Teerawat Pholyiam

[Teerawat Pholyiam]

Yes, I will plan to move the hospital’s information system to cloud computing for sure. Because, the cloud computing can expand patient data storage or integrating new healthcare applications e.g. if a hospital needs more storage for patient records due to an increase in patients, the cloud computing can provide this additional storage instantly without needing new physical servers. This can access easily, for example health care providers can access a patient’s medical records remotely via the cloud at anywhere and anytime which is beneficial in case of emergencies or for providing care in different locations. And the cloud computing reduces the need to buy and maintain expensive hardware, a hospital can use cloud services and only pay for what they use. Additionally, in case of a disaster like a fire or system failure, cloud computing can quickly recover lost data. For example, a hospital’s patient records stored in the cloud are safer and can be restored faster compared to on-site servers. Lastly, a hospital can let cloud providers work as IT management and hospital staffs can concentrate more on patient care or other tasks.

[Teerawat Pholyiam]

Yes, my workplace is company where they build software of collecting data in clinical trials, I have been informed to deactivate external users in EDC system for site in US, their clinic has been hacked data and emails. IT at my workplace asked to stop or action anything in case of this clinic sends emails to us, except answering phone calls.

As heard that Site was unable to access emails and their computer, this is a security breach that unauthorized individuals may have gained access to sensitive information, and might be potential to gain access into other systems from their computers.

Actions from my workplace was to deactivate their EDC access of these external Site’s users and monitor/delete incoming emails from this site immediately, to prevent any potential risk. Next steps are to ensure that the breach of this site has been resolved completely and clinic’s systems are secure enough before to provide new login credentials of EDC system from my workplace to them as well as to advise/train site users to secure their login credentials safely e.g. additional training on recognizing data breach attempts + using multi-factor authentication (MFA) for any logins or requests could add an additional layer of security. Including, to monitor and detect any unusual activity on EDC system, IT team reviews to strengthen the security measures of both the clinic and the EDC system e.g. firewalls, intrusion detection systems, and regular security audits. Lastly, to make sure the response to the breach aligns with legal and ethical requirements that may be relevant to laws like HIPAA or GDPR.

[Teerawat Pholyiam]

Based on my experiences regarding to collecting patient’s eDiary reports in Clinical Trials via ePRO app, I would like to build the ePRO app for Oncology Care department which is able to focus on Patient-Reported Outcomes (PRO), this could help to monitor symptoms, treatment, follow-up or provide any health care guidance, especially chronic and long-term care settings like oncology.

The ePRO app for Oncology Care could be built through mobile application as well as on web portal due to this can be used in case of the patients who do not have or have difficulty to utilize the smartphone. Several channels of ePRO app building should be implemented in case of the server outage and mobile app may be easy to log patient’s eDairy entries from anywhere at any time based on the requests. And eDiary entries could be captured in real-time triggering which is helpful to monitor for urgent matter like Adverse Events. Additionally, the app could be implemented to log entries in case of having poor internet perception and the patients could be able to input data as offline; this could be synced automatically after the internet is re-connected e.g. use the ePRO app to log daily symptoms – nausea and fatigue for post-chemotherapy and then to manage side effects after received chemotherapy and long-term monitoring.

The ePRO app can be captured patient’s eDiary entries in real-time + in case of patients have any urgent matters, the app could be able to monitor and alert the patient’s symptoms + be easy to communicate/provide health care guidelines to patients + benefits to patient outcome reports for analysis and data management.

[Teerawat Pholyiam]

Hi everyone!

My name is Teerawat Pholyiam, I’m currently working as a remote customer support representative in Canada for a software provider specializing in clinical trials for over four years. I have gained extensive experience in this role. Last year, I enrolled in the MAP-C program and I am now nearing the completion of my credits towards earning a DBHI degree. My company develops and provides a licensed Electronic Data Capture (EDC) system along with other healthcare modules for digital data collection. We support numerous sites globally with assistance in multiple languages.

Through my work, I have had the opportunity to utilize various modules such as CTM tracking, eConsent, ePRO, eSource and Data Export portal. These experiences are closely related to the health informatics courses I am taking and they will be advantageous as I pursue my educational goals and seek to deepen my knowledge in Clinical Data Management and statistics.

Feel free to reach out to each other if have any questions and look forward to attending the class with you All! 🙂

[Teerawat Pholyiam]

Based on my experience that is working for an Electronic Data Capture (EDC) system, I found problems for improvement, this is potential to enhance the EDC system which is focusing on the key components of an Information System:

1. Hardware – An EDC system is running on older servers that cannot handle the increased load from more studies have conducted, this may be the cause of slow system responses and delays in accessing the system during peak usage time. This problem should be implemented to redundant servers and storage systems to ensure that if one server fails, another can take over + use Cloud based technology + schedule to replace hardware upgrades in every 4-5 years.

2. Software – An EDC system has an outdated user interface that makes it difficult for users to navigate or utilize and this may be the root cause of data entry errors. To improve this, the EDC system should be implemented for user-friendly e.g. easy to use for dashboard, clear data visualization, this could reduce errors for entering data and repeating training requires. One more thing is to populate the notification alerts of routine tasks like data validation, query generation, and report generation. This can help reduce too much workload for users.

3. Data Management – Data is stored in multiple locations with little to no synchronization and difficulties in data retrieval e.g. there are main navigation tabs for both general Reports and Data export portal, for Data Manager role access often faces the confusion of accessing in the applicable reports. This could be implemented to centralize reports on main navigation tab in the system. Additionally, to implement the dashboards or alerts that can provide real-time monitoring of data collection progress and this can help to early detection of data issues.

4. Processes – Having too many steps for entering data into the EDC system that increase the chance of errors and slow down data collection, especially for Study Coordinator users who they have a bunch of data entry of subjects to be completed. I think that this could re-design workflow of data entry for site users by providing pre-populated fields or options that can lead or guide users to select quickly. Or may provide chat bot window to assist FAQs in case of site users they need further clarifications.

5. People – Users, they have not fully trained on the new features of the EDC system and lack of clear understanding, I think that this could be provided additional regular training sessions and workshops for users who require and one more importantly is to create an internal knowledge base or questions board/forum where users can share tips, ask questions or provide feedback on the EDC system. Feedback from users could take to review pain points and implement on the EDC system’s functionality, this can help to improve user experience and satisfaction.

[Teerawat Pholyiam]

1. How can integrating environmental data improve the accuracy and timeliness of malaria outbreak predictions compared to relying solely on epidemiological data?

I think, to improve the accuracy of environmental integrating environmental data is to provide early warning or alert notifications regarding to malaria risk before the urgent matters or outbreak will occur which is a predictive tool. And to improve the timeliness could be integrating satellite data on rainfall, the system can monitor precipitation levels across different regions. A sudden increase in rainfall can create stagnant water bodies which are ideal breeding sites for mosquitoes e.g. the system detects above-normal rainfall –> issue an early warning –> public health officials can then take proactive measures (distributing insecticide-treated bed nets and conducting mosquito control activities before the mosquito population increases.

2. What are the key benefits and challenges of involving public health stakeholders continuously throughout the development and implementation of a system like EPIDEMIA, and how can their feedback shape the system’s effectiveness?

For key benefits could be real-time feedback/engagement, all feedbacks from users are beneficial to system improvement and they can provide any issues/challenging to update the system e.g. collecting feedback/suggestions from the monthly meeting, this may be concerned to basic features for data upload, processing or reporting which could be system enhancement. But communication and collaboration may be a key challenge for different backgrounds of users/stakeholders or other e.g. language barrier, time zone and cultural awareness.

Feedback from users could be shaped the system’s effectiveness e.g. to implement tools/features which are recommended from users, make it more user friendly and align to users’ needs (to customize EPIDEMIA system that accommodate standard data formats) as well as this should be ongoing process of system enhancement.

[Teerawat Pholyiam]

1. In your experience, what are the biggest challenges to achieving sustainability in health information systems, and how can they be addressed?

I think the biggest challenges to achieve the sustainability in health information systems
in developing country seems similar to above ideas of classmates that are financial supports on external funding + technical resources and professionals. And I think, to address these challenges that may secure multiple streams of non-donor financing from national and local sources. Additionally, to build training programs can improve technical skills and build local expertise. Lastly, developing strategies for integration with existing health systems can avoid duplication and improve data utility to reduce budgets of the development.

2. How has EHIS been designed to adapt to changing needs and technologies in your experience? If you haven’t encountered this, what features do you think are important for adaptability?

I think, the EHIS can adapt to changing needs and technologies by implementing modular designs for gradual updates, incorporating user feedback and utilizing flexible architectures for easy integration and scalability as well as providing ongoing training and support.

The key features for adaptability include interoperability with other systems and scalability to fit varying facility needs, user-centric/friendly design for better accessibility and long term improvement processes based on technological advancement and user’s feedback.

[Teerawat Pholyiam]

1. Please discuss how you think the perceived ease of use and usefulness may differ among the different demographics.

Based on my experiences that related to assist users who use tech devices in healthcare, I’ve faced that younger users, they are more likely to familiar with digital world and they could find these systems easier to use and highly useful if they integrate well with their mobile-centric lifestyles. On the other hand, aging users often experience challenges due to less exposure to technology and physical limitations, but they may find the systems very useful if they address specific health needs e.g. managing chronic conditions.

For gender differences also influence perceptions e.g. men generally more confident and focused on efficiency, while women prioritize usability and comprehensive health management features. Also, for education level further impacts ease of use and perceived usefulness with higher education assisting with better problem-solving skills and comfort with complex systems, but lower education levels may struggle with navigation and require more straightforward information.

2. In your experience of using e-health applications or systems, what are some external factors or variables that should be considered to extend the proposed model for assessing the intention to use the system?

I think that to extend the proposed model for assessing the intention to use e-health systems, there are several external factors should be considered e.g. the availability and reliability of internet access and device compatibility + cultural attitudes towards technology and healthcare, including language support + the affordability of devices and internet services + user’s health literacy and ability to navigate the system + availability of technical support and user assistance + government policies on data privacy and security + the influence of recommendations from healthcare workers, family and friends.

[Teerawat Pholyiam]

1. From the results, What would you recommend to Tak Hospital to improve the syphilis surveillance system?

As per most of case populations are non-Thai speakers, I think to improve the syphilis surveillance system could aware and improve multilingual communication, this should be helpful to translate any materials and make sure they understand their diagnosis, treatment, following-up and other procedures. Additionally, mHealth (the mobile app) may be requireed to implement and provide services to patients for follow-up scheduling, notification reminders, providing guidelines as well as telemedicine should be implemented in services for remote areas for consultations and any unexpected circumstances if arise in the border area.

2. Do you have experience with disease surveillance systems? What are the strengths and weaknesses of that system?

No, I do not have any experiences regarding to the disease surveillance system, however what I can find the strengths and weaknesses that could be:

Strengths –> Up-to-date and real time data collection, this can help to analyze and provide the detection/response of emerging matters + The disease surveillance system can interact with the outbreaks immediately by implementing machine learning which have the ability to predict risk or reduce human error of the reports + Centric-data sources, the system could be able to integrate data from different locations, this help to reduce duplication.

Weaknesses –> Ethical and privacy concerns, patient personal data is confidential upon data collection + Lack of interoperability, different systems among organizations are barrier and time consuming to work on datasets + Lack of funds and sufficient infrastructure, no fund is a big challenge to hire professionals and build enough facilities for implementing the disease surveillance system.

[Teerawat Pholyiam]

1. How can implementing artificial intelligence technologies in epidemic surveillance systems be enhanced to better detect and respond to disease outbreaks?

I think, to enhance to have better epidemic surveillance is data sharing that data sources could be collaborated and exchange seemingly among different organizations/countries, this can expand a larger dataset for analysis and this can be effectively detected and responded to the outbreaks.

One more important thing is to real-time connecting and processing, this can help to respond and interact with one another quickly and efficiently, especially to monitor the detection of emerging outbreaks. Of this, advanced machine learning algorithms should be considered to develop the system in epidemic surveillance.

2. What potential benefits do you see in utilizing AI for public preparedness, and what challenges might arise in implementing these technologies effectively?

Potential benefits –> Early detection of early signs in epidemics by analyzing from a large of data sources + Ongoing monitoring, to keep eyes on in long term and continuously is beneficial to respond to emerging matters + AI can help to identify the areas at high risk with limited public health access + AI can help to provide the analysis needed and this could help to enhance decision-making processes for public health.

Challenges –> Infrastructure/technical issues, to implement AI technology will have to require expertise/professionals to support + Privacy concerns, the ethical awareness should be raised regarding to the collection of personal data from different sources e.g. social media + Long term maintenance by professionals are required for implementing up-to-date versions/technology of the system.

[Teerawat Pholyiam]

1. What additional factors should be considered to identify barriers and unmet needs in health information seeking among youth for HIV/STI and RH than in the paper?

I think, the educational awareness is one of base knowledge to support preventive behaviors (use of condoms, health check-ups, vaccinations) and this could be considered to identify and campaign to support the youth and they can make decisions for their health. For example, higher educational level/better critical skill generally get better understanding of health issues, including sexually transmitted infections that they could be easier and more convenient to know where to find accurate health information. The ways on how this should be improved that are schools/colleges should collaborate openly sexual education that covers HIV/STI prevention, reproductive health, healthy relationships and others + build community centers and gather family/teachers to provide workshops and knowledge of sexually preventive diseases + to connect with other people via social media + peer educator could be a good supporter to provide awareness and break down barriers when open discussions about sensitive topics.

2. Which types of vulnerable people in your community are missing or left behind in receiving necessary health information, and why? How can we best reach these individuals and measure the real impact of health information on their health-seeking behaviors to ensure its effectiveness?

I think LGBTQ+ people, because they mostly experience social stigma and discrimination that this can be a fear or negative reactions with society and that might be a root cause why they are away from accessing necessary health care as well as health information service should provide specific needs for LGBTQ+ individuals who they could be targeted individually such as hormone usage and mental health challenges.

So, friendly health centers for LGBTQ+ community should be established where they can seek health care information without fear + campaign LGBTQ+ by using rival languages from their community via social media. Additionally, the measurement of real impact could conduct feedback/survey and collect health outcomes to evaluate and analyze, to monitor long-term engagement and health care outcomes could be considered as well.

[Teerawat Pholyiam]

Question 1: How can the decision tree model be integrated into clinical practice to assist surgeons in preoperative planning and decision-making?

For the decision tree model is created to capture predictive patients with a high risk for massive IBL. I think, the decision tree model can be integrated into EHR system which is given automated risk management/assessment as a part of patient’s medical history (demographics, laboratory, and biopsy test result). This tree model should be helpful to evaluate quickly without manually entering data. For example, a patient has been scheduled for pancreatic surgery into HER system, then the decision tree model received this and can be calculated risk of massive IBL, an notification alert could be triggered if indicating a high risk of massive IBL. Surgical team looks into the alerts and may implement precautions and collaborate with other concerned parties, patient’s data which was recorded by the decision tree model could be ongoing monitor.

Question 2: What are the potential benefits and limitations of using this model in a real-world clinical setting?

Benefits can be the surgical team can benefit from planning for precautions of complexed issues + Reduce high risk of massive IBL + Reduce costs in case of the case may require for ICU + Keep patients informed about the decision tree model to make decisions of operation, this is to improve IFC process as well.

Limitations are to integrate the decision tree model into EHR system may be technically challenging and this could require budgets to set-up IT infrastructure + Surgeons and other concerned teams have to be requited to get training adequately trained and assess themselves with the system and model before moving to next steps + awareness of legal considerations e.g. confidential data, security, IFC and algorithmic bias (systematic and repeatable errors that create unfair outcomes).

[Teerawat Pholyiam]

Hi All,

Sorry for sharing this late due to my laptop outage last week. I would like to share my Covid-19 dashboard completion through Looker Studio with a brief explanation of how this dashboard aids decision-making:

1. Building interactive filters/controls in the same side, this can easily help users to focus on specific time periods and able to locate across different time locations and time periods + built navigations of filtering buttons can be easily utilize and locate of what the users need quickly and efficiently.

2. Using bright and clear color to visualize critical/unpredictable scenario that this may help users can feel comfortable and understand complexed information. For examples line charts show trends over time while bar charts compare different categories with bright color theme.

3. Highlighting key insights, a summary of key findings provides a quick overview of the most important information e.g. score cards on top dashboards without filtering any things.

4. All text and labels are easy to read, this can ensure that everyone can understand the data, no matter their familiarity with it, Additionally, using colorblind-friendly palettes makes the dashboard accessible to a wider user.

Covid-19 dashboard Link: https://lookerstudio.google.com/reporting/99cc0816-77bb-4b1c-8f70-539a9117b244

[Teerawat Pholyiam]

1. I am currently working with EDC system support, which has ePRO app is a part to collect data from subjects, but I don’t have any experiences regarding to work on/use any health care system to develop for NCD patients. As much as I found there are several ePRO apps in CDSS for NCD patients in remote areas such as Smart Asthma, MyDiabetes and so on, so based on my experiences of ePRO using as the following:

Advantages:
– ePRO can be easily accessed via smartphone in remote areas.
– Real-time response for data collection/ interface.
– Support patient centric care to let them participate/collaborate with their care that can improve further care outcomes.

Disadvantages:
– Remote patients have plenty of technical issues e.g. poor internet connectivity, no smartphones enough access.
– Risk of data loss or cyberattack due to lack of technology to support and has limited ability of app use understanding, that is concerned to sensitive data security and confidentiality.

2. Yes, I think it’s highly effective option to address the shortage of healthcare workers in remote areas nowadays because this way it’s cost effectiveness and easy to access and connect each other as well as to accessibly monitor and promote health care plans.

There are more alternative options, and one of to effective tools to promote health care system is Telemedicine, this platform can be enabled remote consultation with specialists to reduce too many patients visit on site for clinical assessment. For example, Telemedicine can work effectively in managing chronic diseases, diabetes and hypertension in remote areas.

[Teerawat Pholyiam]

1. I think, one of the idea to improve med algorithmic audits is long term monitoring/post system surveillance, this can continuously perform in safety and integrity of medical AI system after they have been deployed in the public. This should be helpful to identify and ongoing monitor in real-time to reduce risk/bias, monitor urgent matter for example to perform analysis of medical AI system for predicting cardiovascular risk to detect biases against specific demographic groups (age, gender or ethnicity) as well as to collect feedback from users (health care workers) to evaluate/observe any issues and improve the system e.g. AI medical development team may collect feedback from radiologists which report regarding to both positive and negative uses by AI medical system in imaging to define the algorithm.

2. In additions to above key characters from discussion topic examples in building trust/confidence is Validation to set the same standards of med AI system development, this could be also related to ethical standards.

Validation, this concerns to system testing to ensure that AI med system performance is aligned with standards setting and can be used in real-world situations, and expecting to be trusted in performance in clinical practices effectively. For example, the mPower Heart Project that was presented by Phyo Thu Aung in the same week, showing that this system has been validated through randomized control trails and demonstrated in reducing systolic blood pressure and managing blood glucose levels effectively.

[Teerawat Pholyiam]

It’s working now! Thank you so much Kansiri! I’ve also experienced this issue that is very helpful upon trying to export the files. Really appreciate krub. 😊

[Teerawat Pholyiam]

Thank you so much for considering our feedback, Ajarn Chawarat! Additionally, I would like to suggest adding clearer example screenshots to the QGIS instructions. It would be really helpful if these images were clear when zoomed in to view and this may help us to follow each step while reading the detailed explanations. I experienced some difficulty with this during the Week 2 practice if these screenshots are clearer, more visible that would greatly aid in understanding and completing each step. 🙂

[Teerawat Pholyiam]

Hi Nicha! I confirmed that I have tried to join and look into this for few times, it seems like the column of “2015_Total_malaria” has not been displayed based on original file as well as I submitted the completed assignment 2.3 without having “2015_Total_malaria” column in the report. Hopefully, Ajarns may provide further information/clarifications for this issue that whould be really appreciated.

Thank you in advance krub. 😊

[Teerawat Pholyiam]

Thank you, Nicha, for providing the idea of QGIS installation! I was also trying to install QGIS a few times and failed. Then I tried downloading it again, closed all existing browsers, and restarted my laptop. Finally, this time the installation was completed successfully. 🙂

[Teerawat Pholyiam]

1. Features could further improve the accuracy of predicting PIH:

Based on my experiences to see CTM Tracking module that is a part of RTSM Team in clinical trials sector, I would suggest the Drug Administration/Monitoring Data feature to monitor or capture records of anesthesia drugs and their dosages, especially real-time changes in drug administration, this may help to improve the model’s ability to predict hypotension e.g. timing and dosage type/amount/ method feature of vasopressors or other cardiovascular drugs administered during surgery – this can help to provide real-time decision making by predicting the interventions.

2. Enhance the predictive model’s applicability across various surgical procedures:

To enhance the model’s applicability, the research directions could be pursued real-time monitoring to provide continuous risk assessment and decision support during surgery. For example If the model predicts a high risk of PIH, the system should be triggered an alert for the surgical and anesthetic team – alerts can be visual as flashing lights on the monitor or alarm sounds.

Additionally, the system could be conducted as randomized controlled trials to evaluate the effectiveness of the predictive model in reducing the incidence of PIH and improving patient outcomes when used in clinical practice.

[Teerawat Pholyiam]

1. Stakeholders who should be involved:

1.1 IT workers or data controller/health informatics, they take responsibilities to design and implement the IT infrastructure necessary for running machine learning models, including servers, cloud services and data storage solutions and to ensure that the infrastructure can handle the computational demands of training and deploying machine learning models. Also, they could do manage databases that store patient data for ensuring data integrity, security measures and compliance with healthcare regulations such as HIPAA. Including, to optimize long term system performance by upgrading hardware, improving software and resolve any technical issues that may disrupt the operation. Lastly, to train healthcare staffs on how to use new IT systems and machine learning tools effectively.

1.2 Regulators, they will ensure that the machine learning system complies with legal, ethical and safety standards before and after deployment for example they should develop guidelines for the development, validation and deployment of machine learning systems + establish protocols for validating to conduct thorough reviews of the machine learning system’s documentation before approving it for use, especially to ongoing monitor to ensure the system compliance with regulatory standards.

2. Potential ethical considerations should keep in mind deploying machine learning models to predict cancer symptoms:

For Security + Data Privacy, this is to ensure that the protection of patient data and maintaining the confidentiality and integrity. For example of access control, clinicians can view and update patient data, but administrative staff can only access billing information. So, conducting audit logs should help to identify and investigate suspicious activities.

HIPAA compliance could be applied to ensure this system aligns HIPAA regulations by implementing appropriate administrative and having technical safeguards.

[Teerawat Pholyiam]

Hi All, below is screenshots of my completion for data visualization using Looker Studio.

You can view the full reports here:

Running sum and comparison https://lookerstudio.google.com/s/l798uZIiZ9U
Running Delta https://lookerstudio.google.com/s/vcD3i-UXwWI
Drill Down and Date https://lookerstudio.google.com/s/vcD3i-UXwWI
Pivot Table https://lookerstudio.google.com/s/hFrBuvHg2mg
Score Card https://lookerstudio.google.com/s/okTmGP_U7o0
Time Series https://lookerstudio.google.com/s/ibwXqKUH70o
Bar Chart https://lookerstudio.google.com/s/o6-Gp66p2Zk

[Teerawat Pholyiam]

Institute for Health Metrics and Evaluation (IHME) COVID-19 Projections Dashboard

URL: https://covid19.healthdata.org/global?view=mask-use&tab=trend

Likes:

1. Users can explore different scenarios, like the impact of mask usage + and other social distancing measures.
2. Help in comparing and understanding important patterns and trends e.g. users can easily see how different variables like mask usage affect infection rates over time.
3. Provide extensive data on infection rates, hospital resource use and mortality e.g. dashboard includes comprehensive datasets that enable in-depth analysis and reporting.
4. Enhance understanding by providing structured and familiar information e.g. line charts and maps helps users quickly understand complex data.
5. Users can select regions and view trends over time e.g. interactive maps give users to focus on specific areas of interest.
6. Include line charts and maps for data presentation e.g. users can choose the visualization method that best suits their needs, it’s tracking trends with line charts or geographic spread with maps.
7. Data is updated frequently + ensure current information + maintain relevance and accuracy in reporting e.g. regular updates keep the data fresh and reliable.

Dislikes:

1. Can be overwhelming for casual users or those unfamiliar with data analysis, because detailed projections and extensive datasets may require a steep learning curve for non-experts.
2. Might require a learning curve to navigate effectively e.g. users may need time to understand how to use the interactive features and interpret the data correctly.
3. Interactive elements and extensive data can cause slow loading times e.g. high data volume and complex visualizations might lead to performance issues.
4. Could be an issue on less powerful devices or slower internet connections e.g. users with limited technical resources might struggle with accessing and using the dashboard efficiently.
5. Projections are inherently uncertain and can change with new data + this might find this aspect less reliable compared to actual reported cases + projections can vary widely based on new inputs which might be confusing for some users.

[Teerawat Pholyiam]

Hi Soe, thank you for sharing your CRF completion. You did quite well, but I would like to suggest adding more ideas that could be helpful as references for creating a CRF.

FYI – this is better if Demographics should be separated from Eligibility section in CRF creation, it might be easier to collect and enter data and reduce error upon completion.

Furthermore, please allow me review and provide more information of improvments of your CRF creation due to the classmate who I have been assigned to review, they have not submitted the CRF completion yet.

Demographics:
• Each CRF should have a standardized date format e.g. DD/MMM/YYYY to be collected for any assessments
• Recommend to use the format of subject ID: site(2 sites for this study) – subject number (150 subjects in each site) e.g. 01-001, 02-001, 01-002, 02-002… until 01-150, 02-150
• May require to collect the year birth for recording
• Should have options for gender and ethnicity

Eligibility Criteria:
• Should create all options for Inclusion Criteria (4 choices of criteria) and Exclusion Criteria (7 choices of criteria), this will ensure that each subject will be proceeded further
• Should collect Date/Time of Sample Collection for performing Pregnancy Test
• Informed Consent form should be signed and handled to each subject and collect date/time of Informed Consent obtained

Vital Signs:
• Should create this part separately to include as below examples

Date of Vital Signs: __ __ / __ __ __ / __ __ __ __ DD/MMM/YYYY
Time: _ _: _ _ hh:mm (24 hr)
Height: _ _ _ cm
Weight: _ _. _ kg
BMI: _ _. _ _ kg/m2
Body Temperature: _ _. _ Celsius
Systolic Blood Pressure (SBP): _ _ _ mmHg
Diastolic Blood Pressure (DBP): _ _ mmHg
Pulse Rate: _ _ beats/min
Respiratory Rate: _ _ breaths/min
Pulse Oximetry (SpO2): _ _ _ %

Physical Examination:
• Should indicate related categories e.g. General Appearance, HEENT, Respiratory, Cardiovascular, Dermatological, Musculoskeletal, Neurological and others, these should be provided choices to opt for test results such as Normal, Abnormal, not clinically significant, Abnormal, clinically significant and Not Done

Subject Check: each subject should be asked to re-check their eligibility and other parts for testing before proceeding with Laboratory Test e.g. Is the subject eligible to participate in the study? Yes or No

Laboratory Test:
• Should create below categories to perform tests

– Hematology
– Serology
– Chemistry
– A/H1N1 AntibodyTiter
– A/H3N2 AntibodyTiter
– B/Yamagata‐lineageAntibodyTiter
– B/Victoria‐lineageAntibodyTiter

Randomization Process:
• Should create Randomization Group to specify vaccine type, but this should be blinded with subject as this is a single blinded, randomized trial
• Should add Local Date/Time of Randomization (GMT+7) with standardized format of units
• Could Add Randomization ID

Study Vaccine Administration:
• Should add Date/Time of Study Vaccine Administration
• Add Injection Location e.g. Right Deltoid or Left Deltoid

Post-Dose Vital Signs:
• Should create post-vital signs after finished vaccination e.g. to observe and collect Vital Signs + 60 mins Reactogenicity Assessment (Solicited Reactions) + Subject Checks + provide eDiary login credentails and instructions to record Diary entries

Additional forms may be created that concerns to data collection, they may be performed after finished Physical Examination as Eligibility Check if applicable:
• Medical History Form
• Adverse Events Form
• Prior and Concomitant Medications Form

I can see how hard you’re working on the CRF and I want to encourage you to keep going! Let’s keep the momentum going together! 😊

[Teerawat Pholyiam]

Hi All! I’d like to share the picture below, which discusses what I’ve learned about ‘PERSONAL HEALTH INFORMATION’ on the previous week.

Apologies for submitting late, thanks!

[Teerawat Pholyiam]

Hi All! I’d like to share the picture below, which discusses what I’ve learned about ‘CYBER HEALTH CARE’ on this week.

Anything else please feel free to share, thanks!

[Teerawat Pholyiam]

I think, the primary benefit of having data standard for clinical trials is to improve Data Interoperability,, each site may collect data in different formats/terminology to explain similar variables and this is challenging and time-consuming to merge and compare data from the clinical trials, so if all sites have standardized data formats and terminology, they will have the ability to easily share, merge, and analyze data across the study as well as this will ensure consistency in data collection and interpretation. For example Site A collect data on blood sugar levels using different units of measurement (e.g., mg/dL vs. mmol/L) and Site B and C might use different terminology to describe the same variables, such as blood glucose vs plasma glucose or each Site records the duration of blood sample collection for the study in weeks and months.

It’s better to standardize to set all clinical trials sites perform and collect data according to formats and terminology established by organizations like the Clinical Data Interchange Standards Consortium (CDISC), all clinical trials could collect data using the same units of measurement, standardized terminology and data structures.

[Teerawat Pholyiam]

Yes, I have seen all of clinical trials that are collecting data entries at my workplace (web-based software provider in clinical trials, it’s called Fusion eClinical Suite), they have been implemented these processes to ensure data quality and integrity.

Audit Trail/Time Stamp – this is mandated to implement and perform a functionality script of audit trail or time stamping to track changes to the data over time, it’s helpful to identify who made what changes or update in the system e.g. the “view audit log” button will be able to view and download the form of audit trail that displays the following details; section name, question, value, query ID, change/bypass note, date/time, user and role.

User Authentication and Access Control – this is functioned to implement user access that all end-users will be required to reset their own password by answering their security questions in every 3 months (old password can’t be reused) or in case they can’t remember this they will have to reach out assistance web-based software provider for verification as well as PI will have their confidential authorization code to sign subject records and their access in the system must be assigned to correct access (applicable role, site number and reports/modules) to perform data entries properly in the system for example Project Management Team will provide the update of the tracker and allow end-users to be assigned to newly released reports/modules and some module like Data Portal must be verified in the agreement contract before to proceed with assignment.

Edit Check and Logical Check – this edit check module has implemented to perform for all of clinical trials an this module can help validate data entered and ensure that it meets predefined criteria or standards in the system, the data makes sense within the context of the study. Within the edit check module will have sub-navigation tabs e.g. Edit Checks Manual, Edit Checks Auto, Open Edit Check Results, Closed Edit Check Results, all of these will help to track the completion of identifying inconsistencies or errors.

Data Backup and Recovery Plan – all members at my workplace have to be trained on SOP documents such as Business Continuity Plan POL, this provides a framework, guidance, and concept of operations to support businesses to continue and/or rapidly restore their critical business functions in the event of a disruption to normal operations. Key elements considered any of the following disruptions e.g. natural disaster, fire, war, civil unrest terrorism, pandemics, epidemics, IT or electrical grid failure and etc. My workplace is implemented in two core phases;

1. Preventative Planning: maintains electronic records of core business elements, as well as daily backups of electronic Mission Critical Systems at a secured location, which is equipped with 24/7 video surveillance systems, fire suppression systems, forced entry alarms, and door access control systems.

2. Response to Critical Function Failures/Business Premise Issues that must be implemented in the event of a failure. Depending on the risk level assessments for the disruptions triggered in any of the following categories (Communication System, Mission Critical Systems, Business Premises), a predetermined Business Continuity Activation plan will be initiated to mitigate the effects of the adverse events.

Additionally, there are concerned SOP documents have been provided to all members such as POL-2, Disaster Recovery Policy/ SDSOP-11, Production System Back-up/ SDSOP-11, Production System Back-up and SDSOP-11-T1: Database Test Restore Form.

[Teerawat Pholyiam]

The Date Format should be instructed and made clear, such as DD/MMM/YYYY, to ensure that date information is not missed in all applicable fields in above CRF form.

[Teerawat Pholyiam]

Based on my experiences, I am currently working with an EDC building company, responsible for supporting Project Management, Randomization and Trial Supply Management teams, as well as external multiple sites, to navigate and instruct them on how to complete data entries properly into EDC. So, I have completed a few steps in data management in clinical trials according to the workflow; specifically, Database Lock/Security, Database Access Control and Data Entry and Processing. Additionally, I am somewhat familiar with other steps but have not had the chance to directly involve myself, as those are responsibilities of other teams.

Furthermore, if possible, I would like to give ideas to improve Database Lock/Security (Roles and permission access). For instance, regarding providing newly released reports and modules to all existing end users, I have been notified by the Project Management team that newly released reports/modules are configured in the EDC system and are ready to be assigned to all applicable end users. However, the EDC system is not sufficient to assign them in bulk; I would have to provide the new access to each user individually, and there are plenty of end users (200++ accounts). This task is time-consuming and lead to human errors. Currently, this issue is being addressed with internal Software Engineering and Product Innovation teams. Additionally, to reduce human errors when assigning multiple applicable sites to end users, I need developing the EDC system to trigger warning notifications if a wrong site has been assigned to the wrong end users, leading to data entry deviations and potential issues.

For Database Access Control (Authentication), all eligible end users (site staff and subjects) should be verified through multiple steps. This includes not only entering their credentials/authorization password but also being required to verify with multi-factor authentication such as dynamic authentication, face, or finger scan ID, if applicable, to ensure the right person accesses the right role in the EDC system. These steps could be implemented through role-based access control to restrict access to sensitive/blinded database within EDC system, allowing only authorized users with specific roles.

For Data Entry and Processing (with interactive verification), I would like to require that the EDC system sends notification emails both within the EDC system and to general emails when a query is raised from the Data Management Team. This would prompt Study Coordinators (site staff) to review and respond to the issued query in a timely manner, whether it requires editing or withdrawal within the eCRF page.

[Teerawat Pholyiam]

1. Purpose of data collection: For research, for public health surveillance, or others

For Clinical trials, they are transitioning from traditional paper-based method to Electronic Data Capture (EDC) system to facilitate data collection across multiple sites worldwide. These sites include university hospitals and private clinics in various countries such as America, Canada, Brazil, the UK, Germany, the Netherlands, Benin, South Africa, Hong Kong, South Korea, Japan, Australia, New Zealand, and more. Currently, there are over 70 ongoing studies from well-known pharmaceutical/med tech companies that focused on vaccines, drugs, and medical devices for testing/trials in human subjects.

2. Was it primary or secondary data collection?

Primary data collection

3. Methods used for data collection

A. EDC (Electronic Data Capture) for administering questionnaires via phone.

B. ePRO (electronic Patient-Reported Outcomes) application for subjects to enter their eDiary entries after finishing medication, surgery operations, or using medical testing devices.

4. Were there any problems that occurred regarding data collection?

• Language barriers (subjects are enrolled around the world with different languages) – this case must be administered with language translator.

• Sensitive information of subjects is blinded to protect privacy and prevent bias (e.g., name, DOB, sex). Subjects may forget their study number or number card lost, this make verification difficult. Additionally, subjects may forget their password to log in to the ePRO app, and it is mandated not to ask for subject’s name or DOB – should contact site staffs in this case to verify if they are responsible for.

• Generation gap, older subjects may find it difficult to navigate technology and smartphones, especially if they are using older devices that are incompatible with the ePRO app + smartphones must have updated versions – could navigate and instruct them slowly and put extra efforts to assist.

• Different time zones can pose challenges, for example sites in Australia may face difficulties due to systems being built in North America, resulting in approximately 12-hour time differences, exacerbated by daylight saving time changes – may let site hold off and complete data on paper in the meantime and escalate to Software Engineering team for further investigation.

•Technical issues such as Wi-Fi or phone connection problems – ensure subject’s devices are connected to their home/phone wi-fi before proceed further.

• Damage to medical devices or phones – take unique device’s number or let them use other alternative devices if use own devices.

• Internet outage due to natural disasters – plan for offline works and try to keep sites informed for urgent matter via phone if possible.

• Unclear communication and the need for quiet, safe places for administering questionnaires and auditing purposes – may request subject to find quiet and safe place and keep them informed that it’s for their confidentiality.

• Awareness of data loss, If previous data entries still exist in the app, precaution is needed to avoid data loss. Follow-up may be required to synchronize data into the EDC system once the connection is stable – always follow the steps from case study and read all applicable instructions on how the system works.

[Teerawat Pholyiam]

Hi All! I’d like to share the picture below, which discusses what I’ve learned about ‘Code of Ethics for Health Informatics’ on this week.

Anything else please feel free to share, thanks!

[Teerawat Pholyiam]

Hi All! I’d like to share the picture below, which discusses what I’ve learned about ‘AI and Ethics in Health’ on this week.

Anything else please feel free to share, thanks!

[Teerawat Pholyiam]

Based on my experiences, I would like to share experiences that I have ever seen regarding to ethical principles and good practices in vaccine development for clinical trials that play an important to guide health care decision-making, especially in the context of controlling policy of the COVID-19 pandemic.

• The principle investigator will ensure that the study is conducted in accordance with relevant regulations and with Good Clinical Practice and the principles of the Declaration of Helsinki.
• The protocol, informed consent form, participant information sheet and any proposed advertising material (if applicable) will be submitted to applicable local/national ethics committees and regulatory agencies for written approval.
• The confidentiality measures in place for study participants. Participants will be assigned an ID number with only initials possibly included on certain documents. All data will be stored securely and accessible only to authorized personnel. The study will adhere to the Data Protection Act 2018, ensuring that personal data is not kept identifiable for longer than necessary.
• The informed consent form (ICF), this is a document used in clinical trials to provide potential study participants with comprehensive information about the study and to ensure they fully understand the nature of the trial, including potential risks and benefits and voluntarily consent to participate without enforcment. Additionally, the ICF outlines participants’ rights, such as the right to withdraw from the study at any time without penalty.
• Study participants will not receive payment for their participation. However, they may be reimbursed for costs incurred during their involvement in the study according to local guidelines and ethics committee policies.
• Additionally, the principle investigator is responsible for reporting an Annual Progress Report to all relevant ethics committees and regulatory agencies on the anniversary of the study’s approval or as defined by local requirements.
• To implement safety monitoring protocols to promptly detect and address any adverse events or safety concerns that may arise during the trial for example implementing real-time monitoring feature to early detection of adverse events.
• To ensure that clinical trial is designed to be accessible to individuals from diverse backgrounds, including different demographic groups and geographical regions, the results are applicable to broader populations. Including those historically underrepresented in clinical research that this can help to promote equitable access including appropriate sample sizes, randomization, and control groups, this can help to minimize bias and confounding factors and ensure the validity and reliability of the findings.
• Study participant’s personal information in clinical trials, including medical history, test results, and demographic data must be handled with strict confidentiality to protect their privacy rights. IRBs/IECs (Institutional Review Boards/Independent Ethics Committees), regulatory authorities, and CROs (Contract Research Organizations) is conducting safely in ensuring the ethical conduct, regulatory compliance and quality management of clinical trials conducted to expedite the development of potential treatments and vaccines while upholding ethical standards and data integrity according to the study protocol.
• To maintain transparency throughout the vaccine development process before initiating clinical trials, vaccine developers should publicly disclose detailed study protocols outlining the research objectives, study design, participant eligibility criteria, intervention details, outcome measures, and statistical analysis plan. This helps build trust among stakeholders and ensures accountability in decision-making.
• Involve communities affected by the COVID-19 pandemic in the vaccine development process through meaningful engagement, consultation, and collaboration for example vaccine developers should establish partnerships with community-based organizations, non-governmental organizations (NGOs), and advocacy groups to facilitate community engagement and enhance the reach of clinical trials + demonstrate cultural sensitivity and respect for community norms, beliefs, and practices when conducting clinical trials (some local people they have their own beliefs to avois being vaccinated).
• To implement post-marketing surveillance systems to monitor vaccine safety and effectiveness after regulatory approval. This allows for the detection of rare adverse events and the ongoing assessment of vaccine performance in real-world settings.
• To collab with international level and data sharing to accelerate vaccine development and to facilitate regulatory approval. This involves sharing research findings, resources, and expertise across borders to address the global health crisis.

Reference: Mahidol-Oxford Tropical Medicine Research Unit (MORU). Chloroquine/ hydroxychloroquine prevention of coronavirus disease (COVID-19) in the healthcare setting; a randomised, placebo-controlled prophylaxis
study (COPCOV). Available from: https://www.tropmedres.ac/covid-19/copcov

[Teerawat Pholyiam]

Based on my viewing of the introduction of NHSO and reading two relevant articles, I think that the National Health Security Office (NHSO) in Thailand has been instrumental in providing universal health coverage to over 48 million Thai people enrolled, this is leading to improved health and longevity. Thailand has achieved remarkable success in achieving high population coverage under the UHC scheme. This ensures that the majority of the population can access healthcare services when needed. Also, the UHC scheme in Thailand offers a comprehensive benefits package that includes medical services from preventive care to treatment and rehabilitation. Individuals have access to essential healthcare services without facing financial barriers and this is one of the key strengths of Thailand’s UHC scheme is its ability to provide financial protection to individuals by reducing out-of-pocket expenses for healthcare services. Moreover, NHSO adopted innovations such as telemedicine and home healthcare services that this can enhance accessibility and efficiency in healthcare delivery (particularly beneficial during the COVID-19 pandemic). Lastly, NHSO is in overseeing the implementation of the UHC scheme and ensuring efficient management of resources.

Strengths of UHC scheme in Thailand:

• This covers a huge majority of the population with over 48 million citizens enrolled that it’s ensuring access to essential healthcare services for all.
• The benefits package provide coverage for a wide range of medical services, including preventive, curative, and rehabilitative care.
• Thailand’s UHC scheme has been successful in reducing out-of-pocket payments for healthcare services, thereby improving financial protection for citizens.
• NHSO plays an important role in overseeing the implementation of the UHC scheme and ensuring efficient management of resources.
• This provides innovative technology such as telemedicine and home healthcare services that can enhance accessibility and efficiency in healthcare delivery, especially during the COVID-19 pandemic.

Weaknesses + areas of improvement of UHC scheme in Thailand:

• The interoperability for health care systems can be a challenge to care coordination efforts in Thailand, this is leading to help exchange data and use information easily between different healthcare providers and settings. This can result in inefficiencies, delays in treatment and patient care as well as this can monitor the performance of the UHC scheme and identify areas for improvement for setting health care data standards, implementing Electronic Health Records, medical device connectivity.
• In remote areas, the healthcare workforce shortage may be a challenge to the effective delivery of healthcare services that this can ensure workforce distribution and the sustainability of the UHC scheme. To improve this, to support healthcare professionals to work in underserved areas through financial incentives, scholarships, or loan programs as well as investing in telemedicine to expand access to care in remote areas.
• This is to ensure that long term financial supports is planned and sustainable to maintain if case of rising healthcare costs and changing demographics is a critical concern. The government should create a fund for healthcare sustainability project which is continuously funded through contributions from various sources such taxes or earmarked revenues. This fund would serve as a financial support to offset future increases in healthcare due to factors like inflation advancements in medical technology and aging population.
• The coverage rate for healthcare is high and disparities (low-income individuals, homeless individuals, or people with disabilities, financial constraints, lack of transportation, or social stigma) still persist in accessing services. To overcome these gaps and ensure fair access to healthcare remains a considerable challenge by investing in healthcare infrastructure/resources in remote areas + implementing programs specifically designed to reach marginalized populations + providing cultural competency training for healthcare providers to improve communication and understanding when working with ethnic minority populations + engaging communities in the planning of healthcare services.

Thailand’s NHSO is recognized and has successfully provided UHC scheme that is progressing in expanding access to healthcare services like telemedicine and improving financial protection for citizens. On the other hand, there are challenges that include interoperability issues, workforce shortages, financial sustainability, and disparities in healthcare access among marginalized groups. So these should be reconsidered and implemented for future of healthcare services in Thailand.

[Teerawat Pholyiam]

In my opinion, Thailand has been increasingly investing in healthcare technology such as electronic health records (EHRs), indicating a growing demand for health informatics professionals. The workforce likely includes healthcare professionals with additional informatics training, IT specialists in healthcare systems, data analysts, and health informaticians. Also, some universities in Thailand may offer relevant programs and government initiatives could further support workforce development.

Below are challenges of the health informatics workforce in Thailand:

• There’s a lack of comprehensive guidelines and standards issued by healthcare agencies (governance framework) to ensure all professionals are going to achieve the same goal of health informatics workforce, this is leading to inconsistencies in health informatics practices across the country.
• There is a shortage/limited of trained professionals to meet the increasing demand and continuous learning of programs like the Growing Expertise in Health Knowledge and Skills (GEEKS) and professional development were necessary due to rapidly evolving technology.
• There is a shortage of technological resources + insufficient financial support to invest the implementation and sustainability of health informatics solutions.
• Inadequate collaboration among healthcare professionals due to a lack of teamwork and burnout can negatively impact the implementation and utilization of health informatics systems.

These challenges could require collaborative efforts from policymakers for governance framework, healthcare leaders, IT professionals, and stakeholders by establishing standardized governance frameworks, promote interoperability, support collaboration, enhance technological resources, and secure adequate funding for health informatics in Thailand.

[Teerawat Pholyiam]

Currently, data sharing in health care systems in Thailand is experiencing difficulties to exchange and share health care information, there are several challenges such as having fragmented information systems with varying standards and formats, this is leading to interoperability issues to exchange information and lacking of well-defined governance framework and technology, resources and fund to conduct, manage and protect to promote responsible health data sharing.

If I were in charge of a data set in Thailand, I would certainly be thinking about health data sharing in health informatics.

BECAUSE:

1. This can improve public health in Thailand, sharing healthcare data can help to identify patterns and trends of diseases and the outbreak as well we to enable public health officials to respond more effectively to potential outbreaks and implement preventive measures. For example, data sharing could be contributed and exchanged as one stop service to public health improvement by Thai authorities during the COVID-19 pandemic due to there are too many apps of Covid-19 tracking record that have been developed by Thai authorities (e.g. Mor Chana app, Mor Prom app). Based on my experience, I used to utilize a centralized electronic health record system in Australia during the COVID-19 pandemic, it’s called “My Health Record” app that is easy to connect upon registration (linked personal information from MyGov account) and the app has been implemented to access med history, COVID-19 tests, vaccine management and so on in only one app, more information is available: https://www.digitalhealth.gov.au/.

2. Sharing health data can help to collaborate with different healthcare institutions and support stakeholders to work together to exchange resources and find solutions as well as to contribute and implement health care systems in Thailand. This can be smoother referrals and transitions of care between healthcare institutions. For example, if a patient needs to be transferred from a primary care clinic or private med center to a main hospital according to Thailand has a barrier to exchange and transfer, if this can be implemented sharing health data can help to reduce duplicated tests and time to proceed with further interventions.

3. Sharing health data can help supporting research/study, researchers is able to use the data to conduct studies in medical science and health care improvement and to identify new treatment methods or develop innovative solutions to healthcare challenges. For example, researchers can access various resources of health data from different health care institutions (hospitals, clinics, research institutions, and other agencies) to conduct and develop drug trials or treatment improvements.

4. Sharing health data can help health care providers to access quickly and make decisions in the event of emergency such as the pandemic or natural disasters, having health care data is available is crucial to support health care providers to proceed with further steps of resource allocation, and coordination of efforts to mitigate the impact of emergencies on public health.

5. This can improve communication and collaboration between healthcare providers, institutions, and patients. These stakeholders have the ability to access to health information and they can coordinate and work together more effectively. And this can enhance patient centered care and they may feel trustworthy when patients have the ability to access and review their own health information. To build trust and strengthens among stakeholders in health care services.

6. Sharing health data can protect and provide access controls of patient confidentiality that they contains sensitive information about individual medical conditions/treatments and personal information according to data protection laws and regulations in Thailand such as Personal Data Protection Act (PDPA). This can lead to build patient trust and relations between health care providers and patients to coordinate care, make informed decisions and achieve better health outcomes for patients.

Health data sharing in Thailand faces significant challenges, including fragmented information systems, interoperability issues, and a lack of governance, technology, resources, and funding. These obstacles delay the promotion of responsible data sharing practices for improving public health, building collaboration, supporting research, enabling emergency response, enhancing communication, and safeguarding patient confidentiality.

[Teerawat Pholyiam]

Using Electronic Medical Records (EMRs) instead of traditional paper-based medical records has several advantages and disadvantages in general as follows:

-Advantages of EMR in Thailand-

Electronic Medical Records (EMRs) can enhance data management efficiency by simplifying access, updates, and sharing of patient information among healthcare providers. Additionally, EMR systems can be customized to support multiple languages, including Thai and any other languages, to ensure accurate documentation and communication.

EMRs play a crucial role in interoperability, enabling the exchange of medical information between international and local healthcare providers. This contributes to enhanced continuity of care for patients seeking medical treatment in the country. Moreover, EMRs contribute significantly to public health planning by providing aggregated and anonymized data, supporting epidemiological research, and formulating healthcare policies. Furthermore, the adoption of EMRs in Thai healthcare facilities not only reduces paper dependency but also brings about cost savings and aligns with environmentally friendly practices.

-Disadvantages of EMR in Thailand-

The implementation of Electronic Medical Records (EMRs) in Thailand encounters several challenges. For example, smaller or rural healthcare facilities face resource constraints, hindering the adoption and maintenance of advanced EMR systems. Healthcare professionals may need training for the effective use of EMRs and may resist change within the workforce. Data security and privacy concerns are essential to maintaining patient trust in the healthcare system.

The diversity of healthcare practices in Thailand, including traditional medicine and have difficulties in incorporating them into EMRs. Also, compliance with regulatory standards and data protection laws demands ongoing efforts and resources. Moreover, connectivity issues in remote areas further complicate the accessibility and functionality of EMR systems. Despite the advantages EMRs bring, overcoming these challenges requires careful planning, engagement with stakeholders, and sustained support for successful implementation in Thailand’s healthcare landscape.

[Teerawat Pholyiam]

Based on viewing and reading the articles that the instructors mentioned. I have found that Dr. Piya discusses and focuses on benefits of big health data and three key challenging areas that related to Health Informatics. First, the increasing volume of health data create both a burden and an opportunity for health systems. Second, there is a challenge in using information to create value for health services. Third, Dr. Piya addresses how data and information can be utilized to enhance overall health system performance. Additionally, there are challenges associated with big health data according to the paper by Silverio et al, including missing data, selection bias, data analysis and training, interpretation and translational applicability of results, and privacy and ethical concerns.

My own suggestions on coping with these challenges are the following:

– Data quality implementation, this could create data validation procedures and conduct regular audits to ensure the standardization of the collected information. This can help to measure and raise the issues such as missing data and inaccuracies. For example, to ensure high-quality data within an EHR system to support clinical decision-making and research, to implement this is to develop standardized protocols for data entry with clear guidelines for healthcare professionals on how to accurately record patient information + to integrate with CDSS systems that utilize on high-quality data to provide evidence-based recommendations + to implement real-time data validation checks and regular audits of data entry + to implement interoperability standards between different healthcare systems + to build patient engagement by allowing individuals to review and update their own health information and educate them on the importance of accurate record-keeping.

– Ethical data use, privacy and security, this could develop clear consent processes by allowing patients to opt-in or opt-out based on their preferences and availability, leading patient and public trust and complying with regulatory requirements + to implement data governance policies that restrict data sharing to ensuring that only necessary data is exchanged + to implement cybersecurity measurement, encryption protocols and security audits.

– Training and collaboration, this could develop strategies for breaking down silos such as introducing joint training sessions, workshops and virtual training that encourage open communication and diverse trainings scheduled among healthcare professionals to ensure can effectively use the available tools and follow the procedures as per protocol + to develop clear evaluation criteria, including patient outcome measures, team performance assessments and staff satisfaction surveys + to support for leadership commitment to interprofessional education and highlight the benefits to patient outcomes and overall healthcare quality

The above presented suggestions highlighted data quality, ethical use, and training, the strategies aim to enhance the management and utilization of health big data. These measures collectively strive for accurate, secure, and responsible handling of health information, promoting better patient outcomes and overall healthcare quality.

[Teerawat Pholyiam]

Based on my reading of Eleanor and her team’s paper. These 4 paths offer a thorough approach to addressing corruption in health and I completely agree with the 4 recommended research paths for tackling corruption in the health sector.

Because:

Individuals – this is to understand the behaviors of individuals involved in corruption is important for developing targeted interventions and preventive measures.
Organizations and Industries – it is to examine systemic issues within healthcare organizations that this can help identify structural problems.
Different Countries (largely from an economic development perspective) – this is to recognize the economic and developmental factors influencing corruption allows for tailored solutions based on the specific challenges in each country.
Different Cultural Contexts (from an anthropological perspective) – to acknowledge the cultural nuances of corruption is essential for implementing effective and culturally sensitive anti-corruption strategies that work well and respect each culture.

Additionally, below suggestions can be the ideas to fight the corruption as following:

– To provide and educate training on ethical standards for healthcare professionals and this can help to build a culture where people act with honesty.
– To share good ideas and working together of best practices and collective efforts in combating corruption in the health sector in the community/organization, country and international level.
– To make healthcare systems more transparent and accountable by regularly checking and reporting.
– To build advanced systems to protect people who speak up against corruption and this encourages reporting without fear of punishment, making sure everyone is accountable.

[Teerawat Pholyiam]

Based on my experiences supporting the company in developing the EDC (Electronic Data Capture) system, I believe that the health system should be improved by implementing a real-time monitoring feature to early detect and promptly respond to adverse events. The enhancement of this feature can significantly contribute to the early detection and response of adverse events, ensuring for subject’s (study participant) safety and improving data quality in clinical trials.

For example, a subject has been reported term for adverse event in a drug trial. In the clinical trial the safety of a new hypertension medication, a subject experiences a sudden increase in blood pressure that exceeds predefined safety thresholds, so this scenario should be required early detection and intervention to ensure the subject’s safety and integrity of the trial.

The EDC system is equipped with real-time monitoring of subject’s blood pressure levels and algorithms should be in place to detect any significant deviation from the expected range based on individual subject characteristics and the study protocol. As per this scenario, EDC system should be programmed to generate immediate alerts when predefined safety thresholds are breached. These alerts could be sent to the study coordinator, investigator, and other relevant stakeholders as well as the study coordinator could contact this subject to assess their current symptoms and gather additional information. Based on the severity of the adverse event, the investigator may recommend immediate further medical evaluation for this subject.

To implement real-time monitoring feature to early detection of adverse events, firstly this can enhance the subject’s safety that can minimize harm to them and ensure the safety issue is identified as soon as possible as per study protocols. Secondly, this can be enable timely and efficiently modifications to treatment plans or modern healthcare practice improvements of study protocols and real-time monitoring can help quickly decision-making by sponsors/principle investigators to proceed with further steps to reduce the burden on healthcare providers by minimizing additional interventions. Thirdly, this can improve subject’s recruitment and contribute to positive experiences in clinical trials. Lastly, real-time monitoring of adverse events can contribute to the overall quality and help to prevent the inclusion of inaccurate of clinical trial data.

The implementation of real-time adverse event monitoring in EDC system has several potential barriers such as technical complexity may arise due to the need for advanced integration with existing systems, while resource constraints, including budget limitations and a shortage of skilled personnel. Data privacy and security concerns emerge due to continuous data transmission, necessitating compliance with regulations. User adoption may be impeded by resistance to change among healthcare providers. Also, this may require collaboration among various stakeholders.

To overcome these challenges in real-time adverse event monitoring in EDC system improvement. This involves conducting risk assessments, engaging stakeholders, implementing strong training programs, continuously evaluating and refining monitoring systems. Including, proactive communication and collaboration with regulatory agencies can help ensure compliance. In conclusion, to enhance real-time adverse event monitoring in EDC system is important for improving patient safety, data quality, protocol adherence, and the overall success of clinical trials.

[Teerawat Pholyiam]

This project management of my trip to Japan during 02-09Mar2024 as a solo traveler, this is incorporating the 12-step project management process as the following details.

Define project: the objective will be a week cultural and lifestyle exploration of Japan during 02-09Mar2024, visiting Osaka, Nara, Kyoto and Nagoya + staying at Osaka 1 night for shopping and nightlife, 4 nights at Kyoto/Nara for cultural and history experiences and 2 nights at Nagoya for museums (return flight from this city, not too crowded people), for the whole budget at THB60K as a solo traveler, excluding flight tickets + JR Pass.

List tasks: Booked flights in advance at THB15K + booked hotels for whole trip at THB20K + exploring cultural and history experiences at old towns + free visa (visit JP registry required) + buy JR pass for trains, buses for travelling + exchange both cash and travel credit cards + buy traveling insurance + open phone roaming + weigh luggage + select a comfortable seat like close to exit door with wild area + take own pillow to sleep on airplane + downloaded fav music into the app for offline mode + bring tiny travel kits to carry in case of needs (toothpaste, perfume, moisturizer cream, candy in case of boosting low blood sugar level).

Sequence tasks: To transit 3 hrs. at Changi Intl airport for round trips (arrive at midnight, may access to wait in the lounge), fly with Singapore Airlines as it’s my favorite airline and cheap during this period + to spend time mostly at Kyoto as I enjoy old town and peaceful city and have cheap hotels + travel to each city by trains and to travel by Shinkanzen from Kyoto to Nagoya + may take heater cloths (will be ended of winter in JP) + travel medicine kits (Activated charcoal, Orz, Paracetamol).

Add safety margin: To arrive at the airport before 3 hrs. for international travelling (lugagge dropped, checked, may do online check-in) + installed the app “Papago” to interpret language barriers, use Google map to view public transport timetable + check weather and traffic upon travelling in case of facing any unforeseen circumstances.

Crash project plan: In case of flight delays or crowded visitors at significant places, may consider to travel new places around that area + if track work of trains or out of service, bus tables should be considers because taxi is very expensive.

Create a Gantt chart: To map Grant chart of travelling flow from a time when leave my home until a time of returning home + to add extra mins/hrs. for any unexpected scenarios (natural disaster, traffics, accidents) + might print out on paper that can present to the immigration and in case of phone losing.

Evaluate resources: Reviewed social media like FB pages, they normally share both good tips to be followed and the things should avoid to do + to reduce time of searing information of visiting places, I may buy one-day trip local tour + collect contacts of travel insurance/JP police/JP interpreter center in case of helps require + save emergency budgets + try to arrive a bit early at any points.

Risk management: Buy full service airline, travel insurance in case of flight delays/cancellations + install the language translation apps/collect contacts of interpreters + surf knowledge, information regarding to cultural awareness, basic JP conversations + check weather, natural disaster (earthquake, tsunami).

Monitor progress: To check and tick lists if each mission/plan completed + emailed to verify booked flight and hotels if they may not receive bookings as booked thru third party + make copy of passport, any necessary docs or take pics in case of losing.

Control costs: Try to use trains/buses that cover in JP pass + finish some meals at 7-11, Lawsons + avoid to use taxi + ask local people for best ways of travelling and eating.

Adjust the plan: Write down additional options for must-visiting places in cases of unavailability + trackwork of trains or delays, buses are optional + facing bad weather, may look for easy places to go like café or shopping malls.

Conduct project review: After returning from the trip, conduct a thorough review. Reflect on what went well, what could be improved, and document any lessons learned for future travels or projects.

[Teerawat Pholyiam]

Hi Hsu,

I like how you’ve suggested training and capacity building for hospital staff that is often overlooked when transitioning to cloud technologies. One more thing, I like your suggestion of using a hybrid cloud model. I would suggest that hospitals could store less sensitive data such as non-critical patient records or administrative information on a public cloud because it’s cost-effective and scalable. For critical systems, like electronic health records (EHRs) that contain sensitive patient information, a private cloud could be more suitable as it offers more control over security and compliance.

[Teerawat Pholyiam]

Hi Aung Thura,

I also found that enabling two-factor authentication is one of the best ways to protect accounts and being cautious with links and verifying the authenticity of the sender for avoiding phishing. Your experience really shows how important it is to build these habits.

[Teerawat Pholyiam]

Hi Panyada,

Wow wow! Your Covid-19 dashboard completion looks well-designed and user-friendly which is very deep detailed and easy to utilize as well as effectively leveraging interactive controls, clear visuals but I might suggest to add more ideas of using the same font in each page that may help users to view the dashboard comfy and use brighter or pastel color theme such as soft mint green, pastel pink, baby blue, pale yellow or o on that should be suitable for viewers to feel comfortable to read complexed or look into unexpected scenario like Covid-19 (this should be considering to human perception concept) , also the key insights are aiding to provide decision-making by filtering each country flag to see deep details and access to important metrics. One more thing, adding more variety of charts such as pie charts or scatter plots where suitable could provide deeper insights into the data. Totally I like it. Great work! 🙂

[Teerawat Pholyiam]

Hi Nakarin, thanks for sharing and this is interesting to explore the COVID-19 Dashboard that shows cases found in Cambodia. Please let me review and provide more ideas.

Likes:

1. Visualizing the pandemic’s impact in Cambodia with comprehensive + up-to-date information that is important to effectively monitor and proceed with decision-making.
2. Effective use of colors and graphical elements can significantly enhance user experience and comprehension, so these engaging visuals help in better understanding and interpreting the data as per URL: https://opendevelopmentcambodia.net/profiles/covid-19-in-cambodia/

Below areas of improvement:

1. The dashboard presents pretty challenges related to complexity, this should simplify the interface and providing clearer navigation, especially those less familiar with data analysis e.g. adding guided navigation or tutorial videos could help users in navigating the dashboard more efficiently on page https://opendevelopmentcambodia.net/
2. May have a risk of potential information overload, the dashboard could implement features like data filtering and summary views to help users focus on the most relevant information + users can select specific data points or timeframes on page https://opendevelopmentcambodia.net/
3. Should implement features like screen reader compatibility, alternative text for images and keyboard navigation can improve accessibility for all users or offering multilingual support.

Additionally, this may enhance friendly user experience e.g. adding interactive tutorials or tooltips can guide users on how to navigate and utilize the dashboard effectively + ensuring the dashboard is optimized for mobile devices + multi language options.

[Teerawat Pholyiam]

Thank you for sharing, Siriluk! I like the idea of using a table format to provide clear checkboxes for each section of the physical examination. I think this approach is very helpful as it helps to avoid errors in data entry and allows for categorization of each result for every PE test.

Additionally, if possible I think that for vital signs such as weight, height, blood pressure, body temperature, pulse rate, and respiratory rate, they should be specified separately in the Vital Signs section with standardized units, as you suggested.

[Teerawat Pholyiam]

Hi Nichcha and Dr. Teeraboon, really appreciate for sharing your experiences as being a site user. That’s very informative for me to know from your side. 🙂

It’s a common scenario I’ve encountered where site users often contact me seeking assistance with resetting their login credentials, even when they can’t recall the answers to their security questions created during the account registration process. I understand how challenging it can be to remember these details. In such cases, I typically request users to send an email for access verification. This allows me to review their personal details before proceeding to unlock access to EDC system or other modules like eConsent and eSource Modules (often iPads shipped to sites from the Depot Team to access these modules separately as this is more convenient and secure for the access of setting).

I also acknowledge that site users may face difficulties with access verification, especially in instances where biometric technology is used or when shared computers. So, this feature may be particularly beneficial for subjects who need to complete eDiary entries using their personal devices. Especially, aging subjects sometimes struggle to recall their login credentials and have no permissions to reset their passwords independently. Of this case, only site staff, including myself, can assist them in this process.

[Teerawat Pholyiam]

I agree with the suggestions you mentioned above to improve healthcare services in Thailand and I would like to share additional ideas. One challenge facing healthcare services in Thailand is the structural issues from above three different schemes. Within hospitals, there is a gap in services and this is leading to inequality among patients for example each scheme has its own set of rules and benefits for instance patients under the Civil Servant Medical Benefit Scheme receive higher benefits as well as there are various types of hospitals in Thailand, including those under the Ministry of Public Health, regional hospitals, specialized expertise hospitals, general hospitals, and others operating under universities or research institutions that this is resulting to be challenges of data exchange and collaboration. I think that there is a need to restructure and consolidate these hospitals to operate and learn from the National Health Service (NHS) in England. The NHS is being the second largest single-payer healthcare system globally, they operate under a unified structure where hospitals, clinics, and other healthcare facilities are centrally organized and managed and patients receive standardized care and access to services irrespective of their location or socioeconomic status. So, Thailand could benefit from studying the successes and challenges of the NHS model and adapting relevant practices to its own context to provide universal healthcare coverage.

[Teerawat Pholyiam]

Hi Panyada! I heard that this healthcare project will be upgraded from the existing one. It looks very promising, as it aims to provide more convenient delivery of healthcare services in Thailand. However, as you mentioned, one of the challenges might be overcrowding in main hospitals. Additionally, I believe this may particularly affect staff burnout, emergency services, strain on their resources, leading to delays in critical care and compromising responsiveness to emergencies. This could result in patient dissatisfaction due to longer waiting times.

To overcome these challenges, I propose implementing strategies such as public awareness campaigns that emphasize the benefits of healthcare facilities. Additionally, promoting telehealth services for non-urgent needs and finding ways to balance patient loads across different healthcare facilities are beneficial steps to ensure the success of the upgraded healthcare project.

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