1. 1
A Personal Journey Toward
Thailand’s eHealth:
A Presentation in Consideration for a Lecturer Position
at the Department of Community Medicine,
Faculty of Medicine Ramathibodi Hospital
September 26, 2013
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Faculty of Medicine Ramathibodi Hospital
http://www.SlideShare.net/Nawanan

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Introduction
Nawanan Theera-Ampornpunt
2003 M.D. (First-Class Honors) (Rama’33)
2009 M.S. in Health Informatics (U of MN)
2011 Ph.D. in Health Informatics (U of MN)
Current Employment:
Medical Systems Analyst
Informatics Division
Faculty of Medicine Ramathibodi Hospital

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Points To Address
• How I view the Department
• How I fit with the Department’s mission
• How I can play a role for the Department

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Outline
• My Personal Journey
• My Academic Work
• Looking Back & Looking Forward
• Community Medicine & eHealth
• Addressing the 3 Questions
• Q & A

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My Personal Journey

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A Humble Beginning

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An Innocent First Encounter

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Journey as a Medical Student
2nd Year

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Journey as a Medical Student
3rd Year

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Extracurricular Activities

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A Confused Medical Student
Image Sources: (Left) http://static.brazencareerist.com/brazenlife/2012/10/confused-250x250.jpg
(Right) http://www.nmsu.edu/~counsel/career/images/bw-confused-student.jpg

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Journey as a Medical Student
5th Year
Image Source: (Right) http://www.flickr.com/photos/99979595@N00/236508120

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“ครูผู้จุดประกาย”

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“ครูผู้จุดประกาย” ของผม
Image Source: http://www.flickr.com/photos/99979595@N00/236508120

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Medical Informatics (Now Known As
Biomedical and Health Informatics)
• “The field that is concerned with the
optimal use of information, often
aided by the use of technology, to
improve individual health, health
care, public health, and biomedical
research” (Hersh, 2009)
The Eye-Opening Field
Shortliffe et al. (2001)

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One Chapter Ends, Another Begins
2003

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A Journey in the New Direction
First Full-Time Physician
Working in the IT Division at Ramathibodi, with
support from these individuals
2004 - 2005

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A Journey in the New Direction
2005

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A Journey in the New Direction
2009 M.S. (Health Informatics) Commencement

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A Journey in the New Direction
2011 Ph.D. (Health Informatics) Commencement

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Fellowship of the International Partnership in
Health Informatics Education (IPHIE)’s
8th International Master Class (2006)
Experiences While Studying Abroad

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President
Thai Student Association of Minnesota
(2007-2008)
Experiences While Studying Abroad

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• Research Assistant, Institute for Health
Informatics, University of Minnesota
Experiences While Studying Abroad

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My Academic Work

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• Thai Hospitals’ Adoption of Information Technology
Survey (THAIS)
• Studied all 1,302 hospitals in Thailand to assess
state of IT adoption, identify associating factors,
and determine relationships between how well IT is
managed and other aspects of IT adoption
Ph.D. Dissertation
Theera-Ampornpunt (2011)

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Survey Instrument
Theera-Ampornpunt (2011)

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Critical Success Factors in Health IT Projects
Theera-Ampornpunt (2011)
Communications of plans & progresses
Physician & non-physician user involvement
Attention to workflow changes
Well-executed project management
Adequate user training
Organizational learning
Organizational innovativeness

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Theory of Hospital Adoption of
Information Systems (THAIS)
Theera-Ampornpunt (2011)

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Kijsanayotin B, Du J, Theera-Ampornpunt N, Gurses A, Speedie SM. Improving access
to clinical information in an emergency department: a qualitative study. Poster session
presented at: Biomedical and Health Informatics - From Foundations to Applications to
Policy. AMIA 2008 Annual Symposium; 2008 Nov 8-12; Washington, DC.
Some Publications

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Theera-Ampornpunt N, Kijsanayotin B, Speedie SM. Creating a large database test bed
with typographical errors for record linkage evaluation. Poster session presented at:
Biomedical and Health Informatics - From Foundations to Applications to Policy. AMIA
2008 Annual Symposium; 2008 Nov 8-12; Washington, DC.
Some Publications

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Theera-Ampornpunt N, Speedie SM, Du J, Park YT, Kijsanayotin B, Connelly DP. Impact
of prior clinical information in an EHR on care outcomes of emergency patients. AMIA
Annu Symp Proc. 2009 Nov:634-8. Cited in: PubMed; PMID 20351932.
Some Publications

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Connelly DP, Park YT, Du J, Theera-Ampornpunt N, Gordon BD, Bershow BA,
Gensinger RA Jr, Shrift M, Routhe DT, Speedie SM. The impact of electronic health
records on care of heart failure patients in the emergency room. J Am Med Inform Assoc.
2012 May-Jun;19(3):334-40. Epub 2011 Nov 9. Cited in: PubMed; PMID 22071528.
Some Publications

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Du J, Park YT, Theera-Ampornpunt N, McCullough JS, Speedie SM. The use of count
data models in biomedical informatics evaluation research. J Am Med Inform Assoc.
2012 Jan-Feb;19(1):39-44. Epub 2011 Jun 29. Cited in: PubMed; PMID 21715429.
Some Publications

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Speedie SM, Park YT, Du J, Theera-Ampornpunt N, Bershow BA, Gensinger RA Jr,
Routhe DT, Connelly DP. The impact of electronic health records on people with diabetes
in three different emergency departments. J Am Med Inform Assoc. Forthcoming 2013.
Epub 2013 Jul 10. Cited in: PubMed; PMID 23842938.
Some Publications

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Theera-Ampornpunt N. Medical informatics: a look from USA to Thailand. In:
Ramathibodi’s Fourth Decade: Best Innovation to Daily Practice; 2009 Feb 10-13;
Nonthaburi, Thailand [CD-ROM]. Bangkok (Thailand): Mahidol University, Faculty of
Medicine Ramathibodi Hospital; 2009 Feb. 1 CD-ROM: 4 3/4 in.
Some Publications

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นวนรรน ธีระอัมพรพันธุ์. Electronic health records: “อเมริกาเข้มแข็ง” สอนอะไรไทย? ใน:
Health Informatics: From Standards to Practice. งานประชุมประจําปีสมาคมเวชสารสนเทศไทย
ครัง้ ที่ 19; 2010 Nov 10-12; Nonthaburi, Thailand.Nonthaburi (Thailand): Thai Medical
Informatics Association; 2010 Nov.
Some Publications

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นวนรรน ธีระอัมพรพันธุ์. ตํานานความเชื่อและข้อเท็จจริงเกี่ยวกับมาตรฐานสารสนเทศทางสุขภาพ.
ใน: Health Data Standards Expo: From Reimbursement to Clinical Excellence; 2011 Aug
8-9; Bangkok, Thailand. Bangkok (Thailand): Mahidol University, Faculty of Medicine
Ramathibodi Hospital; 2011 Aug.
Some Publications

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นวนรรน ธีระอัมพรพันธุ์. หัวข้อวิจัยด้านเวชสารสนเทศในบริบทของประเทศไทย. ใน: Health
Informatics: Strengthening through Meaningful Usage of Health Data. งานประชุมประจําปี
สมาคมเวชสารสนเทศไทย ครั้งที่ 20; 2012 Jan 26-27; Bangkok, Thailand. Bangkok (Thailand):
Thai Medical Informatics Association; 2012 Jan.
Some Publications

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Parchariyanon S, Asavanant K, Srisiriratanakul S, Tongtaweechaikit C, Theera-
Ampornpunt N, Okaschareon C, Ungkanont A. Implementation of Thailand’s first
prototype for exchanging of laboratory results using HL7 version 3 and LOINC. Poster
session presented at: Informatics: Transforming Health and Healthcare. AMIA 2012
Annual Symposium; 2012 Nov 3-7; Chicago, IL.
Some Publications

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คอลัมน์ “ข้อคิดประจําฉบับ” จดหมายข่าวสมาคมเวชสารสนเทศไทย (2011 - Present)
Some Publications

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Otero PD, Perrin C, Geissbuhler A, Cheung NT, Theera-Ampornpunt N, Lun KC.
Informatics education in low resource settings. In: Berner ES, editor. Informatics
education in healthcare: lessons learned. London: Springer; 2014. p. 197-222.
Book Chapter

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1. Theera-Ampornpunt N. Medical informatics: the new specialty for the future. Presented
at: 36th Anniversary Ramathibodi Academic Conference; 2005 May 12-15; Nonthaburi,
Thailand. Moderator, in Thai.
2. Theera-Ampornpunt N. Alternative careers for MD. Presented at: Ramathibodi Faculty
Hour; 2008 Oct 22; Bangkok, Thailand. Panel discussion via videoconference, in Thai.
3. Theera-Ampornpunt N. Next step of health informatics education and research in
Thailand. Presented at: Medical Data Standards Expo; 2010 Aug 20-21; Bangkok,
Thailand. Moderator, in Thai.
4. Theera-Ampornpunt N. Adopting health IT: what, why, and how? Presented at: How to
Implement World Standard Hospital IT?; 2010 Nov 3; Khon Kaen, Thailand. Invited
speaker, in Thai.
5. Theera-Ampornpunt N. Health informatics: the next “stethoscope” in healthcare.
Presented at: Intelligent logistics for innovation hospitals; 2010 Dec 23; Bangkok,
Thailand. Invited speaker, in Thai.
6. Theera-Ampornpunt N. Health informatics for hospital executives. Presented at:
Ramathibodi Hospital Administration Certificate Program; 2011 Feb 14; Bangkok,
Thailand. Invited speaker, in Thai.
7. Theera-Ampornpunt N. Toward the national agenda for Thailand’s public health
informatics. Presented at: Health Informatics Workshop: Health Informatics Challenges &
Solutions in Limited-resource Settings: Capturing, Mining and Applying Healthcare Data;
2012 Jan 31-Feb 2; Bangkok, Thailand. Invited speaker.
Notable Presentations

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8. Theera-Ampornpunt N. Information and technology: emergency medical informatics.
Presented at: The International Conference in Emergency Medicine: Challenges in
Emergency Medicine: It’s Time for Change!; 2012 Feb 1; Bangkok, Thailand. Invited
speaker.
9. Theera-Ampornpunt N. Global or glocal e-Health approaches in Asia: what is new or
next? Presented at: Globalizing Asia: Health Law, Governance, and Policy - Issues,
Approaches, and Gaps!; 2012 Apr 16-18; Bangkok, Thailand. Invited speaker.
10. Theera-Ampornpunt N. Health information privacy: Asia’s viewpoint. Presented at:
Globalizing Asia: Health Law, Governance, and Policy - Issues, Approaches, and Gaps!;
2012 Apr 16-18; Bangkok, Thailand. Invited speaker.
11. Theera-Ampornpunt N. Kijsanayotin B. Thai informatics year in review. Presented at:
The 21st Annual Meeting of the Thai Medical Informatics Association (TMI21 - 2012);
2012 Nov 21-23; Nonthaburi, Thailand. Panel discussion, in Thai.
12. Theera-Ampornpunt N. Leveraging clinical IT for dengue: opportunities for tomorrow.
Presented at: Joint International Tropical Medicine Meeting 2012 (JITMM2012) -
Emergence of Tropical Diseases: Trans-disciplinary Strategies; 2012 Dec 12-14;
Bangkok, Thailand. Invited speaker.
13. Theera-Ampornpunt N. IT health informatics: how IT can help emergency department
flow? Presented at: Prince Mahidol Award Youth Program - Clinical Practice in
Emergency Medicine: Navigating Self and System; 2013 Jan 28; Bangkok, Thailand.
Invited speaker.
Notable Presentations

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14. Theera-Ampornpunt N. HL7 Clinical Document Architecture: overview and
applications. Presented at: HL7 CDA Workshop at the Faculty of Medicine Ramathibodi
Hospital; 2013 Jun 20-21; Bangkok, Thailand. Invited speaker, in Thai.
15. Theera-Ampornpunt N. Ethical and social issues in health IT. Presented at:
Emergency and Trauma Nurses: Trends and Challenges; 2013 Jul 17-19; Bangkok,
Thailand. Invited speaker, in Thai.
16. Theera-Ampornpunt N. eHealth in Thailand: status and trend / security and privacy
for health data. Presented at: IT in Pharmacy; 2013 Aug 7; Bangkok, Thailand. Invited
speaker, in Thai.
17. Theera-Ampornpunt N. HL7 & HL7 CDA: the implementation of Thailand’s healthcare
messaging exchange standards. Presented at: Directions and Future of Thailand’s Health
Information Standards; 2013 Aug 21; Bangkok, Thailand. Invited speaker, in Thai.
18. Theera-Ampornpunt N. Overview of health informatics and disease surveillance
system. Presented at: Leadership in Disease Control Workshop; 2013 Aug 21-23;
Nonthaburi, Thailand. Invited speaker, in Thai.
Notable Presentations

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Ramathibodi
• Healthcare CIO Certificate Program
• Healthcare CEO Certificate Program
• Clinical Fellows
• Nursing Informatics for Undergraduate Nursing Students
MU ICT
• Health IT Track, Undergraduate ICT Students
MU Tropical Medicine
• Diploma & M.S. in Biomedical & Health Informatics
TMI & SIPA
• Health Informatics Students & Healthcare Professionals
Teaching Experiences

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• American Medical Informatics Association
– AMIA 2012 Annual Symposium Scientific
Program Committee
– Chair-Elect (2012) & Chair (2013),
AMIA Student Working Group
– AMIA 2012 Annual Symposium Session Chair
• Asia eHealth Information Network (AeHIN)
– Scientific Program Committee
– Evaluation Working Group Contributor &
Expert
Other Notable Experiences

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• Thai Medical Informatics Association (TMI)
– TMI Newsletter Editorial Board
– Health IT Quality Improvement Framework
Drafting Task Force
– Scientific Program Committee (2012-2013)
– Vice Chair, Education Special Interest Group
• eRefer Task Force (NHSO Bangkok)
• eHealth & Interoperability Development Team
• National Data Clearing House Establishment
Research Team
Other Notable Experiences

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• กองบรรณาธิการ วารสารวิจัยระบบสาธารณสุข
• Peer Reviewer for
– Annals of Internal Medicine
– BMC Health Services Research
– วารสารวิจัยระบบสาธารณสุข
– AMIA 2011 Annual Symposium
– Applied Clinical Informatics
– electronic Journal of Health Informatics (eJHI)
– Thailand’s National Conference on Computer
Information Technologies 2011 (CIT2011)
• Grant Reviewer for NECTEC
Other Notable Experiences

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• Deputy Chief, Informatics Division
– Responsible for risk management, IT infrastructure, and IT
process improvement
• Deputy Director for Informatics, Chakri Naruebodindra
Medical Institute
• Course designer & secretary, Healthcare CIO Certificate
Program, Hospital Administration School
• Committees
– Rama-GRIPP (Health Policy Development)
– R2R
– Medical Students’ Ramathibodi Computer Club
Previous Work at Ramathibodi
Since Coming Back

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• Total International Peer-Reviewed Publications in
Scientific Database: 6
• Total Citations: 13
• H-index: 3
• 3 publications with at least 3 citations
• G-index: 3
• 3 publications with at least 9 citations combined
• Journal Published with Highest Impact Factor: 3.571
Academic Output Summary

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Looking Back &
Looking Forward

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• Shaped & transformed by medical study
Ramathibodi
• Heavily influenced by systems thinking at
Community Medicine
• Found real “passion” in health informatics
• Blessed with opportunities at Ramathibodi
• Long time spent on personal development
Looking Back

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• Find happiness in
your career
• Find happiness in
your relationships
• Keep integrity
• Most importantly,
have a purpose in life
Looking Forward

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• As the second formally-trained M.D., Ph.D.
in Health Informatics in Thailand, I am
driven and socially obligated...
• To promote personal & population health
through establishment of sustainable
foundations for eHealth and strengthening
of the field of Biomedical and Health
Informatics in Thailand before my end of
life.
My “Mission in Life”

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How To Fulfill This Mission
eHealth
Clinical Care
Health
Promotion &
Prevention
Health
Administration
Policy
Advocacy
Research &
Development
Workforce
Development

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• Showcase of Health IT Implementations
• Education & Capacity Building
– Medical Students
– Residents & Fellows
– Health Informatics Students
– Other Health Professionals
• Research
• Policy Advocacy
• Academic Talks & Awareness Building
How To Fulfill This Mission

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Community Medicine &
eHealth

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• Health Policy & Administration
• Health Systems/Health Services Research
• Community Engagement &
Patient Empowerment
• Health Promotion & Prevention
• Primary Care
• Research Methods & Biostatistics
• Epidemiology
• Global Health
Aspects of Community Medicine

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59
Components of Health Systems
59
WHO (2009)

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60
WHO Framework
60
WHO (2009)

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Use of information and communications
technology (ICT) for health; Including
• Treating patients
• Conducting research
• Educating the health workforce
• Tracking diseases
• Monitoring public health.
Sources: 1) WHO Global Observatory of eHealth (GOe) (www.who.int/goe)
2) World Health Assembly, 2005. Resolution WHA58.28
Slide adapted from: Mark Landry, WHO WPRO & Boonchai Kijsanayotin
eHealth

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eHealth Components (WHO-ITU Model)

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• Safety
• Timeliness
• Effectiveness
• Efficiency
• Equity
• Patient-centeredness
Goals for “Health”
(IOM, 2001)

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64
EQESAR Framework
• E - Equity
• Q - Quality
• E - Efficiency
• SA - Social Accountability
• R - Relevance
64
Department of Community Medicine,
Faculty of Medicine Ramathibodi Hospital, Mahidol University

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Landmark IOM Reports
(IOM, 2001)(IOM, 2000)

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Health Information Exchange (HIE)
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home

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The Anatomy of Health IT
Health
Information
Technology
Goal
Value-Add
Means

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Addressing the
3 Questions

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Points To Address
• How I view the Department
• How I fit with the Department’s mission
• How I can play a role for the Department

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How I View the Department of
Community Medicine
• A welcoming environment with a very
important altruistic mission toward better
health of the people and population
• A broad discipline with diverse and vibrant
areas of interest
• A department that houses inspiring role
models and thought leaders in various
areas
• A home that can help me fulfill my dream

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How I Fit with the Department’s
Mission
• Information & Technologies are two
building blocks of health systems
• Common goals toward better health
• Health IT & eHealth are necessary tools
for health policy-makers & clinicians in the
21st Century

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How I Fit with the Department’s
Mission
• Personal Strengths
– Public-Spirited; Strive for Altruism
– Systems Thinker
– Driven, Determined & Responsible
– Multi-tasker
– Integrity
– Attention to Detail
– Independent Thinker
– English Language Skills
– Broad Academic Experiences

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Could I Be The Missing Piece?
Image Source: http://vivavisibilityblog.com/wp-content/uploads/2009/03/missingpuzzlepiece.jpg

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Working As Part of the Big Machine

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How I Can Contribute to
the Department
• Teaching (Common Com Med Topics and/or
Informatics)
– Medical Students
– (Future) Graduate Students at the Department
– (Future) Short Courses
– (Future) Informatics Graduate Curriculum
• Research
– Informatics Research
– Assist Others in Their Research Projects

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How I Can Contribute to
the Department
• Academic Services
– Policy Advocacy
– Serve in External Committees
– Presentations in Seminars & Conferences
• Internal Operations
– IT or Other Internal Process Improvements
– As assigned
• Ramathibodi
– IT Management of Chakri Naruebodindra
– Other Committee Involvement
– Student Affairs

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Map of Collaborations
International
National
Within
Mahidol
• AMIA
• AeHIN
• (University of Minnesota)
• (Northwestern University)
• TMI
• HSRI
• MoPH
• NHSO Bangkok
• ETDA
• NECTEC
• SIPA
• MUIT
• Faculty of ICT
• Faculty of Tropical Medicine
• Faculty of Engineering
• Faculty of Public Health
Bold represents relatively strong collaboration; (In parentheses) is a potential collaboration

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The Journey Beyond:
A Long & Winding Road
Image Source: http://twinstrivia.com/2013/05/20/the-road-to-minnesota-is-long-and-hard/

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A Personal Manifesto
มุ่งสู่ฝัน อันไกล ที่ใหญ่ยิ่ง
มั่นคงนิ่ง แน่วแน่ ไม่แปรผัน
เดินตามทาง ดั่งวาด อาจมองจันทร์
หน้าเรานั้น ต้องฟันป่า และฝ่าไพร
พัฒนา “สถาบัน” อันประสิทธิ์
นานาจิต คิดก้าวหน้า พาสดใส
สร้างประทีป ส่องทาง ยังคนไทย
สรรค์สร้างไว้ ให้ชาติ ผงาดยืน
ร่วมกันสร้าง ทางเดิน เจริญรุ่ง
แรงใจมุ่ง มั่นหมาย ไม่ขัดขืน
ผลักดันเพื่อ ระบบงาน อันยั่งยืน
ดันเต็มที่ ทุกวันคืน ยอมฝืนทน
เพื่อระบบ ข้อมูล สร้างคุณค่า
ฝันนั้นหนา คือเป้า เฝ้าฝีกฝน
อันเส้นทาง ร้างนัก จักเจียมตน
ไกลสุดพ้น ทนได้ ด้วยแรงใจ
นวนรรน ธีระอัมพรพันธุ์ 29 ก.ค. 2556

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Thank You
Q & A