From Passive Records to Active Care: Activating the EHR in Real time in Israel’s hospitals

Israel’s healthcare system is widely recognized as one of the most digitally advanced in the world. Electronic health records are deeply embedded across hospitals, and platforms like Chameleon sit at the center of clinical operations. Patient data is captured, structured and accessible at nearly every stage of care delivery.

But digital maturity alone does not guarantee operational efficiency.

According to OECD data, Israel has fewer physicians and nurses per capita than the OECD average. At the same time, the system operates under long-standing constraints and regional disparities between the center and the periphery, as reflected in Health Ministry reporting and research from institutions such as the Taub center. In periods of sustained emergency readiness and rising clinical demand, those constraints become even more pronounced.

In this environment, workflow efficiency is not a matter of convenience. It is a matter of capacity.

Which is why the next phase of digital health in Israel is not about capturing more data inside the medical record. It is about activating the data that already exists in real time.

Activating the EHR in real time is the process of converting clinical documentation into automatically routed, accountable workflows. When a time-sensitive event is recorded, the system notifies the appropriate on-call clinician, tracks acknowledgement, and synchronizes the response back into the patient record.

Digitized Does Not Mean Operationalized

Israel has successfully digitized the medical record. Clinical documentation, lab results, consult notes, and imaging data are recorded and stored within advanced EHR platforms. Yet when a time-sensitive event occurs, such as a new consult request, a critical lab value, a change in patient status, the pathway from documentation to action is not always seamless.

Too often, the coordination that follows documentation still depends on manual steps: identifying the correct on-call specialist, placing calls, sending messages via consumer messaging apps, waiting for confirmation, and keeping a close watch on whether the request was received. When communication occurs outside of EHR, accountability and documentation can fragment. The clinical record remains comprehensive, but the operational workflow and context around it may not be.

In a workforce-constrained system, that coordination burden adds up.

Activating the EHR in real time means ensuring that clinical events do not remain passive entries in a record, but instead trigger structured, accountable workflows tied directly to patient care.

From Entry in the Record to Actionable Workflow

The partnership between Elad Health and OnPage is built on the premise that the EHR should not only store information but also mobilize it into actionable workflows for clinical decision-making.

Chameleon EHR, used by the majority of hospitals in Israel, already serves as the digital backbone of hospital operations. By embedding a purpose-built communications layer directly into Chameleon, clinical events documented in the system can automatically generate routed, time-sensitive notifications to the appropriate on-call clinician.

For instance, when a consult request is entered, the system can leverage OnPage integration to identify the specialist on duty (based on built-in schedules) and deliver a secure alert to their phone device as a loud “page” that continues to alert until acknowledged. If no response is received within a defined time frame, escalation logic kicks in to ensure the notification advances to the next appropriate provider. Once acknowledged and addressed, the interaction, including time-stamps, is synchronized back into the EHR.

The bi-directional flow creates a closed loop: documentation triggers action, action is acknowledged and the response becomes part of the patient record. The EHR remains the single source of truth. Activating the EHR in real time enables hospitals to:

• Route consult requests to the correct on-call clinician
• Escalate automatically if no response is received
• Document acknowledgements inside the patient record
• Standardize communication across departments

While this integration partnership is anchored in the EHR, it is important to note that the operational model extends beyond a single system. Clinical workflows in hospitals often span laboratory systems, patient monitoring platforms, and other applications that generate time-sensitive events that require hospital staff to be activated. A unified communication layer that can receive signals from multiple clinical and operational systems, and route them to the appropriate on-call team with the same closed-loop accountability, allows hospitals to standardize response processes across the organization. As digital infrastructure evolves, this approach ensures that new systems can participate in the same real-time, documented communication workflows, without creating additional silos.

“Clinical communication is only effective when it is timely, secure, and actionable,” said Judit Sharon, CEO of OnPage Corporation. “Embedding our technology within the ‘Chameleon’ system allows hospitals in Israel to replace fragmented workflows with a unified communication layer that ensures accountability and rapid response in real time.”

In practical terms, this reduces the need for clinicians to search for the right contact, repeat messages across channels, or manually verify if the message was received. In essence, it really transforms communication from an informal process lacking accountability into a structured component of care delivery.

Capacity Through Workflow, Not Headcount

When clinician availability is limited and patient demand remains high, adding staff is not always an immediate solution. Improving the efficiency of existing workflows becomes essential.

By automating consult/ED triage routing, on-call identification, and escalation, hospitals can reduce delays caused by coordination friction rather than clinical complexity. Time spent locating the right specialist or confirming message receipt is time taken away from what matters the most, which is patient care. A system that routes critical requests correctly and documents responses by design creates operational clarity.

This is particularly relevant in emergency departments and high-acuity settings, where response times directly influence throughput and patient outcomes. In regions where staffing levels and access to specialists vary, standardized, closed-loop communication can help ensure that responsibility is clearly assigned and visible within the record.

Beyond capacity expansion, governance also plays an important role. Consumer messaging applications gained popularity in Israel’s hospitals because of their convenience. However, communication that occurs outside the clinical system lacks structured escalation and may not provide a durable, auditable trail tied to the patient chart. As regulatory expectations around data protection and documentation continue to evolve, embedding communication inside the EHR supports both operational and compliance objectives.

Tzafrir Kagan, CEO of Elad Health, frames the integration as an extension of Chameleon’s core mission. “Chameleon EHR’s vision is to empower the clinician-patient interaction,” he said. “Partnering with OnPage extends that vision by strengthening how care teams communicate when it matters most. This integration gives hospitals a secure, enterprise-grade alternative to consumer messaging tools while improving responsiveness and patient safety.”

National-Scale Modernization

Because Chameleon is deployed across the majority of Israeli hospitals, activating the EHR in real time is not a localized experiment. It represents an opportunity to standardize accountable, workflow-driven communication at national scale.

Israel’s first wave of digital health innovation focused on digitization, replacing paper records with integrated electronic systems. We think that with this integration, the next stage is going to be all about operationalization this data: ensuring that the information captured within those systems automatically activate critical communication workflows and moves care forward without delay.

OnPage, a battle-tested global platform recognized in the Gartner Magic Quadrant for Clinical Communication and Collaboration, brings experience from complex healthcare and enterprise environments where reliability and escalation are mission-critical. Embedded directly within Chameleon, this capability becomes part of the existing clinical fabric rather than a separate tool layered on top. And for hospitals trying to become future-ready, OnPage can continue to grow with them and consolidate all their critical communication needs.

The result is not an additional application for clinicians to manage. It is a reinforcement of the systems they already use, aligning documentation, communication, and accountability within a single workflow.

A Resilient Model for the Future

As Israel’s healthcare system continues to navigate workforce pressures, regional disparities, and sustained operational demands, modernization must focus not only on technology adoption but on workflow integrity.

Activating the EHR in real time, transforming passive records into active, accountable processes, supports a more resilient care model. It ensures that critical information does not remain static within a record, but reaches the right clinician at the right moment, with confirmation and documentation built in.

Digital transformation is often measured by the presence of advanced systems. Increasingly, it will be measured by how effectively those systems translate information into action. From passive records to active care, the next evolution of Israel’s hospital infrastructure is already underway!

FAQ

What is closed-loop communication?

Closed-loop clinical communication ensures that a critical event in the EHR triggers an OnPage high-priority message to be delivered, acknowledged, and responses (including time-stamps) documented within the patient record, creating clear accountability for follow-up.

Why is activating the EHR important for hospitals?

Activating the EHR reduces manual coordination, improves response times, and helps hospitals manage capacity by automating workflow routing and documentation.

How does this support healthcare workforce efficiency?

By automating consult routing and escalation, clinicians spend less time locating colleagues and more time delivering care.