In the sixth episode of the HIMSS APAC Digital Dialogue Series hosted by Dr Charles Alessi, HIMSS Chief Clinical Officer, guest speakers Dr Kwin Sirikwin, an ophthalmologist at the Bamrasnaradura Infectious Diseases Institute (BIDI) & Executive Committee Member of the Thai Medical Informatics Association, together with Dr Surangkana Techapaitoon, Deputy CEO of Samitivej and BNH Group of Hospitals & Director, Samitivej Children’s Hospital shared important lessons in their handling of the pandemic in Thailand. 

Approaches to the pandemic: BIDI and Samitivej

BIDI, which is under the Ministry of Public Health (MOPH) in Thailand, is a 240-bed tertiary care hospital with 1000 staff under normal circumstances, Dr Sirikwin explained. However during the COVID-19 pandemic period, it became the hospital which handled the highest number of COVID-19 related patients in Thailand with a total of 6066 Patients Under Investigation (PUI) and total of 214 confirmed cases of COVID-19 at the end of May.

During the COVID-19 outbreak, BIDI’s HIS was utilized to create a suite of digital services for patients. Scheduled patients could perform self-registration at registration kiosks and check their upcoming queuing number via a mobile app. Medicine was also pre-packaged by the pharmacy to reduce patient turn-around time.

Via the mobile app, patients could also check their laboratory results and receive their e-medical certificates to reduce time spent at the hospital. Telepresence robots were used to support transportation at BIDI, serve patients’ requests and facilitate communication between staff and patients in cohort wards. The use of these robots have reduced the exposure risk of the staff, as well as reduced Personal Protective Equipment (PPE) usage. 

Samitivej and BNH Group of Hospitals operate under Bangkok Dusit Medical Services (BDMS), the largest private hospital network in Thailand. Under the Samitivej and BNH group, there are a total of seven hospitals – five in Bangkok and two in the Eastern part of the country. From February to May this year, there were a total of 104 confirmed cases of COVID-19 that were admitted under Samitivej and BNH, Dr Techapaitoon said.

With limited knowledge and information about COVID-19, the initial challenges in handling the rising number of COVID-19 include: 

• Clinical practice guidelines that were changing frequently
• Shortage of and rising prices of PPEs 
• Facility safety and management – separating COVID-19 patients and non COVID-19 patients
• Health information management – initially confusing with too many parties involved, both internally within the hospital group and externally with government agencies
• Fear and concern of medical staff

In terms of digital health platforms, the Samitivej Plus mobile app was developed in 2018 as a means to connect with clients and patients regarding their health information, treatment, laboratory results, medication, online appointments, emergency calls and online payment.

From 2019 onwards, Samitivej added more services such as the Samitivej Virtual Hospital which provides video teleconsultation services and follow-ups with existing clients, Tyto Care, which involves the use of a medical device to help physicians with remote physical examinations, and Engage Care, a tele-monitoring service for diabetes, hypertension and stroke patients. 

During the peak of the pandemic, the number of patients using the Samitivej Virtual Hospital service increased six fold. 

Lessons learnt

“We need the integration of traditional healthcare and digital healthcare, integrate people from multi-disciplinary teams and integrate public and private sectors together, so we can solve problems more effectively,” explained Dr Techapaitoon.

“The second lesson learnt is information management – we need data to improve our tasks but we should integrate data within our hospitals and between the public and private sectors. Effective communication creates better understanding and helps build confidence between teams,” she added.

To overcome of the challenge of procuring PPE in the private healthcare sector, the public sector created an app in which private hospitals could put in their requests for PPE, which will be provided by the Government Pharmaceutical Organization directly to these hospitals, Dr Techapaitoon said.

“We have seen a lot of apps and digital tools to deal with the COVID-19 outbreak, which is very good. Looking forward, there are many possibilities but one thing we would like to address is: what if we have lots of services and applications but none of them can ‘talk’ or exchange information with each other? Why do patients have to answer the same questions to the different service providers over and over?” said Dr Sirikiwin. 

“For healthcare providers, not only do we have to share the information with the organization, but also exchange information with other stakeholders. Unfortunately, the data was in an information silos and couldn’t flow one system to another easily so the staff have to copy or re-enter the data manually.”

Looking at the WHO ITU e-Health governance, standards and interoperability are the fundamentals of applications and services. The current director of the ICT Center at the MOPH realized this and one thing he is focusing on is Thailand’s unified health data platform using a standardized protocol and data model based on international standards,” he said.

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