Peter Ko, MD, FACS

While Hong Kong has one of the most advanced telecommunications systems in the Asia Pacific region, development of telemedicine applications did not begin there in earnest until 1996. Two significant factors set the stage for such development:

1. From its inception in the early 1990’s, and charged with overseeing all the public health and medical facilities in the region, the Hong Kong Hospital Authority has been eager to explore innovative solutions to cost and access problems for a highly urbanized population of 6.5 million.
2. With her unique geographic and cultural advantages, Hong Kong has always served as both a window and a gateway between China and the West. With her return to Chinese sovereignty in 1997, this role has become even more apparent. Exchange of medical information is no exception, and the mission of bridging East and West has always been regarded seriously by local health care and academic leaders.

The initial momentum to develop telemedicine was created by a visionary group at the Faculty of Medicine, Chinese University of Hong Kong (CUHK). In April 1996, a task force for the development of telemedicine was formed, in collaboration with the Faculty of Engineering and other experts in IT and health administration. Its mission was to develop local, regional (especially with China), and international networks to evaluate efficacy of telemedical procedures in clinical care and medical education. Those applications determined to be of value would be systematically introduced into community practice.

In the ensuing 2‡ years, great strides have been made.

On the campus of the CUHK Clinical Science Building and its adjoining 1,400-bed Prince of Wales (P of W) Hospital, a comprehensive audio-visual communications network has been installed. This allows for integrated consultation, teaching, and demonstration throughout the facility. Such "in-house" activities have involved multiple disciplines, including medicine, surgery, diagnostic and interventional radiology and endoscopy, and chemical and anatomic pathology. There are also several on-going trials extending off campus:

A link between the P of W and a district hospital without in-house neurosurgical coverage utilizes teleradiology to help determine triage of head injury patients. Data collected to date suggest reduction of unnecessary and unsafe inter-facility transfer. Time efficiency and cost effectiveness assessments also appear encouraging. Another link between a senior housing facility, a geriatric hospital, and the P of W is used to evaluate admission and transfer criteria. Studies are being designed in areas of tele-home health to monitor patients with diabetes and hypertension. Due to the imbalance between supply and demand in certain specialty services, teledermatology and telepsychiatry implementations are also being studied.

Permanent ISDN lines running at 384 Kbps are installed throughout the facility, allowing 24-hour communication with compatible sites worldwide. Several major teleconferences involving two or more sites have been carried out with partners in Beijing, Guangzhou, as well as overseas colleagues in Australia, the UK and Western Europe, Canada, and the USA. These have been both consultative and educational in nature. Some of the most dramatic include:

• On June 30-July 1, 1997, to commemorate her return to Chinese sovereignty from being a British colony, a 24-hour telemedicine conference was conducted from Hong Kong to 17 academic sites globally, following the path of the sun. It was cleverly named "Moving With the Sun", to bid farewell to the empire on which the sun never set.
• At the beginning of 1998, with the world’s attention focused on the H5N1 avian flu story in Hong Kong, a 3-site teleconsultation conference was carried out, linking local experts with those at the CDC in Atlanta and Pixensart, Belgium. Multiple urgent issues were addressed, including epidemiology, molecular diagnosis, public health, and vaccine development. This demonstrated the efficacy of rapid assemblance of experts worldwide in the face of a public health emergency.
• A multiple-site educational conference is being planned for early 1999, linking Hong Kong, China, the USA, and the UK. The theme will be "Evidence-based Traditional Chinese Medicine". With the ever-increasing appetite in the West for information on acupuncture, herbal medicine, and other forms of complementary therapy, this will be a timely demonstration of how ideas can be cross-pollinated between cultures as we approach the new millennium.

In November 1997, the Hong Kong Telemedicine Association was inaugurated. It is a broad-based organization with membership from health care, education, technology, and commerce sectors. It serves as a platform for local professionals interested in this new arena to debate, develop, and promote telemedicine. The HKTA is chaired by Professor N. Magnus Hjelm (hjelm@cuhk.edu.hk), Chair of the Department of Chemical Pathology at CUHK, who pioneered the university’s telemedicine program.

By recognizing the Faculty of Medicine’s dedication in advancing this new field, the CUHK Resource Allocation Committee earlier this year designated telemedicine an Area of Excellence. As a result, the two-year-old task force has been made the CUHK Committee of Telemedicine, with the vision of developing an academic unit in telemedicine within the medical school. Activities would include organizing telemedicine educational courses for future users at all levels. A dedicated telemedicine consultation center at the P of W will maintain the flow of information between Hong Kong, Mainland China, and internationally. Currently, telepathology consultations take place each month between Beijing and Hong Kong, organized and run by the Dean of the Faculty of Medicine, Professor Joseph C.K. Lee (joelee@cuhk.edu.hk), himself a pathologist. This will be integrated with other disciplines in the format of clinicopathologic conferences for distance medical education.

As collaboration grows with a network of key institutions in Chinese urban centers, CUHK stands ready to lend support to more remote parts of China, as far away as Xinjiang Province in the Northwest. Depending on technical requirements and resource availability, ATM service and satellite transmission are being tested.

Overseas, there is plan to organize a group of academic centers with demonstrated excellence to jointly design and carry out clinical trials. Such multicenter collaboration in telemedicine investigation would promote efficient use of resources and establish credibility. An effort along this line is a monthly case conference series with the University of Southern California School of Medicine, to study the efficacy of teleconsultation over great distances, due to begin at the end of 1998 (Professor Clarke B. Hazlett cbhazlett@cuhk.edu.hk / Professor Frederick W. George fwgeorge@hsc.usc.edu).

Thus far, the pace of progress in telemedicine in Hong Kong has been rapid, and could not have been accomplished without shared vision and uniform dedication among forward-thinking individuals.

Peter Ko, MD, FACX
Assistant Clinical Professor
Research Associate in Telemedicine
U of Southern California School of Medicine
Advanced Biotelecommunications and Bioinformatics Center
Los Angeles, CA
Visiting Fellow
Chinese U of Hong Kong (CUHK)
Faculty of Medicine
Center for Telemedicine
Hong Kong Special Administrative Region, China