After introducing the NHSO in the previous article, today we will focus specifically on the case of hemodialysis information management; addressing the main issues, understanding why they occur, and exploring possible solutions.
What is Hemodialysis?
Hemodialysis is a life-sustaining treatment for patients whose kidneys can no longer effectively filter waste, toxins, and excess fluids from the blood. The process involves drawing blood from the body into a dialysis machine, where it passes through a synthetic filter called a dialyzer. Inside, waste products and extra fluids are removed before the cleaned blood returns to the body. Each session typically lasts about four hours and occurs several times a week. Hemodialysis helps control blood pressure, balance electrolytes, and prevent complications from kidney failure, though it requires precise monitoring and continuous medical supervision.
The programs we will discuss today are the three most commonly used in hemodialysis centers across Thailand. The first one is HD, developed by CHI, the latest version I know of is HD 2.5.1. The second is TRT, developed by Nephrothai, and the last one is 9Thai.
HD 2.5.1 was developed using Visual FoxPro 9 and stores its data in DBF files. CHI has attempted to modernize the program several times by adding functions such as XML export (compatible only with Internet Explorer), ID card scanning for patient information input, and CMD scripts to simplify report exports. The reporting tool, MakeClaim, has been updated to version 5.4.6.
TRT, currently at version 3, was developed using Microsoft Access 97, and its database is stored in MDB format. In contrast, 9Thai was developed using MySQL.
All three programs focus on recording and managing hemodialysis patient information.
Why were three programs developed for the same objectives? The issue traces back to the original HD program, whose core system was designed mainly for Windows 7 and Internet Explorer compatibility. The development team tried to include as many features as possible within the program; however, several important aspects were not fully addressed. For example, the system lacked detailed records of treatment types, additional supplements eg., iron or magnesium intake, and non-NHSO payment information.
To fill these gaps, TRT and 9Thai were later developed as complementary systems. For more information about TRT, 9Thai, see this and this video.
Solution-wise:
As someone who has worked in this field for more than a decade, I believe that a universal and open system should be seriously discussed. An open API standard, such as FHIR (Fast Healthcare Interoperability Resources), is already available and can serve as a model for connecting all systems.
The HD program was an excellent solution for its time, but technology and patient care needs have evolved. Moving toward open standards would not only improve interoperability between systems but also ensure better continuity of care and easier data access for both healthcare providers and patients.
In summary, while Thailand’s current hemodialysis information systems: HD, TRT, and 9Thai; were each developed with good intentions, their fragmented structure limits efficiency and data consistency. These systems reflect different attempts to solve the same underlying problem: how to collect and share patient information accurately across multiple organizations. The next step should focus on integration rather than replacement, adopting open standards like FHIR to enable interoperability among existing platforms. By doing so, Thailand’s healthcare network can move toward a more unified, secure, and patient-centered data ecosystem.