Healthcare Conference 2013 : Genes, Clouds and Cancer - dr. Andrew Litt

Powering the Possible Genes, Clouds and Cancer

Healthcare

Serving >50% of US hospitals that care to 90 million Americans

Leading IT provider for 1st, 2nd and 3rd generation gene sequencing

13,000 employees worldwide.

300+ MDs, RNs and PhDs

Support for >500 software, medical device & scientific instrument providers

#1 Worldwide Healthcare IT Services Vendor - Gartner Serving 7 of top 10 pharmaceutical companies

Managing over 6 Billion medical images in cloud based archive

Serving 100 insurance organizations with 65 million members

Managing 14 billion security events a day

Dell Healthcare & Life Sciences by the numbers

Provide OEM services to 70+ Healthcare and Life Sciences software, medical device and scientific instrument providers

Sponsor of 1st FDA Approved Genomics-Based Pediatric Cancer Clinical Trial

2

Presenter

Presentation Notes

KEY TAKEAWAY: Our commitment and leadership in Healthcare and Life Sciences is evident from the investments we have made in the last few years (Dedicated business unit for HCLS, acquisition of Perot Systems, InSite One, Compellent, SecureWorks..) and the market recognition we have received thus far with the #1 IT Services vendor by Gartner 2 years in a row. Delivery Tips: For more than 25 years, Dell has played a critical role in transforming computing, enabling more affordable and more pervasive access to technology around the world. When it comes to Healthcare, with the level of commitment and focus that Michael Dell has brought in the past 2 years, we have gone through a major transformation from a predominantly hardware player to an end-to-end solution provider. In 2009 we made the first Healthcare specific acquisition of Perot Systems. Since then we have acquired 8 companies including InSite One, SecureWorks, Compellent and Boomi. As a result of our continued commitment and focus on healthcare, we have been ranked #1 in Healthcare IT services by Gartner (now 2 years in a row). More than 50% of the US hospitals are our customers including 15 of the top 25 health systems.

Healthcare

Evidence based medicine

Target population

Selection of representative study cohort

Clinical trail

Therapeutic option 1

Drug of choice for EVERYONE in target

population

Option 2 is not approved for this

indication

30% Response rate


20% Response rate


A

3

Healthcare


Information enabled medicine

A

Target population Therapeutic option 1

B


Selection of representative study cohort

Association of molecular feature to phenotype/response

4

Presenter

Presentation Notes

Example: Hep C -- affects 3% of world’s population --Treated with PEG-interferon- but only works in 50% --Variant of gene IL28B – accounts for 2 fold increase in response Plavix-- metabolized in the liver -- mutation in CYP2C19 causes 3 fold increase in stent clotting -- mutation is present in 30% of European, 40% of African and 50% of Asian ancestries

Healthcare

Information Enabled Medicine

5

Plavix • Mutation in CYP2C19 causes 3 fold

increase in stent clotting • Mutation is present in 30% of European,

40% of African and 50% of Asian ancestries

Healthcare

Molecular profiling

100’s of options

Intelligent interpretation

(understanding)

Selection of an individualized

option


Information –enabled medicine

Precision Medicine

N=1

The key question is: How do we do that ?

Individualized Information

6

Healthcare

Powering the Possible program Finding cures and hope for Pediatric Cancer

• Cancer isn’t just one disease, it’s hundreds – and varies between individuals

• More effective cures can be “discovered” for each tumor and by attacking the unique vulnerabilities of each child’s tumor directly

• Why Pediatric Oncology? – Leading cause of disease-related death in children ages 1-14 – A child diagnosed with cancer every hour – Cure rates have not improved in the last decade – Pharmaceutical companies have thousands of new drugs in development but very few target pediatric cancer

• Why Neuroblastoma?

– Worst clinical outcome of any pediatric cancer – 5% chance of cure in children with advanced stages of the disease – Even with remission, the cancer often returns and is untreatable

7

Presenter

Presentation Notes

Specifically pediatric cancer and neuroblastoma because these children have no other hope… all other convention treatments have failed them. Make a meaningful difference now Infrastructure platform will be useful in the treatment �of all other pediatric cancers and eventually adult cancers An area where technology plays an important/central role We are adding value where it is needed most and in a unique way.

Healthcare

Panel of Genes vs.Exomes vs. Whole Genomes

Whole Genome Sequencing challenges: –Cost vs.

Interpretable Data –Informatics

Challenges

Healthcare

GEDI – Genomics Enabled Drug Inference Gene Drug Relationship Database Genomic Compendium Report

Heuristic Rules Algorithm

Healthcare

First ever clinical trial using Molecular guided Individualized therapy in pediatric cancer

10

Molecular profiling Biopsy

Dell High Performance Computing:

Faster and deeper profiling for each child

Healthcare

DATA ANALYSIS

SEQUENCING

LIBRARY PREP

DAY

S

STANDARD GOAL STRETCH GOAL

SUPER STRETCH

GOAL

Presenter

Presentation Notes

Shown on this graph are the three goal levels for the RNA sequencing portion of the project. The primary goal is to be able to turn around data analysis within a timeframe that meets the criteria of the tumor board meeting – e.g. within two calendar weeks of patient recruitment. The stretch goal is to cut that time in half by advancing the data anaysis approaches to improve on speed without sacrificing accuracy. To meet the stretch goal for this project we also must decrease the amount of time required to perform the wet lab library prep of each sample by 33%. We are happy to announce that we have already met the stretch goal of the project – we can perform analysis of the data for one patient in ~24 hours and can perform the wet lab library prep in under 48 hours. The super stretch goal requires a novel approach for the on-machine sequencing time to effectively remove several days from the required sequencer time. In short due to the collaborative advances between Dell [improved hardware for accelerated data processing] and TGen [novel computationally “divide and conquer” analysis approach developed in Dr. Huentelman’s lab and novel wet lab workflow development to accelerate the time to complete sample library preparation] we have already met the stretch goals for the project and have succeeded in analyzing RNA sequencing data quicker than has ever been reported to be achieved in the scientific literature for a data set that is over 100 million unique counts. “Even though it is very early in our collaboration with Dell we have already achieved a milestone that we considered at the start of this phase of the project to be only marginally attainable – that is, our so-called Super Stretch Goal. In short we are able to generate and analyze next generation RNA sequencing data faster than has ever been reported in the scientific literature. This required a combination of both hardware and software innovations that tapped into the expertise on both sides of the collaboration. Because of this, we can indicate – today – that we can generate and analyze neuroblastoma patient specific RNA sequencing data in a timeframe that is able to be reconciled with the required rapid turn around in laboratory testing necessary to have an impact on this disease. In other words, even at this early juncture in our collaboration we are clearly able to demonstrate hope for the patients and families suffering with this disease.”

Healthcare

Factory-integrated, HPC infrastructure

• Linux-based 512 node cluster • Large memory node • Lustre-based parallel file

system • NAS-accessed output data

/user files • Cluster and workload

management • Rich standard development

tools • Services and support

12

Active Infrastructure for HPC Life Sciences A complete, integrated genomic processing infrastructure

High performance computing meets big data!

Reduce turnaround times from days to hours!

Designed to meet the needs of genomic research

• Includes all resources required for complete analysis workflow

• NGS output directly to compute grid

• Compatible with extensive genomics application ecosystem

• Optimized for performance, density, efficiency & power

Presenter

Presentation Notes

Dell HPC for Life Sciences Extending Dell’s leadership in high performance computing (HPC) and life sciences, Dell announced HPC for Life Sciences Active Infrastructure, a complete HPC infrastructure solution uniquely designed to meet the needs of genomic data collection and analysis. With recent advancements in low-cost genome sequencing systems and widespread availability of mature analysis software and datasets, the computational and data storage requirements of genomic research has become a primary bottleneck in the effort to engineer and exploit scientific breakthroughs across a wide variety of fields including cancer therapy, drug design, forensics, biofuels, and agriculture. [For example, medical research institutions and healthcare organizations need to dramatically accelerate genomic analysis to more effectively develop personalized treatments and therapies for chronic diseases in a timely manner.]

Healthcare 13

Rapid results with maximum efficiency Dell Active Infrastructure for HPC Life Sciences

A complete genome analysis in less than an 8 hr.

Up to 38 genomes processed per day

As low as 25 kilowatts per genome

Up to 9.4 Tflops, 1.5 TBs RAM, 520TBs in 42U chassis

Time to production reduced from months to weeks

One source for solution design, delivery, and support

Presenter

Presentation Notes

The Active Infrastructure for HPC Life Sciences solution enables organizations, researchers and clinicians to accelerate time-to-insight with an easy-to-deploy, open standards-based architecture designed for performance, scalability and efficiency. The solution is uniquely suited to meet the intense computing requirements and massive high-performance data storage needs of genomic processing, and is designed to deploy quickly, reduce analysis times from days to hours, and be cost effective for large-scale production use. It does this while offering best-in-class density and energy efficiency in an open, factory-integrated HPC infrastructure with world class support and expertise. Industry leading genomic analysis: By optimizing analysis software and workloads across the Active Infrastructure’s clustered computing grid and high performance file system, customers can process up to 38 genomes per day in a single Active Infrastructure system, and the ability to turnaround a specific genome analysis within an 8-hour workday [pending legal approval] Best in class density and energy efficiency: Solution includes 512 cores, 9.5Tflops, 480TBs all within one 42U rack that can scale to include larger configurations through custom expansion, while leveraging as low as 25 kilowatts per genome. Open, factory-integrated HPC infrastructure: “Cluster-in-a-rack” for data-intensive genomic workloads. Preconfigured, integrated, tested to reduce time to production from months to weeks. World-class support and expertise: One source for solution design, delivery and support, including Dell genomic pre-sales and architectural support.

Healthcare


14


Molecular tumor board

Dell Genomics Cloud: Improved clinical/scientific

communication and collaboration

Healthcare

Accessing Networked Genomic Data: Multiple Data Portals

Cancer Genome Data Portal

Knowledge Computing Research Portals

Genomic Tumor Board Clinical Trial Data Portal

KIDS-CLOUDS Unifying Precision Medical

Genomics Ecosystem

Public Facing Portals for Specific Trials

Presenter

Presentation Notes

Accessing Data in the K-Cloud Ecosystem Through Multiple Data Portals & Collaboration Sites

Healthcare

Collaborative Molecular Medicine

Video Conferencing & Scheduling Capabilities – Cisco Suite of WebEx and TelePresence Video Interactive Dashboard for Presenting Multi-Media Files In Real Time – Lightbox App

Capturing Corollary Findings, Ideas and Side-Bar Conversations – Research Forum App Searchable Back-end File and Knowledge Management Archive – Dell HIPAA HC Cloud

WebEx Video

Searchable Archive Patient

Centric Files

Data Sharing Portal

Apps Bin: LightBox, Research

Forum, etc

Healthcare


17


Molecular tumor board

Personalized Treatment

Dell Genomics Cloud: Improved clinical/scientific

communication and collaboration

Dell High Performance Computing:

Faster and deeper profiling for each child

Healthcare

Increases computation and collaboration capacity by 1,200%

For Pediatric Cancer, Cloud technology helps identify personalized treatment strategies for children with neuroblastoma

Reduces mapping and analysis from weeks to hours

Expands participation from a few children to hundreds and then thousands

Healthcare

June 6, 2012 October 10, 2012

Powering the Possible for Pediatric Cancer Case Study - Dramatic Response in all 4 tumor areas

Giselle Sholler, M.D. – Presentation, SIOP Conference

Healthcare

Shelby: A Medical Miracle

Healthcare

Big Data: Security and Privacy

Healthcare

It’s all about Trust

22

It’s all about Trust

Healthcare

Patient perspectives on sharing information

• 54% of patients would withhold information

• 38% would postpone seeking care

• 37% would travel substantial distances to avoid a hospital they don’t trust with their privacy

• 73% said serious breaches of PHI would reduce confidence in the quality of healthcare provided

• 97% said healthcare executives have a legal and ethical responsibility to protect their privacy

• 87% think health executives should lose their jobs over failure to act

Source: Fairwarning Report: Industry Best Practices for Patient Privacy in Electronic Health Records, April 2011 23

Healthcare

Percentage of all healthcare providers that had at least one data breach in the past two years

Amount earmarked between 2011 and 2015 for attesting to meaningful use of EHR

$27 billion

65% Proportion of breaches reported involving mobile devices

60% Proportion of healthcare providers that have had 2 or more breaches in the past 2 years

$50 Black market value of a health record

18+ million Number of patients whose protected health information was breached between 2009 and 2011

96%

Presenter

Presentation Notes

Let’s start by taking a look at the realities healthcare organizations face. Healthcare and life science companies are challenged with allowing employees to bring their own mobile devices, and manage increasing endpoints to access data. At the same time, new threats, vulnerabilities and attack methods emerge every day. Cyber criminals are becoming smarter and more organized, and attacks are becoming more difficult to detect. Despite past efforts to strengthen their security posture, healthcare companies are largely still deficient in managing security. In fact, according to a recent Ponemon institute research study - 96% of healthcare providers had at least 1 data breach in the past two years, with patient billing data and medical records representing some of the most vulnerable data types. This is likely because healthcare providers don’t have the proper policies and controls to detect and respond to breaches. Complicating matters, a recent HIMSS study of healthcare providers found that fifty-eight percent of the respondents had no staff members dedicated to security, and 50% spent 3% or less of organizational resources on security. The facts paint a pretty gloomy picture. You’re charged with protecting intellectual property and Protected Health Information, while enabling your employees to become more efficient by allowing mobile device usage, as well as opening up data exchange to business associates to access the information they need, anytime, from anywhere. It’s not an uncomplicated task.

Healthcare 25

Presenter

Presentation Notes

sing only a computer, an Internet connection, and publicly accessible online resources, a team of Whitehead Institute researchers has been able to identify nearly 50 individuals who had submitted personal genetic material as participants in genomic studies. Intent on conducting an exercise in “vulnerability research”—a common practice in the field of information security—the team took a multi-step approach to prove that under certain circumstances, the full names and identities of genomic research participants can be determined, even when their genetic information is held in databases in de-identified form “This is an important result that points out the potential for breaches of privacy in genomics studies,” says Whitehead Fellow Yaniv Erlich, who led the research team. A description of the group’s work is published in this week’s Science magazine.

Healthcare 26

Data visibility

Endpoint access and encryption

Mobile device

strategy

Security strategy should support 4 critical areas

Security and risk

monitoring

Presenter

Presentation Notes

For healthcare providers to protect themselves, they need to ask a couple of critical questions. The first step is to understand where every piece of equipment that stores, accesses or transfers protected data is located. Data could also be stored in some less conspicuous places, such as spreadsheets, thumb drives, and ultrasound machines. This all starts with a comprehensive risk assessment. But just “checking the box” through a risk assessment is not enough. We also need to ask “how are you protecting patient data?” Answering this question is important. What protections do you have in place already? Is your network protected by a Firewall? Is anti-virus installed on all systems? Are you utilizing encryption? If so where and how?

Healthcare

27

Dell Healthcare:

Better information Better healthcare

Presenter

Presentation Notes

KEY TAKEAWAY: Dell Healthcare connects people to the right technology and processes to create information-driven healthcare and accelerate innovation. Delivery Tips: Government and healthcare industry leaders around the world are relying on Health IT to overcome the numerous challenges of the healthcare system and drive much needed transformation. Without a doubt, the adoption rate of new technology in the healthcare sector will rapidly accelerate over the next several years. It is evident that change is coming. But will it be a change in the right direction? Or will the rapid adoption of technology simply accelerate our current problems? The healthcare industry is at a crossroads. How do we move healthcare forward? Simply adding technology is not enough. Dell believes information is the foundation on which healthcare will move forward, transitioning from treating illness to managing wellness. While technology itself plays a major role, it’s also about connecting people to the right technology and integrating that technology into their workflows. Additionally, processes need to be re-examined and, in many cases, re-engineered. It’s about a holistic approach. Dell Healthcare connects people to the right technology and processes to create information-driven healthcare and accelerate innovation.

Healthcare Conference 2013 : Genes, Clouds and Cancer - dr. Andrew Litt

Health & Medicine

Transcript of Healthcare Conference 2013 : Genes, Clouds and Cancer - dr. Andrew Litt