March/April 2009

JEWISH ENTERPRISE
An Israeli Prescription for American Health Care

One of the major grievances among critics of America’s health care system is that it has not adopted electronic medical records (EMRs). According to a study published in the New England Journal of Medicine last summer, fewer than 20 percent of American physicians record patient data digitally. When Americans go in for a check-up—or an operation—odds are good that they’re not the only ones filling out forms by hand.

EMR advocates argue that computerized medical records will reduce errors, decrease the likelihood of duplicate tests and, over time, drastically reduce health care costs. President Barack Obama’s recently passed stimulus plan designates $20 billion for EMRs and calls for the creation of an 18-member committee in the Department of Health and Human Services to plan EMR implementation. The bill “lays the groundwork to move health care in America forward in leaps and bounds,” says Representative Allyson Schwartz (D-PA), one of the foremost congressional activists for health care reform.

The U.S. has much to learn from Australia, Canada, the United Kingdom and its own Veterans Health Administration, which use EMRs. But one of the best models, according to physicians, government officials and IT experts, is Israel, which is years ahead of the U.S.

In 1991, the second largest of Israel’s four health funds, Maccabi, which insures about a quarter of the country’s seven million residents, computerized its records. The largest HMO, Clalit, followed suit two years later. Today, says Dr. Steven Simon, a professor at Harvard Medical School who spent last summer researching Israel’s experience with EMRs, “Every single physician in the country uses an electronic health record.” According to Dr. Shmuel Reis, chairman of the Department of Medical Education at the Technion—Israel’s Institute of Technology—“The plans just told their physician-employees to use EMRs. There was no backlash. It was perceived as necessary progress.”

It sounds simple, and for a compact, highly technology-oriented country with mandatory army service and universal health care like Israel, it was indeed relatively straightforward. For a large, sprawling country like the U.S. with a complicated health care system and a high premium on privacy, a slew of obstacles has thus far hindered the transition.

For most U.S. doctors—especially the 75 percent who work in offices with fewer than 10 physicians and have limited resources—switching from paper to paperless is prohibitively expensive: Estimates range from $25,000 to $40,000 per doctor. Unlike in Israel, where the government footed the bill, American physicians have generally been expected to cough up the funds themselves while insurers (and, ideally, patients) reap the benefits. The stimulus package helps address this by offering technology grants to inner-city and rural hospitals, as well as to small practices to help cover costs typically affordable only to large ones.

The vast size of the American health care system ensures that institutions generally use different EMR systems, making it impossible for doctors at one institution to share information with doctors at another. In the words of several Boston-based experts who recently wrote an open letter to President Obama warning against a mad dash to national EMRs, “If America’s physician practices suddenly rushed to install the systems of their choice, it would only dramatically intensify the Babel that already exists.” But if Israel’s experience is any example, that’s not exactly true. “Interoperability,” as the phenomenon has been termed, is perhaps Israel’s greatest health innovation.

“What’s unusual in Israel is that it has achieved widespread [EMR] adoption nationwide without having a national program,” says Harvard’s Simon. “Hospitals in Israel don’t all use the same electronic health records system.”

An Israeli company, DbMotion, founded in 2000, makes technology that deals with precisely this problem. “What we’ve done in Israel over the past decade is gradually grown the ability to share clinical information at the point of care,” says cofounder Assaf Halevy. In 2001, the company created a network for Clalit’s 14 hospitals, 1,300 clinics and nearly four million patients, allowing doctors to access patient data from unconnected facilities with different EMR systems. The company also has ongoing projects in Belgium, France and the U.K., and in 2006 launched an $84 million partnership with the University of Pittsburgh Medical Center, linking 20 hospitals—each with different EMR systems—more than 400 outpatient locations and nearly 2,500 physicians.

DbMotion can also provide interoperability for small health care providers through the web. That’s where George Blumenthal thinks the future of EMRs lies. His company, Park Avenue Medical Data Systems, has partnered with an Israeli company called eWAVE MD to offer web-based EMRs (think Gmail or YouTube) to create an alternative to existing server-based systems (think Outlook, Quicktime). Google and Microsoft, too, view the web as the way to expand EMRs. As opposed to physician-controlled EMRs, however, their products offer patients the ability to put their own data online in personal health records that can be shared with physicians at their discretion.

A web-based system, says Blumenthal, does not require software, training or updates and could be rapidly implemented. “Obama wants this in five years,” he says. “He could do it in three.” —Jeremy Gillick