1. 1 © 2012 Oracle Corporation – Proprietary and Confidential Big Data Challenge – From EMR’s to Translational Research Miroslav Končar, PhD Oracle Healthcare Business Development Director HL7 Croatia Chair, Associate Professor for Biomedical Informatics

2. 2 © 2012 Oracle Corporation – Proprietary and Confidential What is Big Data Why it is important for Healthcare Providers Now

3. 3 © 2012 Oracle Corporation – Proprietary and Confidential MIT Big Data Definition What kind of big are we talking about here? U.S. Healthcare data is growing by 15 Petabytes a day – currently Up to 80% of healthcare data is currently unstructured. 5 million bytes (megabytes) Complete printed works of Shakespeare 20 billion bytes (gigabytes) Complete recorded works of Beethoven 10 trillion bytes (terabytes) Printed works in the Library of Congress 2 quadrillion bytes (petabytes) Google Earth information managed today Typical person’s EHR ~1MB healthy young, no images 40MB middle-aged w/health issues, no images 3-5GB with several health issues w/images 600 petabytes-10 exabytes (exabyte = billion gigabytes) Estimated size of current US digitized patient data 1.5 million Estimated different medical devices (WHO) Big Data: The management and use of ultra-large amounts of information Management and use = efficient storage, search, analysis, visualization Ultra-large = >1Petabyte

4. 4 © 2012 Oracle Corporation – Proprietary and Confidential Chronic Disease Mgt. Care Patterns Population Health Pay for Performance Telemedicine Patient Advocacy Customer Satisfaction Disease Mgt. / Prevention Social Media Interactions Care / Process Improvements Marketing / Branding Where Are Your Big Data Opportunities? Lower care cost and raise care quality Capacity Management Staffing Optimization Protocol Optimization Process Efficiency Supply Standardization Cost Accounting Personal Preferences Individualized Treatment Biometrics Data Management Apply Research New Clinical Protocols Accountable Care Patient Engagement Personal & Translational Medicine Operational Excellence 1 2 34

5. 5 © 2012 Oracle Corporation – Proprietary and Confidential Why Oracle for Big Data

6. 6 © 2012 Oracle Corporation – Proprietary and Confidential Big Data: Oracle’s Definition Large volumes, high change velocity, complex variety, unknown value per byte Emerging sources of data, ie. sensor, machine generated, social, images, unstructured, etc., that exhibit any or all of “the four V’s”, potentially integrated with “traditional” structured data Healthcare providers can acquire, organize, process, analyze massive amounts of data, primarily through the use of scale-out on low-cost hardware, non-relational data models, APIs The Four V s

7. 7 © 2012 Oracle Corporation – Proprietary and Confidential Oracle’s Leadership Across the Entire Healthcare Ecosystem Provides Us Unique Design Insights Leading provider in:  BioPharma  Clinical Trials  Translational Research  Healthcare Insurers  CMS  HIE & Insurance Exchanges  Population Health Mgt.  Healthcare Data Models  Healthcare Analytics  Interoperability  Identity & Security Mgt.

8. © 2012 Oracle Corporation – Proprietary and Confidential 8 Our Translational Research Center (TRC) Can Be Added For Those Involved in The Research Domain

9. 9 © 2012 Oracle Corporation – Proprietary and Confidential Customer Success Story Erasmus MC, The Netherlands

10. 10 © 2012 Oracle Corporation – Proprietary and Confidential Erasmus MC Erasmus Overview –The biggest Dutch University Medical Centre located in the City of Rotterdam –A 1.200-bed, 1.4BUS$ operational budget, 12.000 employees –Erasmus MC is one of the top 40 best research institutes of the world Long years an Oracle customer –Full ERP (financials, procurement, HR, learning management), Performance Management –Technology – Database, Fusion Middleware

11. 11 © 2012 Oracle Corporation – Proprietary and Confidential Translational Research in Erasmus Today - Clinical genetic testing is typically done for patients who are considered at risk of carrying genetic variations that are linked to a particular disease or disease predisposition. Next step - all variants in coding and non-coding DNA is mapped at once. The vast amount of knowledge that is offered by whole-genome sequencing can provide the scientics with new oppprtunities for disease management Barrier – how to manage vast amounts of data in real time, and manage all risks associated (security, perfromance, etc)

12. 12 © 2012 Oracle Corporation – Proprietary and Confidential Genome sequencing is time and resources demanding process –Complete human variants per sample generate 1.5TB of data Need to provide overview of all variants in genetically defined populations –Variations are displayed in the context of public knowledge –Statistical quality measure for variants –Disease association and functional impact Provide easy access to translational research scientists –Simple search web page to access variation data –Summary reports for disease association –Cytogenetic visual representation of variations HuVariome Database – Business Problem

13. 13 © 2012 Oracle Corporation – Proprietary and Confidential Why Oracle Exadata Data storage is 10x smaller, Scanning process is 2000x faster

14. 14 © 2012 Oracle Corporation – Proprietary and Confidential Conclusion Complete genomics offer new opportunities for disease management –Identifying novel DNA variants relevant for Dx and therapy –Companion diagnostics for targeted therapy Key areas of research – cancer conditions Visit Erasmus and HuVariome project at –http://www.erasmusmc.nl/http://www.erasmusmc.nl/ –http://www.youtube.com/watch?v=KVvVs2 SVfHUhttp://www.youtube.com/watch?v=KVvVs2 SVfHU

15. 15 © 2012 Oracle Corporation – Proprietary and Confidential miroslav.koncar@oracle.com