Questions/Answers

“ThaiRefer” is a software program, using for emergency patient referral from a local hospital to a tertiary-care center. The developer got an idea to develop ThaiRefer from observing a flight information display system at Suvarnabhumi airport, in which a computer displays arrivals and departures flight information in real-time. Thus this system was applied to develop a referral software program. This program resolves problems occur among referral process and makes an early notification at the destination hospital to get ready to receive emergency patients. The ThaiRefer program was developed by collaboration between IT officers and emergency medical team. The ThaiRefer program has developed until it is stable and can be used effectively in Lampang. ThaiRefer has been supported by the Ministry of Public Health and has widely implemented across the country. Seamless health service network results in increasing equality of access to healthcare services. Patients receive quality, safety, and timely referral.

1.Increasing accessibility 2.Increasing safety, timely, and quality of the referral system 3.Providing effective referral system. 4.Decreasing mortality and morbidity during refer 5.Strengthening and sustaining healthcare system

ThaiRefer is the innovation of the information technology for referral system. This program was developed by the emergency medical team that faces problems occurring among referral process. By installing the program in a computer hardware in a hospital, a tablet, or a smartphone and connecting the program with the internet network, the program will link patients’ health records from the database of that hospital and gives the access right of the destination hospital to only view that patient’ s health records. When the referral is initiated, the information of a referred patient is sent to the hospital of destination. Then the destination hospital can prepare for the arrival of the patient. With the GPS that links with the program, the destination hospital can estimate the arrival time of the patient and can prepare for the arrival properly. For security process, password and security log system are used. After the Thai Refer program has been implemented, the mortality rate of transferred patients in Lampang decreased from 0.32% in 2010 to 0.06% in 2017.

ThaiRefer program was invented and developed by an emergency medical team, leaded by Thanin Lokeskrawee MD,PhD., and IT specialists, leaded by Teerin Ketvichit PhD. The program was started in the name of Lampang Refer Link V. The ThaiRefer project has been supported by Lampang hospitaland, Lampang provincial public health office. Patients’ health information that sends to Lampang hospital during referral process makes the referral process seamless and reduces the use of paper records. In addition, the feedback information of the patients from Lampang hospital to a community hospital which makes a referral gets a community hospital prepares for the continuity of care for that patient. Ministry of public health foresees the benefits of the program. The use of Lampang Refer Link is broadening and its name has been changed to ThaiRefer in July, 2012

ThaiRefer was developed by collaboration between emergency medical team and IT specialists. The concept of flight information display was applied to the ThaiRefer program for referring patients from 12 community hospitals to Lampang Hospital in order to get the staffs at the destination hospital readily equipped. The implementation of ThaiRefer was supported by the Executive Board of Lampang hospital and Lampang Provincial Public Health office to reduce the losses during patient referrals. With ThaiRefer, the death rate has been successfully reduced from 0.32% in 2010 to 0.06% in 2017. During these years, ThaiRefer was continuously developed to meet the users’ requirements. Eventually, it was received a patent and was handed over to the Ministry of Public Health to broaden the usage through the whole country.

As soon as a referral report from a community hospital is submitted, the emergency care staffs at Lampang hospital get notified. The information received at the destination includes the patient’s name and the arrival time. The referred patients will be sorted in ascending order of the estimated arrival time. Useful information of the referred patient such as medical treatment history, severity of Illness, and initial diagnostic assessments can be found on the Telemedicine display. This allows medical staffs at the destination and the origin to cooperate in planning the treatments prior to, during, and after the transfer. This process not only helps speeding up but also maintaining the continuity of the treatments. Accordingly, the resulted seamless referral system ensures customers with a higher rate of lifesaving, fulfils the needs of service providers, and reduces costs of patient referrals.

Since the high death rate during referrals had been a serious nationwide problem, Ministry of public health saw the importance of broadening the use of ThaiRefer outside of Lampang. Therefore, with the help of Lampang’s development team, the program was extensively installed in 8 neighbour provinces in the North of Thailand in 2012, 14 provinces in the South in 2013-2016, and 45 provinces in the Central, East and North East, which were 67 provinces in total. After the successful installations, Lampang Hospital delivered the program to the Ministry of Public Health for the sustainable development.

ThaiRefer was a novel program inspired by flight information screens in airports. Seeing that the concept of providing flight information to let passengers manage their time properly was useful, it could thus be adapted in a patient referral system. The Lampang Hospital program development team implemented the program to match Lampang’s public health system. Over 30 versions of the program were developed under the name “Lampang Refer Link” to achieve the maximum efficiency in information connection all over Lampang. Then, after receiving a lot of attention from medical providers throughout Thailand along with the fast developments to expand the coverage of ThaiRefer in the majority of the country, the program’s name was changed to “ThaiRefer” in July 2012. Afterwards, a patent of ThaiRefer was filed on 5th February 2014. Nowadays, the program has been used in 4,482 medical providers of 67 provinces, of all 77 provinces in Thailand. It has proved to reduce patient transfer time resulting in reducing the death and disability rates and made most providers reach the same standard of the patient referral system.

1. Human – Multidisciplinary team including physicians, nurses, IT specialists, and a person who is responsible for referral of each hospital contribute to the online program. Their feedbacks and suggestions help developing team to go forward. 2. Budget 2.1 Private supports; True Corporation; an internet and mobile service provider in Thailand supports the high speed internet in remote areas. 2.2 Public supports; Ministry of public health, provincial public health offices, and hospitals supports IT infrastructures, IT technologies, IT equipment, and IT specialists. End users in each hospital are allowed to feedback and contact with IT specialists when problems occur. In addition, National Institute for emergency medicine develops the guideline for transfer critically ill patients. 2.3 Wisdom supports; emergency care providers collaborate with IT specialists pull their unique potential specialty to develop the program and effective referral system

نعم

ThaiRefer for emergency referral. The first version of ThaiRefer program had been implemented in all healthcare sectors in Lampang.After this successful implementation, ThaiRefer was referenced at healthcare conferences across the country.Public hospitals were required to participate in using the program. Lampang hospital set a team including IT specialists and ER-nurses to provide program implementation and maintenance support. For critically ill patients such as patients with STEMI, strokes, or sepsis, the add-on programs were developed. With these add-on programs, the door to needle time was reduced, complications that caused from delayed treatments were reduced, patients’ survival rate increased, and the disabilities reduced. Also the program helps the referred-back process to be smooth and seamless.

Sustainability of ThaiRefer ThaiRefer initiates the high quality of referral system. It increases patients’ accessibility and promotes equality to healthcare services. The evidences were shown in the increasing of bed occupancy rate to 89.14% in 2017 and the accessibility to healthcare services of in- and out- patients with low-income to 78.9% (1,826,835 patients) in 2017. This program supports the government’s policy that emphasizes on integration and resources sharing of healthcare services that are in the same areas.

Recently, Ministry of public health sets up the health data center that collects the all health data of the patients that using public healthcare services. The health data center aims to serve future public health services at any levels.

نعم

The Public Sector Excellence Award awarded to ThaiRefer in 2017. The recipient of this award is selected by the Office of the Public section Development Commission.

There are the private hospitals and hospitals outside the Ministry of Public Health to joined with the Thairefer program more than 100 hospital.

The ThaiRefer program was proved to increase accessibility rate and increase referral quality. End-users and patients were satisfied with the program. The coverage rate of using ThaiRefer increased from 13 public healthcare sectors in Lampang in 2011 to 478 public healthcare sectors in 2013. There were 4,482 public healthcare sectors in Thailand using ThaiRefer in 2016. The accumulate number of patients using ThaiRefer program until Jan, 2018 were 1,826,835. By using the ThaiRefer program the death that occurs during emergency referral reduced from 0.32% in 2010 to 0.06% in 2017. The death rate is reduced because the referring hospital is required by the program to fill up all important information before refer. Therefore the referring hospital needs to develop the emergency assessment skills.

The success of the program depends on the collaboration between multidisciplinary health professions and 4,482 healthcare sectors. Also supports from 4,482 hospital directors and Ministry of Public Health are keys to success.

1. IT is important to support future healthcare system 2. The success of the ThaiRefer came from the effective supports and collaboration among administrators, developers, and end-users 3. The sustainability of ThaiRefer program developing is based on the collaboration among multidisciplinary health professions