The Meaning of eHRSS to Community Healthcare in Face of Pandemic Challenges
"Patients participating in our Community Interim Medication Refill Scheme (CIMRS) pilot are those with chronic illnesses who require long term medication. The outbreak of the Coronavirus Disease 2019 (COVID-19) has unexpectedly disrupted their scheduled follow-up and medication refill at the Hospital Authority (HA). With the objective to bridge this service gap leveraging community resources and inspired by the use of the Electronic Health Record Sharing System (eHRSS), we and our collaborators sparked off this pilot scheme with the aim to contribute to the continuity of care for patients at the community level, as well as to help release precious resources in the public healthcare sector at this critical time to fight against the pandemic."
The outbreak of COVID-19 in early 2020 has presented unprecedented challenges to the Hong Kong public healthcare system. The activation of Emergency Response Level in public hospitals entailed that many patients would be restricted from visiting or receiving healthcare services at HA's hospitals and clinics, directly impacting on those with chronic diseases who require regular follow-ups and prescribed medications in the Out-patient Clinics of HA. Against this backdrop, the Society for Innovative Healthcare Hong Kong in collaboration with the Pharmaceutical Foundation and other supporting organisations, initiated the CIMRS pilot in February 2020 to provide an interim measure for these patients, making use of their electronic health records (eHRs) shared in eHRSS to provide them with temporary yet urgently needed drug refill and advisory services in the community.
Indispensable Role of eHRSS
"CIMRS serves to share out and complement healthcare services of the public sector in this difficult time to meet the temporary need of patients," Dr Liu explained. "It works through the collaboration amongst various parties in the community, including private clinics, non-governmental organisations (NGO) and community pharmacies to serve those chronic patients with urgent drug refill and advisory services. To achieve this, eHRSS plays a pivotal and indispensable role," he added.
Patients participating in the pilot scheme are required to join eHRSS as a pre-requisite. This enables healthcare professionals (HCProfs) taking part in the pilot, who are also eHRSS users, to access the patient's eHRs, such as diagnosis, prescription and dispensing records shared by HA to the system. Based on the information, participating doctors can review the patients' clinical conditions and previous medications to assess their suitability for the scheme. Dr Liu elaborated how eHRSS plays a part in this, "With eHRSS, doctors can obtain accurate and reliable information about the patient to facilitate the assessment. When they come to us, patients or their carers need not memorise and describe the shape or colour of the drugs in use, or show us their drug bags. Nor do we need to trace or call HA for clarifications. This not only saves our time and effort, but also helps avoid putting additional workload on the staff and system of HA. More importantly, medication safety is enhanced and this surely benefits the patients."
Subject to the doctor's diagnosis, stable patients without drug-related issues will then be prescribed with the same medications up to 4-8 weeks. Patients or carers can then collect the packed drug refills at a scheduled time in the selected community pharmacy simply by presenting the necessary identification document. "Throughout the whole process, waiting time is minimised and crowded gatherings are avoided. Besides, as the required information is readily available in eHRSS, service registration, drug collection and communication amongst HCProfs is simple and convenient," Dr Liu continued to share the benefits brought by CIMRS as facilitated by eHRSS.
Reiterating the meaning of eHRSS to the pilot scheme, Dr Liu said, "In order to support our services, there must be a reliable and secure platform for information sharing." He further supplemented, "While HCProfs are assured of their convenient access to timely and accurate eHRs of their patients, patients and their carers are also assured that their privacy is well protected. They will be notified of when, where and who whenever patients' eHRs have been accessed. Patients can feel relieved and secure when using our services, and we have been receiving positive feedback."
Potential Public-Private Partnership for Community Drug Refill Project
With the charity donation as well as support from NGOs, volunteering doctors, nurses, pharmacists and helpers, enrolled patients could enjoy the services of CIMRS free of charge. The pilot started on 22 February and extended from 4 May 2020 to include collection and delivery of drug from public hospital pharmacies to patients' home, with use of technology – Internet of Things (IOT) to monitor and ensure the drugs were delivered to patients on time. By early May, around 250 patients have already participated and benefited from the scheme.
In facing the challenges of the severe pandemic situation in Hong Kong, CIMRS has set the scene and illustrated the potential for more community collaboration in the healthcare sector. It also shows the beauty of eHRSS in contributing to both the public and private healthcare systems. In the longer term, Dr Liu welcomed the Government to explore the feasibility of introducing similar services as a new form of public-private partnership, with a view to alleviating the service demand in the current public healthcare system while maximising the use of healthcare resources in the community.
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