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Good day, everyone!!
I’m Pisit, I’m working at certain hospital in Chaingmai as a pharmacist. My scope of works are not relate to analyse any data. Howerver, I had once analyzed the prediction model in the senior project. Evaluating the model performance by using C-index and internal validating model by bootstrapping.
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In the context of the drugstore, there are some COVID-19 policies to minimize the COVID-19 transmission
1. Always wearing mask
2. The clients must wear a mask before enter the drugstore
3. If possible, open the all the doors and window to ventilate the air and not using air conditioner
4. Always wash your hands after touch the bills from clients
5. Periodically clean the counter with alcohol -
If I remember correctly, there was a issue about the budget distribution of Universal Health Coverage (UHC). UCH only compensates the hospital for 3,600 baht per capita per medical service. If the medical services are charged more than 3,600 baht, the hospital have to cover the exceed fees. I think that is some of the pitfall of the UHC scheme in Thailand and it maybe the reason why the hospitals have been in the red.
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I would consider for the data sharing if I was in charge of the data set——may be in my dream tonight, who knew?. The data sharing can be a ruthless weapon or bring massive benefits for the greater good, depending on how you handling it. If you shared the data just to make another number for your dollar bills and what if that shared data contained financial data, like credit card numbers or something, or your address. Can you figure out the consequences of that?. For me, I wouldn’t choose that wicked way. The data sharing is most beneficial in the emergency, outbreaking situation and also the rare disease. In the emergency or outbreaking, we need to collect as much as information we can to develop the countermeasures.
Rare disease, as its name suggested, is a condition that affects only a few people. The amount of patients are not sufficient to analysis so the data sharing is also crucial approach in this case too. -
In my opinion, the EMR brings the massive benefits. We can completely access the data anywhere and anytime through the EMR. We can share the data across departments or buildings with just one-click, instead of running around the hospital just to send to document. It is time-saving. The data is stored in the EMR so we don’t need to carefully protect the documents from fire, moist, light and etc. Moreover, we don’t need to panic about whether the documents are lost or not. It is also easier to find the document from, like, 15 years ago.
Anyways, the implementation of EMR can be such a nuisance. First of all, the typo when inputting data because, you know, we presses the buttons on the keywords instead of writing on the paper. Some personnel are computer-illiterate so when it comes to EMR which required to use computer, you can see the issue here.
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Missing data is the most common problem in every Electronic Health Records (EMRs). The data requirement in the EMR system may help in this situation, we need to fill the required data in order to submit them to the system. Some personnel who inputting the data into system may not aware of the need to submit the data. Hence, raising awareness of the personnel may be one of the choices to eradicate this issue. The statistical approach to missing data might also be a good choice too. For example, complete-case analysis, multiple imputation, etc.
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I do agree with the recommendations. It may looks good on the paper but, in my opinion, it is kind of difficult to apply to the real-world setting especially in the context of Thailand. First, megalomaniac and narcissistic are the description of our leader, we had seen that before. So when it comes to push the ‘anti-corruption policy’ into the practice, it’s less likely to be approved by the policy-makers. Second, seniority system is deeply rooted in Thai society. The people who witnessed the corruption are not tend to unravel their corruptions. There are many factors that make the recommendations not viable in Thailand which I’m not mentioned here. To make the recommendations viable, we need to reconstruct social structure and political institution.
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I had experienced the improvement of the health system while I did my internship at certain hospital. There was a implementation of the novel chemotherapy ordering system because the former system had many unnecessary processes. The new system was the web-based application so training the personnel to use this system could be a hindrance to the system improvement, because some of personnel was computer-illiterate. And when it came to the change of the routine, it took some time for everyone to adept to the new system.
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In my point of view, data replication technology should be included in disaster recovery plan in the context of healthcare setting because the patient with critical conditions needs the information from the database to decide for the treatment. Data replication tends to accelerate the recovery time which helps the aforementioned situation.
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From my point of view, the implementation on High Availability technology assures that the patient received the appropriate treatment based on medical record because of the available of the most recent information. It also helps the health care providers make their decision easier if they are able to access to the crucial information in the emergency.
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In the context of Thailand, I think we need to strengthen the centralized helplines for COVID-19 information. We don’t have a main helplines with the support from the government so the helplines are various in numbers and hard to find the reliable helpline. Plus, there are also misunderstandings of COVID-19 and misinformation from social media. The existing helplines in Thailand are not able to meet the demand of people.
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I would like to share some of STEEP factors which affects the healthcare resources in my setting, as a community pharmacist.
Social
According to social distancing, we set up the counter in the front and talk to the patient through plastic screen. There also a panic about COVID-19, so some patient tend to buy the products they believe that would protect them form COVID-19.
For example, Andrographolide which is not approval for COVID-19 prophylaxis. We need to correct their misunderstanding. These make Andrographolide running out of stock for a while.Technologies
There’s a telemedicine application that allows the patient to consult the physician and then prescription will be sent to the registered drug store to delivery the medicine. Due to the lack of our workforce and ethics issue, we are not implementing this technology to our store.Economic and Environment
The COVID-19 outbreak results in recession, the purchasing power is declined. Seasons change also comes with the certain disease. These will dramatically affect the stock management plan, we need to revise the plan more frequently -
The International Health Regulations (IHR) had declared Public Health Emergency of International Concern (PHEIC) of six events since 2007, including H1N1 influenza, Ebola, poliomyelitis, Zika, and COVID-19.[1]
The sudden outbreak of these diseases raises concerns in such an extent because they potentially pose a serious threat in international level and require a international collaboration to response.
In my point of view, bioterrorism can be the cause of the PHEIC, such as smallpox. Smallpox virus DNA is available in the DNA library so it potentially has a chance to be used in in a biological attack.
Reference
[1] Wilder-Smith A, Osman S. Public health emergencies of international concern: a historic overview. J Travel Med. 2020;27(8). -
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The surveillance system which providing inaccurate data can be abysmal. When the data is over-recognition, it may cause the false alarm which require the immediate action to stop the false outbreak. This result in wasting the workforce and fund to take action on the false outbreak, as well as spreading the panic through the outbreak disclosure. Underestimated data unimaginably affects the real outbreak situation because it is not able to detect the outbreak, which delays the outbreak control/handling.
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Unknowingly, Information Technology (IT) do assists the outbreak investigation process in such an extent. Electronic Medical Record (EMR) make the data collection and dissemination a lot easier, not to mentioned that it also help in the data analysis process. Data visualization tools make the data more digestible and then put the crucial information into one-page which helps the policy-makers making their decisions easier. There are various IT I don’t bring up and I’m sure those will greatly benefit to the investigation process.
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I would like to share my understanding and opinion on the tools called ‘data-visualization’. To make a long story short, the data-visualization tools help us to gather the COVID-19 related data in real time and then analyze the data into digestible information, putting the critical information in one page – called ‘Dashboard’. It supports the decision-making of policymakers in the crucial moment of COVID-19 outbreak. These tools also helps the people to understanding the COVID-19 situation which may raise their awareness of the situation and they may tend to abide by the COVID-19 policy.
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How can surveillance help to detect and control the disease?
First, COVID-19 surveillance describes the burden and epidemiology of the disease (i.e., age distribution, infected area, gender, etc.) which helps us to identify the characteristics the might associated with the disease. And that can narrow the target that advocating for the intervention (such as vaccination). Secondly, the surveillance is also monitoring the results of intervention, helping us to determine the best intervention for COVID-19. Lastly, the surveillance is able to detect the early outbreak so we can immediately take an action.Should we conduct active or passive surveillance or both for the disease, why?
In my point of view, I prefer the combination of active and passive surveillance. Active surveillance has advantage of complete and reliable data, but it comes with the massive of workload and cost. On the other hand, passive surveillance is likely to missing the data (underestimate) because only disease with burdensome symptoms will cause the patient to the hospital and vice versa. If we deploy the active and passive surveillance in the right time and scenario, I believe that this will utilize the pros and minimize the cons of both types of surveillance. For instance, we conduct the passive surveillance in the daily basis. if we detect any outbreak signals, we will deploy the active surveillance.Which method should be best to identify cases, why?
Cases in medical facilities VS community
Community-based surveillance is better than identifying cases in hospitals. The cases with no or mild symptoms are less likely to seek the treatment at the medical facilities. Plus, there are situation that the cases are not able to go to the hospital.Sentinel VS population-based surveillance
Population-based surveillance is better than sentinel surveillance in term of case identification because the sentinel surveillance gathers data form single or small number of health facilities, whereas population-based surveillance receives data from the whole country.Case-based VS aggregated surveillance
Case-based surveillance do a better job on identifying cases than aggregate surveillance. Case-based surveillance comprise more details in individual-level data.Syndromic VS laboratory-confirmed surveillance
When it come to case identification, laboratory-confirmed surveillance seems more promising than syndromic surveillance. Syndromic surveillance identifies the cases without laboratory confirmation, which make this surveillance less reliable than the other.What dissemination tools will you choose to disseminate COVID-19 surveillance information? Why do you choose this/these tools?
According to the current outbreaking COVID-19 situation in Thailand, I convince that Real-time dissemination tools are the best candidate for this scenario because it disseminates the surveillance information in real-time which ease to make a decision in this outbreak situation. Moreover, we can monitor the outbreak signals in real-time and immediately take an action. -
I once had a dream of becoming a beautiful novelist but upon my insecurity and inner indecisiveness I won’t able to achieve my dream. I was scared, scared that I would get the bad criticisms. Horrified by the things that yet to happen. Those pushed me to point that I couldn’t even strut out of comfort zone to pursue my only dream. But on that Sunday morning, on my friend birthday, I designed to buy a novel as a gift. I read the brief author’s biography with his photo (perfectly retouched, of course!). And what he said hit me in a depth of my soul. He said he just wanted to be a writer and all he had to do was writing, even if he had never get published or received bad criticisms because that was what he love to do – just write!. At that moment, something that once extinguished had re-ignited again within me. I thought “Well, I want it too, but something has to change. I can’t always be about sheltering in this comfort zone”. I has started to learn about the plot and structure from the books and gradually build my own story plot, everything is going fine. My thoughts has changed, my eyes shine brighter, my voice is softer, my lip corners raise higher, now my feet are firmly stand outside the comfort zone. I couldn’t care less about the forthcoming criticisms as I couldn’t care more about my desire to write – I just write!.
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In my point of view, I think of eHealth as the implementation of the information technology on the healthcare settings which covering the three domains (health in our hands, interacting for health, and data enabling health). On top of that, it should be able to cut the cost and improve the outcomes and take the potential risks into account.
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If you ask me, I convince that the Electronic Health Record (EMR) is considered as Big Data because its characteristics are in line with the 5Vs of Big Data;
• Volume: the EMR tends to have a huge quantity of data. All of the patients information that visit the hospital is accumulated in the EMR database every single day.
• Velocity: EMR is needed to process fast in some time-sensitive scenario, for example, the detection of the prescription of drugs which patients are allergic to or possible cross drug allergy.
• Variety: The EMR comprises a wide variety of data types, such as, health conditions, ultrasound files, X-ray films, laboratory tests, patients’ health insurance, etc.
• Value: The data which is stored in the EMR database can be used in many useful ways including to evaluate the treatment, predict the treatment outcomes, determine the disease pattern, etc.
• Veracity: The collected data in EMR is somehow trustworthy because the data is obtained by the devices such as, blood pressure monitor, EKG monitor, etc. -
When I did my internship in the certain hospital, I exposed to the implementation of health informatics on the chemotherapy order system. The previous system was the paper-based system which caused several hinderances in the ordering process, for example, the time that needed to forward the documents to another department was almost the entire time in the process, or the associated departments were not able to monitor the process. Therefore, they decided to develop the novel electronic-based chemotherapy order system which significantly dropped the process time and the associated departments was satisfied and able to work efficiency since they can monitor the process. In addition, the new system can notify the physicians and pharmacists when the ordered drugs were in the stock. But there still were some challenges in the implementation of this system because some people were not familiar with the electronic devices and this system is still the beta version which required time to test the defects of this system.
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I love to hear your thoughts, thanks for sharing your ideas. I appreciate your analysis on this case study. In my point of view, I think to raising the awareness of phishing email should help in this scenario because the employees might be more cautious when the emails are attached with suspicious attachments.
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If I was about to steal certain confidential information, there were several ways to approach the goal. First, we can take advantage of people’s ignorance to retrieve their information. Some people tends to write their password down on the stick notes and attach to the computer or write down in their notebooks or cellular devices so we can exploit these to get their authentication to receive the confidential data. In addition, they are likely to set their passwords as a ‘easy-to-guess’ passwords such as their birthdays, their names, etc. which ease to get their authentication just to guess the password.
Second, we can steal their data by phishing. We trick someone to send their user accounts/passwords or secured information by pretending to be the trustworthy organization. Lastly, we can easily steal the organization information as their employee because as a employee we can directly access through the organization database if the organization has not limited the authorization. -
There are several reasons why I prefer cloud server to physical server. First, we are short on IT staffs which able to maintain the server. Second, the hospital server is not established yet hence it costs a pretty penny to build the server. Third, the cloud server provider has their own IT officers to maintain the server and only costs a monthly service charge. Lastly, the cloud server can be accessed anytime and anywhere if you able to connect the internet.
I convince that Platform as a Service (PaaS) might be the most appropriate service model since PaaS allow us to develop the application.
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If I would like to draw an enterprise architecture (EA) blueprint for various hospitals in my province, the following should be involved in the designing process;
- Provincial governor: to decide an new EA policy for the province, encourage the hospital executives to follow the policy.
- Hospital executive: to design an EA that align with their business goals.
- Health care provider: to list the challenges when the EA is implemented in their settings and to define the problems about health informatic system in their current setting.
- IT professionals: to develop information system and database, data security
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It goes without saying that the informatician is required a certain level of competence in various fields. As a pharmacist, I’m familiar with health science and statistical field. I would like to expand my knowledge about computer science and management skill in order to make me more professional. I’m not quite good at communication so it’s crucial for me to ameliorate my communication skill.
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Internet of Things (IoT) can provide the real-time patient information which facilitates the health care provider works. It tends to make better decisions in treatment plan. In addition, it also stores the patient information in the database which can further involve in certain medical research. The healthcare data is commonly huge so it is required the implementation of Big Data technology to store and analyze data.
In my opinion, the unprecedented introduction of novel IoT and Big Data technology in the healthcare settings is the biggest challenge since it is required an amount of times to adjust to the new technolgy.
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Dashboards are visual display of important information, it makes complex data more digestible. These tend to ease the decision-making in healthcare policy and to ease the patient-healthcare provider communication. As I aforementioned, I convince that the visualized dashboard is important in healthcare setting in some extent. I suggest that excellent dashboard should be included these features; precise – the visual display of information should be accurate in form, time and detail, concise – the visual display should be short and clear, crucial – should be included all key information, relevant – the information should be related.
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As for me, I would be glad to develop an mobile applications, as a web app, which able to tracking the patient laboratory results. Based on my experience, it was hard to provide appropriate treatment plan on ward rounds when particular laboratory values were undefined. The app should be developed as web app which required hospital intranet hence the patient information is rather confidential and it can use on various platforms.
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I would like to acknowledge that I’m not familiar with any program languages. I would go for Python since it’s user-friendly and widely used in the field of data science. To my best knowledge, Python does not come with built-in mobile development capabilities so I prefer C++ to Python if it is about mobile applications.
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Internet technology may play crucial role in the improvement of healthcare quality in various aspect. First, electronic prescription which significantly reduces patient waiting time and attenuates the medication errors, especially prescription error. Second, the physician can closely monitor up-to-date laboratory findings, X-ray films, etc. while rounding ward. Third, researcher can easily reach to the data from various hospitals which may increase their sample size and lead to more impact researches. Lastly, it ease to refer the patient to the another hospital.
I suggest that the abrupt changes in old procedure to the new one with Internet technology implementation is the biggest challenge. To my best knowledge, the majority of hospitals in Thailand has not/partially implemented a internet technology in their settings.
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Base on my own experiences, the Electronic Medical Record (EMR) system could be troublesome when it came to research, especially multicenter research. The HosXP program, which was EMR, was not allowed to directly draw the data from it, hence I manually screened through the computer screen and exacted the particular data which was time-consuming and ineffective. In addition, EMR database was not linked to other hospitals, which made multicenter studies harder to conduct. These perhaps hindered the research studies in Thailand to such an extent.
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I firmly believe that Personal Area Network (PAN) and Wide area network (WAN) might be the best choice if I want to disseminate the collected blood pressure data to the Ministry of Public Health (MOPH). PAN allows the subjects to connect the blood pressure device directly to their cellular devices which is rather convenience and costs no money. However, due to its closeness, the information is confined to the subjects so it needed WAN to disseminate these information. WAN made information accessible in worldwide so these information can be used for research across the world. On the other hand, these advantage can fall into the pitfall of security issue and this network can not be applied to the area that lack of internet access.
Local Area Network (LAN) resembles PAN but this network covers the small area, such as small hospital, and small company. Some installation is needed, but it’s affordable. Only the organization personnel can reach to the information, however, it unable to pass these information to MOPH. To some extend, the information can possibly leak through the personnel.
Metropolitan Area Network (MAN) is contained within the bigger area that LAN, but smaller than WAN. The installation fee is somewhat exorbitant and there is some great concern of security. Still, MOPH can directly received blood pressure data from the device if the subjects live in the network-covered area.
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I was familiar with Decision Support Systems (DSS) and Transaction Processing Systems (TPS) when I did my internship in the hospital. There was a program that predicted the Vancomycin level in blood, which required the serum Vancomycin concentration and relevant predictors as the input. Then, it processed these data through the various pharmacokinetic models. Finally, it visualized the predicted Vancomycin level as a graph, as the output. We then determined the appropriate dose regimen by the graph. I convinced that it was categorized into DSS.
Unknowingly, I exposed to TPS when I was in chemotherapy unit. They used the program to calculate the amount of vial medication that needed to be prepared. It required the patient’s body surface area and target drug concentration as the input. Then, it processed some calculation and told them the result as the number of the vial and the milliliter of medication that needed to use per doctor order.
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Good day, everyone (´ ∀ ` *)
Pleased to meet you all. As you may know, my name is Pisit Saiwangjit and I am 25-year-old pharmacy graduate from Northern Thailand. This year, I recently obtained my bachelor’s degree in pharmaceutical care and about to get the license to practice pharmacy. I was involved in statistical analysis in the research project a year before my graduation, which worked on model development and internal validation for binary outcome.
During my internship in certain hospital, there was an implementation of information technology in their setting that sparked my great enthusiasm on this particular area. I also interested in high-dimensional data because, based on my own experiences, the real-world data tends to be hierarchy data.
HAPPY SATURDAY !!
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