How Israel is using AI to implement proactive care

Dr. Ran Balicer, chief innovation officer of Israel’s Clalit Research Institute, talks using tech to catch health issues before they become serious at HIMSS20 Digital.
By Laura Lovett
02:59 pm
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When it comes to regions around the world where health tech is in full bloom, it would be hard not to mention Israel. Today we are seeing a rise of health IT innovation and digital health companies rising from this relatively small country in the Middle East. 

That is also true when it comes to the country’s largest healthcare organization, Clalit Health Services, which is combining its swaths of patient data and artificial intelligence to move towards predictive care with actionable steps. Clalit had a leg up when it implemented this system – its integrated EMR. 

“We have had a single EMR in the community-care setting and hospital care. …[A]ll of the data is going to a central data warehouse ... where it is stored and used in order to provide predictive, proactive and preventive care to our population,” Dr. Ran Balicer, chief innovation officer of Israel’s Clalit Research Institute, said during HIMSS20 Digital’s Israel's Largest Healthcare Organization Implements Innovation at Scale

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While many countries had a goal of moving toward predictive care, Israel’s healthcare structure made the switch easier. 

“We had all the ingredients to make it happen a little bit earlier and a little bit ahead of the curve as compared to ... other countries, simply because that data was there,” Balicer said. “We could take and use this data, and use a predictive model in order to have a different way to provide care to our populations. The second thing is we had responsibility for a population in the larger sense and not a necessarily on a patient specific visit approach. Everyone one of our physicians knows they're responsible. Every one of our physicians knows [their] population.” 

Keeping the end user in mind is key, he said. Success doesn’t depend solely on whether or not the tech works. 

“You have to make the right way be the easy way. You can’t make something the is over cumbersome and is a list of requests or accommodations coming from upstairs , with little heed to the daily impossible practice of GPs, and physicians and nurses in general,” Balicer said. “If you are trying to give a set of orders by email of accommodations that usually is going to fail.”

Balicer explained that clinician education is fundamental to predictive care. He gave the example of a pilot done on predicting patients with chronic kidney disease back in 2010. When a patient gets to the point of needing dialysis there is little clinicians can do to turn the condition around. If caught earlier the condition can be avoided.

The new technology could help pinpoint the time a patient was at risk for a disorder. However, just telling clinicians that a patient may or may not  develop a disorder is no use unless the prediction tool is combined with training about what to do if your patient is developing this disorder. 

The tool also has to fit into a clinician’s workflow and not take too much work. 

“I think one of the key things that made that possible was the information systems put in place made proactive care something that was feasible and intuitive. Every physician had a list of patients for proactive care and had guideline embedded in there that [say] what is done in a proactive manner.”

This predictive tool came in handy recently at the dawn of the coronavirus pandemic. The health system was able to identify its most vulnerable 200,000 patients that the virus was spreading to and tell them to stay in their homes. 

“Our doctors have personally called these hundreds and thousands of people [to say] 'Here is my number don’t come in. The risk is too great. We will sort it out through online care, telephone or house visits,'” he said. 

Today Israel continues to have a relatively low coronavirus death count, at 281 – something that he attributes to both predictive care and the young population. 

 

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