eHealth: The Next Building Block for Thailand's Healthcare System
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Transcript of eHealth: The Next Building Block for Thailand's Healthcare System
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
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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
•Lecturer, Department of Community MedicineFaculty of Medicine Ramathibodi HospitalMahidol University
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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
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Needs for Better Information
in Healthcare
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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.)
7http://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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• 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
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• Medication Errors
– Drug Allergies
– Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
Common Errors
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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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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
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eHealth as a Health System
Component
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WHO (2009)
Components of Health Systems
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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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All components are essential All components should be balanced
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealth Components: WHO-ITU Model
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Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Goal: Health Information Exchange
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Outline
Needs for better information in healthcareeHealth as a health system's component• Thailand's eHealth situation• The road ahead for Thailand's eHealth
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Thailand’s eHealth Situation
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eHealth in Thailand: The current status. Stud Health Technol Inform 2010;160:376–80, Presented at MedInfo2010 South Africa
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
25Slide 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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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
29Pongpirul et al., 2004
Vendor/Product Distribution (2004)
30Theera-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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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
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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
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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
3737
eHealth & e-Transactions
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• HL7 Certified Specialists
Kevin Asavanant
HL7 V3 RIM (2009)
SupachaiParchariyanon
HL7 CDA (2010)
NawananTheera-Ampornpunt
HL7 CDA (2012)
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SireeratSrisiriratanakul
HL7 V3 RIM (2013)
Capacity Building on Standards
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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;
(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
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eHealth Components
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• Certificate & Diploma Level• Undergraduate Level• Graduate Level
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Informatics Workforce Programs
42Faculty of Medicine Ramathibodi Hospital, Mahidol University
http://med.mahidol.ac.th/has/42
Healthcare CIO Certificate Program
43Faculty of Tropical Medicine, Mahidol University43
Diploma & Master Graduates in Biomedical & Health Informatics, First Batch
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• 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)
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Informatics Education SIG
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TMI CIO Forum
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• International Medical Informatics Association (IMIA)– MEDINFO & APAMI
• HIMSS AsiaPac• Asia eHealth Information Network (AeHIN)• American Medical Informatics Association
(AMIA)
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Internationalization
47http://www.aehin.org/Meetings/2013AeHINGeneralMeeting.aspx47
Participation in AeHIN
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Outline
Needs for better information in healthcareeHealth as a health system's componentThailand'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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• Addressing– Lack of national leadership & governance,
strategy & investment, policy & regulation– Shortage of informatics workforce– Accelerating standards development– Harmonizing applications– Facilitating local research in informatics
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The Road Ahead
51Image 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...