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)

8

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

9

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