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Please allow me to express my opinion. Health as a bridge for peace is very difficult but it is possible. To do so, the policy in public health of the government and EHO/CBHOs should be mostly similar. In addition, decentralization of MoHS should be conducted, so it can encourage health workers from different organization to work together. Collaboration between EHO/CBHOs and MoHS have to maintain and entrust that the primary benefit is good health of people. If the collaboration is sustained for few years, collaboration in other fields between the government and public sectors can be established. Later, peace is possible.
For health information management systems, Myanmar should start with logistic management system because it can increase efficacy of logistic. The system can summarize what, when, where, and how the device and medication to be delivered. For example, repetitive logistic frequently occurred if we use the conventional logistic. A messenger has to carry drugs from the same pharmaceutical counter to the same wards with consecutive laps. After implement the system, the similar route at the same time can be included in one lap. Moreover, urgent medication can be delivered with first priority.
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According to the study, most of the participants earned high education and owned smartphones. However, the study did not mention about the GPS watch ownership in the participants. They might not be familiar with the GPS watch and had difficulty to use it.
Both smartphones and GPS watches have advantages and disadvantages. For smartphones, participants were familiar with them and they were easy to use. But they might not take the smartphone to every place especially in their household. For example, they left their smartphone on a table and went outside to do the gardening. For GPS watches, they could wear it on their wrist, so it could be carried to most places they went. However, the font size of letter in the GPS watches might be too small that elder participants had difficulty to read.
In conclusion, the information in this article may not be enough to consider between using smartphones and GPS watches.
To answer your first question, there are other factors affecting consideration to use location tracking research in the future. One of them is data security which is one of the factors that participants need to know and to be ensured that their information is going to be used only in the research.
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The burnout syndrome in healthcare workers is a very interesting topic.
1. There are several factors contributing to burnout syndrome. Work overload, for example, excessive night shifts, continuous work with inappropriate time to relax is one of the major factors. Unnecessary documentation or redundant documents is a common factor in many hospitals. Pressure from leaders or colleagues may exist in some corporate culture.
2. The problem of burnout syndrome in healthcare workers is recognized and addressed. Leaders would like to get rid of this problem with some intervention in each problem. For burnout syndrome resulting from excessive or redundant documentation, good information technology can minimize the problem. We must ensure that this technology substitute the previous paper work. Moreover, the redundant work must be zero. For example, the volume of urine output is recorded by practical nurses. This number must be validated only once and must be auto-filled in other documents, for instance, graphic chart, progress note, nurse note, etc. -
Thank you for your interesting topic and presentation.
1. In Thailand, there are some barriers to use telemedicine.
For physicians, the physical examination is impossible in telemedicine. Some symptoms and presentation need physical examination to gather more information, then integrate them to make the provisional diagnosis. In addition, doctor and patient relationship is another concern in some physicians during the telemedicine use.
For patients, the access to the telemedicine needs some information technology, for example, the smart phone, 5G. Therefore, patients who do not use these technologies cannot access to the telemedicine.
For hospitals, telemedicine requires high budget for initialization and maintenance. Hospital directors have to carefully consider to implement the system.2. To minimize selection bias, propensity score matching can partially equalize baseline characteristics between groups of patients. However, they have to select variable to include in propensity score calculation.
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Please visit my dashboard at Preut’s Dashboard
The dashboard provides information about malaria infection in Thailand. We can monitor the incidence of malaria infection in different months during a year. Also, I provide filters that can focus on some occupation, nationality, and species of malaria.
Please feel free to provide your suggestion to improve my dashboard.
Thank you.
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This infographic is a report of Covid-19 situation around the world on May 25, 2020. Sorry that it is in Thai.
I choose this infographic because it has many points which can be improved.
What I like:
– The line plot is easy to understand the trend of Covid-19 infected people.
– Use of national flags can help readers understand without reading the country name; however, ones must know what countries belong to those flags.
– They order the countries from those with higher number of Covid-19 infected people first.What I do not like:
– The report of disease burden should be adjusted with total population.
– The number on Y-axis should be separated by , (comma).
– There are too many lines. We can choose to show only reference countries e.g., the USA, the UK, Japan, China, Singapore
– The top 10 countries with highest infection and mortality should be shown in bar chart which can be easier understood, and can compare among countries. -
Followings are some of my suggestion to improve your CRF:
– Date format with first 3 letter of month (such as Apr, Jun) may be used to avoid confusing with DD/MM/YYYY or MM/DD/YYYY.
– Selection of study visit (screening, enrollment, follow-up, and unscheduled) can be replaced by 4 separate case-record form for each visit.
– The past medical history regarding endocrine/metabolic domain should be clarified to prevent confusing of their illness. History of influenza virus infection should address the onset within 6 months. Recall bias of participants can be occurred.
– Some parameter e.g., BMI can be calculated during the analysis in order to minimize workload on data entry.
– Grading of injection reaction appreciated me. The standard of the grading for mild, moderate, and severe should be found out.Well done,
Thank you. -
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Data standards for clinical research have several benefits in the research. One of them is the ability to combine data from individuals in the metanalysis. We can use the common variable name, formats, and units. These make the data combination and running the analysis easier. Furthermore, data standards for clinical research make common variables, format, and unit understandable by different researchers.
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According to my previous research, I did not do the audit trial or time stamp because the data was collected by myself and the edit could be done under carefully check. In addition, user authentication was used as the password to access my laptop. I did the edit check and logical check. All data was checked for the data entry error. Logical checks were performed to ensure that the data are consistent and relevant. I used the Google drive for my data backup on the cloud with the sync feature, however, I made the mistake that I accidentally deleted the file on the cloud and my file on the laptop was also deleted too. So I had to do the data entry again, and it took more time.
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During my research, these are steps that I have done: protocol discussion, data design, data acquisition, database setup, data entry and processing, data validation, and data quality control. However, there are steps that I would like to take after finishing this course.
– CRF development. I should consider some issues that might occur during data entry. These issues must be written with a definition in the instruction.
– Database access control. As the project grows and there are many people involved in the project, access control with authentication must be enforced.
– Reconciliation of serious adverse events. I would set up a separate database that contains data on serious adverse events.
– External data merging. Since my previous research used data from the same electronic medical record, I did not need data merging. However, if I need data from different systems, I have to consider the data merging process.
– Database lock. After finishing the study, the database should be locked against further changes. -
I would like to share my experience on data collection during my researches; one was a randomized controlled trial in comparing 2 regimens of anti-retroviral therapy for occupational post-exposure prophylaxis, the other was a retrospective study in comparing 30-day mortality of patients who had in-hospital cardiac arrest during admission between in a monitoring ward versus a non-monitoring ward.
1. Purpose of data collection of both studies was for research.
2. The data collection of both studies was primary data collection.
3. For methods used for data collection, the RCT study used the paper-based case record form because the data had to be collected during follow-up visit. The case record form consisted of study ID, clinical data about adverse effects, laboratory findings. I used log book to link between hospital number and study ID to maintain confidentiality of patients. In the retrospective study, I used electronic-based case record form. I prepared the form using Microsoft excel that was set-up for data checking. I accessed the electronic medical record and filled in the case record form.
4. There were some problems occurred during the data collection. For the RCT study, there may be interviewer bias. Participants who assigned to receive one regimen of medication would be asked for the side effects of such medication. Besides, most of the participants were health care worker so that they had knowledge about the common side effects of such medication. For the retrospective study, there was a problem of some operational definition that might not cover all of the possibility of the data recorded in the electronic medical record. In addition, reviewing the electronic medical record which the data were unstructured took time.
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This week, I have learned about ethics for health informaticians. The following is a summary of the principles of professional and ethical conduct.
1. Ethical guidelines regarding patients:
• Patients, including their relatives and caregivers, have the right to know about the existence and use of the electronic health records and have right to create their personal health records.
• They have to be ensured that their data are transmitted, acquired, recorded, stored, maintained, analyzed, and communicated in an appropriately safe, reliable, secure, and confidential way.2. Ethical guideline regarding colleagues:
• We have to establish the participation of patients in the collection, management, and curation of their data.
• We support our roles in healthcare research and education.
• We have to acknowledge our team about the potential information and system issues, e.g., bugs of the systems3. Ethical guideline regarding institutions, employers, business partners, and clients:
• They must understand their duties and obligations to the right of patients on their information.4. Ethical guideline regarding society and regarding research:
• Researchers must be mindful and respectful of the social or public health implications of their work.
• We must disseminate the new knowledge of both positive and negative results. This is difficult to mandate because most of the negative result studies have not been published. There is publication bias.5. General profession and ethical guidelines:
• We should maintain the continuing education, contribute to the education of students.
• We should consult the team if there are technical and ethical limitations. -
What I have learned from this week topic:
1. Technology is being grown and developed faster than the adaptation of regulation
• This put people at risk of security and privacy destruction
2. Ethical acceptability, sustainability, and societal desirability are three main concerning issues to develop responsible research and innovation.
3. “Better safe than sorry”
• If there is a chance of danger from the newly launched technology, we should not wait until there is scientific evidence of harm.
4. Concerning in artificial intelligence
• Biases in training data sets result in biases of derived algorithm
• Health disparities in both increasing and decreasing disparities
• Take people away from each other and replace with robots
• Trust in artificial intelligence application about security, privacy, and data processing to form the result. -
I would like to discuss point number 14 (page 342). The point is that we should always use two-sided P values.
This statement is false.
By default, two-sided alpha is used because we do not absolutely know the direction of the hypothesis. For example, we would like to know the adverse effect of a new drug A compared to the current drug whether there are more adverse effects in the new drug group or in the current drug group. However, one-sided alpha can be used in the hypothesis which we focus on a single direction of effect. For instance, we would like to prove the efficacy of a new drug B in a non-inferiority trial. In addition, the sample size for the one-sided hypothesis is less than that for the two-sided alpha.
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Technology acceptance model (TAM) is a model to evaluate perceived usefulness and perceived ease of use on a new system or technology. Perceived usefulness is defined as the degree to which a person believes that using a particular system would enhance their job performance. Factors which associated with perceived usefulness are the followings.
1. The technology enhances quality of work, productivity, and effectiveness
2. The technology can control over their work.
3. The technology allows the users to work more quickly.
4. The technology makes their jobs easier to be accomplished. -
There are many external variables influencing the perceived ease of use or perceived usefulness of a new technology. Followings are the potential external variables.
The bad experience of the previous change to a new technology makes people fear of changes.
Participation in the implementation of new technology can help users accept changes. Every department in the organization should provide people engaging in the implementation process of the new technology.
Increasing age may associate with reducing aspiration to learn a new technology. Aging people are familiar with the technology developed in their working age.
Infrastructure of the organization also influences on the perceived ease of use or perceived usefulness. Such infrastructure includes network, client computers, central servers, etc. If the network is frequently interrupted or has a slow speed, or if the computer hardware is old and consumes a lot of time for operating a process, these are barriers to the success of implementation of a new technology.
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I would like to provide my non-identifiable data that could identify me if they are combined.
Job titles: internist, intensivist
Workplace: Department of Medicine, Faculty of Medicine, Chulalongkorn UniversityThis topic discussion emphasizes that every record from containing patient information must be kept under security despite of de-identification or removal of identifiable data.
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From my point of view, qualitative research can help us figure out why people do not using bednets. I would like to start with the literature review to determine whether previous studies that mentioned about the reasons for not using bednets. This will help us conceptualize and summarize the potential reasons to ask them.
Next, we will select the population to ask them the questions. Systematic, nonprobability sampling is the approach to people who are not using bednets and who are the target population of the study. The sample size should initially be around 12-26 subject; however, it can be expanded if there are many different reasons of not using bednets and there is heterogeneity of gathered information.
There are many possible methods of collecting data. Commonly used methods are interviews and focus group discussions. The interviews should be semi-structured so that we provide the potential reasons that we have reviewed from the previous studies. If there is another reason besides our lists, in-depth interviews regarding that reason should be used. Convenient atmosphere should be created to make respondents speak freely.
Another common method is a focus group discussion. The advantages of this method are less time consuming, the ability of sharing ideas between participants, etc. However, there may be a limit to sharing their ideas if they are strange to each other.
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Efficacy is capacity for beneficial changes following an intervention under ideal or controlled conditions. For example, a new vaccine shows an efficacy in preventing people from infection of a particular disease. The efficacy can be summarized according to the finding of pre-clinical trial.
Effectiveness links to the notion of external validity which effects the efficacy. For instance, the new vaccine has little effectiveness in immunocompromised patients whose immunity cannot be boosted.
Efficiency is about doing thing right under a limited condition. For example, selecting right people at risk to receive vaccine and good distribution of Covid-19 vaccine lead to high efficiency of vaccination and disease control.
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Number of their contact persons
The number of contact persons can determine their contact pattern. People who have many friends or colleagues during their business or recreation will be in the active contact pattern. On the other hand, those who does not have a lot of friend or do their business have less chance to be active contact pattern. Both older and younger people can have different number of friends and colleagues. Therefore, number of friends should be standardized between these two groups. -
Sorry all, I forgot to answer this topic on yesterday.
During the Covid-19 pandemics, I worked as a physician who contribute to care for severe Covid-19 infection in the intensive care unit. The major problem that many hospitals around the world has to deal with was intensive care unit shortage although we had tried to construct new intensive care units or transform the operating rooms to critical care units. In order to maintain the good practice standards, we have to be aware four fundamental principles of biomedical ethics: autonomy, beneficence, non-maleficence, and justice.
Autonomy
If the patient was fully conscious, we had to respect their decision. We, the physicians, had to provide all information needed for making a decision to the patient. Some patients, especially very elderly patients, did not want to receive any invasive treatment if the long-term outcome did not change.Beneficence/non-maleficence
We had to adhere to provide the most beneficial treatment to the patients. However, many treatment against Covid-19 infection had only few evidence. We had to follow to the newest research to give the benefit treatment without doing harm to the patients.Justice
Every patient has the right to reach every treatment, for example, intensive care unit admission, antiviral medication. However, there was the very high intensive care unit demand during Covid-19 pandemics, we had to consider to admit the patients who had the great chance of having good long-term outcome to the intensive care unit. -
Age-specific mortality rate
Definition: A mortality rate in a specific age group
Calculation: The numerator is the number of deaths in that age group; the denominator is the number of persons in that age group in the population.
Main usefulness: To determine a burden of a disease in term of mortality in a particular age group, especially, there is difference of mortality rate among age groupsMaternal mortality rate
Definition: number of maternal death per 100,000 live birth
Calculation: The numerator is the number of maternal death after giving birth in a specific period of time; the denominator is the number of live birth in the same period of time.
Main usefulness: To show a problem of postnatal care in women -
The Universal Health Coverage (UHC) scheme has been a game changer in healthcare coverage for Thai citizens since about two decades ago. It improves access to hospitals, high-cost medications and treatment, hospitalization, etc. The UHC scheme includes Universal Coverage for Emergency Patients (UCEP). The UCEP is a project that allows patients with emergency conditions to access the nearest hospital and receive proper treatment. Such emergency conditions include unconsciousness, respiratory failure, circulatory shock, sudden cardiac chest pain, stroke, status epilepticus, and other life-threatening conditions. The cost of treatment will be reimbursed by the UHC scheme. After the patients present at the hospital and the physician finds the abovementioned emergency conditions, a hospital officer will contact with the UCEP center for the approval.
The strength of the UCEP project is to provide easy access to a hospital if patients have emergency conditions. These diseases need timely and appropriate medication or intervention so that patients have good outcomes. Delayed treatment can lead to morbidity and mortality.
The UCEP project also faces some limitations. First, it covers the cost of treatment that occurs only the first 72 hours after admission. After that, patients are responsible for the treatment cost or they have to contact the primary hospital to make a decision whether the patient’s disease of the patient exceeds competency of the primary hospital or not. In addition, some patients admitted in a private hospital with UCEP criteria have to seek a public hospital to transfer if their conditions need to be hospitalized more than 72 hours. Otherwise, they must pay for all treatment cost which is expensive for the private hospital. However, referral to a public hospital may not be possible if the destination hospital is experiencing capacity overload. Second, some high-cost treatment is not available in some hospitals because the UHC scheme reimburses as the disease-related group. This means that patients cannot receive any high-cost medical instruments.
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In my opinion, the health informatics workforce in Thailand is underdeveloped, but is still growing. The challenges of developing the health informatics workforce are provided below.
1. Recognition of the importance of health informatics. To be honest, there are many people who do not know what health informatics is, what kinds of health informatics work, and what benefits the hospital from hiring health informaticians.
2. Very high cost of implementation of health informatics implementation. In order to work on informatics, the organization must have many kinds of information technology, for instance, central servers, client computers, and network systems. They are very high cost for some hospitals, especially public hospitals.
3. Need for multidisciplinary knowledge. To be a health informatician, one must have basic knowledge, including medicine, computer science, and data science. Furthermore, soft skills, such as leadership and teamwork, are also important.
4. There are quite few training programs. There are few training programs in health informatics in Thailand. In addition, a small number of universities and colleges have education staff in health informatics. Another reason may be that it needs multiple staff from different specialties.
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From my point of view, there are many factors that have to be considered to make a decision about data sharing. I would like to consider the following factors.
1. Data owners. Data that belong to the hospital or the government can be shared. Such data include epidemiological data, key performance indicators, financial reports, etc. However, data that belong to individuals have to be judged for benefits and risks of other factors before sharing.
2. Agreement on the use of data use. Before sharing, an agreement should be reached between data owners and end users. There should be punishment for those who break the agreement.
3. Accessibility to the data. Consideration on this topic depends on whether receivers can make use of such data for further knowledge or improvement of health care improvement. If such data are not benefits for generals, there have to be limited groups who can access them, for example, researchers who are doing the same research fields.
4. Purposes of use of data. It is easy to make a decision if the purpose of sharing data is for doing some research or improve patient care. However, if the shared data are going to be used for individual business, this brings us to very careful consideration.
5. Data to be shared. All data that can be inferred to individuals or sensitive data, such as anti-HIV results, cannot be shared. Only data that are going to be used in a project should be selected before sharing. We are not going to share all the sharable data with all colleges.
In conclusion, sharing data can make many benefits, for instance, doing research with large sample size, or low incident disease, enhancing patient care, etc. My trend is allow for sharing under specific agreement and conditions.
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About 7 years ago, I had the opportunity to be in a transition period from paper-based medical records to electronic medical records. With the implementation of the electronic medical record, there are many benefits, challenges, and concerns.
Benefits
1. Time savings. Implementing electronic medical records can reduce time spent on many processes, for instance, delivery of laboratory request forms and prescription notes, delivery of previous medical record files, etc.
2. Increased cost effectiveness. Healthcare providers can access electronic medical records to review laboratory results and medication which has been ordered by other physicians. This leads to reduction in investigation duplication and double medication. Therefore, unnecessary hospital expenses are reduced.
3. Error reduction. Laboratory critical value, prescription errors, notification of drug interaction, drug allergy can warn healthcare providers.
4. Reduce paper use. After electronic medical records are implemented, the amount of paper used for healthcare services is significantly reduced.
5. Future innovation development. Having prompt data can transform into value information. A clinical decision support system or other artificial intelligence can be developed to improve patient care.
6. Research opportunities. Researchers can use prompt digitalized data from electronic medical records to do research. In addition, it is easier than before that researchers have to manually enter patient data to the computer.
Challenges and concerns
1. Resistance to change from some healthcare personnel. Some medical staffs do not like to change from paper-based medical records to electronic medical records. They may not be familiar with using a computer, worry about their slow typing on the keyboard, or trust on new system.
2. High initial cost. Many information technology have to be purchased, for example, client computers, central servers, network systems, data storage, etc.
3. Security and patient confidentiality. Patient data are kept in servers that can be hacked by malicious users.
4. Prompt support for technical errors. There were frequent errors during the early phase of the implementation of the electronic medical record. Support staff should be available whenever users experience technical problems.
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Although there are great benefits and opportunities from big data, these make it great challenges to informaticians to retrieve specific data, process them, and transform them into valuable information or clinical applications. The following are such challenges and my suggestions on how to cope with them.
1. Multiple definition. There are some diseases or terms that have synonyms or can be written in other words. We have to think of all possible synonyms that have been used. Moreover, if the terms are unstructured data, we will face with the term which was misspelled and could not be tracked by searching the word. In this scenario, redundant matching of terms can be used to detect some misspelled words.
2. Unstructured data. In many hospitals, many data is still in unstructured form, for example, scan documents, images, history, physical examination, progress note, nurse note, etc. Transformation from unstructured to structured one is essential. However, we have to set up the data that need to be transformed. In addition, some data are found in scan documents written by difficult-to-read hand-writers.
3. Missing data. Every database has missing data which most of them often do not miss at random, leading to selective bias. If the missing data do not exceed 10 percent of all data, there are statistical methods to solve the problem. The methods include imputation techniques, mixed effects regression model, generalized estimating equations, and inference technique. However, increasing the proportion of missing values can lead to compromised results.
4. Data inconsistency. Inconsistencies in the data may occur after we duplicate the data. We have to check the consistency of the data by checking them.
5. Clinical applicability. There is evidence that most of the results analyzed from the big data are not true after well-designed randomized controlled trials are conducted. The results derived from a research on big data tell us about a trend that needs to be confirmed with a standard randomized controlled trial.
6. Legal and ethical issues. The privacy and confidentiality of patients are our main concerns. All identifiable data must be encrypted to de-identify the patients. Additionally, a password may be needed to access the database.
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I agree with all four steps of the recommendation to fight corruption. The details in each step should be modified to meet specific contexts in different organizations. The following are my opinion on such recommendations.
First, we must ensure that we have key stakeholders in the health system before discussing measurement to fight against corruption. A hospital director, policy makers, department heads, and healthcare professionals should be included in a team. A team that lacks key persons from some fields will face difficulty managing corruption in such fields. On the other hand, too many members in the team can lead to diversity of policy direction. During the team meeting, the number of problems addressed is underreported. Some specific problems in some department cannot be recognized by outsiders, so these will not be pointed out.
In the second step, problems must be prioritized with regard to the impact on the health system and the feasibility of eradicating corruption. The problem in the first priority will be discussed in detail to take further action. People who take advantage of corruption, underlying causes, and feasible management should be discussed in details for each problem.
The third step is to establish the solution to combat corruption. The proper solution should be fine-tuned in each problem. Some members, for example, anticorruption specialists, economists, social welfare, should be invited to guide and suggest the best solution.
In the last step, there is little literature on corruption in healthcare published in the main databases, for example, PubMed and Scopus. In addition, there is no evidence-based practice or guideline to prevent corruption. The term ‘corruption’ is often described in other words. Additionally, there is publication bias on this topic.
In my opinion besides the abovementioned steps, we have to create the anti-corruptive culture in our organization. Basic knowledge about starting minor corruption should be given to everyone in the organization. Good culture can prevent minor corruption. However, there must be rules or regulations to prevent major corruption, for example, minimum number and specific requirement of committee for making inspection.
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I would like to introduce you to an example of innovation that can improve the health system. The clinical decision support system (CDSS) is one of the powerful innovations that leads to changes in healthcare delivery. The CDSS is a tool to enhance medical decision with clinical knowledge, patient information, and research. The CDSS can be developed from both conventional software, which we input codes and algorithm in the computer, and artificial intelligence generated CDSS, whose algorithm is generated by machine learning.
There are many advantages of CDSS. First, it improves patient safety. The system can detect several medication errors can be detected by the system. Second, the CDSS can increase adherence to clinical guidelines. It can alert physicians that ongoing management is harmful or does not have significant benefits for patients. Another advantage is increased cost-effectiveness. The CDSS can reduce test duplication, suggest cheaper alternative medications, decrease hospital stay, etc.
However, there are many challenges and barriers to implementing CDSS in our practices. First of all, CDSS needs infrastructural system to support CDSS development, for example, all documents, orders, clinical notes should be on an electronic platform. The speed of central server must be sufficient to handle a tremendous amount of information and sophisticated processing. On the healthcare provider aspect, the CDSS developer should inform their users about the application and limitations of the system to avoid overuses and fear to follow the instructions generated by the CDSS. -
To develop a disaster recovery plan for the organization’s health information system, the plan will be as following.
1. Identification and analysis of disaster risks/threats
There are many potential risks or treats from unexpected disasters that can lead to system failure. The essential functions of the hospital business include healthcare services, financial services, communicating with the central department, research and development services, teaching services, etc. Each function has different risk attributes. We have to consider the attributes of a risk in every single function, for example, the failure of servers used to provide healthcare service can make higher disaster if it occurs during the working hour than during the night. However, the impact of attacking servers for healthcare services is very high and costly.2. Classification of risks based on relative weights
The potential risks should be classified into five categories: external risks, facility risks, data system risks, departmental risks, desk-level risk. In the server failure, for instance, the possible external risks include crimes, cyber-attacks, and human errors. The local facility may compromise due to electrical shortage, fire, air-conditioner malfunction leading to overheating of the server system.3. Building the risk assessment
All potential risks will be listed and scored according to likelihood, impact, and restoration time if risks occur. A rough risk analysis score will be calculated by multiplying the likelihood, impact, and restoration time. The highest score is the greatest risk to the organization.4. Determining the effects of disasters
Consideration of potential risks will cover four aspects: disaster-affected entities, downtime tolerance limits, cost of downtime, and interdependencies. Cyber-attacks to the servers, for example, can affect many issues. Healthcare personnel cannot gather or enter patient information to the system. Patient information can be stolen and used maliciously. The secret strategic plan is open to the public. In addition, the downtime tolerance limits are very low. The cost of downtime of servers is very high.5. Evaluation of disaster recovery mechanisms
There are many possible methods for recovering data. Backup should be the main method to prevent system failure after facing disasters. The full backup is the most suitable, as the information of every patient should not be lost, although the cost is very high.6. Disaster recovery committee
The personnel who will respond to the system failure after disasters must be documented in order to systematically activate and manage disaster recovery. -
The High Availability provides several benefits to the healthcare industry. The following are examples of healthcare services that need High Availability.
Patient service
Good High Availability improves the effectiveness of patient service. Physicians need several items of information to provide diagnosis and decide the best treatment. Information from each server is needed. If there is interruption of High Availability, it will affect patient services in many ways. The patient’s history review cannot be performed. Requests for laboratory investigation and prescription medication are interrupted. This can delay the care provided to the patient, especially critical patients who need immediate and prompt treatment. Furthermore, an in-hand application that the patient uses to contact the hospital is also interrupted. They cannot contact the hospital to postpone the appointment or to send some information to the hospital.Financial service
To run a financial service, there is a lot of information from different servers to summarize the hospitalization cost of a patient. If there is a High Availability, work on financial service work can be affected in many different ways. Financial summary cannot be made due to lack of some information. In addition, hospitalization cost is wrong if the High Availability could not maintain the same information provided to users. -
From my point of view, there are many challenges during a pandemic. Using basic knowledge and experience from the Covid-19 pandemic, I would like to forecast the future challenges by using STEEP letter.
Social factors:
– People are afraid of the pandemic, furthermore, there may be some fake news regarding the pandemic.
– In the future, there will be the larger proportion of elderly population which is vulnerable to the pandemic
Technological factors:
– There will be some newly invented hardware to detect outbreak or spreading in the area. This new technology may require personnel who have trained to use it.
– Advance research and development make sophisticated treatment available in the future.
Environment factors:
– Increasing concern regarding pollution results in detailed consideration of each production step whether there is waste by-product.
Economic factors:
– Because Thailand is a middle-income country, we have limited budget to provide laboratory investigation, medical equipment such as mechanical ventilators, vaccines, etc.
– Some advanced technology, for example a smart watch, will be easily afforded in general population.
– Wide range of inequality can result in that some groups of population cannot afford some medication or advanced treatment.
Political factors:
– Changes of the government or some ministry position cause policy alteration.
– There may be some additional legal concern in the future. -
To be honest, I have never participated as an information system administrator. However, I have had experience as an electronic health record in some hospitals. There are two major problems regarding information security, namely to preserve confidentiality and to preserve availability. In the problem of preserving confidentiality, medical students have to use the electronic medical record; however, they have no username to access the information system. Therefore, they must access the system by using their senior username and password. This problem has been solved by asking the information technology department to generate the username and password for individual medical students. Another problem is to preserve availability. The information system has to be closed during regular maintenance, interrupting our healthcare service. The organization should have another server to use during the maintenance of the main server.
Thank you.
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Your work is very useful for RSV control in the future. Nowadays, the incidence of RSV infection is really high. It can affect both children and adults and may cause serious respiratory complication which needs invasive ventilation. To reduce disease, early detection of an outbreak is a crucial strategy. I agree with your case definition that divided in to three categories. The data collection and transfer method is comprehensive and easy to follow. In addition to data utilization that was mentioned, the data can be analyzed and give us more information regarding RSV outbreak, for example, people at risk of serious respiratory complication, etc.
Thank you.
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Thank you for your presentation. It is useful to record the exposure to establish the future plan for Rabies eradication. In addition to your presentation, let allow me to add some idea.
1. The case fatality rate of rabies in human is 100 percent. The incidence of rabies is extremely low (I think it might be zero) in Thailand. This issue may affect the surveillance system.
2. The incubation period is quite long. Most of cases take about 3 months to show the symptoms since they were bit. Therefore, when they were diagnosed as rabies, the index animal which carried Rabies virus may pass away.Thank you.
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Based on two VDOs of public communication between Prime Minister Lee Hsien Loong and President Trump regarding Covid-19 situation, there are some issues to address according to the six principles of crisis and emergency risk communication.
For Prime Minister Lee Hsien Loong:
1. Be first.
I think he did very well on this topic because one of the purpose of this communication might be to ensure their people that the situation was still under controlled after lots of people hoard goods on the day before the PM talk.
2. Be right.
The information delivered to the public was correct at that time point. He addressed about what we knew, what we did not know, and what was going to be done in the next steps. He did not promise anything whether it would be done or not in the future.
3. Be credible.
His verbal and non-verbal language was full with honesty and truthfulness. His talk based on scientific information, for example, mortality rate of influenza, SARS, and Covid-19 infection.
4. Be empathy.
He emphasized about people fear and did not blame them. He gave them support and trust that the government could be handle the situation by providing adequate food, goods, masks, etc.
5. Promote action.
The PM addressed about how the virus spread. He encouraged their people to wash their hands, not touch the eyes, self-isolation while they were infected.
6. Show respect.
He paid respect to every stakeholder including his people. He did not blame anyone.For President Trump:
1. Be first.
His announcement regarding worldwide Covid-19 situation and general measures released from the US government came on 12th March 2020, that may be too late for Covid-19 pandemics in the US.
2. Be right.
He made too committed talk on viral transmission and ongoing management that may or may not be true.
3. Be credible.
His talk was not well plan and contained lots of unnecessary information. This made his talk less credible. People would not trust him and moved to pay attention to others.
4. Express empathy.
He expressed the negative sides of European measures that failed to control the viral transmission. Besides, he over-honeyed the US measures that could ultimately control the virus.
5. Promote action.
In short duration of his talk, he promoted washing hands, staying home if they got sick, cleaning touch surface, etc. There was no information regarding what to do if they got infected with Covid-19.
6. Show respect.
He made the blame to China which was taught to be the origin of virus spreading that might not be true. In addition, this issue should not be mention in the talk during crisis.Thank you.
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I would like to apologize about my late work.
I would like to introduce you to my leadership when I was in third year resident training. I was assigned to be the chief resident, which there were 4 residents annually assigned to be in this position for 3-month duration. The jobs were about managing admission round (the academic activity that was scheduled on every Tuesday and Friday), coordinating between post-graduate team and other residents, participating conferences that need opinions of residents, directing some aspects of training program with attending staff.
Before my turn as the chief resident, I was very nervous about presenting the admission round. I was anxious about it because I had to prepare my team to present 3 cases of patients, differentially diagnose, and discuss about management. Moreover, there were lots of staffs, fellows, residents, and medial students in the conference room who paid their attention to my team and me. However, after 1st month passed, I felt more comfortable to prepare the admission round, and was relaxed when I was standing at the podium.
After finishing my 3-month job, I realized that the most difficult thing during being the chief resident was not preparing admission round. It is about managing, coordinating, and communicating with people.
This might be a nice introduction to this course.
Thank you for allowing me to share my experience.
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From my point of view, Thailand has good performance to develop digital health policy and implement it to prepare for the next pandemics, However, there are some rooms of improvement. According to the provided article, Thailand still needs to improve some aspects in following themes. First of all, we need to improve some issues of our teamwork skill. The data generated from each point must be integrated to the center and analyze as the whole information. Moreover, this information should be linked among stakeholders, for instance, clinician, citizen, policy makers, etc. Second, inequality to access to the information is still a problem in Thailand. Some people do not use smart phone that enables them to send and receive information by the application.
These are major gaps that I think there is an opportunity to make some improvement.
Thank you.
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The disease outbreak which is potential public health emergency of international concern (PHEIC) should have at least 2 of the following criteria.
1. Serious public health impact of the event
2. Unexpected or unusual event
3. Significant risk of international spread
4. Significant risk of international travel or trade restrictions
After such disease outbreak meets this criteria, the outbreak must be reported to WHO and WHO will make the final decision.Following is list of disease outbreaks with public health emergency of international concern (PHEIC) and the reasons why it is PHEIC.
– Monkeypox. There was unexpected case in some countries, for example, Thailand. In addition, there is a risk of international spread by trevellers.
– Covid-19 infection. The Covid-19 infection is a serious and severe disease that leads to morbidity and mortality. It is a pandemic disease throughout the world. Also, it is high risk of international spread and travel restriction.
– Kivu Ebola. It is a severe disease that leads to morbidity and mortality. Although, there was outbreak in some areas, it has a significant risk of international spread by refugee.
– Zika virus. The virus causes microcephaly of fetus in pregnant women. And it has a significant risk of international spread and travel restriction.
– Ebola. This is a serious and severe disease that causes mortality. Moreover, it is a highly infectious disease that has significant risk of international spread.
– Polio. The polio causes serious neurological sequalae, for example, paralysis. And there were unexpected cases reported in some areas.
– Swine flu. There was unusual incidence of swine flu infection in 2009. In addition, the outbreak was rapidly spread in the US and, later, worldwide.In the future, there will be an outbreak announced as PHEIC by WHO. The truth is the genome of infectious organism is continuously mutated, and emerges as new infectious pathogens. Moreover, people have to travel internationally for their business and recreation which keep the disease potential for international spread.
Thank you.
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The Surveillance, Outbreak Response Management and Analysis System (SORMAS) was designed for reporting, analysis, and visualization of the outbreak. In addition to the evaluation indicators that investigators has been assessed, I would like to add some evaluation indicators for this system.
1. Responsiveness for user experience and service quality
Because the success of this system depends on people who use it, there should be prompt service support if the user faces some problems while using the system. We can assess the responsiveness by sending some questionnaire or interviewing some users about system support if there are errors of the system or if they need some instruction to use the system (since there was limited time for introducing the system to the officers).2. Data quality for system quality
We can check the data quality from two components. First, we can ask the users about variables included in the system whether there are too many, too few, or proper number of variables. Second, we should assess functions of the system for preventing data errors. For instance, the system should design the input interface for receiving possible variable, the out-of-range value cannot be entered to the system, all of the required variables should be filled before they submit the report.Thank you.
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