Healthcare Thinktank Roundtable

1. Healthcare Disruption Nick van Terheyden, MD @drnic1 Chief Medical Officer, Dell HCLS

2. In the next 10 years, data science and software will do more for medicine than all of the biological sciences together Vinod Khosla

3. Dell - Restricted - Confidential 2009 Continua Health Alliance Brigitte Piniewski, MD2008 3 0 25 65 Age IllnessPre-IllnessWellness Unpredictable Health Predictable (Rules-based) Health Death 60-80% Lifestyle Modifiable Health

4. Dell - Restricted - Confidential 2008 4 0 25 65 Age IllnessPre-IllnessWellness Death To put it another way…. Fun No Fun 2009 Continua Health Alliance Brigitte Piniewski, MD

5. Dell - Restricted - Confidential Source: U.S. Bureau of the Census The population is aging Source: Wu, Shin-Yi and Green, RAND Corporation And getting sicker Number of People With Chronic Conditions (in millions) Over 1 in 4 Americans have multiple chronic conditions Source: Medical Expenditure Panel Survey, 2006 Older Adults Are More Likely to Have Multiple Chronic Conditions Source: Medical Expenditure Panel Survey, 2006 13% 16% 19% 20% 20% The problem starts with the chronic disease epidemic

6. Dell - Restricted - Confidential Number of Quality Measures exploding…

7. Dell - Restricted - Confidential Serving more than 50% of U.S. hospitals providing care to 90 million Americans Leading IT provider for 1st, 2nd and 3rd generation gene sequencing 15,000+ Healthcare associates 300+ MDs, RNs & PhDs Over 130+Hospitals &750+ Physician Groups use ourSecure EMRCloud. #1 Worldwide Healthcare IT Services Vendor for the fourth year in a row Serving 7 of the top 10 pharmaceutical companies Managing over 10 Billion Medical Images on the Dell Cloud Enterprise Archiving Platform Serving 100+ insurance organizations supporting 65 million policy holders Manage14billion security events adayfor150+clients. Dell is Leading theWayin Healthcare & Life Sciences Provide OEM services to 70+ Healthcare and Life Sciences software, medical device and scientific instrument providers Managed 400+ revenue cycle engagements, recovering $15 billion for clients over 7 years

8. Dell - Restricted - Confidential Dell strategy Our customers’ imperatives Our End-to-End Portfolio Delivering technology solutions that enable people everywhere to grow, thrive and reach their full potential Our purpose Our differentiated strategy Superior relationship model Efficient, simple and affordable Practical innovation The leading provider of end-to-end scalable solutions Connecting END USERS Integrating and optimizing the ENTERPRISE Simplifying and securing through SOFTWARE Accelerating innovation with SERVICES

9. Dell - Restricted - Confidential High Level Trends • Consumer Empowerment • Automation • Connected Health • Population Data • Big Data • Healthcare IT

10. Dell - Restricted - Confidential Consumers Taking Charge • Increasing choice for Health plan selection • Pre-deductible Spending – HDHP, HSA and FSA • Post-deductible Spending – Amplification • Consumer Influenced Spending – The Google Effect, WebMD and DTC Advertising • Direct Consumer Spending – Activity Tracking, Wellness and Even Chronic Disease (Diabetes)

11. Dell - Restricted - Confidential Technology Driving Improvements • Widening access and Offering of the (Healthcare) Cloud • Smartphones and Mobile Access – Not just about the phone but adjunct technology including GPS, accelerometers, body sensors and cameras (today) • Drug Development Targeted Therapeutics to Specific Disease – Managing the Patent Cliff and focusing on Specific Disease (Hepatitis C, Cohn's, Cancer) – Targeted groups, messaging to specialists and patient communities

12. Dell - Restricted - ConfidentialGraphic Source: ClinicalTrials.gov, accessed June 6, 2014 at http://clinicaltrials.gov/ct2/resources/trends Complexity of Modern Medicine “The complexity of modern medicine exceeds the inherent limitations of the unaided human mind” – David Eddy, 1990

13. Dell - Restricted - Confidential Future Healthcare • Applied and Predictive Analytics – Dell Population Health Analytics, Boomi • Telehealth – eVisit, HealthNet Connect, Healthspot and Secure Healthcare Cloud/Clinical Archive • Patient Engagement – Social Media, Analytics and Mobile Clinical Computing, Boomi • Wearables and Internet of Things – Mobile Clinical Computing, Data Integration • Genomics and Precision Medicine – Data Archive and Big Data Storage and backup • Oh and by the way Securely

14. Dell - Restricted - Confidential What is predictive analytics? Data Demographic Social Behavioral Financial DataAggregation Machine Learning Machine learning crunches data to build a predictive model PredictiveModelDeployed Predictive Model PredictiveScoreGenerated The predictive model acts on “unseen” data Buy or Click Churn or defect Default or prepay Die or become diseased / infected Commit fraud , crime or terrorism Likelihood to… Breakdown or become defective The output is a score

15. Dell - Restricted - Confidential Applied and Predictive Analytics • Unstructured sources are diverse and distributed – Clinical Notes, Medical Records – Healthcare systems (laboratory, imaging, diagnostic) – Communication channels that can include › Social Data, blogs, sentiment › Video content › Audio files › Text, email, word documents › Support and on call, customer service, home visit – Future data from “-omics” – Helping Customers capture, process, integrate and store

16. Dell - Restricted - Confidential 300K Annual deaths as a result of “preventable harm” in hospitals University of Iowa transforms the operating room with real- time analytics Goals: • Predict patients with the biggest risk of surgical site infections • Reduce infection rate to improve patient care and decrease costs Solutions: • Merge historical EHR data and live patient vital signs to predict infection likelihood • Provide doctors with real-time, predictive decisions, using Dell Statistica, during surgical procedures so they can create a plan to reduce risk Results: • 58% reduction in occurrence of surgical site infections • Personalize healthcare based on patient’s own characteristics • Reduce cost of patient care

17. Dell - Restricted - Confidential Taking action on critical asthma events Goals: • Deliver SMS alerts to patients about impending asthma events • Dashboards delivered to alert case managers of the status of their registry of asthma patients • Email notification to emergency rooms forecasting volume and specific patients likely to present for the coming week Solutions: • Integrate and correlate EHR and other data (air quality, weather details and pollen count) using Dell Boomi • Aggregate and virtualize data with Toad Intelligence Central • Analyze and predict the likelihood of these events and provide patient level scores using Dell Statistica Results: • Patients engaged with information for self care • Case managers can provide best quality of care at the lowest cost for their patients • Emergency rooms can effectively staff and allocate resources >3,000 Annual deaths due to asthma. Many of which are avoidable.

18. Dell - Restricted - Confidential Genomics, Sequencing and Data • Took $3 Billion and 10 years to sequence one genome • Sequence in days even hours and for <$1,000 • Explosion of data just to sequence the genome – Plans to sequence 14M new cancer patients every year which would generate 5.6 Exabytes of information. • But there’s even more data in -omics 18 Global bioinformatics market to reach $13B by 2020 21% CAGR1 >5.6 Exabytes to sequence 14M new cancer patients worldwide per year2 Sources: 1. Allied Market Research, Global Bioinformatics Market, 2013-2020 2. http://www.cancerresearchuk.org/cancer-info/cancerstats/world/incidence/ 3. http://www.technologyreview.com/news/531091/emtech-illumina-says- 228000-human-genomes-will-be-sequenced-this-year/ 228,000 whole human genomes sequenced in 2014 1.6M by 20173

19. Dell - Restricted - Confidential Mobile healthcare helps reach more patients Outside the hospital, telehealth and the Internet of Things (IoT) help improve patient outcomes and avoid costly readmissions

20. Source: Qmee July 2014, http://blog.qmee.com/online-in- 60-seconds-infographic-a-year-later/ Every minute of every day…

21. Dell - Restricted - Confidential The Quantified Self Meet Chris Dancy and His 10 devices he wears or carries and 13 more in his home and car

22. Dell - Restricted - Confidential Wearable's and Internet of Things will surpass smartphones and personal computers by 2018 Internet of Things Tablets Smartphone Personal Computers

23. Dell - Restricted - Confidential Number of health apps available for smart phones 100,000 Devices and applications are going to flood the market 2020 – 25 billion devices expected to be on the Internet of Things

24. Dell - Restricted - Confidential Serving more than 50% of U.S. hospitals providing care to 90 million Americans Leading IT provider for 1st, 2nd and 3rd generation gene sequencing 15,000+ Healthcare associates 300+ MDs, RNs & PhDs Over 130+Hospitals &750+ Physician Groups use ourSecure EMRCloud. #1 Worldwide Healthcare IT Services Vendor for the fourth year in a row Serving 7 of the top 10 pharmaceutical companies Managing over 10 Billion Medical Images on the Dell Cloud Enterprise Archiving Platform Serving 100+ insurance organizations supporting 65 million policy holders Manage14billion security events adayfor150+clients. Dell is Leading theWayin Healthcare & Life Sciences Provide OEM services to 70+ Healthcare and Life Sciences software, medical device and scientific instrument providers Managed 400+ revenue cycle engagements, recovering $15 billion for clients over 7 years

25. Patient Engagement is the blockbuster drug of the century Leonard Kish Principal and Co-Founder at VivaPhi

26. Dell - Restricted - Confidential Hi Tech Medicine

27. Dell - Restricted - Confidential Nick van Terheyden, MD CMO, Dell Health and Life Sciences AboutMe http://about.me/obiwan Twitter http://twitter.com/drnic1 LinkedIn http://www.linkedin.com/in/nickvt Blog http://drnick.vanterheyden.com/ FaceBook http://profile.to/drnick E-Mail DrNick@dell.com, drnic1@gmail.com Google Voice (301) 355-0877 Where you can find me

28. Do more. Healthcare. Are you ready to… Do more of what’s possible, Do more of what matters, Do more of what brings success?

29. Healthcare Disruption Nick van Terheyden, MD @drnic1 Chief Medical Officer, Dell HCLS