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6 Concluding Remarks Wylie Burke, M.D., Ph.D. Catherine Wicklund, M.S., C.G.C. Burke and Wicklund were asked to list the main themes they had heard throughout the day’s discussions. Burke remarked that she noted five main themes: 1. The issues for genomic translation are embedded in issues for trans- lation and health in general in our system. The problems that exist in the system are inescapably part of genomic translation. 2. Innovation should be supported, and technology can help reduce cost and increase patient convenience, but it should never entirely replace the opportunity for doctors and patients to interact. 3. There is a lack of robust methods for collecting and assessing data on innovative services in order to determine which ones are ben- eficial and which are not. 4. There is a potential need for a public–private partnership to gener- ate data, particularly data from health systems with large popula- tions in electronic databases (e.g., Veterans Administration). 5. Health technology assessments need to be deliberative processes that are prospective in nature. Wicklund observed that discussion seemed to center around five dif- ferent tensions: 1. “First, do no harm” versus encouraging innovation 2. Gathering data versus moving forward with “enough” data 3. Information technology versus the human element of medicine 

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 INNOVATIONS IN SERVICE DELIVERY IN THE AGE OF GENOMICS 4. Providing services that are appropriate versus providing services that are reimbursable 5. Providing access to genomic services to those who can afford them now versus the potential to exacerbate disparities As a final point, one participant suggested that rather than trying to collect data on patients during their physician visits, genomics researchers might try to find a Framingham of their own to study an entire population over many years. She posited that many people in this nation would volun- teer for such an endeavor. She noted that “the perfect is the enemy of the good” and cautioned against doing nothing for fear of not fixing the system entirely. She encouraged the Roundtable members to do what they can do, rather than what they should do—at least they will have done something. The meeting was adjourned.