At the Largest Hospital in the Middle East, a Breakthrough on Telehealth Technology-Facilitated COVID-19 Care

Leaders at the 1,700-bed Sheba Medical Center in Tel Aviv, Israel have been making major advances in treating patients with COVID-19 or who might have COVID-19, leveraging a range of telehealth-capable and telehealth-related technologies to keep clinicians and hospital staff members safer, while also enhancing the patient experience.

Sheba Medical Center clinicians and administrators have been working hard and fast to set up telehealth as a fundamental strategy for safely delivering care to patients suspected of having COVID-19 and those who have been diagnosed. They have been partnering with three Israeli vendors—EarlySense, Datos Health, and TytoCare (EarlySense and Datos are based in Ramat Gan, and TytoCare is based in Netanya) to develop an integrated technology platform to help launch a full telehealth-facilitated care delivery process.

With regard to what the leaders at Sheba Medical Center have been doing in this area, Eyal Zimlichman, M.D., a practicing internal medicine specialist and the chief medical officer and chief innovation officer of the hospital, who has helped lead the telehealth initiative, spoke this week with Healthcare Innovation Editor-in-Chief Mark Hagland regarding his team’s efforts, and their results. Below are excerpts from their interview.

Can you tell me about the numbers of COVID-19 patients for whom you and your colleagues are caring, at the hospital?

We started seeing the first patients coming from the Diamond Princess in Japan. We airlifted the patients out and they came to Sheba, almost three weeks ago. Those were the first patients in Israel, and we were chosen by the Ministry of Health to house the first patients. In preparation for that, we built an isolation department from scratch within 72 hours with the capacity to hold 40 patients, and now it’s almost completely full. We currently have 34 patients. And of course, we’re still the largest in terms of the numbers of patients in Israeli hospitals. We’ve discharged five so far.

And how many cases have been identified so far in Israel?

Well, the numbers are changing every day, as they are everywhere else; but as of today, about 430 cases.

Would you consider that high, relative to the country’s population?

It depends on how you measure it. We haven’t registered any fatalities yet, which is better than anywhere else. Of course, it’s question of time before there are deaths.

So, tell me about your hospital’s development of remote patient monitoring technology?

So it was our intention in building the facility to minimize contact with our staff. We knew it was a big issue, because when you look at China, South Korea, or Italy now, there’s been a huge issue with staff contracting the virus, and some even dying. And we have a pretty robust telemedicine platform and program at Sheba which we’ve built in the past three years under our innovation arm, called ARC, and we’ve utilized the technology and our experience in this compound, where we’re able to track our patients, take vital signs, chat with them and even examine them, without contact.

Each patient is in an isolation room alone, correct?

Correct. In terms of vital signs, we’ve set everything up so that patients in isolation in their homes can use the thermometer, stethoscope, and pulse oximeter, and relay the results of body temperature, blood pressure, and oxygen saturation, via Bluetooth, to us in the hospital, with the data being entered automatically into the platform. We even have patients place an EarlySense sensor under their mattress, in the home, and do so ourselves in terms of the hospital beds. The EarlySense sensor measures a patient’s respiration rate, heart rate, and motion, and has an AI-based algorithm that alerts us when a patient is deteriorating or about to deteriorate, typically six to eight hours before the patient is about to crash. That gives us the heads-up that the patient needs a higher level of care. And then the clinician goes in and examines the patient, and perhaps transfers the patient to the ICU.

And we have two more technologies in the hospital room. One is from a company called TytoCare, which allows us to examine the patients, look at the heart and lungs, look down the throat, remotely. This was designed for examining children at home.

The doctor is standing outside the room?

The doctor is in a control room and sees the patient on the screen, and the technology is built in a way that it makes it very easy for the patient to know where to place the stethoscope for lung and heart sounds, and through a digital picture, it demonstrates to the patient exactly where to place the stethoscope, and the doctor instructs you where to move it to following places, including on the back. When this is done at home, you typically need someone to help you with the back. But when the patients are in the room—sometimes we have two in the same room, perhaps a parent and child or married couple. So then the clinician does have to do it. But it does allow us with most elements. The technology used for self-examination is from TytoCare.

How well has all of that been working?

We’ve been doing this for nearly three weeks now, and it’s been working very well. And more than a few doctors do this as part of their routine. The quality of the physical examination is very good, and the technology is really robust. And it could help with remote in-home care, which it was designed for. And some of the doctors have been using this to examine patients at home. Of course, sometimes, you do need to walk in. But not so often, to touch the patient.

About what percentage of times is it still necessary for the physician to enter the room?

It depends on the severity of the case. With mild patients, there’s no need. In the past few days, we’re starting to receive more severe patients. We intubated our first patient today, out of the 40 we’ve seen so far. He has comorbid conditions, was a heavy smoker.

What have the biggest lessons learned so far, in all this?

We think that in terms of what we’ve done here, a couple of things. One is that the hospital continues to function undisturbed, because we’ve built this separate unit and separated the corona patients from the regular patients, and that is critical. So we think that was a critical element that we would recommend to other hospitals to do as well.

Second, the use of telemedicine has helped tremendously in terms of protecting the staff. We’ve had no cases of staff contracting the virus so far. And we recommend that others do so as well. We think that moving forward, we’ll have mild cases being hospitalized at home. And that’s the next step using this technology. Once you start using telemedicine technology, you could be 10 meters away or 10 miles away. So we could do the daily checkup of patients while they’re at home, too. So the lesson for hospitals everywhere else is that we recommend that mild cases be hospitalized at home with this type platform.

And we’re building a kit involving equipment from all three companies that would have the technologies inside the box, and the box is delivered through FedEx or whatever method, to a specific patient isolated at home. Box with the technologies, a tablet, and instructions. It’s the hospital at home for corona patients. Plus, you need some level of compliance and basic level of education to go through this, but based on our experience in our compound, this was very easy to use and very friendly.