Eugene Consulting Inc.
1602- 111 St. Clair Ave W
Toronto, ON
M4V 1N5

Decemeber2020/January 2021 Report
About TriNetX• Official website: https://trinetx.com• Founded in 2013
• TriNetX is a global health research networks that connects the world of drug
discovery and development by sharing real-world data to make clinical andobservational research easier and more efficiento They combine real time access to longitudinal clinical data with state-of-theart analytics to optimize protocol design and feasibility, site selection, patient
recruitment, and enable discoveries through the generation of real-worldevidenceo They on-demand platform, datasets, and consulting services connect the life
sciences industry to patient data from around the globe
o It is a market leader in protocol design, feasibility and site selection• The TriNetX platform is HIPAA and GDPR compliant• The company was founded on the idea that incorporating real-world data results inbetter clinical trial design, improves the site selection and patient recruitment
processo Their goal is to optimize clinical research to bring new therapies to market
faster and generate real-world evidence (RWE) to advance the collectiveunderstanding of human health
About the Platform• It is powered by a network of 170 healthcare organization across 30 countries andcollaborates with 15 of the top 20 pharmaceutical companies• Users of the network can access continually refreshed, de-identified data from HER,
registries, and claims• Clients can get answers by using the on-demand platform licensing full datasets, orworking with clinical data analysts• Platformo Allows users to build and explore cohorts, compare outcomes, uncovertreatment patterns, and more
o They also connect with healthcare organizations who supply the data
• Datasetso Users can download datasets that associate every diagnosis, lab result, andother observation to a date and an anonymized patient ID
o They can run more precise longitudinal analyses by importing this data into
their preferred software package

Eugene Consulting Inc.
1602- 111 St. Clair Ave W
Toronto, ONM4V 1N5

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Consultingo TriNetX has a Clinical Sciences team represented by analysts,
epidemiologists, and evidence strategists with decades of experience in everyphase and therapeutic area of research▪ Users can consult with the team
TriNetX’s network of large-scale-up-to-date, longitudinal clinical and claims data is
being used by research institutions, individual researchers, and in classroomso The data that TriNetX offers can help with scientific publications, grant
submissions, poster presentationso The platform also performs advanced analyses which support grant
submission, manuscript and poster submissionso The network allows like-minded researchers to collaborateo Teachers can communicate complex, advanced analyses to students using
real data in real timeo Students can access data for dissertation and manuscript development andexplore data to learn more about target populations, compare drug
effectiveness, assess real-world drug performance and much more
Healthcare organizations in the TriNetX network experience the following
advantages:o TriNetX supplies the hardware for performanceo TriNetX aligns and maps all the data for collaborationo Researchers have access to TriNetX’s industry-leading self-service userinterface with advanced algorithms and semantic search with hundreds ofthousands of synonyms
o All hardware, implementation, data mapping and training is freeo Improves a healthcare organization’s ability to leverage their own patient
data while enhancing its competitiveness and attractiveness for sponsoredclinical trial participation▪ Attract more industry-sponsored trials
Pfizer is using TriNetX for real-time access to clinical, genomic and oncology data todesign clinical trial protocols with greater efficiency

Leadership• The CEO of TriNetx, Gadi Lachman, previously held leadership positions at TriZetto,
American Well, and Elizao He was also at Lehman Brothers and was an Officer in Israeli Special Forceso Education: MBA from Harvard Business School. LLB in law and B.C. inaccounting from Tel-Aviv University• Ian Read, former CEO and chairman of Pfizer is the Chairman of TriNetX

Eugene Consulting Inc.
1602- 111 St. Clair Ave W
Toronto, ONM4V 1N5

Trial Optimization Solutions• TriNetX helps solve the problem of flawed protocols and costly, avoidable
amendments by providing real-time access to patient populations
TriNetX Live• TriNetX Live enables researchers to analyze patient populations and perform “whatif analyses in real-time• Each data point in the TriNetX network can be traced to healthcare organizations
who are able to identify individual patients• It allows clinical researchers to:o Have self-service access to continuously refreshed clinical datao Investigate all attributes and comorbidities of the eligible cohort
o Determine if a sufficient patient population matches a protocolo Analyze inclusion/exclusion criteria and the impact of protocol changes
o Develop virtual patient cohorts that can be re-identified for potential
recruitment into a clinical trial
o Locate study sites based upon their volume of patients matching a protocolo Engage the right contact within the clinical trials office at the right siteo Predict the number of newly eligible patients at each site in the next 12months
o Work with sites that can instantly generate identified patient lists tocommence recruitmento Gain a path back to the identify of the patient if the healthcare organization
decides to participate in their trial
The Network for Oncology Clinical Trials• The TriNetX network connect clients to clinical and genomic data at healthcareorganizations all over the world
o It seamlessly integrates data from sources including tumour registries,
unstructured pathology reports using NLP, molecular genomics, and allleading EMR systems• This enables them to:o Design protocols
o Locate study siteso Assess protocol feasibilityo Identify eligible patients• Their algorithm understands treatment patterns to deduce the liens ofchemotherapy treatment patients are undergoingo In the past, this information was nearly impossible to obtain

Eugene Consulting Inc.
1602- 111 St. Clair Ave W
Toronto, ONM4V 1N5•

The algorithm can also determine how many new patients with the specificinclusion/exclusion criteria you seek will become eligible for your trial in the next
12 months on a site by site basis

TriNetX Research• TriNetX Research combines longitudinal clinical data with powerful analytics,
making it the fastest and easiest method for researchers to create real-world
evidence• It enables:o Comparative effectiveness to identify treatment that have better outcomesfor a given populationo Generation of value-based evidence to characterize drug efficacy and burdenof illness to support payer coverage and patient reimbursementso The ability to explore, assess, and download fully anonymized data from aselect set of TriNetX Research Healthcare Organizations members andoptionally delivered in a format ready to load directly into an OMOP databaseo Having TriNetX do the word directly; delivering custom reports and insights
TriNetX Download• TriNetX Download makes it easy for clinical researchers to query, license, anddownload real-word clinical data that is aggregated and harmonized directly fromhealthcare organizations on a continuous basiso Built on the TNX platform, TriNetX Download offers researchers data that iscurrent, HIPAA and GDPR compliant, and clinically broader than traditional
licensed research datao It also allows for researchers to:▪ Quickly explore available data to assess research feasibility▪ Quickly explore billion of health fact and define new research cohorts
through a flexible web-based cohort builder▪ Purchase and access desired research data sets quickly via webdownload▪ Elevate research ambitions with more extensive clinical data
▪ Increase confidence in research findings through improved data
diversity and traceability
TriNetX Analyze• TriNetX Analyze combines and presents deep, rich clinical data with powerful
analytics via a single web-based platformo It makes it easy for epidemiologists, pharmacovigilance, and clinicalresearchers to query and analyze real-world data without the cost,Eugene Consulting Inc.
1602- 111 St. Clair Ave W
Toronto, ONM4V 1N5oooooo

complexity, and lengthy timelines of integrating stand-alone analytics tools
and licensing third-party data separately
It is built on the TNX platform
Provides on-demand access to longitudinal clinical and genomic data and aset of highly intuitive analytic capabilities
Enables researchers to explore and compare cohorts▪ Reviewing cohort characteristics prior to an event and comparing
outcomes of interest after the event
The Query Builder eliminates the need to be an expert in clinical terminology,
a data scientist or even familiarity with SQL▪ Researchers can easily find and select the diagnoses, medications, andlab results that define the patients and outcomes they want to analyze
The platform allows researchers to explore characteristics across cohorts,side-by-side to assess whether the cohorts are compared/balanced▪ The TriNetX Analyze calculates a “signal” that shows howmathematically significant a difference is across cohorts
Researchers can investigate and compare outcomes across cohorts in thefollowing ways:▪ Measures of association• Compare incidence of outcomes that occur within the selected
analysis time window in terms of risk difference and risk ratio• Look at confidence intervals and p-values to assess statisticalsignificance▪ Time-to-event• Compare the time for outcomes to occur across cohorts with
Kaplan-Meier analysis to determine whether one cohort
experiences the outcomes more quickly than the other cohort▪ Lab distributions• Compare distributions of lab results to determine whether one
cohort achieves different lab results than the otherTriNetX Natural Languages Processing (NLP)• TriNetX Natural Language Processing Services utilizes sophisticated algorithms toextract clinical facts from physician notes and clinical reportso It then links this data with other Electronic Medical Record data and makes
the combined data available for assessing study feasibility, protocol design,
site selection, and subsequent identification of patients for clinical trials
which can be accessed by researchers using the TNX platform• Data can be derived from clinical documentations such as discharge summaries,
progress notes, and pathology reports

Eugene Consulting Inc.
1602- 111 St. Clair Ave WToronto, ON
M4V 1N5•••••

The TriNetX NLP service is based on technology from Averbis, a text-mining andmachine learning company headquartered in Germany
The TriNetX NLP service runs locally on a TriNetX appliance within the healthcareorganizationo A healthcare organization uploads documents into a target directory, alongwith the associated metadata and the NLP service processes the comments,extract facts, and associated them with patients and encounterso The NLP service then inserts these facts into the organization’s TriNetX
database, making them available on the TNX platform
The NLP service does not extract PHI from documents and the process remains
separated from the query engine on the appliance, preventing end users fromquerying documents containing PHI
Benefits of the TriNetX NLP Service:o Embedding NLP to mine clinical documentation can be a significant step
toward attracting more clinical trial activity for one’s patient populationo Exposing important clinical data to more accurately define and identify
patient cohortso Widening one’s population database by exposing unstructured data that had
been previously unavailable
o Enhancing one’s value to collaborative networks
o Increasing available data to enrich one’s internal research projects
If an institutions already has an existing NLP solution they can load the extracted
facts using the TriNetX file investigation process to make the data available throughthe TNX platform

open.trinetx Open Source Library• The TriNetX library of open-source tools and content, open-trinetx, provides realworld data solutions for technical professionals at pharmaceutical companies andhealthcare organizations to analyze and manage their data
• They have partnered with Averbis GmbgH to build a partial mapping from OPS toSNOMED CT• Their mapping covers top ~2000 most frequently used concepts in OPS andaccounts for 90% of procedure data by volumeTriNetX COVID-19 Rapid Response Network• The newly-created COVID-19 Rapid Response Network is currently represents thelargest global COVID-19 dataseto This network consists of a subset of data of patients from the larger TriNetX
network from healthcare organizations that have confirmed interest inreceiving COVID-19 clinical trial and medical chart review opportunities

Eugene Consulting Inc.
1602- 111 St. Clair Ave W
Toronto, ONM4V 1N5•

o It includes data about risk factors, comorbidities and outcomes of COVID-19patientso Data is available for analysis through the platform or may be downloaded
The TriNetX network also allows institutions to quickly connect with hospitals
interested in Coronavirus clinical trials

NewsJanuary 22, 2021
https://www.prnewswire.com/news-releases/covid-19-research-published-in-the-lancetrheumatology-finds-rheumatic-disease-patients-are-at-a-reduced-likelihood-of-severeoutcomes-now-vs-early-days-of-pandemic-301212960.html• Researchers at Massachusetts General Hospital and Harvard Medical School used
de-identified real-world data from TriNetX and found that Rheumatic Disease
patients are at a reduced likelihood of hospitalization and death now compared to at
the beginning of the pandemico This research was published in The Lancet Rheumatology• They suspect that the finding is multi-factorial- due to increased testing capacity
allowing for detection of milder cases, improved supportive care, and improved
treatments• Real-world data enabled them to compare 2 time-dependent cohorts just ninemonths into the pandemic• The study had access to de-identified data from nearly 51 million patients across 35
healthcare organizations• Despite temporal improvement observed, the study noted that there continues to bea considerable risk of morbidity and mortality from COVID-19 among patients withrhematic and musculoskeletal diseases
o The risk of death remains substantial with 5-6% of patients dying within 3days of a COVID-19 diagnosis within the study
January 4, 2021
https://www.psychiatryadvisor.com/home/topics/addiction/substance-use-disorderassociated-with-an-increased-risk-of-adverse-covid-19-outcomes/• In a double-cohort study of 11,124 adults diagnosed with COVID-19 published in
Psychiatric Services in Advance, researchers used data from the TriNetX Research
Network platform to find that substance use disorder was associated with anincreased risk of hospitalization, ventilator use, and mortality• Reliance on electronic health records data made it impossible to assess potential
confounding factors and markers of adverse socioeconomic disadvantages

Eugene Consulting Inc.
1602- 111 St. Clair Ave W
Toronto, ON
M4V 1N5

January 4, 2021
https://www.docwirenews.com/nephtimes/nephtimes-diseases-and-conditions/diabeteshypertension/risk-of-adverse-renal-outcomes-in-ckd-patients-with-diabetes-in-discoverckd/• During a virtual poster at ASN Kidney Week 2020, Alyshah Abdul Sultan andcolleagues reported that they analyzed data from TriNetX and Limited Claims andElectronic Health Record (LCED) discovered that there is an excess risk of adverse
renal outcomes in CKD patients with type 2 diabetes compared with those without
type 2 diabetes• This is explained to a large extent by conventional risk markers in LCED but notcompletely in TriNetX
October 29, 2020
https://www.businesswire.com/news/home/20201029005149/en/Medidata-TriNetXand-Datavant-Partner-to-Enable-Seamless-Integration-of-Real-World-Data-in-ClinicalDevelopment• Medidata, TriNetX, and Datavant announced a partnership that will accelerate theuse of real-world data to power clinical research• This partnership will enable users of Medidata’s end-to-end clinical researchplatform to securely link their clinical data with patient consent to des-identified
patient data without unblinding the study• The solution leverages Datavant’s Patient Key technology and data ecosystem, as
well as RWD from TriNetX’s global network of healthcare organizations who
participate in this program• Patients enrolled in a clinical trial utilizing Medidata’s solutions will have the option
to grant consent for their data to be linkable using Datavant’s de-identified Patient
Keys to both TriNetX’s broad RWD assets and Datavant’s open data ecosystemo This enables sponsors to cost-effectively study the efficacy and safety of their
therapies for many years after the completion of the trial with less risk oflosing patients to follow-up• They suspect that as new vaccines and treatments for COVID-19 come to market
faster than every before, the use of real-world data to gather additional safety andefficacy data will be critical to ensuring patient safety and continued evidence
gathering• Medidata, TriNetX and Datavant are pursuing an open, partnership-first approachand look forward to continued collaboration across the industry to modernize theclinical trial infrastructure for patient benefit

Eugene Consulting Inc.
1602- 111 St. Clair Ave W
Toronto, ONM4V 1N5

September 21, 2020
https://www.prnewswire.com/news-releases/carlyle-makes-strategic-growthinvestment-in-trinetx-acquires-majority-stake-in-leading-global-health-research-network301134411.html• The Carlyle Group made a strategic growth investment and acquired a majority
stake in TriNetX• Terms of the transaction were not disclosed• This investment is a continuation of Carlyle’s long-term global commitment tohealthcare, in which it has invested more than $15 billion of equity since inception• Equity capital for the investment came from Carlyle Partners VII, an $18.5 billion
fund that makes majority and strategic minority investment primarily in the U.S. intargeted industries