Special Feature: The 29th CMAAO General Assembly & 50th Council Meeting Symposium “Health Database in an Information Society”

[ Kong] Health Database in *1

Alvin Yee Shing CHAN1

Present Progress of IT in the Health tronic Record Sharing System Bill Care Area in Hong Kong - drafted - security and privacy issues→safe deposit box A. For healthcare professionals - future “Commissioner for the Electronic Health B. For the public, including public Record (eHRC)” to define data retention policy C. E-Health record sharing - patient information notice D. Primary care directory - consent, PIN, sharable data E. Health database for subsidy programmes (3) The Hong Kong Medical Association (1) Elderly Healthcare Voucher Pilot Scheme TaoYuan Project (桃園計劃)—Clinic Manage- (2) Vaccination Subsidy Schemes ment System (CMS) 3.0 F. For research and development The CMS 3.0 is an open-source clinical manage- ment system project jointly implemented by the For healthcare professionals Hong Kong Medical Association (HKMA) and (1) Information access the Information and Software Industry Asso­ (2) News access ciation (ISIA), with funding support from the (3) CME Office of the Government Chief Information Officer (OGCIO). For the public Now undergoing further enhancement—up- (1) Information access grade existing system so that it would connect (2) Press release to the eHR Sharing System via the eHR viewer; (3) Public education repack it as CME 4.0 (Wenchang project) (文昌計劃 ). E-Health record sharing (http://cms3.hkma.org/pages/index.asp) (1) —Steering Commit- (4) New requirements from government regard- tee on eHealth Record Sharing (eHR sharing) ing uploaded information • Working group on e-HR partnership - Person Master Index for personal identifi­cation • Working group on institutional arrangements - Encounter with dates of attendance when pa- • Working group on legal, privacy and security tients consult private medical practitioners issues - Medication dispensed during healthcare process • Working group on eHealth record and infor- mation standards Primary care directory · Coordinating group on eHR and information - Web-based system containing personal and standards practice-based information of different primary - eHR domain group on drug record care providers - Domain group on person mater index - Public can use the search function to choose - eHR domain group on immunization record the primary care providers who most suit them - eHR domain group on provider index - Consists of sub-directories for different health- - eHR domain group on laboratory record care professionals providing primary care. In - Technical task force the initial stage, we have established the sub- (2) eHR Sharing System Bill (eHRSS Bill)/Elec- directories of doctors and dentists. Sub-directories

*1 This article is base on a presentation made at the Symposium “Health Database in an Information Society” held at the 29th CMAAO General Assembly and 50th Council Meeting, Manila, the Philippines, on September 24-26, 2014. 1 Vice-President of the Hong Kong Medical Association, Hong Kong, China ([email protected]).

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for other professionals, like Chinese medicine · Other institutions practitioners, nurses and allied health profes- sionals will be developed in a later stage Current Status of Privacy Protection and Personal Information Protection, Health database for subsidy programmes Including Handling of Gene Information (1) Elderly Health Care Voucher Pilot Scheme (www.hcv.gov.hk) · The Office of the Privacy Commissioner for Purposes: Personal Data (“PCPD”) - Encourage elders to seek consultation - an independent statutory body set up to over- - Establish a closer relationship with private doc- see the enforcement of the Personal Data (Pri- tors who are familiar with their health conditions vacy) Ordinance (Cap. 486) (“the Ordinance”) - Promote the concept of family doctor which came into force on 20th December, Developments: 1996. - 2009: 5 vouchers of $50 each were provided to · The University of Hong Kong Privacy Policy each elder aged 70 or above annually. Statement (http://www.hku.hk/privacy_policy/) - 2012: increased the annual voucher amount from $250 to $500. Use of the Citizen Numbering System - 2013: further increased the annual voucher amount to $1,000. · Hong Kong Identity Card (http://en.wikipedia. - 2014: further increased the annual voucher org/wiki/Hong_Kong_Identity_Card) amount to $2,000. Unspent vouchers would be carried forward and accumulated by an eligible elder, subject to a ceiling of $4,000. Merits and Demerits of Health Care Highlights: Supported by IT - Vouchers will be issued and used through the eHealth System. They will not be issued in paper Merits form separately. (i) Huge storage of database in limited space - Voucher Recipients need not pre-collect the (ii) Efficient/Fast health care vouchers. (iii) Able to cater different needs - Voucher Recipients need not carry the health (iv) Based on a “need-to-know” basis, informa- care vouchers. tion readily available anywhere anytime to - “Money follows Patient”—Voucher Recipients facilitate assessment and decision can choose freely on private primary healthcare Demerits services in the local community. (i) Security concerns (2) Vaccination Subsidy Schemes (ii) Protection of patients’ privacy and respect of - Childhood Immunisation Programme patients’ choice of not to disclose one’s own - Government Vaccination Programme sensitive health record to unrelated health- - Childhood Influenza Vaccination Subsidy Scheme care providers - Childhood Vaccination Subsidy Scheme (PCV13 (iii) Might need to set up a system separately booster) storing patients’ sensitive data with security - Elderly Vaccination Subsidy Scheme access control over it - Pneumococcal Vaccination (iv) The hiding of certain data might lead to - Residential Care Home Vaccination Programme diagnosis errors or wrong treatment and influence patients’ care For research and development (v) The existence of a separate system might · Faculty of Medicine of 2 Universities: create stigmatization and labeling effect on - The University of Hong Kong patients, thus hampering the trust between - Chinese University of Hong Kong doctors and patients

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