“Thairefer” Medical Referral Software for Thais Thailand's National Health Security Act Requires That Every Hospital Provi
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1 “ThaiRefer” Medical Referral Software for Thais Thailand’s National Health Security Act requires that every hospital provide high quality medical services to its responsible service area. An effective medical referral system ensurespeople receive the best possible care. A referral system is a two-way process. 1) Outward referral is a process whereby an initiating hospital refers its patientwho requires a higher level of care to a higher level facility. It also means the process that a receiving hospital refers a patient back to an initiating hospital when a patient’s medical condition is improved. 2) Inward referral is a process that a receiving hospital provides, and continues medical services to a referred patient In the past, Thailand’s medical referral processhas had many challengessuch as using the telephone to call a referral hospital but they are unable to answer the call.There have also been problems with written referral notes, such as issuing a referral note without underlying diseases,omitted history of drug allergies, bad handwriting, andloss of attached notes about important laboratory tests,x-ray films, and EKG results. These problems increase unnecessary expenses such as call charges, fax charges, repeating laboratory tests, and repeating x-rays. Also, paper documentsare easily damaged and lost. In order to respond to this problem, many Thai hospitals have developed their own medical referral software. Two types of the software have been developed and used. 1) web-based software; this software is implemented in Saraburi hospital, Sakonakorn hospital, Yasotorn hospital, Bhudhashinaraj hospital, Khonken hospital, and MaharajChiangmai Hospital, and 2) web-service software; this software is implemented in Surin hospital and Roi-ed hospital (Refer Link). Lampang hospital has been developingmedical referral software since June, 2011. Our program is based on Refer Link and named as Lampang Refer Link. The program has continuously developed and already has 30 versions. Due to the popularity of the program use among government hospitals, veteran hospitals, teaching hospitals, and private hospitals, the program’s name was changed to “ThaiRefer” on July 1st, 2012. The “ThaiRefer” name emphasizes that this software belongs to all Thais. Currently, this program is implemented in 1232 hospitals in 53 provinces. 1. Features and Functions of ThaiRefer 1.1. Connects to eachhospital’s database 1.2. Automatically connects to participatinghospital’s Health Information System (HIS) 1.3. User-friendly-screen designation 1.4. Readable and printable referral notes 1.5. Patients’ health information from hospital’s HIS will be automatically synced. 2 2. Functions 2.1 Refer-out hospital . Attaches patient’s photos, X-ray files, EKG files, etc. Automatically attaches laboratory results . Automatically attaches patients’ medical history from the last 3 visits at the OPD and the IPD and history of drug allergies 2.2 Refer-in hospital . Status of referred patients are shown on a monitor at ER prior to arrival at the facility. ER team is able to prepare for a refer-in patient in advance(Seamless) . Conducts teleconference for managing patients before hand . GPS tracks a referral ambulance and monitors the patients’ condition during referral process 2.3 Has standardized CPG for Fast track of STEMI, Stroke, and Sepsis 2.4 Automatically reply on patient’s treatments and diagnosis to a refer-out hospitalRefer back 2.5 Appointment services for a community hospital to refer patients. This system will be linked to a hospital contact center. 2.6 In the case that a referred patient needs a higher level of care, the patient’s health information will be forwarded to the next hospital, by one click. Forward 2.7 X-ray files and EKG files of a community hospital can be sent to consult a specialist in a higher level hospital. 3. Data center and information management 3.1. Shows a real time graphic report 3.2. Shows data for benchmarking among implementing hospitals 3.3. Shows a report in 43 files. 43 files is a standard report that every hospital is required to send to the Ministry of Health This program is currently developing the following functions: 1. Mass casualty support function; we are in the process of developing a function that can support a mass casualty event. When a mass accident occurs, patients are sent to treat in several institutions. This system will help healthcare providers more effectively managethe situation by using patients’ national ID. Therefore, all patients’ physical conditions and referrals will be stored in this system. This information will help trauma managers better manage the mass casualty event. 2. Crisis support function; we are in the process of developing a function that supports a crisis situation such as flood, disaster, etc. This system will automatically search for an available patient’s bed in each hospital, and available medical equipment such as ventilators, ICU monitors, etc. This information will help a trauma manager to better manage patients. 3 We did a survey asking clients about the ThaiRefer software. All clients agree that there are 3 outstanding benefits of this program 1. Simple – This program is easy to use, and is not complicated. Also, it reduces repeated entries. 2. Stable- This program is developed by a programmer team. We have a 24-hr team monitoring security,bugs, and other errors. This program is linked to many types of hospital databases including SSB®, HOSxP®, JHCIS, Hospital OS®, Mis® by Datasoft, HOSxP PCU®, Mrecord®, HoMC®, Songkhla-HIS, BUDHOSP, PMK, Nan Hospital Suit,andiMed 3. Seamless and safe. This program helps the referral process. Patients’ referral documents will be sent automatically to a refer-in hospital and all referral patients’ names and conditions will be shown on the monitor of a refer-in hospital. Using ThaiRefer helps the hospital achieve theMinistry of Health’s hospital quality standard. 1. Decreases mortality rates of referral patients at ER. 2. Decreases waiting times at ER, and for OPD cases, a patient will be appointed and confirmed in advance. 3. Increases accessibility of the patients and increases standard of referral services such as Fast track referral 4. Decreases the expense of repeating laboratory tests and repeating x-rays. This will help decrease the hospital costs of the country. Hospitals using ThaiRefer A figure shows hospitals that using ThaiRefer (updated on 10/2015) .