Transforming Healthcare Through Innovation

The whole world watched in awe as Israel became the first country to vaccinate most of its citizens against Covid-19 back in the early days of 2021. And decision makers globally waited with bated breath for the results of the first real-world study on the effectiveness of the Pfizer vaccine. When the results were published in the New England Journal of Medicine on February 24, 2021, confirming the vaccine’s effectiveness, the article was front page news all over the world and, along with a subsequent Clalit paper on vaccine safety, was ranked by Altmetrics in the top 100 most shared scientific publications of all times, out of over 18 million papers.

Prof. Ran Balicer, Chief Innovation Officer for Clalit and Head of its Research Institute, explains the backdrop of this unprecedented impact on the scientific world. “Our research was innovative because of its methodology, the data used, and the ability to provide such data analysis in near real time,” he points out. “We were uniquely positioned to use observational data to emulate a clinical trial by daily matching of hundreds of thousands of vaccinated individuals with an equal number of ‘identical epidemiological twins’ who were not vaccinated. For example, a 56-year old vaccinated man who lives in a specific neighborhood and has three pre-existing conditions was matched every single day with one of his neighbors of the same age and identical health history who was not vaccinated. It’s the first time anything like this was done.”

Clalit’s computers worked around the clock for five days straight in order to find non-vaccinated matches for all the vaccinated people in their database. Subsequent studies based on active sample collection from patients corroborated that Clalit’s early inferences were indeed accurate and paved the way for a locally unprecedented number of top-tier publications in the world’s leading scientific journals, providing the world with invaluable timely insights on the effectiveness and safety of additional vaccine doses and antiviral drugs, as well as the clinical impact of new variants. “Our latest paper in The New England Journal of Medicine was the first to shed light on the impact of the fourth vaccine dose in preventing the severe consequences of the Omicron wave in Israel, and its results were discussed in real time with the world’s leading health agencies to inform their decision making,” he adds.

From data science to clinical impact

The vaccine studies reflect only one component of Clalit’s leadership role in innovation and healthcare research. During the pandemic infection peaks, Clalit advanced innovative data science applications aimed at enabling its 4.8 million members to receive predictive proactive care through a series of transformative initiatives.

Three ground-breaking initiatives during the Covid pandemic are striking examples. As early as March 2020, Clalit deployed Israel’s first predictive model for identifying the patients with the highest risk of severe Covid-19, allowing for a unique individual patient early warning system. Later, a personalized daily risk score for every patient that visited Clalit clinics allowed practicing physicians to intervene in real time and proactively offer tests to highest-risk individuals; and, finally, by predicting future area-level morbidity trends, every Clalit hospital received early warning about the potential of upcoming overcrowding.

Dr. Noa Dagan, director of data and AI-driven care at Clalit Innovation, explains how these models impacted daily practice: “We were able to develop one of the world’s first models that predicted who would most likely develop severe Covid-19 complications, and Clalit’s Digital Division made this data available in our data infrastructure. This allowed Clalit’s Community Medicine Division to ensure that GPs called each of the 200,000 high-risk members to provide them with timely preventive advice.”

To put these tools at the hands of providers and patients alike, Clalit went through a rapid extension of its tele-care and digital services, building upon years of digital infrastructure development led by Clalit’s Digital Division. This collaborative work continues to this very day. This holistic approach of predictive-proactive care started well before the pandemic, and during Covid Clalit developed new data science driven tools to help care for patients proactively. During the last two years, Clalit has also leapfrogged its online services, spearheaded by Clalit’s Community Medicine Division and Digital Division, with approximately half of its medical services taking place online without a physical encounter.

The era of population genomics

Predictive medicine is not the only paradigm shift that Clalit has put into practice in recent years – the extensive use of genomics is another important layer in Clalit’s innovation strategy. This year, Clalit inaugurated its Genomics Center, a state-of-the-art center for genomic analysis. Mirroring Clalit’s structure that encompasses 1,600 clinics and 14 hospitals comprising over 30% of Israel’s acute hospital beds, Clalit’s Genomics Center is based on a unique network model. A central genomic laboratory equipped with the most advanced sequencers works closely with six leading clinical genetics centers at Clalit hospitals, where the bioinformatics analysis and clinical reasoning is performed in collaboration with the bedside physicians who care for the patients. Clalit’s Hospital Division, led by Dr. Orly Weinstein, spearheads the network-wide impact of the new center on the daily care of patients at all Clalit hospitals, including in outpatient settings.

“The Genomics Center uses a fully automated process to facilitate work while decreasing human errors and costs,” explains Prof. Shay Ben-Shachar, Director of Genomic Medicine at Clalit Innovation. “A continuous streaming process of data sharing and multi-party consultation that involves the Genomics Center and the clinical genetics inpatient departments allows optimization of the diagnostic process for the individual patient,” he further explains.

One of the most complex and mission-critical emerging new professions at Clalit is the Variant Scientist. “We now have seven variant analysts in our genomics clinical network, the largest number of such analysts in Israel,” says Prof. Ben-Shachar. “With this professional and technological infrastructure, Clalit promotes the most advanced, whole genome analysis, which recognizes every nucleotide in our three billion nucleotides. Unprecedented resources have been allocated in 2022 to use this precision medicine technology to allow genomic testing to be performed early in the diagnostic process, expediting the ability to quickly solve complex clinical questions.”

Expanding the Clalit international collaborative network

Under the leadership of Clalit’s CEO Ruth Ralbag, Clalit has put reinforced emphasis on the central role of innovation and systemic transformative redesign in Clalit’s strategy. A centerpiece of her innovation strategy for Clalit is the concept of “local innovation” – a decentralized approach empowering each of Clalit’s community health districts and each of its hospitals to establish a local Innovation Center, to address multiple real, burning challenges of local impact. In the recent two years, such innovation centers have been set up in most of Clalit’s hospitals, and the first community health innovation centers are already in progress. Clalit has over 45,000 outstanding professionals as its employees, and they are encouraged to suggest new ways to better execute their daily roles – clinical, technical or administrative.

Another cornerstone of Clalit’s innovation strategy is an emphasis on international collaboration with likeminded clinical, industrial and academic global leaders. In a decisive step forward on this quest, made possible by a generous gift from the Berkowitz family, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration was established at Harvard Medical School and Clalit Research Institute. The work is led jointly by Prof. Isaac Kohane, the Chair of the Department of Biomedical Informatics in the Blavatnik Institute at Harvard Medical School, and Prof Balicer at Clalit.

The program has two arms: research and education. Ongoing studies in the research arm focus on generating insights from data and translating them into frontline clinical interventions. Under its educational arm, it trains the next generation of biomedical informaticians and computational biologists.

In addition, a clinical arm at Clalit is supported by the Berkowitz family, setting up Israel’s first precision medicine clinic, dedicated to identifying tailored therapies for patients for whom no standard treatment has proven effective. The clinic works to untangle medical mysteries in patients with undiagnosed diseases — an approach modelled after the U.S. Undiagnosed Diseases Network, for which HMS is a national coordinating center led by Kohane.

“The many synergies of this collaboration allow us to realize the vision of precision medicine and move toward a future of predictive medicine, where the power to anticipate medical risk can prevent people from getting sick in the first place,” says Prof. Ben Reis, Director of the Predictive Medicine Group at Harvard Medical School and Boston Children’s Hospital Computational Health Informatics Program. “We are making great strides towards realizing the enormous potential of this transformational opportunity for the benefit of patients worldwide.”

Clalit offers its global partners a unique combination of advantages – a care system integrated by design, unique unparalleled data resources, clinical and data science opinion leaders, implementation-ready hospitals and outpatient clinics, and real-world outcome assessment by its world-renowned research institute.

“We believe Clalit’s role is to serve as a global hub of healthcare innovation, allowing the most promising tools and solutions to be tested and implemented at scale, for the benefit of our patients and to advance new best practices in medicine. Bringing innovation into healthcare practice is no longer a ‘nice-to-have’ – it is an imperative, and we are committed to making sure Clalit remains at the forefront of this evolving frontier. We extend an open invitation to innovation leaders worldwide to approach us and collaboratively work with us, for the benefit of patients everywhere,” concludes Prof. Balicer.

For more information about Clalit Health Services, visit the website