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Medical Innovation Global Powerhouse Rises in the Middle East

The highlight of my first visit to the global behemoth health IT conference called HIMSS is a fascinating and substantive interview with Cardiologist and Professor Robert Klempfner, MD and Evan Nierman from Sheba Medical Center of Tel HaShomer, Ramat Gan, Israel.  As someone with deep interest in the nation of Israel, this was a very important interview for me, as I learned how the Startup Nation is emerging as a global powerhouse in medical innovation through the Sheba Medical Center, which is the largest and most advanced medical center in all of the Middle East.  Newsweek magazine placed Sheba as among the top 10 hospitals in the world in its “Best Hospitals in the World” issue that came out March 2019.  Sheba’s bold vision is not just of the usual medical campus, but of an entire city, a literal city, equipped with all of the most advanced technologies that a genius nation has to offer, carefully designed to welcome and serve patients from all over the Middle East and the world.

Dr. Robert Klempfner, who is also the Chief Science Officer of the Arc Innovation Center of Sheba (ARC), talks about various pilot projects that are being incubated and supported by ARC, such as a new wearable that was developed in house at Sheba that’s designed to do remote monitoring and management of  cardiology patients, with results that show a true disruptive win-win for patient and provider alike.  Evan Nierman talks about about the ethos of Sheba, which is all about the patient, decidedly inclusive and rich with empathy.  There are so many surprising elements to Sheba that does not appear to exist in providers or hospitals systems I’ve observed in the USA.  I feel this interview merely touches the tip of the iceberg on what we can learn from such a unique and bold visionary venture such as Sheba.   With this piece, I alert innovators worldwide to the opportunities presented by the Professor and Mr. Nierman.   You will be delighted to note that Sheba is open to partnerships and collaborations from well, anywhere.  Below is part 1 of the 40 minute interview I conducted at the last HIMSS global conference in Orlando, Florida.

 

INTERVIEW WITH PROFESSOR ROBERT KLEMPFNER AND EVAN NIERMAN  

OF SHEBA MEDICAL CENTER, TEL HASHOMER, RAMAT GAN, ISRAEL, PART I

 

 

Victoria Ferro:

Gentlemen, please introduce yourselves and talk about:  What is Sheba Medical Center?

 

Professor Robert Klempfner:

I’m Klempfner, Robert.  I’m a cardiologist by training and I’m a practicing cardiologist with Sheba.  Sheba Medical Center is the largest hospital in the Middle East. It’s a tertiary care center that operates both acute care, rehabilitation, a research facility, cardiac and non-cardiac hotels.  It has a very wide array of specialties, all medicines. Everything that’s been done in Israel we have a department there doing it, cutting edge research, innovative technologies, robotics, virtual reality programs, the works.  And ARC (The Arc Innovation Center) behind me is the innovation center that was created in order to bring all this together.

 

The very structure grid, be it number of floors will be with innovation from within plus we’re giving out grants for innovation for our physicians, nurses and other (clinicians).  We have great collaboration with startups. The second level of the ARC is connecting these startups which we facilitate and integrate into our everyday practice.

We help them to test their ideas, we help them to navigate all the regulations.  We have a very successful pilot by finding the right champion, matching the pilot and the champion together, and searching for the optimal department [with which they can collaborate], helping them to design a protocol, how to create a sample size, how to calculate the necessary specific power statistics.  Call it P to P.  It’s from protocol to publication of the successful research pilot.

 

Evan Nierman:

And if I could just interject for a moment, I’m Evan Nierman, I’m part of the PR and Communications team of Sheba.  It’s hard for us as Americans to wrap our head around what Sheba is. It is a veritable City of Health. So imagine if you were to take the National Institutes of Health (NIH),  Cedars-Sinai, St. Jude’s, Cleveland Clinic, Mayo Clinic, Brigham, all of the top hospitals and health care providers in the United States, then put them all in one campus, then you get a sense of what Sheba is.

Over the course of a single year, you have one in five Israelis treated at Sheba in one form or another.  And the part that I think really makes Sheba special: Yes, everything that Robert said is 100% true. The fact that the clinicians also do research.  The cutting edge aspect. The fact that it’s a hub of innovation. Part of what makes Sheba such a special place is the degree of compassionate care that patients receive from the physicians.  Sheba treats not only Israelis. Sheba treats people in need wherever they are from. It treats some of the most challenging difficult cases, the Palestinians at the nearby Gaza Strip and the Palestinian Territories, Syrian refugees.  Sheba actually, because it feels that its mission is to really be a light unto the nation and part of the underlying ethos of the state of Israel is in order to make the world a better place. Sheba does that by sending its doctors out all the world over in order to provide medicine without borders to those who need it most.  It’s a unique place in so many different ways. But it’s the compassionate care that physicians like Robert and his colleagues provide day in and day out that’s just truly unparalleled.

 

Victoria:

That’s incredible!  So let me ask, going back to the Professor, you’re talking about innovation.  Do you only work with entrepreneurs who are from Israel or do you work with other entrepreneurs from other places in the world?   

 

The Professor:

Definitely.  If there is an entrepreneur anywhere that can facilitate the way we do medicine, if we can improve outcomes, if we can be better than we are today, we will embrace him, and we are currently also doing research, collaborative research, with the United States, with Canada and we definitely are open for any good idea in the field of medicine, clinical research, into biology.  Definitely we are not going to say no to any idea that’s good.  

 

Victoria:

Now I’m going to go back to you Evan.  My question has to do with compassionate care.  You say it’s really what sets the Sheba Medical Center apart.  Can you elaborate on how it’s different? Like what makes it really special.  Give an example of what that looks like.  

 

Evan:

I’ll give you a couple of examples.  It’s something that I’ve seen first hand. I’ve had the opportunity to go to Sheba numerous times to be there and see it myself.  There’s not a day, a week that passes at Sheba where you don’t see someone celebrating a wedding or a Bar Mitzvah. So you’ve got patients who in some cases are very ill, especially children’s cancer.  Week in week out, every day there’s a miracle happening at Sheba.

A child who’s so sick and says “Well, how am I going be able to have my Bar-mitzvah.  Am I going to be able to have it? Guess what? Sheba brings the Bar Mitzvah there. The Bar-Mitzvah that happens at the bedside, family comes together.  I’ll give you another concrete example

The last time I was in Israel I had the opportunity to introduce someone, a little boy to visitors and supporters of Sheba to view his movie.   He’s a boy who was born in the Palestinian Territories. He was brought to Israel very very sick, close to death. Israel, Sheba, which is the national hospital of the State of Israel, saved his life.   The doctors prevented him from dying and his mother stayed there. Sheba provided a place. It’s also very hard for Palestinians to get back … (to return, in this case to Gaza)

So his mother was actually staying at Sheba, in an apartment, on the campus.  Eventually though she decided she wasn’t going to be able to stay with him. She went to return to be with her  other kids. She left Muhi there at Sheba by himself. The doctors and the nurses continued to care for him. They were not going to put him out on the street.  They were not going to send him home. They knew that he needed the right kind of care that they can provide. And so he’s been living at Sheba basically his entire life.  His grandfather decided he was going to give up his life and come live with him. So you’ll see his grandfather, now has a job at Sheba. He works at Sheba. To him and Muhi, Sheba is not just the place that saved Muhi’ life.  It is their home. So he’s out going to school. He’s … unfortunately he’s had to have all of his limbs; not one, not two. All of his limbs have been removed. He’s in a wheelchair. He enjoys the best care that you can find anywhere in the world.  Sheba is his home. That doesn’t happen in every hospital in America. In fact, I would venture to guess. It doesn’t happen in any. It’s a different kind of mentality and approach that really speaks to compassionate care that Sheba embodies. I think that’s really unique.  

Prof. Raz Somech, Director of the Pediatric Immunology Unit and General Pediatrics A, the Edmond and Lily Safra Children’s Hospital, the Palestinian boy Muhi and his grandfather, AbuNaim

 

Victoria:

I have never heard of anything like that, and I’ve been scouring medical systems around the world, well at least here in America and so I really appreciate that.  Especially you are catering to a Palestinian family. So the grandfather is also Palestinian?   

 

Evan:

Yes he is.  

 

Victoria:

I would love to get photographs of them if you have them.  

Again: Prof. Raz Somech, Director of the Pediatric Immunology Unit and General Pediatrics A, the Edmond and Lily Safra Children’s Hospital, the Palestinian boy Muhi and his grandfather, AbuNaim

 

Evan:

We can get you some photos and videos.  The amazing thing is you know Muhi when he was a young boy, he grew up not actually speaking Arabic.  He’s grown up speaking Hebrew. He knows a good bit of English and Russian. The nurses who were taking care of him were speaking to him in Russian.

 

[Note:  To find out more about MUHI and the documentary on his story, go here.]

The other thing I’ll just say.  If you want to see a microcosm of the best that Israel has to offer,  you want to talk about race or great diversity? Walk through the halls of Sheba.  You’ll see doctors who are native born Israelis. You’ll see people on staff in headscarves who are Muslim.  You’ll find Christians. You’ll find people of every color, working together at Sheba and (that’s beautiful)

 

Evan to the Professor:

Give us some examples of where the people are from that you work with everyday.  

 

The Professor:

From all over. We have all the five religions, I think.  We have Christians. We have the Arabs. We have the Jews. We have Hindu nurses. So we have everything.  Whatever. The important thing is taking the money out of the equation. Without having to think about reimbursement…  The CEO and senior management really understand that. Yes it’s important that we have a budget. We are a government hospital.  We have to work with money. We’re not focused around it. We are able to save you or manage it, we’re not going to charge you. It’s okay …most cases, so it’s something that’s quite unique.  It’s not wise to analyze everything to what’s the exact value, moneywise.  We believe that innovation is great if you touch humanity. Patient interaction is armed with keyboard and screen, 60% of the time of our encounter, they are not looking at the patients… they’re not … so we’re doing this wide search.

How can we bring as much of humanity, compassion using technology?  We believe in it! We know it! Technology can be alienating like robots.  Ah you’re going to be managed by systems, No! We believe in the fact that…They are for example augmented intelligence, … dictation where we just pull for the physician to be smarter, make better decisions, they have more time to spend with patients

So things we are developing from the very young physicians coming to Sheba for the purpose of … We teach them to think about innovation how it can benefit the patient.

Think about … for example kids, think about we can help a sick child in the school, using virtual reality, that’s why we invent stuff like that.

 

Victoria:

So are you saying that you have a medical school within Sheba?  

 

The Professor:

We are part of Tel-Aviv University.  

 

Victoria:

Oh you are? Oh and you are teaching your medical students to be innovators from the very beginning.

 

The Professor:

Yes.  

 

Victoria:

That’s incredible.  

 

The Professor:

I teach second and third year.  It’s a state of mind you know, that’s one of the advantages because Startup Nation is in the ground already.  There are quite bright kids who are in medicine, it’s not easy to get in… We give them examples. We show them that it’s doable.  We show them that if its unique, its beneficial… we cause them to use some of our resources and we collaborate with them in order to help them innovate.

 

Victoria:

I’m guessing it’s probably going to be a lot more fun for them as well to do their work, their studies because they’re doing this.  Learning things like Design Thinking, like testing with the customer what’s best for the patients, like the way to design applications.  Would someone like my mother enroll in a program that was designed for a high tech 35 year old manager? So it’s something that you can learn.  Right. Ok. Come pretty early to the hospital and see the innovations, see the doctor engineers engaged in basic research for their education in Sheba, in different areas, including patient engagement.  

 

Victoria:

Sounds like you’re very way ahead of the curve. So I wonder can you give some examples, Professor, of some innovations that you’re working on, that you’re very excited about.  

 

The Professor:

Right, so one of the examples would be we’ve taken out some of the care from the hospital into the community.  In the past patients, if you need cardiac rehabilitation after a heart attack or surgery, you have to come to Sheba twice 3x a year, which is quite complicated, especially if you’re a sicker patient.  There’s a paradox here. For the (United) States, as well as Canada, only 20% of eligible patients in the US actually receive cardiac rehabilitation or is reimbursed. One, the access, its far (hard), it’s intrusive.  One can go on a daily routine, but now you suddenly say, you need to come to Sheba twice a week for 6 months for three months. That’s very difficult so we created a program. We co-partnered with a company. This company created with us a software application.  Smartphones that connects to various wearables including the Apple Watch, that connects the blood pressure monitor devices, glucometers. It brings all the data and securely runs the patient’s application through the patient’s smartphone, Android or iPhone. It has a command and control center that can see the exact amount of exercise you you’ve done today.  What type of exercise you’ve done. What blood glucose, and what heart rate throughout the exercise. You can remotely give instructions, education by secure messaging. What I was once doing face to face, I’m doing remotely with a patient, whether she is in Jerusalem or in South Africa for that matter.  

OLYMPUS DIGITAL CAMERA

 

Victoria:

That’s wonderful!  So it’s like really passive data?  Like you’re collecting all of this passive data from these various sensors?  I mean the patient doesn’t even have to fill out forms or anything like that?

The Professor:

I have some very specific questionnaires but they are minimal.  Most of the data is – heart rate, glucose, saturation, weight are measured by sensors.  

 

Victoria:

That’s amazing.

 

The Professor:

What patients want.  They don’t want an automatic —.  They don’t want a computer system —.  They want to be treated as human by humans.  So we’re treating them as human that is augmented by these technologies, so with these technologies,  I can better manage you.  Because I really understand what’s going on. I also get patient reported outcomes, depression questionnaires so it depends on the scenario…  

 

Victoria:

Are you doing mental health mitigation as well?  

 

Professor:

We are having consultations with … medicine.  And another interesting thing we’re doing, we have a program for profiling patients — so they’re filling up questionnaires. We use very sophisticated machine learning algorithms in order to profile the type of personality in order how to better engage them. 

 

Victoria:

That’s amazing. Do you plot this information into an AI? So that the language is different depending on who you’re talking to?

 

The Professor:

It’s another company called Wellbe. Wellbe company creates something like a ruler with icons, and it suggests the way to optimally talk to you, so for example, if you’re a person that needs more encouragement, more information, it will give you that. If you need more support and if you want to do, this will give more explanation of how better to exercise and diet using the support group compared to another person which is alone, perhaps wants to do it alone.  Right. Releasing more individualized, one on one consulting. There are now tools, that guys here are using to sell socks. Right? The Amazons, tools of the world. We want to take these tools to help heal, not to sell books.  

 

Victoria:

Are you doing anything in voice tech by any chance related to AI and talking to your patients?  

 

The Professor:

We are and one of the companies we’re working with is Beyond Verbal.  We’ve just published a paper and presented it to an American Cardiology conference which show that we can predict coronary heart disease through voice patterns.    We’re now working in heart failure to predict _ heart failure through the voice. If your pattern changes, then I have a red flag comes up. Then that becomes part of the human digitome. You have all the data that comes up, blood pressure etc… Then you add the voice.   We have microbiome in certain programs. We have Genome Information … We believe that if we have a good understanding we can be much more focused. This is the essence of personalized medicine.

 

Victoria:

Right.  And Professor, I think that definitely the way that you’re talking, you are way ahead of a lot of places.  So congratulations on that! 

[Watch out for Part 2 of this interview, next on TheUnpatient.com.]


TheUnpatient.com would like to thank the Society for Participatory Medicine for the travel grant to the HIMSS 2019 global conference in Orlando, Florida.  Special mention to Lodestar.care, EDSAFE-T and VitalOpsConsulting.

 

 

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