Health Informatics - Transforming healthcare delivery in Hong Kong. Presented by Dr Ngai-Tseung Cheung, Head of Information Technology and Health Informatics/Chief Medical Informatics Officer, Hong Kong Hospital Authority, at HINZ 2014, 11 November 2014, 9.15am, Plenary Room

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
A standardised eHealth system can achieve
better, safer, more efficient care delivery
on an industrial scale at a reasonable cost
4

5. HA IT Services Hospital 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 the HA -
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. Electronic Patient
Record
7

8. HA’s Clinical Management System
- 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 Habits of 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: Step by Step
Strategizing
Building
/Implementing
Acculturating
Realizing
benefits
10

11. Principle 5: Use it 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
in the 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: Discharge and
outpatient prescriptions
• Legible, standardized orders
–Standardized formulary
–Structured data
• Link to pharmacy
• Full medica-on history
–Reduced transcrip-on
14

15. Stage 2: Drug checking
• 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: Closed loop
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
Feature Safety 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
with barcodes
• Electronic orders
• Bedside label
printing for all
specimens
• Closed loop
barcoding for
transfusions
20

21. Mis-­‐iden-fica-on
Incidents per month
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 Risk Reduc-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 CHCC Services 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
Chronic Disease 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. NDORS
30

31. MDRO - management of
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 Antibiotics Utilization
- Moving from retrospective to prospective review
32

33. Public-private integration
Secure
Trusted
Peace of Mind
33

34. The Hong Kong Wide
Electronic Health Record
34

35. eHR - An essential 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 Sharing System
EHR
Repository
Access Portal
DH
HA
ePR
PPP
CMS
onramp
Clinics
software
Private
Hospitals
Private
Hospitals
Clinics
software
36

37. eHR OnRamp
37

38. eHR Viewer
10-­‐Feb-­‐2012 Diabetes 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
A standardised eHealth system can achieve
better, safer, more efficient care delivery on
an industrial scale at a reasonable cost
39

40. Bold Claim
A standardised 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