1
The Road Less Travelled -Clinical IT in the Hospital Authority
N.T. Cheung, MBBS
Executive Manager, Health Informatics,
Hong Kong Hospital Authority
Agenda
• Introduction - Healthcare in Hong Kong
• The Hospital Authority’s
Clinical Management System &
Electronic Patient Record
• Delivering business (clinical) benefits
Hong Kong
• Area 1100 km2
• Population 7 million
• Tourists 22million / year
• Proximity to likely future health hotspots
Healthcare in Hong Kong
12%
70%
3%
15%
Primary CarePrimary Care
5%
95%
Secondary & Tertiary CareSecondary & Tertiary Care
OthersOthersDept. HealthDept. HealthPrivatePrivate Hospital AuthorityHospital Authority
2
NTW
HKW
NTE
KE
KW
KC
HKE
Public
Private
Hospitals in Hong Kong Hospital Authority
40 Hospitals with inpatient service15 Emergency Departments36 Specialist Outpatient Clinics14 Integrated Clinics50 General Outpatient Clinics
1,000,000 inpatient admissions2,000,000 emergency visits2,000,000 allied health consultations4,000,000 general outpatient consultations 5,500,000 specialist consultations
2003-2004
Hospital Authority
The Clinical Management System (CMS)
& Electronic Patient Record (ePR)
The journey - built in-house since 1991
The system - one integrated system for
6.5 million patients
3
1990 – “Green fields”
1991 – Patient Administration
1992 – Pharmacy system
1993 – Lab results online
1994 – Obstetric specialty system
1994 – Radiology information system
1995 – Clinical Management System• Direct clinician documentation and order entry
2000 – CMS Phase II• Electronic Patient Record (ePR)• Generic modules
2003 – eSARS
2005 – CMS Phase III
The Journey
6.5 million patient records
29000 clinical users
12000 workstations
CMS Today
Success Factors
! A strategic vision of clinical IT and top levelsupport
! Sustained funding allowing continuousdevelopment
! Development of informatics and technologycapabilities
! Engaging the clinicians
! Delivering organizational value
IT Governance Structure
Hospital Authority Board
Supporting ServicesDevelopment Committee
IT Advisory Committee
IT Policy Group
Head Office Directors Cluster Chief Executives
Chair: IT TechnicalReference Group
Other Members/Advisors
Chair: Clinical InformaticsSteering Group
Chair: ERP ProjectSteering Committee
4
KEHAHO KWKCHKWHKE NTWNTE
IT Governance
HA Board Supporting Services Development Committee
Information Technology Policy Group
Clinical Informatics Program Steering Group
Enterprise Resource Planning Project Steering Committee
Information Technology Technical Reference Group
IT G
OV
ER
NA
NC
E G
RO
UP
S
IT Capabilities
For internal use of HKHA only. © 2004 Gartner, Inc. and/or its affiliates.
All Rights Reserved.Page 12
HKHAExecutive Briefing 9 November 2004
consulting
Application Development Process Maturity
0.0
1.0
2.0
3.0
4.0
5.0
Application Design
Build & Test
Finance & Governance
IT Capability
Measures & Metrics
Project Management
Skills
Sourcing
Capabilities
User Requirements
Assessment Scale
0 = Non-Existent / Not Applicable
-
activity/processes are not applied at all.
1 = Informal -
2 = Documented -
3 = Formalized
-4 = Measured
5 = Leading
HA Results
>= 35% of
Large
IT ShopsMaturity
Target
HA Clinical Systems Network
Services FrontEndDatabase EnginesEngines
Scheduling
CommunicationsWorkflow
Information ArchitectureInformation Architecture
GCD (forms) engine
Terminology engine
Imaging
Rules engineRules engine
Knowledge
Messag
ing
an
d in
teg
rati
on
Pre
sen
tati
on
serv
er
SecuritySecurity
UserAudit
Informatics-led DesignOperationalOperational
LayerLayer
ePRePR Layer Layer
5
Clinician Engagement The Key Success Factor
! Overcome skepticism and resistance
! Demonstrate success
! Gain widespread clinician buy-in
! Clinicians become the drivers
A system built byclinicians for clinicians
Mr Andre GREYLING
HAHOFunctionalCommittees
ClusterClinical
InformaticsCoordinators
PolicyCommittees
TechnicalCommittees
Co-optClinical
Members
New ClinicalSystems
DevelopmentCommittees
Clinical InformaticsProgram Office
Clinical Informatics ProgramSteering Committee
CIPSG
Successful Engagement - “PUSH” Becomes “PULL”
! Pre-2000
! Informatics and ITDdeveloped functions
! Convince hospitalsto use
! Intensive trainingand implementationeffort
Post-2000! Clinicians
demanding moreand more
! ITD unable to meetall demands
! Informatics roleincreasingly one ofdemandmanagement
Single Logon
6
Medication Order Entry Operating Theatre Record
Clinical Data Framework Electronic Patient Record (ePR)
7
ePR Laboratory Results ePR Digital Image Distribution Project
! Make use of the existing CMS/ePR infrastructure
! View digital radiological image in the HA widenetwork using ordinary clinical workstations
! Images can be viewed wherever the patient presents
! 7 major hospitals joined by year end
! Cost - US$2m
Central Archive for Corporate-Wide PACS
Visually losslesscompression
Cost effective use ofstorage and network
ePR
Delivering business benefits
• Cost savings
• Risk management
• Quality improvements
• Infection control (the SARS experience)
• Sharing the patient record (creating the EHR)
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Hospital and HAAnnual Plans
Head Office andHospital
SuggestionsHA Strategic
Plan
DifferentService Areas Consultation
NeedsAssessment and
PrioritizedSchedule
Work Out ResourceAllocation with
Hospitals
Annual Planning process
COC
ClinicalNeeds
Assessment
Community
HAStrategic
Plan
HGC
GovtPolicy
Set ClinicalPrograms
HA ServicePrograms
Overall ServicesEffectivenes
Efficiencyand QualityIndicators
ServiceVolume
IdentifyAppropriateResources
AppropriateAllocation
to Hospitals+ ++
HK$753.9 millionSavings
IT Costs Benchmark vs Peers
Hardware
Software
Telecommunications
Personnel
Disaster Recovery
Occupancy
External ServiceProviders
$256,502
$101,317
$9,798
$102,466
$0
$12,959
$524,576
$103,548
$56,307
$365,106
$10,779
$0 $100,000 $200,000 $300,000 $400,000 $500,000 $600,000
Annual Expenditure ($ Thousands)
Peer
HKHA
$0
$1,154
$175,451
For internal use of HKHA only. © 2004 Gartner, Inc. and/or its affiliates.
All Rights Reserved.Page 15
HKHAExecutive Briefing 9 November 2004
consulting
Risk Management
! Medication checking
! High risk patient alert! Flagging elderly patients at-risk
! Notifying on admission/discharge
! Diabetes monitoring
! Infection risk alert
! Implanted device recalls
! Medication recalls
! G6PD deficiency flag
Registries
The Registry is Dead!
(Long Live the Registry!)
ePR
Alerts & Reports
Disease documentation
Standardforms
Departmentaldata
WorkflowCommunications
Decision support
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Surgical Audit (1995) Surgical Audit (2004)
Clinical Datawarehouse
Clinical ManagementSystem
OperationRecords
Patient Master Index
ClinicalCoding
Audit Scope Definition
Data Analysis
Clinical Data Analysis Reporting System (CDARS)
1
2
3
4
Clinical Data Analysis (CDARS)
10
eSARS
! Managing the SARS outbreak in real time
! Suspect, confirmed and “not SARS”
! Updated clinical status
! Data entry by clinicians at the wards
! Created and deployed Hong Kong wide in 3days
! Built upon the CMS/ePR infrastructure
! Possible because of the informatics culture
already in place
Firewall
eSARS Architecture
ePR
Data Warehouse
PMI
eSARS
Firewall
DM Zone
SARS-
CTS
PMI
eSARS
Contacts
HKU
Dept Health
Police
HA
MIIDSS
Telephone interviews SARS-CCIS
Hotspot
Alert
CMS
eSARS
SituationReports
Labs
eFlu
System
Reports Disseminate
to
CDIS collaborators and partners
Cross Sy stem Reports Disseminate to CDIS collaborators and partners
Sentinel
Surveillance
System
AED
Surveillance
System
Hospital
Discharge
Surveillance
System
Laboratory
Surveillance
System
Planning & Ev aluation
HospitalRCHE/CCCGP/GOPC
Pharmacy
Surveillance
System
PHIS
Data Warehouse Query Sy stem
Data Data Data Data Data Data
Decision
Data Data Data
4 July 2005, by CHP
Media
Monitoring
System
Newspaper,Internet
Data
Real-time Data Monitoring Centre Aberration Detection and Early Warning Module (Alert Tools), Modeling Tools,
Decision Support Tools , GIS (Analy sis and Presenting Tools)
Data
TB
Surveillance
System
STD Surveillance
System
Hospital
Outbreak
Surveillance
System
E-diseaseinterf ace
IncidentLoggingSy stem
Outbreak Intelligence
Centre
Other Department
EmergencyHotlineCentre
Notifiable & ReportableDisease
SurveillanceSystem
Data Warehouse
DesignatedRCHE/CCC/
GP/GOPC
DesignatedCommunityPharmacy
PHSBCHP
PHSBCHP
Hospital
Authority PHLSB(LIS)
PrivateSector
CENO ReportSystem
Clinical
& LabEnquiry System
SituationReport System
Police(MIIDSS) HA
E-disease
Emergency Response Centre
Communicable Disease Information System
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Firewall
ePR Sharing with Private Sector
ePR
Firewall
DM Zone
ePRsubset
HA
SecureToken
CMS
Patient key
25438295
PrivateDoctor
Patient key
25438295
Integrating Healthcare Sectors
! Addressing the imbalance between public andprivate care
! Communicating with private practitioners! Courtesy note on receiving referrals
! Reply letter on discharge
! Sharing HA’s electronic patient record
! Creating the shared EMR
! Enhancing the sustainability of the healthcare system
Summary
! Leadership and support from the top
! Engage clinicians
! Deliver clinical and organizational value
Thank you
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