1. eHealth in Thailand:
Status and Trend
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Faculty of Medicine Ramathibodi Hospital
Mahidol University
www.SlideShare.net/Nawanan

2. Outline
• What is eHealth and Why
• Thailand’s eHealth Status
• Future Trends

3. Landmark IOM Reports
(IOM, 2001)(IOM, 2000) (IOM, 2011)

4. Patient Safety
• To Err is Human (Institute of Medicine, 1999)
• 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 2012Introduction to Healthcare and Public Health in the US: Regulating Healthcare - Lecture d

5. • 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

6. Image Source: aafp.org
• Lack of Attention
To Err Is Human

7. • Medication Errors
– Drug Allergies
– Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
Common Errors

8. Computerized Physician Order Entry (CPOE)

9. – 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 (CDSSs)

10. Example of “Alerts & Reminders”

11. Various Forms of Health IT
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic
Health
Records
(EHRs)
Picture Archiving and
Communication System
(PACS)

12. Still Many Other Forms of Health IT
m-Health
Biosurveillance
Telemedicine &
Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc.
Personal Health Records
(PHRs)

13. Health Information Exchange (HIE)
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home

14. • Guideline adherence
• Better documentation
• Practitioner decision making
or process of care
• Medication safety
• Patient surveillance &
monitoring
• Patient education/reminder
Values of Health IT

15. 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 & Boonchai Kijsanayotin
eHealth

16. 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: Boonchai Kijsanayotin
Health IT

17. eHealth  Health IT
eHealth & Health IT
Slide adapted from: Boonchai Kijsanayotin

18. HIS
All information about health
eHealth
HMIS
mHealth
Tele-
medicine
More Terms
Slide adapted from: Karl Brown (Rockefeller Foundation), via Boonchai Kijsanayotin

19. • Safety
• Timeliness
• Effectiveness
• Efficiency
• Equity
• Patient-centeredness
Goals for “Health”
(IOM, 2001)

20.  All components are essential
 All components should be balanced
eHealth Components (WHO-ITU Model)
Slide adapted from: Boonchai Kijsanayotin

21. Strategy&Investment
Standards & Interoperability
Infrastructure
Services, Applications
Software
Leadership & governance
Legislation,policy&
compliance
Workforce
Thailand: Unbalanced Development
Slide adapted from: Boonchai Kijsanayotin

22. eHealth Development Model
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: Boonchai Kijsanayotin

23. eHealth Applications
Enabling
Policies and
Strategies
Foundation
Policies and
Strategies
Thailand’s eHealth Development
Slide adapted from: Boonchai Kijsanayotin

24.  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
Thailand’s eHealth Situation
Slide adapted from: Boonchai Kijsanayotin

25. EHR Adoption in Thai Hospitals
Theera-Ampornpunt (2011)

26. HOSxP
50%
Self-developed or outsourced
16%
Hospital OS
7%
SSB
4%
Mit-Net
2%
MRecord
2%
H.I.M. Professional
2%
MedTrak/
TrakCare
2%
HoMC
2%
None 2% THIADES
2% HIMS
1%
Abstract ePHIS
1%
Other
7%
EHR Product Distribution:
THAIS 2011
Theera-Ampornpunt (2011)

27. Adoption Estimates: THAIS 2011
Estimate (Partial or Complete
Adoption)
Nationwide
Basic EHR, combined inpatient &
outpatient settings
49.8%
Order entry of medications, combined 90.2%
Theera-Ampornpunt (2011)

28. Functional
Semantic
Syntactic
Standards & 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
Functional Standards (HL7 EHR
Functional Specifications)
Some may be hybrid: e.g. HL7 v.3, HL7 CCD
Unique ID

29. Standards National
1. Content standards (Core data set) 12 & 18 files standards
2. Semantic standards Citizen Identifiers
ICD 10 TM, ICD 9 CM
3. Syntactic standards X
4. Security and privacy standards X
Thailand’s Health Information Standards
Slide adapted from: Boonchai Kijsanayotin

30.  IT is pervasive in Thai health sector
 eHealth foundations lagged behind
 No national eHealth policy
 Fragmented eHealth applications
Thailand’s eHealth Summary
Slide adapted from: Boonchai Kijsanayotin

31. Urges member state to
1. Draw up a road map for implementation of
eHealth and health data standards at national and
subnational levels.
2. Develop 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.
http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R24-en.pdf
Dr Margaret Chan, Director-General of WHO
World Health Assembly
Resolution WHA66.24
May 2013
Slide adapted from: Boonchai Kijsanayotin

32.  Stronger health IT adoption in clinical
settings
 Local data exchange in specific areas (Ex.
referrals; provincial level)
 Standards development
 Efforts to create “roadmap” & architecture
 Privacy laws & other public policies
 Insurance claims & reimbursement a
major driver of eHealth
Trends for Thailand’s eHealth