HIS in Thailand

1. HIS in Thailand Dr.Pinij Faramnuayphol Health information System Development Office , HSRI

2. Structure of Organization MIS MOPH Other Organization Departments Office of Permanent Secretary MIS Insurance Funders Provincial Health Office MIS MIS MIS Regional & General Hospital District Health Office District Hospital Health Center

3. Matrix of HIS Vital Registration Routine Report Patient Records Disease Surveillance HH. Survey Health Account Mortality Morbidity Health service Determinant Health care Cost & expend.

4. Mortality Death Registration Intercensal survey by NSO Under-registration Survey of population change Completeness in 1996 = 95% IMR around 4 times difference 15 provinces 1998-99 Invalid causes of death Verbal autopsy Corresponding causes of death = 25%

5. Mortality Causes of death (death registration) ICD10 training 30% Inside hospital Diagnosis improvement Reduction of death from heart disease 17 provinces 2000 Whole country June 2003 70% Outside hospital Diagnosis by doctor (interview, medical record) Reduction of ill-defined causes from 48% to 28%

6. Morbidity Intra-hospital morbidity Aggregated data (groups of dis.) Routine report All diseases Standard databases (12 files) Hospital patient records Integrated disease surveillance Priority diseases Disease surveillance Around 70 diseases involved Separate for HIV, Accident Chronic diseases Cancer registration Disease registration

7. Morbidity Population-based morbidity NSO every 5 years  2 years Overall illness Health & Welfare survey Self reported illness (OP,IP) Choices, Spending, Compliance, Risk, Wealth data MoPH, HSRI every 5 years Priority diseases National Health Exam survey Chronic disease history, Risk, Physical exam, Blood exam

8. Health service Aggregated data Health service Routine report Hospital level Standard databases (12 files) Hospital patient records Aggregated data Routine report Primary care level Standard databases (18 files) Primary care population and patient records

9. Standard databases • Database at Hospital • Outpatient data • Inpatient data • Diagnosis (ICD10,DRG) • Procedure • Cost of service Standard 12 files • Database at Health center & PCU • Population data, Insurance • Death, Chronic disease, • Service, Diagnosis, Surveillance • Treatment, Cost • EPI, Nutrition, FP, MCH, ANC Standard 18 files

10. Existing problems • Doctors disagree on providing causes of death • Few information from private providers • Few utilization of information at local level • Overlapping between various surveys • Lack of data linkage between data sources • Lack of SE characteristics in data

11. Situation Good aspect Poor aspect Census regularity, coverage timeliness Vital registration coverage ill-defined cause Routine report regularity private sector coverage reliability Disease regularity, timeliness private sector surveillance coverage HH.survey community-based sub-national representative overlaps

12. Potential works • Defining national health indicators • Defining standard minimum dataset • Mapping national health information system • Strengthening capacity of local health • information • Promoting provincial and national data • analyses