With a population of just 9 million, Israel is not a large country. But its contributions to health innovation, in particular digital health, are outsized. The country boasts 500 digital health startups as well as hospitals like Sheba Medical Center, which has recently been ranked in the top 10 in the world by Newsweek.

What does the country have going for it? A mostly interoperable, fully digital EHR system; a genetically diverse population; and a national culture that promotes, indeed requires, doing a lot with a little.

“It has been said that necessity is the mother of invention and this is, in a nutshell, the story of Israel,” Moshe Bar Siman-Tov, director general of Israel’s Ministry of Health, said onstage at the MedinIsrael conference last week in Tel Aviv. “Our security issues led us to develop great defense systems such as the iron dome and cutting-edge cybersecurity technologies. Our severe water shortage led us to become a world leader in water recycling and water desalination. … Our health needs, combined with scarce resources, have pushed us to create one of the most advanced health systems in the world.”

Last year, Israel’s cabinet approved a 1 billion shekel ($276 million) investment in digital health, focusing primarily on commercializing and otherwise deriving value from the country’s medical databanks.

In Israel, interoperability is a reality

Israel's healthcare system has been paperless for about 20 years. And while its hospitals are not all on the same EHR system, those systems do all talk to each other. The country’s healthcare system is organized around four health maintenance organizations (HMOs), and through a health information sharing system called OFEK, when a patient shows up in the emergency room, their doctor can immediately access data from their HMO and any previous hospital visits.

“You can imagine this application has tremendous safety implications, including information regarding medical occurrences and treatment histories. It also allows us to rely on previous tests and save precious time and money,” Siman-Tov said. “But we are not satisfied with OFEK. We are now implementing the next generation of OFEK — EITAN. EITAN enables, again, the shared transfer of the medical data of the individual patient, but it also provides other benefits, such as unifying medical terminology. … EITAN also gives us access to imaging from all points of care and it also includes smart alerts and machine-learning capabilities.”

From a digital health perspective, this data is already helping the consumers. Siman-Tov showed off a smartphone application through his HMO that allows him to make appointments and review data. Another application uses de-identified data and AI to tell patients the percent chance of a range of diagnoses based on their symptoms.

But the catalyst for the launch of the digital health project was the realization of the value of this data on a larger scale.

“We found out a few years ago, about five years ago, that we actually have a gold mine,” Siman-Tov said in a media briefing. “All this data that is longitudinal, integrated, diverse. We are just 9 million people, but the population of Israel came from 150 countries so we are genetically diverse. … We decided that we need to maintain this advantage and make health organizations be aware of the gold mine that they have, because until a few years ago the health organizations were busy with supplying the services that they needed to supply, and they were not open to innovation or collaboration with the industry at all.”

Leveraging a “data gold mine”

Last year Israel launched the TIMNA big data research platform using some of that data.

“It’s a repository of deidentified data from various sources that serve as a basis for research,” Siman-Tov said. “It includes big data that enables scientists to generate insights and identify patterns that can later be implemented in decision support systems.”

Research on the country’s trove of data has already yielded some results for preventative medicine, Siman-Tov said.

“Clalit, the largest HMO in Israel, they identified based on these medical records that the population with adrenal failure has a risk for further degradation, so now they can intervene earlier,” he said. “Maccabi, the second-largest HMO, they found that a drop in hemoglobin level — that does not deviate from the norm and therefore was not flagged — they realized this tiny drop can serve as an indication for the development of colon cancer. Just with these two findings you can imagine we can save hundreds of thousands of lives around the world and this is just the beginning.”

Beyond population-level insight, the country’s researchers hope to leverage the data to advance the cause of personalized medicine, helping to connect the right medication to the right person. That will involve going not only wide, but deep on data.

“Many other countries are doing this across the board — every patient comes in, you take a [gene] sample, and you have a cross-sectional view,” Eyal Zimlichman, chief medical officer and chief innovation officer at Sheba Medical Center, said during a press briefing at the event. “We are looking deep into certain conditions, and then when we do that we don’t only collect the genomic data. Personalized medicine has been around 20 years. Twenty years ago people were saying that by now, they would take a blood test and they would know everything. The reason that’s still not happening is we know genetic data is just one part of the patient. There’s the microbiomic data, the phenotypic data. And that is what we do when we dig deep into these conditions we’ve decided to focus on.”

When Israel made its investment last year, Prime Minister Benjamin Netanyahu discussed the potential in a statement.

“This is a focused databank of the health records of almost each and every one of us over the last two decades,” he said at the time. “This is a great asset and we want to make it available to researchers, developers and companies in order to receive two things: Preventive medicine and personal medicine, personally calibrated for each person.Of course, this depends on the agreement of each person — this right is maintained absolutely. We are achieving a breakthrough here on a global level. The interest of global companies is very great. I have already met with many of them. They all want to come here, and rightly so. They see this as a new direction."

Editor's note: This story was reported in Tel Aviv, Israel on a trip paid for by the Israeli Export Institute, an organization funded in part by the Israeli government, which covered airfare and lodging for reporters. MobiHealthNews Editor in Chief Jonah Comstock also participated as an onstage speaker at MEDinIsrael 2019. As always, MobiHealthNews maintains its editorial independence and made no promises to the Israeli Export Institute about the content or quantity of coverage.