Thai Care Clou d Nemo DMHT SAC A

Thai Care Clou d Nemo DM/HT SAC A M Ahamrop, Ph. D D k in h T Is. B ana. Cnodit h Center Directoorrt is s ly a n A l a c ti s ti t and Sta Data Managemen University n e a K n o h K , h lt a e Faculty of Public H CASCAP re CA Ca Cloud

Data Transfer by Thai Care Cloud User National Health Database Ministry of Public Health User DHS DHS DHS

Data Transfer by Thai Care Cloud User Two ways, Automatic data transfer, Real time manner User National Health Database User Ministry of Public Health User DHS DHS DHS

Toward the National HIS User National Health Database Ministry of Public Health User DHS DHS DHS

Intranet HIS Site Admin • • • Internet Care Cloud Patients Providers Account Apply for an account at. ? ? ? thaicarecloud. org Click Module -> Download TDC Install TDC in the HIS server Operate the trigger in the web service of TDC Any venders can joined TDC via Table view of SQL MOPH required data = Standard data set Each hospital can trigger any other data as required Activate the TDC to transfer the data All are voluntary basis

Background • Thai Care Cloud has been developed based on PHP-My. SQL under YII 2 Framework. • It’s a web application that is free of charge for public use. • Thai Care Cloud originated from CASCAP Cloud at www. cascap. in. th – from one to any diseases. • Key developers are at the Data Management and Statistical Analysis Center (DAMASAC), Faculty of Public Health, Khon Kaen university, under the mission of the KKU's 50 years of social devotion.

Ez. Form • Create and edit unlimited number of online data collection forms • Forms can be shared, hence, easily distributed • Advanced features allow forms as if being created by professional database programmers – – – – More than 20 field types available Hidden/View and Skip pattern Reference across other forms User’s written SQL or Java Script codes Query management tools, Consultation tools Mapping tools to utilize data from existing standard core data set Mapping fields to standard medical terms such as SNOMED-CT, LOINC, ICD-10, ICD 9 -CM, HL 7 • All forms were equipped with full data management tools – – – View and Exporting tools Exploratory data analysis tools Annotated CRF Data dictionary Purify tools • Best complement of existing health information system (HIS)

Ez. Module • Combine several forms created by Ez. Form according to a workflow to generate a single module • A module looks as if an application in the Thai Care Cloud “App Store” • A module can be shared across the network • Standard feature is sufficient for an ordinary module • Advanced module requires a programmer to join the TDC Team. They will develop additional features for the module via Git. Lab and work collaboratively under YII 2 Framework • The TDC module can be transformed to a mobile application using Functions and Libraries provided by TDC Application Kits

Ez. Dashboard

TDC: Thai Database connector Thai Care Cloud Internet Server Install TDC Master TDC Password Slave: connected to internet Firewall HIS Internal Network Request commands from the TDC web service Data recorded based on routine care Data selected based on standard data set EMR • HIS Server Admin • Service provider • Others who were Internet authorized by Site Admin • EMR Owner Summary data or reports • Report for Inbound rejected CID, Name, Surname, House. Num, Village. Num Standard data structure provided via web service Individual record • HIS Server Admin • Service provider • Others who were authorized by Site Admin TDC Web Service Data encoded and encrypted Fields encrypted: Inbound rejected Internet Users 77 Provinces 13 Health Zones 1 Main Server Individual records Summary records Report only monitoring and evaluation -> Health administrators • General report -> Any users

TDC architecture • • HIS needs NOT to open any ports. HIS remains confidentially closed as ever be. No commands from outside can be sent to or executed within the HIS server. TDC inside the firewall of the server requests commands from, and ONLY from, Thai Care Cloud web service where all transactions were encrypted based on SSL (https) security protocol. Transparency: The HIS work load and data retrieved can be monitored via the TDC web service. Membership is absolutely voluntary: The TDC can be terminated at anytime. All data at the TDC can be permanently deleted with NO any effects to the HIS. Also, the membership can be re-initiated at anytime. Flexible and dynamic: TDC Web Service provides tools to create data dictionary for the required or so-called the core standard data set so that the HIS vendor can create the table view accordingly -> data mapping. The data in the table view is the one to be transferred to the TDC architecture allow the data from the HIS to be transferred in real time manner with no interference to and with a minimum load of the HIS server. The trigger algorithms provoke only If there was INSERT, UPDATE, or DELETE to the HIS data that specified by the Web Service. From that, the data will be sent to the TDC database server. That is, TDC tasks involves only data transfer and modify nothing to the HIS data.

What to do to the data on the web • There are tons of tools for data utilization including health and medical care on the cloud- the Care Cloud System. • All data can be seen as either the spreadsheet or the entry form • Each data item has a tool for sharing with the default "Restricted" meaning that only the Site Admin can see it. • Data sharing can be any of these- Site members, Specify members, Public which means all members within TDC. • Data analysis can be done just a click to get results per Standard reporting templates- they display results in real time basis. • Data can be exported and downloaded for further complex analysis or research purposes.

Beyond what is, there is freedom • The data being entered via HIS can be available in the Internet TDC web site of their own- remains belong to them. • In addition to the existing data, users can create any data collection form at any time to collect any data they need. • Each form can be able to link with the citizen identification number (and CID). • These can be done using the Ez. Form of the TDC. • Module Maker can then be used to combine a set of forms to do a single task systematically according to a desired workflow. • The working module become a workbench. • Each module can be shared for collaborative work without border.

TDC Core Syntax • TDC implemented using trigger algorithm • A trigger is a set of SQL statements that is invoked automatically when a change is made to the data on the associated table. • A trigger can be defined to be invoked either before or after the data is changed by INSERT, UPDATE or DELETE statement. • My. SQL Syntax example: CREATE TRIGGER before_employee_update BEFORE UPDATE ON employees FOR EACH ROW BEGIN INSERT INTO employees_audit SET action = 'update', employee. Number = OLD. employee. Number, lastname = OLD. lastname, changedat = NOW(); END

TDC Core Syntax (cont. ) CREATE TRIGGER before_employee_update BEFORE UPDATE ON employees FOR EACH ROW BEGIN INSERT INTO employees_audit SET action = 'update', employee. Number = OLD. employee. Number, lastname = OLD. lastname, changedat = NOW(); END Trigger name Table Views in HIS Table in TDC Server

TDC Core Syntax (cont. ) CREATE TRIGGER before_employee_update BEFORE UPDATE ON employees FOR EACH ROW BEGIN INSERT INTO employees_audit SET action = 'update', employee. Number = OLD. employee. Number, lastname = OLD. lastname, changedat = NOW(); END Trigger name Table Views in HIS Table in TDC Server Standard data set (Data Dictionary) Table Views In the Web service Table Views In the HIS Server • • • • • PERSON ADDRESS DEAD CARD DRUGALLERGY etc.

Thai Care Cloud Overview HIS Server • Database • Enormous number of data tables • Those tables are differ according to venders • Table Views • Each vender designs the table view according to the Data dictionary of the Standard data set in the Web service of their own account • TDC • Works for the web service • Trigger • Created based on the Web service TDC Server • Web service • กำหนด Standard data set เชน 43 แฟม • สราง Data dictionary • มเครองมอสราง Table Views • ทดสอบคำสงทสร าง Table Views จนผาน • สราง Trigger สงให TDC โดยอตโนมต • Monitor activity เกยวกบ Server load และสถานะการสงขอม ล Client • Data Storage and Data Processing • รบขอมลจาก Trigger • จดการขอมล • ใชประโยชนขอมล • Report • Refer • Epi • Vaccine • ANC • Cancer • CKD • Etc. • User added forms • สรางฟอรมเกบขอม ลเพม ดวย Ez. Form • Share forms ไดโดยงาย

Toward National HIS • • Unique Database structure User interface can be tailored to one need One way encoded Ez. Form for user to create CRF by their own Real time data transfer Real time data monitoring and evaluation Provide DSS-Decision Supporting System for policy maker and care provider at point of care

How many data items as of now?

Thai Care Cloud Add on applications to make use of data

Lots of applications for Thai Care Cloud Cancer Care Cloud Palliative Care Cloud DM/HT Care Cloud CKD Care Cloud Patient Social Network Line Group Smart Card Fast Tract สำหรบผปวยโรค ? ? ?

Thai Care Cloud as a tool for wisdom Improve care, Reduce cost, Problem solved Evidence-based practice Data collection, analysis, and report