Lesson 2 reading 03

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journal homepage: www.intl.elsevierhealth.com/journals/ijmi

Electronic healthcare communications in Vietnam in 2004
ˆ` a , H. Lee Seldon b,∗ , Hoang
´ Ch
`
Vu˜ Anh Tran
Ðuc
a
b

a

, Kiˆen Phan Nguyeˆ˜ n a

Biomedical Electronics Center, Hanoi University Technology, 1 Dai Co Viet Road, Hanoi, Vietnam
Peninsula School of IT, Monash University, McMahons Road, Frankston, Vic. 3199, Australia

a r t i c l e

i n f o

a b s t r a c t

Article history:

Background: There is a lack of literature about health information systems (HIS) in “devel-

Received 12 May 2005

oping” countries, including Vietnam. However, computerization and network development

Received in revised form

are proceeding in these places, although not in a systematic, transparent way.

13 December 2005

Objective: This is a preliminary overview of HIS’s and healthcare communications in Viet-

Accepted 3 January 2006

nam’s four-tiered public healthcare system. It is to indicate the direction that nation might
take in order to establish a modern, standards-compliant, national HIS.
Methods: We conducted site visits and interviews in Hanoi and nearby provinces. Additional

Keywords:

information was derived from publications of the Vietnamese government and the United

Vietnam

Nations.

Healthcare communications

Results: Many of the top-level “central” hospitals have HIS’s, although their quality and daily

networks

usage varies. Fewer provincial hospitals have networks; district hospitals have a few stand-

HL7

alone computers, and commune health centers have no computers. Patients often go directly
to higher-level providers, due to a widely held perception of better care at such sites. Communications among healthcare units are largely on paper, consisting mostly of administrative
matters and some hand-written patient referrals. Telephones are used for discussions of
specific matters. Internet connections are almost all dial-up and often belong to individual
staff members rather than the healthcare units. Lower-level units derive much of their general medical information from television and newspapers. However, there is considerable
interest in computerization among healthcare workers at all levels.
Conclusion: Familiarization with computerized communications, i.e., training and hardware
at all healthcare levels, must be the first step towards a modern healthcare communications
network in Vietnam. The skills to do this already exist. The aim of such a network must
be to raise the level of information and quality of care at the lower levels. Adherence to
international standards, such as HL7, from the beginning would enable the country to bypass
many years of haphazard development.
© 2006 Elsevier Ireland Ltd. All rights reserved.

1.

Introduction

Little has been published in the international press about the
healthcare system in Vietnam, and those articles which have
appeared have been mostly concerned with the effects of the

∗

re-structuring of the system in the 1980s and 1990s [1–3]. It is

beyond the scope of this work to review the entire system, but
several aspects are relevant to the aim of describing healthcare
communications, the participants, and the information which
is or should be transmitted.

Corresponding author. Tel.: +61 3 99044336; fax: +61 3 99044124.
E-mail address: (H.L. Seldon).

1386-5056/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ijmedinf.2006.01.002


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The re-structuring replaced the universal public healthcare
system with an arrangement involving reduced public care,
introduction of fee-for-service, and the expansion of private
providers. The public system has retained its tiered structure
of:
• large, central, and specialist hospitals directly under the
Ministry of Health (MoH) and located mostly in Hanoi or
Ho Chi Minh City;
• provincial hospitals (in each of 64 provinces);
• district hospitals (∼50–100 beds, consultation and treatment rooms; staffed by doctors, nurses, administrators);
• commune health centers (four to six beds, delivery room,
medicine cabinet; staffed by doctors, pharmacists and
nurses; do not treat any serious cases, which are transported
to the district hospitals, often by motorbike). The commune
health centers also pay allowances to “Village Health Workers,” who are volunteers involved largely in immunization
and family planning.

There are 26 “central” hospitals. The distinction between
provincial and district hospitals is not so clear as the hierarchy
implies; it is based more on the number of beds and facilities
than on geography. They are all managed by the provincial
departments of health, and there are 800 of these. Finally,
there are over 10,000 commune health centers, making an
average of about 13 such for each provincial/district hospital.
Since the re-structuring, utilization of the public system
has decreased significantly, at least at the lower levels [2]. The
top level may be over-utilized for a variety of reasons, including patients’ perception that these hospitals provide better
care [3].
In contrast, the private sector appears to comprise a large
number of individual providers of various sizes, with no apparent regulation or system. Although patients often prefer private providers, due to a perception of greater accessibility and
better care [3], at least in the case of tuberculosis (TB) this may
not be justified. Private practitioners have a poorer record in
the diagnosis and treatment of TB, due in part, by their own
admission, to poor record-keeping, lack of standardized protocols for diagnosis and treatment, lack of expert supervision,
etc. [4]. Several of these deficits could be linked to a lack of
health information systems and communications.
The MoH has a schedule of fees which depend on care
level and economic levels of the regions. However, individual
provinces, hospitals and even commune health services are
allowed to add their own fees to support themselves [2], so
there is no unified fee structure. The services and drugs which
incur fees vary widely from province to province or commune
to commune. (This is, however, not unlike the situation at the
primary care level in Australia, where individual practitioners
are allowed to determine their fees beyond the fixed Medicare
rebate.)
Continuing education, whether medical or technical, is

problematic [2]. The Ministry of Health lacks the educational
and communications infrastructure to provide unified training or to monitor knowledge levels, even via a professional
registration system. The Ministry provides training programs,
but with little standardization. External donor programs provide some training, but this tends to be focussed around spe-

765

cific projects or illnesses, e.g., TB or HIV, and to be designed
by the donors, again with little coordination with other programs. Training in information systems by MoH apparently
does not exist. On the other hand, in 2002 an agreement was
signed between the MoH and the Ministry of Education and
Training (MoET) for the latter to provide technical training in
the healthcare system. The MoET has contracted some universities, e.g., the Hanoi University of Technology (HUT), to
manage the training. HUT has in turn appointed its Biomedical Electronics Center (BME) to do technical training for some
hospitals. To date (2004) almost all the training provided by
BME has been linked to purchases of new medical devices and
has been in Hanoi.
Prevention programs are welcome, but suffer from a shortage of funds, as they do not collect fees. Fees charged in the
public and private sectors go only to support cures of health
problems, rather than prevention [2,3]. (This again is similar
to the situation in Western countries.) Preventative healthcare, more than perhaps any other discipline, relies on the
dissemination of information to the public and the collection
of information from the public.
Anecdotal evidence indicates considerable reliance on selftreatment or treatment by untrained friends, relatives or
shamans [3]. This may be due partly to financial considerations, i.e., the impression that doctors are more interested
in maximizing their profits than in providing quality service.
Also, visitors to a clinic do not always receive an examination
by a fully qualified doctor, but often by an “assistant doctor” or
other paramedic, which reduces their trust in the service being
provided. Doctors often dispense medication themselves as an

integral part of consultations, and as a supplement to the doctors’ incomes. Many medications, including antibiotics, are
purchased over the counter [3]. This unregulated over-use of
medications can, of course, lead to numerous new problems.
Any attempt to regulate the dispensing of medication would
require information and communications systems.

2.

Background

Although Ladinsky et al. [2] write about “Health Information
Systems,” they mention statistics and data (or lack thereof),
evaluation, planning, etc. The lack of systematic or standardized data collection implies that any statistics may be unreliable. Numbers may be reported to fulfill expectations or to
enhance the status of the reporting body, rather than to reflect
reality [3]. No mention is made of any communications infrastructure, electronic records or such. In the absence of this,
planning becomes very difficult.
The recent SARS and “bird flu” epidemics have emphasized the urgent need for reliable record-keeping and reporting
mechanisms within the healthcare system.
This study was undertaken to understand the current
(2004) status of communications in Vietnam’s public healthcare system. Due to the unregulated and sometimes nontransparent nature of the private healthcare sector, that has
been omitted at this time. Following the determination of the
status quo, technical, and social factors influencing the establishment of a realistic, reliable reporting system are discussed.


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Permission for this project was obtained from the Faculty of
Electronics and Telecommunications, the International Relations Office and the Rector of Hanoi University of Technology,

and from the Faculty of Information Technology of Monash
University.

3.

Methods

The current state of electronic communications in the public healthcare system was assessed by interviews with people and organizations who could provide information about
their own or other healthcare units. Some of them are
included in Acknowledgements. Formal visits to hospitals
were not conducted due to organizational hurdles. (In a reversal of the agreement between the MoH and MoET mentioned above, each official visit to talk to hospital staff
required written permission from the MoH. The authors were
required to ask permission first from university offices, then
from the MoET, and then from the MoH.) The interviews
were in Hanoi and the provinces of the northern part of
Vietnam.
Although the interviews were not formally structured, the
questions derived from the following list:
(Q. 1) Does this healthcare unit have
(A) computers?
If the answer was “yes,” then the location, users and
usage, software, network structure, etc. were discussed.
If not, then they were asked if plans to purchase
computers existed.
(B) a fixed-line telephone?
(C) a fax?
(D) a mobile phone?
(E) a typewriter?
(Q. 2) How are patient records kept and filed (paper, computer,
not kept, etc.)?

(Q. 3) With whom do you communicate often regarding
patients (other hospitals, doctors, friends, etc.)?
(Q. 4) How do you communicate with another doctor, or order
a test, or refer a patient (letter, telephone, fax, mobile
phone, email, . . .)?
(Q. 5) If a patient came to you and said that he had earlier
visited another doctor or hospital, would you contact
the other doctor or hospital? If so, how (letter, etc.)?
(Q. 6) How do you find information about diseases or treatment (books, journals, television, www, etc.)?
(Q. 7) Do you receive information about diseases and treatments? If so, from whom and how (from hospitals, MoH,
UNDP, UNICEF, WHO, etc. by newspaper, mailed report,
email, etc.)? How do you prefer to receive information?
(Q. 8) If the level of computerization or electronic communications was low, the interviewees were asked if the staff
of the unit were interested in these technologies or had
undertaken any steps to acquire them.
It was conceived to not only establish existing structures,
but also to determine existing and preferred communication
methods and partners, whether they are currently used or not.

In several cases the questions about computerization did not
need to be asked, as the situation was clear.
The number of interviews was limited, due in large part
to the restrictions mentioned above. In depth interviews were
conducted at one Ministry of Health Department, one general, two provincial/district hospitals, and three commune
clinics. Visits to two additional general and one additional
provincial/district hospitals did not include official interviews.
Private citizens, including a few doctors, were informally interviewed. Several interviewees provided information not only
about their own service unit, but also about others.
The limited number of interviews could introduce a “sampling error” in view of the total numbers mentioned above, and
that must be kept in mind. On the other hand, the answers

to our questions were consistent and reflected what we saw
and experienced. Some interviewees volunteered information
about other service units; for example, commune health center workers were familiar with all of the centers in their district
and said that there was no significant difference among them.
This is not intended to be a statistical analysis, as the state of
the system is clear without any tests of statistical significance.

4.

Results

The results of our survey are summarized in Table 1.
There has been some development of HIS’s in Vietnam.
˜ˆ in Ho Chi Minh
Some of the central hospitals, e.g., Cho. Ray
City, the National Cancer Hospital, and the Dental Hospital in
Hanoi, have HIS’s developed by the MoH in collaboration with
the United Nations Development Program (UNDP [5]). Some
provincial hospitals also have HIS’s, e.g., Thai Nguyen, Vung
Tau, and Tien Giang. These systems all have similar basic
structures, with linked databases for a patient master index
(“BN”), consultations and emergency (“PIC”), finance (“TC”),
radiology and pathology (“XN”), and pharmacy (“Duoz”). Some
HIS’s have “external links” to the MoH, district hospitals, and
the Internet (although the nature of these links was not specified by the MoH). The implication from the list of hospitals is
that some central and some provincial hospitals do not have
HIS’s.
Descriptions of “typical” institutions are useful for understanding healthcare information systems and communications. One central hospital has about 500 beds and covers most
categories of care for a catchment area covering more than
one province. It employs 100 doctors and 300 nurses. Many

of the doctors have postgraduate degrees. It includes radiology and laboratory pathology, each with modern machines
which, however, are not connected to the hospital LAN. Forty
percent of the patients present directly to the hospital, rather
than being referred, because the higher standard of care and
comfort is visible, and the fees are not significantly higher
than at “lower category” institutions. Each patient is assigned
a numerical ID (and is given a card with the number), and
hardcopy patient files are stored by ID. The hospital has extensive links with other countries and exchanges students and
staff with them, but these links have been developed by
the hospital itself with various international organizations.
It is partly through these links that the staff have become
acquainted with HIS’s; in addition, the hospital has an infor-


Table 1 – Summary of computerization and communication in Vietnam’s public healthcare system
Level

Type of institution

Has HIS?

Internet
connection

Computer
hardware

“General” or
National
Specialty

Hospital

Yes, many

Dial-up

PCs around the
hospital

Province

Province
hospital

Yes, some

Dial-up or
Internet cafe,
no internal
email system

PCs, network in
some cases

District

District
hospital

No

Dial-up, but
often only by
individual staff
members

PCs located in
administration
area

Vietnamese
HIS, Oracle,
Microsoft
Windows,
Word, Excel
Microsoft
Windows,
Word, Excel

Microsoft
Windows,
Word, Excel

Communication
partners

Communication
modes

Vertical to

MoH, province
and district
hospitals

Paper letter,
floppy disk

Statistical reports
(monthly, quarterly,
annual), referrals

Vertical to
MoH, general
or district
hospitals

Paper letter

Statistical reports,
referrals

Vertical to
province and
communes,
horizontal to
other districts

Paper letter,
floppy disk

Regulations, notices
of training and
workshops, referrals
(from templates),
statistical reports
Receive information
from MoH
Receive general
information

Fax· · ·
Telephone· · ·

Commune/
Village

No

Health center

Village Health
Worker

Microsoft
Windows,
Word, Excel

N/A. You can
buy medicine
with or without

prescription.

Fax· · ·

No, but one
may be located
at People’s
Committee

NA

Vertical to
district,
horizontal to
other
communes

Paper letter
(often handwritten)· · ·
Telephone (one
at People’s
Committee,
one at Health
Station, one at
Post Office, few
private)· · ·

Reports and notices as
above; referrals,
receive general and

some specific
information, announce
emergency case

No

No

Commune

Verbal (at
weekly
meetings),
paper

Reports, letters,
notebooks with
records

Dial-up, but
often only by
individual staff
members

PC

No

No

NA

No

Telephone· · ·

Updated price of
medicine
Receive information
from MOH on
medicine trade

767

NA, not applicable.

Pharmacy
(mostly private,
some
self-supporting
hospital ones)

Communication
content

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National
Ministry of
Health

Computer
software


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mation systems department with several qualified staff. The
hospital data network is about 80% complete; PCs are located
around the site. The main software package is an extensive
HIS called MedisoftTM , from a Vietnamese company, Links Co.
Ltd. ( (This is in contrast to
the MoH/UNDP package mentioned above.) It is a client/server
system built on an OracleTM DBMS; this version runs on
Microsoft WindowsTM . According to the company’s web site,
the product is installed in about 20 hospitals around Vietnam.
It was selected by the hospital, rather than by the MoH. The
databases include patient demographics, financial accounts,
test results (which are entered manually), paper record index,
etc. Diagnoses are even coded in ICD-10. Data are entered
mostly by nurses and administrative staff. Numerous views
are possible, including individual patient records, discharge
summaries, and statistical summaries. However, in contrast
to this sophisticated HIS, links to the Internet are dial-up (to
a government Internet Service Provider, ISP), and communications with all other healthcare units are on paper or by
telephone or occasionally via floppy disk.
A province hospital may comprise several buildings containing a few hundred beds. It also has pathology and radiology departments, although the latter is basically restricted to
plain film. Although a few such hospitals have a HIS, generally

computerization is still minimal, with a few PCs located in the
accounting and perhaps administration areas. Clearly there
is no dedicated Internet connection. Staff are, of course, well
trained medically, yet examinations, test orders and results,
etc., are all on paper forms filled out by hand. Patient accounts
are also paper forms with amounts hand-written (and payments are in cash). Communications with other units are as
in the big general hospitals.
A district hospital has about 100 beds; the largest category
of care is obstetrics, followed by geriatrics (often mental problems) and then pediatrics. One sample district has 243 paid
healthcare workers, of whom 105 are based at the hospital,
and of these 27 are doctors. All records and documents are on
paper, and most are hand-written. Patient records are filed by
date. (At the initial visit to a hospital, patients are asked to buy
a booklet, like a school exercise booklet, in which the staff then
write notes. The patients are told to bring the booklet with
them on each subsequent visit. This, interestingly, represents
a form of portable, patient-centered health record towards
which many “technologically advanced” nations are striving.)
There are three stand-alone PCs, one (very old, with 8 MB
of RAM) for general typing and documents, one for accounting, and one for data collection and statistics (using Microsoft
ExcelTM ). The last one had a boot-up problem for 2 months
before the interview, and no support was available. Three staff
members are slightly familiar with PCs. There is no Internet
connection. Data and statistical reports may be delivered on
floppy disks via the post office. There is essentially no transfer of individual patient records to (or from) other healthcare
units, although answers to questions about specific cases can
be gathered by fixed-line telephone. General medical information or education is often gathered from the radio or television.
The hospital staff members are definitely interested in computerization and would like training.
A typical commune health center is surrounded by about
a dozen villages within a 3–7 km radius. It has six staff mem-

bers, of whom one might be a doctor, a couple are pharmacists, and a couple are nurses. Each village has a (volunteer)
health worker. During winter the patients are mostly geriatric or pediatric. Patient records are on paper and are filed by
date; any letters are written by hand. Some records are kept
by the Village Health Workers. General healthcare information is gathered during monthly meetings of all the directors
of commune health centers in a district. It is also received
from visiting speakers (often from donor organizations, especially for preventative care), from television or other medical
personnel. For assistance with specific cases, a staff member telephones the district hospital or other commune health
centers. Statistical reports are delivered quarterly to the district during one of the monthly meetings. Orders for drugs are
made by a monthly “proposal” (estimate) on paper and delivered to the district. Information from the MoH passes through
the province and district levels before reaching the commune
health centers. Information exchange with the village health
workers, besides at monthly meetings, is by face-to-face conversation after travel to or from the village. The commune
health center has one fixed-line telephone, no PC, no fax, and
no mobile phone. The staff is interested in computers and
would like one for patient records. They have submitted a proposal for training to higher levels, but have not as yet received
any.
Overall, computer hardware and software are present at
most levels of Vietnam’s public healthcare system, but only
sporadically at lower levels. District hospitals and commune
health clinics are too small to warrant investment in networks.
Throughout the system, PCs use the Microsoft WindowsTM
operating system and some Microsoft OfficeTM products.
The situation for Internet connections is not entirely clear.
If any permanent, high bandwidth connections exist, they
would be at some central hospitals, but we have not encountered any such. Connections below this level are dial-up, and
may often be private connections of individual staff members, rather than institutional connections. The commune
health centers apparently do not have connections (or computers on the premises). However, the Internet is growing
rapidly in Vietnam, and several large, private Internet Service Providers exist. Internet cafes advertising ADSL connections seem to be in every town with paved roads, and they
appear to be very popular, although mostly with teenaged

children. In any case, this aspect of health information systems may change very quickly, at least around cities and larger
towns.
Much of the communication among units in the healthcare
system comprises reports, notices, and other administrative
material. Most communications are on paper and are sent via
the Vietnamese postal service. Many reports and referrals are
hand-written; at higher levels some are typed by administrative staff. Reports tend to follow a hierarchical path, with districts reporting to provinces, which collate the data and then
report to the MoH. There are relatively few patient-specific
messages such as referrals. Commune health centers send
written referrals with patients who must be transferred to
higher level facilities for treatment. Such centers within travelling distance of Hanoi tend to transfer patients directly to
the large, central city hospitals rather than to the next district
or provincial hospital.


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5.

Discussion

As described in Section 4, communications among providers
in Vietnam’s public healthcare system are largely on paper and
largely administrative in nature.
As can be inferred from Section 1, the system would benefit
from the creation of a faster, more standardized communications network. Given the tendency toward overloading at the
upper levels of healthcare and under-utilization at the lower
(cheaper) levels [6], a main aim of any healthcare information
network must be to raise the quality of care at the lower levels
by providing more and better medical information and links

to higher levels for discussions of specific cases. In addition, a
network for reporting could be useful in:
• assessing the status of communicable diseases, e.g., SARS
or “bird flu”, and/or serious diseases (in both the public and
private sectors);
• assessing the use or over-use of certain drugs, e.g., antibiotics;
• assessing and standardizing the training level of medical
and allied health practitioners.
When thinking about a future digital healthcare communications network in Vietnam, there are two general categories
of problems to solve. The first is obviously the existence of the
network infrastructure. The second is the use of computerized
communications by the healthcare personnel.
The current infrastructure imposes several constraints on
any system to be implemented. Given the general shortage of
stable network connections and computers, especially at the
lower levels of the system and in rural areas, a realistic, reliable electronic communications system may not rely on fixed
or permanent computer networks. Indeed, any such system
will first require placement of PCs in district hospitals and
commune health centers. There is a possibility that this might
be approached; there are some commercial initiatives (e.g., PC
´
´
Thanh
Giong
) to place a million lowcost PCs with young people in rural areas by 2009. However, the
PCs must be purchased by the rural population, so they may
not be able to afford the hardware without financial assistance,
e.g., from donor organizations or the national government. It
remains to be seen if some of these will find their way into
healthcare centers; we have not found evidence of any such

plan.
The use of telephones (PSTN) as interfaces would require
either computers and modems or voice recognition systems.
The latter can be excluded at present as too complex, but the
computer-and-modem approach is very feasible at present.
Many of the units which already have dial-up connections to
the Internet do not use them for patient-specific healthcare
messages or general medical information—an example of the
second problem mentioned above.
Although mobile phones are very prevalent in the cities,
they are still rare in rural areas. A network which accepted
them as “user interfaces” would be more accessible than a
fixed-line network, but only in metropolitan areas. However,
the supporting infrastructure is being extended into rural
areas, although the final coverage may be affected by the

769

inability of the rural population to afford mobile phones. (Average annual income for farm workers is much less than the
national average of US$ 350.)
So the physical infrastructure is being established, albeit
slowly. The choice of software will likely be strongly influenced
by financial considerations, and thus possibly by donor organizations. Robust, open-source software would warrant serious
consideration, and nowadays much such appropriate software
exists. Proprietary systems, even those created in Vietnam, are
financially unaffordable by any of the lower-level healthcare
units.
However, the second problem – that of usage of digital communications by the players – must also be solved. For many
centuries nations like China and Vietnam have had a cash
economy, and even today the penetration of “invisible” transactions like credit cards is significantly less than in Western

countries. It is impossible to quantify philosophy of trust in
transactions involving visible, tangible goods and currency.
This mitigates against the use of electronic data communications on the part of both the health care provider and the
patient. On the other hand, the uptake of mobile phones in the
cities proves that the people are quite capable of establishing
and using complex communications technology. So any use
of such modes of communication in healthcare must be preceded or accompanied by a process of familiarization, at least
in more traditional regions.
So to approach the problem of usage, we note that the
most frequently encountered applications are Microsoft Word
and ExcelTM (the latter for tables of statistics). As hardware
is installed in more healthcare units, usage of these applications will certainly expand. A simple additional measure for
communications could be the provision of email software and
dial-up Internet accounts to as many healthcare units as possible. This would follow the current, sporadic use of email,
largely by individual staff members.
Usage can certainly be accelerated by training staff at all
levels to use computers and electronic systems for communication. The lack of such training was seen by many as a
major obstacle to computerization. As mentioned in Introduction, a framework for training already exists in the agreement
between the MoH and the MoET. However, even a small scale,
systematic program across a healthcare region has yet to be
implemented. (Of course, this cannot happen until a plan for
hardware installation is also implemented.) If such training
could be coupled with the “million PCs” initiative mentioned
above, then that might actually create the necessary basis
of computerized, “literate” healthcare units. From that to a
healthcare information network would then not be such a
great step.
Finally, another factor in digital healthcare communications warrants a mention. HL7 version 2.x is becoming
accepted worldwide as the “standard” for healthcare communications, and there is a chance that version 3.x will gain
acceptance in the coming years. Therefore, any system in

Vietnam should comply with these standards as much as
possible. (This represents a challenge, but also an opportunity.
If the Vietnamese can create a standards-compliant system
from the start, then they can bypass the decades of haphazard and incompatible systems created and later discarded in
Western countries.) On the other hand, the standards have


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been developed for the USA and other Western nations, and
parts of them are not applicable to Vietnam, as well as to other
Third World countries. (For example, in Vietnam pharmacy
orders are rare.) The standards are understood at the technical level; for example, staff at the BME of HUT are currently
studying the HL7 standard with respect to its appropriateness
for Vietnam, and one commercial HIS (MedisoftTM ) claims to
be HL7-compliant (but we were unable to verify this).
Given the constraints mentioned above, it is still too early to
propose or design specific health care networks for Vietnam,
at least beyond those already existing in the large central hospitals. It is now up to the MoH to implement plans to provide
PCs and training to the staff at all levels in the public healthcare system.

Summary points
What was known before the study:
i. Vietnam has had a four-tier public healthcare system
for over 20 years.
ii. Health records, such as they are, have been almost
exclusively on paper.
iii. Patient-related communications have been largely

between adjacent tiers of the system, and have used
paper and telephones.
iv. Some general healthcare information has been distributed hierarchically on paper from the MoH. Lower
healthcare levels have derived much general information from the media.
What the study has added to our knowledge:
i. Computerization is often left to the individual healthcare units, especially at the lower levels. There are few
systems and no integrated systems at these levels.
ii. Network communications between healthcare units
are based on dial-up connections, often belonging to
individual care providers rather than to the units.
iii. Healthcare workers at all levels show great interest in computerization and networking of the public
healthcare system. They are aware of the relevant
applications for health care.

iv. The skills to create a national, standards-compliant
healthcare information system already exist within
Vietnam.

Acknowledgements
We are greatly indebted to numerous people for information
and assistance. Among them are Nguye˜ˆ n Thanh Thuy and
ˆ´ Khoa
Nguye˜ˆ n Thu Ha` of Plan Vietnam, Eng. Nguye˜ˆ n Tuan
(Director, Central Institute for Medical Science Information,
´ Thuaˆ. n (Head, Department of ElecMoH), Prof. Nguye˜ˆ n Ðuc
˜
tronics and Biomedical Engineering, HUT), Nguye˜ˆ n Vieˆ. t Dung
ˆ` Huy I´ch
(Director, Biomedical Electronics Center, HUT), Tran
ˆ Thanh and Tien

ˆ
(Director, Lang Giang District Hospital), Tan
ˆ (Deputy Director, Uong Bi
Lu.c Commune Health Centers, Tan
˘ Ða.i (Uong Bi General HospiGeneral Hospital), Eng. Cao Van
tal), Marie Ryan and many more.

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