Questions/Answers

The Thai continuity of Care (Thai COC) Program aims at finding a solution to improve healthcare data transfer between a tertiary hospital and its local hospital networks. Therefore, data linkage is required among 232 healthcare service centers in Surin province although each service center is distant from one another. After the linkage is established, it would allow patients, especially those living in rural areas, to receive an immediate continuity of care at home and gain access to the healthcare service equally with effective treatment under a vision of “No one is left behind”. Previously, the healthcare data transfer was slow which caused delay in a treatment and incidences of complication, such as pressure ulcers, stiffed joints, and other infections. Some of the patients were required to re-admission at the hospital, taking more time for rehabilitation while some turned to a person with disabilities or even passed away.

Aligning with Category 4 (Promoting digital transformation in public sector institutions), Thai COC is an innovative healthcare software established to connect healthcare database among 232 healthcare centers in long-distance and rural areas with a main hospital in Surin Province. With this data linkage, it can expand service coverage to approximately 1.4 million people in Surin province so that these healthcare centers can provide a continuity of care, starting from a planning stage, equipment preparation, and information management to a follow-up process. The project solution promotes collaboration and modern digital technology usage to enhance management in public sectors.

Designed to align with Sustainable Development Goals Section 3 (Good Health and Well-being), Thai COC leads to the continuity of care from clinicians of the healthcare centers or the tertiary hospitals from which patients receiving a treatment by utilizing the data linkage with support even the patients were already discharged. The Thai COC does not only provide timely communication to the clinicians to manage their immediate care and effective treatment, but it can also enhance knowledge of both clinicians and the patients to be able to look after their health, which results in a better quality of life.

Located in the northeastern region of Thailand next to a Cambodia border, Surin province constitutes approximately 1.4 million people. Surin Hospital is the most modern hospital in the province with a referral center for all healthcare networks. Since these remote healthcare centers may not have comprehensive and modern medical equipment to treat patients, the patients are transferred to the hospital. When recovered, the patients are discharged then return to the healthcare center they came from to receive the continuity of care. Prior to an establishment of Thai COC, it was found that 87% of the discharged patients were unable to receive the treatment at home due to structural limitations of communication among healthcare services. Since established, Thai COC promotes effective communication and data sharing among clinicians in every healthcare institutes in Thailand. Patient data consisting of patient’s healthcare treatment and a discharging plan from the tertiary hospital can be transferred 24 hours for effective care with a real-time management. Furthermore, the data sharing network provides patient information to the community nurses. The patients, as a result, receive standardized care in time; this would eradicate patient’s transportation difficulty and create a better quality of life.

Thai COC is the first of a kind of a free digital information that provides a real-time communication channel, data linkage and data sharing among healthcare service providers. It was created as a solution to solve delayed communication in providing care between Surin Hospital and other regional healthcare centers in their network link. The previous referral communication system relied on a postage service to send the referral letter between the service providers. Today, the network is expanded to 39 provinces. Services were implemented to around 292,155 patients and it is expected that 33.6 million people will benefit from this program.

Thai COC is now an application program in the Thai Care Cloud (www.thaicarecloud.org) . The Thai COC was Initiated by Surin Hospital and Surin Provincial Health Office with collaboration from Khon Kaen University (Collaborative agreement was created between Department of Medical services and Khon Kaen University). It was first used in Surin Province region on September 5, 2016, then expanded to use in the Healthcare Region 9. Finally, the clinicians can use it at free-of-charge and without installing a new server. The training program for new users are also provided as a complimentary.

Thai COC promotes corroborating and teamwork by using digital technology among the institutions. This software program can be utilized with every patient at all ages and all sickness. This program was shared to 39 province healthcare centers throughout Thailand. As Surin Hospital initiated this digital service, Surin province itself acts as a comprehensive regional training center to provide workshops and organize conferences. Moreover, the hospital published user manual booklets and held academic exhibitions to expand the networks.

Thai COC was initiated by Surin Hospital and Surin Provincial Health care Office. They planned and designed the system while The Faculty of Public Health, Khon Khean University, and Department of Medical Services, Ministry of Public Health, developed software, technology and knowledge to support the project. An individual institution formerly used its own budget to train the personnel how to use and expand the use of the program to other institutions. At the present, the program development received supporting funds from Surin Hospital and National Healthcare Security Office (NHSO) Region 9.

The sustainability of the program has proved itself that it can be used practically since it was first established 2 years ago. Initially implemented in 232 healthcare service centers then commonly used in 39 provinces throughout the country, Thai COC is a success initiative. It was revealed that more than 33.6 million people benefitted from the program. As a matter of fact, Thai COC reduces difficulties for patient to travel and receive the services. As a result, patients who living in rural/regional areas can access to healthcare service equally. The program likewise enhances patients’ quality of life, recovers illness, and makes them return to their normal life. Thai COC aligns with Thailand 4.0 (integrity and transparency) and Thailand public health budget plan for 2018 to 2021 in terms of Digital technology transformation to develop data management in healthcare for utilization across Thailand. Nowadays, NHSO Region 9 provides financial support to follow up the patients who stay at home.

Yes

The outcomes of the program in Surin province were officially assessed; and the results were found that that all patients, at all ages and illness, were able to access the home care service up to 94.15%, higher than the rate of NHSO region 9 and it was claimed as the highest rate in Thailand while in other provinces. NHSO Region 9 provides the financial support according to the quality of care through this program, which is categorized into four groups, including an immobilized elderly (bed bound), stroke patient, peritoneal dialysis patient, and chronic obstructive pulmonary patient.

The home-visiting rate increased from 13.00% to 94.1% (pre- and post-data respectively). The patient complication rate was recorded at 2.72%. Prior to the implementation of Thai COC, clinicians were initially unable to retrieve home-visiting within 14 days and Category 3 of patient transfer by 5 days. After the implementation, the rates of those home-visiting program were revealed as 83.72% and 81.43% respectively. The program user satisfaction rate was at 92.80 %. However, the percentage of satisfaction rate of the patients who were unable to be completed was 69.83%

Impact: 1. Many healthcare centers across Thailand were able to transfer patient data and response effectively and efficiently to establish a discharge plan with many levels of healthcare institutions, as a result, patients were able to access the care in the high rate. This prevents patients to have healthcare complication and readmission. Thai COC improves the standard of care from patient and relative participation and other healthcare networks. 2. It enhances the healthcare staff well-being by reducing workload from paper-based system and unnecessary work 3. The public sector has an effective system to provide a continuity of care.

Implementing a home-care program by using Thai COC promotes collaboration between multidisciplinary team, including the Center of Knowledge and statistical analysis in Public Health Faculty from Khon Kaen University that provided a plan and designed contents of sending and responding the home visiting data to suit to the outcome index of home-care in response to the healthcare policy and the user’s needs. The Center of Knowledge and statistical analysis looks after the software system functions, responses to the user’s feedback from 39 provinces to improve and further develop the program. It also monitors and evaluates the system. Design and development of the program were integrated in the provincial and regional levels in the name of in-home continuity of care development with the use of Thai COC. NHSO Region 9: Nakon Chaiburin, Surin Province, directs the policy and National Health Security Office (NHSO) provides financial support. Surin Provincial Public Health Office, Surin community Hospitals in district and subdistrict level as well as the relevant healthcare networks deliver the care to the patients at home, follow up to evaluate periodically by having a meeting three times per month.

During the initial period of the project, some clinicians acquired limited skills in using this Technology. Therefore, the project team provided a free in-house training to individual and institutions and acted as a mentor. A certificate was also provided to the institution that achieved the performance target. The mentor institutions were further supported by knowledge and accomplishment exchange between the users. The conference for program knowledge and skill exchange was likewise provided. Thai COC can be developed into a telemedicine, National Health Information System and an individual disease management platform. The service can be expanded to the neighboring countries.