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EHRs prove invaluable in Israel vaccine campaign

Israel is the world's gold standard on COVID-19 vaccine rollouts, and electronic health records were central to the effort. Here's how.

Israel has jabbed more than 60 percent of its population at least once with a COVID-19 vaccine since last December, putting it far ahead of most of the world.

The astonishing feat sprang from a perfect scenario: an ample supply of vaccine doses (and the willingness to pay premium prices); the flexibility to sweeten the Pfizer vaccine deal with a promise to quickly share Israelis' personal health data to gauge the vaccine's effectiveness; and a unique and highly organized healthcare system capable of delivering speedy inoculations to citizens nationwide. The last leg of that centered in large part on extreme efficiencies brought about through the innovative use of electronic health records (EHRs).

Healthcare in Israel

Residents in Israel must join one of four HMOs to obtain healthcare. The fees are collected through general taxation and subsidized. Residents can switch HMOs from year to year, but few do.

The EHRs used by the country's HMOs were finely honed differentiators in an intensely competitive race over many years to deliver the highest access and quality of care. Now, each of those customized EHR systems was primed to push out vaccines fast and in sync with the best possible patient experiences.

"It's really a unique structure," economist Moshe Bar Siman Tov, who oversaw Israel's coronavirus response last year, told The Wall Street Journal. "I'm not sure it's possible to duplicate it. It's a mixture of socialist fundamentals and entrepreneurial spirit."

While the performance of Israel's healthcare system has earned it many admirers and much can be learned from its progress, it's neither necessary nor possible to completely mimic it to add much-needed efficiencies and improvements in other parts of the world. What is required is a concerted and sustained focus on creative and competitive innovation in EHR deployments and a willingness to make changes in areas typically bogged down by legacy systems.

EHRs are ubiquitous in the U.S. too, but Israel has another advantage: All of the implementations provide a standard format for health data through facilities in the country's Ministry of Health. This means that the ministry has the technical capability to read the patient records of all the EHR implementations by the HMOs. This eliminates overhead and delays that plague the U.S. system.

The human value in the difference EHRs make

"Cloud-based EHRs offer a way to enable users with the latest innovation and functionality that can shape better experiences for clinicians and patients," says Mutaz O. Shegewi, research director of provider IT transformation strategies at IDC Health Insights. "It makes total sense to have cross-platform mobility; anytime, anywhere access; open APIs to integrate with the latest advances in developer communities or wider health IT ecosystems through increased interoperability and other means; or to be able to rapidly 'turn on' telehealth to adapt to an unforeseen pandemic."

Please read: Forrester Consulting says HPE GreenLake Radically Improves EHR Ecosystem Savings And Performance

Israel's unparalleled vaccine delivery effort has led to tangible and lifesaving results that are tracked daily on a dashboard by the Israel Ministry of Health (page is Hebrew only; Google Chrome does a usable translation). But there are other, broader implications in leveraging EHRs, such as data collection, which is critical to any public health initiative.

The patient data Israel shared to gauge vaccine effectiveness has benefitted people around the world as well as its own citizens. Pfizer and the Israeli Ministry of Health were able to correlate vaccine outcomes with detailed (but anonymized) patient histories. While other countries still approve the use of the COVID-19 vaccines according to their own laws and regulations, the data Israel shared sped those efforts along.

In countries where resources to research and procure vaccines are limited, health organizations can confidently distribute vaccines donated by countries like Israel and the U.S. because vaccine data was accrued and analyzed in those countries and elsewhere.

To date, Israel has donated 100,000 surplus Moderna doses to 20 countries and Sinai peacekeepers. The U.S. announced it is sending millions of doses of the AstraZeneca vaccine to Mexico and Canada. Many countries, including the U.S., donate vaccines to other countries by adding money to the universal pot in the COVID-19 Vaccines Global Access (COVAX) effort, which has raised US$6.3 billion and counting, according to a report in Science Magazine.

Donor countries benefit from the vaccine donations because worldwide inoculations diminish disease spread and the rise of more dangerous variants. After all, a contagious virus has no regard for borders or victims' nationalities.

EHR impact on big pharma

While COVID-19 vaccines had to clear regulatory hurdles in many different countries, climbing infection and death rates worldwide drove the need to hurry those processes along. Israel's willingness to be a countrywide and observational real-world trial providing patient data on vaccine effectiveness and potential dangers proved a saving grace for much of humanity.

Please read: Cloud to the rescue: EHR as a service drives future of healthcare

The data from the Israel patient study verified the results of an earlier randomized, controlled trial, according to a report recently published in The New England Journal of Medicine.

"Although randomized clinical trials are considered the 'gold standard' for evaluating intervention effects, they have notable limitations of sample size and subgroup analysis, restrictive inclusion criteria, and a highly controlled setting that may not be replicated in a mass vaccine rollout," wrote the researchers in that report.

The vaccine and patient data collected from EHRs in Israel rapidly overcame this substantial shortcoming and significantly reduced uncertainty as to the safety of the vaccine. The use of EHRs was critical, as these systems are designed to collect, store, and even share patient data in a digital fashion, making them superior to traditional pharma trial data collection methods in the midst of a worldwide crisis. It's highly likely that big pharma will leverage the lessons learned in this approach in future drug or vaccine trials.

"We leveraged the integrated data repositories of Israel's largest healthcare organization to evaluate COVID-19 vaccine effectiveness for five outcomes: documented SARS-CoV-2 infection, symptomatic COVID-19, hospitalization, severe illness, and death. Using this observational data set, we evaluated the effectiveness over time and in subpopulations defined by age, sex, and coexisting conditions," wrote the researchers in the report.

EHR impact on healthcare organizations

Whether a healthcare organization—be it a doctor's office, clinic, or hospital, or a big pharmaceutical company—is based in socialism or capitalism, or a blend like Israel, it must be able to thrive before it can achieve its healthcare mission.

For a healthcare organization to be sustainable, it must be fiscally sound, properly supplied, exceptionally efficient, well informed, and agile enough to respond to challenges as they occur. These are some of the drivers behind continued and growing investments in EHRs despite previous heavy investments in earlier EHR versions and internal legacy systems.

Please read: How the edge is reshaping healthcare

According to IDC's Shegewi, the EU is trending upwards in EHR investments with 50 percent of European healthcare organizations planning a heavy spend in new systems or upgrades, and healthcare providers doing so at a slightly higher rate (55 percent) than hospitals (48 percent). In the U.S., Shegewi says that "despite market saturation and investments made, U.S. hospitals are still replacing and making additional investments in EHRs."

Of those new investments, most of those expenditures are now moving to managed EHRs, either hosted on premises or in the cloud, to relieve pressures on budgets and IT staff, as well as to increase interoperability and scalability. "EHR ranked first for cloud workloads [in healthcare IT initiatives], reflecting perceived benefits of a move to the cloud for clinical documentation," says Shegewi.

Harnessing new efficiencies is now a top driver but with a new twist: Improving the patient experience runs high on the list, alongside operational efficiencies, which makes sense because the two often affect each other.

The four HMOs in Israel built many of their competitive differentiators from their EHR capabilities, and they'll continue to do so. This makes Israel a top real-world, observable study in EHR performance potentials and techniques.

Should they continue to succeed at the rate of success they have already achieved, scalability will become a bigger issue, as it will for healthcare organizations in other parts of the world. Many will find managed EHRs a ready answer for scaling problems in existing EHR systems.

The future of medicine, like the future of most industries, rests on the ability to gather, analyze, and act upon data rapidly. But the stakes are undeniably higher in healthcare, where millions of human lives are in the balance. EHRs put the odds more solidly in humanity's favor.

Oded Shihor, strategist and worldwide healthcare industry lead, GreenLake portfolio management, at Hewlett Packard Enterprise, contributed to this article.

Lessons for leaders

  • One of the great potential and underutilized benefits of EHRs is their use in research.
  • The value of EHRs multiples when interoperability between them is established.
  • The Israeli vaccine success demonstrates the value of a well-crafted database.

This article/content was written by the individual writer identified and does not necessarily reflect the view of Hewlett Packard Enterprise Company.