Salin Sirinam

[Salin Sirinam]

1.) Which single design limitation most threatens valid estimates of sensitivity and representativeness? How would you address it within six weeks?
– It was the lack of involvement of private healthcare providers, resulting in under-reporting and incomplete documentation. When this data was missed, it means the community awareness of AEFI report would be low. Therefore, I would suggest including them by implementing a fast-track training for staff in these centers. For example, scheduling the workshop for the key staff responsible for detecting and reporting AEFI. Then, providing them the necessary tools for detection and documentation. Direct consultation should also be offered to support the fast track process.

2.) Using the CDC surveillance attributes, propose one low-cost intervention to increase sensitivity. State the expected trade-offs, and list 2–3 indicators to detect impact from the intervention.
– Since the lack of participation and low awareness was mentioned, a feedback loop could be implemented. It can be a regular monthly requirement for health center leaders to submit their reports to the central database. A simple summary from the central system should be produced and distributed so that the stakeholders can see their contribution, and also can help monitor vaccine safety data. The trade-off is this practice can add more workload to the local staff as well.
The key indicators could be: the proportion of complete reporting, and the timeliness of reporting.

3.) For a newly introduced vaccine, should the AEFI case definition be temporarily broadened to maximize early signal detection?
– Yes, which means that more inclusive case definition will increase sensitivity, which is important for a new vaccine. The trigger could be for example the standardized reporting rate is achieved, and the decision would be made baked on the judgement of the National Committee.

[Salin Sirinam]

1. Verification and preparation
– IT can be used for verification of case numbers by comparing them to the normal baseline on IT-based surveillance systems
– It can send timely alerts when there’s an excess number, which also helps in identifying the Place.
– IT helps to deliver rapid information to the authorities responsible for verifying the diagnosis and communication for fieldwork.

2. Describe the outbreak
– Fieldwork team can use IT devices and systems in the field for case finding and investigation
– IT tools create the digital line listing and deliver it online, allowing the whole team prompt access to the information.
– IT tools can generate the visualization, such as Epi curves, to see the pattern of outbreak (Time).
– It can also create a digital map to demonstrate the Place by showing case distribution, which benefits hypothesis generation and further investigation.

3. Hypothesis and testing
– IT tools are used to test the hypothesis and obtain results useful for creating control measures.

4. Response and action
– IT is used to deliver rapid and effective messages of the control measures to the stakeholders and the affected communities.

[Salin Sirinam]

I choose social media platforms as a tool that I found having a strong impact on COVID-19 surveillance and response. Through social media, people can quickly become aware of an emerging disease and its characteristics by accessing information shared by public health authorities and their communities. For example, these platforms help spread awareness of symptoms and signs of COVID-19, when to seek testing, how to access vaccines, and updates on preventive measures. They also support real-time communication faster than traditional systems, although some people may still be left behind due to digital inequalities.

However, because of their huge impact, if not carefully managed, social media can also become a source of misinformation, such as from antivax people, or false treatment information. I think this is a big challenge today, and health authorities need to be more aware and proactive in monitoring and correcting such information.

[Salin Sirinam]

For dengue scenario:
1. How can surveillance help to detect and control the disease?
– Surveillance helps detect dengue by monitoring trends and signals of dengue cases in the target area, resulting in an appropriate response when any change is found, e.g. increasing acute febrile illness suggesting dengue infection. It not only helps in early detection and outbreak response, but also helps evaluate the interventions after they are implemented to control the spread of dengue.

2. Should we conduct active or passive surveillance or both for the disease, why?
– We should conduct both for dengue where appropriate. Passive surveillance should be used for routine monitoring in health centers since it requires fewer resources. Active surveillance should be added during the outbreak or peak season or clusters to help collect more detailed information for further intervention and control.

3. Which method should be best to identify cases, why?
Cases in medical facilities VS community
Sentinel VS population-based surveillance
Case-based VS aggregated surveillance
Syndromic VS laboratory-confirmed surveillance
– While it should depend on context, objectives, and available resources. I am not sure about this objective of best identifying CASES (which can be done with case-based medical centers, sentinel coverage, and a lab-confirmed approach).

However, if based on dengue surveillance in limited-resource settings but still aiming for effective disease control, the most appropriate approach could be medical facility-based, population-aggregated, and syndromic-confirmed surveillance.
Medical facility-based method is practical since most clinically significant dengue cases will eventually present at health centers, while the community-based method costs more. For public health control, identifying asymptomatic cases is less critical since the preventive measures can be applied when a signal of the outbreak is detected.
In terms of scope and coverage, population-based surveillance can be used to identify the high-risk area. Aggregated method are suitable for continuous routine surveillance since it is cheaper, while case-based methods can be used during outbreak clusters for detailed investigation.
Lastly, syndromic approach is fast and appropriate for early warning and timely response, with laboratory confirmation that can be added on a subset of cases to verify and provide more detail.

4. What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
– For dissemination of Mpox surveillance information, I would prioritize real-time dissemination tools because the disease requires rapid alert and awareness among health professionals and public health authorities. Periodic dissemination tools can be used later for formal documentation, trend monitoring, and reporting and evaluating the interventions

[Salin Sirinam]

Should you give the data out?
– No, I should not give out individual data with personal identifiers. That would break privacy and confidentiality, even if the research has potential public health benefits.

How do you not violate any of the General Principles of Informatics Ethics?
– I will follow the individual privacy and security, least Intrusive, and ensure transparency of all processes.

If you want to provide the data to them, what and how will you do it?
– I should provide data at village or sub-district level, instead of identifiable individual records. If individual-level data is absolutely required, I will seek approval from the ethics committee and/or responsible authority. A data-sharing agreement is also required to define how the data will be used, stored, and protected. After that, I would share only the data relevant to their research, after de-identifying any personal identifiers.

[Salin Sirinam]

As a health information professional – can you tell your friend?
– As a health information professional, I cannot tell my friend about her husband’s HIV status because it would break confidentiality and professional ethics.

Can you interfere with other people or family issue?
– I cannot interfere with family issues either. Disclosure should come through the patient or the doctor in charge.

But, should your friend not know about this because she might be at risk?
– I believe that she should know for her safety. But the responsibility lies with the patient and the healthcare team to inform her.

How will you follow the fundamental principles about right to self-determination, doing good and doing no harm to others?
– I respect the patient’s right to self-determination. I do good by ensuring that patient data is protected, and I do no harm by making sure no one is put at unnecessary risk.

Isn’t it your obligation and the right of the subject to hold the information?
– It is the patient’s right to decide whether to share his health information with whom. My role is to protect that right and confidentiality.

[Salin Sirinam]

In my hospital, the EMR system is still used alongside paper records, and a newer inpatient digital system is currently being piloted. I think the change management has not been fully effective. Referring to the ADKAR model:

– Awareness: I believe that staff are frustrated, and some concerns may have been raised to the hospital board. However, the problems are not fully acknowledged, as staff keep pushing through daily work to prioritize patient care.

– Desire: Even though frontline staff are frustrated with the current system, many are not motivated to learn a completely new one from scratch. They feel the system only adds more work without clear benefits.

– Knowledge: Training was inadequate and delivered randomly. By the time the system launched, many users had already forgotten what they learned.

– Ability: The system itself is not user-friendly, and IT support is limited. Users often had to rely on each other for help instead of receiving timely support.

– Reinforcement: No ongoing reinforcement or encouragement to adopt the system. Without incentives or follow-up, many staff reverted to using paper records.

[Salin Sirinam]

In my hospital, we use an EMR system, but it still runs alongside paper records. The EMR mainly stores scanned copies of doctors’ handwritten notes, laboratory results, and uses a separate program for imaging studies.

From my experience, the main problems are design and operation. The system is not user-friendly. For example, to review imaging exams I need to switch between different program windows. Recently, a newer system was introduced in the inpatient unit to move toward fully digital records, but its implementation seems slower than expected. More training sessions will be needed for staff, including myself, to use it effectively.

In addition, I believe that cost is another critical barrier. The limited budget restricts improvement not only in my hospital but also in many government health centers across Thailand.

[Salin Sirinam]

Based on the hospitals I work with, the CDSS examples include pop-up alerts during drug prescriptions, such as dosage adjustments for body weight, and allergy warnings. These help reduce prescription errors and reviews.

Factors that could influence the implementation of CDSS are:
– Users: Their trust in the system. Alert fatigue
– Technical: Challenges of integration into existing HIS/EMR
– Resources: IT support within the organization including budget

[Salin Sirinam]

Apart from interoperability, data analysis and sharing, health surveillance, and billing that were already mentioned, without ICD (or other standardized tools), it would be difficult to develop EMR or decision-support systems. Hospitals may also struggle to adopt IT tools that are meant to reduce the workload of health professionals. This can lead to hidden costs from duplicated tasks and inefficient processes. It also could increase inequity in the health system, as hospitals that remain non-ICD–based would face challenges with traditional systems, resulting in poor data quality and affecting patient care in those regions.

[Salin Sirinam]

Thank you for your presentation on eHealth Africa. From the VDO, I understood that they have shifted from paper-based to electronic systems for health data records, vaccination tracking, surveillance, and eLearning. Mobile devices are also used for contact tracing and health campaigns. These implementations clearly cover the three main domains you mentioned. I’d like to add that it also highlights the interaction between global stakeholders, both governments and NGOs, enabling communication on a large scale across the Africa continent, where health challenges is significant. I am really impressed by their work and journey.

[Salin Sirinam]

Hi Hteik! Thank you for your presentation about KOBO. The VDO helped me better understand how the KOBO works, after previously reading peers’ mentions of it. I agree that this project improves field staff’s monitoring and response efficiency. It also enables faster communication between field staffs and regional teams or other stakeholders, supporting timely interventions and data-driven decisions that can enhance public health outcomes in your covered area.

[Salin Sirinam]

I agree with the review that EMRs can cause physician burnout. It aligns with my experience from working with different EMRs in different hospitals, where it clearly shows that design and user-friendliness are very important. Some hospital EMRs cause me frustration when they require too many windows, run too slowly, or force me to go back and forth among various clinical data.

However, I think physician burnout originates more from the heavy nature and environment of clinical work itself. For example, long hours, high patient loads, and pressure to avoid mistakes. EMRs don’t directly create this stress, but they amplify it. When physicians are already overloaded, poorly designed EMRs can add more frustration and lead to heavier burnout.

So, apart from tackling the workload itself, EMRs can still be valuable tools. They should reduce duplication and provide a fast, smooth workflow. Involving health professionals directly in the design process would make EMRs more practical and user-friendly. I also strongly agree that using scribes, voice-over/voice-to-text technology can help with physician routines. In addition, supporting staff who are efficient with EMRs can also help reduce the workload.

[Salin Sirinam]

I would propose eHealth definition as the use of technologies to empower individuals to manage their health, communicate among all health stakeholders, and make uses of health data sources to improve health care widely.

[Salin Sirinam]

I’ll give the example of big data in chronic kidney disease. Big data in the nephrology field can involve not only national databases such as the renal registries in the U.S., UK, Europe (ERA), etc, but also data collected through EHR/administrative claims, clinical trial registries, mobile health devices, and molecular databases. These big datasets fit the 5V framework as follows:

1. Volume: Data are collected from multiple large-scale sources as mentioned above.

2. Variety: Includes structured data such as laboratory values and diagnosis codes in registries, and unstructured data such as radiographs and pathology images.

3. Velocity: Refers to the speed of data generation and collection, which is accelerated by digital technologies. Wearable devices also contribute to real-time data generation.

4. Veracity: Data may be inconsistent and not fully standardized, but its trustworthiness still depends on the accuracy of diagnoses and laboratory values generated by professionals.

5.Value: This data has the potential to significantly improve the management and outcomes of chronic kidney disease.

[Salin Sirinam]

Since the main cause of the attack was a staff clicking a phishing link, I think they could use some extensions that warn users before opening any suspicious links. MFA could also help if a staff clicks a phishing link, the authentication is still required to gain access.

[Salin Sirinam]

I would add that they should also implement a rapid response plan for such incidents, in order to ensure that any suspicious activity is detected and acted immediately.

[Salin Sirinam]

I suggest enforcing its policies by limitng third-party access to critical systems, regular motoring unusual activities and software updated. For the account side, MFA can as well help.

[Salin Sirinam]

My background is a kidney doctor taking care of dialysis patients. In Thailand, we have the Thailand Renal Replacement Therapy (TRT) Registry, a nationwide database that covers around 98% of dialysis services across the country. It integrates data from hospitals and dialysis centers using standardized forms and electronic submission. The TRT collects data on patients with end-stage kidney disease (ESRD) undergoing dialysis, including both hemodialysis (HD) and peritoneal dialysis (PD). The registry includes patient demographics, clinical parameters, treatment details, and outcomes, with data primarily submitted by dialysis nurses through electronic systems.

The TRT helps improve chronic kidney disease (CKD) practice. For example, it highlights key trends and challenges in CKD on dialysis management since 2000, providing epidemiological data and insights for policymakers to plan strategies that benefit public health. Recent data analysis in 2023 revealed that the number of HD patients has increased dramatically since 2022, while the number of PD patients has remained stable. Stakeholders can use these findings to enhance early CKD detection and prevention strategies, as well as to investigate how the choice of dialysis modality impacts public health management. Moreover, the data is available for researchers to gain insights that can guide CKD practice and improve the quality of patient care.

However, the TRT still faces challenges. For example, there is a need for clear clinical definitions of various comorbidities associated with ESRD outcomes. Some data domains are still not standardized, making them difficult to use directly for analysis. Some diagnoses are based on treating physicians’ assessments and are not implemented using standardized criteria across centers. Additionally, many types of data that would benefit public health analysis are still not captured. Implementing an ideal registry practice would faces challenges from health workers, as the registry requires them to manually enter hundreds of data points into the system, rather than capturing data directly, posing interoperability challenges.

[Salin Sirinam]

I have just noticed that someone was trying to attack one of my social media accounts last week. So I’d identify some possible means as followings:

– Reuse passwords: I am too lazy sometimes to change and remember different passwords across many accounts. If one of passwords has leaked somewhere online, attackers could try to use it to guess my other accounts.

– Weak 2FA: I also noticed that I haven’t set the 2FA for this account, so that could be another weak point where someone could trick to be the owner.

– Tied email account: Since I use the same email address to many accounts, attacker s could use it to reset my password.

– Phishing: While scrolling the social media, I might sometimes get hooked by advertisements (that know my personal interests based on my online activities). I might make a mistake clicking on a fake login or even get tricked by a warning message with a fake link.

– Mobile malware: If my device has malware getting from my online activities, it could steal my passwords, or other linked information that attackers could use to log into my account.

[Salin Sirinam]

I propose choosing the cloud server over the physical server based on the following reasons:

– Mobility: Users can work anywhere, as their tasks are mobile within the hospital.
– Scalability: It is easier to scale up and down. For example, during the outbreak with more patients, the cloud server can handle increased patients demand, and it can be scaled down when the demand declines, providing flexibility.
– Data security: Cloud providers professionally take care the security following established protocols and regulations, which our single IT officer cannot easily handle. They also provide backup and recovery.
– Cost saving: No need to buy servers or pay for the maintenance cost.
– Maintenance and support: With only one IT officer, the cloud server reduces their workload as the cloud provider already do these tasks.

And I propose that the PaaS would be appropriate for our web-based patient appointment app for the following reasons:

– PaaS provides platform for app development including the servers, databases, and tools. Therefore, with our hospital setting, it offers fast development and less burden on our IT officer. We can build a customized system for our hospital without worrying about handing the infrastructure, security, or backup.

– IaaS may not be the most suitable type, because although it provides server, storage, and network, but we still require more IT work to manage and maintain them..

– SaaS also may not suitable for our hospital setting. While it offers the infrastructure and platform, but it also provides a ready-to-use software that limits our flexibility to customize the app to fit our hospital.

[Salin Sirinam]

As health informatics combines people and IT, it can support the detection, response, and control of infectious diseases, such as in the following scenario: Influenza in school children in Bangkok.

Detection: School absence data collected through electronic or mobile systems show a rise in influenza-like illness. Hospital pediatric units also observe a spike of influenza cases and report to the local public health organization through electronic reporting system and share dashboard.

Response: Local public health teams identify the outbreak using real-time data dashboard. Therefore, they investigate the schools, and alert teachers, parents, and surrounding communities through digital communication platforms.

Control: Preventive measures such as health education, hygiene promotion, and temporary class closures are introduced to stop further spread. These can be supported by IT tools such as e-learning, mobile educational message, electronic tracking of prevention effectiveness.

In summary, health informatics helps bring the data sources (school absence, clinical and lab reports) into an early detection system that leads to public health action supporting by IT tools communicating among people.

[Salin Sirinam]

I am a clinician with experience in health research, and am currently building up my knowledge in epidemiology and public health to gain a broader perspective on health. To improve my profession in public health/health informatics, I would need to gain knowledge and skills of the followings:

1. Computational and Mathematical Sciences: I have knowledge in medical statistics, but limited experiences with computer science and IT. I would need to develop skills in programming, database, data analysis and IT systems, so I can apply these tools in the public health settings.

2. Management and Social Sciences: Although I have experience leading research projects and working in teams, I would like to strengthen my skills in project management, business/organization administration, health policy, and regulations. These skills will help me apply clinical work with public health management on a broader scale.

3. Health Sciences: This is my area of expertise, given my background as a clinician and health researcher. I would like to learn health informatics to integrate it with my background in health science to solve more complexed health problems.

[Salin Sirinam]

I agree with the point that text messaging and chatbots can be hugely useful nowadays, given the way of our communication in this era. Public health authorities can use these tools to deliver messages to people instantly. Also, IT devices can be useful in the reverse direction in that they aren’t only for communication but also for monitoring the effectiveness of the measures implemented.

[Salin Sirinam]

I still find that some platforms continue to spread misinformation about COVID-19 even today, especially in open chat groups that started during the pandemic and have now turned into anti-vaccine communities. I have seen efforts from both the government and health influencers trying to tackle this news by sharing correct information online to counter false claims. I think what we can do is to keep spreading reliable information on the same platforms and make people stronger in digital and media literacy, which will help tackling this problem in the long run.

[Salin Sirinam]

Thank you for the comment ka. I saw physicians in the U.S. using it in their OPDs. In Thailand, tech start-ups are now developing AI software that can record conversations between doctors and patients and automatically summarize them into HIS/EMR systems, such as Prescribe AI. I think further development is still needed to improve transcription accuracy and ensure it aligns with real-time clinical contexts.

[Salin Sirinam]

I agree with the pilot testing step, especially the idea of including proper feedback mechanisms. In my opinion, feedback should be gathered regularly, especially right after launching with more frequent hearing sessions, so that the EMR can be continuously adjusted and made more user-friendly.

[Salin Sirinam]

Thank you for your comments :). I agree with your point about making the app accessible to all communities. In reality, some people are not aware that these options are available on the app. In my opinion, this tool is especially useful in big cities like Bangkok, where there are multiple health benefit schemes and various health centers, and people are generally efficient at incorporating technology into daily life. However, in some areas, people may struggle with both physical access to health services and technological accessibility.

[Salin Sirinam]

I agree that this could be the slogan of eHealth.

[Salin Sirinam]

Hi Hteik! Thanks for bringing up the EPI data. I agree with your explanation of the 7V characteristics of EPI data. I also would like to add that EPI data can provide more values, such as being used for epidemiology research, economic studies in the cost-effectiveness of vaccination programs, and social sciences e.g. to understand the barriers of vaccine uptake. Therefore, it is valuable not only for clinical use but also for guiding broader health policy.

[Salin Sirinam]

I agree that health workers are one of the main challenges. That’s why health informatics also involves people management in order to make the system friendly for the front-line staffs, while still maintaining data quality that can support public health.

[Salin Sirinam]

I like your example. This also happens on social platforms in Thailand. People often share their personal information, and sometimes it could even be biometric data. These tricks are dangerous for those who are not aware of it.

[Salin Sirinam]

I was hesitant to choose between PaaS and SaaS. Reading the proposals about PaaS helps me better understand the pros and cons of them, so that I can make decisions based on each situation. Thanks for your comment.

[Salin Sirinam]

Yes. Connecting data across different organizations can speed up outbreak detection. It also makes me realize how important the concept of interoperability is. Thanks for your comment.

[Salin Sirinam]

Hi Myo Oo! Thank you for addressing clearly how health informatics helps in every stage of the whooping cough outbreak. I like how you describe the use of IT tools on the ground in the resource-limited setting, which helps me better understand its practical application.

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