Health IT Workforce Situation in Thailand

Health IT Workforce

Situation in ThailandNawanan Theera-Ampornpunt, M.D., Ph.D.

Department of Community Medicine

Faculty of Medicine Ramathibodi Hospital

Mahidol University

November 25, 2015

www.SlideShare.net/Nawanan

http://www.slideshare.net/Nawanan

Introduction

2003 Doctor of Medicine (1st-Class Honors) Ramathibodi

2009 M.S. (Health Informatics) University of Minnesota

2011 Ph.D. (Health Informatics) University of Minnesota

Current Position

Lecturer, Department of Community Medicine

Faculty of Medicine Ramathibodi Hospital, Mahidol University

Contacts

[email protected]

SlideShare.net/Nawanan

www.tc.umn.edu/~theer002

Outline

• The “Informatics Spectrum”

• Literature on Informatics Workforce

• Informatics Workforce Development Abroad

• Informatics Workforce in Thailand

The “Informatics

Spectrum”

What Is “Informatics”: A Review

Theera-Ampornpunt. JTMI. 2015;1(1)

What is “Informatics”

• French: informatique = “information processing,

data processing”Harrap’s New Standard French & English Dictionary (1979), in Collen (1986)

• Russian: informatika

• English: informatics = “the discipline of science

which investigates the structure and properties

(not specific context) of scientific information, as

well as the regularities of scientific information

activity, its theory, history, methodology and

organization.”Oxford English Dictionary Supplement (1976), in Collen (1986)

What is “Informatics”

• “The science and technology of information

processing using computers (Greenes & Shortliffe,

1990)

• “The discipline focused on the acquisition,

storage, and use of information in a specific

setting or domain” (Hersh, 2009)

• “The science of information” (Bernstam et al, 2010)

Medical Informatics

• “Ancient” term

• Being retired

• Future use discouraged by experts

• Only retained in titles of professional

organizations

Main Problems

• Medical = Doctor? (e.g. not nursing?)

• Medical informatics vs. Clinical informatics

Better Terms

• Biomedical informatics

• Health informatics

• Biomedical and Health informatics

A Few Subtleties

• Health informatics suggests the goal is “health”

• Health informatics vs Public health informatics

• Health informatics includes Bioinformatics?

• Choice of terms mostly matter of preference

But What Is M/B/H Informatics Anyway?

• Medical computing/computers in medicine?

• ‘Referring to biomedical informatics as

“computers in medicine” is like defining

cardiology as “stethoscopes in medicine”.’ (Bernstam et al, 2010)

• “The field concerned with the cognitive,

information processing, and communication

tasks of medical practice, education, and

research, including the information science and

technology to support these tasks” (Greenes &

Shortliffe, 1990)

More Definitions of M/B/H Informatics

• “The field that is concerned with the optimal use of

information, often aided by the use of technology,

to improve individual health, health care, public

health, and biomedical research” (Hersh, 2009)

• “The application of the science of information as

data plus meaning to problems of biomedical

interest” (Bernstam et al, 2010)

More Definitions of M/B/H Informatics

• “What BMI training and experience bring to these activities

is the human and organizational context and culture in

which the IT is being applied. The focus is not on the IT

but on the combination—the interactions of IT systems,

humans, and organizations aimed at achieving a particular

purpose.”

• Some practitioners will focus on the IT aspects, whereas

some (e.g. cognitive science & health care professions) on

the human interaction, use, evaluation, and acceptability of

the application. Others (e.g. business & management) on

organizational adaptations, systems, workflow, and cost-

effectiveness aspects of an application.Greenes RA, Shortliffe EH. Acad Med. 2009;84(7):818–20.

Summary of the Field

• Context: Health & Healthcare

• Focuses more on information, not technology

• Task-oriented view:

Collection Processing

Storage

Utilization

Communication

/Dissemination/

Presentation

Focus on “Information”

Wisdom

Knowledge

Information

Data

Data-Information-Knowledge-Wisdom (DIKW) Pyramid

“Information” in Medicine

Shortliffe EH. JAMA. 2010;304(11):1227-8.

3 Sciences for Education of

21st Century Clinicians

• Basic Science

• Clinical Science

• Information Science

Shortliffe EH. JAMA. 2010;304(11):1227-8.

Domains of Biomedical &

Health Informatics

• Health service delivery (health care)

• Medical, dental, nursing, pharmacy, etc.

• IT implementation & management in health care

organizations

• Public health

• Policy & administration, epidemiology, environmental

health, health services research, etc.

• Individual patient/consumer’s health

• Education of health professionals

• Biomedical research (clinical trials, public health

research, research in biomedical sciences)

The “Informatics Spectrum”

Shortliffe EH. J Biomed Inform. 2002;35(5-6):279-80.


Hersh W. BMC Med Inform Decis Mak. 2009;9:24.


Sarkar IN, Butte AJ, Lussier YA, Tarczy-Hornoch P, Ohno-Machado L.

J Am Med Inform Assoc. 2011;18(4):354-7.


Sarkar IN. J Transl Med. 2010;8:22.


Shortliffe EH, Blois MS. The computer meets medicine and biology: emergence of a discipline. In: Shortliffe EH,

Cimino JJ, editors. Biomedical informatics: computer applications in health care and biomedicine. 3rd ed. New York:

Springer; 2006.


Kulikowski CA, Shortliffe EH, Currie LM, et al. J Am Med Inform Assoc. 2012;19(6):931-8.

Informatics Contribution

de Savigny D, Adam T, editors. Systems thinking for health systems strengthening.

Geneva: World Health Organization; 2009.

Workforce Implications

• Biomedical & health informatics is a large

interdisciplinary field covering a broad

spectrum of work in health & biomedicine

• Informatics focuses more on information

than technology

• Workforce should reflect the field’s

landscape & contribution to health

systems

Literature on

Informatics Workforce

Informatics Workforce Paper


Categories of Informatics Workforce

Workforce development by HITECH Act

• IT professionals: install, maintain & optimize

hardware & software

• Health Information Management (HIM)

professionals: medical records documentation,

coding, and legal & compliance issues

• Clinical informaticians: bring expertise at the

intersection of health care & IT to assure successful

adoption & use of HIT & information. Also serve as a

bridge between IT & clinical personnel.


Career Path & Job Opportunities


Diversity in Informatics Workforce

• No distinct professional identity, due to

heterogeneous nature of the field and people

in the field

• “What you do when you complete informatics

education is related in part to what you did

when you entered.”

• Roles sometimes divided into academic vs.

professional/applied/operational


Informatics Workforce Paper

Hersh W. Yearb Med Inform. 2008;157–64.

Hersh W. Stud Health Technol Inform. 2010;151:492–503.

Hersh W. J Am Med Inform Assoc. 2006 Apr;13(2):166–70.

Informatics Workforce Problems

• Incomplete data of HIT workforce

• Low quantity & lack of training of skilled

workers to implement HIT

• IT professionals & HIM professionals often

viewed as separate: Technologists vs.

Medical Records. Artificial distinctions &

ignoring roles of others e.g. clinicians



• No clear definition of the informatics field and its

terminologies

– The “adjective problem”

– Unresolved preferred terms: “Informaticist” vs. “informatician”

• Unclear boundary between pure IT &

informatics– A person who installs applications on hospital PCs probably

doesn’t need informatics training

– CIO & project leads certainly need informatics training

• Lack of knowledge of the profession by career

advisersHersh W. Yearb Med Inform. 2008;157–64.


• Informatics not represented in standard occupational

classifications, thus the field is not represented in

some workforce analyses

• In U.S., Standard Occupational Classification (SOC)

– Health Diagnosing & Treating Practitioners

– Medical Records & Health Information Technicians

– Computer Specialists

– Nothing that combines these elements of what

informaticians do into a single code

• Same issue for International Standard Classification of

Occupations (ISCO) Hersh W. Yearb Med Inform. 2008;157–64.

Forces that Shape Informatics Workforce

• Importance of “informaticians” being

recognized

• Informatics as a professional discipline, with

attributes of a profession

– Well-defined set of competencies

– Certification of fitness to practice

– Shared professional identity, life-long commitment

& code of ethics


Informatics Workforce Assessments

• England estimated employment of 25,000 FTEs out of

1.3 million workers in NHS (1 IT staff : 52 non-IT

workers)

– ICT staff (37%)

– Health records staff (26%)

– Information management staff (18%)

– Knowledge management staff (9%)

– Senior managers (7%)

– Clinical informatics staff (3%)

• Retention issues (mostly due to non-competitive pay)

• Expected skills shortages

• Strong support for establishing formal informatics

profession Hersh W. Yearb Med Inform. 2008;157–64.


• Gartner Research assessed IT staff in 85 integrated

delivery systems in U.S. (1 IT Staff : 56 non-IT

employees)– Programmer/analyst (51%)

– Support (28%)

– Telecommunications (16%)

• HIMSS AnalyticsTM Database (1 IT Staff : 68 hospital

staff)

Hersh W. Yearb Med Inform.

2008;157–64.


IT & informatics

workforce needed to

implement U.S.

Nationwide Health

Information Network

(NHIN)

Hersh W. Yearb Med Inform.

2008;157–64.

Categories of Informatics Workforce


Informatics Workforce: Future Directions

• Optimal education of HIT workforce is another gap in

knowledge

• Need for more research to better characterize workforce

of those who develop, implement, & evaluate HIT

• Workforce research must go beyond narrow focus of single

groups (e.g. IT staff, HIM, clinicians) or applications (EHRs,

HIE), but focus on larger picture

• More effort on occupational coding classifications &

promoting profession

• Focus on other areas of informatics (e.g. clinical research,

public health informatics) & other parts of the world outside

U.S. & Europe


Informatics Workforce in

Developing Countries

Hersh W, Margolis A, Quiros F, Otero P. Health Aff. 2010;29(2):274–7.



• Growing evidence for value of well-trained informatics

workforce

• Educational programs emerging around the world to meet

the need, from graduate education to short courses

• Various Initiatives

– Informatics Training for Global Health Program (Fogarty International

Center, U.S. National Institutes of Health)

– AMIA’s Global Partnership Program (Funded by Bill & Melinda Gates

Foundation)




• Paucity of research

– All national-level data come from English-speaking

developed countries

– Some U.S. studies focused on specific segments of

workforce (e.g. IT professionals, health information

managers)

– No research on long-term needs, specific roles,

competencies & optimal education of health

informatics professionals in U.S. and elsewhere




• Recommended Data Collection

– Characteristics of health care organizations & HIT

applications used, in the context of a country’s

larger health care system

– Data on health care organizations’ ICT structure,

organization & infrastructure, roles &

responsibilities, and needs



Development Abroad

U.S.: HITECH Act & Informatics Workforce

Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5.

U.S.: HITECH Act & Informatics Workforce

Hersh WR. Informatics for the health information technology workforce. In: Berner ES, editor.

Informatics education in healthcare: lessons learned. London: Springer; 2014. p. 93-107.More information: https://www.healthit.gov/sites/default/files/health_it_workforce_6_month_roles_as_of_06_03_10.pdf

U.S.: 10x10

More Information: https://www.amia.org/education/10x10-courses

Image Source: http://www.kumc.edu/health-informatics/ku-amia-10x10.html

• AMIA 10x10 Program

U.S.: Clinical Informatics Subspecialty

Safran C. Yearb Med Inform. 2009;164–5.

U.S.: Clinical Informatics Subspecialty

Detmer DE, Munger BS, Lehmann CU. Applied Clinical Informatics. 2010;1(1):11–8.

U.S.: Advanced Interprofessional

Informatics Certification

https://www.amia.org/advanced-interprofessional-informatics-certification


in ThailandProblems, Progress & Plan

Problems: Professional Identity

http://www.uis.unesco.org/Education/Documents/isced-fields-of-education-training-2013.pdf

• What ISCED category

should health

informatics program

fall into?

Where Is Health Informatics in

the Fields of Education Classification?


Where Is Health Informatics?


My Answer: 0988 Inter-disciplinary programmes and

qualifications involving health and welfareNawanan Theera-Ampornpunt

Problems Voiced by

Practitioners in Thai Hospitals

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.

http://conservancy.umn.edu/handle/11299/162267

• Nationwide survey on

health IT adoption of

Thai hospitals

• 70% response rate

(908/1298)

• Content analysis from

open-ended comments

Problems Voiced by

THAIS Study

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.

http://conservancy.umn.edu/handle/11299/162267

Progress: Informatics Programs

in Thailand

Otero PD, Perrin C, Geissbuhler A, Cheung NT, Theera-Ampornpunt N, Lun KC.

Informatics education in low resource settings. In: Berner ES, editor. Informatics

education in healthcare: lessons learned. London: Springer; 2014. p. 197-222.

Progress: Informatics Programs

in Thailand

Otero PD, Perrin C, Geissbuhler A, Cheung NT, Theera-Ampornpunt N, Lun KC. Informatics education in low resource

settings. In: Berner ES, editor. Informatics education in healthcare: lessons learned. London: Springer; 2014. p. 197-222.

Progress: Informatics Training

in Thailand

Images courtesy of TMI


in Thailand

Image courtesy of Ramathibodi Hospital Administration School

Ramathibodi Healthcare CIO Certificate Program, 6th Class (2015)


in Thailand

Images courtesy of Faculty of Tropical Medicine, Mahidol University

MU Faculty of Tropical Medicine Biomedical & Health Informatics Master

• Graduated first batch of students in early 2014

• Now in third batch of students


in Thailand

Image courtesy of Faculty of Social Sciences & Humanities, Mahidol University

MU Faculty of Social Sciences & Humanities:

Health Information Management Masters Program

Progress: TMI Informatics Education SIG

• In January 2013, TMI approved establishment of the “Biomedical

and Health Informatics Education Special Interest Group” within TMI

(BHI-ED-SIG)

• Executive Committee

• 1. นพ.ดาวฤกษ์ สนิธุวณิชย์ ทีป่รกึษา

• 2. ดร.นพ.บุญชยั กจิสนาโยธนิ ประธาน (Chair)

• 3. ดร.นพ.นวนรรน ธรีะอมัพรพนัธุ์ รองประธาน (Vice Chair)

• 4. รศ.ทญ.ดร.ศริวิรรณ สบืนุการณ์ กรรมการ

• 5. ผศ.ภก.ดร.อนุชยั ธรีะเรอืงไชยศรี กรรมการ

• 6. ดร.นพ.บดนิทร์ ทรพัยส์มบรูณ์ กรรมการ

Plan: Workforce as Part of eHealth Roadmap

Problems in Thailand’s eHealth Workforce from

eHealth Roadmap Brainstorming (August 2015)

• No national eHealth authority, thus no leadership

• No standard competencies of eHealth workers

• No standard IT/eHealth competencies of health

professionals

• No eHealth/IT competencies in the private sector

• Lack of eHealth KM & Community of Practice

• No collaboration among CIOs of various health

departments

Plan: Proposed Strategies for Thailand’s eHealth

Workforce from eHealth Roadmap Brainstorming

(August 2015)

• eHealth HRM

– Workforce analysis

– Standard competencies

– Retention efforts & talent management

• eHealth Development

– Capacity building

– Continuing education

– Expert Profiles & Community of Practice

– Certification

Plan: Workforce as Part of eHealth Roadmap

• The Informatics Knowledge Spectrum

Degree of Informatics Knowledge

Patient/Public Supporting

Hospital Workers

Clinicians/Health

Professionas

Executives IT Workers, HIMeHealth/Health IT

Workers

Plan: Proposed Strategies for Thailand’s eHealth

Workforce from eHealth Roadmap Brainstorming

(August 2015)

• Networking & Collaboration

– Better collaboration between ICT & health agencies

– Cross-departmental ICT communities in health sector

– User training & support

– Public-private partnership & resource sharing

• Public Awareness

– Consumer health knowledge portal

– Improving health literacy & IT literacy

– Engaging local governments on eHealth

Summary of Health Informatics

Workforce

Situation Abroad

• Unique value of informatics workforce in healthcare

increasingly recognized

• Informatics workforce is a challenge in many developed

& developing countries

• Breadth of informatics part of the challenge

• Some, but limited, data/research on current situation,

needs, competencies & training

• Various initiatives to build stronger informatics workforce

Summary of Health Informatics

Workforce

Situation in Thailand

• Unique value of informatics workforce in healthcare

increasingly recognized

• Informatics workforce is a serious challenge: a

bottleneck for Thailand’s 21st Century health system

• Virtually no systematic research on current situation,

needs, competencies & training

• Several initiatives to build stronger informatics workforce

ongoing, but with limited capacity

Health IT Workforce Situation in Thailand

Healthcare

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