Dr. NT Cheung, Chief Medical Informatics Officer at the Hong Kong Hospital Authority (HKHA) has taken on the reins of HKHA’s Clinical Management System (CMS) re-development over the last years.
I spoke with Dr. Cheung to learn about what’s next for the CMS.
Accessible by 29,000 clinical users in 43 hospitals and 120 clinics across Hong Kong, the HKHA CMS offers an EMR, clinical documentation, consultation notes, prescription, images, scheduling, electronic patient record, as well as decision support. Millions of transactions take place within the CMS each day. HKHA reports 400,000 electronic patient record access and about 8million of patient records and half billion of lab records. Look how comprehensive it is in the diagram below (image sourced from the HKHA site).
“The clinical management system has been re-developed to a more modern web-based architecture over the last years. We’ve now transitioned from client server to web-based, and we’re now in the process of rolling out this version,” said Dr. Cheung.
“To be honest, it’s been very technically challenging; it’s quite difficult to deliver the same responsiveness in the old environment. One of the main reasons why we had moved to a web-based framework is for us to be able to take advantage of new technologies, such as mobility. Now on this framework, we can disassociate and do little ‘applets’ of sort rather than have one mega executable. It would have been near impossible to do such in the client server world.”
“We can now take a function of the entire system and put it into an iPad. The users can take that iPad and do pieces of stuff they need to do at the bedside, for instance.”
Dr. Cheung added that HKHA’s in-house development team can do a lot more (and do it faster) now that the transaction logic or middle tier is completely separated from the presentation layer.
He differentiated that native mobile applications may be optimal in certain occasions. “It depends on the degree of user interaction if you will go native or mobile web. Native mobile applications have certain advantages and limitations. Also, it’s an entirely new application development effort.”
Another interesting transformation within HKHA is that they’ve moved now to a completely filmless environment. “We’ve just completed the transition and all our images now are digital and accessible throughout the clinical management system, wherever you are in HongKong,” Dr. Cheung said.
“We also have been closely monitoring patient re-admissions, especially the elderly, who may not have understood what was told to them during their discharge,” said Dr. Cheung. “We wanted to identify risk factors that would indicate if a patient is at risk of re-admission, so using our database we looked at the data of patients which did return early in the past and were able to find those risk factors. Now every day the system searches for recently discharged patients which have the risk factors, and we give them a phone call to offer advice and this lessens the chance of them getting re-admitted.”
“Closed loop medication or in-patient medication administration is upcoming,” he added. Closed loop medication typically involves day-to-day medication management for the patients. Essentially, what this closed loop medication system involves is that doctors do all of their medication — write down medications on a drug chart, either files it on a patient bedside or in a record somewhere. Order then goes to the pharmacy, pharmacy collects the medication and sends these back to the ward. The nurses takes the medication or the orders, scans the barcode to ensure that the right drug is given to the right patient at the right time. “We’ve gone live on our first site. Human errors are pretty much unavoidable, and so we want to eliminate such with the closed-loop medication system.”
Private hospitals in the Philippines have more modern and computerized hospital facilities compared to their public counterparts. HKHA has come a long way. There sure are great healthcare IT opportunities down the road.