Whitespace innovation study healthcare ecosystems

Whitespace Innovation Study:
Evolutionary, Revolutionary and Disruptive Healthcare Ecosystems: 2020

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Company X Whitespace Innovation Study – Final Report
Table of Contents
Pages
n  I. Research Objectives and Methodology, Profile of KIL Respondents 3-4
n  II. Key Healthcare Trends Emerging 5-11
q  Paradigm Shifts
q  Disruptive Innovations
q  Long-term Outlook –KIL Insights and Predictions (Healthcare, Medicine)
n  III. Key Healthcare Policy Initiatives & New Healthcare Models 12
q  U.S. (Models, Drivers, Inhibitors)
q  International (Models, Drivers, Inhibitors)
n  IV. Healthcare Ecosystems Overview (Market Dynamics, Technologies, Key Players) 13-38
q  KIL Insights and Observations
n  V. Key Whitespace Opportunities 39-47
n  VI. Global Healthcare Trends and Timelines 48-51
q  Major Trends and Timeline (2010, 2015, 2020)
n  VII. Recommendations (3-5 yr. ROI Estimate) 52-55
q  Adjacent markets, Drivers and Trends

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n  I. Research Objectives and Methodology
q  Research Objectives and Methodology Process:
§  Provide primary and secondary market research/analysis, while assisting in the identification of
emerging innovation, technology, products, trends , evolving healthcare ecosystems, along with new
whitespace/disruptive innovation insights and opportunities. This research also serve as a market
analysis which identifies emerging global healthcare business opportunities/markets.
Qualitative Research Methodology: Harrison Hayes utilized a primary, qualitative Key Innovation
Leader (KIL) research module – customized specifically for the needs of the Company X Whitespace
Innovation research initiative along with supplementary secondary research.
§  Harrison Hayes utilized a variety of database resources to recruit a world class group of KILs. Harrison
Hayes identified a number of valuable individuals to interview and created a project-specific database
with all pertinent KIL contact information for Company X.
§  41 KILs based in the US, UK, Belgium, Netherlands, Norway, Spain, Australia, S. Korea, Panama and
India were interviewed by phone. The KIL's were pre-screened to assure they could provide insightful
observations and innovative approaches.
§  All interviews were conducted by Harrison Hayes’s Principals and Market Research Team who had
the autonomy to probe deeper and maneuver through unique issues that arose during discussions with
the KILs – what is referred to as improvisational interviewing.
§  The overall content of this study reflects (1) the combined/integrated feedback and in some cases,
consensus, of the KILs who participated in this study, and (2) Harrison Hayes data and qualitative
primary and secondary research analysis .

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n  I. Profile of KIL Respondents
Number of KILs Interviewed:
Geographic Scope: Represented Countries:
-- 41
-- US, UK, Belgium, Netherlands, Norway, Spain, Australia, S. Korea, Panama, India
Professional
Categories of KILs Interviewed:
-- MD’s (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)
KIL Specialties & Research Area Focus:
--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

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n  II. Key Healthcare Trends Emerging (Global)
q  Paradigm Shifts
n  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).
n  Physician’s 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).
n  Shift from taking care of sick people to trying to prevent people from becoming sick. Lifestyle changes important
in patient healthcare self-management.
n  Shift to larger focus is on disease prevention (disease management) and wellness.
n  Shift from primary/secondary health care to more of a focus on patient healthcare self-management and where
the care is given.
n  Shift to IT and communications tools (e.g. smartphones, iPhones, iPads) as new ways of delivering healthcare.

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q  Disruptive Innovation
n  Value-based healthcare delivery
q  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.
q  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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q  Disruptive Innovation – cont’d.
n  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?
n  Implications
q  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.
q  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.
q  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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q  Disruptive Innovation – cont’d.
n  Personalized Medicine/Healthcare
q  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.
q  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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q  Long-term Outlook (Healthcare, Medicine)
q  KIL Insights and Predictions: Major Changes over Next 20 Years
§  Significant life extension with ever-increasing quality of life.
§  Diabetes-Cure within 10 years; Cancer-Early cures in 5 years; all cured in 20 years (via
Nanotechnology) ; Chronic Disease Pain Management-All cured or managed within 15 years.
§  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.

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q  Long-term Outlook (Healthcare, Medicine) – cont’d.
q  KIL Insights and Predictions: Major Changes over Next 20 Years
§  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.
§  Medicine is moving from a trial and error science to an information technology; and information
technologies have shown themselves to be on an exponential growth curve.
§  New understanding of the brain and better drugs and drug targeting (via Nano) will enable deep and
even routine pathologies to be eliminated or ameliorated.
§  Genetic/epigenetic testing will also give parents a tool to better secure their child’s future against
pathologies.

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q  Long-term Outlook (Healthcare, Medicine) – cont’d.
q  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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n  III. Key Healthcare Policy Initiatives & New Healthcare Models
q  U.S. (New Models, Drivers, Inhibitors)
n  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.
n  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.
q  International (New Models, Drivers, Inhibitors)
n  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).
n  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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n  IV. Key Emerging Healthcare Ecosystems
Ecosystems Focus Facilitators Market
Drivers
(Impact)
Market
Inhibitors
(Implications)
Key
Players
Health & Wellness
(Preventive/
Predictive Cure)
(Sub: Patient-
centric/self-
managed
healthcare)
• 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 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.)
• Studies 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
•  Costs
associated with
wellness
• Global
economic issues
(demographic s)
• Medical
device
suppliers
• Functional
food suppliers
• Corporations
• Consumers
(aging
populations,
parents)
• Alternative
medicine
providers

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A.  KIL Insights and Observations: Health & Wellness (Preventive/Predictive Cure)
n  Market Segments:
n  Patient-centric/self-managed healthcare; simulation/virtual reality solutions; video games for health (with
incentives built in); wellness tracking devices (Ambient, virtual medical records, instant diagnosis).
n  Wii Fit: The growing popularity of the Wii Fit product is a great indication of the direction of physical fitness in
the near future; makes exercise fun and competitive.
n  Over the long-term, wellness/health-related games will become even more enticing, tailored to keep an
individual engaged in a virtual reality ad infinitum. Currently, health clubs are now combining fitness with video
games – age ranging targets from7-17 years old.
n  Over the long-term, it is predicted that exercise will be unnecessary as treatments will be developed to
get you fit without the work.
n  Over the long-term, obesity will largely disappear through treatments.
n  Over the short-term, it is projected that mobile technology will help to put a “therapist in your
pocket.” Applications are currently being developed to aid in “mood management”, “stress relievers”, and
direct communication –anywhere and anytime- with a possible, avatar/virtual reality therapist. This is currently a
nascent market.
n  Wearable body sensors which are combined with your mobile device are projected to grow in popularity.
The concept is called “Body Language” –a system combining wearable body sensors, a mobile phone app and
a simple messaging system that facilitates a dialogue between a person and their body, giving the person
advice about what it needs and what to do (e.g. count calories/lose weight; stop smoking; heart monitors. Can
also scan personal social networks to track behaviors, content, etc.

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n  IV. Key Emerging Healthcare Ecosystems-cont’d.
Ecosystems Focus Facilitators Market
Drivers
(Impact)
Market
Inhibitors
(Implications)
Key Players
Personalized
Healthcare/Medicine
• Disease detection
(cancer, diabetes,
hypertension)
• Home-based, self-
managed healthcare
• Personalized medications/
targeted therapeutics
• Home-based diagnostics/
disease maintenance/
chronic pain management
• 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)
• Aging
independently
(e.g. Boomer
effect)
• Growing aging
population
(Global)
• Expansion of
health and
wellness
(Corporate,
personal)
• Fragmentation
of market
(increased
niches)
• Personalized
medicine’s ROI,
not until 7-10
years due to
technology still
evolving. Still
hard to
monetize.
• Federal
healthcare
reform (its
impact still up in
the air)
Samples:
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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A.  KIL Insights and Observations: Personalized Healthcare/Medicine
n  Growing Market Segments
n  Cyberdocs
n  Telehealth & Telemedicine (& Telepresence)
n  Personalized drugs
n  Home-based, self-managed healthcare
n  Advanced/Remote Diagnostics
n  Important Impacts in Personalized Healthcare/Medicine over next 3-5 years
n  Extending care providers ability to interact with patients in real-time, including rural and
remote patient populations via telemedicine / telepresence technologies.
n  More information (including healthcare information ) will be carried by the patient via
smartphones, iPads, computers, and mobile monitoring/diagnostic devices.
BOTTOM LINE OBSERVATION: Within 20 years, every device will have an interface into
some type of healthcare “cloud” network.
n  Medical imaging real-time technology/solutions cost-curve coming down - physicians will be
able to perform medical consultations, procedures remotely and get reimbursed.
n  Movement toward patients receiving common diagnostic tests in homes, via toilets, sinks,
mirrors, phones, for example. These tests could include: blood, urine, heart, temperature,
level of bacteria in system, etc. Physicians, hospitals and pharmacies would also be able to
track and receive baseline health information data , with alert mechanisms. Doctors offices
would be eliminated for most procedures.

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A.  KIL Insights and Observations: Personalized Healthcare/Medicine-cont’d.
n  Six Sigma Approach to Healthcare
n The *LEAN Six Sigma approach can be applied to healthcare. Instead of treating symptoms, look at
the root cause and work from there.
n  Wellness Management vs. Disease Management: It was also suggested that the LEAN Six Sigma
approach be applied to the practice of medicine, along with products and research, instead of just to the
business processes of medicine. * Lean Six Sigma is a relatively well-known approach for achieving operational
excellence

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Ecosystems Focus Facilitators Market Drivers
(Impact)
Market
Inhibitors
(Implications)
Key Players
Smarter, On-
Demand,
Personalized Drugs
(Sub: Smart Medicine
Management)
NOTE: Nootropics
(pronounced /also referred to
as smart drugs, memory
enhancers, and cognitive
enhancers, are drugs,
supplements, nutraceuticals,
and functional foods that are
purported to improve mental
functions such as cognition,
memory, intelligence,
motivation, attention, and
concentration.
• Non-invasive delivery
• Genetic/personalized
drugs
• Pills-On-Demand
• Smart Capsules
• Nootropics/Mind
Enhancing Drugs
• Intelligent pills: Aids
formulation
development; clinical
drug trials; drug
selection; dosing profiles
• Microchips into pills-
networked, digital drugs-
dosage/disease
management
• Smart medicine
management
• Bio-medical materials
(bio-medical printing,
customized dosages,
remote delivery, just-
in-time delivery)
• Digital Drugs
• Smart Drugs
• Device/Drug
identification
• Food industry
applications – aids
in site absorption
studies; hunger
suppressant studies,
allergic reaction
studies
• Growth in
personalized
medicine
technology and
innovation
continuing
advancements
• Advanced
monitoring
(systems which can
be swallowed into a
patient’s body)
• Possible
government
(FDA) pushback
and/or regulation
delays
• Manufacturing
and
development
costs
• Possible
consumer
backlash
• Possible supply
chain/distribution
problems
• Philips
(technology)
IntelliCap
• Proteus
Biomedical –
backed by
Novartis/
Medtronic

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A.  KIL Insights and Observations: Smarter, On-Demand, Personalized Drugs
n  Pills on Demand: Over the long-term, printing pills “to order” to create safer, faster-acting medicines
will be productized. New methods will enable multiple types of medicines to be printed onto one pill.
However, there will be supply chain and sales forecast ramifications. Going to more “customized”
medicines will directly affect these areas and will be quite disruptive to current related processes.
n  Smart Capsules: Researchers at the CNRS Paul Pascal Research Center in Bordeaux, France have
designed smart capsules that are able to release their contents on demand, simply by raising the
temperature. Described in an article published in the journal Langmuir, this novel system has just been
patented. It opens up the way to many applications in a large number of fields such as food, perfumes and
agriculture, for instance to deliver pesticides above a specific temperature. The principle is very simple,
cheap, and applicable to a very large number of systems. The method could be used to monitor freshness
of foods or to release a perfume into the air, onto fabric or onto skin. Another possibility is the release of a
therapeutic agent onto the skin, which in this case could be triggered locally by rubbing when it is applied
(rubbing would cause warming).
n  Smart Drugs/Nootropics: Additional research suggests that smart drugs or “Nootropics” such as
methylphenidate, modafinil and piracetam are increasingly being used by the healthy to augment cognitive
ability. Although current nootropics offer only modest improvements in cognitive performance, it appears
likely that more effective compounds will be developed in the future and that their off-label use will increase.
NOTE: Over the next ten years, it is projected by analysts that the issue of nootropics will become huge. There will
be questions on whether people should be free to take these drugs, whether the social advantages outweigh the
personal advantages, and whether they confer an unfair advantage to users by leading to higher grades, better jobs,
more money. But there’s also the issue of drugs development. If a strong market for nootropics emerges, there is
every chance that new, more effective drugs will follow. Then the question arises – who gets the “good” stuff, and who
suffers as a result? Therefore, the 2010’s are set to be an interesting decade for mind-enhancing substances

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A.  KIL Insights and Observations: Smarter, On-Demand, Personalized Drugs
– cont’d.
n  Intelligent Pills: Philips' new IntelliCap technology has the potential to take intelligent drug delivery to
the next level. It is a technology which designs a pill that combines technologies for localized drug release
with the ability to measure the internal environment and communicate this information to the outside world -
without the need for large machines or wires.
The IntelliCap technology produces a pill that has been designed to be swallowed with food or water like a
regular pill. This IntelliCap is more a drug-filled capsule that uses the natural digestion process to reach the
intestines and then deliver treatment at a specific spot. Once there, IntelliCap has the technology on board
to take specific internal measurements, such as temperature and acidity levels, and wirelessly transmit the
data via a transceiver to an external unit for the doctor to monitor.
APPLICATIONS: Food industry applications – aids in site absorption studies; hunger suppressant
studies, and allergic reaction studies.
n Digital Drugs: Proteus Biomedical, Redwood City, CA, is developing ingestible chips that can be
embedded in pills turning them into networked, digital drugs. The technology aims at reducing the likelihood
of a patient missing a dose, which could lead to serious complications. The Proteus system (e.g. Raisin) has
been tested in trials for drugs that treat heart failure, hypertension, TB and other diseases. There are other
companies with similar technology, however, Proteus is one of the closest to market. According to Proteus,
Raisin-enabled drugs are expected to go on the market as early as 2012.
n  NOTE: Novartis plans to use the system next year in a trial for a transplant drug.

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(Impact)
Market
Inhibitors
(Implications)
Key
Players
Informatics •  Health IT Informatics
•  Clinical Informatics
•  Medical Informatics
•  Nursing Informatics
•  Pharmaceutical
Informatics
•  EMR/PHR
• Medical Imaging
Informatics
• Hosted Informatics (e.g.
Pharma R&D SaaS) OR
Cloud Sourcing
(“Electronic Lab”)
•  Decision Support
•  Disease Management
– Personalized
• 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 Notebooks-
shared library)
• RFID Middleware
solutions
• Individualized treatment
plans for each patient
•  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 Sourcing-
Improves operational
agility –”Just in Time”
(will help with more
efficient CRO (Contract
Research Organization)
engagements
• EMR resistance
of physicians
(lost time, costs,
etc.)
• Issues of
privacy, identity
and permissions
(particularly
challenging on a
worldwide basis.)
• Data integration
across data
layers (enterprise
and globally. Will
take time –
approx. 5-10
years,
conservative
estimate
• Hospital
EMR:
Allscripts/,
Eclipsys, Epic,
Siemens,
Cerner;
Ambulatory
EMR: MD-IT
• Clinical
Informatics:
Partners
Healthcare
• Health IT
Middleware:
•  IBM
•  Oracle
•  Intel

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A.  KIL Insights and Observations: Informatics
n  Future Electronic Lab via Hosted Informatics: A growing sector which can bring scientific information to scientists’
desktops. A subscription-based, software as a service (Saas) model (based on cloud computing) could provide
pharmaceutical companies improved operational agility and virtual collaboration more effectively with virtual teams and
partners in a shared, resource environment.
n  Clinical Informatics: Growing Area-Clinical Informatics is the study of information systems (computers/programs)
used in the clinical practice of medicine. Examples of aspects of the field include: (1) Data Entry at Point-of-Care which
automatically links to a patient’s electronic health record (HER); (2) Telemedicine – transmittal and access of patient health
records via teleconferencing/ teleradiology/ imaging informatics, etc.; (3) Imaging-new CT scanners can incorporate new
software algorithms that allow for 3D reconstruction of vital structures; (4) Data Display-vital signs can be highlighted when
abnormal; and (5) Decision Support-immediate feedback at the time of order entry about drug-drug interactions or patient
allergies has been shown to reduce both patient morbidity and healthcare costs.
n  One of the study’s KIL respondents based in the Netherlands, leads a Dutch IT (Information Technology) researcher
and development team that is currently working on new clinical informatics solutions focused on a “clinical /healthcare
team approach” to healthcare. One of the core elements to their approach is a “treatment plan for each patient.” This
approach includes working in parallel , a team of healthcare/clinician/pharmaceutical providers working together with
the patient. The IT system is designed to be able to accommodate and maintain the clinical and chemical (drug) care
plan and link the results of the steps in the process to the objective. In addition, the data will also link to care
standards parameters unique to specific drug and health ailments/disease states (both local and national
repositories). Resulting data will go into a decision support module to allow for immediate medication and/or
diagnostic feedback to the care team and patient.
n  NOTE: Approximately 99% of the physicians in the Netherlands and the UK are on EMR (electronic medical records).
Technically, however, the US is ahead. We have a bigger set of EMR R&D initiatives spurred on by the US Federal
government.

23
A.  KIL Insights and Observations: Informatics
n  Clinical Informatics: cont’d.
n  Important insights from another study KIL, who is a director of clinical informatics
at Partners Healthcare (Brigham's & Women’s Hospital and Harvard Medical School)
include the following:
n  Healthcare Technologies Investment Outlook: Predicts 1-5 years for investment in healthcare
technologies based on the US Federal government stimulus (capital infusion of $36B.) The benefits in
adopting EMR and PHR is well understood.
n  Working on building a Healthcare information network (Healthcare IT) prototype which would
include essential sources of data. This data would be used to create and manage a virtual database
for comparative data analysis that would be leveraged for development of new devices and drugs.
n  The data from this Healthcare information network would also spur a new type of data analysis that
would use large data sets to make evaluations in disease prevention, as a means of comparison. This
would represent a dramatic change in how we conduct clinical research, resulting in clinical trials for
drug studies becoming easier (e.g. having the ability to identify a plethora of drug side effects with
demographic views of large populations will become very important).

24
A.  KIL Insights and Observations: Informatics- cont’d.
n  Clinical Informatics:
n  Continued: Important insights from another study KIL, who is a director of clinical informatics
at Partners Healthcare (Brigham's & Women’s Hospital and Harvard Medical School) include the
following:
n  The Healthcare information network (Healthcare IT) prototype also addresses pain management and related disease
states. This technology allows them to move from an episodic care relationship to a continuous care relationship which, in
turn, can be home monitored (e.g. for weight, medication dosage, diagnostics, etc.) and intervened by clinicians and/or care
case managers so that they can become more proactive. Clinicians or care case managers can get a continuous read on the
disease with online access enabling the survey of the patient data. This data can also help to predict certain diseases which
can ultimately affect mortality.
n  Another part of this network is the public health data record repository which would include when a patient’s record is
online. In turn, the sytem would have the capability to predict an outbreak of diseases, such as the flu. This information could
spur proactive immunization and wellness initiatives to prevent disease with a good record of a patient’s health and to help
system can keep people current to help ward off epidemics.
n  The network would also enable the patient to be much more proactive using online tools. Whether iPhone applications for
exercise, or weight loss programs, this technology enables the “patient” to be much more proactive in their health care.
n  Synergy with Pharma companies. This type of system would also help to provide pharmaceutical companies with a more
targeted and customized therapy for smaller populutations of patients. Pharma should move away from the blockbuster drug
concept, to more personalized medications.

25
(Impact)
Market
Inhibitors
(Implications)
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 ¾’s
of current global
market for functional
foods.
• Increased focus on
memory loss
weight management
• Increased focus on anti-
aging
• Increased focus on libido
(performance
enhancement)
• Increased focus on joint
health
digestive health
“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)
• 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)
• Consumer
skepticism
•  Marketing
disconnect
• Niche confusion
• Pricing problems
• Ineffective dosage
viability of
nutraceuticals
• $ value vs.
preventing disease
• Functional
Foods: Nestle,
PepsiCo, General
Mills, Kellogg,
Kraft, Danone,
Unilever, Yakult.
Coca Cola
• Cargill, ADM,
Danisco
• Wal-Mart,
grocery stores,
Target

26
A.  KIL Insights and Observations: Nutraceuticals/Functional Foods
n  Market Dynamics: Changing demographics including aging baby boomer population are helping
to set the foundation for future growth. Healthcare trends, including Pharma investments and
research into diseases and chronic conditions are a further source for potential market growth. In
turn, inorganic growth has been largely due to acquisitions, licensing and partnership agreements.
n  Niche nutraceutical market segments include:
n  Kids (US-90% of parents find it difficult to find health products with “child-appeal”.)
n  Seniors (US-31M will turn 65 over the next 10 years, with a growing demand for condition-specific
foods; half of 50-64 yr. olds are very concerned about lack of mental sharpness vs. 43% of the total
population)
n Libido
n  Cognitive Function
n  Beauty from Within
n  Energy
n  Diabetics (Worldwide: Approx. 140M -2009; projected to grow to 300M by 2025. A new generation of
children suffering from type 2 diabetes will further drive functional food market opportunities.)
n  Obese (weight management: In the US, $30B a year is spent on self-care products for obesity.
Satiety is currently a very strong growth section).

27
A.  KIL Insights and Observations: Nutraceuticals/Functional Foods- cont’d.
n  Niche nutraceutical market segments include: - cont’d.
n  Menopausal Women (US-47M women are either menopausal or pre-menopausal)
n  Athletes (Approximately 120M US adults and 30M children participate in organized sports)
n  The largest functional food (nutraceutical) categories are not considered therapeutic.
Rather, they are focused on preventative or wellness-oriented products/services.
n  Focus increases on personalized medicine (e.g. genetic profiles) – future growth.
n  Function foods comprise approximately 5% of the overall US food market. Estimates for
sector growth range from 8.5% to 20% per year.
n  Bottom up trends:
n  Fiber
n  Omega3s
n  Plant Sterols
n  Peptides
n  Nanotechnology
n  Phyto-specific

28
(Impact)
Market
Inhibitors
(Implications)
Key Players
Regenerative
Medicine
(Sub: Biomaterials
Market)- High Growth
Mkt.
• The Biomaterials
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.
• Bio-Medical Printing
• Cell Therapy
• Tissue engineering
(e.g. artificial skin)
• Biomaterials products
include orthopedic,
dental, cardiovascular,
gastrointestinal,
wound care, urology,
plastic surgery, and
others.
• 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
• Reduced clinical trials
expenses
• 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.
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

29
A.  KIL Insights and Observations: Regenerative Medicine
n  Future in vascular tissue (human veins) regeneration (over next 5-6 years)
n  Biomaterials are widely used in medical devices, tissue replacement, and surface coating
applications.
n  Printing human tissues on demand - This was the inspiration for start-up company Organovo
who built and will market, the world’s first production 3D bio-printer.
- KIL study respondent interview with Dr. Gabor Forgacs, Founder of Organovo and
George H. Vineyard Distinguished Professor of Biological Physics Department of
Physics, Biology and Biomedical Engineering University of Missouri Columbia - on
company’s progress and technology:
Organovo will start with producing, only simple tissues, such as skin, muscle and short stretches of
blood vessels and these will be for research purposes. However, based on demand, the company
will be productizing its 3D (inkjet) bioprinter over the next 6-8 months. However, the company
expects that within approximately five years, once clinical trials are complete, the printers will
produce blood vessels for use as grafts in bypass surgery. With more research it should be possible
to produce bigger, more complex body parts, according to Dr. Forgacs because the machines have
the ability to make branched tubes, the technology could, for example, be used to create the
networks of blood vessels needed to sustain larger printed organs, like kidneys, livers and hearts.
The actualization of printing larger organs could take up to 7-9 years, based on FDA approval, etc.

30
A.  KIL Insights and Observations: Regenerative Medicine-cont’d.
n  Though printing organs is new, growing them from scratch on scaffolds has already been done
successfully. In 2006 Anthony Atala and his colleagues at the Wake Forest Institute for Regenerative
Medicine in North Carolina made new bladders for seven patients. These are still working, however,
there have been some complications which haven’t been officially reported according to sources.
n  Implications:
n  On-Demand: Will require a just-in-time system (supplies, database, etc.)
n  Extended Reach: Decentralized production of supplies will result in decreased shipping and
distribution time of medical goods during emergencies and access to hard to reach locations.
n  Closer to Home: Off-location bio-printing systems can store medical specs relevant to individuals,
providing closer access to care.
n  Personalized Printing: Allows for customized dosages and other healthcare-based on individuals’
needs.

31
(Impact)
Market
Inhibitors
(Implications)
Key Players
Advanced
Healthcare
Diagnostics and
Monitoring
• Mobile health
diagnostics –
instant blood/
saliva tests
• Home
Healthcare:
Home-based
and remote
field patient
diagnostic and
home
monitoring
• “Anywhere”
diagnostics
(mobile, home-
based, field)
• Patient monitoring
devices (e.g. remote, non-
invasive blood pressure
monitoring, cardiac rehab,
critical care and perioperative
monitoring, remote field
monitoring,
• 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)
• Medical Imaging (e.g.
Digital mammography,
Molecular imaging, imaging
informatics, etc.)
• Triage, Emergency
Testing in Hospitals
• Veterinary medicine (field
tests, border & disease
inspections)
• 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
• Women’s health:
increased innovation
in breast cancer
research and
diagnostic
• Early detection of
diseases
• Aids R&D
processes
• 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
•  Argento (UK)-Start-
up-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.
device companies:
Abraxis BioSciences,
AstraZeneca, Capsulution
Nanoscience AG, Do-
Coop, Elan Corporation,
J.R. Nanotech, Liquidia
Technologies, Company X
KGaA, Novartis, Pioneer
Surgical, Smith &
Nephew,Star Pharma and
Wyeth Pharmaceutical

32
A.  KIL Insights and Observations:
n  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.
n  Nanotechnology in Diagnostics and Healthcare: The role of nanotechnology in healthcare is very
important in terms of managing and eradicating diseases. NOTE: Argento Diagnostics (UK) has
developed a technology via a mobile device that provides instant mobile medical testing (instant blood and
saliva tests in less than 10 minutes. The device uses nanotechnology to analyze the samples.
n  Web and Mobile connected devices are now able to capture an individual's health-related data
and communicate that information to healthcare professionals situated, anywhere. This information allows
for distributed care enabling remote diagnoses, alerting doctors to changing conditions as they occur in
real-time and providing a total picture of a person’s health so that necessary care can be given.
n  Implications: Less beds, better health; Foreign expertise-Specialists can be utilized in geographically
remote areas through technology/communications-enabled consultations; More relevant, accurate and real-
time data of the health of populations can be gathered.
n  New Diagnostic Devices:
n  Detecting potential skin cancer. A home-use, medical device made for the early detection of nodular
melanoma.
n  Web-based stethoscope for remote diagnosis
n  Intelligent body monitor that preemptively predicts heart failure
n  Remote patient monitoring via an iPhone-mobile services that allows physicians to monitor patient
status information away from medical centers in real-time.
Advanced Healthcare Diagnostics and Monitoring

33
(Impact)
Market
Inhibitors
(Implications)
Key Players
Virtual Reality,
Simulation and
AI Technology
Solutions
(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
• Virtual surgery &
simulations
Development of
cognitive
enhancement
software
• Development of
therapeutic
software used at
home on iPhone,
PDA, computer
• Mobile
technology (e.g.
augmented reality
applications-
physician training)
• Cheaper, more
powerful
consumer
electronic devices
• More powerful
computer
graphics
processing
Behavioral /mental/
cognitive services
healthcare – emerging
market-driven by aging
boomers, military, etc.
• 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
• Reimbursement
issues over
advanced
simulation
treatments
• Business models
still evolving
• Costs of
equipment
• NYU,
University of
Pittsburgh
• Virtual Reality
Medical Center
(open to
investments)
• Innovation in
Learning (open
to investments)
(California-
based)
• Sony
• Microsoft
• Virtual Game
solution
providers

34
n  Imaging simulation and virtual reality (VR) technology: According to a study KIL who is an
expert in virtual reality/simulation technology research, this technology brings to clinical care and clinical
research a controlled stimulus environment of simulation which is projected to be of significant value in the
future for behavioral /mental/cognitive services.
n  This technology can now build VR systems, environments that assess, rehabilitate, test and treat under a
range of controlled conditions for a much lower cost of entry than in the past due to the following factors:
-Computing has gotten faster, better
-Gaming industry has developed better graphics
-Can now watch videos on-line and via mobile smartphones, at greater data speeds
-Now better graphic processing units in computers, smart phones
n  Can now design VR simulations that can be applied across a wide domain of clinical care
solutions:
General domains
- Test drug affects
- Surgical simulation
- Psychological research and treatment (study psychological processes,
measuring and treating them)
- Cognitive neuroscience research and clinical applications
- Motor or physical/occupational therapy
Virtual Reality, Simulation Technology Solutions, and
Artificial Intelligence

35
n  Imaging simulation and virtual reality (VR) technology: cont’d
n  Game Simulations for Physical Therapy: Can now build simulations of physical therapy games that
utilize actions in a virtual world or a game that can drive a character’s movement, such as Wii Fit. This
technology puts people in digital, game-like environments to engage and motivate them to do physical
therapy- after stroke or brain injuries. It can also track a patient’s body movements in space, where you can
systematically control what is going on in functionally relevant environments . You can also control the
stimuli present and measure performance in a more systematic fashion.
n New VR and Simulation Technology Value Proposition: Can now build AI (artificial intelligence) human
characters that serve purposes in the clinical setting. Virtual avatars (characters) can become patients,
letting doctors /nurses/technicians practice skills with a virtual character…e.g. adolescent that has a sexual
assault..taught how to conduct a sensitive clinical interview, etc.
n  Advancements in Medical Training Technology: The development of virtual humans that have AI and
enhanced graphics and animation features, are able to have almost life-like appearance and voice
recognition ; the ability to mimic interaction with real people with life-like facial expressions and body
gestural behavior.
Virtual Reality, Simulation Technology Solutions, and
Artificial Intelligence

36
Ecosystems Focus Facilitators Market Drivers (Impact) Market
Inhibitors
(Implications)
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.
• 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 children’s
participation sports (e.g. 30M)
• Approx. 150 million adults
participate in non-work 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 in
advanced diagnostics,
functional foods, orthopedic
soft tissue repair
• Growing
obesity problem/
Global
• Over-inflated
sports nutrition
claims (e.g.
fortification of
Whey products;
muscle building,
etc.)
• Arthrex,
Conmed
Linvatec,
Depuy Mitek,
Genzyme,
MTF, Fidia and
Smith &
Nephew lead
the market,
among many
others (e.g.
J&J, Stryker,
Bayer AG,
Regeneration
Technologies,
Cardinal
Health, etc.)
• PepsiCo,
Coca Cola

37
n  Sports Medicine R&D Focus: The current focus of sports medicine is the continued research and
development required to help reduce and prevent the number of injuries experienced, speed up recovery,
while reducing the loss of efficiency and performance (Emphasis on proper training, diet, and fitness). The
following procedures are some of the most cutting-edge practices being tested and researched today:
n  Using electricity to zap muscle pain has been a practice for decades, but more and more pro athletes
are turning to a newer form of the treatment, Frequency Specific Microcurrent, to hasten healing.
Traditional electrotherapy methods block pain in part by zapping nerves around the wounded area, but
FSM actually speeds the body's healing capacity by mimicking the electrical currents that occur
naturally in human cells. Terrell Owens (ankle), Donovan McNabb (chest) and Tracy McGrady (back)
have all used it to recover more quickly.
n  According to researchers at Stanford, there's a new surgical alternative for tendinitis: your own blood.
Scientists report that by drawing blood from a healthy part of the body, processing it to boost platelet
content and injecting it into the blood-poor region of the affected elbow, doctors can kick-start healing.
The result: a 93% success rate, equal to that of surgery & but without the knives.
n  To help badly broken bones heal more quickly, sports orthopedists and prominent surgeons such as
Dr. James Andrews are turning to a new bone-grafting method called Infuse. Approved by the FDA for
use in the tibia and spine, the process uses a naturally occurring bone-building protein called BMP that
has been genetically engineered in large quantities. Its new form, rhBMP, is soaked into a bovine-
collagen sponge and applied as a graft to the broken bone. The process triggers much faster healing
than a conventional bone graft.
Sports Medicine

38
n  Sports Medicine R&D Focus:
n  Silk is one of the strongest natural fibers on earth, and it may also be the best way to repair a blown
ACL. Boston biotech firm Serica, building on research by Tufts University, has developed a procedure
in which a ruptured ACL is rebuilt with a scaffolding of biodegradable silk. Serica says the surgery
results in a stronger ligament than one repaired via traditional means (repurposing tendons from the
patient's body). The goal: to reduce recovery time from six to three months. Human clinical trials begin
this year.
n  The presence of AEDs (automated external defibrillators) on high school sidelines continues to grow.
Following the deaths of four prep athletes from sudden cardiac arrest in 2006, Texas has joined
Illinois, Maryland and New York in requiring all public schools to have the device on their premises.
Even states without such laws are seeing a jump in the number of AEDs available to young athletes:
More than half of Washington's schools now provide defibrillators
n  Immediate Post-Concussion Assessment and Cognitive Testing system (ImPACT): a computer
program that measures an athlete’s memory, reaction time, and processing speed. Used to establish
a player’s baseline conditions at the start of the season, then implemented if the player sustains a
mild concussion. Results provide coaches and trainers with a more objective measure of whether the
athlete is healthy enough to return to play. Currently being used by the NFL, NHL, and colleges
throughout the nation. (opportunity for future implementation in high schools)
Sports Medicine – cont’d.

39
n  V. Key Whitespace Opportunities
Whitespace Focus/Opportunities Facilitators
Wellness • 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
• iPads, others
• Clinical Informatics
• Telemedicine, Telehealth
• mHealth, eHealth
Personalized /
Self-managed
Healthcare (e.g.
home-based)
• 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)
• Telemedicine
• Remote patient monitoring
• iPads, others
• Health 2.0
• Social media (networks, online communities)
• Device/Drug Identification
Cyberdocs • Virtual provider care (via Internet, mobile devices,
telehealth)
• Medical Informatics – Decision Support
• Telemedicine
• iPads, others
Smarter, On-
Demand 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 (let’s doctor/family know when pill has
been ingested)
• Functional foods
• Bio-medical materials (bio-medical printing,
customized dosages, remote delivery, just-in-time
delivery)
• EMR
• Device/Drug identification
• Smart “pills” – Remote Diagnostics

40
n  V. Key Whitespace Opportunities (cont’d.)
Virtual Hospitals • Medical tourism
• Health Information Exchanges (at local, state and
federal and global levels). Virtual hospital connectivity
•  Telemedicine, Telesurgery, Teleradiology,
Telenursing
• Virtual surgery and simulations
• Health 2.0
• Health Information Systems
• Health Information Exchanges
• EMR, PHR
• Telemedicine
• iPads, others
• High quality computer graphics/graphics boards
• Faster data/wireless data networks (4G+)
• Expanded fiber optics networks (Verizon, Nextel-
Sprint)
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
• Advanced diagnostic screening using next
generation imaging technologies
• Health 2.0
• EMR, PHR
• Telemedicine
• iPads, others

41
Cognitive/Training/
Wellness Services
(Home and mobile device-
based)
(Personalized, numerous
market niches)
• 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
• 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

42
Clinical Informatics
(Sub: Personalized
healthcare)
• 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
• Health 2.0
• Health IT (middleware)
• EMR, PHR
• Telemedicine
• 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.)
• 4G smartphones w/televideo features = 4G iPhone
• iPads, others
• Health 2.0
• SMS, MMS (text and multi-media instant messaging)
Remote Pharmacy
Portals
(Sub: mHealth)
• Allows physicians to access info and complete
medication orders from anywhere
• Bio informatics- Drug Delivery (computer
models that predict drug interactions-cuts down
amount of time in clinical trials and drug
discovery/R&D costs efficiencies)
• Health 2.0
• Health IT (middleware)
• EMR, PHR
• Telemedicine
• iPads, others

43
Smart Healthcare
Solutions /Disease
Management
•  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.
• Telemedicine
• iPads, others
• Health 2.0
• EMR, PHR
E-Health/Health 2.0
(Health 2.0 will have the
biggest impact when the
combination of tools,
content, and community
changes health behavior.)
• 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.
• New virtual/business intelligence tools for employers,
doctor’s offices and patient communities
• Telemedicine
• iPads, others
• Health 2.0
• EMR, PHR

44
Whitespace • Focus/Opportunities Facilitators
Medical Imaging,
Imaging Informatics,
Diagnostics
(Imaging Informatics, aka
Radiology Informatics or
Medical Imaging Informatics, is
a subspecialty of
Biomedical Informatics that
aims to improve the efficiency,
accuracy, usability and
reliability of medical imaging
services within the healthcare
enterprise. It is devoted to the
study of how information within
medical images is retrieved,
analyzed, enhanced, and
exchanged throughout the
medical enterprise.
FUTURE DIRECTIONS: Molecular imaging & diagnostics; Medical
imaging informatics; Networked Medical imaging and virtual reality
• Molecular imaging/Molecular Probes: One of the most rapidly
evolving areas of medical imaging. Has applications in drug R&D and
clinical diagnostics. Molecular imaging can be used to determine drug
biochemistry & pharmacology in situ (confined to its site of origin and
has not invaded neighboring tissue or gone elsewhere in the body) and
enable researchers to predict toxicology issues and provide information
on the metabolism and action of a drug. In the clinical setting,
molecular imaging probes may be used as surrogate endpoints to
assess new treatments or monitor the effect of therapy for a variety of
diseased states, leading to developmental cost-savings through the
rapid accumulation of clinical evidence to support drug approval and
usage.
• Virtual Surgery & Simulations: Via Human Computer Interaction
(HIC) can help to plan/prepare for an operation, saving time and
improving patient safety.
• Imaging Informatics: Exists at the intersection of several broad
fields: Computer science, Bio & Information science, cognitive science,
bio engineering and medical physics. Also includes: Data mining from
medical image databases; PACS and component systems; workflow,
Business Intelligence, EMR, etc.
•  SPECT-CT & PET-CT hybrids
Spectral CT High field MRI
•  Novel imaging agents CT imaging
agents MRI imaging agents
Ultrasound imaging agents PET &
SPECT imaging agents, real-time,
whole animal imaging,
• Computed tomography Magnetic
resonance imaging
• Key Players: GE Healthcare,
Hitachi Medical Corp., Philips
Medical Systems/Healthcare,
Siemens Healthcare, Toshiba,
Hologic
• US market (biggest market for
diagnostic imaging)
NOTE: Even with factors such as
cuts in physician fees for services by
Medicare, and declining
reimbursement levels, the US is still
expected to lead the global market.

45
Regenerative
Medicine
(Sub: Bio-Medical
Printing Materials)
• 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 individual’s 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.
• 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)

46
Home-based
Healthcare Market
• 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
• Advanced, mobile
diagnostics
• Advanced mobile disease
monitoring devices
• Home-based diagnostics/
monitoring device innovation –
integrated with pharmacists/
doctors who reviewed reports.
(Kaiser Permanente, CO-
trialing easy home-based
monitoring devices)
• IPads, IPhones,
Smartphones, Computers
• Wii Fit, wellness game
software

47
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.
• 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 beat and frequency, oxygen saturation,
ECG, etc.)
•  Teleconference technology
•  4G IPhones
•  Large, Global initiatives

48
n  VI. Global Healthcare Trends and Timelines
q  Major Trends and Timeline (2010-2014, 2015, 2020)
Major Trend 2010-2014 2015 2020
• Power Patients • Patient access to healthcare
records
• Patient social networks
• Patient-centered, multi-provider team
care
• Baby Boomer retirement
• Patients totally connected to
healthcare providers – virtually and
on a global basis
• Consumer Patients • Earlier retirement
• Health 2.0
• Implementation of Health IT
• Physicians using technology
• Customized products
• Total Home-based, virtual
healthcare
• Prevention before
Cure
• Earlier treatments
• Wellness treatments
• Decision Support Solution
Advancements
•  Pre- symptomatic diagnostics
• Personalized
Medicine and
Healthcare
• Genetic testing
• Targeted clinical trials
• Bio-medical printing
•  Major diseases understood at
molecular level treatment
• Bio-medical printing advancements
• Nanotechnology advancements
• Virtual reality/simulation technology
advancements and related solutions
• Pre- symptomatic diagnostics
• Bio-medical materials
advancements
• Nanotechnology advancements
• Virtual reality/simulation
technology advancements and
environments
• Smarter Drugs • Non-invasive delivery
• Bio-medical printing
• Smart pills
•  Non-invasive delivery
•  Bio-medical printing advancements
• Smart Pills - advanced
• Drug cocktails that will enhance
productivity, memory & physical
performance
• Virtual Hospitals • Hospital to Hospital connectivity
(EMR)
• US Federal Healthcare reform
stimulus funds (Health IT)
• Virtual medical communities (growing
demand for EMR-global)
•  Hosted (cloud computing) Informatics
• Global hospital to hospital
connectivity (hosted informatics)
• Virtual reality (simulation)
hospitals – global scope

49
Major Trend 2010-2014 2015 2020
• Regenerative
Medicine
• Early stages of Bio-medical
printing (tissues, wound
treatments, pills, etc.)
• Bio-medical printing (pills) –increased
innovation and development
advancements
• Continued innovation and
development advancements of 3-D
bio-medical printing of tissues/veins
• Bio-medical printing (organs/
tissues) – major advancements –
personalized medicine-genetic
• Advanced nanotechnology
regenerative medicine innovation
• 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
• 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
• 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)

50
Major Trend 2010-2014 2015 2020
• Sports Medicine • Continued research and
development in devices to help
reduce and prevent number of
sports-related injuries – and to
speed up recovery
• 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.
•  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

51
Major Trend 2010-2014 2015 2020
• Cyber Docs • Virtual patient-doctor
relationship
• Decision support – predictive
personalized diagnostics
• Total healthcare services
provided by virtual, multi-provider
teams
• Digital Health • Market of consumer-based
health and wellness innovations
steadily converge with
technology and healthcare
• A plethora of steadily advancing
medical diagnostic and health
maintenance devices will hit the
market – for hospitals and the home
(e.g. robotic prosthetics, telemedicine,
remote monitoring devices, mobile
health applications, etc.)
• Wide-spread connectivity of
patient’s health records
• Seamless healthcare services
provided virtually
• Robotic medical doctors
• Virtual hospitals
• Hosted Informatics or
Cloud Sourcing
• IT cloud services will form 25%
of all incremental global IT
spending by 2012
• Pharma will continue to
outsource its globally dispersed,
multi-disciplinary, virtual teams
via hosted solutions in the IT
cloud.
• Increased potential for Pharma
to provide a hosted informatics
SaaS (software as a service)
• Cloud computing technology
advancements continue to strengthen
and provide more lucrative business
models for hosted informatics SasS
• On-demand information and
collaborations continue to spearhead
major cost R&D efficiencies for
Pharma
• Virtual, electronic labs provide
accelerated drug technology
(nano) innovations and
deployments

52
n  VII. Recommendations (3-5 yr. ROI Estimate)
n  Adjacent Market/s Potential
n  Recommendations
FOCUS: #1 -Home-based, self-managed
healthcare (Patient-centric)
n Recommend Company X consider a multi-faceted-
consumer-directed - medical device and related hosted data
services market play, geared toward the home-based, self-
managed healthcare market.
n  Varied acquisitions, partnerships and/or collaborations
could leverage Company X’s core competencies (see
adjacent markets potential)
n  New role for Big Pharma as “integrator” to generate value
and brand awareness across the entire healthcare and/or
disease and/or niche demographic (e.g. kids, teens, elderly,
etc.) spectrum
n  CHALLENGES: Short-term ROI; data integration;
partnership/acquisition potential
n  Medical devices
n  EMR Solutions/Services
n  Cognitive services/drugs/solutions
n  Radio frequency identification (RFID) Solutions for Healthcare
n  Drivers
n  Personalized healthcare market growing
n  Consumer electronics prices going down (e.g.
smart phones, video devices, better graphic
processing units, etc.)
n  Increased computer power; emerging device
connectivity; middleware solutions
n  Increase communications bandwidth (4G
networks and growing)
n  Changing healthcare service paradigm that will
be geared more toward home-based
consultations, disease and health maintenance
n  Aging populations (global)
n  Global Markets, including remote populations
(India, China)
n  Advancements in cognitive services potential
(e.g. mobile, home-based applications, medical
devices, smart drugs, advanced simulation
technology, etc.)

53
FOCUS: Sports Medicine
n Recommend Company X consider a multi-faceted -
consumer-directed – sports medicine market play, with a
phased-niche (energy-teens, athletes, Boomers, women,
etc.) strategy approach. NOTE: Niche markets also include
sports pain management medications, devices, diagnostics,
orthopedic soft tissue repair, etc.)
n  Varied acquisitions, partnerships and/or collaborations
could leverage Company X’s core competencies
n  New role for Big Pharma as “integrator” to generate value
and brand awareness across the entire healthcare and/or
disease and/or niche demographic (e.g. kids, teens, elderly,
etc.) spectrum
n  CHALLENGES: Partnership/acquisition potential
§  Orthopedic tissue repair; advanced/remote diagnostics;
nutraceuticals/functional foods; orthopedic devices
n  Drivers
• Yearly growth in children’s participation sports
(e.g. 30M)
• Approx. 150 million adults participate in non-
work 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 in advanced diagnostics,
functional foods, orthopedic soft tissue repair

54
FOCUS: Digital Imaging, Medical Imaging
(diagnostics, molecular imaging), Imaging Informatics
NOTE: Imaging informatics, aka Radiology Informatics or Medical
Imaging Informatics- which is a subspecialty of Biomedical
Informatics (devoted to the study of how information within medical
images is retrieved, analyzed, enhanced and exchanged through the
medical enterprise.
Subsets: Molecular Imaging/Probes and Diagnostics;
Virtual Surgery & Simulations
n  Virtual Reality/Simulation Technology
n  Advanced Diagnostic Imaging Technology
n  Health IT/Informatics (EMR)
n  Teleradiology
n  Drivers
n  Medical Imaging Market: The aging population,
urbanization, growing chronic diseases,
government stimulus plans and economic recovery
in emerging markets are few key factors which are
driving the industry growth.
n  Market Analyst Projections: The medical
imaging market earned revenues of $5.73 billion in
2009 and is estimated to reach $6.55 billion in
2012, as the market is expected to bounce back
from declining reimbursements and effects of the
economic downturn. NOTE: Pacific Asian
countries are expected to remain economically
unaffected due to the “demand for healthcare
along with increasing ability of the patient
population to spend on improved health services in
these regions

55
FOCUS: Health IT: Middleware;
Middleware for the Elderly (incl. Ambient
Intelligence)
(e.g. Elderly Smart Spaces, Unobtrusive
sensors, long-term monitoring, elderly,
smart spaces, telemedicine, assistive
systems, personalization. Examples: The
PERSONA (Perceptive Spaces Promoting
Independent Aging) project geared toward
developing a scalable, open platform for
building a broad range of ambient assisted
living solutions- Norway:
www.aal-persona.org
Potential Ambient Intelligence Middleware
Market Segments/Niches
n  People with disabilities; Pre and post
operative care at home; Patients with muscular
dystrophy (apnea) or sleep apnea; Pregnancy
at risk; Patients in prison facilities; drug rehab
programs; Chronic pain management (home-
based)
n  RFID Healthcare solutions
n  Health IT Middleware solutions, including Middleware solutions for
the Elderly
n  Telemedicine
n  Advanced, remote diagnostic devices
n  Drivers
n  Increased development in so-called ambient technologies that
sense and respond to the presence of people. There are user
interfaces that can read gestures, facial expressions, or that can be
controlled by eye movements. The flexibility in the architecture means
that all of them can be integrated with the Universal Control Hub.
n  A growing amount of medical and monitoring wireless devices are
being incorporated to residential and healthcare environments, as
hospital or elderly residences
n  Europe now has both the highest proportion of, and the greatest
increase in, elderly citizens of any major world area. This is leading
to an increase in the number of people with impairments,
disabilities or chronic illnesses.
n Continued innovation of enterprise, systems/data integration
engines/architectures, including data mining, business intelligence,
EMR, transaction engines, clearinghouse services/analytics and
device interconnectivity.

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