Healthcare Service Reform Initiative
e-Health Record Sharing System :
Vision, Actions, Lessons and Prognosis
1
Healthcare Reform:
Ageing Demographics & Medical Inflation
2
Hong Kong population
will be ageing rapidly
Population profile in 2009 & 2039
Mid 2009
Age group
85 +
Male
Female
80 - 84
85 +
80 - 84
75 - 79
75 - 79
70 - 74
70 - 74
65 - 69
65 - 69
60 - 64
60 - 64
55 - 59
55 - 59
50 - 54
50 - 54
45 - 49
45 - 49
40 - 44
40 - 44
35 - 39
35 - 39
30 - 34
30 - 34
25 - 29
25 - 29
20 - 24
20 - 24
15 - 19
15 - 19
10 - 14
10 - 14
5-9
5-9
0-4
0-4
400
300
200
100
0
100
Thousands persons
Mid 2039
Age group
200
300
400
400
Female
Male
300
200
100
0
100
Thousands persons
200
300
400
In 2009 – 1 out of 8 persons was an elderly person.
By 2039 – 1 out of 4 persons will be an elderly person.
Source: Hong Kong Population Projections 2009 -2039, C&SD
3
Hong Kong will see one of the fastest
ageing among advanced economies
Elderly Dependency Ratio of Hong Kong and Selected Economies
Actual
Projection
500
Japan
450
Finland
400
Belgium
350
300
250
Australia
Belgium
Canada
Finland
Hong Kong
Japan
Singapore
Sw itzerland
United Kingdom
United States
200
150
Hong Kong
100
Singapore
50
2032
2030
2028
2026
2024
2022
2020
2018
2016
2014
2012
2010
2008
2006
2004
2002
2000
1998
0
1996
Number of elderly aged 65+ per 1000 population aged 15-64
550
4
The elderly population has
greater healthcare needs
The elderly population uses on average six times more in-patient
care than the population aged below 65.
Average no. of bed days per 1,000 persons
12,000
10,000
Average number of public hospital
bed days utilized by age (2007)
8,000
6,000
4,000
2,000
0
20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84
85 +
Age group
Source: Data from Hospital Authority
5
Everywhere health expenditure is
growing faster than the economy
Average annual growth rate
Average annual real growth rate of total health expenditure and real
growth rate of GDP in HKG and selected economies (1995-2004)
8%
Average annual real growth rate of GDP
7%
6%
Average annual real growth rate of total health expenditure
5%
4%
3%
2%
1%
0%
Japan
Source:
Switzerland
UK
USA
HKG
Australia
Singapore
OECD Health Data 2008 (Jun 2008); WHO – NHA Series; Singapore Ministry of Health; Statistics Singapore; HKDHA: 1990-2004.
Medical Inflation - advance in medical technology, higher public expectation, rising
medical cost -> medical inflation is driving increase in health expenditure everywhere
6
Hong Kong’s health expenditure projected
to rise as a share of the economy
Health expenditure as % of GDP 1990 - 2033
10%
9.2%
Health expenditure as % of GDP
9%
8%
7%
6%
Past
Health expenditure in HK
in 1990 - 2004
Projection
Health expenditure in HK in
2005 - 2033
Total health expenditure
5.3%
5.5%
5%
4%
2.9%
3%
Public health expenditure
Private health expenditure
2%
1%
Source: Hong Kong’s Domestic Health Accounts: 1990 - 2004
Financial projection of Hong Kong’s total expenditure on health from 2004 to 2033
0%
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030 2032
2004 to 2033: Ageing + Medical Inflation
Per capita health expenditure nearly quadruple
when per capita GDP will only double
7
Problems in the Existing Healthcare System
(1)
(2)
(3)
(4)
(5)
Primary healthcare service not comprehensive
enough
Bottlenecks exist in public healthcare service
and long waiting time
Public-private imbalance in healthcare system
and limited choices for patients
Insufficient protection provided under the current
public healthcare safety net
Lack of sharing of medical records between
doctors in public and private hospitals
8
Healthcare Reform:
Enhancing Services on a Sustainable Basis
9
First Stage: Healthcare Service Reform

Enhance primary care
– Primary Care Development Strategy by end 2010

Promote public-private partnership in healthcare
– PPP projects being launched progressively

Develop electronic health record sharing
– First stage eHR Programme for sharing by 2013-14

Strengthen public healthcare safety net
– Expand Drug Formulary to support patients in need

Over $5 billion committed for service reform
10
(1) Enhance Primary care
To put greater emphasis on preventive care, promote healthy
lifestyle, improve the state of health of people, reduce the need
for hospital care.
→
→
→
→
→
Develop basic models for primary care services
Establish a family doctor register
Subsidize individuals for preventive care
Improve public primary care
Strengthen the function of the Department of Health in health
education
11
(2) Promote Public-Private
Partnership in Healthcare
Provide the public with more choices of quality healthcare services
and promote healthy competition and collaboration among the public
and private sectors
→ Purchase primary care from the private market
→ Subsidize individuals to undertake preventive care in the
private sector
→ Purchase hospital services from the private market
→ Pursue hospital development under the PPP model
→ Set up multi-partite medical centres of excellence
→ Engage private sector doctors to practise in public
hospitals on a part-time basis
12
(3) Develop Electronic
Health Record Sharing
As an infrastructure, electronic health record sharing can effectively
enhance continuity of care, facilitate better integration of different
healthcare services, and minimise duplicate investigations
→ Fund the development of the sharing
infrastructure
→ Make available the know-how
to the private sector
→ Consider provision of financial
assistance
→ Promote the benefits of health record
sharing to patients and healthcare
professionals
13
(4) Strengthen Public Healthcare
Safety Net
To provide better healthcare protection for patients who
need to use public healthcare services
→ Reduce waiting time of public
hospital services
→ Improve the coverage of standard
public services
→ Explore the idea of a personal limit
on medical expenses
→ Inject funding into the Samaritan Fund
14
Healthcare Reform:
Enhancing Services on a Sustainable Basis

First Stage Consultation (2008): Healthcare Service
and Financing Reform
–
–
–

The public support reform in general, but have
reservations about mandatory supplementary financing
Prefer voluntary private health insurance, and choice of
private healthcare services according to one’s needs
Want more choice and better protection beyond public
healthcare services provided by the Government
Second Stage Consultation (2010): Voluntary
Health Protection Scheme (HPS)
–
–
–
Standardise and regulate voluntary private health
insurance by legislation for consumer protection
Formulate HPS core requirements and specifications to
address shortcomings of existing private health insurance
Consider making use $50 billion fiscal reserve to provide
subsidies to HPS subscribers
15
Public Healthcare:
Unswerving Government Commitment

The Government will only increase, and not reduce,
its commitment to healthcare

Government continues to increase funding for healthcare
–
Funding for healthcare increases from $30.5 billion in
2007-08 to $36.9 billion in 2010-11, up from 15% to 16% of
the Government’s total recurrent expenditure
–
Subvention for Hospital Authority (HA) increases from
$28.0 billion in 2007-08 to $32.7 billion in 2010-11, and will
be further increased in 2011-12
–
Government committed over $15 billion to invest in
healthcare infrastructure and strengthen safety net, including
$1 billion injection into the Samaritan Fund
16
Public Healthcare:
Unswerving Government Commitment

Uphold public healthcare system as the
community’s healthcare safety net

Public healthcare system will continue to focus on
target service areas

–
Acute and emergency care
–
Care for low-income and under-privileged groups
–
Catastrophic illness requiring professional team
work, advanced technology and high cost
–
Training of healthcare professionals
HA making use of increased funding to reinforce manpower
and enhance various public healthcare services
17
Hong Kong Territory-wide
Electronic Health Record Sharing System
www.ehealth.gov.hk
18
Objectives
 Develop a territory-wide patient oriented electronic
health record (eHR) sharing system
 Enhance the continuity of care and better integration
of different healthcare services
19
What is eHR?
•
NOT just an IT project
•
A territory-wide “infrastructure”
•
Key to improve our health service delivery system in future
•
Indispensable component for our future health care reform & financing
arrangements
•
Benefits everyone: 1 person’s record, multiple access – patients, medical
professional, health care workers etc
•
Change the way health care is provided: faster, efficient, accurate
•
Essential data source for disease surveillance
•
AMBITIOUS project – no country-wide EHR in the world yet
20
Present Situation
Hospital Authority
Private Hospitals
• 8 million patient records
• 800 million lab results
• 340 million prescribed drug
records
• 34 million X-ray images
• 3 million transactions per day
• Mainly electronic billing and
financial systems
• Electronic record lacks sharing
capability
Department of Health
• Essential health data, e.g.
vaccination
• Preparing for eHR sharing
Private Clinics
• Mostly paper-based records
• Electronic record lacks sharing
capability
Private Labs/
Allied Health Providers
• Not connected to other providers
21
Without eHR
Dentists
HA
Private Hospital
Doctors
DH
Nurses
X-ray
22
With eHR
23
Benefits of eHR Sharing
For Patients
Whole record available online
Timely and accurate information for care
Increase the speed of treatment
For Healthcare Providers
Efficient clinical practice
Avoid errors associated with paper records
For Society
Disease surveillance
Public health and policy making
Hospital Authority
Private Hospitals
24
Challenges
 Privacy and security concerns, eHR legal framework
 Change management
- Project management and institutional framework
- Standarisation
- Building block approach – pilots
 Public private partnership
- eHR Engagement Initiatives
- Partnership project
- CMS extension and CMS adaptation
25
Guiding Principles
 Government-led model for development
 Compelling but not compulsory record sharing
 Data privacy and system security of paramount
importance
 Open technical standards for private participation
 Building-block approach for eHR components
26
eHR Legal Framework
 The privacy and security challenges of eHR
 An eHR specific legislation
 Consultant to review the Framework for eHR
 Privacy Impact Assessment
27
Project Management and Institutional Framework
Hospital Authority (HA)
HA IT Services
Government
eHR Office
eHR PMO
Private sector
Steering Committee on
eHR Sharing
Working Group on
Institutional
Arrangement
Working Group on
Legal, Privacy and
Security Issues
Working Group on
eHR and Information
Standard
Working Group on
eHR Partnership
eHR
Projects
PublicPrivate
Interface
Projects
Private
Projects
28
Standardisation of Health Record
Define a scope of eHR sharable data
Standardise Patient Master Index,
immunisation record, drug record, etc.
Support promotion of HL7, ICPC,
SNOMED CT, etc.
29
Public Private Partnership
 eHR Engagement Initiative
• 1st Stage EEI for Private Healthcare Sector (Oct 2009)
• 2nd Stage EEI for IT sector (Nov 2010)
 Partnership Projects
• eHealth Consortium – Validation Platform
• HK Medical Association - CMS 3.0
• HK Dental Association – Dental Clinic Management
System
30
Budget and Targets
 HK$702 million for first stage
Total budget : HK$1.1 billion
 To have the eHR sharing platform ready by 2013-14
for connection with all public and private hospitals
 To make available electronic medical/patient record
(eMR/ePR) systems with eHR sharing capability
 Legal framework
31
Major Milestones
Year
Hospitals
Clinics
2009
Radiological image sharing with private hospitals;
Integration of Healthcare Voucher scheme with eHR
2010
Pilot use of SmartID for patient
authentication
2011
CMS adaptation
basic modules
2012
Begin patient
enrollment
2013
Ancillary
Laboratory sharing
Community PMI
CMS on ramp
HK Drug table
Shared records in Doctor Portal
32
Thank You
33