Challenge tenders are an innovative way of addressing burning problems in the health system (such as fall prevention among elders). While traditional tenders seek to find the best of a few given solutions, challenge tenders describe a burning problem without stating the desired solution. Companies with different solutions can submit their technology as a potentially solution to the problem. By allowing companies to offer their solutions we are exposed to a wide variety of different technologies and different solutions and services that can potentially solve our problem. This challenge tender method allows us to be more open to solutions and technologies we may didn't even know exist that can answer our problems. The method of funding and co running a pilot alongside a health organization in order to examine the technology and how it is executed in the health organization, allows us and the health organization to fully measure outcomes, usability and weather the problem is being solved

Our first challenge tender pilot was in the field of fall prevention among elders. We chose an evidence-based digital-therapeutic solution for customized motor-cognitive training, walking rehabilitation and fall prevention and ran a successful 6-month pilot in the second large HMO in Israel which gave wonderful results, mainly succeeding in preventing falls by 71%. Seeing how well the pilot turned out we chose the next field of intervention, improving treatment and care in long term facilities. This Is also a field in which innovative technologies have a hard time entering due to lack in resources, market failure and speed issues. We called the technological industry to find digital solutions to the urgent problem of improving care in long term facilities by improving documentation of care, streamline patient care and the work of the overly worked caregivers and reduce their reliance on paper and manual reporting instead of digital tools. Our next step is to incentivize implementations

The challenge tenders are a collaboration between a start-up, a health organization and the MOH. The start-up, the technology owner, is responsible for testing it in the health organization and making adaptations to the health organization's needs. The health organization is the pilot's site. It brings patients who test the solution and clinicians who design it to their and their patients' needs and measure its outcomes. The MOH brings funding, regulation and project management specialists.

The main beneficiaries of the pilots that challenge tenders made possible are patients. By using this unique model, we were able to choose different solutions, some of which we didn't know exist. In the fall prevention challenge tender, we were able to choose a solution that was added to existing treadmills in physical therapy institutions, adding a fall prevention aspect to the given treatment. The successful pilot turned into a large implementation affecting thousands of patients.

The first outcome using the challenge tender method was in the field of fall prevention among elders. The product we chose was designed to train elders, as part of their physical therapy sessions, and prevent them from falling. The pilot, involving 200 patients considered in 'medium-to-high' risk category who received 15 sessions of training over 6-7. The results after comparing 6 months before and after intervention showed 71% reduction in the number of falls; 46% reduction in ER visits; 34% reduction in hospitalization days; 28% reduction in FAS; 19% reduction in TUG. These amazing results led to deployment of this solution to dozens of sites throughout Israel. An enormous focus is being put on measuring clinical, usability and financial outcomes in order to value impact. We expect that by giving incentives to health organizations to conduct pilots and measure outcomes, technologies with great impact will be implemented into our health system and solve concerning problems.

The first challenge in executing a challenge tender is choosing the problem we want to address. There are many health needs and problems in our health system and in order to choose a solution that has great impact we need to a well define the problem. We chose to focus on fall prevention and on improving care in long term care facilities. These both 2 topics are one's that innovation and technology have a hard time entering to due to market failure, lack of resource and time issues. Then there is choosing the digital solution from a variety of different solutions in different domains of intervention which enters the tender. We need to make sure that we choose a solution that actually prevent falls, that is clinically tested and that has a high chance of being adopted into the health system. For that purpose, we assembled a committee composed of both clinicians from the MOH, geriatric experts and project management experts, which had to choose the best digital solution for the pilot.

I think first of all it is important to challenge ourselves and come up with 'outside the box' thinking. We took traditional tenders and by adapting ourselves to the needs of the health system, came up with a different method, challenge tender, in order to answer needs of the health system which weren't being answered (prevention of falls, geriatric institutional care). Then we need to create a high enough incentive for start-ups to submit their technologies. We need to create a collaboration between the start-up, a health organization and the MOH strong enough in order for the pilot to succeed, answering each party's needs and demands. We need to put together a team, a management and professional team from the MOH and a management and professional team from the health organization to establish the guidelines for intervention and the success measurements. Also we need to fund all pilot's aspects and provide a road map for future scaling and implementation if the pilot succeeds

After a successful fall prevention pilot, we took out a challenge tender seeking ways to improve geriatric care in long term institutions. Caregivers in geriatric institutions have very high workload, poor digital skills, language barriers sometimes even illiteracy, they have a very high turnover rate, high reliance on paper instead of digital tools and low reliable documentation abilities. These all, lead to gaps in continuity of care and have high impact on patient care. We asked the start-up industry to offer digital solutions to these urging problems and received a few dozens of solutions. We chose a digital icon based app that enables caregivers to replace manual reporting, that streamlines their work and has an interface with patient EMR. This pilot turned out to be very successful and we now give incentives for geriatric institutions to implement such solutions. This type of challenge tender has the potential to be replicated for other urging problems in the health system.

There are a few lessons I would like to share. First, not to be afraid to try and do things different than before. Even strict fields like governmental tenders can transform and be a bit more flexible if we think 'outside the box'. The second lesson is not to limit yourself to what you know. We knew many digital solutions to many of our burning problems, and still, we were surprised to learn how many good solutions there are out there that we didn't know. By only defining the problem and allowing the start-up industry to offer different solutions from different domains, we eventually chose to test and pilot wonderful solutions we may have never even knew existed. Third, collaboration is the key to successful outcomes. Without the engagement of clinical teams, project management teams and IT, from the MOH, the health organization and the start-up, we wouldn't have been able to reach such fast and great results. And last lesson, but not least, Try, maybe you will even succeed!