Update on ASCO s CancerLinQ

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2 Iowa Oncology Society Fall Conference Quality in Cancer Care 10/7/2016 Update on ASCO s CancerLinQ Robert S. Miller MD, FACP, FASCO American Society of Clinical Oncology Medical Director, CancerLinQ

3 Financial Disclosure(s) I have not had any relevant financial relations during the past 12 months to disclose. 10/10/2015 CancerLinQ Confidential 3

4 Off-Label Use Disclosure(s) I do not intend to discuss an off-label use of a product during this activity. 10/10/2015 CancerLinQ Confidential 4

5 ASCO & CancerLinQ Ø World s leading professional organization representing physicians caring for those with cancer Ø Serves more than 40,000 members Ø Mission: ASCO is a professional oncology society committed to conquering cancer through research, education, prevention, and delivery of high-quality patient care. Ø Not For Profit Subsidiary of ASCO Ø Serves the Oncology Community Ø Dedicated staff focusing only on CancerLinQ Ø Mission: Empowering the oncology community to improve quality of care and patient outcomes through transformational data analytics. 5

6 CancerLinQ Mission Statement Empowering the oncology community to improve quality of care and patient outcomes through transformational data analytics.

7 The Challenges 1. To learn from every patient 2. To harness data in powerful new ways

8 Our Ability to Learn is Limited 1.7 MM people diagnosed with cancer in the US Only3% 3% enroll in clinical trials.

9 Getting to the Data 1.7 MM people diagnosed with cancer in the US 97% of patient data locked away in unconnected files and servers

10 and everyday patients tend to be older less healthy and more diverse 25 % of clinical trial patients are vs 61 % of real-world patients are % of kidney cancer patients were not healthy enough to qualify for the trials that supported the approval of their treatments 2 90 % of patients in NCI trials are white 3 23 % vs of the US POPULATION Is non-white 3 than clinical trial patients. 1. Lewis JH, et al. Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol. 2003;21: Mitchell AP, et al. Clinical trial subjects compared to "real world" patients: generalizability of renal cell carcinoma trials. J Clin Oncol. 2014;32(suppl): Taking action to diversify clinical cancer research. National Cancer Institute Web site. Accessed July 23, 2014.

11 The opportunity to capture important information about drug toxicity and efficacy is rapidly lost after approval 11

12 Increase in data required for medical decision-making relative to human cognitive capacity Abernethy A P et al. JCO 2010;28: by American Society of Clinical Oncology

13 Recurring Challenges. information is not the same as understanding ABL1,ACVR1B,AKT1,ALK,APC,AR,ARID1A,ARI D1B,ARID2,ASXL1,ATM,ATRX,AXIN1,B2M,BAP 1,BCL2,BCOR,BRAF,BRCA1,BRCA2,CARD11,CA SP8,CBL,CDC73,CDH1,CDKN2A,CEBPA,CIC,CR EBBP,CRLF2,CSF1R,CTNNB1,CYLD,DAXX,DN MT1,DNMT3A,EGFR,EP300,ERBB2,EZH2,FAM12 3B,FBXW7,FGFR2,FGFR3,FLT3,FOXL2,FUBP1,G ATA1,GATA2,GATA3,GNA11,GNAQ,GNAS,H3F3 A,HIST1H3B,HNF1A,HRAS,IDH1,IDH2,JAK1,JAK 2,JAK3,KDM5C,KDM6A,KIT,KLF4,KRAS,MAP2 K1,MAP3K1,MED12,MEN1,MET,MLH1,MLL2,M LL3,MPL,MSH2,MSH6,MYD88,NCOR1,NF1,NF2, NFE2L2,NOTCH1,NOTCH2,NPM1,NRAS,PAX5,P BRM1,PDGFRA,PHF6,PIK3CA,PIK3R1,PPP2R1A, PRDM1,PTCH1,PTEN,PTPN11,RB1,RET,RNF43,R UNX1,SETD2,SETBP1,SF3B1,SMAD2,SMAD4,SM ARCA4,SMARCB1,SMO,SOCS1,SOX9,SPOP,SRS F2,STAG2,STK11,TET2,TNFAIP3,TRAF7,TP53,TS C1,TSHR,U2AF1,VHL,WT1 Cancer Biomarkers, Vogelstein 2013 Hieroglyphs BC

14 Lung cancer: from one cancer to many KRAS EGFR BRAF PIK3CA AKT1 HER2 EML4-ALK Unknown One disease 7 molecular drivers and more to be discovered

15 Health IT and big data offer a new universe of possibilities 15

16 The Promise of a Rapid Learning Health System a system in which science, informatics, incentives, and culture are aligned for continuous improvement and innovation with best practices seamlessly embedded in the delivery process and new knowledge captured as a by-product of the delivery experience Best Care at Lower Cost: The Path to Continuously Learning Health Care in America September 6, 2012

17 Technology-enabled Rapid Learning System Institute of Medicine, 2013

18 Unlocking the Data will unlock a universe of practical insights to improve the care of every patient with cancer. 18

19 CancerLinQ Will Unlock, assemble, and analyze de-identified cancer patient medical records Uncover patterns that can improve patient care Allow doctors to compare their care against guidelines and the care of their peers Provide guidance by identifying the best evidence-based course of care 19

20 SAP is our Strategic Technology Partner #1 Enterprise software $22.2B+ SAP revenue worldwide 261,000 customers in 190 countries 68,000+ employees worldwide 74% world s transaction revenue 20

21 SAP Partnership ASCO and SAP have engaged in a strategic technology partnership to develop and deploy the CancerLinQ platform ASCO Overall development of CancerLinQ Control over the data, services, and products that stem from CancerLinQ Oncology subject matter expertise SAP Access to SAP global healthcare technical platform Customized tools unique to CancerLinQ s needs Engineering, development, and other technical support World class secure hosting facility

22 CancerLinQ Architecture

23 Data Ingestion CancerLinQ collects a broad range of clinical data about patients. Patient Demographics Provider Characteristics Encounters Diagnosis Staging Pathology Physical Exams and Assessments Laboratory Tests Care Plans Medications Radiology Radiation Therapy Surgical Procedures Post-therapy Care and Surveillance Notes and Documents Clinical data send to CancerLinQ does include PHI Unlike a registry, there is no fixed file format and data definition to adhere to Data ingestion involves both historical patient data and daily incrementals No manual data entry requirements for participating practices

24 CancerLinQ Product Features Easily Accessible and Visually Appealing CLQ presents patients clinical data in an intuitive and effective manner that allows for quick access and understanding of the underlying data. 24

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26 CancerLinQ Product Features Easily Accessible and Visually Appealing CLQ presents patients clinical data in an intuitive and effective manner that allows for quick access and understanding of the underlying data. Real Time Quality Performance CLQ Quality Performance Indicators provide real time clinical quality metrics, give prospective analysis and identify opportunities to improve performance. 26

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28 CLQ quality measures Staging documented within one month of first office visit Pain Addressed by second office visit Pain intensity quantified by second office visit Test for HER2/neu overexpression or gene amplification Tamoxifen or AI received within 1 year of diagnosis by patients with AJCC stage IA(T1c) and IB - III ER or PR positive breast cancer CEA within 4 months of curative resection for colorectal cancer Adjuvant chemotherapy received w/in 4 mos of diagnosis by patients w/ AJCC stage III colon cancer Smoking status/tobacco use documented in past year Rituximab administered when CD- antigen expression is negative or undocumented (Lower Score = better) Hepatitis B virus infection test (HBsAg) and Hepatitis B core antibody (Anti-HBc) test within 3 months prior to initiation of rituximab for patients with NHL

29 CancerLinQ Product Features Easily Accessible and Visually Appealing CLQ presents patients clinical data in an intuitive and effective manner that allows for quick access and understanding of the underlying data. Real Time Quality Performance CLQ Quality Performance Indicators provide real time clinical quality metrics, give prospective analysis and identify opportunities to improve performance. Insights & Trends CLQ Insights allows you to gain valuable insights and uncover trends from the vast CLQ population that can improve quality of care provided to each of your patients. 29

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31 CancerLinQ Product Features Your Patient s Timeline CLQ visually represents your patient s clinical event history in a longitudinal view. 31

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33 CancerLinQ Product Features Your Patient s Timeline CLQ visually represents your patient s clinical event history in a longitudinal view. Powerful Analytic Reports CLQ provides a suite of analytic reports that allows you to make quick observations and uncover insights about your patient population at a glance 33

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35 CancerLinQ Product Features Your Patient s Timeline CLQ visually represents your patient s clinical event history in a longitudinal view. Powerful Analytic Reports CLQ provides a suite of analytic reports that allows you to make quick observations and uncover insights about your patient population at a glance Performance CLQ is designed to efficiently and quickly process large amounts of data Security CLQ is HIPAA compliant, adhering to the highest level of industry standards by implementing regulatory, administration and technical safeguards 35

36 CLQ Growth - By The Numbers 67 institutions contracted with CLQ (= ~1400 oncologists) 4 25 ~956K Individual Records in Data Lake 38 Hospital or Health System Owned Physician Owned Academic ~550K Patient Records in Clinical DB ~300K Patient Records in Analytical DB Allscripts CureMD Epic GE Centricity 1 14 Different Source EHRs I Know Med IntrinsiQ MOSAIQ Varian OncoEMR NextGen Proprietary EHRs

37 Some of Our Vanguard Practices Cancer Treatment Centers of America: Nationwide University Hospitals Seidman Cancer Center, Cleveland, OH University of Florida Cancer Center Orlando Health Orlando, FL Intermountain Health Care, Salt Lake City, UT Utah Cancer Specialists Salt Lake City, UT Catholic Health Initiatives: Nationwide Utah Hematology & Oncology Ogden, UT Pontchartrain Hematology and Oncology: Covington, LA Lynchburg Hematology & Oncology Lynchburg, VA University of MD, Kauffman Cancer Center Upper Chesapeake, MD MedStar Washington Hospital Center: Washington, DC Sanford Health Sioux Falls, SD Cancer Centers of Southwest Oklahoma: Lawton, OK Katmai Oncology Group Anchorage, AK Hematology Oncology Associates of Brooklyn Montgomery Cancer Center: Montgomery, AL Michiana Hematology Oncology: South Bend, IN Medical Oncology Hematology Consultants, PA: Newark, DE Essex Oncology of New Jersey Columbus Oncology Hematology Associates Incorporated Columbus, OH New England Cancer Specialists: Portland, ME Health First Cancer Center: Melbourne, FL Memorial Cancer Center: Hollywood, FL Charleston Hematology Oncology Associates Charleston, SC Augusta Oncology Associates Augusta, GA INOVA Medical Group: Fairfax, VA Epic Care: Antioch, CA Alaska Women s Cancer Care: Anchorage, AK Medical Oncology & Hematology Associates (MOHA) Des Moines, Iowa Arkansas Cancer Institute Pine Bluff, Arkansas New Mexico Oncology Hematology Consultants: Albuquerque, New Mexico West Michigan Cancer Center: Kalamazoo, MI Fox Valley Hematology & Oncology: Appleton, WI IHA Hematology/Oncology Consultants Ypsilanti, Michigan Marin Cancer Care: Marin, CA New Hampshire Oncology Hematology Hookset, NH Ventura County Hematology/Oncology Specialists: Dayton Physicians Network: Dayton, Ohio Edward Elmhurst Health: Naperville, Illinois Oncology Specialists, S.C. Park Ridge, Illinois 37

38 CancerLinQ aims to serve as a convener of the oncology community Practice Structured & Unstructured Clinical Data Additional Structured Data PRO Data Data Sources Beneficiaries Life Sciences Sister Societies Payors Enhanced Lab & Radonc data Patients & Clinicians Genomic Testing Data Genomic Sequencing Data Fed & State Agencies Sister Societies, Onco Initiatives, Federal; State International Data Shaping the Future of Cancer Care Through Data Driven Decisions 38 Research & Academic Institutions International Cancer Centers

39 Building the Coalition Sister Societies Pharma Government Patients Thought Leaders Payers Partners CancerLinQ Providers NGOs Academia Platform HIT Research CancerLinQ Confidential 39

40 Implementation Philosophy Our Focus is to Have Minimal Impact on Your Practice Ø CancerLinQ has multiple ways to connect to your source systems in order to share data with CLQ we are source system agnostic Ø We retrieve data as is and provide the rules and ontology services to normalize data Ø No data entry requirements for participating practices Ø Engagement with your team is primarily conducted through bi-weekly touch points throughout the implementation Ø CancerLinQ provides all resources for project management, training, testing, and application support 40

41 CLQ: How big is big data? 70 Patient Interactions (000,000) Diagnoses Encounters Assessments Labs Care Plans Medications

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44 27, 109 rows of drug names

45 % cancer patients w/ date of dx in a structured field, by practice A B C D E F G H

46 % cancer patients with stage in a structured field, by practice A B C D E F G H

47 % breast ca pts with lab/biomarker results in structured fields, by practice A B C D E F G % ER % PR % HER2

48 % ca pts w/ smoking or pain assessments in structured fields, by practice A B C D E F G Pain Smoking

49 Chemotherapy regimen mapping The challenges: No authoritative source of chemotherapy regimens Classical acronyms not intuitive in the modern era, use of trade names (CHOP, TCH) Ambiguity (AC-T, CAP) Schedule not implied (FOLFOX) Text entry

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51 Additional data sources (potential) Ø Practice management system data Ø Data warehouse extracts Ø Registry data Ø Genomic data Ø Claims data Ø Drug inventory data

52 What Makes CancerLinQ Unique? Ø CancerLinQ is being created by oncologists for the oncology community worldwide to improve the quality of patient care Ø CancerLinQ incorporates ASCO s practice guidelines and QOPI quality measures. The real world evidence and outcomes captured as part of the learning health system will be linked back to the same guidelines and measures and inform their development. Ø CancerLinQ is built on a powerful, incredibly fast and secure technology platform from SAP designed to deliver optimal performance. Ø CancerLinQ is guided by ASCO s mission to support all physicians, in every community and every setting.

53 Thank You