We all know the feeling of waiting endlessly in a queue at a public hospital.
The boredom-inducing delays increase because of the difficulty of finding health records, or setting up new ones, when attending a hospital for the first time.
But advances in technology, particularly in communications, wireless appliances, software, sensors and data exchange are easing these worries and leading to smarter health systems.
Dr Khanat Kruttakul of the Cardiovascular and Metabolic Center, Ramathibodi Hospital, said currently the most common problem reported by patients is extended waiting times to meet doctors, with average statistics finding each patient in Thailand spends over two hours waiting for one appointment, while up to a whole day can be spent at the busier hospitals if the patient has to see multiple departments and also pick up prescriptions.
Certain hospitals are now looking into the feasibility of using the HL7 EHR (Electronic Health Record) system, which is the international standard for electronic data exchange in healthcare service systems, permitting different hospitals and healthcare organisations to easily share clinical information.
Ramathibodi Hospital will use a prototype of HL7and expects the system to be up and running by the third quarter of next year.
For now, patients' blood test and laboratory results from other infirmaries in the same network can be shared and doctors can make the appointment with patients via SMS, reducing waiting times.
In the long term, if Thailand can implement HL7 standard nationwide, patients will be able to easily transfer their data from one hospital to others.
It also plans to set up a joint committee with the Public Health Ministry and Education Ministry to enforce HL7 by developing human resources, with the Medical Council of Thailand responsible for regulation.
Boonchai Kijsanayotin, MD, PhD, of the Bureau of Health Policy and Strategy, Ministry of Public Health, said the lack of provision for sharing health-related data also means that the country has no legislation which grants the right of access by individuals to this data, including the right to demand its deletion, or to choose who it is or is not shared with.
However, the Thai government is in the process of approving 40-50 million baht to revolutionise the public hospital information system under the Strength to Strength 2012 initiative, which is the country's second-phase economic stimulus package.
Panjai Tantatsanawong, Education Minister and Deputy Director of the Commission of Higher Education, Administration for Educational Development Office of Information Technology, said hospitals can use UniNet, a high-speed university network which connects over 200 higher education institutions and medical schools throughout the country on a 10 GB network that is separate from the public internet.
The network not only supports the exchange of information inside the country but also collaborates with affiliates in other regions, such as the US, Europe and other Asian countries, to exchange clinical data and health insurance details.
Klaikong Vaidhyakarn Assistance Program Manager ICT Program, Thai Health Promotion Foundation said wireless communication is another important consideration.
The cross-border Mekong Basin Disease Surveillance System is an example of a piloted mHealth (mobile health) project which uses mobile devices for disease surveillance and management of emergency situations.
The project uses GeoChat SMS groups' communication software to report communicable diseases and emergencies in the border communities of Mukdahan province in Thailand and Suvanakhet in Laos.
The public health personnel working in the sub-district level use SMS to improve the timeliness of reports of potential disease outbreak and disaster.
The project has been organizing as partnership between ICT program-Thai Health Promotion Foundation, InSTEDD, Google.org and CSR program-DTAC.
Dr Boonchai continued that the country should create a multi-stakeholder, national-level, eHealth governing authority to provide leadership and direction, as well as the development or adoption of an eHealth policy to define the vision and action required.
Meanwhile the country's new national ICT framework, ICT 2020, should incorporate eHealth strategy into the framework along with eGovernment, eEducation, eIndustry,eSociety and eCommerce, and legislations related to health information security, privacy and confidentiality should also be enacted to protect people.
Moreover, national health information standards need to be developed to enable interoperable eHealth services, health information exchange and a systematic mechanism for building the capacity of people who design, implement, operate and use the eHealth systems.
Ittaporn Kanacharoen, MD, Deputy Secretary General of the Medical Council of Thailand, said currently there are 500,000 outpatient transaction each day, or 180 million each year, so the use of EHR and data exchange will enable doctors to better manage their appointments schedule.
Important issues when considering a rollout of data exchange standards include legal points and regulatory concerns, for example security and access control levels will have to be clearly defined in order to protect patients' data privacy in alignment with existing data protection and privacy laws, as well as to protect doctors and hospitals against the risk of being sued by patients.
Recently, the medical council launched the MD Card, a smart ID card for doctors which contains fingerprint biometric technology to verify registered medical personnel and combat the problem of fake doctors.
The MD card can only be used by authorised doctor, as it provides access to patients' data.
The doctor's database can also be used with the Geographic Information System (GIS) which can be very useful in some certain situations such as when the country has a health pandemic or disaster in any area, it will show the number of doctors available nearby and make it easier to gather them.
National Electronics and Computer Technology Center (Nectec), Director of Knowledge Elicitation and Archiving Laboratory, Chularat Tanprasert, added that the centre has developed a clinical metadata set for establishing the data exchange standard, as well as currency conversion tools for health insurance, enabling hospitals send health information to insurance companies and refund any payments quicker.
When the data interchange standard is rolled out and linkage is established between all healthcare stakeholders in the country under a National Health Information System, this will make it easier to refer patients between hospitals and make faster and more accurate health insurance payments, as well as supplying information to policy makers and helping them improve their decision-making process.
Moreover, several laboratories are developing smart health devices which will require technology integration, such as signal processing, biosensors and specific knowledge domains.
Examples include wearable health devices such as personalised ECG monitors and portable devices such as cholesterol monitors.
It is possible that Thai citizens could use the cholesterol monitoring device to send information to their doctor's computer and make appointments online through VDO chat on notebook computers.
Alternatively, senior people could benefit from a robot in their home that can monitor the medicine cabinet and issue warnings when it is time to take medicines, and even bring the necessary medicine to the patient if they are physically or mentally impaired.
Even junior doctors in rural areas or small communities can send results to specialists and senior doctors for consultation to help them make better decisions about treatment.
Chularat believes all these developments will happen within 5 to 10 years, and she says Thailand can use its ICT capability to elevate all health process by working smarter and improving people's quality of life through better health care services.
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Autor(en)/Author(s): Suchit Leesa-nguansuk
Quelle/Source: Bangkok Post, 18.11.2009
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