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How IT could assist Outbreak Investigation Process?
Verification and Preparation
1. Establish the existence of an outbreak: by developing real-time dashboards to display case trends over time and place, as well as notifying authorities about unusual surges in cases.
2. Verify the diagnosis: through electronic laboratory reporting to public health authorities and relevant stakeholders, enabling timely data exchange across healthcare settings and supporting decision-making processes.
3. Prepare for field work: by using digital tools to collect field data and integrating GIS mapping to identify hotspots, allowing fast and secure information sharing.
Describe the outbreak
4. Construct a working case definition: by using collaborative digital tools to draft, review, and revise case definitions, which can then be easily shared with the technical working group without requiring in-person meetings.
5. Find cases systematically and record information: by using digital case investigation forms on mobile phones, tablets, or computers for faster reporting, synchronized with a central database so that public health officials can promptly review and make further decisions.
6. Perform descriptive epidemiology: by creating data visualizations and GIS maps to identify case patterns, trends, and clusters through interactive dashboards.
Hypothesis & Testing
7. Develop hypotheses and analytical studies: by applying digital data analysis and statistical tools to explore correlations or associations between cases and possible contributing factors. In addition, IT can support data collection through digital surveys and assessment forms for further analysis.
Response & action
8. Implementation of control measures and follow-up: by using automated communication systems such as SMS alerts and emails to inform affected communities about control and preventive measures. IT can also help create dashboards to monitor the progress of interventions and follow-up actions.
9. Communication including outbreak report: by generating automated data summaries and dashboards for stakeholders, and sharing accurate information with the public via social media platforms. At the same time, IT can assist in monitoring social media behavior to detect and address misinformation in real time.
In addition, IT can support the overall outbreak investigation process by enabling efficient data exchange among stakeholders and decision-makers, minimizing data errors, enhancing efficiency, ensuring scalability, and strengthening data security and control.
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I would choose social media platforms that played an important role COVID-19 response by serving as tools for rapid communication, public engagement, and real-time data monitoring. As described by Budd et al. (2020), social media platforms enabled health authorities to share timely updates, preventive measures, and risk communication messages directly with the public. These platforms work by allowing users to exchange information and interact instantly, creating a two-way communication channel that helps address public concerns and tackle misinformation. Social media data can also be analyzed using machine learning and natural language processing to track public sentiment, identify misinformation trends, and detect early signs of outbreaks. For example, during the early stages of COVID-19, patterns in social media activity provided early warnings of increasing infection rates even before official reports emerged. Despite challenges related to misinformation and data privacy, social media platforms are important for delivering health messages, promoting behavioral change, and strengthening community engagement.
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1. How can surveillance help to detect and control the disease (Dengue)?
Surveillance plays an essential role in detecting and controlling dengue outbreak by enabling early identification of unusual increases in dengue cases, allowing health authorities to respond quickly (by collaboration with different sectors such as clinical setting, public health setting, environmental health setting) before the disease spreads widely. Through continuous monitoring of disease patterns, surveillance system can track trends in dengue incidence, identify high-risk areas, and detect clusters of infection that signal potential outbreaks.
2. Should we conduct active or passive surveillance or both for the disease (Dengue), why?
We should conduct both passive and active surveillance for Dengue. Passive surveillance collect reports from health facilities, while active surveillance involves targeted investigation and case finding in communities. Conducting both would provide early detection and timely responses on Dengue outbreaks.
3. Which method should be best to identify cases (Dengue), why?
3.1: Cases in medical facilities VS communityIdentifying dengue cases through both medical facilities and the community is the best option. However, in resource limited setting, community-based surveillance is more effective for dengue detection. This is because mild dengue cases may not reach hospitals or clinics, and some symptoms may disappear without severe clinical signs and symptoms. Community surveillance helps detect these unreported infections, giving the transmission trend in the area. However, data from health facilities are also important for confirming severe cases and guiding medical response. Therefore, a combined approach ensures early detection and better control of dengue outbreaks.
3.2: Sentinel VS population-based surveillance
For dengue, sentinel surveillance, using selected health facilities or locations, works best in many settings, especially where resources are limited. Sentinel surveillance can provide detailed, high-quality data on trends of the disease without requiring the large effort of population-based surveillance. Although population-based systems give broader coverage, they are costly and need to use extra human resources. Sentinel surveillance, when well chosen in high-risk areas, can offer timely response that helps target prevention and vector control measures more effectively.
3.3: Case-based VS aggregated surveillance
A case-based surveillance is better for dengue detection and control. Collecting data for each individual case, including personal, and geographical information, allows for rapid investigation of clusters, understanding transmission trend, and implementing targeted interventions. Aggregated data, while simpler to manage, lacks the detail needed to trace outbreaks or identify hotspots accurately. As Murray and Cohen (2017) note, case-based surveillance is particularly useful for disease outbreak and require quick public health responses.
3.4: Syndromic VS laboratory-confirmed surveillance
In dengue surveillance, both are important. Syndromic surveillance provides early detection and laboratory confirmation provides disease verification. Since dengue often presents with fever and flu-like symptoms, monitoring these symptoms can provide an early warning before lab confirmation is available. As per Murray & Cohen (2017), combined approach (Syndromic for early detection followed by lab-confirmed surveillance) provides fast and accurate response in managing dengue outbreak.
4. What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
For disseminating monkeypox surveillance information, I would choose real-time online platforms, along with regular epidemiological reports (such as weekly, bi-weekly, etc.) and communication channel (such as social media, SMS) to the general public. Real-time tools are very important because monkeypox can spread quickly through travel and close contact, so immediate sharing of verified information helps health authorities and the public respond quickly to prevent further transmission. At the same time, regular epidemiological reports provide detailed updates (such as trend analysis, disease data, future plan for disease control, research purpose, etc.) for policymakers and health professionals for decision making. Dissemininating the disease status and alerts to the general public is also essential for their awareness and preventive measures.
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Based on the given scenario:
Should you give the data out?
No, we should not give individual-level data such as home addresses, geolocation, and contact numbers. If we do this, we will violate the principles of information privacy, security, and least intrusive alternative, as well as accountability on ethical duties to protect confidentiality and prevent harm of individual information.How do you not violate the General Principles of Informatics Ethics?
Principle of Information Privacy and Disposition: we must respect patients’ right to control over their own health data, identifiable data must not be shared without patients’ consent.
Principle of Security: we must ensure strong safeguards for data storage and transfer. Sharing individual-level data increases risks of misuse.
Principle of Legitimate Infringement & Least Intrusive Alternative : If data must be shared, it should be done in the least intrusive way such as providing de-identified or aggregated data.
Principle of Accountability: Any decision must be justified transparently, with documentation of why and how data is shared, and used.If you want to provide the data, what and how will you do it?
If I want to provide the data, I will do the following in accordance with information ethics:
• Seeking for approval and transparency by informing and getting approval from the relevant officials or managers or decision makers as well as beneficiaries/data owners about data sharing and usage, before proceeding data sharing process.
• Asking for ethical approval for the research conducted from the research team to make sure the research will be conducted under the approval of ethical comitte, before research implementation.
• Data aggregation by providing geograhical level or provincial level data instead of individual level data to maintain data confidentiality.
• If individual level data need to be shared, de-identification of patients’ information by removing patients’ identifiable information such as name, address, contact numbers.
• Transparency on data use agreements by documenting how and why the data will be shared and used for the benefits of country disease control. Then, both parties must be signed and agreed accordingly to protect data security and confidentiality. -
Based on the provided scenario:
• As a health information professional, I should not disclose the patient’s information to my close friend, even if she may face consequences, because we must uphold the ethical principle of patient confidentiality and respect the patient’s right to control access to their own health information. The information channels must be in the appropriate process such as proper counseling session for the patient. The patient has the right to self-determination in deciding whether or not to disclose their condition to his family. Breaching this would harm the patient and violate serious ethical codes. In addition, interfering with family matters could undermine professional integrity and trust, as well as lead to legal consequences.
We must follow the fundamental principles by
• Right to self-determination: We must respect the patient’s right to make decisions about disclosure of their health condition.
• Doing good: We must ensure that the health information system is safe and protective for patients, while providing accurate health information through secure processes.
• Doing no Harm: We must protect patient confidentiality and safeguard their personal health information.
• At all times, we must follow ethical standards when handling patient information to maintain professional integrity. -
I’d like to share another example of a successful system that was used in my previous organization. The system, called Integra, is a real-time project management tool that integrates operations and program activities such as budgeting, supply chain management, human resources, and administration. The main purpose of Integra is to provide transparency to donors and stakeholders through real-time reporting. For example, showing budgets versus deliverables, as well as outcomes.
From my perspective, the system worked well because the organization managed the change process effectively as follows:
• Awareness for change: The senior management team (SMT) began by raising awareness among end users/staff. They introduced the system, explained its purpose, and emphasized the benefits of using it.
• Desire to support change: At first, end users/staff were reluctant to move away from traditional methods, fearing that the system would be complicated, time-consuming, and add to their workload. However, SMT provided proper training through simulation exercises, which increased both awareness and knowledge. They also gathered feedback from users and made system adjustments based on that feedback, which helped reduce resistance.
• Knowledge of how to change: Training was tailored to staff roles and responsibilities. For example, program staff were trained on program-related modules, while finance staff received training on the budget system. At the end of the process, all staff members participated in a collective training session to better understand how the entire system worked.
• Ability to use knowledge for change: At the beginning of system implementation, end users/staff faced unfamiliar and time-consuming using the system. However, SMT and IT staff were always on-board to coach end-users depending on their barriers of using the system. This allowed the end-users to be familiar and comfortable with the system.
• Reinforcement to make the change stick: Organization leaders and SMT continued to monitor the system’s use via regular communication with the staff/users, and collect feedback from staff across departments to ensure the system was being effectively adopted and improved over time. -
Background of the system
I’d like to share an example of a system failure from my previous work, focusing on One Health education. The One Health Workforce Academy (OHWA) was created as a global online hub for training and certification in One Health, which recognizes the interconnectedness of human, animal, and environmental health, and the need to work across these boundaries to address today’s challenges. It grew out of the USAID-funded One Health Workforce–Next Generation (OHW-NG) project, led by the University of California, Davis (One Health Institute), which followed the earlier One Health Workforce initiative launched in 2014. The University of Minnesota and Tufts University coordinated the work in partnership with two regional university networks: the Africa One Health University Network (AFROHUN) and the Southeast Asia One Health University Network (SEAOHUN).
The purpose of OHWA is to build the key skills needed for One Health practice. It also aims to establish a credentialing system that employers, governments, and universities can recognize as proof of One Health competency.What made the system successful?
• Operation/Leadership: OHWA was supported by strong leadership across the Global One Health consortium. Courses were designed to be compatible, accessible, and relevant, user-friendly design, particularly for academics from member countries, enabling them to collectively address One Health issues.
• People/User Satisfaction: Since its launch, OHWA grew quickly. By 2025, more than 6,200 learners from 95 countries had enrolled. Most participants came from Africa and Southeast Asia, where OHWA worked closely with AFROHUN and SEAOHUN.What made the system failed?
• Cost/Funding: After USAID funding ended, continuous IT support and system maintenance became very difficult to sustain. This eventually led to suspension of the platform in September, 2025.
• People: Recognition of OHWA credentials by employers, governments, universities remain a challenge, and course content should be updated regularly to meet the needs of diverse learners. -
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Hi William!
Thanks for your presentation on eHealth Africa, that was really interesting! I can imagine how this eHealth project improves access to health care, especially for people living in remote areas. It would help make health care services more equitable and accessible for the community. I’m just wondering how does the project address cold chain management? Since vaccination programs need to prioritize cold chain management, right? Or, it might be the same scenario with EPI program in Myanmar, I guess. -
Hi Jenny! It’s a great presentation, and thank you for sharing the RxBox implementation in the Philippines. I can see how it improves health outcomes, particularly life-saving health care services, in disadvantaged communities in your country, both in terms of cost and customer satisfaction. It also enhances the decision-making process for clinicians and health teams by providing access to EMR and available data.
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Hi Mio!
It’s a great presentation! I like your conclusion part, “eHealth is more than IT system, it creates faster, smarter, and more connected surveillance system”.
Just a quick comment from my end. In addition to your points mentioned about improving current health practices, I think this app/system improves health outcomes by reducing the cost of repetitive training and supervision compared to the paper-based reporting system, which is more prone to errors/data loss and requires close, frequent supervision to minimize mistakes. It could also enhance customer satisfaction by providing data transparency, allowing stakeholders to monitor real-time situations and take necessary actions. In addition, the system is accessible in ethnic areas with poor Internet connectivity and promotes a sense of inclusiveness within ethnic communities.
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Thanks for your great presentation! I like the way you presented your eHealth project by using your own experience as an example from the customer’s point of view in receiving health services. It clearly highlighted both the cost and customer satisfaction.
In addition to the points you mentioned for improving current health practices, I think we can add reducing the cost of awareness programs and reaching more people, particularly in remote areas, to raise awareness. At the same time, customers would be able to receive timely updates about health care (such as HPV screening and awareness). However, continuous awareness programs about this app will be required to reach a larger community so that no one is left behind, regardless of risk group, geography, or socio-economic status.
Furthermore, this approach would also help provide essential data and indicators for national HPV incidence, as well as a roadmap for national policy implementation. -
From my work experience, one example of a Decision Support System (DSS) is the malaria reporting platform. We used it to record malaria test results, treatments, follow-up care, and patient details through a provided app that synchronized with the national malaria database system. The system helped us keep track of cases in real time (or nearly real time) and could send notification if there was an unusual surge of cases in high-risk areas. It also reminded us about treatments in line with national guidelines, so patients received the right medicines and follow-up care.
From my experience, the system worked well. It made reporting faster and helped us, along with district and provincial health authorities, respond more quickly when cases increased. For example, in the case of an unusual surge of malaria Pfcases, we could respond with prompt treatment and environmental management measures such as Indoor Residual Spraying (IRS) and the distribution of Long-Lasting Insecticidal Nets (LLINs) within seven days, in line with national 1-3-7 strategy. It also saved time because we didn’t have to rely on paper-based forms, which often caused delays. Nevertheless, there were challenges. In some remote areas, internet access was weak, so field health workers could not always submit data on time, leading to delayed notification and responses for some cases.
There are a few factors that influenced the DSS implementation. Human factor such as Training in digital skills for field workers was very important, as not everyone was familiar with the technology. Organizational factor such as Leadership support was also crucial. When supervisors or team leaders encouraged the use of the system, field staff were more motivated to use it properly. Technical factor sucah as the design of the system played an important role. If it was simple and user-friendly, field workers found it much easier and more convenient to use.
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Hi Hteik Htar!
Thanks for your good presentation on the interesting project using KOBO Collect. As you presented, KOBO Collect can reduce the workload for field clinical staff and foster the use of data by the regional HIS team to immediately respond to disease management. This reduces the cost of unnecessary paper-related tasks and, at the same time, improves health outcomes through quicker responses. In addition, it enhances data reporting and visualization for the regional team and other stakeholders by providing real-time updates on the disease situation in the field, which supports better decision-making for public health management.
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If the hospitals in a country do not use the ICD standard, disease classification would be inconsistent, making it difficult to share data among hospitals and leading to a lack of interoperability. This, in turn, would result in ineffective data analysis, wrong diagnosis, and poor treatment or disease management. Moreover, it would affect disease reporting to health authorities, limiting their ability to monitor and evaluate the morbidity and mortality of diseases. As a result, it would negatively impact health service planning and decision-making for health policies.
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According to the article by Muhiyaddin R, et al., six general findings revealed real-life scenarios faced by physicians who experience challenges using EMRs in healthcare settings. Although the article did not mention whether EMRs are recorded in real time, the consequences that contribute to physician burnout are equally affecting such as poor quality of care, career dissatisfaction, poor system design, heavy workload/overtime, and alert fatigue.
I had a conversation with a physician working in a private healthcare setting and he explained the situation of the EMR system at his workplace. Since the EMR system requires real-time data entry, it is quite challenging for physicians to manage both EMR recording and patient consultations at the same time. This negatively impacts the quality of care, as the physician must record patient health conditions, history, notes, and clinical findings in the database during the consultation itself. This creates stress for the physician, who struggles to focus fully on the patient while managing database entry.
Moreover, physicians must complete EMR tasks during the consultation in order for other departments (such as nursing, laboratory, or pharmacy) to proceed with the next steps such as blood tests, medications, or follow-up appointments. The system does not allow these steps to move forward unless the physician completes the record. This increases workload and fatigue in addition to consultation duties, and in the long run, may harm both patient-doctor relationships and the quality of care.To reduce such negative consequences:
• The EMR system should be designed with a user-friendly approach, making it less complicated and more time-saving. It should prioritize key data variables and remove unnecessary information. This requires careful planning and involvement of IT and technical experts during the design phase.
• Advocacy and pilot testing should include a proper feedback mechanism so users can share practical, and meaningful input. IT and technical expert teams should act on this feedback to refine and adjust the EMR before full implementation. Feedback without action is ineffective, as EMR systems cannot succeed through a top-down approach alone. All healthcare providers should be actively involved during advocacy and piloting.
• If EMRs are implemented, consultation times should be adjusted in the initial phase,, to allow physicians to become familiar with the system. For example, if physicians previously made consultation with 20 patients per day, the number should be reduced/adjusted to ensure that both consultation quality and EMR recording can be managed without stress. After the initial phase, the system should be re-evaluated by physicians, who should provide feedback on whether the adjustment should continue. In addition, evaluations should be conducted periodically to improve the system over time.
• The EMR system should be flexible by categorizing data into what must be recorded in real time and what can be entered later. This would reduce overtime and help address alert fatigue. -
Hi Heik Htar! Thank you for your interesting case on cyberattack exploiting Fortra’s GoAnywhere MFT, affecting 4.5 million people. In addition to your preventive measures, we may consider implementing strong multifactor-authentication and zero-trust principles, to enforce strict access control and security, as well as simulation exercises to IT team/staff members.
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Based on insights and several definitions of eHealth on the paper “What is eHealth (6)?”, I would describe it as “The innovative use of digital technologies, guided by a networked and global perspective, to improve the well-being of individuals and communities/population at local, regional and global levels. It integrates personal health monitoring (supporting individuals to manage their well-being), effective communication among health care providers, and the collection and use of health data to support better outcomes in research, policy, and healthcare practices. It aims to enhance efficacy, effectiveness, and efficiency in health systems.”
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Hi Kevin! Thanks for sharing this interesting case. A data breach affecting 5.4 million people is huge. In addition to the preventive measures you mentioned, we could also consider strict policy measures on incident response planning, including ransomware attack detection and recovery procedures. Moreover, conducting simulation exercises with real-world scenarios during staff training could strengthen cybersecurity awareness.
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In addition to Jenny and Thiha’s points, I think Multifactor authentication, which protects data with multiple layers, could be applied to prevent such attacks. Also, strict policy for data privacy and protection should be well in-place and providing training to responsible staff to comply with data standards, data accountability and governance is important.
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Thanks Jenny for your interesting and recent story of cyberattack. That was shocking, but I’ve heard that it happens often in those kinds of cyberattack, especially with identity theft. In addition to your points, I think they should strictly follow law enforcement regulations: comply with the country’s privacy laws and data protection standards. Also, staff awareness regarding cybersecurity must be well established.
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In public health settings, I think COVID-19 data is one of ‘big data’, as the characteristics of data fits into 5Vs:
1.Volume: data provides large numbers of patients’ records such as demography, lab testings, treatments, vaccinations, social-economic, patients-related families’ health history records, etc. The more patients recorded, the bigger size of the data.
2. Velocity: real-time data or daily data reported to public health authorities and different organizations including WHO regarding COVID-19 updates.
3. Variety: Data provides different kinds of data including structured (eg. lab results), unstructured (eg. contact tracing, patient’s records, etc.)
4. Value: the data provides meaningful insights to health authorities to better respond outbreak in targeted areas, as well as strategy to prevent outbreak, and early diagnosis for the outbreak.
5. Veracity: the data can provide the health care providers/health authorities to make better decisions on disease outbreak response.Outside health-care settings, I think social media data such as Youtube, Instagram, Twitter, Facebook as well as Banking systems can be considered as big-data as it fits with 5Vs (at minimum), characteristics of ‘big-data’.
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Hi Thiha!
Your case looks interesting, and I would say there was a very huge financial and reputational loss from the attack by UHC. It was over $3 billion in financial loss and 190 million data records stolen!! And yes, as your justifications, it was the lack of two-factor authentication, allowing the attackers to execute a ransomware attack. In addition to your preventive measures, I think the system could also be enhanced by regular cybersecurity audits, in addition to a real-time monitoring system, so that any abnormal activities could be promptly detected and immediate actions taken. In addition to the employees’ cybersecurity awareness, the responsible staff should be well-trained with real-case scenarios so that they could be well-prepared for any potential attacks, as well as minimizing the risk of financial and reputational loss by UHC. -
Hi Ko Aung!
Your case study is very interesting, and I think you have already provided strong justifications and preventive measures regarding the Heartbleed threat. I would just like to add a few additional points. For example, implementing multi-factor authentication can help minimize data loss or damage to the system. A real-time monitoring system, in addition to regular vulnerability scanning and penetration testing, would allow the system to immediately detect abnormal intrusions. Finally, conducting simulation exercises for organizational staff/IT staff would help them be better prepared for potential attacks and reduce the overall cost of an incident.
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To my knowledge, during the COVID-19 era, Facebook sought to minimize the spread of misinformation by using automated systems to detect and remove suspicious content that repeatedly shared information not aligned with updates, news, and guidelines from the World Health Organization (WHO). In addition, to promote accurate information and public education, Facebook boosted posts from trusted health organizations such as the WHO, ensuring that reliable updates on COVID-19 trends, notifications, and precautions appeared in users’ news feeds. I think other platforms, such as YouTube, use similar technology to minimize misinformation. However, it is sometimes difficult to determine which sources of information are truly reliable and what criteria social media platforms use to check and balance the delivery of accurate information to users. This can be complicated further by potential influences from political interests and decision-makers. For example, political leaders are nowadays using social media platforms to gain public trust.
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Yeah! Operational and people factors matter when disseminating the system. Without proper change management, awareness, and training, the system would be less effective, even if the technology is designed to improve outcomes. I think support from leadership is also critical for this kind of system, as it enhances user satisfaction and encourages people’s involvement.
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Hi Ko Aung! I agree with your point on the importance of EMR design, it really matters! and yes, EMR should be valuable to clinical practice and clinical decision support system. Therefore, building trust and sense of ownership for the clinicians about EMR would be an essential part of EMR system implementation.
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Yeah, I get your point. That’s why I’d like to emphasize access to health care, where considering health equity in planning, designing, and implementation is essential to minimize the gaps between rural and urban areas. I believe even developed countries are still facing these kinds of inequalities, and it will take time to fully address them.
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Hi Kevin!
Yup, I would agree that cost of initial phase (transition) might be costly, but when it’s fully implemented, it would reduce cost of paper-related tasks, logistics, admin costs for the long run. Um, for data security for the app, based on my knowledge, it’s secured with citizen’s 13 digits number (ID) and registered phone number, and it is designed with one-time log-in. So, I think, though the phone is stolen, it would not easy to log-in unless the theft has the information. Also, I would say the app seems quite similar to Thai mobile banking apps, for example, the login steps, use of a PIN, and restrictions on screenshots (that’s just my observation 😀 -
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I could imagine it. When the HSS survey was conducted using a paper-based approach, there were many difficulties as you mentioned. More importantly, when it came to data analysis and quality, it led to poor-quality reporting, which might affect decision-making and policies for HIV prevention and management at the national level. I am wondering about the current status of the National AIDS Program implementation 🙂
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Thank you for sharing your real-world practice in clinical settings. The challenge of transforming data to analysis and insightful impacts is quite big in your practice, especially when there is no standardized criteria to capture the data. And, yes, it’s definitely the issue of interoperability within the setting. Without it and lack of data management procedures could not provide actionable results, and support for decision making (superior outcomes).
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Agreed! Nowadays, “Zhapian” is threatening people from Myanmar and neighbouring countries: Thailand, Cambodia, Laos. In Thailand, many people regardless of age, educational status, gender, have been affected and have lost millions of Baht via different mobile banking systems. Right now, the BOT (Bank of Thailand) is trying to address the cyberattack issues by strictly monitoring and taking actions to strengthen the security of the banking system, such as suspending suspicious banking accounts. However, because this concerns national data security/data security of banking systems, a proper and strategic approach is needed to tackle such a major issue for the country in order to minimize the negative impact on the banking systems and users.
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Hi Thiha! Thanks for sharing your experience. I also had similar experiences with the colleagues who were resistant to change, which was very challenging for us to proceed with the new system. So, I could see how effort you had to make for the change, and it did take sometime. Also, language barrier was one of the big challenges, particularly when dealing with the system, and technology.
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