Pongthep Miankaew

[Pongthep Miankaew]

Hi,

Nice post.

The installation of information systems everywhere, especially in government agencies, is always faced with budget problems because legal hardware and software are expensive. If you want to use open source software, you need to find personnel who have specific knowledge in that software. Let me share a story from Thailand. Just like your country, small government agencies do not have the budget to purchase servers such as web servers, database servers, file servers. So the government provides government cloud system and a data center for free of charge.

If you have a good HIS system, it is about time to look at the standards for collecting and sharing data for various benefits such as improving quality inpatient of care, using data for research, etc., data standardization is also taking into account confidentiality and privacy, which must have a responsible agency to supervise and control.

Thank you for sharing comprehensive experience,
Pongthep

[Pongthep Miankaew]

Tightening up your password security is a good measure, and also be careful when connecting to public networks because it might be a network created by hackers to capture your data.

Thank you for sharing,
Pongthep

[Pongthep Miankaew]

Storing data on the servers of reputable service providers like AWS does not mean that the data is safe. Because if you don’t have adequate IT security measures or SOP in place, there will definitely be security problems. Therefore, we should have technical understanding and put it into practice and install it effectively. I agree with what you said that there should be regular auditing. We know what should be fixed and can find prevention methods in a timely manner.

Nice post,
Pongthep

[Pongthep Miankaew]

Good idea. Using mobile app to access their medical records is very useful for patients. However, we have to strengthen the security of the portal because the data is very sensitive. We have to design the app to protect the confidentiality by using the features like encryption and strong authentication.

Thanks,
Pongthep

[Pongthep Miankaew]

PHP is a good choice for app development. I think it is good for those who are stater programmers because it has less learning curve. It is simple in code and programming syntax.

Thanks,
Pongthep

[Pongthep Miankaew]

JavaScript is one of the most popular programming language because it supports many platforms and Operating System, you can build an application running on Windows, Linux, and cross platform for mobile app too.

Thanks,
Pongthep

[Pongthep Miankaew]

Yes, Telemedicine allows patients and doctors to interact with each other in real-time, just like entering a real hospital. However, one factor that may hinder this type of technology is the speed and stability of the internet system. The hospital should provide a good performance and speed of its computer system and networking for the best services.

Thanks,
Pongthep

[Pongthep Miankaew]

Your opinion shows that you have a comprehensive understanding on computer networking topic.

Thanks,
Pongthep

[Pongthep Miankaew]

Absolutely, a centralized information system plays an important role in enabling all scattered systems and data among different departments to be effective information not only for operating room management, but also in every department or division in a hospital. We need to have a good design in system workflow and data workflow together with tools such as database, visualization, programming, RFID, and other technologies.

Thanks for sharing,
Pongthep

[Pongthep Miankaew]

Copying information from source documents is an extremely difficult task. As you said, it may lead to erroneous data imports that affect data analysis and data quality.

Let’s me share with you, I have experience working with CRF too, which is copying data from source documents. After that, I will import them into the computer system. The system will use an intelligent character recognition (ICR) software to read the data on it, then trying to import to the database.

It also depends on the CRF design. If it is designed with mostly checkbox fields, the software will read them almost 100% correctly. However, if fields are handwriting, there might be a higher error in reading.

Thanks for sharing,
Pongthep

[Pongthep Miankaew]

You have a good understanding of system availablity.
Your posts are very comprehensive and detailed.

Thank you,
Pongthep

[Pongthep Miankaew]

Installing SSL not only helps keep data confidentiality, but also builds organization credibility as well.

A risk assessment is a good idea because it will make us know the weaknesses of the system and fix it before it gets attacked

Thanks for sharing,
Pongthep

[Pongthep Miankaew]

Absolutely, sharing username and password should not happen in an organization. It could lead to many problems later. In terms of password policy in the organization, from my experience, I have implemented an “active directory”, the software from Microsoft to enforce users to behave in accordance with the organization’s policy. So, with this way, I can control, monitor, and enforce them based on the security policy.

Thanks for sharing,
Pongthep

[Pongthep Miankaew]

Sharing username and password is not a good idea. For the problem of system interupting when it is under maintenance, normally IT should maintain the system after midnight, this way affects less users. Another way is a good choice, but it is quite technical, we called “live migration”, IT administrators, especially in cloud setting know this technique. There is no system downtime with this way.

Thank you,
Pongthep

[Pongthep Miankaew]

Nowadays, although cloud technology has advanced and gained popularity. Some people still feel insecure about storing their data in the cloud. Normally, it’s good practice to avoid opening a public IP to users from the Internet to access important data resources. You need to implement a good and strong firewall policy as well as an access control rules. Also, keep monitoring log is a good thing to do too.

Thanks for sharing,
Pongthep

[Pongthep Miankaew]

Risk assessment is the best way to address your organinzation’s cyber threats, policies, procedures, and IT environment. It will provide you a report how good you are able to maintain CIA and what you need to make better security.

Thank you,
Pongthep

[Pongthep Miankaew]

Hybrid cloud is a good choice for an organization that having on-premise system and have a plan to migrate to the cloud system. Absolutely, you can save cost by hosting a sytem on cloud, for example, you can save cost of hardware maintenance, IT network engineers, etc. Also, most cloud service providers also provide many important services with no charge such as full backup service and restoration in different data center locations.

Thanks,
Pongthep

[Pongthep Miankaew]

Today, my information system is hosting on a hybrid cloud too, which has both on-premise and on-cloud systems, connected to each other. Before migrating to the cloud, the reliability of the cloud provider was my first consideration. They must have several standards such as ISO 27001 and CSA STAR which is Cloud Security Certification.

Thanks,
Pongthep

[Pongthep Miankaew]

It is important to consider the cost of where to host the system. I agree with you to choose the one which is cheaper. In fact, hosting the on-premise system, where are many costs we have to consider such as software licensing, server and network equipments. Also, there might be more expenses on IT personnel like network engineers, system administrators, as well as the cost of electricity and cooling system.

I’d like to share my experience. The system I am currently using has both on-premise and on-cloud solution, both of which are related each other. I have been gradually migrating from on-premise to on-cloud until today.
Currently, I would say my systems are a point called “hybrid’ that the two systems could work together. Data can be sent/received between each other, however my plan is to transfer everything to the entire on-cloud. To be honest, it would take a long time.

Pongthep

[Pongthep Miankaew]

Absolutely, you need to have a good plan for the transition. Apart of cost, one thing that very important to take into consideration is about standard of cloud providers. From my experience, the cloud providers should have certification of at least ISO 27001, ISO 27799, and CSA STAR. Also, they should guarantee Service Level Agreement (SLA) Internet Connectivity Uptime 99.xx% and IDC Infrastructure Uptime 99.xx%

Pongthep

[Pongthep Miankaew]

Totally agree! Some medical data is sensitive. With private cloud, we can control our virtual servers, operating system, applications, and database. Also, we can control the security of the system by ourselves. The cloud service provider will not interfere or access to your system.

Pongthep

[Pongthep Miankaew]

You have a good understanding of the types of mobile apps. Hybrid app development is a good option to support multiple OS.
However, sharing information between hospitals, pharmacies, and patients themselves is a very challenging thing. There are many things to keep in mind. especially data security, patient safety and confidentiality

Good post,
Pongthep

[Pongthep Miankaew]

Absolutely, you can create an API with Python. Typically, we create APIs for frontend development because it saves time and improves developer efficiency.

Pongthep

[Pongthep Miankaew]

Great idea! you can use a development tool that has library of machine learning for image processing. With your app, we can reduce the burden of physicians, also we can get more accurate and faster result.

Pongthep

[Pongthep Miankaew]

Of course, native app has better stability and performance compared to Hybrid or cross platform because it is designed for specfic OS, so it can take advantage of hardware on the OS itself.

Pongthep

[Pongthep Miankaew]

Great idea! Today, mobile apps play very important role in healthcare and I think the hospital can improve patient satisfaction through your DrugDeli.
To build a mobile app to support multiple operating systems, you have to use a cross-platform app development.

Pongthep

[Pongthep Miankaew]

You seem to understand how to make web apps. Yes, we use html and css to manage the rendering of web pages. Then use other appropriate languages to operate about data processing, data entry, network communication, and database access.

Thank you,
Pongthep

[Pongthep Miankaew]

Python is one of the best choices for those who have zero experience in programming.

Pongthep

[Pongthep Miankaew]

Actually, python was originally built for data science, but nowadays there are many platforms that make it easier to develop mobile apps with Python, such as BeeWare and Kivy.

Pongthep

[Pongthep Miankaew]

Your intentions are good and challenging. Actually, both PHP and Node.js are sever-side development technology, however, PHP is pretty old and popular in web app development, we have been using it for 2-3 decards, while Node.js is a cross-platform and relatively new. It is faster than PHP because it has many advanced development capabilities.

Thank you,
Pongthep

[Pongthep Miankaew]

Python is a good choice to start with for those without programming experience because it’s a simple language and very similar to English. Today, many schools are starting to introduce python to teach their students.

Thank you,
Pongthep

[Pongthep Miankaew]

You mentioned very well about the overview of app development. You talked about the backend and the front end that indicates you are knowledgeable. Today, the most popular method of app development is microservices, which divide the system into parts such as back-end and front-end (like as you said), which work separately and are easy to deploy.

Good post,
Pongthep

[Pongthep Miankaew]

Absolutely, telemedicine app is playing an important role in the situation of covid-19 pandemic. It has many benefits including symptom initial diagnosis and assessment, social distance, 2 ways comnunication, and cost saving. Howver, when using over the Internet, the app developers should implement a method of how to secure patient information as well.

Thanks,
Pongthep

[Pongthep Miankaew]

Good post. With a virtual hospital application, patients can access to the hospital’s sservices from any place, easilty, conveniently. The app offers real-time consultations with doctors via video calling. They can also take photo and record a video in the app before sending them to the doctor. However, the patient must have a fair amount of IT knowledge.

Thanks,
Pongthep

[Pongthep Miankaew]

Mor-Prom is a very useful app on the Internet and mobile. It is the app that was developed with the specific purpose of collecting information about vaccinations.
I’ve talked to the team who designed and maintained the database of Mor-Prom. They said the app has been constantly updated, especially to store data in the form NOSQL database, which can support the large scale of national data.

Thanks,
Pongthep

[Pongthep Miankaew]

Data sharing is still a big challenge among hospitals. That is the reason why many healthcare organizations including goverment agencies pushed a lot of effort to introduce a standard of data sharing called HL7 FHIR because the real benefit will be the patient well-being and care result. They can see a doctor at any hospital and can grant the doctor access to their patient information. The PDPA law does not only affect hospitals, but it also affects other fields such as research, human ethics experiments, etc. Therefore, everyone must have a good knowledge and understanding of this law.

Pongthep

[Pongthep Miankaew]

Great post, very informative, full of insight and comprehensive.

Pongthep

[Pongthep Miankaew]

Your opinion indicates that you have a good understanding of the application of each type of network.

Pongthep

[Pongthep Miankaew]

That’s right, if we send other sensitve information along with BP value, absolutely, we want higher security in the network. Generally, MAN is safer than WAN(Internet) because it has a smaller coverage area that using within a company or a group of organizations. We can control security and limit people who can access into the MAN network.

Pongthep

[Pongthep Miankaew]

MAN covers a smaller area when compared to WAN. It is a network that connects distant network objects such as connections between offices in different buildings or branches in a city. This network connection uses fiber optic cables or use a microwave (Wi-Max) to connect the offices and braches. In terms of WAN, we can simply say that it is the Internet today because it combines multiple WANs together to form the largest network called the Internet.

Pongthep

[Pongthep Miankaew]

I think you understand the basic principles of network types and their applications very well.

Pongthep

[Pongthep Miankaew]

Because of system fragmentation, that’s why we need to learn and implement data sharing standards like HL7 FHIR and OMOP. However, in my view, besides technical work in IT, another hard task is data mapping, which requires an understanding of our own HIS system and the resources of FHIR.

Thanks for sharing,
Pongthep

[Pongthep Miankaew]

Clinical resreach involves many paper-based documents such as source documents, CRF, AE, SAE reporting, site monitoring, audit, inspectiion. Currently, there are many CDMS (Clinical Data Management System) in the market. Applying this kind of system can integrate and transform the paper-based data to electronic system. I have been working with a CDMS for many years. I think the software can support both decenlized and centralized setting. We can reduce many papers and documents because it is an EDC (Electronic Data Capture).

Thanks for sharing,
Pongthep

[Pongthep Miankaew]

Nowadays, data security is very important, especially healthcare data. Every application that transmits data over a network and stores data on storage must has bmethods to maintain data privacy and confidentiality such as data encryption, user authentication, and authorization. However, in order to keep the information safe from leaking, app users themselve also need to have a good understanding of various types of threats that can attack or deceive them too.

Thanks for sharing,
Pongthep

[Pongthep Miankaew]

Your post is good and comprehensive.

Pongthep

[Pongthep Miankaew]

Creating a central system is a good idea, but it is necessary to plan well. As you said, each system is built regardless of interoperability with other related systems. It has its own operating system and database. Therefore, a centralized system needs to be able to support data from different operating systems and databases. However, in my opinion, barriers to connecting or integrating systems not at IT, but it depends on the policy and vision of the management, especially their willingness to share information with each other.

Great post,
Pongthep

[Pongthep Miankaew]

In my opinion, to scan paper, it can only be stored as an electronic file. but unable to analyze the data to make a decision.
As you said, you’re right. the handwriting is hard to read. Let’s me share my experience, I’ve been working on a project about transforming paper forms into digital data. It actually starts with converting every field on paper into fields in an application and then start developing such application.
After that, we started to key in the old data on the paper into the new system, while new data from the patient’s hospital visit, we started to key-in on the app from that day on. By doing this, the paper system will gradually disappear, but at the beginning, the work will be a little harder.

Thanks for sharing,
Pongthep

[Pongthep Miankaew]

Yes, I agree. each healthcare organization or department has its own system. System fragmentation leads to inability to communicate with each other that could impact on patient well-being.
In my view, currently there are many groups of healthcare people and organizations trying to solve this kind of problem by applying a standard of system sharing and interoperability such as HL7 FHIR and OMOP. That means they don’t care what system is using in each hospital or department as long as they can share their data based on an agreed upon standard. However, it is a big challenge!

Thanks for sharing,
Pongthep

[Pongthep Miankaew]

I agree, no matter where the system works, data security must be a first consideration.
Even though, your production systems are hosting on cloud, you still need to have a good plan for many things such as performance monitoring and tuning, backup policy, and contingency plan.

Nice post.

Thank you,
Pongthep

[Pongthep Miankaew]

Let me share my experience, my organization decided to migrate entire production system to the cloud. For a number of reasons, for example: 1) we wanted to reduce our hardware and server maintenance budget; 2) we had few IT staffs to take care of the hardware infrastructure including server rooms and security systems. So we looked for cloud providers that have security standards such as ISO 27001 with a good and reliable backup systems in place. Today my organization uses both IaaS to host many production applications and SaaS like Office 365 etc.

Thank you,
Pongthep

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