Phone Suu Khaing

[Phone Suu Khaing]

I work as Monitoring and Evaluation Manager for DSTB and DRTB project. My work is related to data and statistics day to day.
This course is really helpful for me to fill my capacity in statistics and thanks for it!

[Phone Suu Khaing]

I am employed as Monitoring and Evaluation Manager in TB project in international non-governmental organization since October 2019. I have to generate biannual and annual report to donors and national program.
I had learnt and applied statistics when I attended Structured Operational Research and Training IniTiative course in 2017 to write a research paper.

[Phone Suu Khaing]

Case-Fatality rate
Definition
It is proportion of death cases from a specific disease among all diagnosed cases of the disease over a certain period of time.
How to calculate
To measure this statistic, numerator is number of death cases from a specific disease whereas denominator is all diagnosed cases of this specific disease.
Main usefulness
Case fatality rate tend to be used to measure severity of acute infectious disease rather than chronic disease with longer duration. This is because accuracy of both nominator and denominator can be affected by length of the disease in which a person can die from other disease rather than the specific disease that we are interested.

[Phone Suu Khaing]

The benefits of HA infrastructure for patient and hospital are as follow.
Reduction of downtime with back up for 24 hour
Cost effectiveness as there will be high performance with HA
Data security is more ensured
Continuity of server data with better service

[Phone Suu Khaing]

Thank you for presentation with new learning topic to us.
1. It might be better if we could do random confirmation to tested cases with RDT only.
2. I do not have such experience and I’m learning through your paper and presentation as well as university lectures.

[Phone Suu Khaing]

Thank you for the presentation!
1. Barriers for using the smartphone tracking technologies in my country may be digital literacy skills of people, proportion of smartphone users as well as concerns about privacy and security of the application for the users. Moreover, strong policy for digital technology intervention is required.
2. Smartphone tracking technologies can be applied in monitoring chronic diseases such as Diabetes, Hypertension, Smoking cessation, monitoring of body weight and monitoring of daily diet etc.

[Phone Suu Khaing]

Thanks for the interesting topic.
1. Actually, HIS should have interoperability so that there will be traceability of patient’s information.
2. There are many uses of digital technology in Tuberculosis control such as AI in reading CXR films and Gene Xpert for fast detecting Tuberculosis gene in the sputum.

[Phone Suu Khaing]

It was a very interesting topic.
For topic 1, experience based facts and facts or decisions from previous leaders influence in making decisions for planning and evaluation than data driven decision making from facility-based routinely collected data.
For topic 2, we have a culture of information use based on our project data. But as project is working in, by and with the public sector, most data is not available to be collected. At those times, leaders use guessing on previous previous experience. So, it is not only organization but also the public sector require reinforcement to be adapted to the culture of information use.

[Phone Suu Khaing]

Thank you for interesting topic.
My discussion points are as follow.
1. I agree that EA is important for healthcare industry at the very beginning.
2. With the knowledge of how EA works well for health industry, there might be more demand on EA. However, it will take time as all stakeholders must involve for the system to be successful.

[Phone Suu Khaing]

It was a great presentation and it reminds me of importance of zoonotic diseases.
For discussion no. 1, animal disease surveillance system will be more difficult as there are pets, livestock as well as wild life and many more species than human race.
For discussion no.2, animal health surveillance system is really important for One Health Concept as we all live together and most of human beings depend on meat as one vital source of food. When zoonotic disease can transmit to human like Covid-19, human race can suffer huge negative impact.

[Phone Suu Khaing]

It is a very interesting topic.
I had learnt much about the blockchain technology from presentation and thanks for this opportunity.
As it is new tech to us, I think change management from policy makers as well as frequent trainings to users will be required for blockchain based electronic recording and reporting to be successfully implemented.

[Phone Suu Khaing]

It was an interesting presentation.
EWARS is successfully implemented because it is easy and ready to use package and it can be used for timely intervention.
Concerns in the EWARS evaluation process is that it did not mention how did they solve for language barrier.

[Phone Suu Khaing]

It was an interesting presentation.
In my opinion, the strong points that EWARS was successfully implemented in Fiji are easy and ready to use package which can be used for timely intervention.
Concerns in the EWARS evaluation process is that it did not mention how did they solve for language barrier.

[Phone Suu Khaing]

Please find my wrap up here https://prnt.sc/146bqos

[Phone Suu Khaing]

Please see my wrap up here.
https://prnt.sc/13m8vcq
https://prnt.sc/13m8x3g

[Phone Suu Khaing]

Please see my wrap up at https://prnt.sc/132qpa5

[Phone Suu Khaing]

Please see infographic in the following link.
http://prnt.sc/12vcaou

[Phone Suu Khaing]

Health informatics is still very new to our country. We do not have this kinda subject in college or university. So, we have very few health informatician workforce here who are graduated from other countries. IT technicians and medical doctors discuss together to develop electronic health system for small projects in private, but still not much in public or countrywide. To fill this gap, 3E workforce model should be applied and GEEKS program should be introduced in our country which are mentioned in the lecture video.

[Phone Suu Khaing]

Health informatics is still very new to our country. So we have very few health informatics workforces here. Instead, IT technicians and medical doctors discuss together to develop electronic health system in small projects in private, but still not much in public or countrywide. To fill the gap, 3E workforce style should be applied and GEEKS program should be introduced in our country which are mentioned in the lecture video.

[Phone Suu Khaing]

In conclusion, data must not be shared for personal purpose which does not benefit community. If data is shared for benefit of community, it should be shared with secure and standard procedure following ethical guidelines of the country.

[Phone Suu Khaing]

Data sharing has many advantages as well as disadvantages. However, there are many benefits by sharing data especially at the time of outbreak or pandemic. Data can be repeatedly used for research purpose and it is valuable thing for all. Thus, surveillance data should be openly shared with secure data structure both locally and internationally. If the data includes sensitive information which require high confidentiality, we must be careful to exclude patient’s identity such as name and address. We should not forget about data ownership too. We should have strong data sharing policy when sharing data of human subject. Study participant must be informed about how data will be used and get consent from each participant.

[Phone Suu Khaing]

Despite US citizens paying higher prices for same treatment in other developed country, they do not get medical service with higher quality. According to WHO’s life expectancy list, America is No. 31 compared to other developed countries. It is quite clear that there mismanagement in health system in US. Root cause for high pricing of health care should be sought. Then, policy makers could reverse the situation by solving root causes. US can learn from Korea and Japan as well as Thailand “30 baht treat all diseases” universal health coverage system. US should try best to provide high quality health service with fair price for its citizens before it is too late because health is one of the basic fundamental human rights.

[Phone Suu Khaing]

Discussion for US health system
Despite US citizens paying higher prices for same treatment in other developed country, they do not get medical service with higher quality. According to WHO’ life expectancy list, America is No. 31 compared to other developed countries. It is quite clear that there is mismanagement in health system in US. Root cause for high pricing for health care should be sought. Then, policy makers could reverse the situation by solving root causes. US can learn from Korea and Japan as well as Thailand “30 baht treat all diseases” universal health coverage system. US should try best to provide high quality health service with fair price for its citizens before it is too late because health is one of basic fundamental human rights.

[Phone Suu Khaing]

Despite US citizens paying higher prices for same treatment in other developed country, they do not get medical service with higher quality. According to WHO’ life expectancy list, America is No. 31 compared to other developed countries. It is quite clear that there is mismanagement in health system in US. Root cause for high pricing for health care should be sought. Then, policy makers could reverse the situation by solving root causes. US can learn from Korea and Japan as well as Thailand “30 baht treat all diseases” universal health coverage system. US should try best to provide high quality health service with fair price for its citizens before it is too late because health is one of basic fundamental human rights.

[Phone Suu Khaing]

It is very impressive to see this kind of project being introduced by government for the rural people for access of information and digital equity.
However, there are some problems although there are numerous benefits as mentioned in the article.
1. Data security problem – all data is vulnerable to risk as there is control and monitor by military government which do not respect people’s right and privacy. Speed of internet
2. Speed of internet- It is mentioned that internet speed is unsatisfactory for those who live far away from the Wi-Fi spot.
3. Cyber security – as users in villages are new to digital literacy, they are prone to be attacked by cybercrimes. Although cybersecurity law was introduced by the government, users should be well educated about benefits and drawbacks of using internet.

[Phone Suu Khaing]

It is a very useful article to read as we are also doing EMR in our TB and MDRTB projects in our organization.
EMR system has both pros and cons in many aspects according to the article as well as according to our experience in our projects.
Benefits
It can save unnecessary time consuming to file records and search records when needed.
It can help avoid duplicate data as there will be unique identifier for each patient.
Patients do not need to carry medical records when coming to clinic.
Management team can access real time data 24/7 so that it is valuable and supportive for timely decision making.
When clinical decision support system is integrated, it can be great support to both clinicians and patients.
Drawbacks
It may increase workload of staff during transition period.
Repeated training with feedback response as well as continuous technical support is needed.
EMR system is vulnerable to electricity outage, internet cut off and computer breakdown.
It also is prone to be attacked by cyber criminals when thorough security measures are not taken.
However, benefits outweigh risks when considering to substitute traditional recording system with EMR. Thus, EMR should be deployed by preparing every basic mandatory steps.

[Phone Suu Khaing]

Please find suggestions for coping with challenges related to big health data as follow.
Missing Data – This is quite an uncommon issue either in traditional recording or electronic recording system. In term of big data, it may have negative impact for data analysis as it is high volume. We should start finding loophole for missing data. If the data collecting tool has loophole, it should be fixed immediately. Health care professionals who are filling data should have access to feedback system and should encourage by reward system to promote awareness on importance of valid data. However, as mentioned in the article, when missing data cannot be filled because of various factors, it is wise to use alternative analysis methods such as imputation techniques, mixed method regression model etc.
Selection bias
To reduce selection bias, it is better to include data from various sources as much as possible.
Data Analysis and Training
It is advisable that frequent trainings to researchers should be done to empower knowledge on analysis. To avoid complexity and errors, data cleaning should be done first followed by advanced analysis tools like logistic regression, latent class analysis, square-root transformations etc.
Interpretation and Translational applicability of results
As big data analysis itself has its own limitation, it might affect data interpretation for applicable results. Researchers from both clinical and public health background should involve in interpretation process by considering culture and context in multi-disciplinary approach.
Privacy and ethical issues
Data security must be set the first priority of all. All possible measures for data security preventing from cybercriminals must be taken in advance. Informed consent from beneficiaries must be taken.

[Phone Suu Khaing]

After reading the article, it is quite clear that there is no standardized procedure or term to define corruption. In my opinion, there should be clear definition and code of conduct in organization and teams in every country. Firstly, we should have zero tolerance to corruption policy with crystal clear definition for corruption.
Secondly, punishment/action for corruption should be done. Law and legislation for taking action to corruption should be strongly encouraged so that there will be reduced corruption practices.
Thirdly, research in multi-disciplinary approach is vital starting from individual to country level. As mentioned in the article, there is few articles published related to corruption especially in health sector researches. Policy makers should consider to invest in such kind of research as it can save many beneficiaries and save budget for citizens.
The last but not the least, morality of each and every person is crucial to fight against corruption. Stories for children and trainings and guidelines for adult people should be repeatedly introduced to improve morality of each and everyone in the community.

[Phone Suu Khaing]

As our country is still using paper based records and reports in almost all places, it is quite difficult to correct reports in time for data analysis. So, we developed electronic recording and reporting system for TB project in our organization. Our team discussed the possible barriers as follow.
There are some challenges in service provision and resource generation as below.
Each management level should involve in change process. Unless, there will be more difficulties in changing paper based to electronic system.
Users need some digital literacy skill and require mobile phones with some specification. It is also linked to financial challenge which we might need to purchase digital devices such as mobile phones and tablets.
Reliable internet connection is required as it is vital in electronic recording and reporting.
Constraints related to leadership/governance include political stability and interest and leadership from policy makers in government sector. We do not have political stability in our country which impact hugely to our new system.

[Phone Suu Khaing]

So far, I had not experienced CIA not being preserved purely. However, confidentiality is vital part to protect patient data and it is important to train frequently about confidentiality for all users at all level. Integrity should be reinforced with authorized steps in monitoring system but it is also not an easy part.
The last but not the least, data back up and secured software and hardware system is required to protect from unnecessary data loss or being hacked. All three facts bring together to ensure ePHI and this lecture guided me what to consider in my M&E web based and mobile based recording and reporting system.

[Phone Suu Khaing]

In this case, principle of security must be respected. So, I cannot provide data out.
However, as mentioned in case scenario, the research study could provide benefit for disease prevention, we also have to consider for it.
We need approval from ethical review committee for this study.
If ethical review committee has approved it and informed to respective authorities, we could provide related data. Unless, we cannot provide any data.
Plus, we also has to respect principle of information privacy and disposition. So, we also must ask consent from group or individual as personal data such home address and disease status are included.

[Phone Suu Khaing]

The success story mentioned in previous topic related to automated report system in our project. When related to ADKAR, it could be discussed as detail below.
A- Staff were aware that the new report system need to be installed in project for better, easier and faster reports
D- Staff do have desire to involve in new system. However, they are afraid that report might be mistaken with new system. Some volunteers do not have own mobile phones so that they cannot involve in the system
K – Some staff have limited computer skills to fill data with laptop. And some volunteers are not good enough at using mobile application.
A – We did trainings again and again to upgrade the ability of staff and volunteers
R – Finally after 10 months, all staff and volunteer are happily using the automated report system.

By this scenario, staff involvement is vital for success of the change process. If staff do not have strong desire to accept and participate in new system, there will not be success.

[Phone Suu Khaing]

I do not the right to disclose patient’s information to others as a health information professional. So, I would not disclose this information to my friend. I would request patient’s doctor to send peer counselor to him for self-determination to disclose his status to my friend. While requesting patient’s doctor, I would say “reminding to reinforce couple testing” for prevention purpose and not mentioning any personal info about patient and his wife (my friend).

[Phone Suu Khaing]

In my organization, we had both success and failure in the same project.
Failure Story
3 years ago, we had started automated report system with freelance software company and it was a failure as it was not finished in time and design had not enough capacity to fulfil the project requirement! Lesson learnt is we should keep track of the improvement during the contract period with the developer and we should provide inputs and feedbacks regularly.
Success Story
Based on lessons learnt, we hired IT development officer and timeline was set for developing two webpages and one mobile app which are interlinked with interoperability. 2 months later, pilot testing could be started at field level and project is now using automated report system since 10 months after webpages and mobile app development. Why does it take 10 months to completely replace paperwork by software system? The answer is user involvement. It really took time to make them reinforce as mentioned in “ADKAR” model.

[Phone Suu Khaing]

That’s totally true!
Mismanagement in resources is one of the biggest adverse effect!

[Phone Suu Khaing]

Can you give an example of Decision Support System used in your organization?
Is it working well?
Are there any factors that might influence the decision support system implementation in your organization?

Actually, we do not have DSS currently in my project.
Just from learning from reading materials and videos, factors influencing implementation of DSS shall be perception of users and level of supportiveness of DSS to users.

[Phone Suu Khaing]

Currently, most hospitals use the ICD standard to classify disease diagnosis. What would happen if the hospitals in the country do not use the ICD standard?
As ICD standard is the fundamental of Health Information System, it is vital to share correct health data within hospitals and health system. Without using ICD, health data analysis cannot be done which means that incidence and prevalence of diseases cannot be calculated or wrongly calculated. Then decision makers might do unnecessary intervention and lack of response to needy intervention. This will lead to non-solving public health problem and burden to both communities and clinical care settings.

[Phone Suu Khaing]

EMR system with voice command is very challenging yet highly benefit!
Thanks for pointing this out!

[Phone Suu Khaing]

What do you think about this finding?
This is really an interesting finding for me that clinicians reporting EHR is the top contributor to burnout.
Have you ever heard any complaints from health officers (or yourself) on using EMR?
Yes. I encountered it when I went to a private hospital. The clinician has to fill patient’s data while consulting the patient. I heard them saying that this is double burden for them and not comfortable.
Any suggestions to avoid or reduce this problem.
1. By providing User friendly features with advanced software
2. Communication with users
3. Feedback Response Mechanism among users, IT technicians and leaders for change
4. Strong leadership
5. Capacity building

[Phone Suu Khaing]

In my opinion, eHealth is health system empowered by information technology to improve individual’s health and public health. eHealth can help patient to get precise treatment as well as reduction in health related costs. eHealth can support clinicians to provide better care to patients. eHealth also plays vital role for policy makers in response to infectious diseases by providing real time data. The last but not the least, eHealth can reduce workload of staff working in health sector.

[Phone Suu Khaing]

I also agree that Weather data is Big Data that fit with 10 V.

[Phone Suu Khaing]

Can you give an example of data that you think it could be considered as “Big Data”?
I think data in Mayo Clinic which is mentioned in lecture is Big Data.

What are the characteristics of the data that fit into 5Vs, or 7Vs, or 10Vs of Big data characteristics?
1. Volume: Huge amount of patient data is stored
2. Variety: Include both structured and unstructured data. Data is in various forms which is text, image, audio and video
3. Velocity: There is massive continuous data flow.
4. Value: Data can be used for the purpose of better treatment outcome
5. Validity: Require accountable data from trustworthy source

[Phone Suu Khaing]

1.Have you ever observed a health informatics project in your (other) organization? Please provide a brief introduction.
I have experienced mobile application called “May May” which means “Mother” application developed from other international organization in my country. User has to fill demographic facts with address when entering first page.
It is an application about maternal and child health which included knowledge session with Question and Answer, Videos and other focus group discussion in all ethnic language. It also had service directory. It is very beneficial to those people from remote area who cannot access to hospitals immediately.

2.Do you think that this health informatics project can help to improve the current practices, how?
This project is a very effective way to make information, education and communication reach to community with low cost as no paper use for both recording and reporting i.e, how many people downloaded the application and which information is most read by community. It could disseminate correct health knowledge related to maternal and child health.

3.Are there any challenges or difficulty in implementing the project?
The biggest challenge is user needs android phones, some knowledge on using android phones as well as internet connection to download t he application (there are places where internet connection is not reached) and to live stream some features.

[Phone Suu Khaing]

Thanks for your report! It is the same case study with me and you clearly mentioned about preventive measures! I totally agree and like best about security safeguards, privacy culture and enforcement which is still not respected by health staff sometimes either knowingly or unintentionally!

[Phone Suu Khaing]

Thanks for your report!
I totally agree that the organization should have risk management in contract with vendor and should also well understand about security system of vendor!

[Phone Suu Khaing]

Thanks for short and sweet explanation!
Assessment of vendor and contracting with risk management that you have mentioned are very important facts to consider! So, we must have terms and conditions related to security since the beginning of the business!

[Phone Suu Khaing]

Thanks for thorough explanation of the case study!
I totally agree on strengthening security by authentication and other related measures. I would also say that strict rules and regulation related to staff code of conduct is also important to avoid similar situation!

[Phone Suu Khaing]

Thanks for interesting explanation on case study!
I really like the way you explained about the impact! I would also say that we should always do risk assessment for data security and should always have contingency plan.

[Phone Suu Khaing]

Excellent wrap up!

[Phone Suu Khaing]

I totally agree with you and it is really a threatening trend nowadays. It shows that we must be more careful and get knowledge with data sharing and secure internet surfing.

[Author]

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