component of policing diseases system miidss ： major incident investigation and disaster support...

Component of Policing Diseases Component of Policing Diseases System System MIIDSS ： Major Incident Investigation and

Disaster Support System (重大事件調查及災難支援工作系統 )

CMS ： Clinical Management System. eSARS ： Electronic Severe Acute Respiratory

Distress Syndrome System.ePR ： Electronic Patient RecordsSARS-CCIS ： SARS-Case Contact Information

SystemCTS ： Contact Tracing System

MIIDSSMIIDSSMajor Incident Investigation and Disaster Support

System (重大事件調查及災難支援工作系統 )originally owned by the Hong Kong Police Forceresponsible to facilitate the critical validation and

analysis of persons, time and placehelp to identify the chain of human transmission of

SARSspeedy identification and isolation action was very

important to control and stop the spread of SARS.

CMSCMSClinical Management Systemwas developed by Hong Kong Hospital

Authorityis an integrated clinical workstation giving

clinicians access to all available electronic clinical information

over eight million patient records are saved into the system.

all records are uniquely identified by using patient’s Hong Kong Identity Card number.

eSARS eSARS Electronic Severe Acute Respiratory Distress

Syndrome Systemwas developed with the network infrastructure,

workstation penetration and user base of the Clinical Management System

deployed at an extremely accelerated mode for the end users to enter the SARS case information and for the management to study the trend

ePR ePR Electronic Patient Recordsis a web-based integrated platform, allows

people to view the data stored in a clinical data repository.

To provide a high quality care and effective management, Hong Kong Hospital Authority determined to integrate the Picture Archiving and Communications Systems (PACS) and ePR.

SARS-CCISSARS-CCISSARS-Case Contact Information Systemis a data management system developed by

Department of Healthis to group analysis function for field

epidemiologists to construct cluster trees and extract cases of identified clusters for analysis

CTSCTSContact Tracing System responsible to control the communicable

diseases. are to confirm the diagnosis determine the

extent of secondary transmission, and identify control measures.

prevent disease spread in the community.

The infrastructure of eSARSThe infrastructure of eSARSHospital Authority (HA) is a statutory body established under theHospital Authority Ordinance to manage all public hospitals in

HK.   43 Hospitals 52,000 staff 46 SOPD and 74 GOPD

Currently manages a Head Office 41 public hospitals / institutions, 48 specialist outpatient clinics 74 general outpatient clinics

HA has a good infrastructure to support its system manages 44 public hospitals 1.2 million in-patient and day patient discharges about 1.4 million annually 7,000,000 patient records Over 27,600 hospital beds

which represented around 4 public hospital beds per 1,000 population

In Hong Kong , there are 162 HA Locations. 12,000 workstations to operate the system. 29,000 clinical users who have knowledge and The eSARS and CMS system are operated by Single Sign on

24x7x52 service.

Hardware Server Components UNIX server which is IBM RS6000 with operating system of AIX 4.3X.

Software Components Backend: Sybase 12.5 ASE DBMS (same as the platform of

CMS)Informix DBMS (for data warehouse)

Middle tier : Windows 2000 server (OS)IIS 5.0 as Web Server Crystal Report for reporting.

Frontend tier : PowerBuilder 6.5 (same as the platform of CMS)IE 5.0 or above (for browser)

Hardware infrastructure 3 data warehouses : Hong Kong Island, Kowloon & New

Territories. Served by different ISP.

The structure of eSARS & design are built on CMS eSARS.home is built on Intel based server for the Middle tier.

Since management do not have the workstations in front of them, they uses it to generate the report and analysis the data.

Software infrastructure CMS and eSARS are all Web-based system. CMS is built by PowerBuilder and Sybase. eSARS and eSARS.home is built by IIS, ASP, JavaScript, Sybase.

Network infrastructurenetwork connections are using WAN to connect 162

locations of HA.use Fiber-Optic Cable to transmit the data

for its Work-to-Internet connection. Each HA location has 2 broadcast network (LANs)

which served by 2 different ISP. each HA locations transmit the data to 2 different data

warehouses & LANs are using to connect the Internet among the workstations

How PolicingHow Policing Disease System Work Disease System Work The ESARS system is based on the development of CMS, so the basic

operation flow is quite similar. The flow of the system is as follow:

Ref: eSARS (Electronic Severe Acute Respiratory Distress Syndrome System ) –Development and Technical Perspective

Once the suspected patients are brought into the hospitals, the ward staff will enter this information on top of the normal clinical data that will be kept in the CMS.

The case and management reporting module generated statistical and trend information for the HA management to study and analyze at their daily steering committee meetings.

if the suspected patient is confirmed as a SARS patient, those information mentioned above will transfer to DM Zone

Then eSARS data is retrieved to the Health Department, Hong Kong Police and Universities.

DifficultiDifficulties in implementing eSARSes in implementing eSARS

Data InaccuracyCostAchieving Rapid Change of EnvironmentToo Many Set Up LocationSecurity Incapability to meet the current and future

needsLack of computer knowledge of frontline

staffs

Data InaccuracyData InaccuracyIn the early stage of the SARS doctors have different views or suggestions

about SARS

CostCostHighly Rely on hardware for CMS, cost

$256,502,000 per year Highly rely on software for CMS, cost

$101,317,000 per year Large IT financial burden to the government

Achieving Rapid Change of Achieving Rapid Change of EnvironmentEnvironmenteSARS have to update everydayfulfill the flexible information transfer

Too Many Set Up LocationToo Many Set Up Location huge information transfer between many

hospitals and departments

Security Security HA is a private organization information can’t be disclosed to the private

sectorfirewall for the security protection

Incapability to meet the current and Incapability to meet the current and future needsfuture needsnew IT technology grow fast gaps between the linkage of the new systems

recently developed in hospitals and those older CMS systems implemented at earlier stages

Lack of computer knowledge of the Lack of computer knowledge of the frontline staffsfrontline staffsnot all frontline staffs are familiar with the new

system most frontline staff had not yet recognized the

full or potential benefits gain clinicians' acceptance in the IT roll out

plan

Solution to tackle the Solution to tackle the difficultiesdifficultiesStandardization of dataMonitoring groupInter-operation of the systems with private

hospital Hotline for frontline staffs

Standardization of dataStandardization of dataStandardize the format or terms of the data can

help to provide a more reliable information Easy retrieval of data

IT Monitoring group for eSARS IT Monitoring group for eSARS operationoperation

Update the systems for sustainable operationCheck the areas for improvementEnsure the privacy and security of the systems

Inter-operation with the private hospitalsInter-operation with the private hospitals Sharing data Have more reliable information to carry out

certain policy

Hotline for Technical EnquiryHotline for Technical EnquiryProvide hotline to help frontline staffs adapt to

the new systems

Latest news about Policing Latest news about Policing Diseases SystemDiseases System

there are 55,000 patients and 1,200 private medical practitioners have enrolled in the PPI-ePR scheme.

Public- Private Interface - Electronic Patient Record Sharing Pilot Project

Support Chinese Characters Input of ePRReal Time Update of the Online Doctors’ List

The CMS development project started last July, beta version of CMS will be available in March, expecting 120 clinics to join the test by April

The ePR serve as tests of the bigger e-health record project to meet the needs of future

Improvement of Policing Improvement of Policing Disease System Disease System establish an enhanced information

management system across the sectors for communicable disease control on a permanent basis

relevant information should be sharedthe system should enclose links to all health

sectors, including the private sector and community clinics.

updating, modification and maintenance of the system are needed

In order to improve the efficiency and effectiveness of the system, the management should have meeting frequently

Deficiencies and improvements of the system should be discussed

Influence of theInfluence of thePolicing Disease SystemPolicing Disease SystemStockholm Challenge Award in 2004innovativecombining the criminal tracking system with

clinical informationsmart tracking systemdaily life with modern technology

CommentsComments

timelymultidisciplinaryhigh accuracyreal-timehigh securityfeasible