Artificial Intelligence Powering Boom in Israel's Digital Health Sector

AI medical use cases include but are not limited to decision support tools for physicians, medical imaging analysis using computer vision, and big data analytics for population health management.

Israel has been a technological wonder, especially because it exists in a hostile environment and is a very small country.  Their contributions include science, space, technology, and health advances. It is worth a look at their health information technology infrastructure.  I wrote this article some time ago, however, due to some personal health issues did not publish it until today.

-Israel’s reams of electronic medical records –health data on its population of around 8.9 million people-- are proving fruitful for a growing number of digital health startups training algorithms to do things like early detection of diseases and produce more accurate medical diagnoses.

According to a new report by Start-Up Nation Central, the growth in the number of Israeli digital health startups –537 companies, up from 327 in 2014—has drawn in new investors, including Israeli VCs who have never previously invested in healthcare. This has driven financing in the sector to a record $511M in 2018, up 32% year on year. By the first quarter of 2019, the amount raised was already at $214M.

Of the $511M, over 50% ($285M) went to companies in decision support and diagnostics which rely heavily on data crunching. Overall, 85% ($433M) of the sector’s total financing went to health companies relying on some form of machine learning–a clear trend showing AI in the ascendancy.  AI medical use cases include but are not limited to decision support tools for physicians, medical imaging analysis using computer vision, and big data analytics for population health management.

AI is powering a boom in Israel's digital health industry. GETTY

Foreign hospitals and universities are increasingly coming to Israel to look for Digital Health technologies and to invest in local companies. For example, in 2018, three major US hospitals engaged with Israeli digital health: Intermountain Healthcare’s investment in Zebra Medical, Mt. Sinai Ventures’ contract with digital speech therapy company Novotalk, and Thomas Jefferson University’s pilot validation program in conjunction with the Israeli Innovation Authority for clinical care and hospital operations solutions.

Start-Up Nation Central’s report on Israel’s Digital Health industry offers a comprehensive and up-to-date analysis of the state of the Israeli Digital Health ecosystem and its trends





Artificial Intelligence Powering Boom in Israel's Digital Health Sector:

Most Health Systems Still Lack Long-Term Digital Strategy

The survey of CIOs and other executives examined digital health maturation and how patient care organizations are strategizing for the future

Healthcare’s digital transformation is still in the early stages of maturity relative to other sectors, but CIOs do understand the imperative to drive digitalization, according to a new report from advisory firm Damo Consulting.

The report’s findings were revealed in focus group discussions with nearly 40 CIOs and senior health IT leaders who are members of the College of Health Information Management Executives (CHIME). When asked to define digital transformation in healthcare, 60 percent of respondents said it is about using digital technologies to reimagine business processes and customer experiences, while others stated that it means delivering healthcare when, where and how consumers want it; or using data, analytics and artificial intelligence (AI) to improve outcomes.

According to the researchers, today, health systems fall into four key models of digital adoption: reliance on electronic health record (EHR) systems to drive digital engagement 

(Model 1); digital strategy singularly focused on virtualization of care 

(Model 2); stand-alone digital initiatives are driven by internal demand 

(Model 3); and strategic investments in long-term digital health platforms (Model 4).

Full Report (download pdf)

“I think it’s very difficult still to define (digital) because everything’s
kind of tied together.”

Health systems in Model 1 are focused on maximizing the value of their EHR investments. An example of that is improving patient access by promoting the use of the MyChart functionality in Epic. Health systems that embrace this the model also prefer to rely on their EHR vendor’s product roadmap as a guide to their own digital roadmaps. In Model 2, health systems take a particular capability like telehealth and commit to virtualization of care at the enterprise level. Despite challenges with reimbursement models, telehealth has been effectively deployed for acute care by many health systems. Express Care and Telestroke are widely prevalent models in virtual care delivery today most health systems, especially smaller and mid-tier ones, operate in Models 1 and 2 and only the nation’s largest health systems are operating in Model 4. The majority of CIOs in the focus group, however, acknowledge that all enterprises need to shift to Model 4, the findings revealed.

“In my discussions with health system CIOs, what emerged is that not only are most health systems in the early stages of adoption, but there is no clear consensus on what digital transformation looks like or how to achieve it,” said Paddy Padmanabhan, CEO, Damo Consulting. “Most health systems consider their EHR system as their digital strategy or are developing standalone solutions on an as-needed basis, without a long-term digital strategy in mind.”

In Model 3, health systems address digital transformation by way of a series of stand-alone digital health initiatives that are funded and implemented based on internal demand. However, these digital projects are undertaken mostly in response to near term priorities and do not necessarily align with enterprise business strategy. Health systems in Model 4 develop a comprehensive enterprise-level digital a strategy that considers stakeholder priorities across functions and departments. Digital transformation leaders evaluate IT infrastructure needs and secure funding commitments for a multi-year digital transformation roadmap in line with enterprise priorities. Health systems in Model 4 also, look to pick strategic technology partners besides EHR vendors to execute on their digital roadmaps. Today, most systems, especially smaller and mid-tier enterprises are operating in Model 1 and Model 2, with larger organizations operating in Model 2 and Model 3. Leading health systems are in Model 4. Importantly, CIOs acknowledge that all enterprises need to shift to Model 4, especially if the health system is embracing at-risk payment models. Payment reform is in various stages, depending on the markets; however, a large percentage of the payer mix is going to be at risk for most health systems in the future. Being able to manage care in this context is a huge driver to go beyond incremental initiatives and develop an enterprise digital roadmap. Health systems that take on risks for patient population also need integration across all settings where patients might receive care. For health systems that operate in multiple markets, a key consideration is the regional strategy in their overall enterprise strategy as there could be important drivers in the regional markets worth recognizing. The mix of patients at a health system often serve to determine to what extent a health system can push the adoption of digital health programs and consequently drive priorities.

Meanwhile, while the adoption of digital transformation is slow and a clearly defined strategy is unclear, most healthcare CIOs recognize the valuable role it can play. Key trends driving its adoption include increasing competition and reduced reimbursements, along with the focus on patient experience and improving access to care for patients.

Health system CIOs in the focus group who are developing patient engagement applications expressed that they are actively looking at monetizing the capabilities by offering them to peer systems that are yet to make the investments. According to one CIO, “I think any digital transformation strategy has to have an affordability component because reimbursement rates are going down and we have to work smarter.”

What’s more, the majority (36 percent) of the CIOs in the focus group indicated that their organizations do not have a digital function, and by default, the digital function sits with the CIO. According to one specific CIO, “We don’t really have that (digital) function here. But if our board was asked who it would fall under, I could see them all saying it would be part of the CIO’s role.”

According to Padmanabhan, “It also comes down to whether health systems can afford to have another senior executive in a CDO role, given the current state of digital maturity and the lack of interest in creating even more C-level roles. Our focus group of CIOs believes most health systems are not large enough for two separate roles. This is in sharp contrast to other sectors such as banking, that have had full-time CDO roles for a while.”

Further, 46 percent of responding CIOs say that their enterprise digital strategy is their EHR system, closely followed by those that build or buy point solutions based on need (45 percent). Less than 9 percent are implementing an enterprise platform in partnership with a major technology firm.

“Based on these figures, it becomes clear that there is no single vendor platform that meets all needs and today, health systems must build their own stacks,” added Padmanabhan.

At the dawn of the HIT and EHR milieu, all EHRs were poorly designed and lacking usability. The federal government in its haste to force adoption incentivized physicians and hospitals at the price of penalties for those who did not comply (decreases in reimbursement). High ranking Department of Health and Human Services and CMS designed a system of 'meaningful use' based on metrics of MACRA and later MIPS. Billions of dollars were invested in flawed systems, and unproved metrics. "Big Data" became a buzzword, and an icon for aberrant analysis. (Garbage in, garbage out)

Report: Most Health Systems Still Lack  Long-Term Digital Strategy:

Report: Most Health Systems Still Lack Long-Term Digital Strategy:eanwhile, while adoption of digital transformation is slow and a clearly defined strategy is unclear, most healthcare CIOs recognize the valuable role it can play. Key trends driving its adoption include increasing competition and reduced reimbursements, along with the focus on patient experience and improving access to care for patients.

Health system CIOs in the focus group who are developing patient engagement applications expressed that they are actively looking at monetizing the capabilities by offering them to peer systems that are yet to make the investments. According to one CIO, “I think any digital transformation strategy has to have an affordability component because reimbursement rates are going down and we have to work smarter.”

What’s more, the majority (36 percent) of the CIOs in the focus group indicated that their organizations do not have a digital function, and by default, the digital function sits with the CIO. According to one specific CIO, “We don’t really have that (digital) function here. But if our board was asked who it would fall under, I could see them all saying it would be part of the CIO’s role.”

According to Padmanabhan, “It also comes down to whether health systems can afford to have another senior executive in a CDO role, given the current state of digital maturity and the lack of interest in creating even more C-level roles. Our focus group of CIOs believe most health systems are not large enough for two separate roles. This is in sharp contrast to other sectors such as banking, that have had full-time CDO roles for a while.”

Further, 46 percent of responding CIOs say that their enterprise digital strategy is their EHR system, closely followed by those that build or buy point solutions based on need (45 percent). Less than 9 percent are implementing an enterprise platform in partnership with a major technology firm.

“Based on these figures, it becomes clear that there is no single vendor platform that meets all needs and today, health systems must build their own stacks,” added Padmanabhan.

Although blockchain has not become mainstream, the technology is being used within various sectors, including healthcare.
From giving patients more access to their information and providing healthcare organizations with more security, blockchain has the potential to dominate healthcare.
Below are five ways the technology is already being used in healthcare, according to TechZone360.
To provide a clear and evident data exchange of patient information between physicians.
As a secure data storage to ensure patient privacy.
To help with hindering the high amounts of data breaches within the medical field.
To secure the tracking of records without fear of alterations or changes.
To provide consistency and efficiency with finances and payments.

Blockchain developer Augusta HiTech launched its first blockchain-powered EHR platform, which streamlines data sharing between patients and emergency medical services.

Four things to know:

One Med Chart

1. The platform, called One Med Chart, can be accessed via an app and allows individuals to record their health information, such as medical records or current medications, straight to their mobile devices.
2. Healthcare providers, physicians, and EMS personnel can access the patient's information through the app as well.
"Hospital staff can quickly log into the health record system for an individual at an emergency room to learn about their past medical history," Augusta HiTech Chief Strategy Officer Sean Caputo said in a news release.
3. One Med Chart's blockchain technology helps keep users' medical information protected through multi-factor authentication and encryption.
4. Physicians can send patients' EHRs through fax, e-mail, directly through the EHR system or upload information to One Med Chart.

"Our blockchain solution for One Med Chart is designed to give patients a more significant stake in managing their healthcare and to prevent unnecessary deaths from lack of information while providing a measurable impact on cost-effectiveness in hospital settings," Mr. Caputo said.

Blockchain has not established itself within the healthcare sector, but that does not mean it doesn't have a place within the industry. Here are five ways blockchain could transform healthcare, according to Coin Rivet:
1. Medical data: Because blockchain can be accessed by all users, many are skeptical if it follows HIPAA policies. However, through technology, physicians and hospitals would be less susceptible to cybersecurity attacks. Providers would be able to more easily and securely share patients' medical histories and update patient records.
2. Patient access: With different blockchains, patients can access and control the ownership of their medical records. The records are traceable on the blockchain, reducing the risk of deleted information, missing vaccinations, and false medication claims.
3. Smart contracts: Currently, smart contracts are the strongest case for introducing blockchain into healthcare. Blockchain reduces inefficiencies, allows for swift payments of medical services and automatically bills insurers.
4. Fraud: In recent years, healthcare has seen an influx in cybersecurity and fraud. Many times, this is due to a lack of communication between providers, hospitals and patients. Blockchain uses a transparent ledger to continuously track payments, prescriptions, and medical documentation.
5. Paperwork: By implementing blockchain technology, providers and hospitals can further reduce the number of paper-based documents required. This could largely effect insurance transactions. With blockchain, patients and providers can eliminate the hassle of providing additional copies and transcriptions of medical services to insurers.

To read the full report, click here.

News on the Digital Health Space Pathway

Few EHR implementations go smoothly or as planned. Here are some recent reports.

$32M Cerner EHR install at Washington state facilities delayed for years: Tacoma News Tribune

It takes healthcare organizations 55 days to detect a breach, survey finds

The Cost of Data Breach (IBM Survey) - Ponemon

Although healthcare organizations tend to identify breaches more quickly than companies in other industries, they take longer to contain the attack, according to a recent survey sponsored by IBM.

IBM tapped the independent research firm Ponemon Institute to conduct the survey of nearly 500 companies for a report on data breach costs. The survey included 2,634 employees from 477 companies across 17 industries worldwide, all of which had experienced a data breach that compromised at least 2,500 records.

Michigan medical practice to close after refusing to pay ransom to hackers

Patient sues UConn Health, says data breach exposed her to bank fraud

Amazon's Alexa is now HIPAA compliant