eHealth: The Next Building Block for Thailand's Healthcare System

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  • 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 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 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 Needs for Better Information in Healthcare
  • 5. 5 “Information” in Medicine Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
  • 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. 7http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf Fragmented Healthcare
  • 8. 8 (IOM, 2001)(IOM, 2000) (IOM, 2011) Landmark IOM Reports
  • 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 • Medication Errors –Drug Allergies –Drug Interactions • Ineffective or inappropriate treatment • Redundant orders • Failure to follow clinical practice guidelines Common Errors
  • 11. 11 Back to something simple...
  • 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 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 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 eHealth as a Health System Component
  • 16. 16 16 WHO (2009) Components of Health Systems
  • 17. 17 17 WHO (2009) WHO Health System Framework
  • 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  All components are essential  All components should be balanced Slide adapted from: Dr. Boonchai Kijsanayotin eHealth Components: WHO-ITU Model
  • 20. 20 Hospital A Hospital B Clinic C Government Lab Patient at Home Goal: Health Information Exchange
  • 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 Thailand’s eHealth Situation
  • 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  All components are essential  All components should be balanced Slide adapted from: Dr. Boonchai Kijsanayotin Recalling eHealth Components
  • 25. 25Slide adapted from: Dr. Boonchai Kijsanayotin Thailand: Unbalanced Development
  • 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 eHealth Components
  • 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. 29Pongpirul et al., 2004 Vendor/Product Distribution (2004)
  • 30. 30Theera-Ampornpunt, 2011 Vendor/Product Distribution (2011)
  • 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 • High IT adoption rates • Drastic changes in adoption landscape • Adequate infrastructure for information exchange • Next question is on interoperability THAIS: Discussion
  • 33. 33 eHealth Components
  • 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 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 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. 3737 eHealth & e-Transactions
  • 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 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 eHealth Components 40
  • 41. 41 • Certificate & Diploma Level • Undergraduate Level • Graduate Level 41 Informatics Workforce Programs
  • 42. 42 Faculty of Medicine Ramathibodi Hospital, Mahidol University http://med.mahidol.ac.th/has/42 Healthcare CIO Certificate Program
  • 43. 43Faculty of Tropical Medicine, Mahidol University43 Diploma & Master Graduates in Biomedical & Health Informatics, First Batch
  • 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. 4545 TMI CIO Forum
  • 46. 46 • International Medical Informatics Association (IMIA) – MEDINFO & APAMI • HIMSS AsiaPac • Asia eHealth Information Network (AeHIN) • American Medical Informatics Association (AMIA) 46 Internationalization
  • 47. 47http://www.aehin.org/Meetings/2013AeHINGeneralMeeting.aspx47 Participation in AeHIN
  • 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 The Road Ahead for Thailand’s eHealth
  • 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. 51Image Source: http://twinstrivia.com/2013/05/20/the-road-to-minnesota-is-long-and-hard/ The Journey Beyond
  • 52. 52 But We’ll Get There...