1. Standardization of Thailand healthcare codes Wansa Paoin MD.

2. Common agreement on • 1. Health data definition or terminology • 2. Classification and codes • 3. Dataset and database • 4. Data interchange protocol

3. Medical Informatics Standards 1. ACR-NEMA standard for Digital Imaging and Communications in Medicine (DICOM) 2. American Society for Testing and Materials (ASTM) Healthcare Informatics Standards 3. CEN CT251 Healthcare Informatics 4. CDISC Operational Data Model (ODM) 5. Electronic Common Technical Documents (eTCD) 6. Health Information Disclosure, Description and Evaluation Language (HIDDEL) 7. Health Level Seven (HL7) 8. Home Health Care Classification (HHCC) 9. IEEE Healthcare Standards 10. IFCC Online-English-Spanish Dictionary of Laboratory Terms 11. International Classification of Diseases (ICD-10) 12. ISO 5218 Information Interchange – Representation of Human Sexes 13. ISO TC215 : Health Informatics 14. International Union of Pure and Applied Chemistry (IUPAC) Recommendations 15. Medical Subject Headings (MeSH) 16. Multilingual glossary of popular technical and medical terms in nine European languages 17. Unified Medial Language System (UMLS) Source : Information Society Technologies, Information Society DG, European Commission

4. Problems with standards • Few standards are worldwide accept • ICD-10 • DICOM • HL-7 • Most of standards are regional or country level created -> unable to use for health data set interchange

5. DIAGNOSIS CODING SYSTEM • ICD-10 OR ICD-10 with Modification • ICD-10-CM USA 2001 • ICD-10-AM Australia 1998 • ICD-10-CA Canada 2000 • ICD-10-TM Thailand 2003 • Additional/Optional System • SNOMED USA • READ CODES Britain

6. PROCEDURAL CODING SYSTEM • OPCS-4 BRITAIN 1963 • CPT USA 1966 • ICPM WHO 1978(Aborted 92) • ICD-9-CM USA 1985 • ICD-10-AM AUSTRALIA 1998 • HC-PCS USA 1998 • CCI CANADA 2000 • ICD-10-TM THAILAND 2003

7. RADIOLOGY CODE • CPT USA 1966 • ICPM WHO 1978(Aborted 92) • ICD-9-CM USA 1985 • ICD-10-AM AUSTRALIA 1998 • ICD-10-PCS USA 1998 • CCI CANADA 2000 • ICD-10-TM THAILAND 2003

8. LABORATORY CODE • CPT USA 1966 • ICPM WHO 1978(Aborted 92) • ICD-9-CM USA 1985 • ICD-10-PCS USA 1998 • LOINC USA 1999 • CCI CANADA 2000 • ICD-10-TM THAILAND 2003

9. PMR CODE • CPT USA 1966 • ICPM WHO 1978(Aborted 92) • ICD-9-CM USA 1985 • ICD-10-AM AUSTRALIA 1998 • ICD-10-PCS USA 1998 • CCI CANADA 2000 • ICD-10-TM THAILAND 2003

10. Dental Services Code • CDT USA 1970 • ICD-9-CM USA 1985 • ICD-10-AM AUSTRALIA 1998 • ICD-10-PCS USA 1998 • CCI CANADA 2000 • ICD-10-TM THAILAND 2003

11. DRUGS CODE • ASHP USA 1959 • BNF BRITAIN 1985 • IOWA USA ? 1990 • ATC WHO ? 1990

12. Problem of different codes • Unable to • Share the data • Communicate • Combine data to analysis • Do researches works Effectively

13. Standard code usage in Thailand, choices to be selected • 1. Adoption • With license fee – almost every codes • Without license fee – ICD-10 • 2. Self development • Researches • Sharing

14. ICD-10-AM+AR DRG license fee • Option 1 – Usage Fee(5 years contract) • Annual payment 108,000 US$ • Option 2 – Buy to modify • One payment 364,000 US$ • Free update for 4-5 years Source : Australian Department of Health and Aging

15. DEVELOPMENT METHODOLOGY • LITERATURE REVIEW • IDENTIFIED ACTIVE KEY PERSONS & DEVELOP WORKPLAN • BRAIN STORMING • ANALYSIS-1 • SYNTHESIS-1 • PUBLIC HEARING-1

16. DEVELOPMENT METHODOLOGY • ANALYSIS-2 • SYNTHESIS-2 • PUBLIC HEARING-2 • TESTING • SYNTHESIS MAINTENANCE MECHANISMS • CONCLUSION

17. CODING CENTERS IN THE WORLD • Country Coding Centers • Australia NCCH • Britain NHS • Canada CIHI • USA NCHS • Thailand THCC

18. Thailand health coding center • 1. Set common standard codes • 2. Maintenance of standard codes • 3. Training coders • 4. User support • 5. Research and development of new codes • Establish March 1, 2006 in MOPH

19. Conclusion • Standard health codes in the world rarely exist • However each country must select which code to use in the country health information system and establish coding center to support standardization