**NCCCP Information Technology Break-Out**

Hosted by: NCI Center for Bioinformatics and Information Technology

[Slide 1]{.underline}

-   Introductions

-   caBIG™ Program Overview

-   Overview of NCCCP Informatics Activities

-   Site overviews and discussion: Strengths, Capabilities and Needs

    -   Current status of IT infrastructure

    -   What systems are in place to support clinical operations?

    -   What systems are in place to support research?

    -   Are any clinical operations software systems currently supplying
        data to research systems automatically?

    -   Any linkages/collaborations with NCI-designated cancer
        centers/other centers that involve IT efforts? Is data shared
        with them?

-   Next Steps, Logistics

[Comments from the Group]{.underline}

Dr. Robb emphasized that in the NCCCP, IT and the biospecimens program
are really 'joined at the hip,' and will need to work together. Dr.
Buetow agreed, and thinks it's also true for other segments (e.g. IT and
clinical trials planning)

[Slide 2]{.underline}

-   NCI Center for Biomedical Informatics and Information Technology
    (CBIIT)

-   Ken Buetow, Ph.D.

    -   Director

-   Leslie Derr, Ph.D.

    -   Director, Community Alliances and Support

-   John Speakman

    -   Associate Director, Clinical Trials Products and Programs

[Slide\--caBIG™ Defined]{.underline}

> A virtual web of interconnected data, individuals, and organizations
> redefines how research is conducted, care is provided, and
> patients/participants interact with the biomedical research enterprise
>
> Next generation World Wide Web of biomedical research

[Slide\--caBIG™ Mission]{.underline}

-   Connect the cancer research community through a shareable,
    interoperable infrastructure

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-   Deploy and Extend standard rules and a common language to more
    easily share information

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-   Build or adapt tools for collecting, analyzing, integrating and
    disseminating information associated with cancer research and care

[Slide\--caBIG™ Imperatives]{.underline}

-   Integrate the biological and clinical silos

-   Integrate IT infrastructure, software and data

-   Integrate institutions and people

-   Address the complexity of cancer

[Slides\-- Molecular Medicine as a Complex Continuum]{.underline}

The People

> Trial Managers
>
> Clinicians
>
> Radiologists
>
> MRI Technicians
>
> Lab Technicians
>
> Pathologists
>
> Geneticists
>
> Molecular biologists

The Activities

> Study creation
>
> Patient enrollment
>
> Clinical data collection
>
> Image sharing and analysis
>
> Tissue banking
>
> Expression analysis
>
> SNP identification
>
> Clinical data correlation

[Slide\--caBIG Approach]{.underline}

-   Modules that address specific needs

-   Use of international data standards

-   Connect through defined electronic interfaces

[Slide\--Boundaries and Interfaces]{.underline}

-   Focus on boundaries, interfaces, how things fit together, not on the
    internal details

-   Once they're built: assume they will be diverse & changing

-   The glue that binds parts together is middleware infrastructure

-   Shape of boundary is defined in APIs

Dr. Buetow reinforced that we're not asking them to chuck their existing
systems---we're asking what they use and what they need, the interfaces
with their system and what they might want to use in caBIG. It's not
about 'rip and replace.'

[Slide\--Addressing real world issues]{.underline}

> Clinical trials management systems
>
> Integrative cancer research
>
> Tissue banks & pathology tools
>
> *In vivo* imaging
>
> Vocabularies and common data elements
>
> Architecture
>
> Data sharing and intellectual capital
>
> Training
>
> Strategic planning

[Slide\--caBIG Compatibility Guidelines]{.underline}

Legacy, Bronze, Silver, Gold

[Slide\--Supporting infrastructure and services]{.underline}

-   Enterprise Vocabulary Services (EVS)

    -   Browsers

    -   APIs

-   cancer Data Standards Repository (caDSR)

    -   CDEs

    -   Case Report Forms

    -   Object models

-   caGrid

    -   Globus

    -   Mobius

    -   Introduce

    -   Dorian

    -   Grouper

    -   ActiveBPEL

-   Developer Toolkits

    -   caCORE SDK

[Slide\--The Clinical Research "World of Standards" Today]{.underline}

Vocabulary standards, biomedical information standards---"so many to
choose from"

NCI brought together HL7 and components of HHS into a common integrated
model (just released last week). They now have defined interoperability.

[Slides\-- The Software Tools]{.underline}

"Inherent in this is we have individual research groups, individual
research centers that can consume of any of the individual components
they want and then... their local instances of security and other
gateway technology to determine who access to what resource. It's an
inherently federated infrastructure..."

Clinical Trial Management Tools

-   Patient Study Calendar (PSC)

-   Cancer Central Clinical Patient Registry\
    (C3PR)

-   Cancer Central Clinical Database (C3D)

Imaging

-   National Cancer Imaging Archive (NCIA)

Tissue Banking

-   caTissue

-   caTIEs---connect to Pathology databases

-   Clinical annotations

Molecular Profiling

-   caARRAY/geWorkbench

-   caIntegrator

-   Cancer Translational Informatics Research Platform (caTRIP)

**Question: Can any of the caBIG modules help with financial tracking?**

**Answer: Dr. Buetow---they're building a financial/billing module. He
feels that this group (NCCP) would be very valuable in further specify
and define that interface.**

More information on some of the applications---remember, this is 'like a
Chinese \[restaurant\] menu', use what you want. Emphasizes that
caExchange is really a data warehouse.

[Slide\--caBIG Application Bundles]{.underline}

-   Electronic Clinical Trials Management

-   Connecting through caBIG and its biomedical research applications

-   Security and Data Sharing

[Slide\--CTMS Bundle: Details]{.underline}

-   The CTMS Bundle brings together a range of interoperable tools
    supporting the clinical trials enterprise.

-   Functions include:

    -   Patient Study Calendar (PSC)

    -   Participant Registry (C3PR)

    -   Adverse Event Reporting (caAERS)

    -   Clinical Source Data Integration (caXchange)

    -   Integration with Cancer Central Clinical Database (C3D), or with
        commercial clinical trials data collection tools at sites

[Slide\--CTMS Bundle: Patient Study Calendar (PSC)]{.underline}

-   Automatically generated study-template-based patient calendar

-   Accurate, versioned representation of study parameter table

-   Prospective forecasting of patient visit information

-   Management of study participant schedules (schedule, reschedule,
    cancel)

-   Retrospective outcomes review and reporting of calendar activities

-   Consent/reconsent notification and tracking

[Slide\--CTMS Bundle: Adverse Event Reporting (caAERS)]{.underline}

-   Adverse Event Tracking and classification using accepted standards

-   Data import / export AE data in common/required formats

-   Automated, rules-based assessment of seriousness and reporting
    requirements (sponsor-level, institution-level and protocol-level
    rules)

-   Reporting, including generation of CTEP, DCP, and FDA compliant
    reports

-   Ability to submit electronically to CTEP AdEERS system

Note: caBIG is building the regulatory reporting infrastructure for FDA.
Using this software could help industry partners with FDA compliance.

[Slide\--CTMS Bundle: Participant Registry (C3PR)]{.underline}

-   Tracks subject registrations to clinical trials

-   Verifies registration criteria (study open, participant eligible,
    consent received)

-   Stratifies subject into a stratum group, randomizes to the trial

-   Tracks participants across sites (handles multi-site trials)

-   Manages study personnel

-   Reporting (federal/local requirements, supplies NCI Summary 3/4
    data)

More ways to use this than the way it was usually compiled. Can talk to
other systems using HL7 dialects.

[Slide\--CTMS Bundle: Clinical Source Data Integration
(caXchange)]{.underline}

-   Enables automatic transfer of clinical data from point-of-care
    systems in medical centers, e.g., clinical chemistry lab systems

-   Accumulates results in a standards-based data warehouse with defined
    electronic interfaces

-   Translation of multiple source data formats into standards-compliant
    data for use in clinical trials

-   Incorporates Viewer -- enabling viewing and selection of data

[Slide\--Biomedical Informatics Bundle: Details]{.underline}

-   The Biomedical Informatics Bundle brings together a range of
    caGrid-interfaced tools supporting biomedical informatics

-   Functions include:

    -   *Tissue Banking (caTISSUE Suite)*

    -   *Gene Expression Database (caArray)*

    -   *Translational Medicine tools (caIntegrator)*

    -   *Biomedical Image Management (NCIA)*

    -   *Array analysis (geWorkbench)*

    -   *...and the supporting caGrid infrastructure ...*

[Slide\--Biomedical Informatics Bundle: caTISSUE]{.underline}

Product Description: caTissue Core is caBIG\'s tissue bank repository
tool for biospecimen inventory, tracking, and basic annotation. Version
1.1 of caTissue permits users to track the collection, storage, quality
assurance, and distribution of specimens as well as the derivation and
aliquotting of new specimens from an existing ones (e.g. for DNA
analysis). It also allows users to find and request specimens that may
then be used in molecular, correlative studies.

Current Version Number: Version 1.1

Release Date of Current Version: February 2007

caBIG™ Compatibility Level: Silver\
Maturity Assessment: Stable Release

Correction: actually up to version 1.2, a lot of bugs have been fixed.

Can interface with pathology software.

[Slide\--Biomedical Informatics Bundle: caARRAY]{.underline}

Product Description: caArray is an open source microarray data
management system that allows users to submit, annotate and download
microarray data. caArray was developed using the caBIG compatibility
guidelines, as well as the Microarray Gene Expression Data (MGED)
society standards for microarray data. Compatibility with these
standards and guidelines will facilitate data sharing and integration of
diverse data types including clinical, imaging, tissue and functional
genomics data. A number of analytical tools that connect to caArray are
already available, including geWorkbench and GenePattern that both
provide a variety of data analysis, visualization and annotation
functions for microarray and other data types.

Current Version Number: Version 1.4

Release Date of Current Version: October 2006

caBIG™ Compatibility Level: Silver\
Maturity Assessment: Stable Release

[Slide\--Biomedical Informatics Bundle: NCIA]{.underline}

Product Description: The National Cancer Imaging Archive (NCIA) is a
searchable, national repository integrating in vivo cancer images with
clinical and genomic data. NCIA provides the cancer research community,
industry, and academia with public access to: DICOM images, Image
markup, Annotations, and rich meta data.

Current Version Number: Version 2.2

Release Date of Current Version: January 2007

caBIG™ Compatibility Level: Silver\
Maturity Assessment: Mature Product

[Slide\--Biomedical Informatics Bundle: geWorkbench]{.underline}

Product Description: geWorkbench provides an innovative, open-source
software platform for genomic data integration, bringing together
analysis and visualization tools for gene expression, sequences,
pathways, and other biomedical data. It gives scientists transparent
access to a number of external data sources and algorithmic services,
combining these with many built-in tools for analysis and visualization
(at present more than 40 distinct analysis and visualization modules are
part of the platform).

Current Version Number: Version 1.0.4

Release Date of Current Version: August 2006

caBIG™ Compatibility Level: In process

Maturity Assessment: Stable Product

[Slide\--Biomedical Informatics Bundle: caIntegrator]{.underline}

Product Description: caIntegrator is a novel translational informatics
platform that allows researchers and bioinformaticians to access and
analyze clinical and experimental data across multiple clinical trials
and studies. The caIntegrator framework provides a mechanism for
integrating and aggregating biomedical research data and provides access
to a variety of data types (e.g. Immunohistochemistry (IHC),
microarray-based gene expression, SNPs, clinical trials data etc.) in a
cohesive fashion.

Current Version Number: Version

Release Date of Current Version:

caBIG™ Compatibility Level: Silver\
Maturity Assessment: Stable Release

[Slide\--DSIC Bundle: Details]{.underline}

(Data sharing and intellectual capital)

-   The DSIC Bundle provides a critical range of processes, procedures,
    policies and template agreements that provide a framework for
    collaboration

-   Bundle includes:

    -   Master Guidance Document

    -   Flow document and questionnaire

    -   Decision tree

    -   Template agreements for MTA, IRB, etc.

    -   Security policies, procedures, and a framework for caGrid-wide
        authorization

    -   ...and a framework for participating in the DSIC process,
        refining the structure for data sharing throughout the program
        ...

They have pre-vetted tech-transfer documents as well.

caBIG recognizes the need new members have for support.

[Slide\--CBIIT caBIG Support Approaches]{.underline}

-   CBIIT Application Support

    -   E-mail

    -   Phone support

    -   List Servers

-   caBIG "boot camps"

    -   Developers

    -   Application Users

-   Online Interactive Training

-   Down-loadable User Materials

-   Training Sessions at Scientific Meetings

**Question: How much support is actually available?**

**Answer: For tier 1 and 2 activities, about 10-15 people. The center
for bioinformatics has a staff of 100-200 people who they can ask for
help with specific types of support or activities.**

**Question: \[couldn't hear the whole question, but the gist was, who is
the caBIG community?\]**

**Answer: caBIG community right now is composed of the NCI-designated
cancer centers. More than a thousand active participants and more than
80 organizations.**

**Question: Anybody who's a star player?**

**Answer: Duke University. Also the NCI Clinical Center. NCI's
intramural program runs the clinical trial components of caBIG, with
literally millions of records stored.**

**Question: What is the database software backend?**

**Answer: Depends a little on the specific application. When the Center
for Bioinformatics writes something, they tend to be an Oracle shop. But
they've created the infrastructure so that it could be something
else---\[for example\] DB2, or an open source database. Application
tiers are usually custom \[built\], normally in Java.**

**Question: Has caBIG designed any applications for patient navigators,
which could link up perhaps with the clinical trials database?**

**Answer: Not specifically. The closest thing would be caMatch, which
was developed in partnership with UCSF. Captures specific clinical
information for patients and looks at eligibility criteria for open
trials.**

**Question: Would software from any major commercial \[medical\] vendor
be able to interface with caBIG?**

**Answer: Not all systems have defined interfaces. Some have proprietary
formats or not-well-defined electronic interfaces. Look for use of HL7
standards.**

**Question: Who is doing the validation? Are the applications safe for
us to be using for our patients?**

**Answer: We build our applications to 21CFR11 standards, which have
validation steps built into the development of any of the tools. Some is
done here at NCI, some with partners developing the components.**

[Slide\--caBIG Enterprise Support Activities]{.underline}

> Knowledge Centers
>
> Program Offices
>
> Designated Support Contractors
>
> Enterprise Adopter Program

caBIG started as a 3-year pilot, like NCCCP, and is now an
enterprise-level program.

**Question: Interface with patient identification security issues?**

**Answer: caBIG team works closely with federal health architecture
groups, describing technical and/or legal standards associated with how
this stuff will work. Participate in privacy and security group of APIC
(sic). Make sure their policies and procedures are part of what we're
doing too.**

**Question: If a center is dependent on private physicians to enroll
patients...will this be Web based so everyone has access?**

**Answer: Yes, everything is Web based.**

**Question: How will these tools work for cooperative-group trials (e.g.
NSABP) we participate in?**

**Answer: Tools generate reports necessary to meet NCI regulatory
requirements. They speak the necessary electronic dialect.**

**Question: \[Does this work when clinical and research groups have
different systems?\]**

**Answer: The vast majority of places we interact with have
patient-encounter systems and hospital information management systems
that are separate from research databases. Here at the NCI CC, we run
Eclipsys, and can connect to that.**

**Question: has caTissue been upgraded to match the Best Practice
report?**

**Answer: That report was only accepted about a week ago, but most of
the core information required is already in there in the
infrastructure.**

**Question: Is caBIG linked to billing or costing?**

**Answer: Not yet, but it is on the design board. Could use input in
this area from NCCCP members.**

**(This might be impacted by CMS changes in July, which is apparently a
big deal and came up frequently in the later discussion.)**

**Question: What about cost recovery information for tissue banking, as
was discussed in the Biospecimens session?**

**Answer: Not yet in caTissue. \[Dr. Robb said something I couldn't hear
from the other side of the room.\]**

\[Turn over of podium to Dr. Speakman\]

Overview of NCCCP Informatics Activities

[Slide\--Our Remit]{.underline}

-   "\[To\] increase knowledge of infrastructure requirements, necessary
    interfaces, and applicability of specific components of NCI's Cancer
    Biomedical Informatics Grid (caBIG™) program for community hospital
    settings"

-   "\[To\] increase implementation of electronic medical records and
    exploration of the application of electronic medical records in the
    provision of cancer care"

[Slide\--Utilizing caBIG™]{.underline}

Organizations *leverage* caBIG™ through the following:

-   Accessing the capabilities of caBIG™, including software, data
    standards, training, documentation, and support

-   Applying caBIG™ to achieve bench-to-bedside-to-bench molecular
    medicine

-   Applying caBIG™ beyond cancer to other diseases

-   Building on/contributing to caBIG™ policies and procedures

[Slide\--"Baseline" (all sites)]{.underline}

-   Year 1: Plan

    -   Assess informatics capabilities/challenges of each site,
        stratify sites into tiers, determine strategy

-   Year 2: Do

    -   Execute according to plan\
        (develop detailed plan for implementing/leveraging caBIG)

-   Year 3: Assess

    -   Evaluate execution according to plan

    -   Document lessons learned\
        (barriers to implementation, successful strategies, future
        opportunities)

[Slide---Diversity of Cancer Community IT Landscape]{.underline}

-   Integrated Systems

    -   Homegrown/\
        Commercial

    -   Smooth navigation between applications

    -   Difficult to expand/extend

    -   Large IT staff

    -   \$10M's invested

-   Heterogeneous Systems

    -   Complex mix of commercial and homegrown components (may be
        composed of dozens of components)

    -   No common interfaces

    -   Medium size IT staff

    -   \$1M's invested

-   Informal/no systems

    -   Use of productivity applications (e.g. Excel, Access)

    -   Complex manual processes

    -   Small or no IT staff

    -   \$100K's invested

[Slide\--Stratification of sites: Tier 1]{.underline}

Baseline: Year 1: Plan, Year 2: Do, Year 3: Assess

"Tier 1" sites: Baseline plus: Collaboratively identify and deploy
caBIG™ tools that would add value to the site, either

-   using NCICB as an application service provider, or

-   installing infrastructure locally, or

-   adapting local systems to share data in a caBIG™ compliant manner

[Slide\--Stratification of sites: Tier 2]{.underline}

"Tier 2" sites: Tier 1 plus: Use local electronic medical record
infrastructure, either pre-existing or open source, to prototype a
virtual clinical data warehouse

[Site Overviews and Discussion]{.underline}

The last hour of the session was devoted to presentations from the
sites, answering the following questions:

-   Current status of IT infrastructure

-   What systems are in place to support clinical operations?

    -   Types

    -   Vendors

    -   Standards

-   What systems are in place to support research?

-   Do you have a structured data warehouse/repository in place?

-   What structured data sources do you have in place that might feed a
    data warehouse?

-   Are any clinical operations software systems currently supplying
    data to research systems automatically?

-   Any linkages/collaborations with NCI-designated cancer centers/other
    centers that involve IT efforts? Is data shared with them?

-   Needs/ Desires

[Catholic Health Initiatives]{.underline}

They have 72 (sic) hospitals, 2 basic clinical systems, a data
warehouse. Everything is different across the system (72 hospitals, 72
different ways of handling data). They have research tracking systems in
place at some hospitals, but not at the 3 pilot sites and the ones that
exist are not centrally controlled.

They don't supply currently NCI cancer centers with any data.

They use HL7 data feeds.

[Spartanburg]{.underline}

They've been using about 90% McKesson, they're just about to roll out a
CPLE (sic), which will be the last of the clinical data elements that
they need.

They have a self-developed research system, Access database.

A collaboration in SC is putting together a clinical research project
using Click (sic) and Vellos.

Very interested in talking to caGIB about data repository.

Looking for a data mining system.

[Ascension Health]{.underline}

Have a hodgepodge of everything. They're moving towards Cerner, but have
Eclipsys in at least one of their sites participating in the pilot.

Their research system uses standard nomenclature, down to UML. They're
willing to share data, with the caveat of legal requirements. Some of
the system has to be extended, such as plug & play on devices for vital
signs). It sounds like different sites have different levels of support
for the research database. Milwaukee may still be using Excel?

They have two big issues/questions: 1) how much we'll really be able to
share data in the U.S. They think it will be important to get consumer
groups in involved/get their buy-in. 2) Linking trial support to
decision support system. Case management---what makes it easy? What
happens with payment systems, other audits and reviews (ex: OIG audit)?

Their biggest priority for their system is strategies for managing
billing, audits, and data sharing; and understanding the continuum of
care within larger communities.

They have issues with consent---they feel it has to be collected too
often...[they need to be able to share data to be able to understand the
community they serve]{.underline}. They suggest talking to AARP and
other big advocacy groups about this issue.

Is NCCCP going to work with OIG? Is it possible to have uniform access
to a giant CT registry, for example, to identify a patient who shows up
in an ER somewhere?

[Christiana]{.underline}

Primarily a Cerner shop, with a single sign-on for physicians, have
electronic signature process. HMS, SMS for billing. Pathology, radiology
software. Associated private practices are entirely paper based, but can
go online to access Christiana's system. Midas for case management.
Prodigy for genetic conseling.

They have a homegrown system for bone-marrow transplant, thoracic
outcomes, surgical oncology outcomes, outreach, tissue back, etc. but
are looking to convert to caBIG for tissue. Rocky Mountain tumor
registry. They have a structured data warehouse repository. Looking at
linkages to a NCI center (Jefferson?).

Delaware has the Delaware Health Information Network.

[St. Josephs, Orange County]{.underline}

One of 14 hospitals in their health system. They have standardized
applications throughout system, Meditech is their primary app. They have
138 apps supported at St. Josephs, about 70 are HL7 integrated. Have a
lot of experience with integration.

They currently pass data back and forth between many repositories.
Primarily manual input for cancer data? They are rolling out
standardization of assessment and CPOE throughout the hospital, which
will take about 2 years.

For the new cancer center that will open in 1 year, they'll be
implementing a new EMR. It's good timing, since they can incorporate new
standards. Have a lot of experience with web-type applications. Next few
years are trying to stabilize overall data foundation.

Their research data is separate from the EMRs. Can caBIG integrate with
Study Manager? Anything they adopt will need to integrate into Meditech.

[Sanford USD]{.underline}

Use Epic. Their goal is to have a single-patient identifier, a single
birth-to-death record. Off-site physicians must also use the system.
They use Lawson on the financial side, with some integration with Epic
(which has been very helpful).

They're 'in infancy' on the research data side, getting help from
USD---they need to move the data outside of the academic side of things,
into the clinic. They collaborate with the Mayo Clinic. Challenge: what
happens when a patient becomes a 'research' patient. This is excellent
timing for them to implement tissue banking w/caBIG, which will also
help with their translational research.

[Our Lady of the Lake]{.underline}

Cerner-based. They have installed CPOE, just put in oncology order
sheets. PAC for radiology, Lawson for billing. Primary care groups using
Meditech. They are having trouble getting Athena and Meditech to 'talk,'
and then communicate with Cerner. They see an opportunity to work with
caBIG for biospecimens and clinical research. Question: will there be
legal problems with data sharing within LOL?

[St. Josephs/Candler]{.underline}

They provide IT services to a 3rd hospital. They're a Meditech/Magic
shop---do not have EMR, but have a clinical data repository. They 'rent
out' IT support to associated private practices. Once they get EMRs
rolling, they'll install them there too. They've installed PAC for
imaging. The presenter wasn't sure what they're using for the clinical
trials registry.

[Hartford]{.underline}

They are 'fully wired,' moving towards using Eclipsys. They have Siemens
for registration, billing. They are fully integrated, except for
associated private practices who do their own thing. They are not linked
up to a research system (and they're not sure what they're using). They
have a data warehouse only for financial information.

Needs: they need to understand what data they need to share, and how to
do that/link up with other systems. They want to have to collect data
from patients only once.

They reinforced the difficulty of linking with private practice, with
lack of EMR or linkages. Is there a solution? This is something lawyers
are looking at now, and a place where hospitals could really add value.
They think the government could help---help them think creatively, out
of the loop. Is there a way to reduce the burden of Stark for community
hospitals?

Dr. Buetow brings up the idea that NCCCP, and in fact the comprehensive
cancer centers, have a real 'bully pulpit' to encourage commercial
vendors to work in transparent, standards-based connectivity.

[Billings]{.underline}

They are breaking ground on their own cancer facility. They have been
live on Cerner for about 3 years, it's their core environment. They have
SMS for financial \[but are converting to Cerner for clinical?---I
couldn't quite catch that\]. They act as ASP (sic) to other facilities
in the area).

When they build the cancer center, they will re-evaluate the systems.
They don't have any private-practice physicians, besides
anesthesiologists. This has allowed them to standardize to Cerner.

[Slide\--Next Steps and Logistics]{.underline}

-   We need IT contact(s) at each site

-   How would you like to communicate

    -   E-mail listservs

    -   Online forums

    -   Other?

-   Regularly scheduled teleconferences

    -   Monthly, twice monthly?

    -   Tues/Thurs 1-3 ET timeframe preferred

-   Your next steps

    -   Comprehensive site evaluation

-   Participate in caBIG

    -   [**http://cabig.nci.nih.gov**](http://cabig.nci.nih.gov/)

    -   Join caBIG Announce listserv