Hongkongers may get option for digital advance directives, according to government proposal, with advocacy groups touting eHealth platform as database

Hongkongers may get the option to give legal instructions electronically to reject certain medications in end-of-life treatment, according to a government proposal, with advocacy and sector groups saying an existing platform can be used to store the information.

Grace Li Fai, an executive committee member of the Elderly Services Association, was among those on Thursday responding to a bill on advance directives introduced by authorities the day before. She said the government could use the city’s eHealth data platform to store digital versions of the documents floated in the proposal.

“In the current system, information such as identity card numbers and medical records are already [on the eHealth platform], shouldn’t we consider a shared use of resources?” Li said.

Advance directives are medical documents that allow patients to choose what medical treatments they wish to refuse when they are dying.

The new bill presented to the Legislative Council, which aims to give more legal power to the directives, will be gazetted on Friday, followed by a first reading on December 6.

In the proposal, authorities said they were exploring the use of electronic advance directives, in addition to the current practice of ones in paper format.

Digital storage of the document in an “electronic system designated by the Secretary for Health” would also be provided, but no platform was named. Scanned and digitised copies of the hard-copy directives would also be stored in the system.

A ward at Kwong Wah Hospital. A new government bill says authorities are looking into electronic end-of-life directives. Photo: May Tse

The government said it was looking into operational details such as the drafting and revoking of the electronic documents, impact brought by the mixed use of paper and digital forms, and how to check the directives were valid.

Li said the government did not need to set up a new storage system for the electronic directives, as it already had the eHealth platform.

“If a separate system is to be set up just for the sake of advance directives, is it a waste of public money?” she said.

The platform is currently used by both public and private healthcare systems and enables the sharing of information between the two.

Patients’ rights advocate Tim Pang Hung-cheong, from the Society for Community Organisation, also said that using eHealth was the “most cost-effective” approach for storing the documents.

“During the Covid pandemic, many people also opened an account on the eHealth platform,” Pang said. “It appears to be an easier way to add the function of storing advance directives.”

Lawmakers earlier called on the government to keep the legal instructions in a centralised database for safer and more secure storage.

Both Li and Pang said they supported allowing digital versions of the document.

“Patients might not keep the paper format well, or might have forgotten where they kept the document,” Pang said. “Digital versions can clearly record patients’ wishes.”

Dr Edward Leung Man-fuk, president of the Hong Kong Association of Gerontology, said the digital format gave patients another option. He said that currently patients who had their advance directives set up with public hospitals already had their data stored in the Hospital Authority’s system, but those using private doctors usually had only the paper format.

“The digital format could help facilitate communication within the medical sector,” Leung said. “If patients got into a private hospital, their advance directive records could also be seen.”

He said that doctors could also prepare both electronic and paper formats when setting up directives to avoid confusion between different versions.

Francis Fong Po-kiu, honorary president of the Hong Kong Information Technology Federation, said the government’s iAM Smart+ digital platform could be used to ensure the authenticity of the electronic documents.

Fong said the platform had a more stringent identification process for registration and allowed users to provide digital signatures.