Innovation in HealthcareROY MALKA, PHDSCIENTIFIC DIRECTOR, INNOVATION CENTERTHE SHEBA MEDICAL CENTER, ISRAEL

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mHealth June, 7, 2017

The Need for innovation

u All over the world the costs of healthcare are rising, with the increase fraction of elderly in the population the trend is expected to continue.

u Within a public healthcare system, Israel an example, most medical services are not lucrative, some of the services are generating negative revenue.u Thus, Hospitals must be resourceful to stay balanced, hence the need for

innovation

The Need for innovation

u A joint study by The World Bank’s, Chinese government & the World Health Organization recommends:u shift away from its current hospital-centric model.

u Health spending are expected to increase in real terms from 3.5 trillion yuan in 2014 to 15.8 trillion yuan in 2035— 9% of GDP.u 60 % of growth would come from increased inpatient services in hospitals.

u Naturally, this is true all over the world – Hospitals services are expensive!

Idea-genesis

Animal modeling of human diseases – Tissue Bank

Feasibility studies on animal models - Pathology

Helsinki Committee documentation

Clinical studies

Establishing IP

Developing IP with partners

"“One Stop Shop

Translational Research PowerhouseFrom Idea to a ProductTraditional medical innovation

How can we overcome the high costs of innovation?

1. Collaborate– preferably with experienced individuals and institutions

2. Focus our efforts– build domain expertise within your hospital

3. Support multidisciplinary work– Rephrase the problem to adopt tools from other disciplines

The characterization of the solution

u Current hospitals services are:

u responsive & expensive

u New services should be proactive:

u which requires predicting the right action, at the right time to the right person.

u New services need to be scalable and not expensive

u Can we increase the physicians productivity?

Technology!!

On the verge of a paradigm shift

u The computer revolution changed the way we do many things:u Many things today are transformed into computations

u For example, 30 years ago it was not clear what is the connection between taking pictures and computational power.

u Today, it is hard to find film based cameras, or film.

Historical perspective

On the verge of a paradigm shift

u Now, we are on the verge of transforming driving into prediction

u How can we change medicine to be prediction based?

Predictions for all

Focusing on Sheba Medical Center (SMC)

Transforming Big Data to Knowledge (BD2K) The Challenge

We Must Analyze Exponentially Growing Healthcare Data Assets

Finance

Pharmacy

Supply System

Health IT

Clinic

EMR

Labs

Imaging

Vital Signs

Research

A mixture of many subsystems that document different aspects of the shared processes

Sheba IT systems

Vital Signs Systems

EMR

Laboratory -AutoLIMS

Imaging- Pacs, Carestream, C-Pacs

Medical Admin.Logistics

HR

FinanceSupply Systems

Information exchange-Between healthcare providers

EnterpriseData

Warehouse

Analysis of millions of patient records to match patients to medication and identify prescription errors

Preventing Medication Errors

Real WorldExample

Preventing Medication Errors

Real WorldExample

An interpretable working principle

Preventing Medication ErrorsAvoiding ‘Alert fatigued’ is a key feature in adopting

such a system

The Sheba Experience (Pilot Study):q One alert / department / day (~0.5% of prescriptions)q Most alerts accepted by physicians and cause a change in prescription (~80%)

Real WorldExample

Preventing Medication ErrorsIndependent Validation

Real WorldExample

Tele-Medicine

u Providing remote specialty servicesu Doctor to doctor consultation

u Using technology to provide objective measurements remotely

u Patient generated data

u Rehabilitation services from the comfort of one’s home

u Management of chronic conditions

Established technology

Real WorldExample

Bridginggeographical

distance

100 150 200 250 300 350AG- Average Glucose (mg/dL)

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Hem

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(%) non-diabetic

type 1type 2linear regression

7%- Treatmentthreshold

6.5%- Diagnosisthreshold

Why glycated hemoglobin (HbA1c/A1c) is used to monitor diabetes? A1c has a linear relation with the average blood glucose

Nathan et al. Diabetes Care 2008

Clinicallysignificantvariability

The missing measurement: assuming all patients have the same RBC lifespan

AG (g/dL)100 150 200 250 300 350 400

HbA

1c (%

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Input

Output

p = 0.85

Simulationmeasurement

Roy Malka et al., Sci Transl Med 2016;8:359ra130

AG (g/dL)100 150 200 250 300 350 400

HbA1

c (%

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Input

Output

p = 0.927

Simulationmeasurement

!

High degree of consistency between the model simulations and the data when adding variability in the mean RBCs age

Roy Malka et al., Sci Transl Med 2016;8:359ra130

The missing measurement (RBC age – not measured clinically) can not be revealed by ‘big data’ approaches!

The approach to innovationat the Sheba Medical Center

Applied and Basic ResearchTo Improve patients outcomes

The three pillars of innovation in medicine Clinical

InventorsImplementation

1. Unmet clinical need

2. Invention that answers a clinical need

3. Real life implementationthat can be integrated in the clinic and change the patient’s outcome.

Sheba innovation center is standing on these three pillars

“The real voyage of discovery consists not in

seeking new landscapes, but in having new eyes”

Marcel Proust

ROY MALKA, PHDROY.MALKA@SHEBA.HEALTH.GOV.IL

Scientific Director Innovation Center

Sheba Medical Center