376 MEDINFO 2010

C. Safran et al. (Eds.)

IOS Press, 2010
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doi:10.3233/978-1-60750-588-4-376

eHealth in Thailand: The current status

Boonchai Kijsanayotina, Narong Kasitipraditha, Supasit Pannarunothaib
a
Bureau of Health Policy and Strategy, Ministry of Public Health, Nonthaburi, Thailand
b
Faculty of Medicine, Naresuan University, Phitsanulok, Thailand

Abstract Thailand is one of the countries that have achieved an elevated

level of access to and use of ICTs and ICT skills (rank at the
The World Health Organization (WHO) defines eHealth as the upper group countries by ICT Development Index -IDI)[3].
use of information and communication technologies (ICT) for +RZHYHU WKH VWDWXV RI H+HDOWK KDVQ¶W EHHQ HYDOXDWHG LQ
health. Thailand is one of the leading countries in emerging and Thailand. This study was conducted in the collaboration
developing economy that the use of ICT applications is EHWZHHQ 7KDLODQG¶V 0LQLVWU\ RI 3XEOLF +HDlth and the WHO
pervasive including eHealth. However, the status of eHealth in 7KDLODQG WR DQDO\]H 7KDLODQG¶V H+HDOWK FXUUHQW VLWXDWLRQ DQG
7KDLODQG KDVQ¶W EHHQ DVVHVVHG (PSOR\LQJ WKH :+2 *OREDO LGHQWLI\ WKH FRXQWU\¶V H+HDOWK GHYHORSPHQW JDSV 7KH SURMHFW
Observatory for eHealth development model and its instrument, aims not only to help Thailand assess her current status on
this study describes the uptake of eHealth foundations and the practices, policies, standards, and the implementation of eHealth
extent of eHealth applications and services implemented in the but also to contribute to the Global Observatory for eHealth
country. A group of the nation 18 eHealth experts met and second survey[4]. Moreover, the gaps identified from the survey
evaluated country eHealth status and provided will help health policy-makers at the ministerial level to plan for
recommendations. The results show that the development of the LPSURYLQJWKHQDWLRQ¶VH+HDOWK
FRXQWU\¶VeHealth foundations is inadequate and need to be the
priority for national eHealth development.
Methods
Keywords: eHealth, Thailand, Evaluation study
This study employed the WHO Global Observatory for
H+HDOWK¶V *2H  GHYHORSPHQW PRGHO DQG LWV VHFRQG VXUYH\
Introduction LQVWUXPHQW  7KH *2H¶V TXHVWLRQQDLUH ZDV GHVLJQHG WR LGHQWLI\
and analyze trends in 1) the uptake of eHealth foundations and
The World Health Organization (WHO) identifies fully 2) the extent of eHealth applications and services implemented.
functional health information system as one of the six important The questionnaire consisted of close end questions and open end
building blocks of high performance health system[1]. To questions asking participants to describe eHealth activities and
XQGHUVWDQGDFRXQWU\¶VKHDOWKLQIRUPDWLRQV\VWHPLWLVHVVHQWLDO projects in the country, including comments which participants
to understand the extent of information and telecommunication considered relevant to the survey. We identified and invited 18
technology (ICT) use in her health system, because, in the world experts from both public and private sectors to participate in the
today, information systems and ICT are closely related and survey. They are experts in health systems, health information
amalgamated to be an almost inseparable entity. WHO broadly systems, and ICT from Ministry of Public Health, public and
defines eHealth as the use of ICT for health. eHealth has the private hospitals, National Health Security Office (the office of
potential to address inequities in health systems and services in FRXQWU\¶V XQLYHUVDO LQVXUDQFH VFKHPH   1DWLRQDO 6WDWLVWLFV
countries. Its applications span across a wide range of areas such Office, Ministry of Information and Communication
as the use of ICT to: 1) store, process and transmit patient Technology (MICT), International Telecommunication Union
information 2) manage the diverse clinical, administrative and (ITU), National Electronics and Computer Technology Center
financial information generated in health services facilities 3) (NECTEC), medical schools, universities, health informatics
improve quality of patient care and patient safety 4) provide professional association and health information non-government
mechanisms for diagnostics and treatment between health organizations (NGOs). These experts are working on various
professionals separated by distance 4) build capacity by offering aspects of eHealth activities in the country. All experts accepted
health sciences training and continuing education courses online the invitation. The questionnaires were sent to the experts three
to students and health professionals 5) offer innovative weeks before a full-day discussion and consensus meeting. We
approaches for health care using rapid growing mobile devices asked them to study the questionnaire and be prepared for the
6) make highly complex biomedical research achievable[2]. GLVFXVVLRQ WR JHW WKH FRXQWU\¶V FRQVHQVXV RQ H+HDOWK 7KH
 B. Kijsanayotin et al. / eHealth in Thailand: The Current Status 377

consensus and experts¶ UHFRPPHQGDWLRQV DUH FRPSLOHG WR with health provider(s) of their choice. Regarding online
represent current Thailand eHealth. pharmacies in Thailand, there is no legislation that either allows
or prohibits internet pharmacy operations and no mechanism
Results that regulates, accredits or certifies internet pharmacy sites.
Furthermore, the legislation that allows or prohibits internet
eHealth foundations SKDUPDF\ VDOHV SXUFKDVHG RQOLQH IURP RWKHU FRXQWULHV KDVQ¶W
EHHQ HQDFWHG LQ WKH FRXQWU\ ,Q VKRUW 7KDLODQG GRHVQ¶W KDYH
Since 2000, Thailand has a national ICT policy/strategy laws to keep up with the rapid changing online pharmacy
framework (IT 2010 framework) and two five years national business. In terms of children protection from online risk, Thai
ICT master plans[5][6]. The framework and plan has been government has sponsored websites or official initiatives to
implemented since 2002.The national ICT framework laid out e- provide appropriate information and education about internet
strategy for eGovernment, eEducation, eCommerce, eSociety, safety and literacy. These efforts aimed to protect general
eIndustry but not eHealth. As the results, the country has no population and children, in particular. However, there is no
national eHealth governing body that provides leadership and safety tools and security technologies required by law for
direction. Although there is no national eHealth policy/strategy, schools, libraries and other public places with internet facilities
many eHealth applications and services has been developed, used by children.
piloted and implemented. Major funding of the projects comes
from public sector, the government. A few eHealth projects Table 1-Summary of eHealth uptake in Thailand
have been supported by public-private partnerships and health
information NGOs. Even though, there are few public-private
eHealth Development Uptake
partnerships, the partnership between the Thai Medical
Informatics Association (TMI), MOPH, public universities and I. Foundation Policies & Strategies
NECTEC to organize annual health information and health 1. National eGovernment policy & strategy ¥ICT2010
information technology conference has been carried on almost 2. National eHealth policy & strategy X
two decades.[Table 1] 3. National eHealth governance body X
3. Funding + Public,
For eHealth capacity building, the human resources skills and No Private
knowledge, ICT skill and knowledge training courses have been 4. Public & Private partnership +
offered for students of health sciences in more than 75% of 5.Infrastructure ++
tertiary educational institutes in Thailand (public and private). II. Enabling Policies & Strategies
There are also institutions/organizations, such as MOPH and 1. Health information security & privacy laws X
universities offer continuing education in ICT for health as part 2. Actions on Multilingualism & Multiculturalism X
of the ongoing training of health and allied health professionals. 3. Capacity building ++
Nevertheless, the short term training courses and degree training 3.1. IT courses for health science students +++
courses in biomedical/health informatics has not been instituted. 3.2. IT courses for health professional +
4. National health IT standards (Interoperability) +
Although Thailand has enacted a legislation to ensure privacy of 4.1.Core data set standards 12 & 18 files
personally identifiable data of individuals irrespective of standards
ZKHWKHU LW LV LQ DQDORJ RU GLJLWDO IRUPDW WKH FRXQWU\ GRHVQ¶W 4.2.Semantic standards ICD 10 TM,
have a specific legislation to protect privacy of individuals' ICD 9 CM
4.3.Syntactic standards X
health-UHODWHGGDWDKHOGLQGLJLWL]HGIRUPDW7KHFRXQWU\GRHVQ¶W
4.4.Security and privacy standards X
have legislation which provides for the sharing of health-related
data between health care staffs through an Electronic Medical III. eHealth Applications
Records/ Electronic Health Records (EMR/EHR) at all level of 1. mHealth ++,
health care services. It means that there is no legislation about mostly pilot
the data sharing 1) within the same health care entity and its 2. Telemedicine +, pilot
3. eLearning in health sciences +
associated network of care providers, 2) with different health
4. EHR/EMR (Health Information Exchange) ++
care entities 3) with health care entities in other countries. 4.1 For administration, claims +++
Moreover, the country has no 1) legislation which grants the 4.2 For clinical care +
right of access by individuals of their health-related data when
held in an EMR/EHR 2) legislation which allows individuals to Note: ¥ $GRSWHG; 1RXSWDNH -25% uptake, ++ = 26-50%
demand the deletion of personal data and/or health-related data uptake, +++ = 51-75% uptake, ++++ = 76-100% uptake, ICT 2010 =
Thailand ICT development frame work 2000-2010, ICD 10 TM =
from their EMR/EHR 3) legislation which allows for the International Classification of Disease version 10 Thai Modification,
transmission and sharing of research data containing personal ICD 9 CM = ICD9 Clinical Modification procedure codes.
and health-related data between research entities in different
countries and 4) legislation about the legal right to specify
which health-related data from their EMR/EHR can be shared
378 B. Kijsanayotin et al. / eHealth in Thailand: The Current Status

Regarding Multilingualism and multiculturalism in eHealth, the scientific institution involved in the development of
country has no national policy or strategy that promotes the telemedicine solutions in the country. In the past decade there
production of electronic health information in a manner that is were many telemedicine projects and activities. Many of them
multiculturally sensitive. Although at the three southern most were short term demonstration projects which were the works
provinces of Thailand there is a large number of Thai Muslims. EHWZHHQ LQWHUQDWLRQDO DJHQFLHV DQG 7KDL¶V XQLYHUVities or big
Their dialect, religion and culture are differences from the private hospitals [8-10]. There was only one national
traditions and language of the majority Thais. The experts agree telemedicine project implemented by the MOPH during 1998-
that this issue should not be ignored and identified this issue as 2003, callHG 023+µV WHOHPHGLFLQH QHWZRUN>@ This big
one of the national eHealth priorities. project aimed to deliver medical care to people in remote rural
areas where there were the shortage of doctors and other
At the national level, ICD10-TM (International Classification of
professionals. However, the project was not very successful and
Diseases version 10-Thai Modification) and ICD9-CM (Clinical
was abandoned in 2003. There were many factors contributing
Modification) are used for coding diagnosis and health service
to the ending of the project, for instance, no national body to
intervention respectively. Thailand has developed and
continuously provide national telemedicine policy and strategy,
implemented citizen identification number for more than two
the lack of requisite IT skills among health professionals, the
decades by the Ministry of Interior. Every Thai citizen has a
FRXQWU\¶VHFRQRPLFFULVLVWKHUDSLGFKDQJHVLQWHFKQRORJ\DQG
XQLTXHLGHQWLILFDWLRQQXPEHUNQRZQDV³GLJLWVQXPEHU´,W
the rapid social and political changes taking place in Thailand.
is also used as patient identifier. There are two national health
Currently, there are private teleradiology services which provide
minimal data set standards which are developed for
services largely for big private hospitals in big cities. Several
administrative purpose. They are 1) standard data sets for health
public telemedicine pilot projects are being piloted such as the
LQVXUDQFHNQRZQDVWKH³-ILOHGDWDVHW´DQG VWDQGDUGVGDWD
teledermatology consultations which run by Institute of
VHW IRU KHDOWK FHQWHU NQRZQ DV WKH ³-ILOH GDWD VHW´[7] They
Dermatology, MOPH.
are used mainly for health insurance payment and healthcare
activities reports. National drug code, national health provider mHealth is an emerging term for medical and public health
identifier, medical device coding standards, survey metadata practice supported by mobile devices, such as mobile phones,
standards, indicators standards are at various stages of patient monitoring devices, Personal Digital Assistants (PDAs),
development. HL7 messaging and LOINC standards (Logical and other wireless devices. mHealth applications include the use
Observational Identifiers Names and Codes - a laboratory of mobile devices in collecting community and clinical health
coding standards) are implemented in a few large hospitals. data, delivery of healthcare information to practitioners,
They are not the national standards. DICOM (Digital Imaging researchers, and patients, real-time monitoring of patient vital
and Communication in Medicine), a standard for handling, signs, and direct provision of care. In Thailand, several mHealth
storing, printing, and transmitting information in medical initiatives are being piloted and implemented. The cross-border
imaging, is used in many health facilities in the country usually Mekong Basin Disease Surveillance System is an example of a
where PACS (Picture Archiving and Communication Systems) piloted mHealth project which uses mobile devices for diseases
are implemented. However, it is not instituted as a national surveillance and management of emergency and disaster
standard. situations. The project uses GeoChat SMS groups
communication software developed by InSTEDD to report
eHealth applications and services
communicable diseases and emergency occurred in community
The mix of paper and computerized patient information in Mukdahan province (Thailand) and Suvanakhet (Laos). The
(individual data and aggregated data) are being used in public health personnel working in the sub-district level use
healthcare services. In public sector, almost all of hospitals SMS format to report cases in order to improve timeliness of
(1,001 hospitals) and health centers/primary care units (10,068 report and warning for potential disease outbreak and
PCUs) have implemented various degrees of capabilities of disaster.[12]
EMR/EHR. If we categorize individual patient information into
In Thailand, eLearning program has been used to teach health
administrative data (used for reimbursement, administration and
sciences students and the development of continuous health
reports) and clinical data (for patient care e.g. laboratory data,
professional training programs in many institutes. At the
SKDUPDF\ GDWD SURYLGHUV¶ QRWHV  WKHVH WZR GDWD W\SH DUH QRW
national level, the use of eLearning to teach health sciences
equally developed in Thailand. Administrative data are
students was estimated at medium level (more than 25% and
computerized and can be transmitted and exchanged
less than 50% of institutes and/or courses). But the level of use
electronically in nearly all health facilities in Thailand. The
for professional development programs in the ongoing training
clinical data are collected in both paper and computerized
of health professionals was estimated at low level (less than
format but the capability to exchange electronically is very
25%). Thailand Cyber University Project [13], operates by the
limited.[Table 1]
Commission of Higher Education, Ministry of Education,
7KDLODQGGRHVQ¶WKDYHDQDWLRQDOWHOHPHGLFLQHSROLF\RUVWUDWHJ\ provides supports to the eLearning programs development for
and also a national agency for the development and promotion students and non-students to teaching institutes in the country
of telemedicine and its applications. Furthermore, there is no
 B. Kijsanayotin et al. / eHealth in Thailand: The Current Status 379

including health sciences teaching institutes. A number of health The third layer, eHealth applications such as EMR/EHR,
sciences eLearning courses are available at its website. mHealth, telemedicine, are being implemented in Thailand, but
these services are fragmented and scattered. It is known that, the
Discussion and conclusions success of these applications is largely dependent on the actions
leading up to them, that is, services in this layer will be more
Among developing countries, evidences show that Thailand is effective if the actions in the first two layers have been executed
one of the leading countries that the use of ICT applications is well. Solid foundational layers lead to more effective eHealth
pervasive including eHealth [3, 14]. However, our study reveals systems and services. Unfortunately, Thailand is inadequately
that the country is lag behind in laying down the eHealth taking actions on developing these two layers.
foundations. The WHO GOe identifies three layers of eHealth 7KH FRXQWU\¶V H+HDOWK H[SHUWV UHFRPPHQGHG WKDt the country
development.[2] [Figure 1] The first layer, the foundation should put the development of eHealth foundations the priority.
policies and strategy, forms the basis of country eHealth The identified foundational gaps should be closed to enable the
development. This includes the creation of an appropriate development of sustainable and effective eHealth systems and
governing body²a multi-stakeholder, national-level, eHealth services. The recommendations are 1) Thailand should create a
authority to provide leadership and direction, the development multi-stakeholder, national-level, eHealth governing authority to
or adoption of eHealth policy to define the vision and action provide leadership and direction, the development or adoption
required, the development of a funding framework to support of eHealth policy to define the vision and action required 2) the
the vision, and mechanisms to develop ICT infrastructure for the country new national ICT framework, ICT 2020, should
provision of eHealth services. Although Thailand has national e- incorporate eHealth strategy into the framework along with
strategy for various sectors, but the vision and strategy for eGovernment, eEducation, eIndustry,eSociety and eCommerce
H+HDOWK KDYHQ¶WEHHQODLGRXW7KLV PD\EHERWKWhe cause and 3) legislations related to health information security, privacy and
result of not having national eHealth governing body. confidentiality should be enacted to protect people 4) national
health information standards need to be developed to enable
eHealth services interoperability and health information
exchange and 5) systematic mechanism for capacity building of
people who design, implement, operate and use of the eHealth
systems has to be planned and implemented

Acknowledgements
The authors gratefully acknowledge all experts who participated
in this study. We thank Mrs Maliwan Yuenyongsuwan and her
staffs at the Bureau of Health Policy and Strategy, Ministry of
Public Health for their secretariat support. We express our
gratitude to Dr. Sombat Thanprasertsuk,WHO Thailand Country
Officer, and his staffs for their support. The funding source of
this project was from WHO Thailand, project activities proposal
Figure 1-The Global Observatory for eHealth Development number 080315.
model (modified)
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