HIS situation in ThailandHIS situation in Thailand

Dr.Pinij FaramnuaypholDr.Pinij FaramnuaypholHealth Information System Development OfficeHealth Information System Development Office

Structure of OrganizationStructure of Organization

Health CenterHealth Center

District HospitalDistrict HospitalDistrict Health OfficeDistrict Health Office

Provincial Health OfficeProvincial Health Office

MOPHMOPH

DepartmentsDepartments

Regional &Regional &General HospitalGeneral Hospital

InsuranceInsuranceUC, SSS, CSMBSUC, SSS, CSMBS

Other OrganizationOther OrganizationNSO, MOINSO, MOI

Office of Permanent Office of Permanent SecretarySecretary

Health Information SystemHealth Information System Population-based Health Information SystemPopulation-based Health Information System

– Population and Housing Census (NSO)Population and Housing Census (NSO)– Vital registration (Ministry of Interior)Vital registration (Ministry of Interior)– Household surveys (NSO)Household surveys (NSO)– Health surveys (MoPH)Health surveys (MoPH)

Facility-based Health Information SystemFacility-based Health Information System– Disease surveillance system (MoPH)Disease surveillance system (MoPH)– Disease registries (MoPH, University)Disease registries (MoPH, University)– Routine reports from facilities (MoPH)Routine reports from facilities (MoPH)– Electronic patient records (MoPH, NHSO)Electronic patient records (MoPH, NHSO)– Primary care health information (MoPH, NHSO)Primary care health information (MoPH, NHSO)– Health resource information (MoPH)Health resource information (MoPH)– National Health Account (IHPP)National Health Account (IHPP)

Vital registration systemVital registration system

Death inside hospital Death outside hospital

Death certificate by doctor Death notification by village head

Death registration at district office or municipality

Ministry of Interior ICD-10 coding at MoPH (BPS)

35% 65%

Death certificate form(In-hospital)

Death certificate form(Non-hospital)

On-line system

Electronic file transfer monthly

Household surveys (NSO)Household surveys (NSO) Health and Welfare surveyHealth and Welfare survey

– Out-of-pocket payment, Health care utilizationOut-of-pocket payment, Health care utilization– Illness, Chronic diseaseIllness, Chronic disease– Perceived health statusPerceived health status– Health service coverageHealth service coverage– Health behaviorHealth behavior

Survey of Population ChangeSurvey of Population Change Disability surveyDisability survey Smoking and Alcohol surveySmoking and Alcohol survey Socio-economic surveySocio-economic survey

Health surveys (MoPH)Health surveys (MoPH) National Health Examination surveyNational Health Examination survey

– History of chronic diseases and injuriesHistory of chronic diseases and injuries– Health behavior : smoking, alcohol, exercise, foodHealth behavior : smoking, alcohol, exercise, food– Physical exam : weight/height, waist, BPPhysical exam : weight/height, waist, BP– Blood exam : Blood sugar, cholesterol, CBCBlood exam : Blood sugar, cholesterol, CBC– Health service (screening)Health service (screening)

Behavior Risk Factors Surveillance systemBehavior Risk Factors Surveillance system– Chronic diseases (Known case)Chronic diseases (Known case)– Health behaviorHealth behavior– Health service (screening)Health service (screening)

Special surveysSpecial surveys – Mental health, Oral health, NutritionMental health, Oral health, Nutrition– Sex behavior, Exercise, EPI coverageSex behavior, Exercise, EPI coverage

Disease surveillance systemDisease surveillance system

Integrated disease surveillance systemIntegrated disease surveillance system– 47 communicable diseases47 communicable diseases

– 11 environmental-occupational diseases11 environmental-occupational diseases

AIDS surveillance reporting systemAIDS surveillance reporting system– AIDS cases and OI cases (hospitals)AIDS cases and OI cases (hospitals)

HIV sentinel sero-surveillanceHIV sentinel sero-surveillance Injury surveillanceInjury surveillance

– Type of accident, severity, outcome (hospitals)Type of accident, severity, outcome (hospitals)

Routine reportsRoutine reports

Groups of diseases reportGroups of diseases report– OPD (21 ICD-10 groups) OPD (21 ICD-10 groups)

– IPD (75 ICD-10 groups)IPD (75 ICD-10 groups)

Service utilization reportService utilization report– OPD visit and admission by insuranceOPD visit and admission by insurance

Financial reportFinancial report Causes of injury reportCauses of injury report

Databases for reimbursementDatabases for reimbursement

In-patient data (DRG-based)In-patient data (DRG-based)– For 3 schemes (UCS, CSMBS, SSS)For 3 schemes (UCS, CSMBS, SSS)

Out-patient data (Point system)Out-patient data (Point system)– OP individualOP individual

– PP servicePP service

Specific health service (Case-based)Specific health service (Case-based)– ART for HIV/AIDS (NAP databases)ART for HIV/AIDS (NAP databases)

– CA.cervix screening databasesCA.cervix screening databases

– Etc.Etc.

Electronic patient recordsElectronic patient records

Standard dataset for hospitals (OPD, IPD)Standard dataset for hospitals (OPD, IPD)– IPD records for reimbursement from insurance schemeIPD records for reimbursement from insurance scheme

– ICD-10 for diagnosis and ICD-9-CM for proceduresICD-10 for diagnosis and ICD-9-CM for procedures

– DRG calculation for reimbursementDRG calculation for reimbursement

– Additional dataset for each insurance schemeAdditional dataset for each insurance scheme

– Data use for morbidity and service utilization pattern Data use for morbidity and service utilization pattern

Database at Hospital•Outpatient data•Inpatient data•Diagnosis (ICD10,DRG)•Procedure•Cost of service

Standard 1243 files

Primary care health informationPrimary care health information

Standard dataset for health centers and PCUsStandard dataset for health centers and PCUs– Electronic data entry for catchment populationElectronic data entry for catchment population

– Health service provision at facilitiesHealth service provision at facilities

– Coverage of prevention, promotion activitiesCoverage of prevention, promotion activities

– Chronic disease managementChronic disease management

– Community healthCommunity health

Database at Health center & PCU•Population data, Insurance•Death, Chronic disease, Accident•Service, Diagnosis, Surveillance•Treatment, Cost•EPI, Nutrition, FP, MCH, ANC ,NCD, Dental, Disability, Community

Standard 2143 files

Integrated standard datasetIntegrated standard dataset1.Person2.Address3.Death4.Card5.Drugallergy

6.Home

7.Service8.Appointment9.Accident10.Diagnosis_OPD11.Drug_OPD12.Procedure_OPD13.Charge_OPD14.Admission15.Diagnosis_IPD16.Drug_IPD17.Procedure_IPD18.Charge_IPD

19.Surveillance20.Women21.FP22.EPI23.Nutrition24.Prenatal25.ANC26.Labor27.Postnatal28.Newborn29.Newborn_care30.Dental31.SpecialPP

32.NCDscreen33.Chronic34.ChronicFU35.LabFU

36.Community_service

37.Disability38.ICF39.Functional40.Rehabilitation

PeoplePatient

Service

OPD

IPD

House

P&P NCD

Community service

Disability &Rehab

41.Village42.Community_activity43.Provider

CommunityProvider

NCD datasetNCD dataset

NCDscreen-Hospital code-Personal ID-Date of service-Smoking/Alcohol-Family history-Weight/height-Waist circumference-Blood pressure-Blood sugar

Chronic-Hospital code-Personal ID-Date of diagnosis-Diagnosis (ICD-10)-Discharge date-Current status

ChronicFU-Hospital code-Personal ID-Date of visit-Weight/height-Waist circumference-Blood pressure-Complication examination

LabFU-Hospital code-Personal ID-Date of investigation-Lab investigation-Lab result

ScreeningScreening RegistrationRegistration

History of visitHistory of visit

Data center at Provincial levelData center at Provincial level

Health centerHealth centerHospitalHospital

OPDOPDIPDIPD

PCUPCU

PHOPHO

MoPHMoPHNHSONHSO

Data centerData center

DHODHO

Matrix of HISMatrix of HIS

MortalityMortality

MorbidityMorbidity

Health serviceHealth service

DeterminantDeterminant

Health careHealth careCost & expend.Cost & expend.

Vital Vital RegistrationRegistration

RoutineRoutineReportReport

PatientPatientRecordsRecords

DiseaseDiseaseSurveillanceSurveillance

HH.HH.SurveySurvey

FacilityFacilitydatadata

Health resourceHealth resource

MortalityMortality

Death RegistrationDeath Registration

Survey of population changeSurvey of population change

Verbal autopsyVerbal autopsy

Under-registrationUnder-registration

Invalid causes of deathInvalid causes of death

Completeness in 2006 = 98%Completeness in 2006 = 98%IMR around 2 times differenceIMR around 2 times difference

Corresponding causes of death = 25%Corresponding causes of death = 25%

Intercensal survey by NSOIntercensal survey by NSO

15 provinces 1998-9915 provinces 1998-99

MortalityMortality

Causes of death (death registration)Causes of death (death registration)

35% Inside hospital35% Inside hospital

65% Outside hospital65% Outside hospital

Diagnosis improvementDiagnosis improvement

Diagnosis by doctor (interview, medical record)Diagnosis by doctor (interview, medical record)

ICD10 trainingICD10 training

17 provinces 200017 provinces 2000

Reduction of death from heart diseaseReduction of death from heart disease

Reduction of ill-defined causesReduction of ill-defined causesfrom 48% to 28%from 48% to 28%

Improving in-hospital COD dataImproving in-hospital COD data

Training for medical doctorsTraining for medical doctors to define to define actual COD in medical death certificateactual COD in medical death certificate– Reduce mode of death, un-specified causes, Reduce mode of death, un-specified causes,

injury codeinjury code– Reduce misclassification, wrong selectionReduce misclassification, wrong selection

Medical records and coding auditMedical records and coding audit for better for better quality of diagnosis of diseases and causes quality of diagnosis of diseases and causes of death (MoPH, NHSO)of death (MoPH, NHSO)

Improving in-hospital COD dataImproving in-hospital COD data

Using medical death certificateUsing medical death certificate for more for more information on COD (a, b, c, d) through information on COD (a, b, c, d) through web-based data entry from hospitals web-based data entry from hospitals (managed by MoPH) (managed by MoPH)

Using electronic in-patient records for Using electronic in-patient records for defining CODdefining COD– Principal diagnosis, co-morbidity, complicationPrincipal diagnosis, co-morbidity, complication

Improving non-hospital COD dataImproving non-hospital COD data

RelativesRelatives

Health center personnelHealth center personnelProviding COD using VA toolProviding COD using VA tool

+ medical history+ medical history

Registrar officeRegistrar office

Village headVillage head(Death notification form)(Death notification form)

RelativesRelatives

Health center personnelHealth center personnelInvestigating COD Investigating COD

using VA toolusing VA tool+ medical history+ medical history

Registrar officeRegistrar office

Village headVillage head(Death notification form(Death notification form

With COD)With COD)

MOIMOI MoPHMoPH

ProvinceProvince

DatabasesDatabasesWith ICD-10With ICD-10

DatabasesDatabasesWith ICD-10With ICD-10

DatabasesDatabases

ProspectiveProspective RetrospectiveRetrospective

18 provinces

MorbidityMorbidity

Intra-hospital morbidityIntra-hospital morbidity

Hospital patient recordsHospital patient records

Disease surveillanceDisease surveillance

All diseasesAll diseases

Priority diseasesPriority diseases

Around 70 diseases involvedAround 70 diseases involvedSeparate for HIV, AccidentSeparate for HIV, Accident

Standard databases (12,18Standard databases (12,1843 files)43 files)Reimbursement databasesReimbursement databases

Integrated disease surveillanceIntegrated disease surveillance

Routine reportRoutine reportAggregated data (groups of dis.)Aggregated data (groups of dis.)

Disease registrationDisease registrationChronic diseasesChronic diseases

Cancer registrationCancer registration

MorbidityMorbidity

Population-based morbidityPopulation-based morbidity

National Health Exam surveyNational Health Exam survey

Overall illnessOverall illness

Priority diseasesPriority diseases

Self reported illness (OP,IP)Self reported illness (OP,IP)Choices, Spending, Compliance, Risk,Choices, Spending, Compliance, Risk,Wealth dataWealth data

MoPH, HSRI every 5 yearsMoPH, HSRI every 5 years

Health & Welfare surveyHealth & Welfare surveyNSO every 5 years NSO every 5 years 2 years 2 years

Chronic disease history, Risk,Chronic disease history, Risk,Physical exam, Blood examPhysical exam, Blood exam

Health serviceHealth service

Health serviceHealth serviceRoutine reportRoutine report

Hospital levelHospital level Standard databases (12Standard databases (1243 files)43 files)

Aggregated dataAggregated data

Hospital patient recordsHospital patient records

Routine reportRoutine reportPrimary care levelPrimary care level

Standard databases (18Standard databases (1843 files)43 files)

Aggregated dataAggregated data

Primary care population andPrimary care population andpatient recordspatient records

Health resourcesHealth resources

Health care resourcessurvey

Health facilites & resources surveyAnnual health resources survey

Personnel management systemadmin data

Asset management system

Health expenditureHealth expenditure

Health expenditureHealth expenditure

Household expenditureHousehold expenditure

SES, HWSSES, HWS

Hospital expenditureHospital expenditure

National health expenditureNational health expenditure

Routine reportRoutine report

National health account National health account

DeterminantsDeterminants

Health behaviorHealth behaviorSpecific behavior surveySpecific behavior survey

SurveySurvey Major risk factors, province-basedMajor risk factors, province-based

HIV, special groupsHIV, special groups

Integrated behavior surveyIntegrated behavior survey

HH.economicHH.economicHH.surveyHH.survey SES, by NSOSES, by NSO

Socio-economicSocio-economic

SituationSituation

Vital registrationVital registration coveragecoverage ill-defined cause ill-defined cause

Routine reportRoutine report regularityregularity no private sector no private sector reliability of datareliability of data

Disease Disease regularity, timelinessregularity, timeliness private sector private sectorsurveillance &surveillance & reliability of datareliability of data coverage coverageElectronic patient dataElectronic patient data

HH.surveyHH.survey community-basedcommunity-based sub-national sub-national representativerepresentative overlapsoverlaps

Good aspectGood aspect Poor aspectPoor aspect

Existing problemsExisting problems

• Invalidity of dataInvalidity of data• Incompleteness of dataIncompleteness of data• Lack of data from private sectorLack of data from private sector• Overload and overlap of data collectionOverload and overlap of data collection• Overlapping between various surveysOverlapping between various surveys• Few utilization of information at local levelFew utilization of information at local level• Lack of data linkage between data sourcesLack of data linkage between data sources

Potential worksPotential works

• Defining health indicatorsDefining health indicators• Defining standard dataset and codingDefining standard dataset and coding• Strengthening capacity of local health information Strengthening capacity of local health information system management through datacentersystem management through datacenter• Promoting local and national data analysesPromoting local and national data analyses

Use of individual patient dataUse of individual patient data

Hospital levelHospital levelHospital levelHospital level

Upper levelUpper levelUpper levelUpper level

ReimbursementReimbursement

Service output monitoringService output monitoring

Health outcome monitoringHealth outcome monitoring

Service transactionService transaction

Quality of care monitoringQuality of care monitoring

Case managementCase management

Health system monitoringHealth system monitoring

Coverage of service improvementCoverage of service improvement

Knowledge generationKnowledge generation

Primary usePrimary use

Secondary useSecondary use

Patient data exchange & referral Patient data exchange & referral

Benefit of individual patient dataBenefit of individual patient data Improve efficiency of serviceImprove efficiency of service Easy to search and display historyEasy to search and display history Easy to select patients by conditionEasy to select patients by condition Easy to analyzeEasy to analyze Reduce workload of analysisReduce workload of analysis Easy to check quality of dataEasy to check quality of data Able to analyze at all levelsAble to analyze at all levels Support data exchange between hospitalsSupport data exchange between hospitals

Data for reimbursementData for reimbursement

Payment methodPayment methodPayment methodPayment method

Fee for serviceFee for service Fee scheduleFee schedule Case-basedCase-based CapitationCapitationPer visitPer visit

IndividualIndividual IndividualIndividual IndividualIndividual IndividualIndividual IndividualIndividual

SummarySummary SummarySummary SummarySummary SummarySummary

Utilization-Utilization-adjustedadjusted

-Diagnosis-Service-Charge

-Diagnosis-Service

-Diagnosis-Procedure

-Verifynumber of visits

-Verifynumber of visits

-Summary of case and charge

-Summary of Service provided

-Number of visits

-Number of visits

Data for monitoringData for monitoring

PeoplePatient

Funders

ProvidersUtilize & pay

Provide service

PayRegister& Inform

PayBenefit

Collective health care financing

-Guarantee access to care when needed-Aim at effective coverage of service-Concern quality of care-Focus on efficiency of health care system-Promote equity of health care system

AccessibilityAccessibility

PeoplePatient

Funders

ProvidersUtilize & pay

Benefit

-Seeking behavior-Compliance of insurance-Unmet need-Utilization rate-Continuity of care-Bypassing pattern-Cross-boundary pattern-Household expenditure-Out-of-pocket payment

-Coverage of insurance-Coverage of benefits-Choice of providers

Access to care

Individual patient data Household

surveyRegistration

QualityQuality

PeoplePatient

Funders

ProvidersProvide service

PayRegister& Inform

Quality of care

-Patient outcome-Severity-Complication-Case-fatality, Survival-Remission-Re-admission

-Continuity of care-Adverse events-Clinical practice quality-Waiting time-Satisfaction

-Resources of providers-Service availability-Quality assurance-Cost of service

Individual patient data Facility

dataQuality assurance data

EfficiencyEfficiency

PeoplePatient

Funders

ProvidersUtilize & pay

Provide service

PayRegister& Inform

Efficiency of system

-Seeking pattern by type of provider-Proportion of service by level

-Primary care vs Tertiary care-Provision pattern

-Admission pattern-Case-mix pattern-Treatment modality-Referral pattern-Resource utilization

-Type & level of providers-Cost of service

Individual patient data

Facilitydata

Household survey

EquityEquity

PeoplePatient

Funders

ProvidersUtilize & pay

Provide service

PayRegister& Inform

Equity of system

-Seeking pattern by class-Coverage of service by class-Utilization by group of patient-Outcome by group of patient

-Type and level of providers by area-Resources of provider by area-Cost of service by group of patient

-Population outcome-Improved health of population by class, group, area

Individual patient data

Household survey

FacilitydataHousehold survey

Thank you very muchThank you very much