This document provides an overview of a presentation on ICT in healthcare in Thailand 4.0. It begins with introducing the speaker, Nawanan Theera-Ampornpunt, who has a MD and PhD in health informatics. The presentation then covers various topics including defining what a "smart hospital" is compared to a digital or paperless hospital, healthcare stages from 1.0 to 4.0, and how information technology can help address issues in healthcare like errors, access to information, and fragmentation. The presentation emphasizes that health IT should focus on quality improvement and using standards to enable information exchange and interoperability.

1. ICT in Healthcare:
Thailand 4.0
Nawanan Theera-Ampornpunt
March 9, 2018

2. 2
2003 M.D. (First-Class Honors)
2011 Ph.D. (Health Informatics), Univ. of Minnesota
Assistant Dean for Policy and Informatics
Lecturer, Department of Community Medicine
Faculty of Medicine Ramathibodi Hospital
Mahidol University
Interests: Health IT for Quality of Care, Social Media
IT Management, Security & Privacy
nawanan.the@mahidol.ac.th
SlideShare.net/Nawanan
นวนรรน ธีระอัมพรพันธุ์ (Nawanan Theera-Ampornpunt)
Line ID: NawananT
Introduction

3. 3
 The Road to Digitizing Healthcare
 What is a “Smart Hospital”?
 Toward a “Smart” Hospital
Outline

4. 4
Health &
Health Information

5. 5
Let’s take a look at
these pictures...

6. 6Image Source: https://en.wikipedia.org/wiki/Industrial_robot (KUKA Roboter GmbH)
“Smart” Manufacturing

7. 7
Image Sources: http://isarapost.net/home/?p=17760
http://www.telecomjournalthailand.com/ตอบโจทย์โมเดลทางธุรกิจ/
“Smart” Banking

8. 8ER - Image Source: nj.com
Healthcare (On TV)

9. 9
(At an undisclosed hospital)
Healthcare (Reality)

10. 10
• 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”?

11. 11
But...Are We That Different?
Input Process Output
Transfer
Banking
Value-Add
- Security
- Convenience
- Customer Service
Location A Location B

12. 12
Input Process Output
Assembling
Manufacturing
Raw Materials Finished
Goods
Value-Add
- Innovation
- Design
- QC
But...Are We That Different?

13. 13
Input Process Output
Patient Care
Health care
Sick Patient Well Patient
Value-Add
- Technology & medications
- Clinical knowledge & skilled providers
- Quality of care; process improvement
- Customer service
- Information
But...Are We That Different?

14. 14
• Large variations & contextual dependence
Input Process Output
Patient
Presentation
Decision-
Making
Biological
Responses
Standardizing Healthcare

15. 15
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/

16. 16
Digitizing Healthcare
Image Source: http://www.bloomberg.com/bw/stories/2005-03-27/cover-image-the-digital-hospital

17. 17
“To computerize
the hospital”
“To go paperless”
“To become a
Digital Hospital”
“To Have
EHRs”
Why Adopting Health IT?

18. 18
• “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

19. 19
Being Smart #1:
Stop Your
“Drooling Reflex”!!

20. 20
Being Smart #2:
Focus on Information &
Process Improvement,
Not Technology

21. 21
If not “Digital Hospital”
or “Paperless Hospital”
Then What Should We
Aspire to Be?

22. “Smart Hospital”

23. 23
So How is
a “Smart Hospital”
Different from a Digital or
Paperless Hospital?

24. 24
Healthcare 4.0?

25. 25
Healthcare 1.0
• Thai Traditional Medicine in the Ancient Times
Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health
Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html
http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html
การย่อยขนาดตัวยาสมุนไพร โดยใช้ครกตาและหินบดยา
ของโรงศิริราชพยาบาล (ปัจจุบันคือ โรงพยาบาลศิริราช)
คนไทยสมัยก่อนมักให้บุคคลในครอบครัวบีบนวดได้

26. 26
Healthcare 2.0
• Modern (Western) Medicine
Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health
Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html
http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html

27. 27
Healthcare 3.0
• Quality-Driven Healthcare
Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health
Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html
http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html

28. 28
Healthcare 4.0
• Smart Healthcare & Smart Hospital
Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health
Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html
http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html

29. 29
So What Is
Smart Healthcare?

30. 30
Smart Healthcare For Policymakers?
Image Source: http://healthdata.moph.go.th/kpi/2557/ProvinceKpiTopicListAll.php?provincecode=99

31. 31
Smart Healthcare For Health Promoters?
Image Source: http://www.hiso.or.th/hiso/picture/reportHealth/ThaiHealth2014/thai2014_3.pdf

32. 32
Smart Healthcare For Clinicians?
Image Source: http://www.medscape.com/viewarticle/780298

33. 33
Smart Healthcare For Patients & Consumers?
Image Source: Agence France-Presse/Getty Images

34. 34
So What Exactly Is Smart Healthcare?
Image Source: http://cdn2.hubspot.net/hub/134568/file-1208368053-jpg/6-blind-men-hans.jpg

35. 35
The Road to Digitizing Healthcare
 What is a “Smart Hospital”?
 Toward a “Smart” Hospital
Outline

36. 36
Connecting People to a Healthy Future With
Personalized Care – Kaiser Permanente
https://www.youtube.com/watch?v=gxz9ZVvduGc

37. 37
Back to
something simple...

38. 38
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?

39. 39
• 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

40. 40
Information is Everywhere in Healthcare

41. 41
“Information” in Medicine
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA.
2010 Sep 15;304(11):1227-8.

42. 42
42
WHO (2009)
Components of Health Systems

43. 43
43
WHO (2009)
WHO Health System Framework

44. 44
• 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

45. 45
• Efficient
–Faster care
–Time & cost savings
–Reducing unnecessary tests
• Equitable
–Access to providers & knowledge
• Patient-Centered
–Empowerment & better self-care
Being “Smart” in Healthcare

46. 46
(IOM, 2001)(IOM, 2000) (IOM, 2011)
Landmark Institute of Medicine Reports

47. 47
• 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
Patient Safety

48. 48
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

49. 49
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

50. 50Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital
To Err is Human 2: Memory

51. 51
• Cognitive Errors - Example: Decoy Pricing
The Economist Purchase Options
• Economist.com subscription $59
• Print subscription $125
• Print & web subscription $125
Ariely (2008)
16
0
84
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• Economist.com subscription $59
• Print & web subscription $125
68
32
# of
People
# of
People
To Err is Human 3: Cognition

52. 52
• It already happens....
(Mamede et al., 2010; Croskerry, 2003; Klein,
2005; Croskerry, 2013)
What If This Happens in Healthcare?

53. 53
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

54. 54
• Medication Errors
–Drug Allergies
–Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
Common Errors

55. 55
Being Smart #3:
“To Err is Human”

56. 56
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
Working
Memory
CLINICIAN
Elson, Faughnan & Connelly (1997)
Clinical Decision Making

57. 57
Example of “Alerts & Reminders”
Reducing Errors through “Alerts & Reminders”

58. 58
Why We Need ICT
in Healthcare?
#1: Because information is
everywhere in healthcare

59. 59
Why We Need ICT
in Healthcare?
#2: Because healthcare is
error-prone and technology
can help

60. 60http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf
Fragmented Healthcare

61. 61
Why We Need ICT
in Healthcare?
#3: Because access to
high-quality patient information
should improve care

62. 62
Why We Need ICT
in Healthcare?
#4: Because healthcare at
all levels is fragmented &
in need of process
improvement

63. 63
Documented Values of Health IT
• Guideline adherence
• Better documentation
• Practitioner decision making or
process of care
• Medication safety
• Patient surveillance &
monitoring
• Patient education/reminder

64. 64
Being Smart #4:
Link IT Values to
Quality (Including Safety)

65. 65
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

66. 66
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

67. 67
eHealth  Health IT
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealth & Health IT

68. 68
Health
Information
Technology
Goal
Value-Add
Tools
Health IT: What’s in a Word?

69. 69
Hospital Information System (HIS) Computerized Physician Order Entry (CPOE)
Electronic
Health
Records
(EHRs)
Picture Archiving and
Communication System
(PACS)
Various Forms of Health IT

70. 70
m-Health
Health Information
Exchange (HIE)
Biosurveillance
Telemedicine &
Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc.
Personal Health Records
(PHRs)
Health IT Beyond Hospitals

71. 71
Strategic
Operational
ClinicalAdministrative
LIS
Health Information ExchangeBusiness
Intelligence
Word
Processor
Social
Media
PACS
4 Quadrants of Hospital IT
Personal Health Records
Clinical Decision Support Systems
Computerized Physician Order Entry
Electronic Health Records
Admission-Discharge-Transfer
Master Patient Index
Enterprise Resource Planning
Vendor-Managed Inventory
Customer Relationship Management

72. 72
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

73. 73
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Health Information Exchange

74. 74
My Life-Long Dream...

75. 75WHO & ITU
Achieving Health Information Exchange (HIE)

76. 76
• The Large N Interfaces Problem
N = 2, Interface = 1
# Interfaces = N(N-1)/2
N = 3, Interface = 3
N = 5, Interface = 10
N = 100, Interface = 4,950
Standards: Why?

77. 77
นวนรรน ธีระอัมพรพันธุ์. ตำนำนควำมเชื่อและข้อเท็จจริงเกี่ยวกับมำตรฐำนสำรสนเทศทำงสุขภำพ. ใน: Health
Data Standards Expo: From Reimbursement to Clinical Excellence; 2011 Aug 8-9; Bangkok,
Thailand. Bangkok (Thailand): Mahidol University, Faculty of Medicine Ramathibodi Hospital;
2011 Aug.
http://www.slideshare.net/nawanan/myths-and-truths-on-health-information-standards
Myths & Truths on Standards

78. 78
Myths
• We don’t need standards
• Standards are IT people’s jobs
• We should exclude vendors from this
• We need the same software to share data
• We need to always adopt international
standards
• We need to always use local standards
Theera-Ampornpunt (2011)
Myths & Truths on Standards

79. 79
Being Smart #5:
Go for Systems that Use
Standards, Not a Unified,
Conquer-the-World System
Image Source: http://www.denofgeek.com/movies/avengers/37236/why-loki-was-cut-from-avengers-age-of-ultron

80. 80
The Road to Digitizing Healthcare
What is a “Smart Hospital”?
 Toward a “Smart” Hospital
Outline

81. 81
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/

82. 82Image Source: socialmediab2b.com
Another Smart Machine: IBM’s Watson

83. 83Image Source: englishmoviez.com
Rise of the Machines?

84. 84
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

85. 85
Being Smart #6:
Don’t Replace
Human Users.
Use ICT to Help Them
Perform Smarter & Better.

86. 86
Some Risks of Clinical Decision Support Systems
• Alert Fatigue
Unintended Consequences of Health IT

87. 87
Workarounds
Unintended Consequences of Health IT

88. 88
Being Smart #7:
Health IT Also Have
Risks &
Unintended Consequences

89. 89
Balanced Focus of Informatics
Technology
ProcessPeople

90. 90
Being Smart #8:
Balance Your Focus
(People, Process, Technology)

91. 91
2003 M.D. (First-Class Honors)
2011 Ph.D. (Health Informatics), Univ. of Minnesota
Assistant Dean for Policy and Informatics
Lecturer, Department of Community Medicine
Faculty of Medicine Ramathibodi Hospital
Mahidol University
Interests: Health IT for Quality of Care, Social Media
IT Management, Security & Privacy
nawanan.the@mahidol.ac.th
SlideShare.net/Nawanan
นวนรรน ธีระอัมพรพันธุ์ (Nawanan Theera-Ampornpunt)
Line ID: NawananT
Q&A