Healthcare IT: the networks supporting our hospitals
Dr Cheung Ngai Tseung is the Chief Medical Informatics Officer (CMIO) and Head of Information Technology (IT) at the Hong Kong Hospital Authority (HKHA). He is also the Consultant for eHealth for the Hong Kong Government and was instrumental in the creation of the Electronic Health Record Sharing System (eHRSS) launched in March this year. He heads a team of about 1400 IT staff and 100 Informatics specialists.
“The use of IT in medicine is a very specific discipline. The role has deepened over recent years and is now mission-critical,” says Cheung, who first became interested in computers a during a high school visit to a mainframe IBM computer which used punch-cards.
When Cheung entered Sydney University in 1982, it never occurred to him to study computing and it was only when he started his degree in medicine that he realised he preferred computers. He started working as a developer for a local software company while he was still studying for his five-year medical degree. He also took a year out to complete an optional BSc (Med), during which he developed a computer simulation of the cardiovascular system of a dog.
“That cemented in my mind the area I wanted to work in,” says Cheung and after a hospital internship, which often required working for 36 hours continuously, he decided not to pursue medicine as a career and went to work full time for the small software company instead. The company was developing patient health record systems on the first generation of Macintosh computers.
“It was then that I realised I was only self-taught in coding and I needed some formal training,” says Cheung and he was awarded a Croucher Scholarship in 1991, to study computer science at Imperial College London (ICL).
The master’s course at ICL was a very compressed course designed for students with non-computing first degrees and despite it being hard work, Cheung describes that time as “a joy”. On completion of his Master’s degree he returned to Australia and later heard about a job that had come up at the recently established Hong Kong Hospital Authority for someone with a medical background to help develop medical information systems.
“I joined in September 1993 and there were already some systems in place but not for specific clinical support that doctors and nurses could use on a daily basis,” says Cheung and he set about implementing a comprehensive computerised record system to improve the documentation and effective management of diseases and care.
Now Hong Kong is some way ahead of most places and the use of IT by clinical staff has been widespread since the 1990s while private health service providers have lagged behind. He assisted in a government programme to bring all of Hong Kong's medical services up to scratch with a new system specifically designed for the private sector.
Cheung explains that in the old days, if a doctor wanted a lab test he completed the paper equivalent of a dim sum menu listing the various tests available and sent it off to the laboratory with the sample. The digital test results were then printed back onto hard copy and hand-delivered back to the doctor.
“We computerised the entire process so that the menu was completed and dispatched digitally and the results could be obtained on the doctor’s computer,” explains Cheung.
“Now you can review a patient’s full medical history and examine all previous tests and scans and even zoom-in in technicolour glory as you wish,” he says and explains the computer data follows the patient from hospital to hospital and from doctor to doctor. And when clinical staff use the computer system it also eradicates errors caused by misreading of their handwriting which was a traditional problem in pharmacy.
He explains the biggest challenge was that doctors were naturally resistant to change and his medical background proved to be essential.
“My medical degree was invaluable and I could not have done this job without it. It allowed me to communicate effectively with medical staff and demonstrate the practical benefits of Informatics,” he says.
Cheung explains that while every patient has individual needs and different hospitals, doctors, specialisations, and wards all have different priorities, by having informatics staff with a medical background, his team can understand the clinical requirements and convert these multitude of requirements into a general clinical platform.
“Healthcare is incredibly complex but we do have the advantage in Hong Kong of being under a centralised umbrella,” he says and believes that because clinical IT is so complex it is essential to have the support of the doctors if it is to work effectively.
“An IT person would not be able to speak the same language as doctors,” he says and outlines future challenges for clinical informatics.
“Healthcare is subject to demographic change and demand grows exponentially with age. With an aging population in Hong Kong how do we deliver more healthcare from the same raw resources? It’s my job to fill that gap by saving time for clinical staff, avoiding duplication of treatment and ensuring the wheels of the medical service run smoothly,” he says.
Interesting new areas include artificial intelligence or so called ‘big data’. His team can now identify high-risk elderly patients by working with clinical statistics experts to get a risk score on individual patients. Using IT, they can identify and contact those patients from a call centre and clinical staff can call them and offer advice and intervention. He also describes ‘clinical decision support’ in areas such as drug prescription where it often makes more sense for a computer to look at drug compatibility and patient allergies or intolerances, rather than rely on human judgement.
“We can multiply the impact of the precious human resource and focus it where it is most required,” says Cheung.
Dr NT Cheung is the Chief Medical Informatics Officer (CMIO) and Head of Information Technology (IT) at the Hong Kong Hospital Authority (HKHA). He is also the Consultant for eHealth for the Hong Kong Government. He holds a degree in medicine from the University of Sydney and was awarded a Croucher scholarship in 1991, to complete a Master’s degree in Computer Science at Imperial College London. Since being appointed as CMIO at the HKHA in 1993 he has pioneered clinical information technology at the Hospital Authority such that it is now considered an indispensable part of the care delivery process for 38,000 clinical users.
To view Cheung's personal Croucher profile, please click here.