Ask almost any American family with relatives in Israel and you’ll hear a version of the same story. A grandmother in Haifa falls, ends up in an emergency room across town, and the doctor on duty already knows her medications, her last blood test and the cardiologist she saw in the spring. Meanwhile her daughter in Boca Raton changes specialists and spends a week chasing faxes, patient portals and a CD of scans that no one’s computer will open.
The contrast is real, and it has become a talking point in American health policy circles. Israel runs one of the most thoroughly digitized health systems on earth, and its data helped answer some of the most urgent questions of the pandemic. The harder question, and the one worth asking honestly, is how much of that model could survive the trip to a country with private insurers, rival software vendors and a very different idea of who owns a medical record.
A System Built Around the Member, Not the Visit
Israel’s advantage starts with structure, not software. Under the National Health Insurance Law of 1995, every resident must belong to one of four health funds, the kupot cholim: Clalit, Maccabi, Meuhedet and Leumit. The funds both insure and deliver care. They run clinics, employ physicians and pharmacists, and in Clalit’s case own a network of hospitals.
Clalit is the giant. According to a report by Israel’s State Comptroller, it served roughly 4.8 million members, about 51 percent of the country’s population, as of December 2022. People tend to stay with one fund for years, often for life, so the fund’s records follow a person from childhood vaccinations to geriatric care.
That continuity is the quiet foundation of everything else. When the same organization pays for care, delivers much of it and keeps the chart for decades, it has every reason to digitize early and keep the data clean. The funds moved their clinics onto computers decades ago, well before most American practices gave up paper. An Israeli family doctor typically sees a record that is not a snapshot of one visit but a long, continuous history.
American medicine is organized almost the opposite way. A patient might carry employer insurance through one carrier, switch jobs and carriers two years later, see a primary care doctor in one health system and a specialist in another. No single party holds the whole story, and few have a financial reason to build it.
The Plumbing Nobody Sees
Even in Israel, a patient’s care does not happen inside one fund. A Maccabi member might be rushed to a government hospital or a Clalit hospital, and the clinicians there need to see what Maccabi knows. The answer was a health information exchange called Ofek, Hebrew for “horizon.”
Ofek grew out of Clalit’s own effort in the late 1990s to link its hospitals and clinics. The technology, built by an Israeli company called dbMotion, sits on top of existing record systems rather than replacing them, and assembles a read-only view of a patient’s history on demand. According to case material from Altera Digital Health, which now owns dbMotion, Ofek today connects all four health funds and about 50 hospitals, after the Ministry of Health decided in 2012 to connect every medical facility in the country to it.
Picture what that means at two in the morning. An emergency physician in Beersheba opens a patient’s file and sees, alongside her own hospital’s notes, the allergies recorded by a family doctor in Netanya and the discharge summary from a hospital in Jerusalem. She doesn’t need to call anyone, wait for an office to open or guess.
The design choice matters more than it sounds. Israel did not force every hospital onto one software product. It accepted that different institutions would keep different systems and built a layer that lets them talk. That is precisely the problem American hospitals face, where a single metropolitan area can run half a dozen electronic record platforms that were never designed to share. Bridging them is unglamorous work done by a whole industry of integrators, from the major record vendors such as Epic and Oracle Health to smaller development shops such as Glorium Technologies that build the interfaces, data pipelines and patient-facing software clinics and hospitals depend on.
Israel’s lesson for that industry is not that one product won. It’s that a national commitment to connect told every vendor what it had to support. In Israel, the health ministry made connection to Ofek a requirement rather than a feature request, and that, more than any line of code, is what made the exchange useful.
What the Vaccine Studies Proved
The world saw what Israeli health data could do in early 2021. Israel moved faster than almost any country to vaccinate its population against Covid-19, and Clalit’s researchers had something few others had: years of detailed, linked records for millions of people, ready to analyze within weeks.
The result was one of the defining papers of the pandemic. Published in the New England Journal of Medicine in February 2021, the Clalit study of the Pfizer-BioNTech vaccine matched 596,618 newly vaccinated people with the same number of unvaccinated people of similar age, health and background. It estimated that two doses were 94 percent effective against symptomatic infection and 87 percent effective against hospitalization, closely echoing the clinical trial in a messy, real-world population.
The paper came out of Clalit’s research arm, with Ran Balicer as corresponding author, and it worked because the matching depended on data that American researchers would have struggled to assemble quickly: diagnoses, prior infections, pregnancies, chronic conditions and vaccination dates, all in one system. In the United States, those facts were scattered across pharmacies, state immunization registries, insurers and hospital records that don’t share an identifier.
For readers who followed those months closely, there was a second, less comfortable lesson. Israel’s data was so useful partly because its population was so legible to the people analyzing it. The same coherence that made the studies possible also raised questions, debated inside Israel, about how much a health fund should know and how freely that knowledge should travel to drug companies and governments.
Sheba’s Bet on the Hospital as a Laboratory
If the health funds show what continuous records make possible, Sheba Medical Center at Tel Hashomer shows what a hospital can try when it treats itself as a test site. Sheba, near Ramat Gan, is Israel’s largest hospital, and its own announcements note that Newsweek ranked it seventh on the magazine’s 2026 list of the world’s best hospitals.
Much of that reputation rests on ARC, which stands for Accelerate, Redesign, Collaborate, Sheba’s center for digital innovation. The idea is simple to describe and hard to copy: put startups, clinicians and data scientists inside a working hospital, let them pilot tools on real workflows, and keep what holds up. Remote monitoring, AI tools for reading scans and hospital-at-home care are the kinds of projects such a pipeline exists to test.
What makes this work in Israel is partly cultural. The country’s technology sector is dense and personally connected, many engineers served together in the army, and a hospital executive can often reach a founder with one phone call. American academic medical centers run innovation programs too, at places like Mayo Clinic and Cleveland Clinic, but they work inside a far larger and more litigious system, where a pilot must clear legal review, payer rules and a procurement process that can outlast a startup’s funding.
What Crosses the Atlantic, and What Doesn’t
So what could American hospitals actually borrow? The honest answer is: less than the enthusiasts claim, and more than the skeptics allow.
The single-payer-style continuity of the kupot cholim won’t arrive in the United States. Americans change insurers too often, and the politics of health coverage make a 1995-style national law unimaginable in the near term. Without a lifelong steward of the record, the deep longitudinal data that powered the Clalit vaccine studies will stay rare, concentrated in large integrated systems such as Kaiser Permanente and the Veterans Health Administration.
Privacy rules also cut differently. HIPAA governs how covered entities may use and disclose health information, and it was never built to create a national research database. Many American patients, including plenty of Jewish Americans who remember why records about minorities have been misused in the past, would resist any plan that looked like one.
But Ofek’s central idea, connecting systems instead of replacing them, is already American policy. The federal Trusted Exchange Framework and Common Agreement, known as TEFCA, went live in December 2023, with an initial group of national networks, including Epic’s, designated to exchange records under a common set of rules. It’s a slower, more voluntary, more commercial version of what Israel’s health ministry decreed, and its success will depend on whether hospitals and vendors treat it as a requirement or a checkbox.
There is also a group of Americans who live the comparison firsthand. Families who split their lives between the two countries, students on a gap year, retirees who make aliyah in their seventies: they move from a system where the record follows them into one where they carry it themselves, or the reverse. Anyone who has tried to get an Israeli discharge letter read by an American specialist, or an American medication list entered into a kupah’s system, knows that the problem isn’t language. It’s that the two systems were built on different assumptions about who keeps the file.
The pieces that travel best are modest ones: a shared expectation that records follow the patient, hospitals willing to pilot new tools under real clinical conditions, and research teams given clean, linked data with real oversight. None of that requires copying Israel’s insurance system. It requires deciding, as Israel did, that a medical record is part of a patient’s care and not the property of whichever building happened to create it.
For the grandmother in Haifa and her daughter in Boca Raton, that’s the gap that matters. Israel didn’t get there through genius software. It got there by deciding early who the record was for, and then building the plumbing to match.