Healthy path to patient records exchange

To facilitate healthcare across multiple medical organizations, governments worldwide are looking at, or have begun implementing national electronic medical record (EMR) systems that aggregate patient records from clinics and hospitals.

Hong Kong, for example, in 2004 first proposed the development of a similar system for the territory. It aims to enable the creation, transfer and retrieval of the patient's personal data between both public and private healthcare providers, subject to the patient's consent.

The first stage of this eHR (electronic health record) Development Programme will span between 2009 to 2010 and 2013 to 2014, according to Hong Kong's Food and Health Bureau (FHB). The bureau is targeting to have the platform ready by 2014, providing access to all public and private hospitals. It is also aiming to have electronic patient records and other health information systems available for sharing between private doctors, clinics and other health service providers.

Also in 2004, Singapore's Ministry of Health (MOH) unveiled the Electronic Medical Record Exchange (EMRX), designed to share medical data across healthcare establishments in the country. The initiative started with two local public healthcare clusters--Singapore Health Services and National Health Group--to facilitate data sharing across all public hospitals and polyclinics under the two groups.

The EMRX has since progressed from the sharing of only hospital in-patient discharge summaries, to now include lab test results, radiology and procedure reports, medication, child immunization and school health clinic records. In addition, a critical medical information archive was established to contain patients' medical alerts and drug allergies.

In 2007, the EMRX was extended to Singapore's community hospitals.

According to the MOH, the initiative helps improve the quality of healthcare provided and increases safety because information about the patient's drug allergies and current medications is now readily available. The system also assists in reducing costs for patients because doctors can view the results of recent blood tests and x-rays online, thus, cutting down the need to repeat tests.

Similarly, Hong Kong's FHB said its system will facilitate the enhancement of primary care and promotion of public-private partnership in the healthcare sector.

An FHB spokesperson told ZDNet Asia in an e-mail that the initiative will "deliver a host of intangible benefits" to patients, clinicians and the healthcare system as a whole.

"These benefits will have a financial, albeit non-measurable, impact in terms of the economic impact of having a healthier population, and a reduction on secondary and tertiary care costs because of providing more effective and early treatment," the spokesperson added.

Ready user acceptance
According to Singapore's MOH, the core purpose of its EMRX is to improve patient safety and care, and this is a goal shared by healthcare professionals in the country as well. As such, the ministry has not faced major obstacles in the way of implementing EMRX, an MOH spokesperson said in an e-mail interview.

"In particular, doctors in emergency departments find EMRX valuable in treating patients with long and complicated medical histories, as these patients may not be able to describe their histories accurately in an emergency situation."

However, the spokesperson added, there are technical issues that need to be cleared. Because various institutions have different data systems, the main technical challenges lie in ensuring that data can be shared seamlessly across these systems.

As the MOH extends EMR sharing to the private sector and step-down care, the integration of different systems and security challenges will increase, the spokesperson explained. He added that there will also be a need to establish guidelines so that data management methods are uniform for all users.

To minimize its technical challenges, Hong Kong plans to focus on developing the territory's EMR system on a "building block" approach, breaking the project into individual components. Modules will be built step by step with pilot trials and will involve user feedback.

Pilot projects will allow the government to test the feasibility and acceptability of the system, as well as different technical and operational options, the FHB spokesperson said. This way, it can ensure each component suits the needs of the healthcare sector and public.

Proven modules with add-on scope and functions will gradually be brought together to support the EMR system.

This strategy worked well when Hong Kong developed its Hospital Authority's clinical management system, and will help avoid the "big bang" approach that has challenged EMR development in some countries, the FHB said.

The sharing of healthcare data across the platform will also be based on predefined security standards and communication protocols to ensure data integrity, and to safeguard the privacy and security of patient data, it added.