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Principles Based Medical Informatics For Success NT
Principles Based Medical Informatics For Success NT
Principles Based Medical Informatics For Success NT
Principles-Based Medical Informatics for Success How Hong Kong Built One of
the Worlds Largest Integrated Longitudinal Electronic Patient Records
Ngai-Tseung Cheunga, Vicky Funga, Wing Nam Wonga, Anna Tonga, Antonio Seka, Andre
Greylingb, Nancy Tseb, Hong Fungc
a
Abstract
Since 1994, the Hospital Authority has been developing
and deploying clinical applications at its constituent 41
hospitals and 121 clinics. The Clinical Management System (CMS) is now used by over 4000 doctors and 20000
other clinicians on a daily basis to order, document and
review care. The territory-wide Electronic Patient Record
(ePR) has given clinicians an integrated, longitudinal, lifelong view of a patients record.
Today the CMS and ePR form an essential clinical and
management tool to the Hospital Authority. The CMS handles two million clinical transactions per day, and the ePR
has over 6TB of data covering 57 million episodes for 7.9
million patients.
This paper describes how the HA has taken a principlesbased approach to Medical Informatics to achieve its success in the enterprise-wide deployment and deep
utilization of a comprehensive clinical information system.
Keywords:
electronic patient record, medical informatics
Introduction
307
and hard road remains ahead. The Annual HIMSS Leadership Survey has shown an striking incongruence between
intent and achievement in installing electronic medical
record systems. In 2003 the survey showed that 19% of
healthcare organizations in the US had fully operational
electronic medical record (EMR) systems, and that 32%
had begun installation. [9] In 2006 the same survey found
that 24% now had fully operation EMR systems, and 42%
had begun installation. [10] That is to say, in the last three
years only a 5% increase in fully operational systems was
seen.
The clinicians using the system for care delivery are obviously the most direct customer. However, clinical and
executive management, policy makers, payers, researchers
and ultimately the patients are all customers of the clinical
systems. To fully engage this large body of stakeholders in
a manageable fashion, the HA has instituted formal Clinical IT Governance structures and processes. The key
governance committee is the Clinical Informatics Program
Steering Group (CIPSG), comprising nominated representatives from different hospitals, specialties, corporate areas
and other constituencies. Each representative chairs a
working group that looks at the detailed needs of that constituency, and reports back to CIPSG. The CIPSG in turns
reports up to the board-level IT Governance Committee
(ITGC).
308
sudden switch from an informatics-driven push of clinical systems to a clinician-led pull of additional
requirements. Today there are far more requirements than
can be met by available resources, in terms of functionality, hardware or support for specific clinical initiatives.
Conclusion
Healthcare operates in a sea of change social, environmental, scientific and technological change. Electronic
medical records are an increasingly important tool to
enable healthcare delivery organizations stay afloat and
perhaps prosper, but they can only do so with the necessary
commitment, skill sets and a adherence to disciplines such
as have been presented in this paper.
One obvious reuse of data is secondary uses, such as quality management, planning and analysis. Where clinicians
run their own quality or analysis programs they will soon
see the need for good data, and we have developed sophisticated, clinician friendly data mining tools to allow
clinicians to run their own ad hoc queries on the massive
data warehouse that has accrued over the years.
Acknowledgements
We would like to thank the members of Clinical Informatics Program Steering Group and all many others at the Hospital
Authority who have contributed their time and efforts to shaping
the CMS and ePR.
References
309
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