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Hi all, here is my Tanyawat Dashboard
So this is Malaria Dashboard from MalariaDataSource dataset using,
1.Scorecard ; Total cases
2.Control/drop down list ; Selected year, occupation
3.Control/slider ; Age
4.Control/Advanced filter ; Search Province
5.Donut chart ; % case by species
6.Bar chart ; number of cases grouped by month , year
7.Google Map ; number of cases by province (1st level) and district (2nd level)
8.Control/button/Download reportPlease feel free to comment. Thank you so much
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https://snipboard.io/lIwRhT.jpg
This is Covid19 Dashboard of City of El Paso,Texas,USA, captured from situation in September 2020.
Main link resource : https://www.epstrong.org/This is one of those dashboard that catch my eye, probably from its partition and color theme, different types of chart but simple and familiar, not overcrowded information for the local people.
The font that they use is easy to read. There are picture/icons that represent some keywords. The scale of situation is clearly seen and like 1-sec wrap up for people who read.
The pie chart, bar chart, line chart are properly used, for estimation value, comparing between area group and also looking the overall trend of disease. I think the light dot grid here is kind of good example to use the grid and they choose one color with different intensity instead of different colors, that makes reader to be more focus.
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Nice work. Your CRF is very detailed. All the important variables and values are included and relatively grouped. The pattern, font size and format work very well.
I would like to point out few issues that could be adjusted,
– Demographic; Race/Ethnic could be added. Since study sites are in Bangkok and Chiangmai which are quite diversity community and that might affect the pre-vaccinated immunity status.
– The open-ended part could be reduced. The “if, please specify…” condition in many part of this CRF might not affect the outcome objectives.
– To minimize the redundancy, some questions in this CRF could be screened out. For example, the criteria in the eligibility part along with the assessment of eligibility part.
– Cumulative form is interesting. However, it could be arranged in multiple answers of associated disease that might be risky, for example, bleeding tendency, immunocompromised host, CKD. It might be more user friendly for data collectors if it’s put after page 3. -
One of the studies that I experienced, it was retrospective study that collect the data from EHR. We used a web application called REDCap to capture the data and create database. eCRF was developed there and assigned access to specific data collectors (me and another colleague). This REDCap has a built-in audit trail that logs all user activity, all pages viewed by every user and changes made by users. We need an account log in for REDCap and project manager has to add you in that particular project so that you can enter the data. In the eCRF developing process, we can assign some conditions to create some level of automated edit check, such as value range, if../condition. We didn’t do a logical check. When we finished data collection, we exported into Excel sheet that kept in a limited access shared folder provided by institute and managed by project manager.
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Date of Birth variable;
Date of birth here might be unnecessary and it is also one of the indirect identifiable data. We could check the participants’ ages in the screening visit whether they are in 18 to 60 years old or not. Also, we can just put “year of birth (yyyy)” instead of full date of birth. -
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According to data management workflow, 60-70% were done in my project, the steps that have not done or incomplete and need improvement;
For the project initiation;
CRF/DMP development/ Edit checks programming; we don’t have a full completion of instruction manual and official DMP. It’s just a final draft use among investigators. We don’t have edit check programming. We should write a complete instruction manual and for each research study involved in joined project should have DMP for their projects. For the large project and sample size, edit check program will improve the data quality.For study conduct;
Data entry and QC; for questionnaire part from teacher and parents, we only written the instruction at the head of the survey document. There are some missing surveys that we try to track back to the school. The QC steps is quite unprofessionally done, it’s investigator-dependent. We might need an in-person meeting separately with the teacher and talk about the questionnaire in details and we should have focus more on data QC steps by steps, especially the large study project.For study closure;
Data standards; We applied the standard criteria for risk definition based on particular subjects such as criteria for ADHD, for joint hyperlaxity. For research study like clinical trial, we should select and follow proper standards coding.
SAP: again we didn’t create the official SAP ahead, we actually think about it in details like table used after we get the data. We should think about SAP in details, so that the analysis part will be more precise to the question. -
I would like to share fun experience of data collection from the group projects that I’d joined. Since we had a couple research studies related the pediatric orthopedic diseases and their risks (such as ADHD, obesity, joint hyperlaxity, limb unequal and deformity, Perthes disease) that need information for control group of healthy children subjects. So, we merged all the needs and conducted the musculoskeletal (MSK) screening project for around 400 kids at the elementary school nearby the hospital.
1.Purpose of data collection : for research study
2.Was it primary or secondary data collection? : primary data source collection
3.Methods used for data collection
The research setting is field-based with a setup environment at the school. This screening project includes (1) Self-administered questionnaire for the parents and (2)for the teachers and (3)physical examination by us (5 physicians; orthopedic staffs and residents). For the questionnaires, we sent the short survey document to the school at the time we sent a consent form, each classroom teacher will distribute a consent form with a short survey to the parents. On the field day, we set up the admin station (teacher gave us a list of students that had parents’ consent and our admin then put the study ID on the list and sticker study ID to the subject) and physical examination station (we use paper-based CRF to record the clinical data)4.Were there any problems that occurred regarding data collection?
There are several issues for consideration for this project;
(1) Material cost; since all parts we use paper-based CRF and also the cost for setting up a field for on-site collection
(2) Require data entry; we have to entry all the data from CRF into the database(excel sheet)
(3) Low response rate and missing data; some of the survey from parents were missing, since it self-administered they returned only the consent but not the questionnaire or incomplete information.
(4) We trained investigators clearly for step examination and it was interviewer-administration, so, this part is quite completed. But some kids are not well-cooperated, some information of physical examination might not be accurate. -
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I would say “No!” to the point 14 on page 342 stated
“One should always use two-sided P values”In some practical situation, we can only go on one direction. For example, when we are testing whether a new drug impairs renal function by measure serum creatinine. It will never be decreasing serum creatinine scientifically. So, this case might be appropriate to use one-sided P value, which tests the null hypothesis that this drug does not increase creatinine level meanwhile two-sided p value for this example, tests the null hypothesis that drug does not alter creatinine level.
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I totally agree with all classmates’ opinion. With the concept of extension of the TAM including social influence and cognitive instrumental process, I’d like to add on example to be more specific, there are several of external variables that might influence an individuals’ perceived ease of use or perceived usefulness of a new technology, in order to be studied or objective monitored. For example, personalization, collaboration environment, utility, price, design, interaction during technology usage, faith of application, quality of content of that new technology, information offer and technical support function.
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Efficacy is the ability to create the expected effect of a given intervention under ideal, very specific and controlled conditions. For example, drug efficacy, vaccine efficacy. It’s rarely used this term outside of pharmacological and clinical trials. Effectiveness is about how well the intervention works in the real world, outside of the perfectly controlled conditions. It like to test how much the results of efficacy trials are applicable to practical life.An example of medical research and its measurement, in asthma trial, efficacy measurement is FEV1 and effectiveness measurement is hospitalization rate.
Efficiency refers to the ratio of output to the input, the cost-effectiveness of the intervention. For example, two drugs could be equally effective to improve patients’ symptoms in the real world, however, if one drug is more costly, that one is less efficiency.
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To figure out why respondents are not using bednets, I’d rather start from literature review. This topic is quite common problem, about mosquito related disease prevention. So, there might be previous published literature in large database such as Pubmed, for the reason or barriers to bednets or mosquito net use. Then with those information, probably there are main factors such as , social factor, individual factor, environment/temperature factors, and bednets availability, we can further dig and sort out the proper approach for particular factors in the list. Then we can conduct a cross-sectional survey of barriers or factors in not using bednets, we will get quantitative data. For understanding more on some factors, we can now conduct some qualitative data for example in-depth interview with head of the village, focus group discussion with those who use and those who do not use the bednets.
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Employment status could be one of confounders that associate with this finding. Those workers and employees, assumed that they are in working age group, they might be assigned from their organization to use a contact tracing application. While self-employed or retired group, they might use this app less, so, the contact pattern found less active.
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Maternal Mortality Rate
Definition
The number of maternal deaths during a given time period per 100,000 live births during the same time period.
* Maternal deaths: Female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy
* Live birth: The complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached.Calculation
In the same period; (Numerator)Number of maternal deaths/(denominator)Number of live births, multiplying by 100,000Usefulness
It captures the risk of death in a single pregnancy or a single live birth. It is often used as an international indicator of the health of a population overall.
For the global concern, it reflects inequalities in access to quality health services and highlights the gap between rich and poor countries. -
So in my setting, a large public healthcare institute, we have been strictly following governance policy, then transformed into action plan on our organization policy which mainly controlled by hospital infection control (IC) unit and then also adjusted to department policy level. As a worker under department and hospital policy, here are some issues that I have observed during COVID-19 pandemic
Beneficence/non-maleficence : All department follow the hospital policy and guideline, but in fact we have different context of work and environment, so for action plan, each department has its own control policy of COVID-19 to achieve the most benefit especially for the safety training and services for everyone; patients, doctors, residents, nurses, medical students and also back office workers.
Transparency : As the pandemic situation still continue, there are new statistical evidences published and it’s dynamic, the policy was contributed based on those scientific data and clearly documented. The action plan is clearly informed to follow, in term of resource preparation for providing service both treatment and vaccination for patients and workers.
Justice : the control policy of COVID-19 has to be fair for everyone. The hospital provides prevention supply (eg mask, gloves, ATK kits) for every level worker in the hospital. They prepared proper vaccine for all and everyone can access the proper treatment. Control policy is strictly used by everyone in the workplace.
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Universal Health Coverage (UHC) scheme or 30 Baht scheme has been a game changer in healthcare coverage for Thai citizens as Dr.Preut mentioned. As it has been establish since 2002, I have a chance to experience along the growth of it as a Thai citizen, a family member of the patient under UC and also a provider in tertiary health center who treat patient under UC.
What works…
Talking about availability, like all Thai citizens including registered tribe in Thai have basic right for health coverage (UHC/30Bath scheme) to access primary/secondary care locator assigned based on national database address.For easily accessible of healthcare service alongside with improving primary care system, we’ve been struggled with extremely workload for all level providers and staffs involved since the beginning but as scheme continued to improve in all dimensions, the capacity of primary care system has been increased and I think this is one of key for successful scheme. Primary care unit plays important role in simple treatment and health promotion like vaccine program, home visit program for patient with chronic disease and also key success in handling services during pandemic for mild cases.
UHC benefit package itself and UCEP, also coverage of accident case. This provides equality of quality healthcare service especially those who are in critical period or accident.
However, in real world, there are some limitation…
Distribution of quality of healthcare service is still limit. Base on the location, people who lives in the same area of secondary and tertiary care can rely on more guarantee public services. Even though there is referral pathway from primary to other level care, those secondary/tertiary care facility have been limited compared to excessive demand. The referral documentation is also another hard part in some area.To add on Dr.Preut’s comment on UCEP that cover critical period 72-hr then transfer to the public hospital, in reality, this seems like ideal situation, actually the coverage part occurs majority in emergency department for resuscitation but not including further investigation for diagnosis and definite treatment and later on the referral process is quite difficult and takes time and patients have no choices and need to pay for the rest of hospital course.
To practice in trauma center, for surgical treatment that need implants, 30 Bath scheme package actually covered those basic implants, however in some particular cases that more complex pattern need special equipment for the best outcome like plan A. There is a co-pay amount, some patients can’t effort that. This is kind of challenge to go with plan B and sometimes those center itself have to cover some part aside of UHC.
What needs to be done…
In my opinion, there are several important issues to make it works; efficiency of budget management; interoperable database system implementation; improvement of primary care system; collaboration of local partners/stakeholders; improvement of referral system; improvement of health workforce (salary/training);and governance support more reimbursement items such as high-cost drugs and implants for at least in secondary/tertiary care. -
In my opinion, even though in some part of Thailand has developed and implemented health information technology to their system, overall knowledge and supply is still inadequate and has a long way to go.
As it is still preferable level not mandatory level and depend on local investment.Challenge#1 The importance of health informatics This refers to government support and also individual perspective. We currently have professionals in the field in national level and they all know how importance of it but people doesn’t, in general. Governance should highlight, acknowledge and promote more to the public and also support and invest in technology implementation nation wide. For individual, for example, in the college or university, we should put this field in the educational guidance, let students know its existence, it might start in related program such as health care, data science or IT field, that they can extend their knowledge into the health informatics field and get a job.
Challenge#2 Health informaticians community I believe there is still limited professionals in health informatician in Thailand. Since we still in developing and implementing health informatic system nation wide. With the human resources limitation, someone with potential, could be IT guy or physician, has been picked up and chosen to do this thing but not a well-trained person at the beginning. So, there might be lack of continuity and synchronicity in a way to run system smoothly. In the future, if there are more professionals and related in the field, whether they are trained aboard or in Thai and they pack together to form community and share resources in person or online, this could help and support health informatics workforce in every aspect. Also, we can spread the basic knowledge of health information usage to public users, since we are living in the era of information and technology.
Challenge#3 Training program in Thailand As I know, now we have probably less than 10 programs in health informatics and related in Thailand. So in general, we are still small group of people and inadequate resource available but I strongly believe that with the trend in healthcare combined with data science technology and digital transformation technology these days, this field will rapidly grow and expand. I think every health organization should provide at least tier 1 for all the staff involve in the health system.
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“If you are in charge of a data set from your country, will you be thinking about data sharing and why?” Share or not to share….
In my opinion, data sharing has pros more than cons. So I will go with sharing but with condition, considering what, when, where, to whom, to minimize the cons side.
1. Under the consensus Policy :There should be the same rule and regulation in general about data sharing in governance level, such as PDPA Law in Thailand. And also in particular organization, a research society, we have ethic committee or IRB that regulate and monitor part of participant consent.
2. Respect the consent and confidentiality : Besides the law, we talk about the consent, because every data has its owner, the importance of de-identification to minimize harms at individual level or community level.
3. Data Standardization : To be able to make the data the most usefulness, Data should be in the standard format, general variables, not too complicated software.
4. Commercializing of data : As I watch the panel discussion, this issue got my interest, I think if the dataset is reused for another project to profit any business, they should pay for it. But note that the content is under de-identified and structured data format. I agree that we should have mechanism for cost recovery and formula for charging data. -
In my hospital setting, using EMR for a decade, I would say it is worth implementing technology in health system.
Advantages
Better security
– Medical records are contained with confidential patient information. Electronic records can be protected with robust encryption methods to keep crucial information secure.
– With EMR system, we can grant access only to authorized users. We can control who can access the information and when and also monitor Or audit trail to tracking if there’re misuse in the system.
– Data backup after disasters is one important issues that EMR could cover better then paper-based records.
Better service quality
– With EMR, multidepartment clinics can share related important information of patient in order to create holistic approach care.
– It can reduce the frequency of medical errors such as, unclear handwriting medical prescription, duplicate order testing.
– We can set clinical decision system to alarm or alert, for example drug allergy alert pop up box.
Less time and space and cost
– Digital record need less space for storage and easier to pull up when needed. We could access from any devices with authorized account instead of making a request for past medical record that is not available in the moment.
– The system could reduce overall operational costs in long run.
Research support
– With benefit of systematic storage over long period, we can use those information in many research, make it easier to conduct long-term clinical researchChallenges and barriers
>> EMR implementation period : initial phase was quite challenge for all of us as users especially senior staff. It took time to get use to the system and of course disturb workflow in the clinic.
>> Currently, everyone are familiar with the system, the issues in everyday use probably from the system interface itself and IT support. There are still developing and upgrading more functional tools and interfaces. -
There are several challenges mentioned in the article. In my opinion, there are 4 main points that should consider to cover those issues, whether organization level or governance level
(1) Recruit skilful professionals
– Big data analyst professionals
– Cybersecurity professionals
– IT professionals(2)Increasing training program for everyone in work environment
– Those professionals could held workshop and seminar for everybody at least to proper handling data regularly, knowledge in storage, importance of data management
– Particular training in big data handling for clinicians or researchers to gain more skills
– Practice in cybersecurity; data encryption, identification and access authorization control, real-time monitoring, endpoint security(3)Invest in digital technology, for example
– Software automation tools or knowledge analytics solution powered by AI/Machine learning to handle big data to help in data analysis and interpretation
– System security maintenance such as Big data security tools (IBM Guardium), endpoint security implementation(4)Conduct proper research methodology with well-designed statistical adjustment to prevent or reduce bias
– Review the literature carefully in order to specify more proper scientific subjects, related dataset variables and sources
– Prioritize in using randomization selection
– Consult the expert for addressing the confounding with several advance statistical techniques
– Use software automated tools, which contain pre-built APIs for a broad data spectrum -
First of all, thank you for bringing up this challenging topic and encourage us to think about it.
In my opinion, all four recommendation in the article are important.
Convene key stakeholders: Find consensus among the stakeholders. This sensitive issue might be approached in each system differently. The result of agreement could be in form of law for particular critical action, organization policy for rules and punishment or organization culture for routine practice. The support team for the victim and confidential report portal are also essential.
Prioritize action: Since there might be a lot of corrupt practices at a particular time and we probably could not handle all that issues, priority setting is always the key management. I do agree that this should be guided by the impact on health system and feasibility of success. Honestly, the most difficult situation is in the case corruption from executive officer of that organization.
Take a holistic view: Although a multi-disciplinary view is essential, majority response should come from healthcare committee, since they know what is matter the most. However, sometimes third party who had that power might be a real key to initiate the change.
Research community sets out four broad paths on corruption: Various evidence-based report will make this issue more academic than dramatic. It will lead us to the real anti-corruption action plan and can be used in development of new social standards as well.
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I would like to share an example of improving quality care in clinical practice from my organization, called “Early hip surgery fast track”.
Morbidity and mortality of elderly hip fracture are quite high. These patients have complicated medical condition and trend to need special pre/postoperative care, delayed surgery and prolong admission with complication. With multidisciplinary care team including cardiologist (assessment, echo) radiologist (doppler US screening DVT), anesthesiologist (regional block), orthopedist/trauma unit and operative team (additional available schedule), we developed project called “Early hip surgery fast track” which aim to surgery within 72 hrs using developed protocol system and particular clinical practice guideline. This project reduces morbidity and mortality rate, improves service quality and safety, reduce hospital cost and improve bed occupancy rate and resource management.
This facility setting commonly occurs in private practice. Fortunately that we successfully run this protocol in public hospital under UC coverage. We did face the barrier at the beginning especially “people” since they have to do an extra work. As the project continued, everyone start to use to it and gain more skill in every steps.
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What procedures should be included in the plan? What technology is suitable?
In my opinion, a disaster recovery plan for organization’s information system should include following elements;
(1) Creation of a disaster recovery team/committee including team member, contact information and roles, reporting hierarchy
(2) Proper identification and assessment of disaster/risk including list of disaster affected entity, list of prioritized services
(3) Sourcing of different applications, resources, and documents including essential vendor/partner contact information, power options, data backups
(4) Clear information of backup and off-site data storage location
(5) Testing and maintenance of the disaster recovery planIn healthcare environment, for hospital running 24/7 services with essential data that need protection, backup is the main technology to be used.
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Implementation of High Availability (HA) technology in Hospital Information System (HIS) would benefit patients and hospitals in several ways; in summary,
Start from increasing patient care service quality, digital health information has been used in every single steps nowadays for particular department and also interoperability.So data availability is one of the key important. HA technology will help and ensure that IT system can be able to run effectively with least disruption.
In terms of business running, HA technology implementation might cost a lot of budget, but when comparing with disadvantage and loss from system failure or disruption from any causes, it could be the most cost-effectiveness investment.
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Considering some STEEP factors related to healthcare resources during on-going COVID-19 pandemic, an uncertainty and very challenging situation;
Social
– Increased in self-healthcare in general, whether awareness of the corona virus or other diseases due to less hospital access. On the other hand, non-covid patients with chronic disease might get worsening condition
– Increased healthcare staffs burnout both frontline workers for massive workload and non-frontline workers who are allocated to non-critical location and loss their routine activities.
Technological
– Increased in quantity and quality in healthcare IT system, e-health, m-health such as telemedicine adoption and there is more collaboration among different stakeholders in technology development .
– Increased in advance research and evidence-based information in IT healthcare field to improve the existing system and deploy new innovation
Environment
– Increased in infected waste product from healthcare system and dealing with its regulation
Economic
– Expansion of insurance reimbursement options for the treatment itself and vaccination sequelae
– Massive spending on support in healthcare field (infection control, investigation, treatment, medication and vaccine, all supply and equipments, healthcare IT implementation) instead of other dimensions
Political
– Changes in government regulation of healthcare such as increased documentation requirement, reimbursement policy
– Push and enhance local/primary healthcare system to increase higher performance -
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Thanks for sharing an experience in real clinical trial. Self-administered diary especially in this study, about AEs is kind of open question and there are various symptoms that could happen whether related or not, this might prone to missing data due to too much details and misunderstanding the instruction. In diary development, written clearly instruction details using more simple content and language and also run the diary test before using might improve this part of data collection.
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Totally agree with you mentioning prioritize issues. In term of training researcher or clinician in data science management, particular in big data and machine learning, it might be a big challenge as it needs quite time and experience to be an expert. Investment in hiring data analyst professionals might probably be an effective option.
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Fantastic works, both Gantt chart and flowchart. Thanks for sharing.
Both are creative, very detailed and easy to follow. With these Gantt and flowchart, everyone in the project would know their specific tasks and work along with others smoothly and you could easily monitor all the processes throughout whole three years. -
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