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– The results of this study are useful for designing interventions for other diseases since the 13 challenges are found in many telehealth interventions. Designing telehealth interventions is not limited to new emerging diseases but can be adapted to current health problems and create newer services, such as non-communicable diseases Tele clinics, psychiatric disorders (telepsychiatry), behavioral modification interventions, and various health promotion.
– While the author did mention that they did not assess the quality of the content of the included studies, in my opinion, this research finding shows the real concerns that must be considered for developing telehealth services.
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In my opinion, the efficacy of teletherapy is “as good as” conventional in-person therapy in terms of improving depressive symptoms and attrition. However, to replace conventional methods with teletherapy there should be further studies about other aspects of the service, such as cost, and technology adoption from both providers and patients.
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From what I have learned, Bayesian and Frequentist are different in perspective of the answers and methods of finding the answer. Like many examples provided, Frequentist tends to rely on current data from repeated test/action while Bayesian tends to rely on prior knowledge. From my experience, I am familiar with the way of Frequentist, but I can imagine why the concept of Bayesian can be used in some situations to predict the result. Since there is no right or wrong between the two, we should learn both approaches to understand the perspectives of both Frequentist and Bayesian.
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My name is Auswin Rojanasumapong. I am a family physician in Lampang Provincial Hospital. I used to work as an instructor at the Department of Family Medicine, Faculty of Medicine, Chiang Mai University. While I was in residency training and working as an instructor, research skill is a requirement so statistics is essential. Right now as a family physician, I still use statistics to work with data from the services and do research that involves primary care. I have learned statistics from my mentor and I took a short course about statistical analysis.
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Since we start with unknown reasons about why they are not using bed nets, we might start with an open-ended question of “why?”. Qualitative research might be useful to explore the reason, which might lead to a deeper understanding and broader perspective of the people that might be connected with the use of bed nets, or even their ideas about malaria prevention.
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– The newer technology should perform better (or at least as good as) than the old one.
– New features or better performance added should be worth an effort to adapt to the newer technology (for instance, if the users have to adapt to the newer system or even change the workflow for the new applications, the newer version of an application must add enough new features or better performance to persuade the users to change) -
I think external variables that might influence an individual’s perceived ease of use of new technology are
– Age, because younger generation tends to learn about technology faster
– Education and electronic literacy
– Socioeconomic status
And variables that might influence an individual’s perceived usefulness are
– Education
– Social and peer influence
– One’s need for a specific reason. For example, people with specific health problems might perceive the usefulness of one specific application that helps to solve their problems more than the general healthy population. -
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My current job is managing Home Isolation System for stable COVID-19 patients. All four principles of biomedical ethics (autonomy, beneficence, non-maleficence, and justice) must be considered, but I would like to give an example that I think is controversial in this project.
Non-maleficence is an ethical issue that is important. Since home isolation lets the patients who tested positive for COVID-19 with stable conditions stay at home and do self-care with the help of health care providers remotely by telemedicine. This system must detect an abnormality of the patient early in order to protect the patient from delayed treatment, which is considered to be “do harm” to the patient. Another good example of doing no harm is to breach patients’ privacy. Home isolation System works with many health care personnel (often including other sectors such as delivery services to deliver foods and medical supplies) and sharing patient information must be done carefully.
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Thailand’s Universal Health Coverage (UHC) is called “30 Baht Treat All” (pay for only 0.90 USD for each hospital visit). This scheme is available for every Thai that has a national ID and not in another health scheme (social security or civil servant). The patient can make a visit to their nearest health care provider that they are registered and pay 30 baht (0.90 USD) for any medical problems. Right now, the system is transforming to make the patient easier to access care by widening the condition of hospital visits, which the patient can visit any hospital without having to visit their nearest registered health care provider (“30 Baht Treat Anywhere”).
The good thing about this UHC scheme is that everyone in Thailand can access health care services without worrying about their economic status, so it helps everyone with justice.
While the system looks promising, especially new transformation, there are some concerns about the quality of care and resources distribution that needs to be considered. For instance, not every area has enough health care providers to serve the population in each area, or the funding and workforce might be lacking in some areas.
What needs to be done to make this UHC scheme works better is the distribution of resources must be done appropriately and develop every health care provider with a similar standard of care (not just a few “excellence centers”, but “equally excellence for all”), so the patient in any area can get the best quality of care as same as another area.
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In my opinion, social activities (eg. current occupation, school) might be the confounder of the result. Young adults tend to have a more active lifestyle and spend more time with others in their society. Adjusting for social activities (current social status, such as employed/unemployed or studying/currently not in school) might be appropriate to explore an association between age and contact pattern.
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In my opinion, the number of health informatics workforce is rising, but still not enough. I think the real challenges are
– Health informatics is new to the Thai health care sector. Many health care personnel does not fully understand the role and the benefits of informaticians.
– High workload of health care services in Thailand obstructs changes in the system. Implementing new methods using health informatics often need changes and adaptation, which many organization avoids and tends to stick with traditional methods due to a high number of patients and they cannot waste time to adapt to a newer system. -
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Mortality Rate
Definition
A mortality rate is a measure of the frequency of occurrence of death in a defined population during a specified interval.
It is typically expressed in units of deaths per 1,000 individuals per yearCalculation
Mortality Rate = [Deaths occurring during a given time period (typically 1 year) / Size of the population among which
the deaths occurred ] x 1000 (in case of expressed in units of deaths per 1,000 individuals)Main usefulness
Mortality data allow health authorities to evaluate how they prioritize public health programs. It can be used to compare the rates in one area with the rates in another area, or to compare rates over time. -
The good things about EMR in my setting are
– Easy to access: Medical records of each patient can be accessed easily anywhere in the hospital (and for some situations, access minor necessary details from outside of the hospital can be done) so when referring the patient from one department to another it is much easier to communicate and provide continuity of care.
– Prevent data loss: Keeping medical records in the electronic system can prevent data loss compares to the traditional paper-based medical record. The EMR system in my hospital regularly backs up the data, so it is much more reliable and assured that the data will not be lost.
– Can be used for another purpose such as improving quality of care and research. It saves time to redo the database and prevent input errors.The bad things about EMR in my setting are
– Not all user-friendly: Many health care personnel (especially old age) does not have enough skills to deal with the newer EMR system, so it is struggling for them and can cause a burden.
– Confidentiality: Since EMR makes it easier to access data, sometimes it is too easy to access personal data and privacy might be breached.
– Need training and time to adapt: If the system changes (which is necessary for the system to be improved), it needs training and adaptation period for workers, which sometimes become a struggle in the workflow. -
My suggestions on coping with challenges in big health data challenges are
Missing Data: Since the missing data was not random, but from the intention of each study to omit or ignore meaningful data that might be useful for further analysis, there should be an agreement on what data should be collected in the similar topics of the study (eg. for cardiovascular research, there should be recommended variables that must be recorded) as a standard so the data (which might not be used to analyze in the current study) can be used in the future combined with other studies.
Data Analysis: It is true that while some clinicians or researchers have knowledge about traditional statistical tools, many still do not have adequate knowledge about handling and analyzing large datasets (even traditional statistical methods, many clinicians who are willing to do the research still do not understand them clearly). Newer techniques to handle and analyze big data, such as data mining and machine learning, should be trained in order to encourage clinicians and researchers to make use of big health data.
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I agree with all of the recommendations. However, in reality, it is much harder to follow the recommended steps. In my opinion, unlike making a decision in clinical care in which there are clear cuts between normal and abnormal(disease), defining the act of corruption is often difficult. If we cannot start by defining what is wrong and what is acceptable, it is much harder to move to the next steps.
And I also agree about the difficulty of explaining the corruption situation, because it is difficult to do the research. Like the article said, it is hard (and might be immoral or worst, illegal) to conduct research that detects the corruption and let it happen (In my opinion, it is like conducting research in human even though we know that the intervention clearly harms the patient)
I think the first step to start to fight corruption is to seek an agreement between stakeholders about the definition of what is considered to be corruption. And I also agree with other participants’ ideas about the seniority and hierarchy culture (which prevent someone who witnesses corruption to speak up) that is much difficult to change. However, if we build a newer culture to the younger or current generation about an anti-corruption idea, this problem might be lower in the future.
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I would like to give an example from the current situation. Currently, Thailand’s health care system is transforming the Universal Coverage Scheme to make the patient easier to access care. Before the transformation (“30 Baht Treat All”), in order to use the Universal Coverage Scheme, the patient must visit the hospital or the health care provider that they registered with as a primary care service before visiting other hospitals. The plan of transformation is that the patient can visit any hospital without having to visit their nearest registered health care provider (“30 Baht Treat Anywhere”).
While the transformation is considered to be the big leap of health system improvement to widening the health care coverage, there are several barriers that could occur in that system improvement process.
– Health workforce: the workforce must distribute appropriately in order to serve the patient that can access the healthcare anywhere (eg. some hospitals might have more visitors than others due to various reasons)
– Information: if the patients can visit any health care provider, accessing the medical record must be available from every hospital. Referring patients from one hospital to another must be easy and seamless.
– Medical products and Financing: like the health workforce, they must be distributed appropriately to serve the patients. -
In my opinion, the procedure that should be included in the plan is data replication. Because hospitals and healthcare sectors must always be up and running, I want to design my organization’s information system to be always available to provide seamless care for the patient. The replication system should be synchronous replication because the system needs instant failover if the primary server fails.
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If I implement the high availability technology in my hospital information system, the benefits are
– Higher patient safety, because health care providers can always access vital patient information which leads to better clinical decisions and better health outcome
– Satisfaction from both health care providers and patients. High availability of the data access guarantees the timeliness of service because the patient does not have to wait for the system if it is failed. High availability also satisfies health care providers, because it makes their job much easier -
I would like to share the factors related to my work. As a manager of COVID-19 vaccine clinic manager, here are STEEP factors of my context
Social: Trends about getting vaccinated change rapidly and change over time depending on the situation that occurs in that time period (eg. news about adverse reaction from vaccine tend to change people’s mind about vaccination, news about the new cluster in the area tend to increase the number of patient in the clinic.
Technology: Using technology really impacts the workflow of the COVID-19 vaccine clinic. It helps in decreasing the workforce, improving the accuracy of the data, and increasing the number of patients we can serve per day.
Environment: The environment of the setting must be considered in order to maintain social distance. We have known some of the high-risk patients that visited the clinic, and we want to protect others from infecting COVID-19 from our clinic.
Economics: While the clinic runs well with the support of the hospital and the Ministry of Public Health, this COVID-19 situation still keeps going, and vaccinating people must be an ongoing service. Vaccinating a large group of people continuously (not only high-risk group such as influenza) is a big task that needs resources in order to continue the service.
Politics: The uncertainty of the vaccine supplied by the government and confusion about the policy about vaccine formula sometimes makes it harder to plan forward in vaccinating everyone in the area
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I do not have experience about not being able to preserve the CIA of the system, but I would like to share the process of running the COVID-19 vaccine reservation and the idea that might be the pitfall of the system.
In the COVID-19 vaccine clinic, we would like to make it easier for the patient to reserve the date and time to get vaccinated, so the idea was that the patient could fill in their name or citizen ID on the website and make a reservation. In the process, when the patient fills in the citizen ID, there is some information that comes up to confirm the identity of the patient (eg. citizen ID, name, surname, age, phone number, place, and time of 1st dose vaccination if to reserve 2nd dose). Then someone in the team mentioned that this might be a loophole for someone to check for others’ personal information(eg. checking someone’s citizen ID, name, or telephone number with his/her name or citizen ID). This idea was changed to not showing the information to confirm the identity but only showing the data that the patient filled in to confirm that he/she uses name/ID to reserve the vaccine.
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Thank you for your presentation. I agree with you about the importance of screening and surveillance for chronic kidney disease (CKD) since it is often missed and may present with late-stage if not early detected. Detecting the early stage of kidney disease can help both the patients to beware of their current underlying disease condition, and help the policymaker in preventing NCDs that are the major causes of CKD (hypertension and diabetes).
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I use to do my project about eHealth literacy and its association with health outcomes. I made Gantt Chart plan my project to do the research while I was in residency training. Because it was my first research project, the time I took for each activity are long, but it was my first time using Gantt Chart.
Here is my Gantt Chart
https://drive.google.com/file/d/12ghT61B7xynugI2kEq9zcsVyWvzHJI4G/view?usp=sharing
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Compares two leaders communicating about the COVID-19 situation, there are some details that both are different
1. Be first: From both messages, in my opinion, they tried to communicate at the right time and as early as possible, but for Singapore PM he stated that the situation has been started for 2 weeks which is acceptable to consider all the facts discovered and the real situation that was happening.
2. Be right: In my opinion, they both told the truth, but for US President some messages are overexaggerated (eg. we are/have the best … in the world). Singapore PM’s statements are, also in my opinion, more humble and realistic.
3. Be credible: They both tried their best to state the situation with truthfulness, but again, the tone of the message from Singapore PM is more humble and realistic which might gain more trust from the listener.
4. Express empathy: Singapore PM’s message mentions the natural human reactions to the situation (“fear and anxiety”). This statement might be the key that shows the understanding of people’s reactions and mental status. Focusing on the psychological and emotional situation of the people is what makes this message different from the US President’s message.
5. Promote action: Both leaders state the meaningful things to do, but US President’s message mentions the economics issue more, while Singapore PM’s message emphasizes more on what the people should or shouldn’t do.
6. Show respect: Both show respect to the audience, but for the US President some of the messages, in my opinion, about others’ fault (eg. poor situation control in Europe) are not necessary.
In conclusion, I think both tried their best to communicate about the situation, but the style of the presentation, the audiences they focus on, and their working team might be different which leads to different approaches.
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I use to study and work at the same hospital for 12 years (medical students, residency training, and working as a staff). I have a good opportunity to train family practice right after I graduated MD and the opportunity to continue my career as a family physician instructor at the same workplace. I have never changed my workplace since I entered the university. Being a family physician who involves primary care tasks but never steps out of a tertiary care setting (university hospital) really questions myself about my potential of being a family physician. However, after working for 3 years I realized that life in the university as a primary physician in a tertiary hospital didn’t suit me, and I have been married for 2 years, but I have to live alone (my wife works in a different province).
So I decided to quit my old job and start my new job as a family physician in a public hospital the same as my wife. Here I have opportunities to practice primary care, live with my family, and have my new mentor here advise me to take this course.
Overall, the risk I took to step out of my comfort zone is really worth it!
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In my opinion, the application that my country still needs improvement is the contract tracing system. We use to rely on self-report and self check-in systems (“Thai Chana” for self check-in when going into the mall, shop or restaurant) for recording time and places that the person visited. If there was a positive COVID-19 case in that area at the same time, the app would have the data and warn the users about the risk. However, this system is often ignored by the user by not using it (not scanning QR code while going into the area) due to the complicated process and mistrust of the application. The contact tracing system should be easy and need no complicated steps to check-in. For instance, instead of manually scanning the QR code for check-in, the system can be changed to Bluetooth proximity detection from the user’s device to automatically collect the contact data. This method is easier and more reliable compares to self check-in.
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List of the diseases outbreak that has occurred that the International Health Regulations Emergency Committees were convened, but only the events with “*” have been declared as the Public Health Emergency of International Concern (PHEIC)
– Influenza A (H1N1) pandemic (2009–2010)*
– The Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak (2013–2015)
– The international spread of poliovirus (2014-ongoing in 2020)*
– The West Africa Ebola Virus Disease (EVD) outbreak (2014–2016)*
– The Zika virus outbreak (2016)*
– Yellow fever (2016)
– The 9th EVD outbreak in the Equateur province of DRC (2018)
– The 10th EVD outbreak in DRC which began in the North Kivu and Ituri provinces (2018-ongoing in 2020)*
– On-going epidemic of COVID-19*The reasons of these outbreaks raise such concerns, refers to PHEIC declaration criteria, are
– Constitutes of an extraordinary event
– Public health risk to other states via international spreading
– Requires a coordinated international responseOther important criteria that some events did not have are
– Sustained community transmission
– Gaps in knowledge due to a novel agent or limited response experienceIn my opinion, a condition that may potentially lead to PHEIC in the future might be a known infectious disease caused by climate change that helps vectors to reproduce or transmit the diseases easier, for example, climate change can lead to change in weather that bugs or mosquitoes prefer in reproducing and the infection might occur in an area that has no history of this disease before.
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Inaccurate data reported to the surveillance system can generate wrong data that affect the following use of the data, such as planning for prevention, policymaking, and resources allocating to manage the problem.
Overestimated data can mislead the policymaking in focusing on the problem that does not exist, or should not be put in the first priority, leading to overlooking the real situation and spending too many resources on an unimportant issue
Underestimated data can leave the important problem undetected, untreated, and lastly, the problem might be too severe to handle easily.
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Information technology can help in outbreak investigation in many ways. For each step of an outbreak investigation, IT cab helps by
Verification and preparation –> Clinical Decision Support System (CDSS) can be used for differential diagnosis, verify and report the laboratory result in real-time.
Describe the outbreak –> Data collection of cases in the area can be easily done by information technology and can be managed systematically in the computer system instead of paper-based.
Hypothesis and Testing –> Data analysis can be done easily and in real-time with statistical software and other analytic systems software.
Response and Action –> Communication of the report and recommended policy now rely on computer networking and the internet, which is an important part of information technology. -
The tool that I like most is contact tracing for COVID-19. This system uses proximity detection to trace and detect contact between people. Before this technology, we asked the individual (with highly suspected or confirmed COVID – 19 case) about their timeline (where and when they went, who they have met) to track for other people who are at risk. This kind of investigation relies on human recall, and people who contacted with the index case might not be specified (no details about who contacted and how to reach that person to notify that they are at risk). The newer technology “digital contact tracing” uses location data (Global Positioning System, cellular network) and proximity data collected from Bluetooth in combination to trace the location data and track the contact of an individual who is nearby. If one tests positive for COVID-19 and records their status in the app, the app will send the data that has the recorded timeline and record of contacted people to the server, and the people who have contact with the index case get a notification to quarantine or get tested. This method is much quicker and more accurate compares to human recall.
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– How can surveillance help to detect and control the disease?
Surveillance can help to detect the control by detecting the time-place-person that infection of COVID-19 occurs. This information can help to allocate the resources, monitor the outbreak, and plan for investigation of the outbreak. The surveillance also helps to monitor the impact of interventions, especially vaccination in the area if it is covered the population and is effective for prevention.– Should we conduct active or passive surveillance or both for the disease, why?
For COVID – 19, we should conduct both active and passive surveillance. COVID – 19 is one of the diseases that need to be notified to the authority in case of new case detection which is considered passive surveillance. For active surveillance, it is necessary because many infected COVID-19 patients are asymptomatic but can be a spreader that does harm to others. These patients did not come to the hospital. Active surveillance, such as screening with an antigen test kit (ATK) in high-risk areas or in an area with a history of an outbreak can early detect the spreading of the virus.– Which method should be best to identify cases, why?
#Cases in medical facilities VS community
Both methods are needed to detect the COVID-19 case. In medical facilities, the patient might come to the hospital with abnormal symptoms (such as fever, upper respiratory symptoms) which are then investigated, diagnosed, and report to the authority. Screening in the community is also important since many infected patients have no symptoms. Using a test kit in the area at risk can detect more cases.
#Sentinel VS population-based surveillance
Both sentinel and population-based surveillance are needed. For example, when there is a new case detected in a particular area, such as a market or a large factory with many workers, we use sentinel surveillance to detect cases in that area. Population-based surveillance is also necessary to represent the national level of the disease.
#Case-based VS aggregated surveillance
Case-based surveillance is still necessary in some areas that the rate of infection is still low to early detect the index case (information from the index case such as timeline, place visited, a person contacted) and control the spreading by approaching the high-risk patient early to limit the contact. Aggregated surveillance is necessary for the area with a large number of patients.
#Syndromic VS laboratory-confirmed surveillance
-Using both laboratory-confirmed method and syndromic criteria can be useful in the COVID-19 situation. We use syndromic criteria (such as fever, upper respiratory tract symptoms) and the history of traveling to an endemic area or contacting with COVID-19 patients as a rule-in for high risk of COVID-19 infection. For laboratory-confirmed method, we use to confirm the high-risk case and determine the needs for investigation for outbreaks and clusters.– What dissemination tools will you choose to disseminate COVID-19 surveillance information? Why do you choose this/these tools?
I will choose ongoing, real-time dissemination tools since the number and the situation of COVID-19 change very often. The data about the situation of infection in a particular area, knowledge about the newer strains of the virus, and the treatment methods must be up-to-date in order to understand the situation and plan for management. -
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When I want to share the database with others in my team I did the same as you did but instead of de-identify the data, I just set the permission in the system to decide which level of access can see the sensitive or identifiable data (only the person who is an administrator can see the sensitive or identifiable data).
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A chatbot is very useful for information giving with frequently asked questions or frequently searched topics. However, the system that you mentioned about matching the patients with attending health care professionals sure helps in answering questions for a specific individual. In my opinion, both systems are essential in this situation and should be implemented together.
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