I'm honored to provide you an example of how performance measures are being defined at a global level. We will talk a little bit about The International Consortium for Health Outcomes Measurement or ICHOM. Global thought leaders identified that healthcare should be based on the concept of value. This idea that we compare outcomes that patient experience, relative to the cost of delivering those outcomes. And that we really need to restructure our care-delivery systems around promoting superior outcomes with appropriate financial incentives that will benefit every stakeholder across the healthcare spectrum. Although we widely share these goals, systems have been unable to achieve them. And one of the key critical pieces that have been missing is outcomes measurement. So here are some examples when we talk about patient outcomes, what does that look like? It could be things such as how soon after treatment can a patient with low back pain expect to return to work? How likely is a man to experience incontinence or sexual dysfunction after treatment for localized prostate cancer? Will a patient diagnosed with macular degeneration today be able to read normally one year, two years, or five years from now? Those are outcomes that are important to patients. In 2012, a group of thought leaders came together to form ICHOM. This included: Professor Michael Porter from the Harvard Business School, Martin Ingvar from the Karolinska Institute in Sweden, and the Boston Consulting Group. And this organizations came together with the mission to unlock the potential of value-based healthcare by defining global standards sets of outcome measures that really matter to patients for the most relevant medical conditions and by driving adoption and reporting of these measures worldwide. I provided a link to the ICHOM website if you're interested in learning more. Into funding the organizations mission I've actually identified or underlined four important parts that I wanted to highlight for you all. One is the global standard sets. The idea is here that ICHOM is going to define what is important in terms of patient outcomes, and take a very global perspective. These would be sets that could be used whether the patient is in Brazil or India or in the United States. The next piece that I wanted to highlight was outcome measures. So these are what actually happened to the patient. What is the patient experience and the focus isn't here on the process measures or the structure measures of providing care, but on outcomes and what happened to the patient. Another important part of this is what really matters to patients. So in defining these global standard sets ICHOM is using and bringing patients to be part of the group to really understand what matters to patients in terms of outcomes. And ICHOM is focusing on the most relevant medical conditions, so they aren't necessarily going to define a global standard set for every medical condition, but they're really trying to target those medical conditions that are large in number and have a significant impact on disease burden. So how does ICHOM work? Well, their goal is to standardize health outcomes data globally, so that doctors whether they're in India, Germany, Brazil, the United States and other nations can evaluate their patients using a universal language and that language has health outcomes. They've brought together experts and patients from around the world to help define those outcomes. And since the founding of the organization in 2012, ICHOM has defined 23 standard sets and this covers 54 percent of the global disease burden. I think to give you an example of one of the standard sets that ICHOM has developed, this is for pregnancy and childbirth. Working with experts and patients they've actually defined health outcomes into four domains. So starting at the top of the circle and working our way around clockwise, the measures fall into areas such as survival, morbidity for both the mother and the baby, patient reported health for the mother and the baby, and patient experience with care. So, it is this combination of 15 measures or so that would be used to track performance of how a healthcare system does around issues of pregnancy and childbirth. Another example of a standard set that ICHOM has developed is around localized prostate cancer. Working with experts and patients they defined health outcomes into three domains. Starting at the top of the circle and working our way around clockwise. These include acute complications of the care that was actually provided or the treatment provided, patient reported health statuses. So how did the patient do after the treatment? Do they have issues with sexual dysfunction or urinary incontinence? And the final area of measures is around survival status. So, what was the patient's prognosis a year later? What was their survival rate five years later? As I may have mentioned ICHOM has completed 23 completed standard sets. This slide lists the standard sets if they've already completed. This does represent 54 percent of the global disease burden. Plus they're working on nine additional or ramping up nine additional standard sets as well. But ICHOM recognized it was important to define standard sets and that was a very important first step. But what they realized early on was when also needed to have a plan of how to drive those into action. How do you ensure that those standards sets get used? So they've also spent a lot of time thinking about how do we get healthcare systems to adopt and implement these standard sets. We've really outlined four steps for the implementation of these standard sets. The first step is to engage and prepare, find those key folks who really believe in this and want to get these standard sets use, engage senior management, engage the workforce. Really find champions for using this type of information. You also need to set up a multi-disciplinary project team, assess your starting point, identify what your goals are and then map out your project plan. The second step towards implementation is to set up actual data collection. You want to develop a data capture model, where are you capturing these data? When are you capturing these data? And identify the tools that you wish to use. How are you going to capture those data points? The third step for implementation is to measure and analyze. So, once the data have been collected, you want to verify the accuracy of your data to ensure it's of high quality. You want to review your goals and ensure that you analyze and risk-adjust data that are appropriate. And then report your data in the most meaningful way. The fourth step towards implementation is to learn from those data and to drive change. Review your outcomes data. Learn what you could do differently, learn what you can do better for your patients, and identify best practices and opportunities for improvement. Ultimately, what we want healthcare organizations to drive towards is an outcomes culture, one where they drive change to the organization to improve the healthcare for their patients.