HIMSS ASIAPAC 11 CONFERENCE & LEADERSHIP SUMMIT SEPTEMBER 2011 MELBOURNE, AUSTRALIA

Transcription

1 HIMSS ASIAPAC 11 CONFERENCE & LEADERSHIP SUMMIT SEPTEMBER 2011 MELBOURNE, AUSTRALIA

2 Public-Private Partnership (PPP) Projects as Cornerstones of ehr Development in Hong Kong Dr CHOY Khai Meng Chief Manager (Service Transformation), Hong Kong Hospital Authority Consultant (Public-Private Partnership), Food and Health Bureau, The Government of the HKSAR 9/22/ Healthcare Information and Management Systems Society 2

3 Hong Kong Healthcare System 9/22/ Healthcare Information and Management Systems Society 3

4 HKSAR Public Healthcare Management Hierarchy 9/22/ Healthcare Information and Management Systems Society 4

5 Source: (1) GDP: 2009 (2) Inpatient (secondary & tertiary care) : Public-private share by inpatient treated in 2009 from HA and Dept of Health (3) Outpatient (primary care) : Thematic Household Survey Report No. 41, Census and Statistics Dept (data collected during Feb May 2008) Hong Kong Healthcare System Dual System Public Highly subsidized by govt Private Self-financed by patients 2.9% GDP 10% inpatients 2.4% GDP 70% outpatients 90% inpatients 30% outpatients Public Health 9/22/ Healthcare Information and Management Systems Society 5

6 Healthcare Structure in Hong Kong Primary Care (distribution of consultations) Public Doctors 28.9% Others 1% Chinese Medicine Practitioners 13.6% Private Hospitals/ Doctors 10% Secondary and Tertiary Care Private Doctors 56.6% Source: (1) Thematic Household Survey Report No. 41 Census and Statistic Dept, September 2009 (2) Public/private share by in-patient bed day in 2009 (HA & Dept of Health) 9/22/ Healthcare Information and Management Systems Society Hospital Authority 90% 6

7 HKSAR Public Expenditure on Health ( Estimate) Education 21.4% Housing 4.3% Community and External Affairs 3.3% Economic 4.6% Environment and Food 4.2% Infrastructure 6.4% Security 11.5% Health 15.2% Support 12.8% Social Welfare 16.3% Source: The Budget 9/22/ Healthcare Information and Management Systems Society 7

8 Fees and Charges for Eligible Persons Service Fees Cost Subsidized Rate Accident & Emergency $100 per attendance $700 86% In-patient (general acute beds) $100 per day $3,790 97% In-patient (convalescent, rehabilitation, infirmary & psychiatric beds) Specialist out-patient $68 per day $1,460 95% $100 (1 st attendance) $60 (subsequent attendance) $530 81%-89% Specialist out-patient (drug) $10 per drug item $120 92% General out-patient $45 per attendance $250 82% 9/22/ Healthcare Information and Management Systems Society 8

9 We take pride in our current health care system We will develop a territory-wide, patient-oriented electronic health record. Donald Tsang Chief Executive Hong Kong Special Administrative Region October /22/ Healthcare Information and Management Systems Society 9

10 Healthcare Reform concerns the welfare of each individual in our community and our future generations These proposals include enhancing primary healthcare, developing electronic health record sharing, promoting public-private partnership and strengthening public healthcare safety net. Henry Tang Chief Secretary for Administration Hong Kong Special Administrative Region March /22/ Healthcare Information and Management Systems Society 10

11 Without ehr Other Healthcare Professionals Private Hospitals Doctors & Nurses HA Private Clinics DH X-ray Images Laboratories 9/22/ Healthcare Information and Management Systems Society 11

12 With ehr 9/22/ Healthcare Information and Management Systems Society 12

13 Efficiency Gain About $860 million per year in total health expenditure 9/22/ Healthcare Information and Management Systems Society 13

14 Guiding Principles of ehr Sharing System Government-led model for development Compelling but not compulsory record sharing Data privacy and system security of paramount importance Open technical standards for private participation Building-block approach for ehr components 9/22/ Healthcare Information and Management Systems Society 14

15 The ehr Vision Realise the concept records follow patients Enable patient-centred healthcare Enhance primary care Facilitate hospital-primary care interface and public-private partnership 9/22/ Healthcare Information and Management Systems Society 15

16 Current Status in Hong Kong Hospital Authority 8 million patient records 800 million laboratory results 340 million prescriptions 34 million X-ray images 3 million transactions per day Department of Health Essential data (e.g. Immunization records) Upgrading the system for ehr connection Private Hospitals Systems mainly for billing and financial purposes Electronic records lack sharing capability Private Clinics Electronic records lack sharing capability Private Laboratories / Allied Healthcare Providers Partial connection available (eg. radiology image sharing) 9/22/ Healthcare Information and Management Systems Society 16

17 Major Milestones Year Hospitals Clinics Ancillary Radiological image sharing with private hospitals; Integration of Healthcare Voucher scheme with ehr Pilot use of SmartID for patient authentication Clinical Management System (CMS) adaptation basic modules Begin patient enrollment Laboratory sharing Community Person Master Index (PMI) CMS on ramp HK Drug table 2013 Shared records in Doctor Portal 9/22/ Healthcare Information and Management Systems Society 17

18 Benefits of Public-Private Partnership (PPP) Saving and Cost-Effectiveness By purchasing services from private sector under bulk contracts, public hospitals can focus more on priority services. Optimal Use of Human Resources Fuller use of human resources in private sector by delivering service for public sector patients. Cross-Fertilization of Expertise and Collaboration Involve private sector to collaborate and cross-fertilize expertise between public and private sector. 9/22/ Healthcare Information and Management Systems Society 18

19 Possible PPP Models for Hong Kong Purchase primary care services from private sector Partially subsidize patients for preventive care Pursue PPP in hospital development (through co-location of public and private facilities at same sites) Purchase low priority service from private sector Set up multi-partite medical centres of excellence Engage private sector doctors in public hospitals 9/22/ Healthcare Information and Management Systems Society 19

20 Public-Private Partnership Projects in Hong Kong Public-Private Interface-Electronic Patient Record Sharing Pilot Project (PPI-ePR) Cataract Surgeries Programme Tin Shui Wai Primary Care Partnership Project Shared Care Programme Radiological Image Sharing Pilot Project Development of Private Hospitals 9/22/ Healthcare Information and Management Systems Society 20

21 Public-Private Interface Electronic Patient Record Sharing Pilot Project (PPI-ePR) Launched in April 2006 PPI-ePR is a prelude to ehr System 9/22/ Healthcare Information and Management Systems Society 21

22 PPI-ePR Citizens and Healthcare Professionals Buy-In 160, , ,000 Over 2,249 private healthcare professionals enrolled 100,000th citizen 100,000 80,000 60,000 40,000 20,000 10,000th citizen Over 153,591 citizens enrolled 0 Apr 2006 Jun 2007 Jul 2010 Jun /22/ Healthcare Information and Management Systems Society 22

23 PPI-ePR : Win-Win-Win Situation Accurate patient records for better diagnoses Minimize potential danger of drug allergy Facilitating the establishment of long-term doctor-patient relationships Efficiency gain by reducing the number of consultation and avoiding paper records Better Patient Care Save money, time, hassles, & pain to repeat unnecessary lab tests Earlier lab test results Peace of Mind, Control Quicker and better diagnoses Second opinions More choices Healthcare Professional Patients PPI-ePR HA Alleviate tremendous pressure imposed onto public hospitals Earlier treatment for HA patients Optimal Resource Utilization and Flexibility 9/22/ Healthcare Information and Management Systems Society 23

24 PPI-ePR Security Measures Hospital Authority Private Hospitals / Clinics Patient receives SMS informing of access to record CMS Secure Token ehr Firewall Shared Record Firewall PPI-ePR User Password Secure Platform with FIREWALL and ENCRYPTION Patient PIN 9/22/ Healthcare Information and Management Systems Society 24

25 Partnership Models at a Glance Mgt protocol Eligible patients PMPs 9/22/ Healthcare Information and Management Systems Society 25

26 Cataract Surgeries Programme (Launched in 2008) The first of its kind PPP Project to offer choices to eligible patients on HA s cataract waiting list to receive surgeries in the private sector. Up to $8,000 co-payment by patient $5,000 fixed subsidy 9/22/ Healthcare Information and Management Systems Society 26

27 Tin Shui Wai Primary Care Partnership Project (Launched in 2008) Purchase of primary care services from private doctors for a specified group of patients who have been attending the public general outpatient clinic for chronic illnesses such as hypertension and diabetes. Co-payment Same fee as GOPC + Subsidy Patient Private Doctor $150 per consultation, 10 times per year 9/22/ Healthcare Information and Management Systems Society 27

28 Shared Care Programme (Launched in 2010) The programme pilots a new model of PPP in providing comprehensive and multi-disciplinary healthcare services to diabetes mellitus and hypertension patients Public Sector HA OP Clinics (mainly SOPCs) Private Sector Patients with DM and/or HT Comprehensive Risk Assessment Subsidy + Co-payment Evidencebased Mx protocol PMPs PPI-ePR & ehr Lab tests Lab tests & investigations Fast track referral for deterioration Drugs Quality incentive to PMPs & patient incentive Comprehensive care 9/22/ Healthcare Information and Management Systems Society 28

29 Radiological Image Sharing Pilot Project (Launched in 2009) The project allows participating private healthcare providers with the patient's consent to send the radiological images of enrolled patients to the Hospital Authority via electronic means. Private Sector Public Sector Radiology facility Gateway and servers CMS / epr 9/22/ Healthcare Information and Management Systems Society 29

30 Development of Private Hospitals Proposals on hospital development with PPP models EOI Exercise launched by the Government TAI PO 14 Dec 2009 to 31 Mar 2010 TSEUNG KWAN O LANTAU WONG CHUK HANG 9/22/ Healthcare Information and Management Systems Society 30

31 THANK YOU Dr CHOY Khai Meng 9/22/ Healthcare Information and Management Systems Society 31