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Application of ICT for Health
in Clinical Settings
Chulalongkorn University
February 15, 2015
Nawanan Theera-Ampornpunt, M...
2
Outline
• Health & Health Information
• Health IT & eHealth
• Health Informatics as a Discipline
• Thailand’s eHealth Si...
3
Health &
Health Information
4
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)
8
(At an undisclosed nearby hospital)
Healthcare (Reality)
9
• Life-or-Death
• Difficult to automate human decisions
– Nature of business
– Many & varied stakeholders
– Evolving sta...
10
Back to
something simple...
11
To treat & to
care for their
patients to their
best abilities,
given limited
time &
resources
Image Source: http://en.w...
12
• Safe
• Timely
• Effective
• Patient-Centered
• Efficient
• Equitable
Institute of Medicine, Committee on Quality of H...
13
Information is Everywhere in Healthcare
14
“Information” in Medicine
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA.
2010 Sep 15;304(1...
15
15
WHO (2009)
Components of Health Systems
16
16
WHO (2009)
WHO Health System Framework
17
Outline
Health & Health Information
• Health IT & eHealth
• Health Informatics as a Discipline
• Thailand’s eHealth Si...
18
Health IT &
eHealth
19
(IOM, 2001)(IOM, 2000) (IOM, 2011)
Landmark IOM Reports
20
• 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
p...
21
• Humans are not perfect and are bound to
make errors
• Highlight problems in U.S. health care
system that systematical...
22
Image Source: (Left) http://docwhisperer.wordpress.com/2007/05/31/sleepy-heads/
(Right) http://graphics8.nytimes.com/im...
23Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital
To Err is Human 2: M...
24
• Cognitive Errors - Example: Decoy Pricing
The Economist Purchase Options
• Economist.com subscription $59
• Print sub...
25
• It already happens....
(Mamede et al., 2010; Croskerry, 2003;
Klein, 2005; Croskerry, 2013)
What If This Happens in H...
26
Mamede S, van Gog T, van den Berge K, Rikers RM, van Saase JL, van Guldener C,
Schmidt HG. Effect of availability bias ...
27
Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them.
Acad Med. 2003 Aug;78(8):...
28
Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr
2;330(7494):781-3.
“Everyone makes ...
29
• Medication Errors
–Drug Allergies
–Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Fa...
30
Why We Need ICT
in Healthcare?
#1: Because information is
everywhere in healthcare
31
Why We Need ICT
in Healthcare?
#2: Because healthcare is
error-prone and technology
can help
32
Why We Need ICT
in Healthcare?
#3: Because access to
high-quality patient
information improves care
33
Why We Need ICT
in Healthcare?
#4: Because healthcare at
all levels is fragmented &
in need of process
improvement
34
Use of information and communications
technology (ICT) in health & healthcare
settings
Source: The Health Resources and...
35
Use of information and communications
technology (ICT) for health; Including
• Treating patients
• Conducting research
...
36
eHealth  Health IT
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealth & Health IT
37
HIS
All information about health
eHealth
HMIS
mHealth
Tele-
medicine
Slide adapted from: Karl Brown (Rockefeller Founda...
38
Health
Information
Technology
Goal
Value-Add
Tools
Health IT: What’s in a Word?
39
 All components are essential
 All components should be balanced
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealt...
40
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic
Health
Records
(EHRs)
Picture Arc...
41
mHealth
Biosurveillance
Telemedicine &
Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, HealthVault.com and A...
42
• Guideline adherence
• Better documentation
• Practitioner decision making or
process of care
• Medication safety
• Pa...
43
• Master Patient Index (MPI)
• Admit-Discharge-Transfer (ADT)
• Electronic Health Records (EHRs)
• Computerized Physici...
44
• Pharmacy applications
• Laboratory Information System (LIS)
• Radiology Information System (RIS)
• Specialized applic...
45
The Challenge - Knowing What It Means
Electronic Medical
Records (EMRs)
Computer-Based
Patient Records
(CPRs)
Electroni...
46
Computerized Provider Order Entry (CPOE)
47
Values
• No handwriting!!!
• Structured data entry: Completeness, clarity,
fewer mistakes (?)
• No transcription errors...
48
• The real place where most of the
values of health IT can be achieved
– Expert systems
• Based on artificial intellige...
49
– Alerts & reminders
• Based on specified logical conditions
• Examples:
– Drug-allergy checks
– Drug-drug interaction ...
50
Examples of “Reminders”
51Image Source: https://webcis.nyp.org/webcisdocs/what-are-infobuttons.html
Some Other CDS - Infobuttons
52Image Source: http://www.hospitalmedicine.org/ResourceRoomRedesign/CSSSIS/html/06Reliable/SSI/Order.cfm
Some Other CDS -...
53Image Source: http://geekdoctor.blogspot.com/2008/04/designing-ideal-electronic-health.html
Some Other CDS - Abnormal La...
54
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
Working
...
55Image Source: socialmediab2b.com
IBM’s Watson
56Image Source: englishmoviez.com
Rise of the Machines
57
• CDS as a replacement or supplement of
clinicians?
– The demise of the “Greek Oracle” model (Miller & Masarie, 1990)
T...
58
The “Human Factor”
• Alert fatigue
Unintended Consequences of Health IT
59
Workarounds
60
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
The Big Picture: Health Information Exchange (HIE)
61
Outline
Health & Health Information
Health IT & eHealth
• Health Informatics as a Discipline
• Thailand’s eHealth Sit...
62
Health Informatics
as a Discipline
63
M/B/H Informatics As A Field
(Shortliffe, 2002)
64(Hersh, 2009)
M/B/H Informatics As a Discipline
65
Biomedical/
Health
Informatics
Computer &
Information
Science
Engineering
Cognitive
&
Decision
Science
Social
Sciences
...
66
Outline
Health & Health Information
Health IT & eHealth
Health Informatics as a Discipline
• Thailand’s eHealth Situ...
67
Thailand’s
eHealth Situation
68
eHealth in Thailand: The current status. Stud Health Technol Inform
2010;160:376–80, Presented at MedInfo2010 South Afr...
69Slide adapted from: Dr. Boonchai Kijsanayotin
Thailand: Unbalanced Development
70
eHealth Applications
Enabling Policies &
Strategies
Foundation Policies
& Strategies
• Services
• Applications
• Softwa...
71Slide adapted from: Dr. Boonchai Kijsanayotin
Thailand’s eHealth Development
72
 Silo-type systems
 Little integration and interoperability
 Mostly aim for administration and management
 40% of w...
73
Section 1 Hospital Profile
Section 2 IT Adoption & Use
Profile
Section 3 Respondent’s
Information
Thailand’s Health IT ...
74
• 4 of 1,302 hospitals ineligible
• Response rate 69.9%
Characteristic Overall Responding
Hospitals
Non-
Responding
Hos...
75Pongpirul et al., 2004
Vendor/Product Distribution (2004)
76
Vendor/Product Distribution (2011)
Theera-Ampornpunt, 2011
77
Estimate (Partial or Complete Adoption) Nationwide
Basic EHR, outpatient 86.6%
Basic EHR, inpatient 50.4%
Basic EHR, bo...
78
• High IT adoption rates
• Drastic changes in adoption landscape
• Local context might play a role
– Supply Side
– Dema...
79
Outline
Health & Health Information
Health IT & eHealth
Health Informatics as a Discipline
Thailand’s eHealth Situa...
80
Current Forces
81
International
• Technology Trends
• Standards & Interoperability Trends
• eHealth Successes & Failures
– UK NHS
– US Me...
82
URGES Member States:
(1) to consider, as appropriate, options to collaborate with
relevant stakeholders, including nati...
83
(3) to consider ways for ministries of health and public
health authorities to work with their national representatives...
84
Domestic
• Thailand’s Health Insurance Trends
• Increased Hospital IT Adoption
• Demands for Data & Information Exchang...
85
Outline
Health & Health Information
Health IT & eHealth
Health Informatics as a Discipline
Thailand’s eHealth Situa...
86Image Source: http://twinstrivia.com/2013/05/20/the-road-to-minnesota-is-long-and-hard/
The Journey Beyond:
A Long and W...
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Application of ICT for Health in Clinical Settings

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Application of ICT for Health in Clinical Settings

  1. 1. Application of ICT for Health in Clinical Settings Chulalongkorn University February 15, 2015 Nawanan Theera-Ampornpunt, M.D., Ph.D. Department of Community Medicine Faculty of Medicine Ramathibodi Hospital SlideShare.net/Nawanan
  2. 2. 2 Outline • Health & Health Information • Health IT & eHealth • Health Informatics as a Discipline • Thailand’s eHealth Situation • Current Forces
  3. 3. 3 Health & Health Information
  4. 4. 4 Let’s take a look at these pictures...
  5. 5. 5Image Source: Guardian.co.uk Manufacturing
  6. 6. 6Image Source: http://www.oknation.net/blog/phuketpost/2013/10/19/entry-3 Banking
  7. 7. 7ER - Image Source: nj.com Healthcare (on TV)
  8. 8. 8 (At an undisclosed nearby hospital) Healthcare (Reality)
  9. 9. 9 • 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
  10. 10. 10 Back to something simple...
  11. 11. 11 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?
  12. 12. 12 • 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
  13. 13. 13 Information is Everywhere in Healthcare
  14. 14. 14 “Information” in Medicine Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
  15. 15. 15 15 WHO (2009) Components of Health Systems
  16. 16. 16 16 WHO (2009) WHO Health System Framework
  17. 17. 17 Outline Health & Health Information • Health IT & eHealth • Health Informatics as a Discipline • Thailand’s eHealth Situation • Current Forces
  18. 18. 18 Health IT & eHealth
  19. 19. 19 (IOM, 2001)(IOM, 2000) (IOM, 2011) Landmark IOM Reports
  20. 20. 20 • 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 errors Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US: Regulating Healthcare - Lecture d Patient Safety
  21. 21. 21 • 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
  22. 22. 22 Image 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
  23. 23. 23Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital To Err is Human 2: Memory
  24. 24. 24 • Cognitive Errors - Example: Decoy Pricing The Economist Purchase Options • Economist.com subscription $59 • Print subscription $125 • Print & web subscription $125 Ariely (2008) 16 0 84 The Economist Purchase Options • Economist.com subscription $59 • Print & web subscription $125 68 32 # of People # of People To Err is Human 3: Cognition
  25. 25. 25 • It already happens.... (Mamede et al., 2010; Croskerry, 2003; Klein, 2005; Croskerry, 2013) What If This Happens in Healthcare?
  26. 26. 26 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
  27. 27. 27 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
  28. 28. 28 Klein 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
  29. 29. 29 • Medication Errors –Drug Allergies –Drug Interactions • Ineffective or inappropriate treatment • Redundant orders • Failure to follow clinical practice guidelines Common Errors
  30. 30. 30 Why We Need ICT in Healthcare? #1: Because information is everywhere in healthcare
  31. 31. 31 Why We Need ICT in Healthcare? #2: Because healthcare is error-prone and technology can help
  32. 32. 32 Why We Need ICT in Healthcare? #3: Because access to high-quality patient information improves care
  33. 33. 33 Why We Need ICT in Healthcare? #4: Because healthcare at all levels is fragmented & in need of process improvement
  34. 34. 34 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
  35. 35. 35 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
  36. 36. 36 eHealth  Health IT Slide adapted from: Dr. Boonchai Kijsanayotin eHealth & Health IT
  37. 37. 37 HIS All information about health eHealth HMIS mHealth Tele- medicine Slide adapted from: Karl Brown (Rockefeller Foundation), via Dr. Boonchai Kijsanayotin More Terms...
  38. 38. 38 Health Information Technology Goal Value-Add Tools Health IT: What’s in a Word?
  39. 39. 39  All components are essential  All components should be balanced Slide adapted from: Dr. Boonchai Kijsanayotin eHealth Components: WHO-ITU Model
  40. 40. 40 Hospital Information System (HIS) Computerized Provider Order Entry (CPOE) Electronic Health Records (EHRs) Picture Archiving and Communication System (PACS) Screenshot Images from Faculty of Medicine Ramathibodi Hospital, Mahidol University Various Forms of Health IT
  41. 41. 41 mHealth Biosurveillance Telemedicine & Telehealth Images from Apple Inc., Geekzone.co.nz, Google, HealthVault.com and American Telecare, Inc. Personal Health Records (PHRs) and Patient Portals Still Many Other Forms of Health IT
  42. 42. 42 • Guideline adherence • Better documentation • Practitioner decision making or process of care • Medication safety • Patient surveillance & monitoring • Patient education/reminder Documented Values of Health IT
  43. 43. 43 • Master Patient Index (MPI) • Admit-Discharge-Transfer (ADT) • Electronic Health Records (EHRs) • Computerized Physician Order Entry (CPOE) • Clinical Decision Support Systems (CDS) • Picture Archiving and Communication System (PACS) • Nursing applications • Enterprise Resource Planning (ERP) Some Hospital IT - Enterprise-wide
  44. 44. 44 • Pharmacy applications • Laboratory Information System (LIS) • Radiology Information System (RIS) • Specialized applications (ER, OR, LR, Anesthesia, Critical Care, Dietary Services, Blood Bank) • Incident management & reporting system Some Hospital IT - Departmental Systems
  45. 45. 45 The Challenge - Knowing What It Means Electronic Medical Records (EMRs) Computer-Based Patient Records (CPRs) Electronic Patient Records (EPRs) Electronic Health Records (EHRs) Personal Health Records (PHRs) Hospital Information System (HIS) Clinical Information System (CIS) EHRs & HIS
  46. 46. 46 Computerized Provider Order Entry (CPOE)
  47. 47. 47 Values • No handwriting!!! • Structured data entry: Completeness, clarity, fewer mistakes (?) • No transcription errors! • Streamlines workflow, increases efficiency Computerized Provider Order Entry (CPOE)
  48. 48. 48 • The real place where most of the values of health IT can be achieved – Expert systems • Based on artificial intelligence, machine learning, rules, or statistics • Examples: differential diagnoses, treatment options (Shortliffe, 1976) Clinical Decision Support Systems (CDS)
  49. 49. 49 – Alerts & reminders • Based on specified logical conditions • Examples: – Drug-allergy checks – Drug-drug interaction checks – Reminders for preventive services – Clinical practice guideline integration Clinical Decision Support Systems (CDS)
  50. 50. 50 Examples of “Reminders”
  51. 51. 51Image Source: https://webcis.nyp.org/webcisdocs/what-are-infobuttons.html Some Other CDS - Infobuttons
  52. 52. 52Image Source: http://www.hospitalmedicine.org/ResourceRoomRedesign/CSSSIS/html/06Reliable/SSI/Order.cfm Some Other CDS - Order Sets/Checklists
  53. 53. 53Image Source: http://geekdoctor.blogspot.com/2008/04/designing-ideal-electronic-health.html Some Other CDS - Abnormal Lab Highlights
  54. 54. 54 External Memory Knowledge Data Long Term Memory Knowledge Data Inference DECISION PATIENT Perception Attention Working Memory CLINICIAN Elson, Faughnan & Connelly (1997) Clinical Decision Making & CDS
  55. 55. 55Image Source: socialmediab2b.com IBM’s Watson
  56. 56. 56Image Source: englishmoviez.com Rise of the Machines
  57. 57. 57 • CDS as a replacement or supplement of clinicians? – The demise of the “Greek Oracle” model (Miller & Masarie, 1990) The “Greek Oracle” Model The “Fundamental Theorem” Model Friedman (2009) Wrong Assumption Correct Assumption Proper Roles of CDS
  58. 58. 58 The “Human Factor” • Alert fatigue Unintended Consequences of Health IT
  59. 59. 59 Workarounds
  60. 60. 60 Hospital A Hospital B Clinic C Government Lab Patient at Home The Big Picture: Health Information Exchange (HIE)
  61. 61. 61 Outline Health & Health Information Health IT & eHealth • Health Informatics as a Discipline • Thailand’s eHealth Situation • Current Forces
  62. 62. 62 Health Informatics as a Discipline
  63. 63. 63 M/B/H Informatics As A Field (Shortliffe, 2002)
  64. 64. 64(Hersh, 2009) M/B/H Informatics As a Discipline
  65. 65. 65 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
  66. 66. 66 Outline Health & Health Information Health IT & eHealth Health Informatics as a Discipline • Thailand’s eHealth Situation • Current Forces
  67. 67. 67 Thailand’s eHealth Situation
  68. 68. 68 eHealth in Thailand: The current status. Stud Health Technol Inform 2010;160:376–80, Presented at MedInfo2010 South Africa Thailand’s eHealth: 2010
  69. 69. 69Slide adapted from: Dr. Boonchai Kijsanayotin Thailand: Unbalanced Development
  70. 70. 70 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
  71. 71. 71Slide adapted from: Dr. Boonchai Kijsanayotin Thailand’s eHealth Development
  72. 72. 72  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
  73. 73. 73 Section 1 Hospital Profile Section 2 IT Adoption & Use Profile Section 3 Respondent’s Information Thailand’s Health IT Adoption
  74. 74. 74 • 4 of 1,302 hospitals ineligible • Response rate 69.9% Characteristic Overall Responding Hospitals Non- Responding Hospitals N of eligible hospitals 1,298 908 390 Bed size** 106.9 117.5 82.9 Public status** Private Public 24.0% 76.0% 17.4% 82.6% 39.2% 60.8% Geography* Central East North Northeast South West 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
  75. 75. 75Pongpirul et al., 2004 Vendor/Product Distribution (2004)
  76. 76. 76 Vendor/Product Distribution (2011) Theera-Ampornpunt, 2011
  77. 77. 77 Estimate (Partial or Complete Adoption) Nationwide Basic 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
  78. 78. 78 • 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
  79. 79. 79 Outline Health & Health Information Health IT & eHealth Health Informatics as a Discipline Thailand’s eHealth Situation • Current Forces
  80. 80. 80 Current Forces
  81. 81. 81 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
  82. 82. 82 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
  83. 83. 83 (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
  84. 84. 84 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
  85. 85. 85 Outline Health & Health Information Health IT & eHealth Health Informatics as a Discipline Thailand’s eHealth Situation Current Forces
  86. 86. 86Image 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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