Fwd: Request of information about eHRSS under Code on Access to Information

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Simon H WANG

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Nov 6, 2020, 2:31:22 AM11/6/20

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---------- Forwarded message ---------
From: <enq...@fhb.gov.hk>
Date: Fri, Nov 6, 2020 at 3:00 PM
Subject: Request of information about eHRSS under Code on Access to Information
To: <simo...@hkbu.edu.hk>

Dear Dr Wang,

Please find our reply attached. Thank you for your interest in the subject matter.

Yours sincerely,
(Miss Cora CHENG)
for Secretary for Food and Health

From: Enquiry FHB/FHB/HKSARG
To: simo...@hkbu.edu.hk,
Date: 23/10/2020 15:54
Subject: Request of information about eHRSS under Code on Access to Information

Dear Dr Wang,

The Food and Health Bureau (FHB) has received your application under the Code on Access to Information on 17.10.2020. Your application is now under processing. According to paragraph 1.16 of the Code on Access to Information, you will be informed of the latest progress of the case separately on or before 06.11.2020. In the meantime, please contact us by e-mail at enq...@fhb.gov.hk if you have any enquiry. Thank you.

(Ms Sylvia CHU)
for Secretary for Food and Health

From: Simon H WANG <simo...@hkbu.edu.hk>
To: enq...@fhb.gov.hk,
Cc: max...@life.hkbu.edu.hk, frey...@life.hkbu.edu.hk
Date: 17/10/20 08:01 AM
Subject: Request of information about eHRSS under Code on Access to Information

Dear Sir/Madam
Thanks for your detailed reply. I'd like to ask a few more questions on behalf of two of my students taking a General Education course and working on a project on the eHealth record sharing system. Please process the questions as Access to Information (ATI) requests under the Code on Access to Information.

1. We'd like to know more about the healthcare professionals (HCP) that have joined the system. Please list the types of HCPs that are eligible to access patients' records using the system. For each type, please provide the numbers under public hospitals, private hospitals, private clinics and other types.

2. To calculate the percentage of HCPs that have joined the system, please provide the total number of HCPs of each type that are actively serving in HK. Or please refer us to the relevant professional organizations.

3. What is the process for an HCP to register for eHRSS? Please provide info with respect to different types of HCPs if the procedures are different.

4. What is the process for an HCP to access patients' records? Please provide info with respect to different types of HCPs if the procedures are different. Are there any screenshots or other documents describing the system/interface for HCPs?

5. A recent survey indicated that 45% of the doctors not in the system thought accessing the system was time-consuming https://www.scmp.com/news/hong-kong/health-environment/article/3010208/pilot-e-health-portal-give-hong-kong-patients What response does the bureau have regarding this belief?

6. Did the Bureau conduct any surveys among HCPs who used the system regarding their satisfaction and perceptions? If so, please provide reports; if not, does the Bureau plan to do so?

7. Did the Bureau conduct any study of the reasons why many HCPs in HK chose not to join the system? If so, please provide reports; if not, does the Bureau plan to do so?

8. Regarding the info provided in the previous reply, please provide the breakdown for 2019 figures by different types of HCPs (GP, specialists, other types of HCPs in different settings- public, private etc )?

The yearly numbers of access by HCP type since eHRSS’ launch in March 2016 are provided in the table below –

Year	No. of Accesses to eHRSS by (to nearest hundred)			Total Number of Accesses to eHRSS by HCPs
Year	Public HCPs	Private Hospitals	Other HCPs	Total Number of Accesses to eHRSS by HCPs
2016	26 300	23 700	100 800	150 800
2017	73 700	47 400	198 800	319 900
2018	148 100	83 400	275 300	506 800
2019	216 700	103 300	336 200	656 200
Total	464 800	257 800	911 100	1 633 700

9. What types of medical records are available for HCPs to access? Please provide the frequencies of the different types of records being accessed by different types of HCPs.

10. To follow up on the question 9 raised previously (see below), what guidelines does the Hospital Authority issue to GPs and specialists regarding when to access patients' records?

9) How do health care professionals in public hospitals and clinics use eHRSS when they serve the patients in various settings? Please provide guidelines and handbooks provided for the staff on this matter.

The Electronic Health Record Sharing System Ordinance (Cap. 625) (eHRSSO) (https://www.elegislation.gov.hk/hk/cap625!en) is specifically developed to provide for, amongst other, the establishment of eHRSS, the sharing and using of data and information contained in the system, and the protection of eHRSS, data and information. A Code of Practice (CoP) (https://www.ehealth.gov.hk/en/ordinance_and_related_information/code_of_practice/index.html) has been issued under eHRSSO to provide good practice and recommendations in the use of eHRSS by HCPs and HCProfs. All participating HCPs are required to comply with the eHRSSO, the CoP and Conditions of Registration of HCPs in eHRSS in order to register in eHRSS. To ensure eHRSS users are well-informed of the policies, requirements and procedures for using eHRSS, regular training and briefings are being organised for HCPs.

11. Please provide use cases in which the eHRSS has added value to the work of the medical doctors.

Since we plan to forward the answers to the ATI requests to the Legislative Council and the answers might be posted on the Legco website, please kindly furnish a reply using the department letterhead in PDF format by email.

The course I am teaching is an experiential learning course that encourages students to seek opportunities to engage the community. Therefore, I hope we could have the opportunity to meet with a government official to discuss these matters in person. Please let us know if this is possible. Please also provide an official's name and contact no. in case we have follow-up questions.

Thanks in advance.

Yours sincerely
Simon Wang

On Fri, Sep 4, 2020 at 6:32 PM <enq...@fhb.gov.hk> wrote:
Dear Dr Wang,

Thank you for your email dated 16 August 2020 enquiring about the Electronic Health Record Sharing System (eHRSS). Our responses are provided below.

1) How many patients have registered in eHRSS? Please provide the latest figures.

As at end-August 2020, over 1.34 million healthcare recipients (patients) have registered with the Electronic Health Record Sharing System (eHRSS).

2) I notice that some programmes such as Colon Cancer Screening Scheme (https://www.colonscreen.gov.hk/en/public/index.html) requires participants to sign up for eHRSS. What other schemes require the registration for eHRSS? How many people have registered for eHRSS through these schemes respectively? Will such requirements hinder the participation of the public in the schemes?

Currently, participants of various Government-subsidised health programmes, including Public-private partnership (PPP) programmes administered by the Hospital Authority (HA) and the Department of Health (DH), as well as the District Health Centre initiative launched by the Government, are required to join eHRSS. The list of programmes and number of participants as at end-July 2020 are tabulated below –

Programme	Cumulative No. of Participants Joining eHRSS (to the nearest ten/ hundred)
Cataract Surgeries PPP	23 500
Haemodialysis PPP	570
Patient Empowerment Programme	158 600
General Outpatient Clinic PPP	43 100
Radiology Image Sharing Pilot	46 900
Colon Assessment PPP	7 400
Glaucoma PPP	1 100
Smoking Cessation Programme	140
Colorectal Cancer Screening Programme	190 100
Provision of Infirmary Service through PPP	130
District Health Centre	6 400
Caesarean Section Service*	10
Breast Cancer Operative Service Collaboration Programme*	10
Trauma Operative Service Collaboration Programme*	40
Radiation Therapy Service*	60

 * Programmes introduced in 2020

The requirement for participants to join eHRSS is essential and fundamental to the implementation of these programmes, of which eHRSS serves as an efficient information exchange platform enabling the inter-flow of medical information across healthcare providers (HCPs) in both the public and private sectors taking care of the patients. Facilitated by eHRSS, programme participants are given the choice to use services of the private sector so that they can receive healthcare services and treatment as early as possible. This is conducive to the provision of more efficient, continuous and quality-assured healthcare services by HCPs for the benefits of patients.

To facilitate public’s participation in eHRSS, a series of enhancement and streamlining measures had been implemented since launch, such as allowing application submission by authorised persons for patients who are unable to register in-person, introducing new means for managing sharing consents with HCPs, and enabling patients to give sharing consents to HCPs when making online application.
3) How many private doctors/ health professionals and private hospitals have registered under eHRSS? In your email reply on 30 Nov 2017, you said the participation rate for health care professionals was not an appropriate measure. Please let me know how the Bureau would assess the extent to which the eHRSS has engaged the health care professionals in HK.

As regards HCPs which register on an organisational basis, all of the 12 local private hospitals and over 1 970 other private healthcare organisations (such as clinics, elderly homes and welfare organisations) have joined. About 8700 accounts have been created for healthcare professionals (HCProfs) working under these private HCPs to access eHRSS.
With regard to the engagement with HCPs, the Government has continued to roll out programmes to promote public-private and medical-social collaboration, of which eHRSS is the key enabler necessitating the participation of HCPs and their utilisation of the system. We have also been partnering with HCProf bodies to support the development and deployment of electronic medical record systems with built-in eHRSS connectivity for private HCPs, in addition to providing them with the Clinical Management System On-ramp software and technical advice free-of-charge.
With more patient registrations and the public’s greater acceptance of electronic health record sharing, it is expected that HCPs will be more motivated to join and utilise eHRSS.

4) Among the patients registered, how many are under the age of 16? How many are under the age of 12?

As at end-August 2020, the number of eHRSS patients under the age of 16 and 12 were about 49 500 and 45 000 respectively.

5) Other than Information presented in the 2019 Legco paper https://www.legco.gov.hk/yr18-19/english/panels/hs/papers/hs20190520cb2-1432-3-e.pdf please provide an update on the Stage 2 development of eHRSS and provide relevant documents including tender documents and technical specifications of the system including a summary of Legco members' comments on this matter.

As presented to the Legislative Council (LegCo) Panel on Health Services in 2019 (LC Paper No. CB(2)1432/18-19(03)), major work targets under the Stage Two development of eHRSS include broadening the scope of data sharing and developing the technical capability for sharing of radiological images and Chinese Medicine (CM) information, enhancing patient’s choice over the scope of data sharing, and facilitating patient access to eHRSS. Comments from panel members are summarised under Item 3 of the minutes of meeting (https://www.legco.gov.hk/yr18-19/english/panels/hs/minutes/hs20190520.pdf).
The latest progress of the work targets are as follows –
i. Radiological images – Development work for radiological image sharing amongst HCPs through eHRSS, such as setting up infrastructure, designing the security framework, and developing the interface for image sharing, is underway. It is expected the function to be piloted in Q1 2021.
ii. CM information – Technical development of the Chinese Medicine Information System (CMIS) On-ramp is complete. A CMIS On-ramp Pilot was launched earlier in 2020 for CM practitioners to test out the system. We have also partnered with the Chinese Medicine Development Fund so as to provide an incentive for CM practitioners to join the Pilot.
iii. Sharing restriction – Development of sharing restriction features along the parameters broadly presented at the LegCo meeting in 2019 is underway and is targeted for launch in the first half of 2021.
iv. Patient Portal – Development of the Patient Portal in the form of a mobile application (eHealth App) along the parameters broadly presented at the LegCo meeting in 2019 is in good progress. Discussion and usability review sessions for stakeholders and target user groups have been held to collect feedback on the prototype for refinement and improvement. The eHealth App is targeted to be launched by end 2020. It will be available for download and use by members of the public through common App download stores.

5a) please provide an update on the development of patient portals including how the members of the public could access the pilot version.

Please refer to the reply at (iv) above.

5b) please provide more technical information about the patient portals under development including the tendering documents and other proposals and reports

For development of Stage Two eHRSS including the Patient Portal, the Government has continued to engage HA as the technical agency to perform the critical technical development tasks in-house having regard to the complexity of the project and the large amount of patient data involved.
As for proposals and reports, an external consultant had been engaged to conduct a study in 2018 to look into relevant international experience and gauge local stakeholders’ views on sharing restrictions and Patient Portal. The consultant’s key findings and recommendations were reported at the LegCo meeting in 2019.

5c) Do the system and/or the patient portals offer any APIs for third parties to access data?

In line with the Government’s strategy to open up data to provide materials for technology research, innovation and smart city development, data related to eHRSS has been made available at the Government’s open data portal (https://data.gov.hk/en-data/dataset/hk-fhb-fhbehrss-hcp-list) since 2019. In planning the further design and development of eHRSS, the feasibility of offering functions and services, such as application programming interface to third party app developers, will continue to be examined and privacy and security protection concerns will be studied.

6) In your email reply dated 2 Mar 2018, you mentioned that the government intends to open up data to facilitate technological research. Please provide documents and reports on this matter including the recent progress.

As mentioned in our reply at (5) above, government data and statistics of Hong Kong has been made available at the Government’s open data portal (www.data.gov.hk) for use by researchers and the general public free of charge. So far, over 200 datasets from the Food and Health Bureau, DH and HA have been uploaded. The datasets are conveniently grouped under headings of the respective bureaux or departments, such as birth and death statistics, statistics on selected diseases (e.g. cancer and different infectious diseases), behavioural habits/ risks, service throughputs of public hospitals and clinics, etc.

7) Please provide more information about the Big Data Analytics Platform (mentioned in your email reply dated 2 Mar 2018) that HA has been working on including the involvement of local academic institutions and review reports on the pilot scheme.

HA’s Big Data Analytics Platform (the Platform) was officially launched in December 2019 following a one-year pilot in 2018. For information about the Platform, you may visit HA’s Data Sharing Portal at https://www3.ha.org.hk/data/Home/Index/ or contact HA at hacp...@ha.org.hk.

8) How many times have the patients' eHealth records been accessed by health care professionals through the system since the introduction of the system? Please provide yearly figures that are available and break down the figures by categories of patients, types of records and types of health care professionals if available.

The yearly numbers of access by HCP type since eHRSS’ launch in March 2016 are provided in the table below –

Year	No. of Accesses to eHRSS by (to nearest hundred)			Total Number of Accesses to eHRSS by HCPs
Year	Public HCPs	Private Hospitals	Other HCPs	Total Number of Accesses to eHRSS by HCPs
2016	26 300	23 700	100 800	150 800
2017	73 700	47 400	198 800	319 900
2018	148 100	83 400	275 300	506 800
2019	216 700	103 300	336 200	656 200
Total	464 800	257 800	911 100	1 633 700

It should be noted that participation in eHRSS by patients and HCPs is voluntary in nature. Access to health records on eHRSS is based on the principles of “need-to-know” and “patient-under-care”. In addition, the need to access eHRSS or other sources of health/medical records is subject to the relevant healthcare professionals’ clinical and professional judgement. The above figures should be considered in the appropriate context.

9) How do health care professionals in public hospitals and clinics use eHRSS when they serve the patients in various settings? Please provide guidelines and handbooks provided for the staff on this matter.

The Electronic Health Record Sharing System Ordinance (Cap. 625) (eHRSSO) (https://www.elegislation.gov.hk/hk/cap625!en) is specifically developed to provide for, amongst other, the establishment of eHRSS, the sharing and using of data and information contained in the system, and the protection of eHRSS, data and information. A Code of Practice (CoP) (https://www.ehealth.gov.hk/en/ordinance_and_related_information/code_of_practice/index.html) has been issued under eHRSSO to provide good practice and recommendations in the use of eHRSS by HCPs and HCProfs. All participating HCPs are required to comply with the eHRSSO, the CoP and Conditions of Registration of HCPs in eHRSS in order to register in eHRSS. To ensure eHRSS users are well-informed of the policies, requirements and procedures for using eHRSS, regular training and briefings are being organised for HCPs.

Thank you for your interest in the subject matter.

Yours sincerely,
(Miss Natalie CHONG)
for Secretary for Food and Health

From: Enquiry FHB/FHB/HKSARG
To: Simon H WANG <simo...@hkbu.edu.hk>,
Date: 24/08/2020 18:19
Subject: Re: Request of information about eHRSS under Code on Access to Information

Dear Dr Wang,

The Food and Health Bureau (FHB) has received your application under the Code on Access to Information on 16.08.2020. Your application is now under processing. According to paragraph 1.16 of the Code on Access to Information, you will be informed of the latest progress of the case separately on or before 05.09.2020. In the meantime, please contact us by e-mail at enq...@fhb.gov.hk if you have any enquiry. Thank you.

(Ms Sylvia CHU)
for Secretary for Food and Health

From: Simon H WANG <simo...@hkbu.edu.hk>
To: enq...@fhb.gov.hk, km...@fhb.gov.hk,
Date: 16/08/2020 01:17 PM
Subject: Re: Request of information about eHRSS under Code on Access to Information

Dear Sir/Madam
I am writing to request information about eHRSS under the Code on Access to Information. Please note that I have discussed this system in the SCMP letter section before based on the information provided by the Bureau and plan to write more on this topic in due course. Your help with my information requests is therefore highly appreciated and will enable the public to better understand the relevant issues.

1) How many patients have registered in eHRSS? Please provide the latest figures.
2) I notice that some programmes such as Colon Cancer Screening Scheme (https://www.colonscreen.gov.hk/en/public/index.html) requires participants to sign up for eHRSS. What other schemes require the registration for eHRSS? How many people have registered for eHRSS through these schemes respectively? Will such requirements hinder the participation of the public in the schemes?
3) How many private doctors/ health professionals and private hospitals have registered under eHRSS? In your email reply on 30 Nov 2017, you said the participation rate for health care professionals was not an appropriate measure. Please let me know how the Bureau would assess the extent to which the eHRSS has engaged the health care professionals in HK.
4) Among the patients registered, how many are under the age of 16? How many are under the age of 12?
5) Other than Information presented in the 2019 Legco paper https://www.legco.gov.hk/yr18-19/english/panels/hs/papers/hs20190520cb2-1432-3-e.pdf please provide an update on the Stage 2 development of eHRSS and provide relevant documents including tender documents and technical specifications of the system including a summary of Legco members' comments on this matter.

5a please provide an update on the development of patient portals including how the members of the public could access the pilot version.
5b please provide more technical information about the patient portals under development including the tendering documents and other proposals and reports
5c Do the system and/or the patient portals offer any APIs for third parties to access data?

6) In your email reply dated 2 Mar 2018, you mentioned that the government intends to open up data to facilitate technological research. Please provide documents and reports on this matter including the recent progress.

7) Please provide more information about the Big Data Analytics Platform (mentioned in your email reply dated 2 Mar 2018) that HA has been working on including the involvement of local academic institutions and review reports on the pilot scheme.

8) How many times have the patients' eHealth records been accessed by health care professionals through the system since the introduction of the system? Please provide yearly figures that are available and break down the figures by categories of patients, types of records and types of health care professionals if available.

9) How do health care professionals in public hospitals and clinics use eHRSS when they serve the patients in various settings? Please provide guidelines and handbooks provided for the staff on this matter.

Please also notice the following statement about our expectations of how the Code on Access to Information applications should be handled.

While we appreciate the government’s efforts to maintain transparency and accountability under the Code on Access to Information, we also notice considerable variation among different departments and bureaux in their responses to our Code on Access to Information applications. We would appreciate it if your department/bureau could maintain professional standards when answering our inquiries. Specifically, we expect answers to each and every one of our questions separately rather than an answer without clearly indicating which questions were addressed. In case of referencing to websites or documents, we need the specific paragraphs in the source texts that are relevant to our questions to be highlighted. If no information is available regarding some of our questions, please indicate that is the case explicitly so we can follow up properly. We will definitely ask our case to be reviewed by a more senior official in your department/bureau if our request is not properly handled. If it is believed that other department/bureau may possess information we request, please feel free to forward the request including our personal information.

Thanks in advance.

Yours sincerely
Simon Wang

On Wed, Apr 4, 2018 at 8:12 PM <enq...@fhb.gov.hk> wrote:
Dear Dr WANG,

Thank you for your email dated 19 March 2018. Our response is provided below.

As set out in the Hong Kong Smart City Blueprint, the Government will open up more public and private sector data in digital forms for facilitating research and innovation and smart city development. Health data is no exception.

For opening up of health data, the relevant parties work closely to discuss data that could be useful for public and researchers’ use and could be opened up. For the Electronic Health Record Sharing System and the Big Data Analytics Platform, the Food and Health Bureau and the Hospital Authority (HA) have been working closely to consider together the various related issues, including the mechanism for opening up data, the type and scope of data to be opened, privacy protection, data integrity, system security and international practices. During the process, we also work closely with colleagues from the Office of the Government Chief Information Officer as and when necessary, e.g. when there are cross-bureau/department innovation and technology issues in relation to the smart city initiative.

HA’s Clinical Management System (CMS), which has been in operation since 1995, is the largest repository of patient health data in Hong Kong and contains health records from over 10 million patients. Leveraging on the great breadth of data in the CMS, the Platform being developed by HA can share with researchers, through the HA Data Collaboration Lab, useful information that may be able to support the formulation of healthcare policies, facilitate biotechnological research, improve clinical and healthcare services and promote innovation in healthcare services in a more facilitative and interactive manner. Researchers may contemplate ideas on research projects, in collaboration with HA, based on the outcomes of their exploration and analyses.

Thank you again for your interest in the subject matter.

Yours sincerely,
(Miss Natalie CHONG)
for Secretary for Food and Health

From: Enquiry FHB/FHB/HKSARG
To: simo...@hkbu.edu.hk,
Date: 28/03/2018 10:58
Subject: Re: Request of information about eHRSS under Code on Access to Information

Dear Dr WANG,

Thank you for your email on 19 March 2018.

We are following up with your request for information and shall give you a reply in due course.

Yours sincerely,
(Miss Natalie CHONG)
for Secretary for Food and Health

From: Simon H Wang <simo...@hkbu.edu.hk>
To: enq...@fhb.gov.hk,
Date: 19/03/2018 17:48
Subject: Re: Request of information about eHRSS under Code on Access to Information

Dear Sir/Madam

Thanks for your reply and your information about the eHealth system. I've published a letter to the editor in South China Morning Post on this topic using some of the information provided: http://www.scmp.com/comment/letters/article/2137555/how-hong-kong-can-become-smart-city-public-health In the letter I made a number of specific suggestions on how to further develop the system. Hopefully the bureau could take my comments into account when working on eHealth.
In the meantime, your most recent reply did not address the questions I asked:

1) Given that both systems intend to share data with researchers, are the development efforts of the two systems coordinated? If so, could you explain how? If not, could you explain why not?

2) Could you provide information about how the Hospital Authority system (CMS) will enable the researchers and policy makers benefit from big data analytics?

3) I am concerned that data from Hospital Authority alone may not accurately represent the overall population in the city since many patients receive care in private clinics and hospitals. How would you respond to this concern?

4) Given the fact that health care is intimately connected with other aspects of life such as education, sports and diet, I wonder if the development teams of the two systems consult colleagues at the Office of Government Chief Information Officer to coordinate with other initiatives in developing a smart city in Hong Kong.

Could you kindly answer the questions? Many thanks.

Cheers
Simon

On Fri, Mar 2, 2018 at 1:03 PM <enq...@fhb.gov.hk> wrote:
Dear Dr WANG,

Thank you for your email of 12 February 2018. Our response is set out below.

It is government policy to suitably open up data in an expedited manner to facilitate technological research, innovation and the development of smart city. The Bureaux and Departments concerned, including the Food and Health Bureau (FHB) and the Hospital Authority (HA), are working together in earnest to achieve this common goal.

For health data, FHB and HA have been working closely on their opening up. We meet from time to time to discuss the relevant issues such as uses of clinical data for research, protection of patient privacy and data integrity, system security and international practices. The aim is to share ideas and information and to see if synergy could be formed in our work.

Under current planning, for its Big Data Analytics Platform (the Platform), HA will first carry out a one-year pilot from the second half of 2018, under which local academic institutions will be able to analyse de-identified clinical data from HA’s Clinical Management System (CMS) in a designated area and formulate collaborative research projects with HA. The researchers will not be allowed to download or take away the data so as to safeguard patient privacy. A review will be conducted after the completion of the pilot.

HA’s CMS was commissioned in 1995 and now contains clinical records from 10 million patients. We consider that the wealth of information will be useful for the development of the Platform and in turn for supporting the formulation of healthcare policies, facilitating biotechnological research, improving clinical and healthcare services, and promote innovation in healthcare services.

Thank you again for your interest in the subject matter.

Yours sincerely,
(Natalie CHONG)
for Secretary for Food and Health

From: Enquiry FHB/FHB/HKSARG
To: simo...@hkbu.edu.hk,
Date: 21/02/2018 15:11
Subject: Re: Request of information about eHRSS under Code on Access to Information

Dear Dr WANG,

Thank you for your email on 12 February 2018.

We are following up with your request for information and will give you a reply in due course.

Yours sincerely,
(Natalie CHONG)
for Secretary for Food and Health

From: Simon H Wang <simo...@hkbu.edu.hk>
To: enq...@fhb.gov.hk,
Cc: "digital...@scmp.com" <digital...@scmp.com>, "elizabet...@scmp.com" <elizabet...@scmp.com>
Date: 12/02/2018 08:49
Subject: Re: Request of information about eHRSS under Code on Access to Information

Dear Sir/Madam
Thanks for your reply. Recently I read a news report that the Hospital Authority plans to develop a new system to apply big data technologies to medical records: http://m.scmp.com/news/hong-kong/health-environment/article/2131941/hong-kong-health-bosses-unleash-big-data-medical
I’d like to ask for more information about this system in connection to the eHealth system. My questions:

1) Given that both systems intend to share
data with researchers, are the development efforts of the two systems coordinated? If so, could you explain how? If not, could you explain why not?

2) Could you provide information about how the Hospital Authority system will enable the researchers and policy makers benefit from big data analystics?

3) I am concerned that data from Hospital Authority alone may not accurately represent the overall population in the city since many patients receive care in private clinics and hospitals. How would you respond to this concern?

4) Given the fact that health care is intimately connected with other aspects of life such as education, sports and diet, I wonder if the development teams of the two systems consult colleagues at the Office of Government Chief Information Officer to coordinate with other initiatives in developing a smart city in Hong Kong.

I’m copying this message to SCMP staff for their attention. Thanks in advance for your information.

Yours sincerely
Simon Wang

On Fri, 2 Feb 2018 at 6:01 PM, <enq...@fhb.gov.hk> wrote:
Dear Dr WANG,

Thank you for your email on 6 January 2018. Further information on the Electronic Health Record Sharing System (eHRSS) is set out below.

Participation and Promotion
The eHRSS was launched in March 2016. Over a span of less than two years, over 680 000 healthcare recipients (HCRs) and 1 400 healthcare providers (HCPs) have joined the system. In general, we find the response encouraging. As participation in the eHRSS is voluntary, it is understandable that citizens with needs for healthcare from different HCPs (e.g. the elderly) would have more incentives to join the system. As regards the access to the eHRSS, the electronic health record (eHR) of a participating patient should only be accessed under the "need-to-know" principle. Whether and how much of a patient’s information needs to be accessed should be subject to the clinical and professional judgement of an HCP.

Going forward, we will continue to step up efforts in promotion and publicity. In particular, we will direct efforts to recruiting children to join the eHRSS for building lifelong health records. Various promotional activities have been launched, such as deploying mobile registration teams to Maternal and Child Health Centres of the Department of Health (DH) to provide on-site registration service and distributing leaflets targeted at parents via DH’s School Immunisation Teams. The workflow of child registration has also been streamlined with a new online registration option. We will continue to explore different means and collaboration opportunities with DH’s services, particularly those providing health services to children and students, to facilitate participation of different target groups. We will also keep in view the operation of the eHRSS and its utilisation, with a view to identifying room for continuous improvement.

Stage Two eHRSS
In July 2017, we commenced Stage Two development of the eHRSS. Major work targets of Stage Two eHRSS include: (a) broadening the scope of sharable data (Note 1) to include radiological images and Chinese Medicine information; (b) developing a Patient Portal to facilitate patients’ access to some information and enhancing patients’ choice over the scope of data sharing; and (c) enhancing privacy / security protection. Stage Two development will be implemented by phases in the coming five years.

In the course of further design and development of the eHRSS, the feasibility of offering functions and services, such as application programming interface to third party app developers, will be examined and privacy and security protection concerns will be studied.

As regards the use of eHR data, the eHRSS Ordinance (Cap. 625) provides that the data and information contained in an eHR may be used for carrying out research, or preparing statistics, that are relevant to public health or public safety. A critical mass of data must be reached in the eHRSS for supporting research in a meaningful way. We will consider when and how eHRSS data may be used for research purpose in light of the volume of data built up in the eHRSS.

Note 1
The current scope of eHR sharable data includes: (a) Personal Identification and Demographic Data; (b) Allergies and Adverse Drug Reactions; (c) Diagnosis, Procedures and Medication; (d) Encounters / Appointments; (e) Clinical Note / Summary; (f) Birth and Immunisation Records; (g) Laboratory and Radiology Reports; (h) Other Investigation Reports; and (i) Healthcare Referrals.

Operating Cost
The operating cost of the eHRSS of about $200 million in 2016-17 covered the ongoing maintenance support of the central infrastructure, daily monitoring of the operation of the central platform and its connections to local medical record systems for HCPs for eHR sharing. Apart from technical maintenance of the infrastructure, the effective operation of the eHRSS also requires ongoing health informatics efforts for development and management of data standards, and support for registration and engagement of both HCPs and HCRs in order to ensure pragmatic utilisation of the eHRSS. The cost for maintaining and operating the eHRSS is understandably higher than a conventional IT system. Except for the general inflation and equipment capacity growth due to increase in HCR and HCP participation, no substantial increase in the operating cost is expected at the present stage.

Thank you for your interest and support towards the eHRSS.

Yours sincerely,
(Miss Natalie CHONG)
for Secretary for Food and Health

From: Enquiry FHB/FHB/HKSARG
To: simo...@hkbu.edu.hk,
Date: 26/01/2018 18:41
Subject: Re: Request of information about eHRSS under Code on Access to Information

Dear Dr WANG,

Please be informed that your case is in progress and we will revert to you in due course.

Yours sincerely,
(Alex FONG)
for Secretary for Food and Health

From: Enquiry FHB/FHB/HKSARG
To: simo...@hkbu.edu.hk,
Date: 15/01/2018 18:23
Subject: Re: Request of information about eHRSS under Code on Access to Information

Dear Dr WANG,

Thank you for your email on 6 January 2018.

We are following up with your request for information and will give you a reply in due course.

Yours sincerely,
(Alex FONG)
for Secretary for Food and Health

From: Simon H Wang <simo...@hkbu.edu.hk>
To: enq...@fhb.gov.hk,
Date: 06/01/2018 11:29
Subject: Re: Request of information about eHRSS under Code on Access to Information

Dear Miss Chong,

Thanks for your reply to my enquiry. I plan to writer another letter to the editor in SCMP to further discuss the eHealth system and would appreciate it if you could address my questions and comments as follows:

1) The concern that the eHealth system is underused
Given that only 610,000 HCRs are enrolled in the system, it is clear that the system has the potential to serve far more people in HK. As you suggest that the participation rate is not an appropriate measure of the utility of the system, could you propose some other measures that are more relevant? How about the total number of times HCR's records are accessed by HCProf via eHRSS in a year?

2) The annual operating cost of eHRSS
"The cost for operating eHRSS in 2016-17 was about $200 million." Is it safe to assume that the eHRSS will incur more or less the same operating cost every year, namely $200 mil? That would amount to $327 per HCR per year. Could you offer some details about the breakdown of the operating cost? It seems to me that for a system that cost 702 mil to build, an annual operating cost of 200 mil seems a bit high.

3) How eHRSS will further develop
You mentioned that the second stage of development of eHRSS will cost 422 mil. Could you provide some information about what new features will be added in this stage?

4) Promote eHRSS among children
I suggest the Bureau should more aggressively promote eHRSS among the children because most children in HK already have some records in the Department of Health. Student Health Service (SHS) also has an online registration platform (https://www.studenthealth.gov.hk/wsmash/login.jsp). It would make sense to integrate eHRSS with the online component of SHS, which may eventually enrol each and every HK resident. Could you comment on the possibility/ feasibility of integrating eHRSS and SHS?

5) Offer aggregate data to researchers and policy makers
One of the potential benefits of the eHealth system is to allow policy makers and researchers to analyse the data for insights that might inform policy making and research studies. Unfortunately, at this stage, I'm not sure how useful the records of 610,000 HCRs are as they cannot represent the entire population of HK. Nevertheless, I wonder if the Bureau could offer access to the records in an anonymised, aggregate form for researchers and policy makers (including law makers).

6) Allow third-party developers to access personal records upon authorisation
As I discussed in my SCMP letter (http://www.scmp.com/comment/letters/article/2049257/fine-tune-e-health-system-shares-records-patients-hong-kong# ), I envision the eHRSS to develop into a smart health care system that offers more value added services to the community. I think the Bureau needs to partner with the private sector to make it happen. Specifically, I suggest that the eHRSS to offer application programmer interface (APIs) to third-party app developers so users of other apps may access the records in eHRSS upon authorisation. Could you comment on whether the Bureau has plans to collaborate with the private sector (e.g. Google, Apple, Tencent, Alibaba) in the near future?

7) Interest in investigating how eHRSS could be further developed and promoted through Health Care and Promotion Scheme (HCPS) http://rfs1.fhb.gov.hk/english/funds/funds_hcpf/funds_hcpf_abt/funds_hcpf_funding.html

In light of the information you provided earlier, I feel that eHRSS would benefit from more engagement with the research community and more promotional activities in the city. Therefore, I am interested in pursuing an HCPS project to investigate how the eHRSS could be better developed and promoted among the HCRs and HCRPros in partnership with my colleagues with expertise in health care communication and computer science at Hong Kong Baptist University. I hope I can count on your support during the process of applying for the funding.

Thanks for your information and your efforts in developing eHRSS for Hong Kong.

Yours sincerely
Simon Wang

On Thu, Nov 30, 2017 at 8:16 PM <enq...@fhb.gov.hk> wrote:
Dear Dr WANG,

Thank you for your email on 11 November 2017. We would like to provide our response as below -

1) How many patients have registered in eHRSS as of Oct 2017? What is the participation rate (the number of enrolled patients over the number of patients that could register for the system)?

As at end-October 2017, about 610 000 healthcare recipients (HCRs) (or generally referred to as patients) had registered in the Electronic Health Record Sharing System (eHRSS).

According to the Electronic Health Record Sharing System Ordinance (eHRSSO) (Cap 625), an HCR that meets the conditions set out in Section 6(7) (https://www.elegislation.gov.hk/hk/cap625!en-zh-Hant-HK?INDEX_CS=N&xpid=ID_1466474234729_001) of the Ordinance may apply to be registered as a registered HCR. In view of the wide coverage of the relevant provision (both Hong Kong and non-Hong Kong residents could register), there is no readily available statistics on the number of patients that could register in eHRSS.

2) How many private doctors/ health professionals and private hospitals have registered under eHRSS as of Oct 2017? What is the participation rate (the number of enrolled private doctors/ health professionals over the number of private doctors/ health professionals that could register for the system)?

Participation of healthcare providers (HCPs) in eHRSS is on an organisational basis. As at end-October 2017, about 1 400 private HCPs, including all 12 local private hospitals, had registered in eHRSS. About 4 300 healthcare professional (HCProf) accounts had been created under these private HCPs.

According to eHRSSO, an HCP that provides healthcare at one or more than one service locations in Hong Kong may apply to be registered as an HCP if it falls under one of the six categories stipulated in Section 19(5) (https://www.elegislation.gov.hk/hk/cap625!en-zh-Hant-HK?INDEX_CS=N&xpid=ID_1466475131875_001) of eHRSSO. In view of the wide coverage of the relevant provision (not only medical institutions could register), there is no readily available statistics on the number of HCPs that could register in eHRSS. Upon successful registration in eHRSS, an HCP can create accounts for its HCProfs to enable them to access the system depending on their own operation needs. In view that the initiative of creating HCProf accounts lies with the HCPs, we do not consider participation rate an appropriate measure in this context.

3) Among the patients registered, how many are under the age of 16? How many are under the age of 12?

As at end-October 2017, the number of eHRSS patients under the age of 16 and 12 were about 12 400 and 11 300 respectively.

4) Whether the records of seasonal flu vaccination and flu infection (info found in Flu Express http://www.chp.gov.hk/en/guideline1_year/29/134/441/304.html) are part of the records in eHRSS.

Seasonal influenza vaccinations are currently provided to the public by various public and private HCPs. While the vaccination records in public HCPs (i.e. the Department of Health and the Hospital Authority) are uploaded to eHRSS, private HCPs will upload such records to eHRSS if they have joined eHRSS and are technically capable of sharing electronic health records to the system, provided that the HCR has given sharing consent to the HCP.

As for the local influenza activity reported in Flu Express, the data therein come from a number of sources and surveillance systems on infectious diseases. For those surveillance data that are not associated with medical records of an individual (e.g. influenza-like illness outbreak, fever surveillance at sentinel child care centres/ kindergartens, fever surveillance at sentinel residential care homes for the elderly, etc.), such data would fall outside the scope of sharable data of eHRSS.

5) Whether the children's records from Family Health Services will be kept in eHRSS when children register.

For children who have joined eHRSS, once they receive immunisation at the Maternal and Child Health Centres of the Family Health Service of the Department of Health, their vaccination records will be automatically uploaded to eHRSS. The Department of Health will enhance the electronic health record system of the Family Health Service to support the sharing of more data domains with eHRSS.

6) What is the cost of setting up the eHRSS and what is the annual operation cost of the system?

The development of eHRSS comprises two stages. The development cost for Stage One eHRSS was $702 million. We are currently developing Stage Two eHRSS at a development cost of $422 million. The cost for operating eHRSS in 2016-17 was about $200 million.

7) In the letter, I proposed an opt-out registration system for eHRSS. Could you comment on the feasibility of the proposal and indicate whether the bureau would consider this proposal in the near future?

In the course of planning the implementation of eHRSS, the feasibility of opt-in and opt-out registration had been considered with reference to overseas experience. We noted that different countries had different preferences over the “opt-out” and “opt-in” participation models. In the Hong Kong context, we noted that the majority of the respondents of the public consultation conducted in 2011, as well as the views from subsequent stakeholder engagement meetings, supported “voluntary participation”. In addition, in adopting “voluntary participation”, we also noted the need for protecting patient privacy and the pace of computerisation of individual HCPs. We will keep reviewing the overall operation and implementation of eHRSS in the light of the operational experience gained with a view to enhancing our services to the public.

If you have further enquiries, please do not hesitate to contact us again.

Yours sincerely,
(Miss Natalie CHONG)
for Secretary for Food and Health

From: Enquiry FHB/FHB/HKSARG
To: simo...@hkbu.edu.hk,
Date: 20/11/2017 15:56
Subject: Re: Request of information about eHRSS under Code on Access to Information

Dear Dr WANG,

Thank you for your email on 11 November 2017.

We are following up with your request for information and will give you a reply in due course.

Yours sincerely,
(Alex FONG)
for Secretary for Food and Health

From: Simon H Wang <simo...@hkbu.edu.hk>
To: "e...@ehealth.gov.hk" <e...@ehealth.gov.hk>, enq...@fhb.gov.hk, km...@fhb.gov.hk,
Date: 11/11/2017 16:41
Subject: Request of information about eHRSS under Code on Access to Information

Dear Miss To,

Following up my letter to the editor on the system in Nov 2016 (http://www.scmp.com/comment/letters/article/2049257/fine-tune-e-health-system-shares-records-patients-hong-kong#), I'd like to request the following information about eHRSS under Code on Access to Information:

1) How many patients have registered in eHRSS as of Oct 2017? What is the participation rate (the number of enrolled patients over the number of patients that could register for the system) ?
2) How many private doctors/ health professionals and private hospitals have registered under eHRSS as of Oct 2017? What is the participation rate (the number of enrolled private doctors/ health professionals over the number of private doctors/ health professionals that could register for the system) ?
3) Among the patients registered, how many are under the age of 16? How many are under the age of 12?
4) whether the records of seasonal flu vaccination and flu infection (info found in Flu Express http://www.chp.gov.hk/en/guideline1_year/29/134/441/304.html) are part of the records in eHRSS.
5) whether the children's records from Family Health Services will be kept in eHRSS when children register.
6) What is the cost of setting up the eHRSS and what is the annual operation cost of the system?
7) In the letter, I proposed an opt-out registration system for eHRSS. Could you comment on the feasibility of the proposal and indicate whether the bureau would consider this proposal in the near future?

Thank you in advance for your information.

Yours sincerely,
Simon Wang

---------- Forwarded message ---------
From: eHR Registration Office <e...@ehealth.gov.hk>
Date: Wed, Dec 7, 2016 at 10:10 AM
Subject: RE: Comments on eHealth system at SCMP
To: Simon H Wang <simo...@hkbu.edu.hk>

Dear Mr Wang,

Thank you for your email dated 27 November 2016 informing us about your letter to the editor of the South China Morning Post. We note and are appreciative of your feedback and suggestions on the Electronic Health Record Sharing System (eHRSS). Please be assured that we will continue to review the operations and implementation of the eHRSS in the light of operational experience with a view to enhancing our services to the public.

Electronic Health Record Registration Office

Telephone: 3467 6300

Fax: 3467 6099

Email: e...@ehealth.gov.hk

Website: http://www.ehealth.gov.hk

Address : Unit 1193, 11/F, Kowloonbay International Trade & Exhibition Centre, 1 Trademart Drive, Kowloon Bay, Hong Kong

This e-mail message (together with any attachments) is for the designated recipient only. It may contain information that is privileged for the designated recipient. If you are not the intended recipient, you are hereby notified that any use, retention, disclosure, copying, printing, forwarding or dissemination of the message is strictly prohibited. If you have received the message in error, please erase all copies of the message (including attachments) from your system and notify the sender immediately.

本電郵(連同附加檔案)只供指定收件人閱讀，內容可能包括只有指定收件人才有權接收的資料。如你並非指定收件人，你不得使用、保留、披露、複製、列印、轉發或發放本電郵。如因錯誤致令你收到本電郵，請從你的電腦系統中刪除本電郵的所有複本(包括附加檔案)，並立即通知發件人。

From: Simon H Wang [mailto:simo...@hkbu.edu.hk]
Sent: 27 November, 2016 9:04 PM
To: eHR Registration Office
Subject: Comments on eHealth system at SCMP

Dear Sir/Madam,

I am writing to bring your attention to my letter to the editor at South China Morning Post commenting on the eHealth Record Sharing System:

http://www.scmp.com/comment/letters/article/2049257/fine-tune-e-health-system-shares-records-patients-hong-kong#

Thanks for your attention.

Cheers

Simon

Simon Wang
Language Centre
Hong Kong Baptist University
Waterloo Road, KowloonTong
HKSAR

Tel: (852) 3411 7044

Disclaimer

This message (including any attachments) may contain confidential information intended for a specific individual and/or purpose. If you are not the intended recipient, please delete this message and notify the sender and the University immediately. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is prohibited as it may be unlawful.

In addition, the University specifically denies any responsibility for the accuracy or quality of information obtained through University E-mail Facilities. Any views and opinions expressed in the email(s) are those of the author(s), and do not necessarily represent the views and opinions of the University. The University accepts no liability whatsoever for any losses or damages that may be incurred or caused to any party as a result of the use of such information.

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Language Centre
Hong Kong Baptist University
Kowloon Tong, Hong Kong
http://lc.hkbu.edu.hk/staff_simon.php

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Language Centre
Hong Kong Baptist University
Kowloon Tong, Hong Kong
http://lc.hkbu.edu.hk/staff_simon.php

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Language Centre
Hong Kong Baptist University
Kowloon Tong, Hong Kong
http://lc.hkbu.edu.hk/staff_simon.php

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Language Centre
Hong Kong Baptist University
Kowloon Tong, Hong Kong
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Reply dated 6.11.2020 to Dr Wang.pdf

Simon H WANG

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Nov 24, 2020, 8:23:22 PM11/24/20

to enq...@fhb.gov.hk

Dear Sir/Madam

Many thanks for your information. We're looking for members of the research community in Hong Kong to consult in order to better understand the data provided and eHealth record sharing system. Kindly let us know if the bureau is aware of (or has engaged) any researchers/professors/health care professionals in Hong Kong or abroad with such expertise.

Yours sincerely

Simon Wang

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