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We have not yet encountered any problem in Confidentiality, Integrity, and Availability in our current EMR. However, we are currently experiencing a problem with confidentiality and availability of a system we are using, the Integrated Tuberculosis Information System (ITIS). ITIS is a web-based application wherein all health facilities in the Philippines are required to record all TB patients registered in their facility for treatment. Recently, they started requiring OTP during login as a form of two-factor authentication. However, we encounter the error “failed to send OTP email” every time we tried to login. Because of this, we are unable to access our TB patients’ data and send reports since the first week of November. Many users across the Philippines are also experiencing difficulty logging into ITIS and we are still waiting for the Knowledge Management and Information Technology Service (KMITS) of the Department of Health to fix the said system. This situation can be prevented by testing system updates and running a trial upgrade before deployment.
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I work with volunteer workers, known as Barangay Nutrition Scholars, who assist in delivering nutrition and other related services in the community. Here are some of my strategies for open, honest, and respectful communication with them:
1. Communicate clearly and straight to the point. In this way, message can be delivered efficiently, avoid misunderstanding, and to avoid wasting time.
2. Always talk respectfully to everyone, regardless of their position.
3. Be approachable. I want my team members to always feel comfortable communicating with me, not afraid to ask for any help or questions.
4. Encourage them to give feedback/opinions/suggestions. Listen to them and make them feel that their voice matters. -
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Hello Nang Phyoe, thank you for your great presentation. You mentioned by 2026 you plan to develop data sharing policies since there are no existing policies in the target area. How about national policies for data sharing in Myanmar? Is there any national policy or law that you can adopt for your system?
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I would like to share my memorable leadership experience in 2023, when I was tasked to lead one of the events during our town festival, the Ana Kalang Lanzones Festival. Our town has been annually holding this festival since 1987, but celebrations had been on hold since 2019 due to election ban and the pandemic. Many people were excited and waiting for it to be celebrated again.
During the festival, I was assigned to lead the cooking contest. I have organized cooking contests before, but my events focus on nutrition and public health, with usually a hundred people in the audience. This time, the event will focus on showcasing our town’s harvest and culture. There will be thousands of people watching, since the event will be streamed on Facebook live. In addition, I was informed by our tourism officer that a national TV show will feature our event in one of their episodes. Out of all the events in the festival they chose ours, so I feel very pressured that time.
Since that was my first time leading the event, I decided to do a democratic style of leadership. Although it was my first time, my team members have been helping organize the festival cooking contest for many years. Their inputs/suggestions have been very valuable and contributes greatly to the success of the event.
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After watching the public communication on COVID-19 of the two leaders, I think the (former) Prime Minister of Singapore is a better communicator than the President of the United States. Here are the reasons why PM Lee Hsien Loong is better in my opinion:
1. Be First
Prime Minister Lee Hsien Loong addressed the nation on February 8, 2020, a day after raising the Disease Outbreak Response System Condition (DORSCON) level from Yellow to Orange and people started panic-buying instant food and toilet paper in Singapore. On the other hand, President Donald Trump’s announcement was made on March 12, 2020, a day after WHO declared COVID-19 as pandemic. During that time, COVID-19 has already reached alarming levels and severity.2. Be Right
PM Lee Hsien Loong presented accurate and verifiable information about COVID-19 in his speech. For example, he compared the current mortality rate of COVID-19 (0.2%) to SARS (10%) and seasonal influenza (0.1%). On the other hand, President Trump only mentioned in his speech that “the risk is very, very low”, without saying what “very, very low” means and what kind of risk he is pertaining to. People may have different interpretations of what this means, and may lead to misinformation.3. Be Credible
Because PM Lee Hsien Loong presented facts about the status of COVID-19 in his country, I think he sounded more credible than President Trump. He was also honest about the current possibility of the virus infecting a large number of people, and its possible effect to the healthcare system.4. Express Empathy
In his speech, PM Lee Hsien Loong acknowledged the fear and anxiety that people were feeling, which he said are “natural human reactions”. He smiles occasionally and was calm during the delivery of his address, which I find reassuring. On the other hand, I found President’s Trump speech as monotonous. I also think that his speech was more focused on addressing the people’s fear of financial hardship caused by COVID-19 restrictions, and the people’s fear on COVID-19 was not emphasized and acknowledged very well.5. Promote Action
Both leaders mentioned that each citizen has a role in preventing the spread of the virus. However, PM Lee Hsien Loong instructions to practice good personal hygiene were more specific. For example, he told people to take their temperature twice daily, and when not feeling well, avoid crowded places and see a doctor immediately. On the other hand, President Donald Trump mentioned in his speech that if people are sick, they should stay at home. Consulting a doctor was not mentioned.6. Show Respect
Both leaders were respectful in their speech. However, PM Lee Hsien Loong was the only one to acknowledge the efforts of volunteers, students, healthcare workers, and other frontline workers in keeping their country running amidst the threat of COVID-19. For me this shows that he sees these people with respect and was grateful to them. -
I think the Philippines still need to improve on all the five themes. However, I think the one that is most relevant today is about Transparency and Trust (Theme 2). The controversy surrounding the alleged corruption on flood control projects worth billions of pesos have been on the headlines for weeks now, with private contractors and government officials under investigation. Although the main agency involved is the Department of Public Health and Highways (DPWH) and not the Department of Health, I think this controversy affects the public’s trust on the government as a whole. We have to put extra effort in getting the public to trust the digital health care tools and systems that we are going to use, and ensure them that their health data are secured and kept private. Transparency is also very important, so people will be assured that their taxes are being used on real digital health projects, not “ghost” projects.
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A Public Health Emergency of International Concern (PHEIC) have been declared for the following disease outbreaks:
1. Influenza A (H1N1)
Date of Declaration: April 25, 2009
Date of Undeclaration: August 10, 2010
Rationale:
• The widespread presence of the virus
• Virus containment unfeasibility at that stage2. Poliomyelitis
Date of Declaration: May 5, 2014
Date of Undeclaration: Still remains as a PHEIC
Rationale:
• The risk of international spread of wild virus and the increasing evidence that adult travelers were contributing to the spread
• During the low season in 2014, there were 10 countries that are considered to have active transmission of wild poliovirus, and in contrast with previous years, there has already been a spread from three of these countries internationally
• Considering the large number of polio-free but conflict torn and fragile states which have severely compromised routine immunization services and are particularly at high risk of infection3. Ebola (West Africa)
Date of Declaration: April 25, 2009
Date of Undeclaration: August 10, 2010
Rationale:
• The Ebola outbreak in West Africa constitutes an ‘extraordinary event’ and a public health risk to other States.
• The possible consequences of further international spread are particularly serious in view of the virulence of the virus, the intensive community and health facility transmission patterns and the weak health systems in the currently affected and most at-risk countries.
• A coordinated international response is deemed essential to stop and reverse the international spread of Ebola.4. Zika
Date of Declaration: February 1, 2016
Date of Undeclaration: November 18, 2016
Rationale:
• The rising international concerns about Zika infections in South America, especially in Brazil.
• The postulated link to rising numbers of babies born with the congenital abnormality known as microcephaly.5. Ebola (Democratic Republic of Congo)
Date of Declaration: July 17, 2019
Date of Undeclaration: June 26, 2020
Rationale:
• The concern about potential spread from Goma (as the city is a provincial capital with an airport with international flights.)
• The concern of the reinfection and ongoing transmission in Beni, which has been previously associated with seeding of virus into multiple other locations.
• The murder of two healthcare workers demonstrates continued risk for responders owing to the security situation.
• The lack of the global community contribution to sustainable and adequate technical assistance, human or financial resources for outbreak response, despite the previous recommendations for increased resources.6. COVID-19
Date of Declaration: January 30, 2020
Date of Undeclaration: May 5, 2023
Rationale:
• Significant increases in numbers of cases and additional countries reporting confirmed cases and that there are still many unknowns, and human-to-human transmission has occurred outside Wuhan and outside China.
• WHO believes that it is still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk.7. Monkeypox
Date of Declaration: July 2022; August 14, 2024
Date of Undeclaration: May 2023; September 5, 2025
Rationale:
• The disease spread rapidly via sexual contact across a range of countries where the virus had not been seen before
• The emergence of a new clade of monkeypox, its rapid spread in eastern Democratic Republic of Congo (DRC), and the reporting of cases in several neighboring countries are very worrying.
• A coordinated international response is needed to stop outbreaks and save lives.References:
WHO Director-General declares mpox outbreak a public health emergency of international concern. (2024, August 14). World Health Organization (WHO). Retrieved October 28, 2025, from https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concernWilder-Smith, A., & Osman, S. (2020). Public health emergencies of international concern: a historic overview. Journal of travel medicine, 27(8), taaa227. https://doi.org/10.1093/jtm/taaa227
In your opinion, is there a disease or condition that may potentially lead to PHEIC in the future? Why?
In my opinion, measles is one disease that may potentially lead to PHEIC in the future. In the United States for example, measles has been officially eliminated since 2020 (meaning no measles spreading within the country and new cases are only found when someone contracts measles abroad and returns to the country). However, according to the CDC, a total of 1,618 confirmed measles cases have been reported as of October 21, 2025. There have been 43 outbreaks, and 87% of the confirmed cases (1,401 of 1,618) are outbreak-associated. Two fatalities due to measles have also been reported, the first time since 2015.
According to the WHO, least 95% of people in a community should be vaccinated in order to be protected through community immunity (herd immunity). In the US, however, vaccine coverage among US kindergartners has decreased from 95.2% during the 2019-2020 school year to 92.7% during the 2023-2024 school year. Vaccine hesitancy, fueled by misinformation and fake news, especially on social media, contributes to the continued decline in vaccine coverage.
Reference:
Measles cases and outbreaks. (2025, October 22). Measles (Rubeola). https://www.cdc.gov/measles/data-research/index.html -
1. Which single design limitation most threatens valid estimates of sensitivity and representativeness? How would you address it within six weeks?
The stability or resilience of the AEFI surveillance system of the Kebbi State most threatens the valid estimates of sensitivity and representativeness. According to the study, 88.7% of respondents reported that lack of resources interrupted the AEFI surveillance system. This may lead to high degree of underreporting of AEFI cases, affecting the sensitivity and representativeness of the system. This can be addressed by increasing the investment to the lacking resources (financial resources, human resources, and logistics such as data tools) in order for the AEFI system to be fully operational.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.
Since interviews and FGDs revealed that some health workers lacks positive attitude towards AEFI reporting and the community have low awareness about AEFI and its reporting, a low-cost intervention to increase the sensitivity of the system is by educating the health workers and the community about the importance of AEFI reporting and surveillance. The expected trade-offs are it will take some time to educate and convince everyone to report AEFI cases and will be added workload to the health worker tasked in educating others. Two indicators to detect the impact from the intervention are increased number of AEFI cases reported and increased participation of the community in AEFI reporting.3.For a newly introduced vaccine, should the AEFI case definition be temporarily broadened to maximize early signal detection?
Because it is a new vaccine, yes, the AEFI case definition should be temporarily broadened to maximize early signal detection. The trigger to revert to the prior definition is when high number of false positive cases were detected. -
Here are some examples of how information technology was applied to assist in the outbreak investigation process:
1. Verification and Preparation
The Early Warning, Alert and Response System (EWARS) application of WHO can be used to improve disease outbreak detection in emergency settings, such as in countries in conflict or following a natural disaster. The app can be used to collect data from various sources, such as healthcare facilities and the community. Standard alert thresholds for a disease can be programmed into the app, and when the threshold is exceeded, it will send an alert to the surveillance officer.2. Describe the outbreak
Spreadsheet applications such as Microsoft Excel can be used in making a line list – a table containing basic information on each case (Unique ID number/case identifier, age, type of case, sex, etc.). A line list allows for organization of information and provides an overall picture. This will help in the creation of descriptive statistics and epi curve.3. Hypothesis and testing
For analytical studies to test hypotheses, OpenEpi can be used. It is a free and open source software that provides statistics for counts and measurements in descriptive and analytic studies, stratified analysis with exact confidence limits, matched pair and person-time analysis, sample size and power calculations, random numbers, sensitivity, specificity and other evaluation statistics, R x C tables, chi-square for dose-response, and links to other useful sites.4. Response and Action
The UK Health Security Agency (UKHSA) shares public health data (mostly from England and sometimes other UK nations) via the UKHSA Data Dashboard. This dashboard covers a range of topics such as respiratory viruses, healthcare-associated infections and antimicrobial resistance that inform public health decision making in England. It was developed to cater to different users, such as members of the general public, public health professionals, policy makers, and media. -
The technology from the article that I liked the most is the use of mobility data to evaluate COVID-19 interventions.
How it works
Smartphones were used to collect aggregated location data via GPS, cellular network and Wi-Fi.Why it is important
Mobility data collected from smartphones was used to:
• Monitor real-time population flows during COVID-19
• Identify potential transmission hotspots
• Give insight into the effectiveness of public-health interventions, such as travel restrictions, on actual human behaviorExamples of how mobility data was used to enhance COVID-19 surveillance and response
• In China, daily aggregated origin-destination data from Baidu are used to evaluate the effect of travel restrictions and quarantine measures on COVID-19 transmission
• In Italy, analysis of location data of smartphone users revealed that in the week after the announcement of lockdown, total trips between Italian provinces was reduced to an estimate of 50%
• Google released publicly downloadable dataset on weekly mobility reports with sub-national granularity, including breakdown by journey type and destination (such as workplaces and parks)
• Apple also released a dataset similar to Google, with daily figures for mobility and assumed method of transportDisadvantages of using Mobility Data
• Access to data is a major challenge
• Ethical and privacy concerns
• Datasets are limited
• No long-term commitment in place for data-sharing with technology and telecom companies
• No standardization of datasets between providers
• Not all countries or regions are included in datasets -
1. How can surveillance help to detect and control the disease?
Surveillance can help detect and control dengue by detecting outbreaks in order to initiate timely and effective control measures, monitoring trends of incidence and number of severe cases and deaths, assessing and confirming possibility of outbreaks, and monitoring the impact of control interventions.2. Should we conduct active or passive surveillance or both for the disease, why?
Both active and passive surveillance should be conducted for dengue because we need data from both health facilities reports and from active surveillance since many dengue cases are asymptomatic or mild and self-managed, leading to underreporting of actual number of dengue cases.3. Which method should be best to identify cases, why?
1. Cases in medical facilities VS community
To identify cases of severe dengue, using cases in medical facilities is better because most severe cases were treated in medical facilities. For mild and asymptomatic cases, community is better because these cases are usually not underreported.
2. Sentinel VS population-based surveillance
Sentinel surveillance is best to identify cases of dengue because it provides higher quality and more detailed data.
3. Case-based VS aggregated surveillance
For faster identification of potential outbreaks, aggregated surveillance is better because it collects and analyzes data on group of cases for a specific region and time period. If the goal is to understand disease characteristics, case-based is better because it collects information about each case at the individual level.
4. Syndromic VS laboratory-confirmed surveillance
Syndromic surveillance is better for early detection of outbreaks dengue cases and related health events, allowing for rapid response.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 tools such as ProMED because it is free, easily available on the internet, and have a large audience. -
1. Should you give the data out?
No, I will not give the data out without free and informed consent of the concerned individuals.2. How do you not violate any of the General Principles of Informatics Ethics?
I will ensure that the study follows the ethical guidelines on research, in particular the Declaration of Helsinki. Local policies and government regulations should also be followed.3. If you want to provide the data to them , what and how will you do it?
First, a data management and sharing plan should be developed before any data collection. The WHO policy and implementation guidance for sharing and reuse of health-related data for research purposes can be used as a guide in developing the plan. Since the researchers need data at the individual level, anonymization or de-identification should be done to protect the identity of the individuals. Free and informed consent of the concerned individuals should also be obtained. -
As a health information professional, I should uphold the principles of informatics ethics. I will not tell my friend or any other people because doing so is a violation of the Principle of Information Privacy and Disposition and it is against the law. As stated in the AMIA’s code of professional and ethical conduct of 2018, inappropriate disclosure of information can cause harm. My duty is to ensure the integrity and confidentiality of the patient’s data.
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I will use the same system that I shared in the previous topic discussion (eOPT+ tool 2023 version).
Due to the negative feedbacks from end users, the National Nutrition Council (NNC) did the following to avoid system failure when introducing major updates to the system in 2025:Awareness
The need to use the new tool was discussed to the nutrition action officers, with emphasis on the accuracy of the tool in determining the nutritional status of children using age in days instead of age in months.Desire
The new useful features of the tool was discussed. For example, the new tool will be able to generate graphs showing the prevalence of malnutrition in the community. It will also provide them with a more accurate picture of the current nutritional status of preschool age children in the community.Knowledge
Unlike in 2023 wherein the orientation about the tool was done in March, the orientation for the 2025 version was done during the first week of January, before the start of the conduct of the Operation Timbang Plus.Ability
To check if the nutrition officers were able to use the tool correctly, NNC asked the nutrition action officers to try using the tool using data from 2024 as an exercise. Results were then sent via email.Reinforcement
District Nutrition Program Coordinators (DNPCs) were tasked to assist the nutrition action officers in using the new tool. They also offered additional training for those who were not able to attend the orientation, such as the volunteer nutrition workers. -
One example of a failed system in our organization is the 2023 version of the Electronic Operation Timbang Plus (eOPT Plus) tool. During the first quarter of every year, a program known as Operation Timbang Plus (OPT+) is done throughout the Philippines. In the OPT+ program, weight and height of all children 0-59 months old are measured in order to identify and locate the malnourished children, generate data for use in future nutrition action plans and measure the effectiveness of local nutrition programs. The eOPT tool is a nutritional status calculator that is used to record, consolidate, and summarize the results of OPT+. A new version of the eOPT tool is released every year, with minor updates, usually in the number of target population.
In 2023, the National Nutrition Council released a version of the eOPT tool with major updates. This new version requires data about the presence of bilateral pitting edema and disability of the child to be entered in the system. Previous versions of the eOPT tool determines the nutritional status of the child based on his/her age in months, while the 2023 version uses age in days which is more accurate. The new version of the tool was also able to generate graphs showing the prevalence of malnutrition in the community and completeness, accuracy and reliability scores for data quality check.
Although the eOPT tool 2023 version has a lot of useful features, the main reason it failed is because of the Operation and People Factor. The tool was rolled out to the end users too late and we are not informed beforehand about the upcoming major changes in the system. For example, in our region (Region IV-A CALABARZON), an orientation about the tool was done on March 6, 2023, during our general assembly. The period for the conduct of OPT+ is every January to March, so by the time we are informed about the new version of the tool, many were already done with data gathering and some areas were already finished with their OPT+ report. Since this new tool requires data about the presence of bilateral pitting edema and disability of the child, nutrition workers (many of whom were volunteers), have to go back to each child again, one by one, in order to complete the data required. The eOPT tool 2023 was met with a lot of negative feedbacks, especially those who have thousands of children and have already finished data gathering. Because of this, the use of the tool was postponed, and an eOPT tool similar to past versions was used instead.
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Our municipal health officer uses the PHQ-9 tool of MDCalc (available online at https://www.mdcalc.com/calc/1725/phq9-patient-health-questionnaire9) to assess the severity of depression symptoms of patients. According to him, the tool is working well because it is easy to use, accessible, provides clear interpretation of PHQ-9 scores, and provides helpful advice/recommendations. Critical actions to take are also highlighted. For example, the tool recommends a suicide risk assessment in patients who respond positively to item 9 of the questionnaire.
Aside from what I mentioned above, another factor that might influence the decision support system implementation in our organization is cost reduction. With the use of CDSS, unnecessary tests may be avoided and cheaper medication or treatment options can be suggested to patients.
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Aside from providing a common/standardized language for recording, reporting, and monitoring diseases, ICD is also used to analyze statistical data on diseases. If hospitals in the country do not use the ICD standard, it will be harder to track the incidence and prevalence of diseases, monitor trends, and identify the onset of an epidemic or pandemic.
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According to the article, one of the causes of physician burnout and stress is the poor design and difficult use of EHR, and EHRs with high number of functions will likely lead to high stress of physicians. I think these findings support the observations on healthcare IT of Dr. John Halamka (as presented by Dr. Boonchai Kijsanayotin in his lecture), a top-down approach never works. The target end-users of the EHR must be involved in the development of the EHR, including the planning and design stage in order to avoid this problem.
According to our municipal health officer, one of the major difficulties he encountered in using the EMR is that it is time-consuming. The EMR requires many patient details to be entered in the system, especially for patients who are availing our facilities’ service for the first time. To lessen the burden on our healthcare workers during consultation, we decided to assign a different staff who will be in charge of interviewing and entering patient details of the EMR.
Another problem we had with the EMR is that it requires an internet connection. We are currently working in a temporary office because our Rural Health Unit was demolished to make way for the construction of a bigger health facility. During our first few months in the office, we had difficulty using the EMR because of poor signal in the area. Fortunately, free internet was installed soon after as part of the Free Wi-Fi for All program of the Department of Information and Communications Technology (DICT).
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Thank you for sharing, that is a very interesting application. By using the app, I think people will become more aware and informed about the various health services they can avail for free. Since the app offers access to various preventive care services, it might also help in reducing health care costs in the long term through early detection and lowering risk of serious diseases.
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Thank you for sharing your experience. Accidentally deleting the database must be very stressful, thankfully you have backup. Role-based access control might also be useful, so staff can only perform operations on the system (such as reading, writing, and deleting data) based on their roles assigned to them.
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Hello Hteik. The system for reporting HFMD cases (Online PIDSR-IS) can only be accessed by Surveillance Officers of hospitals, local, and national health offices. HFMD cases from schools must be reported to their local health office if the students were not hospitalized. If the students with HFMD were hospitalized, the hospital’s surveillance officer will record it on the system, no need to report to the local office.
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