Improve Data Connectivity And Health Surveillance
An effectively connected digital healthcare data network for immediate access and sharing of health records among patients and healthcare service providers in the public and private sectors is essential to facilitate and co-ordinate the delivery of continuous healthcare for individuals and the collection of essential and accurate health surveillance data for effective healthcare policy and services planning for the population as a whole. For policy planning and resource allocation in the district-based community health system, particularly for evidence-based strategic purchasing, data collection on healthcare costs (including manpower and financial costs), health seeking behaviours, as well as district-based health information and providers’ performance are to be enhanced.
A comprehensive and co-ordinated PHC system for enhancing patients’ continuous care can be underpinned by an effectively connected patient data network which provides a robust and secure infrastructure for access and sharing of patients’ health records by healthcare service providers in the public and private sectors. For individuals, patients’ care needs can be fulfilled more timely, effectively and in an integrated manner by multi-disciplinary teams from different sectors. For the community, it facilitates medical-social collaboration, promotes inter-sectoral and multi-disciplinary partnership, and encourages the use of more agile and innovative approaches in providing healthcare services in order to optimise the use of healthcare resources.
At the territory-wide level, patient data would even contribute to health surveillance and facilitate an on-going, systematic collection, analysis and interpretation of health related information for the planning, implementation and evaluation of public health practices. It is necessary for early identification of public health emergencies, monitoring the epidemiology of health condition, monitoring the progress and evaluating the impact of public health intervention, and guiding public health policy and strategies.
In particular, the COVID-19 epidemic has demonstrated the significance of strong information flow and revealed the importance of an interconnected data system and healthcare database as the backbone of health policy planning, preparedness and response. At the same time, the pandemic enabled innovations in PHC being advanced and propagated, such as telemedicine, online scheduling and prescriptions along with strengthened health information system capacity.
Electronic Health Record Sharing System (eHealth)
The eHealth is an electronic platform developed by the Government that enables registered healthcare providers in both the public and private sectors, with the informed consent of the registered patient and proper authorisation, to view and share the patient's electronic health records. The eHealth aims to encourage PPP and facilitate continuity of care as patients move between the public and private healthcare systems. We have also been strongly encouraging members of the public to join the eHealth for building their lifelong electronic health records.
HA has been the Government’s technical agency for the development and operation of the eHealth. To facilitate private healthcare professionals to participate in the eHealth and data uploading, clinical management software and technical support have been provided. These include the Clinical Management System (CMS) adaptation modules for private hospitals to connect to and interface with the eHealth, and the CMS On-ramp, a clinical management software with sharing capability and turn-key system readily usable by private clinics.
In response to the epidemic, we have incorporated the eHealth registration procedure to the booking and vaccination process of the COVID-19 Vaccination Programme. As at early September 2022, over 5.6 million people (over 70% of the population of Hong Kong) have voluntarily registered to join the eHealth, bringing new opportunities to the future development of the system.
The eHealth mobile application ("eHealth App") developed by the Government is the mobile application of the eHealth. Launched in January 2021, it is positioned as the public health portal of Hong Kong for promoting PHC development and encouraging the public to more proactively manage their health. The "eHealth App" will disseminate personalised public health information to users and users can also access some of their key electronic health records in public and private healthcare organisations, including vaccination records, medication, appointments, allergies and adverse drug reactions.
To encourage members of the public to proactively and systematically manage and monitor their health using the eHealth App, the eHealth App has added new functions at the end of July 2021, allowing users to record their daily blood pressure and blood sugar index, which can facilitate the monitoring of changes in their physical conditions. The users can also show the indices to healthcare professionals for reference during check-ups to reduce consultation times. The GOPC PPP of HA and DHCs, which are being gradually set up in various districts, also encourage and assist patients who have joined the relevant schemes to use the eHealth App, with a view to further increasing their awareness in disease prevention, assisting them to record their blood pressure and blood sugar index, as well as enhancing their ability to manage their own health in order to tie in with the Government's PHC policies and reinforce that "prevention is better than cure". As at early September 2022, over 2.6 million people had downloaded the eHealth App.
"HA Go", the mobile application developed by HA, aims to help patients manage their medical appointments and healthcare arrangement in the HA system. "HA Go" integrates multiple applications of HA and adds new functions, including checking appointment record, making out-patient appointment, mobile payment, checking medication information, and carrying out rehabilitation exercise in accordance with prescription, etc. As at end of March 2022, over one million people have used multiple HA services through "HA Go".
"HA Go" and "eHealth App" encourage and facilitate the public to proactively manage their health at different levels. We will further study how to leverage on the strengths of the two mobile applications to optimise and rationalise the related functions.
Health-related data are also available from various health surveys, such as DH’s Population Health Survey (PHS), Health Behaviour Survey and Oral Health Survey (OHS). Social and demographic data are provided through the Population Census and other regular household surveys conducted by the Census and Statistics Department (C&SD).
The PHS is a cross-sectional survey targeted at the land-based non-institutional population aged 15 or above in Hong Kong, excluding visitors, foreign domestic helpers and Two-way Permit holders from Mainland China. The sample was drawn from a record of all addresses in built-up areas and non-built-up areas (known as the Frame of Quarters) maintained by C&SD. The survey comprises two parts, namely household interview and health examination.
The PHS was first conducted in 2003-04, with the last round conducted in 2014-15. DH commenced the territory-wide PHS 2020 in November 2020 to update pertinent information on the patterns of health status, health-related lifestyles and other health parameters of the local population.
The PHS 2020 will continue to adopt a comprehensive approach that contains elements of previous surveys. The PHS 2020 is part of the Government's commitment to the Partnership for Healthy Cities, a global network of 70 cities committed to saving lives by preventing NCDs (i.e. chronic diseases) and injuries.
The first community-wide OHS was conducted in 2001 and DH undertook to carry out an OHS every 10 years. The OHS 2011 was therefore conducted to collect information on oral health status of the people of Hong Kong. The OHS 2021 was commenced in November 2021. The OHS 2021 targets five population groups, namely five-year-old children, 12-year-old youths, adults aged between 35 and 44, elderly aged 65 to 74 and elderly aged 65 and over who are receiving long-term care services. Oral health goals for people of different age groups in Hong Kong will be set by making reference to the results of the OHS 2021. DH will also explore ways to improve dental care services and recommend possible measures for achieving the goals.
Health Technology and COVID-19
COVID-19 has accelerated the development and utilisation of health technologies which are used to help fill gaps in service delivery and in complementarity with in-person services. During the COVID-19 pandemic, the Government has utilised the existing eHealth platform and further enhanced the application of medical technology to help improve the capability in combating the epidemic, as summarised in Table 6.2.
Without a multi-functional one-stop healthcare electronic platform to facilitate the Government in population health management through analysing the big data, healthcare policy and strategies could not be determined in a precise and an evidence-based manner. In this regard, we will continue to enhance and expand the functions of the eHealth App with a view to making its use more prevalent for serving as the public health portal of Hong Kong.
Meanwhile, health-related data, including population health status, health-related lifestyles, other health parameters and socio-demographic data, are now collected through various health surveys. For policy planning and resource allocation of the PHC, particularly for evidence-based strategic purchasing, data collection on healthcare costs (including manpower and financial costs), health seeking behaviours, district-based health information and providers’ performance is also to be enhanced.
The utilisation of health data to help optimise healthcare services and promote medical innovation is an important development direction of Hong Kong's healthcare policy. With eHealth being the backbone to underpin the gate-keeping and referral mechanism proposed in the Blueprint for enhancing care co-ordination and health surveillance, we aim to optimise the use of the health information and data of DH, HA and DHCs under one platform for formulating protocols for disease surveillance, screening, prevention and treatment.
To improve data connectivity and health surveillance, we propose the following –
Enhance the eHealth as the gate-keeping and referral tool for care co-ordination and health surveillance
Launched in 2016, the eHealth is developed to serve as the backbone IT infrastructure to enable PPP, which alleviates the burden on the public health system, and makes better use of our precious medical resources by avoiding duplication of medical assessments and treatment, and improve the continuity, efficiency and quality of care as patients move between various healthcare providers in the public and private health sectors.
Currently, the eHealth supports various PPPs of HA, DHCs, as well as some of DH’s PPP initiatives, such as the Colorectal Cancer Screening Programme. The one-stop CM clinical record system “EC Connect” has also been launched to enable the access and sharing of relevant clinical records by phases through the eHealth platform for the CM sector. We propose to transform the eHealth from a health record sharing system into a comprehensive and integrated underpinning information infrastructure for healthcare data sharing, service delivery and process management especially PHC-related services, with multiple function layers to facilitate service record keeping, essential data sharing (such as allergies history, diagnoses, prescriptions, etc.), health monitoring and surveillance, case and workflow management (including triage, referral and payment), and explore the use of big data analytics to contribute to population health surveillance and individual health management.
Meanwhile, we recommend to mandate the use of eHealth and the uploading of key health data for all PHC healthcare professionals listed on the PCR and participating in the subsidised Government health programmes as mentioned in Recommendation 3.2, including DHs’ VSS, the EHCV Scheme and CDCC Scheme. Under this proposal, participating healthcare providers will be required to upload the health data and information of the relevant patients, before moving further beyond. The ultimate goal is for useful health records and data of our citizens in the public and private healthcare systems as well as different levels of the medical system to be collected in the eHealth. At the same time, it is envisaged that the eHealth would be transformed into an integrated system with multiple function layers to facilitate record keeping, diagnosis, monitoring, triage, referral and payment, with big data analytics contributing to population health surveillance. In the long run, it shall be developed into the healthcare database of Hong Kong, with one single, composite eHealth account for each healthcare provider and each citizen. Public health initiatives can be more readily promoted, co-ordinated and monitored under one centralised IT platform.
Some of the detailed suggested enhancement measures of eHealth are listed in Table 6.3 below.
As regards data upload from the private sector, the current situation is far from satisfactory and without a much-improved scale of upload by healthcare providers, the full potential of the eHealth cannot be actualised. Other than mandating the use of the eHealth for all participants of Government-subsidised health programmes, we will work towards implementing a one-off funding programme that targets facilitating connectivity of clinical management systems by private eHealth solution vendors, with a view to making data upload more palatable and convenient for private healthcare providers.
In the longer run, we recommend to require all PHC service providers to use eHealth and input the medical data, essential health and service data of service users into the eHealth account of the service users, with a view to strengthening the protection for healthcare service users, ensuring healthcare quality and raising standards, and enhancing co-ordinaton and continuity in the healthcare process, especially in the PHC at the community level and referral to and from the public hospital system, through mandates by necessary amendments to the Electronic Health Record Sharing System Ordinance (Cap. 625) and inclusion of relevant requirements in PCR and SPPs.
Promulgation of the eHealth App as the lifelong personal electronic health account
Health data collected under the eHealth platform unlocks the potential for developing patient empowerment functions aimed at serving the specific needs of individual users. For example, push notifications through the eHealth App can be initiated for a targeted age group or demographic, to remind breast cancer screening for females in a certain age bracket or recall for cervical re-screening to facilitate continuity of care. Self-input of relevant personal health information may facilitate on-going management and monitoring of chronic diseases. The eHealth App can also act as the technology platform for self-health management campaigns such as smart eating. In addition, community carers can make use of telecare facilitation to stay connected with their patients. For example, the provision of online exercise or rehabilitation training delivered through an internet platform for DHC or SPPs may be paired with the eHealth App.
Leveraging on the robust infrastructure of the eHealth as the backbone and the vibrant IT sector, our vision on the eHealth App is to promote it as a lifelong and indispensable personal electronic health record sharing system/account to facilitate the traversing of patients across the different sectors and tiers of the healthcare system. Through self-input and retrieval of key health data provided by their family doctors on the eHealth App, users will be able to participate in their own health management, improve their health literacy and be empowered to manage their own health especially if they have chronic diseases. The ultimate goal is to leverage on the eHealth and its reach to the wider community to bolster the Government’s efforts in building a PHC-centric system.
We are also contemplating to develop an eHealth ecosystem which enables the connectivity of the eHealth App with other third-party electronic health apps (such as apps for exercise challenge) or wearables to encourage wider usage. To complement the policy direction of development of PHC with focus on prevention, we will continue to enhance the eHealth App to serve as the individualised health management tool.
In addition, the Government will continue to actively allocate resources to drive medical technology innovation with a view to further enhancing healthcare efficiency and enabling sustainable development of healthcare services.
Support policy planning with data
In the area of healthcare data and technological application, HA’s Big Data Analytics Platform has supported multiple big data and artificial intelligence research projects since its establishment. The research areas include improving PHC services, risk forecast for various chronic diseases, timely prevention of deterioration, etc. Currently, HA has applied artificial intelligence to improve services in different aspects, including introducing artificial intelligence to analyse chest X-ray at all A&E departments in hospitals and GOPCs, in order to assist doctors to screen out patients with lung disease and high risk as soon as possible; using big data to identify patients with higher risks of diabetes, to provide personalised care planning for chronic disease, intervene early and raise the self-management ability of patients, etc. HA will continue to conduct research and introduce more healthcare-related artificial intelligence technology with a view to broadening the application to healthcare services and bringing greater benefits to patients in the long term.
Aside from boosting the impact of the eHealth, in broader terms, we believe that it is important for us to consider how to make better use of survey results and the patient/user health records from DH, HA, the eHealth and DHCs to facilitate overall health surveillance. The Government proposes to provide forecast and projection on the population health profile to facilitate evidence-based PHC policy making and programme planning. For instance, it would be useful to explore whether data available on the HA’s Big Data Analytics Platform may be further utilised to provide forecast and projection on the population health profile. In addition, with the territory-wide launch of DHCs, the data collected from DHCs will also facilitate on-going health monitoring and projection.
To achieve the above, we propose to transform the existing Research Office into a dedicated Research and Data Analytics Office under HHB to develop a population-based health dataset and conduct on-going data analytics and surveys and commission research studies on the population-based health status, disease pattern and burden, and health seeking behaviour, with a view to providing the necessary data, evidence and analysis to support health policy making by the Government, PHC service planning and resource allocation by the Primary Healthcare Commission, as well as the corresponding service planning and resource allocation for the public hospital system. The Office will take up and review the next PHS. The Office should also more effectively promote big data applications and monitor the progress and evaluate the impact of public health interventions to provide guidance on public health policy and strategies.
Chapter 6 - IMPROVE DATA CONNECTIVITY AND HEALTH SURVEILLANCE: Action Plan
To extend mandatory use of the eHealth to all subsidised Government health programmes
To put in place incentive programmes that facilitate connectivity by private eHealth solution vendors
To integrate various standalone public health IT systems/modules under the eHealth platform
To require private medical labs and radiology centres to join and upload lab images to the eHealth
To transform the eHealth into an integrated system – “One eHealth”
To explore the wider use of eHealth as a platform for outside entities
To consider mandating the use of eHealth through amending the Electronic Health Record Sharing System Ordinance (Cap. 625)
To continue to develop and enhance the one-stop CM clinical record system EC Connect
6.2 eHealth App
To enable the connectivity of eHRSS/eHealth App with other third-party electronic health apps or wearables
To facilitate tele-medicine and connection to other health technology for patients and health professionals
6.3 Research and Data Analytics
To transform the existing Research Office into a dedicated Research and Data Analytics Office under HHB
To develop a population-based health dataset
To set up a mechanism including tools and indicators to measure outcomes as listed in the Blueprint
To review the next PHS
Action: Short - Medium
To monitor the progress and evaluate the impact of public health interventions including recommendations in this Blueprint
Action: Medium - Long