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The Road to eHealth: Thailand's Journey


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  • 1. The Road to eHealth:  Thailand’s JourneyNawanan Theera‐Ampornpunt, M.D., Ph.D. Faculty of Medicine Ramathibodi Hospital Mahidol University, Thailand Site Visit at Hong Kong Hospital Authority (Sep. 10, 2012)
  • 2. Acknowledgments• Parts of this presentation are reproduced or  adapted from materials made by• Boonchai Kijsanayotin, M.D., Ph.D. Health Systems Research Institute, Thailand• Somsak Chunharas, M.D., M.PH. National Health Foundation, Thailand
  • 3. Outline• Overview of Thailand• Thailand’s Healthcare System• Thailand’s eHealth Status• Recent Progress• The Road Forward
  • 4. Thailand: An Overview
  • 5. Thailand: An Overview • Capital: Bangkok • 76 Other provinces • 6 Regions: N, C, NE, E, W, S • Size: 510,890 km2 (460 times of HK) • Population: 67+ million  (10 times of HK) Image Source: CIA World Factbook
  • 6. Thailand: An Overview• Upper‐middle‐income country• Constitutional monarchy & parliamentary  democracy• King Bhumibol Adulyadej as Head of State• Prime ministry as Head of Government• Three branches of government: Legislative,  executive, judicial
  • 7. Life Expectancy (X)Income per person (Y) Image Source:
  • 8. Human Development Index (X) GDP Per Capita (Y) Image Source:
  • 9. Thailand’s Healthcare System
  • 10. Thailand’s Healthcare System• Pluralistic system: both public & private  providers• Public providers large part of healthcare system• Financed mainly by public funds
  • 11. Thailand’s Healthcare System3 public healthcare schemes• Civil Servant Medical Benefit Scheme (CSMBS) • Non‐contributory fee‐for‐service scheme since 1980 • Covering most healthcare services (except some non‐ essential prescriptions & unnecessary services) • Public providers (and recently, some private hospitals) • Uncontrollably escalating costs, inequitable, pro‐rich • Cost‐containment measures attempted
  • 12. Thailand’s Healthcare System• Social Security Scheme (SSS) • Mandated tripartite contributions (employee, employer,  government) • Capitation fee to participating public & private providers • Successful in cost containment, but suffers from poor  quality through cream skimming, cost shifting, under‐ provision of care, ineffective regulatory oversight
  • 13. Thailand’s Healthcare System• Universal Coverage Scheme (UC) • Implemented in 2001, coverage to all Thais not covered  by CSMBS or SSS, funded by taxes • Service provided at registered community health center  or public hospital in patients’ residential area, with  referrals if necessary • Capitation fees for outpatient & DRG for inpatients • Effective risk pooling • Equitable access to the poor
  • 14. Thailand’s Healthcare System • Distribution of public and private hospitals in Thailand District hospitals (MOPH) General hospitals (MOPH) Regional hospitals (MOPH) Other hospitals under MOPH* Other public hospitals outside MOPH† Private hospitals*Including general and specialty hospitals under other departments within the Ministry of Public Health.†Including university hospitals, military hospitals, autonomous public hospitals, prison hospitals, hospitals of state enterprises, and public hospitals under local governments.MOPH = Ministry of Public HealthSource: Bureau of Policy and Strategy, Ministry of Public Health (November 2010).
  • 15. Thailand’s eHealth Status
  • 16. Adoption of Health IT: United States U.S. Ambulatory Setting 100 % of Physicians 90 80 70 60 50 48.350.7 34.8 42.0 23.9 29.2 40 24.9 30 18.2 17.3 17.3 20.8 16.9 21.8 9.3 10.5 11.8 20 10 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year of Study Any EHR EHR with Basic FeaturesBasic Features: Demographics, problem lists, clinical notes, test results, imaging results, order entry for medications Source: National Ambulatory Medical Care Survey (NAMCS) 2001-2010
  • 17. Adoption of Health IT: United States U.S. Inpatient Setting 2008 2009 – Basic EHRs 7.2% 9.2% – Comprehensive EHRs 1.5% 2.7% – Computerized 17% 34% Order Entry for Medications Sources: Jha et al., 2009 & 2010
  • 18. Thailand’s Health IT Adoption
  • 19. Thailand’s HIS Market Share  (2004) Pongpirul K, Sriratana S. Computerized information system in hospitals in Thailand: a national survey. J Health Sci. 2005 Sep-Oct;14(5):830-9. Thai.
  • 20. Thailand’s HIS Market Share  (2011) HoMC None 2% THIADES HIMS Abstract Other 2% 2% 1% ePHIS 7% MedTrak/ 1% TrakCare H.I.M. 2%Professional 2% MRecord Mit-Net 2% SSB HOSxP 2% 4% 50% Hospital OS 7% Self-developed or outsourced 16% Theera-Ampornpunt (2011)
  • 21. Adoption Estimates Estimate  Nationwide (Partial or Complete Adoption)Basic EHR, combined inpatient &  49.8%outpatient settingsComprehensive EHR, combined 5.3%order entry of medications,  90.2%combinedorder entry of all orders, combined 79.4% Theera-Ampornpunt (2011)
  • 22. Summary on Health IT Adoption• High IT adoption rates• Drastic changes in adoption landscape• Local context might play a role – Supply Side – Demand Side• International Comparison
  • 23. Thailand’s eHealth StatusKijsanayotin B, Kasitipradith N, Pannarunothai S. eHealth in Thailand: the current status.  Stud Health Technol Inform. 2010;160(Pt 1):376‐80.
  • 24. eHealth Development Model • Public services eHealth Applications • Knowledge services • Provider services • Citizen Protection • Equality Enabling Policies • Multilingualism & Strategies • Interoperability • Capability Building • Governance Foundation Policies • Policy & Strategies • Funding • Infrastructure Modified from Slide by Dr. Boonchai Kijsanayotin (Modified from WHO Global Observatory for eHealth)
  • 25. Thailand’s eHealth Summary (2010)• Pervasive access and use of ICT across the  country• Diverse eHealth applications exist, but most are  scattered, fragmented, disorganized, non‐ standardized, and not interoperable• Lack of implementation and investments in  eHealth foundations Modified from Slide by Dr. Boonchai Kijsanayotin
  • 26. Issues in Thailand’s eHealth• Fragmented reporting systems• Up to 40% of work time used for data reporting• Lack of access to personal health data by  patients• No national governance structure on eHealth• Foundations needed for standards  development, privacy & security regulations,  etc. Modified from Slide by Dr. Boonchai Kijsanayotin
  • 27. Experts’ Recommendations• Development of eHealth foundations is the priority• Create a multi‐stakeholder, national‐level, eHealth governing authority• Incorporate eHealth strategy into ICT 2020 framework • Enact health information security, privacy and  confidentiality laws• Develop national health information standards• Plan and implement systematic  mechanism for capacity building  Modified from Slide by Dr. Boonchai Kijsanayotin
  • 28. Since That Publication in 2010...• ICT2020 framework now includes “Smart Health”• The National Health Information Committee was  established under the National Health Commission• The National Health Information Standards  Subcommittee was formed• An eHealth office was created under the Health  Systems Research Institute• Important standards are being developed
  • 29. National Health Commission Chair: Prime Minister  Secretary: NHC Secretariat National Health Information Committee Chair: Dr. Somsak Chunharas Secretary: Dr. Boonchai KijsanayotinNational Health Information Standards Subcommittee Chair: Dr. Daorirk Sinthuvanich Secretary: Dr. Boonchai Kijsanayotin Modified from Slide by Dr. Boonchai Kijsanayotin & Dr. Somsak Chunharas
  • 30. Since That Publication in 2010...• Capacity Building – New program in biomedical and health informatics – Healthcare CIO certificate program at Ramathibodi – Clusters of health informatics academic activities being  formed• Need for health information privacy & security laws  being discussed in academic forums and by the  Electronic Transactions Development Agency  (Public Organization)
  • 31. The Road Forward
  • 32. The Road Forward for Thailand• Partnerships
  • 33. The Road Forward for Thailand• More capacity building!• Informatics research• Standards development & adoption• Getting over “one country one system” and seeking  cross‐platform Health Information Exchange• Implications of ASEAN Economic Community• Better privacy laws
  • 34. Where Will We Go? Image Source:
  • 35. Thank You! Q&A