SIL-TH journey with FHIR in Thailand
7 July 2022
Prapat Suriyaphol
SIL-TH Team
2
Dr.Kwin Sirikwin
Bamrasnaradura Infectious Diseases Institute Ministry of Public Health
Dr.Supharerk Thawillarp
Department of Disease Control Ministry of Public Health
Mr.Natdanai Thaipipat
Faculty of Medicine Siriraj Hospital Mahidol University
Dr.Daorirk Sinthuvanich
Thai Health Information Standards Development Center (THIS)
Dr.Thanaphop Na Nakhonphanom
Faculty of Medicine Khon Kaen University
Dr.Rath Panyowat
Thai Health Information Standards Development Center (THIS)
Dr.Prapat Suriyaphol
Faculty of Medicine Siriraj Hospital Mahidol University
Technical Lead
Dr.Boonchai Kijsanayotin
Faculty of Medicine Ramathibodi Hospital Mahidol University, THIS
Clinical Lead
Dr.Piya Hanvoravongchai
Faculty of Medicine Chulalongkorn University
Policy Lead
Mr.Kidkom Salelanont
Thai Health Information Standards Development Center (THIS)
Mr.Ratchata Ulman
Buriram Hospital Ministry of Public Health
Learning and Building
Awareness
Health Tech Startup Thailand
Feb 2019
Department of Medical Services (DMS)
Ministry of Public Health
Jun 2019
HiMSS AsiaPac19
Oct 2019
ICT Ministry of Public Health (MoPH)
Apr 2020 – FHIR the big picture
Jun 2020 – FHIR Architecture
FHIR Momentum and
Movement
ICT Master Plan
Dr.Anant Kanoksilp
Director of Information and
communication technology
Anant Kanoksilp 43 files
Living Wellness Health Care Medical Care
Physical Medical Practice
Tele-Medicine & Remote Monitoring
Integrated
HIE Big Data
Collaboration Interoperable
Unified Health Data Platform
Community Health Activity
Self Care
PHR
Anant Kanoksilp
Survey
Encryption
Reimbursement
DeidentificationNHSO CSMBS SSS Others FWF
Data Mining , Data Marts
Anonymize Data
Big Data for Analysis
SDG3
Health Profiles/Policy
Anonymize Data
* NCCR=National Chronic Care Registry *
Stateless/
Escape
cash
Private Insurance
Welfare
Thai
เขต สุขภา พ
รพ./หน่วยงาน
Deidentification
รพ./หน่วยงาน
Management
Business/System Owner NCCR
Medical Hub (มูลค1า1.4 แสนล 9 าน / ป < 61) สสจ.
สสจ.
Expat Welfare
InsurancePrivatecash FWF
Services
MOPH GOV-HOSP
Ex-MOPH
Nursing Home
Private-HOSP
Ministry of Digital Economy and Society
Government Big Data Institute
https://www.youtube.com/watch?v=pP8L8apCa1A
FHIR in Thailand Stroke Care
• Explored the possibilities of modelling the
Stroke Care Record Summary Form information using the HL7 FHIR
• 100% of the Stroke Care Record Summary Form can be modelled using FHIR
• Methods: identifying and mapping
corresponding elements between data models
Figure 1. Stroke Care Record Summary Form
Na Nakhonphanom T. Exploring the use of the HL7 FHIR standard for information modelling of a Stroke Care Record Summary and its mapping to the Thailand Health Minimal Standard Datasets [degree project]. Stockholm: Karolinska Institutet; 2020.
Demonstration of
HL7 FHIR in Primary
Care Cluster Digital
Health Project
Prototype of Health Information Exchange using HL7 FHIR
Web application FHIR resources
HIS from company a
HIS from company b Hospital A
Hospital B
System design
HosXP
Web application
HosXP Hospital A
FHIR Façade
Hospital B
FHIR Façade
HAPI FHIR Installation using Container
FHIR Server Test using Postman
Name FHIR element Constraints
HN Patient.identifier
Photo Patient.photo
Name Patient.name e.g., family, given, prefix
Gender Patient.gender <<AdministrativeGender>>
Date of Birth Patient.birthDate
Marital Status Patient.maritalStatus <<Marital Status Codes>>
Address Patient.address e.g., line, city, district, state, postalCode
Geolocation Patient.address.extension latitude, longitude Systolic Blood
pressure Observation.component.code LOINC (8480-6) Diastolic Blood
pressure Observation.component.code LOINC (8462-4)
HbA1c Observation.code LOINC (4548-4) | TMLT
(320131) Fasting plasma
glucose Observation.code LOINC (1556-0) | TMLT
(320080)
Total cholesterol Observation.code LOINC (2093-3) | TMLT (320070)
HDL-C Observation.code LOINC (2085-9) | TMLT
(320071)
LDL-C Observation.code LOINC (13457-7) | TMLT
(320293)
Triglyceride Observation.code LOINC (2571-8) | TMLT (320072)
eGFR Observation.code LOINC (62238-1) | TMLT
(390001)
Creatinine Observation.code LOINC (38483-4) | TMLT (320055)
Medication Name MedicationRequest.medication TMT
Identify Required Data in HL7 FHIR Resources
Encounter Data from HL7 FHIR
Name FHIR element Constraints
Date Encounter.period.start
Type Encounter.type <<Encounter type>>
Reason Encounter.reasonCode <<Encounter Reason Codes>>
Participant Encounter.participant
Patient Condition from HL7 FHIR
Name FHIR element Constraints
Date Condition.recordDate
Diagnostic Condition.code <<Condition/Problem/Diagnosi s Codes>>
Severity Condition.severity <<Condition/Diagnosis Severity>>
Status Condition.clinicalStatus
Date Resolved Condition.abatementDateTime
Name FHIR element Constraints
Name MedicationRequest.medication
Dosage MedicationRequest.dosageInstructi on.text
Effective MedicationRequest.dosageInstructi on.status
<<Medicationrequest status>>
Date Off MedicationRequest.dosageInstructi on.timing
Note MedicationRequest.Note
Medication Data from HL7 FHIR
Patient’s Current Encounter Overview
Encounter History
Patient history
Medication History
Laboratory and Medication Timeline
System design (initial plan)
HosXP
Web application
HosXP Hospital A
Vonk FHIR Façade
Hospital B
Vonk FHIR Façade
Take too long to learn and implement for us
Command Transfer
43 + 7 +2 + X Files
HosXP
Events Views
Process Queue
Triggers
Web
Service
Thai Care Cloud
System Design (actual implementation)
HosXP
Mysql database
trigger
Web application
HosXP Hospital A
Hospital B
HAPI FHIR Server
FHIR focuses on Implementation
HosXP
Mysql database
trigger
HosXP Hospital A
Hospital B
HAPI FHIR Server
Specific to just one Commercial HIS
How to create a system that is
not specific to a commercial HIS
and can be used throughout the
country?
Hospital A
CSOP format
TMT
HAPI FHIR Server
Start with Medication
CSOP format
HAPI FHIR Server
Any Hospital Information Systems
HIE PHR Health Tech Ecosystem
Publicly Available Tools & Libraries
Security Identity
Standard valueset
Github - Opensource
Health System Reform
Plans to drive activities
that result in significant
changes to the people
http://sil-th.org
Community
Thank you
