In Support of Continuous and Holistic Care

An individual’s care needs to adopt with different life stages. The Electronic Health Record Sharing System (eHRSS) supports continuous and holistic healthcare by providing a basis for comprehensive record keeping and sharing among public and private healthcare providers (HCPs) in Hong Kong.

Dr Choy Khai Meng
Chief Manager (Service Transformation),
Hospital Authority (HA)
Consultant (Public-Private Partnership),
Food and Health Bureau (FHB)

Dr Cheung Ngai Tseung
Head of Information Technology and Health
Informatics, HA
Consultant (eHealth), FHB

Dr Cheung and Dr Choy have been actively involved in electronic health record (eHR) development in Hong Kong since long before the launch of eHRSS in March 2016. From then to now, they have seen how eHR sharing has positively impacted and transformed healthcare service delivery. With eHR development progressing and Stage Two eHRSS coming on board, they believe more benefits can be reaped in future.

Dr Cheung, also Consultant of FHB leading the eHR team of HA which is eHRSS’ technical agency, said, “The successful launch of eHRSS is already a great achievement. We are happy that it has been working smoothly and welcomed by the community. We are also honoured to have received several awards from the information and communications technology sector both locally and globally.”

Participation in eHRSS is voluntary. Yet the number of people joining eHRSS had already exceeded 400 000 in less than a year after its launch. Dr Cheung recalled, “We did not anticipate such an overwhelming response at that time. The enthusiastic participation is a recognition of the efforts we have made over the years.”

Dr Choy, also Consultant of FHB who heads HA’s team on clinical Public-Private Partnership (PPP) Programmes, agreed, “We started eHR sharing in HA about 15 years ago. Modelled on HA’s system, eHRSS has been developed as a patient-centred platform that can potentially serve the entire population of Hong Kong. We are so glad that our work has contributed to transforming the healthcare system for patients in Hong Kong.”

seeing lifelong and comprehensive information in a computer

eHRSS enables the building up of lifelong and comprehensive eHRs of an individual over time

Towards Building up Lifelong Records and Enhancing Collaboration

Embracing the principle of “records follow patients”, eHRSS enables the building up of lifelong and comprehensive eHRs that cover relevant health data and medical records of an individual over time.

Both Dr Cheung and Dr Choy pointed out that people have different care needs at different stages of life, and the availability of lifelong eHRs for viewing by different healthcare professionals (HCProfs) will make continuous and holistic healthcare possible. This is particularly important when the population is aging and medico-social collaboration in providing integrated healthcare is becoming more significant, they believe.

Citing the elderly as an example, they said it is common that their healthcare needs call for a range of care and services from multiple HCPs, such as medical specialists, elderly homes and other non-governmental organisations. eHRSS serves to facilitate more coordinated services by linking them up and allowing the sharing of different types of eHRs on a single platform.

In later 2019, a closer collaboration among HCPs at district level, to be enabled by eHRSS, will be seen with the introduction of the District Health Centre (DHC) services, they added. The scheme will provide integrated primary healthcare for the public with the assistance of a mix of HCPs in their localities. Relevant patient data will be linked through eHRSS.

Dr Choy added that it will be best to commence building health records from birth. “In Hong Kong, most of the newborns will likely join the Hong Kong Childhood Immunisation Programme of the Department of Health (DH). If their parents register them with eHRSS at the same time, their eHRs can start from birth and build up as they grow. In this way, a great proportion of the future population will have comprehensive lifelong eHRs,” he hoped.

Engaging and Empowering Patients

With the patient-centric eHRSS, Dr Choy said, patients can now have more options and flexibility in choosing their own HCPs, as they know that their health data are available in eHRSS and can be conveniently accessed by HCProfs taking care of them.

Not only that, with the introduction of the Patient Portal, one of the major work targets of Stage Two eHRSS, patients will be empowered to take part in managing their own health.

Dr Cheung explained, “The potential of the Patient Portal is multi-faceted. For instance, users can access some of their health data in eHRSS and input simple data such as blood pressure readings using portable devices like mobile phones. Their family members and carers can also help keep track of their health conditions.”

“The flow of information will no longer be restricted to HCProfs. Patients can better communicate with their HCPs by making use of the portal,” he elaborated.

The Patient Portal will empower patients to take part in managing their own health

Benefitting from Public-Private Partnerships

There are currently 14 PPP healthcare programmes run by HA and DH, covering clinical services, medical examinations, and chronic and long-term care. eHRSS provides an essential infrastructure for record sharing between the public and private sectors in these programmes.

These programmes would not have worked well without eHR sharing, according to the doctors, who believe the importance of eHRSS will continue to increase with the implementation of more PPP initiatives.

Well versed on the subject of healthcare PPP, Dr Choy considered the outcome of the General Outpatient Clinic PPP encouraging.

“Since its launch, the programme has been joined by over 30 000 patients and 400 private doctors, with data of several hundreds of consultations being uploaded to eHRSS on a daily basis. More than 90% of these patients are now still staying with the programme and using the services of their chosen private doctors. This reflects that the programme has successfully helped them find their personal family doctor,” he said.

“It is in line with the Government’s policy to strengthen primary care, and a closer doctor-patient relationship can enhance the quality of care.”

Dr Choy revealed that HA will roll out the Glaucoma PPP Programme in mid-2019. Glaucoma is a disease that needs chronic care and eligible HA patients will be invited to join.

Meeting the Challenges in Future Development

With increasing utilisation and popularity of eHRSS come the challenges of meeting the rising expectations of various stakeholders and balancing their needs. Dr Choy and Dr Cheung said they will continue to seek stakeholders’ views, and draw reference from past and international experiences.

Elaborating on sharing Chinese medicine (CM) information which is another major work target of Stage Two eHRSS, Dr Cheung remarked that they have been working progressively towards CM data sharing and he is positive about the prospect. He pointed out that the trial version of CM Information System On-ramp, a turn-key clinical management system for the CM sector, will be available later in the year.

With increasing utilisation and popularity of eHRSS come the challenges of meeting the rising expectations of various stakeholders and balancing their needs

As to the Patient Portal for which both doctors have high expectations, Dr Cheung said it will be developed and launched in phases, with some basic functions designed to meet the needs of such target users as parents and chronic patients to be rolled out first in 2020.

For radiological image sharing, Dr Cheung said efforts have been made in developing eHRSS’ technical capability to accommodate images of huge volume and large file size. “In addition, as the sharing will involve laboratories who might be less experienced in using eHRSS, we will work closely with them, and hopefully we can start radiological image sharing in 2021,” he added.

Despite all the challenges, the principle of maintaining strong system security, ensuring a high privacy protection standard while keeping the system easy and convenient to use will follow through eHRSS development, the two doctors unanimously stressed.