The Thammasat University Library has newly acquired an important book about the future of the Kingdom’s healthcare. eHealth in Thailand: Interoperability and Health Information is edited by Dr. Boonchai Kijsanayotin. Dr. Boonchai is an informatician and physician. He worked in a rural public general hospital as an internal medicine clinician before earning a Ph.D. degree in health informatics from the University of Minnesota, USA. His main research interests are in national health information standards, eHealth, health information exchanges and health information technology (IT) adoption. Currently, he is the health informatician at the Thai Health Information Standards Development Center (THIS) at the Health System Research Institute (HSRI), Ministry of Public Health.

What is eHealth?

Looking forward to a digital future, since around 1999, discussions of eHealth employ up-to-the-minute technology to improve healthcare. Generally, the concept of eHealth involves using electronic and digital processes in healthcare, or simply using using the Internet for healthcare. Health applications (apps) and links on mobile phones, known as mHealth or m-Health, may also be involved. As in all matters dealing with the Internet, cyber-security is an issue, to maintain patient privacy. Aspects of eHealth may include:

• Electronic health records communicating patient data among healthcare professionals.
• Computerized physician requests of diagnostic tests and treatments with results received electronically.
• ePrescribing: printing prescriptions for patients and transmitting prescriptions electronically from doctor to pharmacist.
• Clinical decision support system: providing information electronically about standards for healthcare professionals in diagnosing and treating patients.
• Telemedicine: physical and psychological diagnosis and treatments at a distance, including telemonitoring of patients.
• Consumer health informatics: making electronic resources on medical topics available to the public as a preventive measure.
• Health knowledge management: latest medical journals and best practice guidelines, including physician resources such as Medscape and MDLinx.
• Virtual healthcare teams, with healthcare professionals collaborating and sharing information on patients through digital equipment.
• mHealth or m-Health, using mobile devices to collect patient health data, provide healthcare information to practitioners, researchers, and patients, real-time monitoring of patient condition, and providing direct care through mobile telemedicine.
• Medical research using grids, with powerful computing and data management capabilities to handle large amounts of different data.
• Health informatics / healthcare information systems or software solutions for appointment scheduling, patient data management, work schedule management, and other administrative tasks involving health.

As with all information found on the internet, some statements about health are false and misleading. The more doctors and patients know about sourcing reliable advice about healthcare on the internet, the safer it is to use the internet as an information resource. In developing countries, eHealth can be a valuable resource for remote regions which are difficult to access. In areas that are flooded during rainy seasons, as long as internet connections remain effective, medical advice can be obtained. The World Health Organization (WHO) division eHealth at WHO uses information and communication technologies (ICT) for health. Its website states:

The World Health Assembly in 2018 acknowledged the potential of digital technologies to play a major role in improving public health, where delegates agreed on a resolution on digital health. The resolution urges Member States to prioritize the development and greater use of digital technologies in health as a means of promoting Universal Health Coverage and advancing the Sustainable Development Goals.

Thailand and eHealth

Thailand’s Ministry of Public Health (MOPH) defines eHealth as

the effective use of information technology to manage and support the health system components of the health service system requires the Ministry of Public Health to develop the information and communication technology system of the Ministry… eHealth is an all-in-one health and communication technology (ICT) tool and service. Health professionals include health communications between departments, including electronic prescriptions, electronic health records, health information, referral systems, health care networks, telemedicine, accessory and equipment, portable healthcare portal, it infrastructure, information for research and clinical care, and other ICT tools that help in prevention, diagnosis, treatment, health examination, administration. This will allow for better eHealth operations, including the use of the internet or other electronic media for the dissemination or provision of health care information to the public.

In May, the Healthcare Information and Management Systems Society (HIMSS) Thailand eHealth Summit 2018 was held to further explore this subject. Based in Chicago, Illinois, USA, HIMSS works internationally, applying information and technology to healthcare. A non-profit agency, HIMSS promotes community building, public policy, and professional/ workforce development. At the HIMSS Thailand eHealth Summit 2018, among issues discussed were national eHealth agenda, medical tourism, and increasing demand for services such as aged care. Medical tourism and the ongoing advance of online technology means that hospitals in the Kingdom routinely upgrade their IT infrastructure. Some initiatives are underway from the

Some initiatives are underway from the Ministry of Public Health and the Ministry of Digital Economy and Society, formerly known as the Ministry of Information and Communication Technology) to develop the health IT industry. Plans include to connect 9,000 subdistrict hospitals with high speed broadband internet; centralize databases with patient health profiles; and develop big data analytic capability to prepare for epidemics. Remaining challenges include a shortage of trained medical personnel across different regions. Rural and remote areas are still underserved. eHealth in Thailand: Interoperability and Health Information suggests:

Though health informatics professionals in Thailand have encouraged the adoption of health data standards, there are barriers such as a lack of human resources in health informatics, lack of awareness and unfamiliarity with the potential benefits of using standards and terminologies in healthcare among high level policy makers and healthcare professionals. With these barriers in mind, we recommend the following steps for the development of health information standards in Thailand:

• Governance and leadership of national eHealth systems are essential and critical for the country to achieve interoperability through health data standards.
• Incentives and mandates from the governing body that has authority are important to the adoption of standards.
• Standards maintenance process is a necessary component of successful implementation of every standard.
• Advocacy on the potential benefits from using data standards as well as communication between the organizations and the users are of importance.
• Human resource in health informatics is an important component and building capacity for them is essential.

Last year, a report on eHealth Strategy, Ministry of Public Health (2017 – 2026) was published by the Information and Communication Technology Center, Offi­ce of the Permanent Secretary, MOPH. In the report, H.E. Clin.Prof. Emeritus Piyasakol Sakolsatayadorn, M.D., Minister of Public Health, explained:

The eHealth Strategy is being prepared by the Ministry of Public Health to serve as a framework for driving digital technology. It is a mechanism for the development of the national health system, including paradigm shift, reforming of digital technology operations and health innovation in all sectors.

Dr. Sopon Mekthon, Permanent Secretary for Public Health, Ministry of Public Health, added:

To develop the eHealth strategy is necessary and important, as the WHO has stated, urging each country to work for its achievement… I need to thank all professionals and sectors involved for helping making it possible and indispensable for all healthcare sectors, in order to launch the eHealth Strategy which will prove to be a huge step forward in the direction of getting a smart healthcare system in Thailand.

(All images courtesy of Wikimedia Commons)