(Newsletter April 2023)

In 2015, Thailand was ranked as having the 4th highest rate of ill-defined cause of death in the world by the World Health Organization. While the Medical Certificate of Cause of Death (MCCD) is routinely implemented for all facility deaths in Thailand, the quality of cause of death data recorded in MCCDs has remained a challenge for the country and a priority for the Ministry of Public Health (MOPH). While improved training for physicians has been identified as one channel towards improvement, implementation of routine quality assurance of MCCDs has been identified as essential to improve facility cause of death data in the country. 

Starting in 2021, with the support of Bloomberg Philanthropies Data for Health Initiative (D4H), Vital Strategies in collaboration with MOPH of Thailand, supported the design of and testing of a routine MCCD quality assurance system in one province of each health region in Thailand. The system includes the development and roll out of an electronic Medical Death Certificate (EMDC) to replace paper based MCCDs. The EMDC system not only grants access to MCCD data by provincial auditors, but also improves quality of MCCDs through automated checks at point of data entry and is linked to the civil registration database to allow for automated entering of shared patient data. In November 2022, the EMDC system was introduced to health facilities in Bangkok and some of them are using this system.

The data stored in the EMDC system is reviewed by trained provincial MCCD auditors before being sent to the national MOPH database. The physicians issued the MCCD can also re-access and review feedback and corrected MCCDs through the electronic platform. Auditors and physician errors are supervised closely by supervisors through an electronic dashboard and monthly provincial meetings.  Site visits to monitor progress, raise awareness, and conduct further trainings have been held in each province for all health facilities in that province.

With successful completion of testing and positive feedback from physicians, it is planned to propose this implementation to the MOPH management for further instructing other public health facilities to switch from paper based MCCD forms to EMDC. The EMDC platform also allows for individual physicians to view their MCCD error percentage, and the current supervisory dashboard allows for monitoring and evaluation of each province and physician for further intervention targeting. This is an integral step for using the digitalizing tool for improving the quality of cause of facility deaths. Looking forward, Vital Strategies and MOPH are developing a tool, using machine learning techniques, to automatize MCCD audit processes and further improve the quality of COD data derived from the electronic MCCD (eMDC) system.