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.
