BIG Health Concept Submission Form

The BIG Health Consortium™ is currently selecting and prioritizing a series of concepts to be presented. To propose a concept, please complete the form below. You may also download the form here and submit it by email to Malcolm James (actiongroupconvener@bighealthconsortium.org) or Marcia Kean (connector@bighealthconsortium.org)

( * indicates required fields )

* Name:
* Organization/Affiliation:
* Email:
* Phone:
* Concept Title (This title should serve as a brief description of the project):

* Concept Initiator (Please list at least one person or organization who will be in charge of presenting this concept):

* Targeted Team Members (You may list actual individuals or outline the types of organizations that would be needed to successfully complete this project):

* Concept Description:

* Concept Team Goals:

* Concept Timeline:

* Expected Resource Needs:

* Key Words, Diseases/Conditions, etc.:

* How does this concept tie back to the BIG Health Consortium™ vision to link research and care to achieve personalized medicine?:

* Which of the following BIG Health Consortuim™ goals does this concept include? (Please check all that apply):
Demonstrates how different sectors within the life sciences and/or healthcare can come together in an ecosystem to implement personalized medicine in the real world
Utilizes the tools, infrastructure, and/or standards of NCI's informatics infrastructure (caBIG®) to implement personalized medicine in the real world
Illustrates a self-sustaining model for implementing personalized medicine
Illustrates how clinical care, clinical research, and scientific discovery can be connected in a seamless continuum that speed innovation and benefits patients
* Does this concept touch more than just one group?
* Is this concept multi-institutional?
Please list the potential institutions involved:

* What is the current reach/scope of this concept?
* Does this concept have the capacity to be scalable?
Please list how you might propose it be scaled:

* Is this concept sustainable?
Please list how you would propose sustaining this concept:

Additional Information: