Post on 11-Aug-2020
Integrating Digital Health into Clinical Practice
Maya Leventer-Roberts, MD, MPH
Deputy Director, Clalit Research Institute, Israel
The Web of Health, 15 May 2019
The Web Conference, San Francisco
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Arnold Munk
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Challenge #1: High demand.
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Challenge #2:High cost.
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Source: OECD
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Challenge #3:Doctors and patients are struggling.
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The system is struggling.
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People are turning elsewhere for help.
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We all want:Better care, for more people, in a new era.
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There are many models suggesting this should work.
Source: IHI, Europuls, HBR
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Healthcare can be elegant.
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But how does that happen, exactly?
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OO + NT = EOO
Source: Michael Hammer
OO + NT = EOO
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Old organization + New Technology =
Expensive old organization
Source: Michael Hammer
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Change is hard to embrace.
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Reality is hard to embrace.
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We are here.
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Diverse landscape
National Health Insurance Law
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Mandatory, universal coverageEvery one of the over 8 million residents belongs to one of four health funds
Single, comprehensive system Every fund provides the same basic services, which are updated yearly by an independent committee
Universal accessFunded by the government through capitation
Clalit Health Services
Largest health fund:
• 4.5+ million members
• 53% of population
• >1,500 clinics
• 14 hospitals
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Potential for excellence
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Laboratory data
Community primary care clinic data
Diagnostic and imaging data
Pharmacy, medications data
Allied health services data
Dental, complementary
health services data
Socio-demographic data
Linked to national database
National Cancer registry
Linked to Ministry of Health
Disease registries
Hospital inpatient, ED and discharge data
Administrative data (costs)
Comprehensive digital warehouse
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Resources are scarce.
Source: Taub Center
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Even with all our potential, we were missing something.
Clalit Research Institute
• Established in March 2010, nearly 100 years after Clalit
• Mandate: Turn data to insights, insights to policy– Real world outcomes
– Risk stratification
– Personalization
• Interdisciplinary teams
• Multidisciplinary collaborations
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Clalit Research Institute
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• Deliver the right intervention,
Using real world outcomes to guide clinical decision support
• at the right time,
Empowering providers to intervene efficiently with risk stratification
• to the right patient.
Integrating personalization into clinical practice
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Our method of integration
Real World Outcomes
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Source: CDC
Pneumococcal disease
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Does the vaccine work or not?
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It works in practice.
Source: Clalit Health Services
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It works however you target it.
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The vaccine remains a national priority.
Source: Ministry of Health
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Bariatric Surgery
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Is bariatric surgery worth it?
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It works.
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It saves lives.
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Risk Stratification
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Predict Renal Failure
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Source: Clalit Health Services
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Identify patients at:Pre-clinical stage (Pre-disease)Risk for acquiring the condition
Tailor interventions to:Prevent progression to chronic diseaseTreat when treatment most effective
Preventing Renal Failure
Preventive Nephrology
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Screening for Colorectal Cancer
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The 14 easy steps to doing a FIT.
5,000
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55,000
250 5,000
100
60,000
Top 10% 45,000Top 0.5% Standard risk
CRC350
No FIT in the last year
10
FIT Recommended Not eligible
Source: Clalit Health Services, approximate counts from one district
Patient engagement is sorted based on risk.
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Personalization
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Personalizing clinical trials outcomes
Outcome-specific Predictive
model
(1000 bootstraps)
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I-PREDICT
Recommendation
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Maya Leventer-Roberts, MD, MPH
Deputy Director, Clalit Research Institute
maya.roberts@gmail.com
Thankyou!