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eHealth: The Next Building Block for
Thailand’s Healthcare System
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Faculty of Medici...
2
Introduction
2003 M.D. (First-Class Honors) (Ramathibodi)
2009 M.S. in Health Informatics (U of MN)
2011 Ph.D. in Health...
3
Outline
• Needs for better information in healthcare
• eHealth as a health system's component
• Thailand's eHealth situa...
4
Needs for
Better Information
in Healthcare
5
“Information” in Medicine
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA.
2010 Sep 15;304(11...
6
Needs for Better Information
• Good information needed for quality care
– Past and present history
– Medication list
– P...
7http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf
Fragmented Healthcare
8
(IOM, 2001)(IOM, 2000) (IOM, 2011)
Landmark IOM Reports
9
• Humans are not perfect and are bound to
make errors
• Highlight problems in U.S. health care
system that systematicall...
10
• Medication Errors
–Drug Allergies
–Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Fa...
11
Back to
something simple...
12
To treat & to
care for their
patients to their
best abilities,
given limited
time &
resources
Image Source: http://en.w...
13
The Question Becomes...
How do we deliver better
information, by supplementing
human clinicians with ICT, so that
they ...
14
Outline
Needs for better information in healthcare
• eHealth as a health system's component
• Thailand's eHealth situa...
15
eHealth as a
Health System
Component
16
16
WHO (2009)
Components of Health Systems
17
17
WHO (2009)
WHO Health System Framework
18
Use of information and communications
technology (ICT) for health; Including
• Treating patients
• Conducting research
...
19
 All components are essential
 All components should be balanced
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealt...
20
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Goal: Health Information Exchange
21
Outline
Needs for better information in healthcare
eHealth as a health system's component
• Thailand's eHealth situat...
22
Thailand’s
eHealth Situation
23
eHealth in Thailand: The current status. Stud Health Technol Inform
2010;160:376–80, Presented at MedInfo2010 South Afr...
24
 All components are essential
 All components should be balanced
Slide adapted from: Dr. Boonchai Kijsanayotin
Recall...
25Slide adapted from: Dr. Boonchai Kijsanayotin
Thailand: Unbalanced Development
26
 Silo-type systems
 Little integration and interoperability
 Mostly aim for administration and management
 40% of w...
27
eHealth Components
28
Nationwide survey on hospital IT
adoption conducted in 2011
THAIS: Thai Hospitals’ Adoption
of Information Technology
S...
29Pongpirul et al., 2004
Vendor/Product Distribution (2004)
30Theera-Ampornpunt, 2011
Vendor/Product Distribution (2011)
31
Estimate (Partial or Complete
Adoption)
Nationwide
Basic EHR, outpatient 86.6%
Basic EHR, inpatient 50.4%
Basic EHR, bo...
32
• High IT adoption rates
• Drastic changes in adoption landscape
• Adequate infrastructure for information
exchange
• N...
33
eHealth Components
34
Existing Standards in Thailand
Standards National
1. Core data set standards 12 & 18 files standards
2. Semantic standa...
35
Standards National
1. Core data set standards Referral, Chronic Diseases
2. Semantic standards
Drug Terminology (TMT),
...
36
Thai Health Information Standards
Development Center
www.this.or.th
http://www.facebook.com/thishsri
this@this.or.th
St...
3737
eHealth & e-Transactions
38
• HL7 Certified Specialists
Kevin
Asavanant
HL7 V3 RIM (2009)
Supachai
Parchariyanon
HL7 CDA (2010)
Nawanan
Theera-Ampo...
39
URGES Member States:
(1) to consider, as appropriate, options to collaborate with
relevant stakeholders, including nati...
40
eHealth Components
40
41
• Certificate & Diploma Level
• Undergraduate Level
• Graduate Level
41
Informatics Workforce Programs
42
Faculty of Medicine Ramathibodi Hospital, Mahidol University
http://med.mahidol.ac.th/has/42
Healthcare CIO Certificate...
43Faculty of Tropical Medicine, Mahidol University43
Diploma & Master Graduates in Biomedical &
Health Informatics, First ...
44
• In January 2013, the Thai Medical
Informatics Association (TMI) approved
establishment of the “Biomedical and
Health ...
4545
TMI CIO Forum
46
• International Medical Informatics
Association (IMIA)
– MEDINFO & APAMI
• HIMSS AsiaPac
• Asia eHealth Information Net...
47http://www.aehin.org/Meetings/2013AeHINGeneralMeeting.aspx47
Participation in AeHIN
48
Outline
Needs for better information in healthcare
eHealth as a health system's component
Thailand's eHealth situati...
49
The Road Ahead for
Thailand’s eHealth
50
• Addressing
– Lack of national leadership & governance,
strategy & investment, policy & regulation
– Shortage of infor...
51Image Source: http://twinstrivia.com/2013/05/20/the-road-to-minnesota-is-long-and-hard/
The Journey Beyond
52
But We’ll Get There...
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Transcript of "eHealth: The Next Building Block for Thailand's Healthcare System"

  1. 1. eHealth: The Next Building Block for Thailand’s Healthcare System Nawanan Theera-Ampornpunt, M.D., Ph.D. Faculty of Medicine Ramathibodi Hospital Mahidol University, Thailand June 13, 2014 www.SlideShare.net/Nawanan
  2. 2. 2 Introduction 2003 M.D. (First-Class Honors) (Ramathibodi) 2009 M.S. in Health Informatics (U of MN) 2011 Ph.D. in Health Informatics (U of MN) 2012 Certified HL7 CDA Specialist •Deputy Executive Director for Informatics (CIO/CMIO) Chakri Naruebodindra Medical Institute •Lecturer, Department of Community Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University nawanan.the@mahidol.ac.th
  3. 3. 3 Outline • Needs for better information in healthcare • eHealth as a health system's component • Thailand's eHealth situation • The road ahead for Thailand's eHealth
  4. 4. 4 Needs for Better Information in Healthcare
  5. 5. 5 “Information” in Medicine Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
  6. 6. 6 Needs for Better Information • Good information needed for quality care – Past and present history – Medication list – Problem list – Allergies – Lab & imaging results • Information gaps prevalent in healthcare settings (e.g. Stiell A et al. CMAJ. 2003;169:1023-8.)
  7. 7. 7http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf Fragmented Healthcare
  8. 8. 8 (IOM, 2001)(IOM, 2000) (IOM, 2011) Landmark IOM Reports
  9. 9. 9 • 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
  10. 10. 10 • Medication Errors –Drug Allergies –Drug Interactions • Ineffective or inappropriate treatment • Redundant orders • Failure to follow clinical practice guidelines Common Errors
  11. 11. 11 Back to something simple...
  12. 12. 12 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?
  13. 13. 13 The Question Becomes... How do we deliver better information, by supplementing human clinicians with ICT, so that they make less errors and perform better?
  14. 14. 14 Outline Needs for better information in healthcare • eHealth as a health system's component • Thailand's eHealth situation • The road ahead for Thailand's eHealth
  15. 15. 15 eHealth as a Health System Component
  16. 16. 16 16 WHO (2009) Components of Health Systems
  17. 17. 17 17 WHO (2009) WHO Health System Framework
  18. 18. 18 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
  19. 19. 19  All components are essential  All components should be balanced Slide adapted from: Dr. Boonchai Kijsanayotin eHealth Components: WHO-ITU Model
  20. 20. 20 Hospital A Hospital B Clinic C Government Lab Patient at Home Goal: Health Information Exchange
  21. 21. 21 Outline Needs for better information in healthcare eHealth as a health system's component • Thailand's eHealth situation • The road ahead for Thailand's eHealth
  22. 22. 22 Thailand’s eHealth Situation
  23. 23. 23 eHealth in Thailand: The current status. Stud Health Technol Inform 2010;160:376–80, Presented at MedInfo2010 South Africa Thailand’s eHealth: 2010
  24. 24. 24  All components are essential  All components should be balanced Slide adapted from: Dr. Boonchai Kijsanayotin Recalling eHealth Components
  25. 25. 25Slide adapted from: Dr. Boonchai Kijsanayotin Thailand: Unbalanced Development
  26. 26. 26  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 Boonchai Kijsanayotin et al. (2010) Thailand’s eHealth Situation
  27. 27. 27 eHealth Components
  28. 28. 28 Nationwide survey on hospital IT adoption conducted in 2011 THAIS: Thai Hospitals’ Adoption of Information Technology Survey Self-administered paper-based survey mailed to 1,298 hospitals in Thailand Thailand’s Hospital IT Adoption
  29. 29. 29Pongpirul et al., 2004 Vendor/Product Distribution (2004)
  30. 30. 30Theera-Ampornpunt, 2011 Vendor/Product Distribution (2011)
  31. 31. 31 Estimate (Partial or Complete Adoption) Nationwide Basic EHR, outpatient 86.6% Basic EHR, inpatient 50.4% Basic EHR, both settings 49.8% Order entry of medications, outpatient 96.5% Order entry of medications, inpatient 91.4% Order entry of medications, both settings 90.2% Hospital IT Adoption Estimates
  32. 32. 32 • High IT adoption rates • Drastic changes in adoption landscape • Adequate infrastructure for information exchange • Next question is on interoperability THAIS: Discussion
  33. 33. 33 eHealth Components
  34. 34. 34 Existing Standards in Thailand Standards National 1. Core data set standards 12 & 18 files standards 2. Semantic standards Personal ID, Provider ID ICD-10-TM, ICD-9-CM 3. Syntactic standards X 4. Security and privacy standards X Existing Standards in Thailand Slide adapted from: Dr. Boonchai Kijsanayotin
  35. 35. 35 Standards National 1. Core data set standards Referral, Chronic Diseases 2. Semantic standards Drug Terminology (TMT), SNOMED-CT Lab Code (LOINC) Providers IDs 3. Syntactic standards HL7 Messaging, CDA 4. Security and privacy standards X Standards Being Explored/Developed Slide adapted from: Dr. Boonchai Kijsanayotin
  36. 36. 36 Thai Health Information Standards Development Center www.this.or.th http://www.facebook.com/thishsri this@this.or.th Standards Development Organization Slide adapted from: Dr. Boonchai Kijsanayotin
  37. 37. 3737 eHealth & e-Transactions
  38. 38. 38 • HL7 Certified Specialists Kevin Asavanant HL7 V3 RIM (2009) Supachai Parchariyanon HL7 CDA (2010) Nawanan Theera-Ampornpunt HL7 CDA (2012) 38 Sireerat Srisiriratanakul HL7 V3 RIM (2013) Capacity Building on Standards
  39. 39. 39 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
  40. 40. 40 eHealth Components 40
  41. 41. 41 • Certificate & Diploma Level • Undergraduate Level • Graduate Level 41 Informatics Workforce Programs
  42. 42. 42 Faculty of Medicine Ramathibodi Hospital, Mahidol University http://med.mahidol.ac.th/has/42 Healthcare CIO Certificate Program
  43. 43. 43Faculty of Tropical Medicine, Mahidol University43 Diploma & Master Graduates in Biomedical & Health Informatics, First Batch
  44. 44. 44 • In January 2013, the Thai Medical Informatics Association (TMI) approved establishment of the “Biomedical and Health Informatics Education Special Interest Group” within TMI (BHI-ED-SIG) 44 Informatics Education SIG
  45. 45. 4545 TMI CIO Forum
  46. 46. 46 • International Medical Informatics Association (IMIA) – MEDINFO & APAMI • HIMSS AsiaPac • Asia eHealth Information Network (AeHIN) • American Medical Informatics Association (AMIA) 46 Internationalization
  47. 47. 47http://www.aehin.org/Meetings/2013AeHINGeneralMeeting.aspx47 Participation in AeHIN
  48. 48. 48 Outline Needs for better information in healthcare eHealth as a health system's component Thailand's eHealth situation • The road ahead for Thailand's eHealth
  49. 49. 49 The Road Ahead for Thailand’s eHealth
  50. 50. 50 • Addressing – Lack of national leadership & governance, strategy & investment, policy & regulation – Shortage of informatics workforce – Accelerating standards development – Harmonizing applications – Facilitating local research in informatics 50 The Road Ahead
  51. 51. 51Image Source: http://twinstrivia.com/2013/05/20/the-road-to-minnesota-is-long-and-hard/ The Journey Beyond
  52. 52. 52 But We’ll Get There...
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