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

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

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

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

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

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

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

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

9 Standard databases Database at Health center & PCU Population data, Insurance Death, Chronic disease, Service, Diagnosis, Surveillance Treatment, Cost EPI, Nutrition, FP, MCH, ANC Database at Hospital Outpatient data Inpatient data Diagnosis (ICD10,DRG) Procedure Cost of service Standard 18 files Standard 12 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 Censusregularity, coveragetimeliness Vital registrationcoverageill-defined cause Routine reportregularityprivate sector coverage reliability Disease regularity, timelinessprivate sector surveillance coverage HH.surveycommunity-basedsub-national representative overlaps Good aspectPoor aspect

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