ehealth: the next building block for thailand's healthcare system
DESCRIPTION
TRANSCRIPT
![Page 1: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/1.jpg)
eHealth: The Next Building Block for Thailand’s Healthcare System
Nawanan Theera-Ampornpunt, M.D., Ph.D.Faculty of Medicine Ramathibodi Hospital
Mahidol University, ThailandJune 13, 2014
www.SlideShare.net/Nawanan
![Page 2: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/2.jpg)
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
•Lecturer, Department of Community MedicineFaculty of Medicine Ramathibodi HospitalMahidol University
![Page 3: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/3.jpg)
3
Outline
• Needs for better information in healthcare• eHealth as a health system's component• Thailand's eHealth situation• The road ahead for Thailand's eHealth
![Page 4: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/4.jpg)
4
Needs for Better Information
in Healthcare
![Page 5: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/5.jpg)
5
“Information” in Medicine
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
![Page 6: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/6.jpg)
6
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.)
![Page 7: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/7.jpg)
7http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf
Fragmented Healthcare
![Page 8: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/8.jpg)
8
(IOM, 2001)(IOM, 2000) (IOM, 2011)
Landmark IOM Reports
![Page 9: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/9.jpg)
9
• 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
![Page 10: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/10.jpg)
10
• Medication Errors
– Drug Allergies
– Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
Common Errors
![Page 11: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/11.jpg)
11
Back to something simple...
![Page 12: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/12.jpg)
12
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?
![Page 13: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/13.jpg)
13
The Question Becomes...
How do we deliver better information, by supplementing
human clinicians with ICT, so that they make less errors and
perform better?
![Page 14: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/14.jpg)
14
Outline
Needs for better information in healthcare• eHealth as a health system's component• Thailand's eHealth situation• The road ahead for Thailand's eHealth
![Page 15: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/15.jpg)
15
eHealth as a Health System
Component
![Page 16: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/16.jpg)
16
16
WHO (2009)
Components of Health Systems
![Page 17: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/17.jpg)
17
17
WHO (2009)
WHO Health System Framework
![Page 18: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/18.jpg)
18
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
![Page 19: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/19.jpg)
19
All components are essential All components should be balanced
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealth Components: WHO-ITU Model
![Page 20: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/20.jpg)
20
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Goal: Health Information Exchange
![Page 21: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/21.jpg)
21
Outline
Needs for better information in healthcareeHealth as a health system's component• Thailand's eHealth situation• The road ahead for Thailand's eHealth
![Page 22: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/22.jpg)
22
Thailand’s eHealth Situation
![Page 23: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/23.jpg)
23
eHealth in Thailand: The current status. Stud Health Technol Inform 2010;160:376–80, Presented at MedInfo2010 South Africa
Thailand’s eHealth: 2010
![Page 24: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/24.jpg)
24
All components are essential All components should be balanced
Slide adapted from: Dr. Boonchai Kijsanayotin
Recalling eHealth Components
![Page 25: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/25.jpg)
25Slide adapted from: Dr. Boonchai Kijsanayotin
Thailand: Unbalanced Development
![Page 26: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/26.jpg)
26
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)
Thailand’s eHealth Situation
![Page 27: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/27.jpg)
27
eHealth Components
![Page 28: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/28.jpg)
28
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
Thailand’s Hospital IT Adoption
![Page 29: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/29.jpg)
29Pongpirul et al., 2004
Vendor/Product Distribution (2004)
![Page 30: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/30.jpg)
30Theera-Ampornpunt, 2011
Vendor/Product Distribution (2011)
![Page 31: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/31.jpg)
31
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 settings
90.2%
Hospital IT Adoption Estimates
![Page 32: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/32.jpg)
32
• High IT adoption rates• Drastic changes in adoption landscape• Adequate infrastructure for information
exchange• Next question is on interoperability
THAIS: Discussion
![Page 33: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/33.jpg)
33
eHealth Components
![Page 34: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/34.jpg)
34
Existing Standards in ThailandStandards National
1. Core data set standards 12 & 18 files standards
2. Semantic standards Personal ID, Provider ID
ICD-10-TM, ICD-9-CM3. Syntactic standards X
4. Security and privacy standards X
Existing Standards in Thailand
Slide adapted from: Dr. Boonchai Kijsanayotin
![Page 35: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/35.jpg)
35
Standards National
1. Core data set standards Referral, Chronic Diseases
2. Semantic standardsDrug Terminology (TMT),
SNOMED-CTLab Code (LOINC)
Providers IDs
3. Syntactic standards HL7 Messaging, CDA
4. Security and privacy standards X
Standards Being Explored/Developed
Slide adapted from: Dr. Boonchai Kijsanayotin
![Page 36: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/36.jpg)
36
Thai Health Information Standards Development Center
www.this.or.thhttp://www.facebook.com/[email protected]
Standards Development Organization
Slide adapted from: Dr. Boonchai Kijsanayotin
![Page 37: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/37.jpg)
3737
eHealth & e-Transactions
![Page 38: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/38.jpg)
38
• HL7 Certified Specialists
Kevin Asavanant
HL7 V3 RIM (2009)
SupachaiParchariyanon
HL7 CDA (2010)
NawananTheera-Ampornpunt
HL7 CDA (2012)
38
SireeratSrisiriratanakul
HL7 V3 RIM (2013)
Capacity Building on Standards
![Page 39: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/39.jpg)
39
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 eHealthstrategy, in order to ensure compliance in the adoption of ehealthand 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
![Page 40: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/40.jpg)
40
eHealth Components
40
![Page 41: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/41.jpg)
41
• Certificate & Diploma Level• Undergraduate Level• Graduate Level
41
Informatics Workforce Programs
![Page 42: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/42.jpg)
42Faculty of Medicine Ramathibodi Hospital, Mahidol University
http://med.mahidol.ac.th/has/42
Healthcare CIO Certificate Program
![Page 43: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/43.jpg)
43Faculty of Tropical Medicine, Mahidol University43
Diploma & Master Graduates in Biomedical & Health Informatics, First Batch
![Page 44: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/44.jpg)
44
• In January 2013, the Thai Medical Informatics Association (TMI) approved establishment of the “Biomedical and Health Informatics Education Special Interest Group” within TMI (BHI-ED-SIG)
44
Informatics Education SIG
![Page 45: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/45.jpg)
4545
TMI CIO Forum
![Page 46: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/46.jpg)
46
• International Medical Informatics Association (IMIA)– MEDINFO & APAMI
• HIMSS AsiaPac• Asia eHealth Information Network (AeHIN)• American Medical Informatics Association
(AMIA)
46
Internationalization
![Page 47: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/47.jpg)
47http://www.aehin.org/Meetings/2013AeHINGeneralMeeting.aspx47
Participation in AeHIN
![Page 48: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/48.jpg)
48
Outline
Needs for better information in healthcareeHealth as a health system's componentThailand's eHealth situation• The road ahead for Thailand's eHealth
![Page 49: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/49.jpg)
49
The Road Ahead for Thailand’s eHealth
![Page 50: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/50.jpg)
50
• Addressing– Lack of national leadership & governance,
strategy & investment, policy & regulation– Shortage of informatics workforce– Accelerating standards development– Harmonizing applications– Facilitating local research in informatics
50
The Road Ahead
![Page 51: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/51.jpg)
51Image Source: http://twinstrivia.com/2013/05/20/the-road-to-minnesota-is-long-and-hard/
The Journey Beyond
![Page 52: eHealth: The Next Building Block for Thailand's Healthcare System](https://reader034.vdocuments.mx/reader034/viewer/2022051512/53f81ab88d7f7216518b4636/html5/thumbnails/52.jpg)
52
But We’ll Get There...