Volume I Issue 4 | July to Sept 2014
The official publication of the Asia eHealth Information Network
AeHIN learns from China’s Health IT investments Kunming, China - The Asia eHealth Information Network (AeHIN) with 25 delegates from 11 countries, joined the largest annual Health IT conference in China from July 23-25 to better understand major advances in eHealth and mHealth in the country that showcased state-ofthe-art innovations to improve health outcomes. Attended by over 2,500 eHealth experts and professionals all over China, AeHIN shared health informatics experiences and status of standards implementation and the AeHIN community of practice in the region. The first day was opened with lectures from government agencies, informatics associations, and national universities and hospitals on how eHealth improved patient care, public health, research, training, and instruction. Mark Landry of WHO and Dr. Alvin Marcelo, AeHIN chair, presented global and regional updates in eHealth and the national eHealth Capacity Roadmap which can guide countries to implement their national eHealth strategies and scale up their health ICT investments.
AeHIN also lead the first ever International Exchange Forum component of the China Health IT Conference on the second day where the AeHIN delegation discussed notable eHealth initiatives in member countries. Much of the topics were on: IT Governance, enterprise architecture, and capacity building for eHealth in support of national eHealth development. Government officers from various ministries of health comprising the AeHIN delegation, also reported country eHealth progress and mentioned the role of policy to move things forward.
AeHIN Delegates to the China Health IT Conference
In the afternoon of the second day, a site visit was held at the 5000-bed Kunming Hospital where around 11,000 doctors were trained in using computerized systems, tablets, and use of the latest health technologies. Among innovations featured in the visit are: RFIDs used for newborn and patient IDs, eBanking system for hospital payments, sky train for laboratory test samples, patient tracking system, and mobile devices used for bedside patient care. Continued on page 4
Telemedicine to connect rural Nepalese to health care
Central Coordination Desk at Patan Hospital
Nepal’s Rural Telemedicine Program is connecting Nepalese peoples living in hilly and mountainous region to health care facilities in the urban areas. The program, initially started in 2011, is helping to address prevalence of acute and chronic diseases in the country’s provinces and has also supported to provide specialized healthcare service to the rural peoples. Ultimately the program has supported to reach the unreached peoples. Beginning second quarter of 2014, the program reached 30 out of 75 districts in Nepal. Among technologies used are email teleconsults (Store and forward method), video- conferencing, and telephone-based consultation.
The Hexagon in AeHIN symbolizes “‘interoperability of systems” and when viewed in the context of the organization, it means “working together”. Though the hexagons are differently colored and sometimes overlapping, they still fit together. In AeHIN, like The Hexagons, there are many components to arrive at solutions in many eHealth problems in various countries in Asia. When AeHIN members work together, in every way, problems are solved and capacities are enriched.
Health workers in district hospitals send email consults to Medical Officers at the Central Coordination Desk at Patan Hospital, a tertiary hospital to seek clinical advice from specialists. Video conferences were also encouraged to link doctors for real time advice from medical specialists. According to doctors, video conference is “most effective” form of telemedicine consultation. However, slow internet connection and inadequate infrastructure to support video conferences were reported as hurdles. Telephone consultation component of the program, dubbed as “Hello-Health”, is serving about 300 callers 24-hours a day, seven days a week with consultations mostly related to general medication consultation, counseling and consultation related with sexually transmitted diseases. Continued on page 4
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Korea helps Sri Lanka Install a Hospital Health Information System W
Nursing officer doing electronic registration process
Doctors at OPD doing electronic consultation using HHIMS
Printed and laminated barcode generated at registration desk after electronic registration
Pharmacists doing electronic dispensing at OPD Pharmacy
Electronic consultation at OMF
hat almost seems to be pitfall for a government initiative became a springboard of partnership when the Sri Lankan Ministry of Health join hands with a Korean foundation for the phase two of a government led hospital health information system (HHIS). The HHIS is a web-based opened source electronic health information system for the Base Hospital Avissawella Sri Lanka and other Sri Lankan hospitals. The project, divided in three phases, was initially funded by the Sri Lanka Information and Communication Technology (ICTA). Phase 1 of the project included construction of a fiber optic network covering two-thirds of the hospital departments with the wards and emergency care unit. Hardware such as modern rack mounting main and backup servers , 24 laptops, and 20 desktops were also procured during the said phase. However, “after the finishing of phase 1, we couldn’t start EMR (electronic medical record) due to non-completion of phase 2.” reported Dr. Pradeep Keerthimallawa who is on lead of the HHIS project. “By that time hospital development committee asked help from the Korean Foundation of International Health Care(KOFIH)”. KOFIH is an organization that promotes international health cooperation. With a grant of 85,000 USD, KOFIH did not only provide equipment but also empowered the Sri Lankan team leading the HHIS project. They partnered with the South Korea Inje University to give enroll the HIIS project lead for a 3-month training on network and health information system management among other Sri Lankans also equipped to customize the software. With these, phase 2 of the project is started and HHIS was started in the hospital’s out-patient department. Electronic registration, consultations, and drug dispensing was initiated. Patient information were stored in a barcode being used by patients on next consultations. “There are so many advantage of this system and it is very efficient and almost error free,” said Dr. Keerthimallawa. “Our OPD daily patient averages to 1,000 consultations but due to the new system, we have exceeded 50,000 electronic patient registered in the database in a span of 7 months”, he furthered. Dr. Keerthimallawa said they are planning to implement the HHIMS at emergency department once the modules of the system have been customized. KOFIH and Inje University continuously support the project making it a sustainable system for Sri Lankans.
Mapping of Pakistan eHealth projects launched Seeing the potential of eHealth to address inequities in health system and services, the Pakistan Ministry of Health and the World Health Organization (WHO) launched complete profiling of best practices among eHealth applications that could be applied for improving health care in the country. The profiling revealed that there were some replicable models of eHealth projects operating in the country. However, they are working in silos and mostly spearheaded by the private than the government sector. This was said could be attributed to the lack
of a central coordinating unit on eHealth Programs in Pakistan. Dr. Syed Mursalin, HIS Coordinator in Islamabad, Pakistan, said there is a need to build capacity to health sciences training and continuing education courses online, such as eLearning programs. There is also a potential profit from the growth of mobile devices to offer innovative approaches for health care. Managing diverse clinical, administrative and financial information which are generated in hospitals and providing mechanisms for
diagnostics and treatment between health professionals across distance are among areas where eHealth operates in Pakistan. A total of eight national eHealth programs are reviewed. Dr. Mursalin said the study had certain limitations and suggested that approach may focus on major known initiatives and experiences in the future. Not only is the documentation of eHealth projects useful but its dissemination as well.
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FEATURE STORY
When a job you never plan strikes you How did AeHIN Co-Chair Dr Boonchai Kijsanayotin pursued his unplanned future
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e is a health informatician by an accident, a job he never planned, nor a destination he did not even think of. In 1992, while working in Srisangworn Sukhothai Hospital, a rural public hospital in Sukhothai Province in Thailand, Dr. Boonchai Kijsanayotin was given the task that transformed him - to set up a hospital information systems and telemedicine unit, one of the Thai Ministry of Public Health (MoPH) Telemedicine project. Though trained as an internist, he set his foot in designing an information network and a computerized medical record to improve the hospital’s administrative data repository system. After six years, while doing his accompanied research, he developed a telesonographic consultation services in the Ministry’s Telemedicine Network, which has 20 hospital-based stations nationwide. In 2004, he got an unexpected opportunity to get a PhD in Health Informatics in the United States at the University of Minnesota. Equipped with knowledge of this new discipline, he the realized that his country needs to work on many fronts to overcome healthcare challenges, thus transforming him into a full-fledged health informatician. Dr. Boonchai, now Asia eHealth Information Network’s co-chair, is among Thailand’s leading health informatics experts working for national and regional eHealth collaboration. He has been instrumental in developing national health data standards for interoperability in his country. Together with his colleague, Dr. Daorik Sinthuvanich, they reviewed drug terminologies from Europe, USA, Australia, Hong Kong and the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) to develop the Thai Medicine Terminology (TMT). Currently, TMT releases are provided twice a month which is available to download at Thai Health Information Standards Development Center (THIS) webpage. TMT is being implemented in all public hospitals in Thailand by the Civil Servant Medical Benefits Scheme. Dr. Boonchai was also involved in the implementation of Logical Observation Identifiers Names and Codes (LOINC), a unique identifier for Thai medicinal products, medical laboratory, and clinical observations in Thai health care service system. LOINC was a pilot project in six laboratory information systems in their country, and one among Thailand’s aggressive steps towards interoperability. His work expanded even more from ensuring data for decision making up to various evaluation studies. In 2013, he was asked to be contributor in a report evaluating Thailand’s civil registration system using WHO Rapid Assessment of National Civil Registration and Vital Statistics Systems tool. He also became a part of the Thai research team assessing how Thailand’s Universal Coverage Scheme performed in its first 10 years (2001-2010). Although he has been juggling roles as a researcher, mentor, academician, and a father, only a few knew that Dr. Boonchai Kijsanayotin still finds simple joys in his hobbies. Though his current job as research manager at the Thai Health Information Standards Development Center (THIS) involves tons of research, he still dedicates an amount of his time for regular long distance running, reading, watching movie, and travelling. “I don’t know how he maintains balance between his busy work and his personal life,” said one of Dr. Boonchai’s co-employees at the THIS. Besides an active lifestyle, people around, also see him as a “family man”. Dr. Boonchai, lives with his family in their happy home in Bangkok. On weekends, he takes his daughters out for a movie or a lunch date and spends time with great food and catching-up chats.
Dr Boonchai Kijsanayotin
At the Mahidol University where he teaches, students and employees describe him as “caring, considerate, dedicated, intelligent, kind, knowledgeable, supportive, and hard-working”. The list of positive traits goes on, but according to them, the most important of all these descriptions is that he has the innate ability to encourage anyone to become a health informatician. “I want to be just like him,” said one of his students while admiring his vision in healthcare standards development in Thailand. According to them, he wants his students to always read and understand the big picture in any situation. With his extraordinary capacity to inspire people, to motivate and realize their potential, he leads by believing that “everybody can learn”. “I think that he also makes an amazing workplace for us,” said Wanchana Pontongmak, a LOINC expert and research assistant at THIS. “He turns us into healthcare workforce who are contributing and making a Dr Boonchai with his wife and daughter difference in the country,” he added. While surrounded both by the young and the experts in health informatics, Dr. Boonchai still sees many unsolved problems in maximizing technology in health, most especially in making health Information exchange (HIE) seamless in Thailand. But to him, he recognized that health IT has tremendous potential to enable good quality for effective healthcare services and to save country healthcare expenditure. “I hope that there is a day in my life that patient information can be exchanged seamlessly from primary care to super tertiary care in my country and be effectively used by individual, providers, policy makers, researchers and all health stakeholders,” he said in high hopes that research efforts of today would seed the future of health informatics.
Dr. Boonchai and his students pose with Rama
Dr. Boonchai and his running mates on the “Human Run 2014” at Sanam Luang, August 31 of this year.
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Interoperability design guidelines released for personal connected health devices T
he International Telecommunications Union published July 2014, a set of design guidelines for personal connected health devices which was said to “stimulate innovation” on life saving devices such as wireless blood pressure cuffs, weight scales and a wide range of activity trackers. The standard - Recommendation ITU-T H.8101- contains the Continua Design Guidelines (CDG) which will enable global interoperability that will reduce cost of manufacturing of these health devices and will enable easier integration of electronic medical records for health information exchange (HIE). CDG was authored by Continua, a non-profit, open industry organization of healthcare and technology companies joining together in collaboration to improve the quality of personal healthcare. Read more at http://www.itu.int/pub/T-TUT
Dr. Jakir Hossain Bhuiyan Masud, AeHIN member in Bangladesh presented his poster on “Mobile Application: A Tool to Quit Smoking” at the Conference on Tobacco Control in Bangladesh held on August 12 at the National Heart Foundation Hospital & Research Institute, Bangladesh.
AeHIN learns from China’s Health IT investments Continued from page 1
The International Exchange Forum was organized by the China Center for Health Statistics and Information, National Health and Family Planning Commission, as part of their ongoing work as a World Health Organization Collaborating Center for Health Informatics and Information. New ideas for possible areas for collaboration with China through WHO and AeHIN were discussed including big data analytics, standards implementation, study tours and capacity building, and greater knowledge exchange.
Dr Polawat Witoolkollachit, Director, Information Technology and Communication Center during his presentation
Telemedicine to connect rural Nepalese to health care
Map of Nepal showing the districts with rural-telemedicine program
Dr. Khadzir Ahmad, AeHIN Working Council presents “Interoperability and Health Informatics Standards in Malaysia”
Continued from page 1
Ramesh Bhatta, eHealth expert in Nepal said there are many issues revolving in its implementation. “There is no clear government policy on telemedicine and eHealth programs in Nepal,” he explained, and “infrastructure do not support the technologies being used and there is no specific management team to manage the national telemedicine program,”. Reports said the telemedicine program also needs sustainable funding. But apart these, Mr Bhatta said that telemedicine in Nepal has a lot of potentials. mHealth is currently being explored as a costeffective measure for providing health education and information to the community peoples. Similarly in Nepal mhealth can also be used for health monitoring and surveillance. However to show the effectiveness of the program it is necessary to educate health workers on the used technology and also motivate them for their active involvement. Similarly government also needs to sensitize the community to increase community support and to encourage people to participate in the program.
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