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We can consider that health informatics can help to increase value of healthcare practices, in terms of cost, user satisfaction, and superior outcomes. The papers provided in the reading assignment also discuss how public health informatics can help to improve public health practices and the challenges of the implementation.
Have you ever observed a health informatics project in your (other) organization? Please provide a brief introduction.
How can this health informatics project help to improve the current practices?
Are there any challenges or difficulties in implementing the project?
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Brief introduction about health informatics project
In my previous organization, we implemented a malaria elimination project under the Regional Artemisinin-Resistance Initiative (RAI3E), in close collaboration with PR-DDC Thailand. The project aimed to accelerate the elimination of Plasmodium falciparum malaria in the Greater Mekong Subregion by achieving high coverage of key interventions through area-based micro-stratification and targeting high-risk areas. The goal was to eliminate local transmission of P. falciparum cases by 2023 and all malaria by 2024. Additional focus was placed on active P. falciparum foci and high-burden provinces, which accounted for most malaria cases, as well as on nine temporary shelters along the Thailand–Myanmar border, to intensify elimination efforts.
This project was funded by the Global Fund through PR-DDC Thailand. As part of the initiative, the organization introduced an online malaria case reporting system using the ‘MIS’ application, integrated with the National Malaria Information System (MIS) managed by the Bureau of Vector Borne Diseases (BVBD). The MIS provides real-time, geo-located data on malaria cases and vector information, enabling timely analysis and response by public health officials at all levels. At our organization, we recorded all malaria screening cases, including both positive and negative results on a daily basis and synchronized them with the national MIS. Any positive cases were reported to the national system within 24 hours. This system replaced paper-based reporting, ensuring faster data transmission and strengthening Thailand’s malaria elimination strategy.
How can this health informatics project help to improve the current practices?
This project contributes to malaria elimination by reducing costs, improving user satisfaction, and achieving superior outcomes:
Cost: The system reduces expenses related to human resources for data collection and storage, as well as paper costs compared to traditional paper-based reporting. It also accelerates reporting and streamlines workflows, helping governments and agencies avoid the high costs of uncontrolled outbreaks and epidemics. The automated functions in the MIS minimize expenses linked to delayed outbreak detection and response. For example, when we reported a P. falciparum positive case within 24 hours to the national MIS, national officials could immediately detect the location, geography, and case classification (imported, indigenous, etc.), allowing them to take prompt and effective action.User Satisfaction: The project delivers real-time or near real-time data, which builds trust and usability for organizations and decision-makers at BVBD, PR-DDC, and MOPH. It reduces workload through automation and synchronization with the national MIS, where reported data can be easily shared, stored, analyzed, and monitored. In addition, it strengthens preparedness for outbreak management and disease prevention.
Superior Outcomes: By providing real-time data to the national MIS, health authorities can respond to outbreaks more rapidly and improve public health outcomes through faster data analysis and timely interventions.
Are there any challenges or difficulties in implementing the project?
Challenges in implementing the project include:
1.Poor internet access in some remote areas, which prevented real-time data reporting. Instead, cases had to be entered into the system once internet became available, often requiring front-line health workers to work overtime or outside regular hours.
2.Because malaria cases must be notified within 24 hours, front-line health workers experienced work–life imbalance due to the urgency of reporting.
3.Delayed IT support when system errors occurred at the project level, which caused interruptions and delayed reporting.
4.staff turnover, which slowed project progress since training new staff to become familiar with the system required additional time and resources.
5.At times, data synchronization issues between the project-level system and the national MIS led to missing or delayed reports, causing reporting discrepancies.-
I agree that health workers are one of the main challenges. That’s why health informatics also involves people management in order to make the system friendly for the front-line staffs, while still maintaining data quality that can support public health.
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Introduction of the health informatics project
I have experience in developing and setting up electronic medical records (EMR) for three clinics in Yangon, Myanmar. We worked with the three developers: an architect, a back-end developer, and a front-end developer. This project aims to replace paper-based records with a digital platform that could store patient histories, laboratory investigation results, prescriptions, and referrals in a standardized format. This system enhances data compilation, analysis, and supports informed decision-making.
How does the project help to improve the current practices
Efficiency and cost savings: Doctors, Nurses, and receptionists spent less time searching for paper files, reducing delays. The data entry staff spent less time on data entry. Integrated visualizations into the EMR application improved data compilation, validation, analysis, visualization, and evidence-based decision-making.
Patient satisfaction: Patients benefited from shorter waiting times and fewer repeated investigations.
Better outcomes: Service providers could make more informed decisions and ensure continuity of care across different facilities.
Challenges or difficulties in implementation
Technical issues: Application errors and a poor internet connection were among the challenges. We have a standby developer to solve the application error promptly.
Resistance to change: Some healthcare providers were resistant to change and required extensive advocacy and training to use the system effectively. Frequent advocacy and training sessions were conducted.
Interdisciplinary gap (communication gap): Differences in knowledge, language, and perspective between healthcare professionals and developers. Weekly, bi-weekly check-in meetings between healthcare professionals and developers to bridge this gap.
Interoperability issues: Challenges in exchanging data with different systems.
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Hi Thiha! Thanks for sharing your experience. I also had similar experiences with the colleagues who were resistant to change, which was very challenging for us to proceed with the new system. So, I could see how effort you had to make for the change, and it did take sometime. Also, language barrier was one of the big challenges, particularly when dealing with the system, and technology.
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Thank you for sharing your experience with the EMR project in Yangon. It’s impressive to see how you implemented a comprehensive digital solution across three clinics, involving a multi-disciplinary team of developers. Technical issues, resistance to change, interdisciplinary communication gaps, and interoperability are common challenges in health informatics projects. It’s encouraging that you addressed these proactively through standby developer support, frequent training sessions, and regular check-ins between healthcare providers and developers. These strategies demonstrate thoughtful planning and collaboration, which are crucial for successful implementation.
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Thank you for sharing your experience. Resistance to change is a common challenge in digital transformation. Thank you for highlighting the importance of regular meetings between health professionals and developers to avoid communication gap. I totally agreed with you that continuous communication flow should be established to ensure everyone is on the same page and to make the system works.
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My background is a kidney doctor taking care of dialysis patients. In Thailand, we have the Thailand Renal Replacement Therapy (TRT) Registry, a nationwide database that covers around 98% of dialysis services across the country. It integrates data from hospitals and dialysis centers using standardized forms and electronic submission. The TRT collects data on patients with end-stage kidney disease (ESRD) undergoing dialysis, including both hemodialysis (HD) and peritoneal dialysis (PD). The registry includes patient demographics, clinical parameters, treatment details, and outcomes, with data primarily submitted by dialysis nurses through electronic systems.
The TRT helps improve chronic kidney disease (CKD) practice. For example, it highlights key trends and challenges in CKD on dialysis management since 2000, providing epidemiological data and insights for policymakers to plan strategies that benefit public health. Recent data analysis in 2023 revealed that the number of HD patients has increased dramatically since 2022, while the number of PD patients has remained stable. Stakeholders can use these findings to enhance early CKD detection and prevention strategies, as well as to investigate how the choice of dialysis modality impacts public health management. Moreover, the data is available for researchers to gain insights that can guide CKD practice and improve the quality of patient care.
However, the TRT still faces challenges. For example, there is a need for clear clinical definitions of various comorbidities associated with ESRD outcomes. Some data domains are still not standardized, making them difficult to use directly for analysis. Some diagnoses are based on treating physicians’ assessments and are not implemented using standardized criteria across centers. Additionally, many types of data that would benefit public health analysis are still not captured. Implementing an ideal registry practice would faces challenges from health workers, as the registry requires them to manually enter hundreds of data points into the system, rather than capturing data directly, posing interoperability challenges.
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Thanks for sharing of your experience. Health informatics is very effective to analyze the data not only for treatment but also for research purpose in medical field. Case standardization is also challenging factor in my context. As you mention, we also face interoperability challenges between projects and different clinics.
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Thank you for sharing your real-world practice in clinical settings. The challenge of transforming data to analysis and insightful impacts is quite big in your practice, especially when there is no standardized criteria to capture the data. And, yes, it’s definitely the issue of interoperability within the setting. Without it and lack of data management procedures could not provide actionable results, and support for decision making (superior outcomes).
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We are trying to develop Health Information System according to our organizational strategic plan. As part of this system, we have initiated the surveillance system of infectious diseases in our coverage area. The aim is to supplement the service and system gap in conflict areas to prevent the public health threats. The project started with syndromic surveillance as facility-based practice.
During first year, we have no experience in system set up project and have faced many difficulties in implementation. We collected data as weekly practice for immediately notifiable diseases and took as monthly report for other infectious diseases. This caused the front-line clinic staff to confuse and burden of data entry. As our project area has no internet connection and they had to go nearby township to submit report. So, the data timeliness and completeness were not met to target. As information is not reachable to HIS officer in time, the disease monitoring, case investigation and contact tracing are also late. The front-line clinic staff felt that the surveillance system become burden for them and gave feedbacks and complaints.
Therefore, HIS team met up with program and partner teams to develop electronic reporting system using health informatics in the first quarter of 2025. Due to many constraints and difficulties, we chose to use KOBO mobile application to collect the data and Power BI to monitor the disease trend in real time. The reporting timeline was set up as weekly basic and supported the clinic staffs with mobile tablets and Wi-Fi signal boosters. The surveillance diseases are re-selected and clinic staff are trained to use the KOBO application effectively.
After deploying KOBO to use in the surveillance system, the timeliness of reports is greatly changed and all reports reach the server in time. This is the amazing superior outcome within the project timeline. The staff did not need to go nearby township, not required report logbooks and it is cost saving for the project. The staff are satisfying to use the application; the HIS officer can analyze the data and interact with field team very quickly. The program team can monitor the incidence and trends of disease via dashboard. So, the response and medical supplies can be transported as soon as possible.
Although the reporting and monitoring of diseases is feasible with KOBO App, we cannot use electronic medical records and case investigation/symptom tracking tools.
Not all staff are familiar with technology and reluctance to use.
The data redundancy is still there because other medical recording is using paper-based system.
Due to organization nature, human resources are not enough for HIS team.
The internet stability and ability of mobile devices are still challenging in our project area so the systems are fragmented. -
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In my organization, I led the implementation of OpenMRS HIV for Antiretroviral Therapy (ART) patients. The purpose of the project was digitalization of ART patient management including monitoring adherence and supporting national HIV program reporting.
This project improved current practices in several important ways in diseases like HIV as the whole cohort history is beneficial for the treatment. Clinicians could quickly view a patient’s treatment history and laboratory trends (such as CD4 and viral load results), which supported better clinical decision-making. The system also made it much easier to track patients who were lost to follow-up, allowing outreach teams to bring them back into care. By supporting adherence monitoring, OpenMRS helped reduce the risk of treatment interruptions and contributed to lowering drug resistance in the population. For program managers, the system generated timely reports and dashboards that strengthened monitoring of ART coverage, retention in care, and treatment outcomes. Patients benefitted from reduced waiting times and more coordinated care.
The project faced several challenges from the beginning. There is large volume of legacy paper-based treatment history to digitalize first to kick off the first deployment. That process is very resource-intensive and error-prone. Infrastructure limitations such as unreliable electricity and internet connectivity sometimes disrupted system use. Staff turnover created gaps in trained personnel, requiring repeated rounds of training. In addition, ensuring the security and confidentiality of HIV-related information remained a major concern. Sustaining the system also required ongoing technical support and funding, which was sometimes difficult in low-resource settings.
Despite these challenges, the implementation of OpenMRS for ART showed clear value in improving quality of care, supporting national HIV program goals, and ultimately contributing to better health outcomes for patients. -
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Have you ever observed a health informatics project in your (other) organization? Please provide a brief introduction.
I have experiences in health data management especially volunteer based report. There is a Maternal new born and child health (MNCH) project implemented with community based volunteers. The volunteers were trained MNCH basic skill and provide health services to the community. There are two type of volunteer which are Axillary Midwife (AMW) and Community Health worker (CHW). AMW provided maternal health services like Antenatal care, delivery, Post natal care and referral services if the cases are out of their manageable conditions. CHW provided child health care especially under five year diarrhea and pneumonia cases to get treatment as per protocol. They are responsible to report with specific format like AMW monthly, CHW Monthly report including drug consumption. Our project staff conduct supportive supervision to them and refill the stock monthly. Project staff collected their reports and transfer to data staff to conduct data entry. We used offline Microsoft access database with separate AMW and CHW data entry form. There are around 900 volunteers from 7 tsps. There are four data staff who conduct data entry and provide feedback to project staff if there was irrelevant facts to improve data quality. They reported the offline access database to data officer monthly. The data officer combine the tsp monthly report and conduct data analysis. Then prepared monthly reporting with formatted template. In the format, There is summary of cases like how many deliveries cases by AMW and how many under five diarrhea and pneumonia cases are treated by CHW. Moreover, We also have to monitor the stock usage to forecast the estimated consumption for upcoming quarters.How can this health informatics project help to improve the current practices?
– The data officer are responsible to monitor delivery information, case trending of diarrhea and pneumonia, drug consumption and forecasting for procurement. We can also use the health informatics like there was unusual case load in one village or surrounded villages from corresponded place. It is the alert of GE outbreak. When GE Outbreak occur, we reported to respective township health department and conducted outbreak response with basic health staff.
Are there any challenges or difficulties in implementing the project?
– There are numerous challenges while implementing the project. The first bottle necks was graphically remote area. It is difficult to reach and internet connection is not available to set online reporting. The result is delay reporting and responding. The information are known when project staff visited to their area. The second challenges is volunteer education. Since the area was hard to reach, there was scare resources to assign as a volunteer. Their literacy is primary level and they had difficulties to use registers and prepare report. It was the major impact in data quality. The project staff conducted closely supervision and coaching monthly to improve data quality. -
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Brief Introduction about Health Informatics Project
_I have observed a health informatics project in our organization, where we implemented a Community-Based Health App (CBHA) in our project area. In this project, we provided mobile phone to each volunteer allowing them to collect health data directly through the application.The primary objective of this health informatics project is to improve decision-making in diagnosis and treatment by providing them the symptom-based algorithm and to reduce the burden of the paper works. This application also allows the volunteers to help the tracking of medical commodities so that the monthly manual stock checking is no longer needed.How The Project Help to Improve Current Practices
_The app has significantly reduced the paper-based records, which were previously used by volunteers to track various diseases and projects. This digital transition has simplified the data collection process and significantly reduced the human errors in disease management. Furthermore, it also reduced the burden of manual stock management.Challenges or Difficulties
_However, there are a few challenges in implementing the project. One of the main difficulties is the lack of digital literacy among some volunteers, particularly those of older age which makes it harder for them to fully utilize the app. Another challenge is the limited internet connectivity in some areas, which hinders real-time data transmission. To overcome this, the volunteers need to visit the nearest accessible points or the mobile teams visit these locations to collect data via Bluetooth or other offline methods, uploading it when they have access to better internet.-
Hi Sayar!
Thank you for sharing your experience with the Community-Based Health App (CBHA) project. Digital literacy and limited internet connectivity are common barriers in community-based health informatics projects. It’s encouraging that practical solutions, such as offline data collection and uploading when connectivity is available, were implemented to overcome these issues. -
I can relate with you. Working with volunteers of older age and has low digital literacy was one of the first challenges I faced while working in public health nutrition. I remember explaining to our volunteers what “sending a file” means. Fortunately, I was able to overcome that challenge after a while.
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Brief Introduction
I currently work at the local health office in our municipality, and one of the health informatics project that our organization uses is the Wireless Access for Health (WAH) electronic medical record system. We use WAH for patient records management, health program tracking, generating reports required by the Department of Health, and automatic generation of PhilHealth claims. PhilHealth is a government-owned and controlled corporation that administers the National Health Insurance Program of the Philippines. As an accredited healthcare provider, our organization receive payment/reimbursement from PhilHealth for services rendered to patients.How can this health informatics project help to improve the current practices?
Before using WAH, our health office used eKonsulta (Electronic Konsulta), a system developed by PhilHealth to record patient data. Compared to eKonsulta, WAH is more user-friendly and has more features such as comprehensive health program tracking of various health programs such as Maternal and Childcare, Family Planning, and Tuberculosis. This allows for easier data input and report generation. In addition, since WAH allows us to generate reports faster, we can submit claims to PhilHealth and receive reimbursement faster than when we are using eKonsulta. Payments from PhilHealth are used by our organization for operational expenses, facility improvements, medicines, and to pay for the salary of some of our staff.Challenges or difficulties in implementing the project
We started using WAH as our EMR early this year, and one of the challenges is the cost of using the system (our previous system, eKonsulta is free). Fortunately, we receive reimbursement from PhilHealth to cover the cost. Compared to eKonsulta, WAH requires more patient information to be entered into the system, thereby increasing time spent interviewing the patient. Some patients do not appreciate the additional time they spent being interviewed and want to be seen by the doctor right away. -
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Have you ever observed a health informatics project in your (other) organization? Please provide a brief introduction.
I have observed and operated in a private hospital effort to implement EMR system. When I worked as a medical officer 2 years ago, our hospital initiated using Electronic Medical Record (EMR) system using openMRS platform. It has used the digitalized system for pharmacy department for a long time, so the hospital aimed to expand the system across all departments.
At the beginning, all staff were trained in the software and prepared for transition. In my opinion, I think the hospital did not perform readiness assessments or engaged key stakeholders including consultants and specialists for digital transformation. On the first month of EMR implementation, it was a complete disaster. Workflow disruption occurred and staff became the intermediaries between patients and consultants. In addition to the workload burdens and limited technological abilities, staff all got the blame for delayed operations from consultants and patients. The experience highlighted the importance of readiness assessment and consideration of resistance to change before implementing new digital tools.
Finally, the hospital successfully completed the digital transformation. We all now recognize the benefits of EMR system in hospital operation. This was my first experience of how information technology can enhance healthcare systems.
How can this health informatics project help to improve the current practices?
This health informatics project helps improve the current practices, for example,
Information accessibility: we can browse the relevant information of the patient, trace the investigation results and admission status of every department from anywhere in the hospital.
Reduce redundancy and cost effectiveness: Patients with lost or incomplete records are no longer needed to repeat unnecessary tests and attending doctors can also acknowledge the patients by the full record in EMR.
Coordination of care: Integrated information across departments (eg. Lab, imaging, pharmacy) enhancing patient care.
Data-driven decision-making: I believe the advantages will also be significant for hospital management team to make real-time decision-making and planning.
Quality improvement: Quality team can monitor patient outcomes and staff performance through this system more easily.
Patient safety and satisfaction: Reduce medication error significantly with the installed software and attending doctors can acknowledge full medical history of patients.
Are there any challenges or difficulties in implementing the project?
The challenge in implementing the project is that:
Staff readiness: All staff were given training but when the system completely utilizes only EMR with no paperwork backups, the operation was initially chaotic.
Resistance to change: Senior staff and consultants with busy schedules are hesitant to adopt and cooperate in the system.
Limited technical capacity: Since most of the staff with old service years are not familiar with the technical devices and systems, they are more likely to be stressed.
Weak infrastructure: The EMR system needs a stable internet connection and areas with poor connectivity delayed the operation.-
Thanks for sharing, Ahma. Open-source platforms like OpenMRS or OpenEMR are great for sustainability, though they can be a bit weak on performance, UI and UX. On the other hand, creating new custom platforms gives more flexibility, but they’re costly and create long-term dependency. I’m still figuring out the best balance between the two approaches.
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Brief Introduction
I have observed the implementation of an Electronic Medical Record (EMR) system in the hospital where I worked. This system was used to digitally store and manage patient health information, replacing most of the traditional paper-based documentation. The EMR allowed doctors, nurses, and other healthcare professionals to access patient records more efficiently and provide timely care.How it can help improve current practices
The use of EMRs helped improve healthcare practices in several ways:
Efficiency: Reduced the time spent on paperwork and allowed quick retrieval of patient history, lab results, and treatment plans.
Accuracy: Minimized errors caused by illegible handwriting or misplaced files.
Continuity of care: Enabled better coordination between different healthcare providers, as all relevant information was stored in one system.
Decision support: Some systems had built-in alerts for drug interactions or abnormal lab results, improving patient safety.
Patient satisfaction: Faster and more accurate services improved overall patient experience.Challenges or difficulties
Despite these benefits, there were several challenges in implementing and using the EMR:
Training requirements: Staff needed time and training to adapt to the new digital system.
Technical issues: Power outages or system downtime sometimes disrupted access to records.
Resistance to change: Some staff were reluctant to move away from familiar paper-based methods.
Data privacy and security: Ensuring that patient records remained confidential and secure from unauthorized access was also a major concern. -
1. Have you ever observed a health informatics project in your (other) organization? Please provide a brief introduction.
I have observed a health informatics project in my current organization that focuses on disease surveillance through an Early Warning, Alert, and Response System (EWARS). The project is adapted from the WHO EWARS framework and tailored to the context of ethnic areas. It integrates two main approaches including Indicator-Based Surveillance (IBS) and Event-Based Surveillance (EBS).
In IBS, selected health facilities report weekly case data for the selected major diseases using the Kobo Collect mobile application, which works both online and offline. Once data are submitted to the central server, the surveillance focal point reviews the cases and verifies them with facility focal persons. Verified data are then processed in the surveillance dashboard, where automated analyses generate disease trends, alerts and key performance indicators.
For health events not captured under IBS, EBS is applied. Outbreak-related news is automatically extracted into the central server daily using Google Apps Script from multiple reliable media channels, including their telegram, RSS feeds, and websites. The surveillance focal monitors these inputs and verifies relevant information with local focal persons if needed. In addition, we also use the Program for Monitoring Emerging Diseases (ProMED) and HealthMap websites to watch the verified infectious disease outbreak news globally.2. How can this health informatics project help to improve the current practices?
This project helps to improve the current practices from reactive to more proactive surveillance, enabling quicker response to outbreaks.
Digital tools reduce delays and human errors in using paper-based reporting.
Automated data workflow ensures real-time visualization of trends to enable early warning and faster decision-making.
Early detection of outbreaks through EBS allows the surveillance team to capture health events outside of IBS.
Integration with global platforms (ProMED and HealthMap) expands situational awareness beyond the local level.
Evidence-based response planning is supported through surveillance dashboard that tracks disease trends and potential outbreaks.3. Are there any challenges or difficulties in implementing the project?
Information noise in EBS: Automated extraction rarely gets relevant and usable information, while outbreak sensitivity in local media remains low.
Connectivity gaps: Limited or unstable internet access in remote areas can delay data submission.
Technical capacity: some health workers need digital skills to use data collection tools effectively.
Verification bottlenecks: Surveillance focal point may be overwhelmed by large volumes of data, especially an increase of surveillance sites and during outbreaks.
Data Utilization: encouraging leadership to use data in the dashboard for decision-making is still a gradual process. -
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1.Have you ever observed a health informatics project in your (other) organization? Please provide a brief introduction.
While I worked with National AIDS Program of Myanmar, I had a chance to participate in collecting HIV Sentinel Surveillance (HSS) Survey. As it was a paper-based surveillance, it was costly in terms of paper, labor and space for storing and so on compared to modern electronice surveillance system mention in papers.How can this health informatics project help to improve the current practices?
The HSS identify the HIV positivity among key population which in terms helps setting HIV prevention and control targets of the National AIDS Program.Are there any challenges or difficulties in implementing the project?
In additiona to the difficulties of paper-based surveillance mentioned above, there were misunderstanding of data collection process by the clinical specialists, privacy breach, and loss of quality data in the long data collection process.-
I could imagine it. When the HSS survey was conducted using a paper-based approach, there were many difficulties as you mentioned. More importantly, when it came to data analysis and quality, it led to poor-quality reporting, which might affect decision-making and policies for HIV prevention and management at the national level. I am wondering about the current status of the National AIDS Program implementation 🙂
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