Uploaded byHealth Informatics New Zealand
Health informatics - Transforming healthcare delivery in hong kong
The document discusses the advancements in health informatics in Hong Kong, emphasizing the establishment of a standardized eHealth system aimed at improving healthcare delivery efficiency and safety. With a focus on data management and patient safety, the system has led to significant operational improvements and cost savings in healthcare services. It also highlights the ongoing development of integrated electronic health records and the impact of health informatics on chronic disease management and patient intake processes.
More Related Content
Similar to Health informatics - Transforming healthcare delivery in hong kong
More from Health Informatics New Zealand
Health informatics - Transforming healthcare delivery in hong kong
- 1. Health Informatics -transforming healthcare delivery in Hong Kong NT Cheung Head (IT & HI) / CMIO, HK Hospital Authority Consultant(eHealth), HK Government 1 1
- 2. Total Expenditure on Health as Percentage of GDP % 16 14 12 10 8 6 4 2 1991 1993 1995 1997 1999 2001 2003 2005 USA France New Zealand Sweden UK Australia Japan 5.4% = 2.4% + 3.0% GDP Public Private Hong Kong 2011 Year 2007 2009 18 2011 Sources: (1) Census and Sta2s2cs Department, 2011 GDP (2) OECD Health Data October 2012 2 2
- 3. Walker et al,“The Value Of Health Care Information Exchange And Interoperability” Health Affairs 2005 “…net savings from national implementation of fully standardized interoperability between providers… could yield $77.8 billion annually” “…We suspect that the clinical payoff in im-proved patient safety and quality of care could dwarf the financial benefits projected…” 3 3
- 4. Key Message Astandardised eHealth system can achieve better, safer, more efficient care delivery on an industrial scale at a reasonable cost 4
- 5. HA IT ServicesHospital Authority ❑ Established 1991 ❑ 42 Public Hospitals ❑ 47 Specialist Outpatient Clinics (SOPD) ❑ 73 General Outpatient Clinics (GOPC) ❑ Close to 27,500 Beds ❑ Around 67,600 Staff ❑ Around 22,700 Nurses ❑ Around 5,700 Doctors ❑ Around HK$ 46b Annual Operating Budget (~US$6 billion) ❑ 6.10m GOPC Attendances ❑ 9.37m SOPD Attendances ❑ 2.24m A&E Attendances ❑ 1.57m Inpatient and Day Patient Discharges New Territories East Kowloon West New Territories West Kowloon Central Kowloon East Hong Kong West Hong Kong East Source: 1. HA Statistical Report 2012/13 2. HA Information Fact Sheet Jun 2014 3. www.ha.org.hk 5 5
- 6. eHealth in theHA - An ongoing journey 1990 1991 1995 2000 2003 2004 2006 2008 2009 2010 2013 “Green fields” Patient administration + Departmental systems Clinical Management System (CMS) Electronic Patient Record (ePR) eSARS ePR Image Distribution PPI ePR sharing CMS Phase III Filmless HA Hong Kong wide eHR Inpatient MOE Mobile CMS 6 6
- 7.
- 8. HA’s Clinical ManagementSystem - An essential clinical tool • 10M patients • 357M episodes of care • 1.8B laboratory results • 423M radiology images • 723M drug items • 5.1M updates / day • 1.6M hits / day • Sub-second response time • 7x24 >99.98% uptime since live run 8 8
- 9. The Seven Habitsof Highly Effective Informaticians 1. The customer is always right 2. Medicine is an art and a science 3. Win - Win - Win - Win - Win 4. One step at a time 5. Use it or lose it 6. Focus and prioritize 7. Embrace your informaticians 9 9
- 10. Principle 4: Stepby Step Strategizing Building /Implementing Acculturating Realizing benefits 10
- 11. Principle 5: Useit or Lose it Low data use Poor data quality Data use Data quality 11 11
- 12. Documentation becomes knowledge ePR Management data should be a byproduct of clinical documentation Data warehouse Diseases & procedures Departmental data Generic clinical documentation Clinical Data Analysis & Reporting (CDARS) 12 Reports & Analytics 12
- 13. Medication management inthe CMS Discharge medica-on Outpa-ent prescrip-ons Drug checking Inpa-ent closed loop medica-ons 1995 1996 2002 2013 20 13
- 14. Stage 1: Dischargeand outpatient prescriptions • Legible, standardized orders –Standardized formulary –Structured data • Link to pharmacy • Full medica-on history –Reduced transcrip-on 14
- 15. Stage 2: Drugchecking • Purchase of third party drug checking system • Capture allergies as structured data • Monitor override reasons –Adjust level of alerts • Add customized checking logic 15
- 16. Improving medication safety • Since 2005, a CMS alert has caused the prescribing doctor to change a medication over 350,000 times – Allergy - 272,303 times – G6PD - 9,548 times – Pregnancy - 25,502 times – Drug-drug interaction - 38,162 times – Adverse drug reaction - 9,918 times 16
- 17. Stage 3: Closedloop inpatient medications • Electronic Prescribing • Prescription vetting & dispensing • eMAR & barcoded administration 17
- 18. New Prescribing Features Feature Safety Efficiency IV Drugs and IV Fluid infusion ✔ ✔ orders Permissible diluents ✔ ✔ White / Black routes ✔ Conditional order ✔ ✔ Verbal orders ✔ Common orders ✔ Standardized drug display ✔ format Dose calculation with Body weight ✔ ✔ Medication reconciliation ✔ ✔ Digital signing ✔ 18
- 19. Administration Features FeatureSafety Efficiency Barcoding of right patient, drug, time ✔ ✔ Reminders and task lists ✔ ✔ Standardized schedules ✔ Verbal orders ✔ Urgent refills ✔ Barcode labels for prepared drugs ✔ ✔ Dose calculation with Body weight ✔ ✔ Downtime handling ✔ 19
- 20. Patient safety withbarcodes • Electronic orders • Bedside label printing for all specimens • Closed loop barcoding for transfusions 20
- 21. Mis-‐iden-fica-on Incidents permonth 10 8 5 3 0 Pa-ent iden-fica-on using 2D barcode scanning for Hospital A Hosptial B Hospital C Hospital D Hospital E Hospital F Accurate patient identification using 2D barcode technology laboratory specimen collec-on Misiden-fica-on in department not using 2D barcode scanning -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12 Month(s) pre & post implementa-on 21
- 22. HARRPE (Hospital Admission Risk Reduction Programme for the Elderly ) Risk stratification for elderly Patients Targeted intervention by call centre nurses 22 22
- 23. Hospital Admission RiskReduc-on Programme for the Elderly (HARRPE) 14 Predictor Variables HARRPE score 09/05/11 ©2011 Healthcare Informa-on and Management Systems Society Type 23
- 24. Evaluation A&E attendance 27% Acute patient days 19% Emergency admission to medical ward 26% 24
- 25. Community Health Call Centre (CHCC) Identifying at-risk patients from the total population Delivering the patient lists to appropriate care providers in a timely fashion Enabling new models of care delivery 25
- 26. Development of CHCCServices to Support Chronic Disease Management DM patients cared by HA : ~360,000+ Foster Better Self-‐management by Structured Telephone Advice -‐ Exercise -‐ Medication Management -‐ Diet -‐ Self-‐monitoring Supporting all clusters, ~ 7,000 targeted DM patients in GOPCs Handled ~ 70,000 calls in 2013/14 26 Development of CHCC services to support DM patients with sub-‐optimal disease control (2011) 26
- 27. Evaluation on ChronicDisease Management-‐ DM Program Additional 0.23% point* reduction in HbA1c Improvement in Behaviours Improvement in HbA1c 27 27
- 28. Community Health Call Centre (CHCC) High risk elderly (HARRPE) Mental Health Direct Chronic Disease Management Defaulter tracing 2007 2011 2012 2013 28
- 29. Communicable disease & outbreak management eSARS eFlu, NDORS (No-fiable Outbreak & Repor-ng System) eMilk (melamine tainted milk tracking) MDRO (mul--‐drug resistant organism) 2003 2005 2008 2012 29
- 30.
- 31. MDRO - managementof superbugs Lists of MDRO positive results from lab system Tagging of MDRO positive patients Admission alert on MDRO positive patients Monitoring of overall MDRO situation 30 31
- 32. Big Gun AntibioticsUtilization - Moving from retrospective to prospective review 32
- 33. Public-private integration Secure Trusted Peace of Mind 33
- 34. The Hong KongWide Electronic Health Record 34
- 35. eHR - Anessential health infrastructure Patient-oriented healthcare records Public-private interface and partnership DH Family doctor concept; integrated primary and hospital care HA Private Hospitals Electronic Health Records Sharing Infrastructure 35
- 36. HK-wide eHR SharingSystem EHR Repository Access Portal DH HA ePR PPP CMS onramp Clinics software Private Hospitals Private Hospitals Clinics software 36
- 37.
- 38. eHR Viewer 10-‐Feb-‐2012Diabetes Mellitus AHN 10-‐Feb-‐2012 Type II DM with background retinopathy AHN 10-‐Feb-‐2012 Type II DM with over nephropathy AHN 04-‐Jan-‐2004 Hepatitis Hospital A 04-‐Jan-‐2004 Portal hypertension Hospital A 04-‐Jan-‐2003 Acute upper respiratory infection Hospital A 01-‐Feb-‐1999 Viral hepatitis Dr Wong 38 38
- 39. Key Message Astandardised eHealth system can achieve better, safer, more efficient care delivery on an industrial scale at a reasonable cost 39
- 40. Bold Claim Astandardised eHealth system can achieve better, safer, more efficient care delivery on an industrial scale at a reasonable cost In fact it may be the only thing that can do so 40