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Based on my job experience, I believe that the hospital where I worked provides an information system that is very effective for the staff. However, there are some problems that I think need improvement. One of my responsibilities is to collect the necessary data from the medical records of the project’s participants in the hospital’s EMR system and input it into the case record form (CRF). This process takes a significant amount of time because certain data is often recorded in the doctor’s handwriting, which can sometimes be difficult to decipher or may be missing crucial information. This issue can lead to incomplete or inaccurate data during analysis.
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Copying information from source documents is an extremely difficult task. As you said, it may lead to erroneous data imports that affect data analysis and data quality.
Let’s me share with you, I have experience working with CRF too, which is copying data from source documents. After that, I will import them into the computer system. The system will use an intelligent character recognition (ICR) software to read the data on it, then trying to import to the database.
It also depends on the CRF design. If it is designed with mostly checkbox fields, the software will read them almost 100% correctly. However, if fields are handwriting, there might be a higher error in reading.
Thanks for sharing,
Pongthep-
Your mention of the intelligent character recognition (ICR) software intrigues me. It reminds me of the potential of Optical Character Recognition (OCR) technology, especially in its capability to handle doctors’ handwritten notes. I’m particularly interested in exploring how OCR can be optimized to accurately decipher doctor’s handwriting. This could be a game-changer in ensuring data integrity.
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I completely agree. I have actually implemented a similar approach before, where I collected data from doctors’ recorded OPD cards. It was incredibly challenging to decipher the handwriting, even though I am a doctor myself. This emphasizes the need for an Electronic Health Record (EHR) system, which could automatically and accurately collect patient information in real-time after the doctor completes the patient’s treatment.
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I agree with everyone. I’ve gained experience working as a pharmacist in both Bangkok’s private hospitals and community hospitals. Deciphering the doctor’s handwriting was difficult, and it was even worse when the doctor refused to explain it. On the other hand, in private hospitals where EHR was fully adopted, work became simpler. I am glad that the majority of hospitals are currently implementing the EHR to lower error rates.
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As we don’t have a centralized information system, we are facing a big problem in our organization. Currently, each department has its own system and runs independently. Our processes frequently experience delays as a result of this disorganized approach, especially when we need precise and important information. It takes a lot of time to gather information from various sources and try to analyze it.
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From my experiences, a problematic system I’ve encountered is the operation room management. In my hospital, there are considerable challenges in efficiently coordinating surgical cases. For instance, in emergency situations like acute appendicitis, if you’re the surgeon, you need to contact the available operating room, summon a scrub nurse for assistance, reach out to an anesthesiologist for anesthesia control, and coordinate with the ward for post-surgery bed availability. This collaborative process involves significant time and effort from a multidisciplinary team.
In my view, this cumbersome procedure could potentially be replaced by an Information System that centralizes these tasks with a single click, enabling seamless communication with all relevant personnel simultaneously.
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Absolutely, a centralized information system plays an important role in enabling all scattered systems and data among different departments to be effective information not only for operating room management, but also in every department or division in a hospital. We need to have a good design in system workflow and data workflow together with tools such as database, visualization, programming, RFID, and other technologies.
Thanks for sharing,
Pongthep -
Totally agree, I have seen this kind of situation before. Once, there was an OPD patient who came for a follow-up, and she needed to be admitted immediately on that day due to her condition. The doctor had to contact several staff members in different departments, as you mentioned, and it took almost an hour to receive confirmation. Therefore, I believe it would be better to have a well-designed system in place to reduce the time consumption and ensure a smoother workflow.
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For me, one of the main problem is people. In my workplace, the doctors still prefer handwriting record and they do not accept electronic record. T_T
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Sure, when I started as a project officer, I had a similar experience where I had to convert a hardcopy report to an Excel format. The field team staff initially resisted cooperation because they preferred to continue using their standard reporting format. They are also unfamiliar with using even simple applications like Excel. However, after running a pilot program with 2 sites in a month, when they realized that it was flexible to extract different report components, they started to change. At the end of each month, we now have a standardized reporting format and a reliable data source.
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Keeping up with all the regulations is one of my most critical responsibilities as a regulator at the Thai FDA. Organizational interoperability issues arise as the agency’s information ecosystems become more complex. Since the agency regulates a wide range of health items, several regulations have evolved over time, and each division just keeps updating them on its website. Systems and methods are lacking for managing the information landscape logically and conceptually. There is no doubt that a lack of interoperability causes organizational confusion.
According to what I know, the agency has been working to create a new information system for the past five years. The software has been created to work with current data and hardware. The two most difficult components to make the system function effectively, in my opinion, are the procedures and the people (referred to as the five components covered in our week 1-1 session).
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Based on my experience working as a nurse in ICU, the EMRs is one of the systems that is still having problems even though it was implemented many years ago. In IPD where I work, doctors and nurses are the major users of this system. The doctor’s activities, for example, when they prescribe medication, they need to doubling their jobs on both paper and electronic format as they need to print out Doctor’s order sheet from EMRs (that store every forms of patient’s documents) and write it down manually and then scan and keep them back into the EMRs system later ><, while at the same time they need to enter prescription process again on computer to allow Pharmacists to know what they need in order to prepare the medication from Pharmacy room.
Another example is the doctor’s progress notes and nurses’s note which we need to summarise every shift/day, we are still unable to insert data directly on the system, we do the same: print > write > scan which consider to be our workload, waste of time and also waste a lot of paper. Lastly, I also agree as others that the paper documentation with handwriting is really difficult to decipher when multidisciplinary team need to review the documents and it is also increase risk of potential errors especially medication error which is quite common.
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The fact that doctors need to double their efforts by manually transcribing information from EMRs to paper and then scanning it back into the system is not only time-consuming but also prone to errors. This defeats the purpose of using an electronic system. But, in Myanmar, EMRs are a fragmented network in the private healthcare system, where there’s no connection between different hospitals, which has led to patients having multiple digital IDs across various facilities. This hampers the seamless exchange of patient information and continuity of care.
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In my experience of malaria surveillance, it’s clear that parallel and various information systems, including traditional paper-based methods and digital platforms, have faced challenges such as data inconsistency, delayed response to outbreaks, and uneven resource allocation due to fragmented systems.
From my perspective, the fragmentation of surveillance systems remains a significant issue. Many areas in the country still lack an integrated, real-time system that can efficiently collect, process, and analyze data related to malaria cases.
There’s a compelling need for a unified Information System tailored for malaria surveillance to address these challenges. Such a system could provide a standardized platform for healthcare providers, government agencies, and private organizations to report and access accurate, real-time data. This would significantly enhance timely decision-making processes.
A robust Information System that ensures data governance among all stakeholders, bearing in mind data privacy, would streamline data collection and reporting and facilitate data analysis, allowing health officials to identify trends and patterns. It could also aid in coordinating efforts among different stakeholders and enable seamless information sharing. So, all the public and private agencies should aim to achieve interoperability that allows a comprehensive overview of information. By integrating various data sources into a single system, we aim to provide decision-makers with a holistic understanding of malaria dynamics at the local level. -
I think the problem of information systems where I am from is about actually getting people in the healthcare system to use them. Here in Hong Kong we have a new system paradigm which allows any hospitals and clinics to share and exchange patient information with their consent, which is very convenient because it means that any healthcare provider would be able to see a patient’s history after setting up the system. However, many healthcare providers are either 1. not trained to use it and think it’s cumbersome so they would rather not use it, or 2. are too old-fashioned and are not open-minded enough to integrate the system into their practice. As a result, I have to bring all the hard copies of my scans and medical documents whenever I want a second opinion from another oncologist, even if there is already this information system in place meant to replace hard copies! Sometimes we are too focused on developing the system itself, but forget that its users are a critical element in determining whether the system would be successful.
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From my experience as a pharmacist in a community hospital, one system that could greatly benefit from an Information System implementation is the prescription management process. Specifically, implementing an electronic prescription system could solve the problem such as handwritten prescriptions that are difficult to read. The system can eliminate the need to interpret handwritten prescriptions, reducing the errors due to misinterpretation. This can significantly improve patient safety by ensuring accurate dispensing of medications.
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When I worked in a refugee setting, the organization utilized several databases and tools to collect, verify, and analyze patients’ data such as chronic patient tool, population tool, pregnant women tool, IPD tools, etc. Each tool worked on its own data and information with a separate system. But required data couldn’t be linked when we wanted to extract information from different tools. For example, if we want to know chronic patients who had deliveries and vaccinations in the RCH program can’t be easily checked between those tools. A common platform for data collection or extraction tools is essential for comprehensive health information and to support decision-making.
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As my classmates discussed, I also have experienced two problems in system development when working with the health data management of the projects and setting up the logistics management information system (LMIS) for health commodities in the public sector. The first one is the difficulty of creating a common or centralized system to organize all the necessary data across different programs, as they have different data types and definitions based on various health interventions. Even though we are aware that collecting the same data types is the best way to integrate the system, difficulties itself is defined by these various needs. I would appreciate any suggestions on how we can manage it. The second problem is the lack of support and coordination from the main decision-makers and the procedures for developing the LMIS at the Ministry of Health and Sport (MoHS) up to the township level. The system did not work well in some regions where the value of the information system was not recognized and the procedures were not followed. The information system relatively failed in these places where I think regular coordination and communication and supportive monitoring of the system outputs with data-driven advocacy could be one solution.
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