1 NHSO Report by Nick Marly, September 2, 2015 Introduction 3 Health Insurance schemes: 75%: NHSO handles Claims for the Universal Care (UC) Health Insurance in Thailand 16%: Social Security Scheme for the employees from private companies (SSS) 7%: Civil Servant Medical Benefit Scheme (CSMBS) 2%: The remainders of population (2-3 mil.) are in State Enterprise scheme or local government administration scheme or private insurance scheme. (Thailand Development Research Institute, 2105) NHSO Responsibilities: Meetings Strategic Planning o Health Roadmap since 2010, ICT Strategy since 2000. Beneficiary Enrollment o At birth Health Service Provider Registration o Health care mainly through public hospitals (80 %). o Some private hospitals that can be registered in the reimbursed care. Fund Management (reimbursements) o Capitation and Case Mix / DRG (Diagnostic Related Group) Health Service Quality Control o Already 43 datasets that are used o MoPH: 12 datasets o High incidence of re-admission ; of certain diseases, conditions or complications ; of certain operations ; unacceptable infantile morbidity / mortality ; etc. Consumer Protection 27/07: Preparatory meeting 10/08: ICT@NHSO + (Thai Health Information Standards Development Center (THIS), Health Systems research Institute): standardization/terminology 11/08: NHSO + ICT
2 Feedback Challenges/Issues of the NHSO: NHSO is well equipped and well digitized, has a sound vision and has the capacity to manage 75% of the reimbursement claims in Thailand. Major challenging issues according to NHSO: o Governance structures o Lack of standardization and common terminology o Capacity building, people and infrastructure o Data privacy and security issues (CIA), legislation and enforcement (organization) Overall Governance is necessary to define and advocate common strategy and objectives, to create transparency and to create stakeholder involvement. Single claim handling for the 3 different schemes is desired by THIS. NHSO has the highest capability (established digitization, well defined operations, ) to execute this claim handling compared to the other two schemes, but this doesn t seem to be acceptable by the other schemes. Possibility: new organization (Healthcare Information Systems Standards & Processing Administration HISPA) staffed with NHSO people. Lot of small SW providers equipping hospitals with SW not facilitating standardization and integration. Belgium: well defined functional and non functional requirements which can be homologated. Requirement to define a strategy per hospital which should be aligned with common objectives (but timing can be adjusted base on means of the hospital). Still a lot of (delayed)batch processing due to network latency (2 weeks or more). o Is this really a problem for the claims handling (Belgium has a throughput time of some months between medical act and billing). Could cause financial problems (hospital financing) or fraud opportunities?
3 o Guess that for making available health care information in a distributed way, real-time and 24/7 operations will be necessary. New laws concerning protection of privacy and data security will be passed (or are already passed). This will have an impact on the security and privacy protection capabilitiesthat will have to be put into place. Medical/clinical/health care aspects are (for the moment) not separated from the claims handling. A discussion is ongoing how this should evolve. o Registration of medical information is still often on paper, unstructured (documents) not digitized, not easy to share. Need to be able the share and to have a definition of minimal structured datasets that should be available (administrative, surgery, nursing, clinical, pharmaceutical, lab tests, emergency/summary, psychiatric, ). Centralized or distributed or a combination of both, choice has to be made? o Need for a referential database (where is data available). o Need for registered patient consent and therapeutic relationship. o Need for record and structured dataset definitions/integration: Patient Health Record, Electronic Health Record, Multi-Disciplinary Health Record, etc. ; different datasets have to be defined and made available under a standardized way: Medical, Clinical, Pharmaceutical, Surgical, Administrative, Psychiatric, Lab, Emergency, o Initiatives are emerging: Saraphi, The Happy District uses an Application for Collecting online Health Data for Proactive Health home care application http://www.prcmu.cmu.ac.th/hotnews_detail_eng.php?perin_id=525 Increasing data registration for fraud detection, statistics, etc. but also for health related aspects such as quality of care, patient safety, etc. Number of registrations is increasing. Is there enough alignment between the different needs (MoPH, UC/NHSO, SSS and CSMBS, etc.) to avoid double registrations, alignment between the schemes, only once registration, etc. Administration Centric versus Patient/Citizen Centric care is an important choice to make with its strategic and operational impact.. Todo s for Nick Marly: For Ministry of Public Health (Thai) o Laws Crossroad Bank o 12 datasets, which are the Belgian datasets? o Hospital Information System functionalities (document Ministry of Public Health Belgium) For NHSO o Currently 43 Datasets, which are the Belgian datasets? o Secure transactions of claim based info, tools for encryption. o DONE: Hospital Information System functionalities (document Ministry of Public Health Belgium) o GP information system
4 Appendix EHealth objectives Source: paper ehealth in Thailand: the current status 1) Store, process and transmit patient information 2) Manage the diverse clinical, administrative and financial information generated in health services facilities 3) Improve quality of patient care and patient safety 4) Provide mechanisms for diagnostics and treatment (information exchange) between health professionals separated by distance 5) Build capacity by offering health sciences training and continuing education courses online to students and health professionals 6) Offer innovative approaches for health care using rapid growing mobile devices 7) Make highly complex biomedical research achievable. References ehealth-platform: state of affairs and perspectives ; March 27 2015 ; Frank Robben ; http://www.frankrobben.be/wp-content/uploads/2015/03/20150327.pptx Framework for an Electronic Patient Record Functionalities ; April 29 2014 ; Workgroup Action 2- Ehealth Roadmap MoPH Belgium http://www.health.belgium.be/internet2prd/groups/public/@public/@dg1/@acutecare/documents/ie2 divers/19095623.pdf People 1. Netnapis Suchonwanich netnapis.s@nhso.go.th NHSO Deputy Secretary- General 2. Weerawat Phancrut, weerawat.p@nhso.go.th NHSO Deputy Secretary- General 3. Yolsilp Suchonwanich3. yolsilp.s@nhso.go.th NHSO Assistant Secretary-General, former ICT Director NHSO ICT Director 4. Sinchai sinchai.t@nhso.go.th Tawwuttanakidgul 5. Sayris Pibul sayris.p@nhso.go.th NHSO, Assistant Director of ICT department 6. Pianghatai Ingun pianghatai.i@nhso.go.th NHSO Bureau of
5 (Piang) International Universal Health Coverage 7. Boonchai Kijsanayotin boonchai@hsri.or.th, Thai Health Information kijs0001@gmail.com Standards development center (THIS), Health System Research Institute (HSRI) 8. Yongyuth Pongsupap yongyuth.p@nhso.go.th NHSO expert senior Individual records in NHSO (OP/OutPatient, IP/InPatient data) Source: NHSO Presentation Currently there are 43 registrations defined? Which ones, their purpose and proportionality cloud be interesting. Disease Management 1. Leukemia 2. Lymphoma 3. Hemophilia 4. Heart surgery 5. Epilepsy 6. Cataract 7. Cleft palate 8. HIV 9. Diabetes Mellitus, hypertension & dyslipidemia 10. TB 11. Stroke Prevention & Promotion 1. Screening for metabolic syndromes (sss, csmbs) 2. Screening for stroke 3. Thalassemia 4. Vaccine 5. Thyroid 6. Screening for CA cervix 7. Disabilities 8. Sealant (related to dental care?) 9. Denture in elderly disease management Emergency care 1. Pre-hospital care (EMS)
2. Trauma 3. Poisoning 4. Stroke 6