COMP7430

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1. Top 1 Healthcare Services in Hong Kong

Problems in healthcare

• Aging Population

  Statistics had shown that people in Hong Kong are living longer than
  in the other countries. And people who are over 65 tend to have
  chronicle illness and have a higher chance to be hospitalized.

• Government Subsidized Service

  HK healthcare services are highly subsidized (95%+) by the HK government.

• Advance in new medicine and treatment

  As medicine and technology advances, new medicine and medical treatment are
  expensive

• Quality of Service

  As society advances, people demand a better quality of service instead of just being
  healed

• Human Errors
  

  With manual and paper-based system, human errors can easily be introduced and
  cannot be avoided. On the other hand, a computerized system would get rid of the
  necessary human errors.

Healthcare reform

• Promote patient-centred care (病人為中心)
• Improve hospital environment
• Transparent complaint system (完善病人投訴機制)
• Decentralization
• Strengthen social accountability and stewardship
• Unify all hospitals (統一管理醫院營運制度)
• Internal management reform

“No one will be denied adequate medical care due to lack of means”

Mismatch of funding (in terms of G.D.P)

Public (~2.7%) for 91% In-Patient & 29% Out-Patient + Public Health
Private (~2.5%) for 9% In-Patient & 71% Out-Patient

In summary:

• Private Healthcare System (private pay) vs. Public Healthcare System (highly subsidized)
• in-balance – sustainability
• Patient have to wait
• Efficiency in public or inefficient in private (famous doctor is expensive)
• No choice of doctors in public, because we have to train the junior doctors

2. Health Informatics, Standards, and Management

advantages to divide all the public hospitals into 7 clusters

• Better management on medical equipment, treatment, operations and division of labour
• Bigger bargaining power because of huge volume of purchase
• Easier call back of drugs
• Cutting top level staff cost
• Concentration of resources and cases for better training
• Each cluster has a major hospital to centralize resources (experts, equipment, supports)
• Other hospitals / clinics are front-ends to outreach patients and to fulfill the performance pledge
• They use referrals and transfer cases to the major hospitals when necessary
• For efficiency and effectivenesss

Why we need standards among healthcare systems. Point out some of the problems if there is no standards. And if standard is so important, why can’t we have just one standard?

Reasons why:
• Sharing information
• Human to human, human and computer, Computer to computer
• Data comparability
• Preservation of meaning
• Aggregation of data
• Computability
• Ability of computers to act usefully upon data
• Clinical decision support
• Integration of systems
• Allow new modules to be integrated with or to replace existing ones
• Prevents lock in to any particular solution
• Collaboration and dissemination of knowledge
• Allows the sharing of techniques and applications
• Enables leveraging of existing works
Usages:
• improve decision-making through access to patient data across multiple care points
• reduce technical integration costs
• improve the effectiveness and quality of care
• reduce duplicative diagnostic tests
• reduce cost of processing administrative data
• timely detect, analyze, and respond to public health threats
• support clinical research  growth of scientific knowledge

Innovative Technology in Healthcare

Computer-communication infrastructures
Internet applications
Mobile computing and communication
Portable patient records
Security and data protection
Software agents and distributed systems
Telemedicine
Virtual reality
Wireless applications and handheld devices
Knowledge Management
Automated learning and discovery
Clinical guidelines and protocols
Controlled terminology, vocabularies, and ontologies
Intelligent data analysis and data mining
Decision support systems
Knowledge management
Knowledge representation
Neural network techniques
Pattern recognition/classification

3. EPR & EHRSS

• Explain why IT can help and how ePR/EHR can ease up and solve part of the above
  problems and triggers the medical reform in Hong Kong?

• Reduce Error
• Reduce cost
• More efficient system
• Better quality of service (reminders, alerts, error checking, no more missing records)
• Better training, 40+ hospitals under one system

• Discuss why ePR/EHR play an important role when the public hospitals are divided into 7
  clusters

• ePR/EHR is the most important element in sharing the medical records among the hospitals and
• medical services providers (Doctors, Nurses, and Clinicians)
• With ePR/EHR there will be no missing records, no duplicates records, which enforce there is
  only one truth within the system
• Doctors can do consultation with all the records in front of him/her at the point of care
  Multiple Access, i.e. multiple doctors and clinicians can do consultation together and at the same
  time because of the sharing system
• No problem in transferring a patient from an Acute hospital to the ambulatory hospital within the
  cluster or transfer from one cluster to another cluster since the medical records of that patient
  in always online (i.e. Medical records following the patient’s movement)

• Benefits of eHR / ePR

• Patient:
  Scheduled appointments for convenience
  Having their whole record available at point of care for more accurate and timely clinical decisions
  No need for repeated tests
  Better quality care through clinical decision support at point of care
  Less repeated studies decreasing radiation exposure
• Organization:
  Better use of resources
  Enforcement of policies & best practice at point of care
  Data for planning, research and management
• Hong Kong Community:
  Better planning for disease outbreak
  Prevention of disease (e.g. flu)
  Data for analysis, monitoring, and resource management
  Improve system performance
• Other benefits:
  Higher Efficiency
  Sharing of patient data
  Timely update and multiple access
  Speed up workflow
  More efficient clinical practice
  Access data and images at home or remote sites for expert consultations
  Better Quality of Care
  Make decisions with comprehensive clinical information
  Improve communication among providers
  Avoid errors associated with paper records
  Clinical decision support

A Patient Journey in a Hospital

4. Clinical Mgt. Sys. (CMS) & Clinical Dept. Sys. (CDS) and updates

Sharable Data Store

• Facilitate a lifelong longitudinal view of people’s electronic health records
• Data to survive beyond the life span of people and systems
• Available 7days x 24hours
• Aim for a single version of truth
• Stored in a secured manner

CMS On-ramp

• Clinic management system able to share patients’ clinical data with eHRSS
• Turn-key system readily usable by private practitioners with minimal investment and maintenance
• Platform Independent - able to deploy to different platforms
• Technology Neutral – supports multiple RDBMS products
• Allow system enhancements and integration private sectors

Hospital Medicine – stay in hospital for one day for the surgery
Ambulatory – morning received treatment and go back home
Telemedicine – patient will not see the doctor but thru the Internet
Cybermedicine – Internet consultation to a certain extreme

Sample of Consumer Health IT Tools and Services

• Personal health records (integrated and free standing)
• Applications on common devices like smart phones (technology that provides voice and text communication, video and transmission of wireless monitoring data)
• Access to health information (via multiple electronic sources)
• Integration with remote monitoring (personal and home devices and observation systems)
• Internet-based social networking and support
• Internet-based search engines and electronic knowledge bases
• Internet-based administrative services that support care coordination (appointment scheduling, prescription refills, lab results)
• Home Monitoring

List out all the FOUR major Clinical Departmental Systems and briefly describe their functions and their interactions with CMS. By interactions, one can describe the data flow and workflow between each system with the CMS.

Patient Administration Systems: For managing admission and discharging patients
Inpatient admission: Managing the patients who are within the hospital
• Facilitate patient administration procedures :
– patient admission / registration
– bed assignment
– ward transfer
• Provide timely and comprehensive management information
Outpatient appointment: Booking of appointment for follow ups
• Scheduling features to reduce no. of queues and queuing time
• Analysis of new case waiting time for management
• Widely used in specialist & general outpatient clinics and Allied Health department
Radiology and Imaging Systems: X-Ray, CT SCAN, MRI, Lab Booking, reporting, handling of images.
Laboratory Systems: conducting Lab-test, handling results/reports
Laboratory Information system:

– Registration and Order Acknowledgment
– Result Entry
– Result Authorization
– Result Signout
– Result Enquiry
– ePR Enquiry
– Report Printing
– System Administration
– Advanced Search
– Security and Audit

Critical Result Alerts System: Inform the ward and the doctor if a test result is out of the normal range
Pharmacy Systems: drug dispensing
Pharmacy Dispensing System
– Assisting pharmacy staff throughout the dispensing operation
– Robotic dispensing
– Interface with CMS on Medication Order Entry
Express Dispensing System
– Reduce patient waiting time in drug collection
– Re-configure dynamically to utilise the available resources for maximum throughput
– Streamline the workflow in picking drugs by re-organising the existing procedures

The Clinical Management System (CMS) from the Hospital Authority has the following general layout for their screen design. Point out the usages or functions they usually put on Zone1 to Zone5. What is the purpose of having a standard layout for the screen design? Justify your answers by examples from the lecture notes.

Zone 1: Searching for information and Navigation
Zone 2: Longitudinal display of patient’s records
Zone 3: Reports and results
Zone 4: Alerts and warnings
Zone 5: Ordering Entries or Appointment booking
It is for faster training, if every screen design follows the same layout. Trained doctor/nurse knows where to
find information, read report, order test and navigate the system.

5. eHealth and Consumer Health Informatics

What are eHealth & Consumer Health Informatics? What are their benefits?

eHealth is a term for healthcare practice which is supported by electronic processes and communication
– It is interchangeable with health care informatics
– It is healthcare practice using the Internet
– It is a range of services that are at the edge of medicine/healthcare and information technology
Patient benefits
– Whole record always available online
– Timely and accurate information for care
Clinician benefits
– Efficient clinical practice
– Avoid errors associated with paper records
Society benefits
– Disease surveillance
– Monitor outcomes, performance and resource utilization

6. Data Security and Privacy

7. Clinical Decision Support System

Clinical Decision Support Systems

– Human Limitation and Doctors are Killing
– The 3 reports from IoM (again)
– Best Practices, Evidence-based medicine is slow to pick up
– Value of Clinical Decision Support
– (Data-)Information-Knowledge-Value Chain
– Alerts/Reminders
– Process / Workflow Management
– Mobile Workstations

CDSS today

8. Interoperability and Data Modelling