A Mobile Application and Hybrid Hospital Information Exchange System to Improve Healthcare Access for Persons with Disabilities in Thailand

Abstract

Persons with Disabilities (PWDs) face persistent barriers to healthcare access, welfare services, and timely medical assistance, particularly where hospital information is fragmented across institutions. In Thailand, these challenges are exacerbated by heterogeneous Hospital Information Systems (HISs) across provincial, district, and sub-district hospitals. This study presents the design, implementation, and evaluation of an integrated mobile application and a hybrid Hospital Information Exchange (HIE) system to enhance healthcare accessibility and service coordination for PWDs. The platform integrates a user-centered mobile application (iOS and Android) with a hybrid data exchange architecture (MedEx Hybrid) combining an application programming interface (API) and Message Queuing Telemetry Transport (MQTT). This enables real-time and on-demand data exchange while accommodating hospitals with limited infrastructure. Key functionalities include disability registration, emergency medical service (1669) integration, appointment management, rights notification, service location mapping, teleconsultation, and peer communication. Deployment across 159 hospitals nationwide demonstrates system scalability and interoperability. The system supports secure access to electronic medical records and enables emergency responders to retrieve patient information during SOS events, improving continuity of care. Findings confirm the feasibility of the proposed system and its potential to support inclusive digital health and national healthcare interoperability.

1. Introduction

Persons with Disabilities (PWDs) frequently encounter barriers in accessing essential health and social services, limiting their ability to participate fully in society and maintain a satisfactory quality of life. The Empowerment of Persons with Disabilities Act, B.E. 2550 (2007) defines a person with disabilities as an individual who experiences functional limitations—whether physical, sensory, intellectual, emotional, or communicative—combined with environmental obstacles that restrict daily activities and societal participation [1]. As of 2020, Thailand has more than 2 million registered PWDs, with mobility, hearing, and visual impairments being the most common [2].

Although national policies and legal frameworks guarantee access to rehabilitation, healthcare, education, vocational services, information technology, and social participation, many PWDs continue to face significant challenges. Previous studies and international reports have consistently highlighted that persons with disabilities experience barriers in accessing healthcare services, including limited availability of assistive technologies, fragmented communication with healthcare and government agencies, transportation difficulties, and challenges in navigating healthcare systems and public services [3,4,5,6]. These factors reduce the independence and overall well-being of PWDs.

The 5th National Plan on Quality-of-Life Development of Persons with Disabilities (2017–2021) emphasizes the EQUAL strategy: Empowerment, Quality Management, Understanding, Accessibility, and Linkage, with a goal of improving service access and ensuring equitable participation for PWDs [7]. However, significant operational gaps remain in healthcare information exchange and service coordination across different levels of healthcare facilities, resulting in fragmented care pathways and limited interoperability between community hospitals, regional hospitals, and tertiary care centers.

At the same time, smart city and digital transformation initiatives have highlighted the importance of inclusive and technology-enabled public services that improve citizens’ well-being and social participation. A smart city is not solely defined by technological advancement, but also by its ability to provide equitable access to healthcare, accessibility services, and social support for all residents, including persons with disabilities (PWDs) [8]. In Thailand, where a substantial number of individuals experience disabilities and functional limitations, digital inclusion remains a key component of national social development and disability empowerment strategies [7,9,10].

Recent advances in health informatics, mobile health technologies, and digital health services provide new opportunities to address persistent barriers faced by PWDs in accessing healthcare and social welfare services [11,12,13]. However, healthcare information systems (HISs) in Thailand vary considerably in digital maturity, infrastructure capacity, and interoperability across different levels of healthcare facilities. The fragmentation of health information often limits continuity of care, coordinated service delivery, and timely communication among patients, caregivers, and healthcare providers [14,15,16]. Furthermore, existing digital health platforms are rarely designed with accessibility and usability requirements specific to PWDs, resulting in continued disparities in healthcare access and service utilization [11,13,17].

To address these challenges, this study proposes a disability-centered mobile health platform integrated with a hybrid Health Information Exchange (HIE) architecture to improve healthcare accessibility and service coordination for PWDs in Thailand. The platform consolidates health information from heterogeneous hospital information systems, facilitates communication with healthcare providers, supports caregivers and community volunteers, and provides a centralized digital gateway for accessing healthcare and social welfare services. Through interoperable data exchange and mobile technologies, the proposed system aims to reduce service fragmentation, improve continuity of care, enhance access to health information, and promote independent living and social participation among PWDs [13,14].

The novelty of this study lies in the integration of a disability-centered mobile health application with the MedEx Hybrid Health Information Exchange (HIE) platform to support interoperable healthcare services across heterogeneous hospital information systems. Unlike conventional mobile health applications that typically focus on isolated healthcare functions, the proposed platform integrates emergency medical support (EMS 1669), appointment management, teleconsultation, assistive technology monitoring, disability rights notification, and cross-institutional health information exchange within a unified digital ecosystem. By combining mobile health services with real-time interoperability infrastructure, the proposed system seeks to improve healthcare accessibility, coordinated service delivery, and continuity of care for persons with disabilities while providing a scalable model for future inclusive digital health initiatives.

2. Materials and Methods

2.1. Requirement Gathering and Needs Assessment

This study developed an integrated mobile health platform to improve healthcare accessibility, welfare coordination, emergency response, and social participation for persons with disabilities (PWDs) in Thailand. System requirements were identified using a user-centered approach based on stakeholder consultations, healthcare accessibility assessments, national disability policies, and analysis of healthcare interoperability challenges.

Consultations were conducted with healthcare professionals, rehabilitation specialists, disability service officers, information technology experts, emergency medical personnel, caregivers, and representatives of disability organizations to identify accessibility barriers, service coordination gaps, and interoperability requirements.

The assessment identified key needs, including interoperable health information exchange across heterogeneous hospital information systems, accessible mobile health services, emergency medical coordination, assistive technology management, appointment scheduling, teleconsultation, and communication between healthcare and social welfare agencies.

Based on these requirements, the proposed platform was designed as an integrated ecosystem combining a disability-centered mobile application with the MedEx Hybrid Health Information Exchange (HIE) system. The design aligns with Thailand’s digital health transformation strategy, the Persons with Disabilities Empowerment Act B.E. 2550 (2007), Thailand 4.0 policy, and the United Nations Convention on the Rights of Persons with Disabilities. The conceptual framework and requirement analysis process used to guide platform development are illustrated in Figure 1.

2.2. System Design and Accessibility Framework

The proposed platform was developed using a user-centered design (UCD) framework emphasizing accessibility, inclusiveness, usability, and interoperability. The design process consisted of four iterative phases: (1) user requirement analysis, (2) persona development, (3) prototype design and refinement, and (4) participatory usability evaluation.

Representative personas were developed according to disability characteristics, healthcare access barriers, digital literacy levels, communication needs, and service utilization patterns. The personas included individuals with mobility impairments, visual impairments, hearing impairments, chronic health conditions, and users requiring continuous healthcare support.

The initial interface design was developed using low-fidelity wireframes followed by high-fidelity interactive prototypes optimized for mobile devices. Iterative feedback sessions were conducted with healthcare professionals, disability support staff, caregivers, and PWD representatives to improve readability, interface navigation, accessibility, service integration, and usability.

Accessibility principles were incorporated throughout the design process in accordance with Web Content Accessibility Guidelines (WCAG) 2.1 Level AA standards. Key accessibility features included simplified navigation structures, large touch targets, scalable font sizes, high-contrast visual elements, icon-supported interfaces, text-to-speech compatibility, visual notification alerts, and support for assistive communication methods.

The landing page adopts a grid-based layout optimized for mobile devices, providing direct access to the platform’s core functional modules through clearly labeled icons and simplified navigation structures. The interface was specifically designed to reduce cognitive load and improve usability among users with varying digital literacy levels.

Participatory usability testing was conducted using scenario-based tasks involving appointment scheduling, emergency medical service activation, teleconsultation access, assistive device reporting, healthcare navigation, and rights notification services. User feedback regarding readability, ease of navigation, interface accessibility, and overall usability was collected and incorporated into iterative design refinements. The conceptual user interface and the nine core functional modules of the proposed mobile application are presented in Figure 2.

2.3. Mobile Application Development

The mobile application was designed as an integrated digital health platform consisting of nine core functional modules addressing healthcare accessibility, emergency response, welfare coordination, assistive technology management, health education, and social participation for persons with disabilities (PWDs). The system was developed according to user-centered and accessibility-oriented design principles to support diverse disability groups and varying levels of digital literacy.

The platform integrates healthcare services, social welfare support, emergency medical coordination, and interoperable health information exchange within a unified digital ecosystem. The application interface adopts a grid-based layout optimized for mobile devices, enabling users to access essential services through simplified navigation structures, clearly labeled icons, scalable text display, and accessibility-oriented interface elements.

Each module was developed to address documented barriers in healthcare accessibility, service coordination, assistive technology management, and social participation among PWDs.

A.

Disability Registration Intention and Needs Reporting Module

The application includes a module enabling PWDs to declare their intention to register for disability identification and report individual needs. National assessments indicate that many individuals with disabilities remain outside formal registration systems because of limited awareness of rights, transportation barriers, social stigma, and difficulties obtaining medical certification, particularly in rural areas [10,18,19]. These limitations reduce access to welfare benefits, assistive devices, rehabilitation services, and healthcare support.

To address these barriers, the module provides a digital registration channel allowing PWDs, caregivers, or volunteers to submit essential personal information, disability type, and supporting documentation. Users can additionally report specific needs such as assistive devices, rehabilitation support, communication assistance, or workplace accommodations. Submissions are automatically routed to the appropriate provincial Social Development and Human Security Office using geolocation-based service allocation to improve administrative coordination and facilitate timely follow-up.

Evidence from Thailand’s digital inclusion initiatives suggests that mobile service platforms can improve healthcare accessibility and increase service utilization among underserved populations by reducing logistical barriers and improving information management [20,21]. The module therefore supports the implementation of the Persons with Disabilities Empowerment Act B.E. 2550 (2007) and Thailand’s commitments under the United Nations Convention on the Rights of Persons with Disabilities.

B.

Emergency Medical Service (EMS 1669) Support Module

The Emergency Medical Service (EMS 1669) Support Module was developed to improve emergency medical accessibility for PWDs. Emergency response delays are frequently associated with inaccurate location reporting, communication barriers, and incomplete patient information during emergency calls [3,22,23,24,25]. Such limitations may disproportionately affect PWDs who experience mobility or communication constraints during emergency situations.

The application enables users, caregivers, or volunteers to request emergency medical assistance directly through the system. The platform automatically captures GPS-based geolocation information and transmits emergency requests together with pre-stored health and disability information, including chronic diseases, allergies, assistive devices, and communication requirements. By integrating real-time location tracking and patient information exchange, the module supports rapid triage and personalized emergency response in accordance with mobile emergency healthcare practices [26].

C.

Appointment Scheduling and Reminder System

Missed medical appointments remain a major challenge in chronic disease management and continuity of care [4,5,27,28]. Transportation difficulties, communication barriers, misunderstanding appointment schedules, and forgetfulness may contribute to reduced clinic attendance among PWDs and other vulnerable populations.

To address these limitations, the application integrates a digital scheduling and reminder system connected with hospital information systems. Users can view available appointment slots, book, confirm, reschedule, or cancel appointments directly through the application. Confirmed appointments are automatically added to a personal health calendar, while automated reminders using push notifications, visual alerts, and optional text-to-speech functions help reduce missed visits and improve appointment adherence.

Previous studies have demonstrated that automated reminder systems can improve clinic attendance and reduce healthcare inefficiencies associated with missed appointments [27]. This module additionally supports Thailand’s digital health transformation strategy and Thailand 4.0 initiative by promoting equitable access to healthcare services for PWDs and patients with chronic conditions.

D.

Rights Notification and Entitlement Alert System

Many PWDs remain unaware of their legal rights, welfare benefits, and available support services [6,29]. Limited access to understandable and accessible information may reduce service utilization and create inequalities in access to social welfare systems.

The application therefore incorporates a Rights Notification and Entitlement Alert System that delivers personalized notifications regarding welfare benefits, healthcare entitlements, rehabilitation services, and legal rights. The module retrieves official updates from relevant government agencies and presents the information using accessible communication formats, including plain-language summaries, text-to-speech support, and sign-language video communication.

Notifications are customized according to disability type, employment status, and geographic location to improve service accessibility and user engagement [30,31]. By strengthening communication between government agencies, civil society organizations, and PWDs, the system supports national goals related to empowerment, accessibility, and social inclusion.

E.

Service Location Mapping System

PWDs frequently experience difficulty locating appropriate healthcare, rehabilitation, and social welfare services because service information is often fragmented across multiple organizations and agencies. The Empowerment of Persons with Disabilities Act (No. 2), B.E. 2556 guarantees access to public facilities, rehabilitation services, and vocational support programs.

To improve healthcare navigation and service accessibility, the application integrates a Service Location Mapping System based on geographic information system (GIS) technologies. The module consolidates geospatial information from hospitals, rehabilitation centers, welfare offices, vocational training institutions, and disability organizations.

Users can search for services using interactive digital maps with filtering functions based on service type, geographic location, and accessibility characteristics. Previous GIS-based healthcare accessibility studies demonstrated the usefulness of geospatial systems for identifying service gaps and reducing travel-related barriers among underserved populations [17,32,33]. By centralizing authoritative service information and accessibility metadata, the system supports independent living and improves access to healthcare and social welfare services for PWDs.

F.

Assistive Device Data Management and Maintenance Notification System

Assistive devices are essential for improving mobility, independence, and quality of life among PWDs. Under the Empowerment of Persons with Disabilities Act (No. 2), B.E. 2556, disability service centers are responsible for supporting access to assistive devices necessary for daily functioning.

Previous studies reported fragmented maintenance coordination and incomplete follow-up systems for assistive devices in Thailand, resulting in service gaps after initial device delivery [34,35]. Research on digital assistive technology management systems further demonstrated that reminder notifications and maintenance reporting tools can improve preventive maintenance behavior and device reliability [36,37].

Accordingly, this module supports assistive device registration, maintenance scheduling, repair reporting, and replacement notification. Users or caregivers can record device information, including device type, serial number, issuance date, and expected lifespan, while receiving automated maintenance reminders. Digital repair requests together with supporting images or documentation can additionally be submitted directly to rehabilitation centers or healthcare providers, thereby improving maintenance coordination and reducing device downtime.

G.

Computer-Assisted Instruction (CAI) for Health Education and Skill Development

Educational access and health literacy remain important challenges among PWDs, and national disability policies emphasize the importance of assistive learning technologies, accessible educational systems, and flexible learning resources tailored to diverse disability needs.

Previous studies demonstrated that accessible digital learning systems and assistive educational technologies can improve participation, health literacy, and social inclusion among individuals with disabilities [38,39]. Research on digital health education additionally reported that participatory design approaches and accessible interfaces improve usability and learning outcomes among users with impairments [11,12].

The CAI module was therefore developed to support health education, rehabilitation guidance, self-care training, digital literacy, and vocational skill development for PWDs. The module provides multimedia learning resources including text-based materials, audio narration, instructional videos, infographics, and accessibility-oriented learning interfaces.

Accessibility features include text-to-speech compatibility, scalable text display, simplified navigation structures, captioned multimedia content, and visual guidance icons. The educational content was designed according to inclusive learning principles and universal design concepts to support users with different disability types and varying levels of digital literacy.

H.

Tele-Consultation System

The application integrates a Tele-Consultation System to improve access to healthcare consultations and disability-related support services for PWDs. Mobility limitations and transportation barriers frequently reduce access to in-person healthcare consultations, particularly among individuals living in underserved or rural areas.

The system supports secure video consultations, voice communication, and messaging functions between users and healthcare professionals, disability officers, or trained volunteers. All telehealth services were designed in accordance with the Medical Council of Thailand’s telemedicine guidelines (Announcement No. 54/2563) regarding authentication, confidentiality, and medical documentation.

Previous studies demonstrated that telehealth interventions can improve healthcare accessibility, continuity of care, health knowledge, and quality of life among persons with disabilities [13,14,15]. By supporting remote healthcare access and communication, the module improves continuity of care and reduces transportation-related barriers for PWDs.

I.

Peer Communication and Social Connectivity System

Social support and community participation are important determinants of psychological well-being and quality of life among persons with disabilities [40,41,42]. However, many PWDs experience social isolation and limited opportunities for communication and social engagement.

The Peer Communication and Social Connectivity System was developed to provide digital communication spaces where users can participate in community forums, peer-support groups, moderated discussion channels, and virtual social activities. The module enables users to exchange experiences, seek emotional support, and strengthen social relationships through accessible online communication tools.

2.4. Health Information Exchange (HIE) Integration

The proposed platform integrates with the MedEx Hybrid Health Information Exchange (HIE) system to support interoperable healthcare data exchange across heterogeneous Hospital Information Systems (HISs) in Thailand. The interoperability framework was designed to facilitate secure healthcare communication and real-time information exchange among community hospitals, provincial hospitals, tertiary healthcare centers, emergency medical services, and social welfare agencies.

The HIE infrastructure supports the exchange of patient demographic information, appointment records, emergency medical information, disability-related healthcare records, teleconsultation data, and social welfare coordination information. Through interoperable communication mechanisms, the platform aims to improve continuity of care, reduce fragmentation of healthcare services, and enhance multidisciplinary care coordination for persons with disabilities (PWDs) [13,14,15,16,43].

In addition, the framework supports real-time synchronization of healthcare information across multiple healthcare settings, facilitating coordinated healthcare delivery and timely access to patient information during routine healthcare encounters and emergency situations. The detailed backend architecture, communication protocols, and operational workflows of the MedEx Hybrid HIE system are presented in Section 3.

2.5. Security, Privacy, and Consent Management

Because the proposed platform manages sensitive disability-related and healthcare information, security, privacy protection, and consent management principles were incorporated throughout system development. User authentication, role-based access control, encrypted communication, and consent management mechanisms were implemented to support data confidentiality and secure healthcare information exchange.

Access privileges were differentiated among healthcare professionals, emergency medical personnel, disability service officers, caregivers, volunteers, and general users according to their operational responsibilities. Audit trails and access logs were maintained to support accountability, traceability, and monitoring of healthcare information access activities.

Teleconsultation and healthcare communication functions were designed in accordance with national telemedicine practice recommendations regarding authentication, confidentiality, professional responsibility, and patient privacy protection [44]. Privacy protection measures were incorporated to support secure storage, transmission, and management of patient information while maintaining appropriate access controls for authorized users.

2.6. System Evaluation and Pilot Testing

System evaluation focused on functional testing, interoperability assessment, backend integration, communication stability, and pilot implementation across participating healthcare facilities. The evaluation aimed to assess the operational feasibility of the proposed integrated mobile health platform, including healthcare information exchange capability, system performance, interoperability readiness, and secure communication among heterogeneous hospital information systems.

Functional testing was conducted across all major system modules, including user authentication, disability registration and needs reporting, appointment scheduling, rights notification, service location mapping, assistive technology management, teleconsultation services, educational content delivery, peer communication, and Emergency Medical Service (EMS 1669) support. Additional testing scenarios included healthcare information synchronization, emergency information exchange, appointment data transfer, teleconsultation communication, and real-time retrieval of patient information from distributed HIS environments.

The evaluation further examined API communication stability, MQTT-based event messaging, synchronization reliability, and interoperability performance across hospitals operating different HIS platforms and digital infrastructure capacities. Real-time monitoring of synchronization agents, centralized hospital management functions, and distributed healthcare data exchange processes was also assessed during pilot deployment activities.

Emergency response functionality was evaluated through integration testing with Thailand’s EMS 1669 system. The assessment included SOS activation, real-time GPS location transmission, emergency notification delivery, retrieval of patient information, and communication support between healthcare personnel and emergency response teams. The results demonstrated the operational feasibility of the integrated emergency communication workflow under pilot implementation conditions.

Accessibility-oriented design principles were incorporated throughout mobile application development. Accessibility features implemented within the platform included scalable font display, high-contrast user interface elements, simplified navigation structures, icon-assisted interfaces, screen-reader compatibility, and support for text-to-speech technologies. These features were designed according to accessibility-oriented mobile interface principles and Web Content Accessibility Guidelines (WCAG) 2.1 Level AA recommendations [45].

The pilot implementation primarily focused on institutional deployment, interoperability testing, and healthcare system integration rather than large-scale public distribution. Consequently, public mobile application download statistics do not fully reflect the extent of healthcare facility deployment and interoperability activities conducted during the pilot phase.

The current evaluation emphasized system architecture validation, interoperability readiness, communication stability, and healthcare information exchange capability rather than large-scale clinical outcome assessment or end-user usability evaluation. User-centered usability studies involving persons with disabilities, caregivers, and healthcare professionals will be conducted in future implementation and effectiveness research. Feedback obtained from healthcare personnel, information technology staff, and institutional stakeholders was incorporated into iterative system refinement and backend optimization processes.

3. Backend System Architecture

The backend of the proposed mobile application is implemented using the Medical Exchange Hybrid System (MedEx Hybrid), a scalable and interoperable platform designed to enable secure medical data exchange across heterogeneous Hospital Information Systems (HISs). The architecture integrates API-based and MQTT-based communication mechanisms to support healthcare providers with varying levels of digital readiness, including community hospitals, provincial hospitals, and tertiary care centers.

3.1. System Architecture

As illustrated in Figure 3 and Figure 4, MedEx Hybrid supports three complementary architectures: MQTT-based, API-based, and hybrid configurations.

In the MQTT-based model, hospital HIS instances connect to a centralized MQTT broker using a lightweight publish–subscribe protocol. Hospitals publish real-time clinical events, such as patient admissions, laboratory results, or vital signs, while authorized subscribers, including the MedEx platform and mobile application services, receive these updates in near real time. This approach is particularly suitable for hospitals with limited bandwidth or without public IP addresses.

In the API-based model, hospitals expose standardized RESTful APIs through locally deployed virtual machines. The MedEx system retrieves structured clinical data via secure API requests and performs data validation, normalization, and semantic mapping to ensure interoperability. This architecture supports longitudinal patient records, complex queries, and integration with national health platforms such as the Health Data Center (HDC), provincial welfare registries, and the 1669 emergency medical service system [43].

The hybrid architecture combines both approaches to optimize flexibility and performance. The MQTT broker manages event-driven messaging, while APIs enable secure on-demand data exchange. Each hospital operates a dedicated software agent that interfaces with its local HIS. When a query notification is received through MQTT, the agent retrieves the requested data, transforms it according to the MedEx data model, and transmits it securely to the central system via APIs. This architecture enables real-time responsiveness while maintaining compatibility with centralized health information infrastructures [16].

This hybrid interoperability framework supports scalable healthcare information exchange while maintaining compatibility with heterogeneous hospital information environments and centralized healthcare information infrastructures.

3.2. Operational Modes

MedEx Hybrid operates in two complementary modes: Query Mode (Pulling) and Backup Mode (Pushing).

In Query Mode, a mobile application or web platform submits a data request to the central MedEx system. The system then sends MQTT notifications to relevant hospital agents. Each agent retrieves the requested data from its local HIS and returns it through secure API channels, enabling near real-time data retrieval.

In Backup Mode, hospital agents periodically transmit newly generated or updated patient data to the central data center. This mechanism ensures continuous data synchronization, enhances system reliability, and maintains data backup without requiring real-time user queries.

Together, these operational modes support scalable healthcare information exchange, continuity of care, and integrated healthcare service delivery across distributed healthcare environments.

3.3. Security, Privacy, and Interoperability

Across all deployment models, MedEx Hybrid implements end-to-end encryption, role-based access control, secure authentication, and patient consent management mechanisms to ensure healthcare data confidentiality, integrity, and secure information exchange. These security controls are integrated throughout the platform architecture to protect sensitive disability-related and healthcare information during storage, transmission, and retrieval.

Secure authentication and authorization mechanisms govern access to clinical information, while real-time synchronization supports integrated digital health services, including emergency medical support, teleconsultation, appointment management, rights notification, assistive device monitoring, and healthcare information exchange. Access privileges are differentiated among healthcare professionals, emergency medical personnel, disability service officers, caregivers, volunteers, and general users according to their operational responsibilities and information access requirements.

Audit trails and access logs are maintained to support accountability, healthcare information traceability, and monitoring of information access activities. These mechanisms provide transparency in system operation and facilitate the detection and investigation of unauthorized access or security-related incidents.

The backend security framework was designed in accordance with Thailand’s Personal Data Protection Act (PDPA) B.E. 2562, national digital health security principles, and the Medical Council of Thailand’s telemedicine practice recommendations regarding authentication, confidentiality, professional responsibility, and patient privacy protection [44,46]. Patient consent management mechanisms are incorporated to ensure that healthcare information is accessed and exchanged only by authorized users under appropriate operational conditions.

Interoperable healthcare communication is supported through secure API-based data exchange and MQTT-enabled event-driven communication mechanisms, allowing reliable and scalable information sharing among heterogeneous hospital information systems [16,43]. The hybrid communication architecture combines the efficiency of MQTT message distribution with secure API-based clinical data transmission, enabling real-time healthcare information exchange across hospitals with different infrastructure capacities and information system configurations.

By integrating event-driven MQTT communication with secure API-based healthcare data exchange, MedEx Hybrid provides a robust, scalable, and interoperable backend infrastructure capable of supporting inclusive digital health services and real-time health information exchange for persons with disabilities. The architecture enables secure communication across diverse healthcare environments while maintaining operational flexibility and deployment feasibility for healthcare facilities with varying technological capabilities.

4. Experimental Results and System Evaluation

A.

Functional Implementation and System Validation

The Happy Disability mobile application was fully implemented and deployed as a cross-platform solution, officially released on both the Apple App Store (iOS) and Google Play Store (Android). The system was evaluated under real deployment conditions to verify functional correctness, platform stability, and consistency of user experience across mobile operating systems.

Upon launching the application, users are presented with a secure authentication interface requiring a national identification number and PIN-based access (Figure 5a). The system supports new user registration through a step-by-step workflow, including personal information entry, contact details, and disability profile creation (Figure 5b–f). Functional testing confirmed consistent behavior, data integrity, and accessibility across both iOS and Android platforms.

After authentication, users access a unified dashboard providing five core service categories: Disability Services, Medical Appointments, Social and News, Communication, and Emergency Services (Figure 6). Navigation between modules was verified to be seamless, with stable performance and equivalent functionality across platforms.

Within the Disability Services module, users can register personal disability profiles or manage records for dependents under their care. The application supports digital submission and tracking of disability identification card applications, including both observable and non-observable disabilities. Users can upload supporting documents, specify disability types, and monitor application status in real time (Figure 7a–c). Validation confirmed accurate data handling and reliable status synchronization.

The Rights Notification and Welfare Services module enables users to access and submit requests for healthcare benefits, disability allowances, educational support, vocational assistance, tax benefits, and employment-related rights (Figure 8). Submitted requests are automatically categorized and routed for follow-up, supporting efficient service coordination.

Emergency readiness was validated through direct integration with Thailand’s 1669 Emergency Medical Service, allowing one-touch emergency calls from within the application (Figure 9). All major functional components—including disability registration, welfare services, appointment scheduling, tele-consultation, emergency support, service location mapping, knowledge dissemination, and peer communication—were systematically tested. A summary of validated modules, evaluation criteria, and outcomes is presented in

Table 1. Summary of validated functional modules in the Happy Disability mobile application.

Module	Key Functions	Validation Criteria	Validation Outcome
User Registration & Authentication	National ID login, PIN creation, user profile setup	Data completeness, authentication accuracy, ease of use	Successfully validated
Disability Profile Management	Disability type registration, dependent management, document upload	Correct data capture, status tracking, usability	Successfully validated
Disability ID Registration	Digital submission for disability identification card	Workflow accuracy, real-time status synchronization	Successfully validated
Appointment Scheduling	Hospital selection, department/date/time selection, online & onsite visits	Scheduling accuracy, response time	Successfully validated
Tele-Consultation & Communication	Video conferencing, meeting room creation, link sharing	Connection stability, user accessibility	Successfully validated
Emergency Medical Service (1669)	One-touch emergency call integration	Call reliability, response initiation	Successfully validated
Service Location Mapping	Display of service centers and healthcare facilities	Location accuracy, navigation support	Successfully validated
Service Location Mapping	Display of service centers and healthcare facilities	Location accuracy, navigation support	Successfully validated
Social & News Module	News, activities, announcements for PWD community	Information dissemination, engagement	Successfully validated

.

B.

Usability Outcomes and Service Accessibility Impact

Usability evaluation emphasized accessibility, clarity of interaction, and service completeness rather than clinical outcomes. The appointment scheduling module enables users to select provinces, hospitals, departments, dates, and time slots for both in-person and telemedicine consultations (Figure 10a,b). Consistent functionality and responsiveness were observed across iOS and Android devices.

The tele-consultation and communication module supports real-time video conferencing, allowing users to create or join virtual meeting rooms and share access links externally (Figure 11). Testing confirmed stable session initiation and ease of use, supporting healthcare consultation as well as peer interaction.

The service location mapping module visualizes nearby disability service centers, healthcare facilities, and relevant organizations using an interactive map interface (Figure 12), improving users’ ability to locate and access services. Educational and knowledge-based content is delivered through a structured CAI module, providing health education and capability-building resources adapted to different disability needs (Figure 13).

Overall, experimental results demonstrate that the Happy Disability application—successfully deployed on both iOS and Android app stores—provides an integrated, accessible, and reliable digital platform. The system enhances service accessibility, reduces administrative burden, and strengthens communication among Persons with Disabilities, caregivers, healthcare providers, and government agencies. These findings support the application’s potential to contribute effectively to inclusive digital health services and national disability policy objectives.

C.

Experimental Results on Hospital Information Exchange

The HIE component was evaluated using the MedEx Hybrid platform, which integrates heterogeneous HISs through a hybrid MQTT–API architecture. The system was deployed across multiple hospitals operating different HIS platforms, each connected via a lightweight local software agent. The evaluation focused on system interoperability, real-time monitoring, and operational scalability.

-

Multi-Hospital Connectivity and Centralized Management

The experimental results confirm that the system effectively supports centralized management of multiple hospitals. As shown in Figure 14, the Hospital Management module enables administrators to register hospitals, configure HIS types, and monitor connectivity status in real time. Hospitals can be dynamically added or updated without interrupting ongoing data exchange, demonstrating scalability and suitability for large-scale deployment.

-

Agent-Based Synchronization and System Reliability

The agent-based synchronization mechanism demonstrated stable and reliable performance throughout the evaluation. Each hospital-side agent autonomously retrieves data from the local HIS and synchronizes it with the central data center according to predefined schedules. Real-time system status is visualized through the Agent Monitor dashboard (Figure 15), which displays connectivity, database access, and last synchronization timestamps.

The system successfully detected network interruptions and enabled rapid recovery, while detailed agent logs ensured traceability and auditability of synchronization events. These results confirm that the MedEx Hybrid architecture provides robust, real-time, and scalable interoperability across heterogeneous hospital environments.

-

HIE Connection Statistics

The proposed HIE system is part of an ongoing national initiative in Thailand aimed at integrating heterogeneous HISs across hospitals of varying sizes. At the time of evaluation, the system successfully connects 857 hospitals, demonstrating substantial progress toward nationwide interoperability. These include 7 large provincial hospitals, 50 medium-sized district hospitals, and 800 small sub-district hospitals, reflecting the system’s ability to operate across diverse healthcare settings with different infrastructure capacities.

To accommodate this heterogeneity, the implementation adopts a hybrid integration architecture combining API-based and MQTT-based communication. A lightweight software agent is deployed at each hospital to interface with the local HIS, perform data preprocessing and cleansing, and manage secure data transmission to the centralized HIE platform. This design is particularly effective for smaller hospitals with limited network resources, while still supporting high-throughput data exchange from larger facilities.

As illustrated in Figure 16, the connected hospitals collectively contribute several million patient records across seven provinces, including Surat Thani, Chumphon, Krabi, Nakhon Si Thammarat, Phangnga, Phuket, and Ranong. Each province comprises a mix of hospital sizes and HIS platforms, underscoring the complexity of achieving interoperability at scale. The MedEx Hybrid approach addresses these challenges by enabling real-time data exchange and standardized integration across fragmented systems, either through direct HIS connections or via third-party interoperability services when required.

The results validate the technical robustness and scalability of the proposed HIE system, demonstrating its practical feasibility as a nationwide healthcare data exchange platform capable of supporting real-world operational diversity and long-term expansion.

D.

Experimental Results on Latency

The performance of the HIE system was evaluated by measuring four latency components: MQTT Trigger Latency (L_mqtt), HIS Access Latency (L_his), API Request Latency, and API Transmission Latency (L_API-transmission-single). These metrics represent the delays associated with trigger broadcasting, data retrieval from hospital information systems (HIS), API communication, and transmission of retrieved data to the central server.

Figure 17 presents average latency values recorded over 5 s intervals between 3:22 a.m. and 3:27 a.m. HIS Access Latency was the largest contributor to overall delay, followed by API Transmission Latency, indicating that data retrieval and transfer processes account for most of the response time.

Latency patterns over a 12 h period (Figure 18) show increased delays during peak daytime operations, corresponding to higher transaction volumes across participating hospitals. Despite these fluctuations, the system maintained stable performance and continuous real-time data exchange.

Figure 19 illustrates transaction volumes for a sample hospital over the same period. Transaction activity increased substantially during peak hours, particularly for HIS access and API transmission processes. These findings demonstrate the scalability of the proposed HIE architecture and its ability to support high-volume healthcare data exchange under varying operational workloads.

Table 2. The table provides a detailed breakdown of process latencies (in seconds) for accessing a Hospital Information Exchange (HIE) system across 857 hospitals. The latencies are averaged over a one-hour measurement interval and encompass various approaches for retrieving patient data.

Process/Method	Latency (in Seconds)
API Call	1.48
MQTT Broadcast	1.48
HIS Access	6.07
Push Data via API	5.00
API Reply	6.50
Hybrid Approach	7.55
API Sequential (Method 1)	29,581.86
API Sequential (Method 2)	5492.86
API Parallel	7.98

Note: For the hybrid approach, the total latency involves three components: MQTT broadcasting, HIS access, and data transmission via API. The latency can be expressed as: $L_{\mathrm{h}\mathrm{y}\mathrm{b}\mathrm{r}\mathrm{i}\mathrm{d}}=L_{\mathrm{m}\mathrm{q}\mathrm{t}\mathrm{t}}+\max (L_{\mathrm{h}\mathrm{i}\mathrm{s}},L_{\mathrm{A}\mathrm{P}\mathrm{I}\_\mathrm{T}\mathrm{X}})$. For the API-only methods, the total latency depends on the type of implementation: API Sequential Method 1: The latency accounts for NNN, the number of hospitals, and is given by: $L_{\mathrm{A}\mathrm{P}\mathrm{I}-\mathrm{t}\mathrm{o}\mathrm{t}\mathrm{a}\mathrm{l}}=N\times \left(L_{\mathrm{A}\mathrm{P}\mathrm{I}\_\mathrm{r}\mathrm{e}\mathrm{q}\mathrm{u}\mathrm{e}\mathrm{s}\mathrm{t}}+L_{\mathrm{r}\mathrm{e}\mathrm{p}\mathrm{l}\mathrm{y}}\right)$; API Sequential Method 2: The latency is expressed as: $L_{\mathrm{A}\mathrm{P}\mathrm{I}-\mathrm{t}\mathrm{o}\mathrm{t}\mathrm{a}\mathrm{l}}=N\times L_{\mathrm{A}\mathrm{P}\mathrm{I}\_\mathrm{r}\mathrm{e}\mathrm{q}\mathrm{u}\mathrm{e}\mathrm{s}\mathrm{t}}+L_{\mathrm{r}\mathrm{e}\mathrm{p}\mathrm{l}\mathrm{y}}$; API Parallel: The latency is determined by the sum of the API request and reply times: $L_{\mathrm{A}\mathrm{P}\mathrm{I}-\mathrm{t}\mathrm{o}\mathrm{t}\mathrm{a}\mathrm{l}}=L_{\mathrm{A}\mathrm{P}\mathrm{I}\_\mathrm{r}\mathrm{e}\mathrm{q}\mathrm{u}\mathrm{e}\mathrm{s}\mathrm{t}}+L_{\mathrm{A}\mathrm{P}\mathrm{I}-\mathrm{r}\mathrm{e}\mathrm{p}\mathrm{l}\mathrm{y}}$. These formulations highlight the sequential nature of API methods compared to the parallel and efficient design of the hybrid approach.

summarizes the average latencies of different approaches for accessing the HIE system across 857 healthcare facilities over a one-hour measurement period. The evaluated approaches included the proposed hybrid architecture, API-based sequential methods, and API-based parallel communication.

The proposed hybrid approach achieved the lowest practical latency (7.55 s), combining MQTT broadcasting, local HIS retrieval, and API-based data transmission. By using lightweight local agents, requests are distributed simultaneously to participating hospitals, eliminating the need for public IP addresses and reducing communication overhead.

In contrast, API Sequential Method 1 and Method 2 exhibited substantially higher latencies of 29,581.86 s and 5492.86 s, respectively, due to the cumulative delays associated with sequential hospital queries. Although the API Parallel approach achieved a comparable latency (7.98 s), its implementation requires public IP accessibility at each hospital, which may limit deployment in resource-constrained healthcare settings.

Overall, the hybrid architecture demonstrated superior efficiency and operational feasibility, providing scalable real-time data exchange while accommodating heterogeneous healthcare infrastructures.

E.

Mobile App–Based 1669 EMS Integration

Figure 20 illustrates the integration of the HIE system with Thailand’s national Emergency Medical Service (EMS 1669) through a mobile application–based SOS mechanism. The proposed system enables PWDs to initiate an emergency request directly via the mobile application by activating an SOS button linked to the 1669 EMS service. This function is designed to reduce response time and improve emergency coordination, particularly for PWDs who may face mobility, communication, or environmental barriers during critical situations.

Once the SOS function is activated, the EMS command dashboard immediately receives the emergency alert and displays the user’s real-time GPS location on an interactive map interface. This allows EMS dispatchers and first responders to accurately identify the patient’s location and plan the most efficient response route. In parallel, the HIE system retrieves and presents the user’s electronic medical records, including demographic data, medical history, known disabilities, chronic conditions, allergies, and current medications. Access to this information enables EMS personnel and assisting healthcare providers to better understand the patient’s clinical background before arrival, supporting safer and more appropriate emergency interventions.

A key advantage of the HIE-enabled EMS integration is its ability to provide authorized helpers and EMS teams with timely access to relevant medical records of PWDs, which is particularly critical when patients are unable to communicate effectively during emergencies. This capability reduces information gaps, minimizes medical errors, and enhances continuity of care across pre-hospital and hospital settings.

The EMS dashboard also supports real-time communication features, including voice and video calls, allowing coordination among EMS operators, healthcare professionals, caregivers, or family members when necessary. This collaborative communication environment further improves situational awareness and decision-making during emergency response.

Figure 21 illustrates the implementation of a primary care dashboard, tailored for use by doctors and nurses in primary healthcare settings. This dashboard is integrated with the HIE system to provide real-time access to critical patient information, facilitating more efficient and informed decision-making.

On the web interface, the dashboard offers an overview of patient health statuses, categorized into groups such as chronic diseases, high-risk conditions, and general health. Healthcare providers can easily navigate through patient lists, prioritized alerts, and detailed profiles with just a click. The detailed patient view includes essential medical data, such as demographics, current diagnoses, and treatment plans. It also features a chronological record of medication history and graphical representations of health trends, including blood pressure, respiratory rate, and HbA1c levels, enabling longitudinal monitoring of patient conditions.

This dashboard exemplifies the integration of technology into primary healthcare workflows, enhancing interoperability between diverse healthcare systems. By providing comprehensive, real-time, and visually intuitive patient information, the system empowers medical staff to deliver more precise, timely, and patient-centered care. Its adaptability to both web and mobile platforms further ensures that healthcare providers can maintain continuity of care, regardless of location or circumstances.

Figure 22 presents the API response time performance results obtained from the system testing using Postman, evaluated across five core data retrieval endpoints of the HIE system. All API requests returned an HTTP status code of 200, confirming successful data retrieval in all test cases. The tested endpoints include personal information, visit information, laboratory information, diagnosis information, and order information, all queried using a patient identifier (PID).

The results demonstrate consistently low response times across all endpoints. The personal_information endpoint returned a response in 48 ms with a payload size of 1.044 KB, while the visit_information endpoint responded in 51 ms with 1.103 KB. The labs_information endpoint recorded the highest response time of 81 ms with a payload of 1.044 KB, which is attributed to the relatively larger volume of laboratory data retrieved per query. The diagnosis_information endpoint responded in 50 ms with 1.044 KB, and the order_information endpoint achieved the fastest response at 45 ms with the smallest payload of 937 B.

These results confirm that the HIE system’s API layer delivers reliable and low-latency data retrieval performance, with all endpoints responding well within acceptable thresholds for real-time clinical use. The consistently successful HTTP 200 responses across all iterations further validate the stability and correctness of the system’s data exchange mechanisms across heterogeneous hospital information systems.

In summary, the integration of the mobile application with the HIE and EMS 1669 system significantly enhances emergency service delivery for PWDs. By combining rapid SOS activation, precise location tracking, and secure access to comprehensive medical records, the system enables EMS teams to deliver faster, safer, and more informed emergency care, demonstrating the practical value of HIE in real-world emergency scenarios.

5. Conclusions

This study presents the design, implementation, and evaluation of an integrated mobile service platform and hybrid HIE system intended to improve healthcare accessibility, service coordination, and quality of life for PWDs in Thailand. The proposed system combines a user-centered mobile application with the MedEx Hybrid architecture, which integrates API-based and MQTT-based data exchange methods to address fragmentation among HIS across hospitals with varying sizes and technical capabilities.

Experimental results from real-world deployment demonstrate the system’s scalability and operational feasibility, with successful integration across 159 hospitals at provincial, district, and sub-district levels. The hybrid communication design supports both real-time and request-based data exchange, including in settings with limited infrastructure. The system enables secure access to electronic medical records, emergency medical services (1669 EMS), appointment scheduling, rights notifications, assistive device management, and peer communication. The integration of the HIE with the mobile SOS function enhances emergency response by allowing authorized EMS personnel to access relevant medical information of PWDs prior to patient contact.

The validated functional modules of the mobile application, available on both iOS and Android platforms, confirm the feasibility of delivering accessible digital health services aligned with national disability legislation and Thailand’s digital health strategy. Overall, the results indicate that the proposed system can reduce service access barriers, improve continuity of care, and strengthen coordination among healthcare providers, social welfare agencies, and PWD communities.

Future work will focus on expanding nationwide deployment, incorporating advanced data analytics and decision-support tools, and conducting longitudinal evaluations to assess clinical outcomes, user engagement, and policy impact. The proposed architecture provides a practical and scalable reference model for healthcare interoperability and inclusive digital service delivery in similar healthcare contexts.