How can the healthcare system be rebooted? Last month, ten projects - commercial startups, initiatives from within the healthcare system, and emerging ideas of private individuals, participated in the Leading Healthcare Initiative of Reboot Forum 2017, a multidisciplinary forum comprising diverse representatives from the healthcare system, who teamed up to brainstorm on ways to improve the system and ensure that it will continue to be economically sustainable.
It was clear from the finalists that data is the sought-after good in the healthcare system. Half of the ventures making presentations were commercial ventures that use big data analytics capabilities to improve patient care. Two other ventures are also engaged in data, but not with big data algorithms; and three ventures were classic medical device companies.
The judges’ discussion was lively; less because of disagreement over the quality of the ventures, and more because of the dilemma over what is the best way to kick-start change in the system - whether by supporting new ventures for which every shekel is important, or by supporting more mature ventures which have a lesser need of cash but set a standard of how the different parties want to see the healthcare system function in the future. The three winners will be announced at the joint Reboot Forum and “Globes” 2017 Sustainable Healthcare Conference on 13 June.
MedAware Ltd. - preventing prescription errors
MedAware uses the capabilities of learning systems to prevent prescription errors. In the presentation to the judges, Dr. Gidi Stein explained that the technology was developed after he learned of the case of a 9-year old boy who died after the doctor prescribed, instead of the routine drug that the child should have received, the next drug in the list of the HMO computer - a powerful blood thinner for adults. The boy fell off his bicycle and died of a brain hemorrhage, “A child was killed because of a typo,” says Stein.
Stein says that current alert systems try to predict doctors’ errors and warn them, but that many errors are still missed. MedAware’s approach is to warn of an unusual prescription. “In effect, the system learns from the doctor’s previous conduct about the reasonable range of medications prescribed for such a patient. Deviations from this reasonable range trigger an alert. It is important that we only sound an alert infrequently. Current systems sometimes send to many alerts, most of which are false alarms, resulting in doctors ignoring them. We consciously miss some errors, which is the price we pay to create a system with few false alarms, so that when a doctor gets an alert, he knows that something extraordinary has happened.”
A recent study tested the system’s ability about previously treated patients. It detected errors which were not detected by current systems, including one regrettable case of a death caused by an uncaught error.
“There are bodies lying on the road, which this company picks up,” praised judge Dr. Ran Balicer
MedAware is already operating in the US. At the event, Stein said that if the company wins the prize, it would use the money to install the system in Israel. “It is surprising to discover that it is harder to install such a system in Israel than in the US,” he said, “because of the health funds’ long sales cycle.”
A Drop for Research- aiding the next discovery
What would you say to the next proposal: sign a general consent form, after which every time you take a blood, urine, feces, or other test, you share part of the sample with a biological sample bank, which will save the data about you, although it will still be under the responsibility of your health fund. Academic and industry researchers will be able to submit questionnaires to this database, which will make possible the discovery of a great deal of new information.
Would you give consent? Are you worried about privacy? Ask yourselves what do you have to gain personally? Prof. Varda Shalev, director of the Big Data Research Institute at Maccabi Health Services, who initiated the current venture, explains, “We realized that our customers have a strong will to make change. That is why a person who gives such a sample can see exactly what happened with his sample: which studies he has participated in, and what happened in these studies.”
There is also a less altruistic incentive: every sample will be sent for basic genetic testing, the results of which will be sent to the customer. In this way, every time something is learned from the sample which might be relevant to that health of the patient who donated it, he will be notified.
A survey by Maccabi among its customers found that 50% said that they were willing to participate in the venture.
Asked about why Maccabi had entered the competition and requesting the fairly negligible prize money, compared with Maccabi’s budget, Shalev said that it was mainly seeking recognition and support of the Reboot Forum in order to get the venture through the regulatory obstacles.
Datos - preventing test errors
Many companies are developing algorithms to analyze medical data, but for good quality results of this analysis, the data input must be good quality. The measurement of medical data can frequently be erroneous or biased. A patient did not correctly place the blood pressure monitor on his arm, or a child decided to have fun monitoring his blood pressure or that of the family cat, or the measurement was taken in a very hot or cold room, affecting the sensors, and so on and so forth.
Datos detects unlikely measurements and clears them to obtain a correct snapshot of the patient’s health. The task is complicated, because the unusual reading is the one we are seeking as it indicates a change in the patient’s condition. Is it possible to separate erroneous data from correct but unusual data? Datos believes that it has the tools to do this.
In addition to clearing errors, Datos’s system also enables the integration of data from different instruments and provides an easy-to-use interface to read and analyze the data.
Valera Health Ltd. - detecting mental deterioration
Like other companies founded in recent years, Valera Health is seeking to detect deterioration in a patient’s condition by analyzing his day-to-day behavior. Valera Health, which specializes in mental health, does this without any external equipment, using only data from a mobile phone.
Today, a mental health patient will usually encounter the healthcare system when he is in the middle of some kind of episode. Alternatively, he will go to prescheduled meeting with a therapist, once every few months. During the intervals between meetings, he is definitely liable to face a serious deterioration in his condition. A patient’s decline into a psychotic, manic, or depressed episode causes great suffering that is liable to result in suicide, and it is not certain that the patient can recover. If there is early intervention, it may be possible to halt or mitigate the episode through appropriate medication of psychological treatment.
Valera Health’s product tracks symptoms such as the speed of the patient’s gestures, whether he leaves the house, his sleep patterns, frequency of his conversations, and the strength of his voice when talking. These metrics are integrated with the patient’s characteristic habits, and when he deviates from them is a suspicious manner, the system opens a chatbot for him, which asks him how he is. If the patient says that his condition has worsened and it is not a mistake, there will be human intervention.
Valera Health is already collaborating with a number to top medical facilities in the US.
Healthymize - detecting breathing deterioration
Healthymize also uses data already recorded in a smartphone to alert about deterioration in health. In this case, the target is Chronic Obstructive Pulmonary Disease (COPD) and asthma, lung diseases characterized by problems in breathing, which also affect the patient’s voice. The system records every telephone conversation by the patient, analyzing them to predict when he is experiencing an attack. As with depression, lung diseases involve chronic illnesses with increasingly severe episodes. The earlier an attack is detected, the better the chance of nipping it at the bud and slowing the deterioration.
Healthymize has reported that COPD patients tend to delay seeking treatment during an attack, even up to weeks after the system could have first detected it.
Healthymize does not yet have any commercial agreements, but its product has already undergone clinical trials in which it achieved 97% accuracy in diagnosing an attack.
IBD Passport Ltd. - travelling abroad can be fun
The title for most exciting initiative in the judges’ eyes was unquestionably won by Prof. Shomron Ben-Horin, the founder of IBD Passport. Ben-Horin, a doctor at Sheba Medical Center - Tel Hashomer Hospital, manages the inflammatory bowel (colitis and Crohn’s disease, jointly known as inflammatory bowel disease, or IDB) department. After many patients told him that they could not travel abroad because they did not know how their diseases would flare up overseas, he decided to establish a database to help them manage their overseas travel.
Ben-Horin and his British partner, Kay Greveson, a chief nurse at the Royal Free Hospital in London, who specializes in treating IBD, established the project with a personal investment of a few thousand dollars each. Without algorithms or direct user content, they manually collected relevant data from travelers with IBD: names and addresses of specialist IBD clinics around the world, the names of top doctors, procedures for activating insurance policies for treating IBD overseas, delivery of medications by plane by various airlines, etc. Ben-Horin says that he personally worked into the wee hours of the morning typing the data into the site.
Ben-Horin emphasized in his presentation that overseas travel is not a luxury, but a part of modern life, and that giving it up because of a disease means giving up (unnecessarily) on career, love, family, and more.
Following the presentation, BWell, which operates the medical information site Infomed and is a partner in the Reboot Forum, appointed itself the mentor of the project, irrespective of its place in the competition, with the objective of providing Ben-Horin its accumulated knowhow in properly and efficiently building medical information sites.
Predict-Tor - “penalizing” people who are late for their doctor’s appointment
The Predict-Tor system, developed by Dr. Omer Travitzki from the Ophthalmology Department at Tel Aviv Sourasky Medical Center - Ichilov Hospital, is intended to improve scheduling management at hospitals by studying the behavior of different people who use the service. For example, the system learns to identify people who tend to be late for appointments and who tend to be early; and it schedules the former for appointments later in the day when they are less likely to be late, thereby avoiding delays for others. This is just one example of how the system can customize scheduling management. For example, people who are chronically late can be sent more reminders and more arrival confirmations, and people who miss appointments can be “penalized” by allotting them appointments at less convenient times, and so on.
Predict-Tor’s presentation set off a debate about the difference between customized scheduling management systems or learning Big Data systems and simple profiling, which has already been carried out in a trial study to test the system’s feasibility. The trial study tested only a few variables: age, socioeconomic condition, and place of origin. It turns out, for example, that people born in Eastern Europe tend to be early for appointments, while people born in the Middle East tend to be later. Is it moral to “penalize” a patient with a midday appointment (which is considered less convenient) just because other people from his same ethnicity tend to be late? The question is how Big should the Data be in order for it to go from a level of borderline generalizations, to a world of real personalized customization.
Scade Medical Systems Ltd. - precision in diagnosing skin cancer
Scade Medical Systems has developed new technology for diagnosing skin cancer. Instead of the current color-based diagnostic method, which examines infected dermis and misses some cases of severe skin cancer, Scade’s method carries out 3D diagnosis of the tissue, mapping its structure. Studies conducted by the company found differences in the texture of cancer and healthy tissue. The company has conducted a clinical trial of its product, which found a 100% diagnosis of malignant tumors with a false positive (i.e. classifying non-malignant tumors as malignant) in just 9% of cases.
Currently, most doctors do not want to take the risk, and send every case of possible malignancy for removal; in 99% of the cases, the excised tissue turns out to be healthy. The company has a major challenge in education the market against this approach. It claims that its technology provides earlier diagnosis of malignant tissue compared with color-based diagnosis.
BabySafe - the baby’s heartbeat
BabySafe was also born out of a tragedy. After friends of its founder, Moshe Aharon, lost their son, he decided to try to tackle the problem through an integration of existing monitors. The company’s product is a “fit-beat” - a bracelet that monitors heartbeat which has been slightly adapted for infants. When the baby’s heartbeat drops below 60 beats per minute, the device alerts the parents.
The decision to alert parents at 60 beats per minute was taken on the basis of studies, which found that this is the critical threshold. However, BabySafe needs work on the Beta version to prove that an alert at 60 beats per minute is sufficient to save the child on one hand, while avoiding false alarms, which could cause parents not to use the device.
Doctors among the judges said that the Ministry of Health recently advised not to use current monitors (such as BabySense,) because it has not been proved that they reduce the risk of crib death. Therefore, in order to gain a foothold in the market, the company must show that it provides an alert with a significant level of results.
iNeedle - user-friendly blood test
iNeedle is a system of thin needles on a chip, which autonomously directs the needles’ movement. Through this approach, the company hopes to facilitate blood tests of children by means a rapid control and the tremors of a battery of needles, instead of a single needle. The method can be adapted for tattoo removal, hair removal, and cosmetic skin firming treatments.
The judges said that the development of a new chip is $70-80 million, and that the company should focus on a particular application, before expanding the technology.
Maccabi Family - Audience favorite
The Reboot Forum's favorite venture is an initiative of Maccabi Health Services’ Maccabi Family venture to improve its support network for family members of chronic patients, especially the elderly. The venture is not a technology, but an information, mental, and logistics support service for family members who sometimes find themselves helpless, desperate, and exhausted when taking care of patients. The distress on a family from caring for terminally or chronically ill, or elderly family members has been documented extensively in the literature in recent years, and has been described as a healthcare challenge in its own right. Supporting primary caregivers may prevent decline in their own mental and physical health, and help them cope with caring for a family member suffering from a severe or chronic illness.
For further information and to contact the entrepreneurs, go to Reboot.evolero.com or email email@example.com
Published by Globes [online], Israel business news - www.globes-online.com - on April 3, 2017
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