How EHR Made Israel the World Leader in Vaccination

Posted on: 30 Sep 2021

To fight against COVID-19, the medical community uses not only proven practices but also modern technologies: digital therapeutics, contact tracing applications, and so on. We will tell you about solutions that are used in Israel and have made this country a leader in vaccination coverage, allowing them to overcome the spread of the virus.


Israel is the world leader in vaccination

The cornerstone of Israel's healthcare system is patient electronic medical records. The country’s medical institutions completely switched to digital format a little over 20 years ago, and thanks to this, Israel has the highest level of vaccination in the world today. This is the information that Eyal Zimlichman, the Chief Medical Officer and Chief Innovation Officer at Israel's largest and most reputed medical center Sheba, shared with NEJM Catalyst Innovations in Care Delivery.

The country's centralized system of continuous healthcare uses digital records for each patient - electronic health records (EHRs). People make appointments, ask questions about treatment, and receive prescriptions online through a dedicated application. But most importantly, Israel has built an effective information exchange system that covers 100% of providers and 100% of residents in the country. From EHRs, medical providers receive comprehensive information about patients' health issues, chronic conditions, risk factors, lab results, medical images, and more.

The digitalization of healthcare has allowed doctors to approach vaccination prioritization rationally. They selected people who are at risk due to their occupation, age, or burden of disease from the database and offered vaccines to them first. The government gave official permission so that certain categories of citizens could be vaccinated.

Medical personnel, military servants, and teachers were vaccinated on a priority basis. Then the vaccine was received by people above the age of 60, and after that by younger people. In the coming weeks, Israel is planning to start vaccination of adolescents. As Eyal Zimlichman says, doctors recognized that only the vaccine and time would help to promptly overcome the coronavirus.

Since the early days of the pandemic, Sheba Medical Center has been playing a leading role in the fight against COVID-19. The hospital accepted a group of sick Israelis from the Diamond Princess cruise ship and opened a special intensive care unit in one of its underground parking lots in just 48 hours. Medical professionals were managing to keep mortality from novel coronavirus at 0.8% (two times lower than in the United States) and work successfully under quarantine conditions. Israel vaccinated its first 20-30% of citizens ten times faster than the United States and most other countries. Israel managed to vaccinate about 90% of the population over 60 in a matter of three weeks, which is incredible.


EHR as a major success factor

Since all the data was already in EHRs, people didn’t have to wait in queues, go through medical interviews on the spot, or fill out forms prior to the vaccination.

After a person received a shot, the vaccination identification number was uploaded to the app. A vaccinated person received a Green Pass - admission to visit public places and events, the electronic version of which people can always carry with them.

A well-established procedure has allowed Israel to achieve overwhelming results. As of April 2021, more than half of the country's residents (5.3 million) were vaccinated. About a million citizens have already recovered from the virus, so they must have natural immunity. This means that 68% of the country's population has antibodies that can fight the coronavirus. Therefore, Israel is closer to herd immunity to COVID-19 than any other country.

Measures that helped Israel to stop the spread

Social distancing, quarantine measures, and an extensive network of well-coordinated testing facilities helped the country contain the pandemic for a year until the vaccine was available. Eyal Zimlichman stressed the importance of the fact that doctors were able to increase the capacity of hospitals up to 3.4 times in terms of the number of beds in intensive care units. There are some other factors that have contributed to the successful fight against the pandemic.

  • Exceptional healthcare structure

Israel has four well-interconnected health maintenance organizations (HMOs) responsible for providing insurance and primary healthcare to 100% of the country's residents. These organizations conduct massive campaigns among residents, including vaccinations, and supervise government clinics. The law says that each resident must register at one of the four HMOs, and this helped to drive the national vaccination campaign to such a high level.

  • Vaccine supplies

Though Israel is a small country, it has certain climate characteristics. That’s why the supply and storage of the vaccines (especially Pfizer-BioNTech) should be and were established efficiently. Serum was delivered to two warehouses in the country and stored properly at between -60°C and -70°C. From there, it was distributed to the HMOs and some large medical facilities that vaccinated people around the clock. According to Ran Balicer, the Chief Innovation Officer at HMO Clalit Health Services, the campaign’s success is underpinned by the country’s small territory and population.

  • Focus on vaccines

As Eyal Zimlichman noted, doctors understood that the only rescue for the country was vaccination. Data collection and high vaccination rates were the priority goals of the healthcare system.

  • Promptness and low vaccine losses

Rapid vaccination was aided by a prompt approach to the distribution of shots. Serum taken out of the freezer must be used quickly, as it has a short shelf life. As soon as the clinic staff realizes that there will be excess doses left, they contact people living nearby and invite them for immediate vaccination (regardless of the person's age or whether they are at risk).

  • Overcoming mistrust of a new vaccine

Since the vaccine was invented recently, people had a lack of confidence in its safety and effectiveness. To overcome this barrier, health professionals spoke openly about success rates and possible side effects. Highly respected officials and doctors were publicly vaccinated.

Thanks to these measures, Israel was able to stop the spread of infection by reducing the number of infected (no more than 40 people per day) and deaths (no more than 7 people per day) as of May 18, 2021.


How Israel's experience has helped other countries

As patients’ medical records are digitized and all medical institutions in the country use this information, Israeli doctors have collected anonymous data on the effectiveness of the vaccine. The Ministry of Health has correlated vaccination results with anonymous patient histories and shared valuable findings with other countries. This helped the world evaluate the effectiveness of vaccinations in people of different ages, gender, and living conditions and accelerate efforts to beat COVID-19.

In addition, Israel, the United States, and other developed countries have begun donating vaccines to countries that don’t have the resources for research or drug purchase. For example, this March, Israel donated 100,000 shots of Moderna to 20 countries and Sinai peacekeepers. The US shipped millions of shots of AstraZeneca to Mexico and Canada. Donor countries benefit from volunteering as vaccination blocks the spread of the disease and possible outbreaks of more dangerous strains.

Israel's experience demonstrates the long-term benefits of creating a digital healthcare system. EHRs and other medical technologies are helping healthcare providers quickly collect and analyze data and successfully contain the spread of the pandemic.

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