The global outbreak of the new Coronavirus brought to our attention an inconvenient truth about influenza: The seasonal flu kills between 291,000 to 645,000 people worldwide each year. Still, a December 2019 survey found that 37% of US adults did not intend to get a flu shot.
Digital Health in Israel
Not getting a flu shot could turn out to be an unfortunate decision for people who don’t know—and their doctors don’t know—that they are at high risk for developing flu-related complications. But applying AI algorithms to patient data and identifying unvaccinated high-risk individuals, could “prevent deaths and hospitalization,” says Dr. Jeremy Orr.
Orr is the CEO of Medial EarlySign, an Israeli startup that has developed algorithms that assist healthcare providers with the early detection of a number of life-threatening conditions, including lower GI disorders, prediabetes progression to diabetes, and colorectal cancer. Medial EarlySign’s data sets cover more than 20 million patient lives and 150 million patient years and it has tested its algorithms in studies conducted in 13 clinical sites worldwide.
“When the doctor does a test and tells you everything is in the ‘normal range,’ nothing to worry about, there is a lot of information there that they are not seeing that could suggest that you are at risk for certain clinical conditions,” explains Orr. “The traditional way to interpret lab tests—‘normal ranges’—is totally broken and has been for some time. With machine learning we can see that there are patterns in normal-appearing labs that suggest that the patient has high risk for or already having colorectal cancer, for example.”
This is the promise of “personalized medicine” or “precision medicine,” finding the hidden clues of potential risks and telling data patterns, what Orr calls “the non-intuitive relationships,” in a person’s medical record or test results. And Medial EarlySign’s algorithms alert healthcare providers to a serious disease at a stage where there is a better chance for a successful intervention.
Orr sees Medial EarlySign’s competitive differentiation in the high quality and expertise of its data science team, the work they have done to clean messy healthcare data, and their seamless integration with the existing workflow of the healthcare systems they partner with. In addition, “We don’t go to a health system and say give us all your data,” says Orr. “We give them something they can implement behind their firewall in a secure cloud location. We are giving them the benefit of AI without all the heavy training stage.”
Getting doctors to adopt a new approach is not an easy task and Medial relies on the papers reporting on the results of its clinical studies for convincing evidence of the efficacy of its algorithms. In addition, they overcome AI’s “black box” challenge by offering with their solution a “but why?” feature, explaining to the doctors some of the reasons their patient is considered high-risk. “They can see the value of the machine in picking the subtle things they are likely to miss and they can have a more informed conversation with the patient,” says Orr. And he adds: “AI is not going to replace doctors. They do some really important communications with patients and we want to augment that.”
Medial EarlySign’s currently works with Maccabi Healthcare Services in Israel and Geisinger Health, SLUCare, and Kaiser Permanente Northwest in the US. Orr’s vision for the future is to “get AI insights beyond just healthcare providers.” This means partnering with labs, diagnostics companies, and technology platforms “that can put the insights in different parts of the ecosystem faster.”
Medial EarlySign may become the “AI Inside” for companies supplying products and services to the healthcare industry. Many other Israeli startups vie for a leadership role in transforming healthcare with AI-based new practices and fresh insights. AI is the fastest growing technology within the “digital health” sector in Israel, Startup Nation Central reported last year, with 85% of total investments going to companies utilizing AI solutions. In 2018, the digital health ecosystem in Israel consisted of 537 startups, 4 HMOs, 32 multinationals, 4 health-focused incubators, and around 100 active investors. According to preliminary data from Start-Up Nation Central, Israeli digital health startups raised $662 million across 69 deals in 2019, a 32% increase year-over-year in total funding raised.
This thriving ecosystem is largely driven by the accumulation of over 20 years of digitized healthcare records and years of experience in the analysis of this unique data set. Other developed countries have only recently grasped the benefits of digitization—in Germany, for example, medical record digitization will only become mandatory in 2021. Israel’s four HMOs and their affiliated hospitals have used the same electronic medical records platform, with access to patient records available to each point of care as needed. This means, explains Orr, that “they can make things happen in workflow more quickly” and that it is easier to get the EMR manufacturer to make changes. In contrast, there are more than 1,000 different EMR systems in the US, resulting in serious change management and interoperability challenges.
“We are now in the second revolution,” says Orr, “moving from being data-rich to getting the insights.” Many of the Israeli healthcare revolutionaries have started their data analysis careers in the country’s intelligence services and then used that experience to launch cybersecurity startups, making Israel a leader in a market that will reach $122 billion worldwide in 2022. Digital health provides them with an opportunity to apply their expertise and experience in a fulfilling endeavor. “They see that the time and talent they spend on ad conversion can be better spent on saving their mother or father,” Eyal Gura, co-founder of Zebra Medical Vision told me last year.
To say nothing about the fact that the worldwide healthcare market is about 100 times larger than the cybersecurity market. That point was made recently by Dr. Yair Schindel, head of Israeli venture capital fund aMoon, in an interview with Calaclist (original Hebrew version)—“It is a combination of great economic potential and a desire to help the world.” aMoon is a healthtech and life sciences venture fund founded by Schindel and Marius Nacht, a co-founder (in 1993) of Checkpoint, inventor of the firewall and the granddaddy of Israeli cybersecurity. aMoon has invested around $500 million to date in 31 companies, 20 of them Israel-based and the rest in the U.S.
Like Nacht, other successful Israeli entrepreneurs are getting into digital health. “The fact that they can leverage their power for accelerated healing is a game changer. Some think of their parents, their children, themselves. If I can identify and solve problems like Alzheimer’s or diabetes early, then it pertains to everyone,” Schindel told Calacalist.
One of these Israeli entrepreneurs is Nir Kalkstein, co-founder of Final, a successful algorithmic-trading company. In 2013, Kalkstein founded Medial EarlySign, one of the startups benefiting from an aMoon investment. Says Israeli tech observer Hillel Fuld: “I, for one, would rather know sooner than later if I was on a high-risk trajectory for progressing to a life-changing disease… There is no reason that our healthcare providers shouldn’t be taking a more proactive approach given the data at their disposal, and if EarlySign accomplishes its mission, they will be able to get us there.”