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Regarding public addressing between two leaders, Donald Trump from the USA and Lee Hsien Loong from Singapore. We can summarize the difference between two leaders according to The six principles of CERC from CDC as stated below.
1. Be first
– Singapore’s leader declared to the public concerning COVID-19 infection as soon as a week after the disease had been disseminated.
– The USA’s leader addressed the public after the disease spread around the world.2. Be right
– Singapore’s leader came up with basic knowledge of the disease by comparing SARS and COVID-19, preventive measures, current insight into vaccine and drug development.
– The USA’s leader underestimated the severity of the disease; hence a younger generation did not seem aware of COVID-19 spreading.3. Be credible
– Singapore’s leader had a natural tone when he stated to the public. He had maintained eye contact with the listener all the time. This may seem to be credible even though his staff might write this script.
– The USA’s leader seems like he read the script. The contain of his speech has some credible data. But he was always comparing with adversaries. This situation led to distrust in those countries.4. Express empathy
– Singapore’s leader expressed an empathic message to Singapore’s people and other countries affected by COVID-19 infection.
– The USA’s leader always compares with other countries. The expression of his concern was neutral when he talked to his people. But he said aggressively when he compared with other countries.5. Promote action
– Singapore’s leader did not just declare an outbreak. But he also told the listener about what the situation will become worse, how to prevent the spreading of the disease with plain language.
– The USA’s leader told the listener only a mandatory action by the government. But did not tell the listener how to protect themself from the disease.6. Show respect
– Singapore’s leader showed respect to the medical personnel who work at the frontline and people who protect themself and other people from the disease.
– The USA’s leader did not mention frontline health workers. He also showed disrespect toward adversaries. -
I worked in rural public hospitals for three years. This was an excellent experience for me until my last year as an intern. A job became more routine and mentally demanded me. I had a work shift for three days in a row, a couple of times a month. There was also no scholarship that suited me. Despite the difficult situation, I thought this job was a comfortable life because changing to a new job may be more challenging.
Last year I had an opportunity from my friends working at a regional health center in my hometown. They told me that this center holds a vacant position, so I decided to quit my old job to fill this position. At first, I need to accommodate a lower-paid job. But I have peace of mind and good health than ever before. Currently, I have a good opportunity to attend several conference and education which my director fully supported. Such as YSEALI program, NCD fellowship program from DDC, short course on occupational physician, to name a few.
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There are two major problems in Thailand in terms of the implementation of Digital health during COVID-19.
– Contact tracing
Contact tracing used to be an innovation in public health surveillance. The use of mobile phones and their technology pave the way for tracing COVID-19 patients. This hope comes shortly because of lacking government trust and being ignored by users.
– Centralized case management
Thailand has a large population of displaced workers due to inequality of opportunity between different regions. This leads to a burden on healthcare institutes in the area, which has many displaced workers. Patients in this dense area need to be treat back home, far away from their work areas. Lacking efficient centralized case management makes an attempted alleviate burden of crowded hospital failed. -
Some diseases have been declared as PHEIC
– 2009 H1N1 influenza
– Ebola outbreak
– Zika virus outbreak
– Polio outbreak
These diseases have been raised concern because they have four characteristics of PHEIC
– Is the public health impact of the event serious?
– Is the event unusual or unexpected?
– Is there a significant risk for international spread?
– Is there a significant risk for international travel or trade restrictions?
In my opinion, Future PHEIC may be a disease facilitated by global warmings, such as newly emerging tropical diseases or neglected tropical diseases. -
Using inaccurate data can lead to public health problems. This will affect the hospital where the patient was admitted. Diseases that are hard to diagnose and treat usually have high costs. The hospital will report for lower deduction DRGs. It resulted in financial problems and incorrect surveillance reports. If inaccurate surveillance reports were sent to the Bureau of Epidemiology. Underestimate surveillance data will lead to pandemics of the disease. Overestimate surveillance data will result in wasting cost and workforce.
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Information technology has a crucial role in disease outbreak investigation. There are 4 steps of the outbreak investigation process.
– Verify and preparation
An outbreak usually begins with the first patient/community case. IT can use to identify a patient from an electronic medical record, laboratory testing, radiographic examination. A data preparation process will help for report and further investigation.
– Describe the outbreak
Once the outbreak has been reported, a new case of disease will be rapidly raised. IT can use for analysis. This data can use a database program to collect and create a report for further work.
– Hypothesis and testing
After we collect plentiful data from the outbreak, we can use statistic programs to visualize the cause and effect of disease, Mode of transmission, Determine important factors that facilitate or mitigate the severity of an outbreak. Pharmaceutical companies also use IT for developing new drugs/vaccines.
– Respond and action
Eventually, A new knowledge of an outbreak can be used for controlling the disease. IT will be used to evaluate the effectiveness of outbreak control. If the controlling of disease fails. We can use old data to adapt to a new policy. -
From my experience as a physician working in home isolation for COVID-19. The most technology I like is a public communication and clinical care. These two technologies help my hospital and healthcare team connect with patients at home. A new wave of COVID-19 patients rises. Patients have mild symptoms due to country-wide vaccination programs, but the number of patients might not decrease. Many patients prefer to quarantine in their houses. The government supports a suite program for connecting with home isolation. The suite program includes the patient’s vital sign and symptom recorder, telemedicine, financial programs. These two technologies make home isolation possible.
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– How can surveillance help to detect and control the disease?
The goals of infectious disease surveillance, according to a paper by Jillian Murray, are (1) to describe the current and epidemiology of the disease, (2) to monitor trends, (3) to identify an outbreak of the disease.
We can use this principle to the COVID-19 pandemics.
First, describing the burden and epidemiology of COVID 19. This is a helpful application in a new disease pandemic that we did not have a clue about before. It can help understand the disease and find a way to control and treat the disease.
Second, infectious disease surveillance is used to monitor trends of the disease. This is an important application after we have basic knowledge of the disease. It is also used for evaluating a protocol for controlling the disease.
Third, a key aspect of infectious disease control is a tool for monitoring outbreaks of disease. Because of the economic impact of the COVID-19 outbreak. Monitoring a disease outbreak can reduce the cost of closing unnecessary areas that do not affect by COVID-19– Should we conduct active or passive surveillance or both for the disease, why?
We should apply both methods to surveillance of the disease. In passive surveillance system, health professionals in the area report disease to the public health agencies. This method uses less personnel and cost than the active surveillance system. The passive surveillance system can use in these situations (1) Rural areas where the disease rarely occurs, an area with low population density (2) Can be used in an area with limited health profession personnel and cost. (3) COVID-19 is a notifiable disease and according to current Thai law, COVID-19 patients always report to the health authority.
The active surveillance system requires public health staff to engage and actively find patients in the community. Active surveillance system aims to detect every case. This situation is requiring significant human and financial resources. Active surveillance can use in this situation. (1) A new outbreak of a disease (2) Routine disease screening in important areas such as factory, market, high population density area.– Which method should be best to identify cases, why?
Cases in medical facilities VS community
I will use both community and medical facility method for COVID-19 surveillance. Medical facility method is using with a new case detected at the hospital. Community method is using with a new case in community setting. Rapid ATK test in community is well fitted with community method.
Sentinel VS population-based surveillance
Population based will use at nation and province level which is not fit for identify individual case. Sentinel method will use in a new cluster area.
Case-based VS aggregated surveillance
Case-based can identify new cases based on index case Aggregated surveillance can use in the population-based method.
Syndromic VS laboratory-confirmed surveillance
The laboratory-confirmed method can be more helpful than the syndromic method. Because the syndromic method case is confused with other diseases that have the same symptom.
– What dissemination tools will you choose to disseminate COVID-19 surveillance information? Why do you choose/these tools?
I will choose an ongoing, real-time dissemination tool. Because COVID-19 is an important pandemic disease with a rapid pace of infectivity. This method can implement to the current situation very well. But the quality of data can be a concern. -
This research group wants to access data we call Protected Health Information (PHI). This data can identify an individual patient.
According to HIPAA on research. A researcher group needs to contact Documented Institutional Review Board (IRB) or Privacy Board Approval or ethical committee to rewrite a privacy guideline for this research. The researcher will make a non-disclosure form before collecting data. The use of PHI needs to be minimal and must not identify patients easily. A board must be approved before access PHI. A researcher must change PHI data before sharing it with other researcher groups or declaring study results to the public.
If I am a health informatician in this research. This data must have less sensitive information about an individual patient with approval from the supervisor and research board.
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As we studied and discussed in the second week of this course. Privacy and confidentiality of patients are essential in health informatics.
This scenario is a dilemma in health informatics. This man is an HIV patient. A health informatician is a friend of this patient who does not know about his illness and does not know who knows his condition. We need to use the Hippocratic oath and HIPAA privacy rule before we decide to disclose this illness.
The Hippocratic oath is an earlier medical ethic quote. These include the principles of medical confidentiality and non-maleficence. Medical confidentiality usually applies to the conversation between doctor and patient. But in a modern world, this rule becomes law. HIPAA privacy rule is law in the USA. The patient’s privacy should be a priority between doctor and patient conversation and applied to anyone who can use this information. There is some exception that we do not need explicit patient authorization. one of the following purposes is public interest and other benefits. This purpose is to protect public health risks and to prevent potential severe threats to another person. But they are only written bylaws.
Back to this scenario, we, as health informaticians, do not have a right to disclose patient information. HIV is not a law to inform the public anymore. However, HIV is still a significant public health problem. But this disease can be treated by current technology. A doctor can only notify a patient about the risk and benefits to the patient. A patient has a right to disclose by himself. Health informaticians can not tell patients’ information. -
As I previously discussed, the H4U program. This program has a lot of potential for further development. But the redundancy of the work to do both the H4U and old programs can burden users.
According to the ADKAR model, I propose a guide to change the H4U program as follows.
1. Awareness and desire: Changing from different platforms to a single centralized program can benefit medical care teams and patients. Benefits of this program are improving efficiency, exchange health data between organizations easier, reducing workload in the long term. This should be a priority for medical care teams to raise awareness and effort.
2. Knowledge: Knowledge of changing to a new platform depends on the ease of use compared to old platforms. Seamless transition of the platform reduces the duration of studying a new platform. New benefits from the new platform can be worth an effort of studying new knowledge.
3. Ability: A user support system has a crucial role in facilitating a new change.
4. Reinforcement: Organizations that can adapt to the new system should be rewarded. Some organizations that may resist the change or don’t bother to be changed should be evaluated for a root cause of problems.
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Ministry of Health developed the H4U app. H4U app is a digital health record platform for patients. Users who use this app can see health data such as blood pressure, blood sugar level, vaccination history. Users can book an appointment with a doctor. This app is usually used in rural hospitals. There are many difficulties in this app as follows.
Data: First, data come from different data sources. Many health data was gathering by primary health care. A yearly health examination was recorded by village health volunteers. They have their own program. This data may not display in the H4U app. The second, Complexity of health data. Health data come from different situations. Blood pressure may come from ER visit or IPD admission. The nature of these two situations is drastically different. So we need to carefully select data for uploading to the H4U server.
Cost: The cost of development in a countrywide program usually has a high price and high maintenance cost.
People: We have three groups of people to consider. Medical professions, Patients, Developers. Each group has a difference in health and IT knowledge, socioeconomic, etc.
Operation and design: A countrywide program need to has a careful operation design. Different between each health platform should be considered. -
Most of my experience with Decision support systems (DSS) is simple HosXP alert.
– Drug alert system
This is a standard DSS that I use every day. Drug alert systems may be drug allergy alerts, drug interaction alerts. This Alert is a simple instruction within HosXP. Sometimes, Alert is so annoying because it is the knowledge that I know already. They are no distinction between drug allergy and side effect.
– ICD coding helper
This is also a simple instruction within HosXP. It helps doctors find desired diseases easily. But this usually applies to simple diseases. The more complex disease with a different part of the body still does not have support yet.
– Laboratory alert system.
A laboratory alert system enables nurses to contact doctors rapidly. This isn’t a disease-specific system. Doctors must interpret data.
From my point of view. Factors that might influence the DSS in my organization are as follow. An easy-to-use DSS needs to be developed. Reduce unnecessary alerts, Develop for doctor needs. May be integrated medical guidelines within the system. -
ICD(International Classification of Diseases) is a semantic interoperability standard that WHO created in 1983. It contains codes for diseases, signs and symptoms, abnormal findings, etc. This standard is easy to use. Other semantic interoperability standards are SNOMED-CT, DSM-V. Two situations can happen if the country does not use ICD.
In the first situation, The country is using another less well-known or complex system. This country will operate just fine. But they will have problems if they want to communicate with another country. Some semantic interoperability standards are hard to use, such as SNOMED. This will be resulting in slower coding diseases.
The last situation, The country does not use any disease coding standardization. This will cause many problems. First, the disease does not classify correctly or does not classify. Second, when a disease does not code medical team will need to read the entire medical record to know what the disease is. Third, the interdisciplinary team can not communicate what happens to the patient. It isn’t easy to use for other purposes such as health insurance, epidemiology.
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Early adoption of any new technologies usually had difficulty in adaptation to a new way of working. As time progressed, early adoption, user and developer, became getting used to new technologies. New technologies usually optimize for the efficacy and efficiency of always complex medical care. And they cannot work in the old way again.
From my experience, I was studying in Maharat Nakhon Chiang Mai hospital, which is an early implementing EMR hospital in Thailand. When EMR was used in the beginning years, Personnel had trouble using EMR. As time pass by, EMR has an essential role in a hospital, from viewing patient history to booking a surgical room. An early example of clinical decision support is the drug error prevention system. A doctor does not require to find drug allergy history from the paper-based medical record. The program would give a warning if an allergy drug was prescribed.
To prevent any difficulty of transitioning to new technologies, Developer and user should design the program together. Well established protocol of the program should be made. Training a user is also important. The system must be easy to use and fix the problem regularly.
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According to a research paper from T. shaw, The definition of e-health is an implementation of information technology that covering three domains Health in our hands, Interacting for health, and data enabling health.
I think the definition of e-health by T. shaw is concise. But I would like to think that all the health and medical technology have the same goal. To improve the quality of care and optimize the efficiency and efficacy of the healthcare system. -
NCD patient data has been changed from static data to big data from these characteristics :
Volume: Thailand is a developing country with public health coverage. Every trimester, NCD patients will have a routine check-up at primary care unit around the country. A large number of new health data will be generated and send to a database.
Velocity: NCD patient’s data is not dynamic if we see it as an individual patient. On a population scale, it can become a rapid change.
Variety: NCD patient’s data is composed of multiple categories. Such as physical, laboratory examination.
Veracity: Electronic data records have a standardized method to ensure the integrity of data. But the pitfall is how we are gathering health data. (Technique in blood pressure measuring)
Value: A new health benefit from NHSO will be included with an examination in high-risk populations. Big data in NCD patients can be used to create predicting models of NCD.
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Kampangphet hospital, where I worked 4 years ago, was changed from a paper-based IPD chart to an in-house developed IPD digital chart. This project was developed by a health informatics nurse and her ICT team. The healthcare team can use this program on tablets and desktops because it is a web-based program. This program reduces handwriting errors and costs. The problem is some parts of the hospital are still using an old program. But I think that this program may be replacing the old program soon.
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Imagine that you are working with sensitive health records at a high-profile physical data center. The attacker wants to seize control of the system admin. There are various types of hacking such as
– Social engineering: the attacker act like a yearly external auditor asking an employee who is working closely with the system admin. This attacker wants to know what is the operating system of a data center.
– Physical attack: the attacker is pick locking a door of a server room to install a keylogger.
– Keylogging: intercept an admin password from a USB keyboard in the server room.
– Phishing: the attacker is sending an email to an employee to intercept a password for identity theft. And using stolen ID for sending another phishing e-mail.
– Rootkits: the attacker is using the admin’s password to install malicious in the systems and taking control of the server and clients to do whatever they want. DDoS,MitM,ransom. -
I prefer using a cloud-based system for patient appointment programs. There are more advantages than using a physical(local) server. Type of cloud service model that I prefer is SaaS.
The cloud-based system usually develops and maintains by large IT corporations. So we don’t need to worry about writing a code or keeping a server secured. Some cloud-based appointment programs are well-integrated into office programs. Microsoft booking is a SaaS developed by Microsoft that integrates seamlessly with Microsoft office suites. It usually complies with the privacy and data government.
There are some disadvantages of using a cloud-based system. The cloud-based system often come with subscription-based and price is vary with how many features you want to use. We can’t customized for specific need. (Some service provider have feature for creating mini program such as Powerautomate by Microsoft.)
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My experience as a physician in a provincial public health government that doesn’t have a specific region like a community hospital. My two current projects are working in a supporting role in a community hospital.
The first project is covid vaccination. We use a Mhor Prom application to manage a vaccination program in Nakhonsawan city. This program is working quite well. Vaccine availability and bug are major problems.
The second project is home isolation. We are using the Dietz program. This program is a well-developed application that can record health information from patients and report directly to personnel who are in charge. They are several limitations of this program. This program is web-based only and doesn’t have a built-in telemedicine function. We need to use Line’s official account for communicating with patients.A different health informatics system is a major obstruction for good interoperability.
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Before designing province-wide informatics architecture. We need to understand key stakeholders of healthcare systems which are public and private sectors.
Public sectors are composed of community and regional hospitals, public health provisional governments such as NHSO, DOH, DDC, HHS, NIEMS, and administrative provisional government.
Private sectors are also stakeholders.Each stakeholder have different specialized personnel as following
– Healthcare professions: Multidisciplinary personnel specialized in their role. These personnels are working with the patient. Providing data into health informatics systems and using data to treat patients.
– IT professions: These personnels are creating, maintaining, protecting enterprise architecture.
– Researcher: collecting and analyzing data by using an epidemiologic method.
– Administrative personnel: operating non-medical work such as policy analyst, financier, lawyer, general administration worker.
– Private sector and NGOs: working as a collective person who may concerned. -
My current work is as a general practitioner working in pediatrics OPD and health promotion clinic. I have a good competency in medicine.
To improve the quality of health care service. I have to gain new knowledge about public health informatics, both technical and management skills.On the technical side, I have to learn about public health to understand general population health better in terms of health protection, health improvement, health service. Epidemiology and biostatistics are important disciplinary to understand the underlying mechanism of population health. Programming and information technology are crucial knowledge to accelerate implementing a program in a wider area.
Management skill, including legal and political knowledge, is useful in working with interdisciplinary and other organizations.
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Topic : Implement a fee schedule cardiovascular risk screening in the first-degree relatives of stroke patients in regional health 3 — a cost-effectiveness study.
Rationale : Stroke is the leading cause of disability and mortality in regional heath 3. The etiology of stroke is non-modifiable risks such as age, gender, genetics, and modifiable risk such as hypertension, smoking, diabetes mellitus, high blood cholesterol. The current cardiovascular risk screening guideline by the national health security office (NHSO) focuses on hypertension and diabetes mellitus patients. Many studies indicated that first-degree relatives of stroke patients have a higher risk of stroke than the general population.
Research question : The national health security office had announced that a person above 35 years old could take cardiovascular risk screening. There is still no cost-effectiveness study to implement as a fee schedule program. Screening cardiovascular risk in the first-degree relatives of stroke may be a model of the fee schedule program.
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If I am a director of a public hospital. I still use the local server for operating day-to-day healthcare work and PAC due to the high cost of corporate cloud computing. By transforming health data from the manual/electronic to the digital system to reduce file size and increase usability. Strengthen security protocol for employers at every level. Creating barriers between the internet and intranet. But employers still export/import data from the intranet websites.
I will use cloud computing for non-medical data such as administrative work. -
IoT and Big data have been evolved rapidly in the past ten years. Benefit from the recent development of compact hardware, always-on device and always connecting to the internet. I will discuss these two things separately.
First, the Internet of Things. A simplistic explanation of IoT is a set of devices that connecting to a network. These devices gathering data from users such as heart rate, oxygen saturation, blood glucose level, EKG. Sending health data to the internet for data storage and processing. And present the result to users or notify a caregiver. Resulting in the improvement of individual health care quality.
The challenges of IoT are usability, accuracy, security, and the most important challenge is a type of health data that can’t be measure with current technology.
Second, Big data. Big data is usually having a more real-time, more complex, higher volume of data set than traditional data. A recent example of big data in healthcare is the information of COVID-19.
The challenge of Big data are the inconsistency of data from various users that need to be clean up be for analyzing. -
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Blood pressure data from a wearable device is a personal health record. This is a type of data created from patients. And the right of data belongs to patient. It’s private and sensitive data. PAN is a proper network type for this step. PAN is connected to different personal devices by various methods. Bluetooth and WIFI are commonly used protocols. But it does not send data to external networks.
After the patient and healthcare providers(MoPH) have agreed to use personal health records. This data is turning into an electronic health record. Then transfer to various secured networks for analysis. In this case, electronic health records will be sent to MoPH via WAN which is less secured than PAN. So we need a trusted data transfer protocol between patients and MoPH. -
Internet technology is improving healthcare in many ways. Such as telemedicine, health information system, health education.
Internet system is one of the most crucial infrastructures in the modern world. The challenge of internet technology is not about infrastructure anymore, even rural areas still have some basic internet technology. But its utilization of internet technology, security, privacy, decision-making system. -
In my daily life, I think that TPS is the most commonly used system. such as online shopping, internet banking, etc. It used direct information from customers as input. Then processing directly within the system. Output sent to both customer and service provider.
MIS is a little complicated than the former system. MIS used multiple data sources as input. Then processing directly within the system.
DSS is the most complicated system. A clinical decision support system is an example. Automated Chest X-ray Interpretation was created to interpret chest x-ray, which isn’t binary data. and need to train computer vision before interpreting chest x-ray into binary(word) data. -
My name is Theekhathat Huapai, a 5th-year intern at Health promotion center 3 Nakhon Sawan. As a physician, I am interested in public health and health informatics in non-communicated diseases.
Currently working on an automatic health check-up reporting program in Nakhon Sawan province, Transforming data from health questionnaires and laboratory testing into a report.After I finished a course, I will apply for a preventive-medicine residency program and M.Sc. in epidemiology. I hope that this course will help my research in the future.
Auf wiedersehen!
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