Grey literature – an umbrella term for almost everything not published by commercial publishers – is an important source and product of policy and research. The National Library of Medicine (NLM) collects and archives a wide range of this work, but as both volume and interest in this work increases exponentially how do we determine what is relevant, what is important to preserve, and how best to support future research? Lisa Lang, head of the NLM National Information Center for Health Services Research and Health Care Technology, Erin Holve, a director at AcademyHealth and Bill Silberg, director of communications at the Patient Centered Outcomes Research Institute (PCORI) participated in a Monday morning ARM panel looking at the issues and opportunities of systematically addressing knowledge management for HSR in this century. It was, as Lisa Lang put it,” a discussion at the intersection of the possible and the imperative.” Lang pointed out that various factors--from the establishment of PCORI to the “data liberation” movement espoused by Todd Park, U.S. Chief Technology Officer, to the creation of a new data infrastructure a la the EDM Forum and the imminent use of electronic medical records--raise new questions about what “counts” as grey literature, how we evaluate its relevance and rigor and how we index it in a way that is useful. She enumerated the challenges of identification, access and quality, and raised the point that grey literature is no longer confined to “literature” at all – many models and media exist. Silberg and Holve discussed the current environment from different perspectives, but shared a common theme: no matter what you call it, we need credible, validated, easily accessed, information for research and policy making. Holve in particular, looked at the ways the research landscape is being transformed, with a shift to a “data ecosystem” where information is flowing and changing with use and engagement. Her remarks reflected a researcher’s perspective, raising the issues of grey literature and peer review in promotion in tenure, alternates publication options, and new modes of review, validation and dissemination such as open access online publishing, the H-index and Google Scholar. Asked Holve, “How much does grey status matter if you can be found, your methods are transparent, and you can be unambiguously cited?” Silberg represented more of a research consumer perspective – focused on what users of research, including patients and their care providers need. As such, his talk focused more on the strengths and relative weakness of both grey literature and traditional publishing and how we might move forward. He noted that electronic publishing and data are increasing pressure on traditional publishers and feeding exponential growth of gray literature, which is more nimble, more easily accessed and, in some cases, more focused on answering practical, real world questions. Said Silberg, “We need information resources that answer people’s questions and help them solve problems when they need it.” To shift the conversation, he suggested that we focus on the information itself and not its form, format and mode of production; that we pay more attention to authority, credibility, utility and value to intended audiences; that we reconsider how we evaluate impact, focusing more on metrics like article level use and author contributions over time; and that we align professional, academic and commercial incentives accordingly.