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Policies on production and health workforce: The medical and paramedical schools are fewer in Myanmar compared to other countries. According to Myanmar National Health policy and plan, the production of qualified medical professionals has implemented increasingly in recent years. But student selection, qualified teaching staff and infrastructures are important to produce proficient health workers. Many qualified workers migrated to abroad for better opportunities, some are out of labour force from medical field, and a few are unemployed. So, retaining of employed health workers is the urgent one to act at ground level. It should be considered to attract unemployed health workers. Further learning opportunities and adequate financial income is very important to get motivation to work in current health system.
Other factors: System Collapse was happened due to political event in 2021. The public health system is barely functioning, with severe limitations on vaccinations and emergency services. Health workers face constant, targeted attacks and are frequently arrested, killed, or forced into hiding. Due to economic crisis, many professionals are leaving the public sector. The boarder regions like Rakhine, Sagaing, Northern Shan and Chin faced many restriction and health emergencies requiring humanitarian needs. Despite dangers, many health workers continue to provide care outside military-controlled areas through volunteer networks and ethnic health organizations as an alternative care. External supports for their continued medical education is vital for those health workers to supplement the service delivery gaps at conflict areas. -
Good points of using EMR
1. Real time data reporting:
Data mining and data analysis are faster compared to paper-based records and reduced typing errors due to data validation methods. Decision maker can be reported about the real time situation at clinics such as outbreak or surveillance of diseases without waiting several steps to be confirmed by field level.
2. Duplication of booklets and codes
The code system is used for each patient, but they don’t remember their codes and left the booklets at the home when they visit clinic. So, duplications of patient codes is always happened. When applying EMR in our health system, this challenge is decreased because data registry can easily find the patient’s identity by their unique national registration number and their medical record can directly be sent to clinicians’ computer.
3. Training for staff
Due to new system, the staff got capacity building trainings and technical support for their routine tasks.
sites in the system.
4. Data security and privacy
It is better and safe compared to paper-based records which stored in the locker, can damaged by intentional or unintentional accidents. When using EMR, we build physical security to computers and grating authorized access to data staff only to keep the data safety and security.
Bad points of using EMR
1. Time consuming in data entry.
Data entry to EMR took time due to user friendliness and database system. Some used paper as initial step and change to EMR, it cause workload burden on the staff.
2. Training and technical support
As EMR required basic computer skill and knowledge, all staff need training and management team prepared both technical (database management, regular maintenance) and financial (training cost, power supplies, infrastructures, internet availability) support for this. So, not all clinics cannot run EMR simultaneously, we started with trial ones. Missing data is one of the most challenge in data entry and data visualization is not available for some conditions in our system.
3. Workload and human resource
Due to donor requirement and other policies, we cannot totally use EMR in our system. Primary data source documents are still maintaining in some area, so the staff feel much workload to use both systems. Some staff have language barrier to use EMR and reluctant to do it. Inadequate human resource to run the EMR is still challenging to expand EMR at other sites in the system. -
1. Missing data
The reasons are due to omitted by clinicians, refused by patients, not attending for data collection. Statistical methods have limitations for analyzing missing data and make it difficult to produce plausible results.
Suggestions: data collection protocol should be standardized for the system, not be subjective by clinicians or others. Essential variables should be collected to avoid big volume without meanings. Data Management Trainings should be conducted regularly to reduce entry error to database. Advanced statistical methods can be used to get meaningful data analysis results.
2. Selection bias
The reasons are due to variations in subjects’ geographic, medical history profiles and insurance etc. Exploited statistical analysis can have confounding implications. Large volume is not advantage for representative sample.
Suggestions: sample selection should be following statistical methods/calculations such as weighting, randomization in extracting from big data. Blinding and masking of researcher and clinician can also help to reduce this bias. Appropriate statistical analysis should be chosen for comparing data.
3. Data analysis and training
Big data analysis requires multiple analysis to establish hypothesis and significant correlations. So, the researcher’s skill to use statistical and methodological tools is important.
Suggestions: the clinicians/researchers should collaborate with informaticians, statistician and data scientists in big data analysis. They also need to attend required basic methodological trainings.
4. Interpretation and translational applicability of results
Important to integrate the analysis output to daily clinical practice.
Suggestions: Improve transparency and documentation of datasets, including standardize disease definitions to ensure interpretability and reproducibility between clinicians and researchers. Advocacy and sharing practices with research findings should be carried out as event for raising application of results.
5. Privacy and ethical issues
Data protection policy and regulations must be set up for all big dada storage in server. Data encryption, data authorization and access should be strictly maintained. Data security protocols, safeguarding practice and trainings should be updated regularly. -
Page 344, Item 23:
One confidence interval includes null value but its range is narrow (e.g -5 to 10)
Another confidence interval has no nul but the range is wide (e.g 5 to 40).
If the above two confidence intervals are resulted from the analysis, we should not accept that the first CI without null value is more precise. Because its CI is wider to get reality one than the narrow one. Not only to focus null value but need to look the confidence interval range in final interpretation. -
For the first recommended point, it must be initiated to fight corruption in the health system. Advocating among healthcare workers is an essential and pragmatic starting point for addressing corruption within health systems. Not only manger level but also basic level staff must aware about this to prevent relapse and redo of corruptive behavior consciously or unconsciously. Seeking agreement on both the scale and nature of corruption is particularly important, as it establishes a shared understanding and common baseline from which credible reforms can emerge. This can build trust among the healthcare professionals and reduce misinformation about the process. I agree for this point as this is one of the foundational steps toward transparency and accountability in the health sector.
Second recommended point presents a thoughtful approach to prioritizing anti-corruption actions within health systems, particularly by linking decision-making to impact on vulnerable populations and the feasibility of remedies. The acknowledgment that not all corrupt practices have equal consequences is a strength, as it helps avoid a one-size-fits-all response. Recognizing that some practices may be rational responses to systemic dysfunction also reflects a realistic understanding of operational constraints within health systems. But we need to sustain the action as long term plan, should consider to add a subject or topic to learn in pre-service trainings.
Third, holistic review can be assumed as academic perspective to be studied in health-related databases. In my opinion, routine practice to do journal reading and discussion during workshops can get reviews from various stakeholders and learning can lead to research practice.
In health, research is essential for continued medical practices, so we should foster the research community in addressing complex policy and system-level challenges to fight corruption. By setting out what it can offer, the research community will help manage expectations and ensure that evidence generated is relevant and usable for decision-makers. This clarity can strengthen trust between researchers, policy makers, and practitioners, and reduce the risk of research being perceived as disconnected from real-world problems and fear of discrimination from powerful corruptors. -
In recent years, the Sexual and Reproductive Health (SRH) service provision improvement in Myanmar is one of the improvement of health system targeting in reduction social barriers about SRH and make behavioral changes among the communities. As Myanmar is one of the developing countries, only governmental system is not enough to provide health services for all communities. Non-governmental organizations (NGOs) and local organizations (Community based organizations (CBO), ethnic health organization (EHO)) are largely participating to get universal health coverage (UHC) perceptively. About 10 years ago, both medical and non-medical communities were reluctant to talk about SRH in public health education and accepted as this was inappropriate according to culture and norms. So, many violations of SRH to girls, women and LGBTQ+ were happened and sexually transmitted diseases were spreading among working aged group and it caused huge impact on health status of country.
Due to these results, both Ministry of Health (MOH) and NGOs were collaborating to change the behavior of Myanmar communities relating the risky behaviors of sexual and reproductive health, to get equitable reproductive health services (fully consent contraception, respectful treatment for sexually transmitted infection, private consultations, safe abortion care, ante-natal care, emergency obstetric care). This brings many changes for health system: trained many basic health staff and community volunteers about SRH, seen the changing behavior about SRH among the community (overcome social norms and beliefs), known their rights and can advocate to get by youths and adolescents. Decentralization of governance in health system is ongoing and it makes evidence-based decision in implanting health projects. These are the current health system improvements.
To sustain this improvement, all dispersed activities and data should be combined and shared among stakeholders. Current challenge is weakness in timeliness of reporting, not widely accessible to standardized data reporting and sensitivity issue of data sharing in some areas. The health information sharing is important in health governance and one of the system barriers. The second barrier is financial support and the current health system required risk pooling or risk sharing practice as health financing sector. The service costs at private health systems are very much higher and the public health system cannot cover all basic health services, the services of NGO cannot reach for all levels, the communities have to pay out-of-pocket expenditures to get health services. -
I am working as a Health Technical Manager for QI Department of ECBHO and lead the M&E Team of my organization. The most works related to statistics are data collection, data checking and descriptive analysis for data reporting.
I have learned basis biostatistics knowledge and analysis using SPSS for academic purpose of research paper writing but has limited knowledge on applied statistics. -
In planning phase,
1.Disaster/Risk identification and analysis procedure will be run as first step. Risk register will be opened to record the probable risks (both external and internal) and will be share on drive.
2.Notification and communication procedure will be developed for mitigation and response activities. Data backup (google drive and physical hard disk) and security protocol for data management will be included. Authorized access will be granted for responsible staff
3.Training and testing procedure for raising awareness about disaster among the staff
In the execution phase,
4.Restoration procedure: network and power to recover from backup, bringing up HMIS and verify the data integrity
In recovery/aftermath phase,
5.Damage assessment and documentation procedure (data backup is the most suitable method for my organization)
6.Restoration procedure (reinstalling of programs, HMIS server and cloud server such as google drive) -
The most significant health challenge is emerging and re-emerging of infectious diseases. Due to fast communication around the world, the infections are more likelito spread and imported from many gates.
Concurrenly with infectious diseases burden, antimicrobial resistance (AMR) is also warning sign for all healthcare professionals.
A few philosophical thoughts and cultural norms also hinder in receiving the preventive meaures (like vaccination), and it can cause serious health outcomes for children and vulnerable population.
Not all countries can use standard codes for data interoperability for sharing, this is also challenge in developing new drugs, vaccine and management research and educational processes.
So, WHO is alarming to run the EWARs (Early Warning Alert and Response)/ Surveillance System for common infectious diseases in every countries (e.g for Myanmar, 13 diseases are included in MS EWARs).
They also advocate about AMR and countries also published law to act in preventing antimicrobial resistance.
Many LMIC countries also took technical supports from professional to run digital Health Information System to upgrade from paper-based system to ePHI. -
For patients,
– Can monitor the patient’s health in real time matter
– Diagnosis and investigation procedures take less time to prescribe and record
– Mobilize the community partnership through the system
– Link and provide care to patient even in hard-to-reach situationFor hospital,
– Inform, educate and empower the staff using the HIS
– Can help to develop policies and enforce the public health laws
– HIS can assure competence workforce in the hospital
– Can upgrade the governance and system management
– By using the data in system, further research and evaluation will impact for continued medical education -
Our organization is working with many partners in different projects. So, the donor requirements are different for seperate ones, we have to give the data with their pre-determined formats/databases/reports and it took time and increase workload on staff. The requested variables are also multiple and not identical ones, it confuse the staff in understandig about data collection and entry.
So, I would like to set up an own data system and server with interoperability standards. The collected data must be aligned with standards ad can be analyzed as real time data for decision making. For each partner, we can extract the data from server and share with them without impacting data integrity.
For this change, I am developing megadatabase for the organization and trying to make standard forms and formats to use. I am advocating the team leaders about the data driven decision making and user friendliness of data visualization and management process. As the system development is new to our organization and it is not our highest prioritized plan in current situation, most of the team leaders are still reluctant. Aiming to start this change, I am taking this health informatics course for my organization. -
Yes, we are working with partner organization and share the same platform to use data checking and reporting. We practice authorized access to the platform but the system maintenance is not regularly updated and some functions have to be put manually. So, if I need urgent data reporting, the system cannot give the updated one immediately. There is gap between data entry and data analysis stages. I have to contact the focal person of that platform to give me the data. It takes time and cause some delay in decision making, and availability of system is not quite well. And one staff accidently delete the database from the platform and it makes alarm to all of us about maintaining integrity of information. To prevent it, we discussed among the users and review the software, how to combine data entry and analysis steps, assign the duties to regularly check the system performance, update the access control protocol and prepare the cloud backup if the platform is down.
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To be an effective communication, both the sender and receiver must have a clear understanding of the message being exchanged. To ensure this, I believe that we need to practice two-way communication, where feedbacks are continuously exchanged between parties.
To practice two-way communications, the participants should be approachable, humble and listen to each other. The person at higher level must do rapport building with their supervisees to get honest and important messages.
Within my team, I consistently apply two-way communication to achieve mutual understanding. To apply this practice, all team members are instructed to respond to messages received from me to confirm receipt and comprehension.
When I receive a message, I carefully interpret it, contact the sender if clarification is needed, and provide an acknowledgment to mark their message is well received. Similarly, when I send messages, I always verify that the recipients have received and understood the content correctly. If any misunderstanding is present, we discuss it together. Even in both local and English language, I encourage for myself and my team members to use polite office language to avoid personal emotions on messages. -
As NCD is one of the burden on healthcare, the CKDSS is very impressive to learn, Salin. Congratulations for your presentation! I would like to ask one question as this is differnet from infectious one. How often will you collect the data and analyze at the regional or national office? Do the physician or laboratory technician involve in that? Thank you
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Congratulations for your presentation about HFMD, Jen. In our country, HFMD incidences are increasing and is still micmicing other fever with rash infections. I like your system structure to implement and connected to national surveillance unit. I would like to know more about event reporting and evaluation indicator, stability. Could you please share whether the schools will report i system if there is event among the students? Thank you Jen
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Congratulations for your presentation, Ama Wah. Malaria is still challenging for our regions and require the comprehensive system for the control and prevention of infection.
I have learnt many points from you and I am curious to ask the questions.
Could you please explain about the village health volunteers, whether they will be trained for the surveillance system or they are already health workers from the community.
For usability and adaptability indicators evaluation, how would you suggest for collecting frequency, biannually or annually? Thanks ama. -
PM Lee communicate with the public as early as possible 2 weeks after the new situation while President Trump shared the information only after declaration of Pandemic by WHO.
PM Lee clearly mentioned who was taking leading role for handling the Covid 19 situation and relieved the public not to be panic by comparing the past experience.
President Trump directly talked about the serious health threat in modern history, not considering about the feelings of public. PM Lee mentioned the practical detail points to care about corona virus but President Trump only focused to do personal protective measures.
In doing the right way, PM Lee clearly show authoritative leadership type and communicate with Singaporeans to gain sense of ownership. President Trump relieved the working citizens not to worry about their wages if they have to take leave due to virus and repeatedly talked about the economy rather than the infection. He also guaranteed to find solutions not to suffer financial hardship due to medical bills.
PM Lee did not confine the movement in the country because the mortality was not high in that situation and President Trump took immediate action for travel and trad restriction from Europe and China to reduce the imported cases. So, both of them are credible to be good communicators in emergency risk communication while the empathy can be easily felt in PM Lee’s speech compared to President Trump.
Both leaders promoted the action to follow by citizens but President Trump used some technical terms and sense of showing paternalistic form. PM Lee encouraged to show empathy and share responsibilities for vulnerable groups and medical professionals when the infection became serious.
Both PM Lee and President Trump made the cooperation with community and did rapport building about mentioning their preparedness on investigation, treatment and prevention strategies to fight the novel corona virus. -
For me, leadership is an art which has to be flexible and strong at the same time. Because it relates with human beings, the leadership should not be infected with rigid rules all the time. The presence of mutual respect and belief between a leader and members is critical for getting team success.
Previous year, I became a team manager for new team at my office. I have 4 supervisees, each of them has unique characters and skills. At first, I was not familiar with them, I used commanding style to understand their capabilities. After understanding their range, I started to change pacesetting leadership for getting results in short term projects. In applying this style, some supervicees felt stress and burden so I adapted the style with affiliative one. This one is working for me to lead my team, they even more comforatable to communicate with me.
Now, I am scheduling to lead them with delegating on-job trainings, referring the professional trainings and encourage them to take both authority and responsibilities with my back up supervision (from coaching style), aiming to have democratic leadership style. This is my self-understanding of leadership from experience -
Team: For this theme, our country needs improvement in joint planning and action among different stakeholders. Due to underreporting and difficulty in rapport building among sectors, we must put many efforts to collaborate under same goal.
For transparency and trust, as mentioned above, there is still dilemma to give health data is safe or not when there is political consideration among decision makers. We, health professionals are trying to reduce this barrier in establishing digital health in our country.
For our country, the technology is under improving condition but there is still lack of techquity theme. We have various professionals for applying technology and supports from international organizations in implementing digital health system. But investment in technological infrastructures is very low especially in grass root level and many restrictions to use in some regions of country.
Our country is trying to implement digital health transformation, starting from the ministry of health. But the community still lack capacities and digital literacy to use the digital tools for their health. After facing COVID 19 pandemic, most urban population get awareness about telehealth and mhealth. -
Could you list the disease outbreaks that have been declared as the Public Health Emergency of International Concern (PHEIC)?
1. H1N1 Pandemic: The infection started from North America in April and WHO declared a pandemic in June 2009, a total of 74 countries and territories had reported laboratory confirmed infections
2. Ebola:It started in Guinea then quickly spread to neighbouring countries Sierra Leone and Liberia. In August 2014, WHO declared the outbreak a Public Health Emergency of International Concern.
3. Zika: The infection was started in Brazil since 2015. After getting the transmitted reports from 86 countries, in 2016, WHO declared that the mosquito transmitted Zika infection as Public Health Emergency of International Concern
4. COVID 19: The novel coronavirus, known as COVID-19, has spread from the People’s Republic of China to 20 other countries in 2019
On 30 January 2020 following the recommendations of the Emergency Committee, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern (PHEIC).
In May 2023, COVID is defined as no longer PHEIC and WHO stated that the virus will stay with us for many years.5. MPox: The upsurge of MPox infection in Demographic Republic of Congo and nearby countries was declared as PHEIC in August 2024.
Why do these outbreaks raise such concerns?
1. All these outbreaks caused high morbidity and mortalities for the population. The consequences of those infections are still under research and caused high DALYs.
2. The pathogen is highly transmissible and required external helps to control and preventive measures.
3. Some pathogens are new strain and some are emerging diseases, so the investigation and treatment methods are not ready. This cause panic situation among the community.
4. Due to globalization nature, the infection can easily be imported between countries. This led to pandemic and affected for travels and trades, impacting the countries’ economics and development.In your opinion, is there a disease or condition that may potentially lead to PHEIC in the future? Why?
From my opinion, the cholera may potentially lead to PHEIC in the future.
According to WHO, in 2024, there are 60 countries that reported cholera cases. The burden of the disease increased when compared to 2023 and 98% of all reported cases are from Africa, the Middle East, and Asia.
[Cholera upsurge https://share.google/EyZpXjb5pz19a2Ydo%5D
Due to unexpected occutof natural and man-made disasters, the basic sanitation infrastructures are damaging and will be difficult to access clean water. Increasing poverty, climate change, conflicts and misuse of antimicrobial drugs are also risk factors.
Not all countries have no adequate vaccines and cholera tools for measures and this is one of the disease to be monitored in resource poor regions. -
Which single design limitation most threatens valid estimates of sensitivity and representativeness? How would you address it within six weeks?
In this AEFI surveillance system, there is parallel different reporting systems. These two have no interoperability, usability and used different tools for data management.
For addressing this issue, I will start the re-designing of surveillance system reporting flow. To initiate I will do advocacy meeting with M&E team and Disease Surveillance Unit for the health staff’s awareness of the need for change, targeting to raise their desire to use acceptability interoperable data and data collecting tools (single one). Then, after getting consensus to use single management system, I will prepare the electronic data reporting system for AEFI cases from health facility to common server as immediate reporting. For zero reporting cases, there will be defined specific date (every Tuesday) to report to server. For stability strengthening, I will recruit new staff for surveillance data reporting, prepare the report formats as simple and flexible ones. After this, the AEFI surveillance training will be given to all RI providers, LIO, RIO, DSNO and M&E Officers, emphasizing the importance of data to report and giving constructive feedbacks and required logistics supplies to surveillance site.2.) Using the CDC surveillance attributes, propose one low-cost intervention to increase sensitivity. State the expected trade-offs, and list 2–3 indicators to detect impact from the intervention.
In this case, under-reporting and incomplete data decrease the sensitivity of system. So, I will initiate the direct electronic reporting system to central server (KoBo application can be used freely). All LIO, RIO, DSNO and M&E Officer will be grouped as surveillance team and monitor the reported data as their assigned duty. The reporting format will be prepared to collect the most required data (date, health facility name, village/ward, age, received vaccine, symptoms). After confirmation of the case, the case investigation process will be proceeded by surveillance team to reported health facility.
Expected trade-offs:
(1) Required training to use KoBo application and create KoBo server
(2) Responsiveness from the surveillance team will be faster and start investigation or feedback to health facility
(3) Knowledge and perceptions of RI providers to collect AEFI data will be raised due to proper training.
(4) Their workload can reduce compared to previous system.
(5) Data security and privacy must be applied for the system.
Indicators
(1) Timeliness and completeness of surveillance data on weekly basis
(2) Random data quality assessment reports between primary data source and electronic system reporting
(3) Feedbacks evaluation from RI providers for using electronic reporting system3.) For a newly introduced vaccine, should the AEFI case definition be temporarily broadened to maximize early signal detection?
– If yes, what trigger would you use to revert to the prior definition?
– If no, why should this change not be implemented?
Yes, AEFI case definition should be temporarily broadened to get many positive case as much as. Because we have no adequate capacity in giving information about vaccine safety, no reported AEFI data means that the system is not competent to provide vaccine safety consideration.
To revert the prior definition, I will request for ad-hoc NEC meeting, reporting the system’s pitfalls to consider vaccine safety and modify the AEFI case definition for new vaccine to AEFI National Expert Committee (NEC). -
Verification and Preparation Stage, there are 3 following steps to do.
1. Establish the existence of an outbreak
2. Verify the diagnosis
3. Prepare for field work
To verify the outbreak, the field team can report the data within short time and the response team can check whether it is over alert line or not by comparing the former database. The collected data in the central server will provide epidemiological information and can be used in authorization to mobilize the rapid response team. In preparation of field work, the documentation for knowledge and laboratory data can easily be extracted by information technology.
In describing an outbreak stage,
4. Construct a working case definition
5. Find case systematically and record information
6. Perform descriptive epidemiology
For case finding and line listing, the health information system will provide the fast and valid data to analyze by using GIS technology and can present by data visualization technology to monitor the distribution of the diseases. This can support the response team to start the prevention and control measures. Information technology can also provide the working case definitions and epidemiological analysis in real time.
Hypothesis and testing stage require data to perform the interview for population.
7. Develop hypothesis
8. Analytical studies to test hypotheses
9. Special study (environmental study, laboratory study)
If information technology has database of population and geographical area, it can support whether to do environmental study or laboratory study. We can create heatmap for the outbreak area and can-do contact tracing and find point of source for infection. If the information system has interoperability with other systems, we can detect the causal agent (emerging or re-emerging) and alert others to prevent the pandemic spread.
Response and action stage:
10. Implementation of control measures and follow up
11. Communication – including outbreak report
By using information technology, we can use dissemination tools for control measures such as text messaging and chatbots, wearable devices for contact tracing and follow up. For public awareness and stakeholder advocacy, we can announce the risk communication measures through dashboards and mass media with data visualization techniques. -
I like the data visualization tools for decision support in COVID 19 surveillance and response. In COVID 19 pandemic period, enormous big data were collected through nationwide surveillance sites. If the public health professionals cannot use the information technology for presenting the result of those data analysis, the responses for prevention will be delayed. To make an important decision for public health intervention, the decision makers must clearly see the epidemiological trend of infection. In COVID-19 dashboards, time-series charts and geographic maps were focused to display and it helped to understand the region-level statistics to case-level coordinate data. After that, the policymakers and public gave much attention to watch the data dashboard in real-time. Some dashboard can show contact tracing, status of patients and social distancing directives. Those dashboard data are streaming through mass media like TV channels as daily practice to raise the community awareness. Data is just data if we cannot extract information form it. And it is not information hierarchy if we cannot share the knowledge from the information. So, data sharing through visualization works to inform and educate the public by effective communication way.
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1. How can surveillance help to detect and control the disease?
Surveillance is the ongoing, systematic collection, analysis and interpretation of health data. So, healthcare professional can timely detect the abnormal dengue cases distribution pattern through ongoing data collection and careful monitoring of its trend, it can help to respond the dengue infection before their epidemic peak level in the community.
2. Should we conduct active or passive surveillance or both for the disease, why?
For routine dengue surveillance system, we conduct passive surveillance focusing on data completeness and reliability of the reported cases, e.g. dengue is one of the notifiable diseases surveillances
As dengue is highly infectious vector borne diseases, active surveillance must do because public health staff engage actively in the system and can take prompt action for the detected cases in the community level, e.g. Hess test for every fever patient
If there is potential outbreak signal from passive surveillance, active surveillance must follow in the system to find the symptomatic patients and their contact tracing to prevent public health emergency, e.g. preventive measures for population and vector control activities
3. Which method should be best to identify cases, why?
1) Cases in medical facilities VS community
To identify cases, indicator-based surveillance is more specific to detect the signs and symptoms of dengue. After setting case definition, laboratory confirmation is required. So, cases in medical facilities should be the best compared to community.
2) Sentinel VS population-based surveillance
Sentinel should be the best to identify the cases. After getting data from medical facilities, we can start sentinel surveillance by doing line listing from the patients and start contact tracing. As dengue is vector borne diseases, the infection will be spread according to the vector’s habitat.
3) Case-based VS aggregated surveillance
Case-based surveillance is the best because it can detect the age cohort, it can get detail information of patient and line listing. But it is not suitable for large spreading condition.
4) Syndromic VS laboratory-confirmed surveillance
Laboratory-confirmed surveillance should be the best, because dengue needs to be confirmed from other fever with rash cases. The reliable antigen detection are now feasible and we can start vaccination for prevention.4. What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
I will choose ongoing real-time dissemination tool to disseminate the current monkeypox surveillance information in epidemic regions. Because monkeypox infection requires rapid public health intervention. We can detect geographical distribution and caseloads in timely manner and develop alerts immediately to the public.
For worldwide, I will choose periodic dissemination tool to do advance research and innovation for vaccines and treatment intention. -
No, I should not give the data out even though the research will generate the good prevention and control benefits.
Because their request involve sensitive personal identifiable information which violate the information privacy and disposition. It is not timely condition to violate principle of openess. I will share the data with appropriate fashion not disposing the patients’ identity. Access and security of patient data should be carefully determined to share with other teams. I have to maintain the accountability of maintaining the patients’ data in sych condition.
So, I will prepare the foillowing steps to share the data with research team:
(a) remove all personal identifiable information from data set, data minimization
(b) check whether the consents were taken from patients to use their data
(c) only share to the most responsible person of research team to handle data, limit authorization and identification (by using authentification factors)
(d) upgrade the data security measures in sharing the data between teams
(e) make agreement with research team indicating data sharing is purposed only for educational purpose and have duty to prevent the misuse of data. -
As a health information professional, I must mmaintain the ethics and principles in performing my duties. I have to keep secure this data and try not to manipulate without voluntary consent of patient. This is my accountability.
I cannot tell my friend event though I am sure that she does not know this fact. It is patient’s privacy and I must give respect. According to the given information, I am not in condition to interfere the other people because I assume that they are not currently in emergency life threatening condition. I am also not incharge doctor for this patient’s treatment process.
So, for right to self determination, I have accountability to maintain the patient’s information and he has the right to maintain his autonomy.
For doing good and no harm to others, my actions must not harm to both patient and his family.
It is my obligation to keep the patient’s data secure as a professional -
As mentioned in Topic 1 discussion, our organization is starting to use web based application for data reporting.
For this initiation,
Awareness: the project team did advocacy meeting with senior management team about the sysytem and its usefulness for the project and organization’s values. After getting approval, the project team did consultation meeting with field team and HIS team about the objective and course of system.
Desire, Knowledge and ability: Our partner organization helps as sponsor to start the project and give training to staff frequently. They support the internet charges, laptop and continously feedbacks on any compliant by the staff. They always update the system to be user friendly. The only barrier to continue the system is ongoing cost and this will be weakness in our ability for change.
Reinforcement: The partner offers they can continue their technical support for using system and currently paln to give data management sequential trainings. -
Currently, our organization uses the web base application for electronic medical recording/reporting with the support of partner organization.
Data: it is more systematic and reliable by using the server. Less human error when compare to excel data entry. We can visualize the data more conevniently and analyze quickly.
Cost: Ongoing expenditure to use the server is high. We also have to hire the data asssistant staff for data etry. If the project is close out, we cannot use that price to continue.
Operation: As the data are EMR, we need to train the data assistants about server usage and common medical terms. A supervisor always checks whether the data are correct order or not. It is still burden on continuing the system.
Design: The user interface is simple but it needs internet stability. The data can be missing out when data entry but we cannot directly check due to limitation of access.
People: All staff are now acceptable to the system and they began to change their data entry practice into elctronic format. -
In our organization, decision support system (DSS) is not fully developed yet. But I think the followings are the practices implementing as part of DSS.
As we have funding restriction, we are always tryting to priortizie the resource/medicine/trainings/IECs allocation to field teams. For this occations, we always check with HIs team for their monthly and yearly caseload reports, discuss with operation team and program teams, distributing the quantities in relatable with their workload and caseloads.
For the training opportunities, we exercise the HRHIs and assign to attend the suitable trainings.Unskilled and lack of familiarity with new system, increased workload on meetings and data analysis for distribution are the factors influencing to use DSS in organization.
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i. No standardized case definitions for the diseases among hospitals and different level of medical professionals, data reduntancy
ii. Face challenges in big data analysis for comparing of data, comprehensive management and research purposes, unable to monitor and EWAR system
iii. The above facts will impact on interoperability among institutes and country level ehealth system, increaded workload on data cleansing and verification
iv. If the hospital cannot use ICD standard, it is diffficult in calculating service package purchasing for case defining, management (logistics, financial and insurance)and implementing health economic. -
According to the article, physicians are not familiar with EHR and related IT tasks so they feld burden on EHR’s documenntation and workload burden. As they are working for human beings especially unhealthy cohorts, they will have unconsiciously concerns on inbox alerts and feel fatigue on dealing them.
The collegues working with EHR system in my country also felt above symptoms. Some are still reluctant to do documentation, some requests to assign data assistant for data entry etc.
Suggestions to reduce these:
i. prepare the EMR design to be user friendly setting
ii. train medical professionals about the system and advocate about the importance and benefits of eHealth
iii. use AI technology in implementing EMR and reducing workload burden on medical professionals -
Thanks for your presentation on Seha virtual hospital, Saya.
I see that this ehealth has greatly raised the healthcare practice of community who have been suffering from continous medical care for their chronic diseases.
They also have strategic service plan for speclialized consultation and it will be a help in reducing DALYs of patients.
The most impressive one is that their interoperabilty between 130 hospitals across the Kingdom. -
Thanks for shring the project, Ama Wah. I think this project enhance the citizens to make initiative in reaching of preventive services from health centers. This is a sign of community involvement in public health practice. From this project, health professionals can montior the ground situation and real time data analysis helps in reducing morbidity and mortality.
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eHealth makes the consumers to take ownership of their health and management process. eHealth help to overcome the barriers such as delay in decision making, delay in reaching services and delay in service providing. As they have big data in the system, eHealth can make real time decision for both prevention and treatment ranging from individual to community.
So eHealth is a data driven system making the treatment and prevention measures on real time basic. -
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Thanks for your insightful discussion, Ama. As the communication pattern of dengue is changing, the population-based surveillance can produce attack rate among the patients and suitable for nationwide surevillance. The community has awareness about the dengue, like you mentioned above, the community can activitely participate in case findings.
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