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In nowadays society, the use of information systems has been growing rapidly due to the need for rich information for decision-making, particularly in the institution where I had been involved. During my involvement in the disease prevention and control sector, my organization had implemented computer-based information system (CBIS) in the form of web-based applications to support disease detection, prevention and response in the community.
It is true that the existence of these platforms offers effectiveness in gathering the information to conduct follow-up responses in order to break disease chain transmission in the field. However, as far as I observe, these web-based applications are not integrated each other as they are used by single disease approach. This fragmented system could not cover multiple diseases which shall be collected, processed and stored in one central database, because each disease control officer had developed their own CBIS according to their needs. To illustrate, there were many developed web-based online platform to record the case of Zoonotic disease, HIV AIDS, Covid-19 and other diseases but they work on their system.
From my perspective, these systems should be interrelated between one infectious disease to others in order to simplify the operation and build one database. To accomplish that approach, the main possible solution is through better procedures, including strategies, policies, methods and rules for the management of CBIS.
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Yes, I agree. each healthcare organization or department has its own system. System fragmentation leads to inability to communicate with each other that could impact on patient well-being.
In my view, currently there are many groups of healthcare people and organizations trying to solve this kind of problem by applying a standard of system sharing and interoperability such as HL7 FHIR and OMOP. That means they don’t care what system is using in each hospital or department as long as they can share their data based on an agreed upon standard. However, it is a big challenge!Thanks for sharing,
Pongthep-
That is good insight, thank you very much.
I think to cut these fragmentation and to integrate the system requires policy and commitment from the top leader within my organization. As it happens in government institution (ministerial level) , big transformation about information system management is the key.
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From my experience, there are many hospitals in Bangkok tried to switch from paper-based medical records to electronic-based medical records by digitizing or scanning those papers into a database for quick and easy access to historical records. which I think is very good and convenient compared to traditional paper. However, there are many disadvantages such as requiring people to scan various information. The data is difficult to read because it is handwritten and it is not possible to search for information from handwriting.
All in all, I think that if the hospital could digitalize all data into electronic medical records, it would be able to increase the value of data such as accessibility, accuracy, and flexibility.
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In my opinion, to scan paper, it can only be stored as an electronic file. but unable to analyze the data to make a decision.
As you said, you’re right. the handwriting is hard to read. Let’s me share my experience, I’ve been working on a project about transforming paper forms into digital data. It actually starts with converting every field on paper into fields in an application and then start developing such application.
After that, we started to key in the old data on the paper into the new system, while new data from the patient’s hospital visit, we started to key-in on the app from that day on. By doing this, the paper system will gradually disappear, but at the beginning, the work will be a little harder.Thanks for sharing,
Pongthep
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From my point of view, there are many gaps of improvement for health care system. We should try to work on the pain point of healthcare personnel and patients who interact with the system.
One of the pain points is that clinical data of patients while admitting in the in-patient department (IPD) is still recorded on paper. These documents will be scanned and kept after the patient was discharged from the hospital. While other data such as laboratory and imaging is in electronic form. So, it is difficult to link data between analog and digital platform and translate to the meaningful information.
We (and also patients) will gain a lot of benefit if we succeed in implement computer-based information system (CBIS) in the IPD. We can forecast whether patients will deteriorate in the next few hours. We can classify patients, who need to be transferred to the intensive care unit (ICU), based on severity score that will be automatically calculated by the system. The hospital will have benefits on seeing a large view of patients in the hospital.
There is still some important limitation. First, the implementation of system need a lot of budget and there is a maintenance cost. The other limitation is the systems that have been used in the hospital cannot talk to each other. We may need center system that integrate information and process to meaningful information
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Creating a central system is a good idea, but it is necessary to plan well. As you said, each system is built regardless of interoperability with other related systems. It has its own operating system and database. Therefore, a centralized system needs to be able to support data from different operating systems and databases. However, in my opinion, barriers to connecting or integrating systems not at IT, but it depends on the policy and vision of the management, especially their willingness to share information with each other.
Great post,
Pongthep
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Please let me share my point of view on the system involving clinical research.
As we all know that clinical research is a field involving tons of paper and tons of data points, and there is a huge effort to integrate and simplify the system for all user levels.
The pain point for people who work in clinical research is that all systems are not working together well.
For example, the laboratory result is in System A while the study medication administration is in system B. the case report form is in the system. These systems are not linked together and sometimes lead to the safety concern of subjects involved in a particular study.I think it would be better if all clinical research systems could be linked together creating one integrated system. This would reduce administrative workload and allow clinical research personnel to focus more on the subject’s safety. Moreover, the data would be easier to manage and analyze. This would lead to a higher level of data integrity.
I have heard the trend of “decentralized study” and “central clinical trial monitoring”. This may be the solution of the pain point the discuess above.
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Clinical resreach involves many paper-based documents such as source documents, CRF, AE, SAE reporting, site monitoring, audit, inspectiion. Currently, there are many CDMS (Clinical Data Management System) in the market. Applying this kind of system can integrate and transform the paper-based data to electronic system. I have been working with a CDMS for many years. I think the software can support both decenlized and centralized setting. We can reduce many papers and documents because it is an EDC (Electronic Data Capture).
Thanks for sharing,
Pongthep-
Please let me share my experience working as a Clinical Research Associate in a private clinical research organization. My company has integrated CTMS (Clinical Trial Management System), which is including all study plans/progression, AE/SAE, site monitoring details, informed consent, patient data review/verification, contract, and payment. Most of the studies use the central laboratory system to have the standardization of results and analysis. Almost all the trials are encouraged to utilize the same CTMS. I did not have a chance to review paper data capture yet since the electronic data capture (EDC) was implemented just before I joined the company. In my opinion, the EDC is very useful in data capturing of patient information following the study objectives and requirements. We can use it to extract the report and see the trend of patient data.
However, the challenge is that CRA should review and verify to ensure that the data that was captured in EDC correctly and would comply with the original source, which is still in paper-based data and different systems used in the hospital. This challenge is also linked to the replies from Dr. Kawin (2022-08-10 at 10:30 pm) and Dr.Preut (2022-08-11 at 4:48 pm) about the handwritten medical record and centralized system. The accuracy of data transferring to EDC would be better if the hospital sites implemented the computer-based information system (CBIS) as well.
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I strongly agree with what Mr.Farkhan has mentioned! The information system in Thailand are indeed very much alike. Each hospital has implemented, or created their own hospital information system (HIS). We have various HIS platforms, for example, HosXP, JHCIS, or self-developed softwares. We also have something called ’43-Files standard’ in order to collect data from various hospital yet it is designed and collected for statistical purpose and not ideal for information sharing.
The problem here is there is no unified healthcare system. Each hospital or institution owns their own data. Sharing is per-request basis. You’ll need a document and consent form in order to acquire medical records, which takes time and delay treatment. As far as I know, we are currently working on implementing health care standard, HL7 FHIR, which also is what I currently am interested in! I really wish one day we will succeed in implementing those standards to provide our patients the best of care.
So, in short, current problem from my experience is about “Health Interoperability” which needs to be solved!
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Because of system fragmentation, that’s why we need to learn and implement data sharing standards like HL7 FHIR and OMOP. However, in my view, besides technical work in IT, another hard task is data mapping, which requires an understanding of our own HIS system and the resources of FHIR.
Thanks for sharing,
Pongthep -
Thank you. We are experiencing an identical problem that is system fragmentation due to the rigidity of organizational management. I really agree with your solution regarding system interoperability. In addition, I assume that creating interoperability needs leadership commitment and willingness to provide an integrated system that can prevent overlapping, confusion, and fragmentation as well so that communication and coordination between each department will be sustainable.
And thanks to recommendation from Ajarn Pongthep. Making sense HIS system among health officers is highly required through data mapping. In my observation, the health officers work on their own target, so that many information systems are established on their own way without considering its quality and impact.
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I agree with you all. I’d like to share some of my experiences.
As a healthcare worker in a University hospital and sometimes working at another campus, like a hospital hub, both locators they’ve already implemented the CBIS platform. For example, instead of using physical medical records, we use Electronic medical records (EMR) at the main hospital and eHIS software at the hub. In EMR, some parts are still electronic files (scanned paper), not digital data, and the hand-writing part is quite challenging as Kawin mentioned. For another campus, a paperless clinic, using eHIS, however, there’s such a lot of work filling all field boxes. Both software is linked to the same x-ray software, Synapse, which can be accessed across locators. However, EMR and eHIS are not linked; the patient who visits both locators need to register with a different hospital number and we can’t access the entire medical history across each locator. So even in a modern hospital already using CBIS, there’re still limitations in a system in terms of department/campus interrelation, accessibility, data sharing, and also some data is not ready to use for analysis. However, the system worker team is still continuing to work hard to improve the system I believe.
Another example in my workplace is the Implant stock in the operating unit of our department. As I know, they still record all implants manually, including checking, counting one by one, and writing them down in the implant booklist. When we schedule the case, we have to call in and ask them case by case if this implant is still left, or which size we have, they will check from that booklist for us. There’s an expert keyman behind the calls but they have an operation time limit. It takes them quite much time to do this task manually and also has a human error checking the stock. If we have the specific information system used for the implant stock system, there’re will be a benefit to the tools room keyman and us as a user to check the implant for preop planning anytime, after all, it’s a patient benefit too.
In my opinion, the information system is very important and useful in every field, but the ”people” is still an issue, especially the users. In converting paper-based into a digital system, it has to be a user-friendly application or software since there’s a mixed generation working together in our community.
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Based from my experience at individual pharmacy stores in Thailand, many people with chronic diseases prefer to get their medication at neighborhood pharmacies because it is easy to access and takes shorter time than at a hospital. Anyway, most of the patients do not carry their own medical prescription or lost it. This also happened with medical allergies card records.
Due to the disconnection of patient information from the hospital, most of the patient’s details are from patient’s memories which are not clear and easily wrong. Many times pharmacy stores refuse to dispense medicine because of unclear and ambiguous patient history.
Information systems could help this problem at the small health care unit. Possibly information connecting between hospital and pharmacy stores might help to decrease medication error such as repeated medications, Drug interactions and Medicines allergy.
Moreover, via Mohpromt application, people could approach their own electronic vaccination report to use when needed. I could see the possibility and benefit of having some of our own electronic personal medication records to use when switching between healthcare units as well.
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I totally agree with you especially the point of allergy card and record, I would say more than 90% of them who told pharmacists their history of allergy are presenting without the card but remembering. Sometimes we would better have a system that could access the important information of the patients because patient’s safety is the utmost concern.
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In Philippines, I don’t foresee centralization of databases (pharmacy, hospital) in the near future. Most establishments are privatized and would cost a huge investment if they transition into a central database. Some renowned hospitals may be able to adapt, but small players may have difficulty in implementing such.
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From my experience at drug store and hospital in Thailand, I have experienced lots of problems but one of the most common problem is the drug identification.
Most of the time, patient comes to drug store and asks for white oval-shaped pill for allergy. Which there are several brands as well as generic ones that produce white oval-shaped pill. Sometimes patient presents at the drug store and asks to buy a pill which’s kept in the ziplock (without name of medication on it). This also linked to when patients have drug allergy, they present at the hospital with just a pill in ziplock without any name on it. In addition, this includes Medication Reconciliation (MR) when pharmacist performs for IPD patients.
If we could have a system to identify marketed pills in Thailand or drug identification process, this will definitely diminish the risk of medication errors. Moreover, it could help ensure that patients will receive the right medication. Yet, particularly for MR, the patients will be continued receive the rights medications and dosages that they have been taking during admission in the hospital.
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In my country, a lot of government agencies need to adapt and reshape their organization for the digital future. Previously, filing taxes all resorted to manual computations. It was only in recent times that there were attempts to digitize filing of taxes (through installation of software and electronic submissions) but there are still prevalent problems like unsuccessful electronic submission due to unknown error, and most importantly, there system is there but there were no guides on how to fill-up the form.
Another example is our COVID-19 contact tracing application. In the earlier days of the pandemic where contact tracing methods have sprung up, individual cities implemented their own contact tracing applications. This means that whenever we visit other cities, we have to download another application to accomplish the task. It was only after a year into the pandemic where the government mandated the use of a national contact tracing application. However, some businesses were wary of its use and resorted to their own respective applications.
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From my experience, I studied at a university that supports medical care. I can take service from the hospital that belongs to the university when I was an undergrad student. I have transferred my healthcare rights to the hospital. I think that all my information was transferred too.
One day, I wanted to take service from the hospital belonging to the university. I needed to fill up my information again. The point was that I need to contract several officers in the hospital before taking service. The officer from the first floor told me to pass my document to an officer who works on the second floor.
It’s not that bad but I think it will be better if my information was shared with the hospital. Based on technologies, I think they have the potential to perform systems that support medical care services.
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From my experiences as a patient and a user, the government’s system in general still has problems in information organizing and transferring. I have been facing many situations where they cannot transfer my documents from one to another departments even though they are under the same organization. But I think it become a huge problem when the pandemic spread, there are so many patient and so many information that have to accessed and linked but the system failed to do that. Consequently, COVID patient cannot received the help as much as they needed it. When my family members got infected and need some medicine, we had to call so many numbers in one organization to tell them the same information all over again, which I think it would be less complicated to do if they use Information System to solve the problems.
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