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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)
Page 1Siemens 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
Page 2Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Page 3Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Page 4Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Lab Challenges
Reimbursement
Work flow
Market demand
Oversight & compliance
Competition
Page 5Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Staff & skill mix decline
Purchases of capital equipment
Budgets flat to reducing
Biomarker strategies
Generate complex data
Clinical decisions with data
Efficiencies in laboratory processes and workflow
Workload volume increasing
Staff & skill mix decline
Purchases of capital equipment
Budgets flat to reducing
Biomarker strategies
Generate complex data
Clinical decisions with data
Efficiencies in laboratory processes and workflow
Page 6Siemens Medical Solutions Diagnostics © 2007. All rights reserved
In vitro & In vivo – are they different?
Integrated Diagnostics
In vitrosolutions
In vivosolutions
Generates multi-dimensionaldata
Workload volume increasing
Staff & skill mix decline
Purchases of capital equipment
Budgets flat to reducing
Biomarker strategies
Multi dimensional data
Clinical decisions with results
Efficiencies in total workflow
Page 7Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Healthcare Continuum
Prevention Diagnosis Therapy Care
Page 8Siemens Medical Solutions Diagnostics © 2007. All rights reserved
‘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
Page 9Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Page 11Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Page 12Siemens Medical Solutions Diagnostics © 2007. All rights reserved
The Evolution Of Medicine
Prevention Diagnosis Therapy Care
Analyzes knowledgeRepeats results Analyzes workflows
Efficiency
Craft medicine Disease management
Patient-centric healthcare
Time
Page 13Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Page 14Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Improving Healthcare Efficiency
Time
Workflow
Cost
Process Optimization
Innovation
Through:
PROVEN OUTCOMES
Prevention Diagnosis Therapy Care
Page 15Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Improving Healthcare Efficiency
Improved workflow
Page 16Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Page 17Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Strengthening The Portfolio
Page 18Siemens Medical Solutions Diagnostics © 2007. All rights reserved
One
HDP - Healthcare Delivery Projects
Project idea Concept PartnershipPlanning Implementation
Page 19Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Healthcare Consulting
Global Solutions
Healthcareprofessionals
Medicaltechnologyengineers
Medical ITspecialists
Businessmanagement
experts
Healthcareeconomists Clinical & business
process optimization
Technology & infrastructureplanning & integration
Strategy & management
Page 20Siemens Medical Solutions Diagnostics © 2007. All rights reserved
In Vitro Diagnostics
Prevention Diagnosis Therapy CareScreening Early detection
Individual therapy
Treatment efficacy
Page 21Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Page 22Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Measurement Signals For In Vivo Processes
Morphology Physiology Metabolism Molecules
CT
US
MRI
NM
MI
106-108
/cell
1/cell
In vitro
In vivo
Page 23Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Page 24Siemens Medical Solutions Diagnostics © 2007. All rights reserved
The Future Is Integrated
010100010011010101001101110
1101010010111011101010100110
Healthcare IT
In Vivo
In Vitro
Page 25Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Improving Biomarkers
FDG FDDNP*
*-IND filing successfully submitted as of July 31st, 2006
Improved diagnosis and monitoring of Alzheimer's disease.
Page 26Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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.
Page 27Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Laboratory Tests In Clinical Practice
?Tests
2000
1000
1956 2006 2016
3000
4000
Page 28Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Page 29Siemens Medical Solutions Diagnostics © 2007. All rights reserved
CT Then & Now
SOMATOM Sensation 64 (2005)
0.33s = 64 slices
SIRETOM (1974)5 min = 1 slice
Page 30Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Triple Bypass Visualized
Page 31Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Seeing Is Believing?
Are the horizontal lines parallel or do they slope?
Count the black dots!
Page 32Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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?
Page 33Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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.
Page 34Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Page 35Siemens Medical Solutions Diagnostics © 2007. All rights reserved
The Patient Process Covered by syngo® and Soarian® Informatics
Page 36Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Page 37Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Intelligent Use of Laboratory ResultsEnables More Accurate Decisions
Access to Electronic Patient Record
Laboratory results
Past medical history
Medications
Page 38Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Page 39Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Page 40Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Page 41Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Workflow Oriented IT
Clinical Scenario: Congestive Heart Failure (CHF)
Prevention and Early Detection
OngoingCareIn Vitro
Diagnostics(IVD)
Accurate DiagnosisPersonalized
TherapyIn VivoDiagnostics(Imaging)
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
Page 42Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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
Workflow Oriented IT
Clinical Scenario: Parathyroid Cancer
Prevention and Early Detection
OngoingCareIn Vitro
Diagnostics(IVD)
Accurate DiagnosisPersonalized
TherapyIn VivoDiagnostics(Imaging)
Surgery; Intra-operative PTH to
monitor removal of entire cancer.
Minimally evasive radio guided
Parathyroidectomy
Page 43Siemens Medical Solutions Diagnostics © 2007. All rights reserved
First Full Service Diagnostics Company
SPECT CT PTH testing Management of ectopicparathyroid adenoma
Page 44Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Early Lung Cancer Detection
Page 45Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Lung Cancer: CAD & Knowledge Solutions
Prevention Diagnosis Therapy Care
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
Page 46Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Changing The VALUE Equation
Page 47Siemens Medical Solutions Diagnostics © 2007. All rights reserved
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.”
Page 48Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Conclusions
Better, more
efficient & effective patient care
Page 49Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Medicine and Technology
A fascinating challenge for a partnership approach
Page 50Siemens Medical Solutions Diagnostics © 2007. All rights reserved
Vielen Dank für die Aufmerksamkeit!Thank you for your attention.