Integrating Digital Health into Clinical Practice...Integrating Digital Health into Clinical...

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

24 May 2019Maya Leventer-Roberts, MD, MPH3

Arnold Munk

Challenge #1: High demand.

*5 Maya Leventer-Roberts, MD, MPH 24 May 20195 Maya Leventer-Roberts, MD, MPH

Challenge #2:High cost.

*6 Maya Leventer-Roberts, MD, MPH

Source: OECD

24 May 20196 Maya Leventer-Roberts, MD, MPH


Challenge #3:Doctors and patients are struggling.


The system is struggling.


People are turning elsewhere for help.


We all want:Better care, for more people, in a new era.

Maya Leventer-Roberts, MD, MPH11 24 May 2019

There are many models suggesting this should work.

Source: IHI, Europuls, HBR


Healthcare can be elegant.


But how does that happen, exactly?


OO + NT = EOO

Source: Michael Hammer

OO + NT = EOO


Old organization + New Technology =

Expensive old organization

Source: Michael Hammer


Change is hard to embrace.


Reality is hard to embrace.


We are here.


Diverse landscape

National Health Insurance Law


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



Potential for excellence


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


Resources are scarce.

Source: Taub Center


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


Clalit Research Institute


• 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


Our method of integration

Real World Outcomes



Source: CDC

Pneumococcal disease

*Maya Leventer-Roberts, MD, MPH31 24 May 201931 Maya Leventer-Roberts, MD, MPH

Does the vaccine work or not?

32 Maya Leventer-Roberts, MD, MPH 24 May 2019Maya Leventer-Roberts, MD, MPH

*Maya Leventer-Roberts, MD, MPH33

It works in practice.

Source: Clalit Health Services



It works however you target it.



The vaccine remains a national priority.

Source: Ministry of Health


Bariatric Surgery


Is bariatric surgery worth it?


It works.

38 Maya Leventer-Roberts, MD, MPH 24 May 2019Maya Leventer-Roberts, MD, MPH

It saves lives.

39 24 May 2019Maya Leventer-Roberts, MD, MPH

Risk Stratification


Predict Renal Failure


Source: Clalit Health Services


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


Screening for Colorectal Cancer



The 14 easy steps to doing a FIT.

5,000


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.


49 Maya Leventer-Roberts, MD, MPH 24 May 2019

Personalization


http://www.google.co.il/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi1memy8rnUAhWLchQKHVoGARQQjRwIBw&url=http://www.freeiconspng.com/img/30584&psig=AFQjCNES9oMyUxe4f9LcBagkj-AzkrqNUw&ust=1497411187186463

Personalizing clinical trials outcomes

Outcome-specific Predictive

model

(1000 bootstraps)


I-PREDICT

Recommendation

24 May 2019



Maya Leventer-Roberts, MD, MPH

Deputy Director, Clalit Research Institute

[email protected]

Thankyou!

Integrating Digital Health into Clinical Practice...Integrating Digital Health into Clinical...

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