Questions/Answers

With the government of Thailand sees it important to provide inclusive and equitable health services, even at the smallest and most vulnerable level. Filling the gap of public health service availability in rural and urban areas and understanding the system, the public health services start at the bottom. The most significant element is the village health volunteers (VHV) there exists approximately 15,000 village health volunteers in each province or about 1 million VHV nationwide. These are locals who are integral part of the community, known and trusted by villagers. Each of them is responsible for 15 households. VHVs are basic public health providers who perform duties such as home visits of bed-bound patients, make appointment with family physician or specialist on behalf of patients. Furthermore, they also collect data for local, regional and national public health authorities including incidence of infectious diseases, Non Communicable Diseases (NCD) and results of measures to eradicate public health risks. VHV sometimes face not only the limit of understanding in treatment but also request of data collection which could be of interest for public health authorities. Responding to this challenge, this project aims to provide opportunities for local health providers to be empower and enhance access to good quality public health services. In this regard, the project has been designed to answer to 3 important challenges a) How to provide a good public health service especially to people in remote and rural areas b) How to make use of data sword by different hospitals across the region (lower Northern Thailand) so that treatment could be most adequate and effective. c) how to provide a good learning platform to existing public health service providers even at local levels who face the fast pace and highly demanding public health landscape.

This app is the innovative tool to increase an access to quality public health services for all patients, especially poor people living in rural areas. It also delivers reasonable services to many public health institutes by reforming and transforming service-delivery mechanism to digital system. The use of this system brings a high level of networking and connectivity, and information sharing. From a medical standpoint, the system provides a high degree of continuum of patient care throughout the Heath Region, regardless of where the patient is interacting with a health care professional, so that patient mobility is accommodated.

Goal 3: good health and well-being; to bridge the gap in a color make and social inequalities, the project aims to also confront infection diseases and emerging challenges of Non Communicable Diseases. NU MED Application can also decrease inequity among people in remote areas, who require special treatment for complex diseases and accessibility to medical services from specialists without taking a long journey. This reduces loss, complication, disability or death caused by late treatment and care. A quick consultation on patients’ problems helps them get proper treatment, a seamless medical system for people. Even healthy persons who have awareness of self-care can consult doctors via the application. Furthermore, NU MED Application can be applied in education to extend knowledge and further develop medical staff’s skills, directly to students in the field of medical sciences to learn from real situations and review lessons at all times from the application’s functions that support education widely and sustainably. This program also correspond to UNFDA Strategic Plan 2018-2021, especially in ensuring greater availability of disaggregate data or sustainable development and emphasizing the development is a central goal in itself.

The government under the Ministry of Public Health and relevant authorities are conducting a possibility study to extend this project into a national scale. It is agreed that by extending this program on a national level, the application will be an efficient tool to fill the gap of public health services between the rule and urban areas. A schedule of on-call specialist and general doctors is drawn to guarantee availability of experts views at any time.

Before the system there was a need for local data collection to be constant, well organized, up-to-date and user-friendly. This has effects on risk management and decision-making at local and regional levels. The lack of comprehensive and easy to access patients' health data for concerned authorities not only prevented the fast and efficient decisions on a large scale but also impeded adequate treatment for patients' benefits. In Thailand, a challenge for healthcare providers is that patients may have medicals records in many centers. The lack of comprehensive data could affect the choices of treatments and hence their results. Furthermore, different hospital records medical data in different ways. Therefore it has always been very difficult to merge all different data systems together.

This project regards women as a very crucial component. It does not only emphasize a respective role of women at the grassroots level, but also for lack of trusting agents in culturally sensitive issues; such as sexual and reproductive health.

The benefits to different target groups are identified according to their categories; 1) Grassroots patients- they benefit from better quality and timely healthcare services, as well as receive adequate treatment and prevention. 2) The local Village health volunteer- can improve their performance with support from specialist in a faster and cheaper way 3) Decision-makers- are able to obtain better understanding of health service needs as well as mannish public health risk in an adequate and timely manner.

The project development could be divided into five phases; 1) Planning Step Staff from the faculty of medicine, the faculty of engineering and programmers together designed possible database structure and information -sharing system between Naresuan university hospital and other regional hospitals in lower Northern Thailand. The levels of hospitals are as follows; Primary hospital Secondary hospital Tertiary hospital Centers operated by village health volunteers 2) Survey and Data Collection During this step, the project team members made a comprehensive survey on types of information that different patients and healthcare personnel could need at time of receiving treatment. Some issues were identified: routine prevention measures; care in chronic conditions; attending emergency needs; protocol on transferring patients from different hospital levels. 3) Development of Application The team created easily access and highly secured application in responding to needs as identified. This phase focuses on hospitals and units within 100 kilometers from Naresuan hospital. 5) Pilot launching During this phase, every agents are engaged in providing services to hospitals and village health volunteers within 100 kilometers from the university hospital. 5) Future projection It is under the consideration that this project could be extensive to the whole area of five provinces with in lower North of Thailand. That means 673 hospitals could benefit from a bigger pool of very secured and user-friendly health database.

A major problem was the network interfaced with a large variety of information systems from various hospitals, overcome by the development of intelligent software agents working as front-end agents to intercept incoming communication messages and convert them into the local protocol, and also to convert communication messages created by the local information into the Internet MQTT protocol for transmission to the Data Center in the Cloud. Secondly, medical information is significant sensitivity issue. To ensure the highest level of security, all participants were carefully and fully informed, and signed an Informed Consent.

To support an addition of different data, it is necessary to create an application that backs up one-stop telemedicine consultation with the database system that obtains the patient’s complete records in a digital form, including the reliable network system among hospital networks. The data can be presented in various forms as image data or different files, for instance, Laboratory Information System (LIS), Digital Imaging and Communications in Medicine (DICOM), Vital and Physiological Signs Measuring System, including Automatic Identification System (AIS) like Face ID friendly-designed appropriately for users.

This project is developed from team science and inspired by health systems’ problems and people’s current needs. The Thai government have realized this and driven forward the Thailand 4.0 Policy that declares the 20-year National Strategy assigning the Ministry of Public Health to provide health care services to patients by public health volunteers in primary level.

NU MED Application has been piloted in 12 hospitals and district health promoting hospitals in Phitsanulok. In 2018, the app was continually supported by research scholarship and developed to cover 157 district health promoting hospitals in the province. The hospitals were visited by the National Broadcasting and Telecommunications Commission (NBTC) Committee and Senior Experts who participated in meetings and followed up results from the project in developing technology models that improve the quality of Emergency Telemedicine Services in rural areas with high-speed digital networks via NU MED Application. The NBTC team attended the presentation of working processes, watched the demonstration of consultation systems through the app on the smartphones from real locations and paid a visit to Sao Hin Health Promoting Hospital and Bang Rakam Hospital. On this occasion, the NBTC Committee and Naresuan University planned to extend the results of NU MED Application Model across the country. On 21 March 2019, Naresuan University signed the Memorandum of Understanding to have collaborations on academics with Sukhothai Provincial Health Office, Sukhothai Hospital, Srisangworn Sukhothai Hospital and all community hospitals in Sukhothai in order to further develop the system of telemedicine consultations via NUMED app.

Additionally, the model of developing networks of medical and public health consultations via NU MED Application was published in the international journal on developing fundamental network systems that support innovations IEEE Access, Vol.6, 2018 page: 60224-60233. The application was also selected to be promoted in hospitals across the country in 20th HA National Forum on 13-15 March 2019 and awarded in the Public Sector Excellent Award (PSEA) 2019 or Lert Rat 2019. Furthermore, this project was accomplished the Outstanding ICT Achievement Award Finalist of HIMSS-Elsevier Digital Healthcare Award on 8 October 2019. This concept was transferred by the executive interview in HIMSS channel.

The National Broadcasting and Telecommunications Commission (NBTC) provided the total cost of development over than USD$700,000 for software and hardware acquisition, including administrative supporting personnel. The provision of medical services in the Health Region is organized in "Primary Care Clusters" (PCCs) comprised of three family physicians, 12 nurses, a dentist, three dental technicians, a pharmacist and three pharmacy technicians, a physical therapist, three Thai traditional medicine practitioners, 12 public health professionals, and village health volunteers, serves 10,000 patients in the villages in three Sub-Districts.

According to the vision of Faculty of Medicine, Naresuan University, the innovative medical school is established to create leaders in health system. Moreover, the organization needs to promote continuous development of health system management and services. In addition, the organization must support research and education activities in the field of health systems. The organization’s leadership and workplace environment are the key factors that this project need to sustain as they lead to success.

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This project has been evaluated by the office of the national broadcasting and telecommunications commission (NBTC) under the office of Prime Minister of Thailand. The Faculty of Medicine, Naresuan University evaluated the effectiveness and review the project's performance. Moreover, this projected was awarded in the Public Sector Excellent Award (PSEA) 2019 or Lert Rat 2019 by the Office of the Public Sector Development Commission (OPDC) by assessing 4 aspects of 1) problem analysis, 2) innovative idea and implementation, 3) results and 4) sustainability

Indicators are as follows; Participating hospitals: 17 Registered users: 68 of which - General users: 57 - Experts/advisers: 11 Pilot period: 140 days Number of cases reported: 2053 Satisfactory review score: Overall: 4.48 out of 5 (provided by users) Usefulness: 4.65 out of 5 Quickness in response: 4.43 out of 5 Quality of consultation: 4.43 out of 5

This project is an outstanding achievement in harnessing ICT to provide significant improvements in patient care demonstrably. With its simplicity of operation, NU MED Application is effectively applied to address the major challenges that face public health authorities. The main challenge is to gain the confidence from medical staff to use this app in various hospitals and get patients’ approval. It is also necessary to very carefully and clearly explain to prospective patient participants that their information will be kept anonymous and secured with the systematic control, including treated with respect and for the purpose of their well-being.

This is the collaboration of Faculty of Medicine, Faculty of Engineering, Naresuan University all together Pithsanulok and Sukhothaiand Provincial Health Offices, and the hospitals in the Ministry of Public Health in developing the health system with financial support from the National Broadcasting and Telecommunications Commission (NBTC) and people’s collaborations.

There were 157 hospitals, clinics and health facilities participating in the system with more than 3,523 consultations using the MED NU App. The number of downloaded modules was accounted as 1,289 patients, 284 PCC teams and 831 NU MED advisers.

The NU Med Application’s development is meant to solve problems and provide accessibility to medical service and information for people in remote areas. The system is collaborated between service networks and modern technologies to reduce inequality of medical access. It is planned to develop service areas that cover 10 provinces in Lower North and Upper Central Plain in Thailand.