New Territories West Cluster (NTWC) Session - Smart Hospital in TSWH/NTWC

Smart Clinic is one of the initiatives of Smart Hospital in Tin Shui Wai Hospital (TSWH). It includes a variety of innovative projects integrating into the busy workflow of the outpatient clinic (SOPC). These projects are developed based on patient-centered experience in clinic journey, aiming to improve patients and staff satisfaction, to enhance patient safety and to be environmentally friendly. They could be broadly divided into projects aiding pre-consultation, during-consultation, and post-consultation processes. With the unfailing support from HO IT&HI, they are currently at different stages of development and implementation in TSWH and NTWC. eTriage system is a digitalized platform allowing efficient triage of new case referrals. eHealth station is another project recently put into pilot in TSWH. It is a self-help station which the patient would measure his/her own vital signs before the doctor consultation. The vital signs data would be integrated automatically into Clinical Management System (CMS). eLaboratory result screening have been fully implemented in TSWH in January 2021 and will be extending to other hospitals in NTWC in next 1-2 years. Other projects facilitating doctor consultation include eConsent, on-demand Smart label printing, eSignature MOE, Tele-information, Post-consultation checklist etc. eSignature MOE have been implemented in TSWH in February 2021. eConsent and on-demand Smart label printing will be implemented shortly in TSWH whereas Tele-information and Post-consultation checklist are still under development. During the presentation, these projects, as the building blocks for Smart Clinic in TSWH and NTWC, would be introduced and described. The implementation plan of these projects in other hospitals in NTWC (Pok Oi Hospital and Tuen Mun Hospital) would be also discussed.

NTWC Allied Health (AH) clinical service is greatly affected under the Covid-19 pandemics. Therefore, the application of telecare service in Allied Health is catalyzed in order to cope with the service gap during the pandemics. The development of telemedicine of NTWC AH based on three objectives, namely filling up service gap, creation of virtual space and facilitation of health care equity. 7 pilot telecare programs were successfully piloted in NTWC AH departments. However, the suitability of this telecare service after the resumption of the normal service is a great challenge.
Different telecare provision, e.g. telephone follow up, hybrid mode of teleconsultation with face-to-face consultation, virtual home visit for post discharge patients, were piloted. Programs evaluation and a care-giver focus group were conducted for reviewing the program effectiveness, patients’ acceptance and comment on telecare service. Positive clinical outcome was revealed in most of the programs. Moreover, positive feedback was obtained from patients and care-givers in the post program satisfaction surveys. Detail user opinions were collected from the care-giver focus group interview on 15 Dec 2020. The program limitation, benefits and desirable telecare service model were discussed during the focus group. However, the long-term success and sustainability of the telecare service is not guaranteed because of the success of the pilot programs. According to the technology acceptance model, there are different factors influencing the success of the adopting a new technology. The perceived usefulness, perceived ease of use, social influence, self-identity, individual characteristic that can affect the behavior intention of using the new technology in both of patient and health care providers. The behavior intention brings significant influence to the actual application of new technology. 
The determinants that facilitate users having positive acceptance and adoption of new technology should be considered during the telemedicine service development in order to establish a sustainable new service model.

With a view to augmenting workflow efficiency and improving patient safety, Smart Ward initiatives strike to achieve AI & Automation, Internet of Medical Thing (IoMT) and Paperless Ward Round.


It is worth attaching our attention to the introduction of ‘e-Vital Signs’, which refers to the digitalization of parameters. Having data transmitted automatically, nursing staff could spend less time on documenting vital signs of patients. They could have their attention brought back to bed-side care instead of data collection. Not only does the transformation from manual to electronic charting lessen their workload but also heighten data quality. Digitalization of vital signs guarantees clinical decisions are made based on up-to-date and properly recorded data, which facilitates clinical staff in identifying patient deterioration. In contrast, traditional documentation practice inevitably involves more errors such as incorrect or delayed data input, bringing adverse impacts on abnormality detection and clinical decisions making. With higher efficiency, accuracy and completeness of clinical documentation process, hospitals could provide quality health care services. It exemplified how the application of IoMT, which refers to healthcare information technology systems and sensors connected via networking could improve diagnosis accuracy, reduce errors and lower the cost of medical care.


Incident prevention has been our emphasis to maintain quality care and safeguard patient safety. The external collaboration project hereby provides a technological solution to locate missing patients and prevent fall incidents. For example, the smart patient bracelet equipped with location tracking and motion sensor could respectively locate patients who are not found and alert nurses at the juncture of fall or when pre-fall is detected. Concurrently, a hospital bed monitoring system is under exploration to identify abnormal on-bed activity. Fall detection would be a crucial safety measure in preventing incidents. Health monitoring is thus made continuous while wards are made a safer place to stay.


Other than the individual benefits that the above projects bring, their combination contributes immensely to the development of clinical AI and a virtual command center. A clinical AI model could utilize real-time patient information captured through smart vitals and wearables for patient deterioration or adverse outcomes prediction, followed by an escalation plan and auto-notification to invite earlier intervention of clinical staff. Prompt treatments could be given to patients before their conditions worsen, improving patients’ outcome. Having clinical care data-driven, patient quality care and safety could be promoted and workflow efficiency could be enhanced.


Last but not least, paperless ward round plays a significant role in making our wards smart. Papers and forms would change into digital – electronic records increase the record-keeping quality like prescription legibility, lower the risks of losing and misplacement hence reduce administrative workload. The workflow efficiency could be heightened. In addition, it serves as an integrated platform to assemble patient data on which information is readily shared among healthcare workers for multi-disciplinary communication. When handover is smooth, care continuation is ensured, which contributes to maintaining patient safety.

The first part of the presentation will provide an overview of the robots currently being used in Tin Shui Wai Hospital (TSWH), and how the service robots enhance overall operation effectiveness.


Service robots have widely been used in healthcare setting in some countries. They can be used to deliver heavy goods, to clean hospital facilities, or to perform supporting activities. With the assistance from robots, manpower can be redeployed to other duties which are more complicated and skill-intensive.


With supports from the Government and Hospital Authority, TSWH has acquired 4 different types of service robot to handle a spectrum of tasks in hospital support services. To illustrate the practicality, the presentation will introduce the roadmap of automation in linen supply, from linen cart exchange, to ad-hoc linen replenishment request. The robot can run automatically according to the pre-set schedule, or can be activated by specified signals from AI-camera, to exchange linen carts on round the clock basis.


Unsurprisingly, the introduction of service robots in hospitals has become a trend worldwide, and the trial in TSWH demonstrates the feasibility of future service enhancements and opportunities in Hong Kong.


In the second part of the presentation, we will move on to elucidate how interconnectivity and process automation could be brought about by the smart initiatives in the Operating Theatre in TSWH. 


Building on the existing cluster-based infrastructures for the Anaesthetic Clinical Information System (ACIS) in NTWC, a variety of electronic platforms have been developed to augment the perioperative experiences of patient, patient family and clinical staff.


In the presentation, we would briefly introduce how each of these systems is communicating with each other, namely AI OT Enquiry System for Patient's Family (Family Link), Specimen Auto-tracking System, Auto-notifications via HA Chat, OT Coordinating Centre and Risk Stratification Programme (RSP).


Hopefully, we could provide our audiences with an insight into our vision in leading Internet of Things to clinical effectiveness.

The vision and objective of smart city is to improve how we live by integration and application of technologies in our daily living. Analogously, the vision of smart hospital and healthcare in TSWH/NTWC is to apply information and operational technologies to improve our care to our patients. Initiatives in smart hospital planning in TSWH/NTWC would primarily target to enable smart patients with touchable components. With the high penetration rate of mobile phone in our locality, development and application of mobile technologies for patient access is one of key direction in vision of reducing queuing and length of stay.


Smart hospital and application of technologies in healthcare should be the essential key to enable both improvement in patient quality and safety while upkeeping and enhancing clinical efficiency. We had vision of Smart Staffs – to apply digital technologies to improve efficiency in both clinical and non-clinical workflows. We anticipate the change in smart hospital is tremendous and the staff engagement would be the essential key to success. It is crucial to build up a change culture and teamwork for continuous development as technological advancement should be endless. Smart staff is the sole key to provide smart clinical services.


Smart clinical service and reformation in service or caring model is enabled by technologies of telehealth/telemedicine, internet of medical things (IoMT), 5G technologies, application of artificial intelligence (AI) with big data analytics. It is in our vision to revolutionalize the service model to provide better healthcare services to our patient.


Our smart hospital vision in TSWH/NTWC is: Healthcare by your side, anytime, anywhere (何時何地，並肩同行). With our smart staffs and smart patients, provision of smart healthcare without boundary would be our destination.