Medical Information Exchange in ASEAN Countries: How To Achieve IT?

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

Mahidol UniversityOctober 8, 2013

Medical Information Exchangein ASEAN Countries:

How to Achieve It?

www.SlideShare.net/Nawanan

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Let’s Start with Something Simple

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What Clinicians Want?

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)

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High Quality Care

• Safe• Timely• Effective• Efficient• Equitable• Patient-Centered

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.

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Information is Everywhere in Medicine

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

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Achieving Quality Care with Information

• Safe– Drug allergies– Medication Reconciliation

• Timely– Complete information at point of care

• Effective– Better clinical decision-making

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Achieving Quality Care with Information

• Efficient– Faster care– Time & cost savings– Reducing unnecessary tests

• Equitable– Access to providers & knowledge

• Patient-Centered– Empowerment & better self-care

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That’s Where Health IT Plays A Role...

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The Anatomy of Health IT

Health InformationTechnology

Goal

Value‐Add

Means

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Various Forms of Health IT

Hospital Information System (HIS)

Computerized Provider Order Entry (CPOE)

Electronic Health

Records (EHRs)

Picture Archiving and Communication System (PACS)

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Still Many Other Forms of Health IT

m-Health

Health Information Exchange (HIE)

Biosurveillance

Information Retrieval

Telemedicine & Telehealth

Personal Health Records (PHRs)

Image Sources: Apple Inc., Geekzone.co.nz, Google, Microsoft, PubMed.gov, and American Telecare, Inc.

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A Vision for Health Care

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eHealth & Health Information Exchange

Hospital A Hospital B

Clinic C

Government

Lab Patient at Home

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Goals of Health Information Exchange

• Deliver patient’s health information across systems & settings

• To support high-quality health care delivery by providers

• As well as facilitating other health care functions (patient’s access, reimbursements, public health operations, policy-making, education, research)

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Achieving HIE

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eHealth Components (WHO-ITU Model)

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Standards: Why?

• The Large N Problem

N = 2, Interface = 1

# Interfaces = N(N-1)/2

N = 3, Interface = 3

N = 5, Interface = 10

N = 100, Interface = 4,950

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eHealth & Health Information Exchange

Hospital A Hospital B

Clinic C

Government

Lab Patient at Home

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Objectives• Interoperability• Inter-operable

systems

Ultimate Goals• Continuity of Care• Quality Safety Timeliness Effectiveness Equity Patient-Centeredness

Efficiency

Why Health Information Standards?

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Levels of Interoperability

Functional

Semantic

Syntactic

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How Standards Support Interoperability

Technical Standards(TCP/IP, encryption, security)

Exchange Standards(HL7 v.2, HL7 v.3 Messaging,

HL7 CDA, DICOM)

Vocabularies, Terminologies, Coding Systems (ICD-10, ICD-9,

CPT, SNOMED CT, LOINC)

Information Models(HL7 v.3 RIM, ASTM CCR, HL7 CCD)Standard Data Sets (12 & 18 Files)

Functional Standards (HL7 EHRFunctional Specifications)

Some may be hybrid: e.g. HL7 v.3, HL7 CCD

Unique ID (Provider, Facility, Patient)

Functional

Semantic

Syntactic

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An Example: SNOMED CT

• A coded clinical terminology for use in Electronic Health Records

• Currently maintained by IHTSDO• Each concept has a code, a name

(“term”) and relationships with other concepts

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Concepts & Relationships in SNOMED CT

Source: http://ihtsdo.org/fileadmin/user_upload/Docs_01/Publications/SNOMED_CT/SnomedCt_Intro_20130418.pdf

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Classification vs. Terminology

ICD-10 SNOMEDCT

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In Real Life...

Patient Care

Quality of Care

Profession-alism

ITPolicy

Limited Time &

Resources

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Patients Are Counting on Us...

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Summary

• Better information means quality of care• Health IT helps clinicians care for patients• Health Information Exchange (HIE) should be

our shared VISION• Standards help us achieve HIE, and thus better

care• There are many types of standards needed to

achieve HIE, including SNOMED CT• Let’s walk together toward that common goal,

for the benefits of patients and all stakeholders