Diagnosing Hong Kong: The First Smart Hospital

Covid-19 has posed numerous challenges for medical systems around the world. In Hong Kong, doctors in public hospitals account for about half of the total number of doctors in the territory, but 90% of the local patients use inpatient services in public hospitals [1]. The outbreak of the coronavirus pandemic has greatly increased the burden on an already overloaded public healthcare system. In order to meet the challenges, the Hospital Authority (HA) has cut non-emergency and non-essential services and pooled resources to take care of emergency patients as well as Covid-19 cases. At the same time, the demand for medical services in the private sector has dropped significantly due to plummeting tourist numbers.

These pressures have led to changes in the local medical system, with some hospitals looking to ‘go smart’ or expand the breadth and depth of public-private partnerships. HKTDC Research interviewed Professor Justin Wu, Chairman of CUHK Medical Services and Associate Dean (Health Systems) of the Faculty of Medicine at CUHK, to discover the long-term impact such changes might have on Hong Kong’s healthcare system. In addition, he also served as the Chief Operating Officer of the Chinese University of Hong Kong Medical Centre (CUHKMC) until July 2021.

The CUHKMC opened on 6 January 2021 and became the 13th private hospital in Hong Kong. But the Chinese University of Hong Kong had come up with the concept of a digitalised, smart hospital back in 2015. Such a hospital would use a fully electronic, paperless medical records system, mobile information technology, real-time data, and internet-of-things (IoT) applications to facilitate treatment, provide seamless medical services, and integrate the services of different specialist medical teams. In this way the medical centre would offer improved communication, optimised administration, promote more effective healthcare and more efficient operations and service.

Telemedicine: The Way Forward

To minimise the risk of spreading coronavirus in hospitals, the HA has significantly reduced non-emergency and non-essential services. These have been replaced by telemedicine services [2] such as teleconsultation and remote support. According to Professor Wu, the introduction of telemedicine has been welcomed by patients and is a step towards making the public healthcare system smarter. “Many elderly and mobility-impaired people need to attend follow-up consultations at hospitals,” he said. “Visiting the hospital is not an easy task for them. Teleconsultation makes things easier for both patients and carers by reducing the cost and complications of hospital visits. Telemedicine is no longer castles in the air, it is a reality. Much recent research has shown that patients, including senior citizens, are increasingly willing to try online medical consultations [3].”

Private hospitals have introduced a range of telemedicine services for people to choose in a bid to broaden their customer base. This option also gives access to quality medical services for patients from outside who cannot come to Hong Kong. “Hong Kong’s healthcare services rank among the best in the world,” Professor Wu explained: “They are highly regarded by the medical sector and patients, and have for many years attracted a great number of patients from mainland China, including the Greater Bay Area (GBA). As the Covid-19 pandemic has boosted the popularity of telemedicine in China, more mainland patients are expected to use teleconsultation to access the quality healthcare services in Hong Kong in the future.”

As the public-private partnership (PPP) healthcare model gradually comes of age and the demand for cross-boundary healthcare services rises, comprehensive electronic health record sharing is becoming increasingly important. Professor Wu cited an example. “Although the Hong Kong University Shenzhen Hospital (HKU-SZH) was commissioned by the Hong Kong government to provide specialist and general outpatient follow-up consultation services for Hong Kong citizens resident in Guangdong province amid the Covid-19 border closure, the hospital was initially unable to access patient information contained in the HA’s e-Health system. Even after the Hong Kong government obtained authorisation from the patient to provide copies of their health record to HKU-SZH, the information available was restricted to that outlined by eHealth. As a result, it was incomplete [4].”

Professor Wu hopes that in future access to e-Health will be more comprehensive and personalised. The system could cover the whole healthcare process while offering options for the patient to authorise individual healthcare workers to access their medical record. Many countries, such as Estonia, introduced block chain technology when they first built their electronic health record system. Some of them allow the patient to authorise healthcare workers via mobile app to directly retrieve specific medical records in real-time. Professor Wu pointed out that this practice not only protects patient interests, but also meets the increasing demand for teleconsultation.

Healthtech: Rapid Advances

Professor Wu has noted that start-ups around the globe are developing healthcare technology using artificial intelligence (AI), mobile information technology and IoT, with impressive advancements made in each of these areas. He remarked: “AI medical consultation technology is mainly developed and promoted by mainland start-ups, while the participation of overseas start-ups is relatively limited. On the other hand, Europe and the US are leaders in the development of medical robots, such as the da Vinci Robotic Arm Surgical System. With more government policies introduced to encourage entrepreneurship within educational institutions, the academic research teams in the world-leading universities in Hong Kong are ready to put their research achievements into practice and pursue industrialisation and marketisation.”

Many R&D achievements of the CUHK Faculty of Medicine are being applied in the CUHKMC first. For instance, the HealthyBrain Programme launched by the CUHKMC has taken the lead in introducing two recent R&D achievements of the CUHK Faculty of Medicine, namely Automatic Retinal Image Analysis (ARIA) and AccuBrain® AI Brain Image Analysis. The former uses AI to analyse information on retinal blood vessels and assess the risk of cardiovascular diseases such as stroke or heart attack. The latter uses AI technology to analyse brain MRI images and detect early symptoms of Alzheimer’s disease and other neurocognitive disorder cases.

Professor Wu also pointed out that start-ups must not only possess R&D talent and business skills; they must co-operate with different stakeholders to build sound and practical product prototypes and algorithms as well as to obtain valid clinical data as support for acquiring hospital-grade certification given the scarcity of both time and resources. The CUHKMC has collaborated with many medical technology firms over the years. Professor Wu added: “We can offer advice to start-ups from the perspective of a medical institution and healthcare professionals, help them to develop products that meet the needs of healthcare processes and hospital operation. Besides, as one of the leading medical schools in the world, we have a wealth of resources and networks which can provide start-ups with opportunities for connecting with different stakeholders. We can also use the scientific research experience we have accumulated over the years to help start-ups optimise product algorithms.”

For years the CUHK Faculty of Medicine has offered help to local start-ups. In the early stage of Belun Technology’s development of the Wireless Sleep Monitoring Ring, the CUHK Faculty of Medicine helped the company obtain clinical data and secure certification from the US Food and Drug Administration [5]. The CUHKMC is also currently using the company’s sleep monitoring device in its Sleep Health Programme to screen the programme participants. Professor Wu hopes that the CUHKMC can further deepen co-operation with start-ups and help more of them to commercialise healthcare technology, through a variety of routes such as providing intellectual input in exchange for shares or the exclusive right to use. Such arrangements could encourage investors and other stakeholders to participate in product and technology R&D.

Deepen Public-Private Partnership

In order to alleviate the impact on patients of the reduction in non-essential medical services during the coronavirus pandemic, the HA has expanded the existing public-private partnership (PPP) programme by collaborating with more private hospitals and developing new areas of PPP. Under this programme, patients pay the same medical fees charged by public hospitals for treatment at participating private hospitals.

Professor Wu believes this PPP programme can shorten waiting times for patients and reduce the risk of their condition deteriorating whilst waiting. This, in the long run, can help Hong Kong establish a more sustainable PPP healthcare service model. He said: “As the population ages, the demand for healthcare from patients with chronic diseases is expected to climb. The waiting time for follow-up consultation at specialist outpatient departments in public hospitals can be as long as 50 weeks or more. If private hospitals can complement public hospitals and play a bigger role as service providers for patients with early-stage diseases, they can free up public hospitals to focus on cases which are more complicated or incur higher medical costs. Since the cost of treating early-stage diseases is lower, the overall medical cost can be expected to drop markedly.”

Such a system of division of labour between public and private hospitals is very common in countries like Germany which provide universal healthcare to their citizens. Most of these countries offer more sustainable national health services by strengthening primary and preventive healthcare. In Hong Kong, the number of old people is projected to surge from 1.42 million in 2020 to 2.13 million by 2030, or 27% of total population, a percentage second only to that of Japan [6]. Building a sustainable public-private healthcare service model is therefore important to Hong Kong’s public healthcare system.

Professor Wu commented that the operation of the CUHKMC has put forward a new direction for the development of PPP. He said: “The Hong Kong government has for the first time written public-private partnership targets into the service agreement with the CUHKMC, stating that the medical centre must handle a stipulated number of cases referred by the HA and charge the referred patients according to the fee levels set by the HA. At the same time, our hospital serves other local and non-local patients to support the self-financing model of the hospital.”

It is expected that the CUHKMC will handle at least 3,520 new specialist outpatient cases and 1,320 new day surgery cases in its first year of operation, with the number of cases gradually increasing. Starting from the fifth year of operation, the number of new specialist outpatient cases and day surgery cases referred to the medical centre by the HA will rise to 17,600 and 6,600 respectively [7].

Professor Wu suggested that under PPP, the benefits of medical tourism enjoyed by private hospitals can be transferred to the public medical system. He said: “More than 10 years ago, the SAR government proposed to promote medical tourism, but the idea proved unpopular and was set aside. However, it is the experience of many countries and regions around the world that medical tourism can contribute to the local economy. The industry is scalable and can channel economic contributions to the public healthcare system under different models of PPP.”

Professor Wu stressed that Hong Kong possesses great potential for developing into a regional medical centre, saying: “Hong Kong’s healthcare standards have long been acclaimed by peers in the medical field and patients all over the world. In many areas such as gastroenterology, diabetes, oncology and non-invasive prenatal diagnosis, Hong Kong is highly regarded by the international medical community.”

“The pharmaceutical products registration procedures in Hong Kong are simpler than those in mainland China, so that many new drugs are launched in Hong Kong as soon as they have been approved. There is a measure to enable the use of Hong Kong-registered drugs in public hospitals with urgent clinical use at the University of Hong Kong-Shenzhen Hospital on a trial basis, but there will still be a time difference for obtaining new drugs of six to nine months between the mainland and Hong Kong.

“In the case of pharmaceuticals treating serious illnesses such as cancer, this is a drastic time lag. Moreover, since Hong Kong has a sound intellectual property protection system, leading overseas medical equipment manufacturers are generally more willing to sell the latest models of their products to Hong Kong hospitals. As such, many patients from the mainland and Southeast Asia prefer to come to Hong Kong for surgeries and medical procedures requiring the most advanced medical equipment.”

[1] Blueprint for sustainable development (5) alleviating the pressure on public hospitals through public-private partnerships (構建可持續發展的藍圖 (五) 公私營協作「放下游」壓力 [Chinese only]), Hospital Authority, 12 June 2021.

[2] Response on the Hospital Authority Launching New Public-Private Partnership Initiatives as Part of Prevention and Control Measures, Food and Health Bureau, 23 April 2020.

[3] Survey finds over 60% senior citizens are willing to try online medical consultations, Lingnan University, 29 June 2020.

4] Legislative Council Question 13: Electronic Health Record Sharing System, HKSAR Government press release, 21 October 2020.

[5] Start-Up Hong Kong: “Made in Hong Kong” Helps Instill Consumer Trust, HKTDC Research, 28 October 2020.

[6] Community care services for the elderly in Germany and Japan, Research Office, Legislative Council Secretariat, 16 June 2021.

[7] Proposed loan for the development of the Chinese University of Hong Kong Medical Centre, Legislative Council Panel on Health Services, Food and Health Bureau, March 2015.