1. Welcome
Biomedical and Health
Informatics Students
Faculty of Tropical Medicine
April 1, 2013
© Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

2. About Ramathibodi
• A medical school in Mahidol University
• Established 1965, Operational 1969
• Vision: To be an internationally-recognized
leading medical institution
• Mission: Integrating education, research,
and healthcare services for the society’s
health
• Determination: To be the country’s guiding
light on health

3. Ramathibodi’s Organization Chart

4. Ramathibodi’s Healthcare Services
Item Ramathibodi QSMC SDMC
Hospital
Strategic Super-tertiary care Excellence center Customer-focused
Segmentation for wide variety of in advanced, premium services
patients (public & complex cases targeting patients
private) (e.g. with private
transplantation) insurance,
with integrated corporate security,
wards, ICU, OR, out-of-pocket &
and private care some government
officials
Inpatient Beds 896 Beds 177 Beds

5. Ramathibodi At A Glance
• 1073 Total Beds
• 68 Wards (Rama1=44; QSMC=7; SDMC=17)
• 115 Inpatient admissions/day (+11 newborns)
• 5,600 Outpatients/day
– Regular (Office Hours) 4,400 patients/day
– Special (Non-Office Hours) 1,200 patients/day
– Premium (SDMC) 880 patients/day
• 1,062,030 Active Patients
• 8,300 Employees

6. Health Informatics Division

7. Long History of IT Development
• 1st Generation (~1987-2001)
– CIO: Dr. Suchart Soranasataporn
– Developed HIS from scratch
– Started from MPI, OPD, IPD, Pharmacy,
Billing, etc.
– Platform: Visual FoxPro (UI, Logic, Database)

8. Long History of IT Development
• 2nd Generation (2001-2005)
– CIO: Dr. Piyamitr Sritara
– Developed CPOE for inpatients medication
orders, lab orders and lab results viewing,
discharge summaries, etc.
– Enhanced existing HIS modules and add more
modules and departmental systems (e.g. LR,
OR)
– Platform: Visual FoxPro (UI, Logic, Database)

9. Long History of IT Development
• 3rd Generation (2005-2011)
– CIO: Dr. Artit Ungkanont
– Implemented ERP, PACS, LIS, Doctor Portal
– Use of middleware (web services, JBOSS, JCAPS)
– Implemented data exchange of lab & ADT data using
HL7 v.2 & v.3 messaging
– Informatics academic activities
– Enhanced existing HIS & add more functions
– SDMC becomes operational (2011)
– Platform: Web [Mainly Java] (UI); Web services
(Logic); Oracle & Microsoft SQL Server (Database)
– Legacy platform: Visual FoxPro (UI, Logic, Database)

10. Long History of IT Development
• 4th Generation (2011-Present)
– CIO: Dr. Chusak Okaschareon
– Implemented CPOE for outpatients (go live soon)
– Scanned Medical Records for outpatients
– RamaEMR for physicians and nurses in OPD
– Software project management changed from functional
teams (silos) to project-based teams
– Future projects: CMMI, ISO9001, better software
testing, business intelligence, security
– Platform: Web [Mainly Java] (UI); Web services
(Logic); Oracle & Microsoft SQL Server (Database)
– Legacy platform: Visual FoxPro (UI, Logic, Database)

11. Patient & Bed Management - Inpatient
Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

12. CPOE - Inpatient
Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

13. CPOE - Home Medications for Inpatients
Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

14. Admission Notes
Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

15. Discharge Summary
Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

16. Discharge Summary (Diagnoses & Operations)
Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

17. Discharge Summary (Cause of Death)
Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

18. Lab Orders - Inpatient
Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

19. Lab Results - Inpatient
Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

20. Outpatient
Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

21. RamaEMR - Doctor’s Portal
Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

22. RamaEMR - Doctor’s Portal
Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

23. RamaEMR - Scanned MR Viewer
Screenshots © Faculty of Medicine Ramathibodi Hospital, Mahidol University. All rights reserved.

24. Build or Buy
Build/Homegrown Buy/Outsource
• Full control of software & • Less control of software &
data data
• Requires local expertise • Requires vendor
• Expertise competence
retention/knowledge • Vendor relationship
management is vital management is vital
• Maybe cost-effective if • Maybe cost-effective
high degree of local if economies of scale or
customizations or long- few customizations
term projection

25. IT Outsourcing Decision Tree
Keep Internal
No
Is external delivery
No reliable and lower cost?
Does service offer Yes OUTSOURCE!
competitive advantage?
Yes Keep Internal
From a teaching slide by Nelson F. Granados, 2006

26. IT Outsourcing Decision External delivery unreliable
• Non-Core HIS,
Tree: Ramathibodi’s Case External delivery higher cost
• ERP maintenance/ongoing
customization
Keep Internal
No
Is external delivery
No reliable and lower cost?
Does service offer Yes OUTSOURCE!
competitive advantage?
ERP initial
Keep Internal
implementation,
Yes
PACS, RIS,
Core HIS, CPOE Departmental
Strategic advantages systems
• Agility due to local workflow accommodations
• Secondary data utilization (research, QI)
• Roadmap to national leader in informatics (internal “lab”)
From a teaching slide by Nelson F. Granados, 2006

27. Ramathibodi’s Priorities & Challenges
• Quality software
– Reflects quality of the team and process
– Software testing & lessons learned crucial
• Software development process reform
– Project-based; Value of teamwork
• System outages
– Common issues of real-life IT operations
– Disaster recovery and business continuity
planning

28. Ramathibodi’s Priorities & Challenges
• Secondary use of data / DW & BI
– Important for academic health centers &
university hospitals
– Important for cost savings & quality
improvement
– Privacy safeguards important

29. Ramathibodi’s Lessons Learned
• “Preemptive advantage” of using Health IT
• “Build” approach was economical and makes our
systems flexible to changing internal & external
requirements
• “Legacy systems trap” (aka. vendor lock-in)
• Customization vs. standardization tension
• IT as operational tools or quality improvement tools?
• Recruiting & retaining high-quality workers a
challenge that needs management solutions

30. Site Visit Outline
• 1:00 - 1:45 PM Presentation
• [15-minute walk to Rama1 Main Building]
• 2:00 - 2:15 PM Inpatient Ward (7SW)
• [15-minute walk back to SDMC]
• 2:30 - 2:50 PM Outpatient Clinic (Ortho)
• 2:50 - 3:10 PM Radiology Department
• 3:10 - 3:25 PM Pharmacy
• 3:25 - 3:40 PM Server Room
• 3:40 - 4:30 PM Coffee Break & Conclusion

31. Questions?