Healthcare transformation has long been a driving force at Sheba Medical Center, the largest healthcare facility in the Middle East, ranked by Newsweek as one of the world’s best hospitals for the past five years in a row. Located in Ramat Gan, Israel, Sheba invests heavily in healthcare R&D and new technologies, mainly at its ARC (accelerate, redesign, collaborate) Innovation Center. Both the Covid pandemic and the war with Hamas presented Sheba with new challenges, but also served as catalysts for accelerated innovation.
“We knew that innovation would need to be central to winning the war against the pandemic so we went into what we called the ARC Covid-19 battle mode. In battle, Israelis know how to come together,” says Dr. Eyal Zimlichman, Chief Transformation Officer and Chief Innovation Officer at Sheba Medical Center. “The current war has presented us with a new crisis and as we’ve found out with Covid, it’s also an opportunity for us to move faster, to solve problems that otherwise would have taken us much longer to solve.”
One of the main challenges Sheba had to tackle both with Covid and the current war is the sudden and urgent need to increase the hospital’s capacity in intensive care and other departments, coupled with a severe manpower shortage. This has meant developing and implementing—vey quickly—new tools for augmenting and supporting the hospital’s staff. With 1,952 soldiers (as of December 23) injured in battles with Hamas in Gaza and civilians wounded by Hamas and Hizballah’s ongoing rocket attacks, rehabilitation has become a focal point for rapid innovation.
Sheba expanded its rehabilitation hospital and invited health tech startups to submit rehabilitation-related solutions. Close to 90 companies applied and eight were selected to pitch their solutions to a panel of Sheba clinicians—”doctors, nurses, physiotherapists, occupational therapists, those who can judge which technology would provide the most benefits,” says Dr. Zimlichman. Two startups, Cognishine and Kemtai, were selected to begin a pilot program.
Digitizing traditional therapeutic processes, Cognishine offers a wide range of activities based on real-world scenarios to help patients regain cognitive, speech and social-emotional capabilities. It extends the work of rehabilitation therapists so they can work with a larger number of patients.
Kemtai is an AI exercise platform, providing real-time feedback and corrective guidance during exercise, enabling patients to improve their performance and accelerate their recovery. Using an smart phone’s camera, its motion tracking computer vision system also extends the reach of therapists by observing how patients perform exercises, providing them feedback and guidance, and communicate the performance data back to the therapist so it can be integrated with the patient’s electronic medical record.
The solutions offered by Cognishine and Kemtai further extend the reach of therapists by facilitating the continuation of the rehabilitation process at home, once the patient is discharged from the hospital. Beyond rehabilitation, however, Sheba—and other Israeli hospitals—must keep redesigning their processes and practices to answer the specific healthcare challenges brought on by war experiences and terror attacks.
One such challenge is post-traumatic stress disorder or PTSD. “The focus right now is more on the triage. How can we identify patients with PTSD and direct them to the proper therapy?” says Dr. Zimlichman. Those suffering from trauma include not only soldiers but also civilians and even hospital staff treating patients with horrible injuries in the emergency department.
Right now, Sheba is relying on structured questionnaires, validated in past studies, to distinguish between minor, medium, and severe PTSD cases. There are not enough therapists for minor cases, so they are treated with a digital solution such as Cognishine. The more severe cases are assigned to psychologists and psychiatrists. Sheba is developing an AI-based tool to assist with “these large-scale triage situations,” says Dr. Zimlichman, potentially in the form of conversational AI.
Another challenge is maintaining and updating patient records during mass casualty events. Sheba has been a paperless, digital hospital since 2004, and a mass casualty event is the only situation where every patient that comes into the emergency department gets a piece of paper with which the nurses and doctors register everything that they do. “When on October 7th, we saw the large number of patients that have come in, I said to my team, this is it, this is the last piece of paper, ever,” says Dr. Zimlichman. “In just a few days, we built a digital chart to replace that piece of paper,” a chart that is connected to the hospital’s electronic medical records system.
In addition, when the nurses pointed out they need both hands free and cannot go around holding a tablet, Dr. Zimlichman’s team ran a student competition in one of Israel’s design schools to come up with a mechanism that would attach the tablet to the nurse. Now, the nurses register everything in real-time on a device that is attached to their torso and is connected to the electronic medical records system. “To do this in normal times would have taken us months, if not more,” says Dr. Zimlichman. “But in times of crisis, everybody understands how this is critical for our success, and how much we need to put everything else aside. This is exactly the battle mode that drove us to success during Covid and that worked for us again in the current crisis.”
In mass casualty events, there is also a problem of communications, of finding and talking to the right hospital’s staff member amid the chaos. In development at Sheba is a voice-activated system that registers which staff member is at what location at the hospital. It would facilitate a hands-free conversation between a staff member at the intensive care unit or the emergency department and whoever they need to talk to, finding them not by name, but by function and expertise (e.g., “the doctor in charge of X”), wherever they are at the hospital.
“This is already active and working in our I. C. U. and the next stage of development is to turn this into a small wearable device,” says Dr. Zimlichman. Eventually, hospital’s staff will be able to use this communications platform to query the electronic medical records systems.
The ARC Innovation Center was founded at Sheba by Dr. Zimlichman a few years ago with the goal of redesigning healthcare and establishing a unique process of innovation. It serves as an incubator to heath tech startups and, working with venture capital firm TriVentures, it provides early-stage funding to these startups. In addition to supporting 20 to 30 startups each year, ARC also releases internally developed technology.
The ARC model directly addresses what has plagued the successful transformation of the healthcare sector, the gap between published research on new technology-driven treatments, practices, and solutions and their implementation in real-world hospital settings. In his introduction to the just-published inaugural issue of New England Journal of Medicine AI, editor-in-chief Isaac Kohane notes that by 2020, “clinical evaluations of AI and machine learning had transformed from mere topics into a burgeoning field, that year alone boasting over 300 articles appraising these technologies.” But “for a given AI tool to be used, evidence that it will perform in a safe and effective manner must be demonstrated,” Kohane maintains.
Incubating innovation within a hospital is a sure way to bridge the gap between research and implementation, between innovative ideas and impactful results. “Hospitals are the best breeding grounds for innovation because they have everything in one place. They understand the needs the best, it’s our pain points. They have the capacity to test the technology. The patients are here. The doctors are here. The data is here,” says Dr. Zimlichman. And ARC makes sure the startups and the funding are also there.
The ”C” in ARC, stands for collaboration, global collaboration. “In times of crisis, we push forward on cutting edge innovation that would serve us in normal times. Not only here in Israel, but around the world,” says Dr. Zimilichman.
For example, at the annual ARC Summit earlier this year, Sheba’s ARC and Deloitte Consulting LLP announced a global partnership with the goal of enabling the widespread implementation of the ARC model in healthcare innovation centers worldwide. ARC’s global ecosystem now includes more than 140 members in almost 30 countries. It aspires to have a substantial impact on what healthcare worldwide will look like.
Says Dr. Zimlichman: “There are so many barriers to development in health care. Innovation always takes last place. The main challenge to making hospitals be the breeding grounds of innovation is to change the culture of the clinicians and the cultures within hospitals. To drive that culture change, which we’ve been successful in doing in Israel, we now work globally with our partners.”