a journey toward national ehealth: thailand's case
DESCRIPTION
Academic Health Center (AHC) Informatics Grand Round at the University of Minnesota on Nov 20, 2014TRANSCRIPT
A Journey Toward National eHealth: Thailand's Case
Nawanan Theera-Ampornpunt, M.D., Ph.D.Faculty of Medicine Ramathibodi Hospital
Mahidol University, ThailandNovember 20, 2014
SlideShare.net/Nawanan
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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 MedicineFaculty of Medicine Ramathibodi HospitalMahidol University
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“The Journey” Toward eHealth
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Outline
• The Needs for eHealth• Thailand's eHealth situation• The road ahead for Thailand's eHealth
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The Needs for eHealth
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“Information” in Medicine
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
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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.)
8http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf
Fragmented Healthcare
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(IOM, 2001)(IOM, 2000) (IOM, 2011)
Landmark IOM Reports
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Back to something simple...
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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?
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The Question Becomes...
How do we deliver better information, by supplementing
human clinicians with ICT, so that they make less errors and
perform better?
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13
WHO (2009)
Components of Health Systems
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14
WHO (2009)
WHO Health System Framework
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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
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Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Goal: Health Information Exchange
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WHO-ITU National eHealth Strategy Toolkit
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All components are essential All components should be balanced
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealth Components: WHO-ITU Model
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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
World Health Assembly Resolution WHA66.24 (2013) on eHealth Standardization & Interoperability
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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
World Health Assembly Resolution WHA66.24 (2013) on eHealth Standardization & Interoperability
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Outline
The Needs for eHealth• Thailand's eHealth situation• The road ahead for Thailand's eHealth
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Thailand’s eHealth Situation
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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
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Thailand’s eHealth: 2010
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All components are essential All components should be balanced
Slide adapted from: Dr. Boonchai Kijsanayotin
Recalling eHealth Components
26Slide adapted from: Dr. Boonchai Kijsanayotin
Thailand: Unbalanced Development
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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
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eHealth Components
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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)
Thailand’s eHealth Governance
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eHealth Components
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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
32Pongpirul et al., 2004
Vendor/Product Distribution (2004)
33Theera-Ampornpunt, 2011
Vendor/Product Distribution (2011)
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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
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• High IT adoption rates• Drastic changes in adoption landscape• Adequate infrastructure for information
exchange• Next question is on interoperability
THAIS: Discussion
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eHealth Components
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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 -
Existing Standards in Thailand
Slide adapted from: Dr. Boonchai Kijsanayotin
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Standards National
1. Core data set standards Referral Dataset
2. Semantic standardsDrug Terminology (TMT),
SNOMED-CT?LOINC
Providers IDs
3. Syntactic standards HL7 Messaging?, CDA?
4. Security and privacy standards
Authentication & Encryption Standards
Emerging/Potential Standards
Slide adapted from: Dr. Boonchai Kijsanayotin
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Thai Health Information Standards Development Center
www.this.or.thhttp://www.facebook.com/[email protected]
Standards Development Organization
Slide adapted from: Dr. Boonchai Kijsanayotin
Dr. BoonchaiKijsanayotin
Dr. DaorirkSinthuvanich
Dr. TiemUngsachon
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• HL7 Certified Specialists
Kevin Asavanant
HL7 V3 RIM (2009)
SupachaiParchariyanonHL7 CDA (2010)
NawananTheera-Ampornpunt
HL7 CDA (2012)
SireeratSrisiriratanakul
HL7 V3 RIM (2013)
Capacity Building on Standards
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eHealth Components
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• Certificate & Diploma Level• Undergraduate Level• Graduate Level
Informatics Workforce Programs
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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.
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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.
45Faculty of Medicine Ramathibodi Hospital, Mahidol University
http://med.mahidol.ac.th/has/
Healthcare CIO Certificate Program
46Faculty of Tropical Medicine, Mahidol University
Diploma & Master Graduates in Biomedical & Health Informatics, First Batch
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• 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)
National Professional Society
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TMI CIO Forum
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Thai Informatics Year in Review• Modeled after the popular Dan Masys
Informatics Year in Review & other YIRs• Perhaps the first national-level Informatics
YIR
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• International Medical Informatics Association (IMIA)– MEDINFO & APAMI
• HIMSS AsiaPac• Asia eHealth Information Network (AeHIN)• American Medical Informatics Association
(AMIA)
Internationalization
51http://www.aehin.org/Meetings/2013AeHINGeneralMeeting.aspx
Participation in AeHIN
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eHealth Components
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• Mostly privacy laws– Written broadly & vaguely– Different interpretation, enforcement difficult– Barrier to data exchange
• No “HITECH Act” or “Meaningful Use” Equivalent
Legislation, Policy & Compliance
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Outline
The Needs for eHealthThailand's eHealth situation• The road ahead for Thailand's eHealth
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The Road Ahead for Thailand’s eHealth
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eHealth Components
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• Addressing– Lack of national leadership & governance,
strategy & investment, policy & regulation– Shortage of informatics workforce– Accelerating standards development– Harmonizing applications– Facilitating local research in informatics
The Road Ahead
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• 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
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
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• National Legislative Assembly’s Public Health Committee appointed “Health Information System Standards Subcommittee” to tackle policy & legislative issues of standards & interoperability
• Thai Informaticians represented
Windows of Opportunities for eHealth
Dr. BoonchaiKijsanayotin
Dr. NawananTheera-Ampornpunt
Dr. BordinSapsomboon
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• 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
Windows of Opportunities for eHealth
61Image Source: http://twinstrivia.com/2013/05/20/the-road-to-minnesota-is-long-and-hard/
The Journey Beyond
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But We’ll Get There...
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The UMN Impact
Special Appreciation to Prof. Stuart Speedie and other IHIFaculty for planting the seeds for
Thailand’s future informatics workforce