GenesisCare UK: Varian Medical Systems360 OncologyTM Cancer Care Coordination suite:Collaborative development programmeMatt Hickey – Director of Clinical Strategy. GenesisCare UK

My participation in this Event does not interfere with any other obligations I have undertaken, in particular in connection with my current employment (if any) and that my institution has no objections to my participation in the Event.

I acknowledge that I have no imposing duty or obligation to refer to the institution or any other health care organization, patient, or physician to any health care institution or provider supplied by GenesisCare or its affiliates or to endorse or recommend the ordering or purchasing of any product or service of GenesisCare or its affiliates.

I hereby certify that I will comply with all applicable provisions of law and other rules and regulations of any and all governmental authorities in performing my obligations under my Speaker Letter Agreement, as well as GenesisCare’s own ethics codes and policies, and that I have been furnished with copies of the relevant GenesisCare codes and

policies. I hereby agree that my will at all times fully cooperate with GenesisCare in meeting its obligations thereunder and that my will be bound by the ethical principles underlying such regulations.

I further agree to keep strictly secret all confidential information of GenesisCare or its affiliates which I learn during the Event. I will perform all services in compliance with applicable laws and regulations and apply my best efforts to the performance of the services.

I also grant GenesisCare permission to use my speech of presentation in other capacities within the Scope of Work. I also authorize and license GenesisCare to reproduce or distribute the materials used in the Scope of Work via the GenesisCare websites. GenesisCare shall maintain the appropriate attribution to Speaker. GenesisCare may modify

the materials however, any modification of statements of Speaker that would fundamentally distort the meaning of Speaker’s statements are not authorized by this authorization and license. This authorisation and license shall be for the purpose of advertising, promotion of marketing of GenesisCare and its products and services, and for any other purpose that is in the spirit of the original Scope of Work. For example, the presentation or speech may be recorded, taped, captured via “LiveMeeting” and may be

added to the GenesisCare website.

To the extent that it has not been previously collected, GenesisCare may require collecting certain personal data from my like my name and email address. GenesisCare will do so only for the purposes required under this Letter Agreement, and always in compliance with applicable law. We will only transfer my data to GenesisCare affiliates, to the extent necessary for the fulfilment of this Letter Agreement, and specifically, to Genesis Care UK Limited, Wilson House, Waterberry Drive, Waterlooville, Hampshire , PO7

7XX and my hereby consent to such transfer to the extent that it is done solely for the purposes of this Letter Agreement and in compliance with applicable law.

I also acknowledge that my are an independent contractor, subject to GenesisCare’s direction only as to specific interests where GenesisCare wants the benefit of my services and advice. Nothing in this Speaker Letter Agreement makes my an employee or agent of GenesisCare, or authorises Speaker to speak for, represent or obligate GenesisCare

in any way.

Disclosure

A lack of control on patient outcomes post treatment• Global survivorship league tables paint a grim picture – not the whole story! • After-effects are ‘post-treatment’ - Lack of ‘holistic’ surveillance - reactive care not proactive

Poor harnessing of the collective knowledge of our clinicians• Best practice not being applied consistently

Disproportionate funding• Chemo = 2% of cures, RT = 16% (40% combined therapy) • Lack of public & private outcomes visibility

Commissioner mandates• Demand for transparency• New quality mandates

Cancer funds are under threat• Cost of cancer treatment increasing (£7.6bn = -£17.6bn) - True cost of cancer unknown• True benefits of innovation unknown (DFS v PFS v OS v HQoL)

SOME CANCER SERVICE CHALLENGES

COMPLEXITY OF INTEGRATING THE CARE CONTINUUM

SURVIVORSHIP

SCREENING CHEMOTHERAPY

Explosion of data in disparate data sources

Is the correct pathway being followed?

Need to see patient’s imaging and treatment history in one place

Inefficient care team collaboration

DIAGNOSIS RADIATIONSURGERY FOLLOW-UP

RECURRENCE

Loss of control of outcomes post treatment

Late, incorrect diagnosis

GenesisCare UK Aim

“In line with our visions and values, our goal is to ensure each patient receives a personalised, evidence-based care plan that

achieves the best possible outcomes, during and beyond

treatment”

CANCER CARE COORDINATION

Interoperability

CANCER CARE COORDINATION: REQUIREMENTS

CANCER CARE COORDINATION: OUTPUTS

GenesisCare UK Aim

“In line with our visions and values, our goal is to ensure each patient receives a personalised, evidence-

based care plan that achieves the best possible outcomes, during and beyond treatment”

360 OncologyTM Cancer Care Coordination suite:Clinical Portal

Streamlined referral management

Interoperability with imaging & EMR systems

Standardised data collection

Automatic categorisation of patients (MDT or not)

Referral management

Integrated into governance

Simplify Tumor Board Workflow

Manage Tumor Board Meetings

Access Clinical Insights

Seamless Workflow Integration

Collaborative decision making: Tumor Boards (MDTs) (presence and virtual)

Ensure evidence-based best-practice

Full in-clinic and external MDT engagement

Patient support design

PROMs & PREMs publishing, surveillance and management

Access Clinical Insights

Seamless Workflow Integration

Supportive care and survivorship planning and management

Full in-clinic and external MDT engagement

Patient support design

PROMs & PREMs publishing, surveillance and management

Access Clinical Insights

Seamless Workflow Integration

Supportive care and survivorship planning and management

Dynamic patient-specific insights at the point of care

Context-sensitive (PROMs/ PREMs, personalised)

Predictive & rapid learning consequence of treatment modeling

Treatment Data Analytics

Clinical and Operational dashboards

Data-driven insights

Dynamic patient-specific insights at the point of care

Context-sensitive (PROMs/ PREMs, personalised)

Predictive & rapid , consequence of treatment modeling

Treatment Data Analytics

Clinical and Operational dashboards

Data-driven insights

360 OncologyTM Cancer Care Coordination suite:Patient Engagement Portal

Integrate patient values, needs, preferences

Patient Reported Outcomes & Patient Satisfaction

2-way web-based survivorship planning & support

2-way mobile-based survivorship support

Patient participation in treatment decisions

Meaningful patient engagement: Patient engagement portal

Integrate patient values, needs, preferences

Patient Reported Outcomes & Patient Satisfaction

Survivorship

Patient support via mobile platform

Patient participation in treatment decisions

Meaningful patient engagement: Patient engagement portal

PROM; Hybrid of c35 PROMs Qs

highlighting key symptoms present

in patient presentations for

support

PREM; Hybrid of NHS, GMC,

GenesisCare Australia

(multi-stakeholder benchmarking)

Integrate patient values, needs, preferences

Patient Reported Outcomes & Patient Satisfaction

Survivorship

Patient support via mobile platform

Patient participation in treatment decisions

Meaningful patient engagement: Patient engagement portal

TRANSITION OF CAREEpisode of Care Summary: Referring Physicians, Local Care Team, Dieticians, Social Workers, …

Full charting capability

Automated summary (Txt, RTOG, PROMs etc)

Survivorship plan

Toxicity profile, co-morbidity risk, monitoring plan

Patient participation in treatment decisions

Taking cumbersome manual forms

with incomplete information

TRANSITION OF CAREEpisode of Care Summary: Referring Physicians, Local Care Team, Dieticians, Social Workers, …

Full charting capability

Automated summary (Txt, RTOG, PROMs etc)

Survivorship plan

Toxicity profile, co-morbidity risk, monitoring plan

Patient participation in treatment decisions

Automated, categorised and

proactive, forms

360 OncologyTM Cancer Care Coordination suite:Analytics & knowledgebase

Industry standardised clinical datasets

Benchmarked patient reported outcomes / satisfaction

Rapid Learning & Predictive Modeling Tools

Treatment Data Analytics

Clinical and Operational dashboards

Data-driven insights

Industry standardised clinical datasets

Benchmarked patient reported outcomes / satisfaction

Rapid Learning & Predictive Modeling Tools

Consequence of treatment analytics

Clinical and Operational dashboards

Data-driven insights

Industry standardised clinical datasets

Benchmarked patient reported outcomes / satisfaction

Rapid Learning & Predictive Modeling Tools

Treatment Data Analytics

Clinical and Operational dashboards

Data-driven insights

Industry standardised clinical datasets

Benchmarked patient reported outcomes / satisfaction

Rapid Learning, Predictive Modeling & correlation tools

Treatment Data Analytics

Clinical and Operational dashboards

Data-driven insights – Dynamic knowledgebase

Activated Patients• Shared decision making with clinicians. • Supported transition into post-treatment life. • Optimised personal experiences directly informing therapeutic rationale - brand improvement

and return to source (GenesisCare)

Empowered Clinicians• Dynamic decision aids to identify emerging risks and trends (+/-)• Timely access to quality, integrated information. • Improved shared decision making with patients for optimal treatment and long term planning

– clinicians preferentially refer

Informed Commissioners• Transparent quality information for targeted cost-effective commissioning decision making

from preferred providers • Primary care providers are more empowered to provide preventive care and refer to source

GCUK Cancer Care Coordination: Benefits

Activated communities and society• Lower costs of morbidity. • Improved workplace productivity• Activated patients and empowered carers - socio-economic/ socio-political benefit

Validated research & development• Informed R&D funding• Better post-market release surveillance• Patient experience reflected in public: private investment decisions

GCUK Cancer Care Coordination: Benefits

CHALLENGES

• GenesisCare OIS: Elekta Mosaiq• Third-party Patient Insights, Decision Support and late-effects predictive modelling suite• UK installation – US support• Technical teams with difference skills (gaps)• Limited IT & technical skills & resources in UK

RESULTS (12mths, Sept 2015-16)Feb 9: System locally installed (4 sites, Ox, MK, Maidstone, Southampton)Mar 12: Mosaiq mapped – IT infrastructure, hosting and cloudJune 26: Technical testing complete - System went clinically live (pilot)Aug 12: Prostate and Breast cancer patients now being inducted10 Sept: Clinical feature acceptance clinicians now being finalised (11 Dec 2016)16 Oct: GenesisCare Clinical Collaborative, Brisbane – first RT clinical support officer experience 24 Oct ASTRO, Boston. Varian commercial release12 Nov: GenesisCare UK Clinical Conference – first patient experience presentation

Delivery challenges and results

Varian Core project team:• Sukhveer Singh (Sponsor): Vice President, Varian• Roman Wicha (Project Lead)• Shridhar Parvatikar (Technical Lead)• Gunther Lenz (Director, OCS Technology Office)• Steve Laws (Project Coordinator)• Saurabha Bhatia (Snr Product Manager)• Julien Chergui: (Insightive Lead)

GenesisCare team• Eleanor Love (Project lead)• Thomas Pinn (International CIO)• Delos Wilbur (UK IT) • Gary Bee & Dave Wastall (UK) technical support• Fraser Hughes (Australia) (Technical support)• GenesisCare UK Staff, Clinicians & PATIENTS

Acknowledgements

Innovation Collaboration

for a

Quality Outcome

Thank-you