Currently, many healthcare providers are challenged by a dynamic and quickly evolving technology environment, especially in areas such as digitalization, AI-driven diagnostics or new genomics-based therapies. Moreover, there is a growing push from the patient side, as more and more people who need to undergo hospital treatment are no longer willing to surrender themselves to the typical “hospital machinery” without being informed and involved in their treatment plans.
It is not the case that hospital managers are not aware of these changes. Many of them are struggling with implementing and managing the new dynamics in their traditional provider organizations. Creating entities, structures and processes which are able to embrace innovation for the benefit of the organization and for patients and medical staff, often remains to be their major defiance.
The innovation issue is less about technology, but much more about the question “How do we want to be treated as hospital patients in the future and how does medical staff want to work in a future hospital environment?”
An excellent example for how this has been addressed and accomplished is the Digital Innovation Center at the Sheba Medical Center in Tel Hashomer, Israel.
We interviewed Nathalie Bloch who is heading the Innovation Center. Nathalie will shed some light onto how they managed to become a hub for digital health innovation and how they are knitting knew technology and services into hospital care.
The interview was conducted by Rainer Herzog.
RH: Nathalie, can you please explain to us how it all started: what were the reasons and drivers behind building an innovation hub at a medical center?
NB: About 3 years ago, Sheba Medical Center was able to engage a new CEO. At that time, the hospital already was the largest one in the Middle East with about 2000 beds and with long-standing success stories of innovation in the pharma and medical devices worlds. So the question was how Sheba would be able to not only secure its current position, but to further expand its role as one of the leading drivers of digital healthcare innovation. It was against this dynamic background the new CEO put forward the idea of building an innovation center. Both, the new CEO, as well as the Deputy Manager for medicine and innovation, strongly supported emerging solutions and services based on digital health, big data and artificial intelligence. They believed that Sheba would only remain a cynosure for world class healthcare if the organization embarks on this journey. Actually, they recruited me back to Israel after 17 years abroad for that mission.
RH: There must have been some investments made available in the beginning. Can you tell us who invested to get it going? Who are the stakeholders and who is funding it today?
NB: Yes, of course – we needed funds in the very beginning to get going. The ministry of health decided to rent space within our center for their innovation activities and they paid rent in advance 10 years. The other initial fund came from donors. Later, during our first year of operation, we were able to get more donations and grants. We were also able to collaborate with startups who were funded for this kind of pilots by the Israeli Innovation Authority. Our budget started small with only two to three employees and now we are 19 people and conduct close to 60 projects which many of them are funded in one way or another.
RH: How did doctors and medical staff embrace the work and support you started to offer? Was there a lot of convincing work to do and how did you get people behind it?
NB: For us it was crucial to go out to all the medical departments right from the start and introduce ourselves and our work. It was really like a road-show in the beginning. And it is something that we continued to do. So even today, we regularly meet with the medical teams in the hospital to collect their ideas, needs and exchange the latest projects and results. I regard this activity not only as community-building but also as an opportunity to be part of educating the next generation of physicians on innovation. It is for sure an important part of our work.
In addition, we put out a yearly call for grants worth USD 50,000 for supporting innovation projects. Any department of the hospital can apply for the grant, provided they address an innovative approach to solve a particular issue and helps to improve care and treatment.
RH: Talking about innovation, what is your innovation focus at the moment? Which are the solutions and services you are targeting and how?
NB: Currently, our focus is clearly on everything which is connected with big data and artificial intelligence. Sheba Medical Center is a paperless hospital since 2004. Since everything is collected and stored electronically, you can imagine that by now, we possess an incredible amount of health-, treatment- and patient-related data. The large data pool that we accumulated over time is a fantastic basis for AI-based technology.
In this context, we will also continue to look for applications and solutions that are directly targeting patients and that are able to collect respective patient data inside and outside of the hospital to supply us with objective data that will serve as the basis for machine-learning models.
RH: Can you please tell us something about how you identify suitable solution and service partners and how you work and cooperate with innovative firms and start-ups?
NB: Well, currently, we are in a situation in which we don’t have to actively search for start-ups ourselves, it is rather the case, that they approach us. We actually receive more applications than we can accommodate. In most cases, we provide the proof-of-concept to our partner’s technology. We aim to bring their innovative technology into medical practice at the hospital and at our outpatient clinics.
To achieve this, we are designing pilot trials in cooperation with the medical departments and are overseeing their implementation. In case a pilot trial is successful and meets the goals set out in the beginning and we find the technology valuable to the hospital, part of our agreement with the startups is that they grant the hospital a free-of-charge usage of their solution for free for the first 2-3 years.
This allows us to build a growing arsenal of cutting-edge technologies to be used by our clinicians and for the benefit of our patients.
Besides the use of technology, the startups pay for the pilot’s cost and we ask for small percentage of royalties for products we developed together. By the way: we are not only cooperating with small companies or start-ups, but to an increasing extent also with large corporations coming from areas such as pharma, medtech or diagnostics.
RH: Are you also financially investing yourself in start-ups?
NB: Yes, we only started to do so. Under the leadership of our Deputy Manager, we recently established a new VC fund with a well-known Israeli-American digital health fund to create the Triventure-ARC fund. The innovation center selects and presents investment candidates to members of the VC-committee which then takes respective investment decisions.
RH: Having a portfolio of innovative solutions is surely the first step. But can you explain how you go on an integrate them into clinical practice?
NB: As you can imagine, integrating is not easy. But as our clinicians are very involved in the trials themselves, they are usually eager to implement as much as we are, and this is a strong driving force. If they are the initiators of the idea that we help to develop, it is obvious that they want to see it implemented. And if they are the principal investigator for a proof-of-concept type of project for a startup’s technology, they see the advantage of that technology in direct use and want to continue to work with it.
A big challenge is regulation, but before we start any POC, we work closely with our regulations committee (IRB) to get its approval for a project right from the beginning. Working closely with the IRB also surfaces any regulatory issues which we solve before we even start the pilot.
The main challenge though in implementing is the hospital IT system. We work very closely with the IT team and one of their staff is always tightly involved in our work: he or she meets with my team regularly and is part of our startup committee. IT staff always has a say when and if we accept a startup (even for just a POC), to make sure the burden on the IT system is not too big.
RH: I have to admit this almost sounds like perfect world to me. So let me ask you, what would you say are the most important preconditions for your success with everything you do at the innovation center?
NB: There is still a long way to go, but I agree that for the short time we have been operating, we were able to accomplish some impressive results. Definitely the most important success factor is the support of the senior management. Our CEO and deputy manager for medicine and innovation, who in the meanwhile is building a broader strategy for innovation at Sheba, are very supportive and drive a very robust innovation agenda.
Equally important is what we call the community building. This means that you need to go out to the medical staff in the hospital and involve them right from the beginning to ensure their buy-in. It also helped us quite a lot to open up to industry and make it possible for them to pilot their technologies – hopefully in return for some royalties one day which of course will contribute to support our continued work and efforts.
Finally, I believe that success in this context also boils down to culture: I think that Israelis traditionally have an innovation-oriented approach and an attitude of curiosity. I guess that this also helped us very much to succeed.
RH: To finish off, let’s attempt to look into the crystal ball: what do you think, how will a hospital in 5-8 years differ from what it looks like today?
NB: I think that AI will play a much more important role in daily medical practice inside hospitals. We will have enough data available to embark on such things as predictive modelling and risk stratification in many disease areas. This will substantially improve medical outcomes. Medical staff will have these tools to support decision-making and as a result can spend more time to take care of patients in the true sense of the meaning.
Our internal wards might not necessarily become smaller as the aging population fraction in society is getting bigger, but it will contain mostly very acute patients. In this context, we will see an important shift to homecare. With the development of advanced digital platforms, many patients can be safely kept and monitored in their home environments.
RH: Thank you very much Nathalie for this interview and the valuable insights you shared with us.