Transcript Policing Disease System The use of telecommunications in developing

The use of telecommunications in
developing
Policing Disease System
ITISM 3410 Telecommunications & Networking in Bus.
Component of Policing Diseases
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 Records
 SARS-CCIS ：SARS-Case Contact Information System
 CTS：Contact Tracing System
MIIDSS
 Major 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 Force
 responsible to facilitate the critical validation and
analysis of persons, time and place
 help to identify the chain of human transmission of
SARS
 speedy identification and isolation action was very
important to control and stop the spread of SARS.
CMS
 Clinical Management System
 was developed by Hong Kong Hospital Authority
 is 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
 Electronic Severe Acute Respiratory Distress Syndrome
System
 was 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
 Electronic Patient Records
 is 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-CCIS
 SARS-Case Contact Information System
 is a data management system developed by Department
of Health
 is to group analysis function for field epidemiologists to
construct cluster trees and extract cases of identified
clusters for analysis
CTS
 Contact 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 eSARS
Hospital Authority (HA) is a statutory body established under the
Hospital 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 infrastructure
 network 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 Policing 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.
Difficulties in implementing eSARS
 Data Inaccuracy
 Cost
 Achieving Rapid Change of Environment
 Too Many Set Up Location
 Security
 Incapability to meet the current and future needs
 Lack of computer knowledge of frontline staffs
Data Inaccuracy
 In the early stage of the SARS
 doctors have different views or suggestions about SARS
Cost
 Highly 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 Environment
 eSARS have to update everyday
 fulfill the flexible information transfer
Too Many Set Up Location
 huge information transfer between many hospitals and
departments
Security
 HA is a private organization
 information can’t be disclosed to the private sector
 firewall for the security protection
Incapability to meet the current and future
needs
 new 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
frontline staffs
 not 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 difficulties
 Standardization of data
 Monitoring group
 Inter-operation of the systems with private hospital
 Hotline for frontline staffs
Standardization of data
 Standardize the format or terms of the data can help to
provide a more reliable information
 Easy retrieval of data
IT Monitoring group for eSARS
operation
 Update the systems for sustainable operation
 Check the areas for improvement
 Ensure the privacy and security of the systems
Inter-operation with the private hospitals
 Sharing data
 Have more reliable information to carry out certain
policy
Hotline for Technical Enquiry
 Provide hotline to help frontline staffs adapt to the new
systems
Latest news about Policing Diseases
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 ePR
 Real 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 Disease
System
 establish an enhanced information management system
across the sectors for communicable disease control on a
permanent basis
 relevant information should be shared
 the 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 the
Policing Disease System
 Stockholm Challenge Award in 2004
 innovative
 combining the criminal tracking system with clinical
information
 smart tracking system
 daily life with modern technology
Comments
 timely
 multidisciplinary
 high accuracy
 real-time
 high security
 feasible