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A Journey Toward National eHealth: 
Thailand's Case 
Nawanan Theera-Ampornpunt, M.D., Ph.D. 
Faculty of Medicine Ramathibo...
2 
Introduction 
2003 M.D. (First-Class Honors) (Ramathibodi) 
2009 M.S. in Health Informatics (U of MN) 
2011 Ph.D. in He...
3 
“The Journey” Toward eHealth
4 
Outline 
• The Needs for eHealth 
• Thailand's eHealth situation 
• The road ahead for Thailand's eHealth
5 
The Needs for 
eHealth
6 
“Information” in Medicine 
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 
2010 Sep 15;304...
7 
Needs for Better Information 
• Good information needed for quality care 
– Past and present history 
– Medication list...
Fragmented Healthcare 
http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf 8
9 
Landmark IOM Reports 
(IOM, 2000) (IOM, 2001) (IOM, 2011)
10 
Back to 
something simple...
11 
What Clinicians Want? 
To treat & to 
care for their 
patients to their 
best abilities, 
given limited 
time & 
resou...
12 
The Question Becomes... 
How do we deliver better 
information, by supplementing 
human clinicians with ICT, so that 
...
13 
Components of Health Systems 
13 
WHO (2009)
14 
WHO Health System Framework 
14 
WHO (2009)
15 
eHealth 
Use of information and communications 
technology (ICT) for health; Including 
• Treating patients 
• Conduct...
16 
Goal: Health Information Exchange 
Hospital A Hospital B 
Clinic C 
Government 
Lab Patient at Home
17 
WHO-ITU National eHealth Strategy Toolkit
18 
eHealth Components: WHO-ITU Model 
 All components are essential 
 All components should be balanced 
Slide adapted ...
19 
World Health Assembly Resolution WHA66.24 (2013) on 
eHealth Standardization & Interoperability 
URGES Member States: ...
20 
World Health Assembly Resolution WHA66.24 (2013) on 
eHealth Standardization & Interoperability 
URGES Member States: ...
21 
Outline 
The Needs for eHealth 
• Thailand's eHealth situation 
• The road ahead for Thailand's eHealth
22 
Thailand’s 
eHealth Situation
23 
Thailand: An Overview 
• Bangkok (Capital) + 76 provinces 
• Size: ~ 2.5 times of MN 
• Population: 67+ million 
(12 t...
24 
Thailand’s eHealth: 2010
25 
Recalling eHealth Components 
 All components are essential 
 All components should be balanced 
Slide adapted from:...
Thailand: Unbalanced Development 
Slide adapted from: Dr. Boonchai Kijsanayotin 26
27 
Thailand’s eHealth Situation 
 Silo-type systems 
 Little integration and interoperability 
 Mostly aim for adminis...
28 
eHealth Components
29 
Thailand’s eHealth Governance 
 No permanent national body on eHealth / Health IT 
 Nothing equivalent to ONC (U.S.)...
30 
eHealth Components
Thailand’s Hospital IT Adoption 
31 
Nationwide survey on 
hospital IT adoption 
conducted in 2011 
THAIS: Thai Hospitals’...
Vendor/Product Distribution (2004) 
Pongpirul et al., 2004 32
Vendor/Product Distribution (2011) 
Theera-Ampornpunt, 2011 33
34 
Hospital IT Adoption Estimates 
Estimate (Partial or Complete 
Adoption) 
Nationwide 
Basic EHR, outpatient 86.6% 
Bas...
35 
THAIS: Discussion 
• High IT adoption rates 
• Drastic changes in adoption landscape 
• Adequate infrastructure for in...
36 
eHealth Components
37 
Existing Standards in Thailand 
Standards National 
1. Core data set standards “12 files” & “18 files”; 
“50 files” (N...
38 
Emerging/Potential Standards 
Standards National 
1. Core data set standards Referral Dataset 
2. Semantic standards 
...
39 
Standards Development Organization 
Thai Health Information Standards 
Development Center 
www.this.or.th 
http://www....
40 
Capacity Building on Standards 
• HL7 Certified Specialists 
Kevin 
Asavanant 
HL7 V3 RIM (2009) 
Supachai 
Parchariya...
41 
eHealth Components
42 
Informatics Workforce Programs 
• Certificate & Diploma Level 
• Undergraduate Level 
• Graduate Level
43 
Informatics Workforce Programs 
Otero PD, Perrin C, Geissbuhler A, 
Cheung NT, Theera-Ampornpunt N, 
Lun KC. Informati...
44 
Informatics Workforce Programs 
Otero PD, Perrin C, 
Geissbuhler A, Cheung NT, 
Theera-Ampornpunt N, Lun 
KC. Informat...
45 
Healthcare CIO Certificate Program 
Faculty of Medicine Ramathibodi Hospital, Mahidol University 
http://med.mahidol.a...
Diploma & Master Graduates in Biomedical & 
Health Informatics, First Batch 
Faculty of Tropical Medicine, Mahidol Univers...
47 
National Professional Society 
• Thai Medical Informatics Association (TMI) is 
the national professional society for ...
48 
TMI CIO Forum
Thai Informatics Year in Review 
• Modeled after the popular Dan Masys 
Informatics Year in Review & other YIRs 
• Perhaps...
50 
Internationalization 
• International Medical Informatics 
Association (IMIA) 
– MEDINFO & APAMI 
• HIMSS AsiaPac 
• A...
Participation in AeHIN 
http://www.aehin.org/Meetings/2013AeHINGeneralMeeting.as5p1x
52 
eHealth Components
53 
Legislation, Policy & Compliance 
• Mostly privacy laws 
– Written broadly & vaguely 
– Different interpretation, enfo...
54 
Outline 
The Needs for eHealth 
Thailand's eHealth situation 
• The road ahead for Thailand's eHealth
55 
The Road Ahead for 
Thailand’s eHealth
56 
eHealth Components
57 
The Road Ahead 
• Addressing 
– Lack of national leadership & governance, 
strategy & investment, policy & regulation ...
58 
Windows of Opportunities for eHealth 
Prof. Rajata Rajatanavin, M.D. 
Minister of Public Health 
Outgoing Mahidol Univ...
59 
Windows of Opportunities for eHealth 
• National Legislative Assembly’s Public Health 
Committee appointed “Health Inf...
60 
Windows of Opportunities for eHealth 
• Data reporting burden of front-line workers 
recognized 
• Efforts & pressure ...
The Journey Beyond 
Image Source: http://twinstrivia.com/2013/05/20/the-road-to-minnesota-is-long-and-hard/ 61
62 
But We’ll Get There...
63 
The UMN Impact 
Special Appreciation to 
Prof. Stuart Speedie and other IHI 
Faculty for planting the seeds for 
Thail...
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A Journey Toward National eHealth: Thailand's Case

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Academic Health Center (AHC) Informatics Grand Round at the University of Minnesota on Nov 20, 2014

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A Journey Toward National eHealth: Thailand's Case

  1. 1. A Journey Toward National eHealth: Thailand's Case Nawanan Theera-Ampornpunt, M.D., Ph.D. Faculty of Medicine Ramathibodi Hospital Mahidol University, Thailand November 20, 2014 SlideShare.net/Nawanan
  2. 2. 2 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 Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University nawanan.the@mahidol.ac.th
  3. 3. 3 “The Journey” Toward eHealth
  4. 4. 4 Outline • The Needs for eHealth • Thailand's eHealth situation • The road ahead for Thailand's eHealth
  5. 5. 5 The Needs for eHealth
  6. 6. 6 “Information” in Medicine Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
  7. 7. 7 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.)
  8. 8. Fragmented Healthcare http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf 8
  9. 9. 9 Landmark IOM Reports (IOM, 2000) (IOM, 2001) (IOM, 2011)
  10. 10. 10 Back to something simple...
  11. 11. 11 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)
  12. 12. 12 The Question Becomes... How do we deliver better information, by supplementing human clinicians with ICT, so that they make less errors and perform better?
  13. 13. 13 Components of Health Systems 13 WHO (2009)
  14. 14. 14 WHO Health System Framework 14 WHO (2009)
  15. 15. 15 eHealth 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
  16. 16. 16 Goal: Health Information Exchange Hospital A Hospital B Clinic C Government Lab Patient at Home
  17. 17. 17 WHO-ITU National eHealth Strategy Toolkit
  18. 18. 18 eHealth Components: WHO-ITU Model  All components are essential  All components should be balanced Slide adapted from: Dr. Boonchai Kijsanayotin
  19. 19. 19 World Health Assembly Resolution WHA66.24 (2013) on eHealth Standardization & Interoperability 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
  20. 20. 20 World Health Assembly Resolution WHA66.24 (2013) on eHealth Standardization & Interoperability 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
  21. 21. 21 Outline The Needs for eHealth • Thailand's eHealth situation • The road ahead for Thailand's eHealth
  22. 22. 22 Thailand’s eHealth Situation
  23. 23. 23 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
  24. 24. 24 Thailand’s eHealth: 2010
  25. 25. 25 Recalling eHealth Components  All components are essential  All components should be balanced Slide adapted from: Dr. Boonchai Kijsanayotin
  26. 26. Thailand: Unbalanced Development Slide adapted from: Dr. Boonchai Kijsanayotin 26
  27. 27. 27 Thailand’s eHealth Situation  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)
  28. 28. 28 eHealth Components
  29. 29. 29 Thailand’s eHealth Governance  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)
  30. 30. 30 eHealth Components
  31. 31. Thailand’s Hospital IT Adoption 31 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
  32. 32. Vendor/Product Distribution (2004) Pongpirul et al., 2004 32
  33. 33. Vendor/Product Distribution (2011) Theera-Ampornpunt, 2011 33
  34. 34. 34 Hospital IT Adoption Estimates 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 90.2% settings
  35. 35. 35 THAIS: Discussion • High IT adoption rates • Drastic changes in adoption landscape • Adequate infrastructure for information exchange • Next question is on interoperability
  36. 36. 36 eHealth Components
  37. 37. 37 Existing Standards in Thailand 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 - Slide adapted from: Dr. Boonchai Kijsanayotin
  38. 38. 38 Emerging/Potential Standards Standards National 1. Core data set standards Referral Dataset 2. Semantic standards Drug Terminology (TMT), SNOMED-CT? LOINC Providers IDs 3. Syntactic standards HL7 Messaging?, CDA? 4. Security and privacy Authentication & standards Encryption Standards Slide adapted from: Dr. Boonchai Kijsanayotin
  39. 39. 39 Standards Development Organization Thai Health Information Standards Development Center www.this.or.th http://www.facebook.com/thishsri this@this.or.th Slide adapted from: Dr. Boonchai Kijsanayotin Dr. Boonchai Kijsanayotin Dr. Daorirk Sinthuvanich Dr. Tiem Ungsachon
  40. 40. 40 Capacity Building on Standards • HL7 Certified Specialists Kevin Asavanant HL7 V3 RIM (2009) Supachai Parchariyanon HL7 CDA (2010) Nawanan Theera-Ampornpunt HL7 CDA (2012) Sireerat Srisiriratanakul HL7 V3 RIM (2013)
  41. 41. 41 eHealth Components
  42. 42. 42 Informatics Workforce Programs • Certificate & Diploma Level • Undergraduate Level • Graduate Level
  43. 43. 43 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.
  44. 44. 44 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.
  45. 45. 45 Healthcare CIO Certificate Program Faculty of Medicine Ramathibodi Hospital, Mahidol University http://med.mahidol.ac.th/has/
  46. 46. Diploma & Master Graduates in Biomedical & Health Informatics, First Batch Faculty of Tropical Medicine, Mahidol University 46
  47. 47. 47 National Professional Society • 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)
  48. 48. 48 TMI CIO Forum
  49. 49. Thai Informatics Year in Review • Modeled after the popular Dan Masys Informatics Year in Review & other YIRs • Perhaps the first national-level Informatics YIR 49
  50. 50. 50 Internationalization • International Medical Informatics Association (IMIA) – MEDINFO & APAMI • HIMSS AsiaPac • Asia eHealth Information Network (AeHIN) • American Medical Informatics Association (AMIA)
  51. 51. Participation in AeHIN http://www.aehin.org/Meetings/2013AeHINGeneralMeeting.as5p1x
  52. 52. 52 eHealth Components
  53. 53. 53 Legislation, Policy & Compliance • Mostly privacy laws – Written broadly & vaguely – Different interpretation, enforcement difficult – Barrier to data exchange • No “HITECH Act” or “Meaningful Use” Equivalent
  54. 54. 54 Outline The Needs for eHealth Thailand's eHealth situation • The road ahead for Thailand's eHealth
  55. 55. 55 The Road Ahead for Thailand’s eHealth
  56. 56. 56 eHealth Components
  57. 57. 57 The Road Ahead • Addressing – Lack of national leadership & governance, strategy & investment, policy & regulation – Shortage of informatics workforce – Accelerating standards development – Harmonizing applications – Facilitating local research in informatics
  58. 58. 58 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 • 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
  59. 59. 59 Windows of Opportunities for eHealth • National Legislative Assembly’s Public Health Committee appointed “Health Information System Standards Subcommittee” to tackle policy & legislative issues of standards & interoperability • Thai Informaticians represented Dr. Boonchai Kijsanayotin Dr. Nawanan Theera-Ampornpunt Dr. Bordin Sapsomboon
  60. 60. 60 Windows of Opportunities for eHealth • 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
  61. 61. The Journey Beyond Image Source: http://twinstrivia.com/2013/05/20/the-road-to-minnesota-is-long-and-hard/ 61
  62. 62. 62 But We’ll Get There...
  63. 63. 63 The UMN Impact Special Appreciation to Prof. Stuart Speedie and other IHI Faculty for planting the seeds for Thailand’s future informatics workforce

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