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Dr NT Cheung Head (IT & Health Informatics) & CMIO, HA Consultant(eHealth), FHB APeHRC 2016
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Disruption
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eHealth in the HA The Ongoing Journey1990 1991 1995 2000
2003 2004 2006 2008
2009
2010
2016
“Green fields” Patient administration + Departmental systems Clinical Management System (CMS) CMS Phase II
• Electronic Patient Record (ePR) eSARS ePR Image Distribution PPI ePR sharing CMS Phase III Filmless HA Inpatient MOE HK-wide eHR Sharing System Mobile CMS
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CMS - An essential clinical tool
11M patients
380M episodes of care
2B laboratory results
423M radiology studies
723M drug items
14M transactions / day
1 PB data
Sub-second response time
7x24 >99.98% uptime since live run
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Health Informatics in HA 3 Basic Steps
Build the electronic patient record• Comprehensive• Standardized & structured• Accessible
Support the processes of care• Enter once, use many• Do the right thing• Targeted clinical effort
Improve quality & safety• Specific Q&S programs• Measure & monitor• Continuous improvement
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A Phased Approach to Medication management
Discharge medica-on
Outpa-ent prescrip-ons
Drug checking
Inpa-ent closed loop medica-ons
1995
1996
2002
2013
20
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Stage 1: Discharge and outpatient prescriptions
• Legible, standardized orders
–Standardized formulary
–Structured data
• Link to pharmacy
• Full medica-on history
–Reduced transcrip-on
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Stage 2: Improving medication safety
• Purchase of third party drug checking system
• Capture allergies as structured data
• Monitor override reasons
–Adjust level of alerts
• Add customized checking logic
• Since 2005, a CMS alert has caused the prescribing doctor to change a medica-on over 350,000 -mes
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Stage 3: Closed loop inpatient medications
• Electronic Prescribing • Prescription vetting & dispensing • eMAR & barcoded administration
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ePRData
warehouse
Clinical documentation becomes knowledge
Diseases & procedures
Departmental data
Generic clinical documentation
Clinical Data Analysis & Reporting (CDARS)
Management data should
be a byproduct of clinical
documentation
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Reports & Analytics
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Clinical Data Analysis Reporting System
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Number of CDARS Requests 2003-2015
0
100000
200000
300000
400000
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
3009542749 48276
6363877549
96787
143392
178721
211990
243197
281212300193 308019
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Management Information Portal
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Surgical Outcomes Monitoring Improvement Program (SOMIP)
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Surgical Outcomes Monitoring Improvement Program (SOMIP)
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CMS IV - the 4 P’s
• Paperless• Protocol driven• Personalised• Closed loop communications
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IT a Key Enabler for HA Strategy 2017-22
Service Delivery
Financial Provision
People Management
IT Enablement & Innovation
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Health Informatics in HA 3 Basic Steps
Build the electronic patient record• Comprehensive• Standardized & structured• Accessible
Support the processes of care• Enter once, use many• Do the right thing• Targeted clinical effort
Improve quality & safety• Specific Q&S programs• Measure & monitor• Continuous improvement
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Health Informatics in HA The 4th Step
Build the electronic patient record
Support the processes of care
Improve quality & safety
Enable new models of service deliveryMake data actionable
Engage patients in their care
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Community Health Call Centre Services
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Servicedevelopmentjourney
PatientSupportCallCentre(PSCC)
• 2009 High Risk Elderly (HARRPE) proactive calls
• 2011 Chronic Disease Management - DM patients with suboptimal disease control
MentalHealthDirect(MHD)
• 2012 – 24-hour advisory hotline service
by psychiatric nurses
– “Telecare” service targeting patients with severe mental illness
• 2014 Defaulter tracing service
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Chronic Disease Management- DM Program
Additional0.23%point*reductioninHbA1c
ImprovementinBehaviours
ImprovementinHbA1c
22
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EHRRepository
Access Portal
DH
Clinicssoftware
HAePR
PrivateHospitals
Launched March 2016: HK-wide eHR Sharing System
PrivateHospitals
Clinicssoftware
PPP
CMSonramp
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Patient-oriented healthcare records
Public-private interface and partnership
DH
Family doctor concept; integrated
primary and hospital care
Electronic Health Records Sharing Infrastructure
eHR - An essential health infrastructure
HA Private Hospitals
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“PPP Web”PPP Doctors Directory
Support Hotline
& Training
Enhanced CMS On-ramp
eHR Inbox
One-step Log In
PPP Programmes
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TechnologytoIdea
Idea to Prototype
Prototype to Project
Vendor
Competitor
Open source
Community
Market
Research
University
ecosystem
Selection
Develop
Activate Transformation
The Innovation Funnel
Geek ProjectsDevelop new technology vision into HA solution prototype
Explore technology beyond vendor
Deploy prototype into projects
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Order MedicationsReview
Results
Order Investigations
Diagnosis and Treatment
Mobile CMS
MobileAlbum
MobileRadiology
MobileLabResult
MobileRadiology
MobilePrescription
MobileClinicalCamera
MobileMemo
MobileCarePlanMobileClinicalForms
MobileDxPx
MobileClinicalRequests
MobileAllergyMobileNotes
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HA mobile apps for patients and staff
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TouchMed(Prescription Queuing)
HA Touch
(General Info)
BookHA(SOPD Booking)
easyGO
(Wayfinding pilot)
HRApp(App for HA staff)
mSHR(Staff medical record)
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Geek Project iBeacon Indoor Navigation
Low-cost- HK$ 60 / iBeacon
Support iPhone/ Android Phones- via Bluetooth connect
Indoor navigation- Auto-detection of user’s location - Visual and voice guidance - Shortest route to the destination
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A&E Dashboard
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MIPO Admission Block Alert
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Transforming Healthcare Delivery
• CMS will continue to enhance the quality, safety and efficiency of HA care
• More use of data to drive timely clinical and management action
• IT innovations will improve the patient and staff experience
• IT will enable new models of service delivery