- This topic has 23 replies, 13 voices, and was last updated 1 year, 7 months ago by Kansiri Apinantanakul.
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2022-09-03 at 9:44 am #37901SaranathKeymaster
During the COVID-19 outbreak, information technology has played an important role in outbreak management. Many health information systems, Applications have been developed which aim to assist the outbreak monitoring and control. In your point of view, is there any Health IT project that you think could perform better if we applied some public health informatics knowledge and skills on it?
-Give an example of the existing project
-Problems or limitations of the project
-What knowledge and skills of health informatics could help improve the project?
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2022-09-05 at 1:29 pm #37941Zarni Lynn KyawParticipant
During the COVID-19 outbreak, in my organization, we implemented mobile healthcare and telemedicine parallelly because the needs for health care in rural areas were not met by the government health systems due to a lack of medical supplies.
Telemedicine was developed for internal use first, but after a short trial period, we launched in the two most prominent cities in Myanmar, Yangon, and Mandalay. (https://www.facebook.com/ygnmedicalcover https://www.facebook.com/mdymedicalcover). I am an admin for both pages.
Since they were developed in parallel, there is no system architectural design, and we later found out that some of the data collected in both mobile clinics and the telemedicine arm were useful, and the need to analyze and report is critical for the sustainability of the programs.
The mobile clinic arm is using a paper-based data input method because, in some of the rural areas of Myanmar, mobile network coverage was less than ideal, and the IT literacy of the backpack health workers was still nascent.
At the same time, the telemedicine arm is collecting data using an online data entry using a different format. Due to the need for rapid implementation, we had difficulty combining two data sets.
We had to type in the paper-based data into the same online data entry for the mobile clinic arm and try to combine the two data sets, but since the formats were different at the start, there were a lot of missing data. In the end, during the analysis and reporting phase, because of the limitation of data uniformity and cleanliness, we were not able to publish our results in a peer-reviewed journal.
If we have a health informatics leader who understands the systems architecture needs of both projects, we will set up both systems using a good spine (common data entry format, structure, and process) which will help in
1) Planning Phase
2) Piloting Phase
3) Scale-up Phase
4) Analysis and Reporting Phase.If we use Federal Enterprise Architecture Framework, The Open Group Architecture Framework, or the Zachman framework, we may be able to present our findings more scientifically. These experiences led me to believe that public health leaders, not technologists, must drive the process. In this example technologist-led solution made the two arms run in parallel without a proper framework for the implementation. Although this example is only valid for my organization, I believe similar problems happened throughout Myanmar.
Finally, in order to prevent this kind of problem in the future, the Federal Ministry of Health should take the leadership role and set standards and we should identify champions in the Federal Ministry of Health to strive for health informatics leadership role.
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2022-09-08 at 9:38 am #37971SaranathKeymaster
Totally agree with you that a strong leadership is a key success of the project. Careful planning is important for the sustainability of the project. Thanks for sharing!
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2022-09-10 at 6:43 pm #38017Kansiri ApinantanakulParticipant
Thank you for sharing.
We also have the problem of application interoperability too!
You can see from my comment and Thailand’s classmate.I do agree with you that a well-planned EA would alleviate this problem.
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2022-09-07 at 6:33 pm #37967ABDILLAH FARKHANParticipant
During the Covid-19 pandemic, many apps were invented by Indonesians from various institutions but their aim was identical: to store, manage, and report health data. In my organization at least 6 web apps have been used as tools for travel health surveillance (named A, B, C, D, E, and F apps), but only A, B, and C were interconnected respectively. Furthermore, the rest are still standing alone.
To illustrate, I will briefly mention these apps’ specification. A is the web app invented to record the examination result of the RT-PCR/Antigen swab test. B is the web app specific to vaccination registration. C is the hybrid mobile app designed with a health-decision support system to stipulate whether the user is fit for travel or not according to the vaccination status and result of Covid-19 examination. D is the web app to record the inspection results of ships and airplanes which are under quarantine. E is the web app to record the result of contact tracing and epidemiological investigation. F is the web app to register and monitor the foreign passengers who’ve finished their obligatory quarantine arriving in Indonesia.
Although the system integration and data exchange among A, B, and C has been successfully improved the quality of travel health surveillance, simplified travel procedures, as well as reduced the overlapping function; however, there are 3 other apps that need to be engaged.
Enterprise architecture is important knowledge in health informatics to recover these fragmented health information projects. Although the Covid-19 is new to science which makes the prevention and control efforts sporadic with no integrated business plan, the enterprise architecture enables whole reforms for Covid-19 information systems in health sector. Improving the aspect of enterprise architecture will create standardization of data specification and allows all applications to perform data interoperability.
To facilitate the need for well-improved enterprise architecture, communication skill through group facilitation is important to map all the applications, classify them according to the institution’s business process, identify the relationship between the business processes, and carry out the architecture framework that allows interoperability.
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2022-09-08 at 9:45 am #37972SaranathKeymaster
I think every countries have the same problem as your country has. People like to develop Apps but do not think about how to share and integrate the information to each other. It becomes a burden to operating level who need to feed or input data into those Apps repeatedly.
It’s good to have different groups working on different modules or functions of the App. But you would need a well planned EA and communication process.
Thanks for sharing!
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2022-09-09 at 11:38 am #37998Boonyarat KanjanapongpornParticipant
During Covid-19, I have experience with applications which intend to reduce crowded hospitals and create remote patient management systems. At individual pharmacy stores, There are three main activities related to covid-19 which are ATK-certificate of results, ATK-dispensing for free and telemedicine for home isolation patients.
Because all activities are from different organizations and have been created to support specific health policy, there are a few platforms to use for a single disease. These have created some work replications and caused confusion with both healthcare workers and general users. For example, Time consuming to download, register applications and understand the process, and many general users who want to use services can be confused and they struggled to find the information.
Moreover, security of patient’s information could be another issue. Because of many applications, patients have to register every new application for services. Some applications don’t provide patient authentication in the applications and patients couldn’t travel to identify themselves at the pharmacy because of the isolation. Some personal patient information or healthcare advice have to be sent or communicated via other general communication applications. These possibly increase the chances of confidential information leakage.
Enterprise architecture(EA)could be used to create the big picture of the connecting between all business and IT work. Creating health informatics systems with the design management might help when expanding the data connection. In this case with EA, the following health services could be easier used and connected with previous data to reduce replicated work and create the interoperability between healthcare systems. Moreover, if there are problems while applying applications such as lack of identifying systems, it would be easier to solve the problem at the vulnerable point without affecting other processes.
Overall, This is the first time at the individual pharmacy that I have used healthcare service systems which connect with national health data. There could be burden of applying systems in the real situation. However, Developing EA during Covid-19 could be the blue-print to apply for effective future out-break management.
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2022-09-10 at 5:45 am #38006Kawin WongthamarinParticipant
In Thailand during the Covid-19 outbreak, there are many government-issued applications and names that confuse users such as Thai Chana, Mor Chana, and Mor Prom (similar sounds and meanings in Thai).
Thai Chana app is available for people to scan QR codes at various locations for retrospective timeline checks if they are found to be infected with COVID-19.
Mor Chana is an app that works similarly to Thai Chana in that it automatically saves travel information with GPS, eliminating the need to scan QR codes like the Thai Chana app. It also helps users assess the risk of infection when found to be in the same place and time as a COVID-19-infected person.
Mor Prom is an app for vaccination registration, tracking adverse reactions and proof evidence of COVID-19 vaccination.
All three applications will require registration and preliminary information for the first use. As a result, millions of Thais have to download 3 apps and fill in at least three duplicates. which creates a huge burden for the elderly, people with vision problems, and people who are not good at IT.
I think the solution can be achieved by visionary leaders. Starting from the leaders have defined an appropriate enterprise architecture framework and created a central team to manage the main application. After that, allow sub-teams from different departments to create their own modules that can run on the main app. It is imperative to have good communication between departments. If it can be done successfully, it would reduce the confusion of people and reduce the duplication of data filtering.
In summary, I understand that everything is easier said than done. At that time, everyone was shocked and rushed to create the fastest app available to help people, but it was important for leaders to have a vision and skills to help reduce this problem.
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2022-09-10 at 2:19 pm #38010Hazem AbouelfetouhParticipant
1- During COVID-19, Governments in many countries created a mobile application connected to national COVID-19 test centers to display individual status whether never been infected or time passed from the last infection, The application aims to monitor and control access to crowded places, especially closed stores.
Another example is an application using Bluetooth technology to notify you if get close to an infected person to keep an appropriate distance.
2- The problem was the lack of interoperability between governmental applications and private projects or even on a global level. As many countries were using these applications to allow air travel or moving among cities. Also, this would reduce restrictions and test certificates needed by different countries to enter their land.
3- Improving interoperability and maybe creating a global standard enterprise architecture for COVID-19 monitoring applications would make it easy for countries to exchange information and knowledge as well for maximum control and reduce error and workload.
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2022-09-10 at 4:41 pm #38012PREUT ASSAWAWORRARITParticipant
Since Covid-19 pandemic in Thailand from the early 2020, there have been many applications, platforms, and information systems developed to facilitate the government to make some policy. Such information systems includes Thai-Chana, Mor-Prompt, and information from hospitals that patients visiting for their Covid-19 infection.
The previously mentioned information systems have their own specific objectives. Thai-Chana application can track the Covid-19 infected patients about where and when they had been visited including duration that they stayed in that place. Mor-Prompt is a platform which includes data about vaccination, reports about their Covid-19 infection.
The limitation of these projects is the information in each project cannot be automatically integrated. They have to extract information from each platform, manually input the data themselves, and analysis the data. If we can integrate the data among these information system, we can provide prevention strategy and develop prompt policy.
To link information among these information system, we have to make the interoperability. Firstly, we should define the terminology used in each information system whether the same words have the same definitions. Later, we can develop the information architecture which can link the information form different platforms to the center information system.
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2022-09-10 at 6:38 pm #38016Kansiri ApinantanakulParticipant
I saw many classmates mention popular Thailand applications create by the Thailand government including Thai Chana, Mor Chana, and Mor Prom.
I have to confess that these applications were still very hard to discriminate for me at this moment.
I think communication and interoperability are the main problems of these applications.
Please allow me to share another related IT innovation during Thailand COVID-19 situation which is the COVID-19 infection monitoring dashboard published by the Thailand government.Thai Chana main purpose is to create a platform for Thai citizens to check in in any public place we go. Each time we visit a public place, we need to scan QR code and fill in the form. By sending this information to the database, we could receive the pop-up notification if we are at risk of COVID-19 infection because of COVID-19 cluster contact.
Mor Chana worked quite the same with Thai Chana but much more in automated perspective. This application track user GPS location.
Mor Prom is the vaccine information platform that allows users to track their own vaccine history and enter the vaccine adverse event. The recent patch also allows the user to track their own ATK or RT-PCR results.
COVID-19 dashboard is the daily published dashboard available in the Facebook fan page to give us an overview of Thailand’s pandemic situation.
Having different applications and platforms leads to poor compliance of using and led to low efficacy.
In my opinion, these 4 platform should be sync together and if possible should be integrate in 1 platform where user can track their vaccine, COVID-19 test result and cluster in the real time basis using only national ID number/ national ID card scanning.
When we visited public place or visit vaccination point, if we could simply scan the ID card in 5-10 second. This would be great.As I mentioned that the communication and the interoperability are the main problem of these application.
The knowledge and skill required to leverage these application is the “pre-designed” enterprise architecture (EA)
The government and application developer should closely work together to create the enterprise architecture (EA) that best fit to Thailand government working style (hierarchical – slow process) and Thailand social and culture (aging society – most of citizen are not familiar with technology).The EA should cover key stakeholders and key activities to be concerned.
For the back-end perspective, the developer should design the application database in “relational database” which could easily join with table from other database in order to analyze the result.
For a front-end perspective, the developer should design the UX/UI that best suit user of all ages.
For informaticians, we should proactively communication with the back-end, front-end, and the government policy maker the identify risks and gap of improvement for the platform while we should utilize the data getting from users to support public health disease control and measures.Kindly correct me if I’m wrong
Thank you ! -
2022-09-12 at 5:33 pm #38030Tanatorn TilkanontParticipant
As all Thai citizens know, the most popular applications which were created by the government during COVID-19 pandemic are MOR-Chana, Thai-Chana and MOR-Prompt.
To be honest, at first as a user, I am the one who did not download all 3 applications on my device as the similar names are confusing and I do not understand the real benefit and a need for those 3 applications.Apart from what our classmates have mentioned about the integration of each 3 applications, the problem that I can see is that it is not just only the global Thai-Chana application was used, but also some cities have their own applications when people travel to that city to be registered in addition to Thai-Chana, MOR-Chana, and MOR-prompt downloaded. In my point of view, it can be inferred that the data of traveling is not widely share with the upcountry. This causes the redundancy of information entry. That means there is a lack of interoperability and integration among each city as well.
More and more applications are created to support patients and healthcare providers during COVID-19 pandemic, such as Telehealth/telemedicine, where the applications are only used within a hospital. They aimed to reduce crowded people and prevent disease spreading in the hospital. However, the patient’s history data is only known by each hospital/ clinic.
The room for improvement is that all the information should be centralized, interchangeably and interoperability. The skill of data management and knowledge of enterprise architecture are crucial. By applying the enterprise architecture framework, it could reduce the problem of data redundancy and enhance data standardization at national government level.
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2022-09-13 at 9:15 pm #38048Tanyawat SaisongcrohParticipant
Totally agree with you. I also didn’t download all three main apps at the beginning because it was very confusing for users and also data privacy and security concerns but I got Mor-Prom later for the vaccination purpose.
In my workplace, we also develop the telemedicine portal and home isolation portal via our own hospital application that includes appointments, physician consultation, links to the pharmacy, the payment portal, and also provides patient health education. It actually did work, for monitoring and controlling the disease and also providing health services as well.
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2022-09-21 at 6:37 am #38208Kansiri ApinantanakulParticipant
I totally agree with you that the centralized application is the main key role.
I’m the one user that downloaded all applications but still did not know the key benefit of each application.
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2022-09-12 at 7:21 pm #38031Siriphak PongthaiParticipant
During the COVID-19 outbreak there are many applications created by many organization, sectors, also Thai government. The example of existing project that is widely used in Thai population nowadays is Mor-Prom however there are many limitations that I think it could perform much better.
I personally think that since we have patient information in database of Mor-Prom as well as vaccination records. Why didn’t application allow patients to upload their COVID-19 test result into the system by themselves. Thus the COVID-19 infected patients will receive the proper treatment by healthcare providers or referral system in a timely manner. This will ease the impact to frontline professions, especially local hospitals
The government can also extract COVID-19 infection statistic from the database without asking patient to register at local hospitals, or Or-Sor-Mor themselves. Nevertheless, the government could predict the outbreak on the number of infected cases in the future.In addition the government also developed application “Pao-Tung” for Thais to receive free ATK. I also wonder that why this is not included in Mor-Prom application since all patients COVID-19 related information are in Mor-Prom not in Pao-Tung application. Even though if they argue that because shops and pharmacies have “Tung-Ngen” application but why didn’t they create the interoperability of data between those applications. This will definitely reduce redundancy of downloading applications and facilitate use for the users around the country.
I think if some of us has potential to develop application, health informatics knowledges and skills will help much in developing application as users friendly. Yet to maximize and utilize the data collected in one.
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2022-09-13 at 12:25 pm #38042Boonyarat KanjanapongpornParticipant
I agree with many applications involved with COVID-19 management. I think planning for flexibility and scalability of systems before launching the application might help for the further population health systems.
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2022-09-13 at 9:48 am #38038SaranathKeymaster
Thanks everyone for informative and fruitful discussion.
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2022-09-13 at 6:51 pm #38046SIPPAPAS WANGSRIParticipant
I’d like to share a project from my current workplace. It is a system designed for Cohort Intermediate Ward, OPSI clinic (Out-Patient with Self Isolation) and Home Isolation during COVID-19 pandemic for patient evaluation and follow-up. This system is considered as a part of self-designed EMR and being used only within my hospital. It allows medical practitioners, including nurses and doctors, also patients, to enter data manually. Data includes vital signs, signs and symptoms, antiviral medication usage and important notification. It is a web-based application so that it allows access virtually any devices with an internet connection. This application also provides LINE LIFF functionality (FYI, LINE is the most used and popular communication platform in Thailand) so that patients can access and enter the data with ease whenever a LINE notification is sent. In terms of health care providers, we can see all statistics and patients’ well-being via a realtime dashboard. It provides useful information about the patients, including those who have concerning vital signs or has been missing his/her medications and allow us to notice within time.
It really is a good project yet it has some limitations. As far as I know, not all hospitals have owned or implemented this project. Some of them even use paper-based, and manually enter them in a spreadsheet later on, causing redundancy. This system, like I mentioned earlier, is an EMR so that these information are visible only within the organisation. This system neither provide a functionality to fetch important data from other hospital nor be able to share its data to other hospital. In short, it lacks interoperability. For out-patient cases, they work perfectly fine, but imagine a situation where patients have admitted in our COVID-19 patient care system and had all treatment recorded in this program. When their symptoms improved, they will need to be referred out (or step down) to other hospital where it has not yet implemented this program. Currently, doctors have to MANUALLY summarise those treatments provided into a spreadsheet and print out a paper form and give patient a copy. It is not effective at all.
So, if I have to improve this project with a knowledge in public health informatics, I would adapt a functionality to provide an API (application-programming interface) that supports fetching treatment data to an authorised healthcare institution and perhaps integrate with central government COVID-19 application/platform (e.g. MorProm app — well, if the authority allows me to do so). So that every aspect of data about COVID-19 including vaccination history, infection history, significant contact cases can be accessed and provide useful epidemiological information for the whole country.
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2022-09-13 at 8:50 pm #38047Tanyawat SaisongcrohParticipant
During an outbreak in Thailand, many health IT applications and platforms were developed for different purposes, for example, for reporting the current Covid19 situation, we have COVID19 TH stat dashboard (by the department of disease control, MOPH). For tracking the timeline/transportation of people and risk screening, we have Thai-Chana App (by Krung Thai Bank) and Mor-Chana App (by the department of disease control and DGA, which is no longer used now) and also have Klai-Mue-Mor (by Thai Health Promotion Foundation) and Thai-save-Thai App (by the department of health, MOPG), use for pre-hospital self-screening for COVID19. We have Mor-Prom App (by MOPH) for COVID19 vaccination information separately, it originated for tracking the cases but is being transformed into a national online health platform for Thai and foreigners residing in Thailand.
As in the lecture, the lack of interoperability is so common problem in reality. Some of them use the same set of data and look very similar or are even developed by the same organization. There’s a lot of workload for repeating data entering, a limitation in data sharing among systems, and difficulty to maintain because of different user support systems. The applications mentioned above are developed by many different stakeholders both government in different departments itself and also private organizations, however, there are a lot of redundant data.
In my opinion, the health informatics knowledge of enterprise architecture (EA) is the answer. Imagine if the executive team at the national level could implement an EA framework at the very beginning of a pandemic, this EA can enhance system interoperability and data standards used for all units, and also the concept of a one-for-all operation framework will reduce health data redundancy, create efficiency and well operate and communicate with each different stakeholder as well. Another important benefit from implement a good EA is flexibility and modification in the future without interfering with the existing system.
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