Taiwan’s Hospitals on the COVID-19 Frontlines

Dr. Lee Wui-chiang, director of Medical Affairs and Planning at Taipei Veterans Gen-eral Hospital, notes the precautions the hospital adopted to control the spread of COVID-19. Photo: TVGH

Taiwan has emerged this year as a shining example of pandemic management, with less than 600 reported cases since the onset of COVID-19 in January. The systems and protocols that Taiwan’s hospitals already had in place from its experience combating the SARS epidemic in 2003 were one of the main factors contributing to the island’s success with COVID-19.

Lee Wui-chiang, director of the Department of Medical Affairs and Planning at Taipei Veterans General Hospital (TVGH), says that his hospital’s campus consists of several buildings connected by tunnel-like overhead walkways on second or third floors. Were an infectious disease to break out in one building, the walkways can easily be shut down, quickly isolating the affected area.

When the pandemic first hit Taiwan, suspected coronavirus patients were screened in a special shelter outside TVGH’s emergency clinic in the main Chung Cheng Building. They were then sent to the neighboring Medical Science and Technology Building. The overhead walkway to the Chung Cheng building was closed and the elevators, corridors, and air conditioning were shut off from the rest of the hospital.

A dedicated team of hospital staff set up a negative pressure ward and intensive care unit. The team treating coronavirus patients lived in a hospital dormitory, isolated from both their colleagues and family members. The floor that coronavirus patients were placed in was designed for managing unknown infectious diseases or attacks from bioweapons. Lee notes that the hospital’s primary goal at the time was to protect its other 3,000 inpatients and maintain the hospital’s capacity to treat other ill people. 

Initially, all visitors to TVGH’s outpatient building had to register online for pre-approval after giving their travel history and records of contacts with others suspected of having the virus. They then needed computerized authorization to enter the hospital by scanning a QR code. Procedures have eased since then, yet a few entrances to the hospital are still closed off and proof of being a patient or staff member is needed to enter the cafeteria.

Various platforms introduced by the National Health Insurance Administration (NHIA) using cloud technology also proved to be highly helpful once the pandemic struck Taiwan. In 2013 the agency launched the NHI Pharmacloud system, which allows medical organizations contracted with the NHIA to view patient medications over the previous three months, to avoid prescriptions that are duplications or don’t interact well with previously prescribed drugs. The NHI MediCloud System, also introduced in 2013, enables physicians to view patients’ examination images and reports from other major hospitals, including ultrasound and MRI images.

There’s also “My Health Bank,” a program that started in 2015, which enables people enrolled in Taiwan’s National Health Insurance system to use their card to download their medical histories, including records of doctors visits and tests over the last three years. The program involves integrating databases from different medical institutions into one user profile.  

When the pandemic struck, the government then further integrated these databases with its immigration and customs databases to carry out big data analytics. According to a report in the prestigious JAMA: The Journal of the American Medical Association, in late January NHIA and the National Immigration Agency integrated patients’ past-14-day travel history with their NHI card data.

With this new system in place, Taiwanese doctors could receive real-time alerts during a patients’ visit to a clinic about their travel history and previous symptoms, which helped identify coronavirus cases. The government also used NHIA data to proactively seek out patients with severe respiratory symptoms who had tested negative for flu and retest them for the coronavirus. Out of 113 patients tested, only one case was found, the JAMA report said. 

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