Questions/Answers

Non-communicable diseases tend to increase. It is the cause of death for 71 % of Thais, causing the government to pay more for medical care. Continuity of care at home is an important strategy for reducing hospital stays and helps reduce costs. Patients with chronic diseases, especially children with chronic diseases such as children using home ventilators, disabilities, diabetes and chronic renal failure, need continuous care through cooperation of service units. When children get home, the data transmission is, therefore, important which should have a detailed diagnosis hospital treatment and a written care plan. Forwarding this information will allow personnel in health units to know the details and it can be used for continual care planning. Therefore, Surin Hospital has developed the Thai Continuity of Care (Thai COC) Program as a Web Application with the objective to develop the patient data transmission system from the host hospital to all levels of health units across the country. This system enables efficient use of patient data in various fields, such as, care planning for all disease groups in all age groups, efficient and fast data transmission, free of charge, no need to install additional servers, etc. This system is an upgrade of health care to digital technology. As a result, treatment information and care plans are sent out from the host hospital 24 hours a day, in a timely manner. The program delivers inclusive and equitable services under the principle of “leaving no one behind”. In addition, this program also helps solve problems for patients in terms of reducing complications, re-admission, reducing travel difficulties, reducing waiting times and improving quality of life. For hospitals, this program also improves work efficiency, reduces the use of documents and immediate monitoring and evaluation.

This program responds to category 1, fostering innovation to deliver inclusive and equitable services. That is, the Thai COC Program collects important health information, such as, diagnostic test results, treatment or hospital course, home medications, patient or family counseling, and discharge plans to deliver comprehensive services to patients in more than half of Thailand in 45 provinces, in 6,413 health units, among 21,802 users, with 712,914 patients, total 951,166 visits, It can also provide fair and equitable service, especially in the mother and child group, chronic disease children, and poor patients living in rural areas.

This program responds to targets 1, 2 and 4 of SDGs 3, Ensure healthy lives and promote well-being for all at all ages. The program delivers inclusive and equitable services by providing essential sources of important health information, especially high - risk pregnancy, mother and child, low birth weight, children with chronic illness, on home ventilator, disability, diabetes, end state renal disease, etc. The program also helps planning a holistic individual care at home, which affects the quality of care, patient’s safety, better health outcome and quality of life, building trust and reduced maternal mortality rate and neonatal.

More than half of the health units countrywide in 45 provinces have used the program from 2016 to present. It operates on the Thai Care Cloud Platform, a collaboration website between the Department of Medical Services, Ministry of Public Health and Khon Kaen University. The program is an Online Service; thus, it is stable and users can access it anywhere, anytime, and free of charge. It helps save government budget, releases no pollution to the environment, nor requires paper, neither transport services.

The Thai COC program is the application of information technology in the health service system. This is one of the key policies of Thailand 4.0. The program allows staff to record a patient's health information only once, but can then forward the up-to-date information to other relevant health units across the country. Thereby, it reduces redundant work, the burden of paperwork of the staff involved, and communication problems. It also results in greater efficiency in both service and governance of the government administration system.

This program responds to the policies of the Ministry of Public Health, focusing on strengthening the people, and strengthening economy, to stronger Thailand by upgrading the primary health system, progressive service system under the universal health insurance policy, systematic health care for all, promote good governance and the benefit of the people. The program uses innovative information technology to distribute information to patients of all genders and ages equally.

The main target group of this innovative program is all Thai people and all those living in Thailand. The program has been developed into practical use since 2016. It was found that the Thai COC Program has been used in 11 out of 13 health regions in 45 provinces, in 6,413 health units, among 21,802 users, with 712,914 patients, total 951,166 visits. The patients were satisfied with continued care at home at the highest level 92.46 %, whereas the program was satisfied at the moderate to the highest level among 94.37 % of users. In regards of the effectiveness of the program among the users, it was found that the program was 92.69 % ease of use, 92.36 % stability, 95.82 % speedy, 95.87 % responsiveness, and 95.12 % program support.

Thai COC Program Development Process 1. Analyzed the problems of the information transmission and continuous care from the host hospital to the health units at all levels. 2. Set the meeting between Surin Hospital and the Data Management and Statistical Analysis Center, Faculty of Public Health, Khon Kaen University to develop an innovative program that uses information technology to transfer patient information for continued care at home. 3. Developed the Thai COC Program for data transmission taking a period of 3 months in 2016. 4. Tested the program by complying and running for a period of 1 month in 2016. 5. Started to apply to all health units in Surin and expanded to cover the 9th health region covering 4 provinces taking a period of 3 months in 2016. 6. Followed up and evaluated the program in 3 areas: the patient satisfaction, the user satisfaction and the effectiveness of the program for a period of 6 months. 7. Submitted the Thai COC Program to the contests and got awards: an outstanding award from the Software Innovations in 2017 on the topic “ICT Innovations for eHealth & mHealth” organized by the Ministry of Public Health; in 2018, the Public Sector Excellence Award in the Public Service Category, the highest national award available in recognition of outstanding public sector development; and in 2021, the Public Sector Excellence Award in the Extension of Service Standard Category from the Office of the Public Sector Development Commission (OPDC). 8. Encouraged the use of this program across the country. Currently, the Thai COC Program continues to expand its use countrywide. 9. Established the system for monitoring and evaluating the program annually. 10. The program users can administrate information for continued care at home.

Problems and Solutions of the Thai COC Program 1. No personnel specializing in program development; therefore, a cooperation with Khon Kaen University was initiated. 2. No budget for a server, so it got a cloud server from the Department of Medical Services, the Ministry of Public Health. 3. No program consultant; therefore, it has developed a consultant in each province, set consulting system through social media and create a user manual for the program. 4. Users lacking skills in using the program, the training on how to use the program is provided as well as an annual refreshment training.

The Policy Thailand 4.0 emphasizes on the innovations of highly efficient information technology. The Thai COC Program is one of its best that connects patient information from the host hospital to health units at all levels across the country. It resolves delays and incompleteness of patient care referrals. It evolves to meet the needs of users. There is a network of administrators and users to increase communication channels to provide flexibility in all areas. It can connect to the continuous care system for every disease. Moreover, users can use it from all network providers.

Thai Continuity of Care (Thai COC) Program was inspired by fieldtrips to hospitals in Udon Thani and Nakhon Phanom in regards of information transmission which can be used in provincial area only. The team of Surin Hospital; therefore, adapted this concept to create the Thai COC program covering countrywide. With the cooperation of the Center for Data Management and Statistical Analysis, Faculty of Public Health, Khon Kaen University, a Web Application Program was innovated on Thai Care Cloud Platform. The program started to use in 2016, soon after expanded to cover the 9th health regions and some interested provinces.

Thai COC Program is a stable digital technology. It increases the efficiency of government services. It is located on the Thai Care Cloud Platform, Khon Kaen University. The patient data is uploaded and backup in the cloud system of Department of Medical Services, Ministry of Public Health. This program is used to transmit information on continuing care at home for all genders, ages, and disease groups.

The Thai COC program has been implemented and transferred knowledge to interested hospitals thru workshops, mentors and supervision to enhance skills in using the program. The Key Performance Indicators (KPI) of the program are set in accordance with the KPI of the Nursing Division, Ministry of Public Health. This program helps classifying patients by severity to prioritize care across the country. Hospitals and Health Units are welcome for study visits. The Office of the Public Sector Development Commission (OPDC), and the Office of the Permanent Secretary, Ministry of Public Health also publicize this program through the media of television, the Internet, and electronic books. The program provides care for foreign patients along the border areas of Myanmar, Cambodia, and Laos.The program is expanded to take care of patients with mental health problems under the Department of Mental Health as well as patients with chronic alcoholic including patients with emerging diseases COVID – 19.

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The program has no budget but relies on cooperation under the Memorandum of Cooperation between Health Region 9 and Khon Kaen University to support the Thai Care Cloud Platform System. This platform is located on Cloud Server of the Department of Medical Services, Ministry of Public Health. The program was designed and transferred knowledge by personnel of Surin Hospital under consulting from Khon Kaen University. It has received cooperation from many the host hospitals and health units. Network partners help examine and recommend the program development in accordance with the IT development policy of the Ministry of Public Health.

The program is sustainable in an economic dimension because no additional budget is required. It responds to government policies at the national level, ministries and local organizations. At the national level, it focuses on creating highly efficient information technology innovations. It also serves the Policy of the Ministry of Public Health Year 2022; to develop the secondary service system be an efficient connection point, and to create progressive service system including new normal medical care, digital health, and innovative healthcare management. It meets the needs of patients. That is 92.46% patients were satisfied at the highest level.

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The internal assessment method used a satisfaction questionnaire on four aspects: ease of use, stability, speed, real-time responsiveness, and program support. The internal assessors consist of patients, program users, District Public Health Offices, District Hospitals, Provincial Hospitals, Provincial Public Health Offices, Regional Health Offices and the Nursing Division. The external assessment method consists of 2 items. They are the management process and the empirical outputs and outcomes. The external assessors consist of the Information and Communication Technology Center, Ministry of Public Health, and the Office of the Public Sector Development Commission.

The Questionnaire used in the internal assessment covered 4 areas of satisfaction as mentioned in item 9(b).The program has been assessed externally by 2 organizations with the following criteria. (1) The Information and Communication Technology Center, Ministry of Public Health, uses 5 criteria: the concept of performance development, technology and system design, service model, Guidelines for practical use of the service, and other related plans. (2) The Office of the Public Sector Development Commission used the government service award assessment criteria for 2021. The 2 indicators were the management processes and the empirical outputs and outcomes.

The results from the internal and the external assessments are: 1. The number of program users increased from 8,554 users in 2016 - 2018 to 21,802 users in 2019 - 2021. The growth rate is 254.87 %. 2. The number of health units increased from 3,051 units in 2016 - 2018 to 6,413 units in 2019 - 2021. The growth rate is 210.19 %. 3. The number of patients increased from 205,235 patients in 2016 - 2018 to 712,914 patients in 2019 - 2021. The growth rate is 347.36 %. The statistics of the continuous increase in the number of the program users, health units and patients transmitted for ongoing cares, reveals that the program is popular and widely used because it truly responds to the necessity of local needs.

The related organizations and their relations with this program are as followed 1.The Community Nurses specified the need to use the home visit program to send the accurate and complete information to the host hospitals and the health units. 2.The Computer and Information Technology Center, Surin Hospital developed programs according to the needs of the users. 3. Surin Provincial Public Health Office set policies, monitors, and evaluates. 4.The Data Management and Statistical Analysis Center, Faculty of Public Health, Khon Kaen University were a mentor in program development and system administration. 5.The Department of Medical Services, Ministry of Public Health and Khon Kaen University support a cloud server. 6. Surin Hospital advices on how to use the program. 7. The Nursing Division, the Region Health Offices, the Provincial Public Health Offices, the host hospitals, the hospitals, the Regional Public Health Offices, and all community hospitals control, supervise and monitor the continuous care for all disease groups, and all age groups. They are able to track current information. 8. The health units follow-up home visits for all disease groups and all age groups in the area. They are also able to track current information.

The program sets out in regards of integrative collaboration and equality of all sectors as follows: The Community Nurse Department, Surin Hospital needs a home visit program. So they coordinated with the Computer Center and Information Technology Center, Surin Hospital to design a program. Thus, the program was innovated with the cooperation of Khon Kaen University. After the program was implemented and well proved of its efficiency within the 9th health region, Surin Hospital, as a representative of the 9th health region; therefore, has entered into a memorandum of understanding for cooperation in the development of medical information technology with Khon Kaen University. This MOU covers the development plan of the health service system for patients of all disease groups and age groups under the national health insurance policy of the Ministry of Public Health.

With this innovation, we have learned the importance of THAICOC and its contribution to public health services. THAICOC means T : Team Work H : Holisticity A : Application I : Innovation C : Continuity O : Online C : Care Our experience, knowledge and skills in information technology innovation makes it possible for us to create a Hospital Without Border on the Thai Care Cloud.