Toward the National Agenda for Thailand's Public Health Informatics
Upcoming SlideShare
Loading in...5
×
 

Toward the National Agenda for Thailand's Public Health Informatics

on

  • 1,996 views

Theera-Ampornpunt N. Toward the national agenda for Thailand’s public health informatics. Presented at: Health Informatics Workshop: Health Informatics Challenges & Solutions in Limited-resource ...

Theera-Ampornpunt N. Toward the national agenda for Thailand’s public health informatics. Presented at: Health Informatics Workshop: Health Informatics Challenges & Solutions in Limited-resource Settings: Capturing, Mining and Applying Healthcare Data; 2012 Jan 31; Bangkok, Thailand. Invited speaker.

Statistics

Views

Total Views
1,996
Views on SlideShare
1,926
Embed Views
70

Actions

Likes
0
Downloads
39
Comments
0

2 Embeds 70

http://unjobs.org 69
http://users.unjobs.org 1

Accessibility

Upload Details

Uploaded via as Adobe PDF

Usage Rights

CC Attribution-NonCommercial-ShareAlike LicenseCC Attribution-NonCommercial-ShareAlike LicenseCC Attribution-NonCommercial-ShareAlike License

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Toward the National Agenda for Thailand's Public Health Informatics Toward the National Agenda for Thailand's Public Health Informatics Presentation Transcript

  • Toward the National Agendafor Thailands Public Health Informatics Nawanan Theera-Ampornpunt, MD, PhD Faculty of Medicine Ramathibodi Hospital, Mahidol University Jan 31, 2012 http://www.slideshare.net/nawanan 1
  • Outline• Introduction U.S.• 2001 National Agenda for PHI• Developments in the past decade Thailand• Progress in PHI and informatics• The way forward 2
  • Public Health Informatics• “The systematic application of information and computer science and technology to public health practice, research, and learning” (Yasnoff et al., 2000)• “The application of informatics in areas of public health, including surveillance, reporting, and health promotion” (Hersh, 2009) 3
  • Public Health Informatics Shortliffe (2002) 4
  • Public Health Informatics Hersh (2009) 5
  • PHI and Clinical Informatics Individual Population Health Health Hospitals Public Health & Clinics Agencies Clinical Public Health Informatics Informatics EHRs, CPOE, Biosurveillance, HIS/CIS, HIE, eHealth, PACS mHealth 6
  • An Agenda for PHI: U.S. Yasnoff et al. (2001A) 7
  • An Agenda for PHI: U.S.Origin: AMIA Spring Congress 2001 Yasnoff et al. (2001B) 8
  • An Agenda for PHI: U.S.6 Breakout Tracks• Funding & Governance• Architecture & Infrastructure• Standards & Vocabulary• Research, Evaluation, & Best Practices• Privacy, Confidentiality, & Security• Training & Workforce Yasnoff et al. (2001B) 9
  • An Agenda for PHI: U.S.Output• 74 recommendationsTwo key themes• Need to engage all stakeholders in coordinated activities in PHI• Informatics training is needed throughout public health workforce Yasnoff et al. (2001A) 10
  • Some RecommendationsFunding & Governance• Fund information management as part of the core public health budget• Fund vision of information, not IT• Create diverse funding sources• Allocate adequate funding throughout IS life cycle• Dedicated funding for public health IS• Leadership• Planning & management structures that include all stakeholders• Ensure PH & IT representation in systems planning• Develop a merged superset of PH & informatics planning & evaluation models• Business case for continuing investment in IS and information architecture Yasnoff et al. (2001A) 11
  • Some RecommendationsArchitecture & Infrastructure• Provide Internet access & workstations, as well as software tools, training, and methods for access to data for public health personnel• Develop implementation plan for PH information architecture• Develop a PH data repository from individual records, with process for development of its architectural model.• Establish procedures for monitoring compliance with audit & evaluation criteria & access control measures in PH data systems• [Controversial] Unique patient ID• Provide effective communication & workflow management between public health and health care• Minimize impact of PH data collection on providers Yasnoff et al. (2001A) 12
  • Some RecommendationsStandards & Vocabulary• Increase awareness of & participation in standards development activities within PH workforce• List of existing standards & standards development groups• Identify gaps in coverage of existing standards• Promote consistent use of standards across federal agencies• Increase use of CDC Public Health Conceptual Data Model• Develop new standards for public health reporting• Expansion & maintenance of Dwyer tables for electronic lab reporting to public health agencies• Develop model state regulations on reportable diseases• Develop implementation guidelines for transmitting electronic lab reporting messages• Harmonize key guideline formats within HL7• Create database versions of ICD-9-CM & ICD-10-CM to facilitate automated mapping of clinical terms for reporting & billing Yasnoff et al. (2001A) 13
  • Some RecommendationsResearch, Evaluation, and Best Practices• Process for developing & disseminating of best practices• Establish standards for performance• Establish a program to fund demonstration projects on best practices in privacy protection• Link evaluation explicitly to the goals of Healthy People 2010• Standardize outcome measures• Include data quality, economics, transferability, & individual measures in evaluations• Evaluate existing programs• Develop a research agenda for PHI• Use existing informatics knowledge & methods in PHI research• Involve multidisciplinary teams in PHI research• Include an informatics component in every PH research project• Provide additional research funds to study PHI• Establish & fund research agency for privacy & security Yasnoff et al. (2001A) 14
  • Some RecommendationsPrivacy, Confidentiality & Security• Create a national forum on privacy policy• Establish community advisory boards for privacy policy• Creation of public health ethics committees• Include front-line workers in public health privacy groups• Develop model wording for PH privacy legislation at all levels• Develop regulations & policies that are dynamic & based on risk• Develop policies for cross-jurisdictional exchange of data• Require all public health data systems to have confidentiality agreements & privacy board• Develop model security policies• Adopt HIPAA security requirements in public health• Review security preparedness of public health system• Indirect funding options for security Yasnoff et al. (2001A) 15
  • Some RecommendationsTraining & Workforce• Establish & strengthen academic programs in PHI• Develop competency-based continuing education in PHI• Enhance CDC Public Health Informatics Fellowship Program• Establish instructional guidelines for PHI curriculum• Establish curriculum guidelines for PHI in PH programs• Develop curriculum on data security & privacy• Establish ethical/legal/social issues program in PHI• Involve PH groups when developing PHI curricula• Develop a career track in PHI within informatics• Encourage PH & informatics people to come together• Strengthen AMIA’s Prevention & Public Health SIG• PH & informatics outreach through existing networks• Support development of core competencies in PHI• Examine informatics competencies in other health-related fields• Adapt medical school informatics objectives to PHI• Define PHI Yasnoff et al. (2001A) 16
  • What Happened Since 2001• HIPAA regulations went into effect (2003) and become standard practice for health information privacy & security 17
  • What Happened Since 2001• Creation of the Office of the National Coordinator for Health IT (ONCHIT/ONC) to “develop, maintain, and direct the implementation of a strategic plan to guide the nationwide implementation of interoperable health IT...that will reduce medical errors, improve quality, and produce greater value for health care expenditures” (George W. Bush’s Executive Order, 2004) 18
  • What Happened Since 2001 David Brailer, MD, PhD National Coordinator for Health Information Technology (2004 - 2007) Robert Kolodner, MD National Coordinator for Health Information Technology (2006 - 2009) David Blumenthal, MD, MPP National Coordinator for Health Information Technology (2009 - 2011) Farzad Mostashari, MD, ScM National Coordinator for Health Information Technology (2011 - Present) 19
  • What Happened Since 2001ONC Strategic Plan 2008-20122 Goals • Patient-focused Health Care • Population Health4 Functional components • Privacy & Security • Interoperability • Adoption • Collaborative Governance 20
  • What Happened Since 2001• Regional Health Information Organizations (RHIOs)• Health Information Exchange (HIE) Organizations• Nationwide Health Information Network (NHIN) 21
  • Political Support Behind Health IT ? “...We will make wider use of electronic records and other health information technology, to help control costs and reduce dangerous medical errors.” President George W. Bush Sixth State of the Union AddressSource: Wikisource.org Image Source: Wikipedia.org January 31, 2006 22
  • Political Support Behind Health IT “...Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives.” President Barack Obama Address to Joint Session of Congress February 24, 2009Source: WhiteHouse.gov 23
  • What Happened Since 2001“Meaningful Use”Incentive Programs for EHRs 24
  • The HITECH Act Blumenthal (2010) 25
  • Meaningful Use of Health IT BetterStage 1- Electronic capture of Healthhealth information- Information sharing- Data reporting Stage 3 Stage 2 Use of EHRs to Use of improve EHRs to outcomes improve processes of care Blumenthal (2010) 26
  • Stage 1 Meaningful Use Criteria Blumenthal & Tavenner (2010) 27
  • Stage 1 Meaningful Use Criteria Blumenthal & Tavenner (2010) 28
  • Stage 1 Meaningful Use Criteria Blumenthal & Tavenner (2010) 29
  • Stage 1 Meaningful Use Criteria Blumenthal & Tavenner (2010) 30
  • What Happened Since 2001• AMIA’s Prevention & Public Health Special Interest Group officially becomes Public Health Informatics Working Group*• PHI competencies developed by CDC (2002, updated 2007 & 2009)*• PHI textbook published (O’Carroll et al., 2003)*• PHI career track a reality*• Computers & Internet widely available*• CIOs at all state public health agencies* *From Yasnoff’s PHI 2011 Presentation 31
  • Updated National Agenda• AMIA 2011 Spring Congress revised a national PHI agenda• 5 Tracks• Ethics• Technical Framework• Professional Training & Workforce Development• Research & Evaluation• Sustainability 32
  • An Agenda for PHI: U.S.Output• 62 recommendations (publication forthcoming)Three key themes• Promoting effective coordination & leadership• Improving consistency of PHI through common terminologies, evaluation methodologies & training• Enhancing communication & information sharing Massoudi et al. (AMIA2011) 33
  • An Agenda for PHI: U.S.Changes from 2001 Recommendations• Achieved• Not relevant• New• Evolved Massoudi & Yasnoff (AMIA2011) 34
  • Some Achieved ItemsFunding & Governance• Fund information management as part of the core public health budget• Dedicated funding for public health ISArchitecture & Infrastructure• Provide Internet access & workstations, as well as software tools, training, and methods for access to data for public health personnelResearch, Evaluation, and Best Practices• Use existing informatics knowledge & methods in PHI researchTraining & Workforce• Enhance CDC Public Health Informatics Fellowship Program• Establish instructional guidelines for PHI curriculum• Develop curriculum on data security & privacy• Strengthen AMIA’s Prevention & Public Health SIG• Adapt medical school informatics objectives to PHI Massoudi & Yasnoff (AMIA2011) 35
  • Some New Items• Public health business processes to guide systems development and semantic interoperability• User-centered design• Ensure sharing of public health systems• Integrate PHI research into public health training• Develop & implement innovative PHI training methods• Skills-based training in PHI evaluationEthics track• Have an ethics research agenda• Ensure policy demonstrates utility and value for PHI• Ensure that valid consent processes improve understanding of benefits as well as risks Massoudi & Yasnoff (AMIA2011) 36
  • Some Evolved ItemsArchitecture & infrastructure• A national process for investment and its governance• A coordinating agency• Representatives from national organizations• Success stories, use cases• Get PHI into the PH accreditation process• Promote infrastructure investmentStandards• Expand PH engagement and standards development, implementation and maintenance• Engage in national interoperability initiatives to facilitate information exchange with PH• No-cost PH licenses for data and vocabulary standards• Support data standards life cycle in PH• Develop tools for mapping across standards & vocabularies Massoudi & Yasnoff (AMIA2011) 37
  • Some Evolved ItemsCompetencies, training & workforce• Keep competencies current and developing them further into tiers• Integrate PHI competencies into PH competencies• Promote use of these competencies in PHI training programs• Create standardized and recognized PHI job titles and descriptions• Establish credentialing for PH informaticians• Develop subspecialties within PHI as the profession evolves• Market and promote PHI and informaticians Massoudi & Yasnoff (AMIA2011) 38
  • What AboutThailand? 39
  • Thailand’s Current StatusKijsanayotin B, Kasitipradith N, Pannarunothai S.eHealth in Thailand: the current status. StudHealth Technol Inform. 2010;160(Pt 1):376-80.• National policy and strategy on eHealth are still absent, as is the national eHealth governance body• eHealth efforts exist but are largely fragmented• Urgent need to close the foundational gaps to create sustainable eHealth environmentEnabling factors• Exposure of health practitioners to IT• Use of some information standards 40
  • Thailand’s Current StatusRecommendations• Creation of a multi-stakeholder, national eHealth authority• Incorporation of eHealth strategy into the national ICT framework• Promulgation of health information privacy legislations• Development of national health information standards• More systematic capacity building Kijsanayotin et al. (2010) 41
  • Thailand’s New Developments2011-2012• Governance & National Leadership • National Health Information Committee • National Health Information Standards Development Subcommittee• Engagement & participation of diverse stakeholders in informatics communities & activities 42
  • Thailand’s New Developments2010-2012• Capacity Building & Workforce Development • ICT students with healthcare exposure (Mahidol University’s ICT & Ramathibodi) • Biomedical & Health Informatics curricula with PHI focus (Mahidol University Tropical Medicine) • Strengthening of Health Informatics program at Mahidol University Faculty of Public Health • Healthcare CIO certificate program (Mahidol University’s Ramathibodi) • Dental informatics certificate program at MoPH’s Institute of Dentistry • Ramathibodi’s Medical Data Standards Expos • TMI’s more active academic roles 43
  • New Research Findings on Health IT Adoption Estimate (Partial or Complete Nationwide Adoption) Basic EHR, combined inpatient 49.8% & outpatient settings Comprehensive EHR, 5.3% combined order entry of medications, 90.2% combined order entry of all orders, 79.4% combinedDefinitions | Estimates Theera-Ampornpunt (2011, unpublished) 44
  • The Way ForwardImage Source: Smiletemplates.com 45
  • The Way Forward• Funding & Governance • $$$ • Unified national leadership with full stakeholder representation • A dialogue toward “PHI National Agenda”?• Technical Framework • Architecture & Infrastructure • Vision & Enterprise Architecture for “ThaiHIE” 46
  • The Way Forward• Technical Framework • Standards & Vocabulary • Gap identification • Selection & development of necessary standards • Education & awareness building • Privacy & Security • Review & revise health information privacy law • Education & best practices 47
  • The Way Forward• Research & Evaluation • Research agenda • Systematic support for new research in Thailand’s context • “Translation” of knowledge from global health communities to Thailand’s local settings • A cluster of informatics academicians 48
  • The Way Forward• Training & Workforce • Strengthening of existing programs • Development of new programs with a different focus (clinical informatics?) • Clear career path • More formally trained informaticians!! • Most importantly: • Facilitation of inter-institutional collaboration drawing strengths from various programs for mutual benefits • As opposed to a “race to the bottom” 49
  • Image Source: http://mortgageloans.com.ng/files/2011/05/WayForward.jpg 50
  • References• Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5.• Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010 Aug 5;363(6):501-4.• Hersh W. A stimulus to define informatics and health information technology. BMC Med Inform Decis Mak. 2009;9:24.• Kijsanayotin B, Kasitipradith N, Pannarunothai S. eHealth in Thailand: the current status. Stud Health Technol Inform. 2010;160(Pt 1):376-80.• Shortliffe EH. JBI status report. Journal of Biomedical Informatics. 2002 Oct;35(5-6):279–80.• Theera-Ampornpunt N. Thai hospitals adoption of information technology: a theory development and nationwide survey [dissertation]. Minneapolis (MN): University of Minnesota; 2011 Dec. 376 p.• Yasnoff WA, O’Carroll PW, Koo D, Linkins RW, Kilbourne EM. Public health informatics: improving and transforming public health in the information age. J Public Health Manag Pract. 2000 Nov;6(6):67–75.• Yasnoff WA, Overhage JM, Humphreys BL, LaVenture M. A national agenda for public health informatics: summarized recommendations from the 2001 AMIA Spring Congress. J Am Med Inform Assoc. 2001 Dec;8(6):535–45.• Yasnoff WA, Overhage JM, Humphreys BL, LaVenture M, Goodman KW, Gatewood L, et al. A national agenda for public health informatics. J Public Health Manag Pract. 2001 Nov;7(6):1–21. 51