Creating the Roadmap toward Thailand's eHealth
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Creating the Roadmap toward Thailand's eHealth Presentation Transcript

  • 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 Outline • Health & Health Information • Health IT & eHealth • Health Informatics as a Discipline • Thailand’s eHealth Situation • Current Forces • Shaping the Future
  • 3. 3 Health & Health Information
  • 4. 4 Let’s take a look at these pictures...
  • 5. 5Image Source: Guardian.co.uk Manufacturing
  • 6. 6Image Source: http://www.oknation.net/blog/phuketpost/2013/10/19/entry-3 Banking
  • 7. 7ER - Image Source: nj.com Healthcare (on TV)
  • 8. 8 (At an undisclosed nearby hospital) Healthcare (Reality)
  • 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 Back to something simple...
  • 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 • 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 Information is Everywhere in Healthcare
  • 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 WHO (2009) Components of Health Systems
  • 16. 16 16 WHO (2009) WHO Health System Framework
  • 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 Health IT & eHealth
  • 19. 19 (IOM, 2001)(IOM, 2000) (IOM, 2011) Landmark IOM Reports
  • 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 • 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 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. 23Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital To Err is Human 2: Memory
  • 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 • It already happens.... (Mamede et al., 2010; Croskerry, 2003; Klein, 2005; Croskerry, 2013) What If This Happens in Healthcare?
  • 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 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 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 • Medication Errors –Drug Allergies –Drug Interactions • Ineffective or inappropriate treatment • Redundant orders • Failure to follow clinical practice guidelines Common Errors
  • 30. 30 Why We Need ICT in Healthcare? #1: Because information is everywhere in healthcare
  • 31. 31 Why We Need ICT in Healthcare? #2: Because healthcare is error-prone and technology can help
  • 32. 32http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf Fragmented Healthcare
  • 33. 33 Why We Need ICT in Healthcare? #3: Because access to high-quality patient information improves care
  • 34. 34 Why We Need ICT in Healthcare? #4: Because healthcare at all levels is fragmented & in need of process improvement
  • 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 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 eHealth  Health IT Slide adapted from: Dr. Boonchai Kijsanayotin eHealth & Health IT
  • 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 Health Information Technology Goal Value-Add Tools Health IT: What’s in a Word?
  • 40. 40  All components are essential  All components should be balanced Slide adapted from: Dr. Boonchai Kijsanayotin eHealth Components: WHO-ITU Model
  • 41. 41 Hospital A Hospital B Clinic C Government Lab Patient at Home Health Information Exchange
  • 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 Health Informatics as a Discipline
  • 44. 44 M/B/H Informatics As A Field (Shortliffe, 2002)
  • 45. 45(Hersh, 2009) M/B/H Informatics As a Discipline
  • 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 Outline Health & Health Information Health IT & eHealth Health Informatics as a Discipline • Thailand’s eHealth Situation • Current Forces • Shaping the Future
  • 48. 48 Thailand’s eHealth Situation
  • 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. 50Slide adapted from: Dr. Boonchai Kijsanayotin Thailand: Unbalanced Development
  • 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. 52Slide adapted from: Dr. Boonchai Kijsanayotin Thailand’s eHealth Development
  • 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 Section 1 Hospital Profile Section 2 IT Adoption & Use Profile Section 3 Respondent’s Information Thailand’s Health IT Adoption
  • 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 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. 57Pongpirul et al., 2004 Vendor/Product Distribution (2004)
  • 58. 58 Vendor/Product Distribution (2011) Theera-Ampornpunt, 2011
  • 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 • 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 Outline Health & Health Information Health IT & eHealth Health Informatics as a Discipline Thailand’s eHealth Situation • Current Forces • Shaping the Future
  • 62. 62 Current Forces
  • 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 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 (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 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. 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. 6868 Photo courtesy of EDTA (Aug 21, 2013) eHealth & e-Transactions
  • 69. 6969 e-Transactions Master Plan
  • 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 Shaping the Future
  • 72. 72 Shaping the Future eHealth Education & Workforce Development Research Policy making & Networking Implementation (Creating Success Stories)
  • 73. 73 Shaping the Future To Be Continued...
  • 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 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