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.

1. Global or
Glocal eHealth
Approaches in
Asia:
What is New
or Next?
Nawanan Theera-Ampornpunt, MD, PhD

2. The Need for eHealth & Health IT
“...Our recovery plan will
invest in electronic health
records and new technology
that will reduce errors, bring
down costs, ensure privacy,
and save lives.”
President Barack Obama
Address to Joint Session of Congress
February 24, 2009

3. WHO Health Systems Framework
From a slide by Dr.Boonchai Kijsanayotin (2012)

4. U.S. eHealth Developments
2011
2009
2004
ONCHIT
2000-2001 HITECH Act
“Meaningful Use”
1991

5. The HITECH Act
Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5.

6. “Meaningful Use” of Health IT
Stage 1
- Electronic capture of Better
health information
- Information sharing Health
- Data reporting Stage 3
Stage 2 Use of
EHRs to
Use of improve
EHRs to outcomes
improve
processes of
care
Blumenthal (2010)

7. U.S. Health IT Adoption
U.S. Ambulatory Setting
100
90
% of Physicians
80
70
60
50
48.3 50.7
34.8 42.0
23.9 29.2
40
30 24.9
18.2 17.3 17.3 20.8 16.9 21.8
20
9.3 10.5 11.8
10
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year of Study
Any EHR EHR with Basic Features
Basic Features: Demographics, problem lists, clinical notes, test results, imaging results, order
entry for medications
Source: National Ambulatory Medical Care Survey (NAMCS) 2001-2010

8. U.S. Health IT Adoption
U.S. Inpatient Setting
2008 2009
Basic EHRs 7.2% 9.2%
Comprehensive EHRs 1.5% 2.7%
Computerized 17% 34%
Order Entry for Medications
Definitions
Sources: Jha et al., 2009 & 2010

9. U.S. Health Information Exchange
• Regional Health Information Organizations
(RHIOs)
• State eHealth Initiatives
• Nationwide Health Information Network
(NwHIN)

10. WHO Global Observatory for eHealth
Development Model
From a slide by Dr.Boonchai Kijsanayotin (2012)

11. Thailand’s eHealth Status
Foundation Policies & Strategies Uptake
1. National eGovernment policy & strategy √ ICT2010
2. National eHealth policy & strategy X
3. National eHealth governance body X
3. Funding Public,
No Private
4. Public & Private partnership +
5. Infrastructure ++
Kijsanayotin et al. (2010)

12. Thailand’s Status Summary
• Widespread access to and use of ICT
• Various eHealth applications but
– Poorly integrated and unsystematic
– Not standardized
– Not interoperable
• Lack of investment and groundwork for
eHealth infrastructure
Kijsanayotin et al. (2010)

13. Recommendations
• Establish a multi-stakeholder national-
level eHealth governing authority
• eHealth strategy should be
incorporated into other ICT frameworks
• Enact laws to protect health
information privacy and security
• Develop national health information
standards
• Capacity building
Kijsanayotin et al. (2010)

14. Thailand’s National eHealth Body
National Health Commission
National Health Information
Committee
National Health Information
Standards Subcommittee
From a slide by Dr.Boonchai Kijsanayotin (2012)

15. Thailand’s Health IT Adoption
Estimate Nationwide
(Partial or Complete Adoption)
Basic EHR, combined inpatient & 49.8%
outpatient settings
Comprehensive EHR, combined 5.3%
order entry of medications, combined 90.2%
order entry of all orders, combined 79.4%
Definitions | Estimates

16. Thailand’s
Health Information Exchange
• Most exchange occurs for mandated
claims and reimbursements
• Limited exchange for clinical purposes
in some provinces
• Mostly not based on standards but
rather use of the same health IT
products
• No push from government toward HIE
Kijsanayotin et al. (2010)

17. Summary (1)
United States Thailand
• Decades of awareness • Relatively short period of
building, advocacy, and interest & attention on
research & development eHealth
on eHealth
• Strong national • National governance
governance body body recently established
• eHealth an integral part of • eHealth not yet part of
national policy & agenda national policy & agenda

18. Summary (2)
United States Thailand
• Large funding with • Little funding and
incentives and systematic incentives for eHealth
efforts and no systematic
approaches
• Growing but still • Adoption estimates
suboptimal health IT indicate an encouraging
infrastructure level of infrastructure
• Strong capacity building • Extremely limited high-
efforts quality workforce training
in health informatics

19. Summary (3)
• Local contexts differ for different
countries but lessons from other
countries are important
• National leadership, strong
governance, and raising eHealth to
the national policy level create a
critical momentum for HIE

20. http://oilersnation.com/2011/12/28/the-long-winding-road-trip-to-a-close-team