The UK's National Health Service (NHS) is quite similar to the Israeli system. The entire population has health insurance, which offers community health services and manages hospitals. In the UK, however, the entire chronically cash-strapped health system belongs to the state, while health services in Israel are provided by the health funds and the state owns only some of the hospitals. Nevertheless, the two systems have more similarities than differences.
That may be the reason why UK NHS national clinical lead for innovation Prof. Tony Young has decided to adopt some of the technology commercialization activity by the Israeli health funds in the NHS. "We were enthused about your commercialization companies, because they operate slightly differently. They not only give the health organization's technologies to startups; they sometimes manage them as projects within the health fund. We saw this at both Clalit Health Services and Maccabi Health Services. Sometimes the health fund from which the technology came serves as a research site and founds a company around the internal project only later. It's even possible to get government financing for it through the Israel Innovation Authority. I don't use the term 'unique' very often, but this really is special."
Young said that he was formerly a surgeon, and also founded medical device companies. The NHS has no technology commercialization companies like those of health funds and hospitals in Israel. "The NHS is divided into districts. Each district has a connection with the local university, and can commercialize technology of a doctor working in the same university. For me, this is an advantage for the health funds having their own commercialization company, and I plan to also propose this for our organization."
Young is visiting Israel in order to offer Israeli companies an opportunity to try out their technologies at the NHS. During his visit, he met with 50 companies in 72 hours. "We met companies in a very broad range of areas: companies in information, machine learning, genetic diagnostics, medical devices, drugs, and cyber protection for hospitals. I was very impressed by their products in the sensors, wearable products, and artificial intelligence spheres."
Young said that significant contacts had begun with 5-6 companies interested in establishing activity in the UK and using NHS hospitals as a trial site. For example, following the visit, Upright Technologies, a company that developed a device for keeping proper balance, will try out its product on 1,000 NHS patients. NHS and Upright will jointly fund the trial.
"Israelis don't work the right way in the UK market"
Young's visit to Israel was organized by the Department for International Trade (DIT) in the UK embassy in Israel. Anat Weiss-Ronen, who works with the DIT, is also the address for anyone interested in considering trying out their products in the UK health system or establishing a presence in the UK.
"We saw that many companies aren't working the right way in the UK market. First they market to the UK from Israel, and only later do they found a UK company. For agencies like the NHS, establishing a UK company is an initial step showing a commitment to the UK market and reliability. It is important for a company interested in working with the NHS to present its complete business plan in the UK and a plan demonstrating that installing the technology is economically worthwhile for the organization, including clinical data and backed by opinion-makers in the UK," Young says.
"Globes": Israeli companies that tried to work with the NHS tend to say that it is crippled by its budget, and accepts only products that save money from the first day after they are installed. How much of that is true?
Young: "This is not our policy. We do install products requiring some initial investment. We have a plan called innovation and technology payment, in which we use a government budget to clear away some of the barriers pertaining to technology that does not make back the investment from the first day. One of the products introduced under this program, not an Israeli one, is the Heartflow system, which uses artificial intelligence to examine whether a person offered a stent to prevent heart attacks really benefits from the procedure. Today, unfortunately, many heart patients receive this treatment even if its value is not completely clear, because it is profitable for the hospitals. In the long term, of course, this technology will be profitable for the NHS, but it needs support in the first stage. I saw companies in Israel with similar ideas. You look at the larger picture, and I hope we do, as well."
"I didn't see a system that purports to replace human beings"
Young talks about two other systems recently installed by the NHS. One is My-COPD, a system for managing drug treatment for chronic obstructive pulmonary disease (COPD) patients. Among other things, the system teaches the patients how to use an inhaler correctly, thereby saving on repeat hospitalization. Hospitals, he says, were not very enthusiastic about preventing repeat hospitalization, because they are paid for it.
Another system enabled cancer patients to switch to hospitalization at home, because it can be used to monitor the symptoms they experience and call them back to the hospital if necessary. This digital system was useful not only because it documented the symptoms more frequently and continuously, but also because it lowers the psychological barrier - the patients complain to their tablet much earlier, while they called people only when the situation was already very serious.
Will digital medicine make hospitals unnecessary at some point or significantly reduce their role?
"I think there will always be treatment centers like hospitals. Human evolution shows that the person is the most amazing thing ever developed. The personal connection is the number one factor affecting health. We'll always need people, at least in the foreseeable future.
"There's a lot of hype about digital health, and within this hype, there are several things that are really causing a change. Hype is a good thing, because it leads to investment in innovation, instead of in safe instruments, but not everything that people invest in because of hype will really survive and change the face of medicine."
Which digital medicine applications do you think will survive past the hype?
"Artificial intelligence systems for radiology and pathology, but not as a substitute for professionals - mostly in order to prioritize certain cases in the queue, and in order to speed up their work and make it more efficient. Also tools for planning surgery and diagnostic tools, or automation of laboratory tests. In certain cases in which action cannot be taken today without agreement between at least two people, we may be able to make do with an agreement between a person and a machine. To tell the truth, I've never seen a system purporting to replace people in the medical field soon, and not only because of opposition from doctors and other professionals. The technology simply hasn't gotten there yet."
Published by Globes, Israel business news - en.globes.co.il - on December 26, 2018
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