Whitespace Innovation Study: Identification of Key Emerging Business Opportunities in Healthcare To 2020: New Ecosystems

Company X Whitespace Innovation Study Final Report

I. Profile of KIL Respondents
Number of KILs Interviewed: Geographic Scope: Represented Countries: Professional Categories of KILs Interviewed:
-- 41 -- US, UK, Belgium, Netherlands, Norway, Spain, Australia, S. Korea, Panama, India -- MDs (specializing in Telemedicine/Telehealth -- Health IT (Futurists, Solution Providers) -- Medical/Clinical Informatics Innovators, Researchers (Academia), Corporate Directors, President of European Union -- Six Sigma Experts (Supply Chain Innovation) -- Innovation Research Experts (Health IT, Enterprise Solutions) -- Clinical Neuropsychologists/Psychologists -- CEOs EMR Companies -- Senior Technology Innovation Analysts -- eHealth/mHealth Experts (Global) --Healthcare IT --Clinical/Medical Informatics (Research and Development) Global --EMR (Electronic Medical Records) solutions/services/middleware --WHO-World Health Organization- Telemedicine/Telehealth --HIE (Health Information Exchange) Services (SaaS) --Medical Simulation Technology (Virtual Reality) --Federal (US) Health IT (Innovation/Initiatives --Technology Innovation --Global Process & Equipment Innovation --Telecommunications Global Services --Advanced Technology (Military-US) --Technology Futures --Psychology/Cognitive Sciences --Clinical Neuropsychology --Innovation Research-Enterprise Solutions --Supply Chain Innovation --Advanced Telemedicine --Healthcare IT Futurists --Health/Wellness Virtual Game Applications

KIL Specialties & Research Area Focus:

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II. Key Healthcare Trends Emerging (Global)

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Paradigm Shifts
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Moving from a supplied healthcare model to more of a personalized patient self-management / multidisciplinary provider managed care model, with special focus on patient outcome and quality of care. Integrated Care model (parallel providers working as a team) Physicians role is changing from the Lone Doctor to a role similar to a conductor of an orchestra or a shift from primary care to a more integrated care /participatory health model (multi-disciplinary teams; case managers) Shift from taking care of sick people to trying to prevent people from becoming sick. Lifestyle changes important in patient healthcare self-management Shift to larger focus is on disease prevention (disease management) and wellness Shift from primary/secondary health care to more of a focus on patient healthcare self-management and where the care is given. Shift to IT and communications tools (e.g. smartphones, iPhones, iPads) as new ways of delivering healthcare.

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II. Key Healthcare Trends Emerging (Global)

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Disruptive Innovation
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Value-based healthcare delivery

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The only way to contain costs is to improve healthcare outcomes: in a value-based system, achieving and maintaining good health is inherently less costly than dealing with poor health. Principles of Value-Based Health Care Delivery Prevention -Early detection -Right diagnosis -Right treatment to the right patient -Early and timely treatment -Treatment earlier in the causal chain of disease -Rapid cycle time of diagnosis and treatment -Less invasive treatment methods
*Source: Michael Porter, Harvard Business School 2010

-Fewer complications -Fewer mistakes and repeats in treatment -Faster recovery -More complete recovery -Less disability -Fewer relapses or acute episodes-Slower disease progression -Less need for long term care -Less care induced illness

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II. Key Healthcare Trends Emerging (Global)

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Disruptive Innovation contd.

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Healthcare Information Highway (Health IT)- (infrastructure and applications). Example: The Apple ITunes transformed the way people listened to music. How do we build a better health information/data platform that will be safe and secure? Implications
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The healthcare information highway will transform how people communicate. How do we build a set of standards and infrastructure? Continuing to build an economy and ecology for this service. NOTE: The Office of the National Coordinator for Health Information Technology (ONC) Office of Health and Human Services - awarded $60 million to four institutions - Mayo Clinic, Harvard University, University of Texas Health Science Center at Houston and University of Illinois at Urbana-Champaign - through the Strategic Health IT Advanced Research Projects (SHARP) program. Each institution's research projects will identify short-term and long-term solutions to address key challenges, including ensuring the security of health IT (University of Illinois at Urbana-Champaign), enabling patient-centered cognitive support for clinicians (The University of Texas Health Science Center at Houston), making progress toward new health care application and network-platform architectures (Harvard University), and promoting the secondary use of EMR data while maintaining privacy and security (Mayo Clinic of Medicine).

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II. Key Healthcare Trends Emerging (Global)

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Disruptive Innovation contd.

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Personalized Medicine/Healthcare
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Overview

This system has been described as personalized health care-treatments and services targeted to the biology of the individual, leading to potentially significant improvements in patient care. New technologies offer the potential for revolutionary changes in the development and distribution of personalized medications, along with the practice of medicine - from molecular diagnostic tests that detect disease before symptoms are evident - to patient profiling techniques that help predict which patients are most likely to benefit from or be harmed by specific therapies/medications. These approaches and the extensive data they require will need to be supported by a new information architecture. Personalized Medicine has given the diagnostics field a huge boost in terms of publicity/public attention, revenue potential, and investment interest.

Implications

Will require a new approach to technology assessment and dissemination, one that embraces the tremendous potential of the vision of personalized medicine. Will have an enormous impact on supply chains and sales forecasting for pharmaceutical companies and drug distributors (e.g. gender specific drugs, costs of drugs, going from commodity drug supply to tailored drug supply) New business models will have to be designed to accommodate the change in drug development, supply chain management and entry into new markets.

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II. Key Healthcare Trends Emerging (Global)

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Long-term Outlook (Healthcare, Medicine)

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Major Changes over Next 20 Years

Significant life extension with ever-increasing quality of life Major new understanding of how the brain works; and how mental pathologies can be safely ameliorated better drugs, drug targeting with nanotechnologies (genetic/epigenetic testing) An increase in the use of advanced, intelligent machines and technologies Cures to most, if not all, major diseases, chronic pain and aging process Changes in IT are exponential. Processing power to increase a million times; computing will be embedded into society at the smallest, inter-cellular levels Re-growth of tissues/organs; Bio-printing of replacement organs, tissues, medicines Sports will receive major biologic/mechanical/pharmacologic improvements Doctors offices will be eliminated for most procedures Tailored, personalized medicines that will be monitored

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Long-term Outlook (Healthcare, Medicine) contd.

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Major Changes over Next 20 Years

Innovation will come from the private sector (mHealth, eHealth, Health IT), not from the US government In 3-5 years, will see a lot more connectivity between mHealth, eHealth, Health IT solutions and related devices Data Explosion: We will see more cloud computing and hosted informatics solutions and services, resulting in much better health-related data analysis. Integration of all the data will be challenging, however, and could take 5-10 years before the data is totally integrated. Will take longer, worldwide. New healthcare payer business models will evolve. Healthcare payers will gather more critical diagnostic and usage data from patients (home-based), which will in turn help with more efficient case management analysis, etc. Medication management will come into its own. Pharmaceutical companies will provide venture capital to fund advanced medical device development that will provide monitoring, and advanced diagnostics for patients, for example. These initiatives will also provide critical data of medication usage for more efficient drug procurement and management of medications.

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III. Key Healthcare Policy Initiatives & New Healthcare Models

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U.S. (New Models, Drivers, Inhibitors)

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Now in the midst of the biggest capital infusion of money; the US federal government has invested $36 Billion into EMR and PHR and related healthcare technologies, with goal being by 2014 that a majority of the population have electronic health records. The onus is on the physicians/providers to migrate paper health records over to digital formats. The physicians will be provided with monetary incentives to this migration. Inhibitors: Migrating patient health records over to a digital format is still a tortured Technology adoption by physicians is and will be the largest driving force in health IT. We are not there yet, since the adoption numbers are still low. It will take from 3- 5 years for this migration (estimate). It will take a little longer than people expect but it is definitely on the track.

International (New Models, Drivers, Inhibitors)

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Healthcare is a crucial sector for the economy of European Member States (EU); in particular, the increase of elderly people and chronic diseases asks for new models of care, able to assure an economically sustainable evolution of the healthcare systems (Council of the European Union (2007) Within each country (EU), there is a need to assure the continuity of care across healthcare facilities and to facilitate the access to healthcare and social services. A key challenge is the close coordination of the activities of the healthcare (and social) professionals for shared care, as well as the proactive involvement of the patients themselves and of their families (patient empowerment) in the daily management of the diseases.

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IV. Key Emerging Healthcare Ecosystems

Ecosystems Focus Facilitators Market Drivers
(Impact)
Studies

Market Inhibitors (Implications)

Costs associated with wellness

Key Players
Medical device suppliers Functional food suppliers Corporations

Health & Wellness (Sub: Patientcentric healthcare)

Prevention before cure Early diagnosis & treatments Wellness lifestyle (holistic health, well being) Wellness one-stop shops Customized products (nutraceuticals, functional foods, agerelated, etc.) Alternative medicine health services

Remote patient monitoring, diagnostics Smart phones (iPhone, Droid) iPads, others Digital Health (Health 2.0) Clinical Informatics Telemedicine, Telehealth mHealth Advanced diagnostics Healthcare costs are pushing employers to provide wellness incentives Smart tools, wearables and applications being developed around the world to address health issues, maintenance, diagnostics, patient health data Health/Wellness SW (games) (e.g. Wii Fit; Incentive Wellness games, etc.)

have demonstrated effectiveness of wellness programs Boomer effect Local food supply growing in popularity (e.g. organics, etc.) global movements Growing costs of healthcare worldwide

Global economic issues (demographic s)

Consumers (aging populations, parents) Alternative medicine providers

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IV. Key Emerging Healthcare Ecosystems-contd.

Ecosystems Focus Facilitators Market Drivers
(Impact)
Aging independently (e.g. Boomer effect) Expansion of health and wellness (Corporate, personal)

Market Inhibitors
(Implications)
Fragmentation of market (increased niches)

Key Players

Personalized Healthcare/Medicine
Cyberdocs Telehealth & Telemedicine Personalized drugs Home-based, selfmanaged healthcare Advanced/Remote Diagnostics

Disease detection (cancer, diabetes, hypertension) Home-based, self-managed healthcare Personalized medications Growing aging population (Global) Integrated physician and pharmacy (Google Health, Microsoft Health Vault, etc.)

Telemedicine and Telehealth (e.g. Teleradiology, Telenursing, Telesurgery) Digital Health Remote patient monitoring Smart phones (iPhone, Droid) iPads, others Health 2.0 Device/Drug Identification Nanotechnology Functional foods Robotic prosthetics EMR, PHR (Personal Health Records)

Abbott Diagnostics Affymetrix, Inc. Agilent, Althea Technologies Curidium Medica, PLC. Dako Gen Probe Genzyme Corporation Ipsogen Lipomics Osmetech Perlegen Sciences Provista Life Sciences Qiagen Singulex Theranostics Health Ventana Medical System

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IV. Key Emerging Healthcare Ecosystems-contd.

Ecosystems Focus Facilitators Market Drivers
(Impact)

Market Inhibitors
(Implications)
Possible government (FDA) pushback and/or regulation delays Manufacturing and development costs Possible consumer backlash Possible supply chain/distribution problems

Key Players

Smarter, OnDemand Drugs

Non-invasive delivery Genetic/personalized drugs Pills-On-Demand Intelligent pills: Aids formulation development; clinical drug trials; drug selection; dosing profiles Microchips into pillsnetworked, digital drugsdosage/disease management

Bio-medical materials (bio-medical printing, customized dosages, remote delivery, justin-time delivery) Device/Drug identification Food industry applications aids in site absorption studies; hunger suppressant studies, allergic reaction studies

Growth in personalized medicine technology and innovation Personalized medicine innovation Nanotechnology continuing advancements

Philips (technology) Proteus Biomedical backed by Novartis/ Medtronic

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IV. Key Emerging Healthcare Ecosystems-contd.

Focus Facilitators Market Drivers
(Impact)
Health IT Informatics US Federal Government Physicians/Clinicians Hospitals Health IT (Middleware) Solutions Health Information Exchanges (e.g. Verizon HIE) Cloud computing technology 4th Generation ELNs (Electronic Lab Notebooksshared library) RFID Middleware solutions Parallel healthcare providers working as a team Chemical care paths for patient decision support Federal (US) EMR incentives/penalties Excellent potential for mining EMR for advanced decision support solutions Cloud Computing: Health IT/Cloud SourcingImproves operational agility Just in Time (will help with more efficient CRO (Contract Research Organization) engagements Individualized treatment plans for each patient

Ecosystems

Market Inhibitors
(Implications)
Resistance of physicians (e.g. cost, lost time, etc.) NOTE: Exceptions of Medicare/ Medicaid patient base

Key Players
Hospital EMR: Allscripts/, Eclipsys, Epic, Siemens, Cerner; Ambulatory EMR: MD-IT Clinical Informatics: Partners Healthcare Health IT Middleware: IBM Oracle Intel

Informatics

Clinical Informatics Medical Informatics Nursing Informatics Pharmaceutical Informatics EMR/PHR Hosted Informatics (e.g. Pharma R&D SaaS) OR Cloud Sourcing (Electronic Lab) Decision Support Disease Management Personalized

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IV. Key Emerging Healthcare Ecosystems-contd.

Focus Facilitators Market Drivers
(Impact)
Wellness /Organic food movements global Personalized medicine Steady growth in baby food markets (e.g. Omega3; Pro & Prebiotics) Disease prevention approach Emerging food processing technologies Premium pricing potential Label legislation (simplified approval process)

Ecosystems

Market Inhibitors
(Implications)
Consumer skepticism Marketing disconnect Niche confusion Pricing problems Ineffective dosage viability of nutraceuticals $ value vs. preventing disease

Key Players

Nutraceuticals
(Sub: Functional Foods)
* The US Functional
Food Market is estimated to represented 35-50% of global sales. Together, the US and Asia-Pacific are estimated to account for approximately s of current global market for functional foods.

Increased focus on memory loss Increased focus on weight management Increased focus on antiaging Increased focus on libido (performance enhancement) Increased focus on joint health Increased focus on digestive health Increased focus on beauty from within Increased focus on pet food nutraceuticals and functional food

Boomer Effects Enhanced Pet Foods Food and beverage companies Ingredient and formulation suppliers Agricultural & biotech researchers (DuPont, Bayer Plant Science, Monsanto) Retailers (Wal-Mart, Safeway, Whole Foods)

Functional Foods: Nestle, PepsiCo, General Mills, Kellogg, Kraft, Danone, Unilever, Yakult. Coca Cola Cargill, ADM, Danisco Wal-Mart, grocery stores, Target

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IV. Key Emerging Healthcare Ecosystems-contd.

Ecosystems Focus Facilitators Market Drivers
(Impact)
A majority of devices address sports-related injuries (e.g. knee and shoulder treatments.) Some therapies, such as reinforcement patches and cartilage repair, have applications in other fields such as small joint microsurgery and the treatment of osteoarthritis. Market segments: - Splint products - Pain management drugs - Sports Nutrition (Global market: $27-32B in 2009) Supplements -Sports foods (energy drinks) and beverages - Synovial fluid replacement products - Arthroscopic equipment (visualization and powered instruments) - Surgical implants (cartilage replacement, meniscal replacement - Ligament/tendon replacement, shoulder fixation devices - Cognitive Testing Systems Yearly growth in childrens participation sports (e.g. 30M) Approx. 150 million adults participate in nonwork related sports. Growth of Baby Boomer population-market demand Increased demand for more out-patient surgeries Increased reimbursement for sports injuries Varying characteristics of implants suit the needs of operative sports Quick healing medicines boost growth Continued innovation

Market Inhibitors
(Implications)
Growing obesity problem/ Global Over-inflated sports nutrition claims (e.g. fortification of Whey products; muscle building, etc.)

Key Players

Sports Medicine
(Sub: Orthopedic Soft Tissue Repair)
In 2009, the combined US sports medicine and orthopedic soft tissue repair market was valued at nearly $920M. Combined annual revenues are estimated to reach $1.6 billion by 2016. Combined European market was approx. $542M in 2009.

Arthrex, Conmed Linvatec, Depuy Mitek, Genzyme, MTF, Fidia and Smith & Nephew lead the market, among many others (e.g. Stryker, Bayer AG, Regeneration Technologies, Cardinal Health, etc.) PepsiCo, Coca Cola

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IV. Key Emerging Healthcare Ecosystems-contd.

Ecosystems Focus Facilitators Market Drivers
(Impact)
Bio-Medical Printing Bio-printers (e.g. printed human veins; sprays skin cells on burn wounds; print several drugs onto one pill; biosensors embedded into clothing) Reconstructive surgery and Orthobiologics are the dominant segments in orthopedic biomaterials market. Sports medicine Personalized healthcare Home-based healthcare Improved patient benefits form the most important factor stimulating market growth for biomaterials. Increase in aging population, rising awareness, shorter product approval time, and larger application area Improvement in fabrication technology and new product development at competitive prices

Market Inhibitors
(Implications)
On-demand Extended reach Personalized printing (e.g. customized dosages) Lack of tissue availability and proper reimbursement facilities are restraining the growth of the biomaterials market.

Key Players

SAMPLE: Organovo (Open to investment) GSK; Univ. of Leeds, UK (collaboration) Wake Forest University, NC University Hospital Virgen de las Nieves in Granada, Spain (artificial skin research) Boston Scientific Corp. Genzyme Biosurgery China (Active development) Harvard University

Regenerative Medicine
(Sub: Biomaterials Market)- High Growth
Mkt.
The Biomaterials

Cell Therapy Tissue engineering (e.g. artificial skin) Reduced clinical trials expenses Future in vascular tissue regeneration (over next 5-6 years) Biomaterials are widely used in medical devices, tissue replacement, and surface coating applications. Biomaterials products include orthopedic, dental, cardiovascular, gastrointestinal, wound care, urology, plastic surgery, and others.

products had a market size of $25.5 billion in 2008, and the biomaterial device market size was $115.4 billion in the same year, and is expected to reach $252.7 billion in 2014. In the next five years, the biomaterials market is expected to grow at a CAGR of 15%. Emerging economies such as China, India, Japan, Brazil, Russia, and Romania represent a high growth rate.

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IV. Key Emerging Healthcare Ecosystems-contd.

Focus Facilitators Market Drivers
(Impact)

Ecosystems

Market Inhibitors
(Implications)
Delays in commercialization due to strict regulations/ manufacturing difficulties inhibiting productization Stability of nanoparticles inside biological tissues is important issue to be considered to reduce contamination by drugs

Key Players

Advanced Healthcare Diagnostics and Monitoring

(Sub: Nanotechnology in Diagnostics and Healthcare)
The role of nanotechnology in healthcare is very important in terms of managing and eradicating diseases. Biocompatible implants and coatings and diagnostics comprise some of the major applications which are estimated to experience high growth between 2009 and 2014, 42% and 21.8% respectively.

Mobile health diagnostics instant blood/ saliva tests Home Healthcare: Home-based and remote field patient diagnostic and home monitoring Anywhere diagnostics (mobile, homebased, field)

Patient monitoring devices (e.g. remote, noninvasive blood pressure monitoring, cardiac rehab, critical care and perioperative monitoring, remote field monitoring,

Aging population Patient preference for portability, automation and customization Physicians and hospitals prescribing home care to the patients to reduce huge patient inflow Rise in number of vehicle accidents and sports injuries Womens health: increased innovation in breast cancer research and diagnostic (X-rays, prevention, etc.) devices

Argento (UK)-Startup-Spin-out from UK National Physical Lab) Open to investment & licensing/supply agreements (Sample): 3M Healthcare, Roche Diagnostics, J&J, Medco, Medtronic, GE Healthcare, Baxter, etc. Nanotechnology device companies:
Abraxis BioSciences, AstraZeneca, Capsulution Nanoscience AG, DoCoop, Elan Corporation, J.R. Nanotech, Liquidia Technologies, Company X KGaA, Novartis, Pioneer Surgical, Smith & Nephew,Star Pharma and Wyeth Pharmaceutical

Home self-diagnostics/ monitoring: Blood glucose

monitors and test strips, blood pressure monitor, holter monitor, heart rate meters, pneumonia, diabetes, apnea and sleep monitors, multi para diagnostic monitors and other equipment)

Digital Mammography Digital Microscopes Triage, Emergency Testing in Hospitals Veterinary medicine (field
tests, border & disease inspections)

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IV. Key Emerging Healthcare Ecosystems-contd.

Ecosystems Focus Facilitators Market Drivers
(Impact)

Market Inhibitors
(Implications)
Reimbursement issues over advanced simulation treatments Business models still evolving

Key Players

Virtual Reality Simulation Technology and Products

(Sub: Cognitive Neuroscience; Cognitive Testing Systems)

Treats patients with anxiety disorders Cognitive Disorders: PTSD (Post Traumatic Stress Disorder) Dyslexia, Autism, Alzheimers, Age-related cognitive Decline TBI (Traumatic Brain Injury) ; Worldwide 51 Million patients Provides Avatar (3D) advanced medical training (surgical simulation technology) Provides advanced mental health care Collaborative, virtual medical environments for medical/surgical training Aging with disabilities

Development of cognitive enhancement software Development of therapeutic software used at home on iPhone, PDA, computer Mobile technology (e.g. augmented reality applicationsphysician training) Cheaper, more powerful consumer electronic devices More powerful computer graphics processing

Behavioral /mental/ cognitive services healthcare emerging market PTSD (Post Traumatic Stress Disorder)-Returning war veterans, military Dyslexia Autism Alzheimers Age-related cognitive decline TBI (Traumatic Brain Injury) Growing need for MD/ Nursing medical training simulation centers/ programs Increased military suicides Increase in youth sports, recreation has spurred repeat head injuries, cumulative concussions Opportunity in high schools

NYU, University of Pittsburgh Virtual Reality Medical Center (open to investments) Innovation in Learning (open to investments) (Californiabased) Sony Microsoft Virtual Game solution providers

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V. Key Whitespace Opportunities

Whitespace Focus/Opportunities
Prevention before cure Early diagnosis & treatments Wellness lifestyle (holistic health, well being) Wellness one-stop shops Customized products (nutraceuticals, functional foods, age-related, etc.) Alternative health services Disease detection (cancer, diabetes, hypertension) Home-based, self-managed healthcare (medical devices that can predict skin cancer; diabetes, pain management, etc.) Personalized medications Growing aging population (Global)

Facilitators
Smart phones (iPhone, Droid) iPads, others Clinical Informatics Telemedicine, Telehealth mHealth, eHealth Advanced diagnostics Telemedicine Remote patient monitoring Smart phones (iPhone, Droid) iPads, others Health 2.0 Social media (networks, online communities) Device/Drug Identification Telemedicine Remote patient monitoring Smart phones (iPhone, Droid) iPads, others Functional foods Bio-medical materials (bio-medical printing, customized dosages, remote delivery, just-in-time delivery) EMR Device/Drug identification Smart pills Remote Diagnostics

Wellness

Personalized Healthcare

Cyberdocs

Virtual provider care (via Internet, mobile devices, telehealth) Medical Informatics Decision Support

Smarter, OnDemand Drugs

Non-invasive delivery Genetic/personalized drugs Enhanced nutraceuticals (e.g. foods, beverages)for increased memory, productivity, physical performance, anti-aging, etc.) Pills On Demand Pill Alerts (lets doctor/family know when pill has been ingested)

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V. Key Whitespace Opportunities (contd.)

Whitespace Virtual Hospitals Focus/Opportunities
Medical tourism Hospital connectivity (local, state, federal, global) Telemedicine, Telesurgery, Teleradiology, Telenursing

Facilitators
Health 2.0 Health Information Systems Health Information Exchanges EMR, PHR Telemedicine Remote patient monitoring Smart phones (iPhone, Droid) iPads, others Health 2.0 Health Information Systems Health Information Exchanges EMR, PHR Telemedicine Remote patient monitoring Smart phones (iPhone, Droid) iPads, others

Advanced Diagnostics

Mobile health diagnostics instant blood/saliva tests (e.g. Argento) Disease and pain management devices continued innovation and deployment into home Instant mobile diagnostic testing device innovations Patient-centric healthcare becoming more prevalent

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V. Key Whitespace Opportunities (contd.)

Whitespace Cognitive/Training/ Wellness Services
(Home and mobile device-based) (Personalized, numerous market niches)

Focus/Opportunities
Medical training simulation training centers and mobile applications (e.g. augmented reality, virtual reality simulation technology) Therapist in a Pocket via mobile applications (e.g. mood maps on user cell phones, therapeutic exercises via mobile app, progressive muscle relaxation techniques via phone, etc.) Boomer effect (loss of memory, cognitive prowess) Competitive gaming software with cognitive enhancement software tools Helps to improve cognitive functions (Can be designed to be modular for babies, children, teenagers, adults, aging, corporate, military, medical) 2-3 year development? Advanced MRI (MRI-based diffusion weighted imaging techniques) to analyze nerve axonal injuries at the millimeter level Personalized medicine/healthcare

Facilitators
4G Smartphones Web 2.0 iPad Computer Virtual reality (simulation) technology (advanced) Home electronic devices NYU Medical Center, Clinical Neurology Developing cognitive enhancement software tools University of Pittsburgh-Cognitive Program Center, Brain Imaging research/development

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V. Key Whitespace Opportunities (contd.)

Whitespace Clinical Informatics
(Sub: Personalized healthcare)

Focus/Opportunities
Treatment plans for each patient Parallel providers working as a team Chemical care paths for patient decision support Excellent potential for mining EMR for advanced decision support solutions

Facilitators
Health 2.0 Health IT (middleware) Health Information Exchanges EMR, PHR Telemedicine Remote patient monitoring Smart phones (iPhone, Droid) iPads, others Remote patient monitoring Smart phones (iPhone, Droid) 4G smartphones w/televideo features = 4G iPhone iPads, others Health 2.0 SMS, MMS (text and multi-media instant messaging) Health 2.0 Health IT (middleware) Health Information Exchanges EMR, PHR Telemedicine Remote patient monitoring Smart phones (iPhone, Droid) iPads, others

mHealth (Mobile)

Smart tools, wearables and applications being developed around the world to address health issues, maintenance, diagnostics, patient health data Mobile Video (assists with home visits, medical training, medical consultations, etc.)

Remote Pharmacy Portals

(Sub: mHealth)

Allows physicians to access info and complete medication orders from anywhere

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V. Key Whitespace Opportunities (contd.)

Whitespace Focus/Opportunities
Web-based EHR (Electronic Health Record) solutions Online medical condition and chronic disease management solutions Secure Web technologies to allow cross-sector sharing of relevant clinical data by multidisciplinary teams Software that will allow pharmacists to log all adverse reactions that patients report to them/ The data will be collated at a central repository where it can be analyzed to identify problematic scenarios. NOTE: This new computer
program has been developed by the University of Tasmania (Australia) to monitor adverse reactions to prescription medication has the potential to save the health system nearly a billion dollars.

Facilitators
Telemedicine Remote patient monitoring Smart phones (iPhone, Droid) iPads, others Health 2.0 Health Information Systems Health Information Exchanges EMR, PHR

Smart Healthcare Solutions /Disease Management

Digital/E-Health

SMS (mobile text databases) can text pill codes and specially tagged medicine barcodes numbers to receive object info in native tongue. Goal: to help provide easy access to vita health data, dosage info, symptom assessments, pharmacy drug orders, age recommendations, etc.

Telemedicine Remote patient monitoring Smart phones (iPhone, Droid) iPads, others Health 2.0 Health Information Systems Health Information Exchanges EMR, PHR

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V. Key Whitespace Opportunities (contd.)

Whitespace Regenerative Medicine
(Sub: Bio-Medical Printing Materials)

Focus/Opportunities
Building on advances in physical and 3D printing technologies, artificial constructions of biomedical materials are becoming a reality. Developments that allow for rapid printing of medicines, artificial prosthetics and human tissue point toward future access to medical support any-where and on demand. Opportunity: Personalized dosage printing Allows for customized dosages and other healthcare delivery based on an individuals needs. Opportunity: Extended reach Decentralized production of medical supplies, enhanced supply chain shipping/distribution, access to hard-to-reach locations Opportunity: Pill on Demand- There could be a better way for medicating complex formulations (especially for the elderly), namely a "pill on demand" system that combines macroscopically normalized powders with a "base" material, and cranks out pills on demand, in any combo-formulation required. This would be an enormous step forward for the pharmacists and doctors who could deliver drugs more uniformly (especially for the elderly) over the day.... where the active dose per day is custom-divided into the pill-size - and could even accommodate missing doses, or tardy administration through slightly upgraded formulary. Opportunity: Digital gastronomy Stores favorite ingredients and food components and allows them to print food using ink jet-like nozzles.

Facilitators
3D Bio printers (e.g. can create new blood vessels, etc.-e.g. Organovo (open to investments) 2-3 year investment Bio printers that can spray skin cells onto wounds (Wake Forest University, NC) Bio printers than can print personalized pills (University of Leeds, UK and GSK)

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V. Key Whitespace Opportunities (contd.)

Whitespace Home-based Healthcare Market Focus/Opportunities
Demographic shifts in the healthcare market, along with other factors in the sector include technological developments for example wireless home monitoring and economic trends such as the rising cost of institutional care will drive the growth of the home healthcare (personalized healthcare) market. There is also a growing receptivity to home healthcare among physicians and private and public insurers The value of the global market for home medical equipment is expected to be $17.7bn in 2010, according to US-based market research. The market forecasted to increase to nearly $23.8bn in 2015, at a compound annual growth rate of 6.1% over the five-year period. The largest segment of the market is made up of monitors, sensors, and telemetry devices. This is projected to increase at 7% per annum, rising to $11.3bn in 2015, after being valued at nearly $8.1bn in 2010. The second largest segment, assistive devices, is estimated at $5.3 billion in 2010, and is expected to increase at 1.7% per annum to reach more than $5.8bn in 2015. The segment made up of therapeutic devices is expected to reach nearly $6.7bn in 2015, after rising at 9.3% per annum from its 2010 value of nearly $4.3bn. Targeted Therapeutics Genetic/personalized medicine will have a broad impact on health and wellness

Facilitators
Advanced, mobile diagnostics Advanced mobile disease monitoring devices Home-based diagnostics/ monitoring device innovation integrated with pharmacists/ doctors who reviewed reports. (Kaiser Permanente, COtrialing easy home-based monitoring devices) IPads, IPhones, Smartphones, Computers Wii Fit, wellness game software

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V. Key Whitespace Opportunities (contd.)

Whitespace Telehealth/Telemedicine/ Telesurgery/Telenursing/ Teleradiology
Global Perspective: The fastest growing areas in Telemedicine/ Telehealth have been in South America. Brazil, Argentina and Chile have many programs running right now and have many different ways to fund these programs. The government is also involved in majority of those programs. Some projects in Colombia are funded by the government, but most are funded through grants from Europe and Canada. India and China also very active in telehealth/telemedicine services, technologies, etc.

Focus/Opportunities
Telemedicine will be the enabling technology for an entire new generation of walk-in clinics. In the foreseeable future, immediate access to world-class experts could also become commonplace. Two are the main telemedicine market segments : Doctor to Doctors and Doctors to Patient Doctor-to-doctor / Second Opinion or hospital to doctors are those applications targeting opinion sharing between specialist or centre of excellence to make decisions on diagnosis or for continuous medical education purposes. ( Second Opinion between doctors / hospitals, mainly data exchange and consultancy between experts, essential to make medical decisions in real time to address diagnoses issues with the aid of remote medical experts consultations with the advantage to allow doctors to compare their opinions and clear any doubts essential in remote areas, lacking of specialist doctors ) Doctor-to-patient / Home care that is to say doctor visiting patients for routing health control, psychological support or homecare monitoring of vital parameters, as it is the case for early hospital discharge or chronic illness patients (allows patients to benefit from medical visits in their own home, without having to stay long time in a hospital for post surgery control or for chronicle illness. Well applied when daily or periodic medical control are requested for health care, monitor parameters such as blood pressure, temperature, heart beet and frequency, oxygen saturation, ECG, etc.)

Facilitators
Teleconference technology 4G IPhones Large, Global initiatives

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VI. Global Healthcare Trends and Timelines

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Major Trends and Timeline (2010-2014, 2015, 2020)

2010-2014
Patient access to healthcare records Patient social networks Earlier retirement Health 2.0 Earlier treatments Wellness treatments Genetic testing Targeted clinical trials Advanced diagnostics Bio-medical printing

Major Trend Power Patients

2015
Patient-centered, multi-provider team care Baby Boomer retirement Implementation of Health IT Physicians using technology Customized products Implementation of Health IT Decision Support Solution Advancements Major diseases understood at molecular level treatment Bio-medical printing advancements Nanotechnology advancements Virtual reality/simulation technology advancements and related solutions Non-invasive delivery Bio-medical printing advancements Smart Pills - advanced Virtual medical communities (growing demand for EMR-global) Hosted (cloud computing) Informatics

2020
Patients totally connected to healthcare providers virtually and on a global basis Total Home-based, virtual healthcare Pre- symptomatic diagnostics

Consumer Patients

Prevention before Cure Personalized Medicine and Healthcare

Pre- symptomatic diagnostics Bio-medical materials advancements Nanotechnology advancements Virtual reality/simulation technology advancements and environments Drug cocktails that will enhance productivity, memory & physical performance Global hospital to hospital connectivity (hosted informatics) Virtual reality (simulation) hospitals global scope

Smarter Drugs

Non-invasive delivery Bio-medical printing Smart pills Hospital to Hospital connectivity (EMR) US Federal Healthcare reform stimulus funds (Health IT)

Virtual Hospitals

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VI. Global Healthcare Trends and Timelines

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Major Trends and Timeline (2010-2014, 2015, 2020)

Major Trend 2010-2014
Early stages of Bio-medical printing (tissues, wound treatments, pills, etc.)

2015
Bio-medical printing (pills) increased innovation and development advancements Continued innovation and development advancements of 3-D bio-medical printing of tissues/veins

2020
Bio-medical printing (organs/ tissues) major advancements personalized medicine-genetic Advanced nanotechnology regenerative medicine innovation Sophisticated food processing/ formulation technologies Major nanotechnology advancements in nutraceuticals Continued focus and advancements in personalized medicine (genetic tailoring) More specialized variations of nutraceuticals (genetic tailoring)

Regenerative Medicine

Nutraceuticals

Baby Boomer retirement Health 2.0 Increased focus on weight management Increased focus on anti-aging Increased focus on libido (performance enhancement) Increased focus on joint health Increased focus on digestive health Increased focus on beauty from within Increased focus on pet food nutraceuticals/functional food

Focus on personalized medicine Implementation of Health IT Physicians using technology Customized products Cognitive function technology advanced Mood food advancements and demand Continued focus on joint health Advancements in mood and energy nutrients Advancements in digestive health nutrients Increased focus on pet food nutraceuticals/functional food Increased focus on disease prevention

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Company X Whitespace Innovation Study Final Report

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VI. Global Healthcare Trends and Timelines

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Major Trends and Timeline (2010-2014, 2015, 2020)

2010-2014
Continued research and development in devices to help reduce and prevent number of sports-related injuries and to speed up recovery

Major Trend Sports Medicine

2015
New surgical alternatives becoming more prevalent Advancements in bone grafting techniques Advancements in cognitive treatments and related devices Advancements in pain management medications, devices, etc.

2020
Advanced post-cognitive testing systems Advanced wearable sensors for detection of concussions, etc Timed-medications (nanomedicine) for pain management, etc.

Advanced Diagnostics

Disease and pain management devices continued innovation and deployment into home Instant mobile diagnostic testing device innovations Patient-centric healthcare becoming more prevalent

Remote patient self-monitoring Continued patient-centric healthcare becoming more prevalent Increased patient medical record connectivity with doctor, hospital Advancements in pre- symptomatic diagnostics

Total Home-based, virtual healthcare (fully connected with healthcare providers physicians, hospitals, pharmacies, etc.) Large embedded installed base of diagnostic devices in the home and remote areas Virtual medical diagnostics network global scope

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