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Healthcare on the Farm

Confidential For Discussion Purposes Only


Who We Are

11,037 Employees Student Enrollment 4,215 Employees

62,344 ED visits/year MD candidates: 383 400,000 patient visits/year


MD/PhD candidates: 90
1,095,613 clinic visits/year PhD candidates: 786 4,000 baby deliveries/year
MS candidates: 75
Only Level-1 Trauma Center Postdoctoral scholars: 1,158 94 different specialties
between San Francisco & Residents & clinical fellows: 1,006
San Jose 6 Centers of Excellence
NIH funding (2013) $315,104,246
#1 hospital in California by $1.1 billion operating
U.S. News & World Report revenue
7 current (living) Nobel Prize winners
31 members of the National
$3 billion operating revenue
Academy of Sciences

Confidential For Discussion Purposes Only 2


SUMC
The Quad

Confidential For Discussion Purposes Only


Hospital Renewal & Replacement

Development Timeline

2005 Pre-Application
2007 Application (EIR starts)
2011 Palo Alto Approvals
2012 Hoover Pavilion Opens
2015 Neurosciences Opens
2017 LPCH Opens
2018 NSH Opens
2022 5th Pavilion Opens
2035 Estimated Completion of
Construction
2041 Development
Agreement Expiration

Confidential For Discussion Purposes Only 4


Hoover Medical
Campus
LPCH Expansion

Future Clinics

Welch Road
New Stanford
Hospital

School of Medicine
Summer 2015

LPCH Expansion

New Stanford
Hospital

Confidential For Discussion Purposes Only 6


New Stanford Hospital

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New Stanford Hospital

Confidential For Discussion Purposes Only 8


Lucile Packard Expansion

Confidential For Discussion Purposes Only 9


Lucile Packard Expansion

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Stanford Health Care
Lean Improvements

11
Lean Design - Outpatient Facilities
Emeryville Multispecialty Stanford Neurosciences

South Bay Cancer Center Redwood City Expansion

Confidential For Discussion Purposes Only 12


Plan Do Check Act - Repeat

Decide on the sequence of


1 steps to be completed for
Modify the Standard Write Standard each process
Work or the layout as
Work
applicable

5
2
Modify Balance the
Work

Determine who will perform


4 each process and balance the
work among the team
Evaluate the 3 members
layout Test in the
mock-up
Use key criteria decided
by team to evaluate
each layout Test the standard work in the
mock-up layout

Confidential For Discussion Purposes Only 13


GI Workshop -Value Stream Mapping

Confidential For Discussion Purposes Only 14


Design Options from Workshops

Teams scored each table top way against the design criteria and voted on their top
endoscopy and clinic layouts

Clinic Layout Option 1

Endoscopy Layout

Clinic Layout Option 2


Confidential For Discussion Purposes Only 15
Mock ups to Test Layout and Workflow

Confidential For Discussion Purposes Only


MedModel Virtual Simulations

Confidential For Discussion Purposes Only


C-I-Care design thinking

18
Design Thinking

Confidential For Discussion Purposes Only 19


Boot Camp for Leaders/Executives

DEFINE

EMPATHIZE IDEATE

PROTOTYPE

TEST

Design Thinking Boot Camps (1.5 days)


Target: 150 SHC Leaders
Completed Training To Date: ~90

Design Challenges Completed


Patient Visitor Experience
Patient Preparation Experience
Inpatient Connectedness Experience

Confidential For Discussion Purposes Only 20


Technology to improve the
patient experience

21
Digital Health Initiatives

Press Release

Stanford Health Care Launches Custom


Mobile App That Connects to Epic EHR
and Lets Patients Manage Their Care
on the Go

Hospital Command Center/RTLS


Confidential For Discussion Purposes Only 22
Hospital Operations Center

Themes
How technology and workflows can create experiences

Apply The
Know Me Coordinate Show Me
Leading
For Me The Way
Edge

Own the Apply Stanford


Anticipate my Guide and prompt
complexity of science at the
needs and my actions to
my care bedside to
status to arrive at better
through progress my care
deliver outcomes and
coordination along multiple
effective care better health
fronts

23
Hospital Operations Center

Themes
How technology and workflows can create experiences

Apply The
Know Me Coordinate Show Me
Leading
For Me The Way
Edge

Own the Apply Stanford


Anticipate my Guide and prompt
complexity of science at the
needs and my actions to
my care bedside to
status to arrive at better
through progress my care
deliver outcomes and
coordination along multiple
effective care better health
fronts

24
Hospital Operations Center

Themes
How technology and workflows can create experiences

Apply The
Know Me Coordinate Show Me
Leading
For Me The Way
Edge

Own the Apply Stanford


Anticipate my Guide and prompt
complexity of science at the
needs and my actions to
my care bedside to
status to arrive at better
through progress my care
deliver outcomes and
coordination along multiple
effective care better health
fronts

25
Hospital Operations Center

Themes
How technology and workflows can create experiences

Apply The
Know Me Coordinate Show Me
Leading
For Me The Way
Edge

Own the Apply Stanford


Anticipate my Guide and prompt
complexity of science at the
needs and my actions to
my care bedside to
status to arrive at better
through progress my care
deliver outcomes and
coordination along multiple
effective care better health
fronts

26
Hospital Operations Center

Themes
How technology and workflows can create experiences

Apply The
Know Me Coordinate Show Me
Leading
For Me The Way
Edge

Own the Apply Stanford


Anticipate my Guide and prompt
complexity of science at the
needs and my actions to
my care bedside to
status to arrive at better
through progress my care
deliver outcomes and
coordination along multiple
effective care better health
fronts

27
Phased Deliverables

With a few technology


Phase I enhancements, this level of
information could be available

Creating a truly coordinated


day for the patient requires
Phase II significant, but not impossible,
operations coordination and
decision rules

Reducing clinical variation and


Phase III creating standard care plan
protocols requires a combination
of evidence based medicine,
cultural change and leadership
commitment

Confidential For Discussion Purposes Only 28


Smart Healthcare , Real Estate &
Data

Mark Noronha
Global Lead Startup Engagement
saphana.com/startupfocus
What is SAP Startup Focus

A global program to help promising


startups
In the Big Data, predictive and real-time
analytics space
Develop new applications on SAP HANA
and
Accelerate market traction

2015 SAP SE or an SAP affiliate company. All rights reserved. 2


The Enterprise Innovation Agenda, Powered By Startups

2300+ 175+ 60%


Startups that are building Validated solutions being sold Of the startups are outside the
applications on HANA to SAP customers traditional SAP ecosystem

22 57 2012
Industries Countries When the program started

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What Are Startups Building On SAP HANA?

Innovation beyond what we have traditionally seen

Simulations, pattern Personalized actions Sense-and-respond cycles


recognition (e.g. Synerscope) (e.g. BeyondCore) (e.g. Semantic Visions)

Internet of Things Healthcare Wearables


(e.g. Wittos) (e.g. Convergence CT) (e.g. APX Labs)

2015 SAP SE or an SAP affiliate company. All rights reserved. 4


Secular trends in healthcare
Rapid shift from FFS towards value-based reimbursement
Value-Based Significant investments in cost-saving, efficiency, patient experience, and quality

Reimbursement 50% of all Medicare payments to transition to value-based by 2018

60% of value-based payments are shared savings; moving towards capitation

Labs continue to see downward pricing pressure in FFS model

Major consolidation across all sectors of healthcare


Payers will forward integrate into care coordination & clinical services
Consolidation
50% of health systems are applying/ have applied for an insurance license
Expect to have 50% fewer independent hospitals & health systems in next 10 yrs
Fewer than 25% of physicians will remain in small practices in next 5 yrs

20% of covered population is on a high deductible plan


Employee deductibles have tripled to $4,500 over the last ten years
Consumerism
Personal connected health market is a $4-5B market today
HHS & private payers have released big chunks of price transparency data
Nearly 2K retail clinics and 10K urgent care centers and growing rapidly

Significant shifts in technology and analytics: NGS, proteomics, metabolomics,


clinical tools, consumer tools, artificial intelligence, big data, predictive analytics
Technology & Big Data Billions of dollars in investment in tech, big data & analytics across health plans,
health systems, ACOs, technology and data companies biggest M&A sector
Healthcare informatics market is $8B and one of fastest growing segments
$4B in digital health venture investments in 2014
Telemedicine market growing from $20B to $40B in next four years

2015 SAP SE or an SAP affiliate company. All rights reserved. 5


Hospitals
$1T market growing to $1.6T by 2022

Outpatient accounted for 43% vs. 24% in 91

$200B of reimbursement cuts to fund expansion

Value & quality focus shifting business models

Hosp. acquired conditions & readmits penalized

Significant horizontal & vertical integration

Stronger cost controls & more centralization

Viability hinges on 15-30% cost cutting ahead

>50% own health plans or expected to by 18


Source: Levin Associates, Leerink

2015 SAP SE or an SAP affiliate company. All rights reserved. 6


Impact.

Increased focus on avoidance


of hospitalization
Increased focus on moving
care delivery to appropriate
lower cost setting

2015 SAP SE or an SAP affiliate company. All rights reserved. 7


Real Estate Portfolio Trends

Outpatient
facilities
Repurposing

2015 SAP SE or an SAP affiliate company. All rights reserved. 8


A Higher Purpose

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Consumer(-ization)
Seniors drive >75% of costs (60M > 65 by 20)

Top 1% -> 22% of costs; top 5% -> 50% of costs

Chronic disease -> 85% of costs; 7/10 deaths

20% of covered folks on high deductible plans

OOP expense >$300B; Wellness industry >$6B

Telemedicine $20B; Personal wellness tech $5B

95% of consumers search for health online

12M getting home health; 7.5M in mobile clinics

>2K retail clinics & >10K urgent care centers


Source: PWC, Deloitte

2015 SAP SE or an SAP affiliate company. All rights reserved. 10


Technology
US HIT is $22B; health data/ analytics is $8B

25-30% of $3T spend can be avoided with tech

Telehealth to grow from $20B to $40B by 20

Global mHealth at $23B by 2017


(Monitoring $15B; Dx $3.4B; Treatment $2.3B; DocSupport $1.1B)

$4B in digital health venture investments in 14

Global precision medicine at $40B


(biomarkers, genomics, proteomics, metabolomics, CDx, big data)

Global POC market -> $17B in 15 to $20B by 18

Wearable tech at $10B by 20

Pop. health & quality improvement top priorities


Source: G2 Intelligence, Rock Health

2015 SAP SE or an SAP affiliate company. All rights reserved. 11


Key Elements of an Intelligent Infrastructure
HVAC Controls/BMS ICT/Data Centre

Operating TheatreOT Power Infrastructure

Medical Wards
Life Safety Systems

Integrated Security Enterprise Management

Lighting Control

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Key Technologies

Noise Monitoring Systems

Infection Control Systems


Staff Support Systems

Visitor Management

Patient Healing Environment

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Intelligent Interoperation

Lighting Control Integrated Security Integrated Building Data Centre


Operating Theatre
System Systems Automation Infrastructure

Dimmer units IP CCTV HVAC controls Power distribution Electrical distribution


Lighting controllers Access control Utilities metering UPS
Room switch units IPS
Staff attack Pred maintenance In-row cooling units
Multi sensors UPS
Infant tagging SCADA Integrated security
Surgeons panel
Scene
RFID setting
LOCATION Video intercom M&T Room cooling RFID LOCATION
Environmental
External lighting
SYSTEM Intruder detection Energy reclaim SYSTEM

Hospital Intelligent Technology Infrastructure

RFID LOCATION Servers


RFID LOCATION
HV/ MV / LV switchgear
24/ 7 remote services SYSTEM
SYSTEM
Fire alarm Nurse call Video recording
Energy modeling
Emergency lighting Bedhead services Transformers POE switches
Bill validation
Public address Entertainment Generator integration
Energy pricing Firewalls
Voice evacuation RFID systems Busbar trunking
Load shedding Quality of service
Fire dampers Environment Distribution Digital signage
Maximum demand

Fire Safety Electrical Energy


Medical Areas ICT
Systems Distribution Management

2015 SAP SE or an SAP affiliate company. All rights reserved. 14


Theres a Data Flood coming .. Ready ?

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Budgets & Infrastructure

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In Conclusion

Design for the Future Repurpose or Build


Interoperability
Security
Scalability
Adaptability
Sustainability

2015 SAP SE or an SAP affiliate company. All rights reserved. 17


2015 SAP SE or an SAP affiliate company. All rights reserved. 18