Healthcare Service Reform Initiative e Health Record Sharing System :e-Health Record Sharing System :

Vision, Actions, Lessons and Prognosis

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Healthcare Reform: Ageing Demographics & Medical Inflation

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Hong Kong population ill b i idlwill be ageing rapidly

Population profile in 2009 & 2039p p

75 - 7980 - 84

85 +

Age group

Male Female

Mid 2039

75 - 79

80 - 84

85 +

Age group

Male Female

Mid 2009

50 54

55 - 5960 - 64

65 - 6970 - 74

75 79

50 54

55 - 59

60 - 64

65 - 69

70 - 74

75 79

30 - 34

35 - 3940 - 44

45 - 4950 - 54

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

5 - 910 - 14

15 - 1920 - 24

25 - 29

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

400 300 200 100 0 100 200 300 400

0 - 4

Thousands persons400 300 200 100 0 100 200 300 400

0 - 4

Thousands persons

In 2009 – 1 out of 8 persons was an elderly person. f

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By 2039 – 1 out of 4 persons will be an elderly person.

Source: Hong Kong Population Projections 2009 -2039, C&SD

Hong Kong will see one of the fastest ageing among advanced economiesageing among advanced economies

Elderly Dependency Ratio of Hong Kong and Selected Economies550

450

500

550

ed 1

5-64 Japan

Actual Projection

350

400

450

pula

tion

age Finland

Belgium

250

300

per 1

000

po

150

200

rly a

ged

65+

AustraliaBelgiumCanadaFinland

50

100

mbe

r of e

lder Hong Kong

JapanSingaporeSw itzerlandUnited KingdomU it d St t

Singapore

Hong Kong

4

0

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

2022

2024

2026

2028

2030

2032

Num United States

The elderly population has greater healthcare needs

The elderly population uses on average six times more in-patient

greater healthcare needsy p p g p

care than the population aged below 65.12,000

A b f bli h it l

8 000

10,000

000

pers

ons Average number of public hospital

bed days utilized by age (2007)

6,000

8,000

ed d

ays

per

1,0

2 000

4,000

vera

ge n

o. o

f be

0

2,000

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 +

Av

5Source: Data from Hospital Authority

Age group

Everywhere health expenditure is i f t th thgrowing faster than the economy

Average annual real growth rate of total health expenditure and real

8%te

Average annual real growth rate of total health expenditure and real growth rate of GDP in HKG and selected economies (1995-2004)

5%6%7%

l gro

wth

rat

Average annual real growth rate of GDPAverage annual real growth rate of total health expenditure

2%3%4%

rage

ann

ual

0%1%

Japan Switzerland UK USA HKG Australia Singapore

Ave

r

Japan Switzerland UK USA HKG Australia SingaporeSource: 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

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gy, g p p , gmedical cost -> medical inflation is driving increase in health expenditure everywhere

Hong Kong’s health expenditure projected

Health expenditure as % of GDP 1990 - 2033to rise as a share of the economy

p

9%

10%

P Past Projection

9.2%

6%

7%

8%

s % of GDP Past

Health expenditure in HK in 1990 - 2004

ProjectionHealth expenditure in HK in 2005 - 2033 Total health expenditure

4%

5%

6%

nditure a

Public health expenditure

5.3%

2 9%

5.5%

2%

3%

alth expe

Public health expenditure

Private health expenditure

2.9%

0%

1%

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030 2032

He

Source: Hong Kong’s Domestic Health Accounts: 1990 - 2004 Financial projection of Hong Kong’s total expenditure on health from 2004 to 2033

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2004 to 2033: Ageing + Medical Inflation Per capita health expenditure nearly quadruple when per capita GDP will only double

Problems in the Existing Healthcare System

(1) Primary healthcare service not comprehensive(1) Primary healthcare service not comprehensive enough

(2) Bottlenecks exist in public healthcare service(2) Bottlenecks exist in public healthcare service and long waiting time

(3) Public private imbalance in healthcare system(3) Public-private imbalance in healthcare system and limited choices for patients

(4) I ffi i t t ti id d d th t(4) Insufficient protection provided under the current public healthcare safety net

(5) L k f h i f di l d b t(5) Lack of sharing of medical records between doctors in public and private hospitals

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Healthcare Reform:Healthcare Reform: Enhancing Services on a Sustainable Basis

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First Stage: Healthcare Service Reform

Enhance primary care

g

Enhance primary care

– Primary Care Development Strategy by end 2010

Promote public-private partnership in healthcare

– PPP projects being launched progressivelyPPP projects being launched progressively

Develop electronic health record sharing

– First stage eHR Programme for sharing by 2013-14

Strengthen public healthcare safety netg p y

– Expand Drug Formulary to support patients in need

O $5 billi i d f i f10

Over $5 billion committed for service reform

(1) Enhance Primary care(1) Enhance Primary careTo put greater emphasis on preventive care, promote healthyTo put greater emphasis on preventive care, promote healthy lifestyle, improve the state of health of people, reduce the need for hospital care.

D l b i d l f i i→ Develop basic models for primary care services → Establish a family doctor register→ Subsidize individuals for preventive carep→ Improve public primary care→ Strengthen the function of the Department of Health in health

educationeducation

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(2) Promote Public-Private Partnership in HealthcarePartnership 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→ Purchase primary care from the private market → Subsidize individuals to undertake preventive care in the

private sectorp→ 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

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(3) Develop Electronic H lth R d Sh iHealth Record Sharing

As an infrastructure, electronic health record sharing can effectivelyenhance continuity of care, facilitate better integration of differenth lth i d i i i d li t i ti tihealthcare services, and minimise duplicate investigations→ Fund the development of the sharing

infrastructureinfrastructure→ Make available the know-how

to the private sector→ Consider provision of financial

assistanceP t th b fit f h lth d→ Promote the benefits of health recordsharing to patients and healthcareprofessionals

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p

(4) Strengthen Public Healthcare Safety NetSafety Net

To provide better healthcare protection for patients who need to use public healthcare services

R d iti ti f bli→ Reduce waiting time of public hospital servicesImprove the coverage of standard→ Improve the coverage of standardpublic services

→ Explore the idea of a personal limit→ Explore the idea of a personal limit on medical expenses

→ Inject funding into the Samaritan FundInject funding into the Samaritan Fund

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Healthcare Reform: Enhancing Services on a Sustainable Basis

First Stage Consultation (2008): Healthcare Service d Fi i R f

Enhancing Services on a Sustainable Basis

and Financing Reform– The public support reform in general, but have

reservations about mandatory supplementary financingy pp y g– Prefer voluntary private health insurance, and choice of

private healthcare services according to one’s needs– Want more choice and better protection beyond publicWant more choice and better protection beyond public

healthcare services provided by the Government

Second Stage Consultation (2010): VoluntarySecond Stage Consultation (2010): Voluntary Health Protection Scheme (HPS)– Standardise and regulate voluntary private health

insurance by legislation for consumer protectioninsurance by legislation for consumer protection– Formulate HPS core requirements and specifications to

address shortcomings of existing private health insuranceC id ki $50 billi fi l t id

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– Consider making use $50 billion fiscal reserve to provide subsidies to HPS subscribers

Public Healthcare: Unswerving Government Commitment

The Government will only increase, and not reduce,

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 expenditureSubvention for Hospital Authority (HA) increases from– 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

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$1 billion injection into the Samaritan Fund

Public Healthcare: Unswerving Government Commitment

Uphold public healthcare system as the

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 costf f– Training of healthcare professionals

HA making use of increased funding to reinforce manpower

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g g pand enhance various public healthcare services

Hong Kong Territory wideHong Kong Territory-wideElectronic Health Record Sharing System

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www.ehealth.gov.hk

ObjectivesObjectives

Develop a territory-wide patient oriented electronic health record (eHR) sharing system

Enhance the continuity of care and better integration of different healthcare servicesof different healthcare services

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What is eHR?What is eHR?• NOT just an IT project

• A territory-wide “infrastructure”

• Key to improve our health service delivery system in future• Key to improve our health service delivery system in future

• Indispensable component for our future health care reform & financing arrangementsarrangements

• 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

E ti l d t f di ill• Essential data source for disease surveillance

• AMBITIOUS project – no country-wide EHR in the world yet

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Present SituationPresent Situation

Hospital Authority Private HospitalsHospital Authority• 8 million patient records• 800 million lab results

Private Hospitals• Mainly electronic billing and

financial systemsEl t i d l k h i• 340 million prescribed drug

records• 34 million X-ray images

• Electronic record lacks sharing capability

Private Clinics• 3 million transactions per day

Department of Health

Private Clinics• Mostly paper-based records• Electronic record lacks sharing p

• Essential health data, e.g. vaccinationP i f HR h i

capability

Private Labs/• Preparing for eHR sharing Allied Health Providers

• Not connected to other providers

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Without eHRWithout eHRPrivate HospitalDentists

HA

Private Hospital

Doctors

Dentists

HA Doctors

DHDH

X-rayNurses

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Nurses

With eHR

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Benefits of eHR SharingBenefits of eHR Sharing

For PatientsWhole record available onlineTimely and accurate information for careIncrease the speed of treatment

For Healthcare ProvidersEfficient clinical practiceEfficient clinical practice Avoid errors associated with paper records

For SocietyDisease surveillanceP bli h lth d li ki

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Public health and policy makingHospital Authority Private Hospitals

ChallengesChallenges

P i d it HR l l f kPrivacy and security concerns, eHR legal framework

Ch tChange management- Project management and institutional framework

Standarisation- Standarisation- Building block approach – pilots

Public private partnership- eHR Engagement InitiativeseHR Engagement Initiatives- Partnership project- CMS extension and CMS adaptation

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Guiding PrinciplesGuiding Principles

Government-led model for development

Compelling but not compulsory record sharingCompelling but not compulsory record sharing

Data privacy and system security of paramount importance

Open technical standards for private participationOpen technical standards for private participation

Building-block approach for eHR components

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eHR Legal FrameworkeHR Legal Framework

The privacy and security challenges of eHR

An eHR specific legislation

Consultant to review the Framework for eHR

Privacy Impact Assessment

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Project Management and Institutional Framework

H it l A th it (HA) G t P i t t

eHR Office

Steering Committee on eHR Sharing

HA IT Services

Hospital Authority (HA) Government Private sector

eHR OfficeHA IT ServicesWorking Group on

Institutional Arrangement

Working Group on Legal, Privacy and

Security IssuesWorking Group on

eHR PMOWorking Group on

eHR and Information Standard

Working Group on eHR Partnership

Private Projects

Public-Private

InterfaceProjects

eHR Projects

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Standardisation of Health RecordStandardisation of Health Record

Define a scope of eHR sharable data

Standardise Patient Master Index, immunisation record, drug record, etc.

Support promotion of HL7, ICPC, pp pSNOMED CT, etc.

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Public Private PartnershipPublic Private Partnership

eHR Engagement InitiativeeHR Engagement Initiative • 1st Stage EEI for Private Healthcare Sector (Oct 2009)• 2nd Stage EEI for IT sector (Nov 2010)2nd Stage EEI for IT sector (Nov 2010)

Partnership ProjectsPartnership Projects• eHealth Consortium – Validation Platform• HK Medical Association CMS 3 0• HK Medical Association - CMS 3.0• HK Dental Association – Dental Clinic Management

System

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System

Budget and TargetsBudget 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

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Legal framework

Major MilestonesMajor MilestonesY H i l Cli i A illYear Hospitals Clinics Ancillary

2009 Radiological image sharing with private hospitals;2009 Radiological image sharing with private hospitals;Integration of Healthcare Voucher scheme with eHR

2010 Pilot use of SmartID for patient Laboratory sharingpauthentication

y g

2011 CMS adaptation b i d l

Community PMIbasic modules

2012 Begin patient enrollment

CMS on ramp HK Drug tableenrollment

2013 Shared records in Doctor Portal

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Thank YouThank You

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