1. Creating the Roadmap
toward Thailand’s eHealth
Part 1: Introduction
Department of Community Medicine Seminar
June 11, 2014
Nawanan Theera-Ampornpunt, M.D., Ph.D.
www.SlideShare.net/Nawanan
2. 2
Outline
• Health & Health Information
• Health IT & eHealth
• Health Informatics as a Discipline
• Thailand’s eHealth Situation
• Current Forces
• Shaping the Future
9. 9
• Life-or-Death
• Difficult to automate human decisions
– Nature of business
– Many & varied stakeholders
– Evolving standards of care
• Fragmented, poorly-coordinated systems
• Large, ever-growing & changing body of
knowledge
• High volume, low resources, little time
Why Healthcare Isn’t Like Any Others
11. 11
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?
12. 12
• Safe
• Timely
• Effective
• Patient-Centered
• Efficient
• Equitable
Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality
chasm: a new health system for the 21st century. Washington, DC: National Academy
Press; 2001. 337 p.
High Quality Care
17. 17
Outline
Health & Health Information
• Health IT & eHealth
• Health Informatics as a Discipline
• Thailand’s eHealth Situation
• Current Forces
• Shaping the Future
20. 20
• To Err is Human (IOM, 2000) 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 2012 Introduction to Healthcare and Public Health in the US: Regulating Healthcare - Lecture d
Patient Safety
21. 21
• 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
22. 22
Image Source: (Left) http://docwhisperer.wordpress.com/2007/05/31/sleepy-heads/
(Right) http://graphics8.nytimes.com/images/2008/12/05/health/chen_600.jpg
To Err is Human 1: Attention
23. 23Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital
To Err is Human 2: Memory
24. 24
• Cognitive Errors - Example: Decoy Pricing
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Ariely (2008)
16
0
84
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68
32
# of
People
# of
People
To Err is Human 3: Cognition
25. 25
• It already happens....
(Mamede et al., 2010; Croskerry, 2003;
Klein, 2005; Croskerry, 2013)
What If This Happens in Healthcare?
26. 26
Mamede S, van Gog T, van den Berge K, Rikers RM, van Saase JL, van Guldener C,
Schmidt HG. Effect of availability bias and reflective reasoning on diagnostic accuracy
among internal medicine residents. JAMA. 2010 Sep 15;304(11):1198-203.
Cognitive Biases in Healthcare
27. 27
Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them.
Acad Med. 2003 Aug;78(8):775-80.
Cognitive Biases in Healthcare
28. 28
Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr
2;330(7494):781-3.
“Everyone makes mistakes. But our
reliance on cognitive processes prone to
bias makes treatment errors more likely
than we think”
Cognitive Biases in Healthcare
29. 29
• Medication Errors
–Drug Allergies
–Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
Common Errors
30. 30
Why We Need ICT
in Healthcare?
#1: Because information is
everywhere in healthcare
31. 31
Why We Need ICT
in Healthcare?
#2: Because healthcare is
error-prone and technology
can help
33. 33
Why We Need ICT
in Healthcare?
#3: Because access to
high-quality patient
information improves care
34. 34
Why We Need ICT
in Healthcare?
#4: Because healthcare at
all levels is fragmented &
in need of process
improvement
35. 35
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: Dr. Boonchai Kijsanayotin
Health IT
36. 36
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
37. 37
eHealth Health IT
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealth & Health IT
38. 38
HIS
All information about health
eHealth
HMIS
mHealth
Tele-
medicine
Slide adapted from: Karl Brown (Rockefeller Foundation),
via Dr. Boonchai Kijsanayotin
More Terms...
40. 40
All components are essential
All components should be balanced
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealth Components: WHO-ITU Model
41. 41
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Health Information Exchange
42. 42
Outline
Health & Health Information
Health IT & eHealth
• Health Informatics as a Discipline
• Thailand’s eHealth Situation
• Current Forces
• Shaping the Future
47. 47
Outline
Health & Health Information
Health IT & eHealth
Health Informatics as a Discipline
• Thailand’s eHealth Situation
• Current Forces
• Shaping the Future
49. 49
eHealth in Thailand: The current status. Stud Health Technol Inform
2010;160:376–80, Presented at MedInfo2010 South Africa
Thailand’s eHealth: 2010
53. 53
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
Slide adapted from: Boonchai Kijsanayotin
Thailand’s eHealth Situation
54. 54
Section 1 Hospital Profile
Section 2 IT Adoption & Use
Profile
Section 3 Respondent’s
Information
Thailand’s Health IT Adoption
55. 55
• 4 of 1,302 hospitals ineligible
• Response rate 69.9%
Characteristic Overall Responding
Hospitals
Non-
Responding
Hospitals
N of eligible hospitals 1,298 908 390
Bed size** 106.9 117.5 82.9
Public status**
Private
Public
24.0%
76.0%
17.4%
82.6%
39.2%
60.8%
Geography*
Central
East
North
Northeast
South
West
33.4%
7.5%
11.1%
27.1%
15.3%
5.6%
31.1%
7.8%
13.5%
26.9%
14.9%
5.8%
39.0%
6.7%
5.4%
27.7%
16.2%
5.1%
*p < 0.01, **p < 0.001.
Nationwide Survey Results
56. 56
Characteristic Number of Responses Statistic†
Public status
Private
Public
908
158
750
17.4%
82.6%
Teaching status
Non-teaching
Teaching
901
716
185
79.5%
20.5%
Total employees 890 368.2 ± 573.5 (10-5269)
IT employees 901 4.3 ± 5.3 (0-60)
Total budget (million baht) 443 146.67 ± 313.60 (0.25-3,067)
IT budget (million baht) 598 2.77 ± 8.79 (0-100)
Ratio of IT budget to total budget‡
< 1%
1-4%
5-8%
> 8%
416
135
218
40
23
2.7% ± 4.6% (0-43.3%)
32.5%
52.4%
9.6%
5.5%
Extent of overall IT utilization
Very low
Low
Moderate
High
Very high
905
5
35
169
454
242
0.6%
3.9%
18.7%
50.2%
26.7%
Total PCs in use 883 126.1 ± 218.6 (0-3,000)
Nationwide Survey Results
59. 59
Estimate (Partial or Complete Adoption) Nationwide
Basic EHR, outpatient 86.6%
Basic EHR, inpatient 50.4%
Basic EHR, both settings 49.8%
Comprehensive EHR, outpatient 10.6%
Comprehensive EHR, inpatient 5.7%
Comprehensive EHR, both settings 5.3%
Order entry of medications, outpatient 96.5%
Order entry of medications, inpatient 91.4%
Order entry of medications, both settings 90.2%
Order entry of all orders, outpatient 88.6%
Order entry of all orders, inpatient 81.7%
Order entry of all orders, both settings 79.4%
Health IT Adoption Estimates
60. 60
• High IT adoption rates
• Drastic changes in adoption landscape
• Local context might play a role
– Supply Side
– Demand Side
• International Comparison
– Relatively higher adoption
THAIS: Discussion
61. 61
Outline
Health & Health Information
Health IT & eHealth
Health Informatics as a Discipline
Thailand’s eHealth Situation
• Current Forces
• Shaping the Future
63. 63
International
• Technology Trends
• Standards & Interoperability Trends
• eHealth Successes & Failures
– UK NHS
– US Meaningful Use
– Nordic Countries
• International eHealth Networks
– International Medical Informatics Association (IMIA)
– American Medical Informatics Association (AMIA)
– Asia eHealth Information Network (AeHIN)
Current Forces
64. 64
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 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;
http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R24-en.pdf
World Health Assembly Resolution WHA66.24 (2013) on
eHealth Standardization & Interoperability
65. 65
(3) to consider ways for ministries of health and public
health authorities to work with their national representatives
on the ICANN Governmental Advisory Committee in order to
coordinate national positions towards the delegation,
governance and operation of health-related global top-level
domain names in all languages, including “.health”, in the
interest of public health;
http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R24-en.pdf
World Health Assembly Resolution WHA66.24 (2013) on
eHealth Standardization & Interoperability
66. 66
Domestic
• Thailand’s Health Insurance Trends
• Increased Hospital IT Adoption
• Demands for Data & Information Exchange
in Thailand’s Healthcare
• Thailand’s e-Transaction Trends
• Consumer IT Behavior Trends
Current Forces
70. 70
Outline
Health & Health Information
Health IT & eHealth
Health Informatics as a Discipline
Thailand’s eHealth Situation
Current Forces
• Shaping the Future
