Creating the Roadmap
toward Thailand’s eHealth
Part 1: Introduction
Department of Community Medicine Seminar
June 11, 2014...
2
Outline
• Health & Health Information
• Health IT & eHealth
• Health Informatics as a Discipline
• Thailand’s eHealth Si...
3
Health &
Health Information
4
Let’s take a look at
these pictures...
5Image Source: Guardian.co.uk
Manufacturing
6Image Source: http://www.oknation.net/blog/phuketpost/2013/10/19/entry-3
Banking
7ER - Image Source: nj.com
Healthcare (on TV)
8
(At an undisclosed nearby hospital)
Healthcare (Reality)
9
• Life-or-Death
• Difficult to automate human decisions
– Nature of business
– Many & varied stakeholders
– Evolving sta...
10
Back to
something simple...
11
To treat & to
care for their
patients to their
best abilities,
given limited
time &
resources
Image Source: http://en.w...
12
• Safe
• Timely
• Effective
• Patient-Centered
• Efficient
• Equitable
Institute of Medicine, Committee on Quality of H...
13
Information is Everywhere in Healthcare
14
“Information” in Medicine
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA.
2010 Sep 15;304(1...
15
15
WHO (2009)
Components of Health Systems
16
16
WHO (2009)
WHO Health System Framework
17
Outline
Health & Health Information
• Health IT & eHealth
• Health Informatics as a Discipline
• Thailand’s eHealth Si...
18
Health IT &
eHealth
19
(IOM, 2001)(IOM, 2000) (IOM, 2011)
Landmark IOM Reports
20
• To Err is Human (IOM, 2000) reported
that:
– 44,000 to 98,000 people die in U.S.
hospitals each year as a result of
p...
21
• Humans are not perfect and are bound to
make errors
• Highlight problems in U.S. health care
system that systematical...
22
Image Source: (Left) http://docwhisperer.wordpress.com/2007/05/31/sleepy-heads/
(Right) http://graphics8.nytimes.com/im...
23Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital
To Err is Human 2: M...
24
• Cognitive Errors - Example: Decoy Pricing
The Economist Purchase Options
• Economist.com subscription $59
• Print sub...
25
• It already happens....
(Mamede et al., 2010; Croskerry, 2003;
Klein, 2005; Croskerry, 2013)
What If This Happens in H...
26
Mamede S, van Gog T, van den Berge K, Rikers RM, van Saase JL, van Guldener C,
Schmidt HG. Effect of availability bias ...
27
Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them.
Acad Med. 2003 Aug;78(8):...
28
Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr
2;330(7494):781-3.
“Everyone makes ...
29
• Medication Errors
–Drug Allergies
–Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Fa...
30
Why We Need ICT
in Healthcare?
#1: Because information is
everywhere in healthcare
31
Why We Need ICT
in Healthcare?
#2: Because healthcare is
error-prone and technology
can help
32http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf
Fragmented Healthcare
33
Why We Need ICT
in Healthcare?
#3: Because access to
high-quality patient
information improves care
34
Why We Need ICT
in Healthcare?
#4: Because healthcare at
all levels is fragmented &
in need of process
improvement
35
Use of information and communications
technology (ICT) in health & healthcare
settings
Source: The Health Resources and...
36
Use of information and communications
technology (ICT) for health; Including
• Treating patients
• Conducting research
...
37
eHealth  Health IT
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealth & Health IT
38
HIS
All information about health
eHealth
HMIS
mHealth
Tele-
medicine
Slide adapted from: Karl Brown (Rockefeller Founda...
39
Health
Information
Technology
Goal
Value-Add
Tools
Health IT: What’s in a Word?
40
 All components are essential
 All components should be balanced
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealt...
41
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Health Information Exchange
42
Outline
Health & Health Information
Health IT & eHealth
• Health Informatics as a Discipline
• Thailand’s eHealth Sit...
43
Health Informatics
as a Discipline
44
M/B/H Informatics As A Field
(Shortliffe, 2002)
45(Hersh, 2009)
M/B/H Informatics As a Discipline
46
Biomedical/
Health
Informatics
Computer &
Information
Science
Engineering
Cognitive
&
Decision
Science
Social
Sciences
...
47
Outline
Health & Health Information
Health IT & eHealth
Health Informatics as a Discipline
• Thailand’s eHealth Situ...
48
Thailand’s
eHealth Situation
49
eHealth in Thailand: The current status. Stud Health Technol Inform
2010;160:376–80, Presented at MedInfo2010 South Afr...
50Slide adapted from: Dr. Boonchai Kijsanayotin
Thailand: Unbalanced Development
51
eHealth Applications
Enabling Policies &
Strategies
Foundation Policies
& Strategies
• Services
• Applications
• Softwa...
52Slide adapted from: Dr. Boonchai Kijsanayotin
Thailand’s eHealth Development
53
 Silo-type systems
 Little integration and interoperability
 Mostly aim for administration and management
 40% of w...
54
Section 1 Hospital Profile
Section 2 IT Adoption & Use
Profile
Section 3 Respondent’s
Information
Thailand’s Health IT ...
55
• 4 of 1,302 hospitals ineligible
• Response rate 69.9%
Characteristic Overall Responding
Hospitals
Non-
Responding
Hos...
56
Characteristic Number of Responses Statistic†
Public status
Private
Public
908
158
750
17.4%
82.6%
Teaching status
Non-...
57Pongpirul et al., 2004
Vendor/Product Distribution (2004)
58
Vendor/Product Distribution (2011)
Theera-Ampornpunt, 2011
59
Estimate (Partial or Complete Adoption) Nationwide
Basic EHR, outpatient 86.6%
Basic EHR, inpatient 50.4%
Basic EHR, bo...
60
• High IT adoption rates
• Drastic changes in adoption landscape
• Local context might play a role
– Supply Side
– Dema...
61
Outline
Health & Health Information
Health IT & eHealth
Health Informatics as a Discipline
Thailand’s eHealth Situa...
62
Current Forces
63
International
• Technology Trends
• Standards & Interoperability Trends
• eHealth Successes & Failures
– UK NHS
– US Me...
64
URGES Member States:
(1) to consider, as appropriate, options to collaborate with
relevant stakeholders, including nati...
65
(3) to consider ways for ministries of health and public
health authorities to work with their national representatives...
66
Domestic
• Thailand’s Health Insurance Trends
• Increased Hospital IT Adoption
• Demands for Data & Information Exchang...
6767 http://www.etda.or.th/etda_website/files/system/Stat_Report2013_op.pdf
EDTA 2012 Thailand
e-Transactions
Statistics R...
6868 Photo courtesy of EDTA (Aug 21, 2013)
eHealth & e-Transactions
6969
e-Transactions Master Plan
70
Outline
Health & Health Information
Health IT & eHealth
Health Informatics as a Discipline
Thailand’s eHealth Situa...
71
Shaping the Future
72
Shaping the Future
eHealth
Education &
Workforce
Development
Research
Policy
making &
Networking
Implementation
(Creati...
73
Shaping the Future
To Be Continued...
74Image Source: http://twinstrivia.com/2013/05/20/the-road-to-minnesota-is-long-and-hard/
The Journey Beyond:
A Long and W...
75
มุ่งสู่ฝัน อันไกล ที่ใหญ่ยิ่ง
มั่นคงนิ่ง แน่วแน่ ไม่แปรผัน
เดินตามทาง ดั่งวาด อาจมองจันทร์
หน้าเรานั้น ต้องฟันป่า และฝ่...
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Creating the Roadmap toward Thailand's eHealth

  1. 1. Creating the Roadmap toward Thailand’s eHealth Part 1: Introduction Department of Community Medicine Seminar June 11, 2014 Nawanan Theera-Ampornpunt, M.D., Ph.D. www.SlideShare.net/Nawanan
  2. 2. 2 Outline • Health & Health Information • Health IT & eHealth • Health Informatics as a Discipline • Thailand’s eHealth Situation • Current Forces • Shaping the Future
  3. 3. 3 Health & Health Information
  4. 4. 4 Let’s take a look at these pictures...
  5. 5. 5Image Source: Guardian.co.uk Manufacturing
  6. 6. 6Image Source: http://www.oknation.net/blog/phuketpost/2013/10/19/entry-3 Banking
  7. 7. 7ER - Image Source: nj.com Healthcare (on TV)
  8. 8. 8 (At an undisclosed nearby hospital) Healthcare (Reality)
  9. 9. 9 • Life-or-Death • Difficult to automate human decisions – Nature of business – Many & varied stakeholders – Evolving standards of care • Fragmented, poorly-coordinated systems • Large, ever-growing & changing body of knowledge • High volume, low resources, little time Why Healthcare Isn’t Like Any Others
  10. 10. 10 Back to something simple...
  11. 11. 11 To treat & to care for their patients to their best abilities, given limited time & resources Image Source: http://en.wikipedia.org/wiki/File:Newborn_Examination_1967.jpg (Nevit Dilmen) What Clinicians Want?
  12. 12. 12 • Safe • Timely • Effective • Patient-Centered • Efficient • Equitable Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001. 337 p. High Quality Care
  13. 13. 13 Information is Everywhere in Healthcare
  14. 14. 14 “Information” in Medicine Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
  15. 15. 15 15 WHO (2009) Components of Health Systems
  16. 16. 16 16 WHO (2009) WHO Health System Framework
  17. 17. 17 Outline Health & Health Information • Health IT & eHealth • Health Informatics as a Discipline • Thailand’s eHealth Situation • Current Forces • Shaping the Future
  18. 18. 18 Health IT & eHealth
  19. 19. 19 (IOM, 2001)(IOM, 2000) (IOM, 2011) Landmark IOM Reports
  20. 20. 20 • To Err is Human (IOM, 2000) reported that: – 44,000 to 98,000 people die in U.S. hospitals each year as a result of preventable medical mistakes – Mistakes cost U.S. hospitals $17 billion to $29 billion yearly – Individual errors are not the main problem – Faulty systems, processes, and other conditions lead to preventable errors Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US: Regulating Healthcare - Lecture d Patient Safety
  21. 21. 21 • Humans are not perfect and are bound to make errors • Highlight problems in U.S. health care system that systematically contributes to medical errors and poor quality • Recommends reform • Health IT plays a role in improving patient safety IOM Reports Summary
  22. 22. 22 Image Source: (Left) http://docwhisperer.wordpress.com/2007/05/31/sleepy-heads/ (Right) http://graphics8.nytimes.com/images/2008/12/05/health/chen_600.jpg To Err is Human 1: Attention
  23. 23. 23Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital To Err is Human 2: Memory
  24. 24. 24 • Cognitive Errors - Example: Decoy Pricing The Economist Purchase Options • Economist.com subscription $59 • Print subscription $125 • Print & web subscription $125 Ariely (2008) 16 0 84 The Economist Purchase Options • Economist.com subscription $59 • Print & web subscription $125 68 32 # of People # of People To Err is Human 3: Cognition
  25. 25. 25 • It already happens.... (Mamede et al., 2010; Croskerry, 2003; Klein, 2005; Croskerry, 2013) What If This Happens in Healthcare?
  26. 26. 26 Mamede S, van Gog T, van den Berge K, Rikers RM, van Saase JL, van Guldener C, Schmidt HG. Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. JAMA. 2010 Sep 15;304(11):1198-203. Cognitive Biases in Healthcare
  27. 27. 27 Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003 Aug;78(8):775-80. Cognitive Biases in Healthcare
  28. 28. 28 Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr 2;330(7494):781-3. “Everyone makes mistakes. But our reliance on cognitive processes prone to bias makes treatment errors more likely than we think” Cognitive Biases in Healthcare
  29. 29. 29 • Medication Errors –Drug Allergies –Drug Interactions • Ineffective or inappropriate treatment • Redundant orders • Failure to follow clinical practice guidelines Common Errors
  30. 30. 30 Why We Need ICT in Healthcare? #1: Because information is everywhere in healthcare
  31. 31. 31 Why We Need ICT in Healthcare? #2: Because healthcare is error-prone and technology can help
  32. 32. 32http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf Fragmented Healthcare
  33. 33. 33 Why We Need ICT in Healthcare? #3: Because access to high-quality patient information improves care
  34. 34. 34 Why We Need ICT in Healthcare? #4: Because healthcare at all levels is fragmented & in need of process improvement
  35. 35. 35 Use of information and communications technology (ICT) in health & healthcare settings Source: The Health Resources and Services Administration, Department of Health and Human Service, USA Slide adapted from: Dr. Boonchai Kijsanayotin Health IT
  36. 36. 36 Use of information and communications technology (ICT) for health; Including • Treating patients • Conducting research • Educating the health workforce • Tracking diseases • Monitoring public health. Sources: 1) WHO Global Observatory of eHealth (GOe) (www.who.int/goe) 2) World Health Assembly, 2005. Resolution WHA58.28 Slide adapted from: Mark Landry, WHO WPRO & Dr. Boonchai Kijsanayotin eHealth
  37. 37. 37 eHealth  Health IT Slide adapted from: Dr. Boonchai Kijsanayotin eHealth & Health IT
  38. 38. 38 HIS All information about health eHealth HMIS mHealth Tele- medicine Slide adapted from: Karl Brown (Rockefeller Foundation), via Dr. Boonchai Kijsanayotin More Terms...
  39. 39. 39 Health Information Technology Goal Value-Add Tools Health IT: What’s in a Word?
  40. 40. 40  All components are essential  All components should be balanced Slide adapted from: Dr. Boonchai Kijsanayotin eHealth Components: WHO-ITU Model
  41. 41. 41 Hospital A Hospital B Clinic C Government Lab Patient at Home Health Information Exchange
  42. 42. 42 Outline Health & Health Information Health IT & eHealth • Health Informatics as a Discipline • Thailand’s eHealth Situation • Current Forces • Shaping the Future
  43. 43. 43 Health Informatics as a Discipline
  44. 44. 44 M/B/H Informatics As A Field (Shortliffe, 2002)
  45. 45. 45(Hersh, 2009) M/B/H Informatics As a Discipline
  46. 46. 46 Biomedical/ Health Informatics Computer & Information Science Engineering Cognitive & Decision Science Social Sciences (Psychology, Sociology, Linguistics, Law & Ethics) Statistics & Research Methods Medical Sciences & Public Health Management Library Science, Information Retrieval, KM And More! M/B/H Informatics & Other Fields
  47. 47. 47 Outline Health & Health Information Health IT & eHealth Health Informatics as a Discipline • Thailand’s eHealth Situation • Current Forces • Shaping the Future
  48. 48. 48 Thailand’s eHealth Situation
  49. 49. 49 eHealth in Thailand: The current status. Stud Health Technol Inform 2010;160:376–80, Presented at MedInfo2010 South Africa Thailand’s eHealth: 2010
  50. 50. 50Slide adapted from: Dr. Boonchai Kijsanayotin Thailand: Unbalanced Development
  51. 51. 51 eHealth Applications Enabling Policies & Strategies Foundation Policies & Strategies • Services • Applications • Software • Standards & Interoperability • Capability Building • Leadership & Governance • Legislation & Policy • Strategy & Investment • Infrastructure Slide adapted from: Dr. Boonchai Kijsanayotin eHealth Development Model
  52. 52. 52Slide adapted from: Dr. Boonchai Kijsanayotin Thailand’s eHealth Development
  53. 53. 53  Silo-type systems  Little integration and interoperability  Mostly aim for administration and management  40% of work-hours spent on managing reports and documents  Lack of national leadership and governance body  Inadequate HIS foundations development Slide adapted from: Boonchai Kijsanayotin Thailand’s eHealth Situation
  54. 54. 54 Section 1 Hospital Profile Section 2 IT Adoption & Use Profile Section 3 Respondent’s Information Thailand’s Health IT Adoption
  55. 55. 55 • 4 of 1,302 hospitals ineligible • Response rate 69.9% Characteristic Overall Responding Hospitals Non- Responding Hospitals N of eligible hospitals 1,298 908 390 Bed size** 106.9 117.5 82.9 Public status** Private Public 24.0% 76.0% 17.4% 82.6% 39.2% 60.8% Geography* Central East North Northeast South West 33.4% 7.5% 11.1% 27.1% 15.3% 5.6% 31.1% 7.8% 13.5% 26.9% 14.9% 5.8% 39.0% 6.7% 5.4% 27.7% 16.2% 5.1% *p < 0.01, **p < 0.001. Nationwide Survey Results
  56. 56. 56 Characteristic Number of Responses Statistic† Public status Private Public 908 158 750 17.4% 82.6% Teaching status Non-teaching Teaching 901 716 185 79.5% 20.5% Total employees 890 368.2 ± 573.5 (10-5269) IT employees 901 4.3 ± 5.3 (0-60) Total budget (million baht) 443 146.67 ± 313.60 (0.25-3,067) IT budget (million baht) 598 2.77 ± 8.79 (0-100) Ratio of IT budget to total budget‡ < 1% 1-4% 5-8% > 8% 416 135 218 40 23 2.7% ± 4.6% (0-43.3%) 32.5% 52.4% 9.6% 5.5% Extent of overall IT utilization Very low Low Moderate High Very high 905 5 35 169 454 242 0.6% 3.9% 18.7% 50.2% 26.7% Total PCs in use 883 126.1 ± 218.6 (0-3,000) Nationwide Survey Results
  57. 57. 57Pongpirul et al., 2004 Vendor/Product Distribution (2004)
  58. 58. 58 Vendor/Product Distribution (2011) Theera-Ampornpunt, 2011
  59. 59. 59 Estimate (Partial or Complete Adoption) Nationwide Basic EHR, outpatient 86.6% Basic EHR, inpatient 50.4% Basic EHR, both settings 49.8% Comprehensive EHR, outpatient 10.6% Comprehensive EHR, inpatient 5.7% Comprehensive EHR, both settings 5.3% Order entry of medications, outpatient 96.5% Order entry of medications, inpatient 91.4% Order entry of medications, both settings 90.2% Order entry of all orders, outpatient 88.6% Order entry of all orders, inpatient 81.7% Order entry of all orders, both settings 79.4% Health IT Adoption Estimates
  60. 60. 60 • High IT adoption rates • Drastic changes in adoption landscape • Local context might play a role – Supply Side – Demand Side • International Comparison – Relatively higher adoption THAIS: Discussion
  61. 61. 61 Outline Health & Health Information Health IT & eHealth Health Informatics as a Discipline Thailand’s eHealth Situation • Current Forces • Shaping the Future
  62. 62. 62 Current Forces
  63. 63. 63 International • Technology Trends • Standards & Interoperability Trends • eHealth Successes & Failures – UK NHS – US Meaningful Use – Nordic Countries • International eHealth Networks – International Medical Informatics Association (IMIA) – American Medical Informatics Association (AMIA) – Asia eHealth Information Network (AeHIN) Current Forces
  64. 64. 64 URGES Member States: (1) to consider, as appropriate, options to collaborate with relevant stakeholders, including national authorities, relevant ministries, health care providers, and academic institutions, in order to draw up a road map for implementation of ehealth and health data standards at national and subnational levels; (2) to consider developing, as appropriate, policies and legislative mechanisms linked to an overall national eHealth strategy, in order to ensure compliance in the adoption of ehealth and health data standards by the public and private sectors, as appropriate, and the donor community, as well as to ensure the privacy of personal clinical data; http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R24-en.pdf World Health Assembly Resolution WHA66.24 (2013) on eHealth Standardization & Interoperability
  65. 65. 65 (3) to consider ways for ministries of health and public health authorities to work with their national representatives on the ICANN Governmental Advisory Committee in order to coordinate national positions towards the delegation, governance and operation of health-related global top-level domain names in all languages, including “.health”, in the interest of public health; http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R24-en.pdf World Health Assembly Resolution WHA66.24 (2013) on eHealth Standardization & Interoperability
  66. 66. 66 Domestic • Thailand’s Health Insurance Trends • Increased Hospital IT Adoption • Demands for Data & Information Exchange in Thailand’s Healthcare • Thailand’s e-Transaction Trends • Consumer IT Behavior Trends Current Forces
  67. 67. 6767 http://www.etda.or.th/etda_website/files/system/Stat_Report2013_op.pdf EDTA 2012 Thailand e-Transactions Statistics Report eHealth & e-Transactions
  68. 68. 6868 Photo courtesy of EDTA (Aug 21, 2013) eHealth & e-Transactions
  69. 69. 6969 e-Transactions Master Plan
  70. 70. 70 Outline Health & Health Information Health IT & eHealth Health Informatics as a Discipline Thailand’s eHealth Situation Current Forces • Shaping the Future
  71. 71. 71 Shaping the Future
  72. 72. 72 Shaping the Future eHealth Education & Workforce Development Research Policy making & Networking Implementation (Creating Success Stories)
  73. 73. 73 Shaping the Future To Be Continued...
  74. 74. 74Image Source: http://twinstrivia.com/2013/05/20/the-road-to-minnesota-is-long-and-hard/ The Journey Beyond: A Long and Winding Road
  75. 75. 75 มุ่งสู่ฝัน อันไกล ที่ใหญ่ยิ่ง มั่นคงนิ่ง แน่วแน่ ไม่แปรผัน เดินตามทาง ดั่งวาด อาจมองจันทร์ หน้าเรานั้น ต้องฟันป่า และฝ่าไพร พัฒนา “สถาบัน” อันประสิทธิ์ นานาจิต คิดก้าวหน้า พาสดใส สร้างประทีป ส่องทาง ยังคนไทย สรรค์สร้างไว้ ให้ชาติ ผงาดยืน ร่วมกันสร้าง ทางเดิน เจริญรุ่ง แรงใจมุ่ง มั่นหมาย ไม่ขัดขืน ผลักดันเพื่อ ระบบงาน อันยั่งยืน ดันเต็มที่ ทุกวันคืน ยอมฝืนทน เพื่อระบบ ข้อมูล สร้างคุณค่า ฝันนั้นหนา คือเป้า เฝ้าฝีกฝน อันเส้นทาง ร้างนัก จักเจียมตน ไกลสุดพ้น ทนได้ ด้วยแรงใจ นวนรรน ธีระอัมพรพันธุ์ 29 ก.ค. 2556 A Personal Manifesto
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