Fall 2015 Technology Disruption Impacts On Healthcare Facilities

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

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

Hoover Medical
Campus
LPCH Expansion
Future Clinics
Welch Road
New Stanford
Hospital
School of Medicine
Summer 2015
LPCH Expansion
New Stanford
Hospital

New Stanford Hospital

New Stanford Hospital

Lucile Packard Expansion

Lucile Packard Expansion

Stanford Health Care
Lean Improvements
11
Lean Design - Outpatient Facilities
Emeryville Multispecialty Stanford Neurosciences
South Bay Cancer Center Redwood City Expansion

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

GI Workshop -Value Stream Mapping

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

Mock ups to Test Layout and Workflow

MedModel Virtual Simulations

C-I-Care design thinking
18
Design Thinking

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

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

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
Themes
Apply The
Leading
For Me The Way
Edge

my care bedside to
fronts
24
Themes
Apply The
Leading
For Me The Way
Edge

my care bedside to
fronts
25
Themes
Apply The
Leading
For Me The Way
Edge

my care bedside to
fronts
26
Themes
Apply The
Leading
For Me The Way
Edge

my care bedside to
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

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

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)

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

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

Impact.
Increased focus on avoidance

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

Real Estate Portfolio Trends
Outpatient
facilities
Repurposing

A Higher Purpose

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

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

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

Key Technologies
Noise Monitoring Systems
Infection Control Systems

Staff Support Systems
Visitor Management
Patient Healing Environment

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

Theres a Data Flood coming .. Ready ?

Budgets & Infrastructure

In Conclusion
Design for the Future Repurpose or Build

Interoperability
Security
Scalability
Adaptability
Sustainability


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Healthcare on the Farm

Confidential For Discussion Purposes Only

11,037 Employees Student Enrollment 4,215 Employees

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

Confidential For Discussion Purposes Only 2

Confidential For Discussion Purposes Only

Confidential For Discussion Purposes Only 4

Confidential For Discussion Purposes Only 6

Confidential For Discussion Purposes Only 7

Confidential For Discussion Purposes Only 8

Confidential For Discussion Purposes Only 9

Confidential For Discussion Purposes Only 10

South Bay Cancer Center Redwood City Expansion

Confidential For Discussion Purposes Only 12

Decide on the sequence of

Determine who will perform

Confidential For Discussion Purposes Only 13

Confidential For Discussion Purposes Only 14

Clinic Layout Option 1

Clinic Layout Option 2

Confidential For Discussion Purposes Only

Confidential For Discussion Purposes Only

Confidential For Discussion Purposes Only 19

Design Thinking Boot Camps (1.5 days)

Design Challenges Completed

Confidential For Discussion Purposes Only 20

Stanford Health Care Launches Custom

Hospital Command Center/RTLS

Own the Apply Stanford

Own the Apply Stanford

Own the Apply Stanford

Own the Apply Stanford

Own the Apply Stanford

With a few technology

Creating a truly coordinated

Reducing clinical variation and

Confidential For Discussion Purposes Only 28

A global program to help promising

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

2300+ 175+ 60%

2015 SAP SE or an SAP affiliate company. All rights reserved. 3

Innovation beyond what we have traditionally seen

Simulations, pattern Personalized actions Sense-and-respond cycles

Internet of Things Healthcare Wearables

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

Major consolidation across all sectors of healthcare

20% of covered population is on a high deductible plan

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

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

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

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

Increased focus on avoidance

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

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

2015 SAP SE or an SAP affiliate company. All rights reserved. 9

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