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Israel On Quest For Digital Health Domination

Executive Summary

Israel has set its sights on becoming a global leader in digital health, boosted by the government's new five-year plan to invest nearly $300m to drive innovation in this space.

Israel is on a mission. The self-dubbed "Start-Up Nation" has proclaimed its ambition to become the world's leading digital health innovator and with the launch of a new national initiative, it looks like it could be on its way.

In March, Israel's government unveiled a digital health plan focused on turning this sector into a major economic growth engine for the country and placing Israel right at the forefront of medtech innovation.

According to a Transparency Market Research (TMR) report, the field of digital health is projected to reach $536.6bn by 2025, as the global population ages and health care demands accelerate quickly. 

Israel is hoping to capture 10% of this global market potential in the coming years. Indeed, it is predicted that digital health will have a greater impact on Israel's economy than the cyber security sector in which the country has become an industry leader, producing global giants such as Checkpoint.

"We are doing something of historic significance. We are developing the industries of tomorrow," Israel's Prime Minister Benjamin Netanyahu said in an official statement. "[There is potential] to reach a ILS600bn ($171bn) market and, if we succeed, as we did in cyber security and the vehicle industries, we can expect a significant increase in new products."

The five-year plan, which is a coordinated effort by the Prime Minister's Office and the ministries of Finance, Health, Social Equality, Economy, and Science and Technology, will have a budget of approximately ILS1bn ($280m) and invest in several elements including technological development, academic and industrial efforts and regulatory changes to encourage data research.

A number of factors suggest Israel is already on the right track to reach its digital health goals. The country has a unique, competitive advantage in developing digital health solutions due to the majority of patient medical data being already being digitized and there being clinical data on more than 98 percent of the population, giving researchers access to a wealth of information.

Israel also has a well-established culture of hi-tech innovation and entrepreneurship, which is financially backed by the government. Israel 's Innovation Authority, an independent public body, leads the country's innovation policy and is also involved in the plan alongside the Council for Higher Education.

MiXiii Biomed

MiXiii Biomed is Israel’s leading international life science conference and exhibition, taking place on May 15-17 at the David InterContinental Hotel in Tel Aviv. Both MobileODT and K Health will be presenting this year, alongside a host of other Israeli life science companies. The conference is the largest gathering for health-care professionals from Israel to meet with international colleagues and partners. It offers a unique opportunity for global participants to learn about the latest innovations and technologies of Israel’s biomedical industry. In addition to a digital-health track, the conference this year will also look at trends in ophthalmology, oncology, brain health, personalized diagnostics and therapeutics, and nanomedicine, among others.

Ora Dar, from the Israel Innovation Authority and co-chair of Israel’s MIXiii Biomed conference, told Medtech Insight the government's plan aims to boost investment in digital health innovation. "We want to reduce budget constraints that limit the capability to invest in innovation by academia, industry and health organizations. It will also give incentives to industry and health organizations to found start-ups."

A big component of the plan will be establishing the "Mosaic" project, a clinical genomic database which will account for approximately third of the funding. The initiative is aimed at sequencing 100,000 Israeli volunteers for R&D purposes to advance health. The volunteers will contribute clinical and genomic information, as well as additional kinds of information regarding their health.

"All the population will benefit from the R&D outcomes," said Dar. "We can also benefit from the ethnic variability of Israel. The project will be unique to Israel but can also align with other global efforts in this space. We believe that the wider research community will be interested in it too."

But in its quest to become the world's digital health leader, Israel will need to further educate the next generation of researchers and innovators. At present the country has a shortage of computer engineers and data scientists - something it is keen to change. "There are barriers and hurdles that need to be addressed," explained Dar. "This plan will also focus on expanding and training data scientists and advancing higher education in big-data and data science."

The initiative will also update regulation to enable researchers in academia and industry to access clinical data for R&D. " We want the data held by health organizations to be open for research so we are evaluating new regulation to address this issue. We are also introducing incentives for both researchers and health organizations to collaborate and make the data more available."

But despite Israel's big digital health ambitions, the path to success will not be an easy one. Digital health companies across the world are facing ever growing privacy concerns around data threats, cost pressures and a market marred by reimbursement difficulties.

"There's a lot of activity in digital health and the growth is amazing but the field does have its challenges," said Dar. "The business models are not always clear yet.  Thus, we also need to help those start-ups doing pilot experiments within health organizations to develop an understanding of the market’s needs. For increasing the access to health organization globally, we plan to establish new collaborative agreements and accessibility for pilots in health care organizations in US, Europe and maybe also China."

Ora Dar from the Israel Innovation Authority

ORA DAR, ISRAEL INNOVATION AUTHORITY & CO-CHAIR OF Israel’s MIXiii Biomed conference

OurCrowd Qure – Israel's Dedicated Digital Health Fund

Among the leaders in the investment drive in Israel's digital health innovation is OurCrowd Qure, a newly established venture fund focused exclusively on investing in the digital health space.

The fund typically invests in early stage start-ups and Series A rounds and has already poured cash into companies such as Zebra Medical, Tytocare, Dario Health, Kolgene and CyberMDX.

"We behave like a traditional venture capital fund but with the ability to utilize the OurCrowd equity crowdfunding platform for additional investment in our portfolio companies." Allen Kamer, OurCrowd's managing partner told Medtech Insight. Since its inception in 2016, the fund has attracted a wide range of investors and focuses primarily on Israel-based companies.

"We have five main areas of investment we're targeting," explained Kamer. "Artificial intelligence, big data, genomics, cyber security in health care and personalized medicine. We are currently looking at companies using AI in which the company applies a series of algorithms to improve drug discovery probability. We're also looking at companies that are using AI/algorithms to really help improve the health of people who have suffered severe neurological disorders."

Kamer describes the fund as "hands on" and says it aims to actively assist companies in their development.  "We've put together a global network of partners to really help in a number of ways. Amongst our partners are John Hopkins University and Discovery Healthcare, which is the largest insurance company in South Africa. We are able to get their input on potential investment opportunities and understand what their priorities are. This helps us in having a shopping list to find companies that have cutting edge technologies that meet actual market needs."

OurCrowd Qure partners with organizations like John Hopkins University and Discovery Healthcare, South Africa's largest insurance company, who help the VC create "a shopping list to find companies that have cutting edge technologies that meet actual market needs," according to Allen Kamer, managing partner at OurCrowd Qure.

However, one of the main challenges still facing digital health start-ups is finding an idea that not only solves a problem but is also a money maker says Kamer. "When we are looking to invest, we always look for companies that follow the money. We ask them - tell me how your solution is going to solve a problem that has costs attached to it? If you solve a problem but no one is going to pay for it, then it might be a great idea but not a great business.

"When you're selling to hospitals or medical providers one of the most important things to demonstrate is how it will affect workflow. You can have the best technology but if it doesn't fit workflow and how people actually work and function then you're going to run into challenges. Good technology is not enough, management matters and how you prioritize your technology to solve problems practically."

A US presence is also essential for digital health companies aiming to crack the lucrative US market. "If you want the US to be your main market, then you have to have people there. Each state essentially operates with its own local market conditions and knowing the nuances and understanding it in depth is the key to success," said Kamer.

And although start-ups are facing the threat of being nudged out by big companies entering the space, Kamer believes there is still plenty of room for them. "It would be foolish to dismiss these big companies like Google and Amazon health care aspirations but they're not always quick at being able to adapt to the market."

This year, Kamer will co-chair the digital health track at the MiXiii Biomed conference which will explore trends and innovation taking place in the digital health sector. "The types of companies we are seeing in the digital health space in Israel are very exciting. The quality of companies is high and there's tremendous opportunity to leverage technology from other industries and make Israel's digital health space a real success."

"Israel is a great ecosystem for digital health care and has the ingredients and the seeds like cyber security had 20 years ago. One of the advantages Israel will offer is really great solutions at very reasonable prices for early investors."

Allen Kamer

Allen Kamer, managing partner, OurCrowd Qure

Below, Medtech Insight highlights three promising companies emerging from Israel's digital health space:

Treato – The 'TripAdvisor For Health Care'

Treato, a health care analytics company says it has developed the "consumer voice of health care."

The company's web based platform uses a host of different technologies such as AI and machine learning to identify, aggregate and analyze user-generated content describing health care experiences from across the social health web. The platform generates "patient voice" insights to help drive health-related decisions for patients and providers. Information on the database spans a wide variety of diseases, treatments, procedures, and symptoms.

"We basically bring the consumer health care experience across all health care domains over time and in real time across every decision point," Treato CEO, Ido Hadari told Medtech Insight.  The CEO believes the platform is the single largest data set of consumer health care experiences in the world.

"Today we have 3.5 billion user experiences in our dataset and that grows by about a million experiences a day and covers everything and anything in health care. We basically brought into this world a completely new data asset that didn't exist…we built the TripAdvisor for health care."

Ido Hadari, CEO of a company called Treato.

IDO HADARI, CEO of treato

The company hopes the system will shift the power paradigm in health care from physicians to consumers. "When we looked at health care there was nothing that was consumer-centric. Five years ago, no one cared about consumers in health care, the entire system was 100% focused on the physician. Today there is a massive change in the consumerism of health care and its gradually becoming more focused on consumers – the patients."

It's this human experience that Treato believes is the missing piece from the health care jigsaw puzzle. "We are tapping into the wisdom of the crowd for everything that we do today," said Hadari.  "At Treato we realized there's always been a big missing pillar in health care which is now becoming a critical piece - the human element. Looking at the health care data value chain we see clinical data and financial data but there's always been something missing between the doctor's office and patient outcomes – there's a massive gap in the human experience."

"The power structure in health care is shifting from the smart guys in white robes to all of us and that has created a massive gap of information and engagement with the consumers basically catching the health care system massively unprepared."

"We want to become the number one source or the trusted partner and consumer voice for health care whether its manufacturers, providers or payors or consumers themselves. Everybody needs to understand the human experience in health care and understand the journey. I think that every health care company that wants to be successful going forward is going to have to apply the consumer voice in an area of functions across its business. The next big acceleration of that is going to be driven by giants like Amazon and Apple which are bringing in consumer standards never seen before in health care."

With data and tech giants such as Amazon and Apple entering the health care arena, Hadari says the health care industry is about to witness a major shakeup and he believes Treato is uniquely positioned for.  The company recently launched a messaging service TreatoNow, which he describes as a 'WhatsApp for health care communication.' The app, which is available to download free on iOs and Android connect patients so they can build communities to discuss treatment options and plans.

It already has a few thousand users and is rising each day. "There is so much knowledge and so much information sitting with patients that have experienced treatments and procedures and that is one of the most untapped wisdom resources in health care and we want to solve that problem so we give people access to people like them with information for people them," said Hadari. "The advantage of Treato is when we aggregate millions of experiences within a certain domain, the marginal opinions can be pushed aside and the majority can be heard."

Treato's business model focuses on licencing the database to life sciences and pharma companies to help them gain a patient-centric view of therapeutic areas and treatment. "There's an appetite growing both in the clinical side of pharma to serve the clinical side better. Our technology can help companies design better clinical trials with patient centric endpoints and basically get better products out there that meet unmet patient needs," said Hadari.

Half of the top global 50 pharma companies currently subscribe to Treato and Hadari says the company is beginning to partner with insurance companies who are looking to understand how to better understand high risk diseases and adjust their standards of care to real world practices.

"I like to joke that if you want to know what pharma thinks, go to WebMD, but if you want to know what people like you have done in your shoes, then come to Treato."

Treato Now

TreatoNow, a new anonymous health chat app for patients to connect and discuss medical conditions

K Health – The AI Personal Health Assistant

Allon Bloch, founder and CEO of health app, K Health told Medtech Insight he also wanted to create a product that could give users personalized information about their health based on similar experiences of other people.

"We thought wouldn't it be magical if before or after you went to the doctor you could magically compare yourself to hundreds of thousands of people with symptoms like yours and discover how they were treated. People want to be able to access that information and there was no good information source built directly to address this."

Using AI and machine learning techniques, the app's algorithm is based on 15 years of real anonymized health data, including medical notes from millions of doctor visits.  It's completely anonymous and users are only required to input their age and gender before answering a series of questions so K can learn about the user's health. The app is then designed to understand connections between symptoms, diagnoses, tests, and treatments people experience and turn these learnings into a medical ontology that can be used to talk to users anywhere in the world.

"K follows up to keep learning about how your symptoms are evolving over time. As long as K has experience with the condition and has the symptoms in her ontology, she can point you to personalized information about the diagnoses and treatments that doctors recommended to people like you," explained Bloch.

To date, the company has raised $12m from a series of venture investors to help roll out the app worldwide for both patients and doctors. "Essentially we've built an app which is helpful for both consumers and doctors," said Bloch. "The most interesting thing for me was I went to build a product for consumers and realized doctors don't have this information," said Bloch. "Fundamentally after a year and a half of looking into this field, I realized medicine hasn’t changed much in 50 years and doctors do not have databases that are sophisticated that can really learn from the information they already had."

K is currently available in Israel and the US but Bloch says the app does not aim to replace a trip to the doctors. "We are not a diagnostics platform, we are still a young product and our goal is not to have a product that is clinically regulated, our goal is to give consumers something much more powerful so if they choose to go to their health care provider they have information and choice."

MobileODT  - Mobile-Based Cervical Cancer Diagnostics

Founded in 2012, Israeli firm MobileODT uses smartphones to provide screening and diagnostics for cervical cancer. The company's EVA (Enhanced Visual Assessment) System is a portable, FDA-cleared mobile colposcope and visual assessment tool that works with Android phones to enable remote image capture and patient information tracking. 

The device is connected to a cloud-based software platform that enables immediate remote expert consultations and integrates with a range of electronic health records programs. If a scan detects any abnormalities, the patient can then be referred for a biopsy and treatment.

 EVA system device b radius smoothing

MOBILE ODT'S EVA SYSTEM, A MOBILE COLPOSCOPE AND VISUAL ASSESSMENT TOOL

This year, the company is set to release an algorithm that is able to detect cervical cancer through an image with an accuracy above 90%. "This is significantly more powerful than the PAP smear which means we'll be able to enable women worldwide to no longer have the scrape and wait," Ariel Beery, Mobile ODT's co-founder and CEO told Medtech Insight.

"The 'scrape and wait' is a huge challenge for women's health and we'll be able to do away with that with an algorithm that can run on our device and in less than a second can image the cervix and immediately tell a woman that she is at risk of cervical cancer or not."

MobileODT’s EVA System was initially rolled out for cervical cancer screening but is now also being used by Sexual Assault Nurse Examiners (SANEs) in the US for forensic documentation after a sexual or domestic assault. The system allows SANEs to take images and collect patient information that can be used as evidence in court.

"The EVA System is relatively cheap, small, easy to transport, and makes use of the ubiquitous smartphone. It can also be readily connected to the cloud so it facilitates the collection of biomedical images and other data for diagnostic, analytical, and other purposes," said Beery.

The company hopes its technology will expand and simplify cervical cancer screening services worldwide and improve access in developing countries where a lack of infrastructure and financial barriers can prevent treatment occurring.

"Mobile phone generations are constantly expanding and getting better on an annual basis and we can make that improvement available to clinicians cost effectively. It used to be that you pay $25,000 and you have a big system in the hospital which you didn’t change for 15 years but the tech got worse and less compatible with electronic systems and less user friendly. Then you also have to pay extra for maintenance," he added.

"With our mobile unit you pay significantly less and you have access to our software for three years. We put out a new version every year so it gets better and you can upgrade easily unlike you can with a traditional unit. This is all built on the back of a mobile - mobiles phones are incredibly smart – there's no reason why augmented reality can't be used to save lives."

From the editors of Clinica

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