Greater China eHealth Forum 2011 Takeway Points

Last week I had the pleasure to attend the Greater China eHealth Form 2011 held at Hong Kong, also had the pleasure to share with peers from Greater China about Singapore's development in Health IT standards development and SOA design.

This is the first time the eHealth organizations from Mainland China, HongKong, Taiwan and Macau jointly host the eHealth forum with the theme - Connect, Collaborate and Care.

There are well over 800 people attended this forum, with Health IT professionals from the above four regions and other overseas countries such as USA, Canada, , Germany, UK, Australia, New Zealand, South Korean, and of course Singapore,etc. Every breakout session is full attendance with over 150~ 200 people.

The forum is hugely successful, the following topics and presentations are very insightful and inspiring, and reinforced my passion to further deepen my understanding in different aspects of healthcare domain, and further collaboration with them to share my technical expertise with them.

1) China's development.

Grand vision and impressive planning from China Ministry of Health, the topic was presented by Dr MENG Qun, he is director of center for statistics information, Ministry of Health,China. The business driver of this vision is the urgent need to develop Health IT industry in China to catch up with the pace of health sector reform, delivery model transformation and the need to reduce healthcare cost.

The vision includes multi-tiered regional health network from city, province and all the way to national level integration.

I also had in-depth discussion and sharing with Prof Li Bao Luo, who is executive president of China Hospital Information Management Association, and learned from him that China is currently working on national wide EHR reference architecture and HL7 CDA implementation guide.

The sharing of China HIT market from Mr Sheldon Dorenfest is awesome and wonderful, both challenges and opportunities abound in China, it all depends how to make best use of it.

2) HK's great success

The progress and work achieved by HK hospital authority, this organization has about 1000 staff, they are responsible for the Health IT planning and execution for all the public hospitals in HK. There are many breakout sessions conducted by HK HA, I am very impressed by their terminology development, the mapping of interface and reference terminologies, and the extensive terminology services they have implemented. I am also impressed by their "can do, will do, and just did it" working culture and attitude, and all these services are developed in-house, truly impressive, salute to them!.

HK is using HL7 CDA for integration between different EMR or HIS (Hospital Information System).

3) Taiwan's development

Taiwan's achievement is equally impressive, the centralized EHR system does not store actual medical records, only longitudinal records such as patient conditions and family histories, etc, and indices that link to the actual detail medical records held in the respective EMR systems. The system integration between these EMR system is using HL7 CDA.

Another interesting development from Taiwan is their creative business models to encourage EHR adoption esp. for the GP. Dr HSU Chien-Yeh, who is present of Taiwan Association for Medical Informatics, mentioned any GP who treats patients by reusing the test results or imaging from other GP is entitled 50% of the actual lab test cost. My guess is that even though money is eventually coming from the tax payer, but the overall cost nationwide is lower than the one if doing the same test twice.

4) Macau's vision

Though Macau is small, only half mil people with only three hospitals, but they have the needs to allow these systems to fully integrate with Hong Kong and China, esp a lot of retiree from Macau try to spend retirement in neighboring cities in China such as Zhu Hai. With mainland China, HK and Taiwan are using HL7 CDA, I am sure that they will align their interoperability standards with them, maybe they are already doing it now, since I do not have much visibility, so I can't comment too much on this.

This truly reflect the theme of this conference - Connect, Collaborate and Care.


Lastly, its such pleasure to meet up and exchange ideas with many peers from Greater China market, and meet up with Prof Ed Hammond from Duke University again. BTW Mr Sheldon interestingly acknowledged that HIT grandfather title should go to Prof Hammond after realizing that Ed started HIT career earlier than him, nevertheless they are both HIT grandfather figures.

Unfortunately I missed Prof LUN KC's presentation since I was presenting my own paper at the same time slot, hope to catch up Prof Lun again to learn something they did not teach in medical schools.

One important message I got from this conference is that continuous emphasis from various speakers on the need to collaborate with each other, no single national programme can afford to create their own interoperability standards.

So what we can from these developments, and also consider that most of national EHR programmes, such as UK, Canada, Australia, are using HL7v3 messages and HL7v3 CDA as their interoperability standards, so what's left to decide when you embark on national EHR programme.

Of course, having said that, it does not mean HL7v3 CDA is perfect, though it is best at this moment. There are still a lot of wire format simplification can be applied to CDA, such as the data type simplification, and within HL7 community, there are few exchange formats are being discussed and tried out such as greenCDA, hData and the most recent one - Resource For Health (its official name within HL7 is FHIR - pronounced as 'Fire', Fast Healthcare Interoperability Resource)

All these slightly different exchange formats in fact can complement each other and eventually will be converged into one unified exchange model in the end IMO, just take note the unified exchange model does not necessarily mean one unified wire format for every use case such as lab, it is most likely to be domain specified unified wire format.

Lets see what happens in few years' time.

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