- This topic has 29 replies, 15 voices, and was last updated 4 years, 10 months ago by Saranath.
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2019-09-26 at 10:38 am #13860SaranathKeymaster
In general, different hospitals may have different system to manage their own health information. Medical information may not be shared or transferred across hospitals. Some patients may seek treatment from several hospitals during their course of illness. In addition, for public health purposes, each hospital is required to send reports on number of patients with certain diseases who visited the hospital.
Are there any problems in healthcare or public health process in this situation where there is no enterprise architecture plan for the overall health information system in the province? Please discuss
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2019-10-05 at 11:51 pm #14644tullaya.sitaParticipant
The problem of transferring personal medical data occurs for decades. Patients usually shopping around for seeking the best specialist for each disease. This resulted in, they have a scattering data of their own health problem.
In recent years we hope this problem should be resolved by using the electronic medical record that we put all data of patients into the database, but the new problem occurred. The first one is how to easily retrieve the interested-important data from the general data and another problem is the same problem which is not solved, the lack of transferring and retrieving data from different hospitals.
The lack of enterprise architecture brings a lot of problems onto the EMR era; each system (hospital) had its own database engine, data security method, and user support system. When we need to use the data from every part of systems it difficult to share data between systems, which makes public health personal had to spend a lot of time repeating retrieving the same data from each hospital. The end-user is difficult to retrieve the sets of data from other systems, even the EHR which is the most important part of continuity care for transferred patients. Lack of enterprise architecture also makes difficulty in creates new things onto the system or fixed the system when each unit had collapsed.-
2019-10-06 at 9:51 pm #14660Pyae Phyo AungParticipant
Hi Tullaya.sita, agreed that lack of enterprise architecture makes difficulty. But I think we are getting late to develop EA, and redesign all EMR. I think we should consider alternative option like. Standardize the data structure and concepts of existing EMR and design the EA after that, which might save money and time. That my own idea, I don’t know it is possible or not.
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2019-10-09 at 11:37 pm #14733SaranathKeymaster
We don’t need a unify EMR system for every hospitals to be able to share the data across country. Each hospital can develop and use their own system. But with the thought of EA, each system should have a plan for data interoperability and implementing data standards. In healthcare, we are very much aware of data privacy and it is a challenge to balance between protecting data privacy and data utilization. We will learn more about data privacy& security and health information exchange in the later weeks.
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2019-10-13 at 3:06 pm #14807tullaya.sitaParticipant
Hi Pyae, I’m agree that we are go so far for make the EA for EMR at this point. As an end-user in clinical part I think the data standard sounds like a good option to share data between each unit, but for building the national EHR to have interoparability in other aspects I’m not sure that we can do without building EA first? Can we modified some parts to get them connected? Because I think that in most of public hospitals, which is the biggest part of hospital in Thailand, they use the same EMR systems like hosxp to collect data. The difficult is in private hospital and university hospital, they use the different program.
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2019-10-11 at 11:56 pm #14782AmeenParticipant
I think country with strong primary health care system have fewer problems with patients shopping around for seeking the best treatment. If hospital across countries has similar quality with balanced portion of physician/patient, I think people will more likely to consult fewer physician. From what I have heard, a key of the primary care is family practitioner, no matter how many specialist patient seeking for treatment, records will be backward to the practitioner.
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2019-10-12 at 6:37 am #14788anothailand (OHN)Participant
Ameen, I agree that family medicine practitioner should be promoted as a case manager of the patient. So family medicine practitioner will help patient to access and manage their own personal health record, and be an medical interpreter to assist patient in medical decision, when dealing with each clinic or medical specialist.
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2019-10-13 at 9:27 pm #14808tullaya.sitaParticipant
Ameen, I agree that the country with strong primary health care have less problem with patients go shopping around. Theoretically, the health record of patients who needs specialist will send back to the primary doctor, but it might not have enough information or it might be delayed for primary physician to follow up. I think the second important thing after promoted primary care physicians is a quality of health record and the health record from specialists should be sent right back with the patients.
As a medical teacher, I try hard to teach our medical students to become a general practitioner. But Thai people preferred specialists over the general practitioner so that why we have a few numbers of primary care physician even our health systems support the tier of hospital from primary to secondary to tertiary care hospitals.
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2019-10-06 at 8:34 pm #14650Pyae Phyo AungParticipant
Of course, there are problem in hospital and public health where there is no EA plan which mean no interoperability. Patients are getting services from different hospitals due to may be patients choice or disease condition which need to admit in certain specialist hospital. In general, every hospital records data on their separated system and just give the hardcopy of discharged documents. Patients might lost or damage their own record and others health care provider only get information only on history taking which might consume lot of time and if there is transferable data from one services to another, lots of time and money can be safe, accurate clinical history and diagnosis, no missing history like drug allergy history.
Current situation in developing countries, there is no central data system or architecture to manage different hospitals and public health program. Each program try to develop their own architecture funded from donor with their program specific need and requirement for donor report which become difficult to change the architecture for interoperability(EA).-
2019-10-09 at 11:44 pm #14734SaranathKeymaster
Hi Pyae, absolutely agree with you that what we see now is that each program tries to develop its own data collection system to serve data required by funder. This is quite burden officers at operation level, as they need to fill out too many systems (each system for each disease). In Thailand, the government has set a standard dataset, called 43 files, which aims that this dataset can be used for analyzing health situation of the country. However, there are still problems that make the data are not that usable as we expect.
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2019-10-08 at 1:58 pm #14692ChalermphonParticipant
I think, It should be very difficult to develop enterprise architecture plan in hospitals systems because of Different departments have different systems development. Thailand is in a developing country.The development of the EA health system is not clear.The obvious is the 43 file system But has not used to occur as a system and many problem such as completely ,correct and on time .Application development into many Causing the work load of the staff ,People cannot access information and has not yet integrated the information with other agencies. System Development EA Health System is absolutely necessary to develop the whole system. Like US that mobilize various experts and resource to develop, there are organizations that look after the system Whole health systems and information safety. Thailand should begin to develop the basic EA system of In various departments first in order to be an important foundation for future development Should start with a small organization Expanding to a larger image to create an integrated database with the same format and application development that can reduce unnecessary workloads And able to use the information most efficiently.
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2019-10-09 at 11:55 pm #14735SaranathKeymaster
Chalermphon, I’m glad that you bring issues related to the 43 files system up. In my opinion, I agree that the standard 43 files system has a number of problem. But at least our country already started on the data interoperability and EA. Also, the EMR can increase the workload, which could influence data quality. In the US, there has been a law (HITECH act) that tries to motivate the implementation of EMR. But recently, there are a number of surveys showing that EMR is a top reason for physician burnout.
Check this sites for more details. https://www.hcinnovationgroup.com/clinical-it/news/13030577/survey-physicians-cite-ehrs-as-biggest-contributor-to-burnout
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2019-10-12 at 12:09 am #14783AmeenParticipant
Hi, Chaloemphon. This is the first time I heard about the 43 file system, so I googled it and realized that it’s what I used to see at many clinics. It sounds old fashioned but interesting. I will google more how it work.
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2019-10-12 at 6:32 am #14787anothailand (OHN)Participant
I also heard about HDC Dashboard version 4.0 that own by public health ministry: https://hdcservice.moph.go.th/hdc/main/index_pk.php
Is it integrated or drawn any data form 43 files system?
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2019-10-09 at 11:16 am #14722supawat.chtParticipant
When the patient admit in the hospital, normally doctor need to know all underlying condition together with medicine. This burden is belong to patient family and sometime important information can be missing. Therefore, it would be great if medical information can be transferred across hospitals.
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2019-10-10 at 11:17 pm #14759AmeenParticipant
We should think of a hospital as a provider in the health care complex system. There are other components such as patient, regulator, payer/insurer, or supplier. They all require health information for their operational, decision making or strategic planning. In provider components, apart from hospitals, other patients may seek out services, for example, private clinics, specialist care, alternative medicine, or ancillary services. Speaking of the hospital, there are health and non-health deliverable units such as OPD, ER, OR, IPD, radiology, pharmacy, Laboratories, patient registry, services fee collection. They all have meaningful responsibilities for information and need information for their own operational and decision-making processes at the same time. So if we look throughout a patient care process, especially for chronic diseases or aging-associated diseases, the patient is intensively collected of data. The collection based on the interest and services delivery of each unit and each hospital and they have their system to manage health information. We can imagine that data are scattered across units and providers, some are private and some are government and they operate independently to each other depends on provincial/national health system. This example of fragmented and uncoordinated care led to many problems especially to forefront health care workers, patients, and health outcomes in the overall system. What we don’t care much is collecting routine data which load heavy burden on health care worker and on staff who are in charge of the hospital’s information system. The burden caused by redundant and inconsistent and methods and equipment from each unit. This also may happen to higher hierarchical levels of health information systems. Moreover, financially and economically, the cost of duplicated data collecting and processing is likely to result in unreliable data and to the continuity of data collecting for some specific disease monitoring especially when such staff is not well trained on data management.
On a patient side, which most of Thais are middle or lower-middle-income which health care is still of a luxury and expensive (even government hospital), there are other non-health expenses and health difficulties which may effects treatment adherence and continuity of data collection, for example, the cost of transportations, unpaid time off for hospitals, stress caused by duplicating data collection or time consumed. Overall, health outcomes may be compromised both at the individual level and health system level because of the unavailable of enterprise architecture plan.
What I think also affects the health information system is how the public and government look at health care. Health care as a public service like the UK (NHS) or Thailand (universal health coverage) which most of the citizen is insured/covered by the governmental scheme. Other is health care as consumer goods like in the US, I read an article saying 40% of American are uninsured by either private or government. The said example of policies is at the strategic level, top-down policy, of EA which I think the most impact on health information system as some important of the population may not include in data sets and the result may bias by access to health care.
- This reply was modified 4 years, 11 months ago by Ameen.
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2019-10-11 at 10:08 pm #14777anothailand (OHN)Participant
In my experience, patient have to go to each hospital to request the medical records for currently admitted hospital. It takes time and cause delay in medical decision and management, if it is an emergency case. Moreover, It is not cost effective, if the patient had to send for medical test or was received medication repeatedly from different hospitals.
For the public health aspect, if we have certain diseases to report and investigate, different in EMR of each hospital cause redundancy in case report, and report may be missing in some cases if the semantic interoperability is not good enough.
So, the EA within the provincial level must seriously considered of public EHR and good interoperability.
- This reply was modified 4 years, 11 months ago by anothailand (OHN).
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2019-10-12 at 11:15 am #14793THONGCHAIParticipant
Problems in linking information between hospitals for a long time, because the hospital’s information system does not have a standardized information system in the workplace. Therefore can not see the history of treatment of patients from different service units.
About 10 years ago, there was a standard data connection between agencies such as hospitals or hospitals and the Ministry of Public Health, which is the standard data code called the minimum data set of 43 files.
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2019-10-12 at 11:18 am #14794THONGCHAIParticipant
You can download minimum standard data set for 43 files at http://bps.moph.go.th/new_bps/43file_version2.3
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2019-10-12 at 5:06 pm #14802Pacharapol WithayasakpuntParticipant
May be the concept of Big Data and AI might be able to fix the variability on the data? Instead of using human to standardize the coding, a programming script might be able to create value in data.
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2019-10-12 at 4:34 pm #14798w.thanacholParticipant
There will be redundant and complicated information at a higher level if there is no enterprise architecture plan for an overall health information system. Firstly, the operational level need to input the information several times to different program depends on the program manager. Secondly, the higher level who collect the data might struggle with channel receiving the information and might lost the data. Furthermore, the policymaker level would face with unreliable information because of the operational level and the intermediate level could not enter and consolidate data consistently and continuously. Finally, the overall system could not be evaluated thoroughly thus it cannot be improved effectively.
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2019-10-12 at 5:03 pm #14801Pacharapol WithayasakpuntParticipant
Architecture is indeed important before stepping forward in the direction of interconnected healthcare. Some of the obstacles are
– Scanning documents increases the workload. Standardizing the medical coding also increases the workload, as well as not perfect.
– Patients might not be willing to share information across the hospital. They sometimes want either second opinion or want to be treated anew.
– The corporate building the software itself is not that willing to perfect the software. I can see many doctors being dissatisfied, I myself included. This might be due to lack of competition and “just works”.Anyways, I would like to propose that it should be patients first, like PHR and patient medical education. Doctors and pharmacists, especially at private sector should change the mindset of hogging the treatment decision to themselves, and let the patients know and decide, especially on the medication.
If the over-privacy is not the problem, health institutes can interconnect.
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2019-10-13 at 9:57 pm #14810Penpitcha ThawongParticipant
I totally agree with you ‘Pacharapol’
Sometimes, before thinking about how to link the patient’s information between the hospitals, there is an argument that who is the real owner of the data. Some data, the hospital or even some government departments do not want to share because of some profits. So, I think this may be one of the reasons why Thai hospitals still have this problem.
If we consider EA, I think each hospital uses each system due to their necessities; and we can’t change the system. However, as everyone knows, a house can be renovated in the same way with the hospital’s system. Maybe the good way is there should have a central system between hospitals and can retrieve only necessary data and the name of testing that the patient used to be done. In the case of the special data, doctor or any health informaticians should have their own authorities to access to see the information. It seems to be difficult but in this era, everything can happen.
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2019-10-14 at 10:31 pm #14818weerawan.hatParticipant
No enterprise architecture plan for health information system can make some problems for one hospital or inter-hospital setting and for both patients and doctors. For example, when a patient is referred from a hospital, he needs to take health information with him. If doctors need other information that is not available. That patient needs to go back to the previous hospital to get more information and this may delay treatment. The format of information of each hospital may not be interoperable for doctors to easily understand and this can make duplication of investigation and delay treatment also.
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2019-10-14 at 10:35 pm #14819Dr.Watcharee ArunsodsaiParticipant
An enterprise architecture is needed to be planned by the decision- maker level, all stake holders and builders. These require a large sum of budget and time consuming. In public health hospitals, there are already implemented health information systems which can be sharing to the ministry while can not be linked to each other. It seemed to be one-way communication and redundancy of data because lack of interoperability. As the medical practitioner, we are only the operational level whom will be burnout by the data entry workload but we still need the patient medical records sharing from the other hospitals. We need EA to help not only our practice (available underlying health and diseases) but also governmental health system (utilizing of universal coverage and civil servant medical benefit scheme). Individual hospitals may care about their own information systems and may not feel confident with the others. The other obstacles are the patients themselves whom seek not just only duplicate services in private and public hospitals but also self treatment by over counter medicines. This might not be included in the reliable health informations. So the EA is needed to be set up by carefully balancing of business view and information technology view and served the patient’s privacy and appropriate defined stakeholders. We don’t have HITECH Act but we have only Patient Protection and Affordable Care Act. Then we must ensure the confidentiality of the health information about individuals is not compromised while we plan for the EA.
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2019-10-15 at 9:14 am #14822ywwhoParticipant
Are there any problems in healthcare or public health process in this situation where there is no enterprise architecture plan for the overall health information system in the province?
A simple example of patients shopping around for treatment in many hospitals would lead to over-reporting of cases, which may lead to false alarm of epidemics. In Germany, I heard that they have set up the EHR long time ago. When the patients move to other cities, they have to report to the authority and their health information will be transferred to the new health care providers automatically. This is their regulations. I agree with Dr. Watcharee on privacy and confidentially issues but I think that It can be overcome with good design. The main issue is to get all stakeholders to spell out their need so that the system can be developed up to GEA LEVEL.
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2019-10-23 at 3:11 pm #15057imktd8Participant
As Dr.Saranath said that different hospitals may have a different system to manage their own health information. These effects to medical information may not be shared or transferred across hospitals.
In Thailand context, EA is to define the layout of organization’s components and relationships among them as well as align IT and Business. Some hospitals have own EA, but some no EA to link business and IT. This is a reason why there are many diffence healthcare systems and bring to vary problems and obstacles to develop entrerprise architecture for all hospitals. I agree with Dr. Tullaya too, the lack of enterprise architecture brings a lot of problems onto the EMR era because many hospitals have their own system. This is a big painpoint of health data integration which is not allowed to share or merge data each other. In fact, every hospitals can develope their own system, but all of data are used only in that hospital. To share medical history or personal health data with other hospitals are not possible now.
Let me share my experience with my recent project which joins with 22 banks in Thailand, surely every bank have a difference method and standard, but this project can develop the central standardization for every bank and overcome all barriers. It’s named Electronic Bank Guarantee System on Blockchain Technology. In business process, we have to issue bank guarantee to ensure that vendors will not leave work or if they leave, bank will cover the loss. Every companies, for example, PTT, SCG, IRPC, PTTGC, MEA, EGAT, ThaiOil have their own system which is difference in system design, system architecture and data format. To set the standardization of electronic bank guarantee, 6 Thai commercial banks; BBL, KTB, BAY, KBank, TMB and SCB invest to establish new company (BCI Thailand) to manage stakeholder, data standard template, technology to provide to bank and company. Then all banks and companies will apply the same policy and data template to develop program.
For health information context, I think Bank Guarantee on Blockchain Technology model is the good example for system integrated implementation which may solve the problem and decrease obstacles if…
– Every hospital and related organization joint to set the EA/ Policy/ Platform /Standardization togather.
(Surely, it takes time in the first step and has a lot of problems, but long term this can give high profit to patient; can get the medical treatment at any hospital, for the hospital; can get an up-to-date history of a patient’s health, decrease time in diagnosis and increase precise treatment)
– To adopt Blockchain technology to share data across hospital. (To decrease critical patient data and information topic with occurs from across different hospital and systems. The current healthcare system is operated through one single central database which is managed by one entity in the organization. When use blockchain technology, data can not change by someone who is not the owner. No problem security and privacy issue.)
– To concern about legal which related to personal privacy data. (Which data should open or close to the public)Lastly, to guideline and design IT architectures, logical structure and organizing complex information, we need to has the Enterprise Architecture Framework to plan and provide the environment for software, hardware and network to work smart together. In my opinion, to overcome the barriers for health system and data integration, health organizations in Thailand have to talk seriously about pro/con to invest. It is time for patients to get the highest value from their health informaton in the medical treatment.
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2019-11-06 at 10:16 pm #15448SaranathKeymaster
Thanks for sharing your experience on banking system. IT implementation in financial sector is far beyond healthcare system. One reason that I think is that in healthcare sector, there is no solid financial gain from the investment, as compared with business and financial sectors. This could make the investment in HIT a bit slower. But at least, we have seen an initial movement on healthcare side. Hope we could get the system that could exchange the information throughout the country soon.
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