1) Hospitals face rising healthcare costs as populations age, so innovation is needed to reduce expenses and make services more affordable. 2) Current hospital models are expensive and reactive; new predictive services are needed using technologies like big data analysis and remote monitoring. 3) The Sheba Medical Center is working to transform massive healthcare data into medical knowledge through collaborative multidisciplinary research and real-world pilots like predicting medication errors and providing tele-medicine services.

1. Innovation in Healthcare
ROY MALKA, PHD
SCIENTIFIC DIRECTOR, INNOVATION CENTER
THE SHEBA MEDICAL CENTER, ISRAEL
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mHealth June, 7, 2017

2. 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

3. 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!

4. 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 Powerhouse
From Idea to a Product
Traditional medical innovation

5. 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

6. 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!!

7. 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

8. 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

9. Focusing on Sheba Medical Center (SMC)

10. Transforming Big Data to Knowledge (BD2K)
The Challenge
We Must Analyze Exponentially Growing Healthcare Data Assets

11. 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

12. 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
Enterprise
Data
Warehouse

13. Analysis of millions of patient records to match patients
to medication and identify prescription errors
Preventing Medication Errors
Real World
Example

14. Preventing Medication Errors
Real World
Example
An interpretable working principle

15. Preventing Medication Errors
Avoiding ‘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 World
Example

16. Preventing Medication Errors
Independent Validation
Real World
Example

17. Tele-Medicine
u Providing remote specialty services
u 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 World
Example
Bridging
geographical
distance

18. 100 150 200 250 300 350
AG- Average Glucose (mg/dL)
4
5
6
7
8
9
10
11
12
13
14
HbA1c-GlycatedHemoglobinfraction(%) non-diabetic
type 1
type 2
linear regression
7% - Treatment threshold
6.5 % - Diagnosis threshold
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
Clinically significant variability

19. The missing measurement: assuming all patients
have the same RBC lifespan
AG (g/dL)
100 150 200 250 300 350 400
HbA1c(%)
2
4
6
8
10
12
14
A
Input
Output
p = 0.85
Simulation
measurement
Roy Malka et al., Sci Transl Med 2016;8:359ra130

20. AG (g/dL)
100 150 200 250 300 350 400
HbA1c(%)
2
4
6
8
10
12
14
A
Input
Output
p = 0.927
Simulation
measurement
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!

21. The approach to innovation
at the Sheba Medical Center
Applied and Basic Research
To Improve patients outcomes

22. The three pillars of
innovation in medicine Clinical
InventorsImplementation
1. Unmet clinical need
2. Invention that answers a
clinical need
3. Real life implementation
that can be integrated in
the clinic and change the
patient’s outcome.
Sheba innovation center is standing on these three pillars

23. “The real voyage of
discovery consists not in
seeking new landscapes,
but in having new eyes”
Marcel Proust
ROY MALKA, PHD
ROY.MALKA@SHEBA.HEALTH.GOV.IL
Scientific Director
Innovation Center
Sheba Medical Center