Presented at the Siriraj International Conference in Medicine and Public Health 2016: Innovation in Health, Faculty of Medicine Siriraj Hospital, Mahidol University on June 13, 2016

1. Digital Health in
Thailand & Asia Pacific:
Current Situation & Future
Nawanan Theera-Ampornpunt
June 13, 2016

2. 2
 The Road to Digitizing Healthcare
 Being “Smart” in Digitizing Health
 eHealth Situation in Thailand
Outline

3. 3
Digitizing Health

4. 4
While thinking about the slow
pace of eHealth
Let’s take a look at
these pictures...

5. 5Image Source: https://en.wikipedia.org/wiki/Industrial_robot (KUKA Roboter GmbH)
“Smart” Manufacturing

6. 6
Image Sources: http://isarapost.net/home/?p=17760
http://www.telecomjournalthailand.com/ตอบโจทย์โมเดลทางธุรกิจ/
“Smart” Banking

7. 7ER - Image Source: nj.com
Healthcare (On TV)

8. 8
(At an undisclosed hospital)
Healthcare (Reality)

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 (Yet) “Smart”?

10. 10
• Large variations & contextual dependence
Input Process Output
Patient
Presentation
Decision-
Making
Biological
Responses
Standardizing Healthcare

11. 11
The World of Smart Machines
Image Sources: http://www.ibtimes.com/google-deepminds-alphago-
program-defeats-human-go-champion-first-time-ever-2283700
http://deepmind.com/

12. 12
Digitizing Healthcare
Image Source: http://www.bloomberg.com/bw/stories/2005-03-27/cover-image-the-digital-hospital

13. 13
“To computerize
the hospital”
“To go paperless”
“To become a
Digital Hospital”
“To have
EHRs”
Why Adopting Health IT?

14. 14
• “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

15. 15
Being Smart #1:
Stop Your
“Drooling Reflex”!!

16. 16
Being Smart #2:
Focus on Information &
Process Improvement,
Not Technology

17. 17
The key is not
“Digital Health”
but rather...

18. “Smart Health”

19. 19
The Road to Digitizing Healthcare
 Being “Smart” in Digitizing Health
 eHealth Situation in Thailand
Outline

20. 20
Microsoft Health Future Vision
https://www.microsoft.com/en-us/download/details.aspx?id=12801

21. 21
Connecting People to a Healthy Future With
Personalized Care – Kaiser Permanente
https://www.youtube.com/watch?v=gxz9ZVvduGc

22. 22
Back to
something simple...

23. 23
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?

24. 24
• 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

25. 25
Information is Everywhere in Healthcare

26. 26
26
WHO (2009)
Components of Health Systems

27. 27
27
WHO (2009)
WHO Health System Framework

28. 28
• Safe
–Drug allergies
–Medication Reconciliation
• Timely
–Complete information at point of
care
• Effective
–Better clinical decision-making
Image Source: http://www.flickr.com/photos/childrensalliance/3191862260/
Being “Smart” in Healthcare

29. 29
• Efficient
–Faster care
–Time & cost savings
–Reducing unnecessary tests
• Equitable
–Access to providers & knowledge
• Patient-Centered
–Empowerment & better self-care
Being “Smart” in Healthcare

30. 30
(IOM, 2001)(IOM, 2000) (IOM, 2011)
Landmark Institute of Medicine Reports

31. 31
Summary of These Reports
• 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

32. 32
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

33. 33Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital
To Err is Human 2: Memory

34. 34
• Medication Errors
–Drug Allergies
–Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
Common Errors

35. 35
Documented Values of Health IT
• Guideline adherence
• Better documentation
• Practitioner decision making or
process of care
• Medication safety
• Patient surveillance &
monitoring
• Patient education/reminder

36. 36
Being Smart #3:
Link IT Values to
Quality (Including Safety)

37. 37
Health
Information
Technology
Goal
Value-Add
Tools
Health IT: What’s in a Word?

38. 38
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Ultimate Goal: Connected Health

39. 39
A Smart Machine: DeepMind
Image Sources: http://www.ibtimes.com/google-deepminds-alphago-
program-defeats-human-go-champion-first-time-ever-2283700
http://deepmind.com/

40. 40Image Source: englishmoviez.com
Rise of the Machines?

41. 41Image Source: amazon.com
Smart Phones, Dumb People?

42. 42
Smart Hospital,
Dumb Users?
It shouldn’t be that way...

43. 43
Clinical Decision Support Systems
• CDSS 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

44. 44
Being Smart #4:
Don’t Replace
Human Users.
Use ICT to Help Them
Perform Smarter & Better.

45. 45
The Road to Digitizing Healthcare
Being “Smart” in Digitizing Health
 eHealth Situation in Thailand
Outline

46. 46
Kijsanayotin B, et al. eHealth in Thailand: The current status. Stud Health Technol Inform
2010;160:376–80. 46
Thailand’s eHealth: 2010

47. 47WHO & ITU
eHealth Components (WHO-ITU Model)

48. 48
Strategy&Investment
Standards & Interoperability
Infrastructure
Services, Applications Software
Leadership & governance
Legislation,policy&compliance
Workforce
Thailand eHealth:
Unbalanced Development
Kijsanayotin B

49. 49
Thailand eHealth: Shaky Foundations
eHealth Applications
Enabling Policies
and Strategies
Foundation
Policies and
Strategies
Kijsanayotin B

50. 50
 eHealth Governance Body
 Standards & Interoperability
 Healthcare-Specific Privacy Laws
 Adequate eHealth Workforce
Proposed Actions
Kijsanayotin B, et al. eHealth in Thailand: The current status. Stud Health Technol Inform
2010;160:376–80.

51. 51
Thailand’s eHealth: 2016

52. 52
Asia Pacific eHealth Efforts
Asia eHealth Information Network (AeHIN) Meetings
Health Information
Management Systems Society
(HIMSS) Asia Pacific Conferences

53. 53
• Piggyback on national agenda (e.g. Digital
Economy)
• Use WHO-ITU model as a guide
• Start with national eHealth governance
• Identify how IT adds value in healthcare
• Standards over apps
• Recognize value of “humans”
• Walk together with neighbors
How Should We Move Forward?

54. 54
• “Digital Health” doesn’t mean the goal is
digitizing everything. Rather, it means
Smart Health: using ICT smartly to
improve quality of care.
• Thailand is moving toward “Digital
Health”, slowly....
• Regional efforts are instrumental in
national progress
Summary

55. 55
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Contacts
nawanan.the@mahidol.ac.th
www.tc.umn.edu/~theer002
Nawanan Theera-Ampornpunt
Line ID: NawananT
Q & A