This document discusses eHealth in Thailand and the road ahead. It summarizes that eHealth adoption in Thailand is high but siloed, with a lack of integration and interoperability. Standards development is underway but incomplete. The road ahead involves addressing gaps in national leadership, workforce shortages, accelerating standards development, integrating applications, and growing local informatics research. Overall eHealth can be a key component of Thailand's healthcare system if these challenges are addressed.

1. eHealth: The Next Building Block for
Thailand’s Healthcare System
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Faculty of Medicine Ramathibodi Hospital
Mahidol University, Thailand
June 13, 2014
www.SlideShare.net/Nawanan

2. 2
Introduction
2003 M.D. (First-Class Honors) (Ramathibodi)
2009 M.S. in Health Informatics (U of MN)
2011 Ph.D. in Health Informatics (U of MN)
2012 Certified HL7 CDA Specialist
•Deputy Executive Director for Informatics (CIO/CMIO)
Chakri Naruebodindra Medical Institute
•Lecturer, Department of Community Medicine
Faculty of Medicine Ramathibodi Hospital
Mahidol University
nawanan.the@mahidol.ac.th

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Outline
• Needs for better information in healthcare
• eHealth as a health system's component
• Thailand's eHealth situation
• The road ahead for Thailand's eHealth

4. 4
Needs for
Better Information
in Healthcare

5. 5
“Information” in Medicine
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA.
2010 Sep 15;304(11):1227-8.

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Needs for Better Information
• Good information needed for quality care
– Past and present history
– Medication list
– Problem list
– Allergies
– Lab & imaging results
• Information gaps prevalent in healthcare
settings (e.g. Stiell A et al. CMAJ. 2003;169:1023-8.)

7. 7http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf
Fragmented Healthcare

8. 8
(IOM, 2001)(IOM, 2000) (IOM, 2011)
Landmark IOM Reports

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• 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

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

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Back to
something simple...

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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?

13. 13
The Question Becomes...
How do we deliver better
information, by supplementing
human clinicians with ICT, so that
they make less errors and
perform better?

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Outline
Needs for better information in healthcare
• eHealth as a health system's component
• Thailand's eHealth situation
• The road ahead for Thailand's eHealth

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eHealth as a
Health System
Component

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16
WHO (2009)
Components of Health Systems

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17
WHO (2009)
WHO Health System Framework

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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

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 All components are essential
 All components should be balanced
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealth Components: WHO-ITU Model

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Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Goal: Health Information Exchange

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Outline
Needs for better information in healthcare
eHealth as a health system's component
• Thailand's eHealth situation
• The road ahead for Thailand's eHealth

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Thailand’s
eHealth Situation

23. 23
eHealth in Thailand: The current status. Stud Health Technol Inform
2010;160:376–80, Presented at MedInfo2010 South Africa
Thailand’s eHealth: 2010

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 All components are essential
 All components should be balanced
Slide adapted from: Dr. Boonchai Kijsanayotin
Recalling eHealth Components

25. 25Slide adapted from: Dr. Boonchai Kijsanayotin
Thailand: Unbalanced Development

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 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
Boonchai Kijsanayotin et al. (2010)
Thailand’s eHealth Situation

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eHealth Components

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Nationwide survey on hospital IT
adoption conducted in 2011
THAIS: Thai Hospitals’ Adoption
of Information Technology
Survey
Self-administered paper-based
survey mailed to 1,298 hospitals
in Thailand
Thailand’s Hospital IT Adoption

29. 29Pongpirul et al., 2004
Vendor/Product Distribution (2004)

30. 30Theera-Ampornpunt, 2011
Vendor/Product Distribution (2011)

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Estimate (Partial or Complete
Adoption)
Nationwide
Basic EHR, outpatient 86.6%
Basic EHR, inpatient 50.4%
Basic EHR, both settings 49.8%
Order entry of medications,
outpatient
96.5%
Order entry of medications, inpatient 91.4%
Order entry of medications, both
settings
90.2%
Hospital IT Adoption Estimates

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• High IT adoption rates
• Drastic changes in adoption landscape
• Adequate infrastructure for information
exchange
• Next question is on interoperability
THAIS: Discussion

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eHealth Components

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Existing Standards in Thailand
Standards National
1. Core data set standards 12 & 18 files standards
2. Semantic standards Personal ID,
Provider ID
ICD-10-TM, ICD-9-CM
3. Syntactic standards X
4. Security and privacy standards X
Existing Standards in Thailand
Slide adapted from: Dr. Boonchai Kijsanayotin

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Standards National
1. Core data set standards Referral, Chronic Diseases
2. Semantic standards
Drug Terminology (TMT),
SNOMED-CT
Lab Code (LOINC)
Providers IDs
3. Syntactic standards HL7 Messaging, CDA
4. Security and privacy
standards
X
Standards Being Explored/Developed
Slide adapted from: Dr. Boonchai Kijsanayotin

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Thai Health Information Standards
Development Center
www.this.or.th
http://www.facebook.com/thishsri
this@this.or.th
Standards Development Organization
Slide adapted from: Dr. Boonchai Kijsanayotin

37. 3737
eHealth & e-Transactions

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• HL7 Certified Specialists
Kevin
Asavanant
HL7 V3 RIM (2009)
Supachai
Parchariyanon
HL7 CDA (2010)
Nawanan
Theera-Ampornpunt
HL7 CDA (2012)
38
Sireerat
Srisiriratanakul
HL7 V3 RIM (2013)
Capacity Building on Standards

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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

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eHealth Components
40

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• Certificate & Diploma Level
• Undergraduate Level
• Graduate Level
41
Informatics Workforce Programs

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Faculty of Medicine Ramathibodi Hospital, Mahidol University
http://med.mahidol.ac.th/has/42
Healthcare CIO Certificate Program

43. 43Faculty of Tropical Medicine, Mahidol University43
Diploma & Master Graduates in Biomedical &
Health Informatics, First Batch

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• In January 2013, the Thai Medical
Informatics Association (TMI) approved
establishment of the “Biomedical and
Health Informatics Education Special
Interest Group” within TMI (BHI-ED-SIG)
44
Informatics Education SIG

45. 4545
TMI CIO Forum

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• International Medical Informatics
Association (IMIA)
– MEDINFO & APAMI
• HIMSS AsiaPac
• Asia eHealth Information Network (AeHIN)
• American Medical Informatics Association
(AMIA)
46
Internationalization

47. 47http://www.aehin.org/Meetings/2013AeHINGeneralMeeting.aspx47
Participation in AeHIN

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Outline
Needs for better information in healthcare
eHealth as a health system's component
Thailand's eHealth situation
• The road ahead for Thailand's eHealth

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The Road Ahead for
Thailand’s eHealth

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• Addressing
– Lack of national leadership & governance,
strategy & investment, policy & regulation
– Shortage of informatics workforce
– Accelerating standards development
– Harmonizing applications
– Facilitating local research in informatics
50
The Road Ahead

51. 51Image Source: http://twinstrivia.com/2013/05/20/the-road-to-minnesota-is-long-and-hard/
The Journey Beyond

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But We’ll Get There...