Thai UHC Journey Workshop 2024 Showcased Thailand’s Digital Health Initiatives Aiming to Improve Health System and Advancing Well-being: Smart Hospitals, 30-Baht Treatment Anywhere Scheme, Telemedicine, SAANSOON Platform, Nong Tangjai Chatbot.
The “Thai UHC Journey Workshop 2024,” hosted by the MOPH, ThaiHealth, the NHSO, the NHCO, WHO-CCS EnLIGHT, IHPF and ThaiHealth Academy, centered on the theme “Health Promotion: A Transformative Path towards Sustainable Health and Well-being. ” It was held from November 4-8, 2024, at the ThaiHealth Center, Bangkok. On November 7, 2024, the workshop presented Thailand’s Digital Health initiatives aiming to improve health system and advancing well-being.
• The overview was presented by Dr. Pritaporn Kingkaew, head of Research Unit at the Health Intervention and Technology Assessment Program (HITAP).
She pointed out that “Thailand’s population exceeds 71.6 million, and the country is categorized as an upper-middle-income country with GNI per capita of $6,190 USD. Additionally, it is recognized as one of the countries rapidly achieving Universal Health Coverage (UHC), enabling equitable access to healthcare services for all. This has ultimately contributed to an increase in average life expectancy at birth of 79 years.
Notwithstanding this, the rapidly growing elderly population – accounting for 15% of the total – poses a radical challenge for the country since it may exert wide-ranging impacts on the economy, society, and public services.
Simultaneously, internet usage among Thais has continued to increase exponentially, reaching 88% of the total population, which underscores the country’s complete transition into the digital age. This transformation has presented opportunities to adopt digital technologies to develop the public health system, enhance government services, and create innovations to address the needs of its aging society effectively.”
“Digital Health” refers to the integration of digital technologies into healthcare, with the aim of enhancing individuals’ quality of life and health care. This includes a wide range of technologies: eHealth, which involves the adoption of information and communication technology in health and health-related fields; mHealth, referring to the use of smartphones, wearables, and other applications for health monitoring, such as smart watches and step counters; Big Data, which focuses on analyzing extensive volumes of health data to identify the trends and develop treatments; Genomics, utilizing genetic data to enhance diagnostic and treatment; and Artificial Intelligence (AI), which leverages AI to analyze medical data and aid physicians in decision-making.
The potential of digital health to improve health care can be classified into four primary areas. 1. Improved access to care: It allows patients to access health care more easily, conveniently, and quickly while empowering them to take charge of their self-care. 2. Streamlined workflows: It optimizes the health system, lowers costs, and ensures patient-centric care. 3. Interoperability and data sharing: This fosters effective collaboration among healthcare organizations while enabling data analysis to enhance the health system. 4. Personnel and system development: It ensures continuous professional development for healthcare professionals and strengthens the system’s adaptability to address emerging challenges.
Major national policies and legislation related to the adoption of digital technologies for the health system include, for instance, the 20-Year National Strategy (2018-2037) and Thailand 4.0, the Cybersecurity Act B.E.2562 (2019), the Personal Data Protection Act B.E.2562 (2019), the Electronic Transactions Act B.E.2544 (2001) with its 2019 Amendment, and the National Health Security Act B.E.2545 (2002).
Additionally, digital health policies and strategies have been introduced to enhance the efficiency of the health system. These encompass the Ministry of Public Health’s eHealth Strategy (2017-2026), which promotes the utilization of digital health technologies; regulations and policies for telemedicine services to ensure safety and quality services; the Smart Hospital Policy, which integrates digital technologies to improve hospital services; the Treatment Anywhere with one ID card Policy, and the Digital Health Act (currently under consideration). This act is envisioned to serve as a central framework for governing and promoting digital health development in Thailand, encompassing technology, citizens’ rights, and data security. Simultaneously, it seeks to provide a solid foundation for advancing the country’s digital health system, enabling seamless access to healthcare services through online channels.
1) The Smart Hospital Project, initiated by the Ministry of Public Health in 2024, represents a significant milestone in modern healthcare services. It primarily seeks to promote the efficiency of Thailand’s health system through the adoption of digital technologies, demonstrating the country’s efforts to align the system with global technological advancements. This project is built on four key components: 1. Infrastructure and data management, which encompasses essential technologies, such as servers, cloud systems, networks, and health information systems (HIS); 2. Management and technological integration, which ensures interoperability between systems, such as personal health records (PHR), payment systems, and financial management systems; 3. Service delivery, which utilizes technologies to ensure patient convenience, such as online booking, paperless processes, telemedicine services, and electronic certifications; and 4. Cybersecurity and governance, which prioritizes the protection of health data and ensures that project management adheres project management to established standards.
2) The Treatment Anywhere with one ID card Scheme enables citizens to access healthcare services more easily using only their national ID card at any healthcare facility – whether a public hospital, private hospital, or general clinic. This contributes to an integrated healthcare system, ensuring equitable access to basic healthcare services without financial concerns. The roll-out of the scheme is divided into three pilot phases: Phase 1 (January 2024) implemented in four provinces; Phase 2 (March 2024) expanded to 12 provinces; and Phase 3 (May 2024) extending to 46 provinces. Full national coverage across 77 provinces is expected by the end of 2024. Under the Treatment Anywhere with one ID card Scheme, a dashboard is utilized to monitor and assess PHR connectivity. This allows for continuous and easy access to healthcare services with a single national ID card at any healthcare facility. Additionally, it provides an overview of PHR connectivity, enabling physicians to access comprehensive patient records. Ultimately, it contributes to appropriate treatment planning and minimizes redundancies in care. After seven months of implementation, the scheme has achieved favorable outcomes: 1. Reduced waiting times: streamlined services with greater efficiency; 2. Reduced financial burdens: easing out-of-pocket expenses for the public, especially those with low incomes; 3. Improved treatment efficiency: a reduced rate of patient and family absenteeism; and 4. Broader service accessibility: increased access to primary healthcare services at private clinics.
3) The integration of Telemedicine into Thailand’s healthcare services, particularly during the COVID-19 pandemic, has been endorsed and promoted by government policies, significantly contributing to increased public access to remote healthcare services. Telemedicine has lessened the strain on the public health system, reduced hospital overcrowding, and provided greater convenience for patients. The trend of telemedicine services is expected to continue growing in the years ahead.
Crucial factors contributing to the success of digital health solutions include: Data governance: ensuring the efficient and secure management of personal health information, together with interoperability across systems; Data privacy and security: protecting personal data in compliance with standards; Exchange of health information among agencies; Enhancement of health and digital literacy among the public and healthcare professionals; Feasibility and scalability to wider target groups; User adoption; Proven benefits and clinical validation: the program should demonstrate tangible benefits supported by academic research; and Budget: adequate budget allocation ensures continuous and effective project implementation.
In the digital era where information and communication technology is an integral part of daily life, the digital divide has emerged as a global challenge. It is attributed to various disparities, which hinders certain groups’ access to technology. Key contributing factors encompass: economic factors, where those with low income possess limited purchasing power, preventing them from affording technology and internet services; geographical factors, where those living in remote or rural areas face difficulty in accessing internet; cultural factors, with the older populations less accustomed to using technology; and infrastructure factors, with areas facing inadequate technological infrastructure, such as internet towers.
Digital health in Thailand has been supported by health start-ups and agencies, such as the Ministry of Public Health, ThaiHealth, the WHO, and the WHO-Royal Thai Government collaboration strategy (WHO-CCS DigitalHealth)
• The SAANSOOK Digital Health Platform is presented by Assoc. Prof. Dr. Chujit Treerattanaphan, Associate Dean for Research, School of Architecture and Design, King Mongkut’s University of Technology Thonburi (KMUTT), elaborating on the application designed to support holistic health care.
The SAANSOOK Digital Health Platform’s main features include tracking health behaviors, analyzing data, and providing personalized recommendations, enabling users to adjust their behaviors and achieve better health in the long term. Beyond this, the digital platform functions as an invaluable tool for collecting comprehensive health data, particularly on Thai people’s health behaviors, which can be utilized to predict the overall population health trends. The insights derived from analysis serve as invaluable resources for formulating policies and supporting health promotion activities that align with various lifestyles among individuals.
Additionally, through consistent collection of users’ health behavior data, the platform serves as a health database for the Thai population, aiding in the prediction of overall health trends and the formulation of policies to support health promotion activities tailored to various lifestyles.
The platform’s target users include not only the general public but also a wide range of groups: organizations: encouraging employees to be involved in health promotion activities to foster a workplace environment conducive to good health; communities: focusing on health promotion at the community level, particularly among older populations with limited knowledge and access to technology; students: fostering self-awareness of personal health, with a focus on common health issues among school-aged children, such as BMI, muscle building, weight loss, and overall health care; hospitals: serving as a health database to assist in the care of patients with chronic diseases; and health clinics: streamlining the recording of patients’ health data.
The SAANSOOK platform is designed to assist users in achieving their health goals through various features tailored to individual needs. It serves the needs of different users: Seekers, referred to those just beginning to care for their health; Specialists, those with prior health knowledge, and Wholesome Enthusiasts, those dedicated to long-term health improvements. The distinctive feature of the platform lies in its customization capabilities, supporting users at every stage – from the start to goal achievement. Users can also join community groups to share experiences while drawing inspiration from others, while gaining an overview of their mental and physical health. This platform not only aids users in attaining short-term goals but also cultivates long-term healthy habits.
A survey conducted with 21 organizations comprising 1,299 participants revealed that the SAANSOOK platform offers significant value at both individual and organizational levels. For individuals, it serves as a “health coach”, fostering awareness of the significance of health and inspiring them to take better care of their health. Additionally, it aids with defining personalized health goals and tracking their progress effortlessly. In terms of human resource management, SAANSOOK empowers organizations to promote employee health effectively. It establishes connections among employees through an array of activities, allows for personalized goal-setting, and provides clear performance evaluations. For organizations, the platform allows them to develop cost-effective health promotion programs, focusing on improving employee health and minimizing health expenses in the long term.
The SAANSOOK platform integrates with popular devices or applications, such as Garmin, Fitbit, Apple Health, Google Fit, and Huawei, to collect users’ health data. Moreover, it utilizes AI technology to analyze dietary and health information, enabling accurate and personalized recommendations tailored to users’ needs. The platform collaborates with various partners, such as universities and organizations seeking to promote workplace health, government agencies to access national health data and resources, and the private sector, such as restaurants and franchises, to offer health-promoting products and services. For more information on SAANSOOK and how to download the application, please go to: https://www.creativecitizen.com/saansook/
• In addition, alcohol consumption remains a pressing social issue severely undermining people’s health and quality of life. To tackle this, ThaiHealth has collaborated efforts with the Alcohol (Stop Drink) Helpline Centre and its partners to develop Nong Tangjai, a chatbot designed to assist individuals in quitting drinking.
Nong Tangjai operates as an AI-powered chatbot to provide counseling and support for those wishing to quit drinking. Available 24/7 through online platforms, it functions as a companion offering valuable advice, such as information on the dangers of alcohol consumption, motivational support, strategies to curb cravings, and referrals to additional resources, such as smoking cessation clinics or support groups.
The Call 1413 Alcohol (Stop Drink) Helpline in Thailand began in 2003, with ThaiHealth supporting the establishment of the Stop-Drink Network Office to reduce alcohol consumption during various festivals. In 2006, a telephone-based counseling center was launched to provide counseling and support for those wishing to quit drinking. Later in 2012, the program was transferred to the Department of Mental Health under the Ministry of Public Health to enhance service quality and safety. To achieve this, it adopted the WHO’s SBIRT approach – involving screening, brief intervention, and referral to treatment. From 2014 to 2020, the program was operated by the Department of Psychiatry at Phramongkutklao Hospital to explore systematic approaches to treating alcohol dependence. Since 2021, the program has been overseen by the Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, aiming to develop service systems and foster collaboration with partners to enhance service quality through innovative solutions.
The available services for alcohol or addiction cessation include: 1. Helpline accessible 24/7 for assistance or inquiries; 2. Social platforms, such as websites, Facebook, and LINE; 3. Chatbot, computer programs designed for human interaction, typically utilized to address basic inquiries or common issues; and 4. Follow-up calls, conducted to track progress on issue resolution or to gather feedback on service satisfaction. These aim to ensure accessibility for those in need of support. The service process includes three main steps. 1. Screening by ASSIST: This involves assessing the severity of alcohol consumption, enabling specialists to determine risks and treatment needs accurately. 2. Brief intervention and referral to treatment: In case the screening results indicate a need for intervention, specialists provide initial counseling to explain the impacts of alcohol consumption and highlight the significance of treatment. Additionally, patients are referred for appropriate care based on their conditions. 3. Motivation Enhancement Therapy (MET): This approach is an integral part of this model, focusing on motivating patients to change their behavior. Specialists employ various strategies, such as goal-setting, advice, and emotional support, to empower patients to overcome challenges and achieve sobriety.
Nong Tangjai provides a wide range of features to aid individuals in quitting alcohol: 1. Articles on quitting alcohol: it provides valuable information on the dangers of drinking and practical methods for quitting, together with tools for users to track their drinking behavior; 2. Contacting staff: This allows users to request consultations or further information via two channels: phone calls by pressing “Call 1413” to contact staff directly during operating hours (8:00 AM to 8:00 PM) or leave a message, which can be done via the “Leave amessage” function in case of contacting outside of the service hours; 3. Checking medical facilities and coverage schemes: This provides links to healthcare systems, allowing users to locate medical facilities which offer treatment for alcohol-related issues and check their healthcare rights with ease; 4. Access to therapy: This function facilitates greater access to therapy services for users; 5. Alcohol intake calculator; 6. Drinking log; and 7. Professional use.
Between June 2023 and September 2024, 1,636 individuals accessed counseling services. Among these, 289 of them were screened for alcohol consumption risks, with 62% being male and 38% female. Furthermore, 102 cases – 74 males and 28 females – were referred for treatment of alcohol-related issues. Risk levels identified among the screened individuals were classified into three levels: high risk at 29%, moderate risk at 42%, and low risk at 29%.
A pilot study was conducted to examine the effectiveness of Nong Tangjai in providing counseling for drinking issues among users of the 1413 Helpline service. It involved 20 participants. The findings revealed a greater reduction in drinking days among those using the Nong Tangjai chatbot, compared to those who did not. The severity of drinking-related issues showed a decline.
In addition, the other pilot study sought to explore the effectiveness of a chatbot system for alcohol counseling among 50 university students. The results provided insights into user satisfaction, including both positive and negative feedback. The majority of positive feedback was highly favorable, with remarks such as: “Nong Tangjai’s responses are useful and appropriate”, “It provides actionable information”, “It is easy to use”, “Topics are well-organized”, and “Nong Tangjai is friendly.” On the other hand, negative feedback received moderate agreement: “Nong Tangjai is too robotic”, “Nong Tangjai’s responses are inaccurate”, and “Nong Tangjai cannot handle errors.”
While the Nong Tangjai chatbot has exhibited its promising potential in aiding students with alcohol-related issues to some extent, some limitations need to be addressed, including enhancing its capability to handle complex inquiries and ensuring its responses feel more natural.
For more information on Nong Tangjai chatbot and how to LINE add the chatbot, please go to:
https://www.hfocus.org/content/2023/06/27837
