Nawanan Theera-Ampornpunt, MD, PhD

Global or Glocal eHealthApproaches in

Asia: What is New

or Next?

The Need for eHealth & Health IT

“...Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives.”

President Barack ObamaAddress to Joint Session of Congress

February 24, 2009

WHO Health Systems Framework

From a slide by Dr.Boonchai Kijsanayotin (2012)

1991

2000-2001

20042009

2011

ONCHIT

HITECH Act“Meaningful Use”

U.S. eHealth Developments

The HITECH Act

Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5.

Stage 1- Electronic capture of health information- Information sharing- Data reporting

Stage 2

Use of EHRs to improve processes of care

Stage 3

Use of EHRs to improve outcomes

Better Health

Blumenthal (2010)

“Meaningful Use” of Health IT

18.2 17.3 17.3 20.823.9 29.2

34.8 42.048.3 50.7

9.3 10.5 11.816.9 21.8

24.9

0

10

20

30

40

50

60

70

80

90

100

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

% o

f Phy

sici

ans

Year of Study

Any EHR EHR with Basic Features

Source: National Ambulatory Medical Care Survey (NAMCS) 2001-2010

U.S. Ambulatory Setting

Basic Features: Demographics, problem lists, clinical notes, test results, imaging results, order entry for medications

U.S. Health IT Adoption

2008 2009Basic EHRs 7.2% 9.2%

Comprehensive EHRs 1.5% 2.7%

Computerized 17% 34%Order Entry for Medications

U.S. Inpatient Setting

Sources: Jha et al., 2009 & 2010Definitions

U.S. Health IT Adoption

U.S. Health Information Exchange

• Regional Health Information Organizations (RHIOs)

• State eHealth Initiatives• Nationwide Health Information Network

(NwHIN)

WHO Global Observatory for eHealthDevelopment Model

From a slide by Dr.Boonchai Kijsanayotin (2012)

Thailand’s eHealth Status

Foundation Policies & Strategies Uptake1. National eGovernment policy & strategy √ ICT20102. National eHealth policy & strategy X3. National eHealth governance body X3. Funding Public,

No Private4. Public & Private partnership +5. Infrastructure ++

Kijsanayotin et al. (2010)

Thailand’s Status Summary

• Widespread access to and use of ICT• Various eHealth applications but

– Poorly integrated and unsystematic– Not standardized– Not interoperable

• Lack of investment and groundwork for eHealth infrastructure

Kijsanayotin et al. (2010)

Recommendations• Establish a multi-stakeholder national-

level eHealth governing authority• eHealth strategy should be

incorporated into other ICT frameworks• Enact laws to protect health

information privacy and security• Develop national health information

standards• Capacity building

Kijsanayotin et al. (2010)

Thailand’s National eHealth Body

National Health Commission

National Health Information Committee

National Health Information Standards Subcommittee

From a slide by Dr.Boonchai Kijsanayotin (2012)

Estimate (Partial or Complete Adoption)

Nationwide

Basic EHR, combined inpatient & outpatient settings

49.8%

Comprehensive EHR, combined 5.3%order entry of medications, combined 90.2%order entry of all orders, combined 79.4%

Definitions | Estimates

Thailand’s Health IT Adoption

Thailand’s Health Information Exchange

• Most exchange occurs for mandated claims and reimbursements

• Limited exchange for clinical purposes in some provinces

• Mostly not based on standards but rather use of the same health IT products

• No push from government toward HIE

Kijsanayotin et al. (2010)

United States• Decades of awareness

building, advocacy, and research & development on eHealth

• Strong national governance body

• eHealth an integral part of national policy & agenda

Thailand• Relatively short period of

interest & attention on eHealth

• National governance body recently established

• eHealth not yet part of national policy & agenda

Summary (1)

United States• Large funding with

incentives and systematic efforts

• Growing but still suboptimal health IT infrastructure

• Strong capacity building efforts

Thailand• Little funding and

incentives for eHealthand no systematic approaches

• Adoption estimates indicate an encouraging level of infrastructure

• Extremely limited high-quality workforce training in health informatics

Summary (2)

• Local contexts differ for different countries but lessons from other countries are important

• National leadership, strong governance, and raising eHealth to the national policy level create a critical momentum for HIE

Summary (3)

http://oilersnation.com/2011/12/28/the-long-winding-road-trip-to-a-close-team