Driving Digital Health in the Thai Society (September 13, 2019)

Panel: การขับเคลื่อน Digital Health ในสังคมไทย
นพ.นวนรรน ธีระอัมพรพันธุ์
13 ก.ย. 2562
www.SlideShare.net/Nawanan

What words come to mind when you hear...
Digital Health
Transformation

https://medium.com/@marwantarek/it-is-the-perfect-storm-ai-cloud-bots-iot-etc-4b7cbb0481bc

http://www.ibtimes.com/google-deepminds-alphago-program-defeats-human-go-champion-first-time-ever-2283700
http://deepmind.com/ http://socialmediab2b.com
An Era of Smart Machines

englishmoviez.com
Rise of the Machines?

Digitizing Healthcare?
http://www.bloomberg.com/bw/stories/2005-03-27/cover-image-the-digital-hospital

“Big data is like teenage sex:
everyone talks about it,
nobody really knows how to do it,
everyone thinks everyone else is doing it,
so everyone claims they are doing it...”
-- Dan Ariely @danariely (2013)
Substitute “Big data” with “AI”, “Blockchain”, “IoT”
of your choice.
-- Nawanan Theera-Ampornpunt (2018)

Hype vs. Hope
Jeremy Kemp via http://en.wikipedia.org/wiki/Hype_cycle
http://www.gartner.com/technology/research/methodologies/hype-cycle.jsp

“Smart” Machines?
https://www.bbc.com/news/business-47514289
https://www.standardmedia
.co.ke/article/2001318679/e
thiopian-airlines-crash-
investigators-reach-
conclusion

Digitization 
Digital Transformation

Why Aren’t We Talk About These Words?
http://hcca-act.blogspot.com/2011/07/reflections-on-patient-centred-care.html

The Goal of Health Care
The answer is already obvious...
“Health”
“Care”

• Safe
• Timely
• Effective
• Patient-Centered
• Efficient
• Equitable
Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality
chasm: a new health system for the 21st century. Washington, DC: National Academy
Press; 2001. 337 p.
High Quality Care

ภาพรวมของงานด้าน Health IT
Intra-Hospital IT
• Electronic Health Records &
Health IT for Quality & Safety
• Digital Transformation
• AI, Data Analytics
• Hospital IT Quality
Improvement (HA-IT)
Inter-Hospital IT
• Health Information
Exchange (HIE)
Extra-Hospital IT
• Patients: Personal
Health Records (PHRs)
• Public Health: Disease
Surveillance & Analytics
Patient
at Home

Strategic
Operational
ClinicalAdministrative
LIS
Health Information ExchangeBusiness
Intelligence
Word
Processor
Social
Media
PACS
Personal Health Records
Clinical Decision Support Systems
Computerized Physician Order Entry
Electronic Health Records
Admission-Discharge-Transfer
Master Patient Index
Enterprise Resource Planning
Vendor-Managed Inventory
Customer Relationship Management
4 Quadrants of Hospital IT

Hospital A Hospital B
Clinic D
Policymakers
Patient at
Home
Hospital C
HIE Platform
Health Information Exchange (HIE)

Kaelber et al. (2008)
Personal Health Records (PHRs)

WHO & ITU
Achieving Health Information Exchange (HIE)

https://www.hfocus.org/content/2016/02/11783

Areas of Health Informatics
Patients &
Consumers
Providers &
Patients
Healthcare
Managers, Policy-
Makers, Payers,
Epidemiologists,
Researchers
Copyright  Nawanan Theera-Ampornpunt (2018)
Clinical
Informatics
Public
Health
Informatics
Consumer
Health
Informatics

Incarnations of Health IT
Clinical
Informatics
Public
Health
Informatics
Consumer
Health
Informatics
HIS/CIS
EHRs
Computerized Physician
Order Entry (CPOE)
Clinical Decision
Support Systems
(CDS) (including AI)
Closed Loop
Medication
PACS/RIS
LIS
Nursing
Apps
Disease Surveillance
(Active/Passive)
Business
Intelligence &
Dashboards
Telemedicine
Real-time Syndromic
Surveillance
mHealth for Public
Health Workers &
Volunteers
PHRs
Health Information
Exchange (HIE)
eReferral
mHealth for
Consumers
Wearable
Devices
Social
Media

Where We Are Today...
Clinical
Informatics
Public
Health
Informatics
Consumer
Health
Informatics
Technology that
focuses on the sick,
not the healthy
Silos of data
within hospitalPoor/unstructured
data quality
Lack of health data
outside hospital
Poor data
integration across
hospitals/clinics
Poor data integration
for monitoring &
evaluation
Poor data quality (GIGO)
Finance leads
clinical outcomes
Poor IT change
management
Cybersecurity
& privacy risks
Few real examples
of precision
medicine
Little access
to own
health data
Poor patient
engagement
Poor accuracy
of wearables Lack of evidence
for health values
Health literacy
Information 
Behavioral
change
Few standards
Lack of health IT
governance

Literacy
Literacy
Computer
Literacy
IT Literacy
Information
Literacy
Digital
Literacy
Health
Literacy
Media
Literacy

Literacy
Institute of Medicine 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.

Digital Divide & Literacy
https://www.itu.int/en/ITU-D/Statistics/Documents/Global%20ICT%20Developments%202001-2018%20-%20original.jpg

Digital Divide & Literacy (2016)
https://en.wikipedia.org/wiki/List_of_countries_by_number_of_Internet_users

Thailand ICT Statistics (2018)
“Thailand has an
extensive broadband
network with a current
focus on increasing
speeds and extending
access to remote
villages. Mobile
broadband take-up has
been astonishing, with
barely any 2G
subscriptions left
following the award of
3G spectrum in 2012.”
https://www.itu.int/en/ITU-D/Statistics/Documents/publications/misr2018/MISR-2018-Vol-2-E.pdf

Computer Literacy
•Mainly used through the 1980s
•Skill sets that enable one to be “able to operate
commonly used software packages effectively”
(Bawden, 2008)
Bawden D. Origins and concepts of digital literacy. In: Lankshear C, Knobel M, editors. Digital literacies: concepts, policies and practices. : Peter Lang; 2008.

Information Literacy
•Broader than “Computer Literacy”
•A Multifaceted Concept
•Encompasses “aspects of evaluation of information, and
an appreciation of the nature of information resources”
•While still focuses on computerized information
believed to be most problematic to users, also includes
use of printed resources
•Hence, overlap with library literacy & media literacy

Information Literacy
•American Library Association proposed a 6-stage model
in 1989, comprising six aspects of a linear process of
information handling
Recognizing
Need for
Information
Identifying What
Information is
Needed
Finding
Information
Evaluating
Information
Organizing
Information
Using
Information

Digital Literacy
•Gilster (1997): “An ability to
understand and to use
information from a variety of
digital sources”
•Gilster: DL “is about mastering
ideas, not keystrokes”
•Bawden (2008), referring to
Gilster’s definition: “Simply
literacy in the digital age”
Gilster (1997)

Digital Literacy Skills & Competences
(Gilster, 1997)
• “knowledge assembly,” building a “reliable information
hoard” from diverse sources
• retrieval skills, plus “critical thinking” for making
informed judgements about retrieved information, with
wariness about the validity and completeness of
internet sources
• reading and understanding non-sequential and dynamic
material
• awareness of the value of traditional tools in
conjunction with networked media
• awareness of “people networks” as sources of advice
and help
• using filters and agents to manage incoming information
• being comfortable with publishing and communicating
information, as well as accessing it
Gilster (1997)
Bawden, In Kankshear &
Knobel (2008)
Gilster (1997), via Bawden (2008)

Digital Literacy (Bawden, 2008)
4 generally agreed components of DL
1. Underpinnings
• Literacy
• Computer/ICT Literacy
2. Background Knowledge
• The World of Information
• Nature of Information Resources
3. Central Competencies
• Reading & Understanding Digital &
Non-Digital Formats
• Creating & Communicating Digital
Information
• Evaluation of Information
• Knowledge Assembly
• Information Literacy
• Media Literacy
4. Attitudes & Perspectives
• Independent Learning
• Moral/Social Literacy

Health Literacy
•“The degree to which individuals have the
capacity to obtain, process, and understand basic
health information and services needed to make
appropriate health decisions”
(Ratzan & Parker, 2000; Selden et al., 2000; HHS, 2000)

Health Literacy
Institute of Medicine 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.

Health Literacy
http://nutrition.about.com/od/recipesmenus/ss/learnlabels.htm

ฉลากยา รพ.ระยอง และ รพ.สต.

Health Literacy
•“หญิงไทย 74 ปี อ่านจาก Line ว่า กระชายดาลดไขมัน +
บารุงกระดูก จึงไปซื้อกระชายดามาปั่น กินวันละ 3 ขีด +
กินมะม่วงหาวมะนาวโห่ วันละ 8 ลูก + งาดาวันละ 2 เม็ด
(มี Sales มาขายที่บ้าน บอกว่าลดไขมัน ลดเบาหวาน ลด
ความดัน รักษามะเร็งได้ด้วย ราคาแพง ซื้อต่องวด 5,700
บาท)”
จากบันทึกของแพทย์ท่านหนึ่งในเวชระเบียนของผู้ป่วยรายหนึ่ง

Healthtech Startup Ecosystem
www.facebook.com/HealthTechThailand/ No endorsements implied

Roles of IT in Consumer Health
•Access to information
•Networking opportunities
•Education/Self-study
•Personalization
•Effective & efficient communications
• With providers
• Among patients
•Empowerment
•“User Experience”
Institute of Medicine 2013. Oral Health Literacy: Workshop Summary. Washington, DC: The National Academies Press.

IT & Participatory Medicine
• Richard Davies deBronkart Jr.
• Cancer survivor & blogger
• Found proper cancer
treatment through online
social network after diagnosis
• Activist for participatory
medicine & patient
engagement through
information technology
http://www.epatientdave.com/

E-Patient
•Not “Electronic” Patient
•Engaged
•Equipped
•Empowered
•Educated
•Enlightened
•Etc.
http://www.epatientdave.com/

Envisioning a Smart Health Thailand

Driving Digital Health in the Thai Society (September 13, 2019)

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