Full Service Diagnostics...In vitro In vivo Workload volume increasing Staff & skill mix decline...

Copyright © 2007. Siemens Medical Solutions Diagnostics. All rights reserved.

Full Service Diagnostics

Mr. Dave HickeyVice President of Strategic Marketing and Planning

Tarrytown, NYSiemens Medical Solutions Diagnostics

The Coming Convergence of Imaging, Informatics & In Vitro Diagnostics (IVD)

Siemens Medical Solutions Diagnostics © 2007. All rights reserved

MagneticResonance

In Vivo Diagnostics (Major Medical Imaging Systems)

ComputedTomography

X-ray MolecularImaging

Immuno-diagnostics

ClinicalChemistry

Molecular Hematology LabAutomation

Urinalysis Blood Gas

In Vitro Diagnostics (Major Medical Laboratory Systems)

Healthcare IT

Ultrasound Preclinical Imaging

Integrated medical data translated into actionable knowledge

First Full Service Diagnostics Company


A AudiologyAX Angiography,

Fluoroscopy,Radiographic Systems

CO ComponentsCT Computed

TomographyDX DiagnosticsGS Global SolutionsHS Healthcare ITMI Molecular ImagingMR Magnetic

ResonanceOCS Oncology Care

SystemsRV Vacuum

TechnologySP Special SystemsSW Software FactoryUS Ultrasound

Knoxville MI

Madrid SP

Goa CO

Concord OCS

Hoffmann Estates(Chicago)

MIAX Piscataway

A

Oxford MR Erlangen/Forchheim

AX, SP, CT, GS, MR, AHS, CO, RV, SW

Singapore A

Shanghai CT, AX, CO

Malvern HS

Mountain View US

Suzhou A

Divisions

Manufacturing Sites

Shenzhen MR

Kemnath CO

Rudolstadt RV

Bangalore SW, HS, US

SeoulR&D Center

Kyongju-siUS

Wuxi RV

Indonesia A

> 40,000 employees worldwide

Americas Europe Asia

Tarrytown DX

Los AngelesDX

Siemens Medical International Scale


Growing demand for healthcare

MajorImplication

Demographic Change

i.e. agingand growingpopulation

RelevantMegatrend

Capturing of efficiency potentialin healthcare systems

Healthcare costs

MajorChallenges

Continued Cost Containment and Pressures From Growth

GrowthOpportunities

WorkflowImprovement,e.g. through:

Earlierdiagnosis &interventionDiseaseorientationKnowledge-based decisionsupportIntegrated IT systems

Opportunities For Growth In HealthcareMegatrends in Demographic Change


Lab Challenges

Reimbursement

Work flow

Market demand

Oversight & compliance

Competition


In vitro & In vivo – are they different?

In vitro In vivoWorkload volume increasing

Staff & skill mix decline

Purchases of capital equipment

Budgets flat to reducing

Biomarker strategies

Generate complex images

Clinical decisions with images

Efficiencies in patient imaging workflow

Workload volume increasing





Generate complex data

Clinical decisions with data

Efficiencies in laboratory processes and workflow






Generate complex data

Clinical decisions with data

Efficiencies in laboratory processes and workflow


In vitro & In vivo – are they different?

Integrated Diagnostics

In vitrosolutions

In vivosolutions

Generates multi-dimensionaldata






Multi dimensional data

Clinical decisions with results

Efficiencies in total workflow


Healthcare Continuum

Prevention Diagnosis Therapy Care


‘Adverse Events’

Actual(without ‘Adverse Events‘)

Ideal

Projected Without Adverse Events

‘Adverse Events’

Costs for the insured

Prevention /Early Detection Diagnosis Therapy Care

Up to:90,000 deaths2,000,000 adverse drug events

…in the US every year

Source: Institute of Medicine, To Err is Human, 1999, p.26. American Hospital Association. Hospital Statistics. Chicago. 1999;

RAND study, Journal of Health affairs, September 2005; Institute of Medicine, Preventing Medication Errors, 2006

Improved Healthcare Efficiency


Future Trends in Medicine

Dr. Elias Zerhouni / NIH

Predictive

Preventive

Personalized

Copyright © 2007. Siemens Medical Solutions Diagnostics. All rights reserved.

Siemens Medical Solutions Diagnostics

Vision & Strategy


We help our partners to provide …

Prevention / Early detection Diagnosis Therapy Care

…high quality and patient-centered care ...

... with best processes…

… and with proven outcomes.

... along the healthcare continuum…

Siemens Vision


The Evolution Of Medicine


Analyzes knowledgeRepeats results Analyzes workflows

Efficiency

Craft medicine Disease management

Patient-centric healthcare

Time


The Future Is Integrated

Healthcare IT

In Vivo

In Vitro

Convergence of in vitro diagnostics …with advanced imaging systems…for optimal therapy …yields personalized patient care


Improving Healthcare Efficiency

Time

Workflow

Cost

Process Optimization

Innovation

Through:

PROVEN OUTCOMES



Improving Healthcare Efficiency

Improved workflow


Workflow Know HowServices

Diagnostic /Therapeutic

TechnologiesHealthcareIT Systems

Networking

Optimization ofHealthcareWorkflow

IT and molecular medicine are key areas in the future!

Including Molecular Technologies:Proteomics, Genomics

The Required Portfolio


Strengthening The Portfolio


One

HDP - Healthcare Delivery Projects

Project idea Concept PartnershipPlanning Implementation


Healthcare Consulting

Global Solutions

Healthcareprofessionals

Medicaltechnologyengineers

Medical ITspecialists

Businessmanagement

experts

Healthcareeconomists Clinical & business

process optimization

Technology & infrastructureplanning & integration

Strategy & management


In Vitro Diagnostics

Prevention Diagnosis Therapy CareScreening Early detection

Individual therapy

Treatment efficacy


Molecular Medicine Revolutionizing The Healthcare Continuum

Prevention Diagnosis Therapy CareEfficient prevention

Accurate diagnosis

Personalized therapy

Ongoing care

Molecular Medicine advancements converted into new In VitroDiagnostic and Molecular Imaging technologies

Integrated medical data translated into actionable knowledge


Measurement Signals For In Vivo Processes

Morphology Physiology Metabolism Molecules

CT

US

MRI

NM

MI

106-108

/cell

1/cell

In vitro

In vivo


Molecular Medicine will Change Diagnosis and Treatment of Disease

Today’sProcedure

MolecularProcedure

DNA Chips

MonitoredPrevention

Prognostic Markers

DNA Chips

DiseaseProgression

Current Costs ~ 5 % ~15 % ~80 %

GenomicProfiling

Cancer Progression

Screening,In Vitro Marker

Anatomical Imaging

SurgeryRadiation

Chemo

PETDrug Monitoring

Minimal Invasive

Chemo Radiation

Individualized Drugs

Molecular ImagingProtein Chips

Drug Monitoring Therapy Planning

Surgery

Disease Progression – Example Cancer

MetastasisPredis-position

Cancer Releases Markers

Cancer Grows

First Cell Mutations

Cancer Starts


The Future Is Integrated

010100010011010101001101110

1101010010111011101010100110

Healthcare IT

In Vivo

In Vitro


Improving Biomarkers

FDG FDDNP*

*-IND filing successfully submitted as of July 31st, 2006

Improved diagnosis and monitoring of Alzheimer's disease.


Moore’s Law (1965)

Transistors

10,000

1000

1970 2000

100,000

1,000,000

10,000,000

100,000,000

1975 1980 1985 1990 1995

40048008

80808086

286386TM Processor

486TM DX Processor

Pentium ProcessorRPentium II ProcessorR

Pentium III ProcessorR

Pentium IIII ProcessorR

The number of transistors on an integrated The number of transistors on an integrated circuit & therefore performance will double circuit & therefore performance will double every 18 months.every 18 months.


Laboratory Tests In Clinical Practice

?Tests

2000

1000

1956 2006 2016

3000

4000


30-Sec.-Scan: 3,687 axial images with 64-slice Dual-Source CT compared to 41 axial images taken earlier with 2-slice CT

Dual Source 64-Slice CT2-Slice CT

Managing & Analyzing Image Data


CT Then & Now

SOMATOM Sensation 64 (2005)

0.33s = 64 slices

SIRETOM (1974)5 min = 1 slice


Triple Bypass Visualized


Seeing Is Believing?

Are the horizontal lines parallel or do they slope?

Count the black dots!


Earlier diagnosis and more efficient treatment of patients. Integration of anatomical pathology imaging and results with molecular imaging results

Potential new imaging applications following in vitro diagnostic patient risk assessment or screening programs

Medical imaging of patients at an earlier stage of disease and with fewer symptoms

Improvements in workflow – having the right lab value available before the scan

Implications For Radiologists & Pathologists?


Pathology & Radiology As A Diagnostics Service?

, MDBruce Friedman

Substantial overlap between the

mission of the two specialties --

diagnosis of disease through images

and the analysis of biomarkers --

already exists.

Enhanced clinical and research value

of the merged LIS, RIS, and PACS

databases.

The integrated reports of pathologists

and radiologists working collaboratively

would achieve higher levels of quality.

The merger of medical imaging,

molecular imaging, and molecular

diagnostics is already taking place on a

very active basis in multinational

corporations.

The science and research agendas of

molecular imaging and molecular

diagnostics already demonstrate

extensive overlap.

Substantial overlap between the

mission of the two specialties --

diagnosis of disease through images

and the analysis of biomarkers --

already exists.

Enhanced clinical and research value

of the merged LIS, RIS, and PACS

databases.

The integrated reports of pathologists

and radiologists working collaboratively

would achieve higher levels of quality.

The merger of medical imaging,

molecular imaging, and molecular

diagnostics is already taking place on a

very active basis in multinational

corporations.

The science and research agendas of

molecular imaging and molecular

diagnostics already demonstrate

extensive overlap.

1.

2.

3.

4.

5.

10 Reasons for Merger of Pathology and

Radiology as a Diagnostics Service Although the specialty of radiology has

made great progress with interventional

radiology, clinical specialists such as

cardiologists are extending their

imaging and therapeutic reach to the

vascular system.

Economic and political change in the

healthcare industry is driven by trainees

who have recently finished their

residencies and fellowships.

Much of the core technologies used in

surgical pathology are badly outdated

and would benefit from an infusion of

the new science and technology

currently being explored in medical

imaging and molecular imaging.

Pathology and lab medicine need a

greater influx of capital investment in

the form of corporate R&D funds

analogous to that supporting molecular

imaging.

The future of radiology, pathology, and

lab medicine are all similarly dependent

on information technology, molecular

diagnostics, and imaging technology.

Although the specialty of radiology has

made great progress with interventional

radiology, clinical specialists such as

cardiologists are extending their

imaging and therapeutic reach to the

vascular system.

Economic and political change in the

healthcare industry is driven by trainees

who have recently finished their

residencies and fellowships.

Much of the core technologies used in

surgical pathology are badly outdated

and would benefit from an infusion of

the new science and technology

currently being explored in medical

imaging and molecular imaging.

Pathology and lab medicine need a

greater influx of capital investment in

the form of corporate R&D funds

analogous to that supporting molecular

imaging.

The future of radiology, pathology, and

lab medicine are all similarly dependent

on information technology, molecular

diagnostics, and imaging technology.

6.

7.

8.

9.

10.


Healthcare Enterprise is Tied Together by Informatics Wherever Located

Hospital

Hospital Clinic

HealthcareSystem

Affiliated Physician Practices

Patient’sHome

Independent Physician Practices

Health SystemPhysician Practices

Laboratory

LTC

Surgi-Center

Imaging Center

Outpatient Rehab


The Patient Process Covered by syngo® and Soarian® Informatics


Integrating Enterprise Technologies: A Solid Foundation for the EHR

MICTMR

US

X-ray

Angio

syngo®

Emergency Dept.

Cardiology

Health Info. Mgmt

OperatingRoom

PharmacyRadiologyLab

Soarian®

Professional Services

Acute Specialty

Home CareAmbulatory

Payers

DIC

Community

Mammo

OC


Intelligent Use of Laboratory ResultsEnables More Accurate Decisions

Access to Electronic Patient Record

Laboratory results

Past medical history

Medications


From Data Integration to Systematic Knowledge Research

Indiv. ProviderCross-institutional

IntegratedData

Warehouse

Integration

1

Data Knowledge

Integrated View

Rules-based decision support

2

Knowledge, rules, guidelines

Data mining, knowledge generation

3

xxx x x

x

Data Mining Databaseresearch/

knowledgeIntegrated

Data Warehouse

Patient-specific data

Claims

Lab

Pharmacy

Clinical notes

Images

…Omics


Fusing Imaging Technology, Laboratory & IT

Initial and Follow–up

Exam

Patient Admission

Therapy Planning

Treatment/ Verification

Discharge & Follow Up

Enterprise Systems (Soarian)

Departmental Systems (Soarian)

Common Front End/UI (syngo)

Laboratory Systems (ADVIA, Versant, IMMULITE, CentraLink, Novius)

Treatment Workflow

Medical Technology/

Imaging

Information Technology

Workplace Efficiency

Laboratory Efficiency

Angio

Mammo Ultrasound X-ray

MRI CT

OnocologyCare

Molecular Imaging


Workflow Oriented IT

Clinical Scenario: Breast Cancer

Prevention and Early Detection

OngoingCareIn Vitro

Diagnostics(IVD)

Accurate DiagnosisPersonalized

TherapyIn VivoDiagnostics(Imaging)

Genetic marker panel

Mammography

Assay sensitive to protein pattern

Mammography; Sonography; Breast MRI

Molecular imaging

Image-guided therapy

Proteomic test



Clinical Scenario: Congestive Heart Failure (CHF)


OngoingCareIn Vitro

Diagnostics(IVD)



Cardiac sonogram

SPECT

Evaluation of risk factors

Genetic and proteomic biomarker panels

ApoB / ApoA1

BNP

NT-proBNP

Medical ACE inhibitors,

beta blockers, diuretics,

statins, aspirin

Pre-op SPECT to localize cancer

CT

PET-CT fusion imaging

MRI


PTH Test Pre-op SPECT to localize cancer

CT

PET-CT fusion imaging

MRI

Hypercalcaemia with consistent history

suggests diagnosis

Monitor Calcium and PHT for recurrence


Clinical Scenario: Parathyroid Cancer


OngoingCareIn Vitro

Diagnostics(IVD)



Surgery; Intra-operative PTH to

monitor removal of entire cancer.

Minimally evasive radio guided

Parathyroidectomy


First Full Service Diagnostics Company

SPECT CT PTH testing Management of ectopicparathyroid adenoma


Early Lung Cancer Detection


Lung Cancer: CAD & Knowledge Solutions


Integrated Patient Screening by

combining in-vitro and in-vivo bio-markers

Support lung cancerScreening & diagnosis

by detectingnodules from

thoraric CT / Xray.

Received FDA PMA approval in 10/2006

Patient Screening/risk stratification with in-

vitro biomarkers

Patient-specific combined knowledge-models for personalization of lung cancer therapy

.64

.74

.84

Data Model 1

Data Model 2

Knowledge Model

Combined Model

Area Under ROC


Changing The VALUE Equation


Lab Directors are Excited about Integration

Fred Crowgey, M(ASCP)Administrative Director of Labs

Med Central HealthcareMansfield, OH

“…I was really excited to learn of the Siemens/Bayer/DPC deal…I believe this continues to demonstrate Siemens’ commitment to this vision…… 60 to 90% of diagnostic decisions are made based on diagnostic modalities and clinical lab information. Integration using clinical informatics systems is exciting. Theaddition of molecular science to our traditional studies and the power of “smart” information systems is going to change medicine as we know it.”


Conclusions

Better, more

efficient & effective patient care


Medicine and Technology

A fascinating challenge for a partnership approach


Vielen Dank für die Aufmerksamkeit!Thank you for your attention.

Full Service Diagnostics...In vitro In vivo Workload volume increasing Staff & skill mix decline...

Documents

Transcript of Full Service Diagnostics...In vitro In vivo Workload volume increasing Staff & skill mix decline...