A Journey Toward National eHealth: Thailand's Case

A Journey Toward National eHealth: Thailand's Case

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

Mahidol University, ThailandNovember 20, 2014

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

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

nawanan.the@mahidol.ac.th

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“The Journey” Toward eHealth

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Outline

• The Needs for eHealth• Thailand's eHealth situation• The road ahead for Thailand's eHealth

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The Needs for eHealth

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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.)

8http://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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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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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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Hospital A Hospital B

Clinic C

Government

Lab Patient at Home

Goal: Health Information Exchange

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WHO-ITU National eHealth Strategy Toolkit

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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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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;

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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URGES Member States:(2) to consider developing, as appropriate,

policies and legislative mechanisms linked to an overall national eHealth strategy, in order to ensure compliance in the adoption of ehealth and 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;

(3) ...[snipped]...

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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Outline

The Needs for eHealth• Thailand's eHealth situation• The road ahead for Thailand's eHealth

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Thailand’s eHealth Situation

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Thailand: An Overview

• Bangkok (Capital) + 76 provinces• Size: ~ 2.5 times of MN• Population: 67+ million

(12 times of MN)• Multiple payers• Mostly public-funded healthcare

system, with universal coverage• Strong & growing private sector

healthcare (medical tourism)CIA World Factbook

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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

26Slide 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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No permanent national body on eHealth / Health IT Nothing equivalent to ONC (U.S.), NEHTA (Australia),

Health Infoway (Canada), NHS Connecting for Health (UK)

ICT Center at Ministry of Public Health Lack of authority & informatics expertise

Politics “National Health Information Committee” discontinued

after different government takes office

Boonchai Kijsanayotin et al. (2010)

Thailand’s eHealth Governance

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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

32Pongpirul et al., 2004

Vendor/Product Distribution (2004)

33Theera-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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Standards National

1. Core data set standards “12 files” & “18 files”; “50 files” (New)

2. Semantic standards National Citizen ID, ICD-10-TM

(Diagnoses), ICD-9-CM (Procedures)

3. Syntactic standards -

4. Security and privacy standards -

Existing Standards in Thailand

Slide adapted from: Dr. Boonchai Kijsanayotin

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Standards National

1. Core data set standards Referral Dataset

2. Semantic standardsDrug Terminology (TMT),

SNOMED-CT?LOINC

Providers IDs

3. Syntactic standards HL7 Messaging?, CDA?

4. Security and privacy standards

Authentication & Encryption Standards

Emerging/Potential Standards

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

Dr. BoonchaiKijsanayotin

Dr. DaorirkSinthuvanich

Dr. TiemUngsachon

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• HL7 Certified Specialists

Kevin Asavanant

HL7 V3 RIM (2009)

SupachaiParchariyanonHL7 CDA (2010)

NawananTheera-Ampornpunt

HL7 CDA (2012)

SireeratSrisiriratanakul

HL7 V3 RIM (2013)

Capacity Building on Standards

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eHealth Components

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• Certificate & Diploma Level• Undergraduate Level• Graduate Level

Informatics Workforce Programs

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Informatics Workforce Programs

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.

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Informatics Workforce Programs

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.

45Faculty of Medicine Ramathibodi Hospital, Mahidol University

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

Healthcare CIO Certificate Program

46Faculty of Tropical Medicine, Mahidol University

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

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• Thai Medical Informatics Association (TMI) is the national professional society for– Biomedical and health informatics professionals

– Health information management professionals (medical records, medical statistics & ICD coders)

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

National Professional Society

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TMI CIO Forum

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Thai Informatics Year in Review• Modeled after the popular Dan Masys

Informatics Year in Review & other YIRs• Perhaps the first national-level Informatics

YIR

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

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

(AMIA)

Internationalization

51http://www.aehin.org/Meetings/2013AeHINGeneralMeeting.aspx

Participation in AeHIN

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eHealth Components

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• Mostly privacy laws– Written broadly & vaguely– Different interpretation, enforcement difficult– Barrier to data exchange

• No “HITECH Act” or “Meaningful Use” Equivalent

Legislation, Policy & Compliance

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Outline

The Needs for eHealthThailand'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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eHealth Components

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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

The Road Ahead

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• New minister & deputy minister of public health with health systems & academic mindset; Supportive of eHealth initiatives

• With roots from Mahidol University & Faculty of Medicine Ramathibodi Hospital

Windows of Opportunities for eHealth

Prof. Rajata Rajatanavin, M.D.Minister of Public Health

Outgoing Mahidol University President

Dr. Somsak Chunharas, M.D.Deputy Minister of Public Health

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• National Legislative Assembly’s Public Health Committee appointed “Health Information System Standards Subcommittee” to tackle policy & legislative issues of standards & interoperability

• Thai Informaticians represented

Windows of Opportunities for eHealth

Dr. BoonchaiKijsanayotin

Dr. NawananTheera-Ampornpunt

Dr. BordinSapsomboon

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• Data reporting burden of front-line workers recognized

• Efforts & pressure to harmonize different health insurance schemes (hence needs for data integration)

• Heavy focus on quality of care• Providers increasingly recognize they can’t

survive without good health IT

Windows of Opportunities for eHealth

61Image 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...

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The UMN Impact

Special Appreciation to Prof. Stuart Speedie and other IHIFaculty for planting the seeds for

Thailand’s future informatics workforce