State of the GMI1

Lerner Research Institute 2007 Operations Report

Welcome

State of the GMI

State of the GMI2

2009 LRI STAR Award Winners

Peter Balint

Petra Platzer

There were 31 nominations submitted for 2008.

Of the 10 winners chosen, GMI had 2 STARs – we’re very proud!

This program recognizes individuals who have taken special initiative to help others and enrich the workplace

State of the GMI3

GMI Employee of the Quarter Winners

This award program offers an opportunity for GMI members to recognize peers for their accomplishments and contributions to GMI and being a pillar of Teamwork, Quality, Service or Innovation.

Christina RigelskyChristina Rigelsky3rd Quarter, 2008

Nichole PrescottNichole Prescott4th Quarter, 2008

Todd RomighTodd Romigh1st Quarter, 2009

State of the GMI4

State of the GMI4

State of the Cleveland Clinic Highlights

State of the GMI5

State of Cleveland Clinic - 2009

Quality:patient experience (ie. medical, physical & emotional)

Status

• Research funding (including NIH) up 6% in 2008; publications up 5%

• Building of a new, national Reference Lab Center by 105th St.

• Partnerships with: Google and Microsoft for home monitoring CVS’s “Minute Clinics” for increased patient volume

• Increased media coverage, brand awareness & non-Ohio presence (CC Abu Dhabi, Sheik Khalifa Medical Center, and Lou Ruvo Center for Brain Health)

Status

• Increased accuracy in medical care (EMR) and pharmacy data entry (CPOE)

• Increased compliance and decreased delinquent medical records

• Improved patient access with new facilities

• Decreased complaints and increased patient satisfaction scores (above national average, but there is more work ahead)

Innovation:

State of the GMI6

Contributors to Premature Mortality

Behavior Genetics Social Medical Access Environmental

D.M. Cosgrove, MD, State of the Clinic, 2008

%

State of the GMI7

State of Cleveland Clinic - 2009

Status

• Strategic Council’s 4 main initiatives in 2009:1. Patient Experience2. Operational Excellence3. Growth4. Integration of the Health System

Teamwork:Key areas: HR, IT, Wellness, Patient Experience, Quality & Safety

• Current strategic investments:1. HR – employee engagement2. IT – integration, upgrading, and streamlining multiple systems3. Wellness – employee and patient benefits

• Improving communication and messaging to all employees

State of the GMI8

State of Cleveland Clinic - 2009

Status

• Reduction of overall wait time for outpatient appointments by 5 days (Same day Appt Initiative)

• Improved employee-focused benefits and wellness initiatives

– Weight Watchers program (lost 75,000 pounds so far)

– Smoking Cessation

– Increased tuition reimbursement programs

• Nursing Magnet Status for main campus & Fairview

• 23andMe, a free service for physicians to participate in genomic screening

• Increased Environmental Stewardship, by recycling medical waste, exploring alternate energy sources and reducing energy consumption

Service:patient and employee services given and received

State of the GMI9

State of Cleveland Clinic - 2009

Status

• CC is strong overall and Florida is turning a profit for the first time

• 90% of CC’s $5 billion revenue from patient revenue; patient portion is declining due to costs of expanding the facilities and payor mix change

• Guiding Principles for handling the current economic crisis:1. Maintain Patient Care2. Preserve Jobs3. Maintain compensation4. Invest in the Future

• Expense reduction actions taken thus far are working; Unlike other healthcare institutions, CC has not been forced to lay off any personnel

For every $50,000 the Clinic can “save”, that translates to one job saved

Finances:

State of the GMI10

• Initiatives overall are heading in the right direction

• We should not get too comfortable with our successes

• Take advantage of this opportunity and let it stimulate us to achieve our best

Tom Brokaw:… “we cannot waste the opportunities that lie within this crisis; it isn’t what divides us that’s important; it’s what unites us – and we should continue to “Act as a Unit”….”

State of Cleveland Clinic - 2009

Key take-aways:

State of the GMI11

State of the Genomic Medicine Institute2008 Annual Report

Charis Eng, MD, Ph.D., FACP, Chair & DirectorJune 22, 2009

State of the GMI12

GMI Core Values

To provide a work culture that enables us to bring genetics and genomics, through our research and clinics, into all subspecialties of the Cleveland Clinic’s healthcare system

To promote scholarly activity (research), academic clinical practice and education

To be the expert base for the principles and practice of genomic medicine

To foster innovation ultimately directed at personalized genomic-based healthcare

State of the GMI13

The Research Triad

ResearchLabs

“Cores”GMBIGAC

Genomics

CPGH

GMI’s interdisciplinary design as a one-stop shop is aligned with the LRI’s Research Triad Mission and CC’s Tripartite academic mission

State of the GMI14

New Personnel

State of the GMI15

New Investigator

Effie Sehayek, MDarrived June 2, 2008

• Research FocusGenetics of sterol metabolism and atherosclerotic cardiovascular diseases

Genetics of fat absorption from the intestine

• Academic AppointmentsAssistant Professor, Dept of Molecular Medicine, CCLCM

• Funding / Awards Scored in top 15th percentile for recent R01 submission

Effie Sehayek, MD

Mike Greenbergpostdoc

Katie Lintner,Res TechLaborator

y Members:

State of the GMI16

New Clinicians

Holly Pederson, M.D.Primary Appointment: Center for Specialized Women’s Health

• Specialty:Breast Cancer

• CPGH role:Cancer Genetics Fellowship

Marc Shapiro, M.D.Primary Appointment: Taussig Cancer Center

• Specialty:Lung, Breast, GI cancer

• CPGH role:Breast Cancer Clinical Geneticist

State of the GMI17

Other Recruitment Highlights in 2008

• Stephanie Fritz, Patient Service Representative

• Kristi Bennett, Eng lab postdoc

• Deborah Zygmunt, Aldred lab Sr Technician

• Jessi Mester, Genetic Counselor

• Tom Oravec, Labmatrix Data Entry

• Kathleen Babb, Research Admin Coordinator

Jessi

Kristi

Tom Kathleen

Deb

Stephanie

State of the GMI18

Other Recruitment Highlights in 2008 (cont’d)

• Gina Keeler, Clinical Manager

• Joshua Cowgill, Serre lab Technician

• Jim Hester, Serre lab Computing

• Jessi Moline, Genetic Counselor

• Michelle Maurer, Medical Secretary

• Shirley Tao, Zhang lab postdoc

Michelle

Gina

Shirley

JimJessi

Josh

State of the GMI19

Other Recruitment Highlights in 2008 (cont’d)

• Charissa Peterson, Eng lab Sr Technician

• Patty Arscott, Genetic Counselor

• Jason He, Eng lab postdoc

• Hui-Hui Liu, Zhang lab postdoc

• Shingo Ashida, Eng lab postdoc

• Toni Bartling, Ting lab postdoc

Charissa Patty

Jason Hui-Hui

Shingo Toni

State of the GMI20

Other Recruitment Highlights in 2009 (cont’d)

• Theresa Welgs, Genomics Core

• Junying Lei, Eng lab Sr Technician

• Min Zhu, Zhang lab postdoc

• Monika Hanus, GC Assistant

• Yiran Yang, Eng lab postdoc

• Meredith Holt, Project Manager

Theresa Junying

Min Monika

Yi-Ran Meredith

State of the GMI21

Other Recruitment Highlights in 2009 (cont’d)

• Jeannie Choi, Ting lab Technician

• Hadley Miller, Serre lab TechnicianJeannie Hadley

Since 2007, we have had 31 people join GMI!

State of the GMI22

Translational Disease-Oriented Research & Clinical Programs

State of the GMI23

GMI’s Disease-Oriented Research Programs

Disease Emphasis of GMI Laboratories

Cancer

Cardiovascular

Pulmonary

Neuro-Psych

Type 2 Diabetes

State of the GMI24

Adjunct Staff:Complement GMI’s Research and Clinical Programs

GenomicGenomicMedicineMedicine

Cancer

Heart, Vessels, Blood

Lung

Brain & SpineOpthamology

Cell Biology

Pediatrics, Obstetrics & Specialties

Bioethics & Health Policy*Wilson Tang, M.D.

*Elias Traboulsi, M.D.

*Jonathan Smith, Ph.D.

*Ruth Farrell, M.D.*Eric Kodish, M.D.*Richard Sharp, Ph.D.

*Bruce Lamb, Ph.D.

*Ruth Farrell, M.D.

*Staff members with adjunct appointments in GMI.

State of the GMI25

Outreach to other Research and Clinical Programs

Multidisciplinary Programs • Asthma and Pulmonary Hypertension (Erzurum)

GMI: Michaela Aldred, Christina Rigelsky

• Barrett Esophagus/Esophageal Adenocarcinoma Consortium (Eng)GMI: Charis Eng, Brandie Leach

• Heritable Colorectal Cancer Multidisciplinary Research Group & High Risk Cancer (Church)

GMI: Charis Eng, David Serre, Angela Ting, Brandie Leach

• Endocrine Neoplasia Genomics Research Group and Multidisciplinary Clinic (Eng)GMI: Charis Eng, Emily Edelman

• Head and Neck Neoplasia Genetics & Genomics Research Group & High Risk Clinic

GMI: Michaela Aldred, Charis Eng, Emily Edelman

• Von Hippel-Lindau Disease Multidisciplinary (Virtual) Clinic (Eng)GMI: Charis Eng, Amy Shealy

State of the GMI26

Outreach to other Research and Clinical Programs (cont’d)

• Gorlin Syndrome (Virtual) Clinic (Eng)GMI: Charis Eng, Amy Shealy

• Marfan Syndrome Multidisciplinary Clinic (Greenberg)GMI: Rocio Moran, Christina Rigelsky

• Tuberous Sclerosis Multidisciplinary Clinic (Gupta)GMI: Rocio Moran, Charis Eng, Amy Shealy

• Gene Dosage and Disease Susceptibility Research Group (Nadeau) GMI: David Serre, Angela Ting

• Diabetes Genomics Research Group (Serre)GMI: David Serre

• Neurofibromatosis Multidisciplinary Clinic (Rothner)GMI: Vickie Zurcher, Rebecca Mitchell, Allison Schreiber

• Hearing Management ClinicGMI: Rocio Moran, Allison Schreiber

• Vascular Anomalies Multidisciplinary ClinicGMI: Rocio Moran, Amy Shealy

(new in 2008)

State of the GMI27

Satellite Genetics Clinic Expansion

• CORS/DDI Colon Cancer GC: Brandie Leach

• Hillcrest Prenatal/Preconception GC: Diane Clements

• Vascular Surgery Clinic GC: Christina Rigelsky, Patrica Arscott

• Vascular Medicine Clinic GC: Christina Rigelsky

• Fairview Moll Pavilion Breast Cancer GC: Kate Lynch, Shanna Gustafson

• Beachwood Cancer GC: Kate Lynch, Shanna Gustafson Prenatal/Preconception GC: Diane Clements

• Shaker Developmental & Behavior Pediatrics APN: Rebecca Mitchell

(new in 2009)

State of the GMI28

Publications & Education

State of the GMI29

Publication Highlights

2006 2007 2008

Total Publications 30 24 38

Articles 29 22 36

(Impact Factor >10) 4 7 8

Books / Chapters 1 2 2

State of the GMI30

Teaching: Cleveland Clinic Lerner College of Medicine

Primary Personnel

• Michaela Aldred, Ph.D.

• Charis Eng, M.D., Ph.D.

• Pieter Faber, Ph.D.

• Banu Gopalan, M.S.

• Shanna Gustafson, M.S.

• Rocio Moran, M.D.

• Mohammed Orloff, Ph.D.

• David Serre, Ph.D.

• Amy Shealy, M.S.

• Angela Ting, Ph.D.

Secondary Personnel

• Marvin Natowicz, M.D., Ph.D.

• Ruth Farrell, M.D.

• Donna Hansel, Ph.D.

• Eric Kodish, M.D.

• Wilson Tang, M.D.

• Elias Traboulsi, M.D.

Course Instructors

State of the GMI31

Teaching:Molecular Medicine Ph.D. ProgramCleveland Clinic Lerner College of Medicine of Case Western Reserve University

Inaugural Class

Admissions Committee: GMI Representative: Michaela Aldred, Ph.D.

Two of nine inaugural class students rotated in the Eng lab and one selected this lab for their thesis work.

Ying Ni

State of the GMI32

Funding

State of the GMI33

LRI Research Funding

$-

$50

$100

$150

$ In

Mill

ions

NIH New Awards Total Federal Revenue

$69 $68 $73 $76 $84$90 $85 $91

$82$101$97

$75

2003 2004 2005 2006 2007 2008

Federal Funding TrendTotal Research Funding

(Internal & External)

$166

$202$180

$223$245 $258

$0

$50

$100

$150

$200

$250

$300

'03 '04 '05 '06 '07 '08

($ in

Mill

ions

)

Federal Non-Federal CCF Treasury

Declines in NIH funding are being offset by gains in other federal non-NIH sources (i.e., DOD, NASA, DOE, etc.)

State of the GMI34

Research Funding Highlights

New Grants in 2008

• Charis Eng, M.D., Ph.D., NIH – PO1: “Genetic alterations that initiate follicular carcinogenesis” ($223 ADC, 5 yr); BCRF: “Genes that affect mitochondrial function as novel mediators of beast cancer susceptibility” ($129K ADC, 1yr); BCRF: “Differential biallelic expression of PTEN in patients with heterozygous germline PTEN mutations as a novel mechanism of modulation of breast cancer risk” ($79K ADC, 1yr); Hearst Foundation: “Inherited Breast Cancer Research Program ($150K ADC, 2 yr)

• Aldred, Michaela, Ph.D., AHA: “Progenitor Cells in Pulmonary Hypertension” ($70K ADC, 4yr)

• Zhang, Bin, Ph.D., NIH – March of Dimes: “Receptor-mediated ER-to-Golgi transport of Coagulation factors V and VIII: Deficiencies in the early secretory pathway as pathogenic mechanisms of congenital disorders” ($68K ADC, 2 yr); RO1: “Receptor-mediated ER-to-Golgi transport of Coagulation factors V and VIII” ($225K ADC, 5yr)

New extramural funding in CY 2008 ~$1.1M ADC, or ~$5.9 million total funding

State of the GMI35

Philanthropic Funding

2006 2007 2008

# of donations 1 2 5

Amount (total) $100,000 $8,000 $410,000

Dr. Eng received first endowed chair in Cancer Genomics Research:

$1.5 million endowed chair funded by Sondra and Stephen Hardis to further Cancer Genomics Research

• Arthur Blank Foundation• William W. Baker Family Foundation• Norma & Albert Geller• Roger & Sharon Vail

• Ambrose Monell Foundation: ($100K ADC, 3yr)“Cancer Genomics Training Fellowship Program”

State of the GMI36

Clinical Revenue• New Genetic Counseling service reimbursement model

implemented; utilizes first genetic counseling-specific billing code

• Decoupling Geneticist and Genetic Counselor billing schema has: increased patient access decreased patient appointment wait times provided opportunities for satellite clinic service expansion

• Two recent Cleveland Clinic initiatives: Same Day Appointments Provider-based billing

• Net effect on clinical revenue is being analyzed

GMI’s Center for Personalized Genetic Healthcare is a pioneer in transforming traditional clinical genetics services to a financially self-sustainable model with:

increased patient access improved patient service

State of the GMI37

Innovations & Commercialization

• 4 provisional patents filed Charis Eng, M.D., Ph.D. (3) Effie Sehayek, M.D. (1)

• “eGMI” Patient-entered family

history tool

Collection of personal and family medical history information

Creation of pedigree

Automated risk assessment

Utilizes MyConsult/eCC and Progeny

State of the GMI38

Employee Engagement

State of the GMI39

Gallup Employee Engagement SurveyMarch, 2008

5-point scale: 1= Highly disagree 5= Highly Agree * 38 GMI employees

GMI* LRI CC

Gallup 50th%

Gallup 75th%

Overall Engagement 3.54 3.81 3.80 3.94 4.27

Overall Satisfaction 3.43 3.71 3.68 3.93 4.29

GMI Commitment: “to make GMI the best workplace for GMIers”

Committed to Quality

4.26 4.04 3.94 4.11 4.44

Have Materials & Equip

4.18 4.22 3.22 4.00 4.38

Know what’s Expected

3.34 4.26 4.43 4.50 4.71

Mission/Purpose 3.32 3.74 3.82 4.11 4.44

GMI Strengths

GMI Opportunities

State of the GMI40

Engagement Initiatives

• Job Expectation Clarification: Review and redefining of all position’s key job responsibilities (KJR) Creation of a Job Specification and Performance Roadmap (JSPR)

• Organizational Chart Refinement: Defining subunit structures and mission statements

• Communication Improvement: Increased forums (Town Hall, open staff meetings, Newsletter, etc)

• Employee Recognition: GMI Employee of the Quarter award

• Socializing Opportunities: Summer Picnic and Table 45 Happy Hour

Key:

Admin Support Staff

Management Team

Executive Team

Dr EngChair

Business Advisory Board

Research AdminCoordinator

Babb ComputingBalint

Director,Transl Devel

Rerko

THE GENOMIC MEDICINE INSTITUTE

Admin AsstWilcox

Manager, Integ Devel

Platzer

Admin AsstBlount

Center for Personalized Genetic Healthcare

Dir: Eng

PSRs, GC Assts, Med Sec

MDs

Cancer Genetics / General GeneticsClinic Med Dir: Eng / Moran

Clinical Mgr: Keeler

ANP

Genetic Counselors

ReimbursementSpecialist

GMI EnterpriseRerko

Project MgrHolt

Genetics Educ Cdtr

X

IT Architect

X

eGMIPlatzer

DatabaseProj Mgr

GC

BiorepositoryMgr: X

Clinical Research Program Mgr: X

Research Study/Prog

Coordinators

Int Genomics & Analysis

Mgr: Gopalan

Bioinformatics/Biostatistics

Labmatrix

Eng Lab

Aldred Lab

Zhang Lab

Ting Lab

Serre Lab

Research

SehayekLab

PI Admin AsstsBlount/Wilcox

Res Admin CdtrBabb

Genomics Core

P Faber

State of the GMI42

Engagement: Next Steps

• Completion of all employee JSPRs

• Continued implementation of constructive and regular performance feedback

• Continued focus on improving communications

• Continued supervisor/manager training to be “engaging managers”

• Next round of subgroup meetings to identify next action item plans

• 2009 Gallup survey: June 24 - July 17 LRI goal: improve scores by 5%

State of the GMI43

Community Benefit & Wellness

State of the GMI44

Institute Diversity Program• GMI Members on Diversity Council

2008: Banu Gopalan, CoordinatorKylie Drake

Institute Wellness Program

• Conversational English Program (CEP)- Todd Romigh (coach)- Several GMI participants

GMI TRIes• Triathlon Club (runners, bikers, swimmers)

Nichole Prescott

• Commit10 Challenge ProgramRebecca Mitchell

State of the GMI45

Community Benefit

• United Way campaign

– Last year, CC raised $1.8 million for local community resource centers

– In 2008, GMI had 45.2% participation

– 2009 campaign about to begin; GMI team captain is ?

– 2 GMI folks participated in “United Way Day of Caring”

• LRI’s Harvest for Hunger- generated 215 pounds of food, $2,400 in donations

• Bolton School Supplies- generated ~$16,000 of supplies

• GMI Feature in Cleveland Clinic-Community Breakfast & the Community Service Booklet

• Rebecca Mitchell, M.S.N, C.N.S., camp nurse at Knox County 4-H Camp resulted in Caitlin Pugh Scholarship Fund donations.

State of the GMI46

• Cold Spring Harbor LaboratoryInvited Lecturer: David Serre, Ph.D

Educational & Outreach Highlights

• 8th Intl Anticancer Research Conference Invited Lecturer: Angela Ting, Ph.D.

• 6th Intl Conference on the Biology of Childhood Renal CancersInvited Lecturer: Michaela Aldred, Ph.D.

• 27th Annual Meeting of National Society of Genetic CounselorsSession Co-chair: Emily Edelman, M.S., CGCEducational Breakout Session: Amy Shealy, M.S., CGC

• Genetics Education Campaign KickoffDr. Eng, Dr. Traboulsi, Dr. Moran, Cheryl Scacheri and Champions

“Genetics in Health and Disease” symposium

State of the GMI47

Educational Highlights (Continued)

• Neurofibromatosis: A 21st Century Perspective Invited Participants: Vickie Zurcher, M.D., Rebecca Mitchell, MSN, C.N.S.,

Allison Schreiber, M.S., CGC

• Aspiring Physicians & Research Scientists Conference Invited Panelist: Mohammed Orloff, Ph.D.

• The CPGH Genetic Counseling Internship program trained 2 GC students

• American Society of Human Genetics Invited Science Session:“Organismal and Cellular Phenotypes of Breast Cancer Susceptibility Genes” Chair: Charis Eng, M.D., Ph.D.

• 18th Annual Symposium of Society of Black Academic SurgeonsInvited Lecture: Charis Eng, M.D., Ph.D.

• 6th Annual Pediatric Neurology Update Seminar Invited Presenter: Rocio Moran, M.D.

State of the GMI48

• Cleveland Museum of Natural History• Exhibit: “RACE: Are we so different?”

Dawn Caraballo• Genomics Town Hall

Dawn Caraballo, Drs. Moran and Serre, Cheryl Scacheri

Special Events & Community Outreach

• Minority Men’s Health Fair Dawn Caraballo

• School, Library and Support Group talks in 2008Over a dozen educational talks given by various GMI personnel in 2008

• WKYC: Family Health History Day Dr. Eng, Shanna Gustafson

• PBS: “In the Family” documentary Cheryl Scacheri (message board)

State of the GMI49

Awards & Honors• GMI was honored as the featured member of the month (August)

by the Personalized Medicine Coalition

• Charis Eng, MD, PhD, Chair GMI, named Chair of the Clinical Science Committee of the Personalized Medicine Coalition.

• Charis Eng, MD, PhD was elected to the 2008-2009 Best Doctors in America database for her work in Clinical Cancer Genetics and Cancer Genomic Medicine.

• Charis Eng, MD, PhD was a Visiting Professor in the Human Manpower Development Planning Programme of Singapore’s National Cancer Center

• Charis Eng, MD, PhD was awarded the LRI Excellence Award for Outstanding Science and Marvin Natowicz, MD, PhD was awarded the LRI Excellence Award for Outstanding Educator

• Kristi Benett, PhD and Ying Ni, MS were both awarded entry into the AAAS/Excellence in Science Program award for 2008-2009

State of the GMI50

Awards & Honors• Stacy Williams and Crystal Sterling were awarded the McNair Undergraduate

Summer Research Scholarship for Minority Students Excelling in the Sciences

CONGRATULATIONS

• Shireen Ganapathi was awarded the American Cancer Society Joseph F. Silber Undergraduate Research Fellowship

• Guillaume Assie, MD, PhD was named a Finalist for the Cotterman Award for Best Trainee-First Authored Paper published in Am J Hum Genet

• Rebecca Mitchell, RN and Patricia Pritchard were awarded LRI Star Awards in 2008

State of the GMI51

2009 Brief Updates

• Angela Ting, Ph.D. received a Wilson Foundation grant ($91K ADC, 2yr)

• Bin Zhang, Ph.D., received an R01 summer student supplement ($8.5K)

• Brandie Leach, MS, CGC and group received a National Society of Genetic Counselor SIG grant ($2K)

• Published our first GMI Newsletter, “Translations”

• Met with CC Employee Health Plan to develop a model for appropriate genetic testing recommendations and reimbursement schemas

• Providing education to CC surrounding direct-to-consumer genomics companies and their utility

• Highlighted by the Advisory Board Company in their Genomic Centers of the Future Presentation

State of the GMI52

GMI Goals & Challenges

State of the GMI53

State of the GMI53

Short-term Goals for 2009

• Meet budgetary expectations

• Increase clinical revenue and satellite services

• Increase GMI grant funding by >20%

• Implement Cancer module of eGMI prototype in GMI and Taussig Cancer Center

• Improve employee engagement by at least 5%

• Improve developmental opportunities for Assistant Staff and employees

• Recruit key personnel in Clinical Research Study and Genetics Education Programs

• Increase quantity and quality of publications

• Obtain next generation high-throughput sequencer

State of the GMI54

Continuing Objectives

• Reduce GMI’s dependency on CC operating revenue across all units by 2011

• Further increase depth and breadth of research programs

• Continue to re-examine clinical genetics and genetic counseling process to standardize and implement the best models

• Develop and implement relevant eGMI modules to integrate genetic screening processes into CC patient care

• Continue outreach and education efforts for understanding and utilizing genetics and genomics processes in patient care

• Further train next generation of biomedical researchers in CCLCM and Molecular Medicine programs

• Increase endowment funding and philanthropic support

State of the GMI55

Challenges ahead

• Stagnant NIH budget

• Small annual allocation of capital funding for research from CC

• Growing Federal regulations lead to compliance concerns

• Lack of unassigned laboratory, office and clinic space

• Integration of genomic medicine into CC processes and medical specialties

• Scarcity of qualified clinical geneticists or genomic medicine physicians

• Legislative reform for Genetic Medicine

State of the GMI56

Thank you all for your hard work and a productive year!

GMI Goals & Successes:

Quality Service Innovation Teamwork

We are on the right trend and together as a unit, we will accomplish our mission.

State of the GMI57

Questions?

Now for a visual highlight of 2008 from Peter ….