The document provides an overview of health information technology (IT) and its application for clinical care improvement in Thailand. It discusses how healthcare is error-prone and fragmented, and how health IT can help by improving access to patient information, guidelines, and coordination across settings. The document then summarizes Thailand's current eHealth situation, noting siloed systems, little integration and interoperability, and a lack of national leadership. Surveys found basic electronic health records adopted in around half of Thai hospitals, with higher adoption of computerized medication ordering.
Theera-Ampornpunt N. Global or glocal e-Health approaches in Asia: what is new or next? Presented at: Globalizing Asia: Health Law, Governance, and Policy - Issues, Approaches, and Gaps!; 2012 Apr 16-18; Bangkok, Thailand.
Consumer Health Informatics, Mobile Health, and Social Media for Health: Part...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 10, 2021
Presented at the 8th Healthcare CIO Certificate Program, Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 12, 2018
Theera-Ampornpunt N. Global or glocal e-Health approaches in Asia: what is new or next? Presented at: Globalizing Asia: Health Law, Governance, and Policy - Issues, Approaches, and Gaps!; 2012 Apr 16-18; Bangkok, Thailand.
Consumer Health Informatics, Mobile Health, and Social Media for Health: Part...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 10, 2021
Presented at the 8th Healthcare CIO Certificate Program, Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 12, 2018
Presented at "Hospital Management 2015" Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on August 18, 2015
Presented at the 9th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on March 4, 2019
Presented at the Data Science for Healthcare Graduate Programs, Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 7, 2019
Introduction to Health Informatics and Health IT (Part 2) (February 10, 2021)Nawanan Theera-Ampornpunt
Presented at the 11th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on February 10, 2021
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 4, 2021
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 12, 2020
Presented at the BDMS Golden Jubilee Scientific Conference 2022 "BDMS Beyond 50 years: Looking towards the centennial," Bangkok Dusit Medical Services Public Company Limited (BDMS), Bangkok, Thailand on October 19, 2022
Presented at The Thai Medical Informatics Association Annual Conference and The National Conference on Medical Informatics (TMI-NCMedInfo) 2021, Bangkok, Thailand on November 26, 2021
Presented at the Master of Science Program in Medical Epidemiology and the Doctor of Philosophy Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 25, 2021
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 15, 2021
Consumer Health Informatics, Mobile Health, and Social Media for Health: Part...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 10, 2021
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
Application of ICT for Clinical Care Improvement (January 18, 2018)
1. Application of ICT for
Clinical Care Improvement
Chulalongkorn University
January 18, 2018
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Department of Community Medicine
Faculty of Medicine Ramathibodi Hospital
SlideShare.net/Nawanan
2. 2
Outline
• Health & Health Information
• Health IT & eHealth
• Health Informatics as a Discipline
• Thailand’s eHealth Situation
• Current Forces
9. 9
• Life-or-Death
• Difficult to automate human decisions
– Nature of business
– Many & varied stakeholders
– Evolving standards of care
• Fragmented, poorly-coordinated systems
• Large, ever-growing & changing body of
knowledge
• High volume, low resources, little time
Why Healthcare Isn’t Like Any Others
13. 13
• “Don’t implement technology just for
technology’s sake.”
• “Don’t make use of excellent technology.
Make excellent use of technology.”
(Tangwongsan, Supachai. Personal communication, 2005.)
• “Health care IT is not a panacea for all that
ails medicine.” (Hersh, 2004)
Some “Smart” Quotes
14. 14
If not a “Digital Hospital”
or a “Paperless Hospital”
Then what should we aim for?
17. 17
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?
18. 18
• Safe
• Timely
• Effective
• Patient-Centered
• Efficient
• Equitable
Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality
chasm: a new health system for the 21st century. Washington, DC: National Academy
Press; 2001. 337 p.
High Quality Care
26. 26
• To Err is Human (IOM, 2000) 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 2012 Introduction to Healthcare and Public Health in the US: Regulating Healthcare - Lecture d
Patient Safety
27. 27
• 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
28. 28
Image Source: (Left) http://docwhisperer.wordpress.com/2007/05/31/sleepy-heads/
(Right) http://graphics8.nytimes.com/images/2008/12/05/health/chen_600.jpg
To Err is Human 1: Attention
29. 29Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital
To Err is Human 2: Memory
30. 30
• Cognitive Errors - Example: Decoy Pricing
The Economist Purchase Options
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Ariely (2008)
16
0
84
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68
32
# of
People
# of
People
To Err is Human 3: Cognition
31. 31
• It already happens....
(Mamede et al., 2010; Croskerry, 2003;
Klein, 2005; Croskerry, 2013)
What If This Happens in Healthcare?
32. 32
Mamede S, van Gog T, van den Berge K, Rikers RM, van Saase JL, van Guldener C,
Schmidt HG. Effect of availability bias and reflective reasoning on diagnostic accuracy
among internal medicine residents. JAMA. 2010 Sep 15;304(11):1198-203.
Cognitive Biases in Healthcare
33. 33
Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them.
Acad Med. 2003 Aug;78(8):775-80.
Cognitive Biases in Healthcare
34. 34
Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr
2;330(7494):781-3.
“Everyone makes mistakes. But our
reliance on cognitive processes prone to
bias makes treatment errors more likely
than we think”
Cognitive Biases in Healthcare
35. 35
• Medication Errors
–Drug Allergies
–Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
Common Errors
36. 36
Why We Need ICT
in Healthcare?
#1: Because information is
everywhere in healthcare
37. 37
Why We Need ICT
in Healthcare?
#2: Because healthcare is
error-prone and technology
can help
38. 38
Why We Need ICT
in Healthcare?
#3: Because access to
high-quality patient
information improves care
39. 39
Why We Need ICT
in Healthcare?
#4: Because healthcare at
all levels is fragmented &
in need of process
improvement
40. 40
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: Dr. Boonchai Kijsanayotin
Health IT
41. 41
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
42. 42
eHealth Health IT
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealth & Health IT
43. 43
HIS
All information about health
eHealth
HMIS
mHealth
Tele-
medicine
Slide adapted from: Karl Brown (Rockefeller Foundation),
via Dr. Boonchai Kijsanayotin
More Terms...
45. 45
All components are essential
All components should be balanced
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealth Components: WHO-ITU Model
46. 46
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic
Health
Records
(EHRs)
Picture Archiving and
Communication System
(PACS)
Screenshot Images from Faculty of Medicine Ramathibodi Hospital, Mahidol University
Various Forms of Health IT
48. 48
• Guideline adherence
• Better documentation
• Practitioner decision making or
process of care
• Medication safety
• Patient surveillance & monitoring
• Patient education/reminder
Documented Values of Health IT
49. 49
• Master Patient Index (MPI)
• Admit-Discharge-Transfer (ADT)
• Electronic Health Records (EHRs)
• Computerized Physician Order Entry (CPOE)
• Clinical Decision Support Systems (CDS)
• Picture Archiving and Communication System
(PACS)
• Nursing applications
• Enterprise Resource Planning (ERP)
Some Hospital IT - Enterprise-wide
50. 50
• Pharmacy applications
• Laboratory Information System (LIS)
• Radiology Information System (RIS)
• Specialized applications (ER, OR, LR,
Anesthesia, Critical Care, Dietary
Services, Blood Bank)
• Incident management & reporting system
Some Hospital IT - Departmental Systems
51. 51
The Challenge - Knowing What It Means
Electronic Medical
Records (EMRs)
Computer-Based
Patient Records
(CPRs)
Electronic Patient
Records (EPRs)
Electronic Health
Records (EHRs)
Personal Health
Records (PHRs)
Hospital
Information System
(HIS)
Clinical Information
System (CIS)
EHRs & HIS
53. 53
Health IT for Medication Safety
Ordering Transcription Dispensing Administration
CPOE
Automatic
Medication
Dispensing
Electronic
Medication
Administration
Records
(e-MAR)
Barcoded
Medication
Administration
Barcoded
Medication
Dispensing
54. 54
Values
• No handwriting!!!
• Structured data entry: Completeness, clarity,
fewer mistakes (?)
• No transcription errors!
• Streamlines workflow, increases efficiency
Computerized Provider Order Entry (CPOE)
55. 55
• The real place where most of the
values of health IT can be achieved
– Expert systems
• Based on artificial intelligence,
machine learning, rules, or
statistics
• Examples: differential
diagnoses, treatment options
(Shortliffe, 1976)
Clinical Decision Support Systems (CDS)
56. 56
– 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 (CDS)
61. 61
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
Working
Memory
CLINICIAN
Elson, Faughnan & Connelly (1997)
Clinical Decision Making & CDS
66. 66
• CDS as a replacement or supplement of
clinicians?
– The demise of the “Greek Oracle” model (Miller & Masarie, 1990)
The “Greek Oracle” Model
The “Fundamental Theorem” Model
Friedman (2009)
Wrong Assumption
Correct Assumption
Proper Roles of CDS
77. 77
eHealth in Thailand: The current status. Stud Health Technol Inform
2010;160:376–80, Presented at MedInfo2010 South Africa
Thailand’s eHealth: 2010
81. 81
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
Slide adapted from: Boonchai Kijsanayotin
Thailand’s eHealth Situation
82. 82
Section 1 Hospital Profile
Section 2 IT Adoption & Use
Profile
Section 3 Respondent’s
Information
Thailand’s Health IT Adoption
83. 83
• 4 of 1,302 hospitals ineligible
• Response rate 69.9%
Characteristic Overall Responding
Hospitals
Non-
Responding
Hospitals
N of eligible hospitals 1,298 908 390
Bed size** 106.9 117.5 82.9
Public status**
Private
Public
24.0%
76.0%
17.4%
82.6%
39.2%
60.8%
Geography*
Central
East
North
Northeast
South
West
33.4%
7.5%
11.1%
27.1%
15.3%
5.6%
31.1%
7.8%
13.5%
26.9%
14.9%
5.8%
39.0%
6.7%
5.4%
27.7%
16.2%
5.1%
*p < 0.01, **p < 0.001.
Nationwide Survey Results
86. 86
Estimate (Partial or Complete Adoption) Nationwide
Basic EHR, outpatient 86.6%
Basic EHR, inpatient 50.4%
Basic EHR, both settings 49.8%
Comprehensive EHR, outpatient 10.6%
Comprehensive EHR, inpatient 5.7%
Comprehensive EHR, both settings 5.3%
Order entry of medications, outpatient 96.5%
Order entry of medications, inpatient 91.4%
Order entry of medications, both settings 90.2%
Order entry of all orders, outpatient 88.6%
Order entry of all orders, inpatient 81.7%
Order entry of all orders, both settings 79.4%
Health IT Adoption Estimates
87. 87
• High IT adoption rates
• Drastic changes in adoption landscape
• Local context might play a role
– Supply Side
– Demand Side
• International Comparison
– Relatively higher adoption
THAIS: Discussion
88. 88
Outline
Health & Health Information
Health IT & eHealth
Health Informatics as a Discipline
Thailand’s eHealth Situation
• Current Forces
90. 90
International
• Technology Trends
• Standards & Interoperability Trends
• eHealth Successes & Failures
– UK NHS
– US Meaningful Use
– Nordic Countries
• International eHealth Networks
– International Medical Informatics Association (IMIA)
– American Medical Informatics Association (AMIA)
– Asia eHealth Information Network (AeHIN)
Current Forces
91. 91
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
92. 92
(3) to consider ways for ministries of health and public
health authorities to work with their national representatives
on the ICANN Governmental Advisory Committee in order to
coordinate national positions towards the delegation,
governance and operation of health-related global top-level
domain names in all languages, including “.health”, in the
interest of public health;
http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R24-en.pdf
World Health Assembly Resolution WHA66.24 (2013) on
eHealth Standardization & Interoperability
93. 93
Domestic
• Thailand’s Health Insurance Trends
• Increased Hospital IT Adoption
• Demands for Data & Information Exchange
in Thailand’s Healthcare
• Thailand’s e-Transaction Trends
• Consumer IT Behavior Trends
Current Forces
94. 94
Outline
Health & Health Information
Health IT & eHealth
Health Informatics as a Discipline
Thailand’s eHealth Situation
Current Forces