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eHealth in Thailand: Status & Trend


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eHealth in Thailand: Status & Trend

  1. 1. eHealth in Thailand: Status and Trend Nawanan Theera-Ampornpunt, M.D., Ph.D. Faculty of Medicine Ramathibodi Hospital Mahidol University
  2. 2. Outline • What is eHealth and Why • Thailand’s eHealth Status • Future Trends
  3. 3. Landmark IOM Reports (IOM, 2001)(IOM, 2000) (IOM, 2011)
  4. 4. Patient Safety • To Err is Human (Institute of Medicine, 1999) • 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 2012Introduction to Healthcare and Public Health in the US: Regulating Healthcare - Lecture d
  5. 5. • 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
  6. 6. Image Source: • Lack of Attention To Err Is Human
  7. 7. • Medication Errors – Drug Allergies – Drug Interactions • Ineffective or inappropriate treatment • Redundant orders • Failure to follow clinical practice guidelines Common Errors
  8. 8. Computerized Physician Order Entry (CPOE)
  9. 9. – Alerts & reminders • Based on specified logical conditions • Examples: –Drug-allergy checks –Drug-drug interaction checks –Reminders for preventive services –Clinical practice guideline integration Clinical Decision Support Systems (CDSSs)
  10. 10. Example of “Alerts & Reminders”
  11. 11. Various Forms of Health IT Hospital Information System (HIS) Computerized Provider Order Entry (CPOE) Electronic Health Records (EHRs) Picture Archiving and Communication System (PACS)
  12. 12. Still Many Other Forms of Health IT m-Health Biosurveillance Telemedicine & Telehealth Images from Apple Inc.,, Google,, and American Telecare, Inc. Personal Health Records (PHRs)
  13. 13. Health Information Exchange (HIE) Hospital A Hospital B Clinic C Government Lab Patient at Home
  14. 14. • Guideline adherence • Better documentation • Practitioner decision making or process of care • Medication safety • Patient surveillance & monitoring • Patient education/reminder Values of Health IT
  15. 15. 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) ( 2) World Health Assembly, 2005. Resolution WHA58.28 Slide adapted from: Mark Landry, WHO WPRO & Boonchai Kijsanayotin eHealth
  16. 16. 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: Boonchai Kijsanayotin Health IT
  17. 17. eHealth  Health IT eHealth & Health IT Slide adapted from: Boonchai Kijsanayotin
  18. 18. HIS All information about health eHealth HMIS mHealth Tele- medicine More Terms Slide adapted from: Karl Brown (Rockefeller Foundation), via Boonchai Kijsanayotin
  19. 19. • Safety • Timeliness • Effectiveness • Efficiency • Equity • Patient-centeredness Goals for “Health” (IOM, 2001)
  20. 20.  All components are essential  All components should be balanced eHealth Components (WHO-ITU Model) Slide adapted from: Boonchai Kijsanayotin
  21. 21. Strategy&Investment Standards & Interoperability Infrastructure Services, Applications Software Leadership & governance Legislation,policy& compliance Workforce Thailand: Unbalanced Development Slide adapted from: Boonchai Kijsanayotin
  22. 22. eHealth Development Model 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: Boonchai Kijsanayotin
  23. 23. eHealth Applications Enabling Policies and Strategies Foundation Policies and Strategies Thailand’s eHealth Development Slide adapted from: Boonchai Kijsanayotin
  24. 24.  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 Thailand’s eHealth Situation Slide adapted from: Boonchai Kijsanayotin
  25. 25. EHR Adoption in Thai Hospitals Theera-Ampornpunt (2011)
  26. 26. HOSxP 50% Self-developed or outsourced 16% Hospital OS 7% SSB 4% Mit-Net 2% MRecord 2% H.I.M. Professional 2% MedTrak/ TrakCare 2% HoMC 2% None 2% THIADES 2% HIMS 1% Abstract ePHIS 1% Other 7% EHR Product Distribution: THAIS 2011 Theera-Ampornpunt (2011)
  27. 27. Adoption Estimates: THAIS 2011 Estimate (Partial or Complete Adoption) Nationwide Basic EHR, combined inpatient & outpatient settings 49.8% Order entry of medications, combined 90.2% Theera-Ampornpunt (2011)
  28. 28. Functional Semantic Syntactic Standards & Interoperability Technical Standards (TCP/IP, encryption, security) Exchange Standards (HL7 v.2, HL7 v.3 Messaging, HL7 CDA, DICOM) Vocabularies, Terminologies, Coding Systems (ICD-10, ICD-9, CPT, SNOMED CT, LOINC) Information Models (HL7 v.3 RIM, ASTM CCR, HL7 CCD) Standard Data Sets Functional Standards (HL7 EHR Functional Specifications) Some may be hybrid: e.g. HL7 v.3, HL7 CCD Unique ID
  29. 29. Standards National 1. Content standards (Core data set) 12 & 18 files standards 2. Semantic standards Citizen Identifiers ICD 10 TM, ICD 9 CM 3. Syntactic standards X 4. Security and privacy standards X Thailand’s Health Information Standards Slide adapted from: Boonchai Kijsanayotin
  30. 30.  IT is pervasive in Thai health sector  eHealth foundations lagged behind  No national eHealth policy  Fragmented eHealth applications Thailand’s eHealth Summary Slide adapted from: Boonchai Kijsanayotin
  31. 31. Urges member state to 1. Draw up a road map for implementation of eHealth and health data standards at national and subnational levels. 2. Develop 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. Dr Margaret Chan, Director-General of WHO World Health Assembly Resolution WHA66.24 May 2013 Slide adapted from: Boonchai Kijsanayotin
  32. 32.  Stronger health IT adoption in clinical settings  Local data exchange in specific areas (Ex. referrals; provincial level)  Standards development  Efforts to create “roadmap” & architecture  Privacy laws & other public policies  Insurance claims & reimbursement a major driver of eHealth Trends for Thailand’s eHealth