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I’ve learned in Week4 Telemedicine, let me share with text summary.
Telemedicine is considered a subset of telehealth, specifically referring to clinical services.
Benefits
*. Quick access to care and easy access to specialists,
*. Convenience
*. cost saving
*. Reduce in-person visits for patientsRisks/Cons
*.limited technological access
*.limiations of remote area
*.security and privacy concerns
*.language barriers
*. In-person visit can be necessary (physical examinations,…)Aware of telemedicine application (how to use…)
Telemedicine can lead to improved healthcare quality. -
In week 3 Wrap-up discussion, let me share by text summary.
I have learned that implementing the Personal Data Protection Act (PDPA) within the healthcare sector is crucial. Because health information is highly sensitive and requires transparent handling, including providing individuals with access to personal data. Failure to comply with PDPA can result in significant penalties.Furthermore, PDPA enhances data quality and integration. It safeguards personal data while allowing organizations to use data responsibly, such as restricting access to authorized healthcare professionals. International hospitals, in particular, should prioritize PDPA compliance.
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Data Standards should be in every domain not only health sectors. If we have data standards in clinical research is improved and more benefits in data interoperability. And it can be easier to make communication within different systems using data standards like ICD, and SNOMED.
It can be shared and combined data from various studies. It also can reduce the risk of data misinterpretation and duplication of effort. Standardized clinical research data can increase the efficiency and accuracy of clinical trials.
Therefore, I believe that data standards can more facilitate and collaborate various domains. -
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I have experience in data collection at project sites, but not in a research setting. Volunteer staff and civil society organization(CSO) workers gathered data using paper-based documents. This information was then manually entered into an electronic database by the staff, organized by district/township. The project’s donor provided offline, Windows-based data entry software, which the staff used daily. They backed up the data and uploaded it to an online server. Project data officers then reviewed and analyzed the data from each district/township under user authentication. The use of offline software resulted in double data entry issues and data loss when the data entry laptop was broken or something was missing.
The data management system, relying on paper-based documents, presented security challenges. While a recovery process was available, involving online downloads and offline data entry, this approach lacked the necessary flexibility for the project’s workflow. Consequently, the data entry officer requested a transition to a web-based system for the next phase. Furthermore, the team’s reliance on Microsoft Excel for data rechecking, rather than specialized data analysis software, highlighted a deficiency in staff capacity building. This transition is to create a more flexible, secure, and efficient workflow. -
Let me share what I learned in the code of ethics in health information week,
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Based on your experience in data collection and management, I have been involved in data design (including variables and data fields), data collection processes, and data validation. I developed a health data entry platform and facilitated the transition from paper-based to electronic systems by training end-users.
I was also involved in database setup, programming edit checks, and managing access control. All data variables were based on donor reporting requirements, and I utilized an export function to extract data from the digitized system.
Additionally, if I have a chance, I would like to improve database lock and freeze functionalities in alignment with reporting timelines. Data standard/data coding management and Data Manipulation and Analysis steps also want to improve in the data management workflow more than other steps.
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Currently, my role involves collecting diverse healthcare data for research studies and summary reports to use related work requirements. While I’ve developed data collection tools for online and remote systems, this has primarily involved secondary data derived from hard copy records, encompassing both quantitative and qualitative information from facility and community settings.
My experience doesn’t extend to field-based data collection. However, after developing these tools, I trained end users, which revealed gaps in field-based data collection, such as language barriers, question interpretation, and communication between technical and research teams.
In conclusion, to address these gaps and gain practical experience for my study, I plan to conduct self-administered data collection and document my lessons learned.
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I have learnt data quality and the importance of taking precautions when applying AI tools in healthcare. It needs to use balancing AI and humans in healthcare. We need to think about the situation of using AI in health,
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According to the case study at the WHO reference, the Primary Health case Structure in Myanmar is public sector, private sector (not-for-profit and for-profit), and EHOs ( source Ministry of Health and Sport, 2020). And also needs variability in the level of collaboration between the MoHS and EHOs. In many parts of the country, EHOs are the main providers in many rural areas.
Under the public sector consists of PHC centers composed by township hospitals, station hospitals, urban health centers, RHCs, and sub-RHCs the data is before coup 2021 data. The private sector composed by private general clinics the data from 2025 was collected. At the EHOs sector mostly in rural areas.
COVID-19 IN 2020, during the first and second waves of COVID-19, EHOs were in contact with the MoHS and re-configured clinics to all for triage. EHO health staff received up-to-date health information about COVID-19 from the MoHS such as suspended inbound international travel, implemented social distancing measures and guidance to health care workers on COVID-19 prevention, and treatment guidance issued by the WHO.Scaling up and managing critical emergency services on the COVID-19 response, in 2020 Myanmar updated laws and regulations on key areas specified in the international health regulation. Also launched a National health plan in 2017 and drafted of the national health policy in 2018 that is an expansion of UHC through the strengthening of the PHC system.
Communities use formal channels to engage service providers and policy maker and also many other communities used informal , social media channels such as facebook, saw saw shar mobile application, developed by Myanmar Computer Federation in collaboration with the MoHS to get up-to-date daily information, and Viber to share information and coordinate support.
The government was trying to control the COVID situation, and the military seized power in February 2021. So our health system was breakdown until now. That is the reality conditions on Myanmar, no more secure healthcare services from public health (MoHS). Only deliver and received from EHOs sectors but that is on the border area not in all rural area. My opinion we have to settle not only health care sector but also other our living standard condition. But when and how , no way in until now.
References:
Ministry of Health and Sport. (2020). Myanmar: a primary health care case study in the context of the COVID-19 pandemic. In Myanmar: A Primary Health Care Case Study in the Context of the COVID-19 Pandemichttps://pr-myanmar.org/sites/pr-myanmar.org/files/publication_docs/myanmar_health_systems_review.pdf
https://iris.who.int/bitstream/handle/10665/372726/9789240058811-eng.pdf?sequence=1 -
#Towards the UHC scheme in Myanmar
Myanmar is working towards Universal Health Coverage (UHC), which aims to provide all individuals and communities with access to necessary health services without basic financial cost. In the National Health Plan (NHP) of -2017-2021, to increase equity and financial protection and extend access to the basic Essential Package of Health Services (EPHS) for the entire population by 2021. In the first UHC phase, it will reach three phases by 2030. And the service delivery reforms plan, the basic package of services covers a wide range of interventions for reproductive, maternal, newborn, child and nutrition, communicable and non-communicable diseases and emergency conditions.
#What works
NHP aims to improve health and nutrition for women and children of reproductive health strategic plan of 2014-2018. The NHP recognizes the important role of the private sector in expanding access to services and also the involvement of ethnic health organizations (EHOs) and improvements in access to services in conflict-affected areas position, for example, in the border areas in basic emergency care. The limitation of asses to provide health care and the need for standardization training for ethnic health workers (Community Partner International 2024 ).
# What needs to be done
Other human resource reforms are being initiated, including assessing the role of voluntary health workers and revising the job descriptions of basic health staff in the context of a basic package of services for UHC. Focus on strengthening service delivery at the township level and below is essential because most of Myanmar’s population lives in rural areas that have traditionally received less priority in terms of investment in health care and extending health services to rural communities, developing a community-based health workers (CBHWs) program. However significant increases in the allocation of total government expenditures for health (MoHS) and the public financial management system are needed to improve budgeting and funds.
#Strength and weakness
Weakness in service delivery is constrained by difficult regions, conflict in border areas, health systems challenges, particularly distribution of human resources, poor physical infrastructure, insufficient financing, and low absorptive capacity. In remote and hard-to-reach areas, it is difficult to deploy and retain health workers.
Weakness in Quality of Care: health facility assessment identified limited clean water to accessible for patients, limited staff training on infection prevention and control, and limited budgets for facility maintenance and operations. And access to affordable medicine is critical for quality of care due to being a significant contributor to out-of-pocket spending.
References
https://cpintl.org/type/impact-story/universal-health-coverage-in-myanmar-the-way-forward
UHC Day – UHC2030
The fight for Universal Health Coverage in Myanmar – THET
Moving toward UHC : Myanmar – national initiatives, key challenges, and the role of collaborative activities -
There are a lot of gaps between rural and urban health in our country that is before coup. Most rural areas lack electricity and have poor drinking water and hygiene. So it is effected to poor health outcome. The government can’t support fully basic healthcare services. The rural areas are dependent on private health care, and village health workers (volunteers).
The big difference in access and quality of care between the rural and urban areas is access to health information from primary care providers and specialists in the rural area. And rural patients don’t have any other insurance and it is very expensive for health care costing. Healthcare costs are higher, healthcare providers can’t support full access to health services. On the other hand, also a lack of transportation conditions in rural areas, if the most serious accident conditions don’t arrive in a timely. This is the reality in rural areas in our country.
After the coup and current situation, more and more difficult to get primary health care services in rural. Under military control, urban areas can’t get timely healthcare services because of some laws from the current situation.
I suggest my idea to close the gap, firstly in the rural areas need to develop transportation ( means highway roads) for emergency cases, and support for ambulance vehicles. Secondly needs to set healthcare workers according to the population rate. Thirdly, need to support medicine to cover that population.Conclusion: Our Myanmar people are still far away from UHC (Universal Health Coverage). Before the coup, Myanmar’s aim was to be UHC in 2030. During military control, can’t see any way to fill the gap.
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Actually , I am not much aware of the health workforce situation. When I worked at my current job, I learned health workforce in the ethnic health sector. At that time it is also important in the health sector. When the project is set up or started, activities and workforce performance must be considered.
This includes healthcare providers (doctors, nurses, midwives, mid-level health workers, pharmacists, dentists, lab technicians, community health workers, etc.) as well as managers and support workers (human resource managers, health managers, public health workers, epidemiologists, clinical engineers, teachers, trainers, etc.). Workforce planning should link policy goals to staff member’s skills and numbers and to performance-enhancing incentives. It also depends on several factors in health, including changing needs as service models change, long training time for some professions, and lack of direct government control over the number of professionals being trained, for example, because of the growth of private medical schools.
To improve the health workforce situation, a key to more workforce planning is better coordination between health planning and planning for training and education. Good basic education includes the development of both professional skills and learning skills. Basic training and continuing development should be planned together.
On the other hand, It needs to build confidence in health services through community health. Uncertainly it will happen like the COVID-19 pandemic by building trust and making sure the guidance from the sources is evidence-based and respected, we can help prevent future pandemics. -
EMR is considered potentially one of the drivers for the transformation of healthcare. From a patient care perspective, EMR is expected to improve the accuracy of the information, support clinical decision-making and improve the accessibility of information for continuity of care.
Using Electronic Medical Records (EMR) instead of traditional paper-based medical records has several advantages and disadvantages.
Advantages:
Improved accuracy: EMRs can enhance the accuracy of information, reduce errors associated with readability, and ensure that data is up-to-date.
Better accessibility: Health professionals can quickly access patient records, supporting quicker and more informed clinical decision-making.
Enhanced patient care: EMRs can streamline workflows, facilitate faster diagnoses, and improve the overall quality of care provided to patients.
Disadvantages:
Implementation costs: Transitioning to an EMR system can require significant financial investment and training for staff.
Dependence on technology: EMRs are subject to technical failures and require reliable infrastructure, which may not be available in all settings.
Privacy concerns: Electronic records can be more vulnerable to data breaches compared to physical records.
Training Requirements: Staff may require training to effectively use EMR systems, which can be time-consuming and costly.
Conclusion:
EMRs provide streamlined access to detailed patient information. Healthcare providers can view a patient’s complete history, including test results, diagnoses, treatments, and other relevant information, all with a few clicks. By reducing administrative paperwork and allowing more time for patient care. Electronic medical records pave the way toward a more efficient, accurate, and integrated approach to healthcare documentation. -
Missing Data: A significant challenge in health facility data collection is missing data, which can undermine data quality and integrity. Missing data leads to incomplete analysis, biased results, and poor decision-making in healthcare. Additionally, the lack of standardized data collection methods makes it difficult to integrate information across different healthcare facilities, further complicating analysis.
Selection bias: in the health facility data collection occurs systematically from the data analysis, leading to unrepresentative samples. Routine healthcare data may not capture diverse patient populations due to factors like access to care, and geographic. As a result, findings based on this data may not accurately reflect the health outcomes.
Data Analysis and Training: Data users and researchers must possess the necessary domain knowledge to interpret the data accurately. Proper understanding of data is essential for accurate statistical analysis and hypothesis testing, ensuring meaningful and reliable results.
Interpretation and Translational applicability of result: it has several key issues, such as data storage, searching, and capturing are technical difficulties and analysis. All the results are applicable across different healthcare settings is complex due to variability in data quality and relevant context.
Ethical and Privacy Issues: Big health data faces significant privacy and ethical challenges in data collection. Patient health information must be protected to prevent misuse, requiring robust security measures to defend against cyber threats. Encryption and secure data storage are essential to safeguard patient privacy.
Conclusion: I propose that data quality should be recognized as a critical challenge in big data analysis. Ensuring accuracy, consistency, and completeness in data collection is essential for effective data governance. Moreover, exploring new approaches to manage and analyze large volumes of data will help improve decision-making and outcomes in healthcare. -
Let me share my point of view on the four recommendation points for public health professionals to fight corruption.
I agree on key stakeholders in addressing corruption within the health system, it is essential to identify and engage various parties that have an influence or interest in the health sector. Key stakeholders typically include government officials, health care providers, regulatory bodies, non-governmental organizations (NGOs), patients, and civil society groups.
And also agree on building consensus among these stakeholders involves open dialogue, sharing information about the extent of corruption, understanding the motives behind it, and collaboratively developing strategies to mitigate its effects.
Third agreement on prioritizing action against corruption in the health system, stakeholders must first acknowledge the extent of the issue, as highlighted by surveys in the health systems as corrupt.
Finally, agree on a holistic view in addressing corruption within the health system, it is important to recognize that corruption is a multifaceted issue that requires an interdisciplinary approach. This involves examining the various dimensions of corruption, including governance, bribery, and systemic vulnerabilities.
To effectively fighting corruption in the health system, a multi-faceted approach is essential. Enhanced oversight and evaluation of health system professionals can lead to greater transparency, accountability, and efficiency within the system. -
Currently at a non-governmental organization (NGO), I am working on a health system improvement strategy that involves establishing a facility-based program within an existing clinic in a remote, conflict-affected area. This initiative aims to enhance access to healthcare, improve patient follow-up, and boost patient satisfaction. However, it has not yet fully met its objectives according to the World Health Organization’s six building blocks, which include:
• Service Delivery
• Health Workforce
• Health Information System
• Financing
• Medicine & Technology
• Leadership & Governance
Our implementation process focuses on service delivery, health workforce, and health information systems to sustainably enhance health system performance.
For service delivery, we are establishing standards for essential service packages and promoting access to these services among relevant partners utilizing the facility-based health system. Regarding the health workforce, we are identifying, providing, and supporting community health workers to deliver health services effectively. We also offer feedback on health worker performance to refine health system processes. In the health information systems, we are transitioning to a digital health system to oversee and monitor health data, facilitating informed decision-making.
To summarize, we must work on enhancing the health system using the six building block framework. However, the effectiveness of these functions relies on critical elements like service delivery, health workforce, and health information systems, while improvements in other functions are also necessary. -
The point that I will select for the discussion will be Point 6:” A null-hypothesis P value greater than 0.05 means that no effect was observed, or that absence of an effect was shown or demonstrated.” from page 341.
That I understand this A null-hypothesis P value greater than 0.05 indicates that the observed data does not provide strong enough evidence to reject the null hypothesis, but it does not imply that there is no effect or association. Instead, it shows that there are many hypotheses, including the null, that could fit the data, and therefore we cannot conclude that there is “no association” or “no evidence” of an effect. So we need to look at the point estimate for the effect size to understand what the data suggests. -
Hello everyone, I’m Aye Thinzar Oo, and you can refer to me as “Thinzar.” With a background in computer science, I have approximately 8 years of experience working in software testing, microfinance, and software development, including data collection for Myanmar’s 2015 election. Since 2018, I have been involved in the health sector, focusing on health information systems.
While I don’t have extensive statistical experience, I am proficient in data validation and using SQL queries for health data reporting to assist the M&E team. My organization employs an electronic system for health data collection, which has allowed me to enhance my SQL knowledge. Additionally, I have experience managing health data, including patient and service delivery information. -
I have experience working in various organizations, some of which had dedicated IT departments while others consisted of small IT teams. Each organization implemented a unique disaster recovery plan tailored to its specific needs, utilizing either on-premise systems or alternative technologies like cloud solutions.
Risk assessment and analysis are crucial for identifying potential threats to systems, including external risks such as natural disasters, human-caused incidents, cyber-attacks, hardware failures, and data sharing vulnerabilities.
Clear notification procedures must be established within the contingency plan to guide the response to disasters. A Disaster Recovery Committee, composed of management, IT leads, security personnel, and human resources, plays a vital role in managing the disaster recovery process. This committee is responsible for detecting and communicating disaster information, maintaining recovery plans, monitoring situations, and ensuring a return to normal operations while continuously improving the disaster recovery plan based on lessons learned.
Recovery procedures should be developed to restore IT services, including actions to recover system data and test functionality, ensuring that security controls are operational. Additionally, training on data security, backup procedures, and maintenance processes is essential to prevent future disasters.
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Implementing High-Availability technology in the hospital information system (HIS) can significantly benefit patients and the hospital by ensuring continuous access to healthcare services.
Benefits for Patients: It can reduce patient waiting times and improve patient outcomes leading to faster diagnosis and treatment. Healthcare information can provide real-time information and be across and used from one healthcare center to another. It can provide faster data transfer (medical information) and lead to better patient outcomes. It can avoid some malicious. This allows for more informed treatment decisions, reduces the risk of errors, and facilitates smoother communication among doctors, nurses, and specialists. It can empower healthcare professionals to deliver more effective and personalized care, leading to better patient health outcomes.
For Hospitals, it can optimize resource allocation and overall operational efficiency, allowing healthcare providers to deliver better healthcare consistently. It reduces downtime, which is crucial in emergencies, and ensures that patient data and services are always available. It can help hospitals save time and costs in management, reduce the paperwork burden, and minimize risks related to management and data issues.
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I currently serve as a team leader in software development, overseeing both completed and ongoing projects. I take on the responsibility and accountability for the projects developed, and I typically need to request resources, as cost management falls under the program manager’s view.
While I have not strictly adhered to all 12 steps outlined in project management methodologies, I have utilized several key steps, such as defining the project, listing tasks, planning their sequence, and creating a Gantt chart. My approach differs slightly from standard practices; I developed a customized chart to track task status—ongoing, in progress, or completed—along with task lists, timelines, and assigned personnel. This chart has proven effective for monitoring progress, productivity, performance, and task prioritization, allowing for a clear overview of the project’s status.
I make adjustments to our development plan based on changes in user requirements that arise during the development process. However, we should ensure that we prioritize essential user requirements. For projects where certain requirements are not deemed essential, we generally do not allow for readjustments. Throughout our development, my team and I apply a “review” step to every project. Moving forward, we will consider incorporating elements from the 12-step process into our next project.
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I have experience in healthcare data and information systems, specifically emphasizing the critical importance of confidentiality, integrity, and availability (CIA) in handling sensitive health data, such as patient records from healthcare facilities. To address this, I prepared to develop a data-sharing policy and established user account permission levels for accessing healthcare data. Recognizing that data collected at the entry-level could risk incomplete patient information, I implemented controlled access measures to ensure that only authorized personnel can access certain records, thereby safeguarding data integrity.
In terms of the CIA principles:
Confidentiality is maintained through security measures like usernames, passwords, two-factor authentication, and data encryption.
Integrity is ensured by preventing unauthorized modifications to data without appropriate permissions from management.
Availability is addressed by ensuring that data is accessible only to authorized users, supported by strategies like regular data backups and cybersecurity attacks. -
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Hello Wannisa, thank you for sharing about the Diabetes Surveillance system in Thailand.
Challenges in diabetes disease – 200 deaths per day are severe.
I think it is a high rate.
In data Transfer methods, it is good and interesting about cloud solution, Mobile uploads and Automated Reporting Systems methods. -
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Hi Aung, Thank you for sharing your experience with the data management process. It would be beneficial to develop a data recovery strategy, including regular backup integrity testing and outlining data restoration procedures. I think we need to consider proposing different backup locations for redundancy and business continuity. We would also consider documenting the existing procedures for clarity.
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Thailand’s Social Security Scheme (SSS) is a great approach to a healthcare system the contributions from employers, and the government. So I am very interested in Thailand’s Social Security Scheme (SSS).
Let me share the link that I explored about SSS of Thailand. Thank you for sharing. -
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Thank you for sharing the reality issue. This is a heartbreaking reality. The lack of access to essential medicines and healthcare services in conflict-affected areas is a serious humanitarian issue. The world should step up to support alternative aid channels and ensure that people in Myanmar and all related countries do not suffer due to funding suspensions.
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Thank you share your detailed information. Yes, I also understand that you mentioned it. It correctly identifies that selection bias leads to unrepresentative data, which can skew findings and lead to incorrect conclusions. It is a good point of the suggestions of collecting diverse data and utilizing statistical methods.
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Hi Siriluk, thank you for sharing, regularly testing and training are essential to ensure preparedness while leveraging cost-efficient solutions like cloud backups and Disaster Recovery as a Service (DRaaS) can enhance scalability and compliance. This comprehensive approach is vital for minimizing data loss and ensuring business continuity.
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Thank you for sharing the detailed steps of the disaster recovery plan. It can consider the backup solution, and specific needs, and consider a hybrid approach that combines both cloud and on-premise solutions for optimal data protection. Using a tool and the automation system that you propose will also be more effective and can reduce system failures.
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Hello Siriluk, Thank you for sharing the project idea to transition from paper-based to Electronic Data Capture (EDC) in clinical trials is well-conceived and addresses key aspects like data accuracy, efficiency, and compliance. I think you can set a strong foundation by clearly identifying stakeholders and deliverables and a structured plan covering development and validation phases.
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Hi Wannisa, Thank you for your research project. Your project plan on DRG sounds well-structured and comprehensive. Clearly defining your goals, tasks, and team roles is essential for effective project management. Using a Gantt chart will help visualize the timeline and ensure everyone stays on track. Regular meetings for progress monitoring and problem-solving are also crucial for adapting to any challenges that arise.
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It sounds like your team employs a collaborative approach to project review, which can be very effective. Discussing launching a dashboard or course allows each team member to share insights, which can lead to constructive feedback and improvements. Closing the project after this discussion helps ensure that any lessons learned are formalized and that everyone is aligned on future actions. Thank you for your sharing, Aung
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Thank you for your comment. Changes in governance, data collection protocols, and reporting structures would likely affect the data flow diagram for malaria surveillance after a military coup. Due to instability in health information systems and exchangeable communication pathways among stakeholders, data reporting will also change.
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