Health System Improvement in e-Health setting.
Currently, our ministry is using separate systems(software) for each health care setting. National program of TB, HIV, Hepatitis uses OpenMRS (Medical Record System) separately. We have to re-design the architecture for all the programs and consider upgrading a centralized server for Health Information Exchange.

Barriers to EMR system improvement processes
• Financial challenges (upfront and ongoing costs)
• Lack of technology support
• Lack of technical infrastructure
• Resistance to Changing Work Habits
• Lack of capital resources to invest in HER
• Insufficient time
• Inability to easily input historic medical record data
• Physician attitude
• Physician autonomy
• Physician cooperation Complexity of meeting meaningful use challenges
• Lack of clear state and federal/policies standards
• Technical concerns Privacy concerns
• Resources for training in basic computer literacy
• Complexity of system
• Staff shortages
• Agility to make changes
• Missing data
• Interoperability

The biggest step of health system improvement is the universal health coverage implementation. Despite it seems to focus on fair financial contribution, but to make the sustained system it needs a good governance system to improve effective health facility, skilful technician and efficient resource management. After universal health coverage implementation, Thailand has become a country that has one of the best health care system in the world. However, responsiveness has been a barrier to health system improvement in Thailand. The responsiveness includes both population and health system. Basically, people have the basic right of individuals to be treated with dignity. The system should promote the health provider with the idea of equitable health care as well as improve population health literacy both in the school and society.

I do agree with W.Thanachol that the biggest step of health system improvement in Thailand is the implementation of a universal coverage system. This project based on the idea of equity of health care access and financial support for health care service to all people in Thailand. Furthermore, this system also has a service provision to deliver personal and non-personal health services (such as a preventive measure). The universal coverage project brings the good health, fair beneficial contribution, and responsiveness to Thai people.
The possible barriers in the implementation of universal coverage are consists of good governance and financing. This system is covered health of more than 70% of a Thai citizen, good governance is essentially required for a good strategic policy framework, good system design, effective oversight and, appropriate regulations and incentive. Financing is also another important barrier, due to it is a huge system for most of the people in Thailand, the budget allocation to the hospitals and other organizations involved in the universal coverage system should be reasonable, equitable and transparent.

I agree with K.Thanachol and K.Tullaya and I’d like to add more opinions on how I think our UHC could have been better if we would be able to balance our national healthcare workforce and financing. As we know most of our healthcare workforce is sponsored by the government for their training. It means taxes have been distributed to generate resources since the beginning. Like K Tullaya said, UHC covers around 70% of population but I do not think our public resourcing and spending is proportionate. The private hospital is getting bigger especially when it comes to acquiring resources including physician and nurses. The un-proportional make the tension between patient and healthcare workforce in public hospital where most of the patient are covered by UHC. The responsiveness is not well improved. Despite the fact that the patient’s satisfactory is getting better but counter to the UHC from public healthcare worker is rising due to workload and quality of life of healthcare worker. This issue represents a lot about the governance of our national health authorities and stakeholders. It is said, conflict of interest in healthcare is a huge issue. I think this is the most barriers that the government seems to ignore in order to improve our UHC.

I agree with K.Thanachol K.Tullaya K.Ameen ,the example of health system improvement is Telemedicine on e-Health setting because the main barriers is the number of medical staff to support patient. Multimedia used in the development of medical manpower to help diagnose the disease and increase the potential to treat patients to get better quality in life. I think, barriers that could occur in that system improvement process is the health coverage implementation system. In the pass, the successful implementation of the universal health coverage implementation, there are still weaknesses in the system that must be received and Urgent fix, That is the problem of the number of medical staff and hospitals that are not balanced with the number of people who use it and the problem of budget management that does not on target.Find ways to improve the universal health coverage implementation system, there must be a source of budgets from many sources. More to make the system sustainable Such as collecting contributions similar to social security funds such as Payment in case of needing services that are higher than public health standards or call Co-payment and Taxation for a specific fund or call Earmarked Tax for support the system to be able to continue sustainably. However, cost control in the health insurance system is a problem that is found all over the world.

Health literacy is the cornerstone for health system improvement. The general population in Thailand lacks important health knowledge to care for themselves. For example, people used to think that all minor Illnesses (e.g., common cold, diarrhea, and wound) must seek healthcare professionals’ attention. Therefore, the financial cost and workload for the public health sector are rising sharply and inappropriately. Another problem that we have commonly heard is violence in hospitals caused by unsatisfied patients who do not know how the healthcare process works. These problems considerably affect the workload and morale of healthcare professionals. Also, the migration of healthcare professionals from public hospitals to private hospitals is increasing due to the problems in the public sector. Hence, I think that health literacy as a promotional part of the health system should be improved immediately to reduce workload, financial cost, inequity, and other issues.

The possible barriers for improving health literacy in the general population are unacknowledged government, cooperation between the public sector and private sector (e.g. television, social media, and newspaper), financing, staff shortages, and long implemented process.

The biggest step of health system improvement in Thailand is the implementation of a universal coverage system. Most population use many cost to care in some disease and people not have enouhg attention in personal health care and lack knowledge to care for themselves. Health literacy is the basic for health system improvement. That make health care worker in hospital have very workload maintain health system.

Health application for each project in health department separately.I do agree with K.Pyae Pyao Aung, I think all of health application in thailand have to use one system such as NAP Plus , NTIP , cancer ect. It will effective to information exchan and data sharing between health care unit and health care worker will better happyness to work with EMR. One health care system application, The patient get better to care with the same protocal, low cost to care and get it timely.

An example of health system improvement that I want to share hasn’t yet implemented, but it is a very interesting project that is sharing patient data between hospitals (interoperability). I believe that this program will improve many aspects of the health system if it is successful: sometimes some patients travel to many hospitals for treating their disease and the data will be recorded redundantly or some patients have adverse drug reactions history, for example. As a consequence of this, if we can link some necessary data between hospital patient would gain better quality and safety life and many others. However, there are some possible barriers that should be considered – we need to understand the personal data protection act for protecting patient data from unauthorized people or hackers, the inability to match the patient with the records between hospitals, lack of professional staffs, lack of technical support and infrastructure, and many others.

In my opinion, Telemedicine technology is a hot issue in Thailand now and there is possibility to improve life quality for Thai people in rural areas. There are officially implemented telemedicine programmes at 32 hospitals in rural areas in eight provinces. This technology is expected to reduce expenses for both patients and hospitals and help to improve access to healthcare services. Also, this will help solve the country’s shortages of healthcare professionals in long term. For the possible barriers that could occur in telemedicine system improvement process, I will separate to 3 parts. One is barriers for organizations, second is barriers for patients and the last is barriers for staff. (ranked form high to low barriers) :
1. Frequency of barriers for organizations.
– Implement Cost
– Reimbursement
– Legal liability
– Privacy confidentiality
– Security of data
– Effectiveness
– Old equip
– Efficiency
– Workflow
– Rural setting
– Profit status
– Implementation model.

2. Frequency of barriers for patients.
– Age
– level of education
– eHealth / company literacy
– Bandwidth
– Unawareness
– High expectation of users
– Apathy
– No phone or electronic device
– Gendor
– Preference for personal

3. Frequency of barriers for staff.
– Technically-challenged staff
– Resistance to change
– Licensing
– Perception of impersonal care
– Info overload
– Interoperability
– Poor design
– Language barrier

Remark: For journal refference: Evaluating barriers to adopting telemedicine worldwide: A systematic review, URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768250/

A clear health care improvement is PACS, an X-ray imaging system. As you can retrieve as X-ray you want anytime and anywhere, the treatment is getting quicker.

Of course, there is currently still a problem connecting between hospitals.

There should be more attempt to scan / OCR’d hospital document. In-patient visit’s document is done at my older hospital, but isn’t done in my newer hospital. It is a big problem when I do post-admission followup.