Annex - eHealth

1. References for developing this Code of Practice

Advisory Guidelines For The Healthcare Sector. Singapore. 2014.
Australian Medical Association. AMA Guide to Medical Practitioners on the use of the Personally Controlled Electronic Health Record System. Australia. 2012.
Australian Government Minister for Health and Ageing. Concept of Operations: Relating to the Introduction of a Personally Controlled Electronic Health Record System. Australia. 2011.
British Medical Association. Confidentiality and Disclosure of Health Information. Guidance from the BMA’s Medical Ethics Department. UK. 1999.
British Medical Association and Royal College of General Practitioners. The Good Practice Guidelines for GP Electronic Patient Records. 2011
British Psychological Society. Guidelines on the Use of Electronic Health Record. UK. 2011
Canada Health Infoway Inc. White paper on Information Governance of the Interoperable Electronic Health Record (EHR). Canada. 2007
Canada Health Infoway Inc. Electronic Health Record (EHR) Privacy and Security Requirements – Reviewed with Jurisdictions and Providers. Canada. 2005
Code of conduct / practices of healthcare professionals and relevant registration ordinances in Hong Kong and Code of Practices issued by healthcare organisations in Hong Kong.
Department of Health of Western Australia. Practice Code for the Use of Personal Health Information. Australia. 2009
Department of Health. Contracted Service Providers Participating in the eHealth Record System: Frequently Asked Questions. Australia. 2013
Department of Health. Participation Agreement. Personally Controlled Electronic Health Record System. Australia. 2013
General Medical Council. Good Medical Practice. UK. 2006.
General Medical Council. Confidentiality. UK. 2009.
Hong Kong Medical Association & Independent Commission Against Corruption. Integrity in Practice. A Practical Guide for Medical Practitioners on Corruption Prevention.
Information Commissioner’s Office. Data Sharing Code of Practice. UK. 2011
Information and Privacy Commissioner. A Guide to Personal Health Information Protection Act. Ontario. 2004
Medical Board of Australia. Good Medical Practice: A Code of Conduct for Doctors in Australia. Australia. 2009.
National Health Service. The Care Record Guarantee. Our Guarantee for NHS Care Records in England. 2009
National Health Service. Confidentiality. NHS Code of Practice. UK. 2003.
National Health Service. Information Security Management - NHS Code of Practice. UK. 2007
Office of Privacy Commissioner. On the Record. A Practical Guide to Health Information Privacy. New Zealand. 2011.
Personal Data Protection Commission. A History and Theory of Informed Consent. New York: Oxford University Press. 1986
Principles of Biomedical Ethics. New York: Oxford University Press 1994.
Policies, guidelines & procedures and other relevant information released by the eHR Office for participating in eHRSS
References from the Office of the Privacy Commissioner for Personal Data (PCPD)

2. Substitute decision maker (SDM) arrangement for electronic health record (eHR) sharing

Healthcare recipient under 16, or aged 16 or above and who is of any of the following, an eligible SDM can act on the person’s behalf at the person’s best interest on the following relevant occasions: giving joining consent and sharing consent, renewal or revocation of a sharing consent and request for withdrawal of participation in eHRSS.

Persons incapable of giving consent	Persons who may act as SDM
(a) A minor (below 16 years old)	Parents Guardian¹ Persons appointed by court to manage the affairs of the healthcare recipient Family members or person residing with the healthcare recipient Healthcare provider
(b) Healthcare recipient who is 16 years old or above and is incapable of giving the person's own consent²	Guardian³ Director of Social Welfare or any other person under MHO⁴ Persons appointed by court to manage the affairs of the healthcare recipient Family members or person residing with the healthcare recipient Healthcare provider

¹ Appointed under Guardianship of Minors Ordinance (Cap 13) or appointed by court ² Mentally incapacitated as defined by Mental Health Ordinance (Cap 136) s2(1);
Incapable of managing his or her own affairs;
Incapable of giving joining consent at relevant time;
Incapable of giving sharing consent at relevant time ³ Appointed under Mental Health Ordinance (Cap 136) ⁴ Under MHO s44A(1)(i), 44B(2A) or 59T(1) or 44B(2B) or 59T(2)

3. Healthcare providers in eHRSS

Healthcare provider that provides healthcare at one service location in Hong Kong may apply to the Commissioner to be registered as a healthcare provider for the System for the location.

A person provides healthcare at one service location if the person –

is licensed under the Private Healthcare Facilities Ordinance (Cap. 633) in respect of one private healthcare facility; (Replaced 34 of 2018 s. 196 and E.R. 5 of 2018)
is registered under section 5(2) of the Medical Clinics Ordinance (Cap 343) in respect of one clinic;
carries on the business of dentistry under section 12 of the Dentists Registration Ordinance (Cap 156) at one place;
holds a certificate of exemption issued under section 7(2), or a licence issued under section 8(2)(a), of the Residential Care Homes (Elderly Persons) Ordinance (Cap 459) in respect of one residential home and engages a healthcare professional;
holds a licence issued under section 7(2)(a), or a certificate of exemption issued under section 11(2)(a), of the Residential Care Homes (Persons with Disabilities) Ordinance (Cap 613) in respect of one residential home for persons with disabilities and engages a healthcare professional; or
is a specified entity that engages a healthcare professional to perform healthcare at one premises

The Commissioner may register a Government department as a healthcare provider for the System if the Commissioner is satisfied that the department provides a healthcare professional to perform healthcare for any healthcare recipient.

4. Access to eHRSS by healthcare professionals⁵

Access to eHRSS would be allowed for the following healthcare professionals:

Registered medical practitioner (Cap 161);
Registered nurse or enrolled nurse (Cap 164);
Registered midwife (Cap 162);
Registered dentist (Cap 156);
Registered pharmacist (Cap 138);
Registered medical laboratory technologist (Cap 359A);
Registered radiographer (Cap 359H);
Enrolled dental hygienist (Cap 156B);
Registered chiropractor (Cap 428);
Registered occupational therapist (Cap 359B);
Registered Part I optometrist (Cap 359F);
Registered physiotherapist (Cap 359J); and
Registered and listed Chinese medicine practitioner (Cap 549).

Sharing by different healthcare professionals at different phases will be reviewed from time to time and announced by the eHR Office.

⁵ eHRSSO Cap 625, Schedule

5. Sharable clinical data in initial phase of eHRSS sharing

This section is extracted from the eHR Content Standards Guidebook.

Healthcare professionals should be aware that the eHRC will review, decide and update the sharable scope from time to time.

eHR content	Definition
1. Personal Identification and Demographic Data	All information that is required to accurately and uniquely identify a person, including: eHR person identifier; identity data; demographic data; and next-of-kin data
2. Encounters / Appointments	A list of booked appointments and attended healthcare encounters (contact between a person and the healthcare practitioner who will assess, evaluate and treat a person). An episode is composed of one or more encounter(s).
3. Healthcare Referrals	Information that is required when a healthcare practitioner transfers all or a portion of a person’s care to another healthcare professional.
4. Clinical Note / Summary	The clinical note / summary contains information that summarise the following : Reason originating the encounter / episode and the person’s condition during the initial encounter; Adverse drug reactions, allergies and clinical alerts found during the encounter / episode (this information should also be separately sent to the eHR at the appropriate section); Major diagnostic findings during the course of the episode; Problems identified; Significant procedures performed and other related therapeutic treatment, e.g. medication; The person’s condition, therapeutic orders or treatment plan while preparing a periodic episode summary or upon termination of an episode; Follow-up arrangement; and Education to the person / family Remarks: The sharing of obstetric records by Healthcare Providers is available since March 2020.
5. Allergies and Adverse Drug Reactions	Information on the type of biological, physical or chemical agents that would result in / is proven to give rise to adverse health effects. Details of the adverse reactions, if occurred, should also be included.
6. Diagnosis	All active and inactive significant health and social problems. A problem can be a diagnosis, pathophysiological state, significant abnormal physical sign and examination finding, social problem, risk factor, allergy, reaction to drugs or foods, or health alert.
7. Procedures	Any significant procedures that are done for diagnosis, exploratory or treatment purposes.
8. Birth Records	The basic information about the eHR participant’s birth, e.g. place of birth, birth weight, maturity. Part of the information relating to birth would fall under the other sharable scope, e.g. diagnosis, procedure, assessment.
9. Medication	This includes medication ordered and/or dispensed/administered during the healthcare process.
10. Immunisation Records	Vaccines administered to the person.
11. Laboratory Reports	Result of the laboratory tests which are subclassified according to the nature of the test, namely anatomical pathology, biochemistry, haematology, microbiology, virology, and other laboratory test.
12. Other Investigation Reports	Other diagnostic test results could be of diverse range as discrete data element or a full report of the diagnostic test. Images, e.g. clinical photos, tracing, could also be included.
13. Radiology Reports	Radiology results would include radiology report and images. They are sub-classified according to modality, e.g. plain x-ray, fluoroscopy, ultrasound, computed tomography, magnetic resonance imaging, nuclear medicine, angiography and vascular interventional radiography, non-vascular interventional radiography, positive emission tomography and others.

6. Code of Conduct / Practices of healthcare professionals and relevant registration ordinances

Registered healthcare professionals	Documents	Issuing authority	Cap	Remarks
1. Medical Practitioner	Code of Professionals Conduct for the Guidance of Registered Medical Practitioners English version Chinese version	Medical Council of Hong Kong	Cap 161	Revised in Jan 2016
	COP for Doctors (Private Hospital Association) English version	Private Hospital Association		Revised in May 2020
2. Nurses (registered or enrolled)	Code of Ethics and Professional Conduct for Nurses in Hong Kong Bilingual version	The Nursing Council of Hong Kong	Cap 164	Revised in Jan 2015
3. Dentist	Code of Professional Discipline for the Guidance of Dental Practitioners in Hong Kong English version Chinese version	The Dental Council of Hong Kong	Cap 156	Revised in Dec 2019
4. Dental Hygienists	No information found in the website of the Dental Council of Hong Kong and there is no COP the Dental Hygienists		Cap 156B
5. Chiropractors	Code of Practice for Registered Chiropractors English version Chinese version	Chiropractors Council of Hong Kong	Cap 428	Revised in Jan 2017
6. Midwife	Code of Professional Conduct and Practice for Midwives in Hong Kong English version Chinese version	Midwives Council of Hong Kong	Cap 162	Revised in Mar 2016
7. Pharmacist	Code of Professional Conduct for the Guidance of Registered Pharmacists in Hong Kong Bilingual version	Pharmacy and Poisons Board of Hong Kong	Cap 138	2017 Version
8. Medical Laboratory Technologist	Code of Practice for Registered Medical Laboratory Technologists English version Chinese version	Medical Laboratory Technologists Board of Hong Kong	Cap 359A	Revised in April 2012
9. Occupational Therapist	Code of Practice for Registered Occupational Therapists English version Chinese version	The Occupational Therapists Board of Hong Kong	Cap 359B	Revised in July 2017
10. Optometrist	Code of Practice for Registered Optometrists English version Chinese version	Optometrists Board of Hong Kong	Cap 359F	Revised in Apr 2022
11. Radiographer	Code of Practice for Registered Radiographers English version Chinese version	The Radiographers Board of Hong Kong	Cap 359H	1998 Version
12. Physiotherapist	Code of Practice for Registered Physiotherapists English version Chinese version	The Physiotherapists Board of Hong Kong	Cap 359J	Revised in Jan 2014
13. Chinese Medicine Practitioner Registered Listed	Code of Professional Conduct for Registered Chinese Medicine Practitioners in Hong Kong English version Chinese version	Chinese Medicine Council of Hong Kong	Cap 549	Revised in July 2015
	Code of Conduct for Listed Chinese Medicine Practitioners English version Chinese version			Revised in Jan 2018

7. Code of Practice of healthcare orginisations in Hong Kong

	Documents	Issuing Authority	Cap	Remarks
1. Clinics registered under the Medical Clinics Ordinance under Medical Clinics Ordinance (Cap 343)	Code of Practice for Clinics Registered Under The Medical Clinics Ordinance (Cap 343) English version Chinese version	Department of Health	Cap 343	2010 Version

8. Policies, guidelines & procedures and other relevant information released by eHR office for participating in eHRSS*

General Policies and Guidelines

Participant Information Notice
Conditions of Registration of Healthcare Providers (Private Hospitals) in eHRSS/Conditions of Registration of Healthcare Providers (other than Private Hospitals) in eHRSS
eHRSS Privacy Policy Statement
eHRSS Personal Information Collection Statements
Important Note For Healthcare Providers Who Perform Healthcare Recipient Registration And / Or Obtaining Joining And Sharing Consent In Electronic Health Record Sharing System
Training materials for the operation of registration centres
Guidelines on Management of Healthcare Recipient Index
Guidelines on Management of Healthcare Recipient (HCR) Data by Healthcare Providers
eHRSS Data Retention Policy
Policy and Guidelines for Handling Data Access Request (DAR) and Data Correction Request (DCR) in eHRSS
Guidelines and procedures for using Hong Kong Identity (HKID) Card for eHR
Frequently Asked Questions for eHRSS

eHR Data Standards

eHR Content Standards Guidebook.
Editorial Guide on Hong Kong Clinical Terminology Table – Overview
Guide on Implementation & Maintenance of the Hong Kong Clinical Terminology Table

eHR Security and System Connection Guidelines

IT Security Policies for eHRSS
Security Assessment Checklist for Participating in the eHRSS
Data Interoperability Guide
Communication Protocol (Data Interface) Specification
Encapsulated Linkage Security Application ("ELSA") Installation Guide
eHR Adaptor Interface Specification
Process Report and Exceptional Reporting Requirement

*The policies, guidelines & procedures and other relevant information released maybe updated from time to time. Please visit www.ehealth.gov.hk or contact the eHR Office for the latest information.

9. Roles and responsibilities of user administrator in the Electronic Health Record Sharing System (eHRSS)

To manage user accounts and related administrative matters for healthcare providers to facilitate their participation and use of eHRSS. Such activities may include creation of user accounts with appropriate functions; proper assignment of access rights; maintenance of updated user list, user profile and professional registration information; and timely closure of user account(s) when necessary, etc.;
To act as liaison person to communicate and cooperate with the Commissioner for the Electronic Health Record (eHRC) on matters relating to the use of eHRSS including:
1. To collect feedback from users and to disseminate updates of eHRSS operational information to users (including provision of training on proper use of the eHRSS as and when required)
2. To handle enquiries or complaints;
3. To handle Data Correction Requests in accordance with Personal Data (Privacy) Ordinance (Cap. 486);
4. To report to eHRC any suspected or confirmed data, privacy or security incidents;
5. To provide assistance and information to eHRC and other relevant parties/agencies for facilitating the investigation of data, privacy or security incidents; and
6. To carry out regular audit, investigation and related matters.
To perform other administrative duties for the healthcare providers as required by eHRC for the effective operation of eHRSS.

10. Reference from the office of the Privacy Commissioner for Personal Data (PCPD)⁶

⁶ The references from PCPD listed in this COP are not exhaustive. PCPD may issue more Code of Practice or Guideline Note or other material or update any existing documents from time to time. Readers of this COP are advised to visit the internet website of the Office of the Privacy Commissioner for Personal Data for the latest information.