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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
Public Health Informatics, Consumer Health Informatics, mHealth & Personal He...Nawanan Theera-Ampornpunt
Presented at the Health Informatics and Health Information Technology Course, Doctor of Philosophy and Master of Science Programs in Data Science for Health Care (International Program), Faculty of Medicine Ramathibodi Hospital, Mahidol University on October 24, 2017
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.
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Theera-Ampornpunt N. Informatics in emergency medicine: a brief introduction. In: The International Conference in Emergency Medicine: Challenges in Emergency Medicine: It’s Time for Change!; 2012 Jan 30 - Feb 1; Bangkok, Thailand. Bangkok (Thailand): Mahidol University, Faculty of Medicine Ramathibodi Hospital; 2012 Feb.
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
Public Health Informatics, Consumer Health Informatics, mHealth & Personal He...Nawanan Theera-Ampornpunt
Presented at the Health Informatics and Health Information Technology Course, Doctor of Philosophy and Master of Science Programs in Data Science for Health Care (International Program), Faculty of Medicine Ramathibodi Hospital, Mahidol University on October 24, 2017
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.
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 7, 2020
Theera-Ampornpunt N. [Electronic Health Records: What Does The HITECH Act Teach Thailand?]. Presented at: Health Informatics: From Standards to Practice. Thai Medical Informatics Association Annual Conference 2010; 2010 Nov 10-12; Nonthaburi, Thailand. Panel discussion, in Thai.
Theera-Ampornpunt N. Informatics in emergency medicine: a brief introduction. In: The International Conference in Emergency Medicine: Challenges in Emergency Medicine: It’s Time for Change!; 2012 Jan 30 - Feb 1; Bangkok, Thailand. Bangkok (Thailand): Mahidol University, Faculty of Medicine Ramathibodi Hospital; 2012 Feb.
Clinical Information Systems and Electronic Health Records (October 18, 2021)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 October 18, 2021
Introduction to Health Informatics and Health Information Technology (Part 1)...Nawanan Theera-Ampornpunt
Presented at the Health Informatics and Health Information Technology Course, Doctor of Philosophy and Master of Science Programs in Data Science for Health Care (International Program), Faculty of Medicine Ramathibodi Hospital, Mahidol University on October 3, 2017
Theera-Ampornpunt N. Medical informatics: a look from USA to Thailand. In: Ramathibodi’s Fourth Decade: Best Innovation to Daily Practice; 2009 Feb 10-13; Nonthaburi, Thailand [CD-ROM]. Bangkok (Thailand): Mahidol University, Faculty of Medicine Ramathibodi Hospital; 2009. 1 CD-ROM: 4 3/4 in.
Information Technology Management in Healthcare Organizations: Part 2 (Octobe...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 October 20, 2021
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Presented at the Health Informatics and Health Information Technology Course, Doctor of Philosophy and Master of Science Programs in Data Science for Health Care (International Program), Faculty of Medicine Ramathibodi Hospital, Mahidol University on October 3, 2017
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
Introduction to Health Informatics and Health IT (Part 1) (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 7th Healthcare CIO Certificate Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on August 11, 2016
Public Health informatics, Consumer health informatics, mHealth & PHRs (Novem...Nawanan Theera-Ampornpunt
Presented at the M.S. and Ph.D. Programs in Data Science for Health Care, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 11, 2019
Presented at the 8th Healthcare CIO Certificate Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 21, 2018
Clinical Information Systems and Electronic Health Records (October 18, 2021)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 October 18, 2021
Introduction to Health Informatics and Health Information Technology (Part 1)...Nawanan Theera-Ampornpunt
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Theera-Ampornpunt N. Medical informatics: a look from USA to Thailand. In: Ramathibodi’s Fourth Decade: Best Innovation to Daily Practice; 2009 Feb 10-13; Nonthaburi, Thailand [CD-ROM]. Bangkok (Thailand): Mahidol University, Faculty of Medicine Ramathibodi Hospital; 2009. 1 CD-ROM: 4 3/4 in.
Information Technology Management in Healthcare Organizations: Part 2 (Octobe...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 October 20, 2021
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Public Health informatics, Consumer health informatics, mHealth & PHRs (Novem...Nawanan Theera-Ampornpunt
Presented at the M.S. and Ph.D. Programs in Data Science for Health Care, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 11, 2019
Presented at the 8th Healthcare CIO Certificate Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 21, 2018
Presented at Healthcare CIO Certificate Program (Class of 2015), Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on August 14, 2015
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EHRs, PHRs, EMRs: Making Sense of the Alphabet SoupCHI*Atlanta
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∙ To offer frameworks and paradigms to better understand how EHRs and other HIT can improve population health
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Public Health Informatics, Consumer Health Informatics, mHealth & PHRs
1. Nawanan Theera-Ampornpunt, M.D., Ph.D.
For Ramathibodi M.S. & Ph.D. Programs in
Data Science for Health Care
Oct. 25, 2018 SlideShare.net/Nawanan
Except where
citing other works
2. Stakeholders in Health Care
Patient
Providers
Policy-
Makers
Public
Payers
Diagram modified from Supachai Parchariyanon’s 4Ps Concept
• High bargaining
power
• Benefit with
improved quality in
fee-for-service
• Needs to satisfy many “bosses”
• Faces up-front costs in health IT
investments
• Long-term benefits depend on
payment schemes
• Require data for
policy-making
• Limited budget
• Often face
bureaucracies
• Highly political
• Concerns about resource allocation &
community’s well-being, but not
necessarily individual patients
• Directly benefits from
improved quality of care
• Knowledge gap between
patient & providers
5. Public Policy in Informatics: A US’s Case
1991: IOM’s CPR Report published
1996: HIPAA enacted
2000-2001: IOM’s To Err Is Human &
Crossing the Quality Chasm published
2004: George W. Bush’s Executive
Order establishing ONCHIT (ONC)
2009-2010: ARRA/HITECH Act &
“Meaningful use” regulations
6. Political Support Behind Health IT
“...We will make wider use of electronic records and other
health information technology, to help control costs and
reduce dangerous medical errors.”
Source: Wikisource.org Image Source: Wikipedia.org
President George W. Bush
Sixth State of the Union Address
January 31, 2006
?
7. U.S. Adoption of Health IT
• U.S. lags behind other Western countries
(Schoen et al, 2006;Jha et al, 2008)
• Money and misalignment of benefits is the
biggest reason
Ambulatory(Hsiao et al, 2009) Hospitals (Jha et al, 2009)
Basic EHRs w/ notes 7.6%
Comprehensive EHRs 1.5%
CPOE 17%
8. President Obama Backs 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
Source: WhiteHouse.gov
9. American Recovery & Reinvestment Act
Contains HITECH Act
(Health Information Technology for
Economic and Clinical Health Act)
~ 20 billion dollars for Health IT investments
Incentives & penalties for providers
10. U.S. National Leadership
David Blumenthal, MD, MPP
National Coordinator for
Health Information
Technology
(2009 - 2011)
Farzad Mostashari, MD, ScM
National Coordinator for
Health Information Technology
(2011 - 2013)
Robert Kolodner, MD
National Coordinator for
Health Information Technology
(2006 - 2009)
David Brailer, MD, PhD
National Coordinator for
Health Information Technology
(2004 - 2007)
Office of the National Coordinator for Health Information
Technology (ONC -- formerly ONCHIT)
Photos courtesy of U.S. Department of Health & Human Services
Karen B. DeSalvo, MD, MPH,
MSc
National Coordinator for
Health Information Technology
(2014 - 2016)
Vindell Washington, MD, MHCM
National Coordinator for
Health Information Technology
(2016 - Present)
11. What is in HITECH Act?
Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5.
13. “Meaningful Use” of Health IT
Stage 1
- Electronic capture of
health information
- Information sharing
- Data reporting
Stage 2
Use of
EHRs to
improve
processes of
care
Stage 3
Use of
EHRs to
improve
outcomes
Better
Health
(Blumenthal D, 2010)
15. Health Information Exchange in the U.S.
Regional Health Information Organizations
(RHIOs)
State e-Health initiatives
Nationwide Health Information Network
(NHIN)
Still ongoing efforts, but with significant
progress
16. Other Public Health Informatics Applications
e-Health & m-Health
m-Health in disaster management: #ThaiFlood
Data reporting to government agencies
Claims & reimbursements
Diseases
Utilization statistics
Quality measures
etc.
Biosurveillance (case reporting vs. predictive)
Epidemiologic & health services research
22. Examples of Areas within
Consumer Health Informatics
Image Source: http://www.webmd.com/
23. Examples of Areas within
Consumer Health Informatics
Image Source: http://www.greatdreams.com/cancer-cure.htm
24. Examples of Areas within
Consumer Health Informatics
Image Source: http://www.hon.ch/, http://socialmarketing.blogs.com/r_craiig_lefebvres_social/2007/02/health_literacy.html
25. Examples of Areas within
Consumer Health Informatics
Image Source: http://michaelcarusi.com/2012/01/01/when-you-should-not-become-a-social-media-manager/
26. Examples of Areas within
Consumer Health Informatics
Image Source: http://ucedtech.wikispaces.com/Welcome
28. Defining mHealth (mobile health)
WHO: “Medical and public health practice supported by
mobile devices, such as mobile phones, patient monitoring
devices, PDAs, and other wireless devices. mHealth involves
the use and capitalization on a mobile phone’s core utility
of voice and SMS as well as more complex functionalities
and applications including GPRS, 3G & 4G systems, GPS, and
Bluetooth technology.”
29. mHealth
http://whqlibdoc.who.int/publications/2011/9789241564250_eng.pdf
Majority of Member States reported
offering at least one type of mHealth
service. Many offered 4-6 programmes.
Frequently reported mHealth initiatives
were:
Health call centres (59%)
Emergency toll-free telephone services
(55%)
Managing emergencies and disasters (54%)
Mobile telemedicine (49%)
30. mHealth
Barriers to mHealth adoption by
countries
Competing health system priorities
Lack of evidence on evaluation
Results-based evaluation of mHealth
implementations is not routinely
conducted (only 12% of Member
States)
Data security
http://whqlibdoc.who.int/publications/2011/9789241564250_eng.pdf
31. Examples of Areas within
Consumer Health Informatics
Image Source: http://nutrition.about.com/od/recipesmenus/ss/learnlabels.htm
33. Roles of ICT in Consumer Health Informatics
Access to information
Networking opportunities
Education/Self-study
Personalization
Effective & efficient communications
With providers
Among patients
Empowerment
“User Experience”
34. Issues in Consumer Health Informatics
Health literacy & IT literacy
Cultural diversity & sensitivity
Usability, information presentation
Impact of ICT on behavioral modifications
Integration with provider’s systems
Information exchange & interoperability
Business model
Privacy & security
35.
36. Personal Health Records (PHRs)
“An electronic application through which individuals can
access, manage and share their health information, and that
of others for whom they are authorized, in a private, secure,
and confidential environment.” (Markle Foundation, 2003)
“A PHR includes health information managed by the
individual... This can be contrasted with the clinician’s record
of patient encounter–related information [a paperchart or
EHR], which is managed by the clinician and/or health care
institution.” (Tang et al., 2006)
37. Types of PHRs
Patient portal from a provider’s EHRs
(“tethered” PHRs)
Online PHRs
Stand-alone
Can be integrated with EHRs from multiple providers
(unidirectional/bidirectional data sharing)
Stand-alone PHRs
PC-based applications
USB Drive
CD-ROM or other data storage devices
Paper
39. Ideal PHRs
Integrated
Accessible
Secure
Comprehensive
Accurate & current
Patient able to
manage sharing &
update information
Engaging &
educational
User-friendly,
culturally & literacy
appropriate
The “Hub and Spoke” Model
(Kaelber et al., 2008)
40. Use Cases of PHRs
Data entry/update by patients
Data retrieval by providers
With patient’s consent
“Break-the-glass” emergency access
Data update from EHRs
Privacy settings
Personalized patient education
Communications with providers
42. Other IT for Consumer Health
Traditional Web
MedlinePlus
Other sites
Social Media
The Usuals: MySpace, Facebook, Twitter
Blogs, forums
PatientsLikeMe
Telemedicine & Telehealth
Home monitoring/recording devices
Tele-consultations, virtual visits
http://media.nstda.or.th/video/viewVideo.php?video_id=1273
43. Connecting People to a Healthy Future With
Personalized Care – Kaiser Permanente
https://www.youtube.com/watch?v=gxz9ZVvduGc
44. More “Future Vision”...
Microsoft Health: Future Vision
http://www.microsoft.com/showcase/en/us/details/b112da1c-c918-
41ee-bb45-d6a553496168
NECTEC’s Smart Health
http://media.nstda.or.th/video/viewVideo.php?video_id=1273
45. References
Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5.
Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health
records. N Engl J Med. 2010 Aug 5;363(6):501-4.
Connecting for Health. The personal health working group final report. Markle
Foundation; 2003 Jul 1.
Hsiao C, Beatty PC, Hing ES, Woodwell DA. Electronic medical record/electronic health
record use by office-based physicians: United States, 2008 and preliminary 2009
[Internet]. 2009 [cited 2010 Apr 12]; Available from:
http://www.cdc.gov/nchs/data/hestat/emr_ehr/emr_ehr.pdf
Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A,
Rosenbaum S, Blumenthal D. Use of electronic health records in U.S. hospitals. N Engl
J Med. 2009;360(16):1628-38.
Kaelber DC, Jha AK, Johnston D, Middleton B, Bates DW. A research agenda for
personal health records (PHRs). J Am Med Inform Assoc. 2008 Nov-Dec;15(6):729-36.
Schoen C, Osborn R, Huynh PT, Doty M, Puegh J, Zapert K. On the front lines of care:
primary care doctors’ office systems, experiences, and views in seven countries. Health
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