eHealth and connected care in Hong Kong
Hong Kong has a population of around seven million people, many living in areas with some of the highest population density in the world. Demographic trends would be familiar to Australians: while net growth in the general population from 2008 to 2016 is forecast at eight per cent, the corresponding increases for people aged 65 and over is expected to be 30 per cent. For people over 80, the increase is forecast at 43 per cent.
The Hong Kong Government expects this imminent, rapid ageing of the population to result in a dramatic increase in the demand for healthcare services. The 10 conditions with the highest bed-day consumption in Hong Kong’s public hospitals are predominantly chronic diseases.
Around 90 per cent of the hospital beds in Hong Kong are provided by the Hong Kong Hospital Authority (HKHA) through 39 hospitals. HKHA also delivers around eight million specialist outpatient attendances per year and five million primary care clinic attendances, via 120-plus clinic sites. Primary care is mainly privately provided.
The needs of its front-line clinicians have been targeted by the HKHA for nearly two decades. Today, integrated electronic patient records (EPRs) can be accessed in any of the HA’s hospitals, specialist or general clinics. Comprehensive electronic records (including images) exist for around 9.6 million patients, some spanning more than 10 years.
The clinical system (CMS) has largely been designed, developed and implemented in-house at relatively modest cost by international standards. HKHA retains a high degree of expertise in clinical IT, and is currently developing the third generation of the CMS. Clinical IT outside the public hospital sector, however, is still quite limited.
Development of electronic health record sharing across the entire health sector was one of five streams of healthcare reform proposed by the Hong Kong Government in 2008. Realisation of this vision commenced with the Public-Private Interface – Electronic Patient Record Sharing Pilot Project (PPI-ePR), which allows authorised healthcare practitioners to access HKHA’s patients’ records with the patients’ consent.
By June 2011, the PPI-ePR pilot had enrolled over 153,000 patients and 2250 private healthcare professionals. Participating clinicians need a user ID, a password and a PKI token to access the patient records. When a patient’s record is viewed, the system sends an alert in SMS format to that patient’s mobile phone.
A listing of participating private medical practitioners is publicly available via the HKHA website, not only enhancing accountability but also contributing to patient choice.
While the current PPI-ePR system does not allow private providers to upload their patient records, a more comprehensive shared electronic health record (EHR) scheme is under development. The EHR will comprise sufficient content to support continuity of health care on transfer/referral, improve the quality of health care and enhance health service efficiency.
Other key initiatives focusing on connected care include:
- The Community Health Call Centre. This system supports continuity of care for more than 43,000 high-risk HA patients in the community – after discharge from hospital for follow-up care - with telephone support via a call centre. HKHA’s extensive clinical data sets have been mined to produce evidence-based markers for patients at risk of re-admission, and these feed the follow-up program.
- Public Private Partnership (PPP) programs for patients with chronic diseases. HKHA has a number of on-going collaboration projects to work closely with private healthcare institutions and non-government organisations to support shared care for patients suffering from a targeted group of chronic diseases. Electronic sharing of patient records is crucial to the model of collaborative care and this work is paving the way towards a future patient care model leveraging the territory-wide EHR.
- Closed loop communications. Pilot projects for supporting better clinical communication and for radiological image notification are under way. These projects aim to improve patient safety and work efficiency of healthcare providers by integrating information from a range of sources into the daily workflow of frontline colleagues.
Two of the major reasons for the success of clinical IT in the HKHA are strong clinical systems governance with deep engagement of clinicians, and a stable team of health informatics and IT colleagues who continue to work hand in hand with their clinical colleagues to ensure the system genuinely delivers clinical functionalities and benefits.
Hong Kong has an extensive clinical governance system. Its network of advisory committees has 160 doctors and 100 other health workers regularly participating in the design and ongoing development of the system. Hong Kong’s Society of Medical Informatics was established in 1987, and provides active, powerful and targeted leadership.
Hong Kong has also long recognised health informatics capacity-building as a fundamental enabler of health reform. This has been belated in Australia, although Health Workforce Australia’s willingness to investigate health informatics requirements now demonstrates forward thinking.
We can also learn from Hong Kong’s pragmatism: when private hospitals receive patients from public hospitals (when capacity is stretched) private doctors must enter these patients into a shareable electronic record if they are to be reimbursed. For example, 20,000 patients annually are sent to private hospitals for cataract surgery. Each operation costs HK$7000 (A$870). To receive this money, private doctors have to use the system. Likewise, most of the private radiological facilities absorbing the workload of public system MRI and CT scans have bidirectional sharing of images. This latter group does not receive imbursement, but recognises the value of enhanced chance of referral.
We can also learn from Hong Kong’s sustained, coherent and convergent leadership. Messages are continually and mutually reinforced (e.g. branding such as “eHealth Record — Continuity of Care for You”), eHealth is continuously cited as one of a very small number of tenets for health system improvement, and planning is refreshed appropriately such that it can lead eHealth activity — Australia’s National e-Health Strategy was produced in 2008 and is arguably overdue for refreshment, given huge changes in the Australian healthcare landscape.
About the author
B.Ec.(Hons), G.D.B.A., FACHI, AFACHSM
Managing Director: Direkt Consulting
David Rowlands is managing director of Direkt Consulting, a management consulting company with offices in Australia, Hong Kong and Singapore. He is heavily involved in health informatics in Australia and internationally. Thanks also to Dr C.P. Wong, Chairman of the Hong Kong Society of Medical Informatics Limited.
Posted in Australian eHealth