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HTM Speaks With Dr NT Cheung, CMIO, Hong Kong Hospital Authority

Dr. NT Cheung is the Chief Medical Informatics Officer (CMIO) of the Hong Kong Hospital Authority (HKHA) and is also the Consultant for eHealth for the Hong Kong Government. As the head of health informatics in the Hospital Authority, NT has taken the Authority from a virtual “green fields” site in 1991 to today’s situation where clinical information systems are an indispensable part of the care delivery process for 30,000 clinical users. His current work focuses on taking the Hospital Authority’s Clinical Management System (CMS) on a generational leap to the next level of computerized record system functionality to improve the already world-class facilities in the CMS for the documentation and effective management of diseases and care.

 He works closely with clinicians and executives in the HKHA to ensure that the CMS supports organizational initiatives and that patient benefits are being realized. NT is also working with the government and other healthcare stakeholders in Hong Kong to create a territory wide Electronic Health Record Sharing infrastructure. He is leading the eHR development efforts for the records sharing architecture, information standards, and tools to support implementation of electronic records in the private sector, as well as various eHR pilot projects. NT is active in the informatics research and education communities, and is a frequent speaker at international conferences. He holds a medical degree from the University of Sydney and a Master’s degree in computing science from Imperial College, London.

Please introduce yourself, your background and your current role within the healthcare technology industry:

I have a medical degree and a masters in computer science. I first became interested in medical informatics during medical school. I joined the Hospital Authority in 1993 as the first medical informatician in the HA and worked with frontline clinicians and the ITD to develop the Clinical Management System (CMS) and Electronic Patient Record (ePR) as clinical tools to support the documentation and provision of care. I am currently the Chief Medical Informatics Officer of the HA, and I have a team of health informaticians drawn from different healthcare and information management backgrounds who are dedicated to designing, developing, implementing and maintaining the CMS. The Health Informatics team works closely with frontline clinicians, ITD, and management and administrative colleagues to ensure a highly effective and cost efficient system.

What role does the Hong Kong hospital authority play?

The Hospital Authority has always supported the CMS as a strategic asset to support its mission, and consequently has invested steadily in the development and maintenance of the system. Proper governance and strong clinical engagement have also been critical factors in the success of the system. Today the HA is by far the largest user of health IT in Hong Kong and it is clear that the role of health IT within the HA will only increase. The HA has also been asked to act as the Government's Technical Agent for the development of the Territory-wide Electronic Health Record Sharing (eHR) initiative. The HA has established an eHR Project Management Office to leverage its experience and knowledge and will work with all the healthcare and IT sectors in Hong Kong to deliver this project.

Explain the real value of clinical IT and health informatics in the delivery of healthcare in your region:

The goals of the CMS are to improve the quality and efficiency of care delivery in the HA. This is achieved by focusing on; 1) Providing tools to support the processes of care delivery whilst enhancing patient safety. 2) Building up a longitudinal electronic medical record so the relevant clinical information will be instantly available to clinicians when and where they need it to provide care to their patients. 3) Ensuring the clinical information in the clinical record can automatically flow through to the data warehouse to provide information for management, planning & quality improvement initiatives.

What business opportunities exist for international healthcare technology and IT organizations in HK?

The Hospital Authority has led the way in health IT in Hong Kong, but in recent year’s interest in health IT has blossomed in the other healthcare sectors. The launch of the eHR project by the eHR Office of the HK Government in 2009 has accelerated this trend. Although the eHR is a healthcare project, it is also hoped that the funding provided by the Government for this project will stimulate the Health IT sector as well.

Explain the spending power and value of the Hong Kong healthcare technology and IT industry, and the core products and services that healthcare providers and payers are demanding?

The budget for the 1st phase of the eHR project is HKD$702M, but this is largely to build up the sharing infrastructure as well as some basic clinical systems for hospitals and clinics. It is expected that healthcare providers and organizations will also need to develop or procure and implement their own clinical systems such that they will be able to integrate with the eHR. In terms of services and products, the success of the Public-Private Interface ePR sharing project which enables private sector doctors to view the HA records of participating patients has demonstrated that there is an indeed a demand for shared medical records.

The eHR PMO is adapting various modules of the CMS for private hospitals (including allergy documentation and discharge summary functions) and will continue working with the private sector as their needs and demands develop. IHT: What are the core healthcare technologies that are in demand on the ground, across Asia Pacific? Sharing records in a way that protects patient privacy is probably the key requirement. Of course the implementation of electronic medical record systems in provider organizations is a prerequisite to sharing of said records.

What issues are healthcare providers facing in the selection and implementation of healthcare IT and technology in Asia Pacific?

The availability of funding and the shortage of health informatics and health IT skills are major constraints. The ability to engage clinicians is a key factor. Systems must be developed and implemented in a way that supports and benefits all stakeholders.

Recently on linkedin.com it was asked “what are the major reasons that EMR/EHR implementations fail; what do you think?

It is very difficult to provide a succinct answer to such a multifaceted issue. Perhaps the worst mistake is the conception of an EMR/EHR project as an IT project. Adequate engagement of clinicians is essential, and the provision of sufficient benefits and effective incentives to ensure their participation is a must. All healthcare organizations are different, and software products that were developed for other environments may not fit (a particular problem for Asian markets). Health IT is a disruptive technology, and sufficient attention to change management is essential. Standardization and information management must be tackled strenuously to avoid failure. Overall there is a severe shortage of health informatics and health IT skills and personnel to design, manage and support these very complicated projects.

Many healthcare technology and IT organizations talk about change management during any new technology rollout and how “people”, not “technology”, can be the major reason implementations are unsuccessful or delivered over budget and not on time. What do you think?

There is a common myth that doctors are "resistant to electronic records". In fact the history of medicine shows that doctor’s are the first to embrace technologies which help them deliver better and more efficient care. My conception of "change management" as it applies to health IT is to make sure the technology is deployed in a way that benefits all users (and particularly the front-line staff) of the system and its information - and they are made aware of these benefits. If the technology you are deploying does not help the doctors it will face severe difficulties. In addition, these are large scale IT projects with demands that tax the limits of modern technology, so the need to "get the technology right" cannot be ignored.

Finally how can international healthcare technology and IT companies position themselves in Hong Kong and the surrounding regions and who should they be speaking to?

The eHRO has started the second phase of the eHR Engagement Initiative (EEI), focusing specifically on the IT sector. More information can be found at http://www.ehealth.gov.hk

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