'We understood that we have to do it fast and now'

As anxiety surges during war, Israeli GenAI platform can ease psychiatrists’ workload

A new cutting-edge platform, developed at Sheba Hospital in the wake of October 7, substantially streamlines intake of patients for mental healthcare

Renee Ghert-Zand is the health reporter and a feature writer for The Times of Israel.

Illustrative image of a former French soldier at the 'Athos' house - a place that welcomes veterans with traumas - in Toulon, southern France, on May 26, 2021. (Nicolas Tucat / AFP)
Illustrative image of a former French soldier at the 'Athos' house - a place that welcomes veterans with traumas - in Toulon, southern France, on May 26, 2021. (Nicolas Tucat / AFP)

With the number of Israelis feeling anxious from the ongoing war soaring, a new generative artificial intelligence (GenAI) platform offers the possibility of quicker and more effective mental health screening.

The platform, called LIV, acts as a psychiatric triage system. It gives a person “someone” to converse with about their feelings and concerns. At the same time, LIV helps streamline a physician’s workload by generating possible diagnoses and treatment recommendations.

While the doctor creates the actual clinical diagnosis and treatment plan, LIV serves as a support system for making clinical decisions based on its “conversations” with patients.

This reporter tried LIV and found it to be almost akin to having an open-ended, heart-to-heart conversation with a real person. Like a psychiatrist, the platform knows how to take the conversation gently forward with the right questions to arrive at a possible diagnosis.

LIV and this reporter were in conversation for nearly half an hour about the war’s effects, including the April 14 attack by Iran on Israel. LIV was constantly reflecting back what this reporter expressed and felt, seemingly identifying with it. This made it easy and safe to open up to “her.”

Iris Shtein, director of strategic partnerships at ARC/Sheba Medical Center (Courtesy)

LIV provides the physician with a detailed report containing high-quality information that shortens the length of time they need to spend with the patient in the initial intake appointment. Rather than taking an hour, the initial appointment with the doctor is cut in half or more as the doctor doublechecks that LIV’s insights are correct.

LIV is the product of a collaboration among ARC Innovation Center at Sheba Medical Center, KPMG, and Microsoft.

“I had the notion of LIV years ago but the technology wasn’t as developed as it is today. The timing wasn’t right, and we didn’t have the right partners,” said ARC director of strategic partnerships Iris Shtein, who is leading the LIV initiative.

“Since the war, everything changed because we understood that we have to do it fast and now. We didn’t have any other choice. Fortunately, the GenAI technology just exploded in the last couple of years, which made it possible,” she said.

The platform, named for Shtein’s young daughter, was built in only a month and a half. By December, a feasibility test involving 100 actors was underway.

“We had a two-day training with our clinical team so the actors could learn how to act as though they had anxiety, depression, mania, or PTSD. We also taught them how to present different severities of the conditions. There was also a control group,” Shtein said.

The test compared the performance of LIV to that of physicians. The results Shtein shared with The Times of Israel showed that LIV made correct diagnoses 94 percent of the time. The platform was more accurate than the doctors in assessing the severity of a condition, with LIV getting it right 81% of the time versus the doctors only 79%.

“LIV was also better than the doctors in determining what medication would be appropriate for treating a particular patient,” Shtein noted.

Your new AI bestie

LIV was presented in March at HIMSS, the world’s largest digital medicine conference. It operates using LLM, a type of AI program trained on huge data sets and built on machine learning that can recognize and generate text. It also uses information from DSM-5, a manual of mental disorders published by the American Psychiatric Association. As LIV is used by more and more people, it fine-tunes itself to be even more sophisticated and accurate.

Shtein said the feedback she hears from people participating in a current LIV clinical study at Sheba is that they are enjoying the interface with the platform.

“It’s a personalized experience. A person can choose if they want to talk to ‘her’ or to text ‘her.’ They can choose if they want to interact with an avatar or not, and whether they want LIV to speak in English or Hebrew,” Shtein said.

“Some people in the clinical study are spending 60 minutes talking with LIV instead of the average 30 because they feel very comfortable to elaborate because they feel that no one is judging them. Some mention how they find LIV more empathic than a real therapist,” Shtein said.

Prof. Eyal Fruchter, director of the Maale HaCarmel Mental Health Center and chair of the National Counseling Committee for PTSD, has seen LIV in action and reviewed the research data on it.

“I see great potential [with LIV] because we are lacking psychiatrists, psychologists, and social workers — therapists of all kinds. LIV takes the [patient’s] medical history, helps with a diagnosis, and concludes what’s needed. This spares a lot of time that we as therapists don’t have,” Fruchter said.

Fruchter said he likes the fact that although LIV comes across as warm and friendly, it still has a robotic nature to it.

“I have seen other things that try to have avatars [fully] imitate a person, a therapist, which is unnecessary,” he said.

Mental health for all

Prof. Yoav Kohn, director of the Child and Youth Department at Eitanim Psychiatric Medical Center, has not yet had the opportunity to try LIV. After The Times of Israel told him about it, he said that it sounded interesting and has the potential to streamline the Israeli mental healthcare system as it deals with the surge in cases, which he believes will continue for years.

“However, I would want to know whether the platform will be affordable and whether security measures are in place so that unauthorized people would not be able to get a hold of patients’ personal and medical information,” Kohn said.

Director of the Children and Adolescents Department of the Eitanim Psychiatric Medical Center Prof. Yoav Kohn in his office, April 2, 2024. (Renee Ghert-Zand/TOI)

Shtein explained that LIV is not a standalone application that someone can simply download on their phone.

“Our clients are not the individual patients. Our clients are hospitals, health maintenance organizations, and the IDF — which we are in the process of setting up a trial with now,” she said.

When LIV is acquired by one of these clients, the patient will only be able to access it through the secured cloud-based interface that the client uses to communicate with its registered patients. This is almost always through a two-factor authentication process.

On the other side, only the authorized individuals employed by the client will have access to LIV’s data in the organization’s system.

The fact that LIV “lives” at a hospital or HMO is critical for the platform to work properly when a person shares that they want to hurt themselves or others, or exhibits suicidal ideation. If this happens, LIV shuts down and immediately alerts medical staff, who can jump into action to reach the person in acute distress.

“We always have a human in the loop,” Shtein said.

Shtein and the rest of the team behind LIV expect it to be put into use at Sheba this summer, while the product is submitted for FDA approval. This would be followed by a multi-center clinical trial toward the end of the year and national and international expansion by the middle of 2025.

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