDED, IF YOU'RE IN AN ICU, THERE'S A BUNCH OF VERY HIGHLY TRAINED, VERY EXPENSIVE PEOPLE AND EQUIPMENT AROUND YOU IN THIS KIND OF MEDICAL MAINFRAME THAT'S KEEPING YOU ALIVE AT THE COST OF AN ENORMOUS AMOUNT PER SECOND OR PER DOLLAR TO ACTUALLY DO THAT. AND IT'S NOT A PLEASANT PLACE TO BE, RIGHT? IT'S NOT A PLEASANT PLACE TO PEE EITHER, GIVEN HOW MANY TIMES I'VE BEEN IN THE ICU. AND NOBODY WANTS TO BE THERE, RIGHT? FOR QUALITY OF CARE AND QUALITY OF LIFE, YOU WANT TO BE AT YOUR HOME OR IN YOUR COMMUNITY OR AT YOUR WORKPLACE. AND YOU'VE SEEN OVER THE LAST DECADES THE SHIFT OF HEALTHCARE FINALLY STARTING TO PUT MINUTE CLINICS IN AT THE CONVENIENCE OF THE GROCERY STORE. WE'VE BEEN ON THIS TREND WITH TECHNOLOGY. IT WAS NINE YEARS AGO NOW WHEN AN AED WAS THE TOP CONSUMER ELECTRONICS DEVICE REQUESTED FOR CHRISTMAS FROM MEN.& THAT'S A TOTAL SHIFT LEFT. THIS WAS A BIG PIECE OF BIG EQUIPMENT THAT WAS EXPENSIVE THAT YOU HAD TO BE AN EXPERT OPERATOR TO USE, AND SUDDENLY IT'S A PIECE OF CONSUMER ELECTRONICS. AND THOSE TRENDS ARE CONTINUING. IF YOU THINK ABOUT IT, IT'S NOT THAT HOSPITALS NEED TO GO AWAY. YOU REDUCE THEIR FOOTPRINT AND YOU TAKE SOME OF THAT CAPACITY WHERE WE'RE DOING PRIMARILY CHRONIC CARE MANAGEMENT OR CHRONIC CARE EXACERBATIONS MAN ANLT MANAGEMENT AND DISTRIBUTING THAT ABILITY AND CAPABILITY INTO OTHER PARTS OF THE COMMUNITY. I WOULD ARGUE THE SAME THING THAT I'VE BEEN PREACHING FOR 20 YEARS ABOUT THIS IS HOW WE SAVE HEALTHCARE, IS TRUE FOR RESEARCH. WE'VE GOT TO SHIFT LEFT TOWARDS A MORE PERSONAL DISTRIBUTED MODEL OF HEALTH RESEARCH. SO THERE'S GOING TO BE CERTAIN PIECES OF EQUIPMENT AND THINGS THAT, YEAH, YOU NEED TO GO TO A MAINFRAME ACADEMIC CENTER TO BE ABLE TO CAPTURE THAT KIND OF IMAGING DATA A, BUT WE NEED TO MOVE UP FROM WHAT CAN WE DO IN A PRIMARY WALK-IN CLINIC, WHAT CAN WE DO IN A POP-UP CLINIC THAT'S NEAR SOMEBODY IN THEIR WORKPLACE OR SO THAT THEY COULD OH DO IT AT HOME BUT WITH SOME PROFESSIONAL HELP OR EVEN WITH THE FAMILY AND FRIEND HELP OR DO IT YOURSELF. AND AS YOU DO THAT, YOU'RE GOING TO BE ABLE TO COLLECT DATA MORE IN THE WILD, IN EVERY DAY LIFE, THE QUALITY OF THE EXPERIENCE WILL BE GOOD, AND YOU'RE GOING TO BE ABLE TO CAPTURE NEW DATA TYPES THAT WILL GET YOU INSIGHTS THAT YOU COULDN'T GET IN ALL OF THOSE OTHER LOCATIONS. SO THIS IS PART OF THE EXPERIMENT OF WHAT ALL-OF-US IS TRYING TO DO. SO WE'RE TRYING TO PILD LOCAL CAPACITY TO MEET PEOPLE WHERE THEY ARE. IN PART, FAMILIAR DOCTORS AND FAMILIAR SETTINGS TO THEM, BUT ALSO MAKING SURE THAT WE'RE NOT JUST REACHING TO THE URBAN CENTER BUT OUT TO THE EXTENSIONS THAT MOST OF THOSE PLAYERS ACTUALLY HAVE THROUGH THEIR HEALTH PLANS. THIS DIRECT VOLUNTEER NETWORK THAT WE PUT TOGETHER IS VERY MAGICAL. THROUGH THE PARTNERS THAT WE HAVE TODAY, WE HAVE THE ABILITY TO REACH WHERE 95% OF THE PEOPLE IN THE COUNTRY LIVE IN THE UNITED STATES WITHIN 20 TO 35 MINUTES. NOW WE CAN'T TURN THAT CAPACITY ALL AT THE SAME TIME, WE DON'T HAVE THE FUNDING TO SAY YES, EV WALL EVERY WALGREENS IS READY TO DO THIS FOR AN ALL-OF-US RESEARCH PARTICIPANT, BUT WE'RE BUILDING ADDITIONAL LOCATIONS AND SITES AS WE SEE WHERE PEOPLE IN COMMUNITIES THAT WE NEED TO REACH ARE DOING AND WE CAN EITHER PUT A PERMANENT SITE THERE OR OH WE CAN DO POP-UP CAPACITY AND SAY, HEY, WE'RE COMING TO DOWN FOR SIX TO 12 MONTHS. THEY MIGHT HAVE DONE THE REST OF THEIR SURVEYS AT AN EVENT, THERE'S EVENTS THAT ARE HAPPENING IF YOU'RE NOT COMPUTER LITERATE, WHERE PEOPLE CAN HELP YOU THROUGH THAT PROCESS, OUR MAY HAVE JUST DONE IT ALL ONLINE, BUT AT THE POINT WHEN IT COMES TO DO THE PHYSICAL MEASUREMENTS AND THE BIOSPECIMEN, WE'VE GOT TO PUT THAT TRAINED CAPACITY THERE SO THAT WE'RE GETTING QUALITY DATA SAMPLES ACROSS THE COUNTRY. THE OTHER THING WE'RE DOING IS TAKING A SORT OF JOURNEY EXHIBIT, SO THIS IS IT RIGHT NOW, AND IT'S PRIMARILY IN EDUCATION MODE, SENDING THESE MOBILE EXHIBITS INTO PARTS OF THE COUNTRY, RIGHT NOW TRYING TO TEACH PEOPLE WHAT IS PRECISION MEDICINE, WHAT IS THE ALL-OF-US RESEARCH PROGRAM, WHAT IS RESEARCH? BUT WE'LL BE CONVERTING THOSE MANY TO BE ABLE TO DO PHYSICAL MEASUREMENTS AND BIOSPECIMENS OR THAT COMES TO TOWN, SITTING WITH A LOCAL LIBRARY THROUGH OUR PARTNERSHIP WITH THE NATIONAL LIBRARY OF MEDICINE AND THROUGH OUR PARTNERS CAN BRING TENTS WITH CLINICAL CAPACITY IN OR A BUILDING NEARBY TO GO BE THERE FOR WEEKS AND WEEKS AND WEEKS AT A TIME. SO THAT'S THE KIND OF EXAMPLES OF WHAT WE'RE TRYING TO DO TO GET TO PEOPLE WHERE THEY LIVE, WORK AND PLAY. YOU CAN SEE THE DIRECT VOLUNTEER NETWORK AT THE TOP. A LOT OF PEOPLE DON'T KNOW EMSI, BUT THEY CAN REACH EVERY ZIP CODE EXCEPT FOR ABOUT 5% OF THEM IN THE UNITED STATES. EVERY INSURANCE COMPANY USES THEM, THEY DO IN-HOME PHYSICALS AND EVALUATIONS FOR LIFE INSURANCE, FOR EMPLOYEES TESTING AND OTHER KINDS OF THINGS. SO HAVING A PARTNER LIKE THEM, WE EVEN HAVE THE ABILITY TO GO INTO PEOPLE'S HOMES, WHERE IT'S TOO FRAIL OR TOO UNSAFE FOR ONE OF THEM TO BE ABLE TO GET TO OUR LOCAL SITES. OBVIOUSLY THAT'S MORE EXPENSIVE, WE CAN'T DO IT FOR ALL MILLION PEOPLE BUT THIS IS THE ENVELOPE THAT WE'RE PUSHING FOR TRYING TO BE ABLE TO REACH. IN TERMS OF MEETING PEOPLE WHERE THEY ARE CULTURALLY AND SOCIALLY AND LITERALLY AND LITERACY-WISE, I MENTIONED THESE COMMUNITY PARTNERS, YES, THERE'S GOING TO BE A LOT OF PEOPLE WHO ARE NOT DIGITALLY SAVVY. THESE COMMUNITY PARTNERS ARE WORKING TO HELP CREATE EVENTS AND OTHER MECHANISMS TO HELP PEOPLE ON BOARD. WE'RE WORKING ON OUR PROTOCOL CHANGE WITH OUR IRB TO LET NEIGHBORS AND OTHERS HELP THEM THROUGH THAT PROCESS BUT MAKING SURE THAT THAT PERSON IS STILL CONSENTING AS THEY GO THROUGH THAT EXPERIENCE. THE NLM PARTNERSHIP IN TERMS OF GETTING THESE PUBLIC LIE LYE BREARS, JENNY DISHMAN WOULD HAVE BEEN DOING THIS IN A HEARTBEAT IF SHE WAS STILL A PRACTICING LIBRARIAN DOING THESE COMMUNITY FAIRS AND HEALTH EVENTS WITH LIBRARIES AND ALSO USING LIBRARIES AS A DIGITAL ACCESS POINT FOR THOSE WHO KNOW HOW TO USE IT BUT DON'T HAVE ACCESS TO THEIR OWN TECHNOLOGIES IS KEY. I MENTIONED RIGHT NOW WE'RE PUSHING TO THE FIFTH GRADE READING LEVEL. THE CONSENT EXPERIENCE LIKE PEOPLE WHO -- I FET SOME PEOPLE COMPLAINING SAYING WHY IS IT ALL VIDEOS, I WANT TO GO THROUGH THEM REALLY QUICKLY? I WAS LIKE, IT WASN'T FOR YOU. I CAN READ MUCH FASTER THAN THAT. JUST UNDERSTAND THAT WE'RE TRYING TO CREATE AN EXPERIENCE THAT CAN INCLUDE A LOT MORE PEOPLE THAN HAD TRADITIONALLY HAD BEEN BROUGHT IN. RIGHT NOW WE'RE IN SPANISH AND ENGLISH AND THEN TRYING TO FIGURE OUT WHAT WE'RE GOING TO DO NICKS IN NEXT AND THE LAST PIECE OF THIS IS, WE ARE GOING OUT AND MEETING WITH -- I MEAN, SO WITHIN A WEEK AFTER THE FIRST PROTESTS NATIONWIDE IN TERMS OF CHANGES IN IMMIGRATION POLICY, WHEN EVERYBODY WAS AT AIRPORTS, HERE WE HAVE THIS HEALTH CENTER ON THE BORDER IN MEXICO AND IT'S LIKE, SUDDENLY THEY CAN'T GET THEIR PATIENTS TO COME IN FOR THEIR APPOINTMENTS LET ALONE COME IN FOR A RESEARCH STUDY. HOW DO WE HAVE THOSE EXPLICIT CONVERSATIONS WITH THEM ABOUT THE PLIT WILL CALORIALITY THAT WE LIVE IN? HOW DO WE TEACH THEM WHAT CERTIFICATES OF CONFIDENTIALITY ARE? I'M AMAZED MOST NIH RESEARCH RS DO NOT UNDERSTAND THE 21ST CENTURY CURES BILL FOR ALL FEDERAL RESEARCH MAKES IT MANDATORY TO ACTUALLY PROTECT RESEARCH DATA FROM ANYBODY TRYING TO COME USE IT FROM ANOTHER AGENCY, WHETHER THAT'S AT THE FEDERAL, STATE OR LOCAL LEVEL. AND IF IT WAS SOMEHOW LEAKED, YOU STILL HAVE IMMUNITY FROM PROSECUTION BASED ON THE DATA THAT WOULD BE USED. IF WE DIDN'T HAVE THAT PROTECTION IN PLACE, CAN YOU MANL HOW QUICKLY THE SCIENTIFIC ENGINE COULD SHUT DOWN IF WE CAN'T ASSURE PEOPLE THAT THE DATA THAT THEY'RE DONATING FOR RESEARCH PURPOSES IS NOT GOING TO BE USED AGAINST THEM IN A COURT OF LAW. SO TRYING TO BE TRANSPARENT WITH PEOPLE ABOUT WHAT THESE ARE AND WHAT THEY COVER AND WHAT THEIR LIMITS ARE, BECAUSE THERE'S ALWAYS LIMITS TO EVERY PROTECTION IS PART OF THE APPROACH WE'RE TRYING TO TAKE. THESE ARE SOME OF THOSE NATIONAL COMMUNITY PARTNERS BUT, AGAIN, THERE'S MANY, MANY MORE, AND MOST OF THESE NATIONAL COMMUNITY PARTNERS, SOME THAT ARE PROVIDER-FOCUSED TO ED CADE PROVIDERS AND NURSES AND SOME THAT ARE PATIENT-FOCUSED BEING THERE'S MANY MORE BEHIND THIS IN TERMS OF EACH LOCAL AWARD HAVING THOSE AS WELL, AND MANY OF THOSE WERE KEY TO DOING OUR LAUNCH BECAUSE THEY COULD REACH IN IN STATE. OH, YEAH, THEY COULD PUT CAPACITY IN PLACE THERE WITH COMMUNITY PARTNERS THERE. THE LAST, THE DOUBLE VALUE, IS REALLY ABOUT, AGAIN, TRYING TO BRING VALUE TO THE RESEARCHERS AND THE PARTICIPANTS. SO ONE OF THE THINGS THAT WE'RE DOING IS DRIVING A PARTICIPANT CENTERED DESIGN PROCESS WHERE THEY'RE, AGAIN, PART OF THE DEVELOPMENT OF, HEY, THIS IS IMPORTANT HEALTH ISSUE TO OUR COMMUNITY, WORKING WITH OTHERS TO FIGURE OUT WHAT DATA WOULD NEED TO BE COLLECTED IN THAT REGARD. THERE'S OTHER WAYS THAT WE'RE TRYING TO DO IT IN TERMS OF MHEALTH APPS, IT'S FUN TO PLAY, USEFUL FOR THE RESEARCHERS AND PEOPLE ENJOY IT. I STARTED DOING THAT KIND OF WORK WHEN I FIRST MET PATTY A COUPLE OF DECADES AGO WITH SENIORS PLAYING SOLITAIRE AND LOOKING AT NUMBER OF GAMES LOST AND HOW LONG IT TOOK THEM AND THE CHANGES IN THOSE PATTERNS OVER TIME. SO WE'RE DOING ALL OF THESE KINDS OF THINGS TO TRY TO FIGURE OUT WITH EVERY POINT, AND THEN UNLIKE MOST RESEARCH PROGRAMS, WE ARE RETURNING EVERYTHING FROM RAW DATA TO RESULTS BACK TO PARTICIPANTS FOR THOSE WHO WANT THEM. WHAT I MENTIONED BEFORE, WE'RE NOT JUST THROWING THE DATA OUT THERE AND SAYING GOOD LUCK. WE'RE PUTTING INFRASTRUCTURE IN PLACE TO TRY TO HELP CONTEXTUALIZE, GET THAT INFORMATION TO THEIR DOCTOR IF THEY WANT, PROVIDE COUNSELING -- WE'RE LIMITED, WE'RE NOT CARE FOR ANYBODY, BUT IT'S OUR RESPONSIBILITY TO DO THE BEST WE CAN TO ACTUALLY GET THEM TO MAKE SENSE OF THAT DATA IN A RESPONSIBLE WAY. I WAS GOING TO GIVE YOU AN EXAMPLE THERE. SO LET ME WRAP UP FOR THESE LAST FEW MINUTES, I'M GOING TO SHARE WITH YOU SOME OF THE CHALLENGES THAT WE HAVE, AND I STARTED WITH JUST THINKING ABOUT SOME OF THE IMPRECISE COMMUNICATIONS VI KNOWN AS A PATIENT. SO THERE'S THE UPPER LEFT-HAND CORNER, IT'S LIKE, WELL, WE REALLY DON'T KNOW WHAT TO DO WITH YOU, WE'RE JUST GOING TO DO THE CANCER WHEEL ONE MORE TIME. I SWEAR, MOST OF MY LIFE FELT LIKE THAT FOR THOSE DECADES. OR SOMEBODY LOOKING AT YOU AND IT'S LIKE, COULD BE ANYTHING. WAY TOO GENERAL OF A GENERAL PRACTITIONER. OR MORE OFTEN FOR ME RECENTLY, THE DOCTOR WILL SEE YOU NOW, HERE'S YOUR MEDICAL JARGON PEOPLE DICTIONARY. NOW THAT I JOINED NIH, THEY THINK I UNDERSTAND EVERYTHING. ALL MY DOCTORS NOW ARE JUST LIKE -- I HEARD THE WORD "ERIC" IN THERE, THAT'S THE ONE I UNDERSTOOD. SO WE'RE TRYING TO START DOING PRECISION COMMUNICATION AS PART OF OUR RECRUITMENT AND OUR MESSAGING TO PARTICIPANTS THAT I THINK WILL TEACH US THINGS ABOUT HOW WE TO COULD DO THIS BETTER. SO OUR GOAL IS THE RIGHT MESSAGE FOR THE RIGHT PERSON AT THE RIGHT TIME. RIGHT MEANS AUTHENTIC AND TRUTHFUL, IT'S ALSO ACHIEVABLE, IN OTHER WORDS, TO GET THAT MESSAGE TO THEM IN THAT WAY AND IT'S EFFECTIVE AT ACTUALLY GETTING THE MESSAGE TO THEM. WE STARTED OUT WITH THESE MADE UP FICK TITIONAL PERSONAS. WHEN WE FIRST STARTED TALKING ABOUT BOTH WHAT'S A PARTICIPANT AND WHAT'S RESEARCHES WITHIN OUR CONSORTIUM, THEY NARROW TO A VARIED DEFINITION VERY QUICKLY AND THERE'S NO SUCH THING AS A PARTICIPANT SO WE CAME UP WITH THIS EIGHT-PART SEGMENTATION WITH NOT EVERYBODY'S HAPPY TO JOIN RESEARCH, THERE'S THOSE WHO ARE SUSPICIOUS, THEY HAVE NO TIME, JUST TO START TO FORCE US TO REALIZE THIS IS VERY DIFFERENT AUDIENCES OF PEOPLE THAT WE'RE TRYING TO REACH. NOW, AS WE'RE TRYING TO GET ANALYTICS AND DATA BACK, I SUSPECT A QUALITATIVE IF NOT A QUANTITATIVE SEGMENT TAITION WILL EMERGE BASED ON THE PEOPLE WE HAVE THAT WILL KNOW HOW TO DO THIS. WE'RE DOING COMMUNITY-SPECIFIC MATERIALS, SO WE TALK ABOUT TUSKEGEE IN VERY OPEN WAYS WITH AFRICAN-AMERICAN COMMUNITIES AND TAKE THE MOST TRAGIC THINGS THAT WE'VE DONE TO PEOPLE WITH HISPANIC AND LATIN AMERICAN BACKGROUNDS AND TALK ABOUT THOSE STUDIES IN VERY SPECIFIC WAYS AND HERE'S THE THINGS WE'RE DOING DIFFERENTLY THAT WOULD PREVENT THAT FROM HAPPENING AGAIN. WE ARE DOING A DIGITAL MARKETING STRATEGY. AND THIS IS NOT ROCKET SCIENCE FROM THE STANDPOINT OF THOSE WHO DO DIGITAL MARKETING, BUT WE'RE NOT DOING -- THEY DON'T DO THIS VERY MUCH IN RESEARCH SO WE ARE APPLYING TARGET MARKETING DATABASES AND STRATEGIES TO RESEARCH. NOW DON'T WALK AWAY AND THINK THAT WE'RE SELLING OUR DATA BACK TO FACEBOOK OR CAMBRIDGE ANALYTICA. THAT'S NOT THE CASE. BUT WE ARE TRYING TO UNDERSTAND WITH A WIDE RANGE OF LITERACY, A WIDE RANGE OF RELATIONSHIPS OF TRUST, A WIDE RANGE OF PREFERENCES, HOW TO TARGET THOSE MESSAGES AND DOING AB TESTING OF DIFFERENT MESSAGES, MEDIUMS AND MODALITIES TO DO THAT. AND I BELIEVE WE HAVE TO DO THIS. WE ARE FIGHTING FOR ATTENTION IN A VERY MEDIA-SATURATED WORLD AND WE'VE GOT TO GET PEOPLE'S TIME AND ATTENTION AND ENGAGEMENT SO WE HAVE TO USE A WIDE RANGE OF THINGS TO DO THIS. I THINK IT'S OUR RESPONSIBILITY TO ACHIEVE THE DIVERSITY GOAL. WHEN WE DID A TWITTER CHAT YESTERDAY, I SAW LOTS OF FEEDBACK, PEOPLE DO LOVE TO GIVE ME FEEDBACK, THAT THIS ANTHEM VIDEO THAT WE HAVE, THAT WE PLAYED AT THE BEGINNING, YOUR ANTHEM VIDEO IS -- NO IRB WOULD ACTUALLY APPROVE THIS. WELL, THEY ACTUALLY DID. YOU ARE TRYING TO TRICK PEOPLE INTO JOINING BY DOING EMOTIONAL APPEALS. YOUR NATIONAL LAUNCH WAS JUST MARKETING HYPE. MANY OF OUR PARTICIPANTS ARE LIKE YOU HAVE TO GIVE US THIS OR WE WILL NOT BE ABLE TO BE SUCCESSFUL TO RECRUIT DIVERSE COMMUNITIES OR ANY COMMUNITIES. THEY APPEAL TO ONE THAT'S INCREDIBLY LITERAL, INCREDIBLY TECH-SAVVY, INCREDIBLY HEALTH-LITERATE AND THUS WE START TO LEAVE PEOPLE OUT. I DON'T BELIEVE JUST THE RATIONALE -- WHITE MALE SCIENTIFIC VOICE HAS COOER SELF POWERS OF ITS OWN. LOOK AT THE INFOMERCIALS ON THE -- SCIENTIFIC-LOOKING PEOPLE, WHITE COATS, IT'S LIKE, THIS CONFERS THE POWER OF CREDIBILITY, THIS MUST BE A REAL THING, DID TAKE IT. SO LET'S NOT PRETIND THAT ALL THE MESSAGES THAT WE DO DON'T HAVE THE POTENTIAL TO BE COERCIVE BUT THERE ARE VERY GOOD POINTS IN SOME OF THESE THINGS THAT PEOPLE MAKE. I WENT THROUGH TWO DECADES OF DASHED HOPES, EXTRA EXPENSES, PAYING OUT OF POCKET FOR NEW DRUGS THAT INSURANCE WOULDN'T COVER AND VERY PAINFUL SIDE EFFECTS. INTERFERON WAS SUPPOSED TO SAVE MY LIFE AND IT WAS WON ONE OF MY THREE NEAR-DEATH EXPERIENCES. INTERLEUKIN 2 WAS SUPPOSED TO DO THE SAME, RIGHT? ANTIEYEANTI- -- I CALL THEM SHARK SHAKES BECAUSE THE ONES I HAD DO WERE FROM SHARK CARTILAGE, YOU HAD TO DRINK THEM AND THEY WERE VERY NASTY. I WENT THROUGH THIS. THESE ARE MORE RECENT EXAMPLES. WE CAN'T PRETEND THAT OUR HEADLINES DON'T CONTINUE TO HYPE THIS. RIGHT NOW IT'S CRISPR. I SAW THE 60-MINUTE SPECIAL WITH THE GUY SAYING WITHIN TWO YEARS, WE THINK EVERY GENETIC DISEASE WILL BE CURED, RIGHT? I HOPE SO. WOW, THAT'S A LOT OF EXPECTATIONS YOU'RE BUILDING OUT. SO THERE'S REAL ETHICAL ISSUES WITH THIS KIND OF PRECISION MEDICINE TARGETING WE'RE TRYING TO DO. SO IN GENERAL WE'RE TRYING TO GET PEOPLE EXCITED BUT DON'T OVERHYPE, DON'T COERCE BUT DO DO RELATIVE MEANINGFUL TARGETING. DON'T UNDERMINE THE FAITH IN TRADITIONAL MED SIGN BUT DO KREE TEEK IT, DON'T BLAME PROVIDERS BUT DO SHOW THE SYSTEM THEY'RE IN HAS GREAT BLAME. DO CATER MESSAGES TO INTERESTS AND CONCERNS AND DON'T KOND SENT SEND BUT DO SIMPLIFY THE PROTOCOLS, SURVEYS, ASSETS SO IT GETS MORE PEOPLE. I JUST END WITH THIS, IF I REALLY THINK ABOUT WHAT WE'RE DOING, AND IT'S REALLY JUST STARTED TO PERCOLATE INTO ME 36 HOURS AGO WHEN I STARTED TO PREPARE FOR THIS BUT IT'S SO PROFOUNDLY TRUE, WE'RE BUILDING A LIBRARY WITH A NEED FOR AN ARMY OF LIBRARIANS. FOR OUR PARTICIPANTS, WE'RE GOING TO HAVE A LIBRARY OF DATA AND INFORMATION FOR A MILLION UNIQUE INDIVIDUALS. HOW DO WE MAKE IT FINDABLE? HOW DO WE MAKE IT USABLE AND USEFUL? HOW DO WE SHARE RAW TATA WITH PEOPLE DATA AND WHAT ARE THE STANDARDS, HOW ARE WE GOING TO HELP THEM WITH THE INTERPRETATION, AND WE'RE BUILDING -- WE'RE GOING TO HAVE A LIBRARY OF DATA AND INFORMATION FOR CITIZEN SCIENTISTS ALL THE WAY TO CORPORATE LABS AND NOBLE WINNING PRIZE WINNERS. HOW DO WE TRAIN THEM IN ETHICS AND POLICY? HOW DO WE CLEAN AND CURATE THAT DATA? HOW DO WE DE-IDENTIFY IT EFFECTIVELY? HOW DO WE VISUALIZE THIS NEW/COMPLEX DATA? YOU WORK ON THESE KINDS OF ISSUES ALL THE TIME. SO WHAT I WOULD SAY IS WE APPRECIATED YOUR HELP IN THE NATIONAL LAUNCH IN GETTING THE WORD OUT THIS WEEK, AND I HOPE LIKE WE, YOU ARE ON THE BEGINNING OF THE LONG MULTI-DECADE JOURNEY TO TRY TO FIGURE OUT SOME OF THESE THINGS TOGETHER AND I CAN'T WAIT FOR IT. IT'S GOING TO BE A BLAST. THANKS SO MUCH. [APPLAUSE] >> AMAZINGLY, ERIC HAS LEFT TIME FOR QUESTIONS. NOW I IN US SAY TO OUR MLA COLLEAGUES WHO ARE ONLINE AND THE MLA BOARD, WE CAN'T TAKE QUESTIONS DIRECTLY FROM YOU, BUT IF YOU'D LIKE TO EMAIL ERIC QUESTIONS IN THE FUTURE, HIS EMAIL ADDRESS IS ERIC.DISHMAN, NOT JAMES, ERIC.DISHMAN@NIH.GOV. BUT FOR THOSE OF YOU WHO ARE HERE IN THE ROOM, LET ME ASK YOU, PLEASE, ERIC WILL TAKE QUESTIONS, JUST MAKE SURE YOU TURN ON YOUR MICROPHONE SO WE CAN BROADCAST YOUR QUESTION. >> I'LL MAKE YOUTUBES. >> QUESTIONS OR COMMENTS? GENTLEMAN HERE. >> I SAW THAT YOU WERE PARTNERING UP WITH THE V.A. JUST CURIOUS, IS THAT GOING TO BE THE MVP PARTNERSHIP? I KNOW YOU'VE GOT SEVERAL HUNDRED THOUSAND VOLUNTEERS ALREADY, SO THAT'S GOING TO GO INTO YOUR NETWORK? >> YEAH, IT IS A PARTNERSHIP WITH THE MILLION VETERANS PROGRAM. THEY HAVE ABOUT, I THINK, 650,000 PEOPLE WITH MIX OF DATASETS, I MEAN, YOU'RE GETTING MORE AND MORE DATA FROM FOIX ALL FOLKS ALL THE TIME. SO THEY ARE ONE OF OUR HEALTH PROVIDER ORGANIZATIONS. THEY'LL RECRUIT FROM THERE. THEY ARE WORKING TO MAKE NVP BROADER TO THE VETERANS' FAMILIES AS WELL AS TALKING TO DOD AND TRI-CARE TO SORT OF EXPAND IT TO ACTIVE MILITARY FAMILIES, SO AS THEY EXPAND, THEY'LL BE ABLE TO EXPAND FOR US AS WELL, AS WE GO FORWARD. >> SO WITH THAT, THEN, AND KNOWING THE CLINICAL SYSTEMS THAT THEY USE AND THAT THE PURPOSE OF AOU -- OR THE ALL-OF-US IS TO AGGREGATE CLINICAL AS WELL AS GENOMIC DATA, WHAT ARE YOU DOING ON THE NORMALIZATION SIDE OF THE HOUSE? HAS THAT BEEN DISCOVERED OR TALKED TO? >> YEAH, I MEAN, TO A CERTAIN DEGREE. I MEAN, RIGHT NOW, EVERY ONE OF OUR HEALTH PROVIDER ORGANIZATIONS INCLUDING THE V.A., WHEN THEY APPLIED, HAD TO GO THROUGH A PROCESS THAT WE CALL A DATA SPRINT THAT SHOWED THAT THEY COULD SEND IN AN OMOP STANDARD PARTICULAR DATA THAT WE WERE GETTING IN THE REV 1 PUSH OF EHR DATA, THAT ONCE YOU AUTHORIZE IT, IT CONTINUES TO DO THAT IN BATCHES. NOW, FOR OUR DIRECT VOLUNTEER PARTNERS WHO MAY OR MAY NOT HAVE A DOCTOR, LET ALONE BE ASSOCIATED WITH HEALTHCARE PROVIDER ORGANIZATIONS THREA THREE STRATEGIES THAT WE'RE TAKING. ONE IS A PROGRAM CALLED SY NC FOR SCIENCE WITH THREE OF THE FOUR TOP EHR PROVIDERS INCLUDING EPIC, AND THAT JUST STARTED AT 13 SITES AROUND THE COUNTRY, BASICALLY LEVERAGING THE PORTALS BUILT INTO THE SOFTWARE AND AN API TO BE ABLE TO PULL THAT DATA IN. I THINK IT'S WORKING PRETTY WELL BECAUSE I NOTE APPLE IS BUILT TO THE SAME STANDARD, IT'S LIKE, OKAY, IF THEY'RE GOING FOR IT -- BUT WE'RE GOING TO DO OUR PILOT, MAKE SURE IT'S ALL THERE AND USEFUL AND USABLE. WE'RE GOING TO DO A PILOT WITH SOMEWHERE BETWEEN 15,000 TO 25,000 OF OUR PARTICIPANTS. SOME OF WOMAN ALREADY HAVE EHR DATA COMING IN FROM AN HPO AND SOME WHO DON'T, WITH AGGREGATORS, SO THE FOLKS WHO ARE IN THIS VERY EXPENSIVE -- YOU CANNOT SCALE THIS TO A MILLION PEOPLE, BUT WE WANT TO LOOK AT THAT DATA AND COMPARE IT IN TERMS OF ITS USEFULNESS AND THE CHALLENGE OF CLEANING THAT, WITH REGARD TO OTHERS. THERE'S A THIRD PIECE WHERE SOME OF OUR PARTNERS LIKE EMSI HAVE BUILT DIRECT RELATIONSHIPS WITH SOME OF THE HIEs AND SORT OF THE BACK END SYSTEMS A LOT OF THESE PROVIDERS AND THEY HAVE A SURPRISING AMOUNT OF WEALTH AND DATA THAT THEY CAN ACTUALLY PULL IN, THEN THERE'S SOME OTHERS THAT ARE COMING. SO PART OF THE CHALLENGE, I'VE BEEN TRYING TO GET CONGRESS TO UNDERSTAND THIS, IT'S GREAT THAT WE'VE INCREASED EHR USAGE BY CLINICIANS TO THE AMAZING NUMBERS THAT WE HAVE, BUT THE ABILITY TO STILL GET THAT FROM PEOPLE AND MAKE A HOLISTIC RECORD AND PAIK IT USEFUL FOR RESEARCHERS IS A LONG EXPENSIVE PROCESS. I ACTUALLY THINK EVEN THOUGH WHOLE GENOME SEQUENCING COST IS NOT COMING DOWN NEARLY AS FAST AS I NEED IT TO, I THINK TO GET A RICH LONGITUDINAL HEALTH RECORD FOR OUR PARTICIPANTS AND RESEARCHERS WILL BE OUR SECOND MOST EXPENSIVE ITEM, THE FIRST BEING THE RECRUITMENT EFFORT TO NOT ONLY RECRUIT BUT RETAIN AND BUILD THESE TRUSTED RELATIONSHIPS WITH PEOPLE. >> ANOTHER QUESTION. JERRY. [INAUDIBLE QUESTION] >> WE'RE NOT QUITE TWO YEARS OLD YET. WE FEEL LIKE TODDLERS. WE'RE RUNNING FAST AROUND THE HALLWAY THOUGH. [INAUDIBLE QUESTION] >> LET ME REPEAT. GREAT PRAISE FOR WHAT'S BEEN ACCOMPLISHED IN 23 MONTHS AND I WOULD ECHO THAT ALSO. IT'S AN ASTOUNDING -- ALMOST A LAND SPEED RECORD FOR A GOVERNMENT NICHE TI. INITIATIVE. I ALSO HEARD HIS QUESTION SAYING IF YOU'RE GOING TO ATTEND TO THE RSEARCH FIRST, HOW DID YOU FIGURE OUT WHAT THEY MIGHT NEED, SECONDLY, HOW DID YOU DETERMINE WHICH DATASETS WOULD WORK FORT LARGEST NUMBER OF GROUPS AND THIRD, HOW MIGHT WE GET A NEW DATA ELEMENT IN IF SUDDENLY IT BECOMES IMPORTANT TO KNOW WHETHER OR NOT YOU HAVE SPAGHETTI FOR DINNER OR YOUR HAIR IS BLUE? >> SO REQUIREMENTS, REQUIREMENTS, REQUIREMENTS. SO ONE OF THE THINGS I'M TRYING TO BRING IS A REQUIREMENTS-DRIVEN DESIGN AND DEVELOPMENT PROCESS THAT'S VERY COMMON IN ALMOST EVERY INDUSTRY AND PART OF THE WORLD, IN EVERY PART OF THE WORLD. WE JUST FINISHED A FEW -- IN APRIL, THAT'S LIKE DOG YEARS TO ME, THAT WAS LIKE 68 YEARS AGO, BUT IN APRIL, WE FINISHED THE FIRST WHAT WE CALL RESEARCH PRIORITIES WORKSHOP. WE ASKED ALL 27 INS TUESDAY AND INSTITUTES AND CENTERS TO INVIED OTHER FUNDERS IN THEIR AREAS, INTRAMURAL AND EXTRAMURAL EXPERTS IN THEIR PARTICULAR TOPICS, AND THEN WE ALSO BROUGHT PATIENTS AND PATIENT ADVOCATES IN TO THIS ENVIRONMENT ON A MULTI-DAY WORKSHOP, AND I PUT THEM THROUGH A CLASSIC REQUIREMENTS-DRIVEN PROCESS THAT BASICALLY GOES LIKE THIS: PRETEND THE ENTIRE ONE MILL YOON PERSON MILLION PERSON COHORT PROGRAM IS JUST DESIGNED TO ENHANCE THE SCIENTIFIC AND MEDICAL BREAK THROUGHS IN YOUR NARROW OR LARGE AREA. WHAT ARE THE MOST IMPORTANT RESEARCH QUESTIONS YOU WOULD HAVE, ASK OF IT, THAT SOMETHING THIS SIZE IS THE RIGHT TOOL AND SOMETHING THIS DIVERSE IS THE RIGHT TOOL TO ANSWER? ALL RIGHT, WHAT KIND OF RESEARCH QUESTIONS, WHAT KINDS OF STUDIES WOULD YOU DO? WELL, FOR THOSE STUDIES, WHAT KIND OF DATA WOULD YOU NEED TO CAPTURE? ALL RIGHT. WHAT ARE THE METHODS TO CAPTURE THAT DATA, AND IF YOU HAVE A VERY SPECIFIC SPEC, THEN TELL US THAT. THE PUBLIC BEFORE AND THEN DURING THE WORKSHOP GENERATED 1300 USE CASES. VERY SPECIFIC. I WAS LIKE, DON'T STOP AT THE LEVEL OF WE WANT YOU TO CURE DIABETES. IT THAT'S USELESS. GO DOWN VERY SPECIFICALLY INTO THE STUDY THAT YOU WOULD HAVE, YOUR DREAM STUDY. WE'RE THEN JUST LOOKING FOR COMMON INGREDIENTS ACROSS THERE THAT ARE SCALABLE TO A MULL MILLION PEOPLE AT A REASONABLE COST AND WOULD HAVE MULTI-FIELD IMPACT. SO WHAT WE'D PAY FOR OUT OF THAT PROGRAM ARE THOSE INGREED WRENTS WHERE WE CAN SHOW THIS IS GOING TO HAVE MULTI-SCIENTIFIC IMPACT AND OTHER THINGS THAT CAN'T SCALE TO A MILLION PEOPLE, THAT'S A GREAT CANNED TATE FOR THEM TO APPLY AND USE THE RESOURCES AND ANCILLARY STUDY. THAT REQUIREMENTS DRIVEN PROCESS WILL JUST GO ON AND ON INTO THE FUTURE. WHAT I TRIED TO GET PEOPLE TO DO IS TO SAY THIS IS LOW HANGING FRUIT THAT YOU DO KO DO ALMOST IMMEDIATELY, THIS IS MED YUM MEDIUM STUFF THAT WE -- ON WHICH DATA CAPTURE METHODOLOGY WE'RE GOING TO DO, AND THERE'S SOME THINGS WE WISH WE COULD CAPTURE BUT WE HAVE NO IDEA HOW YOU COULD CAPTURE THAT DATA. THOSE ARE GREAT OPPORTUNITIES FOR PARTNERSHIPS WITH THE NATIONAL SCIENCE FOUNDATION AND OTHERS, WITH ENGINEERING FOUNDATIONS TO SAY, HEY, THERE'S SOME LONG LEAD WORK. I'LL GIVE YOU A SIMPLE EXAMPLE. IF YOU LOOK RIGHT NOW, THERE ARE TWO COMPANIES THAT HAVE NONINVASIVE BLOOD PRESSURE CUFFS -- IT'S NOT A CUFF, IT'S NONINVASIVE, DOING TIME OF FLIGHT MEASUREMENTS WITH SENSORS ON THE BODY. THEY WERE IN INTENSIVE CARE UNITS ONLY INITIALLY. THERE'S NO DOUBT THAT THAT TECHNOLOGY CAN BE SHRUNK IN COST AND SO FORTH AND MOVED TO WHERE WE COULD PROBABLY, WITHIN FIVE TO SEVEN YEARS, GET TO THE POINT WHERE IT'S AFFORDABLE TO ALL MILLION PEOPLE TO GET BLOOD PRESSURE MONITORING LIKE WITHOUT HAVING TO THINK ABOUT IT, WITHOUT HAVING TO DO IT AND NOT THE LAB EFFECT AND NOT THE ONCE A YEAR OR ONCE A MONTH MONITORS THAT WE KNOW ARE USELESS GIVEN THE VARIABILITY OF BLOOD PRESSURE. SO HERE'S A NEED BY LOTS OF PEOPLE WITH RESEARCH, HERE'S AN ECOSYSTEM THAT'S WORKING ON IT AND WE'LL WORK ON A COLLABORATION WITH THEM TO MAKE THAT SCALABLE TO A MILLION PEOPLE AND ULTIMATELY TO ALL PEOPLE AT THAT POINT. >> ONE QUICK QUESTION. >> ACTUALLY TWO TEENY ONES. ONE OF THEM IS ARE YOU USING FIRE WITH THAT THING? >> YES. >> THE SECOND ONE -- >> I KNOW YOU WOULD KILL ME IF WE WEREN'T. >> I KNOW IT'S A HARD ONE, BUT IS THERE AN OPPORTUNITY TO GET SOME SORT OF COMPARABLE SMALL RANDOM SAMPLE JUST TO COMPARE WHAT YOU'RE NOT GETTING OR HOW IT'S DIFFERENT IF YOU'RE GETTING THE NON-RANDOM SAMPLE? >> YEAH. OUR SCIENCE COMMITTEE HAS BEEN TALKING ABOUT THAT AND DOING THAT. I MEAN, YOU KNOW, WHEN WE DID THE -- I MEAN, I DUND UNDERSTAND THESE ISSUES BECAUSE I WAS THE TECH GUY ON THE ORIGINAL COMMITTEE, RIGHT? WE HAD TO MAKE SOME STRATEGIC DECISIONS AND WITH THE P RANS OF PEOPLE THAT WERE INVOSMED IN THAT, ONE OF THOSE BIG ONES WAS ARE WE GOING TO BE A COHORT OF COHORTS OR START AFRESH? SO EVEN IN THE CASE OF THE V.A., WE'RE STARTING AFRESH, THEY'RE GOING THROUGH OUR WHOLE PROTOCOL AND THAT'S THE ONLY COHORT PARTNERSHIP THAT WE HAVE. THE OTHER WAS, WHAT ARE THE STRATEGIES TO DEAL WITH SELF-SELECTION BIAS AND RANDOM COMPARISON AND ALL OF THAT. WE HAVEN'T DECIDED EXACTLY HOW WE'RE GOING TO DO IT. SOME OF THE INSTITUTES HAVE TALKED ABOUT MAYBE WE'LL ACTUALLY DO A SMALL ONE IN OUR AREA EXRABBABLE TO OUR ISSUES BUT WE HAVEN'T SORTED THAT OUT. THERE'S A BUNCH OF THOSE THORNY ISSUES THAT WERE COMING AND WE WERE LIKE, LOOK, WE'RE NOT GOING TO HAVE ANYTHING IF BE TONIGHT START BUILDING THE RELATIONSHIPS AND START COLLECTING THE BASIC DATA AND WE'VE GOT TIME TO FIGURE SOME OF THESE OUT. WE ANTICIPATE THE FIRST BATCH OF CURATED DATA WILL COME OUT IN THE FIRST HALF OF 2019 BUT WE'LL START DOING SOME ALPHA AND BETA TESTS OF THAT IN 2018. I SH YOU JUST MENTION FOR THIS AUDIENCE, IT'S ALL IN GOOGLE COMESH CLOUD, MODERATE SECURITY PROCESS, AND WE'RE MAKING PEOPLE COME TO THE DATA. YOU CAN'T COPY IT OUT OF THE SYSTEM. WHEN PEOPLE SAY, OH OH, YOU WON'T HAVE ENOUGH COMPUTE POWER FOR US, IT'S LIKE, YES, WE WILL. THERE WILL BE ENOUGH COMPUTE POWER FOR WHAT YOU WANT TO DO. YOU CAN BRING YOUR DATA INTO IT. BUT TO REALLY TRY TO PROTECT THE IDENTITY OF THE PARTICIPANTS, WE FELT THIS WAS THE WAY. IT'S NOT THAT WE DON'T BELIEVE IN DISTRIBUTED ANALYTICS, WE DO, AND I THINK IT WILL BE A MULTI-MODEL, BUT ALL OF THIS DATA IS GOING TO BE PROTECTED AND HOUSED WITHIN THAT ENVIRONMENT THAT WE'RE BUILDING. I CAN'T WAIT TO START SHOWING YOU SOME OF THE PROTOTYPES OF CONTAIN RAISED -- THAT WE'RE BUILDING FOR RESEARCHERS. I THINK PEOPLE ARE REALLY GOING TO LIKE IT WHEN THEY UNDERSTAND WHAT'S IN THERE. >> PLEASE JOIN ME IN THANKING ERIC FOR HIS PRESENTATION. [APPLAUSE] ON BEHALF OF BARBARA EPSTEIN, WHO'S THE PRESIDENT OF THE MEDICAL LIBRARY ASSOCIATION AND MYSELF, ERIC, YOU HAVE TO COME BACK. >> OH. >> ON BEHALF OF BARBARA EPSTEIN, MLA PRESIDENT AND MYSELF, WE WANT TO PRESENT ERIC WITH A SMALL CERTIFICATE, ACKNOWLEDGMENT OF HIS BEING NAMED THE JOSEPH LEITER LECTURER. THANK YOU, ERIC.