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Driving Digital Health in the Thai Society (September 13, 2019)

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Presented at the Thai Health Academy Annual Conference 2019: Digital Health, Thai Health Foundation, Bangkok, Thailand on September 13, 2019

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Driving Digital Health in the Thai Society (September 13, 2019)

  1. 1. Panel: การขับเคลื่อน Digital Health ในสังคมไทย นพ.นวนรรน ธีระอัมพรพันธุ์ 13 ก.ย. 2562 www.SlideShare.net/Nawanan
  2. 2. What words come to mind when you hear... Digital Health Transformation
  3. 3. https://medium.com/@marwantarek/it-is-the-perfect-storm-ai-cloud-bots-iot-etc-4b7cbb0481bc
  4. 4. http://www.ibtimes.com/google-deepminds-alphago-program-defeats-human-go-champion-first-time-ever-2283700 http://deepmind.com/ http://socialmediab2b.com An Era of Smart Machines
  5. 5. englishmoviez.com Rise of the Machines?
  6. 6. Digitizing Healthcare? http://www.bloomberg.com/bw/stories/2005-03-27/cover-image-the-digital-hospital
  7. 7. “Big data is like teenage sex: everyone talks about it, nobody really knows how to do it, everyone thinks everyone else is doing it, so everyone claims they are doing it...” -- Dan Ariely @danariely (2013) Substitute “Big data” with “AI”, “Blockchain”, “IoT” of your choice. -- Nawanan Theera-Ampornpunt (2018)
  8. 8. Hype vs. Hope Jeremy Kemp via http://en.wikipedia.org/wiki/Hype_cycle http://www.gartner.com/technology/research/methodologies/hype-cycle.jsp
  9. 9. “Smart” Machines? https://www.bbc.com/news/business-47514289 https://www.standardmedia .co.ke/article/2001318679/e thiopian-airlines-crash- investigators-reach- conclusion
  10. 10. Digitization  Digital Transformation
  11. 11. Why Aren’t We Talk About These Words? http://hcca-act.blogspot.com/2011/07/reflections-on-patient-centred-care.html
  12. 12. The Goal of Health Care The answer is already obvious... “Health” “Care”
  13. 13. • 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
  14. 14. ภาพรวมของงานด้าน Health IT Intra-Hospital IT • Electronic Health Records & Health IT for Quality & Safety • Digital Transformation • AI, Data Analytics • Hospital IT Quality Improvement (HA-IT) Inter-Hospital IT • Health Information Exchange (HIE) Extra-Hospital IT • Patients: Personal Health Records (PHRs) • Public Health: Disease Surveillance & Analytics Patient at Home
  15. 15. Strategic Operational ClinicalAdministrative LIS Health Information ExchangeBusiness Intelligence Word Processor Social Media PACS Personal Health Records Clinical Decision Support Systems Computerized Physician Order Entry Electronic Health Records Admission-Discharge-Transfer Master Patient Index Enterprise Resource Planning Vendor-Managed Inventory Customer Relationship Management 4 Quadrants of Hospital IT
  16. 16. ภาพรวมของงานด้าน Health IT Intra-Hospital IT • Electronic Health Records & Health IT for Quality & Safety • Digital Transformation • AI, Data Analytics • Hospital IT Quality Improvement (HA-IT) Inter-Hospital IT • Health Information Exchange (HIE) Extra-Hospital IT • Patients: Personal Health Records (PHRs) • Public Health: Disease Surveillance & Analytics Patient at Home
  17. 17. Hospital A Hospital B Clinic D Policymakers Patient at Home Hospital C HIE Platform Health Information Exchange (HIE)
  18. 18. Kaelber et al. (2008) Personal Health Records (PHRs)
  19. 19. WHO & ITU Achieving Health Information Exchange (HIE)
  20. 20. https://www.hfocus.org/content/2016/02/11783 https://www.hfocus.org/content/2016/03/11968 https://www.hfocus.org/content/2016/09/12671
  21. 21. Areas of Health Informatics Patients & Consumers Providers & Patients Healthcare Managers, Policy- Makers, Payers, Epidemiologists, Researchers Copyright  Nawanan Theera-Ampornpunt (2018) Clinical Informatics Public Health Informatics Consumer Health Informatics
  22. 22. Incarnations of Health IT Clinical Informatics Public Health Informatics Consumer Health Informatics HIS/CIS EHRs Computerized Physician Order Entry (CPOE) Clinical Decision Support Systems (CDS) (including AI) Closed Loop Medication PACS/RIS LIS Nursing Apps Disease Surveillance (Active/Passive) Business Intelligence & Dashboards Telemedicine Real-time Syndromic Surveillance mHealth for Public Health Workers & Volunteers PHRs Health Information Exchange (HIE) eReferral mHealth for Consumers Wearable Devices Social Media Copyright  Nawanan Theera-Ampornpunt (2018)
  23. 23. Where We Are Today... Copyright  Nawanan Theera-Ampornpunt (2018) Clinical Informatics Public Health Informatics Consumer Health Informatics Technology that focuses on the sick, not the healthy Silos of data within hospitalPoor/unstructured data quality Lack of health data outside hospital Poor data integration across hospitals/clinics Poor data integration for monitoring & evaluation Poor data quality (GIGO) Finance leads clinical outcomes Poor IT change management Cybersecurity & privacy risks Few real examples of precision medicine Little access to own health data Poor patient engagement Poor accuracy of wearables Lack of evidence for health values Health literacy Information  Behavioral change Few standards Lack of health IT governance
  24. 24. ภาพรวมของงานด้าน Health IT Intra-Hospital IT • Electronic Health Records & Health IT for Quality & Safety • Digital Transformation • AI, Data Analytics • Hospital IT Quality Improvement (HA-IT) Inter-Hospital IT • Health Information Exchange (HIE) Extra-Hospital IT • Patients: Personal Health Records (PHRs) • Public Health: Disease Surveillance & Analytics Patient at Home
  25. 25. Digital Literacy & Health
  26. 26. Literacy Literacy Computer Literacy IT Literacy Information Literacy Digital Literacy Health Literacy Media Literacy
  27. 27. Literacy Institute of Medicine 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.
  28. 28. Digital Divide & Literacy https://www.itu.int/en/ITU-D/Statistics/Documents/Global%20ICT%20Developments%202001-2018%20-%20original.jpg
  29. 29. Digital Divide & Literacy (2016) https://en.wikipedia.org/wiki/List_of_countries_by_number_of_Internet_users
  30. 30. Thailand ICT Statistics (2018) “Thailand has an extensive broadband network with a current focus on increasing speeds and extending access to remote villages. Mobile broadband take-up has been astonishing, with barely any 2G subscriptions left following the award of 3G spectrum in 2012.” https://www.itu.int/en/ITU-D/Statistics/Documents/publications/misr2018/MISR-2018-Vol-2-E.pdf
  31. 31. Computer Literacy •Mainly used through the 1980s •Skill sets that enable one to be “able to operate commonly used software packages effectively” (Bawden, 2008) Bawden D. Origins and concepts of digital literacy. In: Lankshear C, Knobel M, editors. Digital literacies: concepts, policies and practices. : Peter Lang; 2008.
  32. 32. Information Literacy •Broader than “Computer Literacy” •A Multifaceted Concept •Encompasses “aspects of evaluation of information, and an appreciation of the nature of information resources” •While still focuses on computerized information believed to be most problematic to users, also includes use of printed resources •Hence, overlap with library literacy & media literacy Bawden D. Origins and concepts of digital literacy. In: Lankshear C, Knobel M, editors. Digital literacies: concepts, policies and practices. : Peter Lang; 2008.
  33. 33. Information Literacy •American Library Association proposed a 6-stage model in 1989, comprising six aspects of a linear process of information handling Recognizing Need for Information Identifying What Information is Needed Finding Information Evaluating Information Organizing Information Using Information Bawden D. Origins and concepts of digital literacy. In: Lankshear C, Knobel M, editors. Digital literacies: concepts, policies and practices. : Peter Lang; 2008.
  34. 34. Digital Literacy •Gilster (1997): “An ability to understand and to use information from a variety of digital sources” •Gilster: DL “is about mastering ideas, not keystrokes” •Bawden (2008), referring to Gilster’s definition: “Simply literacy in the digital age” Gilster (1997) Bawden D. Origins and concepts of digital literacy. In: Lankshear C, Knobel M, editors. Digital literacies: concepts, policies and practices. : Peter Lang; 2008.
  35. 35. Digital Literacy Skills & Competences (Gilster, 1997) • “knowledge assembly,” building a “reliable information hoard” from diverse sources • retrieval skills, plus “critical thinking” for making informed judgements about retrieved information, with wariness about the validity and completeness of internet sources • reading and understanding non-sequential and dynamic material • awareness of the value of traditional tools in conjunction with networked media • awareness of “people networks” as sources of advice and help • using filters and agents to manage incoming information • being comfortable with publishing and communicating information, as well as accessing it Gilster (1997) Bawden, In Kankshear & Knobel (2008) Gilster (1997), via Bawden (2008)
  36. 36. Digital Literacy (Bawden, 2008) Bawden D. Origins and concepts of digital literacy. In: Lankshear C, Knobel M, editors. Digital literacies: concepts, policies and practices. : Peter Lang; 2008. 4 generally agreed components of DL 1. Underpinnings • Literacy • Computer/ICT Literacy 2. Background Knowledge • The World of Information • Nature of Information Resources 3. Central Competencies • Reading & Understanding Digital & Non-Digital Formats • Creating & Communicating Digital Information • Evaluation of Information • Knowledge Assembly • Information Literacy • Media Literacy 4. Attitudes & Perspectives • Independent Learning • Moral/Social Literacy
  37. 37. Health Literacy •“The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Ratzan & Parker, 2000; Selden et al., 2000; HHS, 2000)
  38. 38. Health Literacy Institute of Medicine 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.
  39. 39. Health Literacy Institute of Medicine 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.
  40. 40. Health Literacy Institute of Medicine 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.
  41. 41. Health Literacy Institute of Medicine 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.
  42. 42. Health Literacy Institute of Medicine 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.
  43. 43. Health Literacy http://nutrition.about.com/od/recipesmenus/ss/learnlabels.htm
  44. 44. Health Literacy Institute of Medicine 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.
  45. 45. Health Literacy Institute of Medicine 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.
  46. 46. Health Literacy Institute of Medicine 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.
  47. 47. Health Literacy Institute of Medicine 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.
  48. 48. Health Literacy Institute of Medicine 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.
  49. 49. ฉลากยา รพ.ระยอง และ รพ.สต. https://www.hfocus.org/content/2017/04/13820
  50. 50. Health Literacy •“หญิงไทย 74 ปี อ่านจาก Line ว่า กระชายดาลดไขมัน + บารุงกระดูก จึงไปซื้อกระชายดามาปั่น กินวันละ 3 ขีด + กินมะม่วงหาวมะนาวโห่ วันละ 8 ลูก + งาดาวันละ 2 เม็ด (มี Sales มาขายที่บ้าน บอกว่าลดไขมัน ลดเบาหวาน ลด ความดัน รักษามะเร็งได้ด้วย ราคาแพง ซื้อต่องวด 5,700 บาท)” จากบันทึกของแพทย์ท่านหนึ่งในเวชระเบียนของผู้ป่วยรายหนึ่ง
  51. 51. Healthtech Startup Ecosystem www.facebook.com/HealthTechThailand/ No endorsements implied
  52. 52. Roles of IT in Consumer Health •Access to information •Networking opportunities •Education/Self-study •Personalization •Effective & efficient communications • With providers • Among patients •Empowerment •“User Experience” Institute of Medicine 2013. Oral Health Literacy: Workshop Summary. Washington, DC: The National Academies Press.
  53. 53. IT & Participatory Medicine • Richard Davies deBronkart Jr. • Cancer survivor & blogger • Found proper cancer treatment through online social network after diagnosis • Activist for participatory medicine & patient engagement through information technology http://www.epatientdave.com/
  54. 54. E-Patient •Not “Electronic” Patient •Engaged •Equipped •Empowered •Educated •Enlightened •Etc. http://www.epatientdave.com/
  55. 55. ภาพรวมของงานด้าน Health IT Intra-Hospital IT • Electronic Health Records & Health IT for Quality & Safety • Digital Transformation • AI, Data Analytics • Hospital IT Quality Improvement (HA-IT) Inter-Hospital IT • Health Information Exchange (HIE) Extra-Hospital IT • Patients: Personal Health Records (PHRs) • Public Health: Disease Surveillance & Analytics Patient at Home
  56. 56. Envisioning a Smart Health Thailand

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