Hong Kong's DIY hospital CIO

Friday, 3 September 2010

Healthcare

By Jianggan Li | 14 May 2009

Melvin Choi’s office is like a museum – he kept all the important documents since 1975, when he started his decade long career in health IT. If you want to know how “Electronic Medical Record” was called thirty years ago, he would be a good reference.

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He did the same thing for all the virtual documents, keeping all the PowerPoint slides ever since he started using the software.

In 2006, Choi took up the CIO position for Adventist Health Hong Kong (AHHK), which manages Hong Kong Adventist Hospital and Tsuen Wan Adventist Hospital. The former was the first in Hong Kong to receive JCI Accreditation.

He has convinced the board of AHHK to approve a four year HIS strategic plan. The plan, which is scheduled to span from 2007 to 2010, is divided into four phases, with the ultimate aim of integrating the hospital’s Clinical Information System (CIS) with its Management Information System (MIS).

Choi is confident that the project can be accomplished with the limited resources he has: 16 IT staff members and a budget of HK$16.8 million (US$2.2 million).

“Before I joined, the Hospital only had seven IT staff – four in Hong Kong and three in Tsuen Wan,” Choi says the current workforce is already a major leap.

And when Choi joined the hospital, there were a number of standalone information systems installed in areas such as laboratories and pharmacy, in addition to its finance and reporting applications. The hospital did not have any information system in the outpatient clinic and inpatient ward.

To achieve his goal, it is important to get the users involved, Choi says. “A non-health system analyst, who doesn’t understand the workflow well, might end up taking even 10 development cycles instead of only one,” he explains. “Thus 10 times the cost.”

Early days

Prior to joining AHHK, Choi was the architect behind the first version of Hospital Authority’s Clinical Management System (CMS) in early 1990s. The third version of CMS is currently being rolled out by the Hospital Authority and the system has become Hong Kong’s pride in hospital IT.

And that was not Melvin’s earliest achievement. As an industry specialist of IBM in the 1980s, he helped Princess Margaret Hospital develop its first CIS, before Hospital Authority was formed to take over the management of all public hospitals. “We gave a big discount because we saw the potential in the market,” he recalls. “The project took a whole decade but if we think retrospectively, the scope was so small compared to what we are doing now.”

They did the right thing as a vendor – IBM now remains the biggest IT provider for the Hospital Authority.

After the success of the CIS project at Princess Margaret Hospital, Choi moved on to pilot the Hong Kong Patient Master Index at Tuen Mun Hospital, another major public hospital. “People then realised before records tracing, we would need a patient master index,” says Choi.

With the dedicated work of a few pioneers, HKPMI was successful and IT really took off in Hong Kong’s public hospitals, with a few major projects being undertaken by the then newly formed Hospital Authority.

Different mentalities

Before moving back to Hong Kong to work for IBM, Choi was at a US healthcare system for the first five years of his career in health IT.

Comparing the Hong Kong and American approaches to health IT, Choi says one major difference is that most US hospitals maintain a large IT department with a hefty budget and a fat headcount.

“Are they really doing that much?” he says. “I would say here in Hong Kong we do much more per dollar spent.”

The reason, according to Choi, is that most American hospitals prefer to buy packages instead of developing their own software; and lots of resources are dedicated to implementing, customising and maintaining these vendor packages.

“One of the Adventist hospitals in the US has more than 100 employees in IT,” he says. “And more than 30 of them are implementing and maintaining Cerner.”

Whilst in Hong Kong, a private hospital with 600 to 800 beds would have only a dozen IT staff.

“Again it is mentality,” Choi comments. “People tend to overestimate the complexity of hospital IT systems.”

“But the reality is, they are complex, but not as complex as we think they are,” he adds that it is the reason why he took up the challenge at AHHK to do everything on his own.

Choi stresses that he also hopes to have commercial off the shelf software that he can plug in and use. “But it is not the case,” he says. “No two hospitals operate in the same way, and unless people are willing to change the system to standardise, which I have not seen after so many years, a lot of customisation will be needed.”

In fact, when Choi first joined the AHHK, he considered adopting the well-established hospital IT system at their sister hospital – Taiwan Adventist Hospital. However, after careful study of the system and the practical needs of AHHK, Choi realised among all the modules developed in Taiwan, only Inventory Control and Procurement could be adopted in Hong Kong without major customisation.

Which vendor(s) will thrive?

An IBM veteran, Choi believes that vendors who are in the business usually have a team of clinical professionals, who can speak the same language as the end-users, to develop their products.

“Do you know why there are so many health IT vendors,” he wittily asks. “It’s because the system is not that difficult to develop.”

Having spent five years in a manufacturing company as a break to his decade long career in hospitals, Choi believes that from an IT perspective, manufacturing environment is actually more complex than healthcare.

The problem with lots of vendors, as Choi puts it, is that they don’t know how to package a solution to make it applicable in other hospitals, after the initial success in one hospital.

The decade long experience at IBM taught Choi the importance of packaging. “You need to compile very detailed documentation, you need to make the system user-friendly,” he says. “And the system needs to be customisable by a non-technical person with no programmers involved.”

He then points out that unfortunately, many vendors neglect this aspect, requiring customers to spend a lot of IT manpower and resources to customise the code.

“The market is consolidating, those have a customisable framework will eventually survive and thrive,” he adds.