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For this scenario, TAM would suggest that mandatory and compliance-based approaches are not as applicable as the use of social influence. And it would also suggest that practical demonstration of comparing a new technology to an old one showing the effectives and usefulness of the new one are higher than those of the old one would encourage users to increase their intention to use the new system.
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According to the extension of the TAM, the social influence processes and cognitive instrumental process play vital roles acting as external variables affecting the perceived usefulness. From my experiences, I think the specific external variables would be subjective norm and job relevance. At my organization when we tried to implement an electronic record system, these two variables seemed to spark some of the staff’s intention to use the TAM. And as for perceived ease of use, I think age and digital literacy count as external variables.
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To answer “WHY” questions of the problem, I would use qualitative research. If I go into some details, I would do literature review of the previous qualitative research articles on that issue, build a theoretical framework, use non-probability purposive sampling strategy, collect the qualitative data through semi-structured interviews with the respondents who do not use bednets till the data become saturated, transcribe the recordings,do coding, categorizing ,and do thematic analysis. In these ways, I will figure out why the respondents are not using bednets.
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“Efficacy is the capacity of a given intervention under ideal or controlled conditions.”
(The outcome brought about by the intervention of an experiment study is efficacy. We don’t know for sure if the outcome would be the same if we implement that same intervention in a real world setting – which is not an ideal nor controlled situation.)“Effectiveness is the ability of an intervention to have a meaningful effect on patients in normal clinical conditions.” (It is the level of effect of an intervention in a real world setting. It helps us to know how much benefits an intervention of an experiment study could bring outside of the study – external validation.)
“Efficiency is doing things in the most economical way.”
(Minimizing resource, time and money needed for an intervention as few as possible and maximizing the desired outcome results as much as possible is the concept of efficiency.)Ref : DOI: 10.23937/2643-4512/1710035
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I think young adults have more “free time” than the older ones. Generally speaking the middle-aged ones and the old ones are busy with their works, business and other matters whereas the young adults have relatively less thing to pay attention to. When the middle-aged and old ones’ minds are caught up with the busy matters, they might forget to use the contact tracing application even though they have so many contacts daily. On the other hand, the young adults who have relatively more leisure times would not forget to use the application and record their contact pattern in the application. Moreover, “free time” is not a by product or intermediate step of age group ,and it’s also somehow related to using application and record the tracing. So it has the characteristics of a confounder. So I think “free time” is a confounder for this association.
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Maternal Mortality Rate and Maternal Mortality Ratio
Definition
The maternal mortality rate is the number of maternal deaths in a population divided by the number of women of reproductive age. It is usually described together with maternal mortality ratio. But they are not the same.
The maternal mortality ratio (MMR) is defined as the number of maternal deaths during a given time period per 100,000 live births during the same time period.
Calculation
The definitions of both maternal mortality rate and maternal mortality ratio are self-explanatory in terms of calculation.
For maternal mortality rate,
( Number of maternal deaths / Number of women of reproductive age ) X 100,000For maternal mortality ratio
(Number of maternal deaths / Number of live births) X 100,000, where maternal deaths account for “female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.
But in reality, especially in the developing countries, the actual data are not available due to under-reporting, misclassification and other data quality issues. In such times, they are estimated.
The maternal mortality ratio for Myanmar was 250 deaths per 100,000 live births in 2017 (which is the lowest among countries in Asia/Pacific region). And it was estimated by a regression model using information on fertility, birth attendants, and HIV prevalence. The exact calculation and estimation methods may differ county to country based on the availability of data resources.
Uses
Maternal mortality rate – to reflect not only the risk of maternal death per pregnancy or birth but also the level of fertility in the population
Maternal mortality ratio – to describe the risk of maternal death relative to the number of live births and essentially captures the risk of death in a single pregnancy or a single live birth
They are considered to be primary and important indictors of a country’s overall health status and quality of life. When the health services and facilities are developed, and socio-economic status of the people in the country are high, these indicators tend to be low.
Maternal mortality ratio is one of the indicators in SDG. And it sets out that by 2030, the global maternal mortality ratio (MMR) should be reduced to less than 70 per 100,000 live births, and no country should have an MMR more than 140 per 100,000 live births.
References:
WHO Website
Knomea Website
OECD Website -
No 7 :On page – 341
“Statistical significance indicates a scientifically or substantively important relation has been detected.”
In my words, a p-value of less than 0.05 does not necessarily mean the results of the test are practically significant because p-value tends to depend on the size of the sample. Additionally the statistical significance just only means there is a difference. But for that difference to be practically significant, the scientific judgement needs to be taken into account. Basically this judgement defines whether the magnitude of the difference (effect) is large enough to be practical in a scientific world or not.
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I’m currently working for an INGO HIV project. My work mostly consists of reporting and data analysis. And occasionally I do some data analysis for the research project. But most of the time, I do data cleaning part – not really the statistical part. Anyway, I have some experiences of learning statistics in both SPSS and R softwares. And whenever an opportunity comes, I try to apply these statistical knowledge at my workplace. And from this course, I hope I gather and learn more knowledge relating to statistics and also apply this into my thesis project .
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Here right now in Myanmar, there are thousands of new covid-19 cases day by day. And the diagnostic tests are not available in most parts of the country. Anyway, in some cities, we use the RDT-antigen test for diagnosis. It costs around about 5 dollars. In places where the RDT test is not available, we just use clinical diagnosis by observing obvious symptoms such as fever and cough, sometimes along with the history of contact to a confirmed positive person, and then started the clinical management. Admittedly speaking, as a clinician, I won’t use this machine learning algorithm for the diagnosis in my setting. I don’t know much about machine learning. But I believe this paper delivers other important points to the covid-19 issue. I think it alone might not give much sense in terms of a practical impact. But, I think this is one of the first steps and a part of the bigger picture that the machine learning field would help us fight against the pandemic. What I mean is it has been already cited by the other 11 articles and giving inputs to the existing literature. And it might encourage the other IT professionals to do more research about the covid-19. On a bigger picture, being a part of the many steps may offer something we do not see and perhaps deliver a new concept regarding Covid-19 diagnosis.
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Here’s the link to my PowerPoint. https://drive.google.com/file/d/1xdrEUi-eAnJ3ECkHB_oS3S40B23xWiwk/view?usp=sharing
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Here’s the link to my PowerPointPowerPoint .
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Here is the link to powerpoint
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Perception of Information-use_KaungKhantTinPowerpoint
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For 1 > I think you don’t need to archive all vector, raster, and QGIS project files. My advice is to create a new folder (anywhere you like). And in this folder, save your MS word file and the project file. Then zip it. As for me, the final zip file is only 935 KB.
For 2 > If you followed the steps in the Practical handbook, your qgs file(the project) would contain the essentials in it. And the instructor can check this QGIS project file comparing with the screenshots described in the MS Word file. I think the qgs project file is the most important thing. It contains every step you did in the QGIS software.
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Yeap, I found the same problem with you. And the screenshot given as “your map should look something like this” is not the same as the settings given. Anyway, I followed the instructions as given in the “Settings applied to the symbology of all vector layers loaded”. Please correct me if there’re any mistakes.Thank you.
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Here’s my wrap-up. Please follow this link. https://prnt.sc/13pqkvp
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Here’s my wrap-up. Please follow this link https://ibb.co/r0RrSkL .
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Here’s my wrap-up assignment for this week’s topic discussion. https://prnt.sc/13mlu3b
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Here’s my wrap-up. Please follow the link. https://prnt.sc/13m9y7u
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Admittedly speaking, health informatics is one of the unpopular fields in our country’s health system. And as long as my knowledge goes, there’s no college nor university that teaches courses about this subject. On account of that, there are really a few health informaticians in my country. On the other hand, there are medical professionals who graduated health informatics subjects from international universities. Along with them, some of the IT technicians and some of the doctors whose interests lie in the IT fields are leading the health informatics projects in both private and public sectors, and form a major part of the existing workforce.
To run the health information systems in the country, we still need a significant number of health informaticians, and there are limitations in producing them. To tackle these issues, it is needed to cultivate the interest of health informatics in medical students. And once the interest is achieved, the programs and courses for health informatics should be made available to those interested students. And the curriculum of the medical-related universities also should contain the health informatics subject as a mandatory course. By those, the number for emerging health informatics workforce would be relatively high. After graduating from the universities, the job opportunities of the health informaticians should be widely announced. Last not but least, the salary for health informaticians should be made good and satisfactory. These would contribute to a greater number of entering the health informatics workforce.
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Personally, I believe data sharing is necessary, and it can give rise to many benefits. If we look at the pros and cons of the data sharing in detail, we would see as below.
Pros:
1. The data collection process takes a lot of time, money, and manpower. If the sharing is done, more parties will be benefited from a single data collection.
2. The data sharing allows the researchers to get more comprehensive results that could benefit both parties.
3. It also plays a great role in big data analyses.
Cons:
1. There are possible potential risks of putting the participants’ data in the wrong hands.
2. The participants’ privacy and confidentiality might be at risk.The pros outweigh the cons. Anyway, there are standard measures that need to be followed to get the job done properly. The participants in the data should know how their data will be used, and only with their consent, the data should be shared. The quality of the data should also be good, and shared in a standardized format, and ensure the data have good analytical capacity.
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According to OECD 2019 health spending data, the US is having the world’s costliest health care. And given that fact, the US still just No.31 on the World Health Organization’s life expectancy. This surely shows that there is something wrong with the health system. The article points out this fact on the ground by comparing the healthcare cost in the US with those in other countries. I, myself, am not familiar with the US health system and why the healthcare in the US is the most expensive one before reading this article. Anyway, obviously, there’s no universal healthcare in the US, and most of the people in the US have to get health insurance one way or the another. So, the heavy burden of out-of-pocket healthcare costs lay on the shoulders of Americans. And its complex healthcare system leads to complexity at the health administrative level which contributes to a higher administrative cost than any other country. The costs for drugs, medical technological devices, medical operations, and human resources are also relatively higher than the other countries. Anyway, as health is a fundamental human right, the US government ought to give much more effort to ensure its people to have access to healthcare at an affordable cost.
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It’s great to know about the Net Pracharat project. And I’ve seen its potential and ongoing good impacts on education, health, economy, and society in the lecture videos. Anyway, the article gives another view on the project highlighting the problems brought about by the Net Pracharat. (The discussion will only be mainly based on the lecture videos and the article.)
Few free Wi-fi spot program: For a small village, one spot might be enough. But for most villages, there will be limitations for the villagers to access that one access point in terms of both the distance and the connection. The project should oversee this problem and try to find a solution to solve this.
Cost for the Wi-Fi: Though the project, in theory, claims a lower cost for the villages compared with the big cities like Bangkok, the specific details processes as to how much will be charged are not specified. These things are likely to undermine the public trust in the project.
Potential data privacy and security: According to the article, the public-private Net Pracharat project is promoted by the military government, and the controversial cybersecurity laws came into effect. These two will surely raise concerns over the possibility of putting everyone using the internet under the government’s radar. This might expose the users being watched by the government for every move. As for me, I believe everyone is entitled to have freedom, and the government should not violate the basic human rights of its own people.
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One of our organization’s projects is to give treatment and care to the people living with HIV at different service delivery sites across the country. Previously, traditional paper-based medical records are used for the data management system. Anyway, the organization has been implementing an EMR system which is called the OpenMRS system for a couple of years. The change from paper to EMR has been completed at some of the service delivery sites whereas most of the sites are still in the transition period. And I like to discuss some of the advantages and disadvantages of using the OpenMRS system at my organization.
Advantages
1. Effective and fast-paced data entry (no more exhaustive and time-consuming manual data entry)
2. Less space (No need to store paper-based medical records)
3. A better data backup system (no more worries over the vulnerability of the paper records)
4. Fewer workloads
5. A better control over the clinical management of HIV
6. Good analytical data capacity
7. Efficient data, information, and reports flow in a timely manner to support the information management system at the operational, tactical and strategic levels of the projectDisadvantages
1. Complexity in the data legacy transfer process at the transition period
2. Double data entry (both paper and EMR) at the transition period
3. High costs to implement and sustain electronic devices related to the EMR system
4. End users’ attitudes towards the change
5. Limited technological abilities in the end-users
6. Frequent electricity outage
7. Potential risks of data security -
Missing Data: This issue is usually found in my experiences. And as for the big data, this would, even more, be a greater challenge for the data collection process at a high velocity with a high volume for a high number of variables. Anyway, there are some ways to address this issue. Firstly, there should be mandatory data fields to fill for key variables. Then the data collection policy should also be adopted and advocated to the data collectors, such as doctors, nurses, and pharmacists. Anyway, in spite of implementing these measures, there can also be missing data. Then these missing data will be treated with statistical methods such as single and multiple imputations, likelihood-based methods, and some advanced statistical models. And sensitivity analysis could also be used in some cases as well.
Selection Bias: As most of the big data analyses fall under observational studies, it bears some cons. Of these, selection bias would be an important issue to deal with. The selection bias could contribute to confounding effects that might interfere with the hypothesis. Though randomization would cure this problem, the big data analyses themselves undermine the randomization process. Anyway, it would be wise to check the indications from baseline imbalance before analysis. And advanced regression models can also be used for confounding variables that arise from selection bias.
Data analysis and training: As described in the paper, the clinicians are fine for the data analysis of the small datasets. Anyway, big data analysis requires a significant amount of analytical skills to get the job done. For that matter, professional data scientists should do this job. Or the clinicians and the medical personnel can also be trained for such matters.
Interpretation and translational applicability of results: There are always steps between research literature and clinical practices. One should not be discouraged by this problem. Anyway sometimes, there are much more challenges than anticipated as to translate the results of the big data analysis to action. Issuing standard operating procedure guidelines to guide the whole big data analysis steps. The other possible solution would be to encourage the big data culture and context in the clinical setting so that it gives a large community to hold seminars and workshops on a regular basis to discuss the interpretation problems and applicability of the results.
Privacy and ethical issue: Privacy is very fundamental, and always should be regarded as a high priority. In big data analyses, it is, even more, a broad challenge. To face this challenge, there should be policies and guidelines to ensure the privacy of the patients. And the SOPs should be adopted to guide the steps at the operation level. The security of both software and hardware should also be considered as important. And the rules and regulations should also be adapted to support the privacy and ethical issue from a legal aspect.
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Corruption is not often seen as a big issue in health-related fields though it brings a huge impact on the various level of the health sector. The editorial on corruption in health systems is a very good academic work that enlightens medical personnel to be aware of the reasons behind corruption and possible answers to address the corruption. Here’re my views on the four recommended points described in the editorial.
Convening key stakeholders to seek agreement on corruption: In almost every sector especially in the health setting, when a change is needed, it’s always a good idea to engage the key stakeholders to play a big part in the change. Anyway, it would be a challenging task to have a mutual agreement upon the scale and nature of corruption. Furthermore, in some cases, the key stakeholders themselves might be a part of the corruption whereas in some cases they could need legal and technical support if they act as whistleblowers.
Prioritizing the action: the extent of the solution to each problem in a corrupted health setting would surely vary. Some may need immediate attention, on the other hand, some may need to wait for a certain time. Anyway, there may be actions that require to be done in parallel for the synergistic effect. The team has to weigh the steps of the actions. Then the actions should also be closely monitored and evaluated, and their outcomes should be reported to the key stakeholders to adjust the prioritization.
Taking a holistic view: There’ll be no doubt that the process of corruption in the health setting would surely be interconnected to one another. So, when tackling corruption, the team should take a holistic view of this interactive nature of the corruption. This, in turn, needs to have a multi-disciplinary approach to the problem. Only comprehensive treatment will cure the health system sick with corruption.
Research: To me, I think every action to tackle corruption in a health setting needs to be based upon the informed decision which comes from the academic literature. The research body needs to support the team with its findings and results. And the role of big data in this technology era would surely be supportive of making informed decisions that help address corruption. -
During the last couple of years, our organization has been implementing a system which is OpenMRS medical record system to improve the ongoing health system setting of the organization especially in the information sector which is one of the main six blocks in a health system. As an overview, this system allows our organization to have a better information management system which then leads to making informed decisions for the ongoing health system.
Anyway, there are many challenges and barriers that occur in that system improvement process.
The first one is the data legacy transfer. The previous recorded medical data have to be transferred to the newly implemented one, and that has been a great challenge for us till now.
Another one is end users’ attitudes and skills towards computerized medical record systems. Though this issue could be tackled with the change management process, however, it still stands as a possible barrier to the process. The third one is the financial challenge. Computers, tablets, and other electronic devices have to be purchased on a large scale to cover all of the service delivery sites. And in some areas where the electricity outage is frequent, power generators and inverters are needed for the OpenMRS system to function well. -
For a disaster recovery plan for my organization’s information system, I would first identify and analyze the disaster risks and threats to my organization, then I would classify these risks according to their relative weights. After these steps, I would assess the risks using a risk assessment form which will be followed by determining the effects of the disasters with a disaster effects diagram. Then I would form a disaster recovery committee. And I think “backup” is the most suitable technology for my organization.
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The hospital information system is as important as the patients’ lives. If the HIS is failed or experiences a system downtime in the practice, then it would greatly affect healthcare services to the patients, and in severe cases, it would threaten the lives of the patients. That’s why high availability technology should be implemented in the HIS.
Benefits for the patient
• Get comprehensive and safe health care services around the clock
• Experience the quality services from the registration section to the billing sectionBenefits for the hospital
• Able to maintain the hospital information system 24/7
• High-quality management system that will operate day and night
• Will be regarded as a patient-trusted hospital -
Regarding the CIA Triad, I’ve never had serious experiences in trying to preserve that triad. Anyway, there were challenges, especially with the confidentiality issues. And I like to share a particular event relating to this issue. There are several service delivery sites at my organization, and though they use the same EMR system, the databases are stored separately. This, over time, became a barrier in sharing patient information among the service delivery sites. This led the site officers to share the patient information via Facebook messenger group. Sharing the data through such media is definitely unsafe, and may sometimes lead to the exposure of the patient data to unauthorized people or system. Anyway, the problem is now solved after our unit has established a secure and own platform to share the patient data.
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This is really a great presentation. It is obvious that you put a lot of effort to make this wonderful presentation. A complete set! I just want to add just “data security” in the evaluation indicators. It is needless to say why data security is very important to the data management system in the health sector. And I like to suggest you include this indicator in your evaluation of the surveillance system. Thank you.
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Thank you for the great presentation. There’s just a little point that I like to discuss. I think you should clearly state the objective of covid-19 surveillance. According to your presentation, high burden disease, rapid transmission, severity, public interest, and economic impact are described as objectives. But I think if you rephrase these objectives such as “to mitigate the burden of the disease on the public”, “to contain the rapid spread of the disease”, “to reduce the mobility and mortality of the disease” and etc, it would be better. The second one is about the sentinel surveillance system. I think it would be more comprehensive if you mention the sites of the country where you like to do the surveillance system and the reasons behind it. Anyway, it is a great presentation and I gain a lot of useful knowledge from it.
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Thanks for the feedback. As the two comments focused on the same issue, allow me to reply in a comment. Here in Myanmar, it goes the same. The patients with unexplained fever with an eschar are treated with Doxycycline. Only a few numbers of cases were tested with disease-specific laboratory tests. This leads to the condition where scrub typhus is underdiagnosed and underreported. And also, the limitation of indirect fluorescence assay test would also lead to miss the diagnosis of scrub typhus. Though this particular surveillance system aims to report the probable case as scrub typhus as well, the above facts will still have high chances to contribute to forming a barrier to detect the case early which will eventually delay the detection of the outbreak. Anyway, for the time being, here in Myanmar, to the best of my knowledge, there is no reporting system nor surveillance system for scrub typhus. So, we literally have no data about this disease. That’s why I choose this disease to raise the awareness of scrub typhus among health care providers and public health practitioners. And also, I happened to exclude timeliness and response time dimensions from evaluation indicators though I mention the routine and periodic reporting system in the video. I should have included these two indicators for a more comprehensive evaluation of the system. In conclusion, the third and final objective which is “to detect outbreaks or epidemics of the scrub typhus” will still stand as a big challenge to this surveillance system.
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First of all, I surely should not give the data out to the research team from a western country no matter they claim that their study will bring positive impact on the malaria sector.
They have to follow the standard procedure and steps if they claim they are a reputable research team. And I can guide them not violating the general principles of informatics ethics.
According to the principle of legitimate infringement, the right to the privacy and control over the data can be conditioned by the legitimate, appropriate and relevant data-needs, I will advise them to request the data from a legitimate process. And only from an approval of the research ethics committee of the ministry, I will give the required data. And in doing so, I will follow the principle of the least intrusive alternative to ensure the data is given in the least intrusive fashion and with a minimum of interference. -
Being a health information professional with access to the medical records of the patients, I surely cannot disclose her husband sensitive medical record to her. And I cannot interfere with other people or family issue in such cases. Anyway, I do think that my friend should know about this as she is at the risk of contracting the HIV virus.
According to the principle of autonomy from fundamental ethical principles, her husband has a fundamental right to self-determination which means he can decide whether he disclose his HIV status to my friend or not. Anyway, according to the principle of beneficence and principle of non-maleficence, I do have a right to discuss this with my husband’s physician as I have a duty to advance the good of my friend and to prevent harm to my friend. And I will make sure that his physician does the required counselling and health education relating with HIV, and encourages him to disclose his HIV status to his family for the benefits of his family. -
The system I’ve mentioned in the previous topic discussion is the LTFU information system. And I believe the organization appropriately managed the change. Actually, all the staff working for the project surely did have AWARENESS that the system needed to be changed to meet the requirements of the complex project process. And it could be said that the DESIRE to support the change was already on the mind of the staffs. The organization and M&E team established the system with the ideas and concerns of the stakeholders. And then hands-on training was run providing the software manual and guidelines to support the required KNOWLEDGE and ABILITY. In terms of REINFORCEMENT, the maintenance and the technical support are provided to the users as needed.
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Thank you for the unique point which is external evaluation. I believe it is also an important factor to take into consideration when making decisions. And yes, we should train staff to be able to gather insights from the data. The data interpretation skill is now becoming a required skill in this era of data, I believe.
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I think a single person does not have any privileges to decide, by his or her own means, whether a study can be advantageous before the study starts. And yet, there’s always a need to take consent of the patients, as well as an approval from the respected professionals ,here in this case, ethical research committees.
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