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

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 Healthcare is at a Pivotal Juncture in History

UPMC’s Global Academic Integrated Delivery and Finance System (IDFS) IDFS structure promotes high quality, low cost care and unleashes innovation while others live “Life in the Gap” Insurance Services International and Commercial Services Physician Services 21+ hospitals 234,000 admissions >4.8M outpatient visits 3,321 employed >5,500 total 2.0 M members Hospitals: Italy, Ireland and others 55,000 employees, $10B Revenue Enterprise Services Oracle Informatica Hospital and Community Services

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

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

Smart Technology… …Bringing Intelligence to Information

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

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

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

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

VOL., CLX … No. 55,495SATURDAY, 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 Center of Advanced Genetic/Genomic, Computational Biology Research Leading to Personalized Medicine at the Bedside Unleashing Unlimited Commercial Opportunities and Industry Partnerships around Health IT, Personalized Drug Therapy, and New products not yet imagined The Fondazione Ri.MED Biomedical Research and Biotechnology Center 17 Oracle Informatica

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

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

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

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