I was amazed and really surprised they were spending and had to pay so much effort in an early morning trying to let someone to know his ideas. I asked them why they didn’t simply send out emails to targeted schools or centers, which should be more (cost-) effective and saving some of the trees for our children. They threw me back a stunning answer: “you are not a business guy and you are not gonna understand how business work, no one would read emails, they are presumably junked; while papers are more sustainable and they are to be read one day as long as papers are physically there. The situation is more or less the same in other business, civil engineering is of course no different. Hole, you are really out of pace.”I couldn’t tell anything, not even a single word from my MIS memories. I was really confused (and I m still confused now) digesting their words, yes I admit it I m no business guy, yet am I really that out of pace? 

Maybe Seenu can tell me.

Like most other sectors of the economy,health care has benefited enormously from IT. IT plays a major role inimproving the nature and quality of services rendered and in enhancing theefficiency and effectiveness of internal operations of health care providers.Health care providers were however slow to adopt IT when compared toorganizations in other sectors. Over the past two decades, there has been arapid increase in awareness and deployment of IT applications in the context ofhealth care.

“Now medical errors and theneed for Physician Order Entry are touted as the next tipping point.” - Berner et al, JAMIA 12(1):3-7

Recentreports by HIMSS suggest that a medium-sized health care providermay have approximately 90 different IT applications to handle various clinicaland non-clinical processes.

In the US, a nationwide standardizedelectronic health records infrastructure would save US$77billion annually(Health Affairs, 2005). How about in Hong Kong? In Hong Kong 24% of primary care and 93% of secondary and tertiarycare are provided by the public sector –The HospitalAuthority (HA). The Hospital Authority,being the largest healthcare provider in Hong Kong (43 hospitals, 45 specialistclinics, 74 general clinics), has collected clinical data on patients under itscare through its integrated clinical information system over the past years andestablished a patient-centered, lifelong longitudinal clinical data repository,namely the electronic-Patient Record (ePR).

Development of the ePR

1990 – “GreenFields” the adoption of Computerized Patient Record (CPR)

1991 – Patient admission

1992 –Pharmacy system

1993 – Labresults online

1994 –Radiology information system

1995 –Clinical Management System

• Direct clinician documentation and order entry

2000 – CMSPhase II

• Electronic Patient Record (ePR)

2003 –eSARS, eFlu, Notifiable Disease & Outbreak Reporting Syste, (NDORS)

2004 – ePRImage Distribution

2006 to now– PPI ePR sharing pilot project

From CPR to ePR

CPR is asystem containing patient centric, electronically maintained information aboutan individual’s health status, and care focusing on target events and tasks, directlyrelated to patient care and optimized for clinicians use .And enterprise CPR isan integrated, but not interfaced system, whose functionalities encompassesacute clinical care settings (e.g. individual hospital CMS). ePR is a synchronized,aggregated, longitudinal and life long patient record across all HA hospitals.Collection of replicated and standardized patient information from different HAhospitals and clinics. It also supports direct patient care, integratedoperational system, knowledge management, clinical decision support, clinicaldocumentation, clinical auditing...etc. ePR is having 12,000 users, processingup to 280,000 transactions of 90,000 patients daily.

This is how the ePR interface looks like: (source)

Lab results are standardized and available for inter-hospital/clinicreview: (source)

CT images are available as soon as it is filmed and reports are also availableand archived for reference: (source)

Medications checking for doctors during prescription and counter-alertfor allergic history: (source)

Benefits from ePR

According to Cheung (2006), the ePR can contribute in four aspects:

Patients

• Having their whole record available at point of care for more accurate and timelyclinical decisions
• No need for repeated tests
• Better quality care through clinical decision support at point of care

Clinicians

• More efficient clinical practice - no need to search for information and forms
• Better decision-making with comprehensive information
• Avoid errors associated with paper records

The organization

• Better use of resources
• Data for planning, research and management
• Implicationsto Hong Kong
• Cost savings in annually medical health care expenditure
• Risk management (e.g. SARS)
• Infection control (e.g. pandemic flu, norovirus outbreak)
  

PPI-ePR 

Infectioncontrol

Everyone shouldnever forget the period of SARS in 2003, which was a nightmare and one of thehardest times for every one of us in our life - lives were taken away day byday by unknown hands. How could ePR participate in defending us during that periodof time?

eSARS(2003) - realtime capture of SARS suspects and cases, and realtime acknowledge tothe Department of Health (then to WHO), the police department, and to academicbodies (i.e. the HKU and CUHK faculty of medicine and department ofmicrobiology).

(source)

And more now:

eFlu – electronicreporting of suspected or confirmed avian and pandemic flu cases in real time

NDORS(Notifiable Disease & Outbreak Reporting System) – electronic reporting ofall notifiable diseases including documentation in HA CMS for hospitals and clinics. (e.g. CA-MRSA)

ePR On the Move – the PPI-ePR

The Public Private Interface - electronicPatient Record Sharing Pilot System

(PPI-ePR), which has been launched since 2006, is an online informationsystem aiming at improving the sharing of patient’s clinical informationbetween public and private healthcare providers to facilitate a seamless andbetter quality healthcare environment for patients in Hong Kong. The HA will proactively share the ePR of patients who are under thecare of selected private healthcare providers upon patients’ consent. The pilotproject is being boosted this year together with the health care reform policy.

Time to move

As an ex-user of the ePR system, to be honest, i found this is remarkably one out the few successes archieved by my ex-employer - the HA. I can remember the days before the ePR was adopted and was generally implemented, data retrieval and communications were messy.  Documents and papers, making and receiving phone calls were the only communication means, and they did consume most of our time doing papers work and actually affected the quantity and quality of our effort to our patients.
The situation now in my current employer (in the private sector) is more like those old days when ePR hadn't launched: patient histories were never complete, tests results and appointments were never ontime. It is funny (and sad) that we do have the latest IT, latest equipments, unlimited fund, and an IT department too, yet the computers in our clinics are doing simple copying and scanning; the X-ray would never know what is going on in the Ultrasound; nurses would never know where do the patients' blood samples go...
Can we learn from the ePR? We know that it could be our managerial problem rather than the IT guys fault. But obviously from time to time when things got stuck, the IT is the one to be blamed. This year, the government is putting a lot of efforts fostering the PPI-ePR program. The opportunity is there. Directors, please wake up.