The Road to eHealth: Thailand's Journey

The Road to eHealth: Thailand’s Journey

Nawanan Theera‐Ampornpunt, M.D., Ph.D.

Faculty of Medicine Ramathibodi HospitalMahidol University, Thailand

Site Visit at Hong Kong Hospital Authority (Sep. 10, 2012)

Acknowledgments

• Parts of this presentation are reproduced or adapted from materials made by

• Boonchai Kijsanayotin, M.D., Ph.D.Health Systems Research Institute, Thailand

• Somsak Chunharas, M.D., M.PH.National Health Foundation, Thailand

Outline

• Overview of Thailand• Thailand’s Healthcare System• Thailand’s eHealth Status• Recent Progress• The Road Forward

Thailand: An Overview

Thailand: An Overview• Capital: Bangkok• 76 Other provinces• 6 Regions: N, C, NE, E, W, S• Size: 510,890 km2

(460 times of HK)• Population: 67+ million (10 times of HK)

Image Source: CIA World Factbook

Thailand: An Overview

• Upper‐middle‐income country• Constitutional monarchy & parliamentary democracy

• King Bhumibol Adulyadej as Head of State• Prime ministry as Head of Government• Three branches of government: Legislative, executive, judicial

Image Source: Gapminder.org

Life Expectancy (X)Income per person (Y)

Image Source: Gapminder.org

Human Development Index (X)GDP Per Capita (Y)

Thailand’s Healthcare System


• Pluralistic system: both public & private providers

• Public providers large part of healthcare system• Financed mainly by public funds


3 public healthcare schemes• Civil Servant Medical Benefit Scheme (CSMBS)

• Non‐contributory fee‐for‐service scheme since 1980• Covering most healthcare services (except some non‐essential prescriptions & unnecessary services)

• Public providers (and recently, some private hospitals)• Uncontrollably escalating costs, inequitable, pro‐rich• Cost‐containment measures attempted


• Social Security Scheme (SSS)• Mandated tripartite contributions (employee, employer, government)

• Capitation fee to participating public & private providers• Successful in cost containment, but suffers from poor quality through cream skimming, cost shifting, under‐provision of care, ineffective regulatory oversight


• Universal Coverage Scheme (UC)• Implemented in 2001, coverage to all Thais not covered by CSMBS or SSS, funded by taxes

• Service provided at registered community health center or public hospital in patients’ residential area, with referrals if necessary

• Capitation fees for outpatient & DRG for inpatients• Effective risk pooling• Equitable access to the poor

Thailand’s Healthcare System• Distribution of public and private hospitals in Thailand

*Including general and specialty hospitals under other departments within the Ministry of Public Health.†Including university hospitals, military hospitals, autonomous public hospitals, prison hospitals, hospitals of state enterprises, and public hospitals under local governments.MOPH = Ministry of Public HealthSource: Bureau of Policy and Strategy, Ministry of Public Health (November 2010).

District hospitals (MOPH)

General hospitals (MOPH)

Regional hospitals (MOPH)

Other hospitals under MOPH*

Other public hospitals outside MOPH†Private hospitals

Thailand’s eHealth Status

Adoption of Health IT: United States

18.2 17.3 17.3 20.823.9 29.2 34.8 42.0

48.350.7

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

2008 2009– Basic 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 & 2010

Adoption of Health IT: United States

Thailand’s Health IT Adoption

Thailand’s HIS Market Share (2004)

Pongpirul K, Sriratana S. Computerized information system in hospitals in Thailand: a national survey. J

Health Sci. 2005 Sep-Oct;14(5):830-9. Thai.

Thailand’s HIS Market Share (2011)

HOSxP50%

Self-developed or outsourced

16%

Hospital OS7%

SSB4%

Mit-Net2%

MRecord2%

H.I.M. Professional

2%

MedTrak/TrakCare

2%

HoMC2%

None 2% THIADES2%

HIMS1%

Abstract ePHIS

1%

Other7%

Theera-Ampornpunt (2011)

Adoption EstimatesEstimate

(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%

Theera-Ampornpunt (2011)

Summary on Health IT Adoption• High IT adoption rates• Drastic changes in adoption landscape• Local context might play a role

– Supply Side– Demand Side

• International Comparison

Thailand’s eHealth Status

Kijsanayotin B, Kasitipradith N, Pannarunothai S. eHealth in Thailand: the current status. Stud Health Technol Inform. 2010;160(Pt 1):376‐80.

eHealth Development Model

eHealth Applications

Enabling Policies & Strategies

Foundation Policies & Strategies

• Public services• Knowledge services• Provider services

• Citizen Protection• Equality• Multilingualism• Interoperability• Capability Building

• Governance• Policy• Funding• Infrastructure

Modified from Slide by Dr. Boonchai Kijsanayotin(Modified from WHO Global Observatory for eHealth)

Modified from Slide by Dr. Boonchai Kijsanayotin

• Pervasive access and use of ICT across the country

• Diverse eHealth applications exist, but most are scattered, fragmented, disorganized, non‐standardized, and not interoperable

• Lack of implementation and investments in eHealth foundations

Thailand’s eHealth Summary (2010)

• Fragmented reporting systems• Up to 40% of work time used for data reporting• Lack of access to personal health data by patients

• No national governance structure on eHealth• Foundations needed for standards development, privacy & security regulations, etc.

Issues in Thailand’s eHealth


• Development of eHealth foundations is the priority• Create a multi‐stakeholder, national‐level, eHealthgoverning authority

• Incorporate eHealth strategy into ICT 2020 framework • Enact health information security, privacy and confidentiality laws

• Develop national health information standards• Plan and implement systematic mechanism for capacity building

Experts’ Recommendations


• ICT2020 framework now includes “Smart Health”• The National Health Information Committee was established under the National Health Commission

• The National Health Information Standards Subcommittee was formed

• An eHealth office was created under the Health Systems Research Institute

• Important standards are being developed

Since That Publication in 2010...

National Health CommissionChair: Prime Minister Secretary: NHC Secretariat

National Health Information CommitteeChair: Dr. Somsak ChunharasSecretary: Dr. Boonchai Kijsanayotin

National Health Information Standards SubcommitteeChair: Dr. Daorirk SinthuvanichSecretary: Dr. Boonchai Kijsanayotin

Modified from Slide by Dr. Boonchai Kijsanayotin & Dr. Somsak Chunharas

• Capacity Building– New program in biomedical and health informatics– Healthcare CIO certificate program at Ramathibodi– Clusters of health informatics academic activities being formed

• Need for health information privacy & security laws being discussed in academic forums and by the Electronic Transactions Development Agency (Public Organization)

Since That Publication in 2010...

The Road Forward

• Partnerships

The Road Forward for Thailand

• More capacity building!• Informatics research• Standards development & adoption• Getting over “one country one system” and seeking cross‐platform Health Information Exchange

• Implications of ASEAN Economic Community• Better privacy laws

The Road Forward for Thailand

Where Will We Go?

Image Source: Smiletemplates.com

Thank You!Q&A

The Road to eHealth: Thailand's Journey

Health & Medicine

Transcript of The Road to eHealth: Thailand's Journey