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Innovation in Israel - IoT

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Connected to the Medicine of Tomorrow

The IoT is generating revolutionary changes in the world of healthcare. Innovative applications and smart devices that process and analyze data are redefining primary care delivery and making healthcare less expensive and more accessible and efficient.

Do you recognize the following scenario? It's 8 pm and your child is coughing and suffering from a high fever. You have no choice but to prepare for yet another nighttime visit to the nearest urgent care facility. In the best-case scenario, the visit will end after many long hours of waiting in line. Now imagine that you have the option to open a drawer and pull out a digital device to contact your pediatrician online and perform a complete examination on your child – including throat, lungs, ears and more – without leaving the house or needing any medical training.

Thanks to Tyto Care, an Israeli telehealth company, this is possible. Aspiring to redefine the way primary care is administered, Tyto Care developed a solution that can measure the body's vital signs and virtually transmit the results directly to a doctor. Tyto Care has replicated the physical interaction between a patient and doctor with a digital encounter, without sacrificing any examination quality or precision.  

The telehealth solution, called TytoHome, is a smart, compact device, half the size of a smartphone. The device enables doctors to make a virtual diagnosis of the throat, ears and lungs, as well as skin, heart and digestive problems, all via exam data that until now was only attainable during a face-to-face meeting with the doctor. Advanced self-guidance technology enables patients to easily use the solution to successfully and accurately capture exam data and share it with their physician for a diagnosis. 

TytoHome consists of a handheld device with a camera adapted for skin and throat examinations, a basal thermometer, a sophisticated digital stethoscope for examining the heart, lungs, stomach and heartbeat, and a digital otoscope for examining the ears. The handheld examination tool and telehealth platform enable patients to remotely capture and share high-quality exam data with a doctor in real time as a live video telehealth visit or in advance of a telehealth session (‘exam and forward’).

The founding partners of Tyto Care are Dedi Gilad and Ofer Tzadik. The company's chairman is Dr. Eli Ofer, the former Chief Scientist. Gilad, the company’s CEO, has extensive experience in the high-tech and business industries. 

“The company was born five and a half years ago out of a personal need of mine,” explains Gilad, CEO of Tyto Care. “My daughter had just started attending kindergarten and the entire family experienced the typical nightmare of the first year of acclimation, which meant lots of colds and ear infections and visits to the doctor’s office to check her throat, ears and lungs. As a professional in the industry, the amount of time sitting in a doctor’s office waiting room where everyone coughs and sneezes on each other – spreading germs and viruses – really bothered me. I recognized the need for physical examinations that could be performed digitally at home. That's how the product was born."

"Since then, we have raised a significant sum of nearly USD 50 million from strategic investors active in the world of healthcare. The company was supported at two stages by the Innovation Authority, among others, for developing analytics – including the identification of clinical elements in the data – which have not yet been released to the market."

"Healthcare is marching towards telemedicine," says Ami Appelbaum, Chairman of the Innovation Authority and the Chief Scientist at the Ministry of Economy and Industry. "The Authority supports a range of high-tech and electronics companies working in this area that are considered leaders in their field. These companies develop technologies that are already implemented in remote examination and treatment, such as robots in operating theaters, digital medical records, etc."

"The world of telemedicine –clinical healthcare provided digitally and remotely – has grown rapidly in recent years, and the market is expected to reach USD 30 billion within the coming year. The telemedicine industry is mostly based in the United States, but it is also growing in Eastern Europe and spreading to the rest of the world," says Gilad.

"We discovered that one of the fields that has seen the least technological innovation is that of the family doctor or pediatrician's basic examination: the encounter during which the doctor physically exams a patient using a thermometer or stethoscope to assess the patient's medical condition. These interactions constitute the lion's share of medical consultations, but it is this area specifically that has been neglected as far as technological progress is concerned."

"The reasons that video-based digital doctor's consultations are not yet perceived as a full replacement for physical visits to the doctor stem from two main limitations. The first is the personal dimension - a virtual examination can sometimes make it more difficult for a patient to develop trust in the doctor. The second reason is more practical: these interactions have yet to generate reliable and effective clinical information." 

"Our solution provides a response to these limitations and solves the significant issues of availability, convenience and accessibility. Each virtual telehealth visit with the doctor conducted via Tyto Care’s platform includes two important changes that enhance both the treatment experience and its effectiveness: a device that facilitates a basic family doctor's or pediatrician's examination including receiving precise information on the patient's medical condition. The qualitative tests are not merely numbers on a scale – the second solution uses machine learning algorithms to understand the results. The examination includes the patient's feedback on the entire visit and a recording of the exam, which is transferred to the doctor. If the doctor identifies a medical issue that needs further examination by a specialist, he or she will refer the patient to the necessary professional."

Tyto Care's system received FDA clearance at the end of 2016 and the company began marketing in the US the following year. The device also recently received approval and was launched in Canada. 

"Tyto Care is definitely generating international interest and we are noticing a high level of demand and growth in sales," Gilad says. " Although we are focusing our efforts in the US, we are looking to expand to other markets this year as well. We are working with some of the largest players in the healthcare industry who are integrating Tyto Care into their telemedicine platforms with large telemedicine companies, insurance companies, and with the country's largest employers. In Israel, we have partnered with Clalit Health Services that has done a large-scale launch of Tyto as part of the health services they offer."

One Billion Doctor-Patient Meetings a Year

The telehealth solution developed by Tyto Care enables patients to avoid travelling to the doctor for primary care examinations, thereby avoiding the risk of exposure to germs. Tyto also removes the barrier of transportation for patients living in rural communities with limited transportation options, outlying areas, or those with physical mobility challenges. Because of Tyto Care’s success in rural communities, there has been wide-spread interest from several of the major players in the healthcare field in Africa and the Far East.

"Each user's information is stored individually at the highest possible level of data confidentiality and encryption. We conform to all of the North American and European standards of medical data confidentiality. The device communicates directly with the cloud and transmits real-time data to the doctor through a secured connection. When the physician opens the patient's medical file, he receives a link to the examination performed online and can see the patient’s medical data, video images and pictures."

"I believe that Tyto Care will dramatically transform the way basic medical care is delivered, putting health back into the hands of the consumer by changing the traditional doctor-patient interaction. Approximately four billion face-to-face doctor-patient meetings take place every year in the Western world with all of the associated burdens and costs. In the Third World, these numbers are even larger. Our vision is to convert a significant amount of these meetings to digital when appropriate, thereby granting more accessibility to basic primary care. Telehealth can enable this experience anywhere, anytime – from isolated locations far from any health clinic, or during long winter months that prevent people from leaving their homes. 

"Another advantage of Tyto is the vast amount of medical data it accumulates, one of the product’s unique features. This allows us to receive insights from the tens of thousands of examinations conducted, which are inputted daily. In the future we will also be capable of prediction, which will enable us to issue health warnings and learn about the connection between different phenomena, such as regional developments of seasonal diseases. The overall picture Tyto Care is able to accumulate is much larger than that of independent doctors who examine patients for only a few minutes, and who lack access to big-data."

"Our first goal as a telemedicine company is to create a digital healthcare solution that is available in the average home," summarized Gilad. "The second step is to utilize data to draw conclusions, issue warnings, and enable diagnostics, both at the level of the end-user and of healthcare systems. And we are quickly heading in this direction."

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Your Private Doctor

Datos was also born following a medical incident that sparked an entrepreneur's imagination. Uri Bettesh, the company's co-founder and CEO, is an industrial engineer who, among other things, has worked in the study of implementation and models of optimization in industrial engineering, and in development of products with sales of hundreds of millions of dollars.

During the period in which he hankered to do something new, he experienced a tragedy that became a life-altering event – his father-in-law, who was a diagnosed cardiac patient, was forced to suddenly and urgently undergo open-heart surgery. Bettesh attempted to understand the suddenness of the development after his father-in-law had been chronically unwell for years – in other words, why it hadn't been possible to monitor him and detect a worsening in his condition before it became so acute and thereby avoid the urgent surgery, or at least been possible to predict it. This led to the idea for founding Datos – a company that manages medical data created by the patients (Patient-Generated Health Data, or PGHD).

"I realized that the problem lay not with the technology for understanding blood pressure levels, heartbeat or the accumulation of fluid and other data because that already existed in a range of devices but rather, at the stage of analyzing the vast amounts of accumulated data. It became apparent that reliable ongoing data – therapeutic continuum – is very important in saving lives and improving clinical indices, but that nobody wanted to assume responsibility for the flow of data without it being managed in a smart and efficient manner."

"The platform developed by Datos can do exactly that: it manages all the data received from every patient and enables the smart transfer of reliable information in a cost-efficient manner. Unlike other servers which require monitoring, the Datos platform directly and continuously monitors data using an independent and automatic system which transmits information to health organizations, without the need for operating call-centers. In other words, the platform knows how to receive data from the various smart devices used for examining the physical signs, how to process it into clear conclusions and how to send these directly to the patient's doctor."  

"The system includes a personally-tailored mobile application that is intended for the patient and that communicates with him via a chatbot, a system for processing and analyzing data, and a system for the doctors themselves that enables them to manage their patients: to view information on them, to see whether they are taking their medication, and how the medication is affecting their medical condition."

"Our system receives the data on the patients' indices from personal medical devices, most of which are wearables (see the article on "Paying Full Attention to the Body") and allow the patient to perform an examination in his own home without the presence of a medical professional. Our system enables the use of any data measured by the smart devices – from blood pressure to oxygen, sugar levels, heartbeat etc. Most companies active in the market of these devices focus on transferring the raw data to health organizations. Today we understand that the doctors and health organizations cannot contend with all this data and we are therefore paving the way in the field of data management and the filtering of non-critical data."

"IoT technology enables supervision of medical data that is both much cheaper and more convenient. It is important however to understand that there is still a difference today between passive and active monitoring: active measurement is when a person operates a blood pressure device. Passive measuring is when he wears a watch that performs the monitoring itself. With time, it will be possible over the next few years to passively monitor increasingly more medical indices."

Datos supports the 'Bring Your Own Device' approach – i.e., it works with a range of different types of devices made by different manufacturers, so that both the health organization and the patient can choose the device they want to use. This support is complicated but allows us to make it easier for the patients to acquire their preferred device."

"Increasingly more data is accumulated as the devices develop however the data is raw and cannot be transferred as is. In order to transfer it in a manner that will maximize its possible use, there must be an option for managing the data and for finding the best way to translate it to a clinical level for the medical team – and that is what we do. The system operates in real-time and I can therefore provide the patient with immediate feedback while simultaneously making the data available to the medical team to access whenever their organizational work processes allow. The platform supports a range of medical situations and also allows us to place the patient in the center both as a person and as an active partner in his treatment's success. The option of facilitating measurements and diagnoses without physically meeting the doctor significantly overcomes disparities between the center of the country and the periphery and makes healthcare more readily available, even in isolated areas."


Hey – Have You Taken Your Medication Today?

"Our system doesn’t make do with the passive transfer of data, but rather enables us to enlist the patient himself to the process of contending with his disease. Using the Datos platform, a doctor can prescribe the patient a personally-tailored monitoring program, a process which is today parallel to the issuing of a prescription for lab tests or medication. From this point onwards, the system will guide the patient in managing the tests, treatments and medication that he needs".

"Let's take, for example, a person who comes to the doctor with a heart problem, diabetes, high blood pressure or even an oncological problem. The doctor decides to prescribe him a program of monitoring blood pressure and Type 3 diabetes. The health fund's computerized health system in which he is registered will now enable him to use its specially designated application. The application's chatbot contacts the patient and instructs him during the day. For example, the application informs him when it's time to measure his blood pressure. The patient is asked to connect the blood pressure device to the system and the results are recorded in his medical file. The system also warns him if certain values are too high for that time of the day and will check whether he took his medication as required or instruct him to rest and rerun the test. If the measurement is high and the patient said that he forgot to take his medication that morning, the system will tag the measurement as 'without medication', thereby enabling a better understanding of the data gathered."

"That is the blood pressure scenario, but the system also operates in many other situations. All the data received undergoes corroboration and verification processes just like a lab test and we can therefore provide the doctor with a therapeutic continuum and a complete situation report on the patient. Everyone knows that doctors don't have much time to devote to each patient, so introducing the system into existing work processes allows close and precise treatment even without the need for human supervision."

"Even the most dedicated doctor only sees the patient during visits. By contrast, the situation report received with the Datos system is continuous. This enables not only a far more optimal management of the disease but also a financial saving. The tests we have conducted show that by using the system, blood pressure and diabetes patients return to a balanced state in half the time of treatment administered without the system!"  

"A further project that demonstrates our system's efficacy, and which is being undertaken in conjunction with Tel Hashomer Hospital, relates to the cardiac rehabilitation process. Currently, a patient undergoing surgery or catheterization, for example, needs to subsequently undergo a process known as cardiac rehabilitation. The process includes requiring the patient to travel to Tel Hashomer twice a week in order to monitor his heartbeat while performing cardiac rehabilitation exercise. These visits require a not insignificant effort on the part of the patient and his family, especially if he doesn't live near the hospital. It's no wonder then that only 30% of the patients who need cardiac rehabilitation actually start the process, and that another 50% drop out after 2-3 months."

"As part of the trial, we checked what happens when a patient arrives for cardiac rehabilitation and is given a program for rehabilitation from home that is conducted with our system. In this case, the patient only travels once to Tel Hashomer where he undergoes a stress test. According to the results, he is prescribed a personal program, receives a smart watch and is released to go home. From that moment on, the system monitors and manages him throughout each stage of the rehabilitation process. We have been running this program now for six months – and only one patient had dropped out so far. We have succeeded in proving that the patients exercise more than they did previously and therefore achieve better clinical results. The Ministry of Health has consequently decided to allow the health funds to pay for cardiac rehabilitation from a distance according to our format."

The Transition to Personal and Home Healthcare

"The way it stands today, healthcare needs to undergo a change in order to adjust itself to the era we live in", Bettesh describes. "Some people are clearly indicating that the current situation is simply unsustainable. The increase in the number of elderly people and the amount of chronic diseases are good examples of this. The inability to treat patients at overcrowded hospitals and the need for community healthcare are also obvious. Datos is providing a good solution to some of the difficulties involved in the transition to home healthcare and is providing a therapeutic continuum that is vital to correct care of the patient. In general, Israel is considered a pioneer in these fields and Datos is allowing for the introduction of healthcare into the home, in contrast to previous paradigms, automatically and at a lower cost."

"The discourse today is of personally-tailored healthcare and we have an excellent solution for this. Aside from individual medical characteristics, personally-tailored healthcare also considers biological, environmental and behavioral differences between people and between men and women. The knowledge accumulated in our system enables us, among others, prediction capabilities and preventative medicine,  a better matching of treatment naturally enabling patients better health, and an enhanced and longer quality of life."

"Datos is working on a range of fascinating projects with leading research entities from Israel and abroad, including health funds and hospitals. The work with these research institutes constitutes a further important level in progress towards personally-tailored healthcare. In the context of personal treatment, some are talking about genetic data, but it does not all end there. Today, people are also talking in the same breath about behavioral information and microbiome data – and only an integration of all these tools will truly enable personally-tailored healthcare. Knowledge on the quality of treatment for a specific disease is also significant. The updated medical index of healthcare quality is not if the operation succeeded but rather, if the person succeeded in returning to a healthy lifestyle – side effects and if he is free of pain, and how his lifestyle is influenced by the medical procedures he underwent."

"One of the upcoming studies will measure exactly that among breast cancer patients. We will focus on the question of how the treatment and side effects are expressed in the patients' lifestyle in order to provide a basis for personally-tailored healthcare. In the past, a study like this was complicated to conduct but today, using our system, it can be done very cheaply while combining questionnaires with smartwatches that check the correlation between side effects and the level of activity."

"The aim of the study is to supply patients with personal information on the viability of different treatments for the same disease, by analyzing the results of similar patients. Think of Amazon's recommendation of products that interested buyers like you – the system enables the same personalization in medicine, thereby creating personally-tailored healthcare accessible to everyone."

"The field of medicine is extremely advanced in Israel, both medically and technologically, partly due to the advanced computer systems in Israeli healthcare. Israel's medical indices are all substantially better than those in the US for example – from expenditure per capita to waiting periods, birth and fatality rates."

"In Israel, once I show that I provide better healthcare than that which already exists – I'm in. And I save costs. The Israeli health system is typified by its openness to startups and new technology. In the United States on the other hand, when I turn to a medical organization, regardless of its size, the first thing it thinks of is how to receive money from the insurance companies and so approaching the market and presenting value to the health organizations require completely different strategies."

"Both marketing and work processes take a long time in the healthcare field, so a lot of patience is needed in order to keep going during the development stage before the first revenues are generated. We have been in existence for 3.5 years and have been supported by the Innovation Authority from the outset. They helped us keep our head above water during the critical period. Today, we already have sales of about half a million dollars, but we wouldn’t have succeeded in reaching this stage without the Innovation Authority's assistance."

My vision is to allow patients an integral user experience, not just through a mobile application but also via the many channels that will surround us as the IoT continues to advance, including virtual assistants and smart motor vehicles. We will have to learn how to create an experience which will, on the one hand, be personal and know how to preserve our privacy and on the other, will enable us all better and more advanced healthcare, all subject to the limitations of the sector."

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