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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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I once observed a small health information project in a border clinic (around 10-bedded). At that time, the border clinic was at its nascent stage, and it did not issue or have medical record system for the patients. However, more patients are visiting day by day, and it has become a dire matter to have a medical record system. So, our medical team had a meeting to start using the medical record so that we could easily track their patient’s history. Since the clinic was located in a low-resource setting with no regular electricity and internet connection, we had to resort to using the paper-based health record system. We used the patient’s name, his father’s name, date of birth and visit as the connected identifiers of the patient.
The sample workflow is:
Issuing a booklet to patients to record their medical history and note down findings, test results, diagnosis, treatment, and follow-up instructions —-> Recording the patient’s name, his father’s name, date of birth and visit, diagnosis, treatment in the hospital ledger.Improvements to Practices:
Better Outcomes: Having a medical record system, having access to their past medical history, had a great support in the clinical decision-making process, resulting in improvements on the outcomes of the visited patients.
Patient’s Satisfaction: Needless to say, improving their outcomes leads to better patient’s satisfaction.
Effective Resource Allocation (Cost Efficiency): Having a ledger that records the type of patients and frequency of their visits and the medications provided had a great impact on better resource allocation, by allowing us to prepare our resources and settings according to data-drive insights and trends.Challenges and Difficulties:
Firstly, it takes some time to record patient’s data, so it led to longer wait time in busy hours and times such as flu season.
Secondly, some patients lose their record, and when they re-visit, we had to issue another record, sometimes, leading to duplicate records in our ledger.
Thirdly, we had to assign two staff to record the patient’s data, so we need to train and build the capacity on how to efficiently record the patient’s data.
Fourthly, it is hard to analyze the manually collected data, and it takes a significant time to prepare, clean, and analyze the data for further insights.-
The lack of electricity and internet, it’s really difficult to manage a medical record system without those things. It must have been challenging to keep track of everything on paper. Maybe you could have used a solar-powered system to charge devices. Or perhaps you could have tried to connect to a nearby community center or school for internet access. While not forgetting to consider data security.
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Thank you for your sharing small project. I got some knowledge from your discussion. Currently, I am implementing an electronic medical records system to use in some enterprise clinics. We don’t need to leave the lack of electricity and internet currently the situation. Also, we need to consider the loss of patient records issue.
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Have you ever observed a health informatics project in your (other) organization? Please provide a brief introduction.
While supporting data migration for partner health organizations to integrate their old data into their software, I noticed they had different input formats and different destinated formats (into the software that they developed). It is quite difficult to support migration because it cannot be solved by a single migration script for all organizations.
How can this health informatics project help to improve the current practices?
Introducing health data standardization is a good way to improve this because most people may not have heard of it and software engineers, tech leads, and engineering directors are not coming from the health domain. Therefore, introducing it is a first step. Otherwise, the system design they developed will be a bad design without considering standardization.
Are there any challenges or difficulties in implementing the project?
Since they have not only different data formats from different organizations but also different software (different database structures), automating their data is a complex task because there is no standardization. In terms of resource allocation, it consumes much time for individuals (human resources) from different partners to collaborate with them on their migration plan.
After migration, another challenge is that they preferred their old structure in collecting data and requested to develop an automation system that converts from their structure into their software. In the end, change is difficult indeed.
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I understand your experience. Several years ago, I used to work with someone who was still familiar with the old data structure even after the HIS system had been changed. They continued to convert the data structure from the new system back to the old format they had used for a long time. I didn’t really agree with this approach, but I tried to understand them and wait until they retire, and teach the new data structure to new staff.
Change can be hard, especially with data systems people are used to. Sometimes we need patience until people are ready for new ways. Maybe showing the benefits of the new system slowly could help others accept change easier in the future. Even though it might have caused some missed opportunities for development. -
For the migration data experiences, it was not easy for different structures. It can’t be solved by migration script for all. We have to conduct, communicate, and introduce to the clients first (the decision maker, the owner of the system,). Some leaders come from different professional backgrounds. But some don’t want to learn the new technology practices as well.
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Hello Cing, you have highlighted the significance of having “data standards” in migrating data from an old system to a new one. I agree with you in your statement that having standardized data can assist in exchanging information. Additionally, yes, change is difficult in the case of implementing such a system but we can overcome this by building their data and sharing the benefits we will receive from the new system will encourage them.
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This health information project belongs to a foundation that provides mobile mammography screening for breast cancer in at-risk and underprivileged women across Thailand. My sister, who works there as a radiologist, told me about their traditional service process. It includes registration, taking medical history, risk screening, doctor’s examination, referrals, and data recording which is still 100% paper-based. Even compiling statistical reports is done manually. They face significant problems with document storage space and difficulty using the data for research.
She wants to develop an information system project. This system would connect data from mammogram and ultrasound machines, and link with an e-referral system for patient transfers.
This health information project can greatly improve current practices, such as:
– Upgrading public services efficiently with modern digital technology
– Solve the problem of insufficient document storage space
– Making work easier for service providers, resulting in satisfaction with the information system
– Increasing public satisfaction with the foundation’s operations
– Storing health data of service recipients to meet standards
– Convenient and efficient use of dataThe main challenge in carrying out the project is the budget. As a non-profit organization, all income comes from donations. Most of it goes to helping patients. Also, since they don’t have an academic mission, they may not see the importance of research studies.
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Hello Wannisa, yes, I agree with you that collecting data on paper and doing analysis manually consumes a lot of time. Introducing digitalized system can lead to many benefits that can assist them in providing assistances to those in need such as saving time, saving storage space, and etc. Even though their donations are limited, they can request a open-source and cost-effective software for NGOs from their donors as well.
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Have you ever observed a health informatics project in your (other) organization? Please provide a brief introduction.
Yes, I have experience with health informatics projects in my organization currently. Let me share the project briefly. I developed this project with my team members around January 2019. The project was based on paper-based (hardcopy) data format from clinic-level reports. It contains patient registration, Maternal and Child Health, Family planning, Reproductive Health, and General Mobility.
Paper-based workflows: The organization sent to the clinic to record a patient’s visiting history and note it down in that logbook format.
Before they used the projects, they used paper-based (hardcopy) for patient visiting day-by-day data. So they can’t send the reported data timely. They can send sometimes monthly or quarterly because they haven’t used any electronic patient records system, and also lack electricity and internet availability at the borderline of Myanmar. Firstly, we have to do capacity building at the data entry level (clinic)to use the digitized system. After training the end user, we released the project with a pilot phrase in some ethnic areas.How can this health informatics project help to improve the current practices?
The clinic-level data can be recorded in digitalized format, and they can send the patient’s data on time from where can access the internet, and it can enter data directly to a web-based online system. The head office can monitor and analyze the data. The lack of internet location, we support the project with an offline process. So the clinic level can send monthly to the head office and combine on the central level. On the data side, we are using a unique Identity code for the patient registration process.
So it can track the whole process of patient history with the unique Identity code for the next visit. (eg. The patient can register only one time, and then the patient gets the code (Unique Identity) and that patient can serve any health services (MCH – ANC, Delivery, PNC, Family Planning, Reproductive Health, and General Mobility). On the other hand, some patients forget their code (unique Identity), So it can search more easily with other record data like the patient’s name, date of birth or age, and father’s name in the system. It can avoid patient record duplication.Are there any challenges or difficulties in implementing the project?
Our team needed to deal and work with medical doctors/ health knowledge advisors and MEL team members. Because they are the client of this project. We got a lot of basic information from them. We learned the workflow of their practices. For the data, duplication is not yet covered all, because of using offline access. The migration process challenge was the duplication of data collected. Inaccessible internet connection in some areas also challenges of implementing the project. Another one, we don’t forget about electronic devices (eg. laptops,.) to use the project or system from the donation. And also need to provide human resources on each level (clinic level, volunteer level, and head office level to manage, monitor the data).
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Hello Aye, yes, it is a great idea to start the project at the data-entry level by eliminating workload burden and duplicates. Additionally, using the applications that can save and upload when the system becomes online is a great way to overcome internet difficulty issues. Yes, it is challenging to work with a team of multiple backgrounds but providing hands-on training can lead to ease of workflow in those projects.
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1) Observation of HIS project in the organization and use of the system
I observed 2 levels of HIS applications and project in the local health system of the border areas. The HIS applications are developed based on the 2 level of perspectives, from provider + client perspective and the other one is from heath system perspective. The first one is intended to improve the quality of care, improve clinical decision making and clients access to their health information like EMR. The second one is utilized for health planning, management and disease surveillance as aggregated HIS.
2) Challenges
The two systems are developed based on the different perspectives by different health care unit, information exchange between the two systems are quite difficult due to the different architecture, fields and data elements. This resulted the data cooperation between the system are challenging for health promotion, prevention and management. -
Have you ever observed a health informatics project in your (other) organization? Please provide a brief introduction.
I work in the field of Clinical research, and I have participated in a health informatics project that related to Clinical Trials using paper-based data collection methods. In the field of clinical research, efficient and accurate data collection is crucial for assessing the safety and efficacy of treatments.
Patients’ clinical data, including demographic information, medical history, and treatment outcomes, will be recorded using structured case report forms (CRFs). These paper forms will serve as the primary means of collecting data during patient visits. To maintain data quality, trained research personnel will ensure the accuracy and completeness of the forms, which will be validated through regular quality checks.
However, Using paper-based data collection in clinical trials introduces several risks that can impact the quality, accuracy, and efficiency of the trial. Below are the key risks associated;
• Data Entry Errors: Manual data entry into paper forms increases the likelihood of human errors, such as illegible handwriting, transcription mistakes, or missing data.
• Data Loss or Damage: Paper forms are susceptible to physical damage or loss due to poor storage practices, natural disasters, or mishandling.
• Limited Data Security: Paper records are harder to secure compared to electronic systems. Unauthorized access, theft, or breaches of confidentiality can occur if paper forms are not properly stored.
• Time-consuming and Labor-Intensive
• Difficulty in Real-Time Data Monitoring
• Increased Risk of Data Duplication or Inconsistencies
• Challenges with Regulatory Compliance: Paper records can make it difficult to demonstrate adherence to regulatory requirements, such as audit trails, timestamps, and data integrity standards required by agencies like the FDA.
• Environmental and Operational Costs: Paper-based data collection involves significant use of physical resources, such as paper and storage space, which increases the environmental footprint and operational costs of the trial.How can this health informatics project help to improve the current practices?
Implementing Electronic Data Capture (EDC) systems for clinical trials significantly improves many aspects of traditional paper-based clinical trials. Below are the key benefits of transitioning to an EDC system from a paper-based approach:
• Real-time Data Entry: In EDC systems, clinical data is entered directly into the system by study personnel, reducing transcription errors that are common when transferring information from paper to digital format.
• Automatic Data Validation: EDC systems allow real-time validation checks, such as range checks, consistency checks, and alerts for missing or incorrect data. This improves data accuracy and minimizes the need for manual review later.
• Audit Trails: EDC systems automatically track changes to the data, providing an audit trail for regulatory compliance and quality control.
• Faster Access and Monitoring: EDC systems allow for real-time data access for sponsors, clinical research organizations (CROs), and study teams. This speeds up the monitoring process, making it easier to track the trial’s progress.
• Reduced Paperwork: EDC systems eliminate the need for physical paper forms and storage, simplifying the organization of large volumes of data. This makes the data management process more streamlined and reduces the risk of lost or damaged records.
• Centralized Data Repository: All trial data is stored in a centralized, secure digital repository, making it easier to manage, retrieve, and analyze information. This also facilitates data sharing across study sites.
• Regulatory Compliance: EDC systems are designed to comply with regulatory standards such as 21 CFR Part 11 (in the US), ensuring the integrity and security of clinical trial data. The system’s built-in audit trails also help meet the regulatory requirements of various authorities.Are there any challenges or difficulties in implementing the project?
While EDC systems provide numerous advantages over paper-based trials, there are also challenges:
• Cost of Implementation: Initial setup costs for EDC systems, including software, hardware, and training, can be high, especially for smaller organizations or trials in resource-limited settings.
• Learning Curve: Training study personnel, investigators, and site staff to use the EDC system effectively may take time and effort, especially if they are more familiar with paper-based systems.
• Technical Issues: Data security, system downtime, and technical support are essential considerations. A well-maintained system with sufficient IT support is required to ensure smooth operation.
• Internet Access and Infrastructure: In resource-limited settings, reliable internet access and technical infrastructure can be a barrier to fully implementing EDC systems.
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