1. COMP7830 Assignment 1 Sample Solution Part A

2. Why Medical Informatics

3. What is Medical Informatics It is a scientific field Information sciences & related technology Enhance the size & use of the knowledge base of the health sciences To improve Health care Basic biomedical & clinical research Education Management Policy

4. Features of Medical Informatics Multidisciplinary Developing rapidly Integrative & Innovative Essential infrastructure for Biomedical Science Healthcare Population / Public Health

5. Why Medical Informatics? Challenges of Medical Informatics Growth of knowledge & limitations of human memory The Internet & Integrated EHRs (Electronic Health Records) Higher expectations for care & outcomes National & global aspirations for a ‘wired’ healthcare system

6. Strategy for Current Goal From Non-system of Costly Inefficient Highly Variable Care To System that is Equitable Safe Patient-centered Efficient, effective, & timely

7. National & Global Health Informatics Infrastructure Five Key Dimensions Care-related Communications/Records (C3PRs) 1) Personal 2) Patient 3) Population / Public Health 4) Research & Development 5) Education & Training

8. First-class Health Care Based on NCVHS - The National Committee on Vital and Health Statistics More and more Personal Health Care Requirement is needed Health Informatics can help to guide medical decision Improve health care quality Reduces medical errors Promote a more effective marketplace Greater competition Protect personally identifiable health information

9. National Health Information Infrastructure (NHII)

10. NHII Vision Comprehensive knowledge-based network of interoperable systems Capable of providing information for sound decisions about health when and where needed “Anywhere, anytime health care information and decision support” NOT a central database of medical records Includes organizing principles, systems, standards, procedures, and policies, e.g. Communication networks Message & content standards Computer applications Confidentiality protections Individual provider Electronic Health Record (EHR) systems are only the building blocks, not NHII

11. Why NHII? NHII = “anytime, anywhere health information and decision support” Needed to improve safety, quality, and efficiency of health care Key elements Standards Electronic health records Local health information infrastructures (LHIIs)

12. Four Domains for NHII Four domains hold together Personal / Consumer Clinical / Provider Public Health / Community Research / Policy

13. Current Status of NHII Islands of Information Fragmentary & isolated elements of NHII exist Uneven distribution Lack of coordination Minimal interoperability Many “one-of-a-kind” systems Much duplicative work Limited dissemination of Systems Lessons learned

14. Benefit of NHII Linkage between medical care & public health Test results and x-rays always available eliminate repeat studies Complete medical record always available Decision support always available: guidelines & research results Quality & payment information derived from record of care – not separate reporting systems Consumers have access to their own records 20% of labs and x-rays done because prior results unavailable 1 in 7 hospitalizations occur because information about patient not available Medication errors reduced by 55% Ambulatory computer-based provider order entry (CPOE) could save $44 billion/year (Johnson et al, 2003)

15. Challenges of NHII Key challenges Protect Confidentiality Standards Data representation for exchange Decision support encoding Basic services Incentives Align for EHR adoption Create for LHII development Collaboration for data sharing Governance Legal & Regulatory Allow appropriate investments

16. Accelerating NHII progress Inform Disseminate NHII vision Catalog NHII activities Disseminate “lessons learned” Collaborate with Stakeholders Convene NHII 03: 6/30-7/2/2003 in D.C. National meeting to Develop a consensus action agenda

17. Advantages that HK has over USA in building the NHII and Electronic Patient Record?

18. Advantages Lower Population than USA Everyone live in Hong Kong has an HKID Card that can help hospital to restore records of citizens Population distribution is a kind of clustering Networking management for both public hospitals and private hospitals

19. Advantages – continue A lot of specialty clinics and family doctor clinics can provide private services Government invests a lot of money in building National Health Information Infrastructure and Electronic Patient Record. Lower cost

20. Part B

21. Strategy of hospital networking management

22. Location of hospitals in HK Three major clusters of network New Territories Network Kowloon Network Hong Kong Island Network Every cluster has a major hospital for more server people specific cases no duplications less wastage repositioning of hospital cost effective treatment

23. Services integrated by the Network System Implement networking system Unity and straighten out administrative management Avoid cut-throat competition Information sharing to reduce repeated tests Improve effectiveness and financial management

24. Unify the development orientation Whole system needs development strategy Three specific services: Basic health care services Service network Special health care centers

25. Build up a urban medical services Community-based Services received after leaving hospital, process including assessing, making a leaving plan, coming up with a service strategy, and house-nursing All conducted as community health care model

26. Community-based health care services model

27. Information technology platform Focus on clinical services All public hospitals, Specialty Clinic, General outpatient clinic can share clinical medical record through the clinical medical record system Both public hospitals and private hospitals share the same information platform

28. EHR – Electronic Health Record In-patient oriented IT platform consists of public hospitals, specialty clinic, and general outpatient clinic Sharing with private clinics

29. Awards and Recognition Encourage innovative thoughts and developments eSARS in 2004 ePR Data Warehouse in 2004 ePR image distribution in 2005 AIRS in 2005 The PPI-ePR project from 2006-2007 Helps Hong Kong to rank the first Extra: Public-private Partnership

30. Enhance Management To increase ROI Reduce cost, guarantee quality Ensure patient safety, be strict to new technology and new drugs “What cannot be measured, cannot be managed” Improve bargain power

31. Assistant Supports Set up clinical quality standard Based on scientific research Priority focuses on patient’s safety Enhance cultural establishment, active directions, and teamwork spirit for staffs. HR, staffs training Performance management

32. Set up assurance of clinical quality

33. Promoting evidence-based medical Based on science and clinical research achievement Safety first and good treatment results Reduce resource wasting

34.  Enhance cultural and infrastructure construction Four basic support Culture Structure Process People Corporate culture Patient-centered Advocates continuous improvement and learning Team work

35. Performance management

36. Performance 2% GDP affords 91% inpatient and seriously ill High efficiency use of resource Medical informatics network is pretty good Efficiency audit and control high-tech medical machine and medicine Afford most of medical personal training