Delivering 21st Century Healthcare

By Eric Collins

A recently concluded CityU project led by Professor Frank Chen, Delivering 21st Century Healthcare in Hong Kong - Building a Quality-and-Efficiency Driven System, has made a very real contribution towards improving conditions in the Hong Kong public health sector. Using networked resources, the emphasis was on placing people at the centre of healthcare delivery in Hong Kong.

Patient waiting times for routine surgery at public hospitals are as long as 18 months.

Rising demands on health care services are pushing systems to breaking point around the world. Covid-19 has dramatically exacerbated an already difficult situation as populations age, and an ever-greater proportion of GDP is going to the healthcare sector. Worldwide, public health care services are fraught with high costs, low efficiency and poor quality of patient care service. Hong Kong is no exception, and patient waiting times for routine surgery at public hospitals are as long as 18 months.

Building sustainability into the system

"To help alleviate overcrowding, we developed algorithms to identify elderly patients at high risk of rehospitalsation."

"We wanted to improve an overloaded system, and make it sustainable in the long run," said Dean Frank Chen.

The project focused on hospital resource planning, and was driven by healthcare data analytics and business services innovation, with a focus on quality-and-efficiency driven strategies and systemsoriented solutions.

"The Hong Kong public healthcare system is frequently functioning above 100% capacity. To help alleviate overcrowding, we developed algorithms to identify elderly patients at high risk of rehospitalisation and then plan for more effective post-discharge care."

"We also wanted to explore how Public-Private Partnerships might provide long-term solutions to ease long wait-times in public hospitals and clinics," said Professor Chen.

Delivering 21st Century Healthcare, CityU's Theme-based Research Scheme and the first for the College of Business, was organised in collaboration with the Chinese University of Hong Kong's Jockey Club School of Public Health and Primary Care, Columbia University in the USA and others, and was funded by the Research Grants Council. The project started in November 2014 and completed recently with substantial achievements: over 115 publications in reputable, referred journals, and the training of around 50 PhD and a dozen masters' students. Research outputs included the applications of data science and artificial intelligence to identify target elderly patient segments for two areas: firstly, the most effective and affordable post-discharge care portfolios in the community. Secondly, to predict the onset of chronic diseases. The project also worked on the development of sensor technology for health monitoring of the elderly, and in management with scientific tools for hospital resource planning.

Project team members included Co-Principal Investigators Professor Eliza Wong, and Professor Engkiong Yeoh at School of Public Health and Primary Care of the Chinese University of Hong Kong; Professor David Yao at Columbia University; Professor Hengqing Ye at Polytechnic University of Hong Kong; Professor George Huang at the University of Hong Kong; and Professor Houmin Yan, Professor Kwok-leung Tsui, and Professor Kwai-sang Chin at City University of Hong Kong. Also, Co-Investigators Dr Eman Leung at the Chinese University of Hong Kong; Dr Qingpeng Zhang; Professor David ZLi; Professor Pengfei Guo; Dr Carrie Lin; Dr Yimin Yu at City University of Hong Kong; and Dr Calvin Or at the University of Hong Kong.

Five main impacts on Hong Kong's healthcare

Delivering 21st Century Healthcare in Hong Kong has delivered on multiple fronts. Here are five main quality-and-efficiency impacts:

#1 Reducing emergency admissions

The team piloted a project at a large public hospital, in which they implemented a machine learning tool to identify elderly patients at high risk of re-hospitalisation and then plan for their more effective post-discharge care. Predicting the arrivals and managing patient flows are essential to hospitals. In the vital area of emergency healthcare management, the project has informed the deployment of transitional nursing care using predictive analytics to reduce emergency admissions.

#2 Improving efficiency of key hospital resources

The planning and management of patient flow is key to the efficient use of hospital resources. The team was invited to provide consultation to the development of the new Chinese University of Hong Kong Medical Centre on patient flow, operational planning, and physical design to maximise patient-centred care. They also advised on location decision for key diagnostics equipment in another new public hospital, on stocking locations and facility selection for consumable items, porter dispatch policies, and linear operations strategy, and to develop an appointment system for ambulatory care at a major public hospital.

#3 Unlocking spare capacity in the private sector

In 2018-19, the Hong Kong Government decided to set up District Health Centres (DHCs) in all 18 districts, to provide primary healthcare services through medical‑social collaboration and public‑private partnerships, with the focus on elderly residents. A DHC is a service hub with a core centre serving as headquarters, complemented by satellite centres in sub-districts at convenient locations. The Government envisages "the DHC to be a model for district‑based medical‑social collaboration, using big data to identify the areas of medical care services, establishing a framework to implement measures on disease prevention in a more systematic manner … and strengthening scientifically proven service provision and policy‑led development work." (The Chief Executive's 2017 Policy Address).

The first DHC was implemented in Kwai Tsing District. In applying our TRS-developed algorithms to HK-wide Electronic Health Records (EHRs) made accessible by the Hospital Authority's Data Collaboration Lab (HADCL), we were able to characterise district-specific profiles of highrisk residents in the community and their secondary and tertiary prevention needs. These tools can be further developed and used to inform service planning for DHCs. Although Hong Kong public hospitals take up to 90% of total inpatients, the private sector possesses the lion's share of primary care capacity. However, utilising this extra capacity and advanced tech in the private sector has remained a challenge. These tools can be further developed to assist decisionmakers at DHCs as well as general practitioners to unlock this capacity.

#4 Improved resource management

Resource pooling and sharing among hospitals are important topics in healthcare management research. The team advised on the Hospital Authority's ten-year plan for the non-emergency ambulance service by providing a consultative report reviewing its patient transport service.

#5 Data analytics tools for future healthcare research

Healthcare information and data analytics underlie the achievements and social impact of all other project tasks. The tool kits that have been developed will be of generic use in advancing future healthcare research.

The team developed a number of machine learning models to predict the onset of various diseases that are critical in Hong Kong, including heart failure, mitral regurgitation, acute myocardial infarction, dementia, suicide and depression risk assessment, etc. They also developed advanced machine learning models for predicting future high-cost patients, for example, COPD, and infectious disease models.

Sensor technology has been utilised in the project for monitoring and assessment of elderly's health, including general wellness, blood pressure, gait and balance. The team found that sensors provided researchers with important data, for comprehensive evaluation of health conditions and fall risk prediction.

A general framework of system health monitoring and management (SHMM) has been proposed. It covers continuous surveillance, analysis and interpretation of related data for system monitoring, management and strategic planning. The team provided a new perspective on health monitoring and the management of complex systems, such as health systems in a big data environment.

Legacy – a new phase of collaborative healthcare management

In November 2018, Our Hong Kong Foundation published a report on Hong Kong's health system, entitled "Fit for Purpose: A Health System for the 21st Century," which was led by Prof Eng-kiong Yeoh from the Public Health Team, Chinese University of Hong Kong. It was officially released at the "Our Hong Kong Foundation" Health Systems Summit, which was keynoted by the Chief Executive. The Hong Kong Hospital Authority also commissioned the CityU team at the College of Business to prepare the planning of services and business models of patient transport service (Non-Emergency Ambulatory Transfer Service, NEATS, and Elderly Transport Service, ETS), for the ten-year period of 2018- 2027.

As Professor Chen put it: "We feel the successful completion of this TRS project is just the start of a new phase of collaborative healthcare management research in Hong Kong."

"The achievements in the past five years have provided us with an opportunity for long-term interdisciplinary collaboration and sustainable development in elderly care in Hong Kong."

HomAge: Home-based aging for transformative community care

The College of Business is actively pursuing their research work in healthcare. A team comprising CB faculty members alongside Jockey Club School of Public Health and Primary Care of the Chinese University of Hong Kong, has recently been awarded $23.8M funding from Bank of China (Hong Kong) Centenary Charity Programme (Secretariat: The Hong Kong Council of Social Service). "HomAge: Home-based aging for transformative community care," is a pilot project to implement the home-based care programme based on the Buurtzorg homecare model which has seen global uptake. This 3-year project will leverage on an IT platform for service planning and coordination, and deploy the AI/ data analytics tools developed in the Delivering 21st Century Healthcare TRS project to identify the elderly segment(s) for the most effective and affordable community-based cares, including post-discharge care portfolios. The proposed homebased care programme will provide care services that complement the DHC model.

Several Public Policy Research grants have been obtained by the Team, which will generate more policy reports for the government.

The College of Business looks forward to working with our partners across the educational and healthcare sectors in delivering further collaborative projects which will positively impact on quality delivery in Hong Kong's healthcare systems.