eHealth: The Next Building Block for Thailand’s Healthcare System

Nawanan Theera-Ampornpunt, M.D., Ph.D.Faculty of Medicine Ramathibodi Hospital

Mahidol University, ThailandJune 13, 2014

www.SlideShare.net/Nawanan

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Introduction

2003 M.D. (First-Class Honors) (Ramathibodi)2009 M.S. in Health Informatics (U of MN)2011 Ph.D. in Health Informatics (U of MN)2012 Certified HL7 CDA Specialist

•Deputy Executive Director for Informatics (CIO/CMIO) Chakri Naruebodindra Medical Institute

•Lecturer, Department of Community MedicineFaculty of Medicine Ramathibodi HospitalMahidol University

nawanan.the@mahidol.ac.th

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Outline

• Needs for better information in healthcare• eHealth as a health system's component• Thailand's eHealth situation• The road ahead for Thailand's eHealth

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Needs for Better Information

in Healthcare

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“Information” in Medicine

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

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Needs for Better Information

• Good information needed for quality care– Past and present history– Medication list– Problem list– Allergies– Lab & imaging results

• Information gaps prevalent in healthcare settings (e.g. Stiell A et al. CMAJ. 2003;169:1023-8.)

7http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf

Fragmented Healthcare

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

Landmark IOM Reports

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• 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

IOM Reports Summary

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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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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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The Question Becomes...

How do we deliver better information, by supplementing

human clinicians with ICT, so that they make less errors and

perform better?

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Outline

Needs for better information in healthcare• eHealth as a health system's component• Thailand's eHealth situation• The road ahead for Thailand's eHealth

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eHealth as a Health System

Component

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WHO (2009)

Components of Health Systems

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WHO (2009)

WHO Health System Framework

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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

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All components are essential All components should be balanced

Slide adapted from: Dr. Boonchai Kijsanayotin

eHealth Components: WHO-ITU Model

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Hospital A Hospital B

Clinic C

Government

Lab Patient at Home

Goal: Health Information Exchange

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Outline

Needs for better information in healthcareeHealth as a health system's component• Thailand's eHealth situation• The road ahead for Thailand's eHealth

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Thailand’s eHealth Situation

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eHealth in Thailand: The current status. Stud Health Technol Inform 2010;160:376–80, Presented at MedInfo2010 South Africa

Thailand’s eHealth: 2010

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All components are essential All components should be balanced

Slide adapted from: Dr. Boonchai Kijsanayotin

Recalling eHealth Components

25Slide adapted from: Dr. Boonchai Kijsanayotin

Thailand: Unbalanced Development

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Silo-type systems Little integration and interoperability Mostly aim for administration and management 40% of work-hours spent on managing reports and

documents Lack of national leadership and governance body Inadequate HIS foundations development

Boonchai Kijsanayotin et al. (2010)

Thailand’s eHealth Situation

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eHealth Components

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Nationwide survey on hospital IT adoption conducted in 2011

THAIS: Thai Hospitals’ Adoption of Information Technology Survey

Self-administered paper-based survey mailed to 1,298 hospitals in Thailand

Thailand’s Hospital IT Adoption

29Pongpirul et al., 2004

Vendor/Product Distribution (2004)

30Theera-Ampornpunt, 2011

Vendor/Product Distribution (2011)

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Estimate (Partial or Complete Adoption)

Nationwide

Basic EHR, outpatient 86.6%Basic EHR, inpatient 50.4%Basic EHR, both settings 49.8%Order entry of medications, outpatient

96.5%

Order entry of medications, inpatient 91.4%Order entry of medications, both settings

90.2%

Hospital IT Adoption Estimates

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• High IT adoption rates• Drastic changes in adoption landscape• Adequate infrastructure for information

exchange• Next question is on interoperability

THAIS: Discussion

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eHealth Components

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Existing Standards in ThailandStandards National

1. Core data set standards 12 & 18 files standards

2. Semantic standards Personal ID, Provider ID

ICD-10-TM, ICD-9-CM3. Syntactic standards X

4. Security and privacy standards X

Existing Standards in Thailand

Slide adapted from: Dr. Boonchai Kijsanayotin

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Standards National

1. Core data set standards Referral, Chronic Diseases

2. Semantic standardsDrug Terminology (TMT),

SNOMED-CTLab Code (LOINC)

Providers IDs

3. Syntactic standards HL7 Messaging, CDA

4. Security and privacy standards X

Standards Being Explored/Developed

Slide adapted from: Dr. Boonchai Kijsanayotin

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Thai Health Information Standards Development Center

www.this.or.thhttp://www.facebook.com/thishsrithis@this.or.th

Standards Development Organization

Slide adapted from: Dr. Boonchai Kijsanayotin

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eHealth & e-Transactions

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• HL7 Certified Specialists

Kevin Asavanant

HL7 V3 RIM (2009)

SupachaiParchariyanon

HL7 CDA (2010)

NawananTheera-Ampornpunt

HL7 CDA (2012)

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SireeratSrisiriratanakul

HL7 V3 RIM (2013)

Capacity Building on Standards

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URGES Member States:(1) to consider, as appropriate, options to collaborate with

relevant stakeholders, including national authorities, relevant ministries, health care providers, and academic institutions, in order to draw up a road map for implementation of ehealth and health data standards at national and subnational levels;

(2) to consider developing, as appropriate, policies and legislative mechanisms linked to an overall national eHealthstrategy, in order to ensure compliance in the adoption of ehealthand health data standards by the public and private sectors, as appropriate, and the donor community, as well as to ensure the privacy of personal clinical data;... http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R24-en.pdf

World Health Assembly Resolution WHA66.24 (2013) on eHealth Standardization & Interoperability

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eHealth Components

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• Certificate & Diploma Level• Undergraduate Level• Graduate Level

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Informatics Workforce Programs

42Faculty of Medicine Ramathibodi Hospital, Mahidol University

http://med.mahidol.ac.th/has/42

Healthcare CIO Certificate Program

43Faculty of Tropical Medicine, Mahidol University43

Diploma & Master Graduates in Biomedical & Health Informatics, First Batch

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• In January 2013, the Thai Medical Informatics Association (TMI) approved establishment of the “Biomedical and Health Informatics Education Special Interest Group” within TMI (BHI-ED-SIG)

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Informatics Education SIG

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TMI CIO Forum

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• International Medical Informatics Association (IMIA)– MEDINFO & APAMI

• HIMSS AsiaPac• Asia eHealth Information Network (AeHIN)• American Medical Informatics Association

(AMIA)

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Internationalization

47http://www.aehin.org/Meetings/2013AeHINGeneralMeeting.aspx47

Participation in AeHIN

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Outline

Needs for better information in healthcareeHealth as a health system's componentThailand's eHealth situation• The road ahead for Thailand's eHealth

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The Road Ahead for Thailand’s eHealth

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• Addressing– Lack of national leadership & governance,

strategy & investment, policy & regulation– Shortage of informatics workforce– Accelerating standards development– Harmonizing applications– Facilitating local research in informatics

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The Road Ahead

51Image Source: http://twinstrivia.com/2013/05/20/the-road-to-minnesota-is-long-and-hard/

The Journey Beyond

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But We’ll Get There...