Topic 1 Significance of health informatics

[Saranath]

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 on how public health informatics can help to improve disease surveillance and the challenges of the implementation, particularly changing from paper-based to electronic-based surveillance system.

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?

[Auswin Rojanasumapong]

My former organization had a project to change all of the medical records from the written form into electronic-based medical records. Before this project, they tried to change the system by storing all the medical records in written form into digital images, which is easier for the users. However the drawback of this system is that the more image stored, the more storage space is needed, the data cannot be analyzed automatically because the OCRs (Optical Character Recognition Systems) cannot be implemented due to the variety in handwriting.

If this project succeeds, it can help to improve the current practice by reducing the cost of image storage, improve speed in transferring and accessing patient data from different departments, reduce the error that might occur in reading poor handwriting from the scanned medical records, and help in conducting researches because the data is already in digital form and can be used for many purposes.

However, this entirely changes how the physicians and nurses practice (They predicted that this might occur, so they tried the new system in one primary care clinic, which is run by many physicians from different departments). Physicians have to type the patients’ history and examination results and they struggle, especially older physicians who have lower skills in computer. The negative feedback is too much and they have to change the system back to the old one (handwritten-based medical record, scanned and stored for further use)

[Saranath]

Thanks for sharing! Your organization is not alone. I have seem the same problems in many hospitals. I’m not sure if the system allow hybrid methods, i.e. allow both typing the information and keeping the handwritten image. We may encourage your staff to use the “Real” EMR by typing information into the system first. I think this group is more likely to change.

[Sri Budi Fajariyan]

Based on my experience in developing an information system for a malaria program called SISMAL. the existence of SISMAL really helps the program in improving the quality of surveillance as well as monitoring and evaluation. Before the existence of the system, data was collected using paper and manually inputted from paper into excel. data was collected from all provinces in aggregate and based on district. SISMAL has changed the process. data is collected electronically on an individual basis and on a health facility basis. data becomes easier to collect and analyze. With the availability of data, the program can make strategic plans for malaria elimination and make funding proposals that are more detailed and according to field needs based on existing data. The obstacle in developing SISMAL is integrating SISMAL with other systems within the ministry of health organization. One of the obstacles is the absence of the same standard dataset, for example the health facility code. not all health facilities have a code from the ministry of health for example because they are not accredited

[Karina Dian Lestari]

I was involved in the development of health information system (HIS) using DHIS2 platform. It is a PaaS service model that would serve as database server, data visualization and analysis, and dashboard. It was meant to help the National Malaria Control Programme (NMCP) while they in the early phase of SISMAL system development. In addition, it would help our team to manage, analyse, and visualize the data that has been collected for several years.

However, the project then eventually dropped because NMCP had a better solution for their SISMAL system. Our team also had a limited amount of manpower because everyone already has main jobdesk and work to do. Developing a HIS is full-time work that needs dedicated personnel.

[TARO KITA]

I was involved in the centralization of the laboratory management system in Japan over 20 years ago that was implemented as part of the hospital-wide introduction of the electronic medical record system.
Before the initiative, doctors used to receive many different types of laboratory reports dedicated for each unit of analyzers, many of which were hand-written and were submitted only once or twice a day in batches by dedicated laboratory technicians.
The newly introduced system, which was a very simple LAN with client/ server system although the latest technology back then, drastically changed the whole laboratory management including patients’ sampling, timely reporting and quality control, as well as realizing efficient/ effective HR management.
The introduction of the laboratory management system was actually a shift toward patient-centered laboratory management.
One of the biggest challenges observed in the transformation was a people’s mindset to resist the unavoidable change. The leadership of the hospital governance and management played a crucial role in the implementation process.

[Arwin Jerome Manalo Onda]

I think it’s innate to human nature to resist change especially if that process has long been accepted and routinely done. However, as they say, “the only constant in the world is change.” We must be able to embrace change if it’s for the better. Sure, there are knockbacks in the beginning but starting now will be beneficial to the future generation.

[Arwin Jerome Manalo Onda]

unlike my peers who shared before me, I was not part of any development of a health informatics project in my previous organization. However, I could provide an example to which my organization attempted to digitize contact tracing through the use of a web-based app. Around June 2020 when our government was easing restrictions allowing businesses to open up, economic enterprises were mandated to conduct contact tracing in light of the government’s tagline “Test. Trace. Treat.” Many businesses were left puzzled on how to conduct such and many resorted to paper-based contact tracing. However, it was time-consuming, caused piling of people at the entrance (which, we were trying to avoid), and we as customers, were unsure how the information we filled out would be used in contact tracing – will someone retype those information in the computer?

After few months, the government launched its centralized contact tracing app. It was meant to collect brief medical history and previous exposures to a probable, suspect, or confirmed case in a few taps. Scanning the QR code then tick some boxes and you’re good to go. This could’ve eliminated the problems I mentioned above on paper-based contact tracing. However, the data collected seemed like they weren’t being used at all. Outbreaks have sprung across cities. COVID-19 cases shoot up like never before. Other cities created their own contact tracing app very different from the government’s. The technology and data are there but were never utilized. In addition, the application meant that a visitor should have at least a smartphone – leaving inequity towards others who don’t have such devices.

All the use that’s left for the said application is for compliance with the law – nothing more, nothing else. If it’s intended use were fully utilized then our response could’ve been better.

[Saranath]

It’s interesting that you brought up the issue of inequity. In developing country, we have to consider this issue a lot as not all people can access to a smartphone or sometimes data plan.

[Auswin Rojanasumapong]

Good point about inequity. The projects that involve accessing the internet must concern about the people who cannot have electronic devices or cannot use them. Not only the poor who cannot afford it but for other circumstances that block the people from using the electronic devices, such as elderlies, disabilities, or people with poor electronic health literacy.

[Tossapol Prapassaro]

Yes, I have observed and participated in the health information project in my hospital. Almost ten years ago, my hospital had the plan to change all documents from paper-based to electronic-based system, “The eHIS project for inpatient department.” This project was developed from the previous HIS system to enhance and facilitate all aspects of service such as clinical, pharmacy, nursing, billing, etc. This concept was aimed to change the old system into computerized physician order entry (CPOE) and electronic medical records (EMR).

There are many advantages of eHis system; for example, it could reduce medical errors such as prescription errors and drug interaction. The other benefits include multiple access or remote access, reduced labor work, data storage, etc.

Although they supported the end-user in any way, such as teaching how to use the system, creating a manual, and available technician support, implementation of these projects is not that easy because of the complexity and time consuming of using it.

[chanapong]

I had observed on implementation of EMR instead of paper-based medical records at my former workplace. Before changing to EMR, the paper-based medical records were scan and upload to the database. We had to go through all pages to find what information we want. And some of the medical records were omitted. So, there were not completely stored combined with different handwriting, some are difficult to interpret, leading to the transition to EMR.

This project helps all medical records can be stored and easily to obtained what part we want. It can reduce the medical error from handwriting and error from drug allergy or drug interaction from its CDS. Reducing storage space and workload for scanning documents is also one of its benefits.

The challenge of this project is all officers have to learn about the system and it takes time to accustom to the new system. During the transition period, increased waiting time for hospital service is encountered combine with the personal error from using the new system. But, these challenges have been solved when providing more knowledge and practice to all officers to use this system effectively.

[Pisit Saiwangjit]

When I did my internship in the certain hospital, I exposed to the implementation of health informatics on the chemotherapy order system. The previous system was the paper-based system which caused several hinderances in the ordering process, for example, the time that needed to forward the documents to another department was almost the entire time in the process, or the associated departments were not able to monitor the process. Therefore, they decided to develop the novel electronic-based chemotherapy order system which significantly dropped the process time and the associated departments was satisfied and able to work efficiency since they can monitor the process. In addition, the new system can notify the physicians and pharmacists when the ordered drugs were in the stock. But there still were some challenges in the implementation of this system because some people were not familiar with the electronic devices and this system is still the beta version which required time to test the defects of this system.

[Napisa Freya Sawamiphak]

I have observed the new adverse events (AEs) report system in my formal organization. The organization implemented the new AEs report system using an electronic database. All employees need to install the application on their devices (mobile phones or tablets) and use a unique ID to access the platform. They can report spontaneous AEs reports by filling all information directly in the platform without using a paper-based sheet. All information will be sent to the central data system and notify to the patient safety department. As AEs report needs to be submitted within a short and strict limited timeframe, this project can reduce times from normal process (download AE form, fill it, print or scan, and send to the patient safety department manually). It simplifies the AE report process which can improve the practice by reducing the burden and time. Therefore, the patient safety department would receive the AE reports on time, can report to FDA spontaneously, and can provide supports to patients faster.

However, because it was a new system, all employees must undergo training on how to install and use this system. There were some issues with the system stability during the first launch which led to missed reports. Therefore, some employees reported the cases twice with both approaches (paper-based records and electronic records) to make sure the report was submitted successfully, therefore, this can create duplicated cases. Additionally, some employees were not get used to the new system as well. Then, the department needed to accept both paper-based records and online records.

[Navin Prasai]

We need to consider cost-effectiveness, customer satisfaction, and outcomes for the value. Health informatics plays a major role in the enhancement of Healthcare Values.
once the data are in electronic records they can be used for research, decision support, and better health outcomes. Data are secured and easily assessed in different departments. This reduces the organizational cost. For paper-based health records, they need large storage space, can be easily damaged by natural disasters like fire, flood, etc.
In my previous organization, they realized the importance of Electronic health records and Telemedicine and started introducing the projects which played a major role in the enhancement of Healthcare Values.

[Napisa Freya Sawamiphak]

I agree with you. Several systems mainly focus on improving practice, cost-effectiveness and customer satisfaction are the factors that should be mainly considered as well for long-term use.

[Anawat ratchatorn]

I experienced some health informatics projects during both when I was in medical school and in real working life.

– When I was a medical student in Surgery Department, there was a simple web-based application implemented to collect TRISS Score (Trauma Injury Severity Score) to collect data for research purpose. This project was helpful in improving collecting of data digitally, so data could be managed and analyzed in more convenient and precise way. There were some negative effects from project like this, such as additional tasks must be done by healthcare workers to input the data.

– like other comments, as both observer and involver, EHR adoption and paperless-medical-record adoption are always challenging. Although it’s clearly known that there are many benefits, it is struggle to implementation in real situation. Users might feel difficult to change from writing in paper to typing. Furthermore, in initiation phase of implementation, there might be some duplicated tasks must be done both paper and electronics based that can make users resist to EHR adoption.

– I involved in HIE project called Health Link from Government Big Data Institute. In my opinion, this project is very interesting and can significantly improve seamless healthcare services in nation-wide. To implement this project is challenging in both technical and organizational aspects. For the technical aspect, hospital must prepare their data to fit with FHIR standard that is quite new and challenging for hospital IT team to do that. Fortunately, my hospital can manage those complex data collected from HIS to be fit with FHIR. Another difficult aspect is about organizational issues. If the project success, it means that every patients’ data can exchange nation-wide, so for private hospital, it might effects in both positive and negative way in business view. Additionally, to explain and ensure non-IT executive about cybersecurity and data security implemented in the project is an important task to do.

[Ashaya.i]

I have observed about automatic health report system which is the one of process innovation project implemented by my organization. This project developed by medical statistics department and information technology sector.

Due to the large amount of health data in the hospital, data retrieving to conduct the health report each month is very take time and use more manpower. Automatic report system will serve the need about reducing the time and personnel to conduct the report and make it easy to other department within organization to retrieve the data for further analysis e.g. cost, marketing, disease prevention and control. Besides, it can reduce human errors and duplication of report creating processes. To develop the system, we need to make the agreement about the clear definition of each data we need such as the definition of visit number of patient, admission number, discharge number, ALOS, etc., all of these data be collected and retrived from EMR system. Moreover, we need to create the templates of the report to fill the data so this is one of the challenges in implementing the project. After that, we input these data to the program that IT sector has developed and the system will process and create the worksheet contains the data that we need. The example of the report output such as OPD diagnostic classified by department, total revenue by cluster, financial perspective, all of these report can be use for resource allocation, service management and so on.

Another challenge is data utilization, user also has to realize about which data that they would like to use for further analysis, is it the same definition as the system or not? This is for using data effectively and meaningfully.

[Saranath]

Thanks everyone for sharing! Very interesting projects. Health IT system or project can be useful in many ways (reduce human errors, improve the utilization of data, reduce time spend in working process, etc.). However, the organization has to manage the change in the organization when the new system is developed and implemented (work load, training, IT support, etc.).

[Theekhathat Huapai]

Kampangphet hospital, where I worked 4 years ago, was changed from a paper-based IPD chart to an in-house developed IPD digital chart. This project was developed by a health informatics nurse and her ICT team. The healthcare team can use this program on tablets and desktops because it is a web-based program. This program reduces handwriting errors and costs. The problem is some parts of the hospital are still using an old program. But I think that this program may be replacing the old program soon.

[Weerada Trongtranonth]

My previous workplace changed from paper-based to EHR 2 years ago. All of us need to be trained to use the HIS. Of course that there were many people who might feel difficult to change and these let every processes in hospital went by slowly at first. After that, when everyone got used to it. Every processes went by so fast and we can find out the record easily. Also avoided hand-writting problem and misunderstanding in order.

[Pimthong Sinchai]

Since, I am still a 4th year student, I never used to work with any health informatics project much.
But in my opinion, I think health informatics project will improve a lots with the current situation, even though in senior project that some part, my advisor have used health information from real-patient to analyze the data.

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