Digital Health in

Thailand & Asia Pacific:

Current Situation & Future

Nawanan Theera-Ampornpunt

June 13, 2016

2

The Road to Digitizing Healthcare

Being “Smart” in Digitizing Health

eHealth Situation in Thailand

Outline

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Digitizing Health

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While thinking about the slow pace of eHealth

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

5Image Source: https://en.wikipedia.org/wiki/Industrial_robot (KUKA Roboter GmbH)

“Smart” Manufacturing

6Image Sources: http://isarapost.net/home/?p=17760

http://www.telecomjournalthailand.com/ตอบโจทยโ์มเดลทางธรุกจิ/

“Smart” Banking

7ER - Image Source: nj.com

Healthcare (On TV)

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(At an undisclosed hospital)

Healthcare (Reality)

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• 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”?

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• Large variations & contextual dependence

Input Process Output

Patient Presentation

Decision-Making

Biological Responses

Standardizing Healthcare

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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/

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Digitizing Healthcare

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

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“To computerize the hospital”

“To go paperless”

“To become a Digital Hospital”

“To have EHRs”

Why Adopting Health IT?

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• “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

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Being Smart #1:

Stop Your

“Drooling Reflex”!!

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Being Smart #2:

Focus on Information &

Process Improvement,

Not Technology

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The key is not

“Digital Health”

but rather...

“Smart Health”

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The Road to Digitizing Healthcare

Being “Smart” in Digitizing Health

eHealth Situation in Thailand

Outline

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Microsoft Health Future Vision

https://www.microsoft.com/en-us/download/details.aspx?id=12801

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Connecting People to a Healthy Future With Personalized Care – Kaiser Permanente

https://www.youtube.com/watch?v=gxz9ZVvduGc

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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?

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• 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

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Information is Everywhere in Healthcare

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WHO (2009)

Components of Health Systems

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WHO (2009)

WHO Health System Framework

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• 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

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• Efficient

– Faster care

– Time & cost savings

– Reducing unnecessary tests

• Equitable

– Access to providers & knowledge

• Patient-Centered

– Empowerment & better self-care

Being “Smart” in Healthcare

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(IOM, 2001)(IOM, 2000) (IOM, 2011)

Landmark Institute of Medicine Reports

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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

32Image 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

33Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital

To Err is Human 2: Memory

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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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Documented Values of Health IT

• Guideline adherence

• Better documentation

• Practitioner decision making or process of care

• Medication safety

• Patient surveillance & monitoring

• Patient education/reminder

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Being Smart #3:

Link IT Values to

Quality (Including Safety)

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Health

Information

Technology

Goal

Value-Add

Tools

Health IT: What’s in a Word?

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Hospital A Hospital B

Clinic C

Government

Lab Patient at Home

Ultimate Goal: Connected Health

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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/

40Image Source: englishmoviez.com

Rise of the Machines?

41Image Source: amazon.com

Smart Phones, Dumb People?

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Smart Hospital, Dumb Users?

It shouldn’t be that way...

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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

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Being Smart #4:

Don’t Replace Human Users.

Use ICT to Help Them Perform Smarter & Better.

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The Road to Digitizing Healthcare

Being “Smart” in Digitizing Health

eHealth Situation in Thailand

Outline

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Kijsanayotin B, et al. eHealth in Thailand: The current status. Stud Health Technol Inform 2010;160:376–80. 46

Thailand’s eHealth: 2010

47WHO & ITU

eHealth Components (WHO-ITU Model)

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Strat

egy &

Inves

tmen

t

Standards & Interoperability

Infrastructure

Services, Applications Software

Leadership & governance

Leg

isla

tion

, po

licy

& c

ompl

iance

Wor

kfo

rce

Thailand eHealth:Unbalanced Development

Kijsanayotin B

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Thailand eHealth: Shaky Foundations

eHealth Applications

Enabling Policies and Strategies

Foundation Policies and Strategies

Kijsanayotin B

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eHealth Governance Body

Standards & Interoperability

Healthcare-Specific Privacy Laws

Adequate eHealth Workforce

Proposed Actions

Kijsanayotin B, et al. eHealth in Thailand: The current status. Stud Health Technol Inform 2010;160:376–80.

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Thailand’s eHealth: 2016

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Asia Pacific eHealth Efforts

Asia eHealth Information Network (AeHIN) Meetings

Health Information Management Systems Society

(HIMSS) Asia Pacific Conferences

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• Piggyback on national agenda (e.g. Digital Economy)

• Use WHO-ITU model as a guide

• Start with national eHealth governance

• Identify how IT adds value in healthcare

• Standards over apps

• Recognize value of “humans”

• Walk together with neighbors

How Should We Move Forward?

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• “Digital Health” doesn’t mean the goal isdigitizing everything. Rather, it meansSmart Health: using ICT smartly toimprove quality of care.

• Thailand is moving toward “DigitalHealth”, slowly....

• Regional efforts are instrumental innational progress

Summary

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Contacts

nawanan.the@mahidol.ac.th

www.tc.umn.edu/~theer002

Nawanan Theera-Ampornpunt

Line ID: NawananT

Q & A