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I agree with Aj. and other classmate that the combination of non-identifiable information could be led to to identification of people. Only combination of these character could distinguish me among my colleagues (even though I have up to 70 staffs in my department) and other people
Occupation: Clinical Research Associate (CRA)
Workplace: MSD (Thailand)
Age: 26
It’s interesting that only combination of these 3 characters could identify me. One motto that I heard about concept of personal identification for a while is that the less people of your interest, the less identifier(s) you need to use for identification of people. -
For me, I would start by identify the biases or confounders in the survey response first. The preliminary data from the survey may guide the modality of the next step to find out the answer.
The next step would be “qualitative research” to study to reason of not using bednets in depth.However, the qualitative research itself could be divided into multiple approach including the individual interview of informants, individual interview of key informants, focus group discussion. Since many people response to the survey as not using bednets. I would prefer using focus group to get the holistic view of the community. The interview could be conducted in semi-structured format. Some question maybe derived from the assumption from the survey.
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In my opinion, if my organization would like to implement the new technology with is easier to use.
I also expect the usefulness of be at least equivalence to the old one. However, since the cost of implementing new technology and maintaining system may costly. I think the usefulness of the new system should be superior comparing to the new one. The superiority can be considered in various aspect including
– Enhance productivity (decrease time, increase output)
– Enhance the quality of work: For example, increase the percentage of drug-related problems (DRP) detection after implementing the new EMR-pharmacy system
– Mitigate the existing risk(s) in the process: For example, decrease to number of malware attack after implementing the new hospital IT safety measures -
I also agree with other classmates that there are many factors affecting Usefulness (U) or Ease of Use (EOU) including:
1) Technology on-boarding process: People typically hate changes, especially the change that they did not understand clearly and have no idea how to react with it. The well-prepared on-boarding process including proper training, workshop, IT support may could enhance the technology acceptance especially the EOU domain.
2) Digital Literacy: This factor is the factor showing how well people could adapt to new technology. Young people, including Y and Z generation growing up with many technologies’ disruption. People of these generations tend to adapt well. I once learn about model of product adoption. In my opinion, this model could also adapt with technology acceptance as well. Most young people tend to adopt the product rapidly (innovators or early adopters) while the senior worker of X generation or boomer generation may fell in the late majority and the laggards group. I’m quite sure that the population characteristic, especially age, affect the result of TAM -
Hi All,
Efficacy:
This is measure of effect under ideal condition, for example, in well-designed double-blinded randomized controlled trial (RCT). The main idea of efficacy is that it is the effect of intervention in minimized biases and confounders setting.Effectiveness:
This is the measure of ‘real life’ condition. For example, the study of drug effect in disease prevention in the clinical practice. Based on the real life in nature, this allow us to see the real effect of intervention when you use in the real setting (not the tightly controlled environment which is not possible to do in the real life).Efficiency:
This is the measure of intervention effect in consideration of cost-effectiveness. The cost to be considered may included both direct cost, indirect cost and others. This cost is also varied among settings. For example, Use of Drug A to prevent coronary heart disease is considered cost-effective in USA but not in Thailand. -
Disease awareness
This confounder may be quite related to others comments but what I would like to highlight is the “awareness” of the application user. As our lesson learned from a previous contact tracing application in Thailand. In the initial phase, most people decided to enter information in contact tracing applications as much as possible because they hoped that they would receive the notification if they contacted infected people.
The disease awareness is quite related to the age of the subject. If the subject is too young, they might not be aware of the impact of the disease both for themself and society. If the subject is too old, they might not understand the impact of disease well either since the disease might be new or too complicated for their understanding.
The disease awareness, definitely, related to the contact pattern. If the subject is aware of the disease impact, prevention and other aspects. They tend to avoid contact of infected people and tend to enter the information in application to ensure that they receive notification of disease contact. -
Hi All,
I would like to share with you all about Infant mortality rate
Definition:
Per CDC, Infant mortality rate is defined as the number of infant deaths for every 1,000 live births (this death is needed to occur prior to their first birthday).**Please remark that even the name of this indicator is RATE, the denominator is not TOTAL nor the TIME-dependent parameter but it is the NUMBER of LIVED infant
In my opinion, this is the same concept of Odds ratio.Calculation:
(Number of deaths among children < 1 year of age reported during given time period)/ number of live births during the same time) x 1,000
Use:
This indicator is used to reflect the overall health status of each country based on the assumption that the health of mothers and infants were affected by country factors including prenatal care(mother behaviors and education), postnatal care (immunization program, nutrition status). The higher the mortality rate, the poorer of health status of the particular countryExample of interpretation:
In 2021, the infant mortality rate was 53.98 in Pakistan. It means that For every 1,000 lives of infants in Pakistan, 53.98 infants died before the age of 1 year. -
Dear All,
As same as Siriphak, I am also not directly involved with the contribution of COVID-19 policy in my setting. I’m working as a Clinical Research Associate (CRA). I mostly play the role of the follower of the policy.
I would divide my practice into 2 main settings.At my office/my organization:
Adherence to the company measure: My organization has a policy of ATK-testing prior to entering the office and the policy of wearing mask during working in an office. I always obey the policy of my organization. I also emphasized to my colleague to follow this policy.Empathy and Social responsibility: In Thailand, we were in the panic phase of the COVID-19 phase for a while. During that phase, we usually blame someone who get infected with COVID-19. I always keep in mind that infected people did not want the get infected. We should not blame them on that. However, we are all responsible to protect ourselves and our society from infection. My office has the office of not blaming and encouraging the social responsibility.
At study site (during study site visit):
This setting is quite the same within organization policy. Each study site has its own policy of COVID-19 screening and protection. As CRA, we should strictly follow the policy of the study site as well as keep in my on society responsibility. -
Hi All,
Thank you Dr. Preut for sharing the interesting project on UCEP. This program is crucial and benefit to vast Thailand population including my family.
I would like to bring the attention to the UCEP and the implementation in COVID-19 era as well.
UCEP stands for Universal Coverage for Emergency Patients. This project was implemented in 2017 to ensure that the critical patient receive the timely proper management regardless of their reimbursement capability.
Thailand faced to COVID-19 pandemic and the COVID-19 was included in UCEP project (COVID UCEP) in Apr 2020 as the responsive action to the large number of patients in Thailand.What works:
I think the implement of UCEP COVID is quite good idea to ensure that patient could access the medical care in timely manner especially in the beginning of the era of COVID-19 pandemic that we did not know much about the disease prognosis, and we still did not have adequate vaccination in population level.What need to be done to make it works:
I also heard that in 2020 when the COVID UCEP had been implemented. Even patient could receive medical care for free, but it is very difficult to contact NHSO representative or hospitals to request for admission or other type of medical care due to the high volume of patients.
During that time, Many Thai HCP volunteer to screen and support patient remotely (using line group) and facilitate to hospital admission processes.Strength(s):
In my opinion, this policy is considered good responsive action to the pandemic situation. Apart from that, the policy has been adapted corresponded to the pandemic situation. Currently UCEP COVID is no longer effective in Thailand, but the COVID-19 patient still could access the medical care via different channels.Weakness(s):
The weakness of this project is the cost of treatment that need to be paid by the government which considered high. Apart from that, the implement of COVID UCEP lead to the workload of HCPs at each hospital since the HCPs recruiting is limited during that time. -
If I were in charge for the data sharing authorization. I would consider data sharing. In my opinion, the data sharing is beneficial to the scientific field, public health field and so on.
Each country possesses unique characteristic and perhaps owning the pools for priceless data to be contributed to others. For example, Thailand is the one of countries in Tropical zone. Therefore, the data collection related to tropical zone diseases (malaria, dengue, melioidosis) would be fruitful. Apart from the geographical characteristic, the genetic inherited disease is one of the data that is unique. In Thailand, the incidence of Thalassemia is quite high comparing to other countries. Therefore, here is the suitable site to study the clinical features of this disease.
Sharing data not only reduce the redundancy of the data collection, especially in the human. Sometimes, data could only be obtained in only specific country. Without the data sharing awareness, scientist and/or stakeholders in other country could not study on this topic at all
Although data sharing is beneficial in many perspectives, there are many concerns of to be considered prior to initiate data sharing process
1) Data format and standardization: In Thailand, most of the data and/or document were recorded in Thai language which might not be able to understand for foreigner.
2) Data anonymization: In Thailand, we need to accept that the awareness of privacy is not quite high. The sensitive information including medical history, ID card number, HN number, financial status, address was recorded and easily accessible. The process of data anonymization needs to be strict and ensure that there are no personal identifiers in the data to be shared.
3) Data sharing responsible department: The data should not be published as open access. We should appoint the responsible department to review the data request and approve the request in case-by-case basis.In conclusion, the data sharing is not one-time job. The authorizer needs to consider risk and benefits as a whole picture. Sometimes, we need to invest time, money, staff for processing of data and maintaining data sharing process which is the one of important step to be considered as well.
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In my opinion, the status of the health informatician is not well-established in Thailand.
I heard some of existing role in the government sector and private sector as well. However, the popularity of this role is quite limited. Even I am the pharmacist which is one of the HCPs, I did not know a lot about this role.
In Thailand, the well-accepted career are quite the same with other Asian countries: doctor, dentist, pharmacist, engineer, accountant, lawyer. The IT-related career is not quite popular.
I think we have a gap for raising awareness for IT-related career including health informatician as well. Apart from raising awareness for the career, the building the ecosystem for the health informatician is important as well. In Thailand, the current market for health informatician is gradually growing as the era of big data is coming.In conclusion, the role of this profession is gradually growing for both emerging and existing workforce. The awareness is gradually growing as well.
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As I am working as a CRA. I am not quite familiar with medical record of the hospital in term of patient. care.
I tried to summarize what I experienced during internship and in my CRA perspective.
The advantage and the disadvantage of implementing EMR instead of paper-based medical record could be summarized as follows:Advantage(s):
1) Improve the accessibility of the patient medical record: The information could be derived faster and facilitate the patient care service during the prime time of the day comparing to searching the patient OPD binder one by one. The medical record could be viewed by different people at different location at the same time.
2) Meet the stakeholder need including the policy maker, healthcare insurance and enable data exchange among the stakeholders. This would allow the rapid reimbursement process.
3) Improve the quality of care: the OPD record would be more standardized and reduce the errors occurred in patient care.Disadvantage(s):
1) Proper training is required during transition period since the user may not be familiar with the system.
2) Risk of confidentiality of the data held under the EMR system: Since the data would be kept in the electronic way. The security measures are not the same with the paper based EMR. The storage and the use of data should be complied with the local law and regulation as well.
3) Need of provision of the technical support
4) The concern of sustainability of the infrastructure including cost of set up and maintenance. Apart from that, the inadequate maintenance process may lead to the user rejection and could lead to the problem in the future. -
Hi All,
Below is my suggestion on each challenge.
Missing data:
I agree with the paper that most of the data is not missing at random. It caused by the standard practice or patient refusal. If the proportion of the missing is quite low, I would personally start with the completed case analysis. If the proportion is relatively high, I would try the data analytic technique, for example, imputation. However, I would always keep in concern that the imputed data is not real one. The imputation could lead to the analytical bias. If there is the alternative datapoint that could be used and that datapoint is more completed, I would try that also.Selection Bias:
As this paper mentioned about the selection bias due to the nature of data collection, I do agree with this statement. The selection bias could not be avoided when we obtained the data since we did not create it or collect it ourselves with the standard method. In my practice, I would perform preliminary test to get the overview of the data first. The basic statistical parameter should be calculated as well as the study of data distribution. This could give the analyst the big picture of the obtained data and sometimes we may see the weird pattern due the selection bias as well.Data analysis:
The limitation of knowledge on big data analytic and the algorithm developed to handle big data has been discussed for a while. I suggestion that the researcher should be trained on the handle of big data along with the statistics. The refreshing training and update on the newly released algorithm should be provided on the regular basis.
Applicability of the results:
For this issue, I suggest that the analyst should provide the result and ensure the data processing transparency as much as possible. The complex algorithm is not generally acceptable in healthcare field since most of healthcare staff has little to no data literacy. The complex algorithm is the “black box” for them. In term of the reader, all of us should aware of the big data trend and the important of data literacy that we should seek for.Privacy and Ethical issue:
For this issue, I suggest that the data owner should prioritize the data privacy and the data security on the top of all things. Data is the asset. The data owner should be aware of it and invest on the data security measures. Apart from that, the data owner should try their best to comply with the local law and regulation. -
I do agree with the steps for fighting the corruption and I’m totally agreeing to begin the first step with the communication
Below is my view on each steps:First step: Convene the stakeholders
In my opinion, I think the major and the most challenge is to make people speak up. Concerning the complexity of our society, speaking up something not only impact at individual level but it could impact thousands of people in the same organization as I usually call it “butterfly effect”. I agree that the protection of the corruption exposure is crucial regardless of the severity of corruption level. I’m one of the people who always try to speak up and try to flight for ethical conduct. I truly admitted that it’s hard the speak up but it’s harder that thing would change after we speak, and I guess that is why many people decided not to speak up anymore.Second step: Prioritizing action
As I mentioned earlier, all comments and/or concerns raised may not lead to the prompt corrective/preventive action. I agree that we need to research and plan well before implementing something to fight the corruption due to its sensitivity in nature. However, I think that all policy maker level should response to all cases. Some of them may need only “wait and see” process but the response of acknowledgment and inform the corruption exposure on their plan.Third step: Take holistic view
I agree with this step that at the last before we execute, we should ensure that we see the “whole picture” of the problem, and we have a plan B when things go unplanned. The solution should be reviewed by multidisciplinary team.Forth step: Research the community sets out
What we research and investigate the corruption internally is important but the insight from community might also helpful and reflect our own practice. I agree that we should take it in consideration.Thanks
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Hi All,
Please allow me to share the health system improvement, particularly in research perspective. I’m working as a Clinical Research Associate (CRA) in one of pharmaceutical company.
My company launched the use shared investigator platform (SIP) for about two years and the new features have been updated regularly.
The pros of the platform is that the investigators (physician who oversight the clinical study) and site staff could registered themselves once and use this platform as the document exchange portal, GCP training portal among all sponsors.
The barrier I faced during my work:
1) The lack of user acceptance: site staff and investigator only registered once, and they never visit the website again since they did not understand the important and the features provided in this portal.
2) For document exchange feature which is quite convenient for sponsor and site staff to exchange the document. However, site staff preferred to send the document photo via LINE or other platform based on their familiarity
3) The platform only available in English, the site staff feel difficult the access each featureAll portal functionality training relies on CRA. This training required for all site staff and it is considered as the additional task for use. As we are super busy, we only could train them to register properly and provide training only on basic features (and some of them forgot how to do it very quickly after training T^T).
In the conclusion, the important step of implementing any systems is the proper training (which may required repetition) and the user acceptance.
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Thank you for sharing ka.
I agree with you that the multiple definition and the misspelled word, as well as the data discrepancy is the concern to be addressed.
I have the experience of matching the different trade name of the drug within generic name.
We could also solve this issue by grouping and re-coding but it could take a long time. -
Thank you for your sharing.
In Thailand, we also try to implement ethics training in the curriculum (some of universities/departments may also implemented for a long time).
I think It’s very good to start telling children/student “what is right or wrong”
However, I personally would like to add “conflict management” and/or “dealing with unethical behavior” to the curriculum also since most of the time I think people know what is the right thing to do. However, they refused to do it because of some reasons.
To make them change their mind, we might need the persuasive and conflict management skill. -
Thank you for sharing such an interesting view.
I agree that if we truly would like to fight corruption, we need to identify the true problem and the stakeholders who truly could influence in the process (in a good way).
As P’ Kanoon (Boonyarat) mentioned in #39464, we need a good and powerful leader to fight corruption. -
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Thank you for raising such an interesting topic.
The expansion of an aging society is definitely trend since 2020 moving forward.
I agree with the barriers you mentioned.
Moreover, I personally feel that the culture of each region/country quite affects the pattern of healthcare to be developed in each country.
In Thailand, I think most of us have the culture/norm of taking care of the elderly by ourselves.
We might tend to accept the healthcare technology that facilitates taking care of the elderly at our homes.
On the contrary, some people in other countries may prefer nursing home. -
Thank you for sharing.
I also heard about the free medication for 16 common illnesses program.
I think it is quite a challenge for the stand-alone pharmacy store whose resource (pharmacist, pharmacy assistant) is limited.
I think there would be major change for pharmacy business in upcoming 2-3 years. -
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Thank you for sharing.
I agree with you the COVID-19 pandemic drive the adoption of technology in every field including healthcare. Telemedicine growth rapidly in Thailand and worldwide.
However, the impact of this technology in long term should be assessed. For example
Is this lead to physician burnout? -
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