The document discusses public health informatics initiatives in Thailand and the United States. It provides an overview of the 2001 U.S. National Agenda for Public Health Informatics, which established recommendations across six areas. Developments since 2001 include HIPAA, the HITECH Act, and meaningful use incentives for EHR adoption. The document also summarizes Thailand's progress, including new governance structures and capacity building efforts. It concludes by emphasizing the need for continued funding, governance, and developing a technical framework and national agenda for public health informatics in Thailand.

1. Toward the National Agenda
for Thailand's Public Health Informatics
Nawanan Theera-Ampornpunt, MD, PhD
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Jan 31, 2012 http://www.slideshare.net/nawanan
1

2. Outline
• Introduction
U.S.
• 2001 National Agenda for PHI
• Developments in the past decade
Thailand
• Progress in PHI and informatics
• The way forward
2

3. Public Health Informatics
• “The systematic application of
information and computer science
and technology to public health
practice, research, and learning”
(Yasnoff et al., 2000)
• “The application of informatics in
areas of public health, including
surveillance, reporting, and health
promotion” (Hersh, 2009)
3

4. Public Health Informatics
Shortliffe (2002)
4

5. Public Health Informatics
Hersh (2009)
5

6. PHI and Clinical Informatics
Individual Population
Health Health
Hospitals Public Health
& Clinics Agencies
Clinical Public Health
Informatics Informatics
EHRs, CPOE, Biosurveillance,
HIS/CIS, HIE, eHealth,
PACS mHealth
6

7. An Agenda for PHI: U.S.
Yasnoff et al. (2001A)
7

8. An Agenda for PHI: U.S.
Origin: AMIA Spring Congress 2001
Yasnoff et al. (2001B)
8

9. An Agenda for PHI: U.S.
6 Breakout Tracks
• Funding & Governance
• Architecture & Infrastructure
• Standards & Vocabulary
• Research, Evaluation, & Best Practices
• Privacy, Confidentiality, & Security
• Training & Workforce
Yasnoff et al. (2001B)
9

10. An Agenda for PHI: U.S.
Output
• 74 recommendations
Two key themes
• Need to engage all stakeholders in
coordinated activities in PHI
• Informatics training is needed
throughout public health workforce
Yasnoff et al. (2001A)
10

11. Some Recommendations
Funding & Governance
• Fund information management as part of the core public
health budget
• Fund vision of information, not IT
• Create diverse funding sources
• Allocate adequate funding throughout IS life cycle
• Dedicated funding for public health IS
• Leadership
• Planning & management structures that include all
stakeholders
• Ensure PH & IT representation in systems planning
• Develop a merged superset of PH & informatics
planning & evaluation models
• Business case for continuing investment in IS and
information architecture
Yasnoff et al. (2001A)
11

12. Some Recommendations
Architecture & Infrastructure
• Provide Internet access & workstations, as well as
software tools, training, and methods for access to data
for public health personnel
• Develop implementation plan for PH information
architecture
• Develop a PH data repository from individual records,
with process for development of its architectural model.
• Establish procedures for monitoring compliance with
audit & evaluation criteria & access control measures in
PH data systems
• [Controversial] Unique patient ID
• Provide effective communication & workflow
management between public health and health care
• Minimize impact of PH data collection on providers
Yasnoff et al. (2001A)
12

13. Some Recommendations
Standards & Vocabulary
• Increase awareness of & participation in standards
development activities within PH workforce
• List of existing standards & standards development groups
• Identify gaps in coverage of existing standards
• Promote consistent use of standards across federal agencies
• Increase use of CDC Public Health Conceptual Data Model
• Develop new standards for public health reporting
• Expansion & maintenance of Dwyer tables for electronic lab
reporting to public health agencies
• Develop model state regulations on reportable diseases
• Develop implementation guidelines for transmitting electronic
lab reporting messages
• Harmonize key guideline formats within HL7
• Create database versions of ICD-9-CM & ICD-10-CM to
facilitate automated mapping of clinical terms for reporting &
billing
Yasnoff et al. (2001A) 13

14. Some Recommendations
Research, Evaluation, and Best Practices
• Process for developing & disseminating of best practices
• Establish standards for performance
• Establish a program to fund demonstration projects on best
practices in privacy protection
• Link evaluation explicitly to the goals of Healthy People 2010
• Standardize outcome measures
• Include data quality, economics, transferability, & individual
measures in evaluations
• Evaluate existing programs
• Develop a research agenda for PHI
• Use existing informatics knowledge & methods in PHI research
• Involve multidisciplinary teams in PHI research
• Include an informatics component in every PH research project
• Provide additional research funds to study PHI
• Establish & fund research agency for privacy & security
Yasnoff et al. (2001A) 14

15. Some Recommendations
Privacy, Confidentiality & Security
• Create a national forum on privacy policy
• Establish community advisory boards for privacy policy
• Creation of public health ethics committees
• Include front-line workers in public health privacy groups
• Develop model wording for PH privacy legislation at all levels
• Develop regulations & policies that are dynamic & based on risk
• Develop policies for cross-jurisdictional exchange of data
• Require all public health data systems to have confidentiality
agreements & privacy board
• Develop model security policies
• Adopt HIPAA security requirements in public health
• Review security preparedness of public health system
• Indirect funding options for security
Yasnoff et al. (2001A) 15

16. Some Recommendations
Training & Workforce
• Establish & strengthen academic programs in PHI
• Develop competency-based continuing education in PHI
• Enhance CDC Public Health Informatics Fellowship Program
• Establish instructional guidelines for PHI curriculum
• Establish curriculum guidelines for PHI in PH programs
• Develop curriculum on data security & privacy
• Establish ethical/legal/social issues program in PHI
• Involve PH groups when developing PHI curricula
• Develop a career track in PHI within informatics
• Encourage PH & informatics people to come together
• Strengthen AMIA’s Prevention & Public Health SIG
• PH & informatics outreach through existing networks
• Support development of core competencies in PHI
• Examine informatics competencies in other health-related fields
• Adapt medical school informatics objectives to PHI
• Define PHI Yasnoff et al. (2001A) 16

17. What Happened Since 2001
• HIPAA regulations went into effect
(2003) and become standard practice
for health information privacy &
security
17

18. What Happened Since 2001
• Creation of the Office of the National
Coordinator for Health IT
(ONCHIT/ONC) to “develop, maintain,
and direct the implementation of a
strategic plan to guide the nationwide
implementation of interoperable
health IT...that will reduce medical
errors, improve quality, and produce
greater value for health care
expenditures” (George W. Bush’s Executive
Order, 2004)
18

19. What Happened Since 2001
David Brailer, MD, PhD
National Coordinator for
Health Information Technology
(2004 - 2007)
Robert Kolodner, MD
National Coordinator for
Health Information Technology
(2006 - 2009)
David Blumenthal, MD, MPP
National Coordinator for
Health Information Technology
(2009 - 2011)
Farzad Mostashari, MD, ScM
National Coordinator for
Health Information Technology
(2011 - Present)
19

20. What Happened Since 2001
ONC Strategic Plan 2008-2012
2 Goals
• Patient-focused Health Care
• Population Health
4 Functional components
• Privacy & Security
• Interoperability
• Adoption
• Collaborative Governance
20

21. What Happened Since 2001
• Regional Health Information
Organizations (RHIOs)
• Health Information Exchange (HIE)
Organizations
• Nationwide Health Information Network
(NHIN)
21

22. 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.”
President George W. Bush
Sixth State of the Union Address
Source: Wikisource.org Image Source: Wikipedia.org
January 31, 2006 22

23. Political Support Behind 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 23

24. What Happened Since 2001
“Meaningful Use”
Incentive Programs for EHRs
24

25. The HITECH Act
Blumenthal (2010) 25

26. Meaningful Use of Health IT
Better
Stage 1
- Electronic capture of
Health
health information
- Information sharing
- Data reporting Stage 3
Stage 2 Use of
EHRs to
Use of improve
EHRs to outcomes
improve
processes of
care
Blumenthal (2010) 26

27. Stage 1 Meaningful Use Criteria
Blumenthal & Tavenner (2010) 27

28. Stage 1 Meaningful Use Criteria
Blumenthal & Tavenner (2010) 28

29. Stage 1 Meaningful Use Criteria
Blumenthal & Tavenner (2010) 29

30. Stage 1 Meaningful Use Criteria
Blumenthal & Tavenner (2010) 30

31. What Happened Since 2001
• AMIA’s Prevention & Public Health
Special Interest Group officially
becomes Public Health Informatics
Working Group*
• PHI competencies developed by CDC
(2002, updated 2007 & 2009)*
• PHI textbook published
(O’Carroll et al., 2003)*
• PHI career track a reality*
• Computers & Internet widely available*
• CIOs at all state public health
agencies*
*From Yasnoff’s PHI 2011 Presentation 31

32. Updated National Agenda
• AMIA 2011 Spring Congress
revised a national PHI agenda
• 5 Tracks
• Ethics
• Technical Framework
• Professional Training & Workforce
Development
• Research & Evaluation
• Sustainability
32

33. An Agenda for PHI: U.S.
Output
• 62 recommendations
(publication forthcoming)
Three key themes
• Promoting effective coordination &
leadership
• Improving consistency of PHI through
common terminologies, evaluation
methodologies & training
• Enhancing communication &
information sharing
Massoudi et al. (AMIA2011) 33

34. An Agenda for PHI: U.S.
Changes from 2001 Recommendations
• Achieved
• Not relevant
• New
• Evolved
Massoudi & Yasnoff (AMIA2011) 34

35. Some Achieved Items
Funding & Governance
• Fund information management as part of the core public
health budget
• Dedicated funding for public health IS
Architecture & Infrastructure
• Provide Internet access & workstations, as well as software
tools, training, and methods for access to data for public
health personnel
Research, Evaluation, and Best Practices
• Use existing informatics knowledge & methods in PHI
research
Training & Workforce
• Enhance CDC Public Health Informatics Fellowship Program
• Establish instructional guidelines for PHI curriculum
• Develop curriculum on data security & privacy
• Strengthen AMIA’s Prevention & Public Health SIG
• Adapt medical school informatics objectives to PHI
Massoudi & Yasnoff (AMIA2011) 35

36. Some New Items
• Public health business processes to guide systems
development and semantic interoperability
• User-centered design
• Ensure sharing of public health systems
• Integrate PHI research into public health training
• Develop & implement innovative PHI training methods
• Skills-based training in PHI evaluation
Ethics track
• Have an ethics research agenda
• Ensure policy demonstrates utility and value for PHI
• Ensure that valid consent processes improve
understanding of benefits as well as risks
Massoudi & Yasnoff (AMIA2011) 36

37. Some Evolved Items
Architecture & infrastructure
• A national process for investment and its governance
• A coordinating agency
• Representatives from national organizations
• Success stories, use cases
• Get PHI into the PH accreditation process
• Promote infrastructure investment
Standards
• Expand PH engagement and standards development,
implementation and maintenance
• Engage in national interoperability initiatives to facilitate
information exchange with PH
• No-cost PH licenses for data and vocabulary standards
• Support data standards life cycle in PH
• Develop tools for mapping across standards & vocabularies
Massoudi & Yasnoff (AMIA2011) 37

38. Some Evolved Items
Competencies, training & workforce
• Keep competencies current and developing
them further into tiers
• Integrate PHI competencies into PH
competencies
• Promote use of these competencies in PHI
training programs
• Create standardized and recognized PHI job
titles and descriptions
• Establish credentialing for PH informaticians
• Develop subspecialties within PHI as the
profession evolves
• Market and promote PHI and informaticians
Massoudi & Yasnoff (AMIA2011) 38

39. What About
Thailand?
39

40. Thailand’s Current Status
Kijsanayotin B, Kasitipradith N, Pannarunothai S.
eHealth in Thailand: the current status. Stud
Health Technol Inform. 2010;160(Pt 1):376-80.
• National policy and strategy on eHealth are
still absent, as is the national eHealth
governance body
• eHealth efforts exist but are largely
fragmented
• Urgent need to close the foundational gaps to
create sustainable eHealth environment
Enabling factors
• Exposure of health practitioners to IT
• Use of some information standards
40

41. Thailand’s Current Status
Recommendations
• Creation of a multi-stakeholder, national
eHealth authority
• Incorporation of eHealth strategy into the
national ICT framework
• Promulgation of health information privacy
legislations
• Development of national health information
standards
• More systematic capacity building
Kijsanayotin et al. (2010) 41

42. Thailand’s New Developments
2011-2012
• Governance & National Leadership
• National Health Information
Committee
• National Health Information
Standards Development
Subcommittee
• Engagement & participation of
diverse stakeholders in informatics
communities & activities
42

43. Thailand’s New Developments
2010-2012
• Capacity Building & Workforce Development
• ICT students with healthcare exposure
(Mahidol University’s ICT & Ramathibodi)
• Biomedical & Health Informatics curricula with
PHI focus (Mahidol University Tropical Medicine)
• Strengthening of Health Informatics program at
Mahidol University Faculty of Public Health
• Healthcare CIO certificate program (Mahidol
University’s Ramathibodi)
• Dental informatics certificate program at MoPH’s
Institute of Dentistry
• Ramathibodi’s Medical Data Standards Expos
• TMI’s more active academic roles
43

44. New Research Findings on
Health IT Adoption
Estimate (Partial or Complete Nationwide
Adoption)
Basic EHR, combined inpatient 49.8%
& outpatient settings
Comprehensive EHR, 5.3%
combined
order entry of medications, 90.2%
combined
order entry of all orders, 79.4%
combined
Definitions | Estimates
Theera-Ampornpunt (2011, unpublished) 44

45. The Way Forward
Image Source: Smiletemplates.com 45

46. The Way Forward
• Funding & Governance
• $$$
• Unified national leadership with full
stakeholder representation
• A dialogue toward “PHI National
Agenda”?
• Technical Framework
• Architecture & Infrastructure
• Vision & Enterprise Architecture for
“ThaiHIE”
46

47. The Way Forward
• Technical Framework
• Standards & Vocabulary
• Gap identification
• Selection & development of
necessary standards
• Education & awareness building
• Privacy & Security
• Review & revise health information
privacy law
• Education & best practices
47

48. The Way Forward
• Research & Evaluation
• Research agenda
• Systematic support for new research
in Thailand’s context
• “Translation” of knowledge from global
health communities to Thailand’s local
settings
• A cluster of informatics academicians
48

49. The Way Forward
• Training & Workforce
• Strengthening of existing programs
• Development of new programs with a
different focus (clinical informatics?)
• Clear career path
• More formally trained informaticians!!
• Most importantly:
• Facilitation of inter-institutional
collaboration drawing strengths from
various programs for mutual benefits
• As opposed to a “race to the bottom”
49

50. Image Source: http://mortgageloans.com.ng/files/2011/05/WayForward.jpg 50

51. 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.
• Hersh W. A stimulus to define informatics and health information
technology. BMC Med Inform Decis Mak. 2009;9:24.
• Kijsanayotin B, Kasitipradith N, Pannarunothai S. eHealth in Thailand:
the current status. Stud Health Technol Inform. 2010;160(Pt 1):376-80.
• Shortliffe EH. JBI status report. Journal of Biomedical Informatics. 2002
Oct;35(5-6):279–80.
• Theera-Ampornpunt N. Thai hospitals' adoption of information
technology: a theory development and nationwide survey
[dissertation]. Minneapolis (MN): University of Minnesota; 2011 Dec.
376 p.
• Yasnoff WA, O’Carroll PW, Koo D, Linkins RW, Kilbourne EM. Public
health informatics: improving and transforming public health in the
information age. J Public Health Manag Pract. 2000 Nov;6(6):67–75.
• Yasnoff WA, Overhage JM, Humphreys BL, LaVenture M. A national
agenda for public health informatics: summarized
recommendations from the 2001 AMIA Spring Congress. J Am Med
Inform Assoc. 2001 Dec;8(6):535–45.
• Yasnoff WA, Overhage JM, Humphreys BL, LaVenture M, Goodman KW,
Gatewood L, et al. A national agenda for public health informatics. J
Public Health Manag Pract. 2001 Nov;7(6):1–21. 51