Last week at the Microsoft Connected Health Conference in Chicago, I had an opportunity to sit down with Dr. Yossi Bahagon, Head of the e-Health Wing, Clalit Health Services in Israel. I’m sure some of my American colleagues tire of my HealthBlog diatribes on how far behind we are in America compared to many other parts of the developed world in providing a robust set of e-Health services to our citizens. My meeting with Dr. Bahagon was yet another confirmation of this.
Clalit Health Services (CHS) is the largest Health Maintenance Organization in Israel and second largest worldwide. Through its 14 hospitals and more than 1300 primary and specialized clinics, CHS provides comprehensive medical care to the majority of Israel’s population of about 3.9 million patients. The CHS e-Health wing focuses on deepening patient involvement in managing health through personalized, digital, interactive tools. Currently, CHS e-Health wing provides e-Health services for 1.25 million unique patients monthly. Clalit’s electronic and mobile health services include 3 core components; a personal health record, a personal health knowledge portal, and a personal health services layer.
The personal health record presents patients with their medical history including diagnoses, laboratory results with interpretations in layman's terms, allergies, vaccinations, medications, straightforward explanations regarding medication dosing instructions, important side effects about contraindications, and more. The personal health knowledge portal presents patients with personally tailored recommendations for preventative medicine and health promotion. For example, patients with diabetes are push-notified regarding their yearly eye exam. The various health recommendations include: occult blood testing, mammography, lipid profile etc. Each recommendation contains textual, visual and interactive content components in order to promote engagement and motivate the patient to actually change his health behavior.
But it is the third layer of Clalit’s e-Health and m-Health services that really caught my attention. The personal health services layer enables patients to schedule clinic visits, order prescription renewals, set text messaging medication reminders, and hold virtual consultations with Clalit clinicians.
Since December 2009, during closed clinic hours,Clalit’s personal health portal enables secured pediatric medical consultations via video conferencing. Currently 11,900 digital medical encounters are performed each month. The e-medical encounter includes e-prescription and e-referral capabilities which are biometrically signed by the physician. In order to expand online care usage, CHS has developed a unique online-care kit. It includes a HD web-cam hidden inside Clalit’s logo mascot known as Sweeti. The kit also includes a silicon digital thermometer. Dr. Yossi told me that Clalit provides the kit to new parents at a discounted price of about $8.
Since launching, there have been hundreds of cases in which online care consultations have dramatically influenced disease natural history and treatment. Dr. Yossi relayed one such example. On February 2nd, a worried mother logged in to the CHS online care portal with her 12 year old son who suffered from high fever and a strange rash. After taking the child's medical history, it turned out that a week earlier he had returned from an annual school camp. After examining the rash through the web cam, the consulting pediatrician suspected the child suffered from Mediterranean Spotted Fever,also known as Boutonneuse fever – a disease caused by a Rickettsia infection. In fact, the physician asked the mother to call other parents of her child’s classmates and ask them whether anyone else had similar symptoms. Apparently, several parents reported their child was indeed suffering from similar symptoms, but they thought "it is just a simple virus infection that would be self limited within a couple of days". Dr. Yossi says that following a confirmatory diagnosis, antibiotic treatment was initiated in all classmates who were suffering from the disease.
Isn’t this the kind of access to medical information and services we would all like to have? Yes, I know there are American examples with organizations such as Group Health Cooperative, Kaiser, Geisinger and a few others. But when will the rest of medicine transform itself to provide e-Health services that even come close to those offered by Clalit? If you want to know why we need payment reforms in American medicine and a transition to the Accountable Care Organization model recommended as part of healthcare reform, you need look no further than Clalit for an answer.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft