Hteik Htar Tin

[Hteik Htar Tin]

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.

[Hteik Htar Tin]

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.

[Hteik Htar Tin]

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.

[Hteik Htar Tin]

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.

[Hteik Htar Tin]

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

[Hteik Htar Tin]

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.

[Hteik Htar Tin]

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.

[Hteik Htar Tin]

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.

[Hteik Htar Tin]

I think that EPI data is big data and it fit the 7 Vs as follow:
1. Volume is very large in EPI data because it collects the millions of under five children in country
2. EPI data have structured and unstructured data such as frequency of dosage, regular or catch up vaccination and AEFI incidence.
3. Velocity is also important one in EPI data, because if there is outbreak, the urgent rapid assessment of immunization status is necessary for PEP response.
4. For veracity, we have to check immunization history if the children are presented with vaccine preventable disease. EPI data is collected by the health staff by using the hospital records so it is accurate and reliable.
5. We can present the decision makers with visualization from EPI data. It will help to monitor vaccine coverage and diseases elimination programs.
6. Value: EPI data help to trace the children who are not receiving the full vaccine dosage.
7. It is vulnerable data because all confidential information of children are recorded.

[Hteik Htar Tin]

We are trying to develop Health Information System according to our organizational strategic plan. As part of this system, we have initiated the surveillance system of infectious diseases in our coverage area. The aim is to supplement the service and system gap in conflict areas to prevent the public health threats. The project started with syndromic surveillance as facility-based practice.
During first year, we have no experience in system set up project and have faced many difficulties in implementation. We collected data as weekly practice for immediately notifiable diseases and took as monthly report for other infectious diseases. This caused the front-line clinic staff to confuse and burden of data entry. As our project area has no internet connection and they had to go nearby township to submit report. So, the data timeliness and completeness were not met to target. As information is not reachable to HIS officer in time, the disease monitoring, case investigation and contact tracing are also late. The front-line clinic staff felt that the surveillance system become burden for them and gave feedbacks and complaints.
Therefore, HIS team met up with program and partner teams to develop electronic reporting system using health informatics in the first quarter of 2025. Due to many constraints and difficulties, we chose to use KOBO mobile application to collect the data and Power BI to monitor the disease trend in real time. The reporting timeline was set up as weekly basic and supported the clinic staffs with mobile tablets and Wi-Fi signal boosters. The surveillance diseases are re-selected and clinic staff are trained to use the KOBO application effectively.
After deploying KOBO to use in the surveillance system, the timeliness of reports is greatly changed and all reports reach the server in time. This is the amazing superior outcome within the project timeline. The staff did not need to go nearby township, not required report logbooks and it is cost saving for the project. The staff are satisfying to use the application; the HIS officer can analyze the data and interact with field team very quickly. The program team can monitor the incidence and trends of disease via dashboard. So, the response and medical supplies can be transported as soon as possible.
Although the reporting and monitoring of diseases is feasible with KOBO App, we cannot use electronic medical records and case investigation/symptom tracking tools.
Not all staff are familiar with technology and reluctance to use.
The data redundancy is still there because other medical recording is using paper-based system.
Due to organization nature, human resources are not enough for HIS team.
The internet stability and ability of mobile devices are still challenging in our project area so the systems are fragmented.

[Hteik Htar Tin]

Misconfiguration is the common tyoe of data breach in many system. Regular updating of system/software will prevent this attack to system. And data encryption can prevent the easy access to exposed information.

[Hteik Htar Tin]

The case is interesting and get aware about the phishing mail. I would like to add some suggestions to prevent this attack. The system should be protect with defense in depth at network, application and endpoints. This can delay the exfiltration of data in short time.
Not only on raising the awareness of cybersecuirty, all staff must sit compliance examination of security as routine basic.

[Hteik Htar Tin]

Your case study is interesting and discussion points are clear. I think it will be the common accidents for many organizations, Ama Wah Wah.
I would like to discuss some points from my point of view.
YNHHS faced network hacking, so they should consider their cloud service model and types to prevent the attack.
EMRs and payment system are not affected so their topology is great and should update not to affect the confidential data server.
Regular accessing of staff’s compliance on the data security practice.

[Hteik Htar Tin]

Nowadays, people have habit to post the personal matters on social media platforms. So, the attackers use those information to attack.
E.g., phishing mails use the specific personal information (Name, their jobs. their publications etc) to make the people believe that they are real.
The attackers may act as the service providers and they ask information illegally and use it for their profit.
E.g. they offer online payment for internet and give application to install. After installing, the application set OTP to use. When the user give OTP to the attackers, they have fully authorization to use the user’s money wallet and steal money. The attacker used the weak security of banking system and lack of awareness of user security.
If the attackers want to attack the system, they can use the insider to add bugs via memory stick to the main server. They add trojan softwares and remote control softwares like ANYDESK to user’s computer or mobile devices, then steal the information, access control and money from mobile banks.
In our country, many people are being attacked by Zhàpiàn gangs in various forms, attracting the users about investments via Viber and Messenger applications. It is because of lack of awareness and praactice of data security.

[Hteik Htar Tin]

– Why would you choose cloud server, rather than physical server?
Cloud computing is a model for enabling ubiquitous to share among users at anytime, anywhere. If my hospital uses hybrid cloud and web-based application for patient appointments, the first will be cost saving, having mobility, easy to give support and maintenance. The most important reason is using cloud server will ensure the data security as we have to collect the biometric and personal information from the patients. Moreover, we can make EMR for each patient and store at cloud server.

– What kind of cloud computing service model would be most appropriate (SaaS, PaaS, IaaS)? Why?
As my hospital is initiating to transform from stand alone computer to cloud computing having insufficient infrastructure (server) and IT staff, I would like to choose SaaS server model. SaaS not need variety of costs or efforts to start. It can provide the users with remote access through a web browser which our hospital intended to deploy for patients’ appointment. The different sites of hospital can communicate with each other directly through a link in SaaS model because it uses Bus Topology. And hospital only has to pay for use of the application: gigabyte model. The developer provides SaaS and the users do not need to download., is reliable and simple to use.

[Hteik Htar Tin]

Due to increased travelling, climate change and antimicrobial resistance, the remerging and emerging of diseases and microorganism, the world population is frequently faced from the pandemic and epidemic outbreak of the diseases. Paralleling, the information technology is developing in every sector and become vital in such outbreak management. So, health sector adapts the IT into public health and many health professionals use health informatics to collect the data via systematically application of IT for public health intervention. According to current conflicts in our country, the health sector in some regions is not function its routine preventive and curative services. Due to economic restriction, the community cannot fully focus on their health status, not give attention to health education and easily acquire the communicable diseases. Therefore, we submit the proposals to donor for diseases monitoring and timely response to prevent the mass causalities.
The nature of outbreak is fast and highly contagious among the people, so the real time data is crucial to manage them. Currently, our organization is implementing the early warning, alert and response system to monitor the outbreak of communicable diseases in the project coverage area. By using the health and management competency from health informatics, the health staff in field level used case definitions and alert threshold to monitor the potential of outbreak. They always send the real time data to regional HIS team to track the trend of the disease. The HIS team include public health officer, technical manager and HIS officer to get the complete analysis and report of monitored diseases. We trained them to use offline data reporting with mobile application to us; this is the application of computing science from health informatics. When the data reach server, we directly view and analyze whether it needs case investigation and follow up interventions or not. From this system, the errors in data reports become decreased and the field team can understand the real time data is very efficient for outbreak control and get better case management. After that we share this data among the project team, field team and external professional to get comprehensive management. I think this will be interoperability between teams and use the data efficiently without data redundancy.
For example, we got one signal (They have a suspected measles case) through KOBO application report from our field team last year. We did case investigation using online call, directly see the patient, confirmed case diagnosis and instruct the treatment and preventive measures to field team. That patient recovered from the illness without suffering from measles complication and no other children from that community got infected. Although there are many requirements in our system, we initiated the first step of outbreak control with some knowledge of health informatics. We can create the better one if we use enterprise architecture in our organization, we will have consistent vision with compact blueprint to develop the health system in our coverage area.

[Hteik Htar Tin]

To be a professional in public health or health informatic, I would need to gain the following knowledge and skills from this program.
(1) Health and Biological sciences
I have finished my bechelor degree in medicine and studied the public health for a period of time. And I am currently working in public health field and I am confident that I can learn the public health knowlege from this course and will get the professional skills
(2) Computational and mathematical science
As I am not familiar to computer science and information technology, I must focus on these topics to study and understand the concept and skills. As I have experience as a volunteer in statistics class and enthusiatics to learn the statistics, this will help to study the statistical course in this progrm.
(3) Management and social science
Currently, I am taking as a team lead in my organization and practically manage the staff. But I have a few experience in business administration and political science. So I think I will need more skill and knowledge in this competency when compared to others.

[Hteik Htar Tin]

Yes, I will plan to move the hospital’s information system to cloud computing if I were a director or executive of a hospital.
I will choose hybrid cloud deployment for convenience of use among hospital staff and reducing the security risks.
By using this cloud, the hospital administration can take more control and respond to the emergency alert without prolong waiting time to give decision for management.
Maintainance of data will be more convenient and data extraction will be faster to manage the patient and other administration purpose.
By using the cloud, the EMRs of patient and doctor’s notes can be accessible at anytime and it will reduce the communication problem between patients and hospital in accused of duplicatio of results, prolong waiting time and complaint of mistreatment.
If all hospital staff use cloud computing, the reliance on IT will reduce and less paper work on them. The hospital can raise the volume of scalability when there is compiled of data.
All departments of hospital will not have communication gap in patient management and can share the results in time.
The most important one to be careful is not to violate or lost the patients’ data. The security and priavcy protocol must be strict to all the staff who are handling the data.
Furthermore, by using the cloud data, the clinicians can do research and cliical trials for innovation of managemet or drug trials without breaching the ethics.

[Hteik Htar Tin]

Has your computer or a computer in your workplace ever been attacked by a cyber threat?
How did it happen?
What was the cause?
How was your computer or data affected?
What can you do to prevent it from happening again in the future?

Last year, I received the mail to attend the research conference at Thailand. They describe the detail conference plan and also mention my research paper in that mail . Firstly, I thought that it was an excellent invitation. All fly tickets and accomodatio fees are free of charge but they asked my personal information and registration fees for the conference. So, I called them via phone and a woman explained how to do register and push me to transfer registration fees as soon as possible because of deadline.
After several consideration, I informed my professor and he said that must be forgery mail to collect personal information and money. So, I checked their maid address and it was misspelled. The address of conference and the title were wrong.
So, I block that user and update my mail password and security setting to add those mail itno spam folder directly.
After that, I have a habit to check the web and mail address and not click on the link in mails.

[Hteik Htar Tin]

If I were to build a medical app for patients and doctors, I would like to do changes for medical logistics management system.
According to the collegues’s discussion, the importance of data clearnace and visualization is important between patients and doctors to prevent miscommunication.
In my current setting, we cannot carefully manage the medical supplies. As our services are at grass root level and far from cities, the transportation takes too long between central store and field level.
So I would luke to develop mobile application to monitor and track the medical logistics supply. Mobile app is user friendly and our healthcare staff can use it well after proper training. And they can enter the data into app and send when there is internet. The central team also can monitor as live version for supporting the medical supplies.
By using this mobile app, the medical supplies shortage at field levels will be prevented and the patients can access the health services with full medicine at any time. This will helpful for all especially trauma cases and chronic patient with non-communicable diseases.

[Hteik Htar Tin]

In my current workplace, the first step I have to do is advocating the stakeholders about the effectiveness of information system (People factor).
After their understanding of IS, the next step is to strengthen the data collection and management skill of front line staff (Data factor). When they clearly fill the correct data in their primary data source, the information we get will be valuable.
We have enough hardware resources but need software supports. To get this, we will start with free trial and invest in reliable one to use.
The current process is hybrid in nature and gradually to change into networking.
The main problematic points are the lack of internet accessibility and instability of electricity at field levels.
So, we will consider the offline software to involve in system and support the other sectors to get the information to central level.

[Hteik Htar Tin]

Dear Ajarns and collegues,

My name is Hteik Htar Tin and you can call me “Hteik Htar” or my nickname, Juno. I finished my bachelor degree at University of Medicine, Magway. I am currently working in EHO and take a lead role for health technical team. Biostatistics is my favorite one when I worked as an assistant teacher for my Professor, it makes me interested in the data managment. Then I got an opportunity to apply the BHI program and believe this will upgrade my academic and professional career. I would like to initiate the digital health system by using the knowledges and practices from this program. Let’s create a happy and amazing academic journey.

[Hteik Htar Tin]

Thank you for your feedbacks, Ajarn! I will fix this in next assignments.

[Hteik Htar Tin]

Thanks for mentioning the velocity of data in patient care, Sayama Khaing. It is insightful and I have no idea for this characteristics in EMR. This is very vital for emergency life saving cases.

[Hteik Htar Tin]

Thanks for sharing of your experience. Health informatics is very effective to analyze the data not only for treatment but also for research purpose in medical field. Case standardization is also challenging factor in my context. As you mention, we also face interoperability challenges between projects and different clinics.

[Hteik Htar Tin]

Thanks for sharing Saya. MITM attack is one thing to consider in system set up. Some sensitive information should be encrypted and sent via secure channel to avoid this attack.

[Hteik Htar Tin]

Thanks for sharing of your experience. This remind me to check my behaviour on setting the passwords and data security practice in file sharing

[Hteik Htar Tin]

Thanks for your idea Saya. Firstly I did not assume that PaaS is suitable for this because it has no infrasturcture and only SQL. But from your idea, PaaS will solve the hospital’s requirements and can have ownership too.

[Hteik Htar Tin]

This is the innovative way to interlink between the differnet data systems. From your comment, we can collect the data not only from hospital but also form schools, workplace and others. Thanks for your discussion.

[Hteik Htar Tin]

It is very impressive to read your discussion, Jen. The web based application seem to be user friendly and both stakeholders (field staff and data officers) can apply for patient care. I think data are effectively used and not lost only in records

[Hteik Htar Tin]

Thanks for your comment, ama. As we have some weakness in technical and buget, we try to use free app for initial phase. But the unique system is required and important to use data effectively.

[Hteik Htar Tin]

Like yours, my friends received the message link which appears to be true, from their friends via messenger. Everyoe who click on that link, their account cannot be controlled by themselves and automatically sent the links to others.

[Hteik Htar Tin]

I agree with you, Sirithep, this will make patients to remember the ownership of their health and it will be supportive for informed consent by doctor side. And it will also prevent the untimely death of patients due to prolong waiting time of investigation results.

[Hteik Htar Tin]

Yes, I agree with you on the challenges to implement the information system. In my context, the staff are not aware about the use of information to smooth and upgrade their workflow. They think that is the duty of IT staff and not related to them. That’s people factor to hinder the IS. And we also need the capacity to write the software in accordance with our needs. The methods you are mentioning are insightful and eed to advocate the stakeholders in my context.

[Hteik Htar Tin]

Glad to meet you, Jen

[Hteik Htar Tin]

Nice to meet you too, Sayama

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