Moore's Law and the Convergence of In-Vitro and In-Vivo Diagnostic Technologies

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Ethelbert Hood
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1 Moore's Law and the Convergence of In-Vitro and In-Vivo Diagnostic Technologies Lab InfoTech March 5, 2007 Don Rucker, MD Vice President, Chief Medical Officer Siemens Medical Solutions USA

2 Siemens, GE Enter In-Vitro Diagnostics Market Diagnostic Products Corporation A Siemens Company

Opportunities for growth in healthcare arise from the megatrend of demographic change Relevant Megatrend Major Implication Major Challenges Growth Opportunities Demographic Change i.e. aging and growing population Growing demand for healthcare Capturing of efficiency potential in healthcare systems Healthcare costs Workflow Improvement, e.

3 Opportunities for growth in healthcare arise from the megatrend of demographic change Relevant Megatrend Major Implication Major Challenges Growth Opportunities Demographic Change i.e. aging and growing population Growing demand for healthcare Capturing of efficiency potential in healthcare systems Healthcare costs Workflow Improvement, e.g. through: Earlier diagnosis & intervention Disease orientation Knowledgebased decision support Integrated IT systems Our portfolio reflects the growth opportunities

U.S. makes up the largest piece of the pie, but Asia Pacific is growing the

4 Billion Euro Japan 9% Asia Pacific 7% Latin America 3% North America 44%

4% Japan 6% Asia Pacific 10% Latin America 3% ASIA PACIFIC Growth: 11.

4 U.S. makes up the largest piece of the pie, but Asia Pacific is growing the fastest Billion Euro Japan 9% Asia Pacific 7% Latin America 3% North America 44% EUROPE Growth: 4.0% Europe 37% JAPAN Growth: -1.4% Japan 6% Asia Pacific 10% Latin America 3% ASIA PACIFIC Growth: 11.1% LATIN AMERICA Growth: 6.4% North America 47% NORTH AMERICA Growth: 6.3% Europe 34% Billion Euro *Source: Bayer Strategic Planning Group based on consultant data

5 SIEMENS MED: International scale Americas Europe Asia Divisions Manufacturing Sites Concord OCS Mountain View US Los Angeles DX Hoffmann Estates (Chicago) MI AX Piscataway A Knoxville MI Tarrytown DX Malvern HS Oxford MR > 40,000 employees worldwide Madrid SP Goa CO Erlangen/Forchheim AX, SP, CT, GS, MR, A HS, CO, RV, SW Kemnath CO Rudolstadt RV Bangalore SW, HS, US Singapore A Seoul R&D Center Kyongju-si US Wuxi RV Shanghai CT, AX, CO Suzhou A Shenzhen MR Indonesia A A Audiology AX Angiography, Fluoroscopy, Radiographic Systems CO Components CT Computed Tomography DX Diagnostics GS Global Solutions HS Healthcare IT MI Molecular Imaging MR Magnetic Resonance OCS Oncology Care Systems RV Vacuum Technology SP Special Systems SW Software Factory US Ultrasound

6 Through recent acquisitions we aim to serve the full continuum of care 2000: Shared Medical Workflow-oriented IT Prevention & Early Detection In-vitro Diagnostics (IVD) Diagnosis In-vivo Diagnostics (Imaging) Therapy Care 2006: DPC Bayer Diagnostics 2005: CTI

7 Our Strategy Innovation Process improvement Cost Quality

8 Dr. Elias Zerhouni / NIH Predictive Preventive Personalized

9 Some interesting news recently

10 Molecular prevention 1950 s - Discovery of cholesterol synthesis 1970 s Statins synthesized 1980 s Start of statin therapy Merck s Mevacor

11 Prediction is extremely difficult. Especially about the future. - Niels Bohr

12 Moore s Law The number of transistors on an integrated circuit & therefore performance will double every 18 months. Moore s s Law 1965

13 Modern medical technology Two breakthrough technologies: Modern imaging Moore s Law works here! Genomics Moore s Law works here!

14 CT then & now SIRETOM (1974) 5 min = 1slice SOMATOM Sensation 64 (2005) 0.33s = 64 slices

15 As with omics, imaging is HIGH DIMENSIONAL! 2 Slice CT Dual Source CT 30-Sec.-Scan: axial images with 64-slice Dual-Source CT compared to 41 axial images taken earlier with 2-slice CT

16 Clinical Summary

18 Integrating Images and Information Cath Network Cath Reports Cath Data Cath Lab Echo Echo Reports Echo Data Rest EKG EKG Mgmnt System Soarian Cardiology EKG Reports EKG Data EP Lab Stress Lab Lab Results Registration EP Reports EP Data Tracings Nuclear Reports Nuclear Data Nuclear and Post-processing

19 Imaging now requires IT

21 Headline SOMATOM Sensation 64 11sec for 144 mm 64 x 0.6mm (2x32) Resolution 0.4 mm Rotation 0.37 sec 120 kv / 500 mas 3mm Stent Courtesy of University of Erlangen, Department of Radiology and Cardiology DHZ Munich

22 Computer Aided Detection (CAD) syngo Lung CAD FDA* approval received in October Steps: Identification of nodes Quantification Comparison with prior exams 3 * CE approval expected for early 2007

23 In vivo is coming to the scale of in vitro Morphology Physiology Metabolism Molecules CT Dynamic, Perfusion US MRI, MRS NM Fluorescence (optical) Dynamic, Flow-through, Perfusion Dynamic, Flow-through, Perfusion, Diffusion, Molecules Molecules/Cell 1 Molecule/Cell Perfusion, Molecules Multiple Molecules/Cell Molecules

24 Biograph TM PET/CT Image Fusion

25 PET/CT

26 Radiation Therapy Planning Fused PET/CT Target Definition PET/CT-based Treatment Plan

17.06) MR MR-PET PET Courtesy of University of

27 BrainPET for MAGNETOM Trio First ever in-vivo images simultaneously acquired by MR and PET ( ) MR MR-PET PET Courtesy of University of Tennessee, USA and University of Tuebingen, Germany

28 IT throughout in-vitro and in-vivo diagnostics In-vivo diagnostics (medical imaging systems) X-Ray Computed Tomography Magnetic Resonance Molecular Imaging Ultrasound In-vitro diagnostics (medical laboratory systems) Immunodiagnostics Nucleid Acid Testing Clinical Chemistry Hematology Urinalysis Lab Automation Near Patient Testing

29 Workflow Management - the missing link to sustainable performance improvement 7 Pharm Notified 8 Dietary Notified 9 Resp Notified 6 Pharm Fills d/c Rx's 3 Nurse Review Orders 4 Nurse d/c Process 11 Patient Education 12 Transport Notified 13 Pt Out of Room 2 Nurse Notified 5 Family Notified 10 Family Arrives Patient Discharged 1 Hospital Discharge Order Room Assignment Room Refresh 17 Room Queued 14 Housekeeping Advised 18 Nursing Supervisor Notified 15 Housekeeping Notified 19 Nurse Assigned 16 Room Cleaned 20 Notify Admitting 21 Notify ER Handoffs Bed Turnaround

30 Step = Worklist Item = Activity

estimation is commonly used to diagnose hyperparathyroidism IMMULITE 1000 Turbo

localize ectopic parathyroid adenoma SPECT CT helps plan the proper surgical

32 An integrated in-vivo in-vitro workflow... In-Vitro Diagnostics e.g. PTH Testing Management of ectopic parathyroid adenoma Para-Thyroid Hormone (PTH) estimation is commonly used to diagnose hyperparathyroidism IMMULITE 1000 Turbo In-Vivo Diagnostics e.g. SPECT CT Symbia TruePoint SPECT CT SPECT CT can exactly diagnose and localize ectopic parathyroid adenoma SPECT CT helps plan the proper surgical approach and ensures full resection of ectopic adenoma Intraoperative PTH measurements during surgery help the physician to verify and ensure total resection and minimize chance of residual adenoma being left unresected or second adenoma missed out Source: DPC, Siemens MI

Changing the VALUE equation Both in-vivo and in-vitro diagnostics have great potential to change the value of the care patients receive Medicine is one of the few areas where the guild mentality

33 Changing the VALUE equation Both in-vivo and in-vitro diagnostics have great potential to change the value of the care patients receive Medicine is one of the few areas where the guild mentality still lives As we re-enter market economies throughout the world, prevention and early diagnosis gain new currency Modern in-vitro and in-vivo diagnosis will very likely drive the data sets that underpin cost effective treatment (not the Hx & PE)? Massive disruptions

34 Conclusions Increasing merger of in vitro and in vivo molecular level diagnosis High dimensional, integrated data driven by Moore s Law Rich tool sets to analyze the data IT as the driver of workflows Central to personalized preventive care

35 Thank you!

World Class is our Objective

World Class is our Objective Erich R. Reinhardt, Group President Medical Solutions Financial Market Day, February 17, 2004 We continued our profitable growth in FY03 Orders in billions of euros 4.1 4.1