Not feeling well? Look at the clock. Feeling chest pains? Check what your shirt says. Despite the difficulties, the monitoring of vital signs is one of the fastest developing areas of digital medicine, and Israel possesses several advantages that the Israel Innovation Authority is helping to maximize.
Gill Zaphrir worked for years in the field of military technology before turning to the business arena. He was a partner in a venture capital fund and led successful investments in the fields of enterprise software when four years ago he encountered the world of digital medicine and was captivated by its exciting and far-reaching possibilities.
"Digital medicine is the future. It needs to be significantly more personal and accessible for everyone, all over the world but first and foremost for the people living in the periphery and in distant locations that lack professional medical services. The ability to maintain continuous surveillance and early testing enables better personalized, diagnostic and preventive medicine for all. The future is in the capability to construct a genetic physiological database, to maintain continuous surveillance and to provide treatment in time. The younger generation and those to come will no longer consume medical services in the manner we do today. Medical information is the foundation of future personalized medicine."
"As far as sources of finance and professional support is concerned, the field of digital medicine falls between the cracks. Historically, the investors were divided between internet and mobile mavens and those expert in the field of medical equipment. Digital medicine is a combination of these two fields and the investors are therefore faced with a very long learning process of the field as well as processes of regulatory adaptation. This is the reason that the early support of the Israel Innovation Authority is so critical."
"There are two significant advantages in Israel that are worthwhile leveraging: the existence, for almost 25 years, of a digital database of labelled information in the central health funds and an openness to collaboration with start-up initiatives in the field. Labelled health information is an asset of importance on the national level. The second advantage is that because Israel is only a 'small island', it is easy to connect between the technological disciplines required in order to come up with solutions. The upshot is expertise in the analysis of medical data and in medical research and the ability to combine all these elements to data technologies and provide a closed solution in the patient-clinician environment."
"I initiated an enterprise that exposes Israeli innovation in the field of digital medicine – an international meeting that takes place once a year. The meetings host all the country's digital medicine experts, partners and strategic clients from three continents. The first conference was in December 2013 and we have been meeting every year since. The community has expanded to 500 members in the field of digital medicine and between 500-700 participants attend each conference. It has also become the central stage for exposure to and exchange of information in the national sphere."
Zaphrir is currently involved in three companies active in the field. In one of them, 'Bandmanage', he has progressed from investor to CEO. He tells us of its activity: "Bandmanage is a software company specializing in the analysis of personal physiological data. What we actually do is to transform sports watches with a variety of sensors into a system that tracks changes in the state of health of elderly people. The sensors measure heartbeat, acceleration, skin temperature and the skin's electric conductivity. Our expertise lies in the capability to quickly monitor new physiological situations and enable the automatic cross-checking of information between patients."
"The idea is to take existing products of Samsung, Garmin and others and use the raw information that they possess about each user. We save each user's personal pattern in the cloud and study it for exceptions. For example, the system enables the automatic detection of changes in vital parameters, signs of pre-dehydration, influences of medicines and falls – any case of a marked exception to the patient's regular pattern. Upon detection of such a change, the system sends an alert to the appropriate treatment point such as a protected living nurse or family member."
"The system currently focuses on the elderly because they are the most sensitive. We are aiming at independent patients and assist them and their care-givers in becoming involved during times of emergency – and sometimes, even avoiding it. The fact that they use the watch allows us to keep the service cheap – between 30 and 40 dollars per month for each patient excluding the one-time expense of purchasing the watch itself. We have conducted successful pilots at protected living facilities in Israel and in New Jersey and are now proceeding to our first commercial installation."
"The next stages are to continue to establish and strengthen further models in the field of physiology, to recruit additional commercial clients and to expand to private homes. The future objective is that there will be sufficient information in the database to advance to the area of chronic disease management. Based on the labelled information, and together with the users' medical profile, it will also be possible to conduct retrospective studies."
A Wearable E.C.G
Gary Sagiv, Senior Director of Business Development and deputy CEO of the Health Watch Corporation, is also gazing into the distance: "Digital medicine is the future of modern medicine. I see it repeatedly all around the world. Digital medicine enables the transfer of a person's health management to himself. I sincerely hope that this future will be realized soon. Our luck in Israel is that we live in the clouds: so many clever people, so much good will, so much Israeli technology. We should be proud of our achievements here. We will manage the world."
Health Watch is a start-up company that developed a product called MasterCaution – a digital shirt that constitutes a platform for any sensor with which we want to measure physical information. "The shirt which we are near the final development of, includes sensors that monitor heart activity and body temperature. This is presently the only technology in the world that allows the wearing of a shirt with 12 E.C.G leads without cables."
"How does it work? Take for example, an elderly man at home who feels unwell but doesn't want to go to the doctor. He can wear the shirt, press the button, measure E.C.G and send the data via the internet directly to his physician or to our telephone center. The response is instantaneous: 'Everything is O.K.', 'You should visit your doctor in the next few days', or 'Go to the hospital now'. The whole process takes approximately 51 minutes. By contrast, in reality, 80% of the people who arrive at the hospital emergency room due to chest pains, do not suffer from a cardiological problem. This is a waste both the hospital's time and that of the individual."
"We are in the final stage of development. We have received authorization from the FDA and the CE and already have pending orders. This has aroused interest worldwide, especially in the Third World where they have no access to modern medicine. The shirt can be given to a nurse in a field hospital for her patients to wear - and the results will be sent to a doctor sitting in the regional health center. At our telephone center, a physician from China can sit and treat a patient from Sudan. This is globalization in every sense of the word. More than fifty percent of the world's population live in isolated locations far from immediate medical assistance. Our shirt enables an immediate solution that is easy to operate. This development has the potential to reduce the rate of heart attacks and strokes."
The launch is planned in China, as our main investor is a Chinese corporation. It must be understood that from the perspective of digital medicine, America is in a decline, Europe is dead and South America is yet to awaken. China, Japan, Singapore and Australia – this is the future for the next decade and a half. The United States was very open to other technologies for the last 20 years, but now they are seriously behind the Far East. The Chinese are very open towards new technologies. All the existing stereotypes are simply not correct. They are a people with an extremely rich culture. I have been working in China for 20 years and have a high regard for them and our work together."
"The general public needs to distinguish between medical equipment and wellness. It's all very well to receive information such as how many steps I took today, and I am myself a gadget junkie – but most of them are not medical. Medical equipment that is based on algorithms and that can monitor a serious problem is something else entirely. I don't just believe in the product, I also use it after I experienced a heart attack 3 and a half years ago. I exercise a lot and use the system for safety's sake. In this way, I can see the state of my heart in real time and know that everything is O.K."
Monitoring without Touching the Body
The Pulse Or Corporation is also focusing on sensors that monitor physiological indicators, but in this case these are entirely optic sensors that do not come into contact with the body. This technology is called Laser Speckle Contrast.
Amnon Mahalel, the company's Director of Marketing and Business Development, explains: "The idea is that when coherent light is screened on a surface that is not entirely smooth, a constructive and destructive interference is formed – in other words, a mixture of the two light waves to create bright and dark points. At the points at which the interference is constructive, a "speckle" is created. If the light is reflected back from a moving element – the speckle will also move. The company has developed a technology that discerns the number of speckles and their movement."
"If we take a laser in the infrared spectrum, it penetrates skin to a depth of 2-3 millimeters. The laser's light is reflected back from the red blood cells in the blood vessels – and we can see the speckles move in coordination with the movement of the blood corpuscles. A video camera can record the movement and special algorithms analyze the flow of blood in the area in the area under scrutiny, and this is the gist of the matter. We use this phenomenon in order to measure what is known as hemodynamics – the movement and flow of blood within the body – without entering the body, without making an incision and without touching. The laser penetrates no more than a few millimeters under the skin, but is sufficiently strong to discern even the blood flowing in the brain or under the skull of small lab animals."
"A hemodynamic examination can assist, for example, in cancer research. The cancer needs energy in order to develop and grow rapidly, therefore leading to the growth of a large number of blood vessels. Some of the drugs intended to stop the growth work on the prevention of the blood vessels' development or on their narrowing in order to slow the blood flow in those vessels that have already developed. With our device, we can follow the development of the growth and the efficiency of the drugs developed for fighting cancer. We inject the drugs into mice and, with the help of our device, observe and follow the changes in the blood flow and in the growth itself. In this way, it aids to examine their efficiency. Because the test is not invasive, and harmless for the mouse under examination, we can follow the development of the growth over an extended period of time."
"Our product has received exceptional reviews but we are not yet at the stage of raising funds. The Israel Innovation Authority has awarded us a grant that enabled us to test the idea of additional uses of the same technology, but further investments will be required in order to develop the final product. The field of hemodynamics features other competitors working with methods slightly different to our own. However we believe that our device is both more efficient and cheaper. Despite this, the market is limited and therefore we are attempting to locate new markets and additional products."
"We have decided to try and develop further applications based on the same technology of remote monitoring of human physiological data using Laser Speckle Contrast. The device will enable the monitoring of pulse and breathing variance without interfering with the patient's activity."
"We attempted to think of a possible target market for the product and identified drivers and operators of heavy equipment. The system is based on a camera and a low-strength IR laser source that is directed at the worker's forehead without him even noticing it. From the picture that is received, we measure his pulse and breathing so that problems of heart activity, pressure or tiredness can be detected before a disaster occurs. This constitutes an element of early warning and safety that can save human life and we therefore hope that the authorities will promote the device by a regulatory step that will obligate its use."
"To date, we have proven feasibility. There are two major problems to contend with – variable external lighting and the movement of the subject. If the person moves his head or drives into a pothole, the system reports an error. We have yet to start selling, but in the end people will fight each other to buy this product."
"Another market that we consider potential for a device like this is the prevention of cot-death. A system with a camera and laser lighting installed above the baby's crib, can transfer information and provide a warning of distress within seconds. This involves simple optics, uncomplicated electronics and a camera. The advantage of our system over existing systems is the low number of false alarms and its high reliability."
"Yet another idea that we are trying to promote is the use of the system as a very sensitive and reliable optic microphone with which we will be able to observe movements and noise within the ground, and thereby attempt to fight the digging of tunnels on the Gaza border."
Dr. Chana Rothmann-Scherz, Knowledge expert in the Health Division of the Israel Innovation Authority, summarizes: "The Israel Innovation Authority is playing a leading role in promoting the field of digital medicine. The means for doing so are varied and include supporting measures in a range of technological spheres. In addition, joint ventures are undertaken with government ministries and public bodies such as 'Digital Innovation for Challenges in the Public Arena' and 'Digital Israel' - a unique incubator for projects in the digital health field."