The Future of. Health Informatics. in Hong Kong. Dr N.T. Cheung Chief Medical Informatics Officer Hong Kong Hospital Authority. Tuesday, 16 June 2009
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1 The Future of Health Informatics in Hong Kong Dr N.T. Cheung Chief Medical Informatics Officer Hong Kong Hospital Authority 1 The Hospital Authority 40 Hospitals 45 Specialist Clinics 74 General Clinics 9M patient records 1M annual admissions 13M ambulatory visits 52,000 staff 2
2 Health Informatics in HA The Clinical Management System By the Numbers 3 Development in the HA A long journey Green fields Patient Administration Pharmacy system Lab results online Radiology Information System Clinical Management System CMS Phase II esars Direct clinician documentation and order entry Electronic Patient Record (epr) epr Image Distribution PPI epr sharing CMS Phase III 4
3 Clinical Management System (CMS) 5 4,000,000 3,000,000 CMS - Daily Transactions 3,206,358 3,530,866 2,290,261 2,000,000 1,827,647 1,000,000 0,
4 epr summary screen Patient, Laboratory results 8
5 epr - Scale! 8.9M patients! 223M episodes of care! 890M laboratory results! 70M radiology studies! 388M drug items! 3.5M updates / day! 700K hits / day! Sub-second response time! 7x24 >99.98% uptime since live run 9 Medication Decision Support (2008) Drug Allergy Checking Drug Allergy Alerts Raised 68,790 Alert Accepted 32,102 (47%) Alert Overridden 36,688 (53%) Drug Drug Interaction Checking DDI Alerts Raised 10,975 Alert Accepted 3881 (35%) Alert Overridden 7094 (65%) 10
6 11 Outcomes Decreased Total Emergency Admissions Episodes of Emergency Admission p= % Control Group TNCS Group 12
7 13 Clinical Informatics Governance in the HA 44 groups 160 doctors. 100 others. 14
8 Protecting Privacy!Policies & procedures!people & Promulgation!Technology!Planning 15 Issues and challenges Ever increasing demand Reducing risk and increasing quality Ageing technology Changing environment and business needs Healthcare Reform 16
9 Dr Obama Aims to Treat the US Economy and the US healthcare system! $19 Billion dollars for Health IT 17 The Way Forward HK-wide Electronic Health Record (ehr) 18
10 Without ehr HA Doctors & Nurses Private Hospitals Other healthcare professionals Private Clinics DH X-ray Laboratory 19 With ehr Doctors & Nurses Other healthcare professionals HA Patients Private Hospitals DH X-ray Private Clinics Laboratory 20
11 Patientoriented healthcare records Why ehr? Family doctor concept; integrated primary and hospital care Public-private interface and partnership HA Private Hospital ehr --- Essential Infrastructure for Healthcare Reform 21 Steering Committee on ehealth Record Sharing WG on Institutional Arrangements WG on Legal, Privacy and Security Issues WG on ehealth Record and Information Standards WG on ehr Partnership Participation of all stakeholders Department of Health; Hong Kong Academy of Medicine; Hong Kong College of Family Physicians; Hong Kong College of Radiologist; Hong Kong College of Pathologist; Hong Kong Hospital Authority; Hong Kong Medical Association; Hong Kong Doctors Union; Hong Kong Private Hospitals Association; Other healthcare partitioners and allied health professionals; Health informatics and healthcare IT professionals; Consumer Council; Office of the Government Chief Information Officer; Office of the Privacy Commissioner for Personal Data 22
12 Guiding Principles for ehr development Government led model Compelling but not compulsory record sharing Privacy and security of paramount importance Open technical standards Building block approach 23 Vision DH HA epr Private Hospitals EHR Repository Access Portal CMS onramp PPP Clinics software 24
13 ehr Time Line 09/10 10/11 11/12 12/13 13/14 14/15 15/16 16/17 17/18 18/19 Sharing Cove erage 0.1M 0.2M 0.3M 0.5M 1M 2.5M 4.5M 5.5M 6M HA CMS adaptation (Basic) CMS adaptation (Advanced) DH epr and computerizations PH systems upgrade Interface pilots ehr infrastructure Phase 1 ehr (Dr portal) Phase 2 ehr (Patient portal) CMS on ramp ehr Certification Scheme PPI-ePR and pilots Standardization - ongoing 25 Privacy & Security Explicit consent, Patient control Strong authentication Security by design Segregation of duties Privacy & security reviews Review legislative framework 26
14 Public-Private epr sharing Piece of mind Trusted users Secure Platform 27 60,000 patients 1,400 healthcare providers 28
15 Expensive Globally UK 12.4 billion NPfIT programme to computerize the NHS (HK$2300 per capita) Canada Health Infoway investment total cost expected CAD 10-12B (HK$2250 per capita) USA Kaiser Permanente investing U$4B in HealthConnect project (HK$2800 per capita) Total HK estimate HK$900 per capita 29 The Goal 30
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