Dov Lieber article, Wall Street Journal, about Israel health technology and the role of Artificial Intelligence

1. Israel plans to combine HMOs’ digital health records that cover most Israelis into a single
system for AI and data analytics to tap.
Israel is becoming a testing ground for the power of artificial intelligence to improve health care.
Digital medical records for the vast majority of Israelis are currently stored in databases maintained
by the handful of semipublic HMOs that provide most health care in Israel. While the biggest health-
maintenance organizations already leverage their records in partnerships with private companies to
develop technology for more advanced health care, Israel’s government wants to take such efforts to
a new level.
The government last year announced a $264 million initiative to begin to combine those millions of
records into a giant unified system, one that takes decades of individual patients’ information and
puts it all in the same format so medical data looks the same across all health-care institutions.
Corralling the records and organizing them in ways that maximize their usefulness to AI programs
and data analytics, the government hopes, will make the data of even greater value to researchers
and health-care companies. And the greater goals, officials say, based largely on the promise of AI
technology, are to make health care less expensive, more effective and better tailored to individuals
everywhere.
AI-assisted machines and programs, with their ability to learn and draw conclusions from the millions
of detailed histories, medical tests and diagnostic results stored in these records, have the potential
to help doctors give more preventive care by spotting diseases in earlier stages; tailor more medicine
to the needs of specific patients; read diagnostic imagery and lab tests faster and more accurately;
and make health-care less expensive.
Israel’s plans rely on patients giving their consent for their clinical data to be transferred from the
HMOs to the government system. Patients who agree will be asked to supply genetic information
and other additional data as well.
Medical experts and government officials in Israel are still grappling with the ethical and privacy
implications of the initiative. But a number of international health officials say the potential benefits
outweigh the pitfalls. Israel’s health-care system already is globally recognized as a leader in using
digitally stored data for public health-care delivery. This includes HMO programs and activities such
as constantly running algorithms on their patients’ data to detect signs of kidney disease or colon
cancer.
“I have seen a tremendous amount of output from AI digital startups coming out of Israel,” says Eric
Topol, director of the La Jolla, Calif.-based Scripps Research Translational Institute, which specializes
in tech-powered personalized medicine.
Officials say it could take a decade before the unified system equals the size of databases the HMOs
already have. While the effort may at first seem duplicative, the officials emphasize that the point is
to make the data more accessible to a broader group of researchers and businesses. The HMOs

2. themselves currently maintain the health records of all Israeli citizens, and their sharing of their own
databases with Israeli companies and multinationals working with Israeli partners has led to an
explosion of AI-based digital health-care technologies in the country. The Israeli government has
helped encourage partnerships and cooperation agreements with foreign businesses and research
institutes as well. The technology produced from such partnerships has the potential to be adopted
by the national health-care system.
Creating a similar system in the U.S. could be difficult, since most U.S. medical providers aren’t
digitally connected, or compatible, and must adhere to strict national privacy laws. In Israel, the four
government-run HMOs have kept digital records in compatible formats for all patients since the
early 1990s. The U.S. and several other countries are working to create similar national databases as
Israel, but the data isn’t likely to be of the same quality.
Under the rules of the Israeli initiative, parties accessing the data are barred from identifying patients
or otherwise causing them harm, government officials say. But some ethicists warn of the dangers of
unintended consequences.
Tehilla Shwartz Altshuler, a technology-policy specialist at the Israel Democracy Institute think tank in
Jerusalem, says Israel needs legislation that will clearly regulate when patient data can and cannot be
used. Health data should be used only to create technology that would clearly benefit the health of
Israeli citizens, Dr. Altshuler says, and should not be sold simply for profit. Moreover, people should
be informed every time their data may be used on a given project to allow them to opt in or out, she
says.
The HMOs and Israel’s government say the data is anonymized, meaning it removes any features
that could identify any patient. But that might not be enough to satisfy some critics of the project.
Dr. Altshuler points to a study published in Nature Communications in July that showed that 99.98%
of Americans could be re-identified from any anonymized data set using 15 demographic
characteristics, such as age, marital status and gender.
Health officials are working on legislation that would regulate access to the government and HMO
databases, says Itai Kela, head of health tech at the Israel Innovation Authority, a business-focused
government agency that is working on the database initiative with the prime minister’s office and the
Health Ministry.
“The world is global: On one hand you don’t want to sell the data outside; it’s private data for Israeli
citizens,” Dr. Kela says. “But on the other hand, you want to collaborate.”
Yael Villa, who is heading the work on the national database, known as the Mosaic Initiative, says she
wants to create not just a database with clean, easy-to-use data, but a virtual platform that will also
give researchers the analytical tools needed to run experiments quickly.
“The idea is to do the dirty work for them and have them invest their time in what they really need to
do,” she says.

3. Dr. Villa says that while it could take a few years to reach even 100,000 volunteers, what will
differentiate the Israeli national database from other such initiatives will be the combination of the
rare 20-year-deep clinical records combined with genomic data.
The work so far is moving slowly. Important issues that still need to be resolved include figuring out
how the HMOs will transfer their data to the government system, and exactly who will have access.
The breadth and quality of Israel’s trove of medical information are nearly unrivaled, experts say. The
HMOs have kept digital patient records from cradle to grave—primary and specialty care, lab work,
pharmaceutical prescriptions, hospital care and geographic data. The data is well organized, too.
Doctors across individual HMO systems use the same methods and formats for note taking, experts
say, which will make it easier to design software for working with the new databases—and, more
important, make it easier for AI systems to analyze the data and learn from it.
Lack of good data in compatible formats has been a major problem for companies trying to leverage
technological progress and increased computing power to achieve new breakthroughs in medical
science and health care.
Dr. Topol, of Scripps Research Translational Institute, says Israel’s data sets help it bypass “a
bottleneck for moving the field forward.”
Mining the Israeli data for new insights could provide a windfall for the country’s already-booming
health-care-tech industry. More than 500 Israeli-based startups work in digital health in Israel and
together have raised capital in excess of $500 million in 2018, according to Start-Up Nation Central, a
Tel Aviv nonprofit that connects businesses to Israel’s tech companies.
“As the world moves more and more in the direction [of big-data health care], Israel will be more and
more central,” says Scott Duke Kominers, an associate professor at Harvard Business School and co-
author of a study that examined the research arm of Israel’s second-largest HMO, Maccabi, and its
work with private companies to create technology using its database.
Israel has “an unusually strong competitive advantage because of the way the Israeli health-care
system works: It’s the combination of the data and the computer-science talent,” Mr. Kominers says.
Indeed, while the government databases are still years away from completion, Israeli companies
already have used the HMO databases to great effect.
One example is K Health, a mobile app launched in 2018 that helps users understand their ailments
by mimicking a conversation with a live doctor. The app, through a partnership with Maccabitech,
has access to millions of Israeli medical records, analyzing them in seconds. Users tell the app their
age, gender and what’s wrong. The app then takes less than a minute to compare the user with
thousands of similar cases.
In the U.S., users can pay to speak with doctors who work with K Health about the results. In Israel,
users will soon be able to order simple lab tests after consulting the app, bypassing the need to see a
family doctor first.

4. Allon Bloch, a K Health founder, says Maccabitech has access to more than 400 million doctors notes,
more than a billion lab exams and hundreds of millions of prescriptions, among other data. Mr. Bloch
says his company will continue to add data to the app from countries it operates in.
Anthem Inc., the U.S.-based insurance giant, announced a partnership in July with K Health to
eventually bring the app’s services to its 40 million clients. The app will let consumers, including
those who don’t have Anthem insurance, schedule and pay for medical visits through their
smartphones, as well as learn potential diagnoses and text with doctors.
In May, Israel’s Innovation Authority signed a memorandum with the Mayo Clinic for Israeli health
startups to team up with the U.S. institution’s researchers and equipment. There are currently five
Israeli companies working with the Mayo Clinic, and dozens more have applied for future work.
“We have been impressed by the level of expertise and how Israeli companies have been able to
leverage artificial-intelligence approaches developed in other areas and apply them to solve
problems in health care,” says Kelly Krajnik, director of strategic opportunities at the Mayo Clinic.
For example, researchers at the Mayo Clinic worked with the Israeli-based Beyond Verbal, a voice-
analytics company that uses Israeli health data, in a 2016 a study that found a correlation between
certain voice characteristics and heart disease. The study shows doctors can use a noninvasive
method of checking for heart disease just by analyzing a voice.
Another example is Zebra Medical Vision, an Israeli company that uses AI to search for and recognize
ailments in CT scans, X-rays and mammograms. The company received grants from Israel’s
government to deploy its technology throughout Israel’s hospitals and health clinics. It charges
customers roughly the equivalent of $1 a scan.
While health-care officials are pleased with the results they have seen so far in terms of delivering
new technologies, Israeli privacy advocates remain concerned about what they see as a national
experiment with sensitive information in medical records.
“This is one of the biggest hacks of privacy in Israel,” says Dr. Altshuler, the technology-policy
specialist. “We are going to be very sorry for this process in the near future.”
Varda Shalev, head of Maccabitech, says her HMO uses the highest standards of security. She says
the small risks to privacy are worth the benefit. “Putting it in balance,” Dr. Shalev says, “I think we are
doing the right thing.”