Creating the Roadmap toward Thailand's eHealth

Creating the Roadmap toward Thailand’s eHealth

Part 1: Introduction

Department of Community Medicine SeminarJune 11, 2014

Nawanan Theera-Ampornpunt, M.D., Ph.D.www.SlideShare.net/Nawanan

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Outline

• Health & Health Information• Health IT & eHealth• Health Informatics as a Discipline• Thailand’s eHealth Situation• Current Forces• Shaping the Future

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Health & Health Information

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

5Image Source: Guardian.co.uk

Manufacturing

6Image Source: http://www.oknation.net/blog/phuketpost/2013/10/19/entry-3

Banking

7ER - Image Source: nj.com

Healthcare (on TV)

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(At an undisclosed nearby 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 Like Any Others

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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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“Information” in Medicine

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

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WHO (2009)

Components of Health Systems

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WHO (2009)

WHO Health System Framework

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Outline

Health & Health Information• Health IT & eHealth• Health Informatics as a Discipline• Thailand’s eHealth Situation• Current Forces• Shaping the Future

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Health IT & eHealth

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

Landmark IOM Reports

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• To Err is Human (IOM, 2000) reported that: – 44,000 to 98,000 people die in U.S.

hospitals each year as a result of preventable medical mistakes

– Mistakes cost U.S. hospitals $17 billion to $29 billion yearly

– Individual errors are not the main problem– Faulty systems, processes, and other

conditions lead to preventable errorsHealth IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US: Regulating Healthcare - Lecture d

Patient Safety

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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

22Image 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

23Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital

To Err is Human 2: Memory

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• Cognitive Errors - Example: Decoy Pricing

The Economist Purchase Options

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Ariely (2008)

16084

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6832

# of People

# of People

To Err is Human 3: Cognition

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• It already happens....(Mamede et al., 2010; Croskerry, 2003; Klein, 2005; Croskerry, 2013)

What If This Happens in Healthcare?

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Mamede S, van Gog T, van den Berge K, Rikers RM, van Saase JL, van Guldener C, Schmidt HG. Effect of availability bias and reflective reasoning on diagnostic accuracy

among internal medicine residents. JAMA. 2010 Sep 15;304(11):1198-203.

Cognitive Biases in Healthcare

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Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003 Aug;78(8):775-80.

Cognitive Biases in Healthcare

28Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr

2;330(7494):781-3.

“Everyone makes mistakes. But our reliance on cognitive processes prone to bias makes treatment errors more likely

than we think”

Cognitive Biases in Healthcare

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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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Why We Need ICT in Healthcare?

#1: Because information is everywhere in healthcare

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Why We Need ICT in Healthcare?

#2: Because healthcare is error-prone and technology

can help

32http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf

Fragmented Healthcare

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Why We Need ICT in Healthcare?

#3: Because access to high-quality patient

information improves care

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Why We Need ICT in Healthcare?

#4: Because healthcare at all levels is fragmented &

in need of process improvement

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Use of information and communications technology (ICT) in health & healthcare

settings

Source: The Health Resources and Services Administration, Department of Health and Human Service, USA

Slide adapted from: Dr. Boonchai Kijsanayotin

Health IT

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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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eHealth Health IT

Slide adapted from: Dr. Boonchai Kijsanayotin

eHealth & Health IT

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HIS

All information about health

eHealthHMIS

mHealth

Tele-medicine

Slide adapted from: Karl Brown (Rockefeller Foundation), via Dr. Boonchai Kijsanayotin

More Terms...

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Health InformationTechnology

Goal

Value-Add

Tools

Health IT: What’s in a Word?

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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

Health Information Exchange

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Outline

Health & Health InformationHealth IT & eHealth• Health Informatics as a Discipline• Thailand’s eHealth Situation• Current Forces• Shaping the Future

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Health Informatics as a Discipline

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M/B/H Informatics As A Field

(Shortliffe, 2002)

45(Hersh, 2009)

M/B/H Informatics As a Discipline

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Biomedical/Health

Informatics

Computer & Information

Science

Engineering

Cognitive &

Decision Science

Social Sciences

(Psychology, Sociology, Linguistics,

Law & Ethics)

Statistics &

Research Methods Medical

Sciences & Public Health

Management

Library Science,

Information Retrieval,

KM

And More!

M/B/H Informatics & Other Fields

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Outline

Health & Health InformationHealth IT & eHealthHealth Informatics as a Discipline• Thailand’s eHealth Situation• Current Forces• Shaping the Future

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Thailand’s eHealth Situation

49eHealth in Thailand: The current status. Stud Health Technol Inform

2010;160:376–80, Presented at MedInfo2010 South Africa

Thailand’s eHealth: 2010

50Slide adapted from: Dr. Boonchai Kijsanayotin

Thailand: Unbalanced Development

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eHealth Applications

Enabling Policies & Strategies

Foundation Policies & Strategies

• Services• Applications• Software

• Standards & Interoperability

• Capability Building

• Leadership & Governance

• Legislation & Policy• Strategy & Investment • Infrastructure

Slide adapted from: Dr. Boonchai Kijsanayotin

eHealth Development Model

52Slide adapted from: Dr. Boonchai Kijsanayotin

Thailand’s eHealth 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

Slide adapted from: Boonchai Kijsanayotin

Thailand’s eHealth Situation

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Section 1 Hospital ProfileSection 2 IT Adoption & Use

ProfileSection 3 Respondent’s

Information

Thailand’s Health IT Adoption

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• 4 of 1,302 hospitals ineligible• Response rate 69.9%

Characteristic Overall Responding Hospitals

Non-Responding

HospitalsN of eligible hospitals 1,298 908 390Bed size** 106.9 117.5 82.9Public status**

PrivatePublic

24.0%76.0%

17.4%82.6%

39.2%60.8%

Geography*CentralEastNorthNortheastSouthWest

33.4%7.5%11.1%27.1%15.3%5.6%

31.1%7.8%13.5%26.9%14.9%5.8%

39.0%6.7%5.4%27.7%16.2%5.1%

*p < 0.01, **p < 0.001.

Nationwide Survey Results

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Characteristic Number of Responses Statistic†Public status

PrivatePublic

908158750

17.4%82.6%

Teaching statusNon-teachingTeaching

901716185

79.5%20.5%

Total employees 890 368.2 ± 573.5 (10-5269)IT employees 901 4.3 ± 5.3 (0-60)Total budget (million baht) 443 146.67 ± 313.60 (0.25-3,067)IT budget (million baht) 598 2.77 ± 8.79 (0-100)Ratio of IT budget to total budget‡

< 1%1-4%5-8%> 8%

4161352184023

2.7% ± 4.6% (0-43.3%)32.5%52.4%9.6%5.5%

Extent of overall IT utilizationVery lowLowModerateHighVery high

9055

35169454242

0.6%3.9%

18.7%50.2%26.7%

Total PCs in use 883 126.1 ± 218.6 (0-3,000)

Nationwide Survey Results

57Pongpirul et al., 2004

Vendor/Product Distribution (2004)

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Vendor/Product Distribution (2011)

Theera-Ampornpunt, 2011

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Estimate (Partial or Complete Adoption) NationwideBasic EHR, outpatient 86.6%Basic EHR, inpatient 50.4%Basic EHR, both settings 49.8%Comprehensive EHR, outpatient 10.6%Comprehensive EHR, inpatient 5.7%Comprehensive EHR, both settings 5.3%Order entry of medications, outpatient 96.5%Order entry of medications, inpatient 91.4%Order entry of medications, both settings 90.2%Order entry of all orders, outpatient 88.6%Order entry of all orders, inpatient 81.7%Order entry of all orders, both settings 79.4%

Health IT Adoption Estimates

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• High IT adoption rates• Drastic changes in adoption landscape• Local context might play a role

– Supply Side– Demand Side

• International Comparison– Relatively higher adoption

THAIS: Discussion

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Outline

Health & Health InformationHealth IT & eHealthHealth Informatics as a DisciplineThailand’s eHealth Situation• Current Forces• Shaping the Future

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Current Forces

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International• Technology Trends• Standards & Interoperability Trends• eHealth Successes & Failures

– UK NHS– US Meaningful Use– Nordic Countries

• International eHealth Networks– International Medical Informatics Association (IMIA)– American Medical Informatics Association (AMIA)– Asia eHealth Information Network (AeHIN)

Current Forces

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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 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;

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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(3) to consider ways for ministries of health and public health authorities to work with their national representatives on the ICANN Governmental Advisory Committee in order to coordinate national positions towards the delegation, governance and operation of health-related global top-level domain names in all languages, including “.health”, in the interest of public health;

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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Domestic• Thailand’s Health Insurance Trends• Increased Hospital IT Adoption• Demands for Data & Information Exchange

in Thailand’s Healthcare• Thailand’s e-Transaction Trends• Consumer IT Behavior Trends

Current Forces

6767 http://www.etda.or.th/etda_website/files/system/Stat_Report2013_op.pdf

EDTA 2012 Thailand e-Transactions

Statistics Report

eHealth & e-Transactions

6868 Photo courtesy of EDTA (Aug 21, 2013)

eHealth & e-Transactions

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e-Transactions Master Plan

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Outline

Health & Health InformationHealth IT & eHealthHealth Informatics as a DisciplineThailand’s eHealth SituationCurrent Forces• Shaping the Future

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Shaping the Future

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Shaping the Future

eHealth

Education & Workforce

Development

Research

Policymaking &

Networking

Implementation (Creating Success Stories)

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Shaping the Future

To Be Continued...

74Image Source: http://twinstrivia.com/2013/05/20/the-road-to-minnesota-is-long-and-hard/

The Journey Beyond: A Long and Winding Road

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มุ่งสู่ฝนั อันไกล ที่ใหญ่ยิ่ง

มั่นคงนิ่ง แน่วแน่ ไม่แปรผัน

เดินตามทาง ดั่งวาด อาจมองจันทร์

หน้าเรานั้น ต้องฟันป่า และฝ่าไพร

พัฒนา “สถาบัน” อันประสิทธิ์

นานาจิต คิดก้าวหน้า พาสดใส

สร้างประทีป ส่องทาง ยังคนไทย

สรรค์สร้างไว้ ให้ชาติ ผงาดยืน

ร่วมกันสร้าง ทางเดิน เจริญรุ่ง

แรงใจมุ่ง มั่นหมาย ไม่ขัดขืน

ผลักดันเพื่อ ระบบงาน อันยั่งยืน

ดันเต็มที่ ทุกวันคืน ยอมฝืนทน

เพื่อระบบ ข้อมูล สร้างคุณค่า

ฝันนั้นหนา คือเป้า เฝ้าฝกีฝน

อันเส้นทาง ร้างนัก จักเจียมตน

ไกลสุดพ้น ทนได้ ด้วยแรงใจนวนรรน ธีระอัมพรพันธุ์ 29 ก.ค. 2556

A Personal Manifesto