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Dear All,
Here is my dashboard Siriphak’s Malaria Dashboard based on Malaria situation in Thailand (datasource – malaria.ddc.moph.go.th).
You can choose to filter options on date range, year, occupation, gender, age range, or provinces.
We can easily see infection trends through the line graph. Yet, number of total cases also display in simple numeric figure on top left of the dashboard.Last but not least, I provided first report date and last (update) report date in order that users will be able to know the date that they will use for filtering date range. In addition, I decided to display malaria species in pie chart with embedded percentage on it. However, if you move the cursor to that area, you will be able to see numbers of infected cases and percentage.
In the middle, I provide google map that users can see overall areas of Thailand, with ranging color from light yellow to dark red.
Please feel free to comment and provide any suggestions!
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What I impress is the color and tone of this dashboard since many Thai presses use intense colors and tones for COVID-19 situation.
I like how they use pictures and symbols instead of words this makes me want to read it, rather than provide only information in words without any pictures. Such as the human symbols with colors that classified disease status of patients [red for infected, orange for active, green for cured, and black for death]. In addition, the colors that classified gender are easily differentiated.
Moreover, I like how they demonstrated the line graph that make people could easily understand trends of the situation.
However, for the distribution of confirmed cases by age group reported in bar chart should be showed in color that is different from that uses for gender classification. Since some people (most of male who have problem with color blindness) might have problem with distinguishing tones of colors, the intensity/saturation/tones of blue that illustrates distribution of cumulative cases should be clearer or better make it in different color.
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May I please provide you some comments since I won’t be able to review the assigned person.
Your CRF is nicely clean and well separated.
I like how you provided the default of 20xx for year, it is very user friendly that they will only write down just 2 digit of year.For pregnant and lactating section, it would better specify only female, thus those who are male can skip this part.
A little more on laboratory section, from my opinion, it would be better to have an initial of person who collected the specimen.Your CRF was nicely designed and it is applicable in the real world setting!
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Data standardization improves efficiency by enabling data aggregation from different sources. Since implementing of data standards, it uses the same language, makes the consistency of data, and makes it easier for data transfer and analysis. Most importantly, it enabling the operation efficiency in data management.
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I have been participating in the clinical trials where my position was assigned to different roles depend on the clinical trial. One of the studies, I was assigned to be Pharmacist of Record (PoR). While another study, I was assigned to be Associated Pharmacist (AP). With these two different roles, access control is significantly different.
I would like to give you an example when I want to access into the clinical research management system (CRMS). The PoR was granted access into the system whereas the AP was not. In addition, by logging into the system, in addition to user and password, it needs two factor authentication for second verification process. Yet, after accessing into the system, it also shows the last success login time. Also the time stamp that you edit/add information into the query or issue.
However, for the last two processes (edit check and logical check and data backup and recovery plan), I have not involved with but in the clinical trial that conducted at my site. They have a logical check by the QA/QC department. And the data backup and recovery plan is responsible by IT department.
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Since the project used secondary data for collection and analysis. However, there are many steps that I haven’t done during data collection.
If I could go back, I would like to do data validation/ data quality control and data quality assurance were not done. SAE reconciliation, external data merging, database lock, or document archive (and most of processes) were not involved in the project since the project is a small scale and it is not a clinical trial.
The reasons that I focus on QC/ QA of data because an error from data collection could none or less impact the analysis and findings. If QC/ QA process had done, we would have a better accuracy, completeness, and reliability of both data collection, accuracy, and findings.
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I don’t have experience direct primary data collection experience but I would like to share my experience on data collection when I was a pharmacy student.
– Purpose of data collection – I was doing a seminar/project for Network meta-analysis (NMA).
– Was it primary or secondary data collection – a secondary data collection.
– Methods used for data collection – databases will be used to search for original research articles including Medline (PubMed), Embase, CINAHL, Cochrane Central Register of Control Trials, Web of science, and Scopus. By combining terms of medical subject headings (MeSH) and key words in the search strategy. After the abstracts were screened, Excel Sheet was used for data collection.
– Were there any problems that occurred regarding data collection? – yes, some of articles that appeared after searching are not eligible for the project (due to inclusion and exclusion criteria). Some articles don’t have all the variables we need to be analyzed or we cannot get through full text for some articles. In addition, NMA needs a second independent reviewer in order to screen title and abstract for second time. Any conflict that occurred must be resolved through a team discussion.
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I would like to describe on Page 344, item no 21 “If two confidence intervals overlap, the difference between two estimates or studies is not significant.”
Even 95% CI from two subgroups have overlapped e.g. means from normal populations with known variances are (1.04, 4.96) and (4.16, 19.84), while it produces P < 0.05 (which effect across studies give P = 0.03).
Confidence intervals or error bars that overlap do not give any information about whether the difference between two data sets is statistically significant. To compare between groups, you need to use statistics that measure and estimate the differences between them. Therefore, two intervals that overlap but have a 95% confidence level may still have a big difference between them. Thus we can reject the null hypothesis with a P value that is substantially less than 0.05.
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In order to replace an old technology with a new one, people who’re going to use it must first have good impression. By impressing them with a new one that is easy to use, developer should present performance benefits of new technology:
– How the new technology could help them on working
– How it helps them on lessening time, reducing workload, and magnifying quality of work
Not only represent the new technology just only good part, developer should listen feedback from those who use it. Also the feedbacks should be taking into consideration for ameliorating a better system and to achieve perceived ease of use from users. -
There are many external variables that could influence perceived ease of use and perceived usefulness. I also agree with what friends are sharing on those factors.
For me, I think social influence is the most important. Because when ones are living in the same environment, and they can sense how others feel on a new change. If there is one person who doesn’t agree with a change, but others agree and can explain how good it is. Then the person, who has bad perception of the change, would have change her/his mind.
Another variable could be experiences on what they have faced before. If they have faced bad experiences toward a change, they might be afraid that changing will have an unpleasant effect to them somehow.
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I would decide to do a qualitative study in order to understand the reason why people don’t use bednets for prevention of malaria.
First, I will try to review literature with regard to the topic of study whether are there any conclusions or factors reported on why respondents don’t use bednets. After that I would go for a semi-structure interview by doing a focus group discussion.
By having focus group participants who are in the studied/exposed community. In addition, asking open-ended questions to allow them answers freely in many directions, and to know their attitudes, feelings and beliefs. However, the answers could potentially lead ones agree and change dynamic of the interview. Thus, researchers should have a well plan structure questions in order to keep on track to the point and conclusion. Nevertheless, an in-depth interview might also perform only for key informants (e.g. community leaders) who could provide researcher for a better understanding and reason on why they don’t use bednets.
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Thank you for raising this issue. I previously thought that non-identifiable data cannot be tracked back to identify person. However, persons have their own and specific information. Once those non-identifiable data are combined, one can be identified.
For me, I think non-identifiable data that could make people be able to identify me include sex, age, educational information (primary school, high school, universities), occupation, organization of work, geographic data e.g. city/location of living, or (sometimes) salary.
The person, that I think they could definitely define me, is ones who are in the same field of work. Sometimes, search engine, such as google website, could be able to identify one by putting that information on it.
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Efficacy is the benefit/performance of new medicines on intervention under controlled conditions or ideal circumstances.
Effectiveness is a real performance/intervention under the real-world conditions. In another words, whether it achieves a desired effects on patients in normal clinical conditions. For example, randomized controlled trials conduct to compare effectiveness between two drugs under normal clinical conditions.
Efficiency has cost and economic aspect involved. It looks through on cost-effective whether the benefit of medicines worth the expenses that have to be paid compared to outcomes.
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I think behavioral factors (e.g. lifestyle of living) could be one of confounder of this association, if the abovementioned young adults were defined 18-25 years old.
In this group of age, people are actively active and have their lifestyle which may prone to be more socialize than other generations. In addition, they have their own technology skills and devices that can report via application when compare to other age groups. -
I honestly tell you that my current position/job is not the one that can contribute to the control policy of COVID-19 in my setting. But I would like to share you some perspective that I have learnt during COVID-19 pandemic outbreak.
We strongly and strictly followed Thai MOPH and CDC policy. We ensured that our employees and participants are safe from COVID-19 cluster.
We encouraged people, who are closed contact with confirmed case, to report direct supervisor and self-quarantine. In addition, my organization culture assures privacy and confidentiality of those who confirmed case positive. They did not announce or report individual or unrevealed timeline. This is because they make sure that it is some kind of patient (individual)’s health information, which is sensitive and must not be disclosed, unless individuals will inform by themselves.
The abovementioned considered me what Thai MOPH did during an early outbreak, by revealing personal timeline publicly which it could make one’s stigma for the whole life. Unlike when the number of cases escalated, timeline revealing process was missing. At this point, human right should be taken into account for protecting and respecting individual. Nobody wants to be infected and blamed publicly. Nobody wants to have stigma through the whole lifetime because he/she got infected unintentionally. If the government started raising awareness and community engagement to participate in control measures, it would be better than what happened in Thailand during 2020-2021.
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Universal Coverage Scheme (UCS) in Thailand which was also known as “Gold card” (บัตรทอง) or “30-baht”, which patients had to pay 30 baht copayment per visit. As my understanding, nowadays, patients don’t have to pay anything. They can go to any hospitals with their citizen ID card so, they can get access to healthcare. The scheme aims to provide universal health care as fundamental right for Thai citizens.
What works: Thai citizens can easily access to health services which are not only improve their quality of life but also financial saving.
What needs to be done: Government and parties involved in UCS should increase patients’ promotion and awareness of direct costs that are responsible by the National Health Security Officer (NHSO). As I was a pharmacy internee, I noticed that patients received full basket(s) of prescribed medicines and they paid for nothing. Sometimes healthcare providers didn’t ask if patients have medicines left at home, but a computer program automatically calculate based on dose(s)/day until next follow-up visit. They had no idea how much did the medicines they had received cost. Therefore, they can just easily do not comply with what physicians advised and consequence caused poor medication adherence. Accordingly, the diseases cannot be controlled.
Strength: I think this scheme brought me equitable the most. Regardless socioeconomic status, all Thai citizens have the same right to get access to health services.
Weakness: As I mentioned earlier, the direct costs will be higher without patients’ awareness, in which resulted in rising NHSO’s expenses. In addition, workforce and workload is another concern that I can think of. Since everyone has same right to come to hospital, such as COVID-19 outbreak, healthcare providers were overwhelmed by a surge in number of COVID-19 infected patients who required treatment and care.
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Maternal mortality rate (MRR)
Definition: the number of maternal deaths during a given time period per 100,000 live births during the same time period.
Calculation: (Number of maternal deaths/Total live births) * 100000
Main usefulness: MRR is an indicator reflects on the capacity of health systems that effectively prevent complication during pregnancy and childbirth. In addition, MRR is considerable on overall health status or quality of life and key indicator of health care access and socioeconomic development.Neonatal mortality rate (NMR)
Definition: the number of infants dying within the first 4 weeks or up to 28 days of life per 1,000 live births in a year and geographical region.
Calculation: (Number of deaths under 28 days of age/Number of live births during the same period) * 1000
Main usefulness: NMR is an indicator of quality of care at birth in a country. It is also an indicator for child health and wellbeing. As well as MRR, it reflects socioeconomic development and access that children have basic health interventions. -
To be honest, prior to start studying BHI, health informatics was new to me.
From my perspective, health informatics in Thailand has not yet broaden and well-known. When I was a pharmacy student, nobody told me about roles of informaticians or how we participate in EMR. There is no chance of having an internship in this field. I think to have a greater health informatics workforce in the country, we should have a better educational program specially to cultivate bachelor’s degree students.
If we once introduce them, at least they know what health informatics is. Thus, those who interested to continue pursuing their career as health informaticians can seek for any opportunities such as internship program or master’s degree.In summarize, I think the challenges in my country are no cultivations of interest among individuals, lack of knowledges and skills for IT or healthcare professionals to work on health informaticians, career path opportunities, and educational program and training.
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If I were in charge of sharing data set of my country, I would consider sharing data set. By looking from the above, data sharing has pros over cons. However, there are my factors that needed to consider and ensure that data is safe to be shared.
My first concern is data security, including privacy and confidentiality, which could lead to right violation. We have to make sure that when we collected data, subjects acknowledged or consented that some of their data will be shared. Yet, prior to share data, personal identifiable must be de-identified first. Especially for an emergency or outbreak situation that needs data to be analyzed for a specific outcome.
Data security is another aspect that we have to count for data sharing. If everybody is able access into the data set, there are also chances of data leak and breaching. Therefore, limited access for some dataset must be implemented. For example, data that will be use among hospitals in the country, only those authorized from hospital will have access into dataset. However, we also have to concern of standardized format among hospital so that we can make sure interoperability between systems.
In addition, we must have data control mechanisms. This means that some data is available, but for some people that need to use it. For example, researchers send request form electronically for dataset A, when they meet criteria for dataset A. The dataset A then can be shared to researchers. Nevertheless, it has to be agreement and commitment not to forward data to others or use it for other purposes.
Furthermore, to maintain quality and integrity of data, we should perform data validation periodically to make sure that the data is kept originally and has not modified by someone else.
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From my point of view, implementing EMR has pros over cons. Below are what I think of advantages and disadvantages from implementing EMR:
Advantages:
– Ease for services and patients: patients and their care givers don’t have to carry document paper from one department to other departments since everything is electronically recorded.
– Enhance patient’s safety: for example, in my setting when assistant pharmacists don’t have to transcribe physician’s handwritten order into the computer program for ordering medicines. This potentially reduce transcribing error which is one of medication errors.
– Increase efficiency: patients’ medical records can be retrieved easily as just input hospital number. Thus, patients’ information can be used among departments (physicians, nurses, laboratory, pharmacy, or cashier). In addition, we can compare current medications ordered by physician versus patients’ own medication or medications from previous visit. This is an important step that pharmacists, who will meet patients at the last step of visit, can confirm the change that was made with patients. Most of the time, I found inconsistency between progress note written by physicians, order prescribed by physicians, and what patients acknowledged. Thus, this also enhance patient’s safety.
– Administrative and management: nurses can print doctor’s appointment from the program. In addition, medical records can be retrieved electronically without time consuming in finding 10 years ago paper-based medical records in storage area.
– Improve data quality: including data collection and integrity of data. Since we have to record information into computer. There will also be a must-filled item that cannot be omitted so, we can ensure that data is completely filled when implementing EMR. In addition, the locked access system to those authorized will ensure confidentiality of patient’s medical records.Disadvantages:
– Perception to change: it is important to know if users have good intention and perception of system changes.
– Workload: in an early stage of implementation, I can say that there are tremendous efforts to make it success. Users have to learn how to use the system, it takes time for them to get familiar with the new one. Instead of inputting information electronically, some people also write down into paper before transcribing into computer because lacking expertise. Thus, this could discourage new users at some point.
– Training: we must ensure that all departments and stakeholders that will get involved in the system have trained prior to system implementation.
– System availability: IT staff must be available at all time. Users will be at ease and don’t have to worry if they face any problem because they know that there are IT staff available for helping them.
– Infrastructures: not only hardware and software but also internet supply and power outlet. We must ensure that we have plan B when system down or network down.
– Financial: by implementing EMR, for sure, we have to invest a lot of money in many parts of the project including manpower and IT related equipment.
– Data integrity and confidentiality/ Security: EMR must have highest security system to prevent personal data leak to unauthorized parties or access. By having good security system, we can assure that patient’s medical records were stored confidentially. -
First of all, this paper is very good in mentioning how useful and important of big health data. Particularly when they mentioned that stent thrombosis in patient with CAD undergoing PCI was found through large-scale studies.
There are many challenges for research in using big health data indicated in this paper:
– Disease definition/ Unstructured data: disease definition may be varied among countries. By using clinical coding standards (such as ICD-10) in classifying diseases and health problem could help in heterogeneous of disease classification. Yet, the data from each EHR and sources can be different and could cause big obstacles in collecting and analyzing of data. Therefore, interoperability standards should be set among systems, hospitals, and stakeholders. This will ease data transfer and management.– Legal and ethical issues: especially when many countries have started to be enacted PDPA just like Thailand, or HIPPA rules which was legislated in the States. This could be difficult for future research in using patient’s data in the past. I would suggest that hospital should have agreement at first by asking for consent in sharing medical data for example, laboratory results or imaging results etc. In addition, we must make sure that patient identifiable information must be blinded prior to sharing. Nonetheless, the ethical committee should be in part in considering what research can or cannot do.
– Data security/ Data integrity: researcher team must have specialized IT staff in managing information and system security. The data system should have policy of access control and audit trail to make sure that data are complete, consistent, and accurate to original. Furthermore, backing up data method is crucial to prevent data lost.
– Data quality and missing data/ Data inconsistency/ Training: researchers must be well trained to make sure that data are completely and correctly collected. If we implement interoperability standards at first, we will have a set of information that must be collected from subjects. Thus, this helps in prevent missing of data. In addition, our lives would be easier by having IT helps in checking consistency of data. Most importantly, to solve missing data and ensure quality of data, researchers must also have competence and knowledge in data analytics with multiple testing, in order to know which methods could solve those complexities.
There are many more solutions and suggestions for each challenge mentioned above. However, some of them might or might not be applicable depend on real world setting.
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All the four steps recommended in the articles are good for fighting corruption, but I would like to add and modify something in those four steps. Some of those steps are practical in my organization as well:
– Having key stakeholders: the organization should have reporting system on corruption report. In my setting, employees can send an email or call to the team on what we have heard or have saw that can be misleading to corruption. By blowing the whistle on corruption, I believe people will not be reluctant to speak out what they know.
– Prioritize action: by having this step, we will know which problem or concern should be taking into account and which to develop solution or draw attention to. By having what matter most could make it easy to reach and solve the problem. The key stakeholder then can investigate into the point of report.
– Take a holistic view: this is a good step by seeing the overall picture rather than focusing on one particular spot or department. We should better have a third party come in part of investigation. To make sure that the things that was reported is not come from their own political issue within department/organization.
– Research community sets out: this is good by having outsource or organization conducting research on corruption to reveal what information they have retrieved. This could terrify those who corrupted somehow. In addition, I think this method could prevent future corruption in organizations as well. In my organization, they always have annual organizational survey which we can report on conflict, equity, or ethical behaviors of colleagues, supervisors, and workplace.
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Let me introduce you to the system when I worked at a hospital particularly in Oncology Pharmacy Department. Most of oncologists are familiar in writing chemotherapy order regimen as well as progress note. However, chemotherapy and biotherapy are considered as highly toxic and hazardous drugs to cytotoxic classification.
This kind of drugs need safety handling since transporting, preparing, and administering. As oncologist prescribed by writing, then assistant pharmacist and pharmacist are helping in transcribing an order (drug name, dosage, route of administration, frequency, etc.) into computer system. This step of transcribing can easily bring on medical error “Transcription Error” due to illegible handwriting or human error thus consequently caused harm to patient.
Therefore, the department has developed an electronic ordering system by creating classification of cancer, cancer stages, standard chemotherapy/biotherapy regimen, automatically calculated dose by BSA, next cycle date, provided pre-medication, home medication, follow-up date, and prerequisite blood testing.
In the early stage of system implementation, the rate of using are very low because oncologists were not familiar with electronic version but we extremely encouraged them to use because this is not only reduce medication error but also enhance standard care and safety for the patient. Two years passed by, the rate of electronic order used is gradually increased.
I think the barriers were stability of the system, familiar of the system to users, user friendly, completeness of regimens available for physicians, and the most important is how users accept the system.
Lastly, by implementing electronic ordering system, we can analyze data and speculate trend as well as rate of drug dispensation. We can also use this information as part of drug inventory management to prevent drug shortage that caused delayed treatment for patients.
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According to CISCO disaster recovery plan, procedures that I will include in the plan for my organization are:
1. Identification and analysis of disaster risks/threats: Power outage is one of the most critical risk that can be occurred in my setting (pharmacy storage for products that must be controlled temperature). However, system treats can be occurred if organization system is vulnerable and there is a gap for hacker. This will definitely effect the whole operation of organization.
2. Classification of risks based on relative weights: The risks mentioned in (1) can be classified into facility risks and data system risks.
3. Building the risk assessment: It is always good to have an assessment for risks. To prioritize the likelihood and impact that could happen. By having the risk that has highest score, it must be first concern.
4. Evaluation of disaster recovery mechanisms: After risks have been identified and assessed, we can evaluate suitable methods for recovery plan. For example, if temperature excursion occurred which it directly effect stability of the products. We should evaluate for products’ quarantine time, and recovery time in which how long the sponsor will allow them to be used again.
5. Disaster recovery committee: I think it is good to have disaster recovery committee in place. The roles and responsibilities for each of committee should be clearly defined for making it easier and smooth if the disaster happened.
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If I were able to implement high availability (HA) technology in HIS, I think its benefit not only for patients but also healthcare workers themselves and stakeholders involved.
First, patients can get prompt services provided by hospital uninterruptedly. By having HA hospital can also operate all the systems without downtime regardless how many patients were at that time. In addition, hospitals can be able to serve for unexpected circumstances to make sure that information are ready and available for those who need it.
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Thank you for sharing your view on dashboard. Your dashboard looks so clean and user friendly.
I like how you choose to display number of confirmed cases of each country by year as well as cumulative confirmed, recovered, and deaths were easily glimpsed on top. However, on selecting date range might be difficult for users because we don’t know when the start and end dates were. It would be good if you could provide start and end dates.In addition, I am not sure why there is no color showing on the map while the colors were range from orange to dark red depends on the total confirmed cases.
Yet, I like how you arrange reset, download report, and get the link next to each other on the top right. While filter buttons were put on other side of the corner.
Nicely done and great work!
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I agree with you on the color as well. Since early dashboards that were published at the beginning of pandemic. The colors were too harsh to the eyes and scared people by colors intensity.
One more thing I would like to add is about language:
If they want to use transliterated words, it should be all transliterated words. But the above dashboard reported “Jun” instead of “มิ.ย.” in Thai. For those who don’t understand English will not be able to know what does it mean.In addition, they use both “เข็ม = injection” and dose in the same box of cumulative vaccination record. Instead they should decide to use just either injection or dose.
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Thank you for your review and comments. I agree with you that some information in my CRF are somehow over collected and some has to be added. However, for the size of character, I intended it to be that way “dd/MMM/yyyy” because I need the site staff to write month in a capital letter e.g. JAN or FEB. Thus they all will be in the same way and format.
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In the past, as I remember, those who don’t fall into Social Security Scheme or Civil Servant Medical Benefit Scheme (CSMBS), will be categorized into the NHSO and received Gold Card to present at their primary hospital. But the gold card was discontinued, we currently use Thai citizen’s ID card.
What you asked about a gaming system.. It comes from when insurance companies launched insurance campaign packages only for COVID-19 infection, also known as “Confirmed, Paid, Done”. For example, if customers buy a package of 990 THB, when they got COVID-19 positive confirmed by PCR with medical certificate. Then they would be able to claim for 100,000 THB, regardless how much the actual payment is. During an early outbreak of COVID-19, there was a few confirmed cases in Thailand. But when there was a surge of positive cases, the insurance company started to bankrupt and not to pay for those confirmed cases. Yet, some people were tired to make themselves become positive because they wanted 100,000 THB from buying the insurance package.
You can read it more on cancelled their COVID-19 insurance policies
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Thank you for sharing your information. The program was great as you told.
I think it would be better if the government allowed ATK to be marketed and self test since the beginning of an outbreak. Yet, they should enact a price control policy for this issue because ATK price was so expensive and most of people couldn’t afford it. In addition, it makes financial burden to population to have PCR test only at the hospital. -
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