The Age of Personalized Medicine Moves Research to

The Age of Personalized Medicine Moves Research to the Bedside The UPMC Strategic Framework Steven D. Shapiro M. D. Executive Vice President, UPMC Chief Medical and Scientific Officer President, Physicians Services Division

Healthcare is at a Pivotal Juncture in History • Greatest challenge: – Aging population, increasing chronic disease – Costs are spiraling • But also a great opportunity with revolutions in science and technology The way forward for UPMC • Develop New Models of Clinical Care • Based upon Big Data and Big Science • Leading to improved to Personalized Care

UPMC’s Global Academic Integrated Delivery and Finance System (IDFS) 55, 000 employees, $10 B Revenue Enterprise Services Hospital and Community Services • 21+ hospitals • 234, 000 admissions • >4. 8 M outpatient visits Physician Services • 3, 321 employed • >5, 500 total Insurance Services • 2. 0 M members International and Commercial Services • Hospitals: Italy, Ireland • and others Oracle Informatica IDFS structure promotes high quality, low cost care and unleashes innovation while others live “Life in the Gap”

The UPMC Strategic Framework Smart Technology Big Data Good Science Big Science New Models of Care Improved Outcomes - Cost Effective

New Models of Care: System Re-Design Coordinated, Continuous, Patient-Centered Care Personalized Medicine Care Pathways / Analytics Medical Neighborhood Specialty Care Supporting Finance Horizontal Analysis Cost Accounting Bundling Patient Self-management Telehealth Medical Home Primary Care Team Hospital Emergency Department ICU Re-engineer Discharge Palliative / Support Care Skilled Nursing Facilities Hospice

Smart Technology… …Bringing Intelligence to Information

Enterprise Analytics Delivering real-time data to the bedside Enterprise-Level Data Warehouse Advanced data mining Harmonize structured data (db Motion) and unstructured data (Nuance) Aggregate data into central data warehouse: Cerner, Epic, Peoplesoft, Health. Pla. NET, etc. Clinical Data (Provider) Financial Population Data (Payer) Ask new questions Make digital information usable Ingest over 200 data sources • Deliver better outcomes/optimize cost • Develop new models of care Genetics Genomics • Enable the center for innovative science

Big Data and Big Science for Appropriate Variation in Care and Personalized Medicine Big Data Analytics Clinical Redesign DECREASE variation in population care Big Science “omics” + Systems Biology Personalized Medicine INCREASE variation in individual care Go from “Syndrome” to precise individual network

Framework for Good Science – Personalized Medicine Environment Diet, infection, smoking, pathogens… HOST Genetics Time: Growth and Development, Adult Aging INDIVIDUAL DISEASE Susceptibility, Course, Treatment response Basic science, Drug discovery Discover new treatment for aggressive disease Biomarkers Individualized care, Prevent Over. Dx/Rx Prostate, Breast CA Examples

Better Personalized Medicine Genomic Tests DNA, RNA Patient Samples Proteomics Tests Bioinformatics/ Systems Biology Hyperplexed Pathology Patient Stratification, Diagnostic/Prognostic Tests & Companion Diagnostics

VOL. , CLX … No. 55, 495 SATURDAY, JULY 7, 2012 IN GENE SEQUENCING TREATMENT FOR LEUKEMIA, GLIMPSES OF THE FUTURE

Where are the Innovators in Health Care? • Integrated global delivery system • Academic partner • Commercialization engine • Unleashes innovation “…bad business model preventing innovation” C. Christenson, Harvard Business School

The Fondazione Ri. MED Biomedical Research and Biotechnology Center • The Center of Advanced Genetic/Genomic, Computational Biology Research • Leading to Personalized Medicine at the Bedside Oracle Informatica 17 • Unleashing Unlimited Commercial Opportunities and Industry Partnerships around Health IT, Personalized Drug Therapy, and New products not yet imagined

The General Process of Becoming Affordable and Accessible 1. First bring the problem to the solution 2. Then bring the solution to the problem Minicomputers Desktops Laptops Smartphones Copyright Clayton M. Christensen

The Decentralization That Follows Centralization is Only the Beginning of Healthcare 1. First bring the problem to the solution 2. Then bring the solution to the problem Imaging: MRI, CT, PET Scanners High-speed, Multi-Channel Testers Specialist Physicians Clinics Personal Physicians Offices Nurse Practitioners Retail Clinic Homes Surgical Suites Pharmacists Family Care

Center for Innovative Science Areas of research focus include: § Personalized Medicine § - Core to enable campus § Cancer Biology § Biology of Aging 20

The Fondazione Ri. MED Biomedical Research and Biotechnology Center Carini, Italy