IV. The GAPS Framework To develop national healthcare ICT systems, countries need to work on 4 important fundamental topics.
National Health Information Systems Blueprint (the Architecture) A Health Information Exchange (HIE) makes the sharing of health data across information systems possible 1) who received health services 2) who provided those services, 3) where did they receive the services 4) what specific care did they receive. From: http://ohie.org/architecture/
Indicators Facility Registry Provider Registry Client Registry Shared Health Record Inventory Interoperability Layer EMRs Hospital Systems mhealth Applications Supply Chain Applications HMISs AeHIN Meeting, Nay Pyi Taw August, 2015
Level of Interoperability Process/Service Interoperability Semantic Interoperability Syntactic Interoperability Structure Interoperability Technical Interoperability Harmonized business models Same meaning, ontology-based terminology harmonised messaging and document exchange based on the exchange of agreed data.(data set) harmonised at the plug and play, signal and protocol level Benson T: Principles of Health Interoperability HL7 and SNOMED. 2nd ed. 2012. Springer; 2012. Bobel B: Making Hospital IT Interoperable Hospital Information Technology Europe 2008
Level of Interoperability & Standards Process/Service Interoperability Semantic Interoperability Syntactic Interoperability Structure Interoperability Technical Interoperability Clinical Practice Guideline, Similar Claim Rules (DRG), HIPAA Citizen ID, ICD 10, TMT, LOINC, SNOMED-CT HL7 message,hl7 CDA, DICOM Standards Dataset : Discharge Summary, Prescription XML, PKI, SSL, Web Service Benson T: Principles of Health Interoperability HL7 and SNOMED. 2nd ed. 2012. Springer; 2012. Bobel B: Making Hospital IT Interoperable Hospital Information Technology Europe 2008
HIS/eHealth Training and Study Tour- Thailand Citizen IDs Client Registry Health Facility IDs Facility Registry Provider Registry ICD -10 CGD code DRG TMT Coding & Terminology 12 Files 18 Files Shared Health Record Inventory Indicator s National Provider IDs LOINC SNOMED Interoperability Layer Referral Docs. National Product Catalogue? Open HIM, IHE, HL7, CDA, Authentication, Mapping services EMRs Hospital Systems Insurance Claim mhealth Applications Supply Chain Applications CGD = Comptroller General Department, TMT = Thai Medicines Terminology, DRG = Diagnosis Related Group, IHE = Integrating the Healthcare Enterprise Reference: Dr. Boonchai Kijsanayotin, Thailand HMISs
Citizen Identification Card 1969-1986 Typing machine ID card 1987 1996 Computer Printout ID card Current Smart card type ID card
Thai Vital Statistics after 1996 BORA Ministry of Interior Central Registry Electronic files Ministry of Public Health Compile, code, validate and process statistics Printed/ Web Vital statistics report Data Sync. National Health Security Office (NHSO) Web entry Birth certificate (Start 2010) Hospitals Web entry death certificates (start 2006) Report statistics back to provinces Provincial Health offices
Standard Data set for health insurance (12 files) 1996
Health Center standard data set (18 files) 2002
How DRGs are calculated? Age Sex Diagnosis ICD 10 Procedures ICD 9 CM Discharge status Co-morbidities DRG Grouper Adj RW Length of Stay (LOS) DRGs RW
Contribution of National ID system, IT infrastructure, DRGs to Thailand UHC implementation HIS & HIT context 1. Computerized Civil Registration & Citizen IDs 2. Providers ICT adoption & country s ICT infrastructure 3. Administrative data standards, coding standards & DRG technology Universal Coverage Scheme Implementation 13
Thai Health Informatics Academy Thai Health Information Standard Development Center(THIS) Dosage Form Strength Unit of Uses Pack content SUBS Substance VTM Virtual Therapeutic Moiety GP Generic Product GPU Generic Product Use GPP Generic Product Pack Thai Medicines Terminology (TMT) Data Model TP Trade Product TPU Trade Product Use TPP Trade Product Pack Manufacturer
Thai Health Informatics Academy Thai Health Information Standard Development Center(THIS) TMT an Example 15
Drug Price Hospitals Charged CSMBS: TMTID(TPU) 114955 XARATOR (Atrovastatin 40 mg filmed-coated tablet) Baht/Tablet 16 15 20.5 24 32 30.5 30 41 40 39.5.25 37.5 37.5 36.5 43 43 46.5 46 46 46 46 46 46 45.64 45 44.5 TOTAL Hospitals
Centralized e-government Procurement System (egp) : e-bidding Citizen Sellers Open to Public For discussion Announce Electronic Bid TPU For bidding drug Prepare Draft Bidding Document Announce Bidding Decision Government Office: Buyers GPU For drug specification requirement Announce Bid Winner
40 35 ราคาต อหน วย (บาท) 685136 ZETIA (SCHERING-PLOUGH, U.S.A.) (ezetimibe 10 mg) tablet, 1 tablet 30 25 20 15 10 5 0 เขตส ขภาพ 2 4 9 6 1 9 10
http://this.or.th/files/interopbook.pdf